NHS: Cancer Patients

Lord Sharkey Excerpts

Wednesday 9th November 2016 Lords Chamber

Asked by

[Lord Sharkey]

To ask Her Majesty’s Government what assessment they have made of the latest NHS data on timely diagnosis and treatment of cancer patients.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, the NHS is meeting six out of eight cancer waiting times standards, with the other two being missed by less than 3%. This is against a backdrop of a more than 90% increase in urgent referrals—that is more than 800,000 more people—and treating nearly 50,000 more patients following a GP referral compared to 2010, an increase of 20%.

--- Later in debate ---

[Lord Sharkey (LD)]

Why are the regional variations in early cancer diagnosis so very large? For example, the worst is Lincolnshire West at 33% while the best is West Sussex at 61%. Does the Minister agree with Cancer Research UK and the Royal College of Radiologists that an important factor in the NHS missing early diagnosis targets is the shortage of staff to actually do scans, procedures and lab tests?

[Lord Prior of Brampton]

The new cancer dashboard has given us much more transparency around the country, so at least we now know where the problems are. The noble Lord is absolutely right that the critical area is early diagnosis, which is why one of the targets coming out of the new cancer strategy is that everyone should have a definite diagnosis within 28 days of an urgent referral. He is also absolutely right that one of the major constraining factors is workforce. We will be training an extra 200 non-medical endoscopists over the next couple of years, which should help considerably, but it remains an issue and Health Education England is due to report back in March 2017.

Health: Cancer

Lord Sharkey Excerpts

Wednesday 20th January 2016 Lords Chamber

[Lord Sharkey (LD)]

My Lords, I declare an interest as chair of the Association of Medical Research Charities, via whose members the British public contribute £1.3 billion annually to medical research, the largest part of which is spent on cancer research.

My noble friend Lady Walmsley noted that our cancer survival rates are significantly worse than in many comparable countries. People in the UK are dying of cancer quite unnecessarily. I know that the Government are acutely aware of that and that they recognise the need for urgent progress. The very impressive report of the Independent Cancer Taskforce, led by Sir Harpal Kumar of Cancer Research UK, shows us how to make that progress, and I am glad that the NHS has endorsed its recommendations.

Not surprisingly, a key recommendation of the report is an improvement in early diagnosis. I am myself a beneficiary of a very early diagnosis five years ago of lung cancer. Without that early diagnosis, I would not now be alive. To improve early diagnosis we need better training of GPs, better symptom awareness among patients, and better and quicker access to scanning. In this context, I am very disturbed to read reports of CCGs offering financial incentives to GP surgeries not to refer patients for further tests or specialist advice. Will the Minister tell us how widespread this practice is and what is being done to stop it?

The UK has a world-class record in medical research—a vital tool in improving cancer survival rates—and the mandate for NHS England requires publication of a plan for research. But we do not have that plan for 2016-17; in fact, we never got it for 2015-16. I know that some charities have had sight of a draft plan and that Cancer Research UK, for example, considers it to be limited in its vision of the NHS as research-active. Will the Minister say when we can all see the plan?

To date, the NHS has been slow to engage with the research community and to act on its recommendations. More effort is needed from NHS England to ensure that research funders can help them effectively meet their ambition to support and promote research. For example, as things stand, despite the pledge in the NHS constitution and the wishes of the Prime Minister, only 31% of cancer patients said that taking part in research had been discussed with them. This is despite the fact, too, that there is very good evidence that research-active trusts deliver better health outcomes.

Then there is the issue of money. The Government deserve congratulations for the science funding settlement in the spending review, but there are some important outstanding issues. The plan for a national fund to be held by NHS England for payment of excess treatment costs for cancer radiotherapy trials—a recommendation of the independent task force endorsed by NHS England—has not yet been published. Will the Minister say when we will see this?

Then there is the issue of excess treatment costs in general. We now have the guidance on this, but no published timetable for implementation. Delay in implementation prevents the full benefits of the HRA’s new single-approval system being fully realised, which is critical to the much-needed streamlining of research approvals. Will the Minister say when we might see the excess treatment costs implementation plan?

Finally, there is the question of the Charity Research Support Fund. The Minister will know that this fund is critical to universities seeking charitable funds for basic research, the largest part of which is on cancer. He will know how successful this fund has been: in 2013, the Government’s £198 million leveraged £883 million in charitable investment. We need this fund to continue. We need to protect it in real terms and to increase it in line with charitable investment.

NHS: Innovation

Lord Sharkey Excerpts

Thursday 11th June 2015 Lords Chamber

[Lord Sharkey (LD)]

My Lords, I, too, congratulate the noble Lord, Lord Wills, on securing this debate and on his compelling opening speech. Like him and all other speakers, I very much look forward to the maiden speech of the noble Lord, Lord Prior, in a few moments. I declare an interest as chair of the Association of Medical Research Charities.

In the context of the NHS, “innovation” has a wide range of applications. It covers, of course, innovations in care and treatment, but also medical research, which is where I shall focus most of my remarks this afternoon. A great many things have changed in the NHS in the last 15 years, as other noble Lords have said. Very significant advances have been made, and many of them are the fruits of the UK’s acknowledged excellence in medical research. We recognised this explicitly in our debates on the then Health and Social Care Bill in 2012, which imposed for a first time an explicit duty on the Secretary of State, NHS England and CCGs to,

“promote research on matters relevant to the health service, and the use in the health service of evidence obtained from research”.

It is generally accepted that the UK’s leading role in medical research is of enormous value to patients and the country. That leading role depends to a very large extent on the active participation and leadership of the NHS itself. The Government recognise that, and so does the NHS. In October last year, the NHS published its Five Year Forward View; this document devoted four pages to innovation, usefully not only setting out aspirations but detailing some of the steps needed to achieve those aspirations. The document explicitly confirmed continued support for the NIHR. That is a very good thing.

The NIHR is, with the AMRC and the medical research charities, one of the key funders of medical research, which in the NHS has undergone a kind of renaissance since the advent of the NIHR. It is all the more impressive when you realise that the NIHR’s budget is less than 1% of the overall NHS budget. That is a much smaller percentage commitment to R&D than is the norm for other knowledge-based organisations. There is a real business case, as I said before, for increasing the NIHR’s budget, apart from compensating for inflation. For every £1 of government and charity spend on health research there is a return of between 37p and 40p every year, in perpetuity. This is obviously a vital area. Could the Minister use his very best efforts to persuade his colleagues that a significant part of the promised extra £8 billion should find its way into the NIHR budget? While I am talking about money, when are we likely to see the guidance on excess treatment costs that was promised for before Christmas?

Despite some progress and good intentions, the research landscape in the NHS is not yet entirely encouraging. Around three weeks ago, Cancer Research UK published a report that it had commissioned entitled Every Patient a Research Patient?. The organisation stole or borrowed the title from the Prime Minister’s own stated aspiration that every patient will be a research patient. However, this report says that it has,

“found mounting and pressing concern”,

about research in the NHS. It identified a number of constraints, including,

“the ability of people to commit time to research, in the face of mounting service pressures … the availability of key skills and experience within the workforce”,

and of course generalised financial pressures.

The Chief Medical Officer, Professor Dame Sally Davies, commented on the report. She said:

“There is considerably more to do to improve the commitment, culture, capacity and capability of the NHS to promote, support and conduct research”.

Are there mechanisms in place to measure progress on the lines set out by the Chief Medical Officer? How will we know when we are making progress?

The final area I shall touch on briefly is data. Patient data, actual and potential, are an almost unimaginably important resource. Proper collection, dissemination and analysis of data will allow the next great leap forward in medical science. The NHS explicitly recognises this and has set up the National Information Board to lead the effort. We need real drive and leadership in this area. As my colleague the noble Lord, Lord Turnberg, said, the debacle over care.data has made progress very much more difficult. The Wellcome Trust noted at a recent hearing of the Health Select Committee on patient data that some researchers funded by medical research charities are experiencing significant difficulties and delays when trying to access data from the Health and Social Care Information Centre. Often these delays are more than 12 months. In some cases, researchers have not been allowed to access data at all, even when patient consent has been given and the data anonymised. I am sure the Minister is well aware that the situation is as difficult as it is urgent. Better use of patient data can lead to significantly better outcomes for those patients. I know the department is aware of this and all the other issues I have mentioned and is aware of the need for an overarching NHS research strategy and is working on that. Finally for the Minister’s list of questions, when does he expect to be able to publish a draft of this research strategy tying all these issues together?