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Cancer Services

Mr. Deputy Speaker (Sir Alan Haselhurst): We now come to the second debate on an Opposition motion. I must inform the House that I have selected the amendment in the name of the Prime Minister, and once again placed a 10-minute limit on speeches by Back-Bench Members.

4.15 pm

Mr. John Baron (Billericay) (Con): I beg to move,

That this House recognises that there have been improvements in the provision of cancer care due to the extra investment in the NHS and the hard work and dedication of NHS staff; but notes that a different approach is now needed to raise standards of treatment throughout the entire patient pathway to the best levels achieved in other European countries; believes that more should be done to end the postcode lottery in drugs and treatments; wishes to see more done to raise awareness of the risk factors and symptoms of cancer; further believes that cancer is increasingly a long-term condition and that there should now be a greater recognition of the importance of quality of life issues; and calls on the Government to give the National Institute of Health and Clinical Excellence a much stronger role in establishing holistic standards and entitlements to care covering the entire patient pathway.

No one can doubt the significance of cancer to many millions of people in this country. The disease remains one of the biggest killers in the UK, accounting for approximately a quarter of all deaths and claiming more than 150,000 lives a year. More than one person in three will be diagnosed with cancer at some point in their lives, and there is likely to be a significant increase in the number of new cases over the next few years, partly due to our ageing population structure.

Given its importance, I hope that this debate about the future of cancer services can be constructive. I, for one, recognise that improvements have taken place under this Government, but I shall also highlight the fact that there are still failings in the system, in the hope that they will be recognised and put right.

The Government's amendment runs the risk of appearing somewhat complacent. It is full of self-congratulation, and mainly looks back at the past. Putting that to one side, however, I accept that it would be churlish not to accept that the Government have made extra funding available and that improvements have been made. It is not often that a shadow Minister quotes good figures on the Government's behalf, but one example of those improvements is that, whereas only 42 per cent. of patients diagnosed with colon cancer in the first half of the 1990s survived for five years, that figure had risen to 50 per cent. by the start of the present decade.

Naturally, Opposition Members congratulate staff in the NHS and the voluntary sector on their hard work and dedication to patient care, which have helped to bring about the improvements in outcomes. Those improvements are welcome, but they are not exceptional when compared with the long-term trends that date back to the 1980s.

Dr. Howard Stoate (Dartford) (Lab): Will the hon. Gentleman give way?

Mr. Baron: I intend to make some progress, but I assure the hon. Gentleman that I will give way in a little while.
 
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According to figures produced by Cancer Research UK, mortality rates fell by 11 per cent. between 1988 and 1997, and by 6.5 per cent. in the first six years after Labour came to power. I hope that the Secretary of State will not copy the Prime Minister's trick of using the mortality figures since 1997 as proof of the effectiveness of the Government's cancer strategies. There has been no marked improvement in the overall trend going back to the 1980s, despite the extra funding.

The Government use more selective figures in their amendment, but even they cannot disprove our case. Although there has been a 14 per cent. fall in mortality figures since 1996, the total death rate for people under 75 years of age also fell by 14 per cent. in the final nine years of the previous Conservative Administration.

The Opposition recognise that there have been improvements in outcomes, but they have not outstripped comparable improvements in continental survival rates. According to last year's report from the Karolinska institute, the UK still lags behind other European countries when it comes to survival rates over periods of one year and five years. In fact, Britain has one of the worst survival rates in all of western Europe: whereas 81 per cent. of cancer patients in France survive for one year, the equivalent UK figure is only 67 per cent. Even Albania and Lithuania have better one-year and five-year survival rates than we do. Estimates suggest that more than 20,000 lives a year could be saved each year if the NHS met the best European standards of care.

Meanwhile, the outcomes gap between rich and poor people in the UK is also unacceptable and getting wider. A recent report from the Public Accounts Committee highlighted persistent and unacceptable variations in outcomes, depending on where patients lived. Breast cancer death rates are 20 per cent. higher in some northern regions than they are in other areas, mainly in the south of the country.

Those are unfortunate facts, but whether cancer services are equipped to meet the fresh challenges that we face is also open to question. For example, more cancer patients are now living longer, which means that, increasingly, the disease must be regarded as a long-term condition. The emphasis of policy in the future must shift from getting patients into the early stages of treatment as quickly as possible, important though that is, to ensuring that later stages of care, information and emotional support are widely available. To achieve that, several failings need to be addressed.

Dr. Stoate : I am grateful to the hon. Gentleman for acknowledging that services are improving. Does he agree that the most difficult time for any patient with a possible cancer diagnosis is the early stages of waiting for a diagnosis? Will he therefore join me in congratulating the NHS on reaching the target of ensuring that almost every patient whom a GP suspects may have cancer is seen within two weeks by an NHS specialist? The initial tests can be done quickly to reduce the awful burden of anxiety faced by someone in that position.

Mr. Baron: I take the hon. Gentleman's point, but he refers to early referrals. The problem is that far too
 
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many women are diagnosed with cancer after being referred on a routine, non-urgent basis. It could be argued that the two-week target has distorted clinical priorities. Breakthrough Breast Cancer has made that case many times.

Mrs. Iris Robinson (Strangford) (DUP): My mother was diagnosed with breast cancer and had a mastectomy, and I had quite a scare last September. Does the hon. Gentleman agree that the Government must take steps to ensure the correct analysis of mammograms? Radiographers have got that wrong in the past, but patients need to be assured that they receive the correct results. Does he also agree that herceptin should be given to the women who need it, and that we should not have a postcode lottery?

Mr. Baron: I completely agree with the hon. Lady and I will come to those points later in my speech.

Mr. Sadiq Khan (Tooting) (Lab): The hon. Gentleman compared the UK with European countries with better success rates, but does he agree that we have seen improvements over the past eight years? In 1997, Labour was the first major political party to mention the word "cancer" in a manifesto. In 1997, we had a Green Paper that set a target on death rates for 13 years' time and, in 1999, for the first time, a directorate was set up to deal with cancer. Again for the first time, in 2000, we had a 10-year plan to fight cancer. Is it not the decades of neglect that have led to the problems that the hon. Gentleman mentions?

Mr. Baron: I suggest to the hon. Gentleman that there is no point just talking about cancer—we want action, and we are trying to look forward in this debate. As I said earlier, there have been no marked improvements in mortality rates, despite all the money that has gone into the NHS. The Government can produce as many papers as they like, but what we need are improvements on the ground.

Bob Spink (Castle Point) (Con): My hon. Friend is right to talk about the need for action. Does he agree that long-term survival rates could be greatly improved if everybody had proper access to the most appropriate and up-to-date medicines, without postcode prescribing? For instance, for high grade malignant brain tumours, we need to ensure that sufferers have access to temozolomide and gliadel implants.

Mr. Baron: I agree with my hon. Friend and I shall address the issue of the postcode lottery shortly.

One reason why the Government's additional funding for cancer services has not produced a marked improvement in the longer term mortality trend is that the two-week and one-month targets, to which the hon. Member for Dartford (Dr. Stoate) referred, have focused attention and resources on the front end of the patient pathway, to the detriment of the other end. The later stages of cancer care have been neglected as a result. The Government's targets may have been successful in getting more people into the system more quickly, but staff shortages have created bottlenecks further down the line. Radiotherapy offers an example.
 
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The importance of radiotherapy is that more than half of all cancer patients will undergo it at some stage of their treatment, yet in January a report in the British Medical Journal observed that pressures on cancer units across the UK have led to longer waits for radiotherapy patients and may be reducing chances of survival.

High staff vacancy rates are causing real concern. In evidence to the pay review body, the Society of Radiographers noted that vacancy rates for therapeutic radiographers in England stood at 17 per cent. There is a particular shortfall of experienced, specialist radiographers. The Government may have increased student numbers, but new graduates do not possess the skills needed to fill that type of vacancy. According to the society, the current high number of vacancies and Government targets have made managers reluctant to release existing staff for further training opportunities, so it does not look as though the situation is getting better. As a result, waiting times for radiotherapy have lengthened since 1997. According to figures collected by the Royal College of Radiologists, radiotherapy waiting times in 2005 were worse than those documented in 1998; for example, whereas in 1998, 32 per cent. of patients in need of radical radiotherapy waited longer than the recommended maximum of four weeks, by 2005 the figure had grown to 53 per cent. More than half of all patients receiving curative radiotherapy now wait longer than the recommended maximum of four weeks.

For their part, despite a recent assurance at Health questions that hidden waits would be measured, the Government have insisted that no official monitoring of radiotherapy waiting times will take place. That is a great shame. I put it to the Secretary of State: how can the Government hope to resolve the serious problems in radiotherapy if they have no official idea of the extent of the problems because they are unwilling to collect the statistics? Although I wrote to the Secretary of State about the issue after our exchange at Health questions in January, I am still waiting for a response.

Radiotherapy is not alone, however. There are similar problems for other treatments. According to the Dr.   Foster organisation, there has actually been an upward trend in waiting times for surgery for the 10 most prevalent cancers since 2001. Meanwhile, according to research cited in a report by the cancer capacity coalition, a number of clinical directors expected rising demand for chemotherapy to lead to longer waiting times over the next five years.

Things must change. The Opposition believe that one solution to the problems would be to move away from targets, which distort clinical priorities by focusing resources on the front end of the patient pathway, and to instruct NICE to draw up standards and entitlements for patients covering the entire pathway—a point to which my hon. Friend the Member for Castle Point (Bob Spink) referred. In other words, we should shift entirely the emphasis for cancer care from politicians dictating targets for patients to patients having entitlements to standards of care decided by medical professionals; the entire journey should be covered, including the later stages of treatment such as radiotherapy. Such an approach directly recognises the
 
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fact that there is no use in getting more people on to the patient pathway sooner if we do not ensure their access to all stages of life-saving treatment.

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