Earlier Cancer Diagnosis: NHS Finances

(Limited Text - Ministerial Extracts only)

Tuesday 18th October 2016 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

It is a pleasure to serve under your chairmanship, Mr Nuttall, in my second Westminster Hall debate since I became a Minister. I start by congratulating my hon. Friend the Member for Basildon and Billericay (Mr Baron) on securing this debate and raising the valid points that he did and on his stewardship of the APPG on cancer, which is highly effective and has provided a large part of the briefings that I have received since becoming a Minister. I very much hope that he will carry on that work, and I am sure that he will.

My hon. Friend mentioned several times the phrase “pushing at an open door,” and I reassure him that the door is open. We have discussed this issue twice in fairly formal circumstances, and I am keen to take him up on his offer of meeting him and colleagues to discuss it further and make progress over and above what we can do in Westminster Hall debates and oral questions. I also look forward to speaking at the event in December.

I will talk, as Ministers do, about the progress that we are making in this area across England, but my hon. Friend reminded us that we are not best in class or among the best in Europe, and he is absolutely right. He gave us the statistics for Sweden, where the one-year survival rate is 82% versus our 71%. That is a target; it is where we need to get to. As we have made progress, we have got to where the best in Europe were several years ago. We need to keep progressing in that respect.

My hon. Friend rightly talked about CCG accountability, and I will talk a little about that. I want to emphasise the power of what was done last month, when we published the four indicators for every CCG in the country. That is a massive commitment to transparency. We were quite open that many CCGs needed to improve. My hon. Friend mentioned the figure of, I think, 80%, which we agree with. It is worth analysing the data and spending a bit of time looking at that, because small differences in percentages against the indicators, one of which is one-year survival, make a big difference to how a CCG is perceived. Accountability comes from transparency, and we have made big steps in that regard, last month in particular.

I want to thank the Members who intervened in the debate. As ever, my hon. Friend the Member for Bosworth (David Tredinnick) reminded us of the role that complementary remedies can play as part of an overall solution. There is no impediment to that in the NHS—CCGs can commission what they wish to commission. He mentioned the Barts study. My view is that it needs to be clear that commissioning is science driven, repeatable and all that goes with that, but there is no impediment if CCGs wish to commission complementary therapies.

My hon. Friend the Member for Mole Valley (Sir Paul Beresford), in his capacity as chair of the all-party group on skin, told us how weak some of the training in that area may be at undergraduate level. I was not aware of that, so I will take it up and come back to him. It does not sound acceptable if the skin cancer diagnosis part of the syllabus is the bit that people leave.

[Sir Paul Beresford]

If I could emphasise that a little more, we have a distinct shortage of consultant dermatologists. They are backed up by GPs with a special interest, but a large number of referrals to dermatologists are made due to fear on the part of both the patient and the doctor that they will miss a melanoma or a squamous cell carcinoma when the doctor should be able to diagnose them. Many are dealt with in the early stage with cryosurgery, which is a very effective, quick treatment that I know, having been on the wrong end of it quite often, can be undertaken by a GP who has had the right education.

[David Mowat]

I thank my hon. Friend for that and for reminding us that at the core of the debate is a point we all agree on: early diagnosis is the key, whether it is for cost-saving purposes—I will come on to some of the points my hon. Friend the Member for Basildon and Billericay made on that—or to be cost-effective. There is no question that early diagnosis saves lives and that it is the right thing to do. Whether we argue a bit about precisely how much money is saved is in a way a secondary issue; it saves lives and it is the right thing to do.

I also want to acknowledge the intervention of the hon. Member for Strangford (Jim Shannon), who reminded us about the need for public health and GP awareness. In England we have had a significant increase in the number of referrals and the National Institute for Health and Care Excellence—latterly in England—has changed its guidelines for referral, which, together with the awareness issue, has increased significantly the number of people diagnosed in stages 1 and 2. We need to continue to make progress on that.

[Mark Durkan]

I commend the hon. Member for Basildon and Billericay (Mr Baron) for leading the debate and for the leadership he has provided on one-year survival rates through the APPG. Does the Minister accept the basic premise that value of life and value for money are not in competition? They are perfectly compatible. We can have better use of money with better outcomes because of better-timed treatments, and that also means there is better evaluation and research, which will feed into better education in a virtuous circle, to meet the point made by the hon. Member for Mole Valley (Sir Paul Beresford).

[David Mowat]

I thank the hon. Gentleman for his intervention and completely agree with the point he made. In this instance, there is no competition between saving money, saving lives and doing the right thing. In a sense, there is a secondary question as to just how much cost is saved, and the balance of cost saving versus doing more diagnostically, because in order to save lives, which is a highly cost-effective thing to do and the right thing to do, we need to do more on early diagnosis.

I have not yet got to the start of my remarks and I have a lot of pages to get through, so I will not be giving too much detail. It is worth acknowledging that cancer survival rates are increasing in the UK. In terms of improvement, between 2011 and 2015 we think something like 12,000 lives a year were saved. That exceeds the goals we set out in the cancer outcomes strategy in 2011.

Last year we saw a 91% increase in urgent GP referrals of patients with suspected cancer—that is another 822,000 patients. That shows a massive increase in NHS resources and all that goes with that, and we are beginning to see those early referrals, and the different guidelines GPs are using to refer, start to come through in the one-year survival statistics. However, as my hon. Friend the Member for Basildon and Billericay reminded us, that does not mean that we are the best in Europe. We need to continue the drive to improve.

The cancer strategy produced by the cancer taskforce is the backbone of what we are trying to achieve. The—I think it is fair to say—acclaimed strategy it produced, “Achieving World-Class Cancer Outcomes”, was published last year. It had 96 recommendations in it, and the Government accepted all 96. We are now putting in place an implementation taskforce. We believe that if we are able to make the progress we expect by 2020, a further 30,000 lives a year can be saved.

Recommendation 96 is the one we are talking about today. It essentially says that we need to do a lot more on early diagnosis because of the cost savings that will potentially arise from that. There are differing views in the Department of Health as to whether for all cancer types in all instances earlier diagnosis does save costs because of the increase in cost and effort associated with the diagnosis—the early screening and all that goes with that. That was not addressed overtly in Cancer Research UK’s “Saving lives, averting costs” report, which was mentioned by my hon. Friend. He quoted numbers of several millions of pounds, and there is no doubt that stage 4 cancer costs massively more to treat than stage 1 cancer, but whether or not there are clear cost savings in all instances and even if we dispute the detail of some of those numbers, we go back to the point made by the hon. Member for Foyle (Mark Durkan) that early diagnosis is the right thing to do. My hon. Friend also mentioned that there are not enough health economists in the NHS; the truth is there are not enough of lots of things in the NHS. Early diagnosis is certainly cost-effective in terms of lives saved, even if there may be some dispute as to whether it saves costs in all instances.

My hon. Friend mentioned the work being done by Macmillan, which I acknowledge. It is a three-year study, which we are looking forward to.

[Mr Baron]

I am conscious that I am eating into the few minutes the Minister has left, but the point about cost savings links to the point made earlier about initiatives and processes for earlier diagnosis. I urge him to think carefully about this, as I know he is doing. There has been no shortage of process targets in the NHS, but the one-year survival figures focus on outcomes, and that is the true measure of whether the processes are having an effect. By using outcome measures, we are leaving a large element of discretion to CCGs to introduce the initiatives they think best fit their local populations. That does not necessarily mean big cost increases to introduce such initiatives. Better awareness campaigns and better screening uptake figures do not necessarily cost a lot of money at a local level; they just take a bit of thought.

[David Mowat]

I agree completely with my hon. Friend that it is right that we use outcome measures. I come back to the point that the Government did a big thing in publishing the statistics for every CCG in the country. That allowed headlines to be out there in the press— we all saw them—that 80% of CCGs need to improve. We used a pretty rigorous test to assess the CCGs. If we reach those levels, we will be close to being the best in Europe as we make progress.

I am coming towards the end of my time. I want to finish by re-emphasising the Government’s commitment to early diagnosis. I have not had a chance to talk about our public health measures and all that goes with them, but I thank my hon. Friend again for getting us this debate. I emphasise my commitment to work with him and the APPG to make progress in this area.

Motion lapsed (Standing Order No. 10(6)).