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7.37 pm
The Parliamentary Under-Secretary of State for Health (Yvette Cooper): I congratulate my hon. Friend the Member for North-West Leicestershire (Mr. Taylor) on choosing to debate the role of primary care in the treatment of cancer. It is a timely choice of topic, as the Government are developing cancer services across the spectrum. I know that Leicestershire is a national site for the cancer services collaborative programme, which my hon. Friend mentioned, and that the development of primary care services for patients with cancer and of palliative care services have been key issues for the Leicestershire cancer centre.
As my hon. Friend knows, at the heart of our health modernisation programme is a determination to reduce the impact of cancer on people's lives and to create the best cancer service in the world. We have set a challenging target to reduce the death rate from cancer by 20 per cent. by 2010, preventing 100,000 deaths. To succeed, we will need to deliver a tough programme of action spanning prevention, screening, early diagnosis and high-quality treatment and care. Primary care has a role to play at every stage in the treatment of cancer.
I shall cover some of the general issues raised by my hon. Friend, and then deal with some of the detailed questions that he raised. The advent of primary care groups last year, and the first primary care trusts this April, means that local clinicians are firmly in the driving seat in delivering the new NHS. Local general practitioners and primary care teams ensure continuity of care, informed advice, treatment and, when required, referral to secondary care. As my hon. Friend the Member for Loughborough (Mr. Reed) said, that means the entire primary care team, not simply the general practitioners who work in primary care. The primary care teams care for patients on their discharge and, in the case of terminally ill patients, until their death.
My hon. Friend the Member for North-West Leicestershire is right to say that we need to be confident that appropriate models of cancer care are in place to meet the significant changes expected in our society over the next few years--changes in the population's age structure, in inequalities, in the availability of informal care and in expectations.
Primary care has an important role to play in terms of prevention, particularly in regard to cancer. With an ageing population, the incidence of cancer is likely to rise, but preventive measures, including action on smoking, diet, alcohol, exercise, exposure to the sun, will affect the risk of developing cancer. There is good evidence of the effectiveness of brief interventions by primary care teams in reducing alcohol intake and in encouraging people who want to give up smoking.
Primary care also works with local authorities, in settings such as schools, workplaces and the community, to promote healthy life styles. Nor should we overlook the role of community pharmacists, dentists and optometrists, each of whom provides health services to a substantial proportion of the population each year, and often offers advice on prevention or identifies symptoms of disease.
We continually look for innovative ways to improve health promotion and prevent ill health and cancer, putting additional resources into services for ethnic minorities and for people in low income areas, and, in particular, working with the public health development fund on matters such as smoking cessation.
The role of primary care is important in tackling health inequalities, particularly with regard to cancer. There is some evidence that patients from low-income areas are diagnosed with more advanced tumours than those from higher-income backgrounds. That may be one reason why people from low-income areas have worse survival rates. Health authorities and primary care groups have a key role in addressing such health inequalities. Their role is vital, especially through local health improvement programmes.
Primary care groups have an important role to play in tackling health inequalities through health action zones. The 26 zones are trailblazers, leading the way in tackling health inequalities, acting as test beds for innovation and recognising that the health service cannot do everything in terms of improving people's health.
Primary care also has a role to play in terms of screening for cervical and breast cancer by providing information and education, directly undertaking cervical smears, and by assisting with call and recall programmes for breast screening. We also know that uptake of screening programmes varies across the country from one group to another. Primary care, working with other agencies, can play a vital role in increasing uptake and encouraging health awareness.
My hon. Friend talked in particular about diagnosis and treatment referral. He is right to say that people need to have confidence in their health service, so that, if they have symptoms that could be caused by cancer, they can discuss them with their GP and be referred quickly and appropriately if necessary.
Although cancer is a common problem, with 220,000 new cases diagnosed each year in England and Wales, an individual GP is unlikely to see more than eight or nine cases a year. The task for GPs is to differentiate between patients whose symptoms may be cancer and the much larger group of patients with similar symptoms arising from other causes. My hon. Friend is right to say that that creates important challenges for primary care teams.
That is why we are working with primary and secondary care groups, the voluntary sector and patient groups to develop cancer guidelines for primary health care teams to help them identify those patients most likely to have cancer and to require urgent specialist investigation. Equally, the guidelines will help GPs identify those patients who are unlikely to have cancer or who may require alternative treatment or diagnosis. The guidelines have been issued for consultation. We received many comments on them and we are revising them in the light of those comments.
General practitioners are naturally concerned to ensure that we continue to undertake research to determine the symptoms or signs that indicate someone who has a higher risk of developing cancer and the patients who can be safely followed up through primary care.
Cancer and primary care constituted two of five topic working groups in the recent strategic review of the NHS research and development levy. That reflects their high priority in the Department's research and development activities. The sub-groups on cancer and primary care acted together closely and thus provided an integrated approach. That is important. They recommended a series of priorities for NHS research and development, which reflected gaps in the current evidence base for services and planned service developments. The Department is considering the best way of taking those recommendations forward.
We have also set up a cancer research funders forum to help improve the strategic co-ordination of research and to examine all categories of research including life style, prevention, screening, diagnosis and treatment.
My hon. Friend mentioned the two-week wait. He is right to say that, for patients who have suspected cancer, seeing a specialist quickly is extremely important. That is why, since April 1999, all patients with suspected breast cancer who are referred urgently by their GPs have been offered an appointment within two weeks. During the next year, we will roll out that high standard of care for all cases of suspected cancer that require an urgent specialist investigation.
My hon. Friend also mentioned the way in which primary care provides physical, psychological and emotional support, acts as link and advocate with the secondary and tertiary sectors, and deals with parallel non-cancer illnesses. It also gives the crucial continuity of care and support that nothing else can provide.
Primary care is vital to providing palliative care, which is a core responsibility for GPs and community nursing. The primary care team has, and will continue to have, a central role in providing and accessing palliative and terminal care for patients.
By introducing pooled budget arrangements with social care agencies, the funding for primary care allows primary care groups and primary care teams to develop innovative and flexible services to tackle their local communities' needs, thus making the best use of the resources that we can make available to them.
My hon. Friend raised several specific anxieties about resources. As he knows, we have already put significant additional investment into cancer services. In addition to the £23 million that he mentioned to support the living with cancer programme, another £93 million from the new opportunities fund is being used to buy new equipment for cancer screening, early diagnosis and treatment.
From April this year, £80 million over the next two years will support improved access to cancer care, and we are encouraging health authorities to engage with primary care to support educational arrangements to help implement national cancer referral guidelines and ensure that patients are speedily referred.
However, as my hon. Friend said, we also need to consider how we can minimise variation in cancer care delivery within primary care. Professor Mike Richards, the national cancer director, is already leading work to
develop a national quality improvement framework. That will concentrate initially on developing standards of care for secondary and tertiary cancer care.I know of the excellent work in Leicester, and that the development of a GP practice cancer accreditation programme has recently been awarded primary care NHS beacon status. I have asked Professor Richards to explore with leading GPs and other interested groups whether we should consider rolling out the quality improvement framework to encompass primary care, and to develop a framework for ensuring consistency across the country through investment in cancer education and audit in primary care so that we can deliver a consistent, high-quality service.
We believe that there is considerable scope for developing the work of primary care in prevention, diagnosis, treatment, support and palliative care as well as in line with many of the points that my Friend made. I look forward to following developments in his area. I shall make sure that the experience in Leicestershire is fed into our developing national work.
The Government are determined to improve cancer services. The role of primary care in the prevention, early detection, treatment and care of cancer is vital to delivering the modern, seamless, comprehensive and high-quality service that we all want.
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