“half an hour of the best possible advice will not equip people for what could be thirty years of managing their pension pot”.

It has argued for the kind of careful consideration of evidence undertaken by the last Government, which has underpinned the success of auto-enrolment—that successful measure was developed over a period, decided on by the previous Government and taken forward by the current Government and, in particular, the Minister on the Bench today. Everybody would agree that the proper deliberation that underpinned it has been an important element in its success, but we are not seeing the same thing with these changes. I fear that nobody can, as yet, feel confident about what is going to emerge.

The Minister also knows that we have concerns about the governance of collective defined contribution schemes and about the so called “independent governance

25 Nov 2014 : Column 883

committees” proposed for defined contribution schemes; and about the restrictions on the National Employment Savings Trust—NEST—which my colleague who normally speaks on these matters has long argued should be removed and which the Minister said in July last year would be removed “as soon as possible “. In fact, they remain in place, and the opportunity to remove them in this Bill has not been taken.

The Bill is worth while, but a worryingly large amount more still needs to be done. Working people must not become the victims of yet another mis-selling scandal—that has happened too often already. The dangers of ill-thought-out and rushed legislation are all too clear, and doing all this at the same time as the Treasury changes makes the risks much worse. We can only hope that Members in the other place will have the information they need and will be able to deliver some of the scrutiny which Members in this House have not, sadly, been able to provide.

Question put and agreed to.

Bill accordingly read the Third time and passed.

Self-Build and Custom Housebuilding bill (Money)

Queen’s recommendation signified.


That, for the purposes of any Act resulting from the Self-build and Custom Housebuilding Bill, it is expedient to authorise the payment out of money provided by Parliament of any increase attributable to the Act in the sums payable under any other Act out of money so provided.—(Brandon Lewis.)

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Self-Build and Custom Housebuilding bill (Ways and Means)


That, for the purposes of any Act resulting from the Self-build and Custom Housebuilding Bill, it is expedient to authorise the charging of fees under the Act.—(Brandon Lewis.)

Local government (Review of Decisions) Bill: Money

Queen’s Recommendation signified.


That, for the purposes of any Act resulting from the Local Government (Review of Decisions) Bill, it is expedient to authorise the payment out of money provided by Parliament of any increase attributable to the Act in the sums payable under any other Act out of money so provided.—(Kris Hopkins.)

Health and Social Care (Safety and Quality) Bill: Money

Queen’s Recommendation signified.

5.50 pm

The Parliamentary Under-Secretary of State for Business, Innovation and Skills (George Freeman): I beg to move,

That, for the purposes of any Act resulting from the Health and Social Care (Safety and Quality) Bill, it is expedient to authorise the payment out of money provided by Parliament of any increase attributable to the Act in the sums payable under any other Act out of money so provided.

I will, if I may, pay tribute to my hon. Friend the Member for Stafford (Jeremy Lefroy) for his tireless work on this Bill, particularly for his championing of the cause of information sharing, which sits right at the heart of the Government’s commitment to transparency in health care.

Question put and agreed to.

25 Nov 2014 : Column 885

Control of Horses: Instruction

5.50 pm

The Parliamentary Under-Secretary of State for Environment, Food and Rural Affairs (George Eustice): I beg to move,

That it be an instruction to the Control of Horses Bill Committee that it has power to make provision in the Bill about the powers of owners or occupiers of any land in England in relation to horses which are on the land without lawful authority.

The Control of Horses Bill sponsored by my hon. Friend the Member for York Outer (Julian Sturdy) was supported by the Government on Second Reading and enjoyed support from across the House. I congratulate him on bringing this Bill forward.

The Bill amends section 7 of the Animals Act 1971 with respect to the process for managing horses present on land without lawful authority and applies to England only. In the case of fly-grazing, horses are often abandoned or deliberately placed on another person’s land without permission to do so. The Bill reduces the time that a landowner or a local authority is required to detain a horse before disposing of it from 14 days to four working days, and also creates alternative ways to dispose of horses, other than through sale at auction.

During the debate, the Government also accepted my hon. Friend’s request for this motion. The instruction is needed because the long title of the Bill provides for dealing with horses in public places only. With this instruction it will be possible for the Bill Committee to consider amendments to the Bill to extend its provision to private land. Should the Committee agree to those amendments, the long title of the Bill would then be adjusted accordingly.

This is an important Bill. It has cross-party support, and I congratulate my hon. Friend on bringing it forward and commend the motion to the House.

5.52 pm

Angela Smith (Penistone and Stocksbridge) (Lab): I join the Minister in congratulating the hon. Member for York Outer (Julian Sturdy) on bringing forward the Bill. The Opposition support this motion. I will not repeat the points that we made on Second Reading about why we are where we are, because we just have to deal with the situation as it is. We are pleased to see the Government correcting their position by including private land in the Bill’s provisions and in the title of the Bill.

We are committed to seeing this Bill go through the legislative process as quickly as possible. In fact, the sooner we can get it on the statute book the better, because it is about not just the welfare standards of horses but the significant resource being absorbed by the Royal Society for the Prevention of Cruelty to Animals and by local authorities in dealing with the issue.

5.53 pm

Julian Sturdy (York Outer) (Con): I thank the Minister and, through him, the Secretary of State for tabling today’s instruction. I will, if I may, speak very briefly in support of the instruction and about the comments that have just been made by the Minister and the shadow Minister.

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It is absolutely essential that we crack down on illegal fly-grazing across England. As was stated by the Minister, the shadow Minister, many Members and me on Second Reading, it is important that that happens not just on public land, but on private land. It would be perverse if private farmland were to become an unintended refuge for suffering and abandoned horses, with landowners ill-equipped to alleviate the animals’ suffering. A true refuge would be for the horses to be rescued and re-homed with a loving family or in an animal welfare sanctuary, and that power is proposed under this Bill. I would like the House to be in no doubt of the potential dangers of fly-grazing or the scale of the problem. Since Second Reading last month, abandoned horses have yet again been causing safety issues on Stockton lane in my constituency. It is simply not acceptable for road users and local residents to be put at risk because irresponsible owners have abandoned their horses near the roadside.

Horses require daily care and attention, and today’s instruction will empower private landowners to prevent such neglect, which jeopardises the safety of families travelling on the roads. If we fail to act, it is only a matter of time, sadly, before someone else is seriously injured or killed. I am pleased that there is cross-party support for this motion to allow the Bill to apply to both public and private land, and for the Bill to proceed into Committee and, ultimately, to deliver the powers to end the suffering of abandoned horses and help to prevent any further tragedies.

Question put and agreed to.

Business without Debate


Madam Deputy Speaker (Dame Dawn Primarolo): With the leave of the House, we shall take motions 8 to 13 together.

Motion made, and Question put forthwith, (Standing Order No. 118(6)),


That the draft Electricity and Gas (Energy Companies Obligation) (Amendment) (No. 2) Order 2014, which was laid before this House on 22 July, be approved.

That the draft Electricity and Gas (Energy Company Obligation) Order 2014, which was laid before this House on 24 October, be approved.

Social Security

That the draft Social Security (Contributions) (Limited Liability Partnership) Regulations 2014, which were laid before this House on 13 October, be approved.

That the draft Social Security (Contributions) (Amendment No. 5) Regulations 2014, which were laid before this House on 13 October, be approved.

Health Care and Associated Professions

That the draft Nursing and Midwifery (Amendment) Order 2014, which was laid before this House on 13 October, be approved.

Local Government

That the draft Business Improvement Districts (Property Owners) (England) Regulations 2014, which were laid before this House on 22 October, be approved.—(Damian Hinds.)

Question agreed to.

25 Nov 2014 : Column 887


Localised Health Care in North East Cambridgeshire

5.56 pm

Stephen Barclay (North East Cambridgeshire) (Con): The petition states:

The petition of residents of the North East Cambridgeshire constituency declares that the Petitioners believe that healthcare should be more localised in North East Cambridgeshire; further that residents of North East Cambridgeshire face long travel times and costs when requiring procedures which should be delivered locally; further that the Petitioners believe that treating patients locally brings significant benefits; and further that there is a community campaign entitled “Treat Me Local” calling for healthcare to be more localised in North East Cambridgeshire which has been signed by 1,389 individuals.

The Petitioners therefore request that the House of Commons urges the Government to ensure that the ten pledges of the Treat Me Local campaign in North East Cambridgeshire are fulfilled within twelve months.

And the Petitioners remain, etc.


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Breast Cancer

Motion made, and Question proposed, That this House do now adjourn.—Damian Hinds.)

5.57 pm

Annette Brooke (Mid Dorset and North Poole) (LD): I am very pleased to have secured this debate, as it permits further discussion on some of the work that my hon. Friend the Member for Winchester (Steve Brine), the hon. Member for Washington and Sunderland West (Mrs Hodgson) and I, as co-chairs of the all-party parliamentary group on breast cancer, have been engaged in over the past four years. We work with all the major breast cancer charities, including Breakthrough Breast Cancer, which provides the secretariat for our group, Breast Cancer Campaign, which is merging with Breakthrough next year, and Breast Cancer Care. We thank them all for their work and support.

Breast cancer is a disease that many of us will know about and have experience of. With nearly 55,000 people diagnosed with the disease in the United Kingdom every year, everyone will know of somebody—a loved one, a friend or even themselves—who has experienced this disease. It is still the most common cancer in the UK, and around a third of all new cancers diagnosed in women are breast cancer.

Over the past few decades, great strides have been made in treatment and care, leading to much improved outcomes. Since the 1980s, breast cancer deaths have fallen by more than a third, and today more people survive breast cancer than ever before. More than eight out of 10 people are living five years or more following their diagnosis. The all-party parliamentary group recently carried out an inquiry into breast cancer in older women. The resulting report is entitled “Age is just a Number”. We discovered that there were many improvements that could be made to ensure earlier diagnosis, better communication, and better treatment and support. We are pleased that many of our recommendations will be implemented and hence overall life chances will be improved further.

Steve Brine (Winchester) (Con): I congratulate my right hon. Friend, at the end of her time in the House, on bringing the topic of breast cancer to the Floor of the House of Commons in the way that she has. She conducted the inquiry with me and, as she knows, one of the things that I was so struck by is the belief out there that the risks of contracting breast cancer go down as one gets older and passes the screening age, whereas we know and the evidence shows that, on the contrary, they go up.

Annette Brooke: I thank my hon. Friend for the great leadership that he gave in the inquiry. I believe we brought out a great number of myths, which will much improve the approach to primary breast cancer. However, fewer people know about secondary breast cancer.

In October 2010, the United Kingdom had its first secondary breast cancer awareness day. In secondary breast cancer, sometimes known as metastatic, advanced or stage 4 breast cancer, the breast cancer cells have spread to other parts of the body, most commonly the bones, brain, liver or lungs. Secondary breast cancer is incurable and, sadly, 11,600 people die every year as a

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result of secondary breast cancer—the equivalent of 32 people every day. Many people diagnosed with secondary breast cancer live with the disease for a number of years. In such cases, the care and support that they receive can make a real difference to their quality of life.

I was able to raise the issue of data collection directly with the Prime Minister during Prime Minister’s questions in 2010. At that time there was no reliable data collection on how many people were living with the disease in the UK, meaning that care and support services could not be accurately costed or developed. Subsequently the main breast cancer charities and the three co-chairs of the all-party parliamentary group met the Prime Minister to discuss what was needed. We were very pleased to welcome in 2011 the publication of the Department of Health cancer strategy, “Improving Outcomes: A Strategy for Cancer.” The strategy included the aim of beginning a full collection of statistics on secondary breast cancer from April 2012, yet there still seem to be considerable gaps, as I shall outline later in my speech.

The purpose of data collection is to make sure that the quality of services offered is improved. Although we can undoubtedly find examples of best practice, there are still many concerns about the overall level of service provision in this area.

Steve Brine: I am sorry to interrupt my right hon. Friend’s flow again. One of the things that came out of our time with the Prime Minister on collecting the data on secondary breast cancer was the importance of secondary breast cancer care nurses. I pay tribute to the work of Breast Cancer Care in this respect. Does my right hon. Friend agree that those nurses can make a transformative difference to women and their families who are going through secondary breast cancer, by linking them up to other services in the NHS and providing knowledgeable support to them?

Annette Brooke: Again, I thank my hon. Friend. Over the years we found that the provision of a specialist nurse makes a crucial difference. When someone has a symptom that they are not quite sure about and they think, “I don’t want to bother to go to my GP”, being able to pick up the phone and get expert advice deals with the problem quickly, takes away the worry, and if it is necessary to see a doctor, they can go, confident in the knowledge that they are not just imagining the symptom and that it is important for them to follow it through.

A recent survey by Breast Cancer Care, which was released to mark this year’s secondary breast cancer awareness day on 13 October, reported that 90% of people with a secondary breast cancer diagnosis have experienced pain as a result of the disease in the past month. Half of those described their pain as moderate or severe. For 78% of people, their pain meant that they were unable to undertake normal everyday activities, such as household chores, work, child care, hobbies or socialising. Pain is one of the most common symptoms of secondary breast cancer, but much of it can be controlled and managed through access to palliative care. In fact, guidelines from the National Institute for Health and Care Excellence state that referrals to palliative care should be offered soon after a secondary breast cancer diagnosis. However, the same survey by Breast Cancer Care found that only 41% had been offered a referral to a palliative care team. That means that

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thousands of people are experiencing pain that could be controlled and managed. I am sure that we can all agree that it is unacceptable that anyone should be expected to live with unnecessary pain.

Another indicator of where the care and treatment for secondary breast cancer is not good enough is the lack of secondary breast cancer clinical nurse specialists. The NICE quality standard for breast cancer highlights that everyone with secondary breast cancer should have access to a clinical nurse specialist. The most recent results of the national cancer patient experience survey also found that access to a named clinical nurse specialist was often associated with having a more positive experience in care. For primary breast cancer—I am pleased that progress has been made in this area—it is much more routine for patients to have a clinical nurse specialist to help to co-ordinate their care and provide the support they need.

Mr Mark Spencer (Sherwood) (Con): I congratulate my right hon. Friend on not only securing the debate but the work she has done in the House on this topic together with my hon. Friend the Member for Winchester (Steve Brine). Will she recognise that as well as the physical pain, the psychological aspect of this disease is quite dramatic? One way of fighting the psychological impact is to give hope to those victims that their life can be extended for as long as possible. The data that she seeks to collate and collect can give medical advancement and hope to those victims at the same time.

Annette Brooke: I thank my hon. Friend, and yes, it is so important. We have the good news that life expectancy is increasing under these circumstances, but that makes it all the more important to think about the quality of those extra years.

There are far fewer clinical nurse specialists for secondary breast cancer. There is no definitive figure, but estimates from Breast Cancer Care suggest that there may be no more than 20 clinical nurse specialists who have expertise or experience of working with secondary breast cancer. This is despite there being approximately 36,000 people living with a secondary breast cancer diagnosis. Given the results of the cancer patient experience survey, and anecdotal evidence from those living with secondary breast cancer, we can assume that many secondary breast cancer patients are not having as positive an experience in their care as those with a primary diagnosis. Unfortunately, we do not know for certain as the cancer patient experience survey does not include a specific stand-alone question on secondary breast cancer. It is essential that the survey continues, so could it not include a question on secondary breast cancer?

Breast Cancer Care ran a taskforce on secondary breast cancer in 2006. Its final report, published in 2008, highlighted a number of issues, other than those already mentioned, that patients with secondary breast cancer face. Those include multi-disciplinary teams not discussing secondary breast cancer routinely, the information needs of patients not being met, and patients not being assessed for their psychological or social needs following a diagnosis—the point that my hon. Friend has just made. Unfortunately, it seems that little progress has been made in the six years since that report was released.

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Underpinning the problems with care and treatment for secondary breast cancer—and key to much of this debate—is the lack of data and information about patients diagnosed and living with the disease. As I have already mentioned, we still do not have an accurate figure for the number of people who have been diagnosed with secondary breast cancer, only an estimate. We do not have enough quantitative evidence about the experiences of secondary breast cancer patients.

I had the opportunity to meet some women at a recent Breast Cancer Care event to mark secondary breast cancer awareness day last month, and they told me that the care they received was often inadequate, and certainly not at the same standard as the care that followed their primary breast cancer diagnosis. Some typical comments from patients with secondary breast cancer include:

“A diagnosis of secondary breast cancer changes your life completely—nothing is ever the same again”;

“When you’re diagnosed with secondary breast cancer you can have no idea of just how far and in how many different ways it’s going to change your life. So many people don’t understand what a secondary diagnosis means”;

“So many people tell me how great I look, or tell me that I can beat it with chemo and surgery. They don’t understand that I am in pain and I can’t be cured”;

“The pain I had, from when I was diagnosed, basically it was excruciating. But the pain had started slowly and I’d always had aching pains in my chest area. To the point that it was so bad that I couldn’t hold a glass in my hand or put a handbag on my shoulder. I couldn’t touch my head, I couldn’t dress myself. I couldn’t sleep. I couldn’t turn on my side. And also I couldn’t breathe properly”;

“One thing that does distress me is the lack of continuity in my care and I think that if I had one person who was with me through it all that would help a lot”;


“The strange thing about this whole disease is that they don’t really prepare you at all. It’s almost finding out as you go along”.

I think that those comments highlight how much progress we have made on primary breast cancer, with all the advice and support that is given to patients very early on. I want to use this debate to highlight not only that progress, but the need to address those issues for secondary breast cancer, some of which have been faced with primary breast cancer.

Although the comments I have just read out highlight the human story, they are not enough to help us find the solutions. Without firm data and evidence, it is impossible to understand fully the impact of secondary breast cancer. We do not really know enough about the types of treatment that patients are receiving or how the quality of a patient’s life changes over time. That lack of information makes it virtually impossible for commissioners to be able to plan and commission services properly that meet local needs. That, in turn, makes it much harder for clinical nurse specialists with the right knowledge and skills to be recruited, particularly when NHS budgets are under pressure. The result is that patients continue to miss out on the vital support and care they need.

As I mentioned earlier, the Government have committed to improving the collection of data on secondary breast cancer, making it mandatory for the NHS in England. When my colleagues and I met the Prime Minister, he agreed that adequate data collection was required. Following

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that meeting, in January 2011, the Department of Health published its national cancer strategy, “Improving Outcomes”, which committed to collecting data on secondary breast cancer for the first time, stating:

“During 2011/12 we will pilot the collection of data on recurrence/metastasis on patients with breast cancer with the aim of undertaking full collection from April 2012.”

Jim Shannon (Strangford) (DUP): I thank the right hon. Lady for giving way and apologise for not being here for the beginning of her speech; I was at a do down below and could not get here in time. She has just outlined the importance of collecting and then using data to respond to those who have breast cancer. She will also be aware that Breast Cancer Care has campaigned strongly to ensure that data are collected in England. I understand that it hopes to have a similar initiative in Scotland, Wales and, hopefully, Northern Ireland. She refers to the NHS in England. Does she share my opinion that the data should be collected for the whole of the UK so that we can agree a strategy that all four regions of the United Kingdom of Great Britain and Northern Ireland can benefit from?

Annette Brooke: I thank the hon. Gentleman for his intervention. I hope that the Minister has taken that point on board, because it is really important. Although data are being collected, they are not being received by various groups, and the purpose of this debate is to address that.

The pilot was run by the National Cancer Intelligence Network in collaboration with Breast Cancer Care, and it involved 15 breast cancer units across England. The pilot report, published in March 2012, identified 598 patients with recurrent or metastatic breast cancer. Of those, only 53% were recorded as being referred to a clinical nurse specialist, palliative care nurse specialist or other key worker at the time of diagnosis. That is despite the NICE quality standards and the evidence in the cancer patient experience survey of the benefit to patients of a named nurse.

Steve Brine: The pathway—the person who can help to pilot the patient through services—is not only found in the public sector; there are also services in the third sector. Is my right hon. Friend aware of the amazing work of Breast Cancer Haven, which has two centres—and, I hope, a third on the way in our Wessex area next year? It provides a complementary service that helps women to feel human again after they have had surgery and a devastating secondary diagnosis. This is not just about connecting them to services in the NHS; it is also sometimes about the charitable sector.

Annette Brooke: I thank my hon. Friend for reminding us of those very important services. I very much hope that I can visit one of Breast Cancer Haven’s units in due course, because I have not yet done so.

The pilot recommended that all breast cancer units in England submit data on patients with recurrent and metastatic breast cancer using existing data collection mechanisms. However, since the pilot no such data have been published. Since January 2013, it has been mandatory for all new recurrent and metastatic diagnoses to be recorded in England. The third annual report on the

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strategy confirms that this collection is taking place, but the problem is that the data do not seem to be publicly available.

A recent parliamentary question by the hon. Member for Ealing, Southall (Mr Sharma) about diagnosis of metastatic breast cancer in his constituency was responded to by the Office of National Statistics, which said:

“Detailed information about secondary cancer diagnoses is not routinely recorded on individual cancer registrations sent to ONS for processing and publishing as National Statistics. For these reasons it is not possible to provide figures on secondary breast cancer.”

This information needs to be made publicly available to allow scrutiny of the data and to help highlight areas that require action. It would be helpful if the Minister outlined what plans are in place to start publishing these data and whether the data include routes of referral. If there are no such plans, what is the reason for not making the data publicly available?

Not only have we seen no data published on secondary breast cancer, but there is also evidence to suggest that the data collection is not happening consistently across England. Breast Cancer Care is concerned that this will impact on the quality of the data that could be made available. Whether we will have a clearer picture on the needs of secondary breast cancer patients remains to be seen. Once consistently collected, it is also imperative that data can be accessed by research organisations, including charities, to drive improvements in care. Obviously, it is crucial that there are strong safeguards on privacy, but for numerous other reasons, including uncertainty following the restructuring of the NHS, there is great concern that routinely collected pseudonymised data sets are not consistently being made available for health research.

Breast Cancer Campaign has drawn my attention to some detailed points about data collection. The first relates to the current review of the national cancer peer review programme, which routinely monitors the quality and safety of NHS cancer services. I understand that it collects data on a number of key measures related to secondary breast cancer. There are concerns that it may not continue next year in its current form, or at all. I hope the Minister will comment on that. How will patients be provided with information on the safety and quality of their local cancer services, should the national cancer peer review programme be discontinued?

Secondly, if we are to achieve the Health Secretary’s goal of being among the best in Europe for cancer survival, measures to hold clinical commissioning groups to account for the cancer services they provide are vital. What consideration has the Minister given to the inclusion of indicators on cancer patient access to a clinical nurse specialist and multidisciplinary teams in the CCG outcomes indicator set, and what steps can she take to ensure that CCGs are held to account on their performance against that set? What further discussions is the Minister actually having?

In conclusion, the Government should be congratulated on the important progress they have made on cancer over the past four years. Initiatives such as the cancer drugs fund have made a big difference to patients in improving access to clinically effective drugs and treatments. However, in order to achieve the Government’s stated ambition of being the best place in Europe to survive cancer, more needs to be done. For that to happen,

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evidence is needed to provide the intelligence and insight required to enable local commissioners and health care professionals to plan effectively to meet their patients’ needs. I hope the Minister will join me in agreeing that it is no longer acceptable that the collection of data on secondary breast cancer does not consistently take place.

This is an important public issue. A petition by Breast Cancer Care calling for secondary breast cancer to be a priority for this Government has to date secured almost 12,000 signatures—a fitting milestone, given that almost the same number are dying from secondary breast cancer every year. Will the Minister commit to making secondary breast cancer a priority for her Department and, once more evidence is highlighted from the data, to working with Breast Cancer Care and other charities to improve the support and care that patients receive?

Only once everyone has the opportunity to access a clinical nurse specialist to support their care, to be referred to palliative care so they are not in unnecessary pain, and to receive the best possible care and treatment to live as good a quality of life as possible with the disease can we truly consider the United Kingdom to be one of the best in Europe for cancer care.

6.23 pm

The Parliamentary Under-Secretary of State for Health (Jane Ellison): May I begin by thanking my right hon. Friend the Member for Mid Dorset and North Poole (Annette Brooke), not just for securing this debate, but, as has been rightly said, for her work throughout her parliamentary career and in this Parliament on this issue, and for the thorough and humane way in which she has introduced the debate? I congratulate her. We are lucky to have a very active all-party group on breast cancer. Unsurprisingly, my hon. Friend the Member for Winchester (Steve Brine) is in his place, as are other Members who are interested in and have engaged with this important subject.

I echo the words of thanks to the charities that operate in this area. I deal with many of them regularly and, like other hon. Members, have taken part in some of their fundraising and awareness-raising activities. They do great work and it is good that we have a regular opportunity to record our thanks to them.

As my right hon. Friend the Member for Mid Dorset and North Poole mentioned, the Government want to lead the world in tackling cancer, but we know that we are not there yet. As she said, the Government’s cancer outcomes strategy, which is backed by more than £750 million, set the ambition to save an additional 5,000 lives a year from cancer by 2014-15. That of course includes breast cancer.

One study alone has shown that we could save 2,000 additional lives each year from breast cancer if we matched the best European survival rates. That is quite thought-provoking in itself, but we are starting to close that gap. The NHS is treating more people for cancer than ever, and we are helping more people than ever to survive. Sometimes when people hear of large numbers being referred, they perhaps think that that is a sign of failure. However, we know that referral, particularly early referral, is so important, so large numbers being referred is in many ways a sign of success, because we are intervening and getting them into services more quickly. We also know that there is a long way to go.

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Steve Brine: May I thank the Minister for thanking the three big breast cancer charities? Breakthrough, with support from the others, provides the secretariat for our all-party group. She will be aware of the work of CoppaFeel and its “Rethink Cancer” campaign. Treatment and survival are obviously critical—today’s debate is about that—but prevention is clearly better than cure. Will she take this opportunity to endorse CoppaFeel’s work in educating young women, and men, to spot the signs and symptoms of cancer early so that we can prevent primary breast cancers from developing in the first place? She will know that Kris, who runs CoppaFeel—she has a terminal diagnosis—is passionate about this, and has done so much to put it on the agenda for young women in this country.

Jane Ellison: I certainly pay tribute to all those who are trying to drive awareness of this issue. There are a number of very important campaigns. Prevention is so important; for example, it was good that it was right at the heart of the recent NHS “Five Year Forward View”. There is a lot more to do, and I have recently had discussions with some of the breast cancer charities about how we use their reach and undoubted public credibility, which is enormous, to raise awareness more about some of the things that people can do on the prevention front, as well as about their important work on care and drugs. I join my hon. Friend in paying tribute to those campaigners.

The NHS is treating more people with cancer than ever, as I have said. Survival rates for breast cancer are improving, with more than 85% of women with breast cancer in England and Wales now living for more than five years. The work that all the charities have done in that regard is really important. They have all made significant contributions, but we know that more needs to be done, and that is the focus of this debate. We need to catch breast cancers earlier, and to avoid the risk of secondary breast cancers. We also need to improve the detection and treatment of secondary breast cancer, as my right hon. Friend has highlighted.

My right hon. Friend spoke very movingly about pain and its management. I am sure that we all agree that our NHS doctors and nurses do everything that they can to alleviate pain. In fact, it was good to see from the 2014 cancer patient experience survey that only 1% of patients reported that they did not think that hospital staff did everything they could to control their pain. Indeed, 86% of patients—the highest level in the four surveys so far—reported that staff did everything they could to control their pain. She is right to say that referral to specialist palliative care services can provide more by way of effective pain relief. The NHS must do what it can to ensure that women with secondary breast cancer have access to the right services. She is also right to highlight the room for improvement on that.

On the patient experience for women with secondary breast cancer, the results of the 2014 cancer patient experience survey show improvements in many areas, with 89% of all patients reporting that their care was either excellent or very good. As my right hon. Friend said, there are two specific references to secondary breast cancer in the NICE quality standard. The first states that people who develop it should

“have their treatment and care discussed by the multidisciplinary team”,

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and the second states that people with recurrent or advanced breast cancer

“have access to a ‘key worker’, who is a clinical nurse specialist whose role is to provide continuity of care and support”—

she mentioned that—

“offer referral to psychological services if required and liaise with other healthcare professionals, including the GP and specialist palliative care services.”

NICE clinical guidelines represent best practice, and we expect commissioners and clinicians to take them into account when making decisions, including on the provision of cancer nurse specialists. On the whole, breast cancer patients reported a more positive experience than many other cancer patients, and 93% were given the name of a clinical nurse specialist. My right hon. Friend is right to highlight the fact that we are not doing as well for patients with secondary cancer or a recurrence of cancer—those patients reported a worse experience and were less likely to have a clinical nurse specialist. NHS England is working with NHS Improving Quality, Macmillan Cancer Support and strategic clinical networks to improve the cancer patient experience and spread good practice across hospitals providing cancer care. That includes support from a clinical nurse specialist for those with secondary breast cancer.

Jim Shannon: The Minister is good in debates such as this and we always appreciate her response. One thing that is not always mentioned is the work done by pharmaceutical companies and their investigations to find and perfect new drugs to combat cancer. Current TV programmes often show people saying, “We’re almost there” when speaking about a cure for cancer—well, we are halfway there anyway. Together with pharmaceutical companies, universities such as Queen’s university in Belfast do fantastic work to find new drugs to address cancer and many other things. Sometimes that point is missed in debates such as this, so perhaps this is an occasion to get that on the record.

Jane Ellison: I pay tribute to the hon. Gentleman who is always present in health debates and makes an important contribution. If he were to secure a debate on research and clinical trials, I would be delighted to respond. He is right to say that that topic is sometimes a bit unsung, and it is enormously hope-giving for people to hear what is in the pipeline. He is right to highlight that issue, and perhaps we could explore it in a bit more detail on another occasion.

I alluded earlier to work that is taking place to bring everybody up to the best standard. That includes pairing highly rated cancer trusts with those that have potential to improve, regional events for commissioners to consider how patient experience survey results inform commissioning decisions, and the publication of guidance on using survey data to drive improvement. The survey is used in very hands-on ways, and in previous debates I have been impressed at the extent to which data are used right at the front line to say, “This is what really good looks like”, or to highlight where services can be improved by reference to those who are doing things well.

The need to improve is recognised by the NHS. In his forward to the 2014 survey report, Sean Duffy, NHS England’s national clinical director for cancer, recognised the importance of clinical nurse specialists and the need to be particularly sensitive to the needs of patients with

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a recurrence of cancer. We all recognise the picture that my right hon. Friend painted of people telling others of their diagnosis and what they say and the enormity of the news they are trying to convey not really being understood. Sean Duffy also highlighted the need for sensitivity when the cancer has not responded to treatment as had been hoped.

I understand that NHS England has no plans to discontinue the cancer patient experience survey. I have drawn on it a number of times when responding to debates, and it has been extremely valuable to front-line clinicians for understanding where excellence is being practised. I am keen and have stressed to NHS England on a number of occasions how much Members of the House appreciate the survey and feel that it informs our debates and the knowledge of our constituents.

The survey is overseen by the cancer patient experience advisory group, chaired by Neil Churchill, NHS England’s director of patient experience. Suggestions for amendments or additions to the survey can be addressed to that group. I will obviously draw this debate to the attention of NHS England, and the all-party group on breast cancer will continue to engage with it on ways that the survey could be improved or amended.

My right hon. Friend mentioned the need to improve detection and treatment of people with secondary breast cancer. We need to have good data about those affected. As she said, in the 2011 cancer outcomes strategy we committed to pilot the collection of data about metastatic disease, which had previously not been recorded. In March 2012, a report on the pilot data collection project was published. The pilot programme included data from 15 units and enabled the National Cancer Intelligence Network to identify deficits in the information recorded for those patients. Lessons learned from the pilot have now been applied to a country-wide programme. Since April 2012, all breast units have been required to submit information on all patients diagnosed with a new recurrence or with metastatic disease through the cancer waiting times process.

Analysis of the cancer waiting times data, based on referrals to hospital between 1 April 2012 and March 2013, shows that 7,176 patients were diagnosed or treated for recurrent breast cancer in England. However, we know we need to improve the quality of the data to ensure that we are getting the full picture. There are significant discrepancies between trusts and the analysis will need to be updated with more recent cancer waiting times data to ensure that the figures are robust. The NCIN, Macmillan and the Public Health England knowledge and intelligence teams are working collaboratively on a system to detect patients with recurrent breast cancer by looking at treatment patterns. Results from that collaborative work should be available in 2015. I know it is a source of frustration that they have not been available to date, but that work is at least ongoing. I will pursue that point further with Public Health England after the debate. We have regular meetings. I will of course raise the issue and ensure we keep the House up to date.

On the national peer review programme, I would like to assure my right hon. Friend that NHS England is currently reviewing the national cancer peer review programme with a view to considering how its success might be extended into other new areas of specialised commissioning. Regardless of the outcome of the review,

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cancer peer review will continue to play a critical part in any broader peer review programme the NHS might introduce. Further details will be published shortly as part of the wider review into specialist commissioning.

The clinical commissioning group outcomes indicator set is not designed for use as an accountability tool. For that, NHS England uses the CCG assurance delivery dashboard—I apologise for the jargon, which, unfortunately, is a feature of these debates—to hold CCGs to account. “Everyone Counts: Planning for Patients 2014/15-2018/19” was used by NHS England to identify the relevant indicators for reporting in the CCG dashboard. In addition, as new data have come on line throughout 2013-14, as well as feedback received on the indicators that are currently being used, NHS England has reviewed whether there is potential to make improvements in 2014-15. The cancer indicators used in the CCG assurance dashboard are based on cancer waiting times. NHS England is continually looking to improve the delivery dashboard. I know the all-party group will continue to engage with that process, as will the charity that supports it and the other charities.

As well as improving patient experience, we want to ensure that women are informed about the risks of metastatic disease so it can be diagnosed early. NHS England breast cancer clinical reference group is determined to ensure that everything possible is done to reduce the risk of secondary breast cancer. It is preparing a service specification for the provision of breast cancer services in England. NHS England knows that the information currently given to patients on the risk of secondary breast cancer is variable and frequently inadequate. That was brought to life for all of us in the Chamber by the deeply moving extracts from the comments of sufferers that were read out by my right hon. Friend. I do not think that any of us could have been unaffected by them. The clinical reference group’s service specification will require that all patients should have an end of primary treatment consultation, which will include advice on signs and symptoms that might indicate secondary breast cancer. That information needs to be delivered together with an holistic needs assessment as part of a recovery package. The evidence that this has been done will have to be recorded in the records of every breast cancer patient.

Touching briefly on research, the National Institute for Health Research is enabling patients to take part in trials of new treatments for metastatic breast cancer through its clinical research network.

As we all know, early diagnosis is key. Alongside the work to increase awareness, the Government have committed £450 million to achieve earlier diagnosis and the associated improved cancer survival rates. On breast cancer specifically, in February and March, we ran a Be Clear on Cancer campaign to increase awareness of breast cancer in women over 70. The proportion of women spontaneously mentioning breast cancer rose significantly, as did confidence in people’s knowledge of signs and symptoms of breast cancer. The campaign was well recognised, with many agreeing that the advertising would prompt them to talk to somebody close to them about the symptoms to watch out for. As well as increasing awareness, the campaign appears to have resulted in a large increase in referrals to secondary care in the target age group. The analysis, although only interim, suggests

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a significant increase in the number of women over 70 self-referring for breast screening. We are encouraged by that.

In addition, Public Health England is funding the biggest randomised control trial in the world and extending the NHS breast screening programme to women in the 47 to 49 age group and the 71 to 73 age group. As the trial is studying the effects of screening on breast cancer mortality rates over time, the results will not be known until the early 2020s, but it is an important and extensive study.

To conclude, I thank my right hon. Friend once again for bringing this debate to the House, the manner in which she introduced it and her important work on this subject throughout her parliamentary career, and I thank my other hon. Friends who have supported her and who also take a great interest in this subject. She is

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right to point out that fundamentally there is a message hope: so great is our progress that we can now compare of where we want to be with secondary breast cancer with where we increasingly are with breast cancer. However, she also rightly reminds us that more progress needs to be made.

I shall draw this debate to the attention of the national clinical director, Sean Duffy, and make him aware of the concern expressed in the House on this subject. I reassure my right hon. Friend of the Government’s commitment to reducing the incidence of secondary breast cancer and to improving outcomes for everyone diagnosed with this terrible disease. I offer a message of hope and improvement to all of them.

Question put and agreed to.

6.42 pm

House adjourned.