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BUSINESS OF THE HOUSE
Motion made, and Question put forthwith, pursuant to Standing Order No. 15 (Exempted business),
That, at this day’s sitting, consideration of any Lords Amendments and Messages that may be received may be proceeded with, though opposed, until any hour .—[Mr. Roy.]
NORTHERN IRELAND GRAND COMMITTEE
That-
(1) the matter of Lifetime Opportunities - the Government’s Anti-Poverty and Social Inclusion Strategy for Northern Ireland be referred to the Northern Ireland Grand Committee;
(2) the Committee shall meet in Northern Ireland on Tuesday 12th December at one o’clock; and
(3) at that sitting-
(a) the Committee shall take questions under Standing Order No. 110 (Northern Ireland Grand Committee (questions for oral answer)), and shall then consider the matter referred to it under paragraph (1) above;
(b) the Chairman shall interrupt proceedings not later than four o’clock; and
(c) at the conclusion of those proceedings, a motion for the adjournment of the Committee may be made by a Minister of the Crown, pursuant to paragraph (5) of Standing Order No. 116 (Northern Ireland Grand Committee (sittings)).— [Mr. Roy.]
WELSH GRAND COMMITTEE
That-
(a) the matter of the Government’s Legislative Programme as outlined in the Queen’s Speech as it relates to Wales and Public Expenditure in Wales be referred to the Welsh Grand Committee for its consideration;
(b) the Committee shall meet at Westminster on Wednesday 13th December at nine o’clock and between two o’clock and four o’clock to take questions under Standing Order No. 103 (Welsh Grand Committee (questions for oral answer)) and to consider the matter of the Government’s Legislative Programme as outlined in the Queen’s Speech as it relates to Wales and Public Expenditure in Wales under Standing Order
No. 107 (Welsh Grand Committee (matters relating exclusively to Wales)). —[Mr. Roy.]
Mr. Deputy Speaker (Sir Michael Lord): Shortly before the sitting resumes, I shall call for the Division bells to be sounded.
7 pm
10.10 pm
Royal assent
Mr. Deputy Speaker (Sir Michael Lord): I have to notify the House, in accordance with the Royal Assent Act 1967, that the Queen has signified her Royal Assent to the following Act:
Northern Ireland (St Andrews Agreement) Act 2006.
Petition
Alzheimer’s Drugs
10.11 pm
Tim Farron (Westmorland and Lonsdale) (LD): I wish to present a petition on behalf of those of my constituents who are members and supporters of the South Lakeland Alzheimer’s Society.
That we are outraged by the decision of the National Institute for Health and Clinical Excellence to restrict NHS prescriptions for Alzheimer’s drugs. These treatments are proven to provide real benefits to thousands of people at all stages of Alzheimer’s disease and cost just £2.50 per person per day.
The petitioners therefore request that the House of Commons urges the Secretary of State for Health to ensure that doctors continue to be able to prescribe Alzheimer’s drug treatments to patients who can benefit from them.
Prostate Cancer
Motion made, and Question proposed, That this House do now adjourn.— [Mr. Watts.]
10.11 pm
Mr. Christopher Fraser (South-West Norfolk) (Con): I am grateful for the opportunity to revisit the important matter of prostate cancer. I firmly believe that most men, me included, pay insufficient regard to our general health and well-being. We are much less likely than we should be to go to the doctor when worried about something, particularly on sensitive issues such as prostate problems, for which most men imagine the tests will be unpleasant and intrusive. However, men are putting their health and their lives at risk by such delay. For prostate cancer, as for all cancers, the key to recovery is catching it early before it spreads. I hope that today’s debate will help to raise awareness of it.
I last sponsored a debate on this subject in 1998. On that occasion, I was most grateful to receive the advice and guidance of Dr. James Dobbie. I am pleased to be able to say that for today’s debate I have received immeasurable support from several prostate cancer charities, for which I wish to express my sincere thanks.
At the end of my debate in 1998 I was assured that the Government were
“committed to seeking to provide equal access to high-quality health services”—[ Official Report, 12 May 1998; Vol. 331, c. 289.]
and that priority would be given to improving cancer services, including those for prostate cancer. However, while significant improvements have been made to cancer services in the eight years since that debate, I am afraid it seems that some cancers are more equal than others and that all too often prostate cancer has been regarded as the poor relation.
Much has changed since I last addressed the House on the subject. Almost 250,000 men have since been diagnosed with prostate cancer, and 75,000 men have died from it. Prostate cancer is now the most common cancer in men. In 1998 alone, about 24,000 men were diagnosed with prostate cancer. By 2002, the annual figure had risen to 32,000. I am sure that the Minister will tell the House that the increase is a reflection of wider testing and diagnosis, rather than of an increase in incidence, and that mortality rates have remained fairly stable. However, it has been estimated that a third of men who develop prostate cancer will die from it. It is responsible for almost as many deaths in men as breast cancer is in women, yet it receives only a fraction of the funding. I am not suggesting for one second that funding or resources should be diverted from breast cancer research or treatment, but rather that breast cancer should be regarded as a benchmark or example of best practice, and that there is a powerful and compelling argument for prostate cancer services being funded to the same level.
The inequality and inconsistency that permeates the diagnosis and treatment of prostate cancer as opposed to other cancers was starkly demonstrated in last year’s report by the National Audit Office. According to the NAO, prostate cancer patients reported a generally poorer experience of care than patients with other cancers. They are more likely to wait more than two
weeks to see a specialist, and significantly more likely to have an appointment cancelled. They are less likely to have more than 10 minutes with that specialist, and less likely to be informed about the side-effects of the treatment. They are less likely to have the opportunity to discuss how the treatment has gone, more likely to say that they were not given enough help to deal with the post-treatment pain, less likely to have a named or specialist nurse, and less likely to understand the information they have been given. They are less likely to have their home situation taken into account, and less likely to be given information about support or self-help groups. It is without question a bleak analysis of the widening gap in the level and quality of cancer care in the United Kingdom today.
I want to examine one or two of these points in greater detail. First, it is unacceptable that those with suspected prostate cancer should have to wait longer than those with other cancers to see a specialist. Last year, a Minister in the Department of Health said that 98 per cent. of patients with suspected prostate cancer who were urgently referred by their GP were seen within two weeks. Does that mean that the medical profession is less likely to make an urgent referral, rather than a normal one, for a man who could have prostate cancer than they are for a woman who might have breast cancer? Will the Minister tell the House what percentage of prostate cancer patients are referred to a specialist on a non-urgent basis, and how does that compare with other major cancers? What assessment have the Government made of the reasons why prostate cancer patients are not fast-tracked in this way? Delays are also occurring in pathology and radiology departments. Is the system overstretched? I should be most grateful for the Minister’s views and comments on those points.
Secondly, given the often serious and long-term side-effects of prostate cancer treatments, it is inexcusable that prostate cancer patients are twice as likely as patients with other forms of cancer not to have been informed of the possible side-effects. A recent survey by the Prostate Cancer Charity suggests that when one includes those who did not understand the information that they were given about side-effects, that figure doubles. Therefore, one in five men were not properly informed of the side-effects and risks of treatment.
It is particularly important with prostate cancer—where a choice of treatment, and, indeed, the choice of whether to treat, exists—that patients remain in control of their care. That requires adequate information both in primary care, where initial discussions take place, and later in hospital, at the time of diagnosis. It seems that there is a serious information shortfall that has not been addressed by the prostate cancer risk management programme set up by the Government, which is aimed at GPs, or by the NHS as a whole. Consequently, there is an urgent need to revise and update the arrangements for the delivery of information.
Revisions to the prostate cancer risk management programme should not just deal with scientific theory and data, but should also advise GPs on the societal concerns associated with prostate cancer and give details on how best to respond to inquiries fairly and objectively, helping men to decide for themselves whether they want to undergo a prostate-specific
antigen blood test. Survey evidence from the Prostate Cancer Charity also identifies a startling number of GPs who did not recall receiving details of the risk management programme. As a result, it seems that the guidelines are being correctly followed in only a third of cases.
I turn now to the hospital setting. Despite the wealth of comprehensive, authoritative and independent literature on the treatment and diagnosis of prostate cancer produced by voluntary and charitable organisations, little of it seems to filter through primary care trusts and NHS trusts to patients. That must change. Will the Minister give me a commitment both to update the prostate cancer risk management programme, in consultation with the voluntary sector, and to commission standardised and impartial information from the voluntary sector, which NHS providers can pass on to patients?
Many issues associated with the availability of information for prostate cancer patients could be resolved if there were more specialist nurses. In 2001, it was reported in the national press that there were 3,000 specialist breast cancer nurses across the country in the NHS, but only one NHS-funded nurse for prostate cancer. I am given to understand that the situation may have improved, not least because charitable organisations have, recognising the vital role that they play, begun sponsoring specialist prostate and uro-oncology nursing. However, there is a fear that specialist nurses are being lost or reassigned to general duties.
The prostate cancer charter for action, a collaboration between 24 charities and voluntary organisations with an interest in tackling prostate cancer, found worrying inequalities in the number of specialist nurses across the country, following a survey of cancer networks. Despite NICE’s recommendations that specialist nurses should play a central role in the treatment of prostate cancer, there are wide and unacceptable variations in both the number of prostate cancer specialist nurses available in cancer networks and in the number of urological nurses.
Cancer networks are also confused about what constitutes a specialist nurse, making an accurate assessment difficult. There is an urgent need for the Government to recognise the importance of, and fund properly, specialist nurses as part of the multidisciplinary teams to care for patients and advise them on the treatment paths open to them. Again, I would welcome the Minister’s assessment of the situation and the steps that the Government are taking to increase the number of specialist nurses working in support of patients with prostate cancer.
The Public Accounts Committee’s investigation into the NAO report concluded that
“providing specialist care for patients with prostate cancer has been a lower priority than for other major cancers.”
The Minister will be aware that it was the Committee’s recommendation that an in-depth report on the standards of prostate services in England should be produced. I suggest that the urgency of the situation demands such a report, and strongly urge the Government to reconsider their response. A wider report, following the current round of peer reviews, on cancer services with a summary of the national
position on prostate cancer is entirely insufficient, not least because the national position is far from clear. Will the Minister give the House a commitment urgently to conduct a detailed review of prostate cancer care in the UK?
There is pressing need for national data to be collected and used to explore variations, especially in service standards. There is a clear and growing divide between affluent home counties, where uptake of prostate-specific antigen testing is highest—as are survival rates—and the more deprived areas, such as Yorkshire and the Trent area, where men are less likely to be tested frequently and diagnosed earlier, with the consequence that mortality rates in those areas are significantly higher than in London and the Thames valley. That wide geographic variation is no doubt affected by the regional differences in access to NICE-approved treatments—an issue to which I shall return later in my speech. However, it must also—even in some small part, as the NAO has said—be a reflection of the north-south divide in testing rates and the lower detection rates of early-stage prostate cancer because of the lower uptake of PSA testing. I would be most interested to know what assessment the Minister makes of the causes of that disparity.
I am keenly aware of the shortcomings of, and controversy surrounding, the PSA test and the false assurances and unnecessary anxieties that it may bring. I understand therefore the Government’s reluctance to introduce a national screening programme based on current evidence. The Government have declared their intention of introducing a national prostate cancer screening programme when the evidence supports it. I suggest that that is an unacceptably passive response.
Hon. Members will be aware that work is under way in many academic centres around the world to identify potential markers of prostate cancer and to develop potential new and more reliable tests. Will the Minister please say what proactive steps the Government are taking to accelerate global development in that area and to ensure that the UK is contributing effectively to that effort?
The UK has a large pool of men with prostate cancer who have not had radical surgery or radiotherapy—as they might have had if they lived in countries such as the United States—but who have followed a regime of so-called active surveillance. Consequently, we surely have a unique contribution to make in testing potential biomarkers of prostate cancer behaviours in men untouched by radical treatment interventions.
Prompt access to treatments approved by NICE is vital to survival rates of any cancer. Once again, however, there are two tiers of both cancer and treatment. When a handful of PCTs refused to sanction the use of Herceptin for women with breast cancer, there was a national outcry, but men with prostate cancer are frequently denied access to brachytherapy, a form of radiotherapy that can dramatically reduce damage to surrounding organs and the resulting side-effects.
Similarly, disparities exist in prostate cancer surgery. Research shows that better outcomes in that surgery are achieved in hospitals where high volumes of prostatectomies—the removal of the prostate gland—are carried out each year. One study found that the risk
of serious complications was 43 per cent. greater in hospitals carrying out fewer than 40 prostatectomies a year than it was in those carrying out 140 a year. NICE also recommends that the surgery should be carried out by specialist teams, and that those teams should perform at least 50 radical operations a year.
For the most prevalent cancers, such as breast cancer, specialisation in surgery is becoming the norm, but the situation is not so satisfactory for prostate cancer. Out of the 133 trusts where prostatectomies were carried out in 2002-03, only 12 performed more than 50 operations. As the National Audit Office said,
“Patients’ access to anti-cancer treatment appears to depend on where they live.”
Yet, as the Public Accounts Committee noted, that postcode lottery
“has yet to be tackled decisively.”
What steps are the Government taking to bring about parity in specialised surgery and to tackle the postcode lottery that plagues the NHS?
I began by asking what had changed since I last brought this matter to the House. The Government have said that
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