Improving Cancer Outcomes

Debate between Liz McInnes and John Baron

Thursday 5th February 2015 Commons Chamber

[Mr Baron]

That is a debate for another day. I accept that dramatic improvements could be made within the existing structures of the NHS, and I want to focus on that in this debate.

The Government have estimated that from 2011 to 2015 an additional 12,000 patients will survive for more than five years after diagnosis compared with the previous five-year period. That figure tells us nothing about how we are doing relative to our European counterparts, who will no doubt also have made improvements. Are those 12,000 lives just a continuation of a fairly stable and steady trend line that has been in evidence for the past 25 to 30 years, or a kick-up, as it were, above the trend line that suggests that we are catching up with our European neighbours? I would appreciate it if the Minister provided clarity on how the figure of 12,000 additional lives saved has been calculated and what action the Government are taking to ensure that we continue to strive towards matching the best outcomes in Europe.

I am conscious that a good number of other Members will speak in the debate, so, without being exhaustive, I will focus my remarks on four key areas: earlier diagnosis and survival rates; inequalities and older people; patient experience; and, last but certainly not least, the problem that some charities are having with data access.

Earlier diagnosis has long been an issue that the all-party group has campaigned on: we describe it as cancer’s magic key. All the statistics suggest that the NHS is as good as any other health care system at treating cancers once they are detected, but poor at detecting them in the first place. That suggests that we need to raise our game as regards earlier diagnosis. Most of these 5,000 or 10,000 lives are being lost at the one-year point, and the NHS is not catching up. We therefore need to drive forward initiatives at the coalface that encourage earlier diagnosis. It is almost a national disgrace that one in five cancers are first diagnosed at A and E when those patients are, on average, twice as likely to die within a year than those diagnosed via an urgent GP referral. That shows the importance of earlier diagnosis.

With this knowledge, we have spent the past two years working with the Government and NHS England to ensure that the right accountability levers are in place to encourage earlier diagnosis. We have been successful, together with the wider cancer community—because ultimately this is about teamwork—in getting one-year and five-year cancer survival rates into the NHS outcomes framework and one-year cancer survival rates into the commissioning outcomes indicator set. That is good news. We were also delighted when Simon Stevens agreed to our recommendations on including one-year survival rates in the delivery dashboard of the clinical commissioning group assurance framework from April this year.

I have used a lot of terminology, but there is a basic logic in putting the one-year figures up in lights and breaking them down by CCG. One of the best ways, if not the best way, of driving up one-year survival rates is to better introduce initiatives that encourage earlier diagnosis at the coalface. Those could be, for example, better awareness campaigns at a local level; encouraging better screening uptake figures, some of which are pretty poor; better diagnostics at primary care; better GP referral rates; or an A and E system which, when it detects these one-in-five cancers, instead of pushing patients back down the system, refers them up, potentially saving crucial time. All or any of those could be introduced by CCGs that are trying to get their one-year figures up. Putting the one-year figures up in lights will put pressure on those CCGs to raise their game on earlier diagnosis.

[Liz McInnes (Heywood and Middleton) (Lab)]

Does the hon. Gentleman agree that we need to look at the age range for cervical cancer screening? Only this morning, I heard of a 21-year-old who was found to be suffering from this disease, and who had begged the GP to give her a screening test but was unable to get it until it was too late. We also have a problem at the older end of the spectrum above the age of 64.

[Mr Baron]

Obviously, I cannot comment on the specific case, but I repeat that putting the one-year figures up in lights will put pressure—the best kind of pressure—on CCGs to look at all the initiatives at their command.

I do not think that the Department of Health or NHS England should be too prescriptive about this. We have CCG managements earning six-figure salaries who should, frankly, be able to make these sorts of decisions by introducing initiatives that best suit their populations. Where there is, say, a black and minority ethnic population, an elderly population, or a mining community population, initiatives have to be skewed accordingly, and that is what CCG managements should be doing. We have to leave an element of local initiative. One cannot just sign a cheque to the NHS for £120 billion and not expect accountability. By putting CCGs’ one-year figures up in lights, we can, over a period of time—there is no quick fix—monitor how they are doing. In the case that the hon. Lady mentioned, I would hope that the CCG would have a look at local initiatives that could perhaps change the situation for the better.