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NHS: Cancer Diagnosis and Treatment

Volume 756: debated on Monday 13 October 2014


Asked by

To ask Her Majesty’s Government what is their assessment of the report by Cancer UK highlighting gaps in the provision of National Health Service cancer diagnostic and treatment services.

My Lords, there has been significant growth in the provision of cancer diagnostic tests and treatment over the course of this Government. For example, urgent GP referrals for suspected cancer have increased by more than 50% since October 2009. NHS England is taking action to support the NHS to improve performance, including establishing a cancer waiting times task force. We are investing an additional £750 million over four years to improve diagnosis and treatment of cancer.

My Lords, on the question of waiting times, can the noble Earl confirm that the 62-day target for cancer treatment has been breached in the last two quarters? Can he say why that is and can he confirm that it is really a result of the shambles that Mr Lansley’s changes have brought to the NHS?

My Lords, the noble Lord is correct that although most waiting time standards are being maintained there has been a dip in the 62-day pathway standard in the last two quarters. However, survival rates are improving and we are treating a record number of NHS patients for cancer. Last year, 450,000 more patients were referred with suspected cancer than in 2009-10. That is an increase of 51%. In addition, campaigns such as Be Clear on Cancer have been exceptionally successful in raising awareness of symptoms. In large part, that is what has accounted for the pressure on the waiting time standards: in a way, the campaigns are a victim of their own success.

My Lords, it is still true that the chances of surviving cancer can vary dramatically depending on where you live. Can the Minister say what progress has been made in understanding the reasons for those variations and what progress has been made in reducing them?

My Lords, my noble friend is absolutely right. He will know that medical opinion is clear that a variety of reasons such as lifestyle and others account for regional variations. We want to see a uniformity of speedy diagnosis throughout the country. That depends on early presentation by the patient and speedy diagnosis when the GP first sees the patient. It is with those two things in mind that a lot of work has been going on, particularly to support GPs, but also to inform the public.

I declare my interest as president of the BMA. Will the Minister outline what action has been taken? Given the crisis in recruitment in general practice, the increased pressures on GPs now that they are also involved in commissioning services and the pressures in emergency medicine, how will GPs have time to tackle obesity? In the obese patient, early diagnosis is much more difficult than in the less obese patient. Also, the incidence of some cancers such as breast cancer is higher in those who are obese.

My Lords, the noble Baroness makes a number of important points. In August, my right honourable friend the Secretary of State announced a joint piece of work with Cancer Research UK and Macmillan, which will see GPs offered more support to ensure that cancers are diagnosed as quickly as possible. More generally, NICE is updating its referral guidelines for suspected cancer to ensure that they reflect the latest evidence. GPs already have a guide related specifically to direct referral for diagnostic tests, for which we have provided extra money, and early last year the department part-funded a six-month pilot run by Macmillan of an electronic cancer decision support tool for GPs. That pilot is being evaluated, but Macmillan is working with IT software companies to disseminate an updated version of that tool.

My Lords, given the importance of early diagnosis and of the significant role that GPs play in that, is the Minister concerned that some patients facing the problems that many now have of finding a GP quickly will be put off presenting with those early symptoms? That will thus get in the way of the early diagnosis that is so important.

My Lords, I am aware that in some areas of the country access to GPs is proving problematic and a number of work streams are under way to address that. But we are confident in the light of the statistics that patients are not holding back in presenting to their GPs. As I said, referrals have gone up dramatically over the last few years and the NHS is treating a record number of patients.

My Lords, I declare an interest as a cancer patient. What arrangements are made for determining eligibility for treatment by the CyberKnife at the Royal Marsden and UCLH and does it involve any financial assessment of the likely cost to the NHS of the treatment of a particular patient?

My Lords, my noble friend mentions a particular type of radiotherapy, the CyberKnife. At present there is only limited research evidence of the clinical and cost effectiveness of stereotactic ablative body radiotherapy—the full name. Therefore, it is available only for certain patients with lung cancer. Having said that, NHS England has agreed to make £6 million available over the next few years for new clinical trials which will involve trials on prostate cancer, lung cancer, pancreatic cancer and biliary tract cancers. It is important that we generate that clinical evidence before encouraging the NHS to apply this form of radiotherapy to those cancers.

Will the noble Earl give the House an indication of when the deteriorating waiting times for cancer treatment will be reversed?

My Lords, clearly a lot of work is going on in the NHS to ensure that we are back on track with the cancer waiting times. Local area teams of NHS England are looking at the causes of those waits and whether there are diagnostic tests that are responsible for the dip in performance. But I can assure the noble Lord that we place a high priority on this area.