Examination of Witnesses (Questions 40-59)
16 JUNE 2004
DEPARTMENT OF
HEALTH
Q40 Jon Trickett: I am not asking you
the reasons, I am trying to establish the facts. Do you accept
that, in fact, there has been a widening gap in survival rates,
that, notwithstanding the fact that all sorts of classes are improving,
actually the gap has widened?
Professor Richards: Yes, I do.
Q41 Jon Trickett: Do you accept that
this is for 44 out of 47 cancers?
Professor Richards: Yes, I do.
Q42 Jon Trickett: The Report says something
entirely different, does it not? It implies, in fact it says,
in paragraph 1.5, "for 12 of the 16 cancers examined in men
and nine of the 17 cancers examined in women." It is talking
about the survival gap actually not increasing. If you look at
the detailed information behind it, it talks about 44 out of 47
adult cancers where the survival gap is widening. Do you accept
that?
Professor Richards: I have not
got his paper in front of me, but I would suspect that it is whether
those differences were going to be statistically significant,
that would be my guess about why there would be discrepancy.[3]
Q43 Jon Trickett: Do you accept the following,
another sentence: "These inequalities in survival represented
more than 250,000 deaths per year which could have been avoided
if all cancer patients had had the same chance of surviving up
to five years after diagnosis as patients in the most affluent
group"?
Professor Richards: I have no
reason to dispute that figure at all.[4]
Q44 Jon Trickett: Do you feel that the
information which I have got—I will hand this information
to the Chairman—is properly reflected in this paper?
Professor Richards: I think it
is, because I think what the paper is saying here is that the
survival gap is getting wider, and that I agree with.
Jon Trickett: I do not think really it
does say that. In any event, my questioning and your answers,
I think, are now in the verbatim record and hopefully will be
reflected in our report.
Q45 Mr Steinberg: Basically, exactly
what Mr Trickett was saying baffled me as well. I read the Report
and came to exactly the same view, though, I have to say, I understood
it less well than he did, because I read the paragraph about half
a dozen times and it just did not seem to make sense to me. What
did make sense to me was that it made very depressing reading
for a Member of Parliament who comes from the North East of England.
I looked through the Report and, just quickly going through it,
breast cancer, there is less incidence but there are just as high
mortality rates in the North East. The survival after five years,
you have a lot less chance of living than you have in the South
East of England. If you have lung cancer, there is much more incidence
and there are many more deaths. The same for bowel cancer. Colon
cancer, you are more likely to die in the North East than you
are in the South East. Prostate cancer, exactly the same. Going
on to drugs. Eligible cancer patients prescribed Herceptin are
amongst the lowest rates in the country. Death rates in the North
East of England, in some cases, are twice those in the South of
England. It appears to me, if Mr Trickett is correct in his assumption,
which I think he is, that the more affluent areas of the South
East of England certainly are looked after better than those in
the North East of England, there is not much doubt about that
at all. It seems to me that clearly we have a postcode service,
in terms of cancer treatment. How would you respond to that?
Professor Richards: Firstly, if
you take lung cancer, which is the commonest cause of death, the
major factor there, by far the biggest factor, is the smoking
prevalence. Smoking prevalence does vary across the country and
is higher in the North East than in other parts of the country.
In terms of other cancers, one of the key factors in whether people
are going to survive is whether they present rapidly to their
GP with their symptoms, and again there is some evidence that
factor varies according to social class. Again, that is a major
reason why we need to tackle that particular issue.
Q46 Mr Steinberg: Do more people die
in deprived areas?
Professor Richards: More people
do die in deprived areas, yes, certainly.
Q47 Mr Steinberg: Why?
Professor Richards: Because of
smoking and also, almost certainly, because of later presentation
to health services with their problems.
Q48 Mr Steinberg: Would you agree that
more people survive in affluent areas?
Professor Richards: That is also
true.
Q49 Mr Steinberg: Then the obvious question
is, why are we not doing something about it?
Professor Richards: Certainly
we are doing something about it.
Q50 Mr Steinberg: My constituents have
a worse chance of living than people in the South East of England?
Professor Richards: I think it
is worth just pointing out that these figures on survival relate
to the 1990s, and that is before the Cancer Plan came in, in the
year 2000. We are acting on all the various different things that
you have mentioned. We have taken action specifically on smoking
and initially we targeted Health Action Zones. In fact, if you
also look at the table which refers to Stop Smoking services,
you will find that the North East comes out by far the best under
Stop Smoking services, and I think that is an extremely welcome
finding because in time that will reduce the rates of lung cancer,
heart disease and other diseases. We are tackling it on smoking,
we are tackling it across the country by making sure that we have
got the services in place, the multi-disciplinary teams, which
can make sure that care is provided to the highest quality wherever
anybody is in the country.
Q51 Mr Steinberg: You mentioned that,
in fact, lung cancer was the worst sort of example in the North
East and I would agree with you totally. When my wife became pregnant,
30-odd years ago, in the very early seventies, she stopped smoking
because there was a campaign at that particular time and I stopped
smoking along with her, so we have not smoked for 30-odd years.
It has been known for 30 years that smoking is very dangerous,
has it not?
Professor Richards: For 40 years,
in fact, yes.
Q52 Mr Steinberg: It has been widely
accepted, is that right?
Professor Richards: Absolutely.
Q53 Mr Steinberg: Is it vital that people
are encouraged to stop smoking, regardless of their background?
Professor Richards: I do not think
it is right that we should impose things on people, but it is
right that we should advise them of the dangers.
Q54 Mr Steinberg: You do not think it
is right to impose things, so you do not think that, if something
kills you, you should stop them doing it?
Professor Richards: I think there
are elements of personal choice and I think it is very important
to recognise—
Q55 Mr Steinberg: You think it is alright
to smoke yourself to death then, do you?
Professor Richards: No. I am ex-smoker
myself and I have given up smoking because I recognise the dangers,
and I would want everybody in the country to be aware of those
dangers. It is the single largest cause of both cancer death and
premature death in this country.
Q56 Mr Steinberg: You would agree that
it is sensible for Government to encourage people not to smoke,
regardless of their social circumstances?
Professor Richards: I would, and
over the last four years we have put in place the "ban on
tobacco" advertising, the large media campaigns on television,
the notices on cigarette packets, which are words of warning,
and the Stop Smoking services.
Q57 Mr Steinberg: Was the Secretary of
State given a copy of this Report, do you know? Has he read it?
Professor Richards: I cannot say
whether he has read it. Certainly he is aware of it.
Q58 Mr Steinberg: Could you suggest that
he reads it, because really his statement was quite ignorant,
was it not? Do not answer that. I am saying that his statement
was quite ignorant. People have known for 30-odd years, have they
not, that smoking, and passive smoking, is bad?
Professor Richards: The dangers
of active smoking became apparent before the dangers of passive
smoking, but I think it is widely accepted now.
Q59 Mr Steinberg: For how long would
you reckon that passive smoking has been seen to be dangerous?
Professor Richards: Probably for
at least a decade.
3 Note by witness: Professor Colman's study
referred to in the NAO Report (para 1.5) was to do with 16 cancers
in men and 17 cancers in women. However, we believe that an earlier
study conducted by the same author, covering an earlier time period,
may well have looked at a wider range of cancers and this is,
presumably, where he quotes the figure of 47 from. Back
4
Note by witness: "250,000 deaths per year" is
not the figure that Professor Richards heard and he believe this
cannot be correct as this figure exceeds the total number of cancer
deaths (for example, all cancer deaths in England and Wales: 1997-135,647;
1998-136,289; 1999-134,135; 2000-132,686; 2001-135,839). Back
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