Examination of Witnesses (Questions 60-79)
16 JUNE 2004
DEPARTMENT OF
HEALTH
Q60 Mr Steinberg: When I asked a Parliamentary
Question in March 1999, "To ask the Secretary of State for
Health if he will take steps to impose a legal duty on restaurants
to provide non-smoking areas," what would you expect the
answer to have been?
Professor Richards: Obviously,
Government has to take a whole range of different factors into
account. I have made clear my views on smoking in public places.
Q61 Mr Steinberg: I will tell you what
Ms Jowell said: "No." Then when I put the question,
on 26 November, 2001, "To ask the Secretary of State for
Health what proposals she has to ban smoking in the workplace
and in public places," what was the response from Jacqui
Smith? "We have no plans for legislation in these areas."
Does that not show that Government just has not taken this problem
seriously enough; and for Reid to say what he said is just encouraging
people, who are likely to die anyway, to die a little bit quicker?
Professor Richards: I think the
most important thing is that we have a major consultation, which
is ongoing at the moment, about choosing health, where both smoking
and obesity are major parts of that consultation. It is still
in progress. I think it ends at the end of this month and there
will be a White Paper in the autumn which will address issues
to do with both smoking and obesity.
Q62 Mr Steinberg: Do not get me onto
obesity. It is rather funny, I always seem to get letters just
before we have a meeting of the Committee of Public Accounts,
which usually come in very handy. This is a letter from a Reverend,
and I am not going to say his name because he has not given me
permission to do so. This is to Sir Nigel. He says: "In 1998
my GP referred me to an ENT consultant. He required a CT scan
to assist diagnosis. I had that scan just seven days later. Earlier
this year a similar referral within the same NHS Trust resulted
in a three-month wait to see the consultant. Again a CT scan is
required, but this time there is a three-month waiting list."
I will miss a lot out. "However, it would be encouraging
during this long wait to be able to hope that things might improve
and that one day the high standards of former years could be restored."
That goes totally against what we are told, and really what we
read in this Report, that millions of pounds extra have been put
in. Why do we get a situation like that?
Sir Nigel Crisp: If you get permission
from the Reverend, I am very happy to look at the particular circumstances
in the particular hospital. I will see what it says. I assume
it is the same hospital. There will be some variation which goes
the wrong way.
Q63 Mr Steinberg: Why is it going the
wrong way? It is in the North East of England, again. Is it the
same in the South East of England, Sir Nigel? Do they have to
wait three months in the South East of England?
Sir Nigel Crisp: Some of our waits
are far too long. We have made big improvements in waits, on average,
but clearly, in that particular instance, he got his CT scan in
seven days, which is where we should be aiming, is it not, for
the future?
Q64 Mr Steinberg: Just give me an answer.
You have not given me an answer as to why it is now three months
when it was seven days?
Sir Nigel Crisp: I do not know
the answer. Are they seeing more patients? Seriously, unless you
let me have a look at the letter and find out what the answer
is, I do not know.
Professor Richards: Obviously,
I cannot answer on an individual circumstance, but what I can
say is that the demand for CT scanning has gone up very considerably,
as it has been found to be useful in a whole range of different
conditions for which we were not using it a few years ago. Over
the last few years, I think since April 2000, actually we have
increased the number of CT scanners by 87%; that is bringing them
up to 373 in the country by the end of this year. We have deliberately
targeted those extra machines to make the provision more equal
across the country.
Q65 Mr Steinberg: Less equal in the North
East?
Professor Richards: No.
Q66 Mr Steinberg: It must be. If you
have a scan in seven days and now it is three months, it has got
worse?
Professor Richards: I cannot say
what the circumstances are of that, but I do not believe, on average,
they have got worse. I believe the demand has gone up. The capacity
has increased and we are working extremely hard, through programmes
like the Radiology Collaborative, which is part of the Modernisation
Agency, to reduce waits in all aspects of diagnostics, particularly
radiology. In those places which have been doing that we have
reduced the waits very substantially.
Q67 Jon Cruddas: Sir Nigel, just going
back to the initial questions asked by the Chairman as regards
the research on patient behaviour, referred to on page 32, paragraph
2.31, even though the report is scheduled to come out later this
year, has the research yielded any results yet?
Sir Nigel Crisp: Again, I am sorry,
I think I am going to ask Professor Richards to try to answer
that.
Professor Richards: The research
programme which was commissioned following the publication of
the Cancer Plan specifically because we knew that we did not know
enough about the aspects of either patient delay or GP delay in
terms of cancer, that is now coming to fruition. I have seen some
of the early results from that. I think the facts which come through
to me are, firstly, that the patient element of delay tends to
be the major component, more so than the GP delay. In general,
it is lack of awareness of the problem of cancer rather than fear,
although sometimes fear can be paralysing and make people not
go to seek help. There is an element of age, so that people who
are older tend to delay longer before seeking medical advice.
There is an element of social class in this as well, which may
be related also to lack of awareness. All those parameters are
coming through. Also we have asked the researchers to review the
whole of the world evidence on what can be done to reduce delays
and, as I was indicating a bit earlier, sadly, that research evidence
is extremely thin in telling us in what ways to do things about
it.
Q68 Jon Cruddas: One area you did not
mention there was gender, in terms of some of the stuff that is
coming out in this research, we have mentioned class and age,
and so on. After reading this Report, I got a briefing, through
the House of Commons here, from the Men's Health Forum. In their
covering note, the first paragraph says: "Men are more likely
than women to suffer from nine out of the 10 most common forms
of cancer affecting both sexes, yet there remains an almost complete
absence of strategic thinking about the relationship between gender
and cancer. None of the various national targets relating to cancer
makes any mention of the specific need to reduce the incidence
of cancer in men." What would you say to that?
Professor Richards: Yes, cancers
are often more common in men. Many of those cancers are smoking-related
cancers, because it is not simply lung cancer but it is also bladder
cancer, oesophageal cancer, laryngeal cancer, a whole range of
cancers which are linked to smoking, and the tobacco epidemic
in men has been worse than it has been in women. That is the single
most important factor.
Q69 Jon Cruddas: So you accept that there
is a gender demarcation in terms of the incidence of cancer?
Professor Richards: In terms of
the incidence, there is no doubt at all.
Q70 Jon Cruddas: They say nine out of
10, with the exception of malignant melanoma?
Professor Richards: I would not
dispute that. That is entirely correct.
Q71 Jon Cruddas: In terms of incidence,
it is repeated in mortality rates as well, so it is not just the
incidence?
Professor Richards: Sadly, that
is because many of those smoking-related cancers are the cancers
which have a high death rate.
Q72 Jon Cruddas: The second paragraph
in this Men's Health Forum briefing states: "Consequently,
there is virtually no planning at either national or local level
that takes into account the clear need for policies, programmes
or other dedicated forms of action targeted at men." I notice
that your research did not mention gender. The sole factor that
you have mentioned at the moment is the history of smoking?
Professor Richards: We have been
talking in terms of incidence, which I have been relating to smoking.
The research that we commissioned was looking particularly at
factors which may be associated with people delaying longer before
seeking healthcare advice. To the best of my knowledge, gender
does not come through as a strong factor there, although it may
be a factor. One of the factors which does seem to influence people
is whether they have a partner or a close confidante to whom they
communicate the fact that they have got a symptom, because the
partner, whether that is a male partner or a female partner, probably
then encourages people to go to see their GP. Certainly the evidence
is there in a number of cancers, breast cancer being one, about
people communicating with a partner.
Q73 Jon Cruddas: So men have higher incidence
rates for all forms of cancer which affect both sexes, and, the
mortality rates, this briefing says men are almost twice as likely
in total to die from the cancers in the shared groups. We have
isolated this issue of smoking but also there is a question of
communication?
Professor Richards: There may
be a question of delay in seeking help, yes.
Q74 Jon Cruddas: Even though the research
does not jump out, in terms of the gender?
Professor Richards: It does not
jump out, but I should say that research is not yet published
and so it is not yet in a final form.
Q75 Jon Cruddas: Do you have an assumption
within the Department about what proportion of cancers are preventable?
Professor Richards: Yes. Up to
two-thirds of all cancers potentially are preventable because
around one-third are related to smoking, which obviously is preventable,
and probably up to a further third are related to a combination
of obesity, a diet that is lacking in fruit and vegetables and
lack of physical activity.
Q76 Jon Cruddas: I was looking here at
the European Commission's Code against Cancer and it says that
the evidence that cancer is preventable is compelling. Towards
80% or even 90% of cancers in western populations may be attributable
to environmental causes, defining "environmental" in
its broadest sense to include diet, social and cultural issues,
and all of that. These differences in gender are not biologically
determined, they are culturally, socially, economically or geographically
defined?
Professor Richards: In the main,
yes.
Q77 Jon Cruddas: Accepting all of this,
that it is environmentally determined, and accepting the statistics
which this briefing supplies, would you accept the criticism,
however, that there is not a strategic approach to men's health
or patterns of consumption, over and above smoking, that is what
I am saying?
Professor Richards: Can I say
that, for example, for prostate cancer, obviously which only affects
men, we have made that a specific target area. In fact, it was
the first area that we made a target area. We published an NHS
Prostate Cancer Programme back in 2000 which looked at research,
it looked at better treatment and at early detection. The first
of the advisory groups on a specific cancer that we set up related
to prostate cancer. In terms of the Men's Health Forum specifically,
the Department of Health has provided funding towards the Haynes
Cancer Manual, which the Men's Health Forum has produced, which
is a bit like an owner's manual for a car.
Q78 Jon Cruddas: It seems to me, and
I am not a professional in this, looking at these statistics,
it is pretty stark, in terms of the gender rates, and looking
at the gender mortality breakdown, in terms of the top 10 cancers,
the most common forms of cancer, it seems to say to me that the
present range of cancer prevention policies and programmes is
very much less successful with men than women. Everything else
being equal, that would appear to be the case?
Professor Richards: I am not sure
that I quite agree with you on that, because again it comes back
to smoking. A lot of that is historical and there is a graph in
this Report which shows smoking rates going back about 40 years,
showing that the male smoking rates were very much higher in the
sixties and seventies than they were for women. Now those two
rates have converged, and over time, but probably it will take
another 10 to 20 years, one would expect the cancer rates to come
together because of that, because so many of those things are
related to smoking.
Q79 Jon Cruddas: That is what you are
assuming, is it?
Professor Richards: Because we
know that these cancers are related to smoking, yes, and we know
that giving up smoking helps.
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