Cancer Treatments

Virendra Sharma Excerpts

Tuesday 19th June 2012 Westminster Hall

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Gray, and to contribute to this important debate. I congratulate the hon. Member for Southport (John Pugh) on securing it.

Macmillan Cancer Support estimates that 2 million people in the UK today have had a cancer diagnosis—the number is expected to continue to rise by 3% a year—and that nearly 4 million people will be living with cancer by 2030. Currently, 8,000 people are living with, or beyond, cancer in my constituency alone. Those figures show clearly that the NHS has a demographic challenge on its hands. It will need to become ever more efficient in treating and supporting cancer patients if it is to continue to meet clinical and non-clinical needs and deliver improved outcomes.

Surprisingly, the findings of the international cancer benchmarking project 2010 revealed that survival rates of cancer patients in England continue to lag behind countries such as Denmark, Sweden, Australia, Canada and others. Decisive steps are needed to ensure that England matches the European average and to prevent the country letting down people affected by cancer. The Government have acknowledged that, despite some improvements, cancer outcomes in England remain poor when compared with the best outcomes in Europe, highlighting a significant gap that remains in both survival and mortality rates. In response, the Government put together a cancer strategy that set out a commitment to improve the outcomes and experiences of cancer patients and an ambition to save 5,000 additional lives a year by 2014-15.

I wish to focus first on how we plan to measure how well the NHS has responded to that cancer challenge and whether providers and commissioners are sufficiently incentivised to meet the Government’s ambition. The updated NHS outcomes framework for 2012-13 includes two cancer-specific measures to drive improvements in the earlier diagnosis and more effective treatment of cancer: for one and five-year cancer survival rates for breast, lung and colorectal cancer; and for the under-75 mortality rate from cancer. Although that is a welcome first step on the road to meeting the cancer challenge, I understand from charities such as Macmillan that those indicators are currently too limited, as they measure survival rates for the three most common cancers only. The NHS should be encouraged to improve earlier diagnosis of rarer cancers, which account for almost 50% of all new cancer diagnoses.

I have learnt recently that the commissioning outcomes framework for 2013-14, which will be used to measure improvements in cancer services and outcomes locally, might not even include one and five-year survival rates for breast, lung and colorectal cancer. That unhelpful disparity could result in clinical commissioning groups not placing enough emphasis on the early cancer diagnosis and, ultimately, undermine the ambition of saving 5,000 extra lives a year by 2015. At present, the cancer-specific indicators are too limited to truly measure how well the NHS is responding to the cancer challenge. I should be grateful if the Minister updated hon. Members on the plans to extend one and five-year cancer survival rates to cover more cancers and to include those indicators in both the NHS and commissioning outcomes frameworks.

The cancer strategy also provided that early diagnosis would continue to be a top priority and

“will be included in the mandate for the NHS Commissioning Board for the future”.

Ahead of the Department of Health consultation on the mandate, will the Minister provide assurances that the mandate will include an objective to improve early diagnosis for all types of cancer, as a way of improving outcomes?

Alongside improving early diagnosis and outcomes, the Government have placed a welcome emphasis on improving the experiences of cancer patients. I, too, congratulate the Government on agreeing to run the national cancer patient experience survey again in 2012-13. The national cancer patient experience survey 2010 revealed that

“white cancer patients report a more positive experience of care than other ethnic groups—particular differences were noted on questions around receiving understandable answers, being given enough care after discharge and staff working well together.”

Similarly, people with a disability or mental health conditions, people from the lesbian, gay, bisexual and transgender community and people with rarer cancers also reported a less positive experience.

In Ealing Hospital NHS Trust, only 48% of patients responded that they got understandable answers to questions all or most of the time and only 51% responded that patients had confidence and trust in all ward nurses. The Department of Health has stated that

“commissioners will wish to encourage providers to take note of the differences and to consider positive action to address the distinct need of people from different groups.”

I believe that the Government’s approach to improving patient experience could be even more proactive. The national cancer patient experience survey should be developed as an indicator and included in the NHS outcomes framework. That is the only way that commissioners, providers and the NHS Commissioning Board will have a clear incentive to address areas identified for improvement. Will the Minister explain whether there are plans to correlate the cancer patients experience survey with the NHS outcomes framework to improve outcomes?

Now that the Health and Social Care Act 2012 has been passed, the Government have an opportunity to refocus on effective implementation of their reforms and, more specifically, on delivering their commitments to improving cancer outcomes. It is my view that every cancer patient—regardless of who they are, where they live or what cancer they have—has the right to high- quality care, support and treatment. I ask the Minister to consider the contributions that he hears today to make sure that England’s health and social care system is not just meeting the European average for cancer outcomes, but taking the lead.

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[Liz Kendall]

I thank the hon. Gentleman for his intervention. He was lucky enough not to experience the 16 weeks of the two Public Bill Committees that considered the Health and Social Care Bill, when I regularly raised the key concerns, such as how to improve outcomes for cancer and heart disease and how services, not structures, needed to be reformed to do that. If he has a spare moment and reads the report of those debates, I am sure that he would become aware that I was very concerned about how to improve patients’ lives, their experience and the quality of care, which is always the issue for me. My concern was always about whether the reforms would do that.

I return to the point that I was making about local authorities’ role and the concern that, under the mandated public health services that local authorities will have to commission, public awareness campaigns, including those for cancer, are not included. There is a real worry among public health professionals and those working for and with cancer patients about whether public health awareness campaigns, such as the bowel cancer awareness campaign, which certainly attracted my attention, will continue.

A second issue is how to improve GPs’ skills and their awareness of cancer. Many GPs see cancer patients relatively infrequently, particularly those with rare cancers. Will the Minister explain what national or local action may be taken to ensure that skills and awareness improve?

We want to ensure that, when people are referred by a GP, they have swift access to diagnostic tests. That is about not just good outcomes, but the quality of their experience. Anyone who has had the misfortune of themselves or a family member waiting for cancer diagnostic tests knows that it is a frightening experience and that it should be done as quickly as possible. There were big improvements under the previous Government in speeding up diagnostic tests, but there is evidence that the service is going backwards. Some 78% more patients now wait more than six weeks for diagnostic tests compared with May 2010, and there are even bigger increases in the number waiting for vital tests to diagnose cancer. Some 230% more patients now wait more than six weeks for endoscopic diagnostic tests, and that includes a 242% increase in the number waiting more than six weeks for colonoscopy and a 140% increase in the number waiting more than six weeks for MRI scans. What action could and should be taken to reduce those diagnostic waits, which is vital to improve one-year survival rates?

Turning to the important issue of treatment variation, I want to put on the record the excellent briefing from the King’s Fund, “How to improve cancer survival”, which goes through the issues in detail, with the best clinical evidence and the implications for services on the ground. Treatment factors can be divided into four main groups: surgery, radiotherapy, cancer drugs and the overall co-ordination of care. On surgery, there is a lot of evidence that the outcomes for many types of cancer might be better in centralised, specialist centres, particularly for complex surgery, because their use can lead to better training for surgeons. If they have a higher case load, doctors develop greater expertise and experience. More specialist support is available, such as nursing and intensive care, as well as superior equipment. One concern that we raised when discussing the Health and Social Care Bill and reorganisation was who will lead the strategic configuration that is needed to centralise some services, such as cancer, into specialist centres.

Radiotherapy has a significant although modest overall impact on five-year mortality rates. Obviously, the optimum proportion of patients with cancer who should receive radiotherapy varies by tumour type and stage, but it is thought that overall around 50% of patients with cancer would benefit from radiotherapy. However, in 2005, the radiotherapy access rate in England was 38%. That was one reason why the former Government introduced a new strategy, “Radiotherapy: developing a world class service for England”, in 2007. Can the Minister update me on any progress on that?

I am sure that the Minister will talk about the cancer drugs fund and the Government’s aim of improving access to such drugs. He will know that concern remains that the fund has not removed variations from the system. There have been underspends in some parts of the country, and some regional cancer drug funds approve drugs that others do not. The King’s Fund raises a bigger question in its document. It says that it is more important to improve access to surgery and radiotherapy overall. It is worried that there has been almost too much attention on the cancer drugs fund and not enough on the variations in radiotherapy and surgery.

I am really concerned about older people and the variation in their care. Will the Minister say whether the Government will look into that specifically? Older people are under-treated, and their outcomes for cancer are worse as a result, even when account is taken of the different types of tumour and the presence of other diseases or co-morbidity. Older people are less likely to receive intensive treatment and more likely to be admitted as an emergency.

Crucially, major international studies show that differences in survival rates between the UK and other countries are greater for older people. We are not sure of the reasons for that based on the evidence, but the King’s Fund suggests that there may be three key issues: even later presentation; co-morbidity with older people having two, three or more other long-term chronic conditions, which may lead to cancer then being misdiagnosed or not diagnosed; and age discrimination and the feeling that, because someone is getting older, their health is perhaps not so important. I am pleased that the Minister will implement the ban on age discrimination in public services that the former Labour Government introduced. I am very keen that the Government look more into that issue as part of their work on cancer.

I wish to say something about co-ordination of care, which, as we know, is important for patients and the patient experience. During debates on the Health and Social Care Bill, we asked whether cancer networks would continue in the NHS and, if so, how they would be funded. In May last year, the Secretary of State for Health said that the Government would fund and support cancer networks in 2012 and that, after that, the NHS Commissioning Board would continue to support and strengthen them. Over a year later, however, the future of cancer networks is still unclear.

The NHS Commissioning Board has recently published early proposals for clinical networks, which include the new strategic clinical networks prescribed by the NHS Commissioning Board. The proposals also mention 14 to 15 overarching networks in England that will cover a specific geographical area and review the work of the prescribed strategic clinical networks every six months. I think, however, that people are still quite confused about how that will work, and the Government’s proposals do not refer specifically to the 28 cancer networks. I therefore ask the Minister whether all 28 current cancer networks will become prescribed strategic clinical networks, or will their number be reduced? How will they fit into the umbrella networks?

Funding is crucial. In response to a parliamentary question on 21 May this year, the Minister stated that strategic health authorities will be given £18.5 million to fund cancer networks in 2012-13, just as in the previous two years. Page 6 of the recent document from the Department of Health, “Progress Update on the Design of the NHSCB” states:

“Around £10 million of the costs of supporting Networks and Senates are expected to count against running costs.”

That seems to imply that the £10 million is to run not only cancer networks but all clinical networks and senates and that would be a cut of £8.5 million to the cancer networks. Will the Minister say whether the £10 million referred to in the document about the future functioning of the NHS Commissioning Board covers all networks, or cancer networks alone? That is a real concern for people who work in cancer networks and are already worried about the future.

I will conclude by mentioning the patient experience. Several hon. Members have rightly mentioned the need for the patient’s experience of a service to be placed at the heart of what the NHS is trying to achieve. I agree with the call from Macmillan Cancer Support and Breakthrough Breast Cancer for the NHS cancer patient experience survey to be included as part of the fourth domain of the NHS outcomes framework, which is about ensuring that people have a positive experience of care.

The cancer patient experience survey shows that the NHS does well on issues such as waiting times, pain control and patients who feel that they have been treated with dignity and respect. It does not, however, do as well as it could on issues such as patients receiving written information about their condition, financial help, clinicians who work well in a hospital and the community and whether there is enough nurse support. Those are important matters for patients.

[Mr Virendra Sharma]

Does my hon. Friend agree with expectations that the system will work more closely in partnership with the third sector, so that when patients come into the community they get support from that as well? We need a partnership that works together to improve the condition of patients once they are released from hospital.

[Liz Kendall]

I absolutely agree. Last year, I visited the oncology and radiotherapy wards at Leicester royal infirmary, and I saw the work done by Macmillan Cancer Support to help patients with cancer and their families. It had a multi-disciplinary team that worked around the needs of the individual patient and their family and involved not only doctors, nurses and radiographers in the hospital, but GPs, physiotherapists, occupational therapists, dieticians and pharmacists in the community. Macmillan Cancer Support does excellent work to improve the information and advice that is given to patients and their families, and it deals sensitively with issues such as when patients might want information, how it is provided and what is wanted by different family members. I am very supportive of that.