Improving Cancer Outcomes

Debate between Paul Burstow and John Baron

Thursday 5th February 2015 Commons Chamber

[Paul Burstow (Sutton and Cheam) (LD)]

Thank you, Madam Deputy Speaker. I wish to echo that very point. Some of the best debates that we have in this House, and certainly some of the best Back-Bench business debates, are ones in which people bring their own personal experience and their own stories. My hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti) talked about the stories that gave him inspiration and hope. I hope that people listening to this debate will gain inspiration and hope from what he has said today. I hope, too, that those who are responsible for planning and commissioning our services and for training our medical professions gain insight from it.

We talk a lot about the concept of shared decision making, and my hon. Friend has demonstrated where that can work well and where it can fall apart. When it falls apart, the impact on the person concerned is immeasurable. I am really grateful to my hon. Friend for his unique and important contribution.

I also thank my hon. Friend the Member for Basildon and Billericay (Mr Baron) for tenaciously pursuing not just the opportunity to have this debate but this whole issue. It is undoubtedly the case that, when it comes to cancer, he has been there championing the cause. When I was a Minister, I had plenty of occasions to feel the effects of his championing. I always appreciated the way in which he pursued the matter, and I am sure that the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), has experienced that as well. He is always civil, always polite, but relentless in pursuing what he wants to achieve.

In this particular week, when we have marked world cancer day and had the news from Cancer Research UK that one in two of us are likely to experience cancer in our lifetime, it is absolutely right that we should be debating what more we need to do to go beyond the ambition of this coalition Government to save lives and to achieve the ambition that we set for the NHS in the next Parliament.

Part of the news that sits behind that one in two figure is the fact that we are living longer. I want to caution against the notion that, in some way, living longer is some sort of curse—all too often it is portrayed in that way—and that we should be worried about it. The other thing behind that research is that those cancers that may occur in later life are not inevitable. There are things that we all can do if we make choices about the lifestyles that we lead—whether that is quitting smoking or losing weight. When one considers that there are still 100,000 deaths a year due to smoking and that two thirds of people who are addicted to smoking become addicted before the age of 18, it is clear that we need to focus quite rightly and relentlessly on issues around prevention as well. That is why we should celebrate the news that, just yesterday, the Minister successfully took the regulations through this House that will result in a ban on smoking in cars where children are present, which will make a difference. We have an assurance from the Minister and the Government that, before the end of this Parliament, there will be a vote to have standardised packaging, which will be a real step forward in dealing with the impact of smoking.

We must do more to tackle smoking, especially in the context of mental health and mental health services, where the prevalence of smoking is so much higher. There are examples of good mental health services that have found ways to reduce smoking. None the less, there is a significant difference in life expectancy between people with severe and enduring mental health problems and people who do not have such problems.

Some reference has already been made to the health inequalities with regard to ageing, and I will come back to that. We need to recognise that there is a broader issue around the social gradient. If someone is poorer, they are more likely to be at risk from cancer, especially when lifestyle is a factor. The strategy that is being drawn up by the taskforce needs to address the whole range of health inequalities to deliver on the challenge that was rightly set and the duty that was imposed on the NHS to tackle health inequalities under the Health and Social Care Act 2012.

Sean Duffy, the national clinical director for cancer, has said that our cancer survival rates are at an all-time high, and my hon. Friend the Member for Basildon and Billericay set out the statistics that show why we should celebrate the progress that has been made over a number of years. Clearly, if half of us will get cancer during our lifetimes, we must keep looking afresh at what more we can do. That is why the announcement of the taskforce in January to look at what the next five years should hold for cancer work is absolutely right. We cannot rest on our laurels.

Again, I pay tribute to the hon. Member for Easington (Grahame M. Morris) for tenaciously pursuing the case for radiography, just as my hon. Friend the Member for Wells (Tessa Munt) has done, and I give him due respect for doing so. The strategy that is being developed must answer the concerns that he and other hon. Members have been raising for a number of years. The ability to combine different innovations—whether pharmacological or technological—is absolutely key to how we catch up and then stay ahead in terms of cancer survival rates, and it is why we need this ambition of going beyond just achieving the average cancer survival rates in Europe to strive to become the best in Europe. Better prevention, swifter diagnosis, better treatment and aftercare are all part of that.

On early diagnosis, we have heard that a quarter of diagnoses or thereabouts take place at an emergency stage—far too late—and the outcomes are bad as a result. Therefore, we need a clear commitment to fund the Be Clear on Cancer campaign throughout the life of the next Government, because awareness raising and the identification of signs and symptoms make a difference. For example, in the areas where the lung cancer signs and symptoms campaign was tried initially, 700 extra patients were diagnosed—700 people had an opportunity to live their lives longer as a consequence.

The hon. Member for Washington and Sunderland West (Mrs Hodgson), who, again, is a tenacious pursuer of ovarian cancer issues, is absolutely right to ask why, on the basis of the pilot evidence from 2013, we are not pursuing ovarian cancer in the Be Clear on Cancer campaign. I hope that the Minister will answer that and perhaps give us the prospect of good news. The hon. Lady certainly persuaded me when we took the decision to hold the pilots, and I would want to know why we should not pursue it. Certainly, the pilots that she referred to suggest that there is good cause to do just that.

I was struck in preparing for the debate by the research published by Cancer Research UK looking at what could be achieved with earlier diagnosis if we strove to eliminate inexplicable variations in England. In other words, if we had diagnosis rates at the best level just in England everywhere—for colon, rectal, ovarian and lung cancer—it would benefit 11,000 patients and save the NHS £44 million. If we could do that for all 200 cancers, it would help 52,000 people. It is within our grasp to do massively more if we learn just from the best in our own country, let alone striving to be the best in Europe, which we would become if we did that. I very much welcome the work that CRUK and Macmillan are doing with NHS England to deliver that.

My hon. Friend the Member for Basildon and Billericay talked about the unacceptable cancer death toll among older people and the over-reliance on chronological rather than biological age in making judgments. As the then Minister who took the decision that there should be no exemptions from the equality duty with regard to age discrimination for the NHS, I think that that is not acceptable. Chronological age should not be used; the person and their individual circumstances should be considered in judging which treatments should be available.

It is therefore also vital that we recognise that in later life, because of complex comorbidity and frailty, there are additional needs, sometimes social needs, that are not properly taken into account. While I was the Minister with responsibility for cancer, I was pleased to help launch the work that Age UK and Macmillan were doing to pilot new ways of ensuring that more older people would gain access to cancer treatments. It would be useful if the Minister could say where that has gone and whether it will be continued. I hope the work will be looked at when the taskforce draws up its strategy.

[Mr Baron]

As a Minister, the right hon. Gentleman was always a great champion of cancer. One accepts the complexity arising from comorbidity, but does he believe that the under-75s cancer mortality rate indicator should be looked at again as a means of helping to redress the issue?

[Paul Burstow]

Personally, I think that at some point there must be a legal challenge as to whether that places ageist assumptions at the heart of the NHS. The fastest growing part of our population are the over-85s. How on earth can it be that we do not have statistics that allow us to know how well that older part of our population is being treated for cancer, let alone anything else? When one considers that when the NHS celebrates its 100th birthday, there will be over 100,000 centenarians in this country, it is clear that we need to start catching up in the way in which we use data to ensure that we are not discriminating inappropriately on the basis of the person’s date of birth. I agree that the indicator needs to be looked at.

The hon. Member for Easington also mentioned the cancer drugs fund. After the election there should be a thorough evaluation of the impact of the cancer drugs fund over the past five years. It was a good initiative; it plugged a gap, but unfortunately the gap that it was plugging is now not being filled because there has not been a change in the way we pay for drugs. It could play a part in underpinning combinatorial innovation of the sort that the “Five Year Forward View” mentions.

On the hon. Gentleman’s reference to free end-of-life social care, I have not changed my view. When I wrote the care and support White Paper, we made it clear that we saw much merit in free end-of-life social care. Because of the reports that have been published since, I believe that the evidence has grown even more compelling that this is not a cost to the NHS. It would be a benefit to the NHS. I know that my right hon. Friend the Minister of State who has responsibility for care and support has taken that view as well, and I hope we can see progress on that too.

As the Member of Parliament for Sutton and Cheam, it is a source of great pride to me that I live in a constituency which has a hidden gem—the Institute of Cancer Research. As I am sure hon. Members in all parts of the House know, that is a world-beating research facility, taking research and discovery from the lab to the bedside in collaboration with the Royal Marsden hospital, which is on the same site—a phenomenal site which is looking to expand further. It does fantastic work, including genetic testing, which is an area that I want to raise with the Minister.

The institute has been a pioneer in mainstreaming genetic testing, particularly around BRCA1 and 2. It has developed a good practice model that can mainstream genetic testing into existing oncology appointments. The potential of that is amazing—four times the volume of activity can be delivered through this new pathway at twice the speed and half the cost. In other words, we can gain the benefits of genetic testing without apparently having to spend more money, but delivering much more targeted and insightful diagnosis and onward treatment as a result. That pathway exists. It has been developed, refined and tested, but it has not yet been widely adopted, despite the fact that it is freely available. I wonder what more could be done to make sure that it is more freely adopted. Perhaps the Minister could say how the strategy might help take that forward.

This debate needs to be set in a broader context. If we are to achieve an ambition of matching the best in Europe over the life of the next Parliament, we must address the funding pressures that are acknowledged in the “Five Year Forward View”. This Government have started to acknowledge that with what Simon Stevens described as the “down payment” of the £2 billion announced in the autumn statement, which will come in from this April, but we know that we need to give the NHS certainty about funding for the life of the next Parliament.

All of us who are responsible for articulating different party points of view on health policy need to be clear with the NHS and with the public about what we would do with regard to funding. I am therefore pleased that the Deputy Prime Minister and the care and support Minister have set out how the Liberal Democrats would provide the £8 billion requested in the “Five Year Forward View”. I look forward to the debates we will have over the coming weeks on how others would achieve the same thing, which we need. This debate, however, is an important way of shining a light on the progress that has been made and the opportunities to make further progress.

I thank the hon. Member for Basildon and Billericay for securing the debate and the Backbench Business Committee for allowing it. This is what it makes clear: yes, there has been progress, but there is still much more to come.

Oral Answers to Questions

Debate between Paul Burstow and John Baron

Tuesday 12th June 2012 Commons Chamber

[Paul Burstow]

I am afraid that I did not entirely hear the hon. Gentleman’s question, but it was about research, and the Government are certainly committed to substantial investment, working with partners to ensure that we have among the best research in the world so that we have access to treatments at the earliest opportunity.

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

Does the Minister agree with the recent report by the all-party group on cancer, which found that, if we are to drive improvements and outcomes consistently throughout the NHS, both the one-year and five-year cancer survival rates should be included in the NHS outcomes framework and in the commissioning outcomes framework?

[Paul Burstow]

My hon. Friend, who chairs that all-party group, met me recently to make those points, and as a consequence of that meeting and his excellent note of it I undertook to write to him in greater detail. He will understand that some of those issues go to the heart of data collection and to the quality of the data currently available throughout all cancer sites, and that is the reason why we may not be able to do quite what he wants at the pace that he wants.

Oral Answers to Questions

Debate between Paul Burstow and John Baron

Tuesday 21st February 2012 Commons Chamber

[Paul Burstow]

I say two things to the hon. Gentleman: first, that the reforms will actually release resources from back-office costs and put them back into the front line, which I hope all hon. Members want to happen; and, secondly, that when it comes to our cancer strategy, we committed additional resources in the spending review to invest in cancer services. If he wants to raise specific issues with me, I will be only too happy to address them.

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

The Minister will fully understand the importance of early diagnosis in cancer outcomes and tackling cancer inequalities. May I therefore urge the Government to include the one-year outcome measure in the commissioning outcome framework, so that we can measure the performance of clinical commissioning groups?

[Paul Burstow]

My hon. Friend, who chairs the all-party group on cancer, has been pursuing that issue vigorously. We certainly need to ensure that we use both proxy and other performance indicators on cancer outcomes, and I will want to continue examining whether that indicator is the most appropriate one to tell us what we need to know about improvements in cancer outcomes performance.

Oral Answers to Questions

Debate between Paul Burstow and John Baron

Tuesday 12th July 2011 Commons Chamber

[Paul Burstow]

I am surprised that the hon. Lady does not know. As I understand it, there is a date in all three people’s diaries, but it is not for me to share that date. Although we do need to have cross-party talks between the leaders and the health spokespeople involved, we should also look back and draw some lessons from the royal commission on long-term care. What surprises me is that when that report was published by the right hon. Member for Holborn and St Pancras (Frank Dobson), all that was offered was a debate—not a debate that the Government would lead, but a debate that would take place across the country. We are still waiting for the end of that debate. This Government have a timetable and a commitment to engage.

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

3. What arrangements he plans to put in place to ensure clinical commissioning groups are held accountable for their performance in respect of cancer outcomes.

Oral Answers to Questions

Debate between Paul Burstow and John Baron

Tuesday 7th June 2011 Commons Chamber

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

3. What steps he is taking to enable GP consortia to commission integrated cancer services.

[The Minister of State, Department of Health (Paul Burstow)]

“Improving Outcomes: A Strategy for Cancer” set out our plans to support GP consortia to commission high-quality cancer services that deliver improved outcomes. The strategy confirmed the importance of cancer networks and we have recently confirmed that the NHS commissioning board will continue to support strengthened cancer networks.

[Mr Baron]

I thank the Minister and the Secretary of State for extending the guaranteed funding for cancer networks to 2013 and their commitment to support them thereafter, because the cancer networks’ expertise will be much valued by consortia. How will the authorisation process for GP consortia ensure effective commissioning of those cancer services that span consortia boundaries, such as radiotherapy?

[Paul Burstow]

What we are doing at the moment with the pause is making sure that we revise the proposals in ways that ensure that we deliver the outcomes set out in the White Paper last year. One of the things we said in the White Paper, and which the Bill currently provides for, is that GP commissioning consortia can collaborate where they need to commission for larger populations.

Oral Answers to Questions

Debate between Paul Burstow and John Baron

Tuesday 26th April 2011 Commons Chamber

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

T5. There is some concern about whether GP consortia will be given enough specialist support when commissioning integrated cancer services. Will my right hon. Friend use the pause in the passage of the Health and Social Care Bill to consider extending the guarantee for cancer network funding from 2012 to 2014, when the transition period ends and GP commissioning comes fully into effect?

[The Minister of State, Department of Health (Paul Burstow)]

I am grateful to the hon. Gentleman for his question. The listening exercise is a genuine one, and we intend to bring forward appropriate changes as a result. I can certainly give the commitment that we will want to take on board such representations. We are, and consistently have been, committed to such clinical networks for the valuable contribution they make.

Oral Answers to Questions

Debate between Paul Burstow and John Baron

Tuesday 7th September 2010 Commons Chamber

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

13. What recent representations he has received on the proposed one-year cancer survival measure.

[The Minister of State, Department of Health (Mr Paul Burstow)]

I have received many helpful representations on the proposed one-year survival measure, including his own when I met him along with a number of leading cancer charities in July. We have launched a full public consultation to shape the first ever outcomes framework for the NHS, and I urge all interested parties to contribute. The consultation document has put forward a range of possible outcome measures, including a one-year cancer survival rate that could be included in the framework. A full response to the consultation will be provided when it closes on 11 October.

[Mr Baron]

The one-year cancer survival measure is welcome, because it will encourage earlier diagnosis. As the Minister will know, however, under-treatment of the elderly in the NHS remains a pressing problem, which was highlighted in a recent report on cancer inequalities by the all-party parliamentary group on cancer. Can he assure us that the over-75s will not be excluded from the one-year or the five-year cancer survival measures once they are constructed?

[Mr Burstow]

The hon. Gentleman makes an important point. It is essential for us to ensure that the NHS delivers treatments that are both based on evidence and age-appropriate, which means ensuring that older people receive treatments that will enable them to survive cancers. His representations will need to be taken fully into account as we consider the results of the consultation on the outcomes framework.