House of Commons - Science and Technology

Select Committee on Science and Technology First Report

SUMMARY

There has been real improvement in cancer services and research since the Committee's Report, Cancer Research - A Fresh Look, was published in July 2000. The NHS Cancer Plan is now in its second year, and measurable progress has been made against some of the targets contained within it. The National Cancer Research Institute, which the Committee recommended be set up, has been established for almost a year, and has won praise for its collaborative work, drawing Government, charities and industry together in funding and co-ordinating research efforts in the cancer field. The new National Cancer Research Network addresses several recommendations in the Committee's Report about cancer research facilities and implementation. We are pleased to see that it aims to double the number of cancer patients enrolled in clinical trials within three years. The National Translational Cancer Research Network recently announced the first eight of the cancer centres which will receive funding to become units in which laboratory research can be translated into clinical practice and flourish. We welcome the merger of the Cancer Research Campaign and the Imperial Cancer Research Fund to become Cancer Research UK.

In some areas we continue to be concerned. Since July 2000, serious confusion has arisen in the field of cancer registration and medical research, following the publication of new General Medical Council Guidance on Confidentiality. The Government promised measures to address this in the Health and Social Care Act 2001, but we are still waiting for draft Regulations to be laid before the House. We are disappointed that both the GMC and the Government have failed to clarify this situation, which is causing significant damage to cancer research. We have found evidence of considerable uncertainty surrounding the delivery of resources promised in the Cancer Plan and some mistrust of the Government's understanding of how important this is. Extra staffing and equipment are yet to be seen on the ground, and NHS clinical trial databases have not been developed. Our greatest reservations concern funding, both of cancer services and cancer research. We have received evidence suggesting that Cancer Plan funds are not reaching those areas to which they are allocated. We remain to be convinced otherwise by the Department of Health. The Government pledged to match charitable funding of cancer research by 2003. Although the Department of Health claims that the Government has achieved this objective already, we have not seen very satisfactory evidence to support this claim.

FIRST REPORT

The Science and Technology Committee has agreed to the following Report:

CANCER RESEARCH - A FOLLOW-UP

I. INTRODUCTION

1. In July 2000, our predecessor Committee in the last Parliament published a Report entitled Cancer Research - A Fresh Look.[1] This inquiry lasted a year, and included eight evidence session and several visits. The Committee made 48 recommendations, covering Government-funded cancer research and some aspects of NHS cancer services: screening, diagnosis, treatment, research funding, data collection and research coordination. It was critical of much of the existing provision and made detailed recommendations for improvements. In November 2000, the Government's Reply to the Report was published as a Command Paper.[2] Many of the Committee's recommendations were adopted as policy in the Government's Reply, or were included as action points in the NHS Cancer Plan (see paragraph 3 below). Overall, the Reply responded to the Committee's Report's recommendations favourably. On 11 January 2001, the Report was debated in the House on a motion for the adjournment.[3]

2. In November 2001, we decided to conduct a short followup inquiry, to look at the progress made in implementing the Committee's recommendations and the NHS Cancer Plan. We received over 40 pieces of written evidence, from patient groups, clinicians, researchers, Government bodies and individuals.[4] We held three oral evidence sessions. On 12 December 2001 we heard evidence from Professor Mike Richards, Director of Cancer Services ('the Cancer Czar') and Professor Sir John Pattison, Director of NHS Research, Analysis and Information, both at the Department of Health, and Professor Sir George Radda, Chief Executive of the Medical Research Council and Chairman of the National Cancer Research Institute. On 16 January 2002 we heard evidence from Professor Andrew Miller, Interim Chief Executive of Cancer Research UK, Professor Gordon McVie, Director General of the Cancer Research Fund, and Professor Sir Paul Nurse, Director General of the Imperial Cancer Research Fund. On 6 February 2002 we heard evidence from Yvette Cooper MP, Parliamentary Under-Secretary of State for Public Health, Professor Mike Richards and Dr Russell Hamilton, Director of Research and Development, NHS Executive South West, Department of Health. We would like to thank all those who supplied evidence to us. We are also grateful for the specialist advice of Professor Michel Coleman, Professor of Epidemiology and Vital Statistics, and Head of the Cancer and Public Health Unit of the London School of Hygiene and Tropical Medicine, and Professor Michael Elves, formerly Director of the Office of Scientific and Educational Affairs, Glaxo Wellcome plc.

GOVERNMENT POLICY

3. In September 2000, the Government published the NHS Cancer Plan.[5] We welcome the publication of the Cancer Plan. In essence a subsidiary of the NHS Plan, which had been published in July 2000, this document was the first attempt to create a comprehensive strategy for NHS cancer services. Some areas of the Cancer Plan directly related to recommendations from the Committee's Report. For example, it set out plans for a National Cancer Research Institute, which the Committee had recommended be established and covered several Committee recommendations on research by announcing a National Cancer Research Network.[6] The Cancer Plan had four broad aims:

"to save more lives;
to ensure people with cancer get the right professional support and care as well as the best treatments;
to tackle the inequalities in health that mean unskilled workers are twice as likely to die from cancer as professionals;
to build for the future through investment in the cancer workforce, through strong research and through preparation for the genetics revolution, so that the NHS never falls behind in cancer care again."[7]

It contained targets for patient care, for example reduced waiting times for diagnosis and treatment. It also focussed on public information campaigns aimed to prevent cancer, such as anti-smoking campaigns and healthier diets for children. One of its 11 chapters concentrated on research.

4. In December 2001 the Government published a progress report, NHS Cancer Plan - Making Progress. It gave an upbeat view of developments in the first year of the Cancer Plan. It gave prominence to the public health campaigns which had been started, for example the School Fruit Scheme, and reported that progress had also been made in other fields, such as palliative care, urgent patient referral times, screening programmes and patient information. The research element of the Plan was not discussed at any length although the establishment of the National Cancer Research Institute and the National Cancer Research Network were reported.

OTHER PUBLICATIONS

5. In contrast to the Government's upbeat progress report, the National Confidential Enquiry into Perioperative Deaths, which is an independent body funded mainly by the National Institute for Clinical Excellence, published a report in December 2001 which was highly critical of cancer care in England, Wales and Northern Ireland. It stated "the system is failing patients with a cancer, particularly those who present as an emergency. Currently the picture is one of varying expertise, poor compliance with recommendations and failure to collect data and run adequate multi-disciplinary teams".[8] We realise that the Report was based on information about patient treatment episodes gathered from 1 April 2000 - March 2001, before the implementation of the Cancer Plan. Another report published in December 2001 was NHS Cancer Care in England and Wales, co-authored by the Commission for Health Improvement and the Audit Commission, on the implementation of the recommendations of the 1995 Calman-Hine Report on cancer services.[9] It did not comment on the Cancer Plan but aimed to provide information by which its outcome could be measured.[10] This report was also critical of a number of areas of cancer care. Professor Mike Richards told us "The various reports that have come out recently are, in effect, useful baseline measures against which to measure progress".[11] The conclusions of the next independent study or inquiry on cancer care or research will be crucial in assessing the effectiveness of the NHS Cancer Plan.