I beg to move,
That this House has considered the All-Party Parliamentary Group on Cancer report on cancer priorities in the NHS.
The motion stands in my name and those of other hon. Members.
It is not an exaggeration to say that thousands of lives, if not tens of thousands, depend on our getting the cancer strategy right. That is the scale of things. I therefore thank the Backbench Business Committee for granting the debate and allowing the all-party group on cancer to debate its recent report, “Cancer across the Domains”. I thank fellow officers, Macmillan and the secretariat to the all-party group, particularly Tim Nicholls and his team, for their support and hard work.
The all-party group on cancer is recognised as the wider cancer community’s voice in Parliament and has a proud campaigning track record. It was an early advocate of the need to focus on survival rates as a means of promoting earlier diagnosis. It has campaigned on a range of other issues, including cancer networks and the cancer drugs fund. As hon. Members will know, the group hosts the annual Britain Against Cancer conference, at which the cancer community comes together. Last December, it attracted about 500 delegates and heard excellent speeches from the Secretary of State for Health, the shadow Secretary of State and other experts.
I warmly congratulate my hon. Friend on his sterling work in this field. He mentions cancer survival rates. The most recent European study, published in December last year, showed that UK survival rates are still lagging behind those of comparable western nations in most, if not all, cancers. Does he therefore agree that the need to focus on cancer survival rates is as great as ever?
My hon. Friend makes an excellent point. The fact remains that, although there have been good increases in survival rates and there has been progress when it comes to cancer care generally, we still lag behind European and international average survival rates. That alone means they are costing this country thousands of lives. Thousands of families are suffering as a result of our not being able to match international averages on cancer care. That is not to say that cancer care has not improved over recent decades—it has. Survival rates have improved, but they have done so in line with survival rates across the world. That is good, but it somewhat masks the fact that we remain well behind international averages.
Despite all the additional funding, we still have not managed to catch up with other health care systems and thousands of lives are being lost as a result. My hon. Friend alluded to the fact that if we matched European averages on survival rates we could save an additional 5,000 lives a year. The OECD recently ranked Britain towards the very bottom of the 35 countries whose survival rates it measured, and it suggests that up to 10,000 lives could be saved if we matched international survival averages. Indeed, the Secretary of State for Health himself, speaking at the Britain Against Cancer conference in December, described survival rates as disappointing.
Reliable predictions suggest cancer incidence is on the rise. The World Health Organisation suggests its incidence will increase by 70% in the coming decades. Macmillan Cancer Support estimates that by 2020 almost one in two people will receive a cancer diagnosis—a phenomenal increase. The challenge for the NHS is to ensure that the significant structural change it has seen in recent years is not allowed to obstruct the much-needed improvement in cancer services and survival rates that are necessary if we are to catch up with our neighbours and save those thousands of extra lives.
The report by the all-party group on cancer should be seen in this context. We now have an NHS based around five domains, each with a responsibility for delivering improved outcomes. The report makes recommendations across each of those domains, and is the product of an extensive consultation with the cancer community, from NHS England right through to cancer patients, carers and charities. The recommendations of this year-long project can therefore truly be said to reflect the views of the whole cancer community. I should take a brief moment to thank all those who are involved in the production of the report, from those who responded to the consultation to the charities that devoted significant time and expertise to crafting it, including Macmillan Cancer Support, Cancer Research UK, Prostate Cancer UK, Teenage Cancer Trust and Breakthrough Breast Cancer.
“Cancer across the Domains” makes 18 recommendations and believes that the Government have an important role to play. Although the recommendations are specifically aimed at NHS England—the body that now has responsibility for commissioning services—it is the Health Secretary who retains overall responsibility for health services. The support of his Department is invaluable in achieving these goals, so my first question for the Minister is: will she formally respond to the recommendations set out in the report, or commit her Department to do so?
Other hon. Members will address other parts of the report, but I want to focus on the importance of earlier diagnosis and accountability. There are very few magic keys— where someone can open a door and suddenly untold opportunities lie before them. In cancer, such a magic key does exist: earlier diagnosis, the importance of which cannot be overestimated. When the all-party group on cancer produced its 2009 report, “Tackling Cancer Inequalities”, we found that patients in this country who reached the one year point stood as much chance of making it to five years as most other health care systems. Where we fall down is in getting patients to the one year point. We came to the conclusion, which expert witnesses confirmed at the time, that this clearly showed that the NHS was as good, if not better, at treating cancer when it was detected, but very poor at detecting it in the first place, and that is why we fell so far behind on survival rates.
We sat down with the cancer community and asked: what is the remedy? Do we bombard the NHS with more targets and regulation to try to encourage earlier diagnosis? Should we adopt a much simpler approach—and this is what we concluded—and put up in lights one and five-year cancer survival rates, broken down at a local NHS level, then primary care trusts, now clinical commissioning groups, to encourage earlier diagnosis? We all know that late diagnosis makes for poor survival rates. Therefore, putting the survival rates up in lights and broken down by the local NHS should encourage underperforming CCG management to promote initiatives, at primary care level, aimed at promoting earlier diagnosis. It would be up to them to choose which initiatives suit their local populations: better prevention and awareness campaigns, better uptake of screening programmes, better diagnostics at a primary care level or better education or information for GPs. There could be a host of initiatives in isolation or in combination, but the bottom line is that it would be up to local CCGs to introduce them. Those at the bottom of the table would be particularly encouraged to do so. That was the logic behind the idea of one and five-year figures. We are happy to say that, with the rest of the cancer community, we now have one and five-year figures as outcome measures in the DNA of the NHS. This is to be welcomed. It is in the NHS outcomes framework and it is in the CCG outcomes indicator set governing CCGs at a local level. I will come back to the five-year outcome measure at the outcomes indicator set level a little later, but that is all encouraging.
I will not complicate issues by going on about the importance of introducing other proxy measures at a local level, such as staging and emergency admissions. We have recommended those initiatives, and they have been taken up as complementing the one and five-year figures at a local level because of the smaller population sizes of CCGs compared with PCTs. The campaign has been a success, but it is a success only in that we have managed to get these measures included. Actions speak louder than words and the true success will be judged on what effect these measures are having on survival rates. On that measure, the jury is still out.
That brings me on to my next point: accountability. There is no point in having these wonderful initiatives on one and five-year figures, staging and emergency admissions to try to promote earlier diagnosis if it is not followed through and there are no teeth in the system or levers of change to ensure that underperforming CCGs raise their game on behalf of their local patients. Key questions therefore remain on accountability.
How accountable is NHS England to Parliament? NHS England’s annual report is laid before Parliament, but it is the Secretary of State who must assess performance. The extent of ministerial accountability remains unclear. Parliament seems to have a very limited role in this process. So does the Minister agree that there appears to be limited scope for Members to scrutinise NHS England’s performance? Furthermore, how will the Department of Health monitor NHS England’s performance on cancer care against the NHS outcomes framework and address areas that need improvement?
If that is one concern, a greater concern I have is the accountability of CCGs themselves. While some cancer services, as hon. Members will be aware, remain the responsibility of NHS England, owing to their specialised nature, many vital services are CCG-commissioned, hence the importance of the CCG outcomes indicator set as a means of monitoring performance. What remains unclear is the extent to which NHS England will hold underperforming CCGs accountable. For example, what happens if a CCG is continually at the bottom of the one-year survival rate figures? Where are the levers of change to correct that? The mathematicians in the House will understand that if we raise the game of those at the bottom of the table, it will have a disproportionate effect on averages in general, and that is what we are talking about: catching up with European and international averages on survival rates.
We need clarity, therefore, about what action will be taken should CCGs continue to languish in poor performance. What support would NHS England give to a CCG to improve survival rates, and, should CCGs continue to languish, what powers will be used, what levers of change will be implemented, to ensure that improvements are made at a local level? There is no point having the CCG OIS if failure is not addressed and there are no teeth to the correction regime. We need clarity, both to ensure that corrective action is taken, if needed, and because CCGs need to know that the regime is in place.
Other questions remain, which our report addresses, about the differences between the last two CCG OIS iterations, and perhaps a little clarity from the Minister would be helpful to the wider cancer community. In the 2013-14 OIS, our call for indicators for one and five-year survival rates for all cancers was accepted, and in the 2014-15 OIS, our call, in the “Cancer Across the Domains” report, for indicators on staging and emergency presentations was also accepted—all very good news—but the indicators for the five-year survival rates were dropped from the 2014-15 OIS.
NICE argued there were potential problems with the five-year indicator, as the numbers were small, but those arguments had been made before, when we campaigned for one and five-year survival rate inclusion. Will the Minister help the House and the wider cancer community by explaining what changed in the data between 2013-14 and 2014-15? That would be helpful. We now have an NHS outcomes framework that retains one and five-year indicators, but a local CCG OIS that does not have the five-year indicator. This suggests a disconnect. It is important that the NHS speaks with one voice, yet it has measures nationally different from those at a local level. How will her Department work with NHS England to address this apparent disconnect?
While earlier diagnosis increases survival rates, without data on longer-term survival rates, it will be harder for NHS England to ensure that early diagnosis is being improved by CCGs. Will the Minister re-examine the case for five-year survival rates in the next iteration of the CCG OIS, or at least communicate to the cancer community the logic behind the move and carry the community with the Department so that it is clear for everyone to understand. It remains to be answered, however, why there was a difference between the 2013-14 and the 2014-15 iterations.
The removal of the five-year survival rate indicator raises questions about the process. The development of the CCG OIS is complex; suffice it to say that the system provides for newly suggested indicators, but does not appear to recommend indicators for removal. In the development of the 2014-15 OIS, while emergency diagnosis and stage of diagnosis were flagged for inclusion, five-year survival rates were not flagged for exclusion, meaning that the removal does not appear to have been consulted on. I find this particularly alarming.
The cancer community campaigned hard for the inclusion of one and five-year survival rates, both nationally and locally, to promote earlier diagnosis, but then, at the last minute and without any consultation, was made aware, practically on the last day before Parliament rose before Christmas, that the five-year figures were being removed. There was a lack of communication, and certainly the process itself raises questions. Will the Minister comment on this process? Why does she think it delivers appropriate transparency? It was not clear to the wider cancer community that the five-year indicators would be removed until the final document was published.
On 17 December, the hon. Member for Scunthorpe (Nic Dakin) asked the Minister whether five-year survival rates would be included, and he received an unequivocal answer:
“NHS England will be publishing the 2014-15 CCG OIS next year…which will set out measures aimed at supporting improvements in the five-year cancer survival.”—[Official Report, 17 December 2013; Vol. 572, c. 594W.]
However, the OIS released three days later, on 20 December, excluded the five-year figures, and it would help to know why the position apparently changed completely in those three days.
I thank the Minister for responding to this debate. I appreciate that she has drawn the short straw, given that this is the last debate before the half-term recess, but the all-party group would welcome a detailed response to all our recommendations, if not in this debate, certainly subsequently. She has a great responsibility. She is well aware that few ministerial posts can literally save thousands of lives if policy is got right, and she brings to her post a dedication and professionalism that are welcomed across the cancer community, but I remind her, on behalf of that community, that the Government’s goal to save an additional 5,000 lives every year by 2015 will not be achieved unless the NHS raises its game, particularly on earlier diagnosis. With that thought in mind, I look forward to her response to our recommendations.
I am unaccustomed to being called to speak so early in a debate, and I shall do my best to make the most of the opportunity. I rather wish that I had prepared a much longer speech.
I start by thanking the Backbench Business Committee for scheduling the debate. I particularly commend the excellent work of the hon. Member for Basildon and Billericay (Mr Baron) and the rest of the all-party group on cancer in producing its recommendations. I am especially pleased to speak in this debate as it gives me a chance to make a brief contribution based to some extent on my own skirmish with cancer, which has kept me away from this Chamber for much too long in the past couple of years.
My experience and treatment as a patient, at the Pennine Acute Hospitals NHS Trust, the Salford Royal NHS Foundation Trust and the Christie NHS Foundation Trust in Manchester, has been excellent. I owe enormous thanks to the remarkable surgical skills of Mr Senapati and his upper gastrointestinal team, and to the care of the Macmillan clinical nurse specialists and many other NHS professionals whom I have encountered in the course of my treatment.
My comments will be based on the experience of seeing the delivery of cancer services from the patient’s viewpoint; and that experience places me among the 80% of cancer patients who rate their care as good or excellent. We have yet to see the full consequences of the major structural changes taking place in the NHS. Hopefully, we can expect an improvement in cancer services—and an improvement is needed if we are to save the extra 5,000 lives a year that we must achieve if we are to match average European survival rates. Goodness knows we ought to set our sights on being the best, not just the average.
Given the scale and extent of the upheaval in the NHS, there is a real danger that cancer services will end up being damaged and made worse. That is why the all-party group on cancer’s report is so timely and important. It sets out with admirable clarity what the Department of Health and, through it, NHS England need to do if we want to improve standards and deal successfully with the predicted increase in cancer diagnoses in the period ahead.
The report’s recommendations do not depend on the injection of large sums of money. Much of what is recommended is about doing things in a better way—shaping sensible policies and working practices, from GP and community care group level upwards. The recommendations are particularly aimed at promoting early diagnosis, which, as the hon. Gentleman says, is above all else the key to turning back the cancer tide.
I do not want to go through all the report’s recommendations; I just want to comment on a few points based on my own recent experience. One of the main reasons why I consider my patient experience to have been so positive was the close involvement of cancer nurse specialists at every stage of my treatment. The easy one-to-one contact with a named individual, a clinical expert in the field, meant that there was a way to raise concerns and get reassurance when it was needed and—this was very important for me—to give me the confidence to be an active player in mapping out my own care pathway.
The report is clear that access to clinical nurse specialists is patchy across the country and decreasing in some areas and specialisms. NHS England needs to be clear on how it will ensure the continuation and enhancement of access to clinical nurse specialisms to maintain their vital role in ensuring quality cancer care.
As has been said, early diagnosis is obviously the critical factor in improving cancer survival. My GP picked up reasonably quickly on my symptoms and I soon entered a pathway of diagnosis and treatment. In that respect, I was fortunate in having the right GP, but sadly more than a quarter of people diagnosed with cancer see their GPs three times or more before being referred to a specialist. Too many people are still being diagnosed in the advanced stages of cancer. Again, the report is clear on the need to improve GPs’ awareness of cancer symptoms as a vital factor in helping to identify cancer earlier and improving survival rates.
The starting point is for NHS England to make it clear to GPs, through its community care groups, that they will be held to account on the basis of their outcomes indicator set. Personally, I am encouraged that NHS England accepts the need to incorporate measures to encourage earlier diagnosis by recording the stage of cancer at diagnosis and whether the cancer is detected in an emergency. However, I agree with the hon. Gentleman that that can be effective only if it is recoupled with the survival rate measures to serve best as an important factor in pressing clinical commissioning groups to promote earlier diagnosis.
Under the previous Government, there was huge progress in improving cancer care. The national cancer plan and the cancer networks made a real impact on lifting NHS care for cancer patients towards the standards being achieved in other countries. However, the move from 27 cancer networks to 12 strategic clinical networks, each covering a larger area and with fewer dedicated cancer staff, is a backward step. The report reveals that the funding of cancer networks will be slashed by a quarter, and that 20% of their staff will go. Those worries are exacerbated by the uncertainty over what the strategic clinical networks will be able to deliver in comparison with cancer networks. We face a real risk that the lack of clarity surrounding these structural changes will damage outcomes for cancer patients. NHS England needs to recognise that concern, and to act to remove the uncertainty over the functions of the strategic clinical networks.
Being in a cancer treatment programme can cause big problems and great worry for patients of working age. I know from talking to fellow patients that holding on to their job and continuing or returning to work were major concerns for many. This is not just about keeping the money coming in. The world of work represents a sense of normality for many, and a target to aim for, to help them to get through what can be a debilitating treatment pathway. Again, I speak from experience. My treatment kept me away from this place for a long time, but my ability to continue with a good proportion of my constituency work gave me a sense of normality and helped to counter the negativity and uncertainty that can be a feature of living with cancer.
There are good economic reasons for supporting cancer patients to get back to work. The report refers to the findings by the Policy Exchange in 2008 that estimated lost productivity at £5.3 billion in that year alone as a result of cancer survivors not returning to work. It is for all those reasons that the report calls for NHS England to publish plans detailing how it will support people with long-term health conditions to stay in or return to work. That makes sense not only for the individual cancer patient but for the economy.
I am glad to have had this opportunity to make those few points, and I urge those on the Government Front Bench to respond positively to the report’s recommendations and to work with NHS England on implementing them as a matter of urgency.
It is a privilege to speak in the debate, and I should like to start by congratulating my hon. Friend the Member for Basildon and Billericay (Mr Baron) on his work chairing the all-party group and on his excellent speech, in which he covered the whole area of cancer care. We are all grateful to him.
I am speaking today in my capacity as the chair of the all-party parliamentary group on brain tumours. I have not held the post for long and, like many MPs, I came to the issue through one of my constituents, an inspirational lady called Nicole Witts. She was diagnosed with a brain tumour many years ago, and she contacted me a few years ago and explained the effect that it had had on her life. She talked about the massive need for increased research funding for brain tumours and asked me to become the patron of her local charity, which raises funds for such research. I gladly agreed to do so, and I have been hugely inspired and impressed by all that she has done. It is she who caused me to become the chair of the APPG and to make this speech today.
I did not know a great deal about brain tumours before I met Nicole, and this has been quite a sharp learning curve for me. Brain tumours are among the very few conditions that are becoming more prevalent than they were a few decades ago. They are much more common now than they were in 1970. Cancer patients are reporting a worse experience in the NHS for brain tumours than for any other cancer. Unfortunately, 58% of men and women diagnosed with a brain cancer die within a year, compared with 5% of people with breast cancer, 35% of people with leukaemia and 7% of people with prostate cancer. There are also considerable regional variations in incidence, ranging from 108 per million in London to 145 per million in the south-west. Brain cancer is the chief cause of cancer deaths in children, in the under-25s and in the under-35s. The consequence of brain tumours striking so young is that the average tumour is responsible for over 20 years of life lost in the average patient, making it the most lethal cancer by that measure.
Let us look at the funding that brain tumour charities receive. I think that Members will be quite surprised by how low it is. The National Cancer Research Institute consistently devotes less than 1% of its research spending to brain tumours. Between 2002 and 2012, the figure was 0.8%, and in 2012 itself the figure was only 0.78%. There was an average of 6.9 deaths among the under-45s for every £1 million spent on research for all cancers as a whole, but the corresponding figure for brain tumours was 82.5 deaths, and more than £7,700 was spent on research for every death from leukaemia, whereas just £1,400 was spent for every death from a brain tumour.
Between 2002 and 2012, breast cancer research received £352 million of funding, leukaemia research received £291 million, prostate cancer research received £149 million, cervical cancer research received £47 million and, right at the bottom, brain tumour research received only £35 million, less than 10% of what breast cancer research received. As hon. Members can appreciate, brain tumour research funding is very much the poor relation. That is a particular problem because, unlike with many other cancers, brain tumour research does not benefit from general research, for a number of clinical reasons: brain tumours are very different from other types of cancer; the blood-brain barrier presents particular difficulties for researchers; and there are more than 120 different types of brain tumour, which makes research much more difficult. The conclusion to draw is that it is only through giving directly to brain tumour charities and funding laboratory-based research that all types of brain tumours—adult, paediatric, low-grade, benign, high-grade and malignant—will be cured.
Let us examine the experience of people living with brain tumours. I am indebted to the Brain Tumour Charity for its report on that just before Christmas, just as I am to Brain Tumour Research for its excellent report last July on the research issue. When we examine people’s experiences of care, we find that we clearly need to make improvements to make sure that they have the best possible quality of life before and after diagnosis. We know that 38% of people living with a brain tumour visited their GP more than five times before being diagnosed. We know that communication between health care professionals, and people living with a brain tumour and their carers, very much needs to be improved. The Brain Tumour Charity has made a number of recommendations in that area: it wants professionals to recognise and respond to the signs and symptoms of brain tumours more quickly; it wants data collected on the quality of care in different areas up and down the country, so that we can see who is doing well and who is not; and it wants to ensure that written information about treatment options is given to people, along with proper signposting to sources of expert help.
I also wish to highlight the importance of clinical nurse specialists, which was mentioned by the hon. Member for Ashton-under-Lyne (David Heyes). We know from the 2013 cancer patient experience survey that there is a huge difference in the quality of care experienced by patients when a clinical nurse specialist is present. When a clinical nurse specialist was present 74% of patients were given easy-to-understand written information about the type of cancer they had, whereas fewer than half of patients—only 49%—received it when no such specialist was present. Some 87% of patients were given a choice of different types of treatment—that is pretty important—with a specialist, whereas only 67% were given it when no such specialist was present. If we look at those patients who were given information about support and self-help groups—a really important area—86% got that with a clinical nurse specialist and only just over half, 51%, when there was not one present.
For those patients who were eligible for free prescriptions, 78% were informed of that when there was a clinical nurse specialist present and only 55% when there was not. Prescriptions are expensive, so that can make a big difference. Similarly, with information on financial help and benefits to which patients might be entitled, 58%, who had a clinical nurse specialist were told what they could claim, and only 25% were told when there was not one present. I think the Minister will agree that those are pretty huge variations in the quality of care. I absolutely agree with what my hon. Friend the Member for Basildon and Billericay said about the importance of early diagnosis.
The final matter I want to raise is the excellent campaign run by HeadSmart, which has produced information cards. I know that the Minister is aware of them. I pay huge tribute to the Brain Tumour Charity and to others who are absolutely determined to get these cards into schools across our country. I have written to every colleague in the House—I hope you got the e-mail as well, Mr Deputy Speaker—telling them about how we can do that, and have provided a sample letter that we can all send to our head teachers. I suggest that colleagues write to their local authorities as well. It is so easy to get these cards. HeadSmart provides them, so local authorities and schools do not have to pay anything. The cards provide the warning symptoms that we need to look out for in pre-school children, children aged five to 11 and young people between the ages of 12 to 18. Symptoms include persistent recurring vomiting, recurrent headaches, balance and co-ordination problems, abnormal eye movements, blurred or double vision, behavioural changes and fits and seizures. They are all on the card, which will fit in a purse or wallet.
My challenge to Members here today and to those who read this debate is to get these cards out to their schools, and to our young people. We know the vast difference that early diagnosis can make; it could literally be the difference between life and death. This is something practical that we can all do as a result of this debate, and I ask all colleagues to try to do it.
I am delighted to be able to speak on this matter today and congratulate my hon. Friend the Member for Basildon and Billericay (Mr Baron) on securing the debate and the Backbench Business Committee on allowing it to happen. We would have had many more Members contributing to this debate if it were not on a Thursday afternoon immediately before a recess. Many Members also have problems getting home because of disrupted transport and, when they get there, they have to face flooding issues. It is disappointing that this debate was not scheduled for a much more popular time.
I also pay tribute to the hon. Member for Ashton-under-Lyne (David Heyes) for coming to talk about his personal experiences, which must have been very difficult. I am pleased to see that he is fit and well—or appears to be—and delighted that he is in the Chamber today. Like many Members, I have been affected by cancer, but not personally. A number of members of my family have unfortunately died at very young ages from various forms of the disease. I take a great interest in what happens to people who are either diagnosed with it or who have various issues with it.
One type of cancer that is particularly close to my heart is melanoma, having lost my brother to the disease 13 years ago. In 2011, more than 11,000 people were diagnosed with melanoma. It is a type of cancer that is relatively easily treatable if it is caught early. Simply removing the affected tissue can usually cure the disease. Given that it is easily treatable in its early stages, it is shocking that 11 % of those diagnosed die within the first five years. These figures would surely imply that there is a problem with awareness of the symptoms of the disease, and, as a consequence, with how long it takes patients to be diagnosed. Doctors need to get better at it. As the hon. Gentleman said, it often takes three visits to a GP before referral to a specialist. My brother went to his GP three times in a year before the GP suddenly said, “Well, there is nothing really wrong with you, but I will refer you,” By that time, it was far too late, and he died of a melanoma a few years later.
I note that the APPG’s excellent report recommends that the current advertising campaigns should continue and I am very pleased that an advertising campaign about melanoma will start in May 2014. Although preventing skin cancer is vital, the focus of the campaign should be on identifying its symptoms because, as lay people, most of us do not know what to look out for. I met one consultant who used to work in Australia, who told me that Australian school children go to school with rucksacks on their backs to take their books and kit to and from school and on each side are mesh holders, one for water and one for sun cream. We must encourage that practice in the UK, and teachers must not be frightened to help young people apply the cream in case they are labelled paedophiles. That is complete nonsense and they need to get over it and help young children who cannot apply the cream themselves.
Through my involvement with the charity Melanoma UK, I know that five-year survival rates are hampered by NICE guidelines on the treatment available to late-stage melanoma sufferers. The first line of treatment offered to patients is dacarbazine, which is generally accepted by clinicians as insufficient to treat late-stage melanoma. There is a call for NICE to recommend a second-line treatment, ipilimumab or Yervoy, in the first instance rather than dacarbazine and I believe that NICE is consulting on that.
One study that recommends ipilimumab as a first-line treatment concerns a man named Richard Jackson, who was told that he had only weeks to live when he was diagnosed. He was deciding which hymns to have at his funeral, but when he went to his doctor he decided to give him ipilimumab straight away. As a consequence of the early prescription of ipilimumab, Richard is still alive seven years after diagnosis. It does not make economic sense to use a first-line drug with such a low success rate only, in the majority of cases, to progress the patient on to ipilimumab when they are much weakened by the first drug. That gives them much less chance of doing well. Given the Government’s commitment to fighting cancer, I think it is important that pressure should be brought to bear on NICE to ensure that ipilimumab is available in the first instance. This debate is timely, because NICE is considering the issue right now.
One type of cancer that has been part of a successful national advertising campaign is, of course, bowel cancer. Perhaps Members will remember that when we had not been here for long after the 2010 election one Member wore a tie that contained a musical device that played a tune and it went off. That probably did more to raise awareness of bowel cancer than any other event. Although the Be Clear on Cancer campaign has no doubt been helpful in fighting bowel cancer, it remains to be seen whether its effects have been positive, as the results of the national cancer audit are due to be published later this year. In the interim, I welcome the APPG’s suggestion that the advertising campaign should be extended, as it will undoubtedly lead to more people being diagnosed with bowel cancer earlier.
People do not like talking about their bowels, but they should. They should not be nervous or embarrassed about it, because if they talk about things, they might realise that their symptoms are the very symptoms that are causing problems for so many people. I speak about this from personal experience because three members of my family have died of that cancer between the ages of 51 and 54, and one at 66. That is incredibly young these days. It is such a deadly disease unless, like others, it is caught early. Then, it is curable.
Although there is no mention of cancer drugs in the report, one element of cancer care that particularly concerns me is the legacy of the cancer drugs fund and what will happen to the provision of cancer drugs after its closure in 2016. The east midlands cancer drugs fund closed in 2013, and in every year of its existence it was left with lots of money to spare at the end of the financial year. One constituent of mine, Jill Bilbie, contacted me when she was funding her own treatment for cancer. It did not matter what I said or did, I could not persuade the cancer drugs fund to pay for the Avastin she so desperately needed even when it had the funding. All the fund said was that Avastin did not work, but she survived for three years on something that did not work. Sadly, she has now died, but during her illness, she paid more than £31,000 for the drugs, and people should not have to do that. It goes without saying that the cancer drugs fund and whatever replaces it in 2016 must be more flexible to the requirements of those making funding applications for drugs and must prevent the situation whereby desperate people exhaust their limited finances to fund their treatment.
Selective internal radiation therapy involving spheres is another cancer therapy that my constituents have had difficulty obtaining on the NHS. I was contacted by a constituent, Kate, who I had known for many years, who had been diagnosed with colorectal liver metastases and was trying to get that therapy to reduce the progress of the disease in her liver. As the cancer had metastasised from the primary tumour in her colon, she was refused. Once again, the guidelines for that particular treatment are insufficiently flexible and lead to premature mortality in otherwise treatable cancers. Another of my constituents managed to get the treatment not because the NHS funded it, but because she had private medical insurance. She is still alive today, which shows that the treatment works, so people should be able to get it. I am disappointed that, regarding the treatments that my constituents can get, the east midlands is a poor relation in comparison with other areas.
I generally agree with the report’s findings. A lot of effort went into the report, so I congratulate my hon. Friend the Member for Basildon and Billericay, who puts in a lot of work on the subject all the time, on bringing it forward. There must be an emphasis on the early detection of cancer, but I am worried that not enough is being done to ensure that cancer patients get the right treatment at the right time. I am pleased that the Government are aiming to reduce the number of cancer deaths every year by 5,000, but that aim is less likely to succeed if the Department of Health does not deal with early diagnosis.
It is a pleasure to speak in this important debate. I congratulate the all-party group on its work and, especially, my hon. Friend the Member for Basildon and Billericay (Mr Baron) who, since I came to the House four years ago, has been a determined advocate on all matters relating to cancer, such as funding and NHS treatment. He has set a good example to us all of how to campaign forensically on such matters.
There is little need for me to repeat what other hon. Members have said: cancer is a devastating disease. It is obviously right that the Government do all they can to put the best support in place and to set up appropriate frameworks to prioritise finite resources. I welcome the all-party group’s report and its recommendations on improving survival rates and supporting patients through recovery. A third of a million people are now diagnosed with cancer each year, and despite the considerable advances in research, about half those cases will sadly still be fatal.
I shall focus my remarks on end-of-life care. There is a considerable gap between what people want and what they receive. We know that 63% of all patients would prefer to die at home, while a further 29% would choose a hospice. Just 3% of patients would choose to die in hospital, yet more than 53% ended up dying there last year. Among cancer patients, nearly three quarters—73%—want to die at home, but only 29% are able to do so, which means that 36,400 cancer patients died in hospital last year although they wanted to be at home, surrounded by their loved ones. That causes great distress to family members, and many hon. Members will have met constituents who have expressed a lot of frustration about what happens at such a difficult time in their families’ lives.
The national end-of-life-care strategy has rightly called for that to change as a priority, and it has support from across the House. However, practical barriers need to be overcome to make it a reality. This is rooted in reprioritisation of resources, which, if done properly, will not mean increased costs. That is the challenge with so much that happens in the NHS. If small changes are made in certain procedures—the way that things work and research is conducted, and the way that referral processes take place—money can be saved.
There are three challenges. First, high quality 24-hour community support needs to be available. Secondly, patients need to be able to see how their services perform in helping people to die at home. Thirdly, the NHS needs to use innovative tools more effectively so that hospital professionals know what a patient has told their general practitioner. Nearly half of all primary care trusts in 2010 did not provide 24/7 community services, despite groups such as Macmillan Cancer Support and Marie Curie Cancer Care emphasising its importance and despite the clear economic case for doing so. A day of community care costs around £145, compared with £425 for a hospital bed. Improving community care is one of the most effective ways to free up much-needed bed space and prevent emergency admissions, and, of course, give a better quality of life experience for the patients involved.
In Wiltshire, we have a dedicated community nursing team, and Sarum clinical commissioning group in my constituency has chosen to focus on improving end-of-life care. It has a clear target to ensure that there is not just 24-hour community care, but specialist support and advice, which is particularly important in the context of cancer. In addition, it has chosen to set an outcomes indicator on the number of patients who are supported to die in their place of choice.
I wanted specifically to highlight this as the APPG cancer report recommends that the national indicators set by the National Institute for Health and Clinical Excellence should include it. I agree. It is important that patients can see how their local health services are respecting their wishes, or, in some cases sadly, not. It is important that where they fail to do so they can be held to account and a local dialogue can take place. This can only happen with clear and transparent data. If this measure were adopted nationally, it would mean that pressure could be exerted when patient preferences were not being respected.
Patient choice and accountability are at the heart of many of the NHS reforms in recent months and years. Those principles need to apply to end-of-life care. In some London boroughs, I understand that as many as 70% of all patients die in hospitals, yet fewer than half of Wiltshire patients end their days in the same way. It is unacceptable that one area can support 49% of cancer patients at home, while another can reach only 16% of patients. It is important that patients can readily see these numbers, and clinical commissioning groups can account for progress towards meeting their goals and targets.
In 2013, NICE recommended that death in the preferred place of care should be taken forward as an outcome indicator. I urge the Minister to make progress on this issue and ensure that the data will be available as soon as possible in a form that can be understood and digested by our constituents. But it is not just about data for patients; it is also about data for professionals. Innovation allows us to ensure that this is used more effectively, and electronic palliative care co-ordination systems are a real step forward in that area. The proportion of patients on EPaCCS who have died in their preferred place is 76%, and just 8% died in hospital. Not only is that a substantial relief for the families who have benefited, but it delivers, on average, a saving of £270,000 to a clinical commissioning group.
Salisbury district hospital, the outstanding hospital at Odstock that serves my constituency, has taken that concept further. Through greater integration with GPs in the area, emergency department doctors can now access medical records that include an end-of-life care plan. They have trialled an innovative rapid discharge pathway for patients in the last 72 hours of life, and 20 patients were successfully supported at home last year. As a result, the scheme is being rolled out across the hospital and will bring great benefit to patients in the last few days of their life.
Obviously, cancer will continue to present a significant challenge for the NHS, but I hope that the progress that has been made on palliative care can be built upon so that the NHS can support patients during an extremely difficult time. I would like to finish by once again reiterating my support for the work of the APPG and the considerable efforts being undertaken to challenge the Government, in a constructive way, to come forward with measures that will make such significant improvements in the quality of the experience for our constituents and to the functioning of the NHS.
It is a pleasure to follow my hon. Friend the Member for Salisbury (John Glen). On behalf of the Backbench Business Committee, I thank my hon. Friend the Member for Basildon and Billericay (Mr Baron) not only for securing this important debate, but for agreeing to host it on such a difficult day—the last day of term before we break up for the recess.
I speak as someone who has a personal, family experience of cancer and I speak on behalf of my constituents. As I have said in the House before, both my parents died of cancer, as did three of my immediate family—uncles and aunts. They died many years ago, when the treatments now available were not available. Had they been, there is no doubt that they would have survived far longer. The good news is that progress has been made over many years in cancer treatment.
Most of this debate focuses on health matters, but I want to flag up an issue that can also affect people who suffer from cancer. A constituent came to see me. He had worked all his life, for 40 years, in a particular industry, doing quite heavy work. He was suddenly diagnosed with life-threatening cancer. He went to the jobcentre to get benefit while he received treatment. He was denied any benefit, for the simple reason that his doctor’s letter stated that his treatment was likely to last six months. He was therefore disqualified from receiving benefits. He was down to his last few hundred pounds to sustain his family. Fortunately, I was able to intervene and it was found that his treatment would last a minimum of six months, and more likely a year or longer, so he would be out of work for that period. Unfortunately, in many respects the way benefits are dealt with is not helpful to cancer sufferers. I do not expect the Minister to respond to that point today, but it is something we should flag up for Ministers in the Department for Work and Pensions.
I also speak from another perspective. When I was a local councillor, St Luke’s hospice in north-west London was founded in my ward. It has gone from strength to strength. It started out as an outreach service for people suffering from life-threatening diseases or who were at the end of their life; it helped them at home. It has now moved to its own headquarters, which is also a headquarters for Macmillan nurses. It treats many thousands of cancer sufferers across north-west London in an excellent way. St Mark’s hospital, which is world-renowned in the treatment of bowel-related diseases, particularly cancer, is also in my constituency.
As some Members may know, over the past year, I have been under the care of St Mark’s hospital following medical treatment, and I have personally witnessed the terrible distress that individuals go through when they are told that unfortunately they are suffering from some form of cancer. It is not until you see those people and see the terrible effect not only on them, but on their relatives and friends, that it really comes home to you what a terrible thing this disease is and how important it is that we continue to treat people in an appropriate and sympathetic manner. However, the good news is that just because someone has been diagnosed with cancer, that does not mean it is the end. There is treatment available and the capability of a full recovery, but often people do not realise that until they are thus affected.
Of course, as we all live longer and live healthier lives, there is a greater risk of suffering from cancer. As my hon. Friend the Member for Basildon and Billericay said, within six years, one in every two people will be diagnosed with some form of cancer. That means that every family in the country will experience the terrible problem of having a relative diagnosed with cancer and the impact that that has on the whole family. We need to understand that this will not go away but get worse as a potential problem.
I congratulate the Government on the introduction of the cancer drugs fund, which categorises money and makes it available for treatment of cancer-related diseases. The sad fact is, however, that it is time-limited; it will end in 2016. Concerns are being raised—they are raised very strongly in the report by the all-party group—about what will replace it and what the impact will be on funding for treatment of the various diseases.
There is another big challenge in relation to the clinical treatment of cancers: quality of life issues versus the age of the patient and their ability to recover from the treatment—whether the treatment will actually kill the patient is a concern. More importantly, such issues are balanced against the cost of the treatment to be provided. If a patient is going to have their life prolonged by a week, the clinician can be asked whether it is worth the huge amount of money that may be invested in doing so. However, if they will be given another five years, there is no question about what should be provided. Then the challenge is what to do in between those time frames. That is a direct challenge to our clinicians and to all those making decisions about funding the cost of treatment and the provision that we make for it.
During this debate, we have talked about early diagnosis. There is no question but that if people are diagnosed early, their treatment is less severe and the chances of recovery are far greater. Women, in particular, have had strong advice over many years to check themselves for breast cancer. Smears have been available, as have other forms of treatment and checks. Men often do not want to talk about the fact that they may be suffering from early signs of cancer. They do not go to doctors early enough. They do not consider themselves to need treatment, and of course, by the end, it may be too late for that treatment to take place.
A system of screening across the country for the most common forms of cancer needs to be available for every single patient on the NHS. However, there must be a word of warning—after screening, the patient may be shown not to be suffering from a form of cancer at the moment, but that does not mean that they will not suffer from it next week, next month or thereafter. The risk is that people may feel that they are safe as a result of screening, but they are not. Therefore, screening must take place regularly so that people can understand that early treatment can get them into a good position.
There is also the aspect of specialist treatment that must be available. There are a number of rare cancer diseases where the cost of treatment is quite high but the number of cases is relatively few. We should therefore ensure that the people who suffer from those rare forms of cancer have a good chance of recovery through proper treatment, proper drugs, and proper specialist care.
I want to highlight in particular the work being done at University College hospital on blood cancers. One of the problems is that, while treatment kills many cancer cells, it leaves behind small numbers that are very difficult to detect and that at some future stage may spring back into action and infect the whole body via the blood. University College hospital depends on donations from members of the public for the equipment it uses. In my view, there should be far greater investment from the NHS in that research, which enables experts to make diagnoses and produce the detailed treatment needed by those suffering from blood cancer in particular.
Another issue is the drug companies that produce the drugs that treat cancers, be they common or rare. It is clear that the cost of research is enormous, that the failure rate of the drugs is difficult to determine and that there is a challenge—this is particularly true of rare cancers—with regard to the number of patients who can be treated. Will the Minister consider an open-book policy for the drug companies whereby they would say, “We’ve spent this much money on research and this is how much it has cost us to develop these drugs, so this is how much we need to recover from treatment using these drugs”? At the moment, there seems to be a battle between the drug companies, the National Institute for Health and Care Excellence and the NHS with regard to the cost of treatment. It is clear that that needs to be addressed.
It would be remiss of me, during a debate on cancer, not to say that individuals also have a responsibility. If we can educate young people to have a better diet and not to start smoking in the first place, and if we can educate people who do smoke to give up, we have a chance of reducing the risks of contracting cancer. I congratulate my hon. Friend the Minister, who has been a Health Minister for only a short period, on the major change earlier this week to the Government’s policy on smoking in cars when children are present and on the issue of standardised packaging of tobacco products. She has made a huge impact.
We have not completed the job yet and we look forward to the regulations being introduced, but now we have another challenge, which is the treatment of cancers through the use of various drugs that assist people who suffer from those terrible diseases. It is a new challenge and a new opportunity, and I am sure that the Minister will take it up with gusto and zeal and that she will achieve the same degree of success as she has in relation to smoking.
I congratulate my hon. Friend the Member for Basildon and Billericay (Mr Baron) on securing this debate and his work in the all-party group on cancer. I commend the group’s work and its recommendations to the Minister, and I hope she will respond positively to them. I am sure she will; as has just been rightly said, she is a very forward-thinking Minister.
I also commend the sterling work of Macmillan Cancer Support in bringing the issue to the attention of the public and Parliament. So many of our constituents hold that charity and other cancer charities in high regard. As my hon. Friend the Member for Harrow East (Bob Blackman) has said, few families have not been touched in one way or another by cancer, and mine is certainly no exception. It was also very good to hear the personal views of the hon. Member for Ashton-under-Lyne (David Heyes) in his courageous and outstanding speech. It is always good to hear from personal experience.
Medical science has given hope to many people where no hope existed in the past, and survival rates are much better than they were 20 or 30 years ago. It seems to me, however, that the material question is whether this country harnesses the benefits of advances in medical science as well as other countries do. That raises many questions, as I suggested in my intervention on my hon. Friend the Member for Basildon and Billericay.
Across the health services of the constituent nations of the United Kingdom, across the years and under Governments of both the main political parties, there has been a gap in survival rates for cancer compared with those of other countries. There is a gap in how well we harness the advances of medical science, certainly relative to comparable economies in Europe, other western nations and the United States.
It is a material question whether we are managing to close the gap. I drew attention to that in a debate about the cancer patient experience in Westminster Hall in October. Since then, further statistics have been produced by Eurocare. In December, it published a survey of cancer survival rates across Europe, which looked at the five-year relative survival rates of adult patients who were diagnosed with cancer from 2000 to 2007. I am indebted to the House of Commons Library for providing me with the results, which are the material comparisons we should make. Eurocare is a cancer epidemiology research project on the survival of European cancer patients, which is based on collaboration between some highly esteemed cancer registries and specialists, with results from 22 European countries.
I am afraid I have to report to the House that the survey of 22 countries suggests that the gap in cancer survival rates remains considerable. The clinical outcomes for cancer patients in this country lag behind those of many other countries. For every type of cancer, the United Kingdom is certainly well behind Scandinavian countries, and it is well behind western European nations with similar economies to our own, including France and Germany. We are also behind southern European nations for every type of cancer except, perhaps understandably, skin cancer.
The economies of those countries are certainly no larger than ours—in some cases, they are smaller—but it appears that their cancer survival rates are higher. For example, the prostate cancer survival rate is 9% higher in Portugal than in this country; the breast cancer survival rate is 6% higher in Italy than in this country, while that for stomach cancer is 15% higher; and the stomach cancer survival rate is 8% higher in Spain than in this country. We have to ask why that is the case. We are ahead of eastern European countries for most of the common cancers, but we are behind even them for some types, particularly stomach, lung and ovarian cancers. Why is the stomach cancer survival rate 5% higher in the Czech Republic than in this country, when it laboured for so many years under a very undeveloped communist system?
I invite the Minister to address those questions. As my hon. Friend the Member for Basildon and Billericay and the Government have rightly said, we could save the lives of thousands of cancer patients in this country if we brought our survival rates just up to the European average. Why does this advanced economy, which is doing very well economically compared with other countries, have cancer survival rates that are so much lower than those of comparable nations? That question must be asked over and over again.
Some excellent points have been made about the early detection of cancer. I hope that the Minister will make a full response to those points. I invite her to respond on the question of cancer survival rates for older patients. Many people believe that older patients do not get as good a deal in this country as they do in comparable European countries. Will the Minister tell me—if she does not have the statistics to hand, I would be happy if she wrote to me—whether the gap that still exists is being closed? Have we made any progress over the years in closing the gap between ourselves and those European countries? Is it the Government’s ambition to close that gap? What specific measures does she think would help us to achieve that?
There is no reason why this country should have a lower cancer survival rate. The advances in medical science are as available to us as to other countries. We can afford them because we have a developed economy. This country has wonderful pharmaceutical companies that produce world-beating research. We also have excellent clinicians, doctors and nurses, and very good hospitals. Why is it that we have this stubborn gap in cancer survival rates, with survival rates for common cancers being much lower in this country than in comparable western nations?
I applaud the Government for their ambition, but I urge Ministers to focus on closing that gap. It is a stubborn gap that has been there for many years under Governments of both main political parties. There is no reason why the public in this country should have to put up with it.
Like other hon. Members, I thank the Backbench Business Committee for providing time on the Floor of the House for us to debate this excellent report by the all-party parliamentary group on cancer.
I commend the hon. Member for Basildon and Billericay (Mr Baron) for his tireless work on this issue. Like the hon. Member for Salisbury (John Glen), I have been in this place for four years and have been amazed at the work that the hon. Member for Basildon and Billericay has done and at his forensic attention to detail. He never gives up and I am sure that he never will. I am grateful to him for that. I also pay tribute to the work of my hon. Friend the Member for Easington (Grahame M. Morris) and the noble Baroness Morgan of Drefelin, who are officers of the group.
The hon. Member for Harrow East (Bob Blackman) was right to say that hearing the words “You have cancer” is one of the most frightening things that can happen to somebody. It is frightening not only for the person who is given the diagnosis, but for their family. He was also right that more and more of us will hear those words in the future. As we live for longer, the prevalence of cancer increases. Just last week, the World Health Organisation warned that the world faces a “tidal wave” of cancer, with the number of cases globally set to reach 24 million a year by 2035. We often think of cancer and heart disease as issues of the western, developed world. In fact, long-term conditions are becoming the primary health conditions in developing countries as well. We have made big strides in tackling conditions such as malaria and HIV, but long-term conditions such as cancer are big issues in developing countries.
In the UK, 330,000 people are diagnosed with cancer each year. That figure has gone up by 50,000 in a decade. The primary reason for that is the ageing population. Cancer Research UK has highlighted a number of other risk factors: alcohol and the increase in obesity are two of the biggest drivers of that change.
Cancer Research UK produced a report in December, which showed that cancer deaths have dropped by 20% over the past 20 years. I am proud of the Labour Government’s contribution to that record. We launched the first ever national cancer plan in 2000 and made cancer a top priority. That work was led by Professor Sir Mike Richards who, as Members will know, is now the chief inspector of hospitals. The plan was backed by increased funding and, crucially, by reforms to drive improvements in cancer care, including better diagnosis, reduced waiting times for treatment and better standards of care. As a result, survival rates have improved steadily and cancer deaths have fallen by 50,000 a year.
Many hon. Members have rightly highlighted the need to ensure that patients with cancer have the best outcomes and survival rates, and that we narrow the gap with other countries. Many figures have been cited, but in some areas we have seen the gap narrow. An article by John Appleby from the King’s Fund in the British Medical Journal in January 2011 reminded us that death rates for lung cancer in men peaked in the late 1970s, but they have steadily come down and are now lower than those for French men. There has been a similar trend in breast cancer mortality for which we have virtually closed the gap with France. As the all-party group on cancer report rightly said, however, we need to do much more to prevent, treat and cure cancer, which means raising awareness of the symptoms of cancer among members of the public and GPs.
I am grateful to the hon. Lady for expanding my point because, as I made clear in my speech, I am not out to make any political point about this. According to Eurocare statistics, which I have been supplied with by the House of Commons Library and which refer to December last year—more recent than the article the hon. Lady mentioned—the survival rate for lung cancer in Frenchmen is 4% better than for people in this country. For lung cancer we lag behind nearly every other country in Europe, certainly western Europe.
I am not a statistician; I am reporting something from the British Medical Journal. There are different ways of cutting the statistics and different reports, but I absolutely agree that we need to do more to catch up with other European countries. There are a variety of statistics on that, and in some areas—but not enough—we have made big improvements in recent years.
We must raise awareness of the symptoms of cancer among members of the public and GPs, to ensure that everyone gets the earliest possible diagnosis. We must tackle variations in treatment so that everyone gets the best possible care, and we must provide better support to cancer patients and their families as they go through treatment, not just in terms of physical care, but emotional and social support such as help with finances, benefits and work. The hon. Member for Harrow East made an important point about how when they go through such a terrible time, many patients have a problem with their finances and benefits. I visited a brilliant multidisciplinary cancer team at Leicester Royal Infirmary, where Macmillan Cancer Support had a brilliant network of people providing financial information and support, as well as emotional support. That joined-up care is exactly what we need.
We must also ensure that people who have recovered from cancer can cope with life after cancer. People’s experience of the condition, as many hon. Members will know, does not end—hopefully—with the all-clear, because there are all sorts of emotional problems after that. As the hon. Member for Salisbury said, we must ensure that patients who cannot be cured, and their families, have real choice and control over the last days of their life, including where they die. The hon. Gentleman has probably not been reading the Hansard reports of the Care Bill Committee, but there is cross-party support for moving more quickly on that issue. In that Committee, the Minister of State, Department of Health, the hon. Member for North Norfolk (Norman Lamb), said that he was personally committed to getting that up and running and sorted out quickly.
As the hon. Member for Salisbury said, we should help people to stay at home with the right social care and support, including support for family members. It can be quite frightening to think that one’s loved one may be dying at home, and people can feel panicked about that. If we can provide the right social care support, and Macmillan specialist nurses to sit with people through the night, it can be better for those families and also provide better value for money. I hope that when the Care Bill reaches Report, we will get some clearer commitments.
The overarching question that the all-party group focuses on is how we can make such things happen on the ground. It takes the new structure within the NHS and asks, “How are we going to make this work?” The Health and Social Care Act 2012 reform was not perfect, and it was clear that cancer networks took the lead in driving changes and improvements in cancer services. As my hon. Friend the Member for Ashton-under-Lyne (David Heyes) has said, we had 27 cancer networks that brought together the commissioners of services and the providers of cancer care to plan high-quality services in their areas. They were staffed by people with specific expertise in cancer care and local knowledge of the different hospitals and services. They worked across primary and secondary care and on a wide range of issues such as increasing the uptake of screening, improving training for staff on the best possible treatments, spotting early symptoms and signs, and championing a focus on the patient experience and the patient’s pathway through the system.
As the all-party group’s report states, there is concern, including among organisations such as Macmillan, that the good work and vital expertise of those networks are being lost. I was first alerted to the problem by Dr Mike Peake, a lung cancer specialist at Glenfield hospital. He is also the national clinical lead for cancer and responsible for the national cancer intelligence network. The worry is that the Government’s reorganisation means that the dedicated cancer networks have been abolished and subsumed into 12 generic strategic clinical networks, which cover a larger geographical region and have fewer dedicated staff. The fundamental concern is that moving from a specialist to a generic focus will reduce the ability, which we desperately need, to drive improvements in cancer care.
Members on both sides of the House, and clinicians and staff, are saying that in every other part of the health system we need to concentrate specialist services like cancer services to improve outcomes, rather than having them delivered through every district general hospital. It does not make sense to people: we say that we want clinical advice to drive clinical improvements and change, but then we go the opposite way—from specialist to generic. That is a cause for concern.
There is also confusion about how the strategic clinical networks will work with all the other parts of the new system—the 10 specialist commissioning hubs, the 19 commissioning support groups, the 211 clinical commissioning groups, the 27 local area teams, the 152 health and wellbeing boards, NHS England, Public Health England and Health Education England. The new system is very confusing. People have to work together, so clear lines of responsibility and accountability are important.
We urgently need clarity on two points. First, will the Minister update Members on what is happening in the strategic clinical networks, and, specifically, how is the cancer expertise being protected? Secondly, will she outline precisely how the strategic clinical networks will work with other parts of the system?
The all-party parliamentary group report makes many excellent recommendations and raises many issues. I cannot go into all of them in detail, but will focus on the two that I believe are the most important for patients. The first, as most hon. Members have said, is early diagnosis. The second is improving the patient experience, which we have not discussed in detail.
Getting early diagnosis right is the key to improving survival rates. Several things would make a difference, but I shall describe the most important ones, the first of which is raising public awareness of symptoms. If the Government want to meet their target of saving an additional 5,000 lives by 2014-15, we must arm people with knowledge of the warning signs and symptoms. Once again, the Government’s reorganisation means that the responsibilities for public health are split between lots of different bodies and we are not clear how they will work together. The APPG report says that the responsibilities for increasing public awareness must be more clearly spelt out for NHS England, the Department of Health and Public Health England, and for local authorities and health and wellbeing boards. I hope the Minister will set out exactly who will be responsible for running public awareness and other campaigns.
Secondly, we have to improve the ability of GPs to spot signs and refer people to specialists for early diagnosis. As the report states, more than a quarter of people diagnosed with cancer see their GP three times or more before they are referred to a specialist. Under the old system, before the Health and Social Care Act 2012 and the reorganisation, cancer networks absolutely led improvements in training for GPs and other health professionals, but it is not really clear who is going to do that now. How will NHS England work with Health Education England, the royal colleges and other education providers to ensure that training programmes for health professionals are really there on the ground?
Thirdly—this is probably the most important point in the report, one which the hon. Member for Basildon and Billericay emphasised—how are we going to hold clinical commissioning groups to account for the one and five-year survival rates? The report states:
“NHS England has not provided any guidance on how the one- and five-year survival rates will be used to drive improvements in CCGs.”
The data may be available, but what will happen to them? Will NHS England identify poor performers? Will it make practical support and guidance available to CCGs? How will we know whether actions and steps have been taken? How can we hold them to account? As a local MP, I would certainly want to know how my CCG rates, what the problems are, what it has not been doing, what its action plan is and when it is going to report back. We do not know any of that. The survival rate targets are excellent, but we have to make sure we can deliver. At the moment, we simply do not have the mechanisms to do that.
The other point I want to focus on is improving the patient experience. This is not only absolutely central for patients, but a key driver of improvements in the quality of care and better value for money. As such, it should be a much higher priority in the NHS. We all know, whether from personal experience, the experience of those we love or those in our constituencies, that a good experience makes patients feel as though they have been supported and respected as an individual. A bad experience makes them feel at best that their needs do not matter, and at worst that their basic human dignity has been denied. Cancer patients I have spoken to, for example those at the Macmillan Cancer Support group in my constituency, constantly emphasise their experience of care and how they are treated by NHS staff. That would be important at any point, but for someone going through such a frightening time, it is even more important.
The importance of patient experience goes far beyond the personal value to individuals. There is now strong evidence that good patient experience is consistently and positively associated with better health outcomes, and safer and more clinically effective care. The British Medical Journal published a systematic review of 55 studies last year, which provided very clear evidence. Patients who have a good experience are more likely to stick to their recommended treatments and medicines, and more likely to use preventive services such as screening and healthy living programmes.
There is also increasing evidence, although I would say that it is from the US and not the UK at this stage, that a good patient experience is linked to getting better value for money. It is associated with reduced length of stay in hospitals and fewer problems with patient safety—the so-called “adverse incidents”. A good patient experience is also associated with higher staff retention rates and, in turn, lower staff turnover. That is common sense: when staff feel valued and respected they are more likely to treat patients in that way.
For all the reasons I have outlined, the patient experience in cancer care should be given an even higher priority. The cancer patient experience survey introduced by the previous Government has made a big difference in trying to drive improvements. I welcome the assurances given to the all-party group on cancer that the survey will continue, but for how many more years? We must ensure that we use that information to drive changes on the ground, and I will make some concrete proposals on how to do that. First, commissioners should be held to account through the inclusion of a cancer patient experience indicator in the CCG OIS. If that is how we hold them to account, we have to include patient experience. Secondly, patient experience should be much more central to the hospital inspection process led by the chief inspector of hospitals. Currently, out of 150 CQC indicators, only two concern patient experience. We need more patient experience indicators in the work of the CQC, including one specifically for cancer teams or services.
Thirdly, we need to look at how we improve professionals’ training in patient experience. I want to highlight a brilliant example from my own constituency that I hope the Minister will look into. Under a joint Macmillan and De Montfort university partnership project, people training to be nurses, pharmacists and NHS managers get training from Macmillan in patient experience and how to talk to and support patients. In return, those students volunteer for Macmillan in the community in order to increase awareness about cancer, particularly among black and minority ethnic groups—Leicester is a very diverse city. That is something to think about. Has the Minister spoken to Health Education England and the royal colleges about how to improve training in patient experience for professionals, and will she speak to Ministers in the Department for Business, Innovation and Skills to see what other universities could do to learn from the fantastic work at De Montfort?
To conclude, Members on both sides of the House want to see big improvements in cancer care. The new system in the NHS is confusing. Both as MPs and as people with families and friends, we want the right people held to account so that they take the right action, but it is not yet clear how that accountability will work. For me, that was at the heart of the all-party group’s report. The Minister might not be able to respond to all the many questions she has been asked in this debate, but if she cannot, I hope she will write to me about the specific issues I have raised. This is about improving patient experience and early diagnosis and ensuring that CCGs are held to account. We as MPs must hold them to account on behalf of our constituents.
Before addressing only some—I fear—of the many points raised in this debate, I would like to thank the all-party group, which, as the shadow Minister and others have said, does astonishing work. It rightly, and regularly, holds Ministers’ feet to the flames—my feet regularly feel the heat—but that is a good thing, because this is about driving up standards and pushing us all to work harder and do the right thing in this important policy area.
I also pay tribute to my hon. Friend the Member for Basildon and Billericay (Mr Baron), who brought this debate, and to the Backbench Business Committee—it used to be more fun being on it than responding to its debates—and I also warmly welcome the contribution from, and the presence of, the hon. Member for Ashton-under-Lyne (David Heyes), whose personal testimony greatly enhanced the debate this afternoon. We should also pause to think of our colleague, my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti), who is being treated for bowel cancer; our thoughts are with him.
I shall try to reply to some of the many points raised in this fascinating debate. I shall try to respond, to some extent, on the structure of the report and the different domains, and to pick up on some other points made, and I absolutely undertake to get back to colleagues where I cannot respond substantively. As my hon. Friend the Member for Basildon and Billericay said, this is part of an ongoing dialogue, and I am delighted that he will be meeting the national clinical director soon. Out of that dialogue, I think we can progress in some of these areas. Some of the issues are inevitably a work in progress. However, important points have been made and I shall try to respond to as many as I can while updating the House more generally on what the Government are doing.
Many of the report’s recommendations are for NHS England. As I said, I am pleased that the national clinical director is to meet the all-party group later this month. He will find the meeting a helpful opportunity to discuss the report in detail. As I prepared for this debate, I was particularly struck by the fact that NHS England is considering the report in great detail—indeed, it contributed during the consultation phase. I am really encouraged by that, as NHS England is absolutely critical in our new health structures. It is very aware of its responsibilities. Some of the challenge today has been about how we interact and how those new responsibilities settle.
I want to set out some of the actions under way that I hope will provide reassurance about the Government’s and NHS England’s commitment to delivering on our ambition, articulated by other Members, to make England among the best in Europe on this issue. My hon. Friend the Member for Hertsmere (Mr Clappison) said that we had major challenges and a long way to go in that regard, although the shadow Minister was right to say that we are beginning to make significant progress in some areas. However, we recognise that we have a long way to go.
I was first asked to respond formally to the report, and it would be improper if I did not respond to such a thoughtful and well put together piece of work. Obviously, I hope to respond to some degree today, but I will take the report away and certainly respond formally later. Some of that will be about the Government’s responsibilities in holding NHS England to account. I will think about how we can do that.
The first domain that the report addresses is preventing people from dying prematurely. It raises concerns about responsibilities and accountability in the new health system. It is right to challenge on such issues; we cannot pretend that, when there is such major change to a system, everything will immediately be settled and clear. I accept that there is a challenge. Our progress must be as speedy as possible in understanding who is responsible for what—particularly in understanding how we make accountability as transparent as possible and a driver of change and improvement.
We are responding to the new system and the inevitable tensions between devolving power on delivery in a way that empowers clinicians while also being accountable to Parliament. No one could pretend that that is not challenging. I certainly feel that challenge as a Minister; the responsibility for delivering most of that clinical care sits somewhere else, so the issue is about how we respond and account to Parliament for that.
I gently say that we should be careful not to suggest that, in such a large and complex health economy, all was perfectly clear and beautifully directed from the centre before. I respect the shadow Minister’s enormous knowledge of the NHS and I know that neither she nor anyone else is suggesting that. However, in highlighting concerns about where the new system is settling down, it is sometimes tempting to think that previously Ministers had a big lever under their desks that they could pull to make everything right. Even if that was the theory, it certainly was never the practice, as is evidenced by our persistent lagging in some of the key survival statistics discussed today.
The challenge is to respond to the new system and get clarity where there is none at the moment. A number of Members, including the shadow Minister, have mentioned how we hold people to account at the most local level. That issue emerges from this debate as the one on which we have the most work to do and to which we must give the most thought.
I want to discuss how the system is set out. I accept that the way in which we make it work in practice is not necessarily the same as that, but I will go through how we have set out the different frameworks and processes of accountability.
The indicators in the NHS outcomes framework provide the basis against which the performance of the NHS will be monitored. NHS England is responsible for delivering year-on-year improvement and is accountable to the Secretary of State. Those arrangements are set out in the Health and Social Care Act 2012, under which the Secretary of State set out the strategic priorities for NHS England through the mandate. The mandate makes it clear what is expected of NHS England with regard to contributing to the prevention of ill health through the better early diagnosis and treatment of conditions such as cancer.
The outcomes framework sets out different measures against which we hold people to account, and the Department has quarterly accountability meetings with NHS England, through which NHS England’s progress in delivering those improved outcomes is monitored. We will continue to monitor its progress in delivering against the mandate. The evidence showing how it has met the mandate is published, and forms the basis on which Ministers can ultimately judge the success or otherwise of NHS England’s performance.
I entirely accept the point that that is quite a macro way of looking at things, and that Members are also seeking a sense of what can be done on the ground. Perhaps I need to respond in more detail after the debate on the challenges relating to the role of the strategic clinical networks. Cancer has been made a priority for those networks. Making the new networks work is also a challenge for the national clinical directors and other colleagues in NHS England. Their role in relation to cancer is obviously to drive quality and innovation in prevention and screening, survivorship and end-of-life care. I know that NHS England is keen to see the links between the national clinical directors and those respective networks strengthened. There is clearly more to do, and I welcome the fact that the all-party group is in direct dialogue with the national clinical director. I will pick this up with the group and with him after their meeting.
With regard to clinical commissioning group accountability, NHS England is responsible for ensuring that the CCGs secure the excellent outcomes that we want, through commissioning. The assurance framework provides the basis for that assessment. It is an integral part of the agreement of improvements to be delivered locally. When CCGs are found to be at risk of failing to deliver improvements, NHS England will provide the necessary support. Statutory intervention powers exist, but they are to be used as a last resort only when CCGs are demonstrably lacking the capacity to make improvements.
Through “Everyone Counts”, the planning guidance for 2014-15, NHS England has asked CCGs to set a level of ambition for reducing premature mortality as part of their strategic and operational plans. They will be expected to demonstrate progress against those plans. The 2014-15 CCG outcomes indicator set is used as a tool by CCGs to understand trends in outcomes and to help them to identify potential priorities for improvement. It has a range of new cancer measures covering early detection, stage at diagnosis, and diagnosis via emergency routes. I pay tribute to the all-party group for championing the inclusion of those indicators, which have now been adopted, as the hon. Member for Basildon and Billericay said. The indicators will help to ensure that progress is being made on early diagnosis and, in turn, on survival rates.
With regard to the various bits of data, we will shortly have the one-year cancer survival information for patients diagnosed in 2012, which will tell us the stage at diagnosis. This will allow us to calculate stage-adjusted one-year survival, and that will probably represent the most accurate and timely cancer data that have ever been available in England. Using those data, we will be able to populate important indicators in order to drive up improvement, including the public health outcomes framework and the CCG outcomes indicator set, in relation to the proportion of cancers diagnosed at stages 1 and 2—the early stages.
On the five-year data, I am sorry that things have changed since the answer that I gave to my hon. Friend the Member for Basildon and Billericay at Health questions. That was the information that I was working on at the time. NHS England has been working with the London School of Hygiene and Tropical Medicine to establish whether the five-year indicator was statistically valid. When I answered my hon. Friend’s question, the data had not been fully gathered in. Having gathered them in, however, the conclusion was that because of the small number of survivors at five years, disaggregating the data down to individual CCGs would not leave the data statistically robust enough to draw conclusions. It would therefore be unsafe to do so. They are not therefore planning to publish at the CCG level, but they are considering how it can be published at a level that is not only meaningful and helpful, but statistically safe. I understand that this has been disappointing, but I think that the all-party group and Members will understand that the data set is so sensitive that if it was not felt to be safe and robust, it could not be published in that way. We will talk to NHS England about it.
I very much welcome that explanation, which goes a long way towards explaining the reason for the change in such a short period. May I leave the Minister with the thought that there appeared to be almost a complete disregard of the need to consult? Although I accept that this is NHS England’s ultimate responsibility, the cancer community came together on this issue and it seemed to be completely ignored from the point of view of consultation. Perhaps the Minister will look at that.
That is a fair challenge, and I will certainly take it up and raise it. On what we can do with data and transparency at the local level, the Department is looking at a number of things. The Government have tried to use data transparency in lots of different ways to drive improvement and accountability, and we are currently looking at some other ideas which I hope will produce a far greater sense of what is happening on the ground and in someone’s local area. We are very open to suggestions, and some have been made during the debate. I am happy to look at those, but this is an area under active consideration.
There has been a lot of discussion in this excellent debate about awareness and early diagnosis, and we know that it is one of the keys to getting better survival rates. It is central to meeting our ambition of saving the additional 5,000 lives each year by 2014-15, and we have committed more than £450 million in funding to achieving that and doing more on early diagnosis. To date, we have run national campaigns on tackling bowel and lung cancers; we have the Blood in Pee campaign, which hon. Members will be aware of, to raise awareness of bladder and kidney cancers; and we are currently running a breast cancer campaign for women aged 70 and over. The early response to that campaign has been really encouraging.
The shadow Minister raised some of the core public health issues which I spend much of the day job discussing: obesity, alcohol and smoking. I am slightly surprised that we have had relatively little discussion of those in the context of early diagnosis and prevention. Public health has been devolved to local authorities. They have more than £5 billion of ring-fenced money over two years, and all the local authorities I speak to—I was at the Local Government Association public health conference two weeks ago—are excited by the possibilities that that holds for them. There is a fair challenge about where the responsibility sits, but if everyone is doing work on awareness and early diagnosis, that can only be a good thing. Many local authorities are taking seriously the challenge of raising their game locally, and that is in addition to the national campaigns.
As hon. Members will be aware, many of the indicators are very mixed; there is a variety of statistics and variation around the country. I pay tribute to my local Wandsworth authority, whose six-week “get to know cancer” pop-up shop closes this Sunday. A local shopping centre gave the authority an empty unit and it worked with NHS London, staffing the unit for six weeks during the same hours as the shopping centre. It was run on a walk-in basis, and hundreds of people in my local community have popped in to that non-threatening environment to talk to trained nurses and get advice about cancer and some of those important awareness issues. Such local initiatives can only help us in our ambition to do much better.
My hon. Friend the Member for South West Bedfordshire (Andrew Selous) has had to leave us for a constituency engagement, but he touched on the work of charities. I met people from the excellent HeadSmart charity recently and I undertook to write to health and wellbeing boards about its work, so I will give him that assurance when I next see him. I also pay tribute to the work that Cancer Research UK has been doing on pilots dealing with melanoma, which my hon. Friend the Member for Mid Derbyshire (Pauline Latham) mentioned.
NHS England works with Public Health England and the Department to determine the focus of campaigns and to manage the development of the Be Clear on Cancer campaign. Decisions on the 2014-15 campaign activity will be based on the evidence and learning from the evaluation campaigns of the past two years, and it will be subject to all the normal clearances in terms of delivering really good value for money.
To deliver access to the best treatment, we have committed more than £173 million to improve and expand radiotherapy services. That includes £23 million for the radiotherapy innovation fund, which has supported centres to deliver increased levels of intensity modulated radiotherapy—a more accurate form of treatment that can reduce side effects.
The cancer drugs fund featured heavily in the debate. More than 44,000 patients have benefited from the fund so far, and last September we announced a further £400 million to extend it to the end of March 2016. Going forward, we will consider what arrangements can be put in place to deliver access to drugs previously funded through the CDF at a cost that represents value to the NHS. I recognise the nervousness that exists among those who understand what the fund has done and the impact it has had on individual patients. My hon. Friend the Member for Mid Derbyshire highlighted that matter, but clearly it is something that NHS England will be taking forward, and it will be aware of the concerns that have been expressed in the House.
Regarding the all-party group’s specific concern about NHS England’s duty to promote research, NHS England recently carried out an open consultation on a draft research and development strategy to deliver its statutory responsibilities and the NHS mandate duties. Again, we will learn more about that when the meetings take place, and as NHS England delivers that project.
The all-party group rightly highlights the importance of supporting cancer survivors. Increasingly, cancer is viewed as a long-term condition—that was certainly not the case when many of us were younger—as more are living with and beyond the disease. In March 2013, the Department’s national cancer survivorship initiative published “Living with and beyond cancer: taking action to improve outcomes”. It set out key recommendations to improve survivorship care, which were drawn from two years of evidence gathering.
I understand that the national clinical director is working closely with Macmillan, which provides the secretariat so ably to the all-party group, to encourage implementation and spread of the recommendations, including around stratified care pathways. The all-party group will be pleased to learn that ensuring all survivors benefit from the survivorship recovery package is a priority work programme.
We want to support people to stay in and return to work. A specific concern of the all-party group is how NHS England intends to support people to do that, as set out in the mandate. I can confirm that NHS England has issued an invitation to tender for a piece of work to examine the factors that impact on the employment rate of people with long-term conditions and to identify the useful interventions that can be made. It will be looking to consider the next steps. I think it is expecting to report on that in 2015.
The all-party group has also said that it would like to see wider use of the patient reported outcomes measure—PROM—data. This month, we have already seen the publication of “Quality of life of cancer survivors in England—one year on”. That is a survivorship update commissioned by the Department, which provides important information on recovery, unmet needs and the consequences of treatment. NHS England has already begun work to extend the PROM programme. A new pilot PROM data collection has recently started looking at quality of life issues for survivors of womb, ovarian and cervical cancer. For men, NHS England is supporting Prostate Cancer UK on a nationwide PROM data collection.
The all-party group makes a number of recommendations on the national cancer patient experience survey, which was referred to by the shadow Minister. I think we all acknowledge that it has been an invaluable tool in driving improvement in cancer care. When I first heard about it and looked at it in response to an earlier debate in Westminster Hall, I was very impressed with the level of detail that it can drive down to individual trusts. It uses what the best are doing to drive performance among those that are not meeting the highest standards.
NHS England recognises the value of the survey and currently has no plans to halt the programme. NHS England is the lead, but I think the more often we in Parliament recognise how important the programme is, and show how much parliamentarians value it and regard it as central to understanding the cancer patient experience, the more NHS England will feel that it is the right decision to go forward with it. I know that NHS England intends to examine the potential for a survey-related indicator as part of the future development of the clinical commissioning group outcome indicator set. That is a good thing. The shadow Minister made some interesting points and constructive suggestions in that regard, which I will happily look at after the debate and draw to the attention of NHS England.
The all-party group was concerned that more could be done to understand the experience of those who are close to people affected by cancer, and its members might be interested to know that following the NHS’s commitment to carers event, held last December, a number of priorities for supporting carers were identified. An action plan is in development and although it focuses more on the experience of carers in general, NHS England will consider cancer care as part of that. The 2014 cancer patient experience survey will begin in March and report in late summer. I am sure that there will be parliamentary interest in that report.
In order to realise the Berwick report’s vision of the NHS as an organisation devoted to continual learning and improvement, NHS England and NHS Improving Quality will establish a new patient safety collaborative programme to spread best practice, build skills and capabilities in patient safety and improvement science, and focus on actions that can make the biggest difference to patients in every part of the country.
NHS England is undertaking work to improve the collection and analysis of patient safety data, including introducing “safety thermometers” for medication error, maternity care and mental health, and revising the NHS serious incident framework further to support best practice. It is working with the Care Quality Commission and others to provide consistent and clear information for all on what patient safety data are available.
Let me try to pick up on some of the points made by hon. Members. My hon. Friend the Member for Hertsmere expressed a concern about older people with cancer. I will respond to him in more detail after the debate, but we know that older people sometimes do not get the support they need and what happens during diagnosis is often the primary driver of poor outcomes. He might be interested to know that we have worked on a £1 million project with Macmillan Cancer Support and Age UK to improve uptake of treatment in older people. That has established some key principles for the delivery of age-friendly cancer services and, as I mentioned earlier, we are seeing encouraging take-up of the over-70 breast screening programme in response to the current campaign.
Finally—I apologise, Madam Deputy Speaker, but I had many points to respond to and although I have not reached all of them, I will draw my remarks to a close—I am advised that NHS England will engage with the vision for the management of complaints and concerns developed on the recommendations of the right hon. Member for Cynon Valley (Ann Clwyd) and Professor Tricia Hart. I think the whole House acknowledges the amazing work done by our parliamentary colleague in that regard. The plan is to establish an advisory group of patients and patient representatives to feed into the complaints improvement work.
My hon. Friend the Member for Salisbury (John Glen) talked about palliative care. Work is going on in that area and I shall write to him after the debate. He might also be interested to know that NHS England is considering the potential for an indicator based on death in a preferred place of care. I will get back to him with more detail on that.
My hon. Friend the Member for Harrow East (Bob Blackman) mentioned issues to do with work and pensions, which I shall refer to the Department for Work and Pensions. He also talked about procurement issues and smoking. I am afraid that at the risk of sounding a little boring after Monday I must put on the record the fact that the Government have not yet made a decision about standardised packaging. We have instead introduced regulation-making powers so that we can make a decision when we have received the Chantler review and considered the wider aspects of that policy while taking its findings into account. Ministers will make the final decision. I am sure that my hon. Friend understands why we must put that rather legalistic sounding statement on the record.
In conclusion, I apologise for the length of my response, but this was such a good debate and many interesting points were made. I will take away those that I have not been able to respond to in detail. Once the all-party group has met the national clinical director, that might be a good time for us to meet again, to reflect on the meeting and to consider what more we can do to take this important work forward. I thank everybody who has contributed to the debate, and the all-party group for its continued detailed work and the challenge it puts out to us all to do better in this area on behalf of all our constituents.
I thank the Minister for her response and especially welcome her offer of a meeting, which we will be more than happy to take up.
This was always going to be a difficult slot to fill. Many Members who would have wished to speak are not here, and that is fully understandable, given the transport disruption caused by the floods. However, in that vein, I thank those Members who did make a contribution. We heard excellent speeches, and I thank those who courageously shared their personal experiences, whether as patients themselves or family members. Our thoughts are with those Members who are battling cancer, including my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti).
If there is one message that I would like to relay to the Minister, it is: please, please focus on clinical commissioning group accountability. There is no point having the tools in the toolbox if they are not going to be used. We have the measures in place and we know that we are monitoring survival rates as a means of promoting earlier diagnosis, but we need to be sure that there is follow-through so that underperforming CCGs are brought up to the mark. If we fail to do that, we are failing thousands of NHS patients throughout the country, given that our survival rates are woefully behind the average on the continent and internationally. It is a national disgrace that a quarter—one in four—of all cancers are first diagnosed at A and E, when it is often too late. That is the challenge before us, so the NHS needs to raise its game, as thousands of lives depend on it doing so. I look forward to the Minister responding to our report in full in due course.
Question put and agreed to.
That this House has considered the All-Party Parliamentary Group on Cancer report on cancer priorities in the NHS.