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Pembury Hospital

Volume 401: debated on Thursday 20 March 2003

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Motion made, and Question proposed, That this House do now adjourn.ߞ [Charlotte Atkins.]

6 pm

I am delighted to have this opportunity to raise the issue of the impending possible closure of the haematology research unit at Pembury hospital in my constituency. It is not a research unit of which I was previously aware, and I understand that the Minister's office was not previously aware of it either. However, on examination, it is a remarkable research operation that has been running for some 17 years and is now threatened with closure because of a lack of financing, and I shall talk about the value for money that it offers.

I am keen to raise the issue in the House not just because the unit's closure would be a tragedy for the country and the NHS, but because broader lessons must surely be learned from the possible loss of an outstanding facility and its dedicated staff. I ask to the Minister to address three questions. It may well not be possible to provide all the answers in the short time available this evening, but I seek an undertaking that he and his officials will consider the issue extremely seriously.

First, what can be done, even at this very late stage, to save the unit, its staff and scientists who have done such good work in the past? Secondly, in the very unfortunate event that the unit cannot be savedߞI appreciate that it is late in the dayߞwhat can be done to ensure that the very good research that has been done in the past can be transferred elsewhere and that the learning is not lost to the country and the NHS? Thirdly, will the Minister comment on the broader implications for the way in which we fund, through the NHS, such long-term research that is of value to the nation and, indeed, the rest of the world?

Surely, if such research units are left to fund themselves year on year, hand to mouth, so that scientists and doctors have to go out cap in hand and spend a great deal of time that could otherwise be spent on clinical responsibilities simply because of the short-term nature of funding, it is no way to build up a long-term research and development capability in our medical sciences. I hope that the Minister will be able to respond to those issues.

Dr. Colin Taylor, a consultant haematologist, originally founded the unit some 17 years ago to look at the reasons why some types of leukaemia were unresponsive to chemotherapy, and it has broadened its field research beyond that into other sorts of cancer. The unit has a long track record of research. Overall, it has had 50 papers on its work published in peer review journals and it has presented 90 abstracts at international conferences. The Minister will have a copy of those research documents, provided by my office, and it is a truly impressive list by any standards.

The unit is of international repute and widely respected not just in this country, but in the United States and elsewhere. The type of research that was pioneered by that very small unit is now being taken up elsewhere in the world, particularly in the United States, on a significant scale and, in some cases, a significant commercial scale. The unit is currently involved in international research work on leukaemia, ovarian cancer, breast cancer and bladder cancer, and the publications that I have referred to testify to that fact.

In addition, the unit, as a result of its research, has started to develop a clinical service that is used by NHS hospitals throughout the country. That service performs approximately 300 to 400 chemotherapy sensitivity tests a year on both solid and haematological tumours. In other words, it provides a service that can test the tumours for their response to the right level of chemotherapy and mix of drugs to produce the best possible result. The service can not only save and preserve life, but can reduce enormously the side effects of cancer treatment, which, as we all know, is often extremely distressing to patients. It is an extremely valuable service.

My hon. Friend knows that my constituents benefit immensely, as do his and people much further afield, from this remarkable life-saving research facility. Does he agree that as such extensive use is made of it by NHS practitionersߞoncologists, surgeons and physiciansߞthat in itself presents a compelling reason why the NHS should ensure financially that it continues?

I am grateful to my right hon. Friend for making that point. It is not just that the unit is providing a service, it is being used by other hospitals in the NHS in the treatment of cancer even though this unit is not funded by the NHS. It is in all respects a bargain for the NHS, both because of the form of its funding and because of the value of its service. The unit has helped a total of 4,000 patients over time with a number of different tumor types. The research has shown that by using the chemotherapy sensitivity testing technique on patients, for example in advanced ovarian cancer, the five-year survival rate can be increased from 12 to 24 per cent.—in other words, survival rates are doubled for those patients with that acute form of cancer.

To pick up on my hon. Friend's point, it has been reported in a peer review journal by Professor Michael Drummond, who is the director of the centre for health economics at York university, that the potential cost saving to the NHS of using chemotherapy sensitivity testing in chronic leukaemia is £1,470 per patient per year on medication. The test enables the treatment to be specifically right for that patient. It ensures that the response is the most efficient one for that patient. If we assume that that is correct and is also right for other forms of testing that the unit undertakes, the saving per annum for 300 patients is some £450,000 a year. The unit costs less than that to fund. It is paying for itself without costing the NHS anything. It is an absolute bargain. If it closes, the consequential cost to the NHS will be greater and the suffering of patients will be greater. We will have patients who will suffer more and die earlier. That is the issue.

It is easy to talk about research, facts, figures and funding, so let me put some colour on this. I have received many letters from people all over the country who have benefited, or whose relatives have benefited, from the work of the unit. We must remember that at the end of the day this is about patients who are suffering acutely from severe illness, often in advanced stages of distress. Sharon Howell, whose daughter Sarah died of leukaemia aged 18, said of the unit:
"If it wasn't for their hard work Sarah wouldn't have had an extra two years of life."
Today, a colleague working in the House rang up to say he was so glad that I was raising this issue because his daughter would not be alive today without the work of the Pembury research unit. It matters to people. None of the people who have benefited or the clinicians up and down the country will understand if we let the unit go without ensuring that we have done our best to save it, or, if we cannot save it, ensure that the work is continued and developed elsewhere.

Dr. Jean Sergeant, the principal research scientist at the Pembury unit said:
"It is sad that the work is finishing because what we are doing is helping patients. The only positive thing is that all the work of the unit has been published and is available for the benefit of the public to be used by other researchers. I just hope that the testing can be continued in other units for the continued benefit of cancer patients."
I am not raising this issue in order to criticise anybody. In many ways, it was a tragedy that I did not become aware earlier of the work of the unit and its funding situation. Had I been aware, perhaps I, as the MP, could have done more to help it. It is not that the Minister has cut off funding to the unit, and it is not that any individual has decided to close it. Rather, the unit has had the misfortune of being the victim of its own success. Because it has been such good value over time, it has been funded hand to mouth by research grants that it has applied for and by voluntary contributions from foundations and charities. As a result, the unit has never established a long-term basis for its funding or its secure financial future. Dr. Colin Taylor has told me that one of the reasons why he has concluded that it will be very hard to continue is that he and his colleagues are spending too much of their time trying to raise money instead of concentrating on their research and clinical work. He and many of the staff are obviously distressed at the situation, but feel that, without secure long-term funding, they simply cannot continue.

The costs of the unit are not great; I will give them in round numbers. The unit costs £150,000 to keep open for one year. Of that, £90,000 goes on salaries for scientists and staff, £20,000 goes on consumables, and £40,000 goes on equipment. In the scale of things, those are not substantial sums of money—although I know that there are many different claims on NHS resources. The unit receives rent-free accommodation from the Maidstone and Tunbridge Wells NHS trust. That, substantially, is the contribution of the NHS to the unit's funding. It is obviously of a modest order. The unit has, in the past, received 60 per cent. of its funding from research grants and 40 per cent. from local charitable donations. Unfortunately, the unit's two most recent applications for research grants were unsuccessful. Obviously, I cannot evaluate those applications as I am not qualified to do so, but, as far as I can tell, they were unsuccessful not because they were of insufficient merit, but because there were other priorities. In one case, the funds required simply were not there.

Quite apart from the loss to patients and the extra cost to the NHS, if the unit closes its current national and international collaborationsߞwork on leukaemia, ovarian cancer, breast cancer and bladder cancerߞwill all be discontinued. The units with which the Pembury unit works, and doctors and scientists around the world, will be amazed if it closes. I understand that there are two other units in the country that undertake comparable workߞone in Bath and one in Portsmouth. It is possible that at least some of the testing work can be transferred to those units. However, they, too, face comparable funding problems and are substantially funded by periodic research grants. The Minister may be able to address, or undertake to address, the question of what their financial future is likely to be.

Just to survive, the unit needs £150,000 in funding. However, the issue is broader than that. It will be no good simply providing enough money for the next few months. We are talking about scientists—people who want to devote their career to this work and who believe profoundly and passionately in what they are doing. They need to be given the opportunity to develop their work in the knowledge that they have a reasonably secure future. They should not have to go round cap in hand. It is not just a question of research grants. There is an appetite for helping, and the local community will help. Even in the weeks since it became clear that the unit might close, some £20,000 has potentially been raised in the local community. A remarkable local campaigner, Mr. Simon Bender, has been very active in raising funds. I have no doubt that in Tunbridge Wells, in the constituency of my right hon. Friend the Member for Tonbridge and Malling (Sir John Stanley), a contribution will be made. The question for the Minister is this: is there any way, from Government or comparable resources, of providing a future for the unit?

I do not want to miss this opportunity to pay tribute, on behalf of not only my right hon. Friend and myself but, I hope, the Government, to the staff, doctors and scientists who have been involved in the work of the unit over the years, especially Dr. Colin Taylor and Dr. Jean Sargent. All the staff work incredibly hard in fairly primitive conditions to keep the unit going. It will be a tragedy if the unit is closed and their work is lost.

The unit is a bargain for the NHS and for the country. How could it have been allowed to continue without being put on a secure basis? What does that say about the way that the NHS funds long-term research and development projects? What does that say about the extent to which funding, especially for cancer research, actually reaches the front line?

I do not want to tax the Minister's patience, but I should like to share with him remarks made by the Secretary of State for Health at the conference held by the all-party group on cancer on 5 November 2002. The right hon. Gentleman said:
"When I became Secretary of State three years ago, I said that reducing the number of deaths from cancer and improving the care and treatment cancer patients receive was a personal priority for me."
We can all applaud that sentiment. He continued:
"I know sometimes there have been concerns about whether this extra funding"—
the extra £570 million—
"is all getting through to front-line cancer teams".
We are asking only for a scintilla of small change from that budget to help units such as Pembury to continue. People working at units in the United States and elsewhere which collaborate with Pembury will be amazed to hear that it is closing for want of a few pennies. By the standard of US funding and the commercial value of the research that is being developed there, the amount is extremely small. If nothing else comes of this debate, I hope that we can create a secure base somewhere in this country for such research and the staff who want to work on it. They need continuity and development of the service that they provide for cancer patients throughout the country. If we can only do that, we shall have achieved something and there will be a lasting testimonial to the outstanding work of the doctors and staff at Pembury.

6.17 pm

I congratulate the hon. Member for Tunbridge Wells (Mr. Norman) on securing the debate. The future of the haematology unit at Pembury hospital and its research is clearly of importance not only to him and his constituents, but to many people in the UK.

This country has an outstanding record of scientific innovation. In health terms, that rests on mutual support among the NHS, our universities and the bodies that fund high quality research and development. As well as providing solid support for the national science effort, the NHS must support research and development that is relevant to its national priorities and responsive and accessible to the needs of those who use the NHS, as well as its staff and decision makers. We must take an integrated approach to securing the knowledge that we need if we are to tackle health inequalities and provide modern health and social care.

It is estimated that more than £450 million is spent on cancer research in the UK every year. Cancer research funding is made up of several components, including the direct spend on research programmes, infrastructure, support services and laboratories. The first of these, direct support for research, is of most value for coordination and strategy setting. The largest proportion of the total expenditure is in the field of biological research, although research into aetiology and treatment is also well supported. The research is funded by approximately 250 charities, numerous Government bodies and the pharmaceutical industry. It is supported by the National Cancer Research Institute, a partnership between the major funding bodies that has the objective of accelerating progress in research in the UK for the benefit of patients.

By 2004, a new cancer research network will be fully implemented. That will enhance the quality, speed and co-ordination of clinical research and ensure better integration with cancer care. More than 31 of the 34 cancer service networks are now receiving research funds for an integral national cancer research network. Phase 2 of the cancer services collaborative programme commenced in April 2001. The national programme focuses on prostate, breast, lung and ovarian cancers in all 34 cancer networks. There is a total of more than 600 projects, which have yielded in excess of 1,500 real improvements in cancer services for patients. That confirms a healthy picture of a varied and generally well-balanced cancer research base in the UK.

I come now to the specific funding issue that the hon. Gentleman raised. The haematology research unit was set up in Pembury hospital in 1985. It is an independent research unit that carries out research into drug resistance before therapy in the field of chemosensitivity for bladder, breast, acute leukaemia and ovarian cancers, and it has some notable achievements to its credit. I am very happy to pay tribute to that work. Traditionally, it has taken samples from patients from a number of hospitals across south England, testing about 300 samples every year. More recently, its facility has been used some of London's teaching hospitals and more local centres such as the Ashford breast cancer centre.

During its 17 or so years, the unit has had many papers published and the results have been used to help cancer sufferers all over the world. Historically, the unit has received its funding through various routes. Trusts pay for the testing services, but those funds are not sufficient to meet the large operational costs of the unit. Additional funding comes from the haematology research fund, which is supported by the host trust's general charitable trust fund, together with, as the hon. Gentleman said, a research grant from the Medical Research Council. The trust provided accommodation free of charge to the unit at the Pembury site.

I recognise the efforts that have been made by the unit and local people to try to raise funds in support of the unit—they have done so very successfully for many yearsߞbut even their efforts have not been enough to secure the continued long-term operation of the unit. I understand and have every sympathy with the position that the unit now finds itself in.

The hon. Gentleman acknowledges that it is rather late in the day to take action, and in a sense the position is clear. Funding decisions in the NHS now rest with primary care trusts. It is for PCTs, in conjunction with their strategic health authorities, to plan and develop services according to the needs of their local communities. Unfortunately, it is not appropriate for Ministers to get involved in those decisions. This is an independent research unit with charitable status. The NHS has supported it over many years by providing free rent and employment contracts for its staff. The NHSߞspecifically the West Kent and the Maidstone and Tunbridge Wells NHS trusts—is involved in a number of clinical trials involving cancer patients. The Kent and Medway strategic health authority continues to encourage research and development across Kent through its research and development and other networks. But, again, it is for the local research and development network to make decisions on a research and development strategy to increase research opportunities in Kent.

The hon. Gentleman, as he indicated, may ask, why do we not tell the Medical Research Council to continue funding the unit? The reason is that the MRC is an independent body that receives its grant in aid from the Office of Science and Technology. It is a long-standing and important principle of successive Governments that they do not prescribe the detail of how individual research councils should distribute their resources between competing priorities.

Does the Minister accept that it is clearly not for the primary care trust to fund a unit that provides research of a long-term nature that is of value to the whole country, not just the PCT area? I am sure that he will agree that it is not sensible to ask the PCT, which is already strapped for funds, to fund research of that kind. There must be another apparatus for doing that. Does he accept that the nature of the unit, as I said earlier, is to provide a service to the NHS that is of value today? It cannot be regarded as just a normal piece of research. No one is suggesting that the Government should tell research agencies to make grants, but this is an emergency. Something must be done or the resources will be lost forever.

If I may, I would like to move on to the nature of the research and what is going on across the country. Right across the country, in individual primary care trusts and strategic health authority areas, much work is going on in the locality that is of tremendous national benefit. It is right that such decisions are made in conjunction with the primary care trust and the strategic health authority.

I agree with the hon. Gentleman that, should the Pembury unit close, every effort should be made to ensure that the work that it undertakes should not be lost to the wider NHS. Two other established units, in Bath and Portsmouth, carry out similar research into chemosensitivity testing. I am advised by officials that discussions are about to take place to determine whether samples tested at Pembury can be managed at those sites. In addition, the Royal London hospital has confirmed that it is able to take on the work that the unit does specifically in the area of chemosensitivity testing for childhood leukaemia. As he will know, those tests form a crucial part of the unit's most recent work on relapsed leukaemia trials, on which other laboratories across the UK are also working.

In addition, I understand that scientists from St. Bartholomew's hospital, London, have spent time with the unit in Pembury learning the techniques that it uses. As I have said, the unit at Pembury has historically taken samples from hospitals across the south of England. Although I can understand the hon. Gentleman's disappointment that this type of research may not continue at the haematology research unit in Pembury, I can assure him that discussions are under way to transfer the unit's testing of samples to other sites in the south of England, and that some specialist work will transfer to the Royal London. As I understand it, samples are sent through the post, so distance is not an issue as long as the samples are received within 24 hours.

For the longer term, I understand that new types of research are being developed that could replace chemosensitivity in the future. Many labs throughout the UK are currently working on gene expression profiling. GEP is very similar to chemosensitivity, in that the labs take fresh samples of cancer cells from patients and profile them against different drugs. Eventually, it should be possible to match up about 30,000 different types of cancer genes with the most appropriate drug therapy.

To turn back to the hon. Gentleman's area, a research and development network has been established in Kent and Medway, which brings together primary care, secondary care and universities to work on a research and development strategy to increase research opportunities. I understand that Maidstone and Tunbridge Wells NHS trust is already taking part in several clinical trials involving cancer patients—

The motion having been made after Six o'clock, and the debate having continued for half an hour, MR. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at half-past Six o'clock.