Examination of witnesses (Questions 1-19)
MS HAZEL
BLEARS, PROFESSOR
MIKE RICHARDS
AND DR
RUSSELL HAMILTON
MONDAY 15 JULY 2002
Chairman
1. Welcome, Minister. It is nice to have you
back. It is your first time in your new position.
(Ms Blears) Indeed, it is.
2. Congratulations. I am sure we will have a
very pleasant time.
(Ms Blears) Indeed.
3. Can I say we have had the Government's response
to our follow up report which was published in June and really
we do appreciate the positive tone in it but we have still got
this doubt in our mind about justifying where the money comes
from and goes to, and that is what we are trying to unravel. We
are very grateful to you for coming to see us. I just want to
give you the opportunity to open up and make any statement you
would like to make at this point before we go into the questions.
(Ms Blears) Thank you, Chairman and Members
of the Committee. I would just like to begin by thanking you for
inviting us back for another opportunity to expand, perhaps, on
any of the elements which are in our response to your original
report. I have been following the chronology of this inquiry quite
closely and it has been going on for quite some time, I think,
with your original report in 2000. I think it is fair to say that
many of the recommendations in that original report have really
helped us in setting up a good infrastructure for cancer research:
the National Cancer Research Institute together with the cancer
research networks which we are able to map on now to the cancer
service networks and, very importantly, the NTRAC centres of excellence
where we will be able to really, I hope, make a push on translating
the research. I think the phrase is from bench to bedside, which
I think is a lovely phrase, but actually really to get the benefits
of the scientific research into the clinical services for the
patients absolutely key on our agenda. I am very conscious that
Members are concerned about the funding: where has it gone and
what is it doing. I share those concerns and I am pleased that
the Committee has raised those issues. Also, I note the Committee
was very concerned about the regulations to be laid under Section
60 of the Health and Social Care Act, trying to ensure that cancer
registries could still continue to operate and provide the essential
data for us to look at incidence and surveillance and prevention
work too. I am delighted now that those Regulations have been
laid and approved by both Houses. They were not without their
controversy, as I am sure you will appreciate, they were fairly
controversial Regulations but those are now through. Just by way
of update, I am pleased to be able to inform the Committee that
the cancer registries themselves are looking at perhaps further
ways in which they can anonymise data which may help with patient
confidentiality in the future, so that agenda is continuing to
move on. I know you were impatient about those Regulations, and
rightly so, but we have managed to achieve that now. I think there
is a range of recommendations here in your follow-up report which,
again, will be very useful to us in Government to enable us to
press on with what is one of the most important areas certainly
of my portfolio.
4. Thank you very much for that. I take it there
is nothing specific in the spending review. I heard it myself
in the Chamber. I did not hear cancer mentioned but no doubt it
will benefit from the general increase to the Health Service anyway,
there is nothing specific?
(Ms Blears) Not at this stage but clearly Members
will know that we have had a historic increase in funding for
the National Health Service over the next five years which will
give us a good long term planning base in which to improve all
our services. Clearly cancer is one of our top priorities—cancer,
coronary heart disease, mental health, older people—and
therefore we have seen, already, tremendous increases over the
last spending review. I think a 30 per cent increase over the
1999 base line, investment in equipment, staff, consultants and
facilities, all of which were under-funded. I am sure the extra
investment announced a little while ago for health will flow in
fact through into cancer as it will into all of our other priorities
for the health of the community.
Chairman: As you know, this Committee has been
very excited by the identification of cancer as a priority and
has supported it and made suggestions to make sure it moves on.
Can I move on to you, Bob, to ask the next question.
Bob Spink
5. Certainly. You mentioned the 2000 Report,
our predecessor Committee's Report, and the recommendations they
made.
(Ms Blears) Yes.
6. There was a recommendation to spend £200
million on cancer research and we note that you told us in February
that your Department spent £190 million on cancer research
in 2000-01 but we note also that still included up to £30
million by the Higher Education Funding Council for England and
about £5 million on the NHS R&D. So we just wonder when
you are going to actually get down to achieving the target of
£200 million? Do you have any particular time frame in mind?
(Ms Blears) I do not have specific information on
that. What I would say is that I know the £190 million was
a concern of the Committee on the last occasion, as to what the
component parts were of that £190 million, whether it was
pure NHS money, whether it included the Higher Education money
and the R&D support money as well. I think that all the statements
which have been made on this issue are prefaced, usually, with
the phrase that comparisons of cancer research funding are fraught
with difficulty, that is the phrase which has come up time and
time again. I think it is right to say that, that trying to drill
down into the service to look at what are pure cancer research
monies and what relates to other multi-purpose dual kinds of research
is quite difficult. Certainly I have been keen to pursue some
examples. There was a concern of the Committee that this was rebadging,
if you like, of some monies. Therefore I have been quite keen
to see what are the kinds of examples of where there might be
dual research going on which benefits not just cancer but, for
example, coronary heart disease as well. It is quite difficult
to say this is just for cancer and that is just for coronary heart
disease. One of the examples which has been outlined to me is
a programme to look at the development of comprehensive gene sets
for mice and humans and to dissect shared genetic pathways. What
that means really is looking at the genetic make up of mice and
humans to see what genes they have got in common which may well
have an impact not just on cancer but also on coronary heart disease.
To say that was a pure research programme on cancer would not
be the right thing to say but clearly neither is it just a research
programme for CHD, it is actually multi-based scientific research.
Really I do want to say at the outset there is no intention on
the part of the Department or Government to have a cynical exercise
in rebadging this expenditure. It is genuinely the case that it
is difficult to put it simply into one pot or another. The £190
million is the figure that I am able to say to the Committee today.
I do not know whether my colleague wants to go into any further
detail about the timescale for the extra investment?
(Dr Hamilton) The additional investment that we have
laid out is an extra £20 million over three years, which
we mentioned to you last time, for NCRN, an extra £4 million
for prostate cancer research. That will take us in excess of £190
million, as you know, that we have laid out already in the figures
that we presented to you last time.
7. You reckon that £20 million a year for
three years will take you above the £200 million mark?
(Ms Blears) Yes.
(Dr Hamilton) Yes.
Chairman
8. The Wellcome Foundation when it does its
research says it does not fund cancer research, it does actually
very basic genetics and so on so it does not badge it as cancer
or whatever, it says we do not fund cancer research. Are you classifying
basic research as cancer research is the question? Is that what
you are saying to us?
(Ms Blears) What we are saying is there will be some
examples of that. As I understand it, the NCRI currently is going
through a process of actually validating what projects are going
to be known as cancer research. What is important about that is
that all the different parties will have a role, the voluntary
sector as well as Government and the MRC in coming to an agreed
consensus as to what constitutes cancer research because it is
a wide variety of things. I think it is very important in this
that there is honesty and openness. Therefore, having a dialogue
with all the parties to say "We think this is cancer research,
would you agree it is" and then to get that validated by
NCRI is really important to us.
Bob Spink
9. When will the NCRI study results be published?
(Ms Blears) In the autumn, as I understand it.
10. The autumn of this year?
(Ms Blears) The autumn of this year.
11. If can just go back to the earlier comment
made. You mentioned that there was £25 million and £5
million being spent in other areas which would be additive to
the £190, does that mean that the target we are looking at
now is £225 million over 2001-02? Is this a new target we
can consider or what? What is the target for the current year?
Do you have the figure or is it just as much as you can get?
(Ms Blears) I think our original target was to be
contributing the same as the voluntary and charitable sectors.
That was where we were aiming to be. As it has turned out, as
we have analysed what the spend is, we have got up to that level
before we needed to and we will be beyond that level, as we understand
it, because, again, we are saying that the amount of spending
in the voluntary sector is about £180 million. That might
be a movable feast, as ours is a movable feast, I was going to
say it is not a science but clearly it is. In terms of trying
to fix on it, where we want to be is that we are an equal partner
in Government with the voluntary and charitable sectors and we
are there already. The extra £20 million that is going in
is really as well about trying to fund the cancer research networks
properly with their proper infrastructure too.
12. Do you think it would help if the Government
published a report with some real meaty detail on definitions
of where the money is spent detailing what money is being spent
in cancer research, under what heads of terms, so that we do have
total transparency and we build trust and get away from this rebadging
question which is rather murky? Do you think that would be helpful?
(Ms Blears) I think that is exactly what NCRI actually
embarked upon by having this dialogue with all the partners to
get transparency and agreement as to what the situation is.
(Professor Richards) Can I just add to that. Absolutely,
as the Minister says, it is trying to get that transparency in
a level of detail that we have never had before, looking at all
the major partners in cancer research, from the Government point
of view that is obviously the Department of Health and the Medical
Research Council but also the charity partners. I think what is
important to say is that there is an independent panel made up
of members from all those partners actually looking at this database.
They are adjudicating on what goes into the database and not and
if there are any disputes there is going to be an external adjudicator
from the National Cancer Institute in the United States. I think
we can be sure this is as transparent a process as you can possibly
have.
13. The Government will be publishing figures
with these definitions at some stage because in your response
to our Report, which was very positive and very welcome, you avoided
giving us a specific answer on that so I am trying to squeeze
you now for one.
(Ms Blears) The NCRI will be doing that.
14. That will be the Government setting out
exactly what is spent in what projects so that everybody can see
over and above board that this is real cancer research money.
(Ms Blears) Absolutely. I think the added value to
that is that it will not just be the Government saying it, it
will be our key partners saying it together.
Mr McWalter
15. Can I just say on that, first of all I think
the example you have given about genetic susceptibility to cancer
is a very good one. I think clearly the Committee is very strongly
of the view that sort of work should go on. Clearly the Government
then announces £5 million or whatever for such a project,
we would welcome it, we would look it and so on, that is fine.
What worries us is the Government on Monday announces £5
million for that project, then it thinks it is quite relevant
to say ten areas of its activities and so there is a half a million
of it potentially to be ascribed to cancer, as it were, and then
on Tuesday it announces a cancer figure which includes that £0.5
million which it has announced on Monday already as part of this
more generic programme. That is the kind of confusion that we
feel has been in the system. We want to make quite clear that
while we welcome a general programme which has got a cancer component,
we want to see, firstly, funding that is clearly cancer directed
and, secondly, a clear statement of the resources which are being
applied to areas of study which have a recognisable cancer component
also. Do you think you will be able to do that?
(Ms Blears) Yes. I think that is exactly the direction
where we want to go. We have no interest in not having a clear
picture ourselves as to what expenditure is being made, what projects
it is being made on and what programmes are part of it. There
is absolutely no intention on the part of the Government to double
count and seek to deceive.
16. There is an interest because it makes for
better headlines. If you have one headline on Monday saying "We
have this fantastic programme about genetic susceptibility"
and then you have another announcement on Tuesday saying "We
have devoted all this money to cancer", there is an interest
in doing that. I am pleased to hear you are taking ruthless steps
to distance the Government from any such shenanigans, that would
be correct, would it not? You looked as if you were worried about
what I was saying there, Professor Richards?
(Professor Richards) Not at all. I think we are going
for openness, exactly as the Minister has said. We are going for
openness for your benefit but also for our benefit so we know
exactly what is happening too.
Dr Turner
17. Minister, as you are aware, cancer clinicians
have been coming to me feeling very concerned because they wonder
where the money to fund the cancer plan has got to. You are very
familiar with the plan. Their understanding is the same as mine
which is there is a plan for service growth to be funded. You
have identified new money and they have not seen it. I can tell
you all they have seen is their share of the £76 million
which was earmarked for this financial year. Now your answer to
our criticism or the comments in our report which the Department
took great exception to says it went into general allocations.
Our original criticism had been that clearly it had not been passed
along with any sort of label or structure or earmarking to make
sure that health authorities spent it on cancer services because
the situation, as I said we all know, is that health authorities'
finances have been so stretched that any new money, if it does
not have a clear label on it, is soaked up immediately in meeting
their cost pressures. So I have checked with these massive volumes
which I understand to be the way in which the Department communicates
with health authorities and tells them what their budget is about
and for the first year of the cancer plan it makes no mention
whatsoever of any cancer allocations. I have managed to find about
£20 million in the pink pages on the centrally funded initiatives
but of the rest it has presumably just gone into the global pot,
as far as I can tell from this, with no identification whatsoever.
Do you have any other way of communicating this intention because
it is not in the regular format?
(Ms Blears) Right. I think this is an extremely important
area and I know the Committee was very concerned that money for
cancer from reports that you were getting, and indeed I was getting,
was not getting to the front line of the service to fund the improvements
which we wanted to see happen. The situation for 2001-02 was there
was an extra £255 million in the base line with £25
million centrally allocated for the network so that is the £25
million you have identified there. I will come back to deal with
how we are trying to follow through what happens to the base line
monies shortly but for 2002-03 there will be £76 million
earmarked and therefore more tightly controlled than was the previous
case in the previous year. There will as well be another £51
million central allocation again to the networks in that way.
18. I found that.
(Ms Blears) You will have £76 million central,
£76 million earmarked and then the base line allocation.
It is important that we try and follow the money through to see
what has happened. Therefore what will happen is we have been
meeting with all the heads of the cancer networks to really ask
them "From last year's money what did you get for it"
because it is clear that some of the best ones spent something
like 80 to 100 per cent of their base line allocation actually
on achieving improvements, and some of the others did not. Therefore
we have to follow through what exactly it was that they got for
the money we put in there. Now we have agreed a template for each
of the networks to report to us on that so we will at least have
a follow through for them.
Chairman
19. Is that list available? Is that transparent
in all of this?
(Ms Blears) That is only just being developed as we
speak to go through that process so we can follow through what
was done there. The final point I want to make on this is that
obviously we are shifting the balance of power. There is a tension
between devolving money to the organisations to achieve improvements
and for us to look at, if you like, what the outputs are. Are
they meeting the waiting times? Are they meeting the targets?
Are they improving their services? That is not going to be directly
correlated to identifying a spend on each item but we need to
keep that tension and that balance and that dynamic going at the
same time as drilling down and finding what they have spent it
on.
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