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2.46 pm
Dr. Peter Brand (Isle of Wight): I congratulate the hon. Member for Rayleigh (Dr. Clark) on an excellent report, which is also timely. As the hon. Gentleman pointed out, cancer is not all about misery now; it is also about hope.
I remember that, 30 years ago, childhood leukaemias involved nasty treatment and extremely poor outcomes. People indulged in "heroic" surgery, in which the patient was the victim and the surgeon was thought to be the hero. We have moved a long way since those days, and I welcome the Government's response to the Committee's excellent report, but there are still some bits missing.
As the introduction to the report helpfully explains, the steps that we can take in cancer treatment and research depend largely on a fundamental understanding of the cancer process. We still do not know why some cells start to behave aberrantly; nor do we know why some people manage to get rid of the aberrant cells, while others do not. However, I think that we are near to finding answers to some of those fundamental questions, and that we should not forget the importance of basic research. I certainly approve of the concept of a national cancer centre, benefiting from international collaboration.
The report also deals with research in treatment. The last Government did well in commissioning the Calman-Hine report, but did abysmally in terms of its implementation. It was ridiculous to allow the market in
health care to determine where people should have their cancer centres. It was ludicrous not to draw up a national, or even regional, strategy determining where radiotherapy services or linear accelerators should be. I am glad that the planning is now gaining some semblance of order, but I am disappointed that there is not a stronger regional input in decisions about where such services are to be.The hon. Member for Ruislip-Northwood (Mr. Wilkinson) spoke eloquently in support of his local unit. It is a unit of great excellence, but I sometimes doubt whether having two or three adjoining units of great excellence is the best way of serving the country. I do not deny that we have some excellent centres, but I also feel that one of the most striking aspects of outcomes is the postcode lottery. Outcomes depend on where people live, and where they can be referred to.
May I be critical of the Government? The new system of out of area treatment as opposed to extra-contractual referrals is having a dramatic impact on referral patterns, patient choice and patients' ability to get to units that may be at the leading edge of a particular treatment regime for a particular cancer, which could not have been foreseen by the health authority or trust. So arrangements cannot always be easily made.
We can refer out of area, but there will be no obligation on the people to whom we refer to accept that referral if they cannot guarantee getting the resources to go with the treatment. The OAT scheme must be looked at. We are almost working against the rules to make things happen. That cannot be in either the patient's or the clinician's interest.
I echo the hon. Member for Norwich, North (Dr. Gibson) in congratulating the Government on recognising the tremendous value of laboratory scientists and pathologists. I remember the front page of a local paper having a nice picture of a man in a white coat holding a chicken. He was a qualified laboratory technician with a science degree who had stopped being a laboratory technician and become a chicken sexer, which brought in £2,000 more a year. That is ridiculous. I am glad that we are taking steps to correct that.
If we are going to get something out of the system other than just treading water and enormous pressure, all the people involved with research, whether it be fundamental research or research in treatment, require thinking time and deliberation time, which in today's clinical practice is often missing. That is one of the reasons perhaps why trusts are putting such an enormous premium on research being done within the trust. It is costing their clinicians' time and their scientific staff's time to an extent that is becoming unreasonable.
Mr. Philip Hammond (Runnymede and Weybridge): The hon. Gentleman has made an interesting point. Does he agree that the figures that the Prime Minister has used to suggest that the Government will match voluntary sector funding are deeply suspect, given that much of that funding is being used within mixed clinical and research situations in the NHS and is liable to be diverted in the way the hon. Gentleman has suggested?
Dr. Brand: I am not as suspicious or as cynical as the hon. Gentleman, but we perhaps take a different approach to these matters. It is difficult to cost the two. My plea is that, where clinicians are working in an area where there
is active research, that should be recognised in their work load and their departments should be adequately staffed to cope with some of the work that needs to be done.I pick up two or three points that may seem minor in relation to the report but are important and practical. We now have to refer all research to research and ethical committees in a correct way, but we have not gone far enough in streamlining the system when the research involves more than one health authority area. The trading standards people have a rather better system. A home trading standards authority approves a particular product and that recognition is given nationally. We need to be a little more streamlined in sorting that out.
No one likes unnecessary animal research, but there is no doubt that animal research has made, and will continue to make for the foreseeable future, a big contribution to our understanding of the causes and treatment of cancers, among other things. The current process where one has to go through not only a Home Office procedure but a medical research and ethics committee is unduly cumbersome, very long and not in the interests of either the researchers or the animals that we are thinking about. It distorts and lengthens a process that should be rigorous, but consistent.
It is important that newer treatment be researched. We do not use the opportunities that the NHS provides. We probably have a unique system world wide in having records that are complete in a vertical sense--from primary care through secondary care to tertiary care. When looking at new treatment, we do not use adequately the enormous resource that an integrated health service provides.
I ask the Minister to examine the effect of the establishment of the National Institute for Clinical Excellence on the introduction of new drugs and on research. There is some evidence that clinicians and funding health authorities are reluctant to accept the introduction of a new treatment because it has not been considered by NICE and, indeed, has not been referred to NICE yet. NICE should either be resourced to the extent that all new treatments can be looked at quickly, or it should be made clear to health authorities that the fact that NICE has not considered a drug is not an excuse for not using it.
That was the evidence with some of the new cancer drugs. Health authorities used the existence of NICE not to make a drug available. That will stultify the excellent scope for doing post-marketing and population research.
A number of expert hon. Members are keen to contribute to the debate. I again echo what the hon. Member for Norwich, North said. I was taken by his comparison of mental health services with the approach to cancer services. Cancer is an emotive subject, but it is not a unique disease. Other diseases are just as ghastly and a number of diseases are more deadly than some of the cancers. There is a wide spread, as the report points out.
I welcome the focus on cancer services in the report, but I hope that, whatever lesson is drawn from the report, from the Government action and from the audit of the action on how to arrange the inter-relationship between primary care, secondary care and tertiary care, the experience will be reflected in how we deal with some of the other illnesses and diseases that we are all keen to tackle.
2.58 pm
Dr. Lynne Jones (Birmingham, Selly Oak): As many other hon. Members wish to speak and time is short, I will confine my remarks to just two main points.
I welcome the Government response to the Select Committee's report. I welcome in particular their recognition of many of the points that we have made in the NHS cancer plan. That plan acknowledges, as the Select Committee does, that there is a serious shortage of therapists and clinicians to treat patients who are suffering from cancer. The Government have promised that the process of improvement will begin immediately, provided that the NHS can recruit the staff that it needs, and that the necessary reforms are put in place. The aim is that, by 2008, access to treatment for all types of cancer will compare with the best in Europe.
Members of the Select Committee welcome and support that aim, but we must make the best use of resources available in the meantime, and especially of staffing resources. I want to highlight some work being done in Birmingham to encourage collaboration between different specialties to ensure that they work together effectively.
The joint approach to cancer outcomes in Birmingham project--JACOB--is greatly improving collaboration between different specialties. It is hoped that, by April this year, all projects will hit the target for first treatment within two months from urgent GP referral. That is the target that the Government have determined must be reached nationally by 2005. The work done by projects in Birmingham and elsewhere is putting us on course to reach it.
As an example of what is being achieved, in Birmingham the waiting time for prostatic biopsy has been cut from 10 weeks to two. I therefore commend the Government on the work that they are encouraging within the NHS. It is definitely leading to a substantial improvement in waiting times for treatment and therapy.
The other main point on which I want to focus is cancer registration. It is easy to underestimate the importance of cancer registration for cancer treatment and research. The Committee's inquiry identified serious concerns about the impact of the Data Protection Act 1998 on researchers' ability to gather and process complete data. Local interpretations of the legislation have already led to anomalies in cancer registration practice. For example, the Institute of Cancer Research told the Committee that enforcement of the 1998 Act had already held up its research into mesothelioma.
The Committee recommended that, as a matter of urgency, the advisory group on patient confidentiality should address the problems posed by the 1998 Act for the registration of cancer. The Committee recommended also that the Government should introduce legislation to make the registration of cancer a legal requirement, to ensure the completeness of cancer registry data and to ensure access to those data for legitimate research purposes.
That recommendation has been supported, through early-day motion 138, by 115 hon. Members, who also expressed concern about the guidance issued by the General Medical Council. The council suggested that doctors should no longer pass on the names of patients to the national cancer registry. In their response, the Government stated that they were determined to secure
the future of cancer registration and that they would take the necessary action to do so. They also said that they would be setting out their plans to strengthen cancer registries, taking into account the review carried out by Professor Charles Gillis.
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