| Previous Section | Index | Home Page |
10.7 pm
The Minister of State, Department of Health (Mr. John Denham): I congratulate my hon. Friend the Member for Barnsley, Central (Mr. Illsley) on obtaining this debate. He has made a compelling and moving speech on behalf of his constituent, Mr. Harley. My sympathy and that of the House goes to him for his predicament, and we send our best wishes for his future treatment, which we hope will be a success.
My hon. Friend mentioned the fact that I visited the Trent region earlier today. It is one of those ironic coincidences that I was visiting the Jasmine centre at the Doncaster royal infirmary, which is a specialist breast cancer clinic. It is a national leader in patient-centred cancer services for women suffering from breast cancer. My hon. Friend's speech reminds us all of the unacceptably wide variations in the quality of treatment and care and access to care in the NHS, which the Government are determined to tackle.
My hon. Friend told us of the delay in diagnosing Mr. Harley's cancer. He will understand that I cannot get involved in a discussion of the details of that individual
case. I understand that the Minister for Public Health will shortly reply to my hon. Friend's letter, but it is difficult for me to discuss the detail of this case.However, I can say a little about the options available to any of our constituents who have cause for concern about the treatment they have received. First and foremost, there is the NHS complaints procedure. I understand that in this case the chief executive of the NHS trust has written to my hon. Friend's constituent and given a commitment to a thorough investigation of his concerns.
A constituent is also entitled to refer to the General Medical Council any doctors--private or NHS--whose practice gives grounds for believing that they have been negligent or incompetent. Doctors can be referred to the GMC for suspension or removal from the list.
I should like to deal with the particular points that my hon. Friend raised in the context of the Government's commitment to providing fairer and faster care as part of our determination to modernise the national health service. We want to ensure that all parts of the health and social services system work better together; to improve clinical performance and NHS productivity; to increase flexibility in training and working practices; to ensure fast and convenient access to services; to empower patients through information; and to tackle inequalities and avoidable ill health. If we do all that, we can deliver the services that we all want.
We are impatient for change, and want to see evidence of faster, fairer, more convenient services, including modern diagnostic and treatment services. We want to ensure that services are moulded to the needs of individual patients. The Budget statement announced substantial additional investment in the national health service, part of which has already been released to my hon. Friend's health authority. We have set up action teams to tackle each of the key issues, and a national plan for the NHS will be published in July, identifying the main modernisation measures and targets.
Improving cancer services must and will be an integral part of our modernisation plan. Professor Mike Richards, the national cancer director, has been asked to develop a national cancer programme setting out key objectives and deliverable outcomes for cancer care. We are determined to reduce the impact of cancer on people's lives, and to create a world-class cancer service. We have set the challenging target of reducing the death rate from cancer by 20 per cent. by 2010. We can meet it only if we have a tough programme of action involving prevention, screening, early diagnosis and high-quality treatment and care.
Patients need to have confidence in their health service, and to know that if they have symptoms of what could be cancer they can discuss them with their GP and be referred quickly and appropriately if necessary. However, although cancer is a common problem--about 220,000 cases are diagnosed each year in England and Wales--an individual GP is unlikely to see more than eight or nine cases a year. GPs must differentiate between patients whose symptoms may be those of cancer, and the much larger group who have similar symptoms but do not have cancer.
That is why we have published cancer referral guidelines for primary health-care teams this year. The guidelines are intended to enable those working in primary health care to identify the patients who are most
likely to have cancer, and to require specialist investigation urgently. They cover all cancer sites, including the head and neck, and provide incidence figures for those sites. They highlight common risk factors, and list common symptoms. They give GPs concise, useful information that is easy for them to use, helping them to ensure that people with cancer-like symptoms are referred quickly for further tests.Although that action has already been taken, it must feature largely in my response to my hon. Friend. It is a recent initiative on the Government's part, which is clearly intended to secure consistently high-quality referrals by GPs working in primary care--and, of course, to enable those GPs to identify people who are unlikely to have cancer, or may require a less urgent referral to hospital. We will continue to support research to determine which symptoms indicate that people consulting their GPs have a higher risk of developing cancer, and which patients can be safely followed up within primary care.
That will be backed up by the significant investment that we are making in new technology in both primary and secondary care over the next three years. It will help to provide a range of networked services such as out-patient appointment booking, test result delivery and e-mail to all GPs by the end of 2002. All that will enable patients to be referred quickly to the most appropriate specialist team for the initial investigation and appropriate management of their condition.
We need to build on effective referral by ensuring that people have speedy access to services. Services should be there when people need them. Those who need treatment urgently, as many cancer patients do, should receive it on an urgent basis. In April 1999, we set a two-week waiting-time standard for all patients with suspected breast cancer whose GPs judged that the need for referral was urgent. That is the time to be taken from a patient first contacting her GP and the GP making an urgent referral for an out-patient appointment.
From April to December 1999, more than 56,000 women benefited from that high standard and 96.4 per cent. of breast cancer patients were seen within the target period. We will be rolling out that standard for all other cancers throughout the year, with lung cancer, children's cancers and leukaemia patients being the first to benefit from the two-week standard from April 2000.
It is important, too, to minimise the time that patients have to wait for diagnostic tests. We are seeing the biggest ever single cash investment in cancer equipment of £93 million of lottery money from the new opportunities fund.
Many of the investments are in the Trent region. Barnsley will receive an updated mammography X-ray machine, as requested by the clinical director of the breast screening unit, to replace a machine that is 10 years old. I understand that that will be installed and working within the next few weeks.
I understand, too, that as part of the developments in cancer services resulting from the Calman-Hine standards, Barnsley district general hospital will shortly open a purpose-built chemotherapy unit to enable patients receiving non-complex chemotherapy treatment on an out-patient basis to be cared for closer to home, rather than having to travel to Sheffield for their treatment.
Having given the broad picture about our approach to modernising cancer services and having emphasised the importance that we attach to speedy GP referral and
out-patient consultation, I should like to discuss the general mechanisms that are being put in place to tackle the performance of individual clinicians, or the failure of systems to deliver good-quality care.Key to that is clinical governance. That process places quality at the heart of health care. We are ensuring fair access to effective, prompt, high-quality care wherever a patient is treated in the NHS by setting clear national standards, but with responsibility for delivery being taken locally through the implementation of clinical governance, backed by consistent monitoring arrangements.
Through clinical governance, we intend to ensure that we have clear lines of responsibility and accountability for the overall quality of clinical care; a comprehensive programme of quality improvement activities; clear policies aimed at managing risk; and procedures for all professional groups to identify and to remedy poor performance. We have underpinned the development of clinical governance by a new statutory duty of quality on NHS trusts, primary care trusts and health authorities, which requires them to put and to keep in place arrangements for monitoring and for improving the quality of health care that they provide.
In addition to developing clinical governance, we have reached an outline agreement with the British Medical Association in the shape of a new form of consultant contract, which will involve regular appraisal of performance. Indeed, under proposals put forward by the chief medical officer, all doctors will be subject to regular appraisal.
The chief medical officer is drawing up a report on dealing with adverse clinical incidents. That will reflect the fact that most such incidents are the result of the failure of systems, rather than simply of individuals.
As I have said, we need to ensure that patients have access to high-quality diagnosis, treatment and care services. We are committed to improving the quality of cancer services through the implementation of "Policy Framework for Commissioning Cancer Services", the Calman-Hine report.
We have published evidence-based guidance on improving outcomes for breast, colo-rectal, lung and gynaecological cancers. Further guidance on cancers of the stomach, oesophagus and pancreas will be published in the spring, and guidance on urological, skin, haematological and head and neck cancers will be commissioned over the next two years by the National Institute for Clinical Excellence.
We are developing national standards and performance indicators, based on that evidence-based guidance, which will be used to deliver and to measure continuous quality improvement in a consistent manner throughout the country within a national quality management framework.
All those improvements--setting standards, publishing evidence-based guidance on treatment of cancers and developing clinical governance systems--enable us to ensure that the health service performance can be independently reviewed by the new Commission for Health Improvement, which began work in April. We have asked the commission to conduct a national review of implementation of Calman-Hine as one of its first tasks.
My hon. Friend asked about the National Institute for Clinical Excellence and the impact of its work on the availability of cancer drugs. NICE has been asked to
assess the cost effectiveness and availability of a number of anti-cancer drugs. Because of the relatively high cost of some of those drugs, some difficulties about interpreting clinical evidence and various debates, health authorities have reached different decisions on whether to fund them. That is the background to so-called postcode prescribing, which is one of the problems that we are determined to tackle.Last week, NICE published the first of its guidance, recommending the use of paclitaxel--taxol--in ovarian cancer. Such guidance will help the NHS to focus its increasing resources on the treatments that will best improve people's health. Effective treatments will be actively promoted. As we must make the best use of NHS resources, treatments without good evidence of clinical benefits--or treatments that are more expensive than effective alternatives--would be discouraged by the NICE process.
After the Budget, when my right hon. Friend the Secretary of State for Health released the £600 million of additional funding for this year, he made it perfectly clear that we expect that money to be used, among other things, to pay for the cost of implementing NICE recommendations. I do not believe that the fears that my hon. Friend expressed about what he described as tumour-based prescribing will prove to be justified. NICE
has been asked to review the evidence on the clinical cost-effectiveness of particular drugs in treating the conditions for which they have been licensed and for which there is an evidence base.We have recently announced that, in the next year, a range of other anti-cancer drugs will go to NICE for assessment. They include three drugs for colon cancer, three drugs for lung cancer and three drugs for blood cancers, such as leukaemia. NICE will also assess some other recently licensed cancer drugs, including one for brain tumours and one for pancreatic cancer. I am certainly convinced that NICE's work will tackle some of the unacceptable variations in access to cancer treatment and care that are currently too evident in the health service.
My hon. Friend--on the basis of what has happened to his friend and constituent--raised the very important issue of cancer services and performance of the national health service. I hope that, in this brief debate, I have been able to assure him that we have taken action to address many aspects of that issue. Although there is some way to go before we have the cancer services that we aspire to deliver, we are determined to continue to make progress month by month and year by year.
| Next Section
| Index | Home Page |