HC Deb 22 July 1988 vol 137 cc1496-504

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Dorrell.]

2.31 pm
Mr. Barry Jones (Alyn and Deeside)

My subject is cancer. One in three women in Wales still smoke, despite widespread health warnings. I am told that, according to a survey, one in four new cases of lung cancer now being registered in Wales is a woman. That is almost double the rate of 15 years ago. The survey warns that the incidence of lung cancer among women will continue to increase over the next 30 years, and nearly 500 new cases of lung cancer among women are being diagnosed in the Principality each year.

I believe that the Minister's Department says that the most marked increase is in lung cancer in females. That has been attributed to the increase in cigarette smoking among women since the second world war. The increase is in sharp contrast to the position among males, where the incidence has either remained constant or has fallen very slightly in men under 75.

As long ago as 27 June 1984, the Select Committee on Welsh Affairs considered cancer treatment in north Wales. Evidence was given by the Health and social work department of the Welsh Office, distinguished medical representatives, the DHSS and the Mersey regional health authority. A Welsh Office memo stated: access to Radiotherapy is more difficult. The same memo instanced the distance and expense of travelling. During the examination of witnesses, the chief medical officer pointed to higher mortality ratios for cancers in the Gwynedd area than for Wales as a whole. The evidence stated that patients from north Wales went to Clatterbridge hospital in Mersey and to Christie hospital in Manchester for radiotherapy and subsequent chemotherapy. The waiting time for treatment increased, especially between 1978 and 1982. There is a history of travel for treatment for cancer, and at one period there was concern over the waiting time for treatment. There has also been concern in the past about the shortage of either staff or cash or both to meet the needs of those requiring the excellent treatment that is given.

The Select Committee examined witnesses in 1984 but it was only in the summer of 1988 that a firm of consultants, Deloitte Haskins and Sells, was invited to undertake a study of cancer services in north Wales, including the provision of a radiotherapy centre in north Wales. Four years is too long to set up a consultants' study. Cancer is a terrible affliction. It hurts whole families. I want at least a satellite radiotherapy centre to be established in north Wales, and one is suspicious when progress, admittedly in the right direction, takes four years.

I do not intend to criticise the Clwyd health authority. I pay tribute to the quality of treatment that is given to my constituents and to others. I know that the Under-Secretary of State for Wales is committed to obtaining the best possible deal for my constituents and for others in north Wales. However, I emphasise that progress has been too slow. Even though a study by consultants is now under way, there is no guarantee whatsoever that a satellite radiotherapy centre in north Wales will be established.

I wonder whether bureaucracy is the reason for the slow progress. It took a long time for the Gwynedd, Clwyd, Powys, Shropshire and Wolverhampton health authorities, as well as the Mersey, North-West and West Midlands regional health authorities to seek to co-operate with and agree the terms of reference for the consultancy study. I want to know whether the consultancy study is literally under way and when it is expected to report. What is its status? When it has been completed, will the report go direct to the Secretary of State for Wales or will it go first to the authorities that I have mentioned? If the report goes first to the authorities, I foresee further delays.

Is genuine hostel accommodation provided at Clatterbridge for patients who have travelled from north Wales? Even after having perused the Select Committee's report, I am not sure of the answer to that question. Are there enough radiotherapy staff at Clatterbridge hospital? Is the Minister able to say categorically that the Gwynedd and Clwyd health authorities are collaborating well with their counterparts over the border, especially with the Mersey regional health authority? Has the Welsh Office paid any money to the Mersey regional health authority and to Clatterbridge for the services that it obtains for its north Wales patients? If I cannot be given the answers to those questions now, I should he grateful if the Minister would write to me at length at his convenience during the next few weeks?

The minutes of evidence attached to the Select Committee's 1984 report included a reference by Dr. H. Parry to a wait of six weeks for radiotherapy treatment while patients were in pain. Has that problem been solved? I presume that it has. I hope that nobody now suffers pain because of having to wait for treatment.

Dr. Coe was also examined by the Select Committee in 1984. He said that, wherever the north Wales radiotherapy centre is sited, it must be on the site of a district general hospital. Four anxious years have passed since Dr. Coe said that, with all that that entails for patients and families. I ask the Welsh Office to show a sense of urgency. I am asking for decisive action and a guarantee of meaningful development when the consultants report. I hope that the Minister will use his undoubted influence to ensure that the consultants reply with their study urgently. My request is for a satellite radiotherapy centre if we cannot have an independent centre. I concede that the former is more likely. I would listen to expert advice on that.

I am aware of the problems for patients who receive chemotherapy treatment and have to travel a long way to get it. Patients from Corwen, for example, have to travel to the world-famous Christie hospital in Manchester. That is a long journey. Apart from the upset and trauma caused by the treatment, the people concerned are likely to be sick as a result of the long journey. I know that the Minister will be sensitive to the humanity of the issues that I am raising and I am sure he will respond accordingly. Patients from the Rhyl area have to travel to Clatterbridge. Some radiotherapy patients receive treatment locally, but the majority have to travel to Manchester.

It would be helpful if a consultant from Liverpool or Manchester could hold clinic sessions at say Ysbyty Glan Clwyd, which is the great district hospital at Bodelwyddan near Rhyl, or at Ysbyty Maclor, the district hospital at Wrexham, each week. Better still, a consultant could be appointed for north Wales, holding sessions at Bangor, Wrexham and Rhyl Bodelwyddan. The consultants at Wrexham appreciate the expertise that is to be found at Christie's in Manchester. The Minister knows that it is a world-renowned hospital. The consultants at Wrexham would hate to lose their contacts with it, but it would be helpful to have more local treatment.

How many hospices are there in north Wales for the care of the terminally ill? On Deeside, some devoted people, who are my constituents, are very effectively collecting cash for a hospice outside the constituency at Backford near Chester. When, eventually, the proposed Deeside community hospital is built, does the Minister envisage the existing small community hospital at Mancot becoming a hospice run by Clwyd health authority? Does he know that, in Clwyd, there are fears that financial difficulties facing south Manchester health authority might lead to a reduction of the services provided by clinical staff at Christie's hospital? If that were to happen, it would be a blow to my constituents and the whole of north Wales.

How many hospices are there in north Wales for the care of the terminally ill? On Deeside, some devoted people, who are my constituents, are very effectively collecting cash for a hospice outside the constituency at Backford near Chester. When, eventually, the proposed Deeside community hospital is built, does the Minister envisage the existing small community hospital at Mancot becoming a hospice run by Clwyd health authority? Does he know that, in Clwyd, there are fears that financial difficulties facing south Manchester health authority might lead to a reduction of the services provided by clinical staff at Christie's hospital? If that were to happen, it would be a blow to my constituents and the whole of north Wales.

There is barely a district hospital manager and treasurer who does not have pressing financial problems, but I should like some assurances, if not now perhaps in a letter. My local council—Alyn and Deeside—Connah's Quay town council and others support, the campaign for at least a satellite radiotherapy centre. The Minister is aware of my disappointment and anger about the substantial delay with the building of a community hospital at Aston Deeside. It has been delayed by three years, and it has been scaled down in the number of beds and the proposed services to my constituents. The community that I represent is very upset at this development, but we have had this out previously. I emphasise that my constituents have no district general hospital, despite a huge urban population. That is an injustice to my constituents, who are always travelling to Manchester, to Liverpool, to Rhyl, to Wrexham and to Chester.

It has nothing to do with the Minister or with this Administration, but, historically, Deeside missed out a generation of growth. So be it. but I now want guarantees, not only for the radiotherapy centre, but for more funding for the excellent Clwyd health authority. If that authority had specific extra cash, it would be able to buy more of the time of the superbly experienced consultants at Manchester Christie. My constituents would benefit greatly and speedily. They could be treated at Wrexham by consultants from Manchester more often.

I also want a special cash subvention to provide better back-up services locally concerning cancer. That subvention would be made available for more social work. more health visitors and more Macmillan nurses. I conclude my remarks so that the Minister may respond to me and then get his helicopter back to Wales.

2.46 pm
The Parliamentary Under-Secretary of State for Wales (Mr. Ian Grist)

I thank the hon. Member for Alyn and Deeside (Mr. Jones) for his good wishes for my second chance to experience that form of aerial transport.

I congratulate him on his choice of topic for this afternoon's debate and I shall be writing to him in reply to his many detailed questions. He will know from exchanges in the past that my right hon. Friend and I attach a very high priority to the development of specialist services for patients in north Wales, particularly for those suffering from cancer. It is a much feared group of diseases by virtue of its indiscriminate impact on young and old and by the difficulty—and as yet on occasion the impossibility—of successful treatment.

In responding to the hon. Gentleman's speech I hope to reassure the House that the Welsh Office has a coherent strategy for tackling cancer in north Wales. It is a strategy for securing better information, of promoting health education, providing targeted screening facilities and reappraising and developing diagnostic and treatment services. Much of that strategy is already in place and the rest is coming to fruition. There is certainly no lack of commitment either of effort or resources to provide what is required. I am much encouraged that in pursuing our strategy in north Wales we have had strong support not just from the Welsh health authorities but from those in England which are most directly concerned. The hon. Gentleman will understand that I cannot speak for those services which lie across the border, but he can be assured that Welsh Office officials maintain close contact with the English health authorities.

The availability of impartial and objective statistical information on the incidence of cancers is of prime importance in tackling the many and complex issues that they present to us. We have been very fortunate for many years in Wales in having a highly regarded unit whose principal function has been to provide the soundest possible data and to publish them in the public interest. I refer to the Welsh Cancer Registry which is responsible for the cancer registration scheme in Wales. It collects information on an entirely confidential basis about cancer patients resident in the Principality and its third report entitled "Cancer Registration in Wales 1974–84" was published earlier this month. The report contains a detailed analysis of the numbers and incidence of cancer for Welsh residents in each of the years 1974–84. It is our intention that the latest report of the registry should be given the most careful consideration, not only within my own Department but by all those involved in dealing with cancers in the Principality.

I shall not attempt to describe all the main features of the registry's latest report. I will say that, if no allowance is made for changes in the age and sex composition of the population, the number of cancer registrations in Wales expressed as a rate per 100,000 has increased by about 30 per cent. between 1974 and 1984. Of course, cancers are naturally prevalent amongst the elderly and more people are living longer in Wales than they were in 1974. Allowing for changes in the composition of the population as a whole, the overall incidence of malignancies over the period 1974–1984 has remained broadly constant for men, although as the hon. Member for Alyn and Deeside has said, for women the incidence has increased. It is clear that, aside from changes in demography, increased numbers of registrations may also be due to improvements in diagnosis and in the reporting of diagnosed cases to the registry. Naturally, improvements are made to the system of reporting wherever necessary and desirable. It is important to keep that in mind when interpreting the data.

The pattern of distribution for cancers in the Principality varies for each type of malignancy. Speaking very broadly and taking all malignancies together, I can tell the House that in north Wales rates appear to be elevated compared with what one would expect for Wales as a whole. This is not the case for every type of cancer or for every area in north Wales, as the mapped illustrations in the registry document show.

Such evidence as we have suggests that the incidence of cancer in north Wales has been above average over many decades. It is not clear why this should be. It is possibly an effect of the changing demographic profile caused by people retiring to the area but the causes and correlations are extremely difficult to pin down.

Last year we commissioned Emeritus Professor Hubert Campbell to undertake an investigation of the data relating to the incidence of cancer on the north Wales coast for 1974 to 1983. Professor Campbell has provided an analysis of the results of his investigation. He makes it clear that in his view there is nothing new in the reported incidence of cancers in north Wales; he notes that the high incidence has been known for at least 70 years. Professor Campbell's report is very full. I do not propose to describe its contents in detail today, but I hope shortly to be able to make a statement about it.

There can be no question that some cancers are, as the hon. Gentleman said, substantially preventable. One need only reflect on the levels of smoking and the incidence of lung cancer among women in Wales to see the point. It is heartening that through the Welsh Health Promotion Authority we have been able significantly to enlarge the investment in health education for Wales. This is vital to help the public make informed choices about lifestyle. It is crucial for prompting people to set smoking aside and for sponsoring sensible moderation in drinking, sound diet, beneficial exercise and individual responsibility for overall health maintenance. In all this the authority works actively with the voluntary sector, with the network of health education officers in district health authorities, and with many others to carry the message to schools, the workplace, and to people throughout the Principality.

Complementary to these health education initiatives is the Government's commitment to early diagnosis and treatment. That is particularly true of the national screening arrangements for cancer of the cervix and breast.

Discussion of prevention, incidence and causation naturally leads on to the facilities that are currently available to diagnose and treat patients in north Wales. In doing so we must not overlook the considerable advances that have been made in recent years in treating the disease. The Bagshawe report on acute services for cancer reminds us that: Lengthening periods of survival show that even where it is not possible to cure cancer it is increasingly feasible to offer treatment to contain its effects and development. That is achievable particularly through the development of new drug therapies, more sophisticated radiotherapy and the development of computerised treatment planning.

Our task is to ensure that patients throughout Wales have ready access to these facilities as quickly as doctors believe is clinically necessary. That process begins with diagnosis. The diagnosis of cancer is undertaken by clinical specialists at district general hospitals on referral from general practitioners and our strategy to make computerised tomography screening more accessible to patients in Wales has done much to enhance diagnosis. About £1 million has been invested by the Department in scanners at Ysbyty Glan Clwyd, Rhyl and Ysbyty Gwynedd, Bangor. This investment has clear benefits for early identification of cancer.

The treatment of patients suffering from cancer may take the form of surgery, medical oncology or radiotherapy or a combination of these. Surgical treatment in north Wales, as elsewhere, is provided as a district-based service carried out by surgeons in district general hospitals. As such, it is the responsibility of district health authorities to plan and fund these services within their financial resources and according to the extent of local need.

Medical oncology, which is the treatment of cancer by drugs, is also provided as a district service at district general hospitals. However, medical oncology may be combined with radiotherapy treatment and, if so, is usually then provided at the regional radiotherapy centre which treats the patient. I shall return to the implication that has for district health authorities in Wales.

Radiotherapy treatment is recognised throughout England and Wales as a regional service provided at regional radiotherapy centres. Those centres, which have for many years provided north Wales patients with radiotherapy treatment or radiotherapy combined with medical oncology treatment, are the radiotherapy and oncology centre at Clatterbridge hospital, Wirral; Alderhay hospital, Liverpool; Christie hospital, Manchester; and the Linden-Davies radiotheraphy unit for Shropshire and mid Wales at the Royal Shrewsbury hospital.

As the hon. Gentleman said, consultants based at Clatterbridge and Christie hospitals hold out-patient clinics. A complex network of services already exists to provide patients with a comprehensive service of diagnosis and treatment. This may be available locally or may require the resources of a regional radiotherapy unit with equipment such as linear accelerators, cobalt machines and computerised tomography scanning and treatment-planning facilities. It is a part of medicine that has experienced significant technical advances and expansion of treatment activity. As the hon. Gentleman said, from 1984 to 1986 the Department conducted a review of regional services to north Wales patients, including radiotherapy and oncology services. That review was prompted, in part, by anxiety about the service being provided for north Wales' patients.

The findings of the working party's comprehensive study were the subject of consultation in 1986, in the light of which the then Secretary of State for Wales announced in April 1987 his decision on the action to be taken.

With regard to radiotherapy and oncology the working party review made several recommendations, and I shall refer to the most important.

In respect of the Christie hospital, it proposed that arrangements for the treatment of patients from south Clwyd should continue. We have sought to secure this and have been assured by the general manager of South Manchester health authority that potential restrictions in clinical services provided at Christie hospital, which have been publicised subsequently and which might have implications for radiotherapy treatment for north Wales patients, were not to be introduced. This will ensure the maintenance of the service.

The review team were concerned to ensure provision, through Welsh Office funding, of fast, comfortable transport to and from the regional radiotherapy centre at Clatterbridge for those patients who have to travel very long distances—that is, those from the western parts of Gwynedd. This proposal was willingly accepted. Capital funds of £75,000, together with recurrent funding of nearly £97,000, were made available in 1987 to Gwynedd health authority to acquire fast, comfortable transport, and I am pleased to learn that this has done much to ease the conditions of sick patients who must travel long distances for radiotherapy treatment.

One issue to which the review team gave particular attention was whether north Wales should have its own satellite radiotherapy centre. It concluded that the Welsh Office should undertake a detailed feasibility study, including site options, regarding the provision of a satellite radiotherapy centre linked to the main unit at Clatterbridge, but located within north Wales, and that discussions should take place with Mersey RHA to solicit the co-operation of the regional centre to support the running of this unit, which should be funded by the Welsh Office as part of its regional services.

The consultation process, to which I referred earlier, revealed some disagreement about the appropriateness of a satellite radiotherapy centre located in north Wales. Being concerned that the treatment of cancer patients in north Wales, whether by surgery, radiotherapy or medical oncology, should be developed in a rational and comprehensive manner, the then Secretary of State decided that the most appropriate way forward was a comprehensive examination of the provision of cancer services in north Wales, at district and regional levels. Accordingly, discussions were initiated with the interested English and Welsh health authorities to seek their co-operation in a consultancy study to examine the provision of cancer services in north Wales.

I am pleased to say that we received a strongly supportive response in each case and proceeded to select a. company to undertake the study. We were particularly pleased to have the assistance of the district general manager of Clwyd health authority, Dr. Jones. The study is to be started in the next four weeks. It will report to the Secretary of State after consultations with district health authorities. We have set the date of January 1989 for the receipt of its findings. Officials of the Welsh Office met representatives of Deloitte, Haskins and Sells this week at the start of their work.

The consultancy study is expected to be completed early in the coming year. It will entail a detailed exploration of the incidence of cancer, the treatment infrastructure, clinical developments and treatment requirements. Following that, it will be expected to explore how these requirements can most effectively be met and to undertake an appraisal of the options to meet them, including the feasibility of providing a radiotherapy centre in north Wales. That demanding remit will be carried out in close consultation with clinicians and officers of north Wales health authorities and of English regional health authorities, which at present provide the service. It can be expected that those groups representing patients will also he involved. Perhaps I may emphasise the point that we have been assured by Deloitte, Haskins and Sells that it and its clinical advisers will be actively seeking the views of local interests, including clinicians.

The hon. Member will understand that, until that study has been carried out and I have had the opportunity to consider it, it would be inappropriate for me to encourage speculation about whether such a unit will be set up, or where.

Turning from the review report and our response to it, I shall refer to the service currently provided by the English health authorities. As I have already mentioned, officials have met their counterparts in north Wales health authorities and neighbouring English regional health authorities to explore arrangements for more effective liaison on regional service issues. A clinical director has recently been appointed by Mersey regional health authority in respect of the regional radiotherapy service and the director has already been involved in discussions with officers of north Wales health authorities and Welsh Office officials regarding the development of radiotherapy services at Clatterbridge hospital. I understand that he has committed himself to improving the service that his hospital offers to Welsh patients—as to others—and I welcome that. Additionally, the West Midlands regional health authority is intending to mount a review of cancer treatment services and officials have sought to ensure that the interests of north Wales patients are fully considered there too.

In conclusion, I can assure the House that the commitment to cancer services for patients in north Wales to which I have referred in my speech will be sustained. I look forward to the results of the Deloitte report: it will be given the most careful consideration in consultation with interested parties in North Wales and England. I believe that the Department has forged a strong relationship with north Wales authorities on this issue and that it will bear fruit in the improved service for patients, for which the hon. Gentleman has called.

Question put and agreed to.

Adjourned accordingly at one minute past Three o'clock.