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3.19 pm
Dr. Desmond Turner (Brighton, Kemptown): The report is concerned with the rational approach to cancer therapy and research, and that is meat enough for one discussion.
I am very proud to be associated with the report. I think that it is probably one of the most important Select Committee reports produced this Session--if not the most important. That is not simply because of the efforts of the members of the Committee, but because of the gravity and emotional impact of the subject. It is an authoritative and comprehensive report and a great deal of credit for that should go to the special advisers who helped us with it, to whom we owe a debt of gratitude. If the Government have the wisdom to accept all our recommendations, they, too, will owe the special advisers a debt of gratitude.
In the very brief time left, I will have to cherry pick. I echo the thoughts of my hon. Friend the Member for Norwich, North (Dr. Gibson). We feel very strongly about the importance of a national cancer research institute and the central importance of its role. Although the Government have accepted the notion of such an institute in principle, I do not think that they have quite taken on board the degree to which we see it as essential to get proper co-ordination into the cancer research effort in this country.
We have seen how such co-ordination works in different forms in other countries. It does not have to be a mighty bricks-and-mortar edifice--that is not what we have in mind. We are not seeking to replicate Bethesda. However, the United States, Canada and other countries
have a co-ordinating mechanism--even if they do not call it a national cancer institute--and it pays enormous dividends. It shows, in the long term, in their cancer survival rates, and that is the acid test. We have truly world-class, leading-edge, basic research, yet we have some truly appalling cancer survival rates compared with our neighbours. That gap must be bridged.We see the national cancer research institute as the lead organisation co-ordinating the whole effort and strategy. We also see it as disbursing the money. I suggest that the amount of money that the Medical Research Council currently disburses for cancer research should be given to the cancer institute. When we took evidence from the MRC, some of us could not help feeling that there was a certain lackadaisical quality in its approach to cancer. We felt that it did not have the commitment to cancer that is really needed.
That is why we come back to a national cancer Act. It would be a political gesture but it would focus the effort on cancer and bind every party in the House to that effort. We have seen the American example, where the grand old party and the Democrats are committed to fighting cancer through their National Cancer Act and have virtually outdone each other to make sure that there are adequate funds. We were very impressed. On our visit to Bethesda, the Government's budget increase for cancer research in America was being discussed. They were in the middle of a five-year programme to double their spending on cancer research. The increase that they were considering and explained to us dwarfed our entire national cancer research budget.
I am not suggesting that we can match American big bucks or even that we should. One thing that British scientists have shown they can do, because they have had to, is to make the most of very limited resources. We have a history of cost-effective research, but that does not mean that we should not put more resources into research. We need to do so urgently because of the decades of under-investment, and we have to do some very fast catching up.
In recent years we have been deprived of taking advantage of certain new research technologies such as gene chip technology because there has not been enough funding available, and that has disadvantaged leading British laboratories. That cannot be allowed to happen in future. We need a commitment not just to match the charities' level of funding, but to do it quickly. It is a matter or urgency, as are other things. Our radiotherapy departments, for instance, have not had modern equipment for decades. Their equipment belongs to the stone age and that has a great impact on outcomes. So we need to act urgently.
We were very impressed, when we visited St. Mary's, to see the operation of a machine called a multi-slice CT scanner. That, in conjunction with therapeutic programmes, is fantastic. It can lead to realistic attempts to treat lung cancer and can revolutionise colon cancer therapy and detection. That involves a lot of such machines, and screening of at-risk groups can lead to a massive advance. The Government are interested in that technology but they still want to conduct research projects. Research has been done--it is all there, published in the literature. We must be prepared to use information that is in the literature, wherever it is.
I congratulate the Government on their wisdom in agreeing with most of our report, but we want them to accept everything in the report because we think that it is right.
3.27 pm
Dr. Brian Iddon (Bolton, South-East): In the final few minutes available for Back-Bench contributions, I want to continue that theme. First, I refer to the computerised tomography scanner at St. Mary's hospital. These new machines are made in Britain by Marconi Medical Systems UK Ltd. and cost about £250,000. Marconi told us at St. Mary's that it was willing to help the Government to put those machines in place in the cancer centres.
At present, the machines are being used as diagnostic machines. By the time people walk into St. Mary's with lung cancer, for example, the cancer is far too advanced. The specialist at St. Mary's hospital asked to use the machines as screening instruments. The scanners scan a whole body, tip to toe, in about 15 minutes. Within another 15 minutes, the computer attached to the machine will give a three-dimensional picture of any organ in the body. It was absolutely fascinating for us to walk through the three sections of the colon or both lungs of a patient and observe whether they were clean of polyps and tumours, or observe the size of the cancer and where it was in the lung. Sometimes it blocked a whole lung, so the patient had only one lung. If only that could be done when tumours were small, they could be eliminated without the cancer putting out secondaries all over the body.
The other instrument that we saw in action was at the Royal Marsden hospital at Sutton. When radiotherapy is carried out on various parts of the body--on the neck and head, for example, or on colorectal cancer--healthy as well as cancerous tissue is damaged by the radiation. Irradiation of the neck can result in paralysis and if the rectum is irradiated, incontinence can result--that is not very nice for the patient.
At the Royal Marsden, we saw three-dimensional conformal radiotherapy in action; that allows the operator to shape the zone of radiation to the shape of the tumour. In Finland, we saw intensity-modulated radiotherapy--IMRT--which allows the operator to vary the intensity of the radiation. Those techniques combined can hit the tumour with extremely high doses while avoiding the surrounding tissue. That is extremely useful in killing cancerous tissue.
I make two pleas to my hon. Friend the Minister. First, please put in the money necessary to spread that new instrumentation across the cancer networks. Secondly, it is important that staff be adequately trained; radiotherapists will need retraining and there is in any case a shortage of radiotherapists. We need to train many more people to handle those state-of-the-art machines.
3.31 pm
Mr. Philip Hammond (Runnymede and Weybridge): I begin by congratulating the Select Committee on Science and Technology and its Chairman, my hon. Friend the Member for Rayleigh (Dr. Clark), on this excellent report and on the obviously exhaustive inquiries they carried out during its production. It is a testimony to them not only that Members of the House will congratulate them on their work, but that the perhaps far
more knowledgeable body of people with cancer research expertise has congratulated them. The Committee has done a great service to the House.I pay tribute to all the hon. Members who have spoken during the debate. All but two of them were members of the Committee and had thus contributed to its work. I congratulate my hon. Friend the Member for Bosworth (Mr. Tredinnick), who gave us a slightly different perspective on some of the issues, and my hon. Friend the Member for Ruislip-Northwood (Mr. Wilkinson), who eloquently described the centre of excellence at Mount Vernon hospital.
My hon. Friend the Member for Rayleigh gave a characteristically understated description of the reasons that had driven the Committee to begin its investigation into cancer and cancer research. In fact, the figures produced by the Committee and published in its report are quite horrifying. It is not merely that we do not perform well according to European standards on cancer survival rates; we are at the bottom of the league table, among the newly democratising east European countries such as Estonia, Slovakia and Slovenia--way behind our north European neighbours. That clearly shows that something is wrong and that something must be done.
The hon. Member for Brighton, Kemptown (Dr. Turner) said that he wanted Government spending on cancer research to match that of the voluntary sector. He may have missed the Prime Minister's announcement on 26 September 2000 when the right hon. Gentleman made precisely that pledge; it seemed extremely grandiose at the time. However, the Prime Minister pledged money that the Government had already announced. It amounted to additional spending of only £24 million.
In the context of public spending, Government spending on cancer research is relatively small. I repeat to the Under-Secretary of State for Health, the hon. Member for Pontefract and Castleford (Yvette Cooper), the concern that I expressed during an intervention on the hon. Member for Isle of Wight (Dr. Brand)--that a significant proportion of Government-funded spending on cancer research is allocated to NHS hospitals, where the distinction between research spending and the financing of general overheads and clinical service support is not always clear. We all realise that hospitals are under tremendous pressure, especially as they try to deliver the Government's newer targets for cancer treatments and the times for such treatments. Will the Minister tell us what she intends to do to ensure that the money allocated to hospitals for research is used for that purpose and not for the equally worthy and valuable, but quite different, purpose of day-to-day treatment of patients?
The report makes 48 recommendations. I shall address a few of them specifically and ask the Minister some questions. Recommendation (d) deals with screening. The Opposition have pledged that, if prostate screening has been demonstrated to be effective, we shall introduce it when we are in government. Can the Minister give the House a similar assurance? The Government response to the Committee report notes only that the Medical Research Council is considering a proposal for a prostate screening trial.
We are delighted that the Government are moving towards considering overall time scales--from initial referral to commencement of treatment--as the relevant milestone. I only wish that they would acknowledge that
such time scales are relevant for patients throughout the NHS. The amount of time patients spend on waiting lists is not the key issue if they have already waited a year to get on to a list.We are slightly surprised, however, that the Government persisted with their two-week target for urgent GP referrals to initial specialist consultation. Those who know much more than I do about such matters question the wisdom of that target. The president of the Royal College of Surgeons, Professor Barry Jackson, said that
- clinics are being snowed under with inappropriate referrals for breast cancer . . . breast surgeons are coping, just, at the moment, but it could be at the expense of other things.
- the two week rule has completely backfired. It has led to a waste of resources, and a waste of specialists time.
- New guidelines for urgent referral of patients with cancer are a waste of energy.
Are initial figures available to show whether the two-week target for GP referral to consultation is successful for all cancers? Will the Minister do anything about the problem that beset the early stages of the breast cancer pledge? That guarantee applied only to referrals received by the hospital within 24 hours of being made by the GP; hospitals were counted only on their performance in dealing with that particular group of referrals--not on all referrals. From the point of the view of patients, that is quite unacceptable.
Who is actually seen when a referral is made? There is plenty of evidence to suggest that early referral helps, but much more to suggest that the degree of specialisation of the person who sees the patient has a far greater influence on the outcome. In the summer, I asked the Minister a series of questions--ending with one on 27 July, to which I received no answer--about the specialism of consultants who saw patients referred within two weeks. At the time, the Minister told me that it was not possible to distinguish consultants' specialisations from the data. Will she take steps to ensure that we begin to measure and record those specialisations? All the evidence shows that they are a more important determinant of a successful outcome than a simple time scale.
Will the Minister also acknowledge that, as long as initiatives such as the waiting list initiative distort clinical priorities in the national health service, cancer patients, along with all other patients, will suffer? I have in my
hand a letter from the consultant urologist at my local hospital to the chief executive, copied to me, which refers to a particular case. He says:
- You were fully aware of three other patients of mine who were admitted for major cancer surgery, only
- to be cancelled three times, each within 30 minutes of being called to the theatre. These are but three examples of a long-standing problem. One year ago, I was put under pressure by the management to treat non-urgent, long-waiting patients instead of patients with cancer.
The Committee made several recommendations in relation to prescribing and the way that NICE operates. It specifically identified a concern that the mere fact that NICE recommended that a drug be made available did not ensure that it would be made available, and that patients in the United Kingdom were being seriously disadvantaged by the low levels of use of the latest cancer drugs. The Government's response was simply that trusts
- will be expected . . . to promote the rapid uptake of NICE's guidance,
I am not bashing health authorities; we know that some of them labour under very serious financial pressures and have deficits to pay off. However, will the Minister consider the solution that the Opposition propose: an exceptional medicines fund, which would take the funding of those expensive but efficacious medicines out of the local health authority budget? Patients throughout the country may then be assured of equality of treatment in the knowledge that a national fund is available to support treatment with proven, efficacious drugs that have been through the rigorous NICE appraisal procedure.
I shall use the last couple of minutes available to talk about the problem of data transfer and the cancer registries, which several hon. Members mentioned. I hope that the Minister can tell us specifically what solution the Government propose. It was not clear yesterday, on Second Reading of the Health and Social Care Bill, whether clause 59, on patient information, is intended to be the basis of the solution.
Will the Minister confirm, for the benefit of some of her hon. Friends who may not have heard this remark, that Lord Falconer advised the other place that the Data Protection Act 1998 presents no impediment to the transmission of data to the cancer registries, and that it is the GMC's interpretation of that Act that has proved to be the problem? I understand the difficulty of obtaining patient consent at a particularly sensitive moment--the moment of diagnosis--but I am sure that it will be interesting for the House to know whether the Minister believes that, to overcome this problem, some form of
statutory compulsion in relation to the registration of cancer will be required. It would also help if the Minister could tell the House what arrangements she will propose--I understand that there was a commitment to do so in the new year--to finance and fund cancer registries. That will give some flesh to the statement in the national cancer plan, which says:
- The public health benefits depend on the completeness of cancer registration in the population. The government is determined to secure the future of cancer registration and will take the necessary action to ensure this.
I have asked plenty of questions and many issues have been raised today. We were already aware of a number of those, but we owe a debt to the Committee for having collated those questions and put them together clearly and coherently. I look forward to the Minister's speech and hope that she can answer many of the questions that have been posed.
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