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Mr. Michael Wills (North Swindon) (Lab): I want to clarify one point about the hon. Gentleman's attitude to the postcode lottery. He has been eloquent about how much he disapproves of it, but how does that square with his leader's much-vaunted commitment to localism?
Mr. Baron: The hon. Gentleman is getting confused. At the end of the day, there is no doubt that if we aim to end the postcode lottery and have fairness in access to drugs throughout the NHS, there must be national standards and national appraisals. The bottom line is that there is a fundamental difference between standards and targets. Obviously, he has not taken that up. I am going to try to make some progress.
Mr. James Gray (North Wiltshire) (Con): Before he does, may I ask my hon. Friend whether he is not simply astonished that the hon. Member for North Swindon (Mr. Wills), in making his intervention, did not mention his constituent, Anne Marie Rogers, the lady whose request for herceptin was turned down by Swindon PCT? Is not that odd? Is the hon. Gentleman saying that he likes local decision making that goes against his own constituent?
I want to focus on the importance of detecting cancers early, which is vital in giving patients the best possible start to treatment. The Government's record in this area, too, is mixed. The Public Accounts Committee report highlighted the fact that a public awareness campaign on the signs and symptoms of cancer due in 2001 has still not been fully implemented. As a consequence, the report claims:
With regard to cancers in general, as part of its new role in public health, NICE should be involved in drawing up a full, evidence-based communications campaign on the signs and symptoms of cancer to encourage patients to present earlier. But if patients are going to present earlier, and in larger numbers, GPs, many of whom see only a handful of cancers each year, clearly need improved guidance on referral. According to the National Audit Office, only about half of GPs surveyed had seen departmental guidelines on spotting cancers and found them useful. That needs to be put right.
Screening, too, has an invaluable role to play in catching cancers early, but again much more needs to be done. The success of the NHS breast screening programme, introduced in 1988, clearly demonstrates
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how catching cancers early can save lives, and I look forward to the day when other cancers can be detected in this way. On bowel cancer screening, for example, we welcome the Government's commitment to roll out a national programme from April, but why are Ministers now obfuscating about funding?
In October 2004, the then Secretary of State made a commitment to fund the programme to the tune of £37.5 million over two years, but now the programme is said to be subject to budgetary considerations. Perhaps this Secretary of State will explain to the House what has happened to that allocation. Is bowel cancer screening now to become the latest victim of NHS deficits?
Perhaps the right hon. Lady will also explain why her Department has been so coy when asked about the future of the programme. The charities Bowel Cancer UK and Beating Bowel Cancer hand-delivered a letter to the Department on 13 December last year, inquiring about plans for national screening. However, only last week, in reply to my parliamentary questions, did Ministers acknowledge the existence of the letter and promise to reply. That really is not good enough. Bowel cancer appears to be one of the poor relations among cancers, and that needs to be put right, if only because it kills about 17,000 people a year.
Mr. James Clappison (Hertsmere) (Con): As my hon. Friend will know, this country is lagging way behind western Europe and north America in bowel screening. Has he noticed that in the Government's amendment to the motion there is no mention at all of bowel screening? Does he agree that the House would look forward to a full explanation from the Secretary of State of what the Government plan to do on that?
Mr. Baron: I do agree. As I said, bowel cancer is the poor relation among cancers, and that has been demonstrated by the lack of response from the Department on some of the issues that various charities have raised about the screening programme. I hope that the Government will shortly put that right.
On prostate cancer, various studies have cast doubt on the effectiveness of the prostate-specific antigen test, which is why we have called on the Government to give leadership to international efforts to find a reliable test for this disease, which kills almost as many men in the UK each year as breast cancer kills women. In the meantime, the prostate cancer risk management programme supports GPs in offering men an informed choice about PSA testing. However, many GPs are not even aware that support tools exist. That, too, needs to be put right.
So far we have discussed improving survival rates, but there is also a need to transform the quality of life of cancer patients. There needs to be better recognition by Government that, because more patients are living longer with cancer, cancer needs to be treated as a long-term medical condition. Patients should be given support to manage their own care as much as possible and to make informed choices about treatments where appropriate. Access to information is crucial for people living with cancer and is vital if patients are to be put in the driving seat. Yet communication issues continue to be a common cause of complaint for people with cancer.
According to the recent Public Accounts Committee report, one fifth of patients are not made fully aware of the potential side effects of treatment. About 40 per cent.
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of cancer patients were not informed about cancer support or self-help groups. As well as emotional support, patients should also receive, as a matter of right, information about entitlements to benefits.
According to Macmillan Cancer Relief, three quarters of patients do not receive such advice. The last thing that patients undergoing treatment require is to have to worry about not paying bills because of low uptake of benefits to which they are entitled. Another failing of the system is that it does not adequately address what I call the black hole between health and social care, into which too many patients fall without the care and treatment that they need. The gap needs to be bridged. That is why individual needs should be assessed on a holistic basis with professionals and health and social care staff working together through multidisciplinary teams.
Specialist clinical advice and support is also extremely important. Currently, Britain has too few specialist cancer nurses. We believe that NICE should be instrumental in drawing up holistic standards and entitlements to care that address the emotional and information needs of patients throughout the entire patient pathway, and so bridge the gap between health and social care. These standards would be for the whole journey, including, perhaps, giving patients the right to die at home if they so wish.
These standards should also be enforceable. One way of achieving that would be for clinical guidelines to be the basis of contracts between NHS commissioners and providers. In short, we should aim to create a culture of entitlements to care. For example, we on the Opposition Benches are increasingly attracted to the idea of an information prescription given by GPs or specialist nursesI am pleased to say that the Government are picking up on thisas the starting point of patient empowerment. Expertise in meeting these challenges and improving the quality of patient care already exists in the voluntary sector, and should now be harnessed by the NHS in meeting more robust professional guidelines set by NICE.
Jeremy Wright (Rugby and Kenilworth) (Con): On the subject of NICE, my hon. Friend will be aware of the arguments that relate to Alzheimer's drugs. I ask him to consider whether those arguments should apply also to cancer drugs. Should not NICE consider the economic impact on social services as much as on health services when considering the economic viability of cancer drugs?
Mr. Baron: In short, we very much agree with that. That is one criticism of the decision involving Alzheimer's drugs, in that it concentrated on health costs and benefits. The decision should have focused also on social costs and benefits, so as to bridge the gap. Cost savings could then be made with the provision of good standards of care in viewing the whole journey to the end, as it were. That is one of the faults of the system at present. It is focused too much on health and we need also to consider social care.
Reducing inequalities of outcome is not only a matter of improving survival rates. The battle against cancer must increasingly be fought by increasing awareness of
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risk factors and influencing lifestyle choices. This is the importance of prevention. Smoking is by no means the only risk factor that is associated with cancer. We must now put the focus on factors such as obesity, which causes about a third of all cancer deaths. Mesothelioma affects a new generation that are not aware of the risks of asbestos. They are embarking on potentially dangerous do-it-yourself renovations of old buildings, for example. There is a need for better warning about this deadly disease. These facts can be used powerfully to argue for a much better public health and awareness campaign to tackle health inequalities. We as a party were pledged to put these themes at the heart of our policies if elected last year.
As part of its new public health role and alongside communication campaigns on the symptoms of cancer, we believe that NICE should be involved in drawing up an evidence-based awareness programme of how people can alter their lifestyles to reduce risk.
The present situation is unacceptable. Despite extra investment and some improvements, Britain's cancer survival rates are still among the worst in Europe. The Government's targets focus on the front end of the patient pathway to the detriment of the latest treatments, which have been neglected. Waiting times for radiotherapy, for example, have undoubtedly increased, but the Government refuse to monitor the situation. There is still a postcode lottery in access to drugs, with British patients benefiting from new treatments later than their European counterparts. Guidance from the National Institute for Health and Clinical Excellence on technologies and standards of care has not been universally implemented.
The Secretary of State's intervention over herceptin unfairly raised the hopes of women with early-stage breast cancer. By failing to make specific funding available, she has put primary care trusts in an impossible situation, and she has disappointed patients. Meanwhile, services have not yet fully recognised that cancer is increasingly a long-term term condition, and should be treated as such. The black hole between health and social care needs to be addressed. In future, decisions about cancer services should be taken as much as possible by clinical experts from NICE, rather than by politicians in Whitehall.
The NHS has been a political football for too long. It is time for politicians to step back, and allow the medical professionals to get on with the job. NICE should take on a much more ambitious role in drawing up guidelines on entitlement to care. Those standards should take account of patient needs on a holistic basis, including the need for information and emotional support, and they should join up health and social services effectively. Standards must cover the entire patient journey from prevention and awareness to the later stages of curative and palliative care and, like technology appraisals, they should be enforceable. To end the postcode lottery in access to drugs and treatments, NICE guidance appraisals and recommendations should be made alongside resource implementation assessments so that national guidance is realistic and successful, enabling us to end the unfairness inherent in the system.
In short, it is almost a crime that, despite a massive increase in funding, cancer services still lag behind their European counterparts. We need an ambitious programme for the future of cancer services and a fresh
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approach that puts patients in the driving seat by providing them with an entitlement to standards of care, as decided by medical professionals, not the politicians; by raising treatment standards throughout the patient pathway; and by recognising quality-of-life issues, which are important to patients. For those reasons, I urge the House to support the motion.
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