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Lord Tebbit: My Lords, I thank the noble Baroness for her reply. I sometimes wonder how she manages to maintain her place as a Minister in this Government. She is so reasonable and so competent that she shines like a
 
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candle in a dark world among the incompetents and ne'er-do-wells who, I should add, we find principally at the other end of the Corridor.

I still draw the opposite conclusion about Mr Smith's case to that which the noble Baroness draws. The fact that he has said in public that he has been HIV positive for the past 17 years indicates to me that attitudes—I almost said social attitudes but I felt a tap on my shoulder from the shades of Enoch Powell—have changed over that time.

I doubt very much whether there is a stigma attached to cancer. There is a fear attached to cancer in many people's minds, but I do not know anyone who does not want to go out to dinner with someone because the former has heard that that person might have cancer. Indeed, the noble Baroness was on slightly thin ground when she referred to the distinction in her mind between conditions which are not diagnosed until symptoms appear and those which are diagnosed before symptoms appear. I do not know too many people who regularly go to their doctor and say, "Doctor, I might have cancer. I do not have any symptoms. There is nothing which causes me to conclude that I might have cancer, but would you test to see whether I do"? That is an unlikely proposition.

I think I know when I am beaten. I have the feeling that to press this amendment this afternoon would perhaps be something rather worse than the Charge of the Light Brigade. I would not have as many people as that following me.

Of course, I shall withdraw this amendment, but the noble Baroness should not be surprised if, perhaps in another place, her colleague who will be answering there will have to make the case not for excluding this paragraph, because it is unlikely that one would achieve that, but for adding a number of other conditions, most notably but not exclusively motor neurone disease. I will leave that thought with her, but fortunately she will not have to answer that argument. It would be harder than answering the arguments that I have put today on this issue. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Lord Skelmersdale moved Amendment No. 41:

The noble Lord said: My Lords, it is my personal regret that not all your Lordships join with the disability charities in welcoming the Government's decision to add multiple sclerosis, HIV and cancer to the list of disabilities covered by the Bill from the point of diagnosis. These are all potentially progressive diseases. It has been put to me that all progressive diseases—the point made by my noble friend Lord Tebbit—should be covered in the Bill. While there is logic to this, it is not the subject of this group of amendments. Our concern is the decision of the Government that they should take an order-making power to have some cancers, the so-called "non-serious" cancers, excluded from the Bill.

The term "cancer" covers a wide range of conditions, and it is the most likely cause of death if, as I do, you count heart disease separately from stroke.
 
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I declare an interest as vice-president and former chairman of the Stroke Association. The Office for National Statistics has said that cancer accounted for 26 per cent of all deaths in 2003, so we owe it to everyone to look carefully at those cancers which may or may not be excluded from the Bill. We know that the Government are consulting on basal cell skin cancer, commonly known as rodent ulcers, most squamous cell carcinomas of the skin, and in situ cancerous growths of the cervix and uterus, which we are told are likely to be treatable successfully by cone biopsy, and non-melanoma skin cancer.

I am told by Macmillan Cancer Relief, although the Minister has not confirmed it, that Bowen's disease and in situ cancers that do not affect the full skin thickness and can normally be treated initially, easily, and simply, are also under consideration. It was also revealed in Committee that melanomas and cancerous cells of the uterus may be included.

I do not pretend to be a doctor, but I know that once cancer of any kind gets a grip on the body it will spread, and if it spreads to a major organ it will, sooner or later, cause fatal damage and ultimately death. The fact is that having been diagnosed with cancer, no matter how minor the cancer may be for the individual, it can have a serious impact—this is another answer to my noble friend Lord Tebbit who has escaped us—when it comes to employment, travel insurance and life insurance, which is necessary to secure mortgages. It is clear that the stigma and ignorance that surrounds cancer is at the root of the discrimination against people affected by cancer. Indeed, the Government have admitted as much. The stigma and ignorance apply to all cancers at the point of diagnosis, not just the major ones, such as breast cancer or cancer of the oesophagus.

There is always going to be an effect on someone's life. The Minister made the point in Committee that a one-off intervention may be less onerous and have less daily impact than dealing with a broken shoulder. That may be, but the fact is that after removal of a cancerous lump, follow-up investigations are invariably required to ascertain whether the surgeon has cut it all out. As the Minister and I agreed on Second Reading, the severity, or spreadability, of a cancer depends essentially on the speed of the patient presenting it to a doctor, the doctor recognising it, and prompt treatment being given. I am reliably informed that a melanoma more than one sixteenth of a millimetre deep is most likely to lead to more serious and spreading cancer. I am afraid that I found the Minister's answer to that dismissive: "Well, if it does, the patient comes back under the ambit of the Act".

A quick reading of the debate in Committee shows that the Minister was on a losing wicket. No Member agreed with her that it was sensible for the Government to have a list of cancers to be excluded. The Minister said:

I take the point, but surely what matters is what other people think; one's neighbours, family, friends, and what extra premium an insurance company will charge for a one-off but possibly continuing intervention. As
 
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to whether they should all be called cancers, the fact of the matter is that they are, at least in common parlance. The Bill makes no provision for separating out and defining what should and should not be called a cancer. People who have a diagnosis of one of the excluded cancers have a cancer. The noble Lord, Lord Ashley, said in Committee:

I could not have put it better myself. I beg to move.

Lord Ashley of Stoke: My Lords, I hope that my noble friend Lady Hollis will look favourably on this, since she was unfortunately unable to do so in Committee. I have a few points to make. First, again I do not agree with the noble Lord, Lord Tebbit, about stigma not being attached to cancer, at least not as much as it used to be in the olden days. This is a purely subjective point of view, and either of us can be right. In my experience, people still are as terrified of cancer, and it is still as much of a bombshell of a word that stops all thought, all arguments, and raises fear and apprehension among anyone who is told. This is very unfortunate.

Secondly, my noble friend Lady Hollis said a few moments ago on a different amendment that she was against keeping records. Presumably, that comment was intended solely for that amendment. If this amendment is resisted, we will have the keeping of records. People who want to know where they stand on cancer, and whether their cancer is included will have to look at the records. Imagine the dialogue. "You have cancer. Let us see the British National Formulary to see what kind of drugs you are treated with. What sort of cancer is it? Unimportant? Very important? Rather important?". It could go on and on, and be even more confusing than looking at mere records. Any doctor or any surgeon who is able to say definitively, "That cancer is not serious", is sticking his neck out. Maybe doctors can do that, but my feeling is that they would be very apprehensive and very chary of categorising any cancer as not serious. We know that there are greater and lesser cancers, but to say so categorically may leave them vulnerable. It would be a very big step, and we will reach that stage if this amendment is not accepted.

I simply do not see anyone who is not concerned by the word "cancer". With all the education in the world, all the experience, and all the medical knowledge, cancer is still cancer. Although medicine has moved forward, public perceptions have remained static. Until you can change these public perceptions, we need this amendment.


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