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Cancer Care (England and Wales)

Volume 558: debated on Tuesday 12 February 2013

Thank you, Mrs Riordan, for calling me to speak and for chairing this debate. It is a privilege to serve under your chairmanship.

The subject under discussion is cancer care in England and Wales. Naturally, I understand that the Minister who is here is only responsible for treatment and care in England, and that health is a devolved matter, with responsibility for it in Wales falling to the Welsh Government. However, the different approaches will allow each nation to share best practice and compare outcomes, with the objective of raising the standard of cancer care wherever we live.

I do not want this debate to be party political; this issue is far too important for that. I want to compare the facts and to recognise success, wherever that may be found. The starting point for the debate must be mortality rates or, to put it another way, the success of any medical intervention. Overall, life expectancy among men in Wales is 77.6 years, and in England it is 78.6 years. Among women, life expectancy is 81.8 years in Wales and 82.6 years in England. I am sorry to say that the figures for Scotland and Northern Ireland are worse than the figures for either England or Wales.

However, focusing purely on life expectancy is too broad an approach, and we need to consider the influences on life expectancy. There may be historical and social reasons for the differences in life expectancy, but it is fair to say that cancer survival rates are a significant factor, which brings me to my key points. The most commonly diagnosed cancers are breast cancer among women and prostate cancer among men.

Is the hon. Gentleman aware of the “Hear me now” report by Rose Thompson, the chief executive of BME Cancer Communities, which was launched here in Parliament yesterday? It revealed that the death rate from prostate cancer is 30% higher among black men than among their white counterparts. Does he agree that such inequalities in cancer outcomes must be addressed?

I am grateful to the hon. Lady for making an extremely valid point. The collection of data is exceptionally important, to identify which groups are potentially more vulnerable or which groups are not seeking the right sorts of treatment. Comparison between the home nations is important, but so is comparison between groups within the home nations, in order to bring the data together. It is exceptionally important if we are to reach the right conclusions.

I will focus on breast cancer to begin with. As I have already said, the mortality rate from breast cancer in England is 24.3 per 100,000 people, and in Wales it is 25.8 per 100,000 people. Clearly, those are worrying data, and it is worth considering the different approaches to treatment in the two nations.

In England, a patient concerned about the possibility of breast cancer can expect to see a consultant within 10 working days of the GP referral. In Wales, there is a different approach, which means that a GP differentiates between urgent and non-urgent cases. In cases that are deemed urgent, 95% of patients should expect treatment to start within 62 days, and in cases deemed non-urgent, the patient should expect treatment to start within 26 weeks. I want to underline this situation: a woman in England who is concerned about the risk of breast cancer will be reassured, or have her case elevated to the next level, within 10 days. In Wales, however, a patient has no such guarantee of consultant expertise until much, much later in the process.

We need to recognise that these are different measures and approaches. Breakthrough Breast Cancer has a helpful quote. It says that waiting for a referral is like being “left in the dark”.

The issue of waiting time for treatment and diagnosis is important to me. Does my hon. Friend agree that there should be an absolute focus on awareness, particularly regarding colon and rectal cancer, from which the chance of recovery is far greater if diagnosed early? There has to be a focus on early diagnosis, because it greatly increases the chances of recovery.

My hon. Friend makes a valid point about screening and awareness. Today I want to focus on treatment, but awareness and screening are exceptionally important and no doubt warrant another debate.

My hon. Friend has in some respects taken the words out of my mouth. To what extent does he attribute some of the differences between England and Wales to a problem of education and diet, as well as to the problems of treatment and early diagnosis?

My hon. Friend raises an important point about diet. There are historical and social issues. Diets and issues like that are relevant and also need wider consideration, perhaps in another debate that my hon. Friend may choose to nominate.

Does the hon. Gentleman agree that however good the cancer care in hospitals is—it is excellent in many places—it often leaves a gap in psychological, emotional and social support? Excellent work is being done by Maggie’s centres in that respect. There is one in Swansea, and I believe one is due to open in Cardiff. There are also many centres in England and Scotland, including in my constituency. Will he endorse the value of their work?

I am grateful for the right hon. Gentleman’s valid point. I absolutely endorse the role that independent and charitable organisations can play; I quoted Breakthrough Breast Cancer. Emotional support is exceptionally important, and that relates to my point about delays in receiving treatment. A consultant can reassure people on many occasions, give a realistic assessment of the condition and provide the wider support available from some of the charitable organisations that have been mentioned.

Will my hon. Friend acknowledge the importance of care in the recovery of cancer patients? Statistics from Macmillan Cancer Support reveal that 19% of 18,000 newly diagnosed cancer patients in Wales were deemed to lack that kind of support, not just during diagnosis or treatment but, critically, in aftercare.

I am grateful to my hon. Friend for sharing those data. In interventions, hon. Members have talked not only about pre-screening, awareness, social issues and treatment, which I will focus on, but the aftercare that is needed, the emotional support that is provided, and the need for and responsibility and role of a whole host of agencies, including those in the charitable sector.

Returning to the point about treatment, I had been comparing the different approaches to breast cancer in England and Wales. The wait before seeing a consultant in England is 10 days. It is interesting to note that the Welsh Government removed 10-day monitoring in 2006. Although data are recorded locally, they are not published nationally. In the interests of transparency, it would be helpful if those data were published to allow fair and just comparisons. Waiting time targets improve survival outcomes, reduce emotional distress and improve the quality of life for people with cancer and those who turn out not to have cancer.

There are similarly alarming figures for prostate cancer. Five-year survival rates can be higher than 80%. There are no figures comparing the rates of the home nations, but the side-effects of the sort of treatment one receives for prostate cancer can be significant and can have a huge impact on future lifestyle. Again, there is a different approach to prostate cancer care in the two nations.

I want to draw attention to the availability of treatment. There was significant attention some years ago to access to brachytherapy. Even when it was finally approved by the Welsh authorities, after having been widely available in England, Scotland and Northern Ireland, the threshold for intervention was much higher in Wales. As far as I know, that remains the case.

Currently an identical debate is focused on robotic surgery. A constituent who suffers from prostate cancer, who is qualified medically and who consulted widely before making the decision with his clinicians on the most suitable form of treatment for himself, wrote to the Welsh Health Minister. He shared a copy of the letter with me, in which he said:

“I was both surprised and disappointed to find that this option is not available to Welsh men in Wales and that a significant number of Welsh men are opting to go to England, where this technology is established and available throughout the country.”

Does my hon. Friend accept that if that kind of treatment—be it robotic or radio surgery—was available perhaps in a location such as Bristol, it would be accessible for patients in south Wales, along the M4 corridor and elsewhere, and those who go down the M5, right the way through to Cornwall?

My hon. Friend makes a valid point about the need for joint working and better co-ordination between the health services. Devolution can provide valid comparisons to establish the success of various treatments, but on many occasions there is a need for joint working where capital investment is needed, allowing patients to benefit from a different sort of intervention, but with shared responsibility between the two organisations.

I was talking about my constituent who had wanted robotic treatment for prostate cancer. He was later forced, in his stressful situation, to raise the £13,000 necessary to receive the form of treatment that he thought best suited him. I am pleased to report that the outcome of the treatment was positive.

The Wales Minister argued that if local heath boards do not provide treatment routinely, people could follow a process for individual patient funding requests. The panel meets monthly, which hardly reflects the urgency of some cases. I am not aware that any case of robotic treatment has been successfully applied for.

That leads me on to the cancer drugs fund, which is available in England but not in Wales. The fund allows clinicians and patients to prescribe and receive the latest drugs. Again, that is not available in Wales, where there is a cumbersome process to seek such a prescription.

The Rarer Cancers Foundation reported that 24 cancer treatments that are not routinely available in Wales may be available in England through the cancer drugs fund. It concludes that people in Wales are five times less likely than people in England to gain access to a cancer drug that is not routinely available. It also states that if the same approval rate occurred in Wales as it does in England, 159 cancer patients in Wales would gain access to life-extending treatment, instead of the 31 recorded. I raised the issue with the Welsh Health Minister, and she reported that establishing such a fund would reduce the money available for treating other serious conditions, as in England. I find that worrying, and I would be grateful if the Minister could address that point in her response.

That deficiency applies to other cancers, too. Selective internal radiation therapy is an innovative treatment for inoperable liver tumours. Although the University hospital of Wales in Cardiff is part of the UK-wide phase 3 clinical trial, not one patient from Wales has been funded for treatment. The patients under trial have been financed by the cancer drugs fund, yet the hospital is in Wales and demonstrates the expertise that exists in Wales in the field.

Survival rates for pancreatic cancer also differ significantly, and I could go on at length about those. When it comes to five-year survival rates for pancreatic cancer, Wales scores better than England. Unfortunately, that tends to be the exception rather than the rule. Those differences are worrying, and had I referred to Scotland and Northern Ireland selectively, I would have been able to paint a more alarming picture, but that is not the point; it is not about the politics of the issue, but about sharing best practice and getting the right treatment for the right people.

The motivation for the debate came from individual cases in my surgery. Having researched the data, I was forced to bring the matter to the House’s attention. I hope the Minister and Members present will be able to use their influence on colleagues here and elsewhere to raise standards, allay fears and improve survival rates for cancer patients.

As ever, it is a pleasure to serve under your chairmanship, Mrs Riordan.

I congratulate my hon. Friend the Member for Vale of Glamorgan (Alun Cairns) on securing this debate. He makes the important point that it is not acceptable for cancer, of all the conditions that touch the lives of so many families, to be a party political issue. He is right, however, to bring to this place his concerns about the treatment of people in Wales who are suffering from cancer so that a comparison may be made with England and lessons might be learned by both countries. As he said, I am unable to respond to the detail of his concerns because Health Ministers in England are not accountable for health services in Wales, which are matters for the Welsh Assembly. I am sure the Assembly will read the account of this debate in Hansard and make particular note of some of my remarks on what seems to have been put about in the Principality.

In my constituency of Aberconwy in north Wales, and also in other parts of Wales, we are dependent on the health service in England to provide specialist services unavailable in Wales. We have been told time and again that patients from Wales often have to wait longer for treatment in hospitals in England. As a Health Minister in England, will my hon. Friend provide any guidance to Welsh Members on whether that is true?

As ever, my hon. Friend asks a particularly pertinent question, and, to be frank, I cannot immediately give him the answer. I can and will ensure that he receives a full response in a letter. He may also talk to any of my officials at the conclusion of this debate.

In England, the Government have committed to improve survival rates, reduce mortality rates and put patients at the heart of the service. In January 2011, we published a four-year cancer outcomes strategy that set out a range of actions for improving early diagnosis, screening, access to treatment and drugs and providing support to people living with and beyond cancer. That strategy is backed by more than £750 million for implementation, including more than £450 million for early diagnosis.

To improve early diagnosis, we must encourage people to recognise the symptoms and signs of cancer and to seek advice from their GP as soon as possible. Of course, we also need GPs to recognise cancer symptoms and, if appropriate, refer people urgently for specialist care.

Since 2010-11, the Department has been funding and delivering local, regional and national “Be Clear on Cancer” campaigns to raise awareness of cancer symptoms. We are currently running a regional pilot campaign for kidney and bladder cancers that is rather charmingly know as “blood in pee”; a regional breast cancer campaign aimed at women over 70; and a local pilot campaign for ovarian cancer.

I had the great pleasure of attending the all-party group on ovarian cancer, chaired with great ability, compassion and campaigning skill on behalf of ovarian cancer sufferers and their families by the hon. Member for Washington and Sunderland West (Mrs Hodgson). That is an example of a cross-party initiative on cancer, which is as it should be.

As part of the pilots and schemes to raise awareness, there is a more general campaign on cancer symptoms called “Know 4 Sure”, which lists four key symptoms: unexplained blood not from an obvious injury; an unexplained lump; unexplained weight loss; and unexplained pain that does not go away. If someone has one or more of those symptoms, the message is clear: “Go and see your GP.” There is information on GP attendance, and urgent referrals for suspected cancer and diagnostic tests will be analysed to assess the impact of the campaigns. We will study the campaigns to see how effective they have been. If we need to roll them out across England, we will do so. I hope the Welsh Assembly will look at the success or otherwise of those campaigns and learn accordingly.

Support for GPs is important, and a range of support is available to help them assess when it is appropriate to refer patients for suspected cancer, but we know we can do more. As part of the preparation for all the campaigns, we commissioned Cancer Research UK to produce briefing materials for GPs within the relevant networks. We are promoting GP direct access to four key diagnostic tests to support early diagnosis of bowel, brain, lung and ovarian cancers. We have provided GPs with best practice guidance on using those tests, and we are publishing data on their usage. We are also working on providing electronic and desk-based cancer decision support tools to help GPs assess and identify patients with possible cancer more effectively.

We know how valuable screening is, and we are working to deliver age extensions for bowel and breast screening programmes. We will continue to support the roll-out of evidence-based screening programmes. For example, we are introducing bowel scope screening to the existing national bowel screening programme. We are aiming for 60% roll-out by March 2015. Experts estimate that the bowel scope programme will prevent some 3,000 cancers every year and save thousands of lives.

The hon. Member for Nottingham South (Lilian Greenwood), who is no longer in her place, rightly mentioned some of the difficulties we face with some men, notably in the black community, who are more at risk of prostate cancer. I will provide her with details on the Department’s various initiatives to ensure that we pay particular attention to those parts of our community that need such information to ensure they go along to have the screening and to see their GP if they have any concern about that aspect of their health.

As my hon. Friend the Member for Vale of Glamorgan explained, once cancer is diagnosed it is important for patients to have access to appropriate treatment delivered to a high standard.

The latest cancer waiting times show that 95.4% of patients in England—or 291,974 patients out of 306,011—were seen by a specialist within two weeks of an urgent GP referral for suspected cancer. We set high levels of expected performance, which in that case is 93%, so I am pleased that we have exceeded our own high standards. Some 87.3% of people treated began their first definitive treatment within 62 days of being urgently referred for suspected cancer by their GP, and 98.4% of people treated began first definitive treatment within one month of receiving their cancer diagnosis. We should celebrate those figures, but, of course, we can always do better.

We are expanding radiotherapy capacity by investing more than £173 million over four years and ensuring that all high-priority patients with a need for proton beam therapy get access to it abroad. That includes £23 million for the radiotherapy innovation fund, which is designed to ensure that, from April 2013, radiotherapy centres are ready to deliver advanced radiotherapy techniques to all patients who need it. From April, cancer treatments will be planned and paid for nationally by the NHS Commissioning Board, which means that, for the first time, cancer patients will be considered for the most appropriate radiotherapy treatment regardless of where they live.

My hon. Friend mentioned the cancer drugs fund. Between 1 October 2010 and December 2012, the fund stood at £650 million and helped more than 26,500 cancer patients in England to access the additional cancer drugs their clinicians recommended.

When I was first elected to this place, I received letters from constituents who were rightly upset and concerned that they spent so much of their own money to access certain drugs, and I do not think I have had one such letter or e-mail for at least 18 months. That is a mark of achievement.

To be absolutely clear about the funding of the cancer drugs fund, it is not true that any reduction has been made in any service. It is not true to suggest that money has been taken from the NHS budget. If anybody says such a thing, I am afraid they are either deliberately not telling the truth or just plain ignorant. I am happy to explain how the coalition Government have funded the cancer drugs fund in England. Raising the threshold for national insurance effectively saved the NHS £200 million. That £200 million was not secreted away or given to the Treasury or anybody else; it was the start and has been the continuation of the cancer drugs fund. I hope that that is clear. I know that it will be recorded in Hansard, and no doubt my hon. Friend and others will be able to publicise it widely in Wales and set the record absolutely straight.

In the last minutes available to me, I will explain cancer networks. The NHS Commissioning Board has set out its plans to establish a small number of national networks from 1 April to improve health services for specific patient groups or conditions such as cancer and cardiovascular disease. The cancer networks have existed for some time, and they have worked extremely effectively. It seems a bit odd, but those involved in the delivery of care and treatment for people suffering from cancer, for example, were not always the best at communicating among themselves, so the networks were set up, with great success. We are building on that success.

We have increased the amount of money going into the new strategic clinical networks, and we are confident that they will continue to work closely with providers and commissioners in the new health system and to play an important role in improving cancer care. I understand that transition arrangements, which concerned a number of people, are now well developed, and good progress is being made, with appointments in key positions in the clinical networks.

We are committed, however, to improving the experience of cancer patients. It is not all about early diagnosis, screening and treatment; it is also about cancer patients’ experience. The 2011-12 national cancer patient experience survey found that 88% of cancer patients in England rated their care as excellent or very good; of course, we aim to increase that figure. The results are helping trusts to identify areas in cancer care that need improvement locally and to raise standards across the service.

A 2012-13 survey will commence later this month. I am not sure how a 2012 survey can begin later this month; it looks like a bit of a typing error. That will get me into trouble with my officials. Such a survey is about to commence. It is an important piece of work, because it will enable us to identify and build on progress already made. From April, responsibility for such surveys will move to the NHS Commissioning Board, but hon. Members can be assured that this Minister will keep a close eye on it. The clinical commissioning group outcomes indicator set is the responsibility of the NHS Commissioning Board, but again, it drives improvements across the piste, as we say.

I add my profound support for Maggie’s cancer caring centres, whose praises the right hon. Member for Oxford East (Mr Smith) rightly sang. I visited the one in Nottingham the other week and saw there the excellent support that it gives, not just to cancer patients but to their families. Even if there has been a bereavement, the care and loving support continues. It is a remarkable organisation, and I hope that it will grow and become available to even more people.

In partnership with Macmillan Cancer Support, we are working on the national cancer survivorship initiative to implement improved care and support for cancer survivors. We want health services that are responsive to individual needs and that ensure access to specialist care when needed. We will shortly publish a document setting out the evidence base for future services to support people living with and beyond cancer in England. I hope that the Welsh Assembly Government will look to the experience in England and learn from it; I am sure that there are elements that we can learn from them as well. It is to be hoped that the outcomes in Wales will meet the success of the outcomes in England.

Question put and agreed to.

Sitting adjourned.