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Mr. Paul Keetch (Hereford) (LD): I am delighted to have secured this important debate for my constituents and delighted that the Minister is here to answer some of the questions that I shall put to her.
It is evident that the questions surrounding the availability of cancer care and drugs are common to many primary care trusts in England. The lack of vital services, medical personnel and new technology make news headlines almost every day. However, it is the availability of new life-saving drugs, such as Velcade for multiple myeloma and Herceptin for breast cancer, and the provision of acute radiotherapy care, that concerns my Hereford constituents most.
Herefordshire PCT has an excellent reputation as a cancer service provider. It is one of only 4 per cent. of PCTs in the UK that have achieved a three-star rating for two years running in the Healthcare Commissions assessment of trust performances. However, the notion of a cancer drugs postcode lottery and the need to travel excessive distances to obtain vital care is fuelling a great deal of anxiety among my constituents.
Cancer is one of the biggest killers in the UK, and accounts for a quarter of all deaths. One in three people has the prospect of being diagnosed with cancer at some stage of their life, so it is understandable that people are concerned when they believe that they are being denied the right to critical care and life-saving drugs just because they do not live in the right area. Surely everyone should have an equal right to life and treatment.
Under the current guidance from the National Institute for Health and Clinical Excellence, both Herceptin and Velcade are still waiting to be agreed as suitable for cancer sufferers in England. Yet in Wales and Scotland they were approved more than a year ago. Consequently, Welsh patients being treated in Hereford county hospital and, indeed, other English hospitals along the Welsh border, automatically receive those drugs. However, Herefordshire patients being treated at the same hospital do not always receive them. I am delighted that Welsh patients receive the drugs, but the essential thrust of my debate is to ask when the Government and NICE will stop the postcode lottery.
The county hospital in Hereford is one of the finest hospitals in the region and I was delighted when it opened. I pay tribute to the Labour Government for providing that hospital. We have some of the most dedicated doctors and nurses in the countrya plethora of talentwho cater for approximately 200,000 patients and provide acute care for those in Herefordshire, Powys and the bordering areas of Gwent, Shropshire and Worcestershire. The hospital provides essential health carenot only accident and emergency care but vital cancer care.
Between 2004 and 2005, there were more than 2,000 finished consultant episodes at the county hospital and 96.2 per cent. of cancer patients were treated within31 days; that is a very good record. Only recently it was announced that my constituents will be blessed with a new £3.4 million cancer care unit, partly to be funded by the national charity Macmillan Cancer Support. The remainder of the funding will be provided by the
hospital trust. Indeed, I shall shortly attend the launch of the Macmillan appeal to raise its £1.5 million towards the cost of the unit. The new facility will provide first-class chemotherapy care for the county, and I of course welcome that investment in cancer provision. However, much more still needs to be done.
The nearest hospitals to Herefordshire offering full oncology treatment are in Cheltenham and Birmingham. Many patients from the Herefordshire catchment area must travel to the Cheltenham general hospital for radiotherapy treatment. For some that is a 150-mile round trip in difficult circumstances. Many of the patients are old and frail and have little support at that most trying of times. On top of the mental anguish and distress to which the disease subjects them, they must undergo harrowing journeys because of the current unavailability of radiotherapy facilities in Herefordshire. My constituents have written to the Prime Minister on that very issue, and a local newspaper, the Hereford Times, has carried a campaign to cut the cancer miles misery which has attracted huge local support.
The 3 Counties cancer care network, which is responsible for providing acute services in Gloucester, Herefordshire and south Worcestershire, is looking to develop a radiotherapy service in the next few years, but many people in my county believe that that is too late. As anyone who has come into contact with cancer sufferers will confirm, it is a disease that can break hearts as well as bodies, and time is of the essence. It has come to my attention that cancer sufferers in Herefordshire are cutting their treatment short because they can no longer cope with the journeys. Frankly, that is a disgrace in a country whose health service was once the envy of the world.
Macmillan Cancer Support claims that many patients in outlying rural areas are facing grossly unfair journeys of up to 200 miles. I know that my neighbour, my hon. Friend the Member for Brecon and Radnorshire (Mr. Williams), is campaigning about that, as his constituents also suffer. He wanted to be present for this debate, but he is attending to other parliamentary business. When will the Government begin to address the shortage of cancer care provision before it is too late for many of my constituents?
Not only are many cancer sufferers in Herefordshire forced to travel hundreds of miles for vital treatment, they are denied life-saving cancer drugs. I have been contacted by constituents who are suffering from multiple myeloma and just cannot understand why NICE is still appraising Velcade, the cancer drug to treat myeloma. Velcade was granted a licence in spring 2004, so will the Minister explain why its appraisal is taking so long?
The All Wales Medicines Strategy Group, the Welsh version of NICE, appraised and approved Velcade in June 2005 and Welsh patients can now receive it on the NHS. You will be pleased to hear, Miss Begg, that the drug has also been approved by the Scottish Medicines Consortium and is available in Scotland. So why is it not yet available on the NHS to my constituents in Herefordshire?
It is expected that Velcade will not receive guidance from NICE until September 2006, despite the fact that the Government issued a statement in November 2005 saying that it and other life-saving cancer drugs would be part of a new rapid process for accessing drugsthe
so-called fast-tracking. When I asked the then Health Minster, the right hon. Member for Liverpool, Wavertree (Jane Kennedy), a parliamentary question about that, she replied that the
proposed changes to enable the National Institute for Clinical Excellence (NICE) to produce faster guidance on life-saving drugs would go ahead immediately."[Official Report, 2 December 2005; Vol. 440, c. 854W.]
The former Minister said that that system would benefit thousands of patients, especially those with life-threatening conditions, and would provide greater certainty about the provision of new treatments, yet we are now six months down the line and it is more than three years since the drug was licensed, but English patients are still waiting.
In that time, many thousands of people have been diagnosed with myeloma, yet their pleas have fallen on deaf ears. Sufferers cannot wait until the end of the year to start receiving the drug. Myeloma is a terminal disease and more than one third of patients die within a year of diagnosis. Between 1998 and 2001 the relative survival rate for patients diagnosed with multiple myeloma in England was 25.6 per cent. That is worrying and must be addressed now.
Of course the NHS is not obliged to fund the provision of a drug until NICE issues guidance, but cancer sufferers do not have time to wait. According to the Department of Health, PCTs are free to use treatments that have been licensed, even if they have not received NICE approval, and Ministers have repeatedly stated that whether funding is provided for treatment is a matter for local decision making. However, in practice, hospital bosses and local clinicians are reluctant to provide the drugs because of financial constraints.
Herceptin is another life-saving drug that is being denied to cancer sufferers, although in recent weeks one patient has successfully won a High Court appeal to be prescribed Herceptin by her local PCT. I am extremely pleased for the lady involved, who fought a very dignified campaign, but many thousands of breast cancer sufferers are still being denied Herceptin for early-stage breast cancer. No doubt that court ruling will have huge complications and we must wait to see what the result will be, but it highlights the fact that we are still witnessing postcode prescribing rather than local decision making.
In Herefordshire, that is a sensitive issue. We are witnessing breast cancer sufferers in Wales being prescribed Herceptin free of chargeas with Velcadebecause the drug is funded by Welsh local heath boards, even if patients are treated in England at Hereford county hospital. However, women in the early stages of breast cancer who live in England and who are treated at the same hospital must pay between £20,000 and £30,000 a year because the local trust will not always foot the bill. Again, NICE has said that it will fast-track the appraisal when the licence has been grantedsupposedly in Julybut that does not alter the fact that many PCTs cannot afford the new drugs and are avoiding the issue.
The Government have said that PCTs need to ensure that they allocate sufficient resources to meet their local contribution to tackling cancer care, and we would all agree with that. However, given that one in four NHS trusts failed to balance their books in 2004-05, leaving the NHS with a deficit of £250 million, how on earth
can the Government expect the trusts to fund the new cancer facilities and drugs? Many PCTs believe that the Government are passing the buck to them. The Government also expect PCTs and hospital trusts not only to keep within their budgetsagain, I do not disagreebut to be able to dispense the drugs at higher cost from existing funds. The trusts simply cannot afford it.
In conclusion, when will the Ministers Department tackle this grossly unfair postcode lottery, so that everyone has an equal right to life and treatment? When will the new drugs be available to my constituents? When will the Government begin to address the problem of the harrowing journeys that my constituents have to make to receive radiotherapy and other vital cancer care? My constituents and I look forward to the Ministers reply.
The Minister of State, Department of Health(Ms Rosie Winterton): I congratulate the hon. Member for Hereford (Mr. Keetch) on securing this debate. He has set out his and his constituents concerns clearly. However, I hope he accepts that cancer has remained a key priority for the Government and that there has been real progress in recent years. For example, cancer mortality rates have fallen; more than 99 per cent. of patients with suspected cancer are now seen by a specialist within two weeks of being referred by their general practitioner, up from 63 per cent. in 1997; the number of cancer specialists has increased by 42 per cent.; and since 2000, more than 1,200 items of equipment have been delivered to diagnose and treat cancer. I hope that the hon. Gentleman agrees that those improvements have been made.
However, cancer continues to remain a priority, because there is a long way to go before we have a perfect system. Whether, as medical technology changes, there can ever be a perfect system is debatable, but the Government have made a real commitment to investing in and improving cancer services.
Mr. Keetch: I should like to put on record my acknowledgement that, as I have said publicly in Herefordshire, under recent Labour Governments there has been a massive increase in investment for health care provision in the county. I welcome that; I am only sorry that the hon. Member for Leominster (Bill Wiggin)the other MP with a Herefordshire constituencyis not here to hear me say that.
Quite rightly, the hon. Gentleman wanted to highlight the provision of cancer services for the residents of Herefordshire; he highlighted some of the difficulties that they experience. I join him in congratulating all the staff who work in local cancer care services in his constituency, because they have achieved a number of things at a local levelnot least the fact that Hereford county hospital is one of the top-performing hospitals in England in respect of cancer treatment.
I turn to some of the hon. Gentlemans specific points. He referred at length to the drugs Herceptin and Velcade. I shall give a little background, of which I am sure he is aware. While NICE is developing guidance, there is no restriction on the prescribing of those drugs within their licensed indications. During that time, decisions remain for local determination, but the Department has made it clear that funding for newly licensed treatments should not be withheld because NICE guidance is unavailable. As the hon. Gentleman said, NICE is assessing Herceptin and Velcade under its new single-technology assessment, which has been specifically designed to meet some of the concerns about the time that it sometimes takes to carry out appraisals. Velcade is one of the first five drugs to be appraised using the new process, and we expect guidance shortly.
As regards the use of Herceptin and Velcade in Herefordshire, my officials have checked again with Herefordshire PCT. We have been assured that no patients from Herefordshire have been refused treatment with Herceptin or Velcade when it was recommended by an NHS clinician. The key, of course, is that the treatment must be recommended by an NHS clinicianthat is absolutely right, and I hope that the hon. Gentleman agrees. I hope that that addresses some of the particular issues about those two drugs.
More generally, we want treatment for cancer patients in Herefordshire to be delivered quickly. Obviously, that is a key condition for successful outcomes, and the information that we have shows that treatment is, by and large, delivered quickly. At the same time, I understand the hon. Gentlemans concern about the distance that some of his constituents must travel to receive treatment.
Let me return to the issue of cancer networks, to which the hon. Gentleman referred. We have set up cancer networksthe first were set up about 10 or12 years agoto bring together all the bodies in an area that are responsible for planning and developing cancer service strategies, and there were good reasons for doing that. We wanted to make sure that clinicians, the NHS, patients organisations and other stakeholders were looking at overall provision to ensure that it was planned carefully, particularly where specialist treatment might be needed. The sad truth, particularly as regards specialist treatment, was that a proper view was not taken of how to maximise the use of individuals and clinicians skills, so it was important to have a view from a wider area than just one PCT. Networks therefore play a crucial role in delivering cancer services and they have played a major part in delivering some of the improvements that we have seen.
Herefordshire, together with Gloucestershire and south Worcestershire, is part of the 3 Counties cancer network, which the hon. Gentleman mentioned. He also mentioned the rural nature of the area that he represents and the fact that the geographical challenges can be quite significant when it comes to providing specialist health services. As he said, the 3 Counties cancer network specialist regional services are provided by the Gloucestershire Hospitals NHS Foundation Trust at the Cheltenham oncology centre. Currently, patients from Herefordshire who need radiotherapy and in-patient chemotherapy are treated in Cheltenham.
I accept that the distances for Herefordshire patients are large, and for those living on the Herefordshire-Wales border they are greater still. However, the hon. Gentleman will agree that it is important that issues of patient safety are paramount in providing specialist services such as those provided at Cheltenham. It is important that there are sufficient numbers of patients to make sure that staff can maintain and develop their specialist skills. As I said, in rural areas that brings significant challenges, but the 3 Counties cancer network is looking into how to make sure that it meets those challenges.
As I understand it, some patients at Cheltenham will require in-patient treatment, and it is important that there is an oncologist on hand to monitor those in-patients when they have their chemotherapy. That is one reason why it is important for the services to be in a specialist centre. There has been an increase in the levels of chemotherapy carried out, and the number of day-case sessions of chemotherapy at Hereford county hospital has increased from about 1,800 in 2003-04 to about 2,800 this year. The cancer network is looking at how that progress can be built on.
The Hereford Hospitals NHS Trust, to which the hon. Gentleman referred, has announced that it will work with Macmillan Cancer Support to build a new cancer unit at the county hospital to replace the Charles Renton unit. The hon. Gentleman is going to the launch of the appeal, which I am sure will be very welcome. I understand that it will be a state-of-the-art unit costing £3.4 million£2.4 million of which will come from Macmillan, with the trust providing the balance. That will significantly increase the capacity for patients to receive chemotherapy in Hereford. I understand that when the centre is completed, it will have the capacity to provide some 4,500 sessions of day-case chemotherapy each year. That is sufficient capacity for all Herefordshire patients to be treated locally.
In-patient chemotherapy will continue to be provided in Cheltenham, as I said, because specialist staff are requiredfor example, to support a consultant oncologistto monitor patients for up to 24 hours after receiving the treatment. The hon. Gentleman referred to radiotherapy. The network currently has four linear accelerators and two simulators at the Cheltenham oncology centre. That is the only radiotherapy service in the network at present, and all patients requiring radiotherapy are treated in Cheltenham.
The hon. Gentleman raised the sensitive issue of patients not travelling to receive radiotherapy because of the distances. I understand that there are some patients who had a terminal diagnosis and who have chosen not to travel, essentially as a quality-of-life decision. However, the PCT has assured us that there is no evidence of patients who are receiving curative radiotherapy choosing not to travel. Obviously, this is very difficult, and I will come on to what else is being done in terms of increasing the provision of radiotherapy locally.
Recommendations on these issues have come from the Royal College of Radiologists. As a result, the number of linear accelerators in the network will be increased to seven by 2010-11. The network is supporting plans to increase the linear accelerator
complement at Cheltenham to five by 2007-08. Beyond that, it has asked interested trusts to put forward proposals for developing the next round of linear accelerator provision in 2009-10. All three truststhose based in Cheltenham, Worcester and Herefordhave expressed an interest in developing these services. The network has produced draft criteria for assessing the options; access is included as a criterion alongside issues such as safety, staffing and cost.
Mr. Keetch: I hope that access is one of the key criteria, because if the 3 Counties cancer network were to develop yet more centralised operations at Cheltenham that would be very unfortunate, not only for my constituents but for those from Powys and Brecon who also come across. Access for people suffering from cancer is a key criterion, and I hope that the Minister will ensure that it is one of the units principal criteria.
Ms Winterton: I suggest that the hon. Gentleman looks at the draft criteria that the network has produced just to reassure himself. I have certainly been assured that those criteria include access, but he might like to check that, and I shall make sure his comments on this matter are passed back.
I am informed that the current clinical view is that a linked satellite of the Cheltenham service could be viable in either Hereford or Worcester, but I must stress that no decision has been made on the final location of the two additional linear accelerators, one of which will replace one of the older machines at Cheltenham. The three trusts have all been invited to submit their proposals to the network board and a decision, which will be based on the criteria, is likely to be made in spring 2007.
In conclusion, I reiterate that I am sure that the3 Counties cancer network is aware of the points about which the hon. Gentleman and his constituents are concerned. It is planning future development of radiotherapy services across Herefordshire, Gloucestershire and south Worcestershire. It is aware of the difficulty that some of the hon. Gentlemans constituents are encountering in travelling to the service in Cheltenham, and access is one of the criteria being considered in the development of those services. There have been improvements in recent years, but we obviously always need to ensure that the services are of the highest quality. It is what the public want, and I am sure we would all agree that it is what our constituents deserve.
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