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2.45 pm
The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson): I congratulate my hon. Friend the Member for Dartford (Dr. Stoate) on securing this debate, on his enthusiasm for this subject and on his re-election. I am sure that that enthusiasm is infectious in both cases. The debate is particularly timely, as prostate cancer awareness week falls at the end of this month. I take this opportunity to congratulate the signatories to the prostate cancer charter for action on all their efforts in combating this terrible disease.
We acknowledge that prostate cancer has not previously received the attention that it deserves, which is why we published the NHS prostate cancer
programme in September 2000. It set out what was known about prostate cancer and established a framework for future action, and it explained the action that the Government propose to take in three relevant areas: research; prostate specific antigen testing; and improvement of services for patients with urological cancers, including prostate cancer. I will briefly review the progress that has been made in each of these areas in the past three and a half years.Prostate cancer is the only cancer that has a Department of Health funding target for research, and we are on track to spend the promised £4.2 million on research into prostate cancer in 2003–04. That is a twentyfold increase compared with 1999–2000. I can confirm that this level of funding will remain for future years—scientific quality of research proposals permitting, of course. Two National Cancer Research Institute prostate cancer research collaboratives have been established, in Newcastle and London. Funded research includes studies on various treatments for prostate cancer, on improving the prostate specific antigen test and on ethnic differences in prostate cancer incidence.
As part of the prostate cancer risk management programme, evidence-based primary care resource packs were sent to all general practitioners in England in September 2002 to aid them in counselling men who are worried about prostate cancer. The PSA test for prostate cancer is not perfect, and men need to know the advantages and disadvantages of the test to make an informed choice on whether to have it. Other elements of the risk management programme include ensuring that a systematic and standardised follow-up pathway is available for men whose test result is above the PSA threshold, and action to improve the quality of laboratory testing of PSA samples.
The Cancer Research UK primary care education research group is evaluating the programme. The evaluation focuses on GPs' use of the packs and their views, on the views of men and on the reasons given for taking a PSA test. It will be funded by the Department of Health via NHS cancer screening programmes, and the results are expected during the next year. They will inform the continuing use of the packs and any appropriate changes will be made in response.
On waiting times, between October and December 2003, 98.6 per cent. of patients with suspected urological cancers, including prostate cancer, were seen for their first out-patient appointment within two weeks of their GP deciding that they should be urgently referred.
The cancer services collaborative is modernising cancer care, including prostate cancer care, by reducing unnecessary delays in the system for patients throughout the cancer journey. "Action on Urology", which is sponsored by the Department of Health, is a programme that aims to improve access to, and delivery of, patient-focused services for urology patients. New approaches to urology care are being piloted in 15 pilot sites across England and Wales, at a cost of £1.4 million. Examples of work under way on prostate cancer include using specialist nurses and GPs to carry out prostate assessment clinics in primary care; redesigning the pathway for patients undergoing transurethral resection, so that they can go home within 24 hours; and using the skills of specialist nurses to follow up patients after PSA testing and cancer surgery.
There has been a 40 per cent. increase in the number of consultant urologists since 1997, the figure having risen from 343 to 473. National Institute for Clinical Excellence guidance on urological cancers, including prostate cancer, entitled "Improving Outcomes in Urological Cancers: the Manual", was published in September 2002.
The guidance states that all patients with urological cancers should be managed by multidisciplinary urological cancer teams. Patients should be assured of streamlined services, balanced information about management options and improved management of progressive and recurrent disease. In addition, nurse specialists should be trained to take key roles in providing the services. The guidance is being implemented across all cancer networks in England and Wales.
We are committed to introducing a screening programme if and when screening and treatment techniques are sufficiently well developed. There is no conclusive evidence from any country that screening for prostate cancer would reduce the death rate from it. The UK National Screening Committee has advised the Government that, on existing evidence, a national screening programme for prostate cancer would not be justified. The Government have asked the NSC to keep this work under review and to look at any developments in testing techniques or technology that would make a screening programme effective.
Much has been achieved since the prostate cancer programme was published in 2000, but we recognise that there is still much to be done. That is why we welcomed the launch of the prostate cancer charter for action on 29 January 2003. To ensure better collaboration and communication between the charter members and Government, we have set up the Prostate Cancer Advisory Group, chaired by Professor Mike Richards, the national cancer director, with a membership including representatives of the charter, allowing us to combine the expertise of the voluntary sector with that of the NHS for the benefit of patients. We are determined that stakeholders should be at the heart of policy making.
The model of the advisory group and the charter for action is a good one. As my hon. Friend knows, advisory groups have been set up for both bowel and lung cancer, and the Department is continuing to encourage, build on and improve partnership work between stakeholders such as the NHS, the voluntary sector and professional organisations.
That brings me to the subject of choice. One size does not fit all, and we should ensure that services are shaped to meet people's needs rather than expecting people to fit the system. The Government believe that it is right that people should have the power to choose what is appropriate and convenient for them and how they want to be treated. That is why much of the work of the advisory group is centred on patient choices. Prostate cancer is perhaps unique in the amount of choices to be made along the patient pathway. There is the choice of whether to have the PSA test in the first place, which I have already spoken about in relation to the prostate cancer risk management programme. There are also treatment choices to be made, and issues of public awareness—men need to be educated about prostate cancer in order to make choices.
That is why four working groups have been set up under the advisory group, focusing on information for prostate cancer patients, improving the treatment of prostate cancer, public awareness and, as my hon. Friend mentioned, a national prostate cancer website.
Patients diagnosed with prostate cancer face a number of choices. That is why the working group looking at information for prostate cancer patients quickly decided that the greatest difference could be made by helping men diagnosed with localised prostate cancer to decide which treatment course to follow.
Each of the treatment options—radical prostatectomy, radical radiotherapy, the emerging brachytherapy, or active monitoring—has advantages and disadvantages. The decision that a man takes must be based on his values and lifestyle. Decision-making aids can help that process. The working group has teamed up with "Action on Urology", which has been building on work based on the American experience in Boston. We are also aware of other work in Canada. We therefore propose to hold a workshop in May to decide on the best way forward for the NHS decision-making aids for men diagnosed with localised prostate cancer.
Improving the treatment of prostate cancer is another important area. A working group on the issue, chaired by Professor David Neale of Cambridge university, will meet for the first time later this month. One of the first things that it will consider is multi-disciplinary team training, following the model developed for cancer of the rectum at the Pelican centre in Basingstoke. Although the training concentrates on one new technique, total mesorectal excision, not only the surgeon benefits. All the members of the MDT learn how their role benefits from the new procedure, including the specialist cancer nurse, who will be able to explain the procedure to patients. There is also the added benefit of their spending time together away from the pressures of their local hospital.
Public awareness is another key issue, already identified by my hon. Friend. Men cannot make choices unless they understand what the choices are. We want men to be aware of their bodies and know what their prostate gland does, and also what can go wrong with it. We need to raise awareness in a responsible way and not scare men into rushing to see their GPs when there may be nothing wrong with them. The public awareness working group has been reviewing what information is out there for men about prostate cancer, along with assessing the evidence over public awareness interventions, and it will shortly be making recommendations on the way forward for men and the NHS in England.
The Department of Health is funding other work on public awareness of prostate cancer: a section 64 grant to the Prostate Cancer Charity to increase further information about prostate cancer; another section 64 grant to the same charity to improve awareness of the risks and symptoms of prostate cancer among men from African and Afro-Caribbean communities in Britain; and the database of individual patient experiences website on prostate cancer.
The fourth working group has been looking at the possibility of a national prostate cancer website for use by the general public. Plans are well developed, and it is envisaged that the site will contain essential information
for prostate cancer patients alongside information for members of the general public who just want to find out more about the disease. The website will be key in helping men make informed choices about prostate cancer right along the patient pathway, and I am delighted to be able to confirm to my hon. Friend today that the Government will provide two thirds of the funding for the website. That amounts to some £40,000 in the current financial year, with further funding over the next two years. The website will be developed in close collaboration with NHS Direct and the coalition for cancer information. The final third of the funding will be provided by signatories to the prostate cancer charter for action, a great example of the Government and the voluntary sector working together for the benefit of the people of this country.My hon. Friend raised another point that I have not yet dealt with—the interim report on the prostate cancer programme. In the interests of collaboration, I am asking the Prostate Cancer Advisory Group to discuss the merits of having a three-year progress report, in addition to the three-year NHS cancer plan report. That will be debated at the next meeting in April—not far away.
On sustaining the investment to build the necessary capacity, the planned future investment combined with reform will provide further improvements for the NHS, including expanding capacity, increasing staff and training numbers and reducing waiting times. On the basis of a headcount from September 2001, we envisage major staff increases by 2008—for example, 15,000 more consultants and general practitioners; 35,000 more nurses, midwives and health visitors; and 30,000 more therapists and scientists. We also envisage an increase in treatment capacity to more than 10,000 beds, 42 additional major hospital schemes and 750 primary care one-stop centres to establish a broad range of services.
Against that background and in the light of the current work going on, I am sure that my hon. Friend would agree that we have come a long way since the publication of the NHS prostate cancer programme in 2000. We know that there is much more to do and we look forward to continuing to work in partnership with key stakeholders from the prostate cancer charter for action to tackle the challenges ahead, including making sure that informed choice is a reality for men with prostate cancer.
- Adjourned accordingly at two minutes to Three o'clock.
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