NHS Cancer Services: 14th September 2012

The Parliamentary Under-Secretary of State for Health (Anna Soubry)
I congratulate my hon. Friend the Member for Basildon and Billericay (Mr Baron) on securing the debate. I am aware of the excellent work that he has done with the all-party parliamentary group and with cancer charities to promote the inclusion of relevant cancer indicators in the NHS, public health and commissioning outcomes frameworks.

As you will know, Mr Deputy Speaker, there is a lot of terminology in the Department of Health—to which I am very pleased to have been appointed—and I apologise at the outset for any jargon that is used. One thing is certain: my hon. Friend will be more than familiar with it. However, I hope to explain the position in as much plain language as possible.

I am fully aware of the frustration felt by my hon. Friend, his all-party group and the cancer charities over the recommendations from the National Institute for Health and Clinical Excellence about the indicators for the commissioning outcomes framework and the difficulties that are likely to occur in 2013-14, but I can assure him that a methodology for possible one-year and five-year survival rate indicators for potential inclusion in COF is under way. I hope he will accept that that is good news, as is the fact that work is also under way to investigate composite cancer survival indicators at both national and clinical commissioning group level. I will say more about that, but I wanted to begin by reassuring my hon. Friend that we had taken his previous points fully on board.

As my hon. Friend knows, the Government published “Improving Outcomes: A Strategy for Cancer” in 2011. It set out our ambition to halve the gap between England’s ​survival rates and those of the best in Europe. My hon. Friend spoke of the disappointment that many people feel about our survival rates, and said that everyone wanted them to improve. It is estimated that halving that gap would save 5,000 more lives every year by 2014-15. The strategy is intended to reflect the importance of improving outcomes through the five domains—or areas, as I would call them—of the NHS outcomes framework: preventing people from dying prematurely, improving the quality of life for people with long-term conditions, helping people to recover from illness or injury, ensuring that people have a positive experience of care, and treating and caring for people in a safe environment and protecting them from avoidable harm.

In recognition of the fact that cancer is a big killer—more than 130,000 people die of the disease each year—we have included seven cancer indicators in domain 1 of the NHS outcomes framework. They cover the under-75 mortality rate from cancer and one and five-year survival rates for three major cancer killers, namely colorectal, breast and lung cancer. In addition, two overarching indicators will include cancer data: potential years of life lost from causes considered amenable to health care, and life expectancy at 75.

My hon. Friend has urged us previously to consider other indicators that would reflect improvements in survival rates for rarer cancers, and he mentioned them again today. I can confirm that we have asked the London School of Hygiene and Tropical Medicine to develop composite indicators that might allow improvements in survival rates across all cancers to be assessed. We hope to be able to make a decision in time for the NHS outcomes framework for 2013-14, which is due to be published later in the autumn.
Mr Baron
I am heartened by what the Minister is saying, but does she appreciate our view that a composite index should complement the one and five-year survival indicators rather than replace them? We fear that a composite index will mask bad news on rarer cancers with improvements on the more common cancers, which would have greater force in the index because they are more numerous.

Anna Soubry
I thank my hon. Friend for making that point, and I certainly take it on board. If there is anything that I am not able to cover in the short time that is available to me today, we will write to him; and, as he knows, my door is always open so that we can continue the debate. It is important, and it is especially important that we do things right.

The NHS Commissioning Board will translate the national outcomes goals for the NHS into measures that are meaningful at a local level in the commissioning outcomes framework. The board authority is now working with clinical commissioning groups and other stakeholder organisations to discuss the shape of the commissioning outcomes framework for 2013-14 and beyond. COF will play an important role in driving up quality in the new system. Covering £60 billion in services commissioned by CCGs across the NHS, it will translate the NHS outcomes framework into clear, comparative data on the quality of services that CCGs commission for their local populations and the outcomes achieved for patients.

Concerns have been expressed that the NICE COF advisory group recommended only one indicator for inclusion in COF and, in particular, that the group ​recommended no survival rate indicators. NICE’s advisory group is independent of both the Department and the NHS Commissioning Board. NICE was asked to give advice on potential measures to include in the framework, based on the best available evidence. It is now for the NHS Commissioning Board to decide on its final shape for 2013-14.

The NHS Health and Social Care Information Centre has been asked to work with the London School of Hygiene and Tropical Medicine and the Office for National Statistics to develop a methodology for one-year and five-year survival rate indicators for potential inclusion in COF. These will be composite indicators, because of the difficulties associated with getting statistically valid indicators for individual cancers at CCG level.

Mr Baron
The national one-year and five-year figures for the three main cancers have been calculated. They must have been drawn from local figures. Experts in this area tell me that once the boundaries are known, it should be possible to slice those figures to show the one-year and five-year picture at a local level.

Anna Soubry
The difficulty is that the numbers in each CCG might be very small indeed, and therefore the statistical benefit will be limited. It may well be possible to look at the situation in respect of the health and well-being boards, however; we might be able to look at this at a local authority level.
Mr Baron
The Minister is being very generous in giving way, and one of the purposes of Adjournment debates is to enable us to have a bit of a discussion. I take on board her point, but the CCGs are larger than was originally estimated. I would also say that we have suggested the use of proxy measures such as staging and accident and emergency admissions figures to complement, but not replace, the one-year and five-year figures, because they would give a more complete picture at the local level.
Anna Soubry
We will certainly examine the points my hon. Friend raises. A letter or meeting between us may be the best way to resolve things.

Further work is required, and work is being undertaken to look at the feasibility of developing other measures, such as patient experience of cancer services, for possible inclusion in COF for 2014-15. We would expect the board to work with NICE and other stakeholders to establish priorities for development for the 2014-15 COF and beyond.

We recognise that the challenge of cancer is huge. Over 250,000 people in England are diagnosed with cancer every year, and currently about 1.8 million people are living with, and beyond, a cancer diagnosis. It is fair to say that cancer touches all our lives; if not our own individual life, then that of someone we know in our family, our circle of friends or the people we work with. Like many hon. Members, no doubt, I lost a member of my family: my father died of cancer many years ago. It is a pernicious disease, but great strides are being made all the time. However, despite improvements in the quality of cancer services, more can and should be done to improve outcomes for those afflicted by it. Regardless of the shape of the NHS and the commissioning outcomes frameworks in 2013-14, we are committed to delivering improvements in cancer survival rates, as set out in our strategy.

Finally, I again pay tribute to my hon. Friend, his all-party group on cancer and the various charities for all their work and their great contribution to the debate, including this debate. I look forward to continuing that debate and speaking with him so that I can answer all his questions and discuss all his ideas in full.

Question put and agreed to.