I beg to move,
That this House has considered the e-petition relating to research funding for and awareness of pancreatic cancer.
It is a pleasure to serve under your chairmanship, Mr Chope. I thank the Backbench Business Committee for granting this important debate. That citizens of the United Kingdom can, through their petitioning, move issues up the national agenda shows the strength of our democracy. Pancreatic cancer has not had the strong public spotlight of concern that some other diseases have had, so it is fantastic that the public’s voice has led directly to this debate, which I am proud to initiate. I thank every one of the 106,398 people who signed the petition by 8 April, and all those who have signed it since.
I pay particular tribute to my constituent, Maggie Watts, who started the petition with a determination to push pancreatic cancer further into the public’s conscience and higher up the political agenda. That we are here today in a packed Westminster Hall debate is tribute to her efforts and to those of everyone in the pancreatic cancer community—the charities, clinicians, patients, survivors and family members and friends of patients—who energised the nation to say through the petition that the time is right for us to up our collective game on pancreatic cancer.
It is worth pausing to consider the powerful testimony of the petition text, which asks the Government to:
“Provide more Funding & Awareness for Pancreatic Cancer to aid long overdue progress in earlier detection and, ultimately, improved survival rates”.
It reminds us that pancreatic cancer is the
“5th leading cause of UK cancer death with the worst survival rate of all cancers yet it receives only c1% of research spend. 5 year survival of 3% hasn’t improved in over 40 years, whilst survival rates for other cancers have… More funding/more public awareness is vital so that progress can be made in earlier detection and, ultimately, better survival rates. Often termed the “silent killer”, many of PC’s symptoms mirror other less critical illnesses. Sometimes GPs may not recognise these early enough, looking first at other possible causes resulting in lost time before diagnosis. By this time, in many cases, the prognosis is terminal.”
The petition calls for action:
“Another 40 years can’t pass without change. The requirement is for significantly increased research funding and inclusion in the National Awareness & Early Diagnosis Initiative (NAEDI) Public Symptoms Awareness Campaign”.
Pancreatic cancer is the fifth most common cause of cancer death in the UK. It has the worst five-year survival rate of the 21 most common cancers, and that has not changed in 40 years. Maggie Watts’s husband Kevin died of pancreatic cancer exactly 20 months from diagnosis, aged 48. His mum died 40 years earlier of the same disease, aged 27. Maggie said:
“What shocked me the most when I started to research pancreatic cancer is that, actually, Kevin stood no better chance of survival in 2009 than his mum did in 1969. Their deaths were 40 years apart yet there was no change in survival rates in all of that time. I found that hard to understand—there is not a lot in this world that hasn’t changed or improved over a 40 year period, including most other cancers but, for pancreatic cancer, survival rates are still shockingly low.”
She concluded that
“there must be a direct correlation between the lack of funding allocated to pancreatic cancer and the lack of progress in the disease.”
The lack of funding has meant that there has been no progress in 40 years. It has not been a public or political priority, and that has to change. As Dr Andrew Millar of London Cancer told the all-party group on pancreatic cancer last week, the very fact that people have only a one in 90 chance of getting this cancer, but a 95% chance of dying once it is diagnosed means that it is less likely to attract commercial funding than the more treatable forms of cancer. As he said, that is exactly when the Government need to step up to the mark and step in, yet site-specific funding for pancreatic cancer research is very low in real terms when compared to other forms of cancer. Only £5.2 million, or just 1% of the National Cancer Research Institute’s 2013 budget, was spent on pancreatic cancer research—that equates to just £625 per death per year on pancreatic cancer, compared with £3,426 per death per year on breast cancer—despite pancreatic cancer being responsible for 5.2% of all cancer deaths in the UK and deaths from pancreatic cancer increasing between 2002 and 2013, while deaths from most other cancers declined.
I congratulate the hon. Gentleman on taking up this issue in Parliament and the campaigners on raising the petition. Constituents have come to me to explain their concerns about pancreatic cancer. Does he agree that it is important that the campaign continues to do excellent work in raising awareness of the difficulties with pancreatic cancer?
The hon. Gentleman is absolutely right. The campaign must go on, beyond today and into the future. Campaigners are here today in strong heart and with a strong determination to ensure that that is the case.
Breaking down the NCRI spend into contributions from individual partner members is difficult, but we know from evidence given to the all-party group that in 2013, Cancer Research UK provided £2.3 million and the Medical Research Council provided £750,000. The contribution from the Department of Health was therefore just £700,000. In its 2012 policy briefing, “Study for Survival”, Pancreatic Cancer UK calculated that at least £10 million of investment is needed by 2015 and that £12 million is needed by 2017. The target is £25 million by 2022. The minimum figure of £10 million to £12 million has not been plucked out of the air; it comes from a high-level analysis of other cancers, such as prostate and bowel, which suggests that there is a point where funding starts to grow in a more rapid and, importantly, more sustainable manner. A critical mass is needed to generate a solid research infrastructure—for example, through the establishment of centres of research excellence. A critical mass of researchers generating competitive research proposals needs to accrue, and those investment targets are a key starting point for such progress.
Maggie told me that she considers herself in a way to be lucky. She said that she and Kevin had 20 months post-diagnosis and that he was an incredibly positive man, who refused to give in to the disease. Maggie said:
“When I say we were ‘lucky’ I mean because we got 20 months to do and say everything we wanted to. People that I have met whilst I’ve been working on the e-petition lost their loved ones weeks or even days from diagnosis. They were only just getting their heads around a terminal cancer diagnosis when they were having to deal with death. I’ve heard some incredibly sad stories around pancreatic cancer and I’ve heard lots of them.”
Stories of such shattering losses are not rare. One quick look at the tributes left online for victims is testament to that.
I congratulate my hon. Friend and the others who have raised this debate, as well as those who have petitioned on this vital matter. Does he agree that, as well as the general need for more research funding, screening tools, which are not presently available, need to be developed to make early diagnosis possible? Such developments have been responsible for so much progress with other cancers.
My right hon. Friend is absolutely right that the nub of the issue is how to get early diagnosis—the difficult-to-achieve holy grail.
In evidence to the all-party group a week after celebrating six years of survival, pancreatic cancer survivor Ali Stunt said:
“We need to focus on early diagnosis… Those of us who are diagnosed in time for surgery, which is what we want to achieve, have a tenfold increase in the chance of surviving five years… I was lucky. I was told that surgery was an option and that my operation would be booked in for a week’s time. I was told I needed chemotherapy and a week later was in my consultant oncologist’s office. I told him that I wanted to live to see my boys graduate. Following combination chemotherapy for 6 months and then chemo-radiotherapy, my scans were clear. Regular check-ups followed with scans and blood tests—all of which revealed ‘no evidence of disease’. My oncologist finally ‘signed me off’ in April 2013.
This is a story not often heard when pancreatic cancer is involved. These past 4 years since I founded Pancreatic Cancer Action I have met and got to know some fabulous people who have bravely fought and helped me raise awareness of this cruel disease. Not many of them are still alive, but all will have a special place in my heart. It is and always will be my mission to get more people diagnosed sooner—so more can have the same outcome as me.”
I first became aware of pancreatic cancer many years ago when my friend and colleague Martin Newbould became ill with it. Martin was an inspirational individual, a wonderful family man and an outstanding head of maths. More recently, my witty local newsagent Mick Emerson retired only to be diagnosed with pancreatic cancer soon after and then pass away. My friend Sir John Mason passed away just before the summer after a dignified battle against the disease, leaving a massive legacy of good work in the community. Having been ill for some time with an undiagnosed condition, John’s pancreatic cancer was, I understand, finally diagnosed after an emergency admission at Scunthorpe hospital’s A and E.
Currently, a staggering 48% of pancreatic cancer diagnoses are made by emergency admission, which is more than twice the total for other forms of cancer. That is important, as presentation via emergency admission is normally when the disease is more advanced and associated with much poorer survival rates than other routes to diagnosis. For example, one-year survival for patients presenting via emergency admission is just 9%, as opposed to 26% for those diagnosed as a result of GP referral. Over 40% of pancreatic cancer patients visit their GPs three times or more before even being referred to hospital. Some 16% have to visit their GP or hospital seven times or more before the correct diagnosis is made. By comparison, figures show that 75% of all cancer patients combined are referred to hospital after only one or two visits to their GPs.
Such data are only recently known as a result of the National Cancer Intelligence Network’s impressive work. It shows the power of data in helping us to tackle this disease. Further improvements in the collection and application of real-time data have the potential to transform medical practice in this area. Evidence given to the all-party group last week suggests that establishing a tool to collect patient data online would not be difficult to achieve. Such a robust IT system would radically improve data collection. Patients support their data being used for analysis and expect their data to be used to improve care for everyone else. London Cancer’s Dr Millar recommended that patient data be made freely available for use, within the law, for research in return for the free health care received under the NHS. Linking more GP data with that already received through secondary care and the research lab will help to improve early diagnosis in terms of the amount of data that can be analysed.
One issue highlighted throughout the all-party group’s inquiry was the disconnect between primary and secondary specialist care in achieving timely, effective treatment. Pancreatic cancer patients are not transferred quickly enough from primary to secondary care when time is of the essence if better outcomes are to be achieved. Most European countries do not have the same GP gateway as the UK; patients can see a specialist more quickly and clinical outcomes are better. One consultant surgeon and surgical oncologist told us:
“The patient turns up and the chap says, ‘Well it’s not reflux and I’m a reflux doctor. Back to your GP.’ So he goes back to the GP—more delay is coming. The GP says, ‘Well it isn’t reflux. Maybe now he has some back pain or something. We’ll try the spine doctor.’ So he goes to the spine surgeon. The spine surgeon says, ‘Well, it’s not spine pain. Back to your GP.’ This is the common scenario. The patient becomes a tennis ball.”
To get around this investigative ping-pong, it is worth seriously considering whether to allow GPs direct, easier access to CT scans, which would be much more likely to rule cancer in or out at an earlier stage than other investigative measures. One experienced GP told us:
“I think it’s about getting the right test, for the right patient, at the right time. Presently a hospital doctor who has had—no disrespect to my colleagues—two years’ medical experience can request a CT scan for a patient in hospital where I can’t.”
There is recognition that allowing GPs to refer patients directly for CT scans could accelerate diagnosis, but there is understandable concern about how it might work in practice.
Mr and Mrs Stella, constituents of mine who tragically lost their son Robert aged just 26, are sitting in the Public Gallery. I am a working doctor and fully understand how difficult it is to diagnose pancreatic cancer early because of the non-specificity of the symptoms. However, the solution might be in research. GPs require a test and to be able press a button and diagnose something from within the primary care setting. As the hon. Gentleman rightly points out, obtaining tests from primary care is difficult. Does he agree that once we have found such tests, which will come with time, primary care is where funding should be placed, so that earlier diagnosis is more achievable? Pancreatic cancer can be beaten, but to beat it we must diagnose it early.
I absolutely agree that the need is to find the tests and to have the wherewithal to allow them to take place.
I want to ask the Minister a few specific questions that she may pick up on in her response. Will the Government put in place pilots across the UK to experiment with direct GP referrals for CT scans to see how that might work and what impact it has on what actually happens—the positives and the negatives—so that we can learn from the experience? What actions can she take to boost awareness of pancreatic cancer signs and symptoms among GPs, to which the hon. Member for Birmingham, Yardley (John Hemming) referred earlier? Will the Department of Health consider pump-priming research into more recalcitrant cancers, such as pancreatic cancer, with ring-fenced grants where sustainable research has yet to be reached? As pancreatic cancer survival rates remain stubbornly low, will the Minister consider running specific awareness campaigns for the public through appropriate media?
The petition and this debate will have helped to raise pancreatic cancer up everyone’s agenda. I pay tribute to how Julie Hesmondhalgh—Hayley Cropper in “Coronation Street”—has helped to raise awareness of pancreatic cancer. I understand that she has been nominated for the best soap actress award at the TV Choice awards tonight. We wish her luck with that, because it will move pancreatic cancer yet further up the agenda. It is good to have her here today as part of the campaign. Julie points out:
“What the Coronation Street storyline did for pancreatic cancer awareness is phenomenal, but much more attention and funding is required. I worked with Maggie, along with many motivated people affected by pancreatic cancer and the charities Pancreatic Cancer Action and Pancreatic Cancer UK, to push the petition to the 100,000 signature milestone. This cancer desperately needs to be in the spotlight.”
She is absolutely right. The spotlight shines on it today. We need to seize this opportunity, this moment, this petition, this debate to up our game. Another 40 years cannot pass by without change. We need to set our stall out to make the same progress that we have made in prostate, breast and bowel cancer in the past 40 years for pancreatic cancer in the next 40 years. Nothing less is satisfactory. It is, as our parliamentary inquiry says, time to change the story.
I call—[Applause.] Order. It is not customary for us to applaud. We keep quiet and listen. I am sure that the mere presence of so many people in the Public Gallery is an indication of the strength of feeling on this important issue. I call Eric Ollerenshaw.
Thank you, Mr Chope. It is good to serve under you, and we did hear the applause.
I congratulate my colleague the hon. Member for Scunthorpe (Nic Dakin) on such a brilliant start to the debate and I thank him for the support that he has given the all-party group on pancreatic cancer month after month. May I also put on the record that my interest in the subject comes from having lost my partner to pancreatic cancer in 2009, only six weeks after diagnosis? I am grateful for the support that I received, and continue to receive, as a result of my loss from my hon. Friends the Members for Pudsey (Stuart Andrew), for Milton Keynes South (Iain Stewart) and for Redditch (Karen Lumley). They are sat close to me to keep me going in the debate, and I am always grateful for their support.
I decided to campaign on pancreatic cancer and helped to set up the all-party group, which I now chair. As the hon. Member for Scunthorpe pointed out, that has meant starting to meet others campaigning on the same issue. I have met representatives from charities such as Pancreatic Cancer UK, which acts as a secretariat for the all-party group and is ably led by Alex Ford, its chief executive; from Pancreatic Cancer Action, founded and led by pancreatic cancer survivor Ali Stunt; and from the Pancreatic Cancer Research Fund, founded and led by Maggie Blanks, who lost her husband to the disease.
I have also met Maggie Watts, whose petition ultimately led to today’s debate. As it happens, she lost her husband, Kevin, only two months after I lost my partner, so we have shared and similar frustrations. That shared sense of loss, the sense of injustice and the shocking survival rates for pancreatic cancer, along with the small amount of time that can generally be spent with people following diagnosis, drive us all—whether MPs, chief executives, charity workers or volunteers—to raise awareness and, I hope, to bring about change so that others do not have to go through what we did.
I thank Maggie Watts and the hundreds of people who campaigned so hard to get more than 100,000 signatures on their petition. I know it was touch and go, but they have managed it in only the past few days. The effort that they have put in to change the status quo, in honour and memory of their loved ones, should be applauded. I really thank them.
As the hon. Member for Scunthorpe mentioned, the all-party group on pancreatic cancer produced a report last year, which made a number of recommendations on how to improve awareness, diagnosis, treatment and care for pancreatic cancer patients. We did not even broach the subject of research in that report; to have done so would have complicated things unnecessarily. This year, therefore, the all-party group is carrying out an inquiry into how to increase the quantity and quality of research into pancreatic cancer in the UK. We held the last of the four evidence sessions last week and will be producing a report in late October. I want to spend some time talking about issues that emerged from the inquiry.
I thank the hon. Gentleman and the hon. Member for Scunthorpe (Nic Dakin) for securing this important debate. Before I was elected, I used to do research into cancer targets. Pancreatic cancer was one of them, and I was looking for new targets. I support the call for research. An oncologist who worked on the issue and with whom I was collaborating said, “All my patients will die very quickly from this unless they are hit by a car in the meantime. We have to change that situation.”
I thank the hon. Gentleman for underlining that critical point about survival rates and their impact on the ability of researchers to get that much-needed research.
The consensus we found was that more work is needed and that one of the reasons why survival rates for other cancers are increasing is that effective screening and markers have been developed to allow early diagnosis, thus giving more time for curative treatments to be given to patients. The other side of the argument, which we will go into, is that what we are looking for is support and treatment to allow survival rates after diagnosis to increase. In this day and age, having only six weeks left in which to make life-shattering decisions is unbelievably difficult for people.
I am glad that we are able to have this important debate. Does the hon. Gentleman agree that, in addition to the need for primary research, there is a disparity between the UK one-year survival rates and the best survival rates in Europe—it is often as much as 11%? Things are known about pancreatic cancer that we can perhaps learn from to treat and diagnose the condition.
The hon. Lady makes an extremely important point, which the all-party group was trying to weigh up. The hon. Member for Scunthorpe made an important point about CT scans and made the important suggestion that there should be pilots. Also, interestingly, he mentioned that the going backwards and forwards between the GP and the specialists delayed diagnosis. There are certainly things that we could learn from other countries.
One of the basic needs that came up from our research was the need for investment in the basic science and biology of tumours, as well as access to better infrastructure that would allow that, such as access to tissue samples. On the latter point, the Pancreatic Cancer Research Fund told the APPG that it was working in conjunction with Barts on creating a specific pancreatic cancer tissue bank, which would help. That is a massive investment for a small charity and it should be applauded.
As Members know, there is a massive shift throughout all cancer research towards personalised medicine. Pancreatic cancer patients could benefit particularly from such an approach, given the nature of the disease and the fact that so many different tumour types are involved. New treatments need to be developed to attack and destroy the cancer cells. That does not mean new drugs alone, but perfecting the use of advanced radiotherapy techniques, such as NanoKnife or CyberKnife, for the benefit of patients and to the satisfaction of the National Institute for Health and Care Excellence, so that they can be provided on the NHS.
All in all, a lot of research needs funding. A key statistic for this debate, as mentioned in Maggie’s e-petition, is that pancreatic cancer receives only 1% of the National Cancer Research Institute’s site-specific spend of £5.2 million a year. That is despite the fact that pancreatic cancer is the fifth biggest cancer killer in the UK, and predicted to become the fourth biggest by 2030. It is responsible for 5.2% of all cancer deaths in the UK. The National Cancer Research Institute itself acknowledges that research into pancreatic cancer and other cancers deemed to have unmet need, such as brain and oesophageal cancers—forgive me if I do not pronounce that correctly—remains “relatively low”.
By “relatively low”, however, the institute means “low”. I contend that £5.2 million a year from the NCRI partner funders is simply not enough to tackle the extreme intransigence of a disease as tough as pancreatic cancer, a disease that has seen—as has been mentioned before and should be mentioned again and again—little change in survival rates over the past 40 years or by comparison with other countries, as the hon. Member for Belfast East (Naomi Long) said.
Why does funding matter? Is money the be-all and end-all? No—other things need to be done as well if research into pancreatic cancer is to become more effective. However, if we look at other cancer types, we see that sharp increases in survival rates from breast, prostate and bowel cancer, for example, have mirrored sharp increases in research spending into those diseases. As Professor Peter O’Hare, chair of Pancreatic Cancer UK’s scientific advisory board—now there’s a powerful job—told the APPG inquiry:
“I think if you simply looked at the history of science, I don’t think you can, as a scientist, start to make guarantees about research. It’s not like a sausage grinder; you don’t put research in and it comes out and you solve the problem. It just doesn’t work that way”—
we totally understand and agree with that—
“there are convoluted pathways and you can’t make guarantees.
However, I think there is a guarantee you can make: if you don’t carry out research, you are not going to move; nothing is going to happen. That’s the guarantee that you could make.”
Some evidence suggests a critical mass, a level at which research needs to be funded, if advances are to start to gather pace. Pancreatic Cancer UK produced a report in 2012, “A Study for Survival”, which demonstrated a level—around £10 million to £12 million minimum—at which the amount of research starts to become sustainable and from which new research proposals and ideas are generated. Those new ideas in turn lead to more funding coming in, and we get a virtuous circle.
We are some way off that level of funding at the moment. National Cancer Research Institute funding partners contribute just £5.2 million at present. Incidentally, we learned during the all-party parliamentary group’s research inquiry that the Department of Health’s contribution to that sum is just £700,000 a year. Although they are growing, charities for pancreatic cancer are still small and supply probably less than £2 million a year between them for research. Where, then, can that extra funding come from? What needs to be done?
In its new research strategy, published in April this year, Cancer Research UK made a welcome move in the right direction, with a promise to increase funding into pancreatic and other cancers of unmet need—brain, lung and oesophageal—twofold or threefold over the next few years. That is great news.
My hon. Friend is making a customarily powerful and passionate speech. He is aware that the five-year survival rate in the United States is 6%, as against 3.3% in the UK. Is he also aware that, under the Recalcitrant Cancer Research Act of 2012, the US Congress has given a legal imperative for the director of the US National Cancer Institute to produce a strategy to tackle such cancers? We should do the same in the UK.
I am grateful for that intervention, particularly as I will go on to mention the Recalcitrant Cancer Research Act—as usual, my hon. Friend has got in before me. He is on exactly the right lines in terms of what we are all thinking.
I have talked about good news and extra money. However, I am not sure whether that goes quite far enough. There is still no ring-fencing per se of money for research into pancreatic cancer, brain tumours and so on. Instead, applications will still have to be made for funding. They will be peer-reviewed and selected from similar applications for research into other cancer types.
The issue is that the reason given by Cancer Research UK for not awarding more funding for pancreatic cancer in the past has been that not enough quality applications have been received, so the doubling or trebling of funding set out in the strategy will happen only if more applications are made. For that to happen, we need more researchers in the field, whether established and respected researchers coming over from abroad, such as Professor Andrew Biankin from Australia, who has recently relocated to Glasgow—as usual, Scotland sets the trend—to carry on his pioneering work there, or new, young researchers starting out in their careers.
We are currently in a Catch-22 situation, however: new researchers do not generally want to enter the field, partly because it is deemed difficult to make advances in it—that puts them off as they fear it will hold back their careers, as the Department of Health’s written response to the e-petition mentioned—and partly because the funding is not there. But the funding is not there because not enough research applications are being made.
I firmly believe that we need to break that vicious circle and to pump-prime research into pancreatic cancer, making sure that we hit the minimum funding level required to gain critical mass. I also firmly believe that the Government can and should play a role in that.
I have long lamented the fact that celebrity endorsements seem to increase the funding of research into particular illnesses and conditions disproportionately in terms of the impact that those conditions and illnesses are having on broader society. Does my hon. Friend agree that the Government might want to take into account the funding that certain conditions receive from private sources because they are deemed fashionable, so that greater Government funding can be given to those conditions that are seemingly less fashionable?
My hon. Friend makes an important point. It is difficult for Ministers and boards to make decisions about what is or is not fashionable. Nothing we are trying to do, in getting pancreatic cancer higher up the agenda, is aimed at taking away from the advances being made for other cancers. We all welcome those. We simply want fairer funding ourselves, and some recognition of the impact of this particular cancer. We are not asking to take away from anything else, but unfortunately we are asking the Minister for something extra.
I come now to the Recalcitrant Cancer Research Act, which my hon. Friend the Member for Peterborough (Mr Jackson) mentioned. It was passed in 2012 in the United States, and requires the director of the US National Cancer Institute to prepare a special strategy for recalcitrant cancers in the US. A recalcitrant cancer is defined as a cancer type with a five-year survival rate of less than 20% that kills more than 30,000 US citizens a year.
The result of the Act has been more focus on pancreatic and lung cancer research in the US, as well as a welcome increased focus on and awareness of those cancer types more generally. I would like the Minister to consider whether the British Government need to produce their own recalcitrant cancer research strategy, commissioned and produced either by the Department of Health or the National Institute for Health Research. Such a strategy should focus not just on pancreatic cancer but on other cancers of unmet need—those with low survival rates.
If a British strategy were to use the US definition of “recalcitrant”, it would cover pancreatic cancer, which has a survival rate of just under 4%; lung cancer, for which it is 10%; oesophageal cancer, for which it is 15%; brain tumours, for which it is 19%; and stomach cancer, for which it is 19%. That would help to give a focus.
I apologise to my hon. Friend for arriving late—I was at a Statutory Instrument Committee. My brother-in-law died of pancreatic cancer in July in the United States. I draw my hon. Friend’s attention to the fact that research has then to go on to produce outcomes, and we are still a long way from that. I hope he will agree that it will be a long-term project.
I thank the hon. Gentleman for that. I think everybody here—all the people who signed the e-petition and the hon. Members who are here to support the debate—realises that it will be a fairly long journey. We are trying to say that we want a quicker start to that journey, please, given what has happened.
I will not detain hon. Members for too much longer, but I want to finish by mentioning a hobby-horse that I have mentioned in previous debates: the need for more and more effective treatments for pancreatic cancer to be made available on the NHS. The treatments do not need to be discovered; they already exist. Last week, I spoke in the House about the need for the National Institute for Health and Care Excellence to reform if it is ever to be fit for purpose, at least when it comes to ensuring that patients have access to cancer drugs. That is evidenced by the fact that in 2011-12, NICE, as it is called, rejected 60% of the cancer medicines it assessed—an increase since 2010. Simply put, that means that drugs licensed for use in the UK are not being made routinely available on the NHS to all who need them.
The cancer drugs fund for England was introduced in 2010 to clear up the mess—we welcome the fund—and because of it 55,000 patients have been able to access drugs they would not otherwise have managed to access. Those drugs have extended patients’ lives, giving them more time to spend with their loved ones. Unfortunately, the CDF is funded only until 2016. Doctors have to apply for drugs from the fund, which are not routinely available, and any drug on the list could in theory be removed by the CDF panel at any time.
The drug Abraxane, for metastatic pancreatic cancer patients, was added to the CDF list in March this year, following a public campaign and a debate held in the main Chamber. Sadly, however, things have moved on. The Health Secretary recently announced that the CDF will get more money, but the accompanying announcement said that the CDF will be reformed. The precise wording was that it would be more closely “aligned with NICE” and that a new cost-benefit analysis will be introduced when new drugs are considered. Imagine the alarm, Mr Chope, when Sir Andrew Dillon, the chief executive of NICE, said to the Health Committee last week:
“We would like to move away from a situation where…the Cancer Drugs Fund then says yes to the treatments we have said no to…I don’t think that makes any sense. It’s not a criticism of the decision to allocate more money to cancer. It’s about an alignment of processes and methodologies that we need to get sorted out…There is no reason at all why we can’t provide the basis for NHS England’s decisions on cancer treatments just as we do for all other treatments.”
I say to Sir Andrew that there is a reason why: as I have already said, NICE does not work for cancer patients. To treat cancer as if it were like other diseases when it causes so many deaths and when the population is ageing—we know the likelihood of cancer increases with age—is to take a step backwards.
I would be grateful if the Minister commented on the cancer drugs fund. We are worried at the moment. Abraxane has been considered by the fund. We are grateful that it has received ministerial sign-off in Wales. The cancer drugs fund agreed to list it, but now that is with NICE. I hope I am wrong on this, but I suspect that in the near future it will be rejected by NICE for routine use in the NHS in England. It is the first advance in some kind of pancreatic cancer treatment for 40 years, and it looks likely that NICE will reject it. That is a disgrace.
I have held up the Committee for too long, but I do not mind because of the importance of the issue. Just to finish, next year 8,800 people will be diagnosed with pancreatic cancer, of whom 80% to 90% will probably not survive beyond six months. Thousands of relatives and friends will then enter a parallel world: the cancer world.
I congratulate my hon. Friend on securing the debate. Does he think that we need to follow the example given to us by the e-petition to educate our constituents? Should we not take part in pancreatic cancer awareness month in November to help raise awareness of this killer disease in all our constituencies?
I thank my hon. Friend. If raising awareness was the one thing to come from this petition, all of us who have been affected would say that was positive.
Thousands have signed the e-petition that we are debating because they believe the purpose of government is to make improvements in people’s lives. For the sake of the thousands of cases to come, and for those of us left behind, I urge the Minister to help us to prove that our partners, relatives and friends did not die totally in vain.
It is a pleasure as always to speak with you in the Chair, Mr Chope. I congratulate my hon. Friend the Member for Scunthorpe (Nic Dakin) on the excellent way he opened the debate and the hon. Member for Lancaster and Fleetwood (Eric Ollerenshaw) on working with my hon. Friend to secure the debate and his very moving contribution. I join them in congratulating Mrs Maggie Watts on gaining more than 106,000 signatures for the petition. Anyone who takes or promotes petitions through social media will know what a mountain 100,000 signatures is to climb.
Mrs Watts started the e-petition to help to push pancreatic cancer higher up the political agenda, to raise the disease’s profile and to encourage more funding and research into it. That is certainly starting to happen with the debate today. As Mrs Watts has said,
“pancreatic cancer has been neglected both in terms of funding and awareness for way too long.”
The fact that her husband stood
“no better chance of survival in 2009 than his mother did in 1969 demonstrates completely how little progress has been made.”
As the petition states, pancreatic cancer is the
“5th leading cause of UK cancer death, with the worst survival rate of all cancers”.
Yet, as we have already heard, it receives only about 1% of the research spend. Further, the five-year survival rate of less than 4%, as we have heard,
“hasn’t improved in over 40 years, whilst survival rates for other cancers have.”
It is worth looking at those survival rates. The current survival rate for bowel cancer is 54%; it was 22% in 1971. The current survival rate for breast cancer is 84%; it was 56% in 1971. For prostate cancer, to which I recently lost a friend, the current survival rate is 81%; it was 31% in 1971. From those figures, we can see that pancreatic cancer lags behind. Clearly, as has already been discussed, more funding and more public awareness are vital so that progress can be made, both in earlier detection, to which hon. Members have already referred, but, ultimately, in better survival rates.
Pancreatic cancer is termed the silent killer. As we have heard, many of its symptoms mirror other, less critical illnesses. We have also heard that GPs may not recognise these early enough, looking first at other possible causes, resulting in lost time before diagnosis. That is serious because in many cases the prognosis will be terminal by then. It is quite a disturbing fact that deaths from pancreatic cancer did not just stay the same but increased between 2002 and 2013, while deaths from most other cancers declined.
It is clearly difficult that the signs and symptoms of pancreatic cancer can be late occurring and non-specific. As my hon. Friend the Member for Scunthorpe said earlier, these non-specific symptoms may lead to patients being treated or investigated for other more common illnesses, such as gallstones, before a diagnosis of pancreatic cancer is made. This in turn can mean significant delays in diagnosis and treatment, including potential curative surgery. As we have heard—I am sure we will come to this point and put more questions to the Minister on it—we are talking about patients whose symptoms and diagnosis do not fit our system. Our system needs to change, so that these patients get the investigations and diagnosis they want.
Yes, indeed I am. As is always the case in these debates, I was coming to that point. We have had an excellent briefing from Pancreatic Cancer UK, which says that there are symptoms that lead patients to visit their GPs. As the briefing said:
“If patients can present at an earlier stage and GPs are better trained and supported to identify and investigate the possible signs of pancreatic cancer, more people will be diagnosed at a stage when curative surgery is still an option.”
The NHS England cancer patient experience surveys have shown that more than 40% of pancreatic cancer patients visit their GP three or more times before being referred to hospital. I found examples in case studies that were many more times than that. Some people, as in the tennis ball example mentioned by my hon. Friend the Member for Scunthorpe, went to GPs 10, 15 or 16 times. That is not acceptable. By comparison, figures show that 75% of all cancer patients combined are referred to hospital after only one or two visits to their GP. That is as it should be for this dreadful disease.
The hon. Member for Bracknell (Dr Lee), who is no longer in his place, spoke about the difficulties for GPs. Pancreatic Cancer UK found in a survey it conducted that, although most GPs could list one or two of the symptoms of pancreatic cancer, half of GPs were not confident that they could identify the signs and symptoms of pancreatic cancer in a patient. All these facts underline the need for better awareness of pancreatic cancer. Leading charities want to see a campaign based on the specific symptoms of pancreatic cancer.
The briefing reminds us of the need to challenge perceptions of pancreatic cancer as a disease affecting small numbers of elderly, male patients. Although it is true that incidence increases with age and the majority of cases are reported in older patients, it may be that they would be younger if the diagnosis and investigations were better. However, about 25% of cases still occur in people under the age of 65. We have heard examples concerning people in their 40s. The disease affects men and women equally.
Pancreatic cancer awareness month in November, which the hon. Member for Redditch (Karen Lumley) referred to, will help raise awareness. We know the awareness-raising value of storylines such as the one in “Coronation Street” with Hayley Cropper, which developed the pancreatic cancer that led to the character’s death and helped to create a great upsurge in internet traffic, inquiries and donations to pancreatic cancer charities. Like my hon. Friend the Member for Scunthorpe, I pay tribute to Julie Hesmondhalgh for her support for campaigns and for the petition that led to the debate. We need to see much more of that.
We have had excellent briefings for the debate, but I wanted some insight into treating pancreatic cancer. I asked a doctor working in palliative care. He described his thoughts and his experience of treating patients with pancreatic cancer in these words:
“The issue is not only one about cure rates but that pancreatic cancer presents a massive challenge to the health service in terms of the consequences of this awful disease.
The symptom burden in patients with pancreatic cancer is both substantial in the number of patients affected but also in the intensity of those symptoms.
From the research, 75-80% of patients present with pain at initial presentation. Of these, 44% of the patients admitted to a palliative care setting have severe pain.
Because of the anatomy of the pancreas, many of these patients will have infiltration of the coeliac plexus causing neuropathic pain which is often difficult to treat and may require complex pain interventions including nerve blocks.”
Another important factor is, of course:
“Pain is linked with depression and anxiety…it underlines the importance of treating pain.
Whereas, overall, advanced cancer patients…have a 30% chance of developing major depressive illness this rises to 50% for pancreatic cancer one of the highest instances of depression for any cancer.
The incidence of obstruction of the bile duct is common requiring hospital admission for stenting in the last months”—
of life when patients would rather be at home.
In short, not merely in terms of survival and early diagnosis is pancreatic cancer a major health issue, it constitutes a major burden of symptoms and distress for patients and their families, requiring careful, sensitive integrated care between primary care, hospital staff, oncology and palliative care services.”
Low awareness of pancreatic cancer among GPs and the public, late diagnosis and poor survival rates are not the only issues we have to deal with. Even after people are diagnosed, there is a huge burden of symptoms for the NHS to treat. Those symptoms can mean misery, depression, pain and surgical complications for the patient with pancreatic cancer. As the Minister will know, not all patients are able to benefit from the type of careful, sensitive, integrated care that has been described as what they need. It is clearly an aspiration for the health service, but it is not always achieved.
There is much to do, and the Minister has already been asked to take several actions, but I will ask her, too, because we should all press those points. What action could the Minister take, and what action is she taking, to boost public awareness of pancreatic cancer? It is vital that its symptoms should be better understood by the general public. What can she do to boost awareness among GPs and other medical professionals of pancreatic cancer signs and symptoms? As we have heard and will repeatedly hear, survival rates remain stubbornly low, and mortality rates have been increasing even as they fall for other types of cancer. Will she consider ensuring the development of specific awareness campaigns through appropriate media? The success of the “Coronation Street” story underlines the importance of that for all aspects of the campaign. What action will she take to end the state of affairs in which a patient can be pictured as a tennis ball? What can be done to give GPs more direct access to CT scans or ensure that patients with symptoms that could be pancreatic cancer have all the appropriate investigations in a more timely way?
As my hon. Friend the Member for Scunthorpe and the all-party group have said, it is time to change the story. I hope that the debate will ensure that change takes off, from today.
It is a pleasure to serve under your chairmanship, Mr Chope, and to follow the hon. Member for Worsley and Eccles South (Barbara Keeley). I am impressed by the standard of the speeches in the debate. The hon. Member for Scunthorpe (Nic Dakin) made a powerful opening speech, and the remarks of my hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw) were moving, passionate and heartfelt.
At the moment we feel that pancreatic cancer is an unfashionable issue that is low on the agenda politically and even in the health world, but other causes have been in that position, and have risen up the agenda because of pressure from this place. Pancreatic cancer is an issue that unites people across parties, and it needs attention. I would compare it to dementia and autism, which were once unfashionable, but then were the subject of landmark legislation and rose up the political agenda. That led to some success, and a huge impact on the people affected by the conditions, and their families.
I want to thank the charity Pancreatic Cancer UK for its brilliant work to raise the issue—and particularly David Park, whom I met a few months ago for a briefing—as well as the all-party group on pancreatic cancer. Seldom do all-party groups make an impact, but that one has set an agenda with the report it produced last year. I also thank Maggie Watts, of course, for her fantastic work. Her diligent, committed efforts got the e-petition going. It would have been easy for her to step back and say, “This is not something I want to get involved in. It is Government and politics, and I will leave it to someone else.” However, her sheer passion and commitment to doing what she thought was right, to right a wrong and raise an agenda, have been utterly commendable, and I congratulate her.
As we have heard, the issue is not one that can be tackled by pressing one or two buttons. The dreadful comparisons that can be made between pancreatic cancer survival rates and those for others including breast cancer and prostate cancer have been pointed out. For example, in 1971 the survival rate for prostate cancer was 31% and it is now 81%. My view is that because pancreatic cancer is now so prevalent and such a major killer, it is no longer acceptable, as a matter of NHS governance, that it should be left solely to the discretion of clinical commissioning groups. I am not a born-again centralist, but I believe we need very strong guidance, at least, from the Department of Health and the NHS, to bring the experience of the best, such as the University Hospital Southampton priority jaundice clinic, to the rest of the country. That is enormously important.
Progress has of course been made in the past few years. NICE is improving outcomes for upper gastrointestinal cancers and of course a pancreatic cancer quality standard is in development. Those things, and the cancer outcomes strategy of 2013, are all very welcome. Of course, they are focused on the quality and efficiency of cancer services, improving patients’ experience of care, and the quality of life of patients and cancer survivors. The hon. Member for Scunthorpe made the point that it is vital for the Government to have both quantitative and qualitative data at their disposal, to make value judgments about research.
I came to this subject almost by accident. It is an often overlooked aspect of being a Member of Parliament that we may stumble on issues, and then have the capacity—the honour and privilege, through being elected—to ask awkward questions and make ourselves a bit of a pain in the backside by doing so, sometimes.
Or frequently, in my case, as my hon. Friend says.
A good friend of mine—a non-political friend in my constituency—was utterly shocked at the premature death of the husband of a very good friend of hers. He was, I think, 48, and the father of two young children. He had visited his general practitioner several times and was told over again that he was suffering from a very bad case of back pain. By the time he had his scan it was too late; the tumour was inoperable and was wrapped round other vital organs. It was not possible to operate and the poor gentleman died, leaving a young family, a matter of weeks later. That account prompted me to think and research more. Of course, I read the moving article that my hon. Friend the Member for Lancaster and Fleetwood wrote for The Daily Telegraph about his experience and the tragic death of his partner such a short time after diagnosis, and that, too, prompted my interest.
Figures have already been given about the comparative spending on different cancers. The current figure of 1% of research spending, representing £5.2 million, is pitiful for a cancer that is so prevalent. If 8,800 people were being knocked down on the roads every year or killed on level crossings or through any other possibly preventable cause, we would demand immediate action; but it seems we are prepared to countenance little if anything being done by central Government on pancreatic cancer. That is not a party political view, obviously. The comparative data show that the USA has a 6% survival rate after five years and Australia has a rate of 5%; but in the UK it is only 3.3%. We must address that. My hon. Friend the Member for Stevenage (Stephen McPartland) made the point that it is shocking that people attend accident and emergency jaundiced and clearly seriously ill before it dawns on anyone that they are in the advanced stages of pancreatic cancer. I just feel that something more can be done, not least because, according to the briefing we have received, one in six people attend a general practitioner or other health care facility more than seven times, yet they do not receive the treatment they need.
I congratulate my hon. Friend on his powerful speech. I think we all accept that earlier diagnosis is cancer’s magic key. The problem is that one in four cancers are first diagnosed late in A and E and the figure for pancreatic cancer is double that—nearly half of all pancreatic cancer patients are diagnosed there. In fairness to the Government, and I will speak about this when I make my speech, does my hon. Friend agree that the focus on survival rates as a means of driving forward initiatives for earlier diagnosis at local level, whether better awareness, better screening, better diagnostics or better care pathways, is the secret to unlocking this dreadful disease?
I thank my hon. Friend for his excellent work as chairman of the all-party group on cancer in raising the issue of cancer generally. He is right in saying that there is no magic bullet and that a multi-faceted strategy is needed to deal with the issue. I will elucidate on that in a few moments without taking up too much further time.
The hon. Member for Worsley and Eccles South is right about public perception. We must remember that 25% of men and women who are diagnosed with this condition are not old, but younger men and women. The public should understand and embrace that fact, and I know from my experience of a much younger man who was diagnosed with the disease and died very quickly. It affects everyone throughout the country irrespective of gender, age, ethnicity, region and so on.
Over and above academic research, we should focus on GP education. This is not an opportunity to have a go at general practitioners, who do a fantastic job and work hard, but reference has been made in the nicest possible way to the ping-pong effect, as was mentioned in the all-party group’s report. We must stop that and make a decision to have clear strategies with a clinical pathway that people can get on to if they exhibit certain symptoms.
There are several reasons for the poor rate of diagnosis, which are not strictly speaking the “fault” of the general practitioner. As I have already said, there are no definitive biomarkers or tests and there is no way to get round that. It may be ameliorated or overcome following future research, but at the moment GPs are unable to decide definitively that someone is suffering from pancreatic cancer. That is clearly linked to more funding over and above the current 1%, to which I will refer later.
Low awareness of symptoms among the general public needs a multi-media approach to try to persuade people that they are not wasting a general practitioner’s time by alerting them to their symptoms, even if they are under 65. There is a lack of obvious referral pathways into secondary care for patients without obvious symptoms. The hon. Member for Worsley and Eccles South gave an excellent anecdote about the way people are pushed around between different clinicians. That is completely different from the treatment of breast cancer where there are prescribed and definitive treatment pathways.
What are the priorities? It is vital to develop local screening tests. People should not have to travel 40 or 50 miles, and there should be such a testing facility locally in an acute district hospital or in primary care facilities. There should be collaboration between clinical commissioning groups, for example, as well as GP training, referral guidelines and diagnostic support.
I am realistic and I understand that not every GP will be an expert on pancreatic cancer, but there should be a general practitioner in the local area who can offer expert advice, training and assistance. GPs should also have direct access to CT scans. The all-party group on pancreatic cancer made all those recommendations. There should be one-stop shops where patients with vague symptoms can have a battery of different diagnostic tests. That would not remove the risk that someone has pancreatic cancer, but it would reduce the risk that they remain undiagnosed. There should be a rapid access clinic for jaundiced patients. It may be too late for some people, but some may be saved.
We need research into the biology of tumours and we must look again at the cancer drugs fund, as my hon. Friend the Member for Lancaster and Fleetwood said. We must move to a personalised-medicine approach. It is wrong that pancreatic cancer is struggling to receive even £10 million a year for research. The Department should aspire to higher funding than the current £700,000. It should aspire to £25 million by 2022. We need a new strategy along the lines of the Recalcitrant Cancer Research Act passed by the US House of Representatives for cancers of unmet need. We must ring-fence grants for such recalcitrant cancers by means of clinical trials.
This has been an excellent debate. I am convinced that the issue will rise up the political agenda and I thank everyone who has made that possible. I have had dealings with the Minister and I know that she is compassionate and diligent. I believe that she and her Department are listening and that we are well on the way to beating pancreatic cancer.
I am grateful to you, Mr Chope, for giving me the opportunity to speak in this important debate. I add my thanks to the hon. Member for Lancaster and Fleetwood (Eric Ollerenshaw) and my hon. Friend the Member for Scunthorpe (Nic Dakin) for securing it. We heard two excellent and personal speeches from them both. I echo the kind words from my hon. Friend and those from my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) about Julie Hesmondhalgh and her role in this. I am proud to say that Julie is one of my constituents. I hope that the hon. Member for Lancaster and Fleetwood will not mind me saying that another important constituent is his mum. I think we all agree that she should be very proud of his speech and the part he has played in the campaign.
This is a hugely important topic, about which there has been great public concern, as evidenced by the e-petition calling for more awareness and funding having reached more than 100,000 signatures. My awareness of pancreatic cancer has substantially increased due to the effectiveness of the campaign. I have been shocked at the information the campaign has highlighted, particularly about mortality rates, and I am pleased that we have the chance to discuss this issue today.
As we have heard, the threat posed by pancreatic cancer could not be starker. It is the fifth leading cause of cancer deaths in this country and, worryingly, has the worst survival rate of all cancers. Despite that, it receives only 1% of research spending, and that figure has jumped out at many of us when we have been approached by constituents, yet the survival rate has been just 3% over five years, having not improved in more than 40 years. I was staggered to learn that, especially as the cancer mortality rate overall between 1996 and 2008 fell by 19%. The statistic is terrible on its own, but even more worrying in that context.
As a result, I have several concerns, which other hon. Members share and which I want to raise today. However, first, I want to pay tribute to my constituent, Mrs Jan Lord, who was brave enough to share with me her personal experience of losing her mother to pancreatic cancer. Jan’s mother had been complaining of bowel and back problems for months before she sadly passed away in September 2012 from pancreatic cancer. She had been told by her GP and hospital doctors that her mother’s deterioration was due to irritable bowel syndrome or perhaps just old age. Her mother was diagnosed with pancreatic cancer just five weeks before her death, and Mrs Lord believes that that diagnosis was reached only when she had pressed doctors to investigate further her mother’s failing health. That is a very sad story to hear, especially when we consider that with greater awareness and understanding, things could have been different. I am sure that everyone present today can sympathise and has heard similar heartbreaking stories from their constituents. I hope that there is some comfort in the fact that many of the families affected by such stories have been the ones behind this campaign to raise awareness, and they should be very proud of what they have achieved.
I want to bring up some specific issues that I hope the Minister will address in her closing remarks—of course, they are similar to those we have heard in other speeches. The first is that lack of research spending, or, more accurately, that lack of research spend. As I have mentioned, the pancreatic cancer research field currently receives only 1% of all cancer research spend, and we have to find a way to improve the amount of research occurring. The urgency for that is paramount. More research will lead to earlier diagnosis, which is crucial, especially because earlier diagnosis means a greater likelihood of being able to operate. I understand that, at present, only 10% of people diagnosed are offered surgery as a solution.
Early diagnosis will also mean that we are able to run more clinical trials and improve the data we possess. Those two things are clearly related. I was present at the meeting last week of the APPG on pancreatic cancer, where that subject was raised. It was an incredibly useful and insightful meeting. An argument was put forward about the need to improve the way in which we record and use patient data, making them available far sooner—in fact, almost as soon as the patient interaction occurs—to improve our understanding of what might be successful. The arguments were so compelling that they have made me substantially rethink how I feel about patient data and how they can be used in future.
I would be interested to hear what the Government believe is necessary to develop better screening tests. The analogy given at the APPG was that we are currently asking a GP to sit on a motorway bridge on the M1 and spot a car that passes only once every three years. Clearly, we need to give GPs more support, and I hope that the Minister will express a willingness to do so. In our system, the GP is the gatekeeper; they are the first port of call for a patient, and we have to recognise that we are asking something very difficult of them. However, research shows that knowledge of linking pancreatic cancer symptoms to the disease is often low and that diagnosis is often missed, which is perhaps not surprising given the lack of research and that many similar but less deadly ailments have comparable symptoms. GPs do an excellent job—I hope they do not think we are having a go at them—but they clearly need more help in this area. To go back to the comments at the APPG, we need to find a way to put some cameras on the M1 bridge to help them spot that car going past.
My hon. Friends in the shadow health team are looking at how best to improve cancer diagnosis, treatment, research and outcomes across a range of cancers. I was cheered by the shadow Secretary of State for Health, my right hon. Friend the Member for Leigh (Andy Burnham), saying that improving cancer outcomes would be a priority for us, and I believe that we will see a cross-party agreement on that in future.
To conclude, I want to pay tribute again to the hon. Members who secured the debate and to the remarkable campaign behind it. I also want to thank again my constituent, Jan Lord, for her campaigning and the courage she has shown in highlighting the need for more to be done to tackle pancreatic cancer. I believe that it has shown that not enough is happening at the moment and I intend to take a close interest in this area now that I am aware of just how great the need is. I look forward to the Minister’s response, and I hope that the Government also see this as a priority in future.
I congratulate the hon. Member for Scunthorpe (Nic Dakin) and my hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw) on securing this important debate, as well as other Members on their powerful contributions so far.
May I, as chairman of the all-party group on cancer, focus my remarks briefly on the importance of earlier diagnosis? That has been touched on by everybody who has spoken, but sometimes when we consider the figures that are available, they bring into stark relief the need to drive forward local initiatives to encourage earlier diagnosis.
Recent statistics have clearly shown that if we could match the average one-year survival rates in Europe, we would save something like 5,000 lives a year. The recently published OECD report said that if we could match the average international one-year and five-year survival rates, we could save up to 10,000 lives a year. Those are the sorts of numbers we are talking about. They run very easily off the tongue, but those are individual lives and it is individual grief when it comes to family and friends. It is shameful in this country that something like one in four cancers are first diagnosed as late as A and E. That cannot be right and when it comes to pancreatic cancer, as I think everybody in this room knows, the figures are much worse. They double: something like half of all pancreatic cancer sufferers are not first diagnosed until they reach A and E, when often the condition is so well advanced that it makes survival far less likely, which the figures bear out.
Many years ago, the all-party group on cancer produced a report on cancer inequalities. We found that we in this country stand as much chance as anybody else of getting patients from the one-year point to the five-year point, but compared with others, we fail to get patients to the one-year point. What that suggests, and this was substantiated by the good and great of the cancer world at the time—that report was now five years ago, which suggests that I have been chairman for far too long—is that the NHS is as good as anybody else, and maybe even better, at treating cancer once it has been diagnosed, but it is very poor at diagnosing cancer in the first place. Once we fall behind that one-year point, it is very difficult to make up the lost ground. We lose those 5,000 or 10,000 lives—depending on what we are comparing—at that one-year point, and it is exceptionally difficult to catch up, no matter how good the treatment is within the NHS.
We therefore came up with a very simple measure to try to drive forward earlier diagnosis. It was very straightforward, because we believe that early diagnosis is cancer’s magic key—if we can catch the cancer earlier, we stand a so much better chance of improving all cancers, including pancreatic. Instead of bombarding the NHS with a load of targets, we decided to come up with one measure: to get the local NHS—then the primary care trust, now the clinical commissioning group—to focus on one-year cancer survival rates. The logic is very simple: if there is late diagnosis, we get poor one-year figures. Therefore, by getting the local NHS to focus on one-year survival rates, we get the local NHS, through the CCGs, to focus on introducing initiatives to drive forward earlier diagnosis. It is that simple.
What could those initiatives be? It is up to the local CCG managements—the local NHS managements—to decide what initiatives to introduce that best suit their local populations. They could be, for example, better screening uptake or better diagnostics at primary care. They could be better referral pathways to, for example, CT scans, or better awareness campaigns. It could be any or all of those coming together to drive forward local initiatives to encourage earlier diagnosis.
This is where I would like to congratulate the Government. That may come as a bit of a surprise on my side, but I think the Government have done what is required in this respect, because as of the end of—let me get this right—June, we now have, in the local DNA of the NHS, one-year survival rates. That is very much to be welcomed, because broken down by CCG, it is now going to encourage managements—or it should encourage them—to focus on their one-year figures, and where they are behind, where they are towards the bottom of the table, it will encourage them to act. All of us will be coming together—the cancer community, cancer charities, MPs and local politicians—and putting the spotlight on the underperforming CCGs. If it works as it should—and provided the levers of change and accountability are there—that should encourage underperforming CCGs to raise their game and introduce local initiatives to encourage earlier diagnosis, and over time, improve their one-year survival rates.
The tools are in the toolbox for us all to use to encourage earlier diagnosis. I congratulate the Government on actually listening, because we have been campaigning on this issue for five years now and we now have those tools in the toolbox. However, things are never quite what they seem, and I wanted to speak in this debate to bend the Minister’s ear on a particular issue. We all have our wish list of things that we would like to see introduced by way of initiatives, and I know that the Minister will respond in the fullness of time, if not in this debate, but one thing that I would like to get across to her is what we have learned since succeeding in getting the one-year figures into the local DNA. CCG chief executives have been contacting us and others in the cancer community, making the point that CCG chief executives are more focused on the delivery dashboard, as part of the assurance framework, than on the outcomes indicator set, which is where the one-year cancer survival rates are placed.
We had been aiming to get the one-year figures in the local DNA, which is great. We have succeeded, but lo and behold, another layer of accountability has been shunted in, which has knocked down the OIS, and CCG chief executives are now more focused on the delivery dashboard than on the OIS. There is actually no health outcome in the delivery dashboard, and I think that that is wrong, because in the health reforms introduced by the Government, there were two big ideas. There was the restructuring, which some of us did not agree with, but there was also the focus on outcomes, which was a brilliant concept and, I think, will be far more transformative for the NHS than any restructuring. The restructuring is now history, but the focus on outcomes as a way to deliver improvements or focus on improvements is a real plus. However, if we then put that focus on outcomes in a structure that gets knocked down when it comes to accountability and CCG chief executives are instead focusing on the delivery dashboard, introduced by NHS England and the Department of Health, that risks dissipating the potential benefits that we could see by focusing on outcomes.
I therefore ask the Minister this, and she does not have to reply in this debate. I do not want to put her on the spot, but she knows that I have raised this issue before. Could we focus on putting health outcomes into the delivery dashboard? I am focusing on cancer. I think that the one-year figures in the delivery dashboard would be transformative. We have the figures. They are broken down by CCG. There is no reason why they could not be put into the dashboard. I am speaking with high-ranking officials—I will not name names, but the Minister will know who they are, because she knows whom I am meeting—in NHS England, and they cannot see any reason why that should not happen either, so we need to push on this. If we are serious about saving by 2014-15 or 2015-16 those extra 5,000 cancer lives—that was described to me as above the already improving trend line—we have to ensure that health outcomes are in the DNA of the NHS and that CCG chief executives are focused on them and know that if they do not deliver and they underperform, there are levers of accountability that will really put the spotlight on them. That is how we will improve outcomes in the NHS and how we have to drive forward improvements in the NHS.
Even if we just meet the average in Europe, that will be 5,000 lives saved, which is a phenomenal number, and that is just the average. The average survival rate in this country is about 68% or perhaps 69%; in Sweden, it is over 80%. That is what we are talking about; that is the potential, but we have to get those outcomes into the DNA of the CCGs, and we are being told and are advocating that the best way to do that is by getting it into the delivery dashboard. I shall leave that point with the Minister. I do not want to thrash it too much. She knows where we are coming from, and we will be raising the issue in December at our Britain Against Cancer conference, which will be attended by 500 or 600 people. The great and the good of the cancer community, including the charities, will come together, and we will focus on that.
May I also ask the Minister this, please? She has had our report from last year, “Cancer across the Domains”. We still have not had a response; there has been no official response from the Department of Health to that report. I spoke with her before the recess. I encourage her, please, to let us have that response, because time is now on the wing, given that we have Britain Against Cancer. If the Minister thinks that she has sent it, I would love to know, because we have not received it. If the fault is at our end, I will be the first to apologise, but we have not received it yet—neither the secretariat nor my office.
In conclusion, Mr Speaker—Mr Chope, my apologies. [Laughter.] I do not know whether you will be standing, Mr Chope, but there is plenty of potential, I am sure. I congratulate the Government. We have the focus on outcomes. We have the one-year measure. We have the tools in the toolbox. However, I suggest that unless we put those one-year figures in the delivery dashboard, we will not be using those tools, and many cancer patients will suffer as a result.
Order. Before I call Mr Morris, let me just say that two other hon. Members wish to speak after him. The latest time for starting the winding-up speeches should be 7 o’clock, which would give us half an hour for those two speeches. If we can have a bit longer, so be it, but if we can fit three speakers into the remaining time for Back Benchers, that would be helpful.
Thank you for calling me, Mr Chope. I apologise for not being present for the whole debate; I meant no discourtesy to colleagues. I wanted very much to speak in the debate. I begin by congratulating my good and hon. Friend the Member for Scunthorpe (Nic Dakin) and the hon. Member for Lancaster and Fleetwood (Eric Ollerenshaw), who made a very moving contribution. I also thank the Backbench Business Committee and, indeed, all the volunteers. I had the pleasure of meeting Maggie Watts, but there are also many hundreds of others working in charities and as volunteers who have campaigned so effectively on this issue; they have helped secure the signatures to get this debate on what is very often a forgotten and neglected form of cancer.
I know that there are time constraints, but there are some specific issues that I want to raise with the Minister. I will just make some general points and then move straight to my questions. We know from earlier contributions that pancreatic cancer is not an uncommon cancer. My understanding is that by the time this debate has concluded, three more people will have lost their lives to the disease.
We heard in the contribution from the hon. Member for Basildon and Billericay (Mr Baron) that the UK still lags behind most other European countries when it comes to cancer survival rates. To be fair, there have been significant improvements in cancer treatments across the board in recent decades, but as we are aware the rates for pancreatic cancer, at 5.2%, have virtually stood still in the past four decades, so this is not a criticism of the current Minister or the present regime—the present Government.
The very nature of pancreatic cancer contributes towards poor survival rates. I do not intend to go over the arguments put so eloquently earlier about the difficulty of getting a proper diagnosis and the lack of an effective pathway to make the necessary early referrals. However, one thing that I am concerned about—I want to put this point to the Minister—is this. Yes, it is very important to have awareness campaigns, and I pay tribute to the campaigners who have brought this subject to Parliament today, but if we are to have real progress, there need to be improved treatments as well. Pancreatic cancer receives just 1% of the National Cancer Research Institute partners’ research spend. That equates to £625 per death.
[Philip Davies in the Chair]
I fully understand that we one cannot equate such things in financial terms, but that compares with almost £3,500 per death on breast cancer, the campaign against which receives much more public attention. If we as politicians—I am talking about all politicians; this is not a criticism of the Minister or the Government—are serious about improving survival rates for pancreatic cancer, our rhetoric must be backed up with firm action on the allocation of resources.
We have heard that relatively few treatment options are available for patients with pancreatic cancer, and research into the development of new drugs and treatments is key if we are to bring survival rates for pancreatic cancer down towards those of other common cancers. Over the past week or so, the case of the little boy Ashya has been in the news, and we have heard about the terrible circumstances and trauma that his parents went through in being unable to access the advanced radiotherapy that they felt was an appropriate form of treatment for their son. The hon. Member for Lancaster and Fleetwood has already referred to the potential of advanced radiotherapy. Forms of the treatment such as NanoKnife and CyberKnife, which can target tumours very precisely with intense bursts of radiation, may be particularly effective for some, although not all, pancreatic cancer patients.
I know that the Minister is sick of me going on about advanced radiotherapy, but we are not doing as much as we should to develop the evidence base for the treatment. I fully understand that it is not suitable for all types of cancer, or even for all types of pancreatic cancer; there are a number of different forms. The National Institute for Health and Care Excellence insists that before it allows routine use of the treatment, particularly in the NHS, there must be an evidence base.
Many of the cancer charities that I have spoken to have argued that, as a matter of urgency, the technology for advanced radiotherapy must be verified. I make an appeal to the Minister on that. Patients already receive advanced radiotherapy for other cancer types, and the treatment is available for private patients. I fully understand that we need to have an evidence base and see what is effective in different circumstances. Until research into advanced forms of radiotherapy for the treatment of pancreatic cancer is increased and the viability of the technology can be properly verified—until we actually grasp the nettle and fund the research and the trials—NHS patients will continue to miss out.
The hon. Gentleman and I have debated radiotherapy and chemotherapy several times. I am proud that my NHS hospital trust was given the first CyberKnife by a wealthy donor, so it has the evidence required for advanced techniques and advanced radiotherapy. I sound a note of caution, however. My constituents have to make a 60-mile round trip to access that treatment. We have just opened a chemotherapy unit that can be used by someone who has cancer in Stevenage, but if they receive radiotherapy they often have to make a 4,000-mile journey over the course of their treatment. Although patients can have advanced radiotherapy, the difficulty is accessing that treatment.
That is a sensible point, which I have made to the Minister and several of her predecessors on a number of occasions. My view is that each of the 28 cancer networks should have access to advanced radiotherapy and that we should carry out a series of trials to evaluate the effectiveness of that treatment.
I would be interested to hear the Minister’s response, particularly on research into advanced radiotherapy. I hope that when our successors debate the matter in 40 years’ time, they will be talking about survival rates significantly higher than the current 3%. For that to happen, I respectfully say that the Government, or a Government, must act.
It is a pleasure to serve under the chairmanship of my neighbour, Mr Davies. I begin by congratulating the hon. Member for Scunthorpe (Nic Dakin) on securing the debate. It has been my pleasure to work with him in the past on the campaign for the children’s heart unit in Leeds, and I know how dedicated he is to a cause once he gets the bit between his teeth.
I also pay tribute to my hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw). I was interested to hear the hon. Member for Stalybridge and Hyde (Jonathan Reynolds) say that my hon. Friend’s mother lives in his constituency. Having heard a lot about my hon. Friend’s mother, I would love to see the canvass session when the hon. Member for Stalybridge and Hyde knocks on the door asking for support at the next election.
On the subject of the election, as someone in a marginal seat I have started to reflect a bit on my time here and wonder whether I will be re-elected. I have been remembering the things that have happened during those few years. I will take away many good memories, and I will be sincerely pleased also to take away my friendship with my hon. Friend the Member for Lancaster and Fleetwood. Thanks to his experience in politics over many years, he has given me good counselling and good advice.
On the subject of the debate in particular, my hon. Friend has often struggled with something that was very personal to him and very difficult, and he has often worried about his privacy and that of his partner. I want to put on the record how proud I am of him as a friend, and how proud I am of his campaign. I did not have the privilege of meeting his partner, but my hon. Friend has done that job exceedingly well.
I add my thanks and congratulations to the actress Julie Hesmondhalgh. She will not know this, but we met many years ago. Longer ago than I want to think about, I was at a Manchester Pride event dancing away on the set of Baker Street in Granada Studios, when bouncing along next to me came Hayley, as we all knew her then. She has clearly put her enthusiasm and her smile into the campaign. Having worked in the charity sector, I know that it is a great achievement to get someone with such magnetism behind a campaign. She has done a fantastic job in supporting the charities involved.
In 2012, I attended another debate on pancreatic cancer in Westminster Hall secured by my hon. Friend the Member for Lancaster and Fleetwood. I also attended his debate in March this year in the main Chamber, in which he rightly called for the drug Abraxane to be made available on the cancer drugs fund in England. I made the point that, given the short time that some patients face, if Abraxane gives someone only an extra couple of weeks, those are still an important couple of weeks for patients and their families to get their affairs in order. I was keen to take part in yet another debate on the subject, this time as a result of an e-petition. Many people have thanked Maggie Watts and her fellow campaigners. This is one of the occasions when Parliament actually works for people in this country.
I have been involved in a similar campaign for ovarian cancer. Through a debate like this one and by meeting Ministers, we managed to get an awareness campaign piloted in several areas in the country. I hope that that will be the start of improving diagnosis of that cancer.
During the debate in May 2012, my hon. Friend the Member for Lancaster and Fleetwood told us that 8,100 cases of pancreatic cancer were diagnosed each year. It is sad and terrible that that figure now stands at 8,800. It is even more tragic that 8,300 people died from pancreatic cancer last year—that is 23 people every single day. In simple terms, the mortality figures for pancreatic cancer are getting worse and the survival figures have remained largely unchanged. More people are being diagnosed with the disease and more people are dying of it. That is happening at the same time as mortality rates for most other cancers are falling and survival rates for most other cancers are rising. There is a huge inequality of outcomes compared with other cancers that needs to be addressed. There is still so much that needs to be done to improve the chances for pancreatic cancer patients, as well as for their families and loved ones, who are often overlooked in such situations.
I will now explore the inequality of outcomes in a little more detail and in a couple of different ways. The truth is that there is variation in pancreatic survival outcomes, both internationally and regionally within the United Kingdom. I will take the international outcomes first. The UK lags behind many G7 and G20 nations when it comes to pancreatic cancer survival rates. According to the Pancreatic Cancer Action charity’s website, the five-year survival rates in the US and Canada of 6% are nearly double the survival rates in the UK. Australia is also ahead of the UK on the same measure with 5.2%.
Our European neighbours also seem to perform better than us on pancreatic cancer. The EUROCARE-4 study of 2009 found that the UK’s relative one-year survival rate for pancreatic cancer, at 15.85%, was well behind the European average of 20.9% and behind countries such as Portugal, Spain, Poland and the Czech Republic. Belgium came out on top with 28.3%, nearly twice the UK’s figure.
I will now come closer to home. I know that the figures may come about because of the different ways in which data are recorded, but the trend seems to be clear. Will the Minister say whether any work is being undertaken to try to establish why other countries seem to be achieving much better patient outcomes? Is the Department of Health doing anything to try to learn from those other countries?
The truth is that there are large variations in survival rates across the UK, too. Five-year survival rates in England, based on the 2012 data, were 5%, whereas the survival rates for Scotland were just 3.2%, Wales 3.4% and Northern Ireland 4.7%. One-year survival rates saw the same fluctuation: England on 19.6% and Scotland again behind on 15.7%. There are even massive variations between the regions of England. Using a regional comparison of five-year survival data put together by the charity Pancreatic Cancer UK, based on the old English cancer network boundaries, the best-performing part of the UK was north-west London on 8%. That rate was four times greater than the rate in the Greater Midlands cancer network area. My own area of Yorkshire fared about average on 3.6%.
Again, those variations could be down to the way the data are collected, public health issues or any number of things, frankly. We need some research to get the answers because, on the face of it, if we can bring the worst performing parts of the UK up to the very best, we will go from being the laggard in world performance to being the world leader. What is the Department doing to try to work out why there are such variations in outcomes across the UK? What can we learn from north-west London and export to other parts of the UK? How can we start to end the existing postcode lottery? I am asking for research into why such differences exist.
In addition to more procedural and systems-oriented research, we need more scientific, medical and clinical research into pancreatic cancer. The National Cancer Research Institute report on spending across all cancer types between 2002 and 2011 concluded that spending on pancreatic cancer research is still relatively low. As we heave heard, £5.2 million a year is put into site-specific pancreatic cancer research, compared with well over £40 million for breast cancer. It seems fair to draw a link between those levels of research funding and the relative change in breast and pancreatic cancer survival rates over the same period. Breast cancer survival has soared, whereas pancreatic cancer survival has remained largely the same.
The Minister and her colleagues in the Department of Health have given a number of answers to written questions on this subject over the past year or so. All those answers point to large sums being spent at different institutes, including the Liverpool pancreas biomedical research unit, where £6.5 million is being spent on researching gastrointestinal disease. Although some of that money is likely to be spent on pancreatic cancer research, it will be only a small portion of the overall sum.
The fact remains that, although funding for general cancer research is welcome, and some of that work will undoubtedly benefit advances in pancreatic cancer care, there is still not enough site-specific research. Given that pancreatic cancer is such a difficult cancer to diagnose and treat, more support from major funders is needed if we are to see the advances that we need. Does the Minister have any plans to work with the NCRI, the Medical Research Council, the National Institute for Health Research and others to seek increased funding for pancreatic cancer research in coming years?
As we have heard, pancreatic cancer has some of the worst survival rates of any cancer tumour. Attention must rightly be focused on improving diagnosis and patient care, but support following a terminal diagnosis is also crucial. I have bored hon. Members many times about my background in the hospice movement, but in that movement I have seen the excellent work being done by so many organisations. I am pleased that we are seeing more palliative care in the community, but it is important that we get it right. There is a saying that nothing is certain in life other than death and taxes. In politics we seem to talk an awful lot about taxes, but we do not talk a lot about death.
I have seen so many people who were not able to die in the place they wanted. Recent studies show that 79% of people want the opportunity to die at home, and slightly fewer would prefer to die in a hospice, but just 23% of people get to die at home. The reason is that it takes planning, and the problem with pancreatic cancer is that time is often against the patient. There is not an opportunity for patients to go in and get the excellent care that hospices provide. Families I have spoken to have wanted to get their relative out of hospital but, as my hon. Friend the Member for Lancaster and Fleetwood said, they had entered the cancer world and suddenly all the decisions that had to be made became so difficult. Before the family knows it, the patient has sadly lost their life.
I pay tribute to the work of hospices, and I hope that we can do more work so that they are able to get to these patients quicker and provide a better environment as patients come to the end of their life. I hope we can expand palliative care in the community, and I pay tribute to nurses such as the Macmillan nurses, who offer excellent home support.
There are a couple of things that would help to get palliative care right. Access to emergency medicine packs is important. It is vital that they are stored in the homes of palliative patients who have chosen to spend their last days at home. The packs contain strong medication that can be administered by a registered nurse or doctor. Pancreatic Cancer UK’s support line, however, has received calls where that has simply not happened. In one case, the family had to wait for the Macmillan nurse to arrive and there was no emergency medicine pack. The nurse had to obtain a prescription from a GP and collect it from a pharmacist, which took four extra hours. That was incredibly upsetting for the patient and for the family, who had to watch their loved one suffer. I would like us to look more broadly at developing further packages of 24-hour, seven-day-a-week community care so that we can help more people die in the place of their choice.
We have heard some excellent, varied points today. There is a danger in such debates that we all make the same points, but it has been incredible that today’s speeches have all touched on different things. I also praise David Park for the work he has given us, and, finally, I pay a special tribute to my hon. Friend the Member for Lancaster and Fleetwood. I will break a parliamentary rule by saying that, Eric, you have done a fantastic job.
It is a pleasure to serve under your chairmanship, Mr Davies. I am grateful for the opportunity to take part in this important debate. As my hon. Friend the Member for Pudsey (Stuart Andrew) just said, it is one of the most important and enlightening debates that we have had the privilege to take part in. I pay heartfelt tribute to the hon. Member for Scunthorpe (Nic Dakin) and my hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw) for the huge amount of work that they have done not just to help secure this debate but across the board to promote the issue of pancreatic cancer.
One of the most important and rewarding parts of being a Member of Parliament is championing and giving voice to issues that often go unsung and ensuring that they get the attention and consideration that they deserve in Government and agencies. I echo what my hon. Friend the Member for Pudsey (Stuart Andrew) said about my hon. Friend the Member for Lancaster and Fleetwood. I know how hard it is for him to speak publicly about matters that are private and personal; the fact that he does so to champion this important issue is entirely to his credit. I am proud to call him my friend as well as my colleague. Like everyone else, I pay tribute to Maggie Watts and everyone who has worked to ensure that the e-petition was successful and that we met here to talk about it.
This debate has covered many important issues, but I will explore an aspect of early diagnosis that has been mentioned: what we can do to improve referral systems. As we have heard, that is particularly important in cases of pancreatic cancer. Some 16% of pancreatic cancer patients must visit their GP or hospital seven times or more before the correct diagnosis is made. By comparison, 75% of all cancer patients combined are referred to hospital after only one or two visits to their GP.
As we have heard, we need to do more to train GPs and give them effective tools to identify possible cases of pancreatic cancer, and for that matter any other type of cancer, more quickly. However, once GPs have identified cancer as a possible cause of a patient’s symptoms, that patient needs to be referred for specialist tests to rule cancer in or out definitively, and such referrals must be made quickly and as effectively as possible. The hon. Member for Scunthorpe and others have mentioned the ping-pong or tennis-ball treatment of sufferers who are referred to specialists to rule something out, then back to their GP, then back and forth until the correct diagnosis is made. As we have heard, it is often too late by then for any effective treatment.
The all-party group report concluded:
“This process of going backwards and forwards between primary and secondary care—with waits between appointments and test results—is frustrating from all perspectives. For those patients who are eventually diagnosed with pancreatic cancer, and find that they have been diagnosed at a stage too advanced for curative treatment, it is simply heartbreaking.”
We must do all that we can to break the cycle and get patients referred for specialist tests, and give them the outcomes of those tests, as soon as possible.
There are several ways in which we could help in that area. One is to ensure that robust and clear referral guidelines for pancreatic cancer are produced, helping GPs to make the right referral in the first place. Effective referral guidelines should highlight for GPs the best diagnostic routes for patients with particular symptoms and help speed up the diagnosis process, as well as making it more accurate. The guidelines need to set a low threshold at which GPs should consider sending patients on for specialist and definitive diagnostic tests if they display the symptoms of pancreatic or other types of cancer. Let us be honest: in most cases, cancer will not be the reason for a patient’s symptoms, but we should move to a system in which we seek to rule out cancer at an earlier stage.
Scotland has been mentioned a couple of times. I want to explore what is happening north of the border, although I know that everyone is preoccupied with a certain vote happening next Thursday. Healthcare Improvement Scotland is doing something potentially instructive for cancer care in the rest of the UK. It has just updated its referral guidelines for the NHS in Scotland to improve the list of symptoms that prompt GPs to consider whether to consider that a patient may have pancreatic cancer. Importantly, it has also set a low threshold at which patients presenting with particular symptoms—for example, non-responsive dyspepsia or late-onset diabetes in a weight-losing patient—should be referred for imaging scans or other diagnostic tests. That approach should be considered for the rest of the country. In her concluding speech, can the Minister tell us when NICE is planning to review its cancer referral guidelines for England and whether draft new guidelines will take note of what has happened recently in Scotland?
Faster access to imaging scans, especially for GPs, will help to make more definitive diagnoses more quickly; the hon. Member for Scunthorpe and others have raised that point. To quote again from the all-party group report, one experienced GP said:
“Presently a (hospital) doctor who has had…two years’ medical experience can request a CT scan for a patient in hospital—where I can’t.”
We should consider introducing systems that will allow GPs more direct access to scans for their patients. I know that there will be concerns in some quarters that radiology departments could become clogged up with needless referrals. However, again, looking north of the border is instructive. Scotland has made a step in that direction, and new guidelines making it easier for GPs to make direct referrals for imaging tests have been introduced. As I understand it, when the approach in Scotland was piloted, it did not lead to a clogging-up of the system, so it was rolled out more widely. Ultimately, I do not think that we should ignore the importance of treating symptoms as cancer until proven otherwise, and CT scans remain an effective way of achieving faster and more definitive diagnoses. Is the Minister prepared to consider that further for England?
The next issue is what I might term “three strikes and you’re referred”. There must, of course, be some sort of investigative threshold in place; not every patient can or should be sent for a scan. One way is to prioritise patients with particular symptoms, based on solid referral guidelines, as I mentioned earlier. However, another approach, or even a tandem approach, would be to send for a scan patients who have repeatedly turned up with the same vague symptoms a particular number of times, in order to get to the bottom of things once and for all.
I understand there have already been discussions in and around the NHS for a “three strikes and you’re referred” policy, under which if a patient visits their GP three times with the same symptom or set of symptoms that have not been resolved, they should be referred to secondary care for further investigation to get to the bottom of the problem. That is vital for pancreatic cancer, but it could also be important for other conditions that often go undetected for long periods. In my constituency this morning, I met representatives from a Huntington’s disease charity. It is an issue with that disease as well: people have the symptoms of all sorts of illness, but they are not diagnosed with Huntington’s until quite far down the line, often when earlier treatment could have been more helpful. The Department should consider such a policy, particularly for pancreatic cancer but more widely as well. Can the Minister say whether her Department is looking at introducing a cut-off point where a patient should be referred for more definitive tests, such as a CT scan?
Perhaps a more radical approach, which again is discussed in the all-party group report, is to create “one-stop shops” where patients with vague symptoms can have multiple tests carried out in one place rather than having to return to their GP after each test by a different specialist. The tests could be carried out in special dedicated centres over the course of one day or, if necessary, over several days. The key point is that this sort of multidisciplinary diagnostic clinic would speed up diagnosis, give peace of mind to patients who do not prove to have cancer and—most importantly—allow earlier treatment for those who are ultimately diagnosed with the disease. As has been said very movingly today, time is everything with pancreatic cancer patients, but too many of them are being diagnosed after emergency admission, which is too late for them to receive any form of curative treatment.
Last year’s all-party group report tells us that this cancer diagnostic centre model is already being used in countries such as Denmark and Canada. I understand that at the all-party group’s meeting last Tuesday members heard from London Cancer and London Cancer Alliance—integrated cancer systems that bring together GPs, hospitals, specialists and academics—that there are plans to test a similar model in the capital. It is hoped that this approach will not only improve patient outcomes but save the NHS money by cutting down the number of GP visits and repeat referrals, and the use of consultants’ time. A testing of this model would be a welcome step in the right direction. Can the Minister say how innovations of this kind, which are designed to improve and speed up referral pathways, can be developed and rolled out across the UK, in order to reduce the time taken to diagnose pancreatic cancer?
I conclude where I began, by saying that we need to speed up the time that it takes to diagnose pancreatic cancer; we need to stop patients being treated like ping-pong balls and being referred from a GP to a specialist, and back again, many times; we need to come up with new methods of referral that are better for clinicians and patients alike, and that will cut diagnosis times and ultimately save lives; and we need to do all this quickly, because too many people are dying far too quickly.
It is a pleasure to serve under your chairmanship, Mr Davies.
I congratulate my hon. Friend the Member for Scunthorpe (Nic Dakin) on making a truly superb speech to open this debate, and the hon. Member for Lancaster and Fleetwood (Eric Ollerenshaw) on proving that inspiration is not simply found in one’s own party; his contribution to the debate was tremendous. Through their leadership of the all-party group on pancreatic cancer, I am aware of the importance of this debate and I thank them for their efforts to raise awareness of this vital issue. I also thank other hon. Members for their contributions to the debate, which are a testament to the strength of feeling across the House about this subject. Also, to find such an uncommonly well-attended debate while we face a looming constitutional crisis demonstrates how important this issue is to Members from all parties in the House.
We need only to consider the number of people—106,399—who signed the petition calling for the Government to look at pancreatic cancer to appreciate the strength of feeling right across the country. Like those who have preceded me, I must take this opportunity to pay tribute to Maggie Watts, who launched the petition to help push pancreatic cancer higher up the political agenda, raise its profile and encourage more funding for research into the disease. I say to her that hers is a job well done and she is indeed an example to others.
The story of Maggie’s husband, Kevin, shows why we here today. It has been said before, but it is shocking that when Kevin died in 2009, aged only 47, the survival rate for pancreatic cancer was no different from that when his mother died of the same disease in 1969; as many colleagues have said, not to have made any progress in 40 years is an appalling situation, and one that requires all of us to give this issue our urgent attention. It is shocking that only 20% of people diagnosed with pancreatic cancer survive a year, compared with the 68% average for all other cancer diagnoses, and it is appalling that only 5% of pancreatic cancer patients will survive for five years after diagnosis, compared with an average of 50% for patients with other cancers. So I am glad that Members have had this opportunity to highlight pancreatic cancer and examine in detail ways to improve the situation for future pancreatic cancer patients.
However, as we have heard today, we have much further to go to ensure that we raise awareness of pancreatic cancer and diagnose it earlier, refer people swiftly when pancreatic cancer is suspected, and treat the disease more effectively. In addition, we must not lose sight of the importance of working to prevent the disease from developing in the first place. I will consider each of these issues in turn.
On raising awareness and earlier diagnosis, we know that finding cancer early can make a real difference. When pancreatic cancer is diagnosed at an early stage, the treatment is often simpler and the outcome more likely to be positive. We also know that one in four people with cancer are diagnosed after an emergency admission, and for those with pancreatic cancer that figure almost doubles; almost half of pancreatic cancer diagnoses happen after an emergency admission. Tragically, a diagnosis at that stage means that on average patients are around twice as likely to die compared with those who have been referred by their GP.
The Government’s cancer strategy sets the welcome target that by 2014-15 some 5,000 additional lives will be saved each year and rightly states:
“It is mainly through earlier diagnosis where these lives will be saved.”
We all agree with that. I would welcome an update from the Minister on what steps the Government are taking to achieve that goal through improving earlier diagnosis. More must be done to raise awareness, so that people are able to spot the signs of cancer and visit their GP sooner rather than later. Efforts to promote public awareness, such as the Be Clear on Cancer campaigns, are very welcome and do great work, but we do not yet have a specific campaign for pancreatic cancer. Can the Minister say whether she has any plans to introduce such a campaign, so as to promote better awareness of the symptoms of pancreatic cancer?
Of course, I recognise that raising awareness of pancreatic cancer, the symptoms of which are not always clear, is more difficult than raising awareness of cancers that have more specific symptoms. However, the low levels of public and professional awareness about pancreatic cancer must be addressed. A 2012 survey of more than 250 GPs undertaken by Pancreatic Cancer UK found that although most GPs could list one or two possible symptoms, half of those surveyed said they were not confident that they could identify the signs and symptoms of possible pancreatic cancer. I am concerned about how frequently I hear of people going to see their GP with a concern or worry, returning a couple of times, only for them to be diagnosed with cancer a few weeks or months later. How many times have we all, as constituency MPs, heard of that? I am sure that all of us here today can recount tales of such episodes. Does the Minister have any plans to improve training for GPs to help them to spot the signs of pancreatic cancer?
Regarding swift referrals, as vital as awareness-raising is, it will not be enough on its own if people are not referred quickly after pancreatic cancer is first suspected. Before Christmas, we heard that the Government are missing their target for 95% of people with suspected cancer to be seen by a specialist within two weeks in as many as half of all cases. Today’s report from Cancer Research UK adds to concern about that situation by highlighting that, after decades of progress, cancer patients are now waiting longer for tests and treatment, and that is particularly true for pancreatic cancer patients. The all-party group’s report on pancreatic cancer, which was published earlier this year, revealed that patients are experiencing delays in referral to specialist centres or completely missing out on the opportunity to receive specialist treatment. Can the Minister say what the Government are doing to ensure that suspected pancreatic cancer patients are referred for testing and treatment as soon as the cancer is suspected, and that after they are referred they do not wait longer than two weeks to see a specialist? The Cancer Research UK report shows that the number of cancer cases is going up as the UK population ages. If that is the case, how will the Government ensure that the NHS will be fit for the purpose of diagnosing more people, treating more people and helping more people to recover from pancreatic cancer in the coming decades?
On the issue of high-quality treatment, after being diagnosed with cancer, patients need to feel safe in the knowledge that they will receive the most effective treatment possible, yet the paucity of treatments for pancreatic cancer is shocking; surgery remains the only way to cure someone. However, less than 20% of those who are eligible for surgery go on to have curative procedures, because for most people by the time they are diagnosed the disease is far too advanced. Can the Minister say what action the Government are taking to support research into the development of a wider range of treatments for pancreatic cancer?
Pancreatic cancer patients do not just need treatment; they also need high-quality and patient-centred care. I, too, pay tribute to Macmillan Cancer Support; the briefing that it provided to all Members in advance of today’s debate is exceptionally. Also, the findings of the 2013 national cancer patient experience survey, run by NHS England, show that patients affected by upper gastrointestinal cancers, including pancreatic cancer, experience poorer levels of care than those affected by common cancers. Only a quarter of upper gastrointestinal cancer patients were offered a written assessment and care plan; a third reported not being definitely involved in decisions about their care and treatment; and a quarter indicated that test results were not completely explained to them. Moreover, a shocking 37% said that they had not been given written information about their type of cancer.
Those findings were echoed in the all-party group’s report. In its inquiry, it found that there are serious shortcomings in providing patients with consistent access to high-quality, patient-centred care, including the provision of support and information. Will the Minister set out how she is improving the experience of pancreatic cancer patients in our NHS?
On prevention, we all know that our battle against cancer cannot be won with better care and treatment alone. Around 37% of pancreatic cancers in the UK are, sadly, linked to lifestyle, and risk could be reduced through such measures as smoking cessation, promotion of a healthier diet, exercise and drinking alcohol in moderation. We all know this.
Tobacco smoking is one of the biggest risk factors in developing pancreatic cancer; almost a third of pancreatic cancers in the UK are linked to smoking. Under the previous Government, the number of smokers dropped by a quarter, which in my view is a significant achievement. Yet the proportion of our population who smoke today—20%—is still too high. Experts have warned that current decreases in smoking-related cancer incidence will eventually stop unless further progress can be achieved in reducing exposure to tobacco.
Earlier this year, Parliament voted in favour of introducing standardised packaging of tobacco and, together with Labour’s proposal to ban smoking in cars carrying children, this is a great step forward in protecting children and ultimately creating, we hope and believe, a shift in smokers’ behaviour. As the independent report from Sir Cyril Chantler concluded, it is
“highly likely that standardised packaging would serve to reduce the rate of children taking up smoking”.
We must maintain momentum and push ahead with the regulations and ensure that these two victories are not seen in isolation but are part of a much bigger, broader, more effective ambition. I would appreciate an update from the Minister on where we are with regard to the regulations.
As we have heard today, although we are making progress in our fight against cancer, this does not apply to all types of the disease, not least pancreatic cancer, for which survival rates have not improved in 40 years. As pancreatic cancer threatens to overtake breast cancer as the UK’s fourth biggest cause of cancer death by 2030, we need concerted action from the Government to improve diagnosis, speed up referral times and improve care and the development of treatment.
This is something we all care about, something that touches all of us and something that we all want to do something about. The all-party group report is right to say that it is time to change the story. I appreciate that the Minister has a slew of questions to answer, and I look forward to her considering them.
It is a pleasure to serve under your chairmanship, Mr Davies. It has been an excellent debate, with excellent contributions from all hon. Members. I will try to do justice to all questions that I have been asked, but inevitably there will be some that I cannot pick up in my speech. I may stick more broadly to pancreatic cancer and research and perhaps pick up points on other matters outside this debate with the shadow Minister; we are happy to update him on all those.
I, too, congratulate the hon. Member for Scunthorpe (Nic Dakin) and my hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw) on securing this debate and thank the public for their role in it. I served for more than two years on the Backbench Business Committee and was present when the e-petition system first came in. As others have said, it illustrates how swiftly we can bring an issue of great concern to the public to the Floor of the House and, I hope, do justice to the subject in a way that they feel justifies their faith in us and their efforts to get it here. I believed in the e-petitions system then, and now, on the receiving end, as Minister responding to the debate, I am equally happy that we have it.
I reassure the public—both those who have taken care to come here today and those listening or reading afterwards—that they are very well served by the all-party group on pancreatic cancer. It is fair to say that one or two all-party groups in our Parliament do not put in much of an appearance from one year to the next, but this is an excellent all-party group that genuinely takes its mission and its role within Parliament seriously. Its members have achieved much in highlighting the needs associated with this dreadful disease, not least through their report, “Time to Change the Story” and through their current inquiry on research, which is where I will focus most of my remarks in a fair bit of detail.
Hon. Members have spoken of the impact of pancreatic cancer on those who get the disease, their friends and their families and of the need for improvement in research and services. Obviously, I will look at as many points as I can. I reassure Members that it is certainly not a low priority for me. Of all the debates on cancer that I have responded to in my time as a Health Minister, I have responded to debates on pancreatic cancer more than any other, so this subject is certainly not low on my radar and—I reassure hon. Members again—not the Government’s.
I understand why people feel frustrated. Hon. Members have mentioned awareness levels, neglect or fashion and some of those things play a part, but fundamentally this is hard: it is a hard disease that is hard to diagnose and research. The scientific opportunity is not as readily there as it is in some other areas of human medicine. This is not easy territory, but we need to do better; we all know that and that is acknowledged.
As many hon. Members and the petitioners have said, investment in research is crucial. The Government are investing a record £800 million over five years to 2017 in a series of biomedical research centres and units—my hon. Friend the Member for Pudsey (Stuart Andrew), among others, mentioned this—including £6.5 million of funding for the Liverpool pancreas biomedical research unit. So that advancements in science can lead to benefits for patients, that unit is working in partnership with industry and leading research institutions to develop new treatments for, and ways of diagnosing, pancreatic cancer. This includes research on biological markers, which might be one way to help achieve earlier diagnosis.
The Minister’s knowledge is far superior to mine in relation to advanced radiotherapy and the funding of trials—the hon. Member for Lancaster and Fleetwood mentioned the NanoKnife and the CyberKnife—so will she clarify whether there are any such trials in relation to its efficacy for pancreatic cancer?
The hon. Gentleman will like my next page. I move on.
The unit that I mentioned is involved in a major European collaboration. I want to put that on the record because a lot of hon. Members have asked, rightly, whether we are learning from international examples, collaborating and learning what we can from those who are best in Europe—and that happens in that unit. It is also involved in the European Registry of Hereditary Pancreatitis and Familial Pancreatic Cancer, looking at hereditary factors as well.
As a number of hon. Members have eloquently described, the challenges of a stubbornly low survival rate are great, so it is also important that we consider new treatments for pancreatic cancer. For example, due to the limited evidence currently available, stereotactic ablative body radiotherapy—SABR—is available only for certain patients with lung cancer. To address this, NHS England has agreed to make up to £6 million available over the next five years to fund the treatment costs of new clinical trials for SABR. I am pleased to inform the hon. Member for Easington (Grahame M. Morris) and other hon. Members that one of these trials will be in pancreatic cancer.
I join hon. Members in welcoming the commitment made by Cancer Research UK to increase spending on pancreatic cancer research. That will in turn drive further investment by the National Institute for Health Research. I want to explain how that happens in two principal ways. First, scientific breakthroughs are translated into interventions benefiting patients, through infrastructure for experimental medicine, for example, with the Liverpool pancreas biomedical research unit. To talk to the point made about pancreatic cancer losing out and being the poor relation, Members might be interested to know that this is the only biomedical research unit that is organ-specific, with a focus on cancer.
Secondly, new investment, including NIHR investment, is driven by support from Government spend, as emerging interventions are investigated in studies and trials through the NIHR clinical research network. I was talking to the chief medical officer earlier this afternoon, ahead of this debate, to understand how this comes about. This is essentially known as NHS research support costs. For example, there might be, in a trial considering a specific treatment for people with pancreatic cancer, a lot of wrap-around care needed for the patients in that trial that might be beyond pure treatment for that cancer. That is where NHS research support costs come in and support the work going on in a specific trial.
The National Cancer Research Institute is a UK-wide partnership—it has been mentioned in this debate—between the Government, charity and industry, which promotes co-operation in cancer research among the 22 member organisations. In turn, NCRI is a member of the International Cancer Research Partnership, which includes cancer research funders from all over Europe, the United States, Canada and Japan.
The NCRI clinical studies groups—I apologise for the number of acronyms that crop up in health debates; I am afraid that it is just one of those things—bring together clinicians, scientists, statisticians and lay representatives to co-ordinate development of a strategic portfolio of trials within their field. The upper gastrointestinal cancer clinical studies group has a pancreas sub-group that plays a vital role in developing pancreatic cancer trials. It is effectively doing the same job as the US Recalcitrant Cancer Research Act—looking strategically at what is needed and where the gaps are.
My hon. Friend the Member for Pudsey made the point about looking at inter-regional and international comparisons and variation. We would expect the NCRI to look at that area, but I will make a point of making it aware of the strength of feeling in this debate on a number of issues, although I am sure they will be following it closely.
More broadly, improving cancer outcomes is a major priority of this Government. Our ambition is, as has been said, to save an additional 5,000 lives a year by 2014-15 and, crucially, to halve the gap between cancer survival rates in England and the best in Europe. Tackling late diagnosis, as many Members have said, is vital, as is raising public awareness and encouraging earlier presentation. Significant money has been put into that, and to put a cost in human lives on that, we know that we could save an additional 75 lives a year from pancreatic cancer if we matched the best in Europe. As many Members have illustrated, with so many examples from their constituencies, that does not begin to tell the story of the human suffering that could be averted if we did that.
To touch on Be Clear on Cancer, symptom awareness campaigns are a difficult area. Since 2011, the Department of Health has undertaken a series of local, regional and national Be Clear on Cancer campaigns, some of which have had excellent results. Public Health England now leads on that work in partnership with the Department, NHS England, charities and others. New campaigns are tested locally and then regionally to ensure that messages are correct for the target audience and to assess the impact on NHS services. That is important, because in some cases the balance has to be found when sending a lot of people in for diagnostics that might not be there or might stretch capacity. We ask experts to strike a careful balance and, if appropriate, we run the campaigns nationally.
The focus of those campaigns so far has been on cancers with the largest number of avoidable deaths, but the campaigns are under constant review and we work with relevant experts to see what more can be done to tackle the cancers, including pancreatic cancer. The group that makes decisions on the campaigns is called the public awareness and primary care steering group. It is chaired by the national clinical director for cancer, the excellent Sean Duffy, who I am sure a number of Members have met. Those who have met him will know what an important and serious clinician he is and how dedicated he is to making progress in this area. The group has considered pancreatic cancer for a possible campaign. Although it could not recommend that at this time, because symptoms are not always clear, it will keep that under review and would be happy to look at it again in the light of new evidence. Again, that group will note this debate and the interest in it.
During the debate, Members have raised the issue of how we support GPs to recognise signs and symptoms, particularly for such a difficult to recognise and difficult to diagnose cancer. Pancreatic cancer is often symptomless. When symptoms do develop, however, diagnosis can be complicated because, as Members have said, those symptoms are often similar to a range of benign conditions. We therefore have terrible rates of presentation through emergency routes, and that is clearly unacceptable. NICE is updating its guidelines on the referral of suspected cancer to ensure that they reflect the latest evidence. A number of Members raised that issue, and we anticipate a publication date of May 2015.
In early 2013, the Department of Health part-funded a six-month pilot, run by Macmillan Cancer Support, of an electronic cancer decision support tool for GPs. It is designed to recognise the symptoms of five cancer types, including hard-to-detect cancers such as pancreatic. Some 500 GP practices across England participated in the pilot, and I am aware that the all-party group is keen to see that tool being widely used by GPs, if evaluation shows that it can help to identify patients with symptoms. Initial indications were that the cancer decision support tool influenced a GP’s decision on around half the occasions that it was used. A full formal evaluation of the pilot has been undertaken by Cancer Research UK and one of the Department’s policy research units, and we hope to publish the results in an academic journal. I want to see that happen as quickly as possible, if the tool can do good, and I have made that clear. Macmillan has already begun to address many of the issues, which were highlighted by the draft evaluation that was shared with it, through changes made to the diagnostic software. It will continue to make further changes as it rolls the system out across the country.
In introducing the debate, the hon. Member for Scunthorpe spoke about allowing GPs to refer patients directly for MRI scans, as did my hon. Friend the Member for Milton Keynes South (Iain Stewart). I thank the hon. Member for Scunthorpe for giving me advance notice of that point. We have promoted direct referrals through the cancer outcomes strategy and have increased funding for GPs to access a range of diagnostic tests. NHS England is now working with providers to identify innovative ways of diagnosing cancer earlier, which could include extending direct referrals by GPs. Again, I will make sure that the strength of feeling expressed today, which I share, about looking seriously at whether that work can be accelerated is brought to the attention of NHS England.
Recently, the Secretary of State for Health announced a joint piece of work with Cancer Research UK and Macmillan to look at a number of innovative ways in which we can support GPs to ensure that cancers are diagnosed as quickly as possible. It is worth saying that last year GPs referred nearly half a million more patients to cancer specialists than were referred in the last year of the previous Parliament. A number of Members have said that this is not an easy one for GPs, because they see this cancer very rarely. The average GP actually sees some of the more common cancers surprisingly rarely, and this cancer is particularly rare, so anything we can do to support GPs is important.
Further policies have been unveiled that will improve the quality of life of cancer survivors. NHS England is rolling out additional support, in co-operation with Macmillan, so that cancer survivors will have their needs fully assessed and plans agreed for meeting those needs. In that regard, we are drawing heavily on the cancer patient experience survey, which has been mentioned.
The work going on to help to support cancer survivors to take regular physical activity will help. Physical activity is important in recovery and might help prevent recurrence. We have not touched a lot on lifestyle factors, but they are definitely an issue in some instances of pancreatic cancer. I undertake to talk to Public Health England about what more can be done. A major piece of work will be announced this autumn on physical activity, and I will have that conversation with Public Health England in that context. That new package of measures adds to the extra £750 million that the Government invested at the beginning of the Parliament.
At the end of August, the Health Secretary announced that thousands more cancer patients in England will be offered vital treatment through the £160 million boost to the cancer drugs fund in 2014-15 and 2015-16. I note the concerns of my hon. Friend the Member for Lancaster and Fleetwood about the interactions between NICE and the cancer drugs fund. I am happy to talk to him further about that, but NICE, for lots of good reasons, is an independent expert body, free from ministerial intervention. I do, however, note his concern. We discussed and explored that in a bit more detail in the Adjournment debate that he so ably led earlier in the year, when we looked specifically at NICE and new drugs.
In conclusion, I thank all those who have contributed to the debate. There is a huge challenge for us all, and we need to make a significant improvement to outcomes for people with pancreatic cancer. I do not underestimate the nature of that challenge—I know that Members do not—and I hope that my response has illustrated to the Chamber and to the many thousands who have signed the e-petition that pancreatic cancer is a priority and that more money is going into research, and not only what is directly invested. I have tried to illustrate what the wrap-around research support is.
As I said, I spoke today with the chief medical officer. She heads up the Government’s research policy, and some of the bodies that I have referred to report to her. Given the strength of feeling in this excellent debate, which has had thoughtful contributions, I will ask the chief medical officer if she is happy to meet with me and the debate’s co-sponsors to look in a bit more detail at the research package and to understand the research journey and where it might go. I will get back to my hon. Friend and the hon. Member for Scunthorpe after the debate about that.
We all know that change needs to come, and that it will not be easy, but we can make change. We have seen it in other hard areas of medicine, so it is not impossible; it is just difficult. Through the Government working in partnership with patients, charities, the nation’s excellent research teams, the pharmaceutical industry and the NHS, as well as by drawing on international data, we can make progress, and we all know that we must.
It is a pleasure to see you in the Chair, Mr Davies. It is important that the House of Commons takes seriously issues that are of concern to the general public. As the Minister recognised, that an e-petition can get a subject on our agenda is a big plus for UK democracy and is something of which we should all be proud. Those who worked with Maggie Watts to get the e-petition over the 100,000 mark should be congratulated on helping to secure today’s quality debate and to shine a spotlight on pancreatic cancer.
What a debate we have had! Twenty-five Members of Parliament have been in the room during the sitting and the Public Gallery has been full throughout. As the hon. Member for Pudsey (Stuart Andrew) said, the debate has been varied. As the hon. Member for Peterborough (Mr Jackson) said, it has been Parliament at its best. We had a contribution from the hon. Member for Lancaster and Fleetwood (Eric Ollerenshaw), whom I congratulate on the leadership that he has shown on the issue over the past few years in this Parliament. It is my pleasure to have worked with him. We also heard contributions from my hon. Friends the Members for Worsley and Eccles South (Barbara Keeley), for Stalybridge and Hyde (Jonathan Reynolds) and for Easington (Grahame M. Morris), the hon. Members for Basildon and Billericay (Mr Baron) and for Milton Keynes South (Iain Stewart) and then the shadow Minister and the Minister. Each and every contribution was of the highest quality.
The issues that we constantly returned to were cracking the challenge of early diagnosis, getting faster referrals from primary care to specialist secondary care to improve outcomes, the nature of research and the amount of funding, GP training and awareness, GP access to CT scans and the use of international and intra-national comparisons to help drive our performance. The Minister’s response engaged with the points made in the debate and was full and positive. As she said, the issue is fundamentally hard, but we need to do better. Listening to her, I thought that she shares our determination to ensure that we do better and that, following 40 years of no change, the next 40 years will be transformational in how the disease is dealt with. I welcome her willingness to continue to meet the all-party group and campaigners from outside Parliament to help to improve our performance on pancreatic cancer.
The title of the all-party group’s report is worth repeating as we conclude the debate: “Time to Change the Story”. It is time for action. This is the beginning of the rest of the campaign.
Question put and agreed to.
That this House has considered the e-petition relating to research funding for and awareness of pancreatic cancer.