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Bill read the Third time, and passed, with amendments.
THE SPEAKER’S ABSENCE
That the Speaker have leave of absence on Thursday 15th June to attend the National Service of Thanksgiving at St Paul’s Cathedral to mark Her Majesty’s eightieth birthday. —[Mr. Roy.]
PETITION
Council Tax
10.12 pm
Tom Brake (Carshalton and Wallington) (LD): I wish to present a petition from Clare Nunns that has been signed by 175 residents of Carshalton and Wallington. It concerns the IsItFair campaign to scrap the unfair council tax and replace it with a fairer system that is based on people’s ability to pay.
The petitioners therefore request that the House of Commons votes to replace Council Tax with a fair and equitable tax that, without recourse to any supplementary benefit, takes into account ability to pay from disposable income. Such tax to be based on a system that is free from any geographically or politically motivated discrimination and that clearly identifies the fiscal and managerial responsibilities of all involved parties.
Bowel Cancer
Motion made, and Question proposed, That this House do now adjourn. —[Mr. Roy.]
10.13 pm
Dr. Ian Gibson (Norwich, North) (Lab): I am delighted to have the opportunity to talk about bowel cancer, because many members of the public and Members of the House have experience of members of their families, or perhaps themselves, having the prognostication of bowel cancer and know of its effects on their lives. We have a real opportunity in this country to make a difference on bowel cancer, which is often called colorectal cancer, but it is my contention that we are not doing that as quickly as, or to the extent that, we ought to be.
I do not want to go into the numbers, although we conventionally talk in such debates about the numbers of people who develop and die from a cancer. However, hon. Members can take it from me that the figure is up there in the thousands and thousands and that the problem is very serious indeed. The research that has gone on in this country and the United States will undoubtedly help us to tackle not only bowel cancer, but many other cancers. For example, in the United States, at the Johns Hopkins university in Baltimore, Bert Vogelstein has discovered something that is quite magnificent in the sense of what it tells us about the development of cancers. He has shown that five or seven individual events can take place, all of which are necessary to develop the full-blown cancer, which sadly can kill. The genetic changes that he has identified are an important illustration of what research can do. The interesting thing is that the order in which they happen is not A, B, C, D, E, F, G and so on, but A-C, E-F and so on in different individuals. As a New Statesman article next week will prove, that shows that cancer research is telling us much more about how cancers progress from one stage to the next. It is not that someone has it and everything else is inevitable. The research shows that early detection not only of a genetic event, but of other events as well, is important and can help to save lives. My contention is that we can save thousands of people’s lives if we take the subject much more seriously.
Many people will say that bowel cancer is caused by diet and we can prevent it by taking care of what we eat. Lots is going on in that sector, but it is not the subject of the debate. We must have a process of screening individuals, and it is which individuals and when we screen them that is the subject of the debate going on not just in this country, but across the world.
We have been lucky with some of the research into bowel cancer because we can say things about the disease that we cannot say about other important cancers. The major screening programmes are for cervical cancer, breast cancer and bowel cancer, but bowel cancer is the only disease for which we have additional information about the stages that happen in the process. We have not quite reached that point with the other cancers.
How do we screen individuals? People can look at their stools and faeces—I cannot use rude words in the Chamber, but I hope that people know what stools and faeces are—for blood that might be present. They can
do it themselves by taking the stool and faeces and passing it on to the experts to analyse whether blood has been exuded from the body. If it has been, further tests can be done. The faecal occult test—it sounds like a religious group—is used for men and women aged between 60 and 69. It is very effective in what it does, because the next stage illustrates what we can do with the result. However, we need to ask why 60 to 69—why not 70, 75, 80 and so on? That is true for many other screening technologies, including breast cancer.
If there is evidence that blood is exuded by an individual, the next process is flexible sigmoidoscopy, which has been used in pilot studies of people aged over 50. A small flexible tube, with a camera attached, is inserted through a person’s rear passage. We would not all welcome that, but it does happen. I and others I know have been through that. It is quite exciting to lie there and look at one’s insides—parts of our bodies that we have not seen before—on a screen. It is better done after lunch and dinner, of course, and certainly after breakfast. However, it is interesting what one can see.
It is possible to see lesions and polyps on the screen. Polyps are little structures that may have developed at a certain stage in someone’s lifetime, perhaps over a period of eating certain foods, or whatever the factors are that induce their existence. When the doctor sees those structures, he gets the message. One can eliminate those polyps, which appear at an extremely early stage in the development of bowel cancer, and people can survive for many years if they do not develop the disease. Flexible sigmoidoscopy is an important procedure in identifying the early stages of bowel cancer.
The cancer can develop beyond that stage and, sadly, it has done so in most of the cases with which I am familiar, including that of my brother. Very little can be done, as the cancer has entered a different phase and spread to the liver. In such cases, even surgery will not extend someone’s life by many years, so early detection is extremely important. Removal of the polyps is even more important, as mutations, changes and so on can be detected in those structures. Rectal insertion is not the only technology used to tackle the disease. New scanners have been developed that allow us to look at people’s insides, so we can discover the polyps in their bowels without inserting an instrument in their rear passage.
We can argue about whether people should be screened at 50, 60, 69 and so on, but we need to consider the issue of take-up. Thankfully, the Government have introduced screening, but take-up is only 60 per cent. That is understandable, as people do not want to undergo such a test. Men, in particular, do not like such procedures or the effects on their bodies. The position is even worse for certain groups, where take-up is less than 60 per cent. Screening is not worth while if people do not use it. Recently, I received a paper from Warwick, De Montfort and Essex universities on take-up among black and ethnic communities. Before rectal insertion, a faecal occult blood test is necessary: people collect three samples over three days—goodness knows where they keep them, as they cannot be stored in a fridge with food—and send them for analysis. For various cultural reasons, black and ethnic communities do not like to
take that test. That is understandable—my researchers, who come from different cultural backgrounds, said that it was disgusting. The take-up among much of the multi-cultural community therefore falls below 60 per cent. to 30 per cent. and even lower. We await better tests, as many people are not taking up that test.
The national health service records the results of the tests, and flexible sigmoidoscopy is carried out. The problem of take-up has been tackled by Cancer BACUP, which has produced leaflets encouraging people to take the test. It has a great deal of experience of talking to people with breast and cervical cancer, urging them to take tests that can save their lives. However, low take-up is a huge dilemma, and I urge the Government to increase it. I do not think that we will ever achieve 100 per cent. take-up, but we can do better than 20 or 30 per cent. in certain communities. Indeed, we can do better than 60 per cent.
There is inequality in our society, and not just in black and ethnic groups. The politics of cancer in the United Kingdom is the politics of deprivation and the poverty of many people. Not only do they suffer more pollution and eat cheaper, poor quality food, but they do not take up the diagnostic tests. I run the all-party cancer group. Our conference this year, “Britain against Cancer”, will be about the inequalities in our society, where certain groups of people who come from certain backgrounds do not take up the tests that are available.
I urge the Government to regard that as a priority and to do more about it. It is all right to say, “Eat more fruit. Eat more organic food,” but as I know, the surge in the green vote in Norwich, which is all about eating organic fruit, involves the middle classes. On the working class estates in my constituency, people do not eat organic foods. They go to Lidl and buy food as cheaply as they can. The difference in the diseases that they get reflects the difference in lifestyle. We must take on the class problem and factors such as what people eat, where they live, the pollution that they encounter, and so on. I urge the Government to do more about that.
I know that the Department of Health is trying to do more and to induce people to be tested. The Department must speak much more to the relevant charities and groups. Bowel Cancer UK and Beating Bowel Cancer have great experience of talking to the population and thinking about the problems. We need a taskforce to encourage people to come forward and take the test.
What have the Government done? In no way am I suggesting that they have done nothing. They have, for example, set up various pilot schemes, which have been quite successful. In certain parts of the midlands they have saved around 250 lives. Saving 250 lives by testing for bowel cancer is pretty good news. We could make that 20,500 lives if we extended it to other parts of the country. There have been some delays in getting money into such programmes, but in April 2006, after a little flurry here and there, we managed to get £10 million for the first year of a bowel cancer screening programme, with the help of the national cancer screening programme. That is good, but what will happen in years 2 and 3?
At a Britain against Cancer conference, the then Minister spoke of a three-year programme tackling
bowel cancer. There is some scepticism about that. I want to hear tonight, please, that years 2 and 3 will happen. We have a hub and a screening centre, but we promised that there would be five hubs and 13 screening centres across the country. It has been proven that the one existing hub and the screening that is going on can save lives, and we could save many more lives. There is very good news. It is a winner, and do we need winners in this area of health! Does the Minister agree?
When people die of bowel cancer, I find it difficult not to wonder why the disease was not diagnosed sooner, why the treatment was not effective, why the polyp was not removed and so on, and why their lives were not saved. That is a challenge for the Government. We need to discuss how we will raise awareness, engage the charities, get leaflets out, engage with the communities and at what level, to make sure they know that there is good news and that the technology for dealing with the disease is improving.
We need to know where the programme will happen. I will love it when it is rolled out in Norwich and Great Yarmouth—everything happens there eventually—and the pilots seem to have been effective.
We need to know whether the Government have estimated how many lives might be saved, and I wonder whether the NHS can find the extra money. It was said that some £35 million would be found over three years, but will that happen? When will we know that the money is in place for years 2 and 3?
We must consider the capacity issues. What about the personnel who will conduct the tests? We need nurse specialists to look after patients, cancer doctors, pharmacists and stoma nurses. I do not think that people will not respond because of the nature of the cancer.
I want to hear from the Minister tonight that the programme will happen over the next three years, the three years after that and the three years after that, because it is a win-win situation. If the programme is successful in bowel cancer, progress will be made on prostate cancer, because there will be discoveries in that field, too—there will be discoveries across the spectrum of cancers over the next few years. We can show in this country that the best treatment for any particular cancer comes from early screening.
10.31 pm
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): I begin by congratulatingmy hon. Friend the Member for Norwich, North(Dr. Gibson) on securing this important Adjournment debate on what all hon. Members regard as an extremely important issue. I am not sure whether I thank him for going into so much detail in describing the nature of the condition and some of the treatment, but he brought the matter to life and revealed the reality of what many individuals go through at a very stressful time in their lives.
I want to put the matter in context before responding directly to some of my hon. Friend’s specific questions. Bowel cancer is the second largest cancer killer in England, accounting for more than 14,000 deaths a year. Around 28,000 bowel cancers a year are diagnosed, and, sadly, the disease has historically poor survival rates. It can be difficult to recognise bowel
cancer, as symptoms are often not reported at an early stage and can be similar to less serious conditions, which is why we need, as my hon. Friend has said, a proper national screening programme.
Research undertaken in Nottingham and Denmark in the 1980s showed that screening men and women for bowel cancer using the faecal occult blood test could reduce the mortality rate from bowel cancer by 15 per cent. in those screened, and an independently evaluated pilot in Warwickshire and Scotland showed that that research can be replicated in a national health service setting. Based on the final evaluation report of the pilot and a formal options appraisal, we announced that the NHS bowel cancer programme would begin screening men and women aged 60 to 69 from April 2006.
I can confirm that the bowel cancer screening programme is definitely being rolled out over the next three years, as confirmed in the White Paper, “Our health, our care, our say”, which was published in January. The programme is one of the first national bowel cancer screening programmes in Europe, and the first cancer screening programme in England to involve men as well as women.
My hon. Friend will be pleased to hear that we have always intended to have a three-year phased roll-out of this substantial new national programme. However, we cannot put an entire screening programme in place in a single year. We estimate that around £10 million will be spent on the first year of the programme. Funding decisions have not yet been made for future years, but we are committed to ensuring that the necessary funding is available to see through the full implementation of the programme.
Mr. Russell Brown (Dumfries and Galloway) (Lab): I share the admiration expressed by my hon. Friend the Member for Norwich, North for what the Government have done. I also appreciate that the health service is a devolved issue in Scotland, and we all want to see a standard service across the country. The screening programme in Scotland will not begin until March next year, which is some 11 months late. However, it covers an age range of 50 to 74, which is far more significant than that covered in England. I hope that as we progress through the three-year programme we will start to extend the age range that is covered.
Mr. Lewis: My hon. Friend makes an important point. As we progress through the three-year period and the screening programme develops, we will keep that under review and look to learn from our Scottish colleagues.
It is probably useful for both my hon. Friends to be aware that 100,000 testing kits have been ordered from the supplier for the purposes of the necessary screening programme. We estimate that between 100,000 and 120,000 men and women will be screened by the programme by March 2007. We believe that a very innovative model has been developed for our national bowel screening programme. For example, men and women will be sent a testing kit to complete in the privacy of their own homes. My hon. Friend referred
to the importance of dignity and sensitivity in the way that we handle this. We believe that about 2 per cent. of those who take the faecal occult blood—FOB—test will be positive and will be invited for a full colonoscopy. It is likely that about one in 10 of those will be found to have bowel cancer. It is probable that a further four out of 10 will be found to have polyps that can be treated to prevent the possibility of bowel cancer developing at all.
When fully rolled out, the programme is expected to detect around 3,000 bowel cancers a year. As my hon. Friend said, five programme hubs across England will invite men and women to participate in the programme, sending out FOB testing kits, interpreting the kits and sending out results. There will then be 90 to 100 local screening centres providing endoscopy services for the 2 per cent. of men and women who have a positive FOB test result. The pilot in Rugby will continue to run to the end of March 2007. The first of the five programme hubs will also be established in Rugby because of the substantial experience and expertise gained through the pilot. That programme hub will start by inviting men and women in Wolverhampton to participate in the screening programme. It will eventually cover the west midlands and north-west England. NHS cancer screening programmes are currently assessing where the other programme hubs will be located, and announcements will be made as soon as possible. We heard my hon. Friend’s bid for his own part of the world, which would be expected in the course of such a debate.
We intend that by March 2007, all five programme hubs will be established and around 14 local screening centres will be operating. Last August, strategic health authorities were asked to bid for their local endoscopy units to become local screening centres as part of the first wave of the programme in 2006-07. Similar exercises will take place for the second wave in 2007-08 and the third wave in 2008-09. It is up to SHAs to decide where local screening centres should be located for the benefit of their own populations. In particular, SHAs need to take into account the efficiency of their service for patients with bowel cancer symptoms to ensure that those are not affected by the local introduction of bowel screening.
Preparations for the roll-out of the programme have been going on for some years. As my hon. Friend said, training in the necessary bowel scoping is vital to the diagnosis of bowel cancer. A national training programme has been established to train specialist staff to carry out vital procedures for diagnosing bowel cancer. Based on current trends and definitions, the training programme is projected to develop training for 1,573 specialists by 2006-07.
Dr. Gibson: Will my hon. Friend say something about how we are going to increase awareness in people about having this particular test, because unless they think that it is going to preserve their life, they will not undertake it?
Mr. Lewis: I will come to that in the moment.
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