Examination of Witnesses (Questions 140-159)
16 JUNE 2004
DEPARTMENT OF
HEALTH
Q140 Mr Williams: What would you regard
as the clinical urgency time span?
Professor Richards: I consider
that the anxiety of the patient is part of the clinical situation,
but, in addition to that, in terms of whether a disease is going
to progress, it is very difficult to put an exact timescale on
that. In setting our targets for cancer, in saying we want people
from urgent referral to get through to treatment, and we have
set the target of that being two months, I think you can see that
for each step in the process, getting to the hospital, getting
through diagnosis, getting to treatment, we want that to be a
matter of weeks only.
Q141 Mr Williams: Thank you. One final
question, because my time is up. Do you smoke?
Professor Richards: No. I have
said already that I used to.
Q142 Mr Williams: Do you, Sir Nigel?
Sir Nigel Crisp: No. I used to
smoke. We are reformed at this end of the room.
Q143 Mr Williams: Do you find that, if
possible, you avoid smoke-filled rooms?
Sir Nigel Crisp: By and large
I would, but not always.
Professor Richards: I tend to
avoid smoke-filled rooms.
Mr Williams: We will draw these comments
to the attention of some of our colleagues. Thank you very much.
Q144 Mr Jenkins: Sir Nigel, do not go
away feeling that we are critical of this Report, in fact I think
it is quite a good Report in many areas, it shows we are moving
forward across a wide front. If we look at figure 23, where it
shows, particularly on the north side, the progress we have made,
I have worked out that we have dropped a good way down the league
table and the only country that has bettered us is Finland, we
are almost on a par with Finland, so I think we have done some
good work there. We were looking at the chart earlier on and I
want to ask a question on figure 19, on page 21, it was quite
interesting I thought. If you look at one end of the chart, am
I reading this right, South Yorkshire with regard to prostate
cancer mortality has got 45 as a rate per 100,000, and the other
one, Thames Valley, has got 85, on the incidence scale? Why is
South Yorkshire, which has never struck me as a particularly healthy
part of the world, so low?[8]
Is it a blip, is it an accident in the collection of data, or
really is it that they are eating something or doing something
up there which I need to know about quick?
Professor Richards: When we were
preparing this Report with the NAO, clearly all of us asked that
same question. I do not think I have an absolute answer to it,
but with prostate cancer in particular the reported incidence
of the disease depends critically on how much PSA testing is done
in the locality. What I would want to know, and I do not have
an answer to, is whether the PSA testing rate in that part of
the country is significantly lower than it is in other parts.
I simply do not know that.
Q145 Mr Jenkins: Would that cause you
concern and would you flag up now the need to do some more testing
in that area to show us the real figure we are looking at?
Professor Richards: Certainly
we would wish to explore that further. In fact, I believe that
during the course of the preparation of the Report we went back
to the relevant cancer registry and asked them specifically to
check that figure. They checked it and said to the best of their
knowledge that was accurate but I am not sure that they were able
to tell us the specific reason for it, except the possibility
that it relates to low PSA testing rates. I agree that it looks
very strange.
Q146 Mr Jenkins: It could be a hidden
condition?
Professor Richards: It could be,
yes.
Mr Jenkins: Yes, that was what I suspected.
Q147 Mr Bacon: Professor Richards, going
on to this point about Herceptin and the lack of various parts
of the system, like pharmacists, chemotherapy suites, nurses,
and so on, you said that the training for a nurse was three years.
I want to clarify this, because everyone knows that it takes three
years to train a nurse. Are you saying that once you have got
a trained nurse it is a further three years to have an oncology
nurse?
Professor Richards: No.
Q148 Mr Bacon: Was that not what you
were saying? I was talking about Sir Nigel's point about the lack
of nurses. My assumption was, and I need to get this clear, if
you have got a nurse and you turn him, or her, into an oncology
nurse, how long extra does that take?
Professor Richards: Usually one
would be taking somebody who is already an experienced nurse and
at usually at least an E or F grade, so they would have spent
three years training to become a nurse, usually at least another
couple of years of experience as a registered nurse, and then
to become an oncology nurse on top of that takes between nine
months and a year to get those skills to be able to deliver chemotherapy.
Q149 Mr Bacon: It should not take that
long. I still do not understand. I find it incredible that the
variation in this chart for Herceptin can be explained simply
by the lack of things like nurses. I have got two other questions
and I do not have a lot of time. Are nurses prohibited from telling
patients about Herceptin?
Professor Richards: No.
Q150 Mr Bacon: There is a lady at the
back of the room who campaigns on Herceptin and she said she was
at a conference three weeks ago where a nurse spoke and said that
she was prohibited from telling patients about Herceptin. How
can you explain that?
Professor Richards: I certainly
cannot explain that because I do not believe that is good practice.
I think that all patients should have the advantage of at least
having Herceptin discussed with them.
Q151 Mr Bacon: The survival rates, you
mentioned that it increases the length of life for women with
this particular kind of breast cancer by six months; what is that,
an average?
Professor Richards: Of course
it is an average, yes.
Q152 Mr Bacon: From where did you get
that number?
Professor Richards: There has
been a large, randomised control trial of patients with advanced
breast cancer, comparing patients getting standard chemotherapy
with Herceptin versus standard chemotherapy on its own.
Q153 Mr Bacon: What is the range? You
say six months is the average; what is the range?
Professor Richards: The range
is from no extra benefit up to several years. Certainly I know
of individual patients who have lived for several years when I
would not have expected them to.
Q154 Mr Bacon: So has the lady at the
back of the room, she is one of them, she has lived for three
years and she says there are cases of four years around. Is this
six months a reliable figure?
Professor Richards: It is a reliable
figure as the average, yes, it is absolutely reliable, but I accept
that there is a range on this and I know of patients who have
lived, let us say, five years or more when I would not have expected
them to do so without it.
Q155 Mr Bacon: How much is a course of
Herceptin per month?
Professor Richards: Off the top
of my head, I cannot give you an answer to that, but a total course
of Herceptin certainly would run into thousands of pounds.
Q156 Mr Bacon: Per month?
Professor Richards: I would have
to come back to you on the exact costing.
Q157 Mr Bacon: If you could send us a
note on that, please?
Professor Richards: Yes, certainly.[9]
Q158 Chairman: I think we are nearly
at the end of our hearing now, Professor, but just to give you
a chance to say—and we have very much enjoyed having you
here this afternoon, with your obvious dedication to your job
and your knowledge—what further improvements in the incidence
of mortality and survival do you expect in this country in the
next five years?
Professor Richards: May I say,
I have enjoyed being here too. I think there will be very considerable
improvements over the next few years in cancer in general. I think
there will be further improvements in both mortality and survival
rates. In some cases incidence is set to continue to rise because
of the ageing of the population, but despite that incidence rising
I am confident that we will see both falls in mortality and improvements
in survival, and I would attribute that to several different things.
I think we will see the prevalence of smoking going down, which
will reduce the death rate from smoking-related cancers, particularly
lung cancer. We will see the introduction of bowel cancer screening,
which will reduce the mortality from bowel cancer. We will see
further progress on waits, both for urgently-referred and for
routinely-referred patients. We will see all patients being seen
by specialist teams and therefore getting the best treatments.
We will see the variations decrease in relation to the drugs approved
by NICE, and we will see patient experience improved in terms
of provision of information and communication and palliative care.
I think we will see improvements across the board. I am confident
that we will achieve the 20% reduction in the death rate for people
under the age of 75 by 2010, as set out in our targets. I am confident
also that over time we will catch up with Europe in terms of our
survival rates.
Q159 Chairman: In this Committee, everything
you say is noted down and may be used against you, so I hope that
is right?
Professor Richards: I am confident
in those statements.
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