Cancer

HC Deb 17 March 1994 vol 239 cc1074-89 7.19 pm

Mrs. Gwyneth Dunwoody (Crewe and Nantwich)

Some weeks ago I received a letter from one of my constituents who had been diagnosed as suffering from breast cancer. She said that, once the diagnosis was finally established, she had received both the best of treatment and the best of support services from the national health service. However, she wanted to make a very important point. She detailed the length of time that her diagnosis had taken and pointed out that she had had considerable difficulty in getting some sort of treatment at an early stage as a result of problems of diagnosis and referral.

My constituent said that it seemed to her that Members of Parliament were concerned about matters that she regarded as not life-threatening, but when it came to something like the death of a woman from cancer—something which is, unfortunately, not altogether unusual—it was difficult to get Members of Parliament to take an interest in the difficulties that women face every day in trying to receive help. I thought that that must be wrong, so I sought the help of the Secretary of State for Health.

I told the Secretary of State the problem. I sent her the letter from my constituent. For reasons of confidentiality, I did not choose to raise the matter on the Floor of the House. I received a reply which is becoming almost standard from the Government. It was the equivalent of, "Don't call me, I'll call you." It said that the treatment of that particular patient was the responsibility of a particular trust and that was all there was to it. I received no explanation of the Government's views. I received simply a bald statement of what had happened in the case of that patient, and the Secretary of State's referral back to the health trust involved.

My constituent was extremely distressed by the letter because, as she pointed out to me, her letter was not a complaint about a particular NHS trust. She had undertaken that task. She had dealt with the NHS trust and had received a reply of sorts. She either accepted or did not accept what it said. The point that she made over and over again to the Department of Health and to Members of Parliament was that what was important was early treatment, diagnosis and referral of cancer. She had received neither an adequate response nor any idea of what the Government intended to do about any of those problems.

Therefore, I went to the Table Office and tabled a series of questions. discovered that the Joint Council for Clinical Oncology had drawn up a series of sensible guidelines because it was so worried about the whole question of treatment. I asked the Secretary of State for Health (1) how many hospitals comply with the target of radical radiotherapy involving complex treatment planning within two weeks laid down in the guidelines…(2) how many hospitals comply with the target of urgent palliative radiotherapy within 48 hours laid down in the guidelines … (3) how many hospitals comply with the target of urgent radiotherapy or chemotherapy within 24 hours laid down in the guidelines…(4) how many hospitals comply with the target of intensive chemotherapy within one week laid down in the guidelines". I received from the Under-Secretary of State for Health, the hon. Member for Bolton, West (Mr. Sackville) the reply that This information is not held centrally."—[Official Report, 7 March 1994; Vol. 239, c. 83.] That is outrageous. What is happening to the Government? Are they deliberately seeking to fragment the prevention and treatment of cancer by splitting up the market into individual small pieces? Are they seeking to hide the information that we need about the delays faced by those in need of cancer treatment? Are they prepared at least to comment on the targets that have been set for treatment waiting times? Or are they prepared to say, as it appears from the reply that I received, "This is really not a matter for Her Majesty's Government because the information is not held centrally"?

Mr. Nicholas Winterton (Macclesfield)

Does the hon. Lady agree that, in respect of the health service, the Government should be accountable at the end of the day to the House? If the Government have delegated responsibility to the National Health Service Management Executive, as they clearly have, surely it would not be too difficult for my hon. Friend the Minister to obtain a reply from the executive in response to the valid and important questions posed by the hon. Lady. If the Management Executive does not provide such information, it fails entirely to do the job for which it was set up, and the House clearly cannot represent the best interests of the people of Britain.

Mrs. Dunwoody

The hon. Gentleman, who was a most distinguished Chairman of the Health Select Committee, not only understands the subject well but is committed to improving health care in the national health service. I am afraid that he sets out exactly what the Government ought to do. The alternative is the type of comment that we saw in the Health Service Journal of 16 September 1993, which read: People with cancer are having to wait eight weeks or more for treatment in some cancer centres, a report from the Joint Council for Clinical Oncology reveals. In new guidelines the council suggests urgent radiotherapy or chemotherapy should usually begin within 24 hours of seeing a specialist. It is worth examining those guidelines carefully, because they highlight exactly what is wrong. The report is headed "Reducing delays in cancer treatment". The joint council deliberately highlighted the problems it saw, because it believed that Delay in treating cancer is unacceptable. Its natural history is to spread locally and metastasise distantly. Whilst the reduction in cure rate caused by delay is difficult to quantify, the known biology of cancer and the published differences in cure rate…makes it evident that delay adversely affects cure. That was said by people dealing with the problems of cancer patients every day.

In case the Government find it difficult to understand, the council has also laid out what sort of delays can get in the way of starting treatment. It says that sometimes there are delays in recognising symptoms of cancer. It says that, therefore, it is tremendously important that there should be better public education and more rapid referrals to specialist units. It says that there can be delays in progress through primary care to hospital. It says that the efficiency of administrative arrangements, including waiting times for out-patient appointments and investigations, must be reviewed regularly. Continuing medical education to ensure appropriate and timely referrals must be encouraged and, where necessary, improved. It says that delays in hospital before specialist referral to an oncology unit also contribute to the problems.

Already, within the NHS trust which particularly concerns me, we see clear signs that referrals to radiotherapy departments are taking longer and longer. I am convinced that the split into provider services and the purchaser theory, which is so relevant to, and redolent of, incompetence, is having a direct effect on the provision of treatment. Those waiting times are not even chronicled by the Department of Health and they are not available to individual Members of Parliament. Once upon a time, we would simply have tabled questions and asked how long people normally had to wait before they got an appointment. Such information is now hidden. We are told that it is a matter for the individual trust.

In 1992, the Royal College of Radiologists received a number of reports about delays in starting treatment that had been advised at the initial oncology consultation. Its faculty of clinical oncology carried out a survey of oncology centres in the United Kingdom and received 29 replies, in which 14 centres reported waiting times for radiotherapy of four weeks or longer. In several of those, the delay was of seven or eight weeks. Those delays were after a clinical oncologist had seen the patient and advised radiotherapy, so it was not that people did not know what treatment was required—the patient had been seen and referred by a specialist.

The report states: Whilst there are recognised emergencies in cancer therapy"— it mentions spinal cord compression— the majority of cancer patients do not need to begin their definitive treatment within hours. The clinical situation, including severity of symptoms and the anxiety of the patient, should properly determine the arrangements made. In some patients a `fast track' to treatment will be needed with waiting times shorter than the targets which the joint council set out. I shall place those targets on the record because I want some publicity on the matter. I want some action.

The joint council recommends waiting time targets from the date of the first consultation to the start of radiotherapy or chemotherapy. For urgent radiotherapy or chemotherapy, good practice is within 24 hours, and the maximum acceptable is 48 hours. For palliative radiotherapy, according to the severity of the symptoms, good practice is defined as 48 hours, and the maximum acceptable period is two weeks. For radical radiotherapy involving complex treatment planning, good practice is defined as two weeks, and the maximum acceptable period is four weeks. For intensive chemotherapy, good practice is defined as one week, and the maximum acceptable waiting time is three weeks. Those targets arose because the joint council had been told that people were waiting anything up to eight weeks.

I began to inquire into not only obvious cancer figures but cancers generally. Of course one is concerned about cancers that particularly affect females. The numbers of registered deaths from breast cancer in the UK were: in 1990, 114 men and 15,179 women; in 1991, 90 men and 15,403 women; in 1992, 98 men and 15,221 women.

The figures on deaths from other cancers show that the changes have not been remarkable. Despite changes in treatment and advances in medical care, the number of people dying has not altered a great deal. Even in my region, where there are considerable problems with industrial and lung cancers, one only has to consider the figures on prostate cancer to see what is happening to men.

The information given in a written answer in Hansard, at column 43 on 7 February 1994 shows that in 1988, 7,458 men died of cancer of the prostate and in 1992, 8,735 men died of that disease. In my region of Mersey, the number of deaths from cancer of the trachea, bronchus and lung in 1992 was 1,198 for men and 700 for women.

In what other situation could one imagine a House of Commons treating those consistent figures as a matter of little concern? What other disease or set of circumstances that killed that number of the population would be treated with that sort of superficial response? It would be difficult to find any other set of circumstances where the House of Commons would accept deaths in those numbers without taking urgent and immediate action.

It is clear that problems arise not only with breast cancer and breast cancer screening. A variety of screening methods can pick up cases of prostatic cancer much earlier. Does the Department intend to take any steps to develop a screening programme? There should be more fast tracking of patients with suspected cancers. The waiting list initiative which, whatever the Minister says, has distorted clinical priorities, could well interfere with the fast access that patients should have to screening facilities. There is no reason why general practitioners should not have much better access to screening facilities, such as ultrasound and CT scans. As far one can see, however, none of that is happening.

The House faces a Government who have adopted an accepting attitude. They seem to say, "Here is a major disease; we have done a certain amount, we have cervical screening and a certain amount of publicity. Of course, it is true that we do not spend anything like the amount on cancer education that we spend on glossy reports for NHS trusts or individual publicity campaigns for the Department of Health, but that should not matter to us because, after all, the people of Britain will not be particularly put out if more and more of them are faced with this problem in the coming years and nothing is done to assist them."

We should be concerned, and not just that my constituent has to write to me asking, "Why cannot I get a Minister to take seriously what I am saying?" We should ask ourselves why other constituents who have not written to hon. Members, but who are fighting fear and illness and, in many cases, major problems caused by poverty and illness, have not been given the voice they need on the Floor of the House. The Department of Health has not shown anything like the vigour and the campaigning in the treatment of cancer that has been shown in highlighting other diseases.

Why does the Secretary of State for Health, who appears to refuse absolutely to push hard for the banning of tobacco products, not do something to monitor the rate of response of doctors to the needs of those who are suffering from carcinoma? At what point will we receive accurate information? We do not want the answer, "Write individually to each health care trust and if you are lucky you can put all the bits together. If you go to the Library, someone else might do it for you." We want accurate information on how long people have to wait before they are referred for their first appointment, what sort of treatment they receive and how long they have to wait for it after their first appointment with a consultant and what sort of general support services are available.

I was impressed when I telephoned the service of the British Association of Cancer United Patients—a service which is run mainly by the nurses of St. Bartholomew's hospital to help people who may have been diagnosed, or think they may have been diagnosed, as suffering from cancers. The response was helpful, civilised and informative. It gave exactly the type of support that one would need if one was very frightened.

The word "cancer" terrifies people, especially women. They are terrified if they think that they might have something that needs treatment. Many of them are still not confident enough to come forward at an early stage because they are terrified. If an unnecessary barrier is put in their way, such as the need to wait for an appointment or the failure of the system to refer them to a specialist early enough, they will give up or, in some cases, decide that they ought to try to obtain some other treatment.

If one were a private patient, one would not have to wait for a suitable appointment in a radiotherapy department or with a consultant oncologist. The response would be rapid. Indeed, one might be offered a series of appointments. What does one do if one cannot, or will not, go to a private doctor? What does one do if one lacks the money or the back-up to go outside the national health service and demand some immediate care pattern? One worries oneself into a state of collapse before there is any sign of suitable treatment, whatever it is and whenever it happens.

I believe that the Government are determined to wreck preventive health altogether by the way in which they have split the national health service, so one should not be astonished by their response on that subject. However, some people demand that we force the Department to give us some answers—instead of allowing it to reply to five or six questions in the House, tabled correctly, with a reply about whether the information is "available". It does not say, "We cannot collect it." It does not say that it is too expensive. It does not even say, "We are terribly sorry; we used to do that; now we do not." It simply says: This information is not held centrally."—[Official Report, 7 March 1994; Vol. 23, c. 83.] The lack of information has one immediate effect. It means that no one realises the extent of the emergency, no one puts pressure on the Ministers and no one does anything other than treat the matter individually at every level.

Before I give the Minister the chance to read his usual anodyne series of unrelated statistics, I shall read another letter to the House, which sums up some of the difficulties. It is about a disease which, oddly enough, is not capable of responding to early treatment. It was sent to the Speaker and I have her permission to quote from it because it is of importance to the debate.

The gentleman who wrote the letter asked the Speaker to send his letter on to Members of Parliament, and especially the women Members of Parliament. He says: Right Honourable and Honourable Ladies, I approach you in this way respectfully but unashamedly for the manner of the approach. I wish to bring to your attention a situation that potentially affects all ladies… At 4.45am just before dawn on Wednesday 22nd September 1993 my gentle, caring wife became a little known statistic. She was one of ten that day, one of nearly 4000 women in the year, to die from ovarian cancer. She died after a five month illness. This cancer is lethal and this year more than twice as many women will die from it than cervical cancer. Over 75 per cent. of these women will have gone to their doctors when the disease has spread outside the ovary—it is then already too late. More than 72 per cent. will die within 5 years compared with 38 per cent. and 42 per cent. with cancer of the breast and cervix respectively. If detected in its early stages, ovarian cancer, limited to the ovary itself, can be treated by surgery and over 90 per cent. thus treated will survive 5 years. For those of you who think 5 years is a short time then think of my wife and I who only had 5 months to say the things we needed to say and say goodbye with as much dignity as we could. Incidences of this horrendous disease is limited of course to women …. If the deaths had…been clue to say, influenza, with its 134 deaths in a month of this years outbreak then there would be an outcry against the Health Service and dark tales of epidemics and shortage of vaccines. It is almost inconceivable that there is not a national outcry against this cancer, sometimes called, even by the normally stoical medical profession, 'The Silent Killer.' The Silent Killer is not detectable in early stages with present day medical techniques…It is undetectable until it is too late… I would be made a leper of society if I were to go out into the outside world today and denigrated women as second class citizens. Yet this is what this disease does. Deaths in this particular branch of…cancer go unreported, unnoticed and it seems only the immediate families care how the loved one became a victim. He goes on to say that there is one chance, and one research unit. There is no clear sign that there will be sufficient funding even to start the research work at the Royal London hospital, which could make it possible to save many more women. He finishes: I am not appealing on behalf of any charity. I did this simply for ladies everywhere and for the memory of my wife. I know I may have been unethical in my approach; respectfully I apologise for that but not for the content of the letter…read this and I will know that you care.

We need a series of targets; we need action from the Department of Health; we need to take the work that is being done and to say how many departments throughout the United Kingdom do their job properly. We should not leave it to individual Members or individual doctors. We should act on behalf of the people who need our support.

No other group of people would be allowed to suffer as women are being allowed to suffer and it is an added disgrace that a female Secretary of State for Health has done nothing—nothing—to change the situation.

7.47 pm

Mr. Ian McCartney (Makerfield)

I congratulate my hon. Friend the Member for Crewe and Nantwich (Mrs. Dunwoody), not only on being lucky in the draw, but on the way in which she decided to present to the House the issue of early treatment of cancer. Each year, 16,000 women die of breast cancer. In this country each and every year, there are more than 110,000 cancer-related deaths because of tobacco consumption. However, I want to debate not tobacco consumption but the three areas of cancer and prevention strategies. My hon. Friend has covered some of it eloquently. There are other areas which she has highlighted.

It is necessary for the Government to give clear and precise answers about their strategic approach in relation to the early diagnosis and treatment of cancer. Only improved diagnostic skills, with improvements in screening, will determine whether the outcome for the sufferer is a period of progress and health or one waiting for a slow, lingering death.

The profile of cancer prevention has never been higher because of the debate in relation to the banning of advertisements of tobacco products. My hon. Friend the Member for Bristol, South (Ms Primarolo) has assiduously asked the Minister questions about the cost-effectiveness of screening and early detection.

The Minister would see an immediate return in one area without one extra penny having to be spent. Professor Smee's report on the banning of tobacco advertising shows that by that measure alone, 5,000 lives a year would be saved. The lives of 5,000 of our fellow citizens would be saved without an extra penny being spent on the national health service. Some £95 million of immoral earnings goes to the Treasury through the tax yield from children's purchases of cigarettes; yet only £5 million of that—5 per cent.—is reinvested in prevention programmes. That is an obscene set of priorities for a Health Minister.

I should like the Minister to turn his mind to three areas. I will give only a snapshot of the problems raised by my hon. Friend the Member for Crewe and Nantwich to illustrate the way in which the Government fund, manage, resource and plan the national health service. I shall refer to prostate cancer, bowel cancer and primary liver cancer.

The incidence of prostate cancer has risen by 19 per cent. in five years, from 9,127 a year to 10,837. Death rates are up 17 per cent. in five years, from 7,458 to 8,735. In the past five years, 40,722 men have died from prostate cancer. It is the most common cancer affecting men over 60 in the United Kingdom. It is a silent killer; post mortem investigations prove that 10 to 30 per cent. of men between 50 and 60 and 60 per cent. of those between 70 and 80 have silent prostate cancers—undetected cancers—at the time of death.

Using those figures, at least 20 male Members of Parliament currently have an undetected, silent prostate cancer. Yet with screening methods, 15 to 18 of us would be identified early enough to survive. The survival rates are good if the cancer is detected early. Some 43 per cent. of those whose cancer is detected early are alive five years after diagnosis. In 1990, the British Medical Association's "Family Health Encyclopedia" said of the outcome of this very dangerous cancer: When the growth is discovered at an early stage, the outlook is very good. However, if the cancer has spread outside the prostate gland and does not respond to hormone treatment, the prognosis is poor. Despite that, the Government remain stubbornly opposed to the introduction of a screening programme.

My hon. Friend the Member for Bristol, South (Ms Primarolo) recently asked the Under-Secretary of State for health what was his policy for the screening of this cancer. He replied: The key to any screening programme must be to secure a demonstrable improvement in health by increasing length of life and enhancing quality of life. There is, as yet, no evidence to suggest that this would be achieved in relation to prostate cancer. The Department of Health is pursuing research in screening through its own centrally commissioned programme and through the national health service research and development programme. A copy of the Chief Medical Officer's speech to a recent 'British medical Journal' conference setting out current policy implementation issues for screening in the NHS will be placed in the Library."—[Official Report, 3 February 1994; Vol. 236, c.855.] In 1992, the disease claimed 9,396 mens' lives; that is four times the number of deaths from cervical cancer. There are rightly screening programmes in place for cervical cancer, yet the Government will still not introduce screening devices for men in relation to a killer disease. As I have said, the figures are alarming. Yet the prostate gland is an accessible piece of the anatomy for clinicians to reach. New scanning techniques, such as ultrasound, can detect prostate cancer. There are a number of proven treatments, such as radiology, chemotherapy, hormone therapy and, if necessary, surgery. With the use of those proven treatments, survival rates are good.

It was left to Doctor Thomas Stuttaford, writing in The Times on 6 March 1992, to put the matter into perspective. He spoke for many colleagues in the medical profession in advocating the institution of a screening programme. He said: If the tumour is localised, early surgery gives a 65 per cent. chance of surviving for ten years. As well as saving lives, a screening programme would reduce the number of men condemned to suffer lingering ill-health, and pain, for years."

However, among the Department of Health advisers and among the medical establishment, there is a group of people who discriminate ideologically against men in relation to prostate cancer. Many say that the cancer is part of the aging process and that it is not, therefore, cost-effective to screen men. They say that we should simply leave growing percentages of men, as they age, to be susceptible to the disease. Intellectually, that is an unacceptable and unsustainable argument.

If Department of Health officials are saying that they will intervene only at the point at which the individual concerned has a cancer and is unable to maintain his fitness, they are treating only to die and not to live. If that is not the Department's position on men and prostate cancer, the only option is to treat to live. To treat to live, there must be the option of screening, because without screening there is no early detection. Without early detection, it is difficult to sustain life after the operation, but with early detection, as Doctor Stuttaford has shown, there is a 65 per cent. chance of life after 10 years.

The Department and those in the medical establishment who advise the Department must come clean on the issue. Why are they discriminating against such a large proportion of the male population? Why should men simply have to accept that in the aging process, between 55 and 70, a growing proportion of us will have prostate cancer? As there is no screening, we shall have to accept that a growing proportion of us will die even if we have expensive and intensive treatment. That is nonsense in medical terms and in moral terms, but it is what the Government offer middle-aged men.

The argument for screening is overwhelming. Let us consider the evidence in the United States and in Germany, where all men over the age of 45 are advised to undergo an annual screening test—a prostate-specific antigen or PSA blood test. If the Government are in the business of preventive medicine, it is inconceivable that they can hold out much longer in such discrimination against so many men. If we accept the concept and principle of screening to prevent cervical cancer among women, how can we refuse to accept the concept of prostate cancer screening for men when the death rate from prostate cancer among men is four times as high as the death rate from the deadly disease of cervical cancer among women?

Some 22,000 of our fellow citizens die each year of cancer of the colon and rectum. Survival rates are poor even when it is detected, at 30 per cent. after five years. Yet in the specific area of colorectal cancer, which causes 17,500 deaths a year, early detection increases survival rates dramatically. With detection through early screening and the work done by consultants concerned, 80 per cent. of people survive.

The two cardinal symptoms of the disease are a change in bowel habits and rectal bleeding. As my hon. Friend the Member for Crewe and Nantwich said, because of the lack of coherence, the failure to identify the disease through screening, the lack of patient involvement in preventive health care, and the lack of significant effort being made to give general practitioners and practice nurses better training and information, a growing number of men and women are having those cancers identified too late. If treatment took place, their life expectancy would improve dramatically.

We therefore need to take a number of steps. We must improve general health education, with information for patients and patients groups and work done at GP level. We must improve education and training for doctors and nurses, particularly general practitioners and practice nurses. We need a technique to improve screening methods.

Screening does not necessarily mean blood tests, urine tests and samples on every occasion. It means introducing into the NHS a preventive strategy whereby, on a regular basis at community and primary health care level, people susceptible to those diseases are seen regularly by GPs and practice nurses, who discuss with them whether the pattern of their bowel habits has changed or there is rectal bleeding. That general approach would significantly improve the identification of the disease and thus the survival rate once treatment has been implemented.

In a written question on 27 May 1993, my hon. Friend the Member for Bristol, South asked the Secretary of State for Health: what plans she has to publish guidance to doctors in relation to screening for occult blood. That important test can determine at an early stage whether someone is likely to be suffering from the consequences of bowel cancer. Yet the Under-Secretary replied: We have no plans to issue guidance at this time."—[Official Report, 27 May 1993; Vol. 225, c. 668.] So the Government have no plans to notify or explain to GPs that that screening method is one of the most effective ways to identify the disease at an early stage.

Where is the Government's strategy for prevention? Where is the Minister's concern and interest? He is not even prepared to send a letter to tell GPs that the introduction of an occult blood test would assist greatly in identifying cancer in so many of their patients. He should not forget that that cancer causes 17,500 deaths a year. The stakes are high. He could at least send a letter to GPs about the matter.

Tests and procedural advice would help greatly in ensuring that GPs did not misread the symptoms of colorectal cancer as haemorrhoids. A constituent of mine is now terminally ill because such advice was not given to his general practitioner, who misread his symptoms. My constituent's symptoms went unchecked for more than 12 months. When that gentleman was admitted in an emergency to a local district hospital, sadly, he had a tumour in his colon bigger than the palm of the surgeon's hand. That is no exaggeration—it is in the discharge notes written by the surgeon, who said that on carrying out surgery to save my constituent's life he was appalled to find an inoperable tumour that was larger than the palm of his hand.

My constituent had consistently been to his general practitioner with symptoms which could have shown that he was suffering from cancer of the colon. If the Secretary of State had given that general practitioner the advice sought in the question tabled by my hon. Friend the Member for Bristol, South, the general practitioner and his colleagues in the medical profession would have been more aware that symptoms suggesting haemorrhoids could also be symptoms of cancer of the colon and rectum.

Primary liver cancer is the most common in the world. Its main cause is the hepatitis B virus. Thankfully, a large proportion of this country's population are not infected by that virus and deaths from that common cancer so far are relatively low compared with other forms of cancer that have been outlined. However, this debate is about early detection and prevention. The World Health Organisation wrote to the Government, along with other Governments, advising them that, for a variety of reasons, the spread of hepatitis B in the developed world poses a potential threat to future and current young generations. The World Health Organisation could not have given a clearer message that there has been arid will continue to be a spread of hepatitis B in communities such as the developed industrial society in which we live.

Until now, it has been a disease of the third world and the developed world has ignored it, as we have ignored the spread of tuberculosis, which is the world's largest killer. We have turned a blind eye to it because deaths from it have been mainly in the third world. We have therefore failed to recognise the growth of tuberculosis in the United Kingdom and have at the same time allowed health authorities to ignore screening and vaccination programmes for the first time since the introduction of such programmes in our society. That short-termism will undermine the community's long-term health and well-being.

Despite the increase in tuberculosis, the Government have so far ignored the World Health Organisation's warnings about the spread of hepatitis B in our society. The World Health Organisation has come back to the Government and recommended that we should put into place by 1997 a hepatitis B preventive vaccination programme which should target not only children in socially deprived communities but all children in the UK. Why do the Government refuse to comply?

I am talking about a vaccination to prevent cancer. The hepatitis B virus is the most common factor in the development of primary cancer of the liver; yet the western world faces now the possibility of our young people being put at risk because the hepatitis B virus is becoming more widespread. In later years, therefore, there is likely to be a significant increase in primary liver cancer. Medical science has given us a vaccination which can prevent the onset of this cancer, but the Government refuse to take the advice offered by the World Health Organisation.

The Government are penny wise and pound foolish. They allow health authorities to spend millions on BMWs, Jaguars and Range Rovers for executives while denying our children access to preventive strategies against hepatitis B. In some areas our children are not being vaccinated against the onset of tuberculosis either. That shows that the Government are not interested in preventive strategies or in a co-ordinated approach to the prevention and treatment of disease.

Like my hon. Friend the Member for Crewe and Nantwich I shall end by reading out a letter. It is typical of the letters that I receive in my role as shadow spokesperson on health. I could have brought a hundred similar letters sent to the Leader of the Opposition, the shadow Secretary of State for Health or the shadow Minister for Health. All those hundreds of letters offer poignant proof of the Government's failure to introduce the right surveillance programmes to deal with many of the cancers that threaten our society. The Government's failure has led and will continue to lead to thousands of needless deaths.

Not only will middle-aged men die needlessly: they are being discriminated against in terms of access to the health care that they need. What is the Government's position? When are they likely to make an announcement about the right of men to screening for prostate cancer? Do they intend to continue to discriminate against men? With detection, there is an excellent chance of successful treatment and longevity.

The following letter was sent to me by a lady about her husband: For a period of time my husband complained of backache. There was early diagnosis by his GP of rheumatism. At his most recent check in February 1992 he was informed that things would be okay. To the horror of his family when he could not stand the pain any longer in June 1992 he was diagnosed as having cancer of the prostate. No screening in the intervening period was ever provided, yet I understand that this disease, if screened, can be successfully treated. I believe this is one of the major causes of death among men, yet there is a simple blood test that can detect whether the prostate gland is working correctly. All the time we are hearing of the need for better preventive medicine. The result of all that was that my daughter had to leave her home and her work and for six months help me to nurse the unfortunate victim, my husband, who died in agony on 14 July 1993. It seems unbelievable that much of the expenditure which ensued as a result of his illness could have been prevented had this type of cancer been detected early enough. The lady is saying, poignantly, that her husband was treated to die, not to live. If only a small proportion of the NHS resources that are used to prolong life after diagnosis had been used to screen this man, he would have been saved. Screening is therefore cost-effective, not just for the Exchequer but for that priceless thing, family life. I am talking about love, togetherness, and the ability of families to live together for life, all of which can be torn to shreds in a matter of months because of the failure of the system to intervene early enough to treat positively gentlemen such as the one mentioned in the letter. The lady continued: As there was no alternative offered in relation to nursing my husband at home we had no option but to sacrifice everything to nurse him through his final months. As a result we, his carers, are still suffering the effects of the trauma we had to go through. For many months we were on duty 24 hours a day nursing, with little or no room for improvement. We were supplied with seven extra hours help per week, and it needs to be remembered that patients are ill 24 hours a day, seven days a week—including weekends and bank holidays. Vast amounts of NHS money have been used to supply drugs, sometimes up to 10 different types, visits to specialists and regular hospital check-ups. Some of the most distressing experiences we had were too extensive to write to you in this letter, but we feel it will draw your attention to some of the matters which have caused great concern to us. The irony is that when the NHS was asked to intervene with all the resources at its command—primary and secondary care, consultants, drugs—one vital ingredient was missing, and the treatment came too late.

I urge the Under-Secretary of State to respond tonight to the issues that I and my hon. Friend have raised, and to respond positively. For every positive action that the Minister takes, some family in Britain in the weeks, months and years ahead will be spared the trauma undergone by the woman who wrote to me and by the woman who wrote to my hon. Friend. Every week, thousands of families in this country lose a loved one prematurely because of treatable, curable cancers.

8.18 pm

The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville)

There is no disagreement between us about the fact that cancer is a terrible scourge which kills many people prematurely in a most distressing way, or about the fact that we must make every effort to deal with it.

Controlling cancer forms an enormous part of the NHS's work. It consumes nearly one tenth of the total NHS budget. Probably one in three people will be treated by the NHS for cancer at some time in their lifetime. Some 200,000 cases are diagnosed in England and Wales each year. There is no disagreement on the seriousness of the issue, although we could argue about the technicalities and the efficacy of certain screening programmes. However, I shall return to that later.

First, in response to the hon. Member for Crewe and Nantwich (Mrs. Dunwoody), obviously we have been at pains over the past few years, and particularly over the past two years, to bring down waiting times. Although more people are waiting for treatment on the NHS, the average time they wait has fallen considerably in recent months and years. That is good, although we must make further progress.

It is particularly important, however, that urgent cases—which must include cancer cases—for whom delay in investigation or treatment would pose an unacceptable risk, are treated promptly. That is why we wrote last month to remind all those involved in the NHS of the need to ensure proper clinical priorities—that is, giving priority to those patients who have an urgent need to be seen or treated and ensuring that GPs and everyone else concerned makes that distinction.

Mrs. Dunwoody

Does setting clinical priorities also include closing specialist hospitals such as the Royal Marsden, or is that simply a by-product of the policy?

Mr. Sackville

As the hon. Lady knows, it was agreed in February that the Royal Marsden would be an NHS trust. Whatever happens, I can assure her that there will be a proper network of cancer centres in London, as elsewhere. I have no knowledge of what she says about closing the Royal Marsden. If she has some information that I do not, perhaps she would let me know.

Mrs. Alice Mahon (Halifax)

The Secretary of State told the Select Committee that funding would be guaranteed only for 12 months. Of course, purchasers could withdraw contracts and put them somewhere cheaper, so the market could close the Royal Marsden very quickly.

Mr. Sackville

Any unit within the NHS has to have the appropriate demand for its services. Health authorities have to make decisions about how they use their funds. If we did not adhere to that principle, we would be running an extraordinarily inefficient health service and we would be spending money on buildings instead of patients.

We cannot guarantee funding any particular unit. The health authorities have to make decisions to spend the resources available to them with particular units.

Mrs. Dunwoody

The Minister could save us all a lot of time and he could certainly save me a lot of blood pressure. Does he not understand that if no long-term support is promised to a very specialised unit such as the Royal Marsden, he will be negating everything he has said about the necessity of setting up specialist units elsewhere or making information available to people throughout the United Kingdom? The existing market will destroy those specialised units, because the money will not be there to maintain them for a long time. Why does he not admit that that is one of his objectives? Why does he not stop treating Members of the House of Commons as if we were incapable of understanding that reading out long lists does not constitute a health policy?

Mr. Sackville

I was not aware that I had read out any lists. There is no hidden agenda against specialist centres. There is a place in treating cancer for specialist centres, district general hospitals and the community; it is diverse and will remain so.

Obviously, cancer must be treated promptly and sympathetically. Delays must be reduced to an absolute minimum. We all know that to wait, whether for the result of tests, for diagnosis or for treatment, is agony for anyone. People are understandably scared of cancer; they are terrified and we have to recognise that fact in anything we do. Clearly, long waits, such as those the hon. Lady mentioned, for radiotherapy or chemotherapy are unacceptable, and we have to make sure that they do not happen.

Mrs. Dunwoody

How would the Minister know?

Mr. Sackville

The hon. Lady must let me get on to the questions that she asked. She wanted to know how many hospitals met the standards set by the report of the Joint Council for Clinical Oncology. I said that we did not collect that information. That was a factual statement.

The NHS does not exist to collect information, but primarily but to treat people. We have to take decisions on how many civil servants, officials and administrators to employ—the people that the hon. Member for Makerfield (Mr. McCartney) talks about; the men in grey suits who simply collect numbers from units. We have to accept that every extra employee in the NHS who carries out that task is consuming NHS resources which should be used for treating patients.

Mr. McCartney

The hon. Gentleman is being disingenuous when he links the so-called men in grey suits with the use of information as a diagnostic tool to identify what is going on in our health care system. My hon. Friend is trying to find out from Minister why, when cancer levels continue to be high—both the incidence of cancer and the deaths from cancer—the system fails to take account of the issues raised because the Government will not examine the available information.

Why can the Minister not keep the information for which my hon. Friend asks, when he can tell me how many cars executives have? It is matter of priorities. If he can tell me how many cars national health service executives have, he can provide the information we require.

Mr. Deputy Speaker (Mr. Michael Morris)

Order. Interventions should be short and on one specific point.

Mr. Sackville

We have to consider carefully how many resources we spend on administrators and people who process returns from hospitals. It is true that we have an overall figure for the leasing expenses of cars used in the NHS. We certainly do not have a figure for how many are driven by managers or anyone else, but we know that in most trusts three quarters of cars are driven by community midwives, nurses, doctors and people visiting patients. Perhaps the hon. Gentleman should admit that.

We are all aware that bodies such as the Standing Medical Advisory Committee, which represents the medical royal colleges, has issued guidance on the clinical management of cancer on lung cancer and ovarian cancer in recent years. I must make it plain that we are also conscious that there is carefully considered clinical advice prepared by the experts in the professions which is not always put into practice. The treatment of cancer is probably a good example in many cases.

For that reason, the Department launched last year a major new initiative to see better use made of research-based evidence of clinical effectiveness. Good practice guidance has been issued to all health authorities, last year and this year, about the management of cancer in detection and treatment.

We have helped to make a growing body of information available to the NHS. For example, last year we issued as part of the "Health of the Nation" programme a handbook to help health authorities draw up plans precisely for reducing mortality and morbidity from cancers. We commissioned work, which will be published shortly, on the needs of populations for the management and care of patients with cancer of the lung and lower bowel. A series of effective health care bulletins have been issued; we are currently considering a further one on breast cancer. That, principally, is what we are doing on treatment.

The hon. Member for Crewe and Nantwich referred to the Joint Council for Clinical Oncology, which set targets for reducing delays in cancer treatment. That is just one of the pieces of data that we are using.

Early detection is enormously important and was covered at some length by the hon. Member for Makerfield. We must ensure that patients receive early treatment for cancer. To do that, we must detect it at the earliest possible stage. That is why we have established national screening programmes for breast and cervical cancer. We lead Europe in having established national screening programmes for those cancers.

Between 1987 and 1990, some £70 million was allocated to set up and run the breast screening programme, which is extremely successful, because we know that some 70 per cent. of women invited for screening are accepting the invitations. We are also the first country in the EC to have a comprehensive cervical screening service based on computerised call and recall. We did not hear much about that from the hon. Gentleman.

Mr. McCartney

Will the Minister give way?

Mr. Sackville

I will carry on, because the hon. Gentleman spoke at some length.

GPs' contracts have been designed to encourage all GPs to improve the take-up of cervical screening among eligible women. Nearly 97 per cent. of GPs achieved one of the targets. The screening programme will undoubtedly save lives and make a major contribution to the health of women in this country.

Before one embarks on a national screening programme, one must be absolutely sure that there is unequivocal evidence of the efficacy, that one will not have a system that will unnecessarily spread alarm, which would lead to a great many false diagnoses and to a great many operations and not achieve an overall improvement in health and longer life. It is too simple for the hon. Gentleman to say "Let us have a letter to GPs about faecal blood, and a screening system." It is more complicated than that.

It is not necessarily feasible to say that we can have a screening system for colorectal cancer based merely on occult faecal blood. That might mean that, to be effective, we would have to invite all men of a certain age for a fairly unpleasant investigation such as flexible colonoscopy. We might find fairly great resistance to such a screening programme among people who are healthy and who feel healthy. We must think carefully before we commit ourselves to any new screening programmes, although several are definitely currently under review.

The chief medical officer, who is a cancer specialist, has established an expert advisory group that will look carefully at the whole question of cancer services in this country. Its first task will be to advise health authorities on how to improve their services, from primary care right the way through to palliative care.

Mrs. Dunwoody

Will the Minister give way?

Mr. Sackville

I will carry on, if I may, because I have a few more things to say.

I am certain that, within the system that we have, there are problems and instances of lack of co-ordination. There are gaps. I think that the hon. Lady talked about people having a series of appointments. That is precisely the sort of problem that we need to address. We need a better co-ordinated approach to cancer services in this country. People can get lost between the primary care system and the hospital system, or lost or delayed between different parts of the hospital system—for example, between radiography and different consultants. That is precisely the sort of advice that we need and which the chief medical officer's advisory group seeks to introduce.

The chief medical officer must also decide with his colleagues the general shape of cancer treatment in this country. It is divided between specialist cancer centres, district hospitals and the community. Perhaps we shall see more instances of cancer treatment being delivered at the primary care level. But the claim that patients do better in specialist cancer centres is unproven except, perhaps, in very rare conditions such as eye cancers, bone tumours and particularly in children's cancers.

We cannot just say that it is all about specialist cancer centres or that everyone should be treated in cancer departments in district general hospitals. The evidence on the more common cancers is currently being reviewed by the chief medical officer's expert advisory group and will need to be updated regularly.

We are also concerned that patient services may suffer because of outdated radiotherapy and other specialist equipment. That is why we have made £15 million available centrally over the three years as part of a rolling programme to help replace equipment. That includes linear accelerators, scanners and mammography equipment. Some equipment is old and is being replaced. We must have the highest standards of quality of treatment and we intend soon to issue, for example, model guidance on quality assurance in radiotherapy.

Cancer is a common disease and is a large part of the whole NHS effort, which is measured by what is done or by total spending. There are no easy answers that suggest to us that we should immediately move to a whole series of further screening programmes, although, as I have said, several are potential. If we have absolute evidence of the efficacy of calling for a national screening programme a particular group, whether it be of men or women of a particular age group, we will do that.

Cancer is a disease of the elderly. Clearly, with a larger aged population we will see more cancers. We must work harder to ensure that we have better detection and treatment to prevent the alarming figures to which the hon. Gentleman referred from going further.

We take seriously cancer and the need to improve its detection and treatment. I take it seriously. I lost a close relative in the past few weeks from a long undiagnosed cancer and know well precisely what it can do to individuals and families. I assure the House that we intend to ensure that we have the best services possible in this country for the detection and treatment and cancer.

In accordance with Mr. Speaker's Ruling—[Official Report, 31 January 1983; Vol. 36, c. 19]—the debate was concluded.