I beg to move,
That this House notes the findings of the independent cancer taskforce published in July 2015; and calls on the Government to publish an action plan on implementing the new cancer strategy.
I want to begin by thanking the Backbench Business Committee for granting this timely debate. I also thank fellow officers of the all-party group on cancer, some of whom are going to participate in this debate, and the officers of the other cancer-specific all-party groups, who joined me in applying for this debate. This therefore represents a coming together of all the cancer-related APPGs. Although we want to raise specific issues, we are all agreed on the importance of debating the new cancer strategy delivered by the cancer taskforce.
I hope you will not mind, Mr Deputy Speaker, if I mention the fact that on 8 December the all-party group on cancer will hold our annual Britain Against Cancer conference in Central hall. It is the largest gathering in the country of the cancer community, and I warmly invite all Members to join us on the day. My thanks would not be complete if I did not also thank the Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), who is sitting on the Front Bench, having stepped into the shoes of the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), who has responsibility for cancer. Unfortunately, she cannot be with us today, but she is a good friend of the cancer community. To help my hon. Friend on the Front Bench, I sent him an advance copy of my speech. He may not be able to answer all of my questions from the Dispatch Box, but I look forward to receiving his written responses to those that he cannot answer today.
Perhaps we need to remind ourselves of the challenge. There are currently 2.5 million people living with cancer in the UK, and by the end of next year it is expected that 1,000 people will be diagnosed with cancer every day. Macmillan Cancer Support has suggested that in a few years’ time, one in two people will have been affected by cancer.
The challenge of delivering world-class cancer outcomes for all patients is growing ever greater. Hospital admissions for cancer in England have gone up by 100,000 a year compared with five years ago. For 17 months, the NHS has missed the target for cancer patients to receive their first treatment within 62 days of an urgent referral. Our outcomes continue to lag behind our European counterparts. Research has shown that the one-year cancer survival rate in the UK is about 13 percentage points behind the best in Europe, which is about 81%. That may not sound like a big figure, but it means that in the region of 10,000 lives a year are lost needlessly, in large part because the cancer was diagnosed too late.
That is the backdrop against which the cancer taskforce delivered its recommendations for a new five-year cancer strategy in July—something that the whole cancer community welcomed. Like others who are campaigning for improvements in cancer services, I was disappointed that the cancer taskforce report ended up being a report to the NHS and its arm’s length bodies, rather than a report of the NHS and its arm’s length bodies. That was not the original intention. However, that should not detract from the excellent work that went into it. Our congratulations should go to Mr Harpal Kumar for his efforts and hard work in preparing the strategy.
The recommendations of the strategy are based on evidence and advice from organisations across the cancer community, including the all-party parliamentary group on cancer. It covers the whole cancer pathway from early diagnosis to care after treatment and at the end of life. It aims to deliver a radical improvement in cancer outcomes by 2020.
Since its publication, the strategy has been welcomed by the Government, the health sector, the charities and the cancer-related all-party groups in this place. Attention must now turn to the implementation of the taskforce’s report. I congratulate Ministers on pre-empting the spending review in at least two ways by committing the Government to two of the key recommendations in the strategy. First, there is a commitment to ensure that all patients receive a definitive diagnosis within four weeks of their referral from a GP. Secondly, there is a commitment to ensure that all patients are offered a recovery package by 2020 and to develop a new metric on quality of life.
However, the taskforce has been clear that the recommendations set out in the strategy will deliver a step change in outcomes only if implemented as a whole. It is therefore important that there is urgency in implementing the remainder of the strategy. If he can, will the Minister outline today when he expects to publish the implementation plan and what degree of consultation he envisages before its publication? What assurances can he give that Ministers will ensure that the implementation plan contains clear deadlines and earmarked resources for implementing the strategy’s recommendations?
May I touch briefly on the importance of earlier diagnosis, which is one of the key priorities identified in the strategy? That point is of particular interest to the all-party parliamentary group on cancer and the other cancer-related all-party groups. As some Members will be aware, the all-party parliamentary group on cancer campaigned tirelessly on improving early diagnosis—what we call “cancer’s magic key”. The logic behind our campaign is exceedingly simple: the evidence shows that people who are diagnosed earlier are more likely to survive for over one year and, therefore, to survive cancer generally.
I warmly congratulate my hon. Friend and all the cancer APPGs on securing this important debate. Early diagnosis is absolutely key, as he rightly points out. Regrettably, my mother died of acute myeloid leukaemia in 2012. She was diagnosed on the day before her death. We really do need to bear down on this issue. Will my hon. Friend pay tribute to charities such as Bloodwise that do such important work in highlighting this area of cancer?
I will do so by all means. Let me express my heartfelt sympathies to my hon. Friend as regards his mother. He is absolutely right that charities such as Bloodwise, as well as many others across the charitable sector, realise the importance of earlier diagnosis. I will give him one statistic that directly answers his question. I spoke at an event about bowel cancer yesterday. The statistics quite clearly show that 90% of people diagnosed in the early stages of bowel cancer survive for more than 10 years, but that figure drops to just 5% if they are diagnosed at a later stage. That is the difference that earlier diagnosis can make.
The logic behind focusing on earlier diagnosis is very simple. We have found over a number of years that the NHS is as good as any other healthcare system at getting patients from the one-year point after diagnosis to the five-year point, but is poor at getting them to the one-year point in the first place. That suggests that it is not good at detecting cancer. We lose the vast majority of those 10,000 lives in the early phase—up to one year—and then it is simply not possible to catch up. We therefore need to do more on earlier diagnosis.
Getting the NHS to focus on the one-year figures will encourage initiatives on the frontline to promote earlier diagnosis. By putting the one-year figures up in lights, we can ensure that the local NHS realises that it is being monitored. It will therefore be up to the local NHS to introduce and adapt a range of initiatives that suit the local population best, whether they are elderly people, black and minority ethnic populations or whatever. The initiatives range from everything from encouraging better screening uptakes to encouraging better awareness campaigns when it comes to education, better diagnostics in primary care and better GP referral rates, all or any of which could be approved locally to drive up earlier diagnosis.
I suggest that earlier diagnosis, as well as being better for patients, can also save the NHS money. Incisive Health and Cancer Research UK published a report last year that set out the cost savings of diagnosing a patient early. One example is in colon cancer. Stage 1 treatment costs about £3,300, while stage 4 treatment costs £12,500, which is a notable difference. If we look at the range of cancers and the number of cancer patients involved, we can see that we could save hundreds of millions of pounds if we raised our game and diagnosed cancer early.
The all-party group on cancer and the wider cancer community, including the Cancer Campaigning Group, have worked collaboratively with the Government and NHS England—I congratulate the Government most heartily on listening to our concerns—and have campaigned together to get the one-year figures into the DNA of the NHS. We have managed to get them into the NHS outcomes framework and the commissioning outcomes framework.
Last year, our efforts culminated in a successful campaign to ensure that a one-year cancer survival rate indicator is included in the delivery dashboard of the clinical commissioning group assurance framework from this April. For the moment, that is the primary mechanism by which CCGs are held to account. Many CCGs have told us that it is the primary tool they use for determining priorities at local level. With the one-year figures now up in lights in the top tier of NHS accountability, commissioners will be encouraged to take action in their local area to improve earlier diagnosis and ultimately to improve cancer survival rates.
Many people may think, “Job done. We’ve managed to get the one-year rate into the DNA of the NHS. We’ve managed to get it on the radar screen of CCGs. Is there anything else we should be doing except following through on those initiatives?” However, many of us are concerned that the recently proposed changes to the accountability system in place for CCGs may undermine this work. A few weeks ago, the Secretary of State announced a new scorecard for measuring the performance of CCGs, which will involve each CCG being awarded an Ofsted-style rating with effect from next April. Although the all-party group on cancer approves in principle the improvement of accountability, we strongly advocate, on behalf of the cancer community as a whole, that the use of the one-year figures to drive earlier diagnosis at local level is not lost throughout this process. Will the Minister outline in further detail the Government’s plan to implement a CCG scorecard and the process by which the metrics relating to cancer will be determined? Will he confirm that the focus on one-year survival rates will not be diluted?
Let me mention the reforms suggested in the cancer strategy for the patient pathway. With a growing number of people surviving cancer, it is particularly important that we make improvements throughout the whole cancer pathway, and there are two key parts to that. First, all too often patients report being treated as a set of symptoms rather than as a person, and certain groups of patients—namely older people, ethnic minorities and those with rarer cancers—report a poor patient experience. Secondly, many cancer patients lack the necessary support to get on with their lives once treatment has ended.
The all-party group on cancer welcomes the increased focus on patient experience across the NHS, but we must do more to ensure that we have the right data to drive improvement at local level. Although the cancer patient experience survey is a useful tool, too often the data are difficult to access and not widely used. The cancer strategy recommends the creation of a new metric to measure the patient experience across the whole pathway. Will the Minister set out how the Government plan to implement the strategy’s recommendation on a new patient experience metric, and say how they will ensure that data are used effectively to drive improvement at local level? Will he confirm that there will be sufficient resources for the new metric and the cancer patient experience survey?
We welcome the Government’s commitment to ensuring that all patients have access to a recovery package following their treatment, but if we are fully to address that challenge it is vital that the NHS understands where it is working well and where improvements are needed. As such, it is vital that the strategy for the development of a new quality of life metric is taken forward as a priority. Will the Minister ensure that the Government’s commitment to take forward that recommendation for the cancer strategy to develop a quality of life metric is backed up with clear plans for funding and implementation?
In the few minutes that remain, let me address a couple of key issues including rarer cancers and the cancer drugs fund. It is an interesting fact that the combined number of rarer cancers—those less common than breast, lung, prostate and bowel cancer—outnumber the sum total of those more common cancers. Services for people with rarer cancers are no less important, and we must ensure that people with rarer cancers get access to the right level of specialist expertise, irrespective of where they live. The taskforce recommendation for the creation of highly specialised multi-disciplinary teams for rarer cancers is particularly welcome. Will the Minister assure the House that that will happen, and that MDTs will be supported by technology so that they can deliver specialist care without inconveniencing patients?
Research efforts into rarer cancers must be redoubled. The Government are leading the world in their investment in genomics, most notably through their 100,000 genomes project, which is sequencing the genomes of those with cancer and rare diseases in general. It is good that the project has so far fully sequenced the genomes of 5,000 patients, but will the Minister update the House on progress with cancer patients? May I suggest that, once complete, Genomics England should independently carry that research forward for the benefit of the NHS and patients, given its excellent track record?
Is the hon. Gentleman as worried as I am that companies that are investing in finding drugs for rarer cancers are, because of their nature, small in number, and they should not be put off investing in research to find cures for those cancers because they feel that the Government—whatever party is in power—will perhaps pull the plug or concentrate only on the more common cancers?
The hon. Gentleman makes an excellent point, and one hopes that there is proper dialogue with all the parties concerned to ensure that what he describes does not happen. The approach to science must be collaborative. Nobody has a monopoly on good ideas, but I suggest that the Government should be congratulated on their ground-breaking 100,000 genomes project, as long as it does not freeze out research in the private sector. I hope that there is dialogue to ensure that that will not happen. If there is not, that issue needs to be raised with the relevant bodies in this place.
On the cancer drugs fund, people living with cancer need the best treatment available. We can all agree to that. Approximately 72,000 cancer patients have benefited from the fund. That testifies to the Government’s commitment. We recognise, however, that reform is needed over the longer term. We need a longer term solution to the cancer drugs fund. The Government apparently also believe that reform is essential. Recent NHS England board papers indicated a continuing overspend on the cancer drugs fund, underlining the fact that a long-term solution is needed now.
When reforms are introduced, it will be important that the spirit of the CDF—that patients are able to gain access to the treatments their doctors recommend—is maintained at a cost that is affordable to the NHS. There have been reports about NHS England refusing to discuss some offers of cost reduction with drug companies due to the rules under which the CDF operates. That needs to be addressed urgently if the overspend is to be tackled. I very much welcome—I am sure everybody else in the House does, too—the news that the CDF consultation opened today, at, I think, 1 o’clock this afternoon. I recommend, as I am sure others do, that all relevant parties participate in this very important consultation. Will the Minister provide assurances that the NHS will be supported in demanding the best possible deal from the drug companies, because that will be an important element of the process?
I want to finish by speaking about the importance of leadership and accountability, both at national and local level. The all-party group on cancer strongly welcomes both the strategy’s recommendation to introduce cancer alliances to drive improvement at a local level, and for the National Cancer Advisory Board to provide accountability at a national level. The National Cancer Advisory Board, in particular, will be important in ensuring accountability for the strategy, and that momentum and focus is retained. It is vital that this body is set up as a priority, so we can monitor progress and implementation from the beginning and set up the right structures to ensure strong accountability. Will the Minister set out how the Government plan to monitor the delivery of the cancer strategy recommendations and to measure their success?
I thank the Minister once again for responding to the debate. I know this is not his usual brief and I would be very happy for him to write to me after the debate if he does not have the answers to all the questions at his fingertips. As ever, there are a number of areas I have not had the chance to cover. Time simply has not allowed it, but I hope they will be covered by other colleagues speaking in this afternoon’s debate.
I want to finish by emphasising the opportunity presented by the new cancer strategy. By implementing its recommendations in full, and by retaining the focus on the one-year survival rates as a means of driving forward and promoting earlier diagnosis, we have the potential to deliver world class outcomes across the entire cancer pathway: to dramatically improve our cancer survival rates, to deliver care tailored to the patient and to ensure that patients are supported. But action must be taken now. Doing nothing is not an option. The challenge, as I highlighted at the beginning, is huge, but in the cancer strategy we have a clear plan for how to make it work. I urge the Government to take action now, to fulfil our manifesto commitment to implement the strategy in full, and to deliver the care, treatment and world class outcomes cancer patients deserve.
I should start by saying that I am, with the hon. Member for Enfield, Southgate (Mr Burrowes), the joint-chair of the all-party group on stem cell transplantation.
I want to raise a few brief points in respect of the care of blood cancer patients who have had transplants and the ongoing care they receive. It is fair to say that at present the level of support can be described as patchy at best. There is a considerable lack of understanding of some of the issues that transplant patients face.
Anthony Nolan estimates that, by 2020, there will be 16,000 people in the UK living with the long-term effects of a stem cell transplant, and they will have a higher risk of secondary cancers, infections, particularly in the early stages, infertility and problems with muscles and joints. Then there is an area not touched on much: the psychological effects of both the diagnosis of blood cancer and a transplant. Graft-versus-host disease will affect the majority of patients in the early post-transplant period, but it can persist for many years. Some element of the disease is not necessarily a bad thing, because it shows the transplant is working, but if it gets out of hand, it can cause organ failure and a host of other problems that can, and do, kill patients. In the longer term, the effects can be as minor as skin irritation, but, if in the gut, they can lead to more complicated problems, resulting in the patient having to go back into hospital.
As I said, the flare-ups can occur not only in the first few years, but many years down the line, yet a survey of 27 transplant centres in the UK found that while they all provided support for a year post-transplant, only half followed up after five years. Importantly, only 28% offered mental health support. This problem affects not only cancer patients, but a whole host of healthcare issues: we address the physical side of an illness, but then the patient walks out the door without our addressing their mental health needs or asking how they are coping with the diagnosis and other ongoing problems.
Some years ago, I spoke in the Chamber about my son’s experience of having a stem cell transplant. We had to look for support and counselling. Children, particularly younger children, will have questions such as, “Why has this happened to me?” and “Why can’t I run like I used to?”, but we had to ask for that support. It was not necessarily there in the first place or as part of an overall package, as one might have expected.
I said in the Chamber that I was particularly concerned about the lack of support for children going back to school. I believe there are still no national guidelines for how schools should deal not only with returning pupils, but with other, particularly younger, children. How might they feel about seeing a child they have not seen for a while? The last time they saw them they looked like them, but now they might be on steroids or have no hair—a particular issue for girls, although it is not great for anybody. I was concerned about the poor provision and the lack of guidelines. Some schools do it very well, but some show very little understanding. CLIC Sargent has done a lot of work in this area, but we need to do more. We have to look beyond cancer. Cancer is what people are treated for, but there is a host of other issues around it. We need to look at the whole, rather than just the illness itself, and at how we support people after that illness.
We define the transplant period as 30 days prior to and 100 days after the transplant, but this assumes that all patients need the same support and have the same outcomes. It takes very little account of some of the late effects that patients will experience. No patient is the same or will have exactly the same demands, yet there is this idea that we can set an arbitrary period of 100 days, as though at the end of it we can say, “Well, everyone’s fine. We don’t need to give them the same level of support.” However, patients go to their local area and then we are back with this postcode lottery, where some get very good support but some get very little, particularly if people are not exactly sure where they should go to receive support.
I do not think that is particularly fair, so I would like—and I know Anthony Nolan would like—a system that looks a lot further than 100 days and instead looks for support for a five-year period at least. Clearly there will be different requirements within that. Hopefully, some patients will not need a great deal of support, whereas others may need a lot of ongoing support. We need the flexibility to respond to that, rather than taking a one-size-fits-all approach.
We need to do more on ongoing support, and we should not forget either that stem cell transplants are now evolving—they are a lot more common than they were—and it is not just blood cancers we are looking at. Through the work of the all-party group on stem cell transplantation, I know that this is an area that offers us a great opportunity. Equally, we cannot ignore the fact that 50% of transplant patients die within the first two years, so there is a lot of work we need to do—generally, it is not the transplant that kills them, but some of the associated problems and immunity issues.
Finally, let me say to the Minister that we need to look more broadly at how we support transplant patients, get beyond this arbitrary figure of 100 days, and support people with the physical illness but also, very importantly, with adjusting to some of the psychological issues that can arise.
I must start by offering my congratulations to my hon. Friend the Member for Basildon and Billericay (Mr Baron)—who is smiling next to me—who I have watched over the years toiling in this Chamber in the cause of cancer patients. He has done so, if I may say so, very effectively, and not just on cancer outcomes—he focused today on one-year outcomes—but on the provision of specialist drugs for patients. He has maintained a relentless pressure on the Government and it has been a joy to serve with him as a junior vice-chairman on the all-party group on cancer.
I hope today to bring to bear some of my experience in the House, which on Tuesday Mr Speaker generously described as 28 years of experience. He might have said 28 years of pursuing an holistic, patient-centred agenda that broadens choice in the health service. If we look at the cancer outcomes report, “Achieving World-Class Cancer Outcomes: A Strategy for England 2015-2020”, we find that the key themes are integrated pathways, holistic support for patients and a patient-centred service—“Patients should feel empowered”.
The agenda we find in that report is not a new one in the House. I have referred to my long involvement in this side of parliamentary life—I have been chair of the all-party group on integrated healthcare since it was formed and before that I was chair of the all-party parliamentary group for alternative and complementary medicine, so it covers pretty much the whole of my time in the House. If we look back at the meetings of that group, we see that they offer some instruction. The first message to get across to the House is that there is no need to recreate the wheel. If we look back, as I did, at the meetings of the all-party group on integrated healthcare—I discovered that I chaired more than 100 of them over the best part of the last 30 years—we find that there has always been a strong base of holistic and personalised care, which has been developed in certain hospitals and care institutions in this country.
I looked up the information about the 2001 exhibition that we put on in the Upper Waiting Hall for providers of complementary medicine. It was to highlight particularly good practice in the integrated healthcare awards of 1999. The winner was Charing Cross cancer services for offering a multidisciplinary approach to specialist cancer and palliative care services, which integrates complementary therapies, massage, aromatherapy, reflexology and art therapy for patients receiving treatment for cancer.
If we go forward two years, in March 2003, Caroline Hoffman, a nurse consultant in cancer care rehabilitation at the Royal Marsden and editor of Complementary Therapies in Nursing and Midwifery, spoke about her experiences at the Marsden hospital. Chris Perrin, a registered general nurse who uses complementary therapies in his work, also spoke. In May that year, the then Member representing Salford, Hazel Blears, launched new national guidelines for the use of complementary therapies for long-term or chronic illness. She was then the parliamentary Under-Secretary of State, and these were new national guidelines for use in hospitals, hospices, primary care, cancer support centres and self-help groups. The document was called “National Guidelines for Complementary Therapies in Supportive and Palliative Care”.
If I blow the dust off this document, I see that it could well have been integrated into the cancer proposals that we have before us now. It looked very closely at the possible options to expand patient choice in holistic care—the very things that the new report calls on. It is worth quoting—I see my hon. Friend the Member for Basildon and Billericay is looking at me intently—Professor Mike Richards, who was the National Cancer Director at the time. He said:
“A substantial number of cancer patients choose to receive complementary therapies alongside their mainstream cancer treatment. Individual patients frequently report that the use of a complementary therapy has helped them.”
He went on to say that there was
“broad agreement, however, that patients should have ready access to reliable information about complementary therapies and complementary therapy services”,
and finished by saying:
“The guidelines will usefully complement the forthcoming NICE guidelines on supportive and palliative care.”
Would that those NICE guidelines had been implemented then—all those years ago! I live in hope, particularly under the guidance of my hon. Friend the Member for Basildon and Billericay and the Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), that we will make more progress. In March 2011, Professor Karol Sikora, the medical director of Cancer Partnership UK and Sosie Kassab, director of cancer services at the Royal London Hospital for Integrated Medicine came to give evidence to us.
The message is that a lot of the work that this report calls for has already been done. A lot of effort has already been put in. It is instructive in going through the Macmillan contribution to the 2015 to 2020 proposals to note that it points out:
“More than one in three of cancer patients use complementary therapies and many report finding them helpful.”
Macmillan’s own “Cancer and Complementary Therapies” booklet says it would
“like to see more high-quality research into complementary therapies”.
We have been calling for that for many years. Some evidence is very good; some is not so good—but there is a lot of evidence that patients are content with these services.
Having sat through so many Budget debates, I am not normally a great one for statistics, which I know can send colleagues to sleep, but my second statistic, apart from the one that a third of all cancer patients use complementary therapies, is that one third of the incremental annual cost of cancer care—this can be seen in the small print on page 76 of this lengthy report—is for living “with and beyond cancer”. Once patients have had chemotherapy and radiotherapy, it is often to the holistic and alternative world that they turn. It is there that we find a Gruyère cheese landscape. Many of these services are not available throughout the country, and we must address that.
A number of contributions are worth quoting, but I will quote one about acupuncture. “We are Macmillan Cancer Support” says:
“Some studies show acupuncture has helped reduce sickness in people who have had surgery or chemotherapy… acupuncture may help in treating other problems such as breathlessness and a dry mouth.”
In the last Parliament I served as vice-chairman of the herbal working group, under Professor David Walker. We reported on the last day of the Parliament. The Prime Minister generously wrote me a letter, which I received this morning, saying that the Government would respond before the House rose for Christmas. Herbal medicine is part of the two-pronged Chinese approach to treatment. I hope that my hon. Friend the Minister will respond positively by recommending either statutory regulation—for which many have asked—or voluntary regulation.
As I have said, the landscape of treatment available in this country is very patchy. Let us now look elsewhere in the world. The Prime Minister said that he had been to a football match at Wembley with the Indian Prime Minister, Mr Modi, and I believe that that was also mentioned by the right hon. Member for Leicester East (Keith Vaz), my Leicestershire colleague. Prime Minister Modi is quite a supporter of complementary medicine, and India now has a Department of Ayurveda, Yoga and Naturopathy, Meditation and Homeopathy. It has a Ministry—it used to be a Department—that draws all those complementary services together. In February 2012, when Prime Minister Modi was Chief Minister, he said that
“homeopathic medicines are affordable and free from side effects”,
“homeopaths should create awareness...among the people”
of an easy method of treatment. He added:
“There should not be a question of conflict between allopathy, Ayurveda and homeopathy”.
All three systems of treatment had some very good things in them, he said.
It was therefore with some surprise that I saw a headline in—I think—The Daily Telegraph last week: “Prescribing homeopathy on the NHS may be banned”. Given its widespread use in the various complementary centres in the country, I wondered what on earth Ministers were thinking of. The doctors who practise homeopathy have been regulated by Act of Parliament since 1950. Ministers have been encouraging complementary therapists to become accredited by the Professional Standards Authority, and 2,000 members of the Society of Homeopaths have just achieved that accreditation.
What could be behind what I see as a kind of madness? The answer is that a tiny lobby group is trying to stop the use of £100,000 of Government money for homeopathic prescriptions every year. When we look into who those people are, we find that they are closely aligned with the medical establishment, and have been using legal challenges to try to stop health authorities and clinical commissioning groups using these treatments. I think that that is quite wrong. During Health questions this week, I pointed out that, according to Clinical Evidence, a review published by The BMJ,
“only 11% of the 3,000 treatments looked at in clinical trials”
in the UK
“proved to be beneficial, with 50% being of unknown effectiveness.”—[Official Report, 17 November 2015; Vol. 602, c. 507.]
If The BMJ says that, why are the Government considering picking on the homeopaths? I suggest to the Minister that these people are at best foolish and at worst wicked, because they know that they are trying to remove a very valid medical system from the health service.
In support of what I am saying, in 2001 Professor Edzard Ernst, in a published overview of exemplary studies and available systematic reviews of complementary therapies in palliative care, which is included in the 2003 report “National Guidelines” I mentioned earlier, says:
“Several clinical trials suggested that homeopathy also may benefit patients suffering from cancer. For instance, a recent double-blind RCT included 66 women undergoing radiotherapy after breast cancer surgery. In addition to conventional treatment, they received either a homeopathic mixture (belladonna 7CH, X-ray 15CH, i.e. two homeopathic remedies in high dilutions) or a placebo daily for 8 weeks. The results suggested that the homeopathic mixture was superior to placebo in minimizing the dermatologic adverse effects of radiotherapy.”
If we look at the hospitals where these support therapies are offered, we see that one not far from here offers aromatherapy, homeopathy, massage, reflexology and shiatsu. This is not some tiny clinic buried in a remote part of the capital. This is Barts Health, which is the largest NHS trust in the country. It has 15,000 employees and a £1.25 billion budget.
One of the issues that my hon. Friend the Minister is going to have to address is how we get more properly regulated practitioners into the health service. If we are going to provide the cancer support that this report argues for—the holistic support, the patient-centred support—and if we are going to listen to what patients want, we need to get a greater number of professionals deployed in the health service. He and his colleagues need to look at the Professional Standards Authority, a Government organisation that has 63,000 practitioners on 17 accredited registers covering 25 occupations. The Society of Homeopaths is one of its most recent additions: it now oversees the society’s regulation. However, there are many other groups there. It is important that we do not ignore that valuable resource. One third of the costs of the whole cancer budget is going on care after treatment. We can reduce that bill by using these people. I know the field of homeopathy very well. With acute conditions, if conventional medicine and homeopathic medicine are used, one reduces the acute drugs bill and with chronic conditions one tends to increase patient satisfaction, so it is a win-win situation.
I am not going to speak for much longer as I know other colleagues wish to contribute, but I want to raise the Cancer Act 1939 with the Minister. When his colleague appeared in a Committee Room not long ago, I got the distinct impression that that was not something the Department had looked at very recently. It says—this is important when it comes to trying to get patient-centred health care and broadening the scope of treatments for cancer care:
“No person shall take any part in the publication of any advertisement—
(a) containing an offer to treat any person for cancer, or to prescribe any remedy therefor, or to give any advice in connection with the treatment thereof.”
That means that it is illegal to advertise or promote any medicine, diets, therapies or treatments as cures for cancer. Well, most of the treatments that I have discussed and referred to today are not claiming to cure. They are claiming to help and to increase the quality of life of those who have the disease. The Advertising Standards Authority and other bodies have been very sharp with anyone who is suggesting that they can assist patients in the provision of therapies that will improve their quality of life.
There are many examples of good support services across the country. I am not going to mention them all, but I do want to mention Coping with Cancer in Leicestershire and Rutland, an independent local charity that provides practical and emotional support to anyone affected by cancer. It offers counselling, complementary therapies, befriending and drop-in centres.
We heard today on the news that in China there is now a superbug that defeats all antibiotics. The last resort antibiotic has no power, and I suggest to my hon. Friend the Minister that we have to go back to the future. I served on the Science and Technology Committee for most of the last Parliament when we looked at antimicrobial resistance, and I was on the Health Committee for the whole of the last Parliament when we looked at this issue. If we have not got the antibiotics and nothing is coming through the pipeline despite the efforts of those the Front Bench, we will have to go back to the future, as medicine is going back to the dark ages, as a commentator said this morning on Radio 4. That means we will have to look more at natural remedies. We will have to listen to people who have used acupuncture for thousands of years and know their way around herbal medicine.
I will end on the following note. I have served with many Secretaries of State in this House. One of them once called me the hon. Member for Holland and Barrett which I took as a great compliment as its headquarters are in my constituency. I am sure it helped me in the 1997 general election, which was not the easiest for Conservative Members. I would like to quote the former right hon. Member for Holborn and St Pancras, Frank Dobson. He said when he was Health Secretary:
“I believe that what works is what counts and what counts is what works. With so many threats to our health we can’t afford to ignore anything that works and is safe.”
I agree. Where patients are gaining benefits, those services should be available.
It is a pleasure to follow the hon. Member for Bosworth (David Tredinnick), who painted a very broad canvas of things for us to think carefully about as we take this strategy forward. May I also begin by praising the hon. Member for Basildon and Billericay (Mr Baron) for his leadership in this area and for the way in which Members across the House have worked together in this important field?
It is worth saying from the outset that a large part of the challenges we face are the challenges of success. Success in tackling many cancers has led to a right and proper rise in expectations. It is therefore important to pay tribute to all who work in this field—clinicians, patient groups, charities and a host of other people and organisations—for the outstanding work they do. However, the cost and challenge of treating cancer will continue to rise rapidly during this Parliament. The “Five Year Forward View” projections indicate that expenditure on cancer services will need to grow by about 9% a year, reaching £13 billion by 2020. This growth is between two and three times the rate of other health spend.
The commitment for everyone to have access to the recovery package by 2020 and the development of a quality of life metric by 2017 are welcome, but clear plans need to be put in place for these to happen. It is vital that there are commitments, both in terms of funding and resource, to deliver the full living with and beyond cancer programme, cancer alliances and a workforce review.
A national cancer advisory board, as recommended in the strategy, needs to be set up urgently to hold all the arm’s length bodies to account on delivering the recommendations laid out in the strategy. It is vital that this board is fully independent, with an independent chair. The Government must also fund and implement the recommendations set out in the independent review on choice in end-of-life care to ensure that there is choice and quality in that care.
Such investment in the national choice offer should result in a significant increase in out-of-hospital care, including through district nurses, allied health professionals, pharmacists, social care services and specialist palliative care teams, to ensure that every dying person has access to round-the-clock care seven days a week. That investment should also result in greater co-ordination between services to improve the quality of end-of-life care and to support carers and families; more empowered patients and carers who are able to exercise greater choice in their place of death; a reduction in hospital admissions for people at the very end of their lives; and the use of the latest technologies to support end-of-life care.
As chair of the all-party parliamentary group on pancreatic cancer, I strongly welcome the cancer strategy, and in particular the recommendations relating to improving early diagnosis and improving patient care and end-of-life care. I am concerned, however, that despite recognising the existence of a group of cancers with high incidence but low survival rates—highlighted as group 3 in the strategy—the strategy fails to acknowledge the need for specific actions to tackle the problems unique to that group.
Pancreatic cancer is the fifth most common cause of cancer death in the UK, and it is a clear example of an unmet need in cancer care. On average, one person is diagnosed with pancreatic cancer every hour, yet its five-year survival rate has remained virtually unchanged over the past 20 years and remains shockingly low at around 4%. That is the worst survival rate of the 21 most common cancers.
The hon. Member for Basildon and Billericay rightly welcomed the fact that the strategy recognises the need to improve early diagnosis by reforming the referral system. Improving early diagnosis is the key to improving survival rates. Only 80% of pancreatic cancer patients are currently diagnosed at a stage where surgery—the only real hope of a cure—is still an option, and only 10% go on to receive that life-saving surgery. Ensuring that more patients are diagnosed earlier, while surgery is still a viable option, is therefore essential to improving the appalling survival rates faced by pancreatic cancer patients. That is also an issue for other cancers, such as blood cancers. At present, 50% of acute myeloid leukaemia diagnoses, 37% of myeloma diagnoses and 35% of chronic myeloid leukaemia diagnoses are happening in emergency settings. I echo the comments of the hon. Member for Crawley (Henry Smith) on the excellent work being done by Bloodwise in this area.
The recommendation of a four-week diagnosis target is welcome, and I am pleased that the Department of Health has committed to looking at adopting that recommendation by 2020. I also welcome recommendation 21, which calls on NHS England to pilot the implementation of multi-diagnostic centres as a priority. Such centres would allow patients presenting with vague symptoms, such as abdominal pain, to have multiple tests on the same day, preventing the need for them to present at their GP surgery repeatedly before being diagnosed, thus speeding up their diagnosis. That could be especially significant for pancreatic cancer patients, who report having to visit their GP on multiple occasions before being referred for tests. A UK-wide survey carried out by Pancreatic Cancer UK found that 23% of pancreatic cancer patients had to visit their GP seven or more times before they received a diagnosis. The introduction of multi-diagnostic centres would therefore be a big leap forward.
The call for GPs to have direct access to investigative tests by the end of 2015 is also very welcome. None the less, it is important to ensure that GP surgeries have the imaging capacity—in terms of equipment and of staff training—to carry out investigative tests such as CT scans. Will the Minister tell us what assessment the Department of Health has made of GP practices’ current imaging capacity and the capacity that would be needed to ensure that all GPs were able to carry out investigative tests?
The measures in the strategy to improve patient experience are to be warmly welcomed. National cancer patient experience surveys show that the pancreatic cancer patient experience continues to fall short of expected standards, especially in the lack of appropriate information about their diagnosis, about treatment options and about what to expect following discharge from hospital. Access to a clinical nurse specialist is a key factor in improving the patient experience, but it is also essential to ensure that clinical nurse specialists have the resources needed to provide a good quality service. In a survey of these specialists carried out by Pancreatic Cancer UK in 2015, only 28.36% of respondents said they felt they were able to spend as much time with their patients as necessary and had enough resources to provide a good quality service.
The need for more clinical research into cancer is also highlighted by the new cancer strategy, and I strongly support this recommendation, as the kind of change needed to make any significant impact on survival rates will be achieved only through research: research that will aid earlier diagnosis and screening; research that will result in more and better treatments; and research that, we hope, will offer opportunity for a cure. Despite accounting for 5% of cancer deaths, pancreatic cancer received only 1.4% of the National Cancer Research Institute partners’ research spend in 2014. Although that is an increase on the 2013 research spend, pancreatic cancer research funding continues to lag behind many other areas of cancer research.
The strategy also makes reference to the need for
“a sustainable solution for access to new cancer drugs”.
That has exercised the minds and thoughts of Members from across this House, as well as plenty of people outside it who know a lot more about the matter. It is only a fleeting reference in the strategy, yet access to drugs is one of the most important issues for pancreatic cancer patients. In particular, pancreatic cancer patients face a persistent lack of access to treatments, making access to new drugs especially important. That is demonstrated most starkly by the removal of the life-extending drug Abraxane from the cancer drugs fund list recently. The CDF decision is compounded by the fact that the National Institute for Health and Care Excellence has also reviewed and rejected Abraxane for use on the NHS, on the grounds of it not being cost-effective enough. In a way, that is not surprising, as between 2007 and the end of 2013 NICE recommended only 31% of cancer drugs for use on the NHS. That is why the setting up of the CDF is to be commended, as it is to compensate for this bias by NICE against cancer drugs. The NICE scoring system is even less flexible than the CDF one. Again, it is not fair to judge a new treatment for a disease with such poor survival rates and very few treatment options on the same criteria as other treatments for other cancers and other conditions. We need more imagination and more flexibility if we are to make the strides forward that need to be made.
There is ever such a lot to welcome within the strategy, but it could have gone further, by including measures to deal with group 3 cancers. Despite identifying cancers with high incidence but low survival rates, the strategy has not yet set out any measures aimed at tackling that precise problem. Greater awareness of the symptoms of these cancers, which can be non-specific, alongside more research into diagnosing and treatments, and the creation of a fair and flexible drugs appraisal scheme remain essential. I hope that in taking the work of this strategy forward, the people involved will endeavour to put those things in place.
I, too, begin by thanking the Backbench Business Committee for scheduling this very important debate and my hon. Friend the Member for Basildon and Billericay (Mr Baron) for his endeavours. A great deal has happened since we last had the chance to debate cancer, and I am pleased to be able to discuss the Independent Cancer Taskforce’s report on a cancer strategy for England, which is a major step in the right direction for all those affected by cancer.
As chair of the all-party group on brain tumours, I particularly welcome the focus of the report on early diagnosis. A target for 95% of patients to be diagnosed within four weeks of being referred by a GP by 2020, which has recently been implemented by the Government, is absolutely crucial for improving cancer outcomes for patients, especially those with brain tumours. Currently, 58% of brain tumours are diagnosed in accident and emergency, which unfortunately is far too late for many. That has contributed to brain tumours being the biggest cancer killer of children and adults under 40. Patients diagnosed with brain tumours have a five-year survival rate of just 19.8% compared with cancer as a whole, where 50% of patients can expect to survive for at least 10 years. Cancer survival rates doubled between 1970 and 2010, while, shockingly, brain tumour survival rates increased by a mere 7.5%.
The current poor level of early diagnosis and a general lack of awareness of brain tumours contribute to the stories of far too many people. The Green family from my constituency had a son, Danny, who was a normal, happy, energetic 10-year-old who suddenly suffered a dizzy spell after playing football one afternoon. It was eventually confirmed by his local hospital that he was suffering from a brain tumour. Tragically, despite having an operation to remove the tumour, chemotherapy and radiotherapy, Danny lost his fight for survival in July 2012. He died from pneumonia.
Although the Greens believed that something was really seriously wrong with their child, they found that when they initially took him to hospital, doctors dismissed his symptoms as nothing more than a migraine. It was only when his condition deteriorated and he collapsed in A&E that he was sent for a CAT scan and an MRI scan. Brain tumours are relatively rare, but as Danny’s mother, Lisa, says:
“They are not rare enough when it’s your relative.”
That is why the family would like to see patients with possible brain tumours sent for MRI scans much sooner than they currently are.
I very much welcome the new cancer strategy, but I have a number of concerns, including the lack of a clear, ambitious commitment to improve research. That lack of commitment impacts on the cures and treatments of the future for cancers with low survival rates, such as brain tumours. Those cancers of “unmet need” will not see the boost in survival rates that the more common cancers will, because early diagnosis and prevention alone do not affect the effectiveness of treatment to a significant extent. For example, there are no lifestyle factors that are proven to increase the likelihood of getting a brain tumour, which means that a focus on prevention will do nothing to stop the incidence of the disease, which, for whatever reason, is rising. There should be a stated priority to increase research and to find new curative and palliative treatments for rarer cancers.
The two excellent charities that I work with as part of the all-party group, Brain Tumour Research and the Brain Tumour Charity, have issued their own response to the new strategy. They, along with the two charities in my constituency, the Danny Green Fund and the Indee Rose Trust—the Indee Rose Trust is also tragically named after a little girl who lost her life at the age of three, five months after being diagnosed with a brain tumour—do exceptional work in raising awareness of brain tumours and of the importance of early diagnosis. They also increase the amount of funding for research and improving treatments.
For the strategy to be effective for people with brain tumours and to allay the concerns that I have raised, we need to focus on a few particular areas. First, we need to streamline the process of repurposing drugs. The repurposing of drugs and compounds to tackle brain tumours could open up new treatment options for patients. Repurposing refers to a process whereby a drug or a compound that has previously been used to tackle a certain illness—for example, depression—is examined and studied to see whether it can be used to tackle another illness, such as brain tumours. There is solid evidence that treatments can be developed through repurposing that are safe and effective, and that add years to the lives of patients with terminal cancers. The Government can help to streamline that process by reducing the regulation and red tape on scientists along with incentivising pharmaceutical companies to release compounds for research. The research and trials that will be sparked could result in huge strides being made in the field and in ground-breaking treatments for patients.
Secondly, we need a national register of all site-specific research to track all research work, grants and results. Currently, there is not a great deal of transparency in the research field. There is no clear idea of what research is being funded and what results are being achieved. That leads to confusion, duplication of work and a system that prioritises research in more common cancers rather that in diseases such as brain tumours. A national register will make research more transparent, reduce duplication and allow greater variation in the type and scope of research.
Thirdly, we need an innovation fund for research into rare and rarer cancers. Grant applications to existing research funding bodies require evidence of previous research—pilot work as well as published results. That results in something of a catch-22 situation. Applications must be deemed low risk in nature and as having a high likelihood of success before a grant is awarded. That means that there has to be a pre-existing bank of evidence. Novel research, particularly relating to brain tumours, suffers as a consequence of a lack of existing research. This ring-fenced fund should be set aside for areas of new research on rarer cancers and diseases. There should be a lower threshold for grants to be awarded in new projects, or in existing schemes such as the 100,000 genomes project. This stimulus will create a new wave of research that previously would not have been possible, widening our knowledge of cancer and creating the treatments we need.
Finally, we would like the Government to devote an absolute amount to brain tumour research. Brain tumours represent 1% of cancers diagnosed, yet 3% of cancer death. Within the innovation fund a consistent or growing absolute figure should be devoted by the Government to brain cancer research. Some 16,000 people are diagnosed with a brain tumour every year, and those affected are disproportionately children and young adults, who may have young children themselves. I hope that the Minister will commit to implementing and funding the new cancer strategy so that those 16,000 people, and indeed the tens of thousands more diagnosed with other forms of cancer, get access as quickly as possible to the treatment and the funding for research that they need to give them the best chance of survival.
I am vice-chair of the all-party parliamentary groups on cancer and on breast cancer. I welcome the strategy and the hard work of those who have put it together. Looking at a situation with a fresh pair of eyes is always beneficial, for all the reasons that my hon. Friend the Member for Basildon and Billericay (Mr Baron) pointed out.
My hon. Friend the Member for Castle Point (Rebecca Harris) and the hon. Member for Scunthorpe (Nic Dakin) highlighted one of the problems: there are more than 200 types of cancer, which makes it highly complex to deal with unless we have an overarching strategy. That goes not only for the cancers and their different forms, but for how we approach the use of drugs, research into them, and so on.
The new cancer strategy has the ability to be transformational, inspiring us to lead the world or at least to match those who are ahead of us. That is where we should be in patient outcomes. For me there are positives, but in order to achieve these things we need full implementation and adequate funding. There are some key asks—the national ambition for early diagnosis is probably one of the principal ones. As individuals we can help in diagnosis by presenting early enough. Some 20% to 40% of people find out that they have cancer only when they present at accident and emergency, and by then it is usually too late, so early diagnosis is key. My hon. Friend the Member for Basildon and Billericay referred to the figures for bowel cancer. Some cancers have much better outcomes if diagnosed early. That gives people a better quality of life and a better journey through the cancer path.
The strategy asks for a definite diagnosis within four weeks of referral, to be achieved by 2020. Ensuring that CCGs are held to account for improving one-year survival rates is crucial to drive early diagnosis. How will we hold the CCGs to account and make sure that rates are improving from June 2016? Linked to this is the way in which we improve cancer commissioning, as we have heard. The current picture is fragmented and confused.
Accountability, responsibility and transparency are needed, and with modern advances in medicines and diagnostics flexibility is hugely important, as is communication. Currently no one body or person at local, regional or national level holds responsibility, and this does not aid clarity in the system. Clinicians and patients are liable to fall foul of duplication or fall through the gaps, wasting precious time and resources, which neither the NHS nor the patient on the receiving end can afford.
The creation of cancer alliances can support the commissioning process and ensure that the strategy is delivered. Living with and beyond cancer is a growing challenge. There will be 3 million of us by 2020 and 4 million by 2030. Speaking from personal experience, I know that being a cancer patient is at times a bit of a challenge. Being medicalised is no fun, as I know, but both the new five-year guidelines on living with and beyond cancer and the new quality of life metric that has been spoken about are vital to drive service improvements. As the hon. Member for Alyn and Deeside (Mark Tami) said, sometimes it is the not-so-obvious things that people need help with. His child needed help in comfortably settling back in at school and ensuring that those around him understood the journey, too.
Scan anxiety sits heavily on people who are being tested to see whether they have cancer. The hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) did a lot of work in that area before she came to this place. It puts a great deal of pressure not only on the individual but on their family.
Under the strategy, those living with secondary cancer have emerged as a very distinct group. For example, 36,000 women are living with secondary breast cancer, and to date their needs have been neglected. The ambition of the strategy is to focus on the long-term quality of life, including for those who
“are living with an advanced and incurable form of the disease”.
This highlights the importance of multi-disciplinary teams in planning the care of all cancer patients.
The NHS is changing and adapting. Ensuring that the organisation has the right skills in the right places is the key to delivery not only of our cancer strategy but of many of the ambitions we hold. The strategy asks for everyone to have access to clinical nurse specialists, and I would wholeheartedly support that. Today, as I stand here, I would like to say a huge thank you to our nursing profession—a highly skilled group of people. I know from constituents and others that their professionalism, care, and, at times, very “no nonsense” approach has been as important as anything else in the recovery process.
If the aims of the strategy are to be achieved, working smarter and doing things differently may well be the key. Nurse consultants are now becoming a feature in the profession, and workforce planning will be crucial. The strategy focuses on the needs of older people and those from the black and minority ethnic community, who are often much more reticent about going to seek help. We know that we are living in an ageing society. The upside is that we are living longer; the downside is that there are more health challenges. In 1949, at the start of the health service, 50% of our population died before they were 60. Thankfully, that is not the case nowadays, but the strategy highlights the need to focus on treatment for older people—another sign of the changes in our NHS.
The cancer strategy is to be applauded in calling for a national action plan to address obesity. That is welcome, but there are individual responsibilities too. Obesity is a known causal risk factor in breast cancer and many other cancers. There is good evidence to show that five 30-minute bits of exercise a week, like a brisk walk, would help not only with obesity but with the likelihood of the disease recurring. There is plenty for people to do in this regard.
I would like to mention drug innovation and the cancer drugs fund. How will the cancer strategy’s recommendations on NICE guidelines on the use of bisphosphonates be taken forward? I would really appreciate understanding a little more about how we are going to use off-patent drugs and drugs that have been shown to have a secondary purpose beneficial to cancer patients. I would like to see communication between clinicians, pharmaceutical companies and others so that we can ensure, along with the accelerated access review and the cancer drugs fund, that we are getting to patients, in a timely fashion, the drugs they need and deserve.
Finally, I ask that the right accountability structures are in place, and that the national cancer advisory board ensures that what needs to be done is being done to secure optimum patient outcomes for all.
It is a pleasure to follow the hon. Member for Bury St Edmunds (Jo Churchill), particularly as she ended by referring to off-patent drugs. She spoke powerfully on Second Reading of the Off-patent Drugs Bill, which was promoted by the hon. Member for Torfaen (Nick Thomas-Symonds) only a couple of weeks ago. This debate draws on many points made in previous debates, including that Second Reading debate and Westminster Hall debates. There have been debates about the cancer drugs fund, specific cancers and, recently, secondary breast cancer.
I am an officer of a number of all-party groups, including that on cancer, which is so ably led by the hon. Member for Basildon and Billericay (Mr Baron), who secured this debate. We have also heard from colleagues who are members of other all-party groups, including the hon. Member for Scunthorpe (Nic Dakin), who is on the all-party group on pancreatic cancer, and the hon. Member for Castle Point (Rebecca Harris), who is doing so much to raise awareness and to promote action on and understanding of brain tumours.
I welcome the fact that the Backbench Business Committee has afforded us this opportunity to join up what might otherwise appear to be disparate work. The APPGs are not rivals—their efforts are entirely complementary. The cancer strategy is a benchmark document and this debate gives us an important opportunity to consider how we can marshal parliamentary effort and will behind it. We need Ministers in the Department of Health and elsewhere to know that we are not taking it for granted and that, just because we have had unmet need for a long time, that should not continue to be the case. I would like to hear a Minister tell us that their portfolio means that they see themselves as the Minister for meeting unmet need. If they set that target and seek to make that change and turnaround, they will have many backing vocalists from the different all-party groups.
Other hon. Members have said that there may be some issues with aspects of the cancer strategy, but it clearly lays down some important standards, not least on a recurring message that the APPGs get from the evidence we receive, namely the question of early diagnosis.
The hon. Gentleman is a good friend of the all-party group on cancer. He will already know this, but it is worth putting it on the record that the separate all-party groups on cancer are endeavouring to get their act together and to speak with one voice where there is a common interest—and there are many when it comes to cancer.
I fully recognise that point. That was what I was trying to say when I said that the APPGs are not rivals. This debate allows us to bring together their work and their common message, and to acknowledge the work of the hon. Gentleman and the chairmen of the other APPGs. In that regard, I should also mention the hon. Member for Washington and Sunderland West (Mrs Hodgson). She cannot be here this afternoon, but she has done so much on the all-party groups on ovarian cancer and on breast cancer.
Early diagnosis is a common theme and the issue is not just about making sure that there is more access to diagnosis. The hon. Member for Bury St Edmunds has mentioned how many people end up being diagnosed in A&E, which is not what should happen. Although certain cancers raise more sensitive and technical questions than others, there needs to be more awareness among GPs, and diagnostic tools are also key. However, this is about not just ensuring earlier diagnosis with better use of diagnostic tools, but ensuring much clearer referral pathways. The cancer strategy sets a target of making sure that, by 2020, 90% of people are diagnosed within a month to see whether or not they have cancer. That is a very good working standard.
All the APPGs, particularly the all-party group on cancer, have strongly suggested that the indicator of one-year survival rates would be a very good test of our ambitions and efforts and of the actions of health authorities. That working standard needs to be adopted, because it would help us to monitor and manage our progress.
I am conscious of the fact that I speak as a Member from Northern Ireland, whereas the cancer strategy and much of this effort relate to England. However, as everybody knows, in a lot of these areas we are talking about predictive policy. When we set frameworks or national strategies on particular diseases or illnesses for the NHS in England, they can extend, through policy airspace principles, to the devolved areas. That is one reason why I have no hesitation in joining in the work of the APPGs here—it helps to advance understanding at home.
Of course, that was not the case with the cancer drugs fund. We do not have a Northern Ireland version of that, which has led to the frustration that was identified by the late Una Crudden, who suffered from ovarian cancer. Many of the drugs that were available in England under the cancer drugs fund had been the subject of clinical trials in the excellent centre in Belfast, yet they were not available to patients in Belfast.
The success of the cancer drugs fund has shown its limitations, which is confounding us in thinking about how to develop and replace it. When considering the future of the cancer drugs fund and what will succeed it, I ask him to think not just about doing something for England and then seeing whether the devolved Administrations can match it or do better, but about the possibility of a UK-wide funding pool for some of the newer drugs and for some innovations in research and diagnosis, such as molecular diagnostic testing, which comes under the cancer drugs fund. Perhaps this is a conversation that we need to have with the Chancellor in the context of his announcement next week and what will happen beyond that. I am saying not that it should all be funded by London, but that there could be a pool of money to which the devolved areas contribute, with common standards and bands. It might be that certain groups of patients would then be covered by further arrangements made at the devolved level.
The more commonality and consistency we can bring to funding, the better. It would make it so much better for the many good cancer charities and policy advocacy groups that work with cancer patients, which have to busk around the different Administrations to see who has what bit of money. That also creates a lot of confusion at the parliamentary level. It is hard for us to join up our efforts and marshal our arguments when we are dealing with different structures and systems. The more commonality we can create in funding, particularly in the area of innovation, the better.
Perhaps there should be a UK-wide effort, or perhaps it should go beyond the UK. The British-Irish Council includes all eight Administrations on these islands, including the south of Ireland. Perhaps there should be a common effort at that level, given some of the clinical networks that will be involved. When we consider the rarer cancers that will not be treated in some of the other places, perhaps a more united effort would help to take the thinking forward. A lot of the ingredients in the cancer strategy for England might best be brought forward as part of a combined strategic effort on cancer across these islands.
I congratulate the hon. Member for Basildon and Billericay (Mr Baron) on securing this incredibly important debate along with the hon. Members for Bury St Edmunds (Jo Churchill) and for Bosworth (David Tredinnick). I welcome the considered way in which he set out the issues in his opening speech. He raised a series of important questions for the Minister on earlier diagnosis, the measurement of the performance of CCGs, patient experience metrics and the cancer drugs fund. Those are all important issues that are set out in the strategy. I echo his tribute to the various all-party parliamentary groups on cancer. They do an extremely good job of highlighting these issues in Parliament and we all welcome the contribution they make.
I thank my hon. Friend the Member for Alyn and Deeside (Mark Tami) for raising the important issue of blood cancer. His family experience highlights the lack of support, particularly for children, during the period beyond cancer. The strategy tries to begin to address that issue. I also thank my hon. Friend the Member for Scunthorpe (Nic Dakin) for his speech, as well as for his work as chair of the all-party group on pancreatic cancer. He quite rightly pointed out the very poor survival rates for pancreatic cancer and the difficulty of getting referrals for diagnosis from GPs.
I echo the comments made by the hon. Member for Castle Point (Rebecca Harris). She raised important issues regarding the repurposing of drugs, particularly for the treatment of brain tumours. The hon. Member for Foyle (Mark Durkan) also made valid points about how the various groups should not be seen as rivals. Indeed, they should be united behind this one strategy, the full force of which has been expressed today.
I also echo the comments made by the hon. Member for Bury St Edmunds. She pointed out that, with more than 200 different types of cancer, an overriding strategy is needed. She reminded us of the shocking statistic that about 20% of diagnoses take place in accident and emergency, which really highlights the challenge we face in making correct diagnoses. She also highlighted the policy gap in relation to off-patent drugs, which we recently discussed in the Chamber.
All Members speak on this matter from experience, which is sometimes of a very personal nature. It is the personal experience of many of those who have contributed to the strategy that we are debating that makes the document so powerful. We know that one in five people who are diagnosed with cancer feel they are treated as a set of symptoms, rather than recognised as a person. We clearly need to change that. The very moving speeches today help us to remember that behind every statistic there is a person with a family and friends.
The Opposition welcome the recommendations of the independent cancer taskforce, many of which build on proposals that the Labour party set out before the election. We hope that the strategy will be implemented in full. It has the potential to deliver improved outcomes for patients, while also delivering better value to the taxpayer. However, as several hon. Members have said, we will realise such benefits only if the recommendations are delivered in full, with front-loaded investment. I hope that the Minister will confirm that the funding required to deliver the strategy will be included in the comprehensive spending review next week. He may be under instructions not to pre-empt the Chancellor’s big day, in which case we hope that the mood of the House can be conveyed to the right hon. Gentleman.
There have been some positive developments on cancer drugs and screening in recent years, but our progress on cancer care has stalled to some extent. The target to treat at least 85% of cancer patients within 62 days of being urgently referred by their GP for suspected cancer has been missed in successive quarters across England for almost two years. Of the 21,629 patients who waited more than 62 days in 2014-15, 42% waited between two weeks and one month after the target date and about a quarter waited for even longer. As Cancer Research UK has pointed out, this is not just a missed target; patients are being failed when they have to wait too long for treatment.
Another concern is that, despite progress in improving some cancer survival rates over the past decade, we still lag behind the best-performing countries. As several hon. Members have mentioned, it has been estimated that up to 10,000 deaths each year in England can be attributed to lower survival rates compared with those in the best-performing countries. As hon. Members have repeatedly pointed out, diagnosis of cancer at a later stage is generally agreed to be the single most important reason for the lower survival rates in England, so it is vital that we do better not only on early diagnosis, but on prevention and awareness.
With a total of 95 recommendations, the strategy will need consistent political and financial support if it is to be implemented in full. We welcome the possibility of a national cancer advisory board, which, as the report states, would allow a mirror to be held up to the NHS on progress in implementing the strategy. No doubt the precise make-up of such a body would be a matter of detail, but we are keen to ensure that there is an independent chair, as has been mentioned, and that patients’ voices are heard on that body.
With so many individual recommendations in the report, it is impossible to do them all justice in the time available. For those unable to read the entire report, I suggest that the principles set out on page 16 are a very helpful overview of the core aims of the strategy. I do not propose to go through all 95 recommendations—we certainly do not have time to do so—but I want to talk about one or two areas.
I want to speak about the quality of life after treatment and about end-of-life care. One of the most compelling and difficult debates in which I have been involved during my short time in the House was that on the Assisted Dying (No. 2) Bill. One message that came through loud and clear in the debate was that there are massive differences in the quality of palliative care available. Evidence consistently shows that far more people diagnosed with a terminal illness would prefer to die in their own home than currently get the chance. That is not an easy conversation to have, but we must get better at it.
I was pleased that the report acknowledges the clear link between cancer and poor mental health. Around 10% of patients with cancer will develop serious depression, and around half of all patients have some unmet need six months after treatment has concluded. Proposals to improve detection of mental health issues and to integrate better the various treatments are to be welcomed, and will hopefully lead to better patient outcomes.
However, the strategy goes well beyond that and, as we have heard, it recognises that support for patients post-treatment in terms of lifestyle, finances and work must be hugely improved. Secondary cancer is also a huge problem, and we must ensure that care after cancer is just as good as treatment of it. I am glad that the Secretary of State has committed to the development of a quality of life metric. Improvements to the system must ensure that how well people are living is just as important as how long they live for.
Too many people are left to fend for themselves in a complicated, bureaucratic maze, while having to cope with unmet physical, emotional and financial needs—my hon. Friend the Member for Alyn and Deeside set out starkly some of the challenges that individual patients have to deal with. Nobody should have to go without help after suffering the hardship of cancer treatment, and we hope it will be possible to ensure that everybody with cancer has access to a recovery package by 2020.
In the short term, steps can be taken to make life easier. Macmillan Cancer Support has calculated that the financial impact of a cancer diagnosis makes someone on average £575 a month worse off. That is why proposals in the Welfare Reform and Work Bill to take away £30 a week in unemployment support allowance from those with cancer who are placed in the work-related activity group seem at odds with what is set out in the strategy. We need joined-up thinking not just across the health service, but across the Government and the whole of society. The report estimates that by 2030 the number of people in work who will be affected by cancer is set to increase by 1 million, and although there is statutory protection under the Equality Act 2010, in reality someone is 1.4 times more likely to be unemployed if they have cancer.
The greater role that wider society can play is set out clearly in the report, which calls for
“a radical upgrade in prevention and public health.”
If we are to make this strategy work, we must consider forming a new tobacco control strategy, and a national obesity strategy that goes beyond the responsibility deal, which is largely limited to reducing the prevalence of obesity in children. The strategy is right to include an ambition to reduce the prevalence of overall adult smoking to less than 13% by 2020. It is not difficult to imagine that current measures will do much to make that happen, and I am pleased that the report includes a recommendation that the NHS should work with the Government to deliver and implement a new tobacco control strategy within the next 12 months.
This is a matter of equality. We all know about the diverse life expectancy figures in different parts of the country, and about how a difference of just a few miles can mean huge gaps in life expectancy. There would be around 20,000 fewer deaths per year across all cancers if socioeconomically deprived groups had the same incidence rates as the least deprived. Smoking plays a large part in that, and more than half of the inequity in overall life expectancy between different social classes can be at least partially attributed to higher smoking rates among the less well-off.
My hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) deserves praise for her marathon effort to ban smoking in cars with children, and such measures will further deter smoking and encourage people to give up. However, even before that strategy has found its feet, it has been undermined by another huge cut to the public health grant for local councils, which will almost certainly mean that smoking cessation services are slashed.
If we are to take the Government seriously on public health, and if this strategy is to work, it must be supported fully. In-year cuts to public health funds go wholly against the strategy, and are contrary to any strategy that seeks a sustainable health service moving forward. As many experts have said, these cuts will end up costing more than they save. They are a political choice, and we should send a strong message to the Chancellor that they should not go ahead.
The introduction of the cancer drugs fund has been a positive development, and it delivered important benefits to patients over the course of the last Parliament, which we welcome. However, 19 treatments were cut from the cancer drugs fund at the beginning of the year, and another 18 went this month. Charities estimate that more than 5,500 patients a year will now be denied access to these life-extending treatments. Will the Minister tell the House whether he supports the removal of those treatments, and, crucially, what support will now be given to the thousands of patients who will miss out on the drugs in the future? I appreciate that this is not an easy situation, but it seems particularly cruel to give people hope and then to take it away.
I want to mention the need for renewed focus on treatments other than drugs. Before the election, Labour promised to create a new cancer treatment fund to look at all treatments available. Surgery and radiotherapy are responsible for nine in 10 cases where cancer is cured. The taskforce concluded that in a number of areas access to treatments such as radiotherapy are not at the level they should be. About half of all radiotherapy machines are reaching the end of their useful lives. We need to upgrade them so we can deliver safer care. We should also enable the more widespread use of modern radiotherapy techniques. Some 38% of cancer patients in England currently have radiotherapy as part of their treatment, but evidence from abroad suggests that this should be closer to 50%. We need to understand why there is this difference and to work towards correcting it.
I have touched on only a few parts of the strategy, and I hope there is recognition that there are wider challenges beyond the strategy itself. Where the Government are clearly working towards the aims of the cancer strategy, they will have our support. I would therefore like to ask the Minister what steps the Department will be taking to ensure that comprehensive implementation plans are laid out for the strategy as a whole by 31 March 2016.
Many Members will have lost someone close to them as a result of cancer. We owe it to everyone affected by this terrible disease to implement and support in full the recommendations set out in the strategy, so we can take further steps towards finally beating cancer.
It is a great pleasure to respond to the excellent speeches that have formed this interesting and remarkably well-informed debate. I echo the thanks given by the shadow Minister and others to my hon. Friends the Members for Basildon and Billericay (Mr Baron), for Bury St Edmunds (Jo Churchill) and for Bosworth (David Tredinnick) for securing the debate in such a timely manner. I do not think that even they would have anticipated it coinciding with today’s launch of the consultation.
The debate touches on the lives not only of everyone in this House but of everyone in the country. The frustrating regularity of cancer diagnosis—in the past week, two of my friends have had a cancer diagnosis confirmed—is shared by Members and by people watching this debate across the country. That is why this is such an important and salient issue for all our constituents. I am therefore very grateful to hon. Members for both speaking on this matter and for bringing it to the attention of the House.
At the start of my speech, it is worth reflecting that we are able to speak about this issue from a position of celebrating the success of the past few years. There have been quantum leaps in the treatment, diagnosis and survival rates of cancer. More than half of people receiving a cancer diagnosis now live 10 years or more, a remarkable statistic that would scarcely have been believed 20 or 30 years ago. The fact that we are able to speak frankly about this at all, with the very personal speeches hon. Members have given today, marks the end of the dangerous taboo surrounding talking about cancer. Happily, we are now able to replicate that fight in relation to mental health and end-of-life care. The work done by cancer charities over many years, to talk about cancer and to make it a live issue in the public imagination, is now reflected in other important areas of care.
The Minister is absolutely right to say that we have made great strides, and the Government are to be congratulated on playing their full part in that, but may I gently remind him that as we have made great strides, other countries have also made great strides? The debate is largely about the fact that we are still well behind European averages on survival rates. The first year survival rate in this country is 69%, whereas in Sweden it is 81%. That apparently small difference accounts for about 10,000 lives a year in this country being needlessly lost because we diagnose too late. I am sure the Minister will agree that there is still a lot to improve on.
I could not agree more with my hon. Friend. I was not trying to offer mere bromides. Indeed, I was about to say that although we perform well in many clinical areas, we perform badly on cancer compared with other countries. We have made significant progress over the past few years, but we are still not where we should be: at the top of the pack. There are many reasons for that, some of which we understand and some of which we do not, but it behoves us all to do something about it, which is why the taskforce was set up. In that regard, I add my thanks to Harpal Kumar and the many people who contributed to the taskforce’s conclusions.
I am speaking to an expert audience here—I am conscious that almost everyone who has spoken has considerably greater expertise in this area than I do—so I will not rehearse the history of the taskforce or its recommendations. Importantly, there is now a consensus about what needs to happen. Various things have to happen if we are to deliver on the aims of the taskforce.
We should indeed. I found the hon. Gentleman’s remarks extremely interesting; I learned a lot from them.
I want to answer hon. Members’ questions as well as I can, although I am conscious that I am answering them on behalf of the public health Minister, who has responsibility for cancer and has considerable expertise in this area. She is sorry she cannot be here. My hon. Friend the Member for Basildon and Billericay (Mr Baron) asked some salient questions. The first was: when will the taskforce conclusions be implemented? He will know that the new national director for cancer has just been appointed, and I met her yesterday. As he knows, she is an immensely impressive women, having run one of the foremost cancer institutes in the world, and she is aware that one of her initial tasks is rapidly to set out an implementation plan. In doing that, I know she will want to speak to the all-party group on cancer as soon as she develops her plans in order to keep its members abreast of developments and to hear their views about the pace of implementation. I will ensure that officials write to Members with any further details about implementation.
My hon. Friend asked about the CCG scorecards. I understand the nervousness—I detected it in his voice—about the complex measurements and the dashboard being translated into apparently simple measurements in the scorecard. I want to give him some reassurance. The scorecards used for hospitals are immensely complex and have behind them a huge amount of data that are then distilled into simple scorings, the point of which is to provide clear accountability and transparency to patients and people living in CCG areas, who, at the moment, have no grip, because we do not give them any, on how well a CCG is performing. The expert panel looking at the operation of the scorecards will be out for consultation next month and will report back before the scorecards are put in place in April. I know it will listen carefully to his comments about one-year survival rates and the detail of how the scorecards are put together, but I am clear that the oncological experts on the panel will not want to undermine the work done on the various metrics and the dashboard.
My hon. Friend spoke with eloquence about genomics. It is of course true that the reason we are able to make increasingly rapid progress is that cancer is a genetic disease, and genetics and genomics are the great new frontier in medical innovation. In a sense, therefore, dealing with cancer and drugs for cancer will be the tip of the spear when it comes to developing all new drugs in the decades ahead. It is very exciting, but presents massive challenges to funded healthcare systems around the world. It is in trying to find a way of affording the new drugs that are coming online, but also releasing the unique possibilities that the NHS offers, that we think we are in such a strong position to offer opportunities both to those wanting to research cancer from an academic point of view and to those businesses and companies doing so in order to develop drugs.
The point of saying that is that the cancer drugs fund, which many Members referred to in their speeches, will necessarily have to change in response to the significant changes of the last few years. To the shadow Minister’s point about the cancer drugs fund, I would gently say that it was an innovation personally promoted by the Prime Minister in 2010. He has made a personal commitment to it, so all Members should take solace from the fact that he will be watching carefully how the fund develops. It has risen from a few hundred million pounds to over £1.2 billion. That demonstrates a commitment that was not present before the cancer drugs fund was invented. Its size is such that it now makes up a considerable part of the overall drugs spending of the NHS.
I hope hon. Members will take comfort from the fact that the consultation announced today by NHS England aims to build on the success of the cancer drugs fund, to incorporate the new structures that need to come about as a result of the significant changes in genomic research over the last five years and to align the general research, licensing and funding of drugs through NICE with the principles of the cancer drugs fund, so that we have a far more integrated system in future. I would encourage all hon. Members present to contribute to the consultation on the cancer drugs fund and thereby help to inform the second stage of its existence, when that comes about—I imagine at some point next year.
I may be pre-empting what my hon. Friend is about to say, but on the point about widening the scope of drugs, which he has alluded to, will he take note of the remarks about broadening the scope of patient choice and the range of therapies available, and perhaps using Professional Standards Authority-regulated professionals rather more?
I will, and I was about to move on to my hon. Friend’s remarks. He made a similar point—that great progress had been made but there was still much to be done. He spoke with eloquence and detail about complementary treatments, in which I have absolutely no expertise—I shall have to disappoint him on that. I know that he has written to me about the regulation of herbal medicines. I have today spoken to the Minister for Life Sciences, and I know that my hon. Friend will be receiving a full response about the various issues he has raised.
In response to my hon. Friend’s points about complementary treatments, I would say that it is very important when spending taxpayers’ money on cancer treatments that there is a solid evidence base for what we do. However, his point is well made—that the entire person needs to be taken into account when considering treatment. That can also involve people living with cancer, not just the treatment of it.
It was very nice to hear the hon. Member for Alyn and Deeside (Mark Tami) speak. It was also good to hear him speak from a personal point of view—it was good of him to share his sorrow regarding his son. On the stem cell transplantation issue that he raised, I can tell him that the recovery package as part of the taskforce’s recommendations that the Government have already moved on will apply to blood cancer patients who have undergone stem cell transplantation. The Government are very supportive of the work by the Anthony Nolan trust and other charities, but I will make sure that the hon. Gentleman gets a fuller response on the specific issues that he raised, so he can be satisfied that we have taken into account the particular difficulties and challenges facing those who have undergone stem cell transplantation.
It was a great pleasure to hear from the hon. Member for Scunthorpe (Nic Dakin). I have a particular affection for him, not only because he helped me on the way through King’s Cross the other day, but because he spoke just before me in my maiden speech—we made ours at the same time. This is a good point at which to reflect that the Member who spoke after me was the former right hon. Member for Oldham West and Royton, who is much missed in this place.
The hon. Member for Scunthorpe brought to our attention the issue of rare cancers—specifically pancreatic and blood cancers. I would like to reassure him about research. He will know that Cancer Research UK has looked specifically at the rare cancers and has prioritised work in the areas where it feels additional research funding and effort need to go, which include blood and pancreatic cancers—and, indeed, brain cancers, which my hon. Friend the Member for Castle Point (Rebecca Harris) mentioned. The hon. Member for Scunthorpe also raised the issue of GP imaging capacity, and I would like to reassure him that, as part of the ACE programme—Accelerate, Co-ordinate, Evaluate—by NHS England, imaging will be expanded within primary care. I hope that I will be able to write to him with further details.
I thank my hon. Friend the Member for Castle Point for her fascinating speech and for bringing to our attention the very sad story of her constituent Danny Green. Her point about a national register for off-label drugs was well made, and I know it is an issue that the Under-Secretary of State for Life Sciences, my hon. Friend the Member for Mid Norfolk (George Freeman), is looking at actively. My hon. Friend the Member for Castle Point made a point about research,. She will be aware that it is always difficult to try to divvy up research funding, but I will make sure that her point is reflected back to my hon. Friend the Under-Secretary.
My hon. Friend the Member for Bury St Edmunds (Jo Churchill) made some very good points about joined-up care. It is certainly the case that we need to see such care across the NHS.
The hon. Member for Foyle (Mark Durkan) spoke about the cancer drugs fund, and made an interesting point about a UK-wide set of arrangements. I shall certainly pass on his comments to the Minister responsible for cancer. He also spoke about molecular diagnostics, and I would like to reassure him that, in England at least, we will significantly roll out molecular diagnostics as a result of our acceptance of the principles of the taskforce recommendations.
Finally, the hon. Member for Ellesmere Port and Neston (Justin Madders), the shadow Minister, rightly made some points about public health strategy. It is, of course, difficult to make sure that we balance the books, while keeping to our manifesto pledges. His points about tobacco and obesity were well made, and I know that the Government will be coming forward with obesity plans in short order.
With no more time available to me, I would like to thank Members for their full, excellent and expert contributions to this fascinating debate. I hope that the Government have shown the kind of progress and commitment to this important area that they are so keen to see.
That is very kind and generous, Madam Deputy Speaker.
I would like to thank all who contributed today—it proves how much expertise has been brought to bear in such a well-informed debate from all sides. I would like to thank the Minister once again for stepping into the cancer Minister’s shoes and for answering our questions. I am sure he will want to answer some further questions in writing. I would like to thank him, too, for taking on board the importance that the whole cancer community attaches to the one-year cancer survival rates as a means of promoting earlier diagnosis. I thank him for that.
I leave the Minister and the House with just one thought. There are not many areas of Government policy that could save 10,000 lives a year if we raised our game on earlier diagnosis. We need a policy that will match the best internationally. We have that capability in our hands: let us hope that we seize the opportunity.
Question put and agreed to.
That this House notes the findings of the independent cancer taskforce published in July 2015; and calls on the Government to publish an action plan on implementing the new cancer strategy.