§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Betts.]
9.49 pm§ Mr. Eric Illsley (Barnsley, Central)I am grateful for having secured the Adjournment debate this evening, especially as it has begun at such a reasonable hour. I am less happy about the subject that I intend to raise with the Minister of State, Department of Health, my hon. Friend the Member for Southampton, Itchen (Mr. Denham), whom I welcome back to the Dispatch Box after his visit to the Trent regional health authority this morning. I hope that his visit was productive and that he promised lots more money for that health authority.
Once again, I am raising issues of health care in my locality, specifically in the Trent region. I want to consider the failure of a succession of doctors and consultants to detect cancer in an individual until it was so far advanced that treatment will prove especially difficult.
The type of cancer is mouth cancer, which is a particularly unfortunate form. The tumour from which my constituent suffers was so large when it was diagnosed in March that he was advised that it was inoperable without the risk of losing his tongue, larynx and voice box, and thus the power of speech. If the diagnosis had not been delayed, my constituent could have had an operation much earlier. Such treatment could have been successful. I hope that he will still be able to have an operation if the current treatment is successful.
My constituent, Steven Harley, is a 41-year-old business man. He is also a personal friend; that makes the case all the more difficult. I shall explain the case in a nutshell. Mr. Harley developed throat pains, which became increasingly severe, last July. Nineteen medical examinations by 11 different doctors did not lead to a diagnosis of those throat pains as a form of mouth cancer.
Mr. Harley visited his general practitioner to complain of a sore throat. In the following 10 weeks, he saw his GP six or seven times. He had blood tests and courses of antibiotics. He was told that he was probably suffering from a virus and that he would simply have to sit it out. At that time, there was no suggestion of referral to an ear, nose and throat specialist or any offer of an MRI scan, which might have picked up the tumour. Mr. Harley suffered 10 weeks of persistent pain.
I accept that GPs cannot be expected to diagnose special types of cancer. Indeed, many GPs go through their medical careers without seeing, or dealing with, particular types of cancer. I do not therefore claim that a GP should have been able to tell Mr. Harley immediately, "Yes, it's cancer. Here's the treatment. Off you go." However, Mr. Harley asked his GP more than once, "Could this pain be a form of cancer?" He was repeatedly told that it was not. If a GP is sufficiently qualified to dismiss unequivocally an inquiry about whether a condition is cancer, he should be aware of the other side of the coin. How does he know that a condition is not cancer? If the signs exist, would he recognise them? If not, how can he simply deny that a condition is cancer? He cannot do that without knowledge about, or expertise in, cancer.
Mr. Harley has private medical insurance, which enabled him to arrange to see a specialist. He saw the specialist three times in four weeks. After those 983 consultations, he was told that nothing had been found and nothing could be done. Even that specialist did not even consider a scan or a referral to another specialist or anyone else. Incidentally, had Mr. Harley wanted to take advantage of an ear, nose and throat surgeon at Barnsley, he would have been unlucky. Of the two places for ENT surgeons that Barnsley had at that time, there was one vacancy. One of the surgeons had left and the other one was off sick. He would not have been able to see an ENT surgeon at Barnsley if he had wanted to do so. Even now, ENT surgery on people in Barnsley is carried out at Rotherham district general hospital. There is a locum in place at Barnsley throughout the week, but if anyone in the area has an ear, nose and throat problem between 5.30 pm on Friday and 9.30 am on Monday, he or she has to go to Rotherham. I am not happy with that.
At this stage, Mr. Harley's pain was increasing severely. It was spreading in his mouth, jaw and neck. He felt that he had to visit Barnsley district general hospital one Saturday night to ask for pain killers. He presented himself at the casualty department to ask for them so that he might have help in sleeping. He did that on several occasions. He once more returned to his general practitioner, and again he was dismissed by the practice. Through his insurance, he arranged to see privately an orthopaedic surgeon in December, thinking that something orthopaedic could be wrong with him. He was told by that surgeon that there was nothing wrong and that nothing could be done for him.
By millennium eve, or new year's eve, Mr. Harley was in so much pain that he went once again to the casualty department of Barnsley district general hospital. He described his symptoms to a junior doctor. He asked for help and particularly for pain killers because the pain was so intense. The junior doctor prescribed pain killers and sent him home.
The pain was so bad that Mr. Harley presented himself again on millennium day, or new year's day. He asked for stronger pain killers. He told the doctor that the pain killers that he had been given the previous evening were not giving him any respite and that he needed something stronger. He was then seen by a senior doctor, who took his blood pressure. He refused to give him any stronger pain killers and laughed at the idea that the pain killers that he had already been given were not sufficient to do the job. He then took Mr. Harley on one side, put his arm round his shoulder and said, "Look, if I were your brother I would tell you to forget about this, to go home and live your life." That was the attitude of the doctors at Barnsley district general hospital—go home and get a life.
I find that incredible. No one would go to a hospital on new year's eve or new year's day over the millennium period unless he or she had a real problem. However, a doctor was dismissing Mr. Harley out of hand. There were three things wrong with that doctor's approach. First, he failed absolutely to diagnose anything wrong with Mr. Harley. He refused to acknowledge that there was any possibility that he could be suffering from any sort of disease, let alone cancer.
Secondly, he would not believe the extent of the patient's pain and accordingly did not prescribe a pain killer. Thirdly, he did not refer him elsewhere so that he might get some relief. He then took Mr. Harley on one side and told him that he was imagining things, that there was nothing wrong with him and that if he went away and forgot about it, everything would be all right.
984 I am concerned that my constituents are being treated by a doctor with such an attitude. It is bad enough that South Yorkshire, Barnsley and the Trent region have so many problems as a consequence of the health authority's poor funding and that there has been poor performance over previous years, without having to deal with the attitude of the medical profession in certain circumstances.
Is the training and education of our doctors so bad as to produce such a response when one of my constituents presents himself in pain during a bank holiday period? Have we reached the stage when a doctor takes a person on one side and says, in effect, that he does not believe him?
§ It being Ten o'clock, the motion for the Adjournment of the House lapsed, without Question put.
§ Question again proposed, That this House do now adjourn.—[Mr. Betts.]
§ Mr. IllsleyIs knowledge of cancer really so poor in our health service? Should we believe that none of the 11 different doctors—from GPs to specialists and consultants—who were consulted on 19 occasions could not put a finger on the problem and say, "I think that this could be cancerous. I must refer you for a scan or to a specialist oncologist who knows about this condition."?
The catalogue of errors involving Mr. Harley continued. In January, he arranged another private consultation with another consultant. He had an MRI scan, but was told that nothing could be done. That MRI scan took place seven months after he had first complained about his symptoms. The specialist he saw prescribed pain-killers and gave him a return appointment. That appointment took place on 1 March this year, by which time Mr. Harley had lost two stone and had difficulty eating or speaking because of the size of the tumour, which was swelling in the back of his tongue.
That specialist referred him to an ENT surgeon in the same hospital because, at last, they had diagnosed that his problem could be mouth or throat cancer. Those were private consultations, but at least his condition was diagnosed. Unfortunately, he was told that the tumour had become too large, so he could not undergo surgery immediately. He was told that he might require operative treatment if chemotherapy and radiotherapy could not shrink the tumour. He was also told of the threat of losing his tongue, voice box or larynx.
Mr. Harley is undergoing chemotherapy and, I think, radiotherapy to try to shrink the tumour. My family and I—and, I am sure, the House—wish him well and hope that his treatment will enable operative treatment to be carried out successfully. However, during nine months, a man who had private medical insurance under which he could arrange private consultations quickly and at short notice underwent 19 examinations by 11 doctors. What would have happened to someone who was simply an NHS patient in those circumstances? I fear that that cancer would have gone undiagnosed for far longer.
Mr. Harley tells me that, when he was diagnosed with mouth cancer, he contacted Cancer Bacup, one of the cancer charities in this country, which sent him a leaflet about mouth and throat cancers. When he read about the symptoms, he realised that he had been suffering from every one. He had presented himself to doctors while suffering from the symptoms listed in the leaflet, 985 but 11 doctors could not equate them with cancer, while the charity could do so. If Mr. Harley's condition had been detected earlier, it could have been treated far more easily. Why was he not believed when he presented himself in such pain? Why was he not listened to? Why did none of the doctors think that he could have cancer? Why were they so sure that he was wrong and they were right? I sincerely hope that the various health authorities involved will take a good long look at themselves and ask whether what happened was good enough. The Government should consider the issue nationally and especially in the Trent region, where underfunding is always a problem. I am becoming a little tired of complaining in the Chamber about the poor health service that my constituents receive, and we now have another problem to add to all the rest that I have raised.
I should like to touch on a connected issue concerning the availability of cancer drugs, especially taxanes. There are various derivatives of that type of drug, but they are generally known as taxanes. I should like to place on record my thanks to Hugh McKinney of the campaign for effective and rational treatment, whom I met today to discuss this issue. As my hon. Friend the Minister knows, there are real concerns that such drugs are not available on the NHS. I have been told this evening that they are likely to be available only to private patients, and that NHS patients will not have access to them. That is of real concern to me because the vast majority of patients in my constituency are NHS patients and will be denied access to those drugs.
I am also told that the availability of those drugs will depend on the type of cancer, and that we are likely to move from postcode prescribing to tumour-type prescribing. Whether the drug will be available will depend on the type of cancer. Even with the 6.8 per cent. much welcomed uplift in cash funding for the NHS, there will still be a problem of funding for these drugs.
This case has been a nightmare for my constituent, and he is still living it. He has been ignored, insulted and left to organise his own health care. I hope that he now gets the proper treatment that he deserves, and that my area gets a better health service than it has at present.
§ 10.7 pm
§ The Minister of State, Department of Health (Mr. John Denham)I congratulate my hon. Friend the Member for Barnsley, Central (Mr. Illsley) on obtaining this debate. He has made a compelling and moving speech on behalf of his constituent, Mr. Harley. My sympathy and that of the House goes to him for his predicament, and we send our best wishes for his future treatment, which we hope will be a success.
My hon. Friend mentioned the fact that I visited the Trent region earlier today. It is one of those ironic coincidences that I was visiting the Jasmine centre at the Doncaster royal infirmary, which is a specialist breast cancer clinic. It is a national leader in patient-centred cancer services for women suffering from breast cancer. My hon. Friend's speech reminds us all of the unacceptably wide variations in the quality of treatment and care and access to care in the NHS, which the Government are determined to tackle.
My hon. Friend told us of the delay in diagnosing Mr. Harley's cancer. He will understand that I cannot get involved in a discussion of the details of that individual 986 case. I understand that the Minister for Public Health will shortly reply to my hon. Friend's letter, but it is difficult for me to discuss the detail of this case.
However, I can say a little about the options available to any of our constituents who have cause for concern about the treatment they have received. First and foremost, there is the NHS complaints procedure. I understand that in this case the chief executive of the NHS trust has written to my hon. Friend's constituent and given a commitment to a thorough investigation of his concerns.
A constituent is also entitled to refer to the General Medical Council any doctors—private or NHS—whose practice gives grounds for believing that they have been negligent or incompetent. Doctors can be referred to the GMC for suspension or removal from the list.
I should like to deal with the particular points that my hon. Friend raised in the context of the Government's commitment to providing fairer and faster care as part of our determination to modernise the national health service. We want to ensure that all parts of the health and social services system work better together; to improve clinical performance and NHS productivity; to increase flexibility in training and working practices; to ensure fast and convenient access to services; to empower patients through information; and to tackle inequalities and avoidable ill health. If we do all that, we can deliver the services that we all want.
We are impatient for change, and want to see evidence of faster, fairer, more convenient services, including modern diagnostic and treatment services. We want to ensure that services are moulded to the needs of individual patients. The Budget statement announced substantial additional investment in the national health service, part of which has already been released to my hon. Friend's health authority. We have set up action teams to tackle each of the key issues, and a national plan for the NHS will be published in July, identifying the main modernisation measures and targets.
Improving cancer services must and will be an integral part of our modernisation plan. Professor Mike Richards, the national cancer director, has been asked to develop a national cancer programme setting out key objectives and deliverable outcomes for cancer care. We are determined to reduce the impact of cancer on people's lives, and to create a world-class cancer service. We have set the challenging target of reducing the death rate from cancer by 20 per cent. by 2010. We can meet it only if we have a tough programme of action involving prevention, screening, early diagnosis and high-quality treatment and care.
Patients need to have confidence in their health service, and to know that if they have symptoms of what could be cancer they can discuss them with their GP and be referred quickly and appropriately if necessary. However, although cancer is a common problem—about 220,000 cases are diagnosed each year in England and Wales—an individual GP is unlikely to see more than eight or nine cases a year. GPs must differentiate between patients whose symptoms may be those of cancer, and the much larger group who have similar symptoms but do not have cancer.
That is why we have published cancer referral guidelines for primary health-care teams this year. The guidelines are intended to enable those working in primary health care to identify the patients who are most 987 likely to have cancer, and to require specialist investigation urgently. They cover all cancer sites, including the head and neck, and provide incidence figures for those sites. They highlight common risk factors, and list common symptoms. They give GPs concise, useful information that is easy for them to use, helping them to ensure that people with cancer-like symptoms are referred quickly for further tests.
Although that action has already been taken, it must feature largely in my response to my hon. Friend. It is a recent initiative on the Government's part, which is clearly intended to secure consistently high-quality referrals by GPs working in primary care—and, of course, to enable those GPs to identify people who are unlikely to have cancer, or may require a less urgent referral to hospital. We will continue to support research to determine which symptoms indicate that people consulting their GPs have a higher risk of developing cancer, and which patients can be safely followed up within primary care.
That will be backed up by the significant investment that we are making in new technology in both primary and secondary care over the next three years. It will help to provide a range of networked services such as out-patient appointment booking, test result delivery and e-mail to all GPs by the end of 2002. All that will enable patients to be referred quickly to the most appropriate specialist team for the initial investigation and appropriate management of their condition.
We need to build on effective referral by ensuring that people have speedy access to services. Services should be there when people need them. Those who need treatment urgently, as many cancer patients do, should receive it on an urgent basis. In April 1999, we set a two-week waiting-time standard for all patients with suspected breast cancer whose GPs judged that the need for referral was urgent. That is the time to be taken from a patient first contacting her GP and the GP making an urgent referral for an out-patient appointment.
From April to December 1999, more than 56,000 women benefited from that high standard and 96.4 per cent. of breast cancer patients were seen within the target period. We will be rolling out that standard for all other cancers throughout the year, with lung cancer, children's cancers and leukaemia patients being the first to benefit from the two-week standard from April 2000.
It is important, too, to minimise the time that patients have to wait for diagnostic tests. We are seeing the biggest ever single cash investment in cancer equipment of £93 million of lottery money from the new opportunities fund.
Many of the investments are in the Trent region. Barnsley will receive an updated mammography X-ray machine, as requested by the clinical director of the breast screening unit, to replace a machine that is 10 years old. I understand that that will be installed and working within the next few weeks.
I understand, too, that as part of the developments in cancer services resulting from the Calman-Hine standards, Barnsley district general hospital will shortly open a purpose-built chemotherapy unit to enable patients receiving non-complex chemotherapy treatment on an out-patient basis to be cared for closer to home, rather than having to travel to Sheffield for their treatment.
Having given the broad picture about our approach to modernising cancer services and having emphasised the importance that we attach to speedy GP referral and 988 out-patient consultation, I should like to discuss the general mechanisms that are being put in place to tackle the performance of individual clinicians, or the failure of systems to deliver good-quality care.
Key to that is clinical governance. That process places quality at the heart of health care. We are ensuring fair access to effective, prompt, high-quality care wherever a patient is treated in the NHS by setting clear national standards, but with responsibility for delivery being taken locally through the implementation of clinical governance, backed by consistent monitoring arrangements.
Through clinical governance, we intend to ensure that we have clear lines of responsibility and accountability for the overall quality of clinical care; a comprehensive programme of quality improvement activities; clear policies aimed at managing risk; and procedures for all professional groups to identify and to remedy poor performance. We have underpinned the development of clinical governance by a new statutory duty of quality on NHS trusts, primary care trusts and health authorities, which requires them to put and to keep in place arrangements for monitoring and for improving the quality of health care that they provide.
In addition to developing clinical governance, we have reached an outline agreement with the British Medical Association in the shape of a new form of consultant contract, which will involve regular appraisal of performance. Indeed, under proposals put forward by the chief medical officer, all doctors will be subject to regular appraisal.
The chief medical officer is drawing up a report on dealing with adverse clinical incidents. That will reflect the fact that most such incidents are the result of the failure of systems, rather than simply of individuals.
As I have said, we need to ensure that patients have access to high-quality diagnosis, treatment and care services. We are committed to improving the quality of cancer services through the implementation of "Policy Framework for Commissioning Cancer Services", the Calman-Hine report.
We have published evidence-based guidance on improving outcomes for breast, colo-rectal, lung and gynaecological cancers. Further guidance on cancers of the stomach, oesophagus and pancreas will be published in the spring, and guidance on urological, skin, haematological and head and neck cancers will be commissioned over the next two years by the National Institute for Clinical Excellence.
We are developing national standards and performance indicators, based on that evidence-based guidance, which will be used to deliver and to measure continuous quality improvement in a consistent manner throughout the country within a national quality management framework.
All those improvements—setting standards, publishing evidence-based guidance on treatment of cancers and developing clinical governance systems—enable us to ensure that the health service performance can be independently reviewed by the new Commission for Health Improvement, which began work in April. We have asked the commission to conduct a national review of implementation of Caiman-Hine as one of its first tasks.
My hon. Friend asked about the National Institute for Clinical Excellence and the impact of its work on the availability of cancer drugs. NICE has been asked to 989 assess the cost effectiveness and availability of a number of anti-cancer drugs. Because of the relatively high cost of some of those drugs, some difficulties about interpreting clinical evidence and various debates, health authorities have reached different decisions on whether to fund them. That is the background to so-called postcode prescribing, which is one of the problems that we are determined to tackle.
Last week, NICE published the first of its guidance, recommending the use of paclitaxel—taxol—in ovarian cancer. Such guidance will help the NHS to focus its increasing resources on the treatments that will best improve people's health. Effective treatments will be actively promoted. As we must make the best use of NHS resources, treatments without good evidence of clinical benefits—or treatments that are more expensive than effective alternatives—would be discouraged by the NICE process.
After the Budget, when my right hon. Friend the Secretary of State for Health released the £600 million of additional funding for this year, he made it perfectly clear that we expect that money to be used, among other things, to pay for the cost of implementing NICE recommendations. I do not believe that the fears that my hon. Friend expressed about what he described as tumour-based prescribing will prove to be justified. NICE 990 has been asked to review the evidence on the clinical cost-effectiveness of particular drugs in treating the conditions for which they have been licensed and for which there is an evidence base.
We have recently announced that, in the next year, a range of other anti-cancer drugs will go to NICE for assessment. They include three drugs for colon cancer, three drugs for lung cancer and three drugs for blood cancers, such as leukaemia. NICE will also assess some other recently licensed cancer drugs, including one for brain tumours and one for pancreatic cancer. I am certainly convinced that NICE' s work will tackle some of the unacceptable variations in access to cancer treatment and care that are currently too evident in the health service.
My hon. Friend—on the basis of what has happened to his friend and constituent—raised the very important issue of cancer services and performance of the national health service. I hope that, in this brief debate, I have been able to assure him that we have taken action to address many aspects of that issue. Although there is some way to go before we have the cancer services that we aspire to deliver, we are determined to continue to make progress month by month and year by year.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-three minutes past Ten o'clock.