Cancer Care (England and Wales): 12th February 2013

The Parliamentary Under-Secretary of State for Health (Anna Soubry)
As ever, it is a pleasure to serve under your chairmanship, Mrs Riordan.​

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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