[Relevant documents: The Government's response to the Sixth Report from the Science and Technology Committee, Session 1999–2000, Cm 4928,.]
§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Kevin Hughes.]1.46 pm
§ Dr. Michael Clark (Rayleigh)
I welcome the opportunity to present the report of my Select Committee on Science and Technology entitled "Cancer Research—A Fresh Look". I thank the Liaison Committee for allowing us to have this estimates day debate and the Leader of the House, who has now departed, for agreeing to include it in this Session's busy programme.
The attendance this afternoon may not be as large as we might wish to see for a debate on cancer, but those attending have a great interest in the issue and will, I know, make a useful contribution when the time comes.
Over my lifetime, there have been subjects that one has never talked about. When I was a boy and a youth, homosexuality was never mentioned. When I was a young man—even a married young man—contraception was taboo and not discussed. Yet both those subjects are now quite rightly widely discussed. However, all my life, until very recently, cancer has been a taboo subject, and only recently has it been discussed openly and frequently among people, at work and at leisure.
Why has cancer been a taboo subject for so long? It is not as though it is rare—40 per cent. of people in the United Kingdom will be diagnosed at some time as having cancer. It is not as though cancer is something to be ashamed of: it is not caught from an illicit sexual contact; it is not a sign of unclean living; and it is not contagious—it cannot be transmitted by contact. So why has cancer been ignored in conversation and swept under the carpet for so long?
I believe that the reason is that cancer kills—it kills 25 per cent. of the population. Not only does it kill, however: until very recently, there has been no cure and little hope. If people spoke about cancer they did so in hushed tones, in awe of an unbeatable killer. They knew that for the friend, the relative, the loved one who had cancer, the death knell had sounded. For that reason, cancer was not discussed.
In recent years, there has been an amazing virtuous circle. Medical science has advanced quietly, very often from behind the scenes, without much trumpeting of its success. People have talked about patients surviving cancer. Cancer has slowly become a topic for discussion. The more discussion there has been, the more optimism has entered into the whole issue of cancer treatment and cancer medicine, and the more money has been given by the public to charities for cancer research. As a result, advances have been made in drugs and in treatment; there has been more success, followed by more hope, more money and more results. There is complete openness about cancer because we have got rid of the terrible situation that I described—in which cancer was a killer and there was little hope.
Our report was conceived at the beginning of last year; we started our inquiry in March 2000. We chose its title because we thought that there was a new opportunity on cancer. We were not the first to think so. In 1995, 1258 the Conservative Government published a report on cancer treatment, led by the heads of the national health service in England and in Wales, which became known as the Calman-Hine report. That was the beginning of the consideration of how to improve the organisation and delivery of cancer services.
In July 1999, about eight months before we began our inquiry, the Labour Government issued a report, "Saving Lives: Our Healthier Nation", which identified cancer as a disease—among others, such as coronary heart disease—on which action was needed to improve the quality of life for people in this country. In October 1999, a national cancer director was appointed. Thus we do not claim that our report is the beginning of a movement for the improvement of cancer treatment; it is part of a continuum—we like to think that it is a helpful and significant part.
Immediately we announced our inquiry, the BBC contacted us and asked if it could make a programme in the "Scrutiny" series on the work that we planned to undertake. We agreed, but with the proviso that the programme should be a serious study of a serious subject—not a frivolous film that aimed to catch Members of Parliament out as they went about their business.
I am delighted to say that the BBC filmed the majority of our eight evidence sessions, in which we heard from 30 eminent witnesses. The corporation also filmed all but one of our five visits to cancer treatment centres in the United Kingdom; and accompanied us on our visits to the United States, Canada and Finland, where we compared and contrasted cancer treatments with those in the UK. A 40-minute film was produced; it was screened on BBC 2 on 29 July. The majority—if not all—members of the Select Committee thought it a worthwhile film; it was well and professionally made, and we thank the BBC for its interest and for its contribution to the fight against cancer.
While we were abroad, we found much to admire; we were grateful that every institution that we visited received us warmly. We were gratified that each of them appreciated and praised the work being done in this country. Our visits abroad were not just about finding out whether other countries were doing better than us, as they were in some respects. Each centre and each country congratulated us on the high quality of individual work in this country, on our centres of excellence and on our research. That does not mean that we cannot do better, because we can, but it does mean that we have international standing.
§ Mr. David Tredinnick (Bosworth)
I note, in my hon. Friend's excellent report, recommendation (m):More clinical research is needed to determine the benefits that patients derive from complementary therapies.Is my hon. Friend aware that that recommendation neatly ties in with the House of Lords Science and Technology Committee report on complementary and alternative medicine, which argued for more research, and with the fact that nearly 160 Members of this House have signed an early-day motion broadly supporting the Lords report? Can my hon. Friend mention recommendation (m) in his opening remarks?
§ Dr. Clark
Of course complementary medicine should not be ignored. We mentioned it in our report, as my 1259 hon. Friend rightly says, and I would continue to support the need for research into complementary medicine, but I believe that our key priority at this stage is to find money for more traditional research, which is likely to have a greater payback in terms of cancer treatment. By that I do not mean that complementary medicines should be excluded. The research should continue in parallel with the traditional research to which the report principally refers.
§ Rev. Martin Smyth (Belfast, South)
The hon. Gentleman spoke about traditional research, and mentioned the fact that tributes were paid abroad to the research that was taking place in this country. May I press him and encourage him in his campaign to get more money into that research, bearing in mind the fact that at least £25 million will be needed in Northern Ireland alone—in an excellent department under Professor Johnston—and that that need is replicated all over the United Kingdom?
§ Dr. Clark
The hon. Gentleman is right. At the end of my few remarks I shall discuss the need for more money. We recognise in our report the excellent work that is being done in Belfast, and Northern Ireland in general. We took evidence from people from the Province, and one of our last witness sessions—one of our larger sessions—gave us the opportunity to hear people who were recovering from cancer, who had travelled from Northern Ireland to tell us about the excellence of the service there.
Not only was it right that the organisations that we visited abroad should pay tribute to cancer research in this country, but that we as a Committee paid tribute to the cancer professionals, the cancer charities and all those associated with cancer care in this country. We are grateful for the willing help that we have obtained in preparing our report—from the Committee's own advisers, from the 30 witnesses who came to see us and from the host of institutions that we visited, in Northern Ireland and elsewhere. We received 106 written submissions, all of which were carefully scrutinised, and all of which were very valuable in helping us to prepare our report.
I mentioned that we had one witness session at the end to which we invited 20 witnesses, some of whom came from Northern Ireland to tell us of their experience of cancer. We lifted that idea from what we saw when we visited the United States Congress, where we attended a session at which members of the public were invited to speak for no more than five minutes to present their views on an issue. We held a similar session in this Parliament, at which we heard 20 witnesses in two hours. Each person was allowed five minutes to express their point of view. They came along with some trepidation, never having given evidence to a Select Committee. We received them in as friendly a way as we could and listened to their points of view, which we have taken into account in our report.
I commend to other Select Committees the idea of holding a witness session that members of the public may apply to attend to give evidence. Twenty are selected and can present their individual, and sometimes lonely, point of view to a Select Committee of the House.
1260 It was right to call our report "A Fresh Look". There have been changes to the way in which the services are delivered. A national cancer director has been appointed, and the two largest cancer research charities are now willing to work together.
What was it, then, that triggered our report? Many factors did so, some of which I have mentioned. Comparisons have been draw between the mortality and survival rates in this country and those in other parts of the world, especially north America and Europe. It is difficult to draw definitive comparisons, but we found that some of our mortality and survival rates were not as good as they could be compared with those in other countries in the developed western world, particularly in north America. Although the survival rates for cancers overall have steadily improved in this country, there has been little or no improvement in the survival rates for cancers of the lung or the prostate.
Our report is comprehensive, as is the Government response, dated November 2000. Many issues were highlighted and discussed in our report, and other members of the Select Committee present this afternoon will wish to raise many others. I shall, therefore, quickly confine myself to dealing with three topics in the report—epidemiological and public health research issues; Government funding, as I promised the hon. Member for Belfast, South (Rev. Martin Smyth); and the national cancer research institute.
On epidemiology, cancer registration is an invaluable tool in the fight against cancer, yet the organisation of records is haphazard—probably because of historical accident, rather than by design—and needs to be improved if we are to get the most of our those records, which can be valuable in fighting cancer. If we are to fight cancer effectively, it is always helpful to know where, in which age group and in relation to which type of life style cancers occur. The Government are aware that data collection may be hindered by the Data Protection Act 1998.
In our report, we recommended:The Government should introduce legislation to make registration of cancer a legal requirement, both to ensure completeness of the cancer registry data and to ensure access to those data for legitimate purposes.I believe that the Government have sympathy with that point of view, and I look forward to hearing the Minister's views on that matter and what she and the Government might do about it.
On Government funding, in the United Kingdom, for every pound spent by the Government, £2 is spent by charities. However, in north America, for every pound spent by charities, £2 is spent by Government. In the United Kingdom, because of the public's generosity to cancer charities, it is possible that the Government have, to some extent, been let off the hook. That is no longer acceptable. The Government should view public giving not as an excuse to minimise their own contribution, but as showing the public's earnest determination to improve the situation. The Government should recognise the fact that the public want to improve the situation, and match— and preferably double—charitable giving.
In paragraph 102 and 103 on page 16 of their response, the Government give an encouraging reply. They say:The UK Government expenditure on cancer research is inevitably a smaller proportion of total expenditure from all sources than in many countries where a tradition of popular support for cancer research is less evident.1261Nonetheless, the Government accepts the Committee's basic premise, and supports the case for increased investment in order to redress years of under-funding, to make the most of exciting new opportunities.That is a generous Government response to the criticism that we made, but there is still a need for delivery in due course.
The day before the press conference on our report, the Government announced an extra £200 million for cancer research. I am sure that, in winding up the debate, the Minister will recap on all the initiatives that the Government have undertaken and all the new money that they plan to make available.
Finally, we proposed a national cancer research institute to co-ordinate cancer research in the United Kingdom and cancer research funding. On 27 September 2000 the Government responded positively with the announcement in the NHS cancer plan of their intention to come forward with definitive proposals for such a research institute, broadly along the lines that we had proposed. Page 20, paragraph 117 of the Government reply 117 sets that out. We are grateful to the Government for that response and look forward to seeing the benefits of implementing those proposals in due course.
Although we are debating cancer from our adversarial positions in this House, cancer is not a political topic. It is a human problem of national and, indeed, international importance and dimensions. The alleviation of suffering, the treatment of patients and the cures for the disease are also national and international responsibilities. We on the Science and Technology Select Committee have tried to present a fair, comprehensive and helpful report. The Government's response was appreciative and encouraging. I believe that the Government are ready to acknowledge that there is still a lot to do, and we wish them well in their endeavours.
§ 2.6 pm
§ Dr. Ashok Kumar (Middlesbrough, South and Cleveland, East)
As a member of the Science and Technology Committee I start by paying tribute to our Chairman, who co-ordinated the work and ensured that we all behaved cordially and made significant progress. My hon. Friend the Member for Norwich, North (Dr. Gibson) was the prime mover and the idea was his brainchild. We should, therefore, record, that the agenda was set by him.
As the hon. Member for Rayleigh (Dr. Clark) said, the debate is essential and we need a fresh look at cancer research in the United Kingdom. I agree that what the Government have done and the Secretary of State's announcements have given a boost to cancer treatment. That boost fits perfectly with the national plan for the NHS. The NHS is the greatest achievement of Labour Members. We recognise that the health plan fits in with the Government's programme for the 21st century.
As the hon. Gentleman said, cancer is one of the great scourges of our time. It is a disease that knows no boundaries—boundaries of country, class, gender or race. The prevalence of cancer means that one person in four will at some time be diagnosed as suffering from a cancerous condition and a third of all those here will die from that condition.
As anyone who has had a close family relative with cancer knows, the sheer malignancy can infect the entire household emotionally. I know that only too well myself 1262 as my aunt died from breast cancer in 1983. In a close-knit, Asian family where ties of affinity are great, it hit me hard personally and caused a lot of pain and heartache. I saw at first hand what a deadly disease cancer was. My aunt was only 52. She was effectively robbed of her young life. She was a happy, lively woman and I adored her. She faced this dreadful disease with dignity and courage. She was given all the support of her doctors, nurses and hospital staff and, of course, of her family— her nearest and dearest.
The challenge that we face is to eradicate the conditions that help to foster cancer. Society can then begin to make positive steps towards the better treatment and analysis of the cancers that still occur.
At this point, I want to highlight some of the Committee's findings and to place them in the context of the work being carried out on cancer research, treatment and prevention, from which my constituents could benefit. The report makes 38 good recommendations. I want to focus on only a few of them, specifically those in paragraphs 119 and 143 of the report, relating to the need for patient involvement and the need to spread cancer research across the United Kingdom in a new network of centres of excellence.
Research is being carried out into the causes and the nature of cancer and can be fertilised by other research being carried out in related fields, notably the work being carried out on the human genome project. Research into drug discovery and design is also taking place, as is translational research that seeks to transfer the findings of interdisciplinary teams of scientific workers into treatment regimes. Such work is based on clinical trials and their evaluation. Research is also being carried out into improving patients' quality of life. It is crucial that such work is seen as cross-disciplinary and cross-frontier, and that everyone involved, in whatever sector, is able to appreciate how his or her work can be seen to contribute to the over-arching cause: the eradication and overcoming of cancer.
There are many strands to the research work. The Medical Research Council, in giving evidence to the Committee, stated that such strandscan be pursued and shared simultaneously.It is crucial that all the agencies involved in this battle see their work as complementary and not competitive. The national health service is the key agency in this country, but there must be parity of esteem between consultants and specialists working for the national health service and scientists working in an academic setting or in drug company laboratories.
Specialists working in those fields must, likewise, pay heed to the work of those dedicated people who manage national and local cancer charities. Charities fund much research work at local and national levels, as the hon. Member for Rayleigh mentioned. All those engaged in research must be conscious of the efforts of people working at the sharp end of the treatment process: the consultant oncologists, the nursing staff, professionals allied to medicine, radiographers and voluntary workers from the various cancer relief groups.
Those involved in research must, above all, have empathy with cancer sufferers and patients, who have a role in combating the disease by volunteering for clinical trials and by playing a full role in supporting research 1263 work carried out in their locality. One of the Committee's most far-reaching recommendations is in paragraph 119, which is thatall Government-supported cancer research committees include patients' representatives as full members and that the Government provides resources to ensure proper training and support for patients' representatives.I said earlier that the NHS must be the UK pivot. The Committee's most important recommendation, to be found in paragraph 143, is that national health service funding for cancer research should be increased immediately by £100 million, and that this dramatic increase in funding should be spread geographically across the UK so that at least 12 new centres of excellence can be established. Those centres should be at least the equivalent of the Royal Marsden hospital, which Committee members visited.
This call for resources is little more than cancer sufferers and their families deserve. The Committee showed, on the evidence of cross-comparisons, that Government support for advanced research into cancer is low compared with that available in other advanced nations. We come out particularly badly when compared to the United States. Indeed, as paragraph 145 of the report points out, the two UK centres that we visited— Belfast city hospital and the Beatson oncology centre in Glasgow—receive better funding from the US National Cancer Institute than they do from our own Government. That should not be tolerated.
The siting of centres of excellence should be tied to existing facilities, such as new large hospitals and universities with records of excellence in medical research and training, and to areas where there are specific incidence of cancer. My area of Teesside should be considered. It has hospitals and university expertise at the university of Teesside and the university of Durham's Teesside campus, which is located in Stockton. The simple reason why such a centre should be situated there is that we are unfortunate in having one of the highest incidence of cancer in the country.
Specialists from the South Cleveland hospital, which is managed by the South Tees acute hospitals NHS trust and is the cancer centre for Teesside, told me that they support, from a local perspective, the sentiments of many of the report's conclusions. Oncologists in particular are optimistic. Mr. Peter Dunlop, the clinical director of radiotherapy and oncology, and a cancer specialist at the hospital, told me:Research and development and education are vital elements involved in running an effective cancer service … Stimulate and advance local academic and research training activity and you will get quality outcomes for patients … Many of these recommendations for enhancing the UK cancer research resource base in the UK are fully supported.However, Dr. Dunlop gave a serious warning. He said:I still believe that difficulties lie ahead. Recruitment of specialist staff will be needed across many disciplines, particularly those suffering the worst workforce planning blight ever … We are still short of nurses, we have difficulty in recruiting therapy radiographers, medical physics and technical staff, whilst other specialisms such as clinical oncology … are entering a barren period.In that context, Dr. Dunlop explained that he is one of only 340 clinical oncologists in England and Wales. On average, he sees two and a half times the number of new 1264 cancer patients that are seen by his equivalent in any other developed country. He thinks that at least 700 more consultants in clinical oncology are needed to meet European standards at a time when stress levels among staff are leading to an even higher number of people taking early retirement. Dr. Dunlop's warning is very simple: we must proceed with many of the improvements suggested in the report, but there must be full cross-collaboration, and we must not raise expectations unduly.
It is not only consultants who welcome aspects of the report. Another local leading cancer fighter, Dr. Pat Keane, director of the local Cancer Care Alliance at Middlesbrough general hospital, told me:We would welcome the opportunity to increase our contribution in cancer research, both locally and nationally, to the proposals outlined within the report … Unfortunately the Teesside area has some of the highest incidence of deaths from cancer, particularly for lung … cancer, in the U.K … We are very keen to increase resources to support local clinical staff in matching their excellent clinical work with a higher involvement in both clinical trials and ongoing research associated with the quality of life of people with cancer.That is the voice of the people at the sharp end who, in general, support the report's proposals. However, I acknowledge their view that simply considering the possibility of establishing new centres of research excellence without looking in more depth at the staffing of the centres is not enough. We need to consider the flow of research graduates from our universities and to tie in good links between research, clinical practice and the work of the pharmaceutical industry. We also need to use the national plan for cancer to train, recruit and retain more specialists. I know that the Minister recognises that need. There needs to be a proper dialogue with academia and industry so that everyone pulls together to ensure that the ultimate beneficiaries—cancer sufferers and their families—receive the treatment and the quality of life that they deserve.
I believe that this is an excellent report, though I am bound to say that because I was involved in it. It points out a way forward for the radical overhaul and improvement of UK research centres. I know that the Minister will respond positively and I look forward to a day when many more announcements will be made on the back of the work that we have done.
§ Mr. John Wilkinson (Ruislip-Northwood)
I pay warm tribute to my hon. Friend the Member for Rayleigh (Dr. Clark) and his Select Committee for their outstanding report. I served on the Science and Technology Committee almost 30 years ago, but do not remember any of our reports offering such a wide range of potential benefits to the community as that which is before the House.
I shall point out how the admirable recommendations of the Select Committee relate to the work of Mount Vernon hospital, Northwood, in my constituency, which is one of the premier cancer treatment and research centres in the south of England and, indeed, the whole country. Recommendation (e) states:We recommend that the Government and the National Screening Committee evaluate high speed and precise techniques with a view to commencing large-scale trials for CT cancer screening. This would require the NHS to purchase state-of-the-art diagnostic equipment.1265 Mount Vernon is pre-eminent in that field. Recommendation (g) states:We recommend that the Government address the service problems in the delivery of radiotherapy and actively encourage research into radiotherapy.Mount Vernon hospital has worked in this field since the second world war.
Recommendation (n) states:We believe that cancer care networks should also provide an essential resource for clinical research and that research based on cancer networks should be given more emphasis than was evident in the Calman-Hine report itself. Clinical research should be an explicit part of the remit of both cancer centres and their associated units.This is precisely what Mount Vernon is all about—the co-ordination and integration of medical treatment with cancer research. Recommendation (z) states:There is widespread agreement that the poor state of the infrastructure for cancer treatment and research in the NHS is a serious barrier to clinical research. The Government must act quickly to address this through investment in the necessary staff, training, equipment and buildings.Mount Vernon's work is second to none and the intellectual quality of all who work there is outstanding, but the fabric of many of its buildings is declining and needs to be addressed.
Last, but not least, recommendation (oo) states:We recommend that annual NHS R and D funding for cancer research support be increased by £100 million immediately. This extra funding should be spread across the UK to ensure that approximately twelve large centres of cancer research excellence are developed, capable of delivering a volume of clinical research similar to or greater than that currently being delivered at the Royal Marsden Hospital.Mount Vernon is in the Royal Marsden hospital league already, but it needs more money. Its research is largely supported by extremely generous donations, but the Government can and should do more.
Mount Vernon was established in 1930 as a cancer hospital, having begun operation before the first world war, and it quickly established a reputation in surgery and radiotherapy. The Radium Institute, which was originally established in central London in 1911, moved entirely to Mount Vernon in 1939. The radiotherapy department of the Middlesex hospital became established at Mount Vernon during the war. With the establishment of the national health service, a centre for radiotherapy for the north-west Thames region was established at Mount Vernon under the direction of Professor Sir Brian Windeyer.
To general medicine and surgery—well established on the site since the war—was added the centre for plastic surgery in 1952. Hon. Members are aware that in many cases, plastic surgery is an essential element in cancer treatment and rehabilitation. Sad to say, it is planned that the plastic surgery unit at Mount Vernon might be moved away from the site to Northwick Park in the not too distant future. I regret the move and have resisted it, but it does not mean that the excellent work of the cancer centre cannot continue.
The Gray laboratory was established in 1957 on the Mount Vernon site by the British Empire Cancer Campaign, now the Cancer Research Campaign. It was initially a unit for radiobiological research, but after the death of its first director, Dr. Gray, it was called the Gray laboratory and soon gained a premier position in research 1266 in its field. Now responsible to the Gray laboratory cancer research trust, with a staff of almost 100, it continues to play a leading role in radiation and tumour biology. The work performed in collaboration with the clinical oncologists of the cancer centre has received widespread international recognition. In many areas of research, the laboratory is ahead of the field worldwide.
In 1967, the Marie Curie hospital—established in 1926 in Hampstead for the care of women with cancer—was transferred to the Mount Vernon site and became part of the cancer centre. In 1977, Michael Sobell house, a hospice for terminal patients, was built adjacent to the site and later expanded to give out-patient as well as in-patient services.
The cancer centre at Mount Vernon is long established as a regional centre caring for a population of 1.8 million living in Hertfordshire, south Bedfordshire, adjacent areas of Berkshire and Buckinghamshire, and the suburbs of north-west London. Sixteen consultant medical staff visit 15 general hospitals in the area, where patients with cancer are initially seen and screened. Patients who are to receive radiotherapy or intensive chemotherapy go on to attend the cancer centre at Mount Vernon for their treatment, and return closer to home for follow-up treatment.
At Mount Vernon, about 4,200 new patients a year with cancer receive treatment by radiotherapy and/or chemotherapy. The centre currently has five linear accelerators for radiotherapy, but work is proceeding on two further accelerator housings, which should be installed this year, bringing the total number of high energy machines to seven. With the new building which is being constructed, a new treatment simulator is to be added to the two at present in action, and there will be an extension of the research facilities of the Marie Curie research wing.
There are 65 in-patient beds in three wards, together with a unit for high-dose chemotherapy. Complementing in-patient facilities is a hostel, a CHART—continuous hyperfactionated accelerated radiotherapy—lodge, which was constructed in 1990. It contains comfortable hotel rooms, which are extremely useful for patients undergoing chemotherapy or for their relatives to stay nearby.
The Paul Strickland scanner centre was opened in 1985 and has been extended on three occasions. The centre is supported by voluntary donation and is now equipped with a spiral computed tomography, two magnetic resonance imaging units and a positron emission tomography scanner. That equipment provides an excellent service for the radiological investigation of patients attending the centre, facilitating diagnosis, treatment planning and the assessment of response. During 2001, a cyclotron will be built in collaboration with industry, so as to allow further advance in the care and research that the PET has facilitated.
I must inform the House that a most imaginative scheme, the Lynda Jackson Macmillan centre, was opened in 1993 to provide support and information to cancer patients being treated at the Mount Vernon cancer centre and to the area served by it. Approximately 4,000 patients per annum use the service, and a psychological research team has undertaken several studies which show improvement in the quality of patients' lives and demonstrate that the centre is instrumental in giving them 1267 and their families invaluable support. The centre has recently gained an NHS beacon award, which is a Government recognition of high-quality cancer care.
The cancer centre provides comprehensive care in the treatment of patients with cancer. There are special groups concerned with breast cancer; cancer of the upper and lower gastrointestinal tract; gynaecological cancer; urological cancer; germ cell tumours; head, neck and lung cancer; and haematological malignancies, including myeloma and lymphomas. A traditional strength of the centre is close integration of clinical care and research, which is at the heart of the Select Committee's recommendations. The translation of laboratory advances into clinical practice has long been a feature of the work at Mount Vernon, which is built on the strong links with the Gray laboratory.
The Cancer Research Campaign's tumour biology and radiation therapy group is sited in the Marie Curie research wing at the cancer centre. Professor Saunders, Dr. Hoskin and Dr. Makris have established an international reputation for its work on the physiology of tumours and the importance of their oxygen supply, together with programming radiotherapy to improve tumour responses and decrease the changes in normal tissues. The clinical trials group at the centre, under the direction of Dr. Rustin, has established an international reputation for its work in ovarian cancer. It is also engaged in original work looking at vaso-active drugs that shrink tumours by attacking their blood supply. A new clinical research group headed by Dr. Rob Glynne-Jones has been established to investigate the role of combination chemotherapy in the treatment of intestinal cancer.
The cancer centre at Mount Vernon plays a prominent role in the pan-London training scheme for doctors training in clinical oncology. Again, the Select Committee is adamant that we need to do more to train more specialists in that field. There are 24 junior medical staff at the cancer centre, whose registrars are trained in clinical oncology and medical oncology. Seventy nurses, including clinical nurse specialists and nurse practitioners, are responsible for the care of the patients on the ward, while 40 therapy radiographers operate and treat patients on the treatment machines. Postgraduate training for nurses and radiographers is continued at the centre, and they are encouraged to take part in research projects. Six clinical physicists and two radiographers are responsible for patient planning, together with the running of machines, quality assurance and the commissioning of new equipment.
There are difficulties at present. Organisational changes have been made and medical and surgical services have been shifted away from the Mount Vernon site. There has been a change in ownership of the site as a whole, which comes under Hillingdon health authority, whereas regional specialist services in cancer, burns and plastics are the responsibility of the eastern region to the north of the hospital. That dichotomy does not make administrative sense. It is accepted that the everyday working of the cancer centre has been made more complicated by those transfers.
As a consequence, the cancer centre is now a lodger in its own home. Maintenance standards of property have fallen and it is often difficult to get improvements to basic support services without making an enormous effort.
1268 Nevertheless, it is remarkable that, despite all those problems, the number of patients treated at the Mount Vernon cancer centre, continues to rise. The standard of care continues to improve, while morale and staffing levels have been maintained. The centre's popularity among the patients attending remains high, and its national and international reputation continues to rise. Those performing clinical research, together with their colleagues in laboratory science, have performed well. The work of established research groups has been assessed by teams of doctors and experts from the United Kingdom and overseas and has always been given a high rating.
Funding has been maintained and, in some cases, increased. New proposals for research have a high success rate. I am convinced that the Select Committee proposals, which I wholeheartedly applaud, can only help the admirable work of the Mount Vernon cancer centre and its related research institutes.
§ Dr. Ian Gibson (Norwich, North)
For me, the inquiry was precipitated by two matters. First, cancer survival rates in the United Kingdom are atrocious when compared with those in other countries, especially in Europe, and they fall far short of those in the United States. That is true for breast, lung and colon cancers; indeed, it is true for 10 major cancers suffered by men and women.
Secondly, basic biomedical research into cancer in the United Kingdom is world class, yet the major discoveries are not being translated into clinical practice. There is little political recognition of that, and a serious lack of noise from many cancer interest groups. It took 26 years from the initial laboratory work to develop the drugs that we use to treat breast cancer today. That is far too long. We need a different infrastructure to make sure that that does not happen again.
The question is not whether the Government have tried to tackle cancer—they certainly have—but whether they will solve the problems that I described. Will the many recent announcements, including the national cancer plan and increased investment, correct the position whereby cancer survival rates in the United States are three times greater than those in the United Kingdom? Analysis of the statistics clearly shows that five-year survival rates for the major cancers are better in most European countries than in the United Kingdom. Let us put that in perspective: approximately 10,000 deaths per annum could be avoided if we attained the average European survival rates. Two thousand of those deaths are from breast cancer.
There are major geographical variations in the incidence of colon cancer in this country. High incidence rates are associated with economic deprivation and poverty. I acclaim the Government's attitude towards tackling poverty because health will benefit from that. We could save 2,500 lives a year through equality of diagnosis, treatment and patient care throughout the country. For major cancers, the 10-year survival rate for the richest sector of our society is better than the five-year survival rate for the poorest. We cannot justify that, and we cannot sleep until we correct that aberration.
I appreciate that basic scientific and medical research has received a large injection of money from the Government for equipment, repairing, for example, 1269 university laboratories and bringing the boys—and, hopefully, the girls—back home from their rich, luxury laboratories in the United States. However, is it enough? I agree with some other speakers who doubt whether it is enough at this stage.
It takes time to train clinical oncologists, thoracic cancer surgeons, histopathologists, radiographers, biochemists and physics technicians. I welcome the Government's injection of massive sums into the pay packets of such people in the past 48 hours. They are essential for providing cancer screening in this country. The Government's action constitutes a major political advance. Many of us acclaim it, and we will be proud to talk to the unions who represent those professions and the Institute of Biomedical Science, which campaigned for that tremendous leap forward. Many graduates will welcome the chance to enter those professions because we have addressed the pay problem and begun to consider the career structure.
I say to the Government, "Yes, great, more money has been put in, but we need even more." We can improve our basic research and cancer services even more. We can carry out clinical trials, which are shown to benefit patients, if we provide more money. I shall say more about the way in which we could do that. A local consultant told me last week that Culyer money was available to fund trials co-ordinators. The local trust refused the money and charity money had to be found to enable the trials to happen. I could repeat many such anecdotal stories of available money that does not get to the place where it counts.
We may need to think in the same way as we did for education. Perhaps we should give a pot of money directly to the relevant cancer network, unit or centre so that the practitioners can use it to effect improvements.
In order to establish a challenging service, we need to develop not a virtual cancer institute but a real one: a small centre, not a huge, rambling building as in Washington. It should co-ordinate and develop a national strategy for all aspects of the cancer journey and cancer care. That must be supported by a national cancer Act, as in the United States. The Government side-stepped that issue in their reply, so I look forward to the Minister saying something about that now.
A national cancer Act would make the matter independent of which party was in Government. The question whether we are putting enough money and resources into cancer research would have to be reviewed every year. That is a challenge for this century, and one that we could take up.
It is a tremendous advance that the Government have acknowledged the need for a national cancer research institute. The silence on that issue has been deafening. It is a major political contribution to the cancer arena and the national health service, and I look forward to hearing more about it. A national cancer institute could co-ordinate work on a tobacco policy, on diet and cancer, on the new human genome project and the outcomes of that, and the knowledge that we will have. It would be a real step forward to have an institute where people could talk about cancer and develop a national strategy and priorities.
1270 Many consultants and practitioners would welcome a national institute. They have campaigned for such a body for some time.
§ Mr. Alan W. Williams (East Carmarthen and Dinefwr)
I, too, welcome the Government's acceptance of our Committee's recommendation on the establishment of a national cancer research institute. How would my hon. Friend tie the funders, especially the charities, into the strategy of such an institute?
§ Dr. Gibson
I would envisage a co-ordinated policy. A council could sit down with the national cancer research institute and combine their knowledge with that of all the other groups—consultants, charities and patients' groups. We should co-ordinate and combine, rather than continue the fragmentation that has beset the cancer challenge year after year.
To get decisions on cancer services and research requires the involvement of 46 groups and individuals. They all have acronyms and they have an input in decisions about funding. There are about 600 cancer charities in this country, and that cannot be right. I welcome the fact that the Imperial Cancer Research Fund and the Cancer Research Campaign have got their trustees together to talk about merger, which cannot come soon enough. The old rivalries must be dispelled, and we must have a unitary policy. We could take a leaf out of the Jubilee 2000 group's book. In a short time, it has affected the politics of world debt and how to handle it. That is a message for cancer charities.
The two-week waiting list proposal is superb, but we must ensure that at the end of that people do not have to wait weeks or months for a CT scanner and a linear accelerator. The whole process can be speeded up. I know that the Minister has many examples of that happening, and we need to make it happen across the country.
The issue is not just about cutting bureaucracy, but about getting trained staff and equipment together to ensure that the journey is much quicker for our people. We must carry out research into many areas of radiotherapy, IMRT and Conformal, because much research has led up a blind ally. That is the challenge of cancer research. There will be new technologies and new techniques, and we need a national strategy that can be developed locally in the various centres.
Although research and infrastructure are crucial to the task of defeating cancer, much can be done more immediately to improve the quality of life of people living with cancer. The increasing use of concepts such as "living with cancer" has shown how, in many cases, cancer can become a chronic long-term condition that responds well to treatment, with a good prospect of survival. Even when the survival prospects are less good, the quality of life of people undergoing treatment can be far greater than could have been envisaged a few years ago. Much research needs to be carried out in that area on quality care, drugs and so on.
Improving the quality of life for patients and coping with the side effects of treatment are just as important as the treatment of the disease itself, and in some cases more important. As the hon. Member for Rayleigh (Dr. Clark) said, many people who visited the Committee called for research into improving the quality of life, yet research into service provision for all aspects of supportive care is 1271 accorded far less priority for funding and attracts far less academic interest. We have a duty to all who are living with cancer to ensure that the maximum effort is made to give them the best possible support, and to enable them to enjoy as much independence and as good a life as can be provided.
I was proud to be associated with the inquiry, with the members of the Select Committee and with the disciplined way in which some of us were made to respond in certain circumstances. I give credit to our Chairman for ensuring that, when excitement got the better of us, we managed to contain our enthusiasm.
There was a very unco-ordinated campaign, involving many different groups, to put pressure on the Government to show the political will that they are showing now. We have turned a corner, in that the Government now recognise the need to act, but there is never a time for us to rest on our laurels: we must deliver better co-ordination and teamwork between all the groups involved in cancer care.
What we have learned about cancer treatment could, I think, be applied to the treatment of mental health and heart disease. We are developing important structures. In the next few years, our message should be "teamwork, co-ordination, and partnership among industry, patient groups, cancer charities and Government". That will enable us to rise in the league tables and, I am sure, to be at the top in no time. Our people will receive the best treatment that is available to those elsewhere in the world.
The challenge is there, and the Government are taking up the cudgels. We must now give them all possible support in order to ensure that there is no rest, and that we continue to forge ahead in developing even better standards.
§ Dr. Peter Brand (Isle of Wight)
I congratulate the hon. Member for Rayleigh (Dr. Clark) on an excellent report, which is also timely. As the hon. Gentleman pointed out, cancer is not all about misery now; it is also about hope.
I remember that, 30 years ago, childhood leukaemias involved nasty treatment and extremely poor outcomes. People indulged in "heroic" surgery, in which the patient was the victim and the surgeon was thought to be the hero. We have moved a long way since those days, and I welcome the Government's response to the Committee's excellent report, but there are still some bits missing.
As the introduction to the report helpfully explains, the steps that we can take in cancer treatment and research depend largely on a fundamental understanding of the cancer process. We still do not know why some cells start to behave aberrantly; nor do we know why some people manage to get rid of the aberrant cells, while others do not. However, I think that we are near to finding answers to some of those fundamental questions, and that we should not forget the importance of basic research. I certainly approve of the concept of a national cancer centre, benefiting from international collaboration.
The report also deals with research in treatment. The last Government did well in commissioning the Calman-Hine report, but did abysmally in terms of its implementation. It was ridiculous to allow the market in 1272 health care to determine where people should have their cancer centres. It was ludicrous not to draw up a national, or even regional, strategy determining where radiotherapy services or linear accelerators should be. I am glad that the planning is now gaining some semblance of order, but I am disappointed that there is not a stronger regional input in decisions about where such services are to be.
The hon. Member for Ruislip-Northwood (Mr. Wilkinson) spoke eloquently in support of his local unit. It is a unit of great excellence, but I sometimes doubt whether having two or three adjoining units of great excellence is the best way of serving the country. I do not deny that we have some excellent centres, but I also feel that one of the most striking aspects of outcomes is the postcode lottery. Outcomes depend on where people live, and where they can be referred to.
May I be critical of the Government? The new system of out of area treatment as opposed to extra-contractual referrals is having a dramatic impact on referral patterns, patient choice and patients' ability to get to units that may be at the leading edge of a particular treatment regime for a particular cancer, which could not have been foreseen by the health authority or trust. So arrangements cannot always be easily made.
We can refer out of area, but there will be no obligation on the people to whom we refer to accept that referral if they cannot guarantee getting the resources to go with the treatment. The OAT scheme must be looked at. We are almost working against the rules to make things happen. That cannot be in either the patient's or the clinician's interest.
I echo the hon. Member for Norwich, North (Dr. Gibson) in congratulating the Government on recognising the tremendous value of laboratory scientists and pathologists. I remember the front page of a local paper having a nice picture of a man in a white coat holding a chicken. He was a qualified laboratory technician with a science degree who had stopped being a laboratory technician and become a chicken sexer, which brought in £2,000 more a year. That is ridiculous. I am glad that we are taking steps to correct that.
If we are going to get something out of the system other than just treading water and enormous pressure, all the people involved with research, whether it be fundamental research or research in treatment, require thinking time and deliberation time, which in today's clinical practice is often missing. That is one of the reasons perhaps why trusts are putting such an enormous premium on research being done within the trust. It is costing their clinicians' time and their scientific staff's time to an extent that is becoming unreasonable.
§ Mr. Philip Hammond (Runnymede and Weybridge)
The hon. Gentleman has made an interesting point. Does he agree that the figures that the Prime Minister has used to suggest that the Government will match voluntary sector funding are deeply suspect, given that much of that funding is being used within mixed clinical and research situations in the NHS and is liable to be diverted in the way the hon. Gentleman has suggested?
§ Dr. Brand
I am not as suspicious or as cynical as the hon. Gentleman, but we perhaps take a different approach to these matters. It is difficult to cost the two. My plea is that, where clinicians are working in an area where there 1273 is active research, that should be recognised in their work load and their departments should be adequately staffed to cope with some of the work that needs to be done.
I pick up two or three points that may seem minor in relation to the report but are important and practical. We now have to refer all research to research and ethical committees in a correct way, but we have not gone far enough in streamlining the system when the research involves more than one health authority area. The trading standards people have a rather better system. A home trading standards authority approves a particular product and that recognition is given nationally. We need to be a little more streamlined in sorting that out.
No one likes unnecessary animal research, but there is no doubt that animal research has made, and will continue to make for the foreseeable future, a big contribution to our understanding of the causes and treatment of cancers, among other things. The current process where one has to go through not only a Home Office procedure but a medical research and ethics committee is unduly cumbersome, very long and not in the interests of either the researchers or the animals that we are thinking about. It distorts and lengthens a process that should be rigorous, but consistent.
It is important that newer treatment be researched. We do not use the opportunities that the NHS provides. We probably have a unique system world wide in having records that are complete in a vertical sense—from primary care through secondary care to tertiary care. When looking at new treatment, we do not use adequately the enormous resource that an integrated health service provides.
I ask the Minister to examine the effect of the establishment of the National Institute for Clinical Excellence on the introduction of new drugs and on research. There is some evidence that clinicians and funding health authorities are reluctant to accept the introduction of a new treatment because it has not been considered by NICE and, indeed, has not been referred to NICE yet. NICE should either be resourced to the extent that all new treatments can be looked at quickly, or it should be made clear to health authorities that the fact that NICE has not considered a drug is not an excuse for not using it.
That was the evidence with some of the new cancer drugs. Health authorities used the existence of NICE not to make a drug available. That will stultify the excellent scope for doing post-marketing and population research.
A number of expert hon. Members are keen to contribute to the debate. I again echo what the hon. Member for Norwich, North said. I was taken by his comparison of mental health services with the approach to cancer services. Cancer is an emotive subject, but it is not a unique disease. Other diseases are just as ghastly and a number of diseases are more deadly than some of the cancers. There is a wide spread, as the report points out.
I welcome the focus on cancer services in the report, but I hope that, whatever lesson is drawn from the report, from the Government action and from the audit of the action on how to arrange the inter-relationship between primary care, secondary care and tertiary care, the experience will be reflected in how we deal with some of the other illnesses and diseases that we are all keen to tackle.
§ Dr. Lynne Jones (Birmingham, Selly Oak)
As many other hon. Members wish to speak and time is short, I will confine my remarks to just two main points.
I welcome the Government response to the Select Committee's report. I welcome in particular their recognition of many of the points that we have made in the NHS cancer plan. That plan acknowledges, as the Select Committee does, that there is a serious shortage of therapists and clinicians to treat patients who are suffering from cancer. The Government have promised that the process of improvement will begin immediately, provided that the NHS can recruit the staff that it needs, and that the necessary reforms are put in place. The aim is that, by 2008, access to treatment for all types of cancer will compare with the best in Europe.
Members of the Select Committee welcome and support that aim, but we must make the best use of resources available in the meantime, and especially of staffing resources. I want to highlight some work being done in Birmingham to encourage collaboration between different specialties to ensure that they work together effectively.
The joint approach to cancer outcomes in Birmingham project—JACOB—is greatly improving collaboration between different specialties. It is hoped that, by April this year, all projects will hit the target for first treatment within two months from urgent GP referral. That is the target that the Government have determined must be reached nationally by 2005. The work done by projects in Birmingham and elsewhere is putting us on course to reach it.
As an example of what is being achieved, in Birmingham the waiting time for prostatic biopsy has been cut from 10 weeks to two. I therefore commend the Government on the work that they are encouraging within the NHS. It is definitely leading to a substantial improvement in waiting times for treatment and therapy.
The other main point on which I want to focus is cancer registration. It is easy to underestimate the importance of cancer registration for cancer treatment and research. The Committee's inquiry identified serious concerns about the impact of the Data Protection Act 1998 on researchers' ability to gather and process complete data. Local interpretations of the legislation have already led to anomalies in cancer registration practice. For example, the Institute of Cancer Research told the Committee that enforcement of the 1998 Act had already held up its research into mesothelioma.
The Committee recommended that, as a matter of urgency, the advisory group on patient confidentiality should address the problems posed by the 1998 Act for the registration of cancer. The Committee recommended also that the Government should introduce legislation to make the registration of cancer a legal requirement, to ensure the completeness of cancer registry data and to ensure access to those data for legitimate research purposes.
That recommendation has been supported, through early-day motion 138, by 115 hon. Members, who also expressed concern about the guidance issued by the General Medical Council. The council suggested that doctors should no longer pass on the names of patients to the national cancer registry. In their response, the Government stated that they were determined to secure 1275 the future of cancer registration and that they would take the necessary action to do so. They also said that they would be setting out their plans to strengthen cancer registries, taking into account the review carried out by Professor Charles Gillis.
§ Dr. Jones
I thank the hon. Gentleman for that clarification. I was trying to rush through the point, but the Committee was told time and again that it would be very difficult to get the express permission of patients. That is why we recommended that patient confidentiality should not necessarily apply in the case of cancer registration.
Local interpretations of the legislation are causing considerable problems. When they responded to our report, the Government said that they would respond early this year to the review being carried out by Professor Gillis. However, that already represented a shift in time scale from the original promise contained in the NHS plan, which was that a response to the review would be available by autumn last year.
When my hon. Friend the Minister responds to the debate, I hope that she will spend some time describing how the Government will deal with that problem. I know that the chief medical officer has written articles in the British Medical Journal emphasising the importance of cancer registration.
§ 3.6 pm
§ Mr. David Tredinnick (Bosworth)
I am very pleased to have caught your eye in this very important debate, Madam Deputy Speaker. I congratulate my hon. Friend the Member for Rayleigh (Dr. Clark) on this excellent report. It will make a sizeable and significant contribution to the alleviation of suffering experienced by people with cancer. In addition, the timeliness of the Government's response is helpful.
I want to suggest some alternative resources that may be useful to the Government and to everyone involved in caring for cancer patients. My approach may be a little oblique for some people in mainstream medicine, as I am the long-standing treasurer of the parliamentary group on alternative and complementary medicine. I may not have the length of service in the House of my hon. Friends the Members for Rayleigh or for Ruislip-Northwood (Mr. Wilkinson)—the latter entered the House in 1970— but I have served as treasurer of that group during three Parliaments.
In that time, there has been a complete change in the approach to some complementary therapies. I want to suggest that the shortage of resources could be alleviated by looking afresh at some of the therapies that are available, and by thinking slightly differently about how they can be used.
When I entered the House in 1987, chiropractic and osteopathy were thought by many doctors to be pretty much off the wall. If they did not get the evil eye, patients who told their doctors that they had been to a chiropractor or osteopath would certainly receive a ticking off.
1276 That has changed. Osteopaths are now regulated by legislation. Passage of the relevant legislation covering osteopaths and chiropractors took place over two Parliaments, and I sat on both the Standing Committees scrutinising the proposals. Disciplines that were once regarded as suspect are now part of mainstream medicine, but there is great scope for that process to be taken further.
In that regard, publication of the Select Committee report, and of the report by the House of Lords Science and Technology Select Committee on complementary and alternative medicine, has helped the Government tremendously. In addition, an early-day motion supporting that House of Lords report has been signed by nearly 160 hon. Members of various persuasions, some of whom are in the Chamber today.
As I said, I want to focus on resources. The report emphasises the problems of availability—of personnel, drugs, equipment, technicians and communications. Recommendation (c) talks of an "over-stretched service" and of the need for a "fast-track system". Recommendation (f) speaks of the need for an increase in the number of specialist surgeons, and recommendation (g) of "service problems in… delivery". Recommendation (h) talks about drugs "only available to some" and recommendation (i) talks of the need for additional funding for NICE-approved treatments. Recommendation (g) talks about the shortage of key personnel.
There are shortages of key personnel—don't we know it?—but there are other personnel who are not referred to by name in the report but who are available. Recommendation (m) is specifically about complementary and alternative medicine. It says:We recommend that the Government seeks guidance from NICE on the cost-effectiveness of complementary therapies for cancer care to ensure consistency of provision across the NHS.I should tell my hon. Friend the Member for Rayleigh that I differ from him slightly on that recommendation. The need to establish the cost-effectiveness of complementary or alternative medicine is not necessary in many instances. Many therapists offer their services for very little money and some are free. If we can find a way into that pool of available complementary therapists, we could obtain their services for little or nothing. We should not ignore that, because it is important.
As the Government try to tackle the problem of cancer, the additional resources available to them include about 50,000 complementary therapists—homeopaths, herbalists, phytotherapists and traditional Chinese medical practitioners. In addition—perhaps parallel to those therapies—there are about 50,000 healers who channel energy. I have had some experience of their work and seen them working with cancer patients. I know that some hon. Members may feel that the idea of someone making a difference by transmitting energy flow through their hands is off the wall—that is what some hon. Members thought about osteopathy in 1987. However, the use of healers will develop. More and more people are learning to heal and there will be a greater opportunity for its use in the health service.
Some years ago I had the great opportunity of travelling on a lecture tour with Dr. Rosie Daniel. Dr. Daniel ran the Bristol cancer health clinic. Many patients who could not be treated by conventional means or who had received conventional treatment but whose cases were not satisfactorily resolved would call on the clinic for help— 1277 I am sure that that still happens now. Complementary practitioners can often help those to whom doctors have been unable to offer a cure.
One of the ways in which the clinic helped cancer patients was to look at their diet. One of the ways of alleviating the problems of cancer patients is a greater insistence on the need for a carefully controlled diet. The Gerson diet is well known for offering relief to cancer patients. At clinics such as Bristol, a range of therapies are on offer. I hope that the Minister will respond soon to the Lords report and that we can move further towards an integrated health care system. It is to be hoped that it will not only be osteopathy and chiropractic that can come in from the cold, but we will find a much greater use of other disciplines, such as traditional Chinese medicine, homeopathy and aromatherapy. I should like to focus on those three therapies.
I have some experience of traditional Chinese medicine. I have talked at length to representatives from Peking university who are pioneering their brand of traditional medicine in the United Kingdom. They believe that they can help cancer patients in two specific ways. I know that there are many distinguished doctors in the House and they can interrupt if they feel that I am misguiding hon. Members, but I do not think that I am. The first method is by using traditional herbs, which will boost the organs of the body, and the second is by using acupuncture. An experienced acupuncturist can dramatically increase the energy flow to different organs in the body. One aspect of Chinese medicine that I find fascinating is the way that internal organs are linked to different limbs. For example, the kidneys perhaps have some influence on bone repair, and energy can be increased through the kidney meridians. Traditional Chinese medicine has had and will continue to have a considerable success rate with cancer patients. I am suggesting not that it should be used as an alternative but that it could be used to complement other therapies.
Homeopathic remedies are also useful. I will not go into detail now because I am aware that time is short. I have just received a friendly note from a friendly Whip telling me to sit down and shut up. I can tell my hon. Friend the Member for Cotswold (Mr. Clifton-Brown) that I do not need to read it because I know what it says. One does not need to be psychic when my hon. Friend is on the Bench. He has often helped me during my contributions, as all Lord Commissioners do. [Interruption.] Although my hon. Friend is not yet a Lord Commissioner, we look forward to the day when he will be, after we return to government.
Some of the complementary therapies that are classified by the Lords report as needing further research offer a lot to cancer patients. Aromatherapy can offer a great deal of relief. The use of simple oils can alleviate mood and have a beneficial effect, not least in preparing patients for operations.
Following the help from my hon. Friend the Member for Cotswold, I shall come towards the end of my remarks by saying that there is one other group of people who should be looked at with great care from the point of view of solving cancer problems. The healers or energy specialists—call them what you like—are trained to transfer, through their hands, energy of their own or from some other source. I have looked at healers at work in two prisons in Britain and seen how they can change the mood of dangerous prisoners. I have talked at length with 1278 healers about what they can do for cancer patients. They can provide relief for those who will not make it and perhaps extend their lives, and they can complement the work done by the mainstream profession, particularly after chemotherapy. They can change the mood and, apparently, increase energy levels.
There have been many trials on healing and there are always calls for more. The work of Matthew Manning was studied in great depth. Uri Geller, who is known for using energy to bend spoons, can also use energy to heal. There have been many reports showing that healing is an effective treatment. The Minister might want to take to heart the fact that many groups, including the National Federation of Spiritual Healers, do not charge at all. It is a free service and, when trying to square the circle of funding and resources for cancer care, I hope that the Minister will consider that. I hope that she will also bear it in mind when responding to the Lords report and in her winding-up speech today. I apologise to the Minister for the fact that, sadly, I will not be present for the end of the debate.
My hon. Friend the Member for Cotswold is again encouraging me to bring my speech to an end. He may have a word with me later in the Smoking Room—one never knows one's luck with a Whip. Complementary therapy has come a long way in 13 years. That which was right off the wall is now in mainstream use. There are many other disciplines that should be included in mainstream NHS provision, as many of them could help cancer patients. I have highlighted traditional Chinese medicine and the healing movement. I commend those practitioners to the House and hope that better use will be made of their services.
§ Dr. Desmond Turner (Brighton, Kemptown)
The report is concerned with the rational approach to cancer therapy and research, and that is meat enough for one discussion.
I am very proud to be associated with the report. I think that it is probably one of the most important Select Committee reports produced this Session—if not the most important. That is not simply because of the efforts of the members of the Committee, but because of the gravity and emotional impact of the subject. It is an authoritative and comprehensive report and a great deal of credit for that should go to the special advisers who helped us with it, to whom we owe a debt of gratitude. If the Government have the wisdom to accept all our recommendations, they, too, will owe the special advisers a debt of gratitude.
In the very brief time left, I will have to cherry pick. I echo the thoughts of my hon. Friend the Member for Norwich, North (Dr. Gibson). We feel very strongly about the importance of a national cancer research institute and the central importance of its role. Although the Government have accepted the notion of such an institute in principle, I do not think that they have quite taken on board the degree to which we see it as essential to get proper co-ordination into the cancer research effort in this country.
We have seen how such co-ordination works in different forms in other countries. It does not have to be a mighty bricks-and-mortar edifice—that is not what we have in mind. We are not seeking to replicate Bethesda. However, the United States, Canada and other countries 1279 have a co-ordinating mechanism—even if they do not call it a national cancer institute—and it pays enormous dividends. It shows, in the long term, in their cancer survival rates, and that is the acid test. We have truly world-class, leading-edge, basic research, yet we have some truly appalling cancer survival rates compared with our neighbours. That gap must be bridged.
We see the national cancer research institute as the lead organisation co-ordinating the whole effort and strategy. We also see it as disbursing the money. I suggest that the amount of money that the Medical Research Council currently disburses for cancer research should be given to the cancer institute. When we took evidence from the MRC, some of us could not help feeling that there was a certain lackadaisical quality in its approach to cancer. We felt that it did not have the commitment to cancer that is really needed.
That is why we come back to a national cancer Act. It would be a political gesture but it would focus the effort on cancer and bind every party in the House to that effort. We have seen the American example, where the grand old party and the Democrats are committed to fighting cancer through their National Cancer Act and have virtually outdone each other to make sure that there are adequate funds. We were very impressed. On our visit to Bethesda, the Government's budget increase for cancer research in America was being discussed. They were in the middle of a five-year programme to double their spending on cancer research. The increase that they were considering and explained to us dwarfed our entire national cancer research budget.
I am not suggesting that we can match American big bucks or even that we should. One thing that British scientists have shown they can do, because they have had to, is to make the most of very limited resources. We have a history of cost-effective research, but that does not mean that we should not put more resources into research. We need to do so urgently because of the decades of under-investment, and we have to do some very fast catching up.
In recent years we have been deprived of taking advantage of certain new research technologies such as gene chip technology because there has not been enough funding available, and that has disadvantaged leading British laboratories. That cannot be allowed to happen in future. We need a commitment not just to match the charities' level of funding, but to do it quickly. It is a matter or urgency, as are other things. Our radiotherapy departments, for instance, have not had modern equipment for decades. Their equipment belongs to the stone age and that has a great impact on outcomes. So we need to act urgently.
We were very impressed, when we visited St. Mary's, to see the operation of a machine called a multi-slice CT scanner. That, in conjunction with therapeutic programmes, is fantastic. It can lead to realistic attempts to treat lung cancer and can revolutionise colon cancer therapy and detection. That involves a lot of such machines, and screening of at-risk groups can lead to a massive advance. The Government are interested in that technology but they still want to conduct research projects. Research has been done—it is all there, published in the literature. We must be prepared to use information that is in the literature, wherever it is.
1280 I congratulate the Government on their wisdom in agreeing with most of our report, but we want them to accept everything in the report because we think that it is right.
§ Dr. Brian Iddon (Bolton, South-East)
In the final few minutes available for Back-Bench contributions, I want to continue that theme. First, I refer to the computerised tomography scanner at St. Mary's hospital. These new machines are made in Britain by Marconi Medical Systems UK Ltd. and cost about £250,000. Marconi told us at St. Mary's that it was willing to help the Government to put those machines in place in the cancer centres.
At present, the machines are being used as diagnostic machines. By the time people walk into St. Mary's with lung cancer, for example, the cancer is far too advanced. The specialist at St. Mary's hospital asked to use the machines as screening instruments. The scanners scan a whole body, tip to toe, in about 15 minutes. Within another 15 minutes, the computer attached to the machine will give a three-dimensional picture of any organ in the body. It was absolutely fascinating for us to walk through the three sections of the colon or both lungs of a patient and observe whether they were clean of polyps and tumours, or observe the size of the cancer and where it was in the lung. Sometimes it blocked a whole lung, so the patient had only one lung. If only that could be done when tumours were small, they could be eliminated without the cancer putting out secondaries all over the body.
The other instrument that we saw in action was at the Royal Marsden hospital at Sutton. When radiotherapy is carried out on various parts of the body—on the neck and head, for example, or on colorectal cancer—healthy as well as cancerous tissue is damaged by the radiation. Irradiation of the neck can result in paralysis and if the rectum is irradiated, incontinence can result—that is not very nice for the patient.
At the Royal Marsden, we saw three-dimensional conformal radiotherapy in action; that allows the operator to shape the zone of radiation to the shape of the tumour. In Finland, we saw intensity-modulated radiotherapy—IMRT—which allows the operator to vary the intensity of the radiation. Those techniques combined can hit the tumour with extremely high doses while avoiding the surrounding tissue. That is extremely useful in killing cancerous tissue.
I make two pleas to my hon. Friend the Minister. First, please put in the money necessary to spread that new instrumentation across the cancer networks. Secondly, it is important that staff be adequately trained; radiotherapists will need retraining and there is in any case a shortage of radiotherapists. We need to train many more people to handle those state-of-the-art machines.
§ Mr. Philip Hammond (Runnymede and Weybridge)
I begin by congratulating the Select Committee on Science and Technology and its Chairman, my hon. Friend the Member for Rayleigh (Dr. Clark), on this excellent report and on the obviously exhaustive inquiries they carried out during its production. It is a testimony to them not only that Members of the House will congratulate them on their work, but that the perhaps far 1281 more knowledgeable body of people with cancer research expertise has congratulated them. The Committee has done a great service to the House.
I pay tribute to all the hon. Members who have spoken during the debate. All but two of them were members of the Committee and had thus contributed to its work. I congratulate my hon. Friend the Member for Bosworth (Mr. Tredinnick), who gave us a slightly different perspective on some of the issues, and my hon. Friend the Member for Ruislip—Northwood (Mr. Wilkinson), who eloquently described the centre of excellence at Mount Vernon hospital.
My hon. Friend the Member for Rayleigh gave a characteristically understated description of the reasons that had driven the Committee to begin its investigation into cancer and cancer research. In fact, the figures produced by the Committee and published in its report are quite horrifying. It is not merely that we do not perform well according to European standards on cancer survival rates; we are at the bottom of the league table, among the newly democratising east European countries such as Estonia, Slovakia and Slovenia—way behind our north European neighbours. That clearly shows that something is wrong and that something must be done.
The hon. Member for Brighton, Kemptown (Dr. Turner) said that he wanted Government spending on cancer research to match that of the voluntary sector. He may have missed the Prime Minister's announcement on 26 September 2000 when the right hon. Gentleman made precisely that pledge; it seemed extremely grandiose at the time. However, the Prime Minister pledged money that the Government had already announced. It amounted to additional spending of only £24 million.
In the context of public spending, Government spending on cancer research is relatively small. I repeat to the Under—Secretary of State for Health, the hon. Member for Pontefract and Castleford (Yvette Cooper), the concern that I expressed during an intervention on the hon. Member for Isle of Wight (Dr. Brand)—that a significant proportion of Government-funded spending on cancer research is allocated to NHS hospitals, where the distinction between research spending and the financing of general overheads and clinical service support is not always clear. We all realise that hospitals are under tremendous pressure, especially as they try to deliver the Government's newer targets for cancer treatments and the times for such treatments. Will the Minister tell us what she intends to do to ensure that the money allocated to hospitals for research is used for that purpose and not for the equally worthy and valuable, but quite different, purpose of day-to-day treatment of patients?
The report makes 48 recommendations. I shall address a few of them specifically and ask the Minister some questions. Recommendation (d) deals with screening. The Opposition have pledged that, if prostate screening has been demonstrated to be effective, we shall introduce it when we are in government. Can the Minister give the House a similar assurance? The Government response to the Committee report notes only that the Medical Research Council is considering a proposal for a prostate screening trial.
We are delighted that the Government are moving towards considering overall time scales—from initial referral to commencement of treatment—as the relevant milestone. I only wish that they would acknowledge that 1282 such time scales are relevant for patients throughout the NHS. The amount of time patients spend on waiting lists is not the key issue if they have already waited a year to get on to a list.
We are slightly surprised, however, that the Government persisted with their two-week target for urgent GP referrals to initial specialist consultation. Those who know much more than I do about such matters question the wisdom of that target. The president of the Royal College of Surgeons, Professor Barry Jackson, said thatclinics are being snowed under with inappropriate referrals for breast cancer … breast surgeons are coping, just, at the moment, but it could be at the expense of other things.Dr. Joan Austoker, of the Cancer Research Campaign, said thatthe two week rule has completely backfired. It has led to a waste of resources, and a waste of specialists time.Professor Karol Sikora, the former head of the World Health Organisation's cancer programme, said:New guidelines for urgent referral of patients with cancer are a waste of energy.I entirely understand that the two-week limit is intended to reassure patients who have been told by their GP that they may have cancer. In fact, 90 per cent. of breast cancer referrals will be found to be clear of the disease. As physical resources are still scarce—although, hopefully, that will ease over time—does that limit really make the best use of them? Would they not be better directed towards speeding up the time between diagnosis and treatment rather then being focused at the front end of the process? I realise that the National Institute for Clinical Excellence will review the guidelines in 2002–03, but the problem exists now. Hopefully, by 2002–03 the additional resources will be starting to relieve the problem somewhat.
Are initial figures available to show whether the two-week target for GP referral to consultation is successful for all cancers? Will the Minister do anything about the problem that beset the early stages of the breast cancer pledge? That guarantee applied only to referrals received by the hospital within 24 hours of being made by the GP; hospitals were counted only on their performance in dealing with that particular group of referrals—not on all referrals. From the point of the view of patients, that is quite unacceptable.
Who is actually seen when a referral is made? There is plenty of evidence to suggest that early referral helps, but much more to suggest that the degree of specialisation of the person who sees the patient has a far greater influence on the outcome. In the summer, I asked the Minister a series of questions—ending with one on 27 July, to which I received no answer—about the specialism of consultants who saw patients referred within two weeks. At the time, the Minister told me that it was not possible to distinguish consultants' specialisations from the data. Will she take steps to ensure that we begin to measure and record those specialisations? All the evidence shows that they are a more important determinant of a successful outcome than a simple time scale.
Will the Minister also acknowledge that, as long as initiatives such as the waiting list initiative distort clinical priorities in the national health service, cancer patients, along with all other patients, will suffer? I have in my 1283 hand a letter from the consultant urologist at my local hospital to the chief executive, copied to me, which refers to a particular case. He says:You were fully aware of three other patients of mine who were admitted for major cancer surgery, onlyfor the surgeryto be cancelled three times, each within 30 minutes of being called to the theatre. These are but three examples of a long-standing problem. One year ago, I was put under pressure by the management to treat non-urgent, long-waiting patients instead of patients with cancer.That is happening in hospitals throughout the country. Can the Minister do something about that problem by restoring proper clinical priorities to the national health service to ensure that patients who need cancer treatment do not get pushed out of the queue in order to achieve the Government's political waiting list targets?
The Committee made several recommendations in relation to prescribing and the way that NICE operates. It specifically identified a concern that the mere fact that NICE recommended that a drug be made available did not ensure that it would be made available, and that patients in the United Kingdom were being seriously disadvantaged by the low levels of use of the latest cancer drugs. The Government's response was simply that trustswill be expected … to promote the rapid uptake of NICE's guidance,but Cancer Bacup reports that more than 20 per cent. of health authorities are still not following national guidance for the drug treatment of breast and ovarian cancer. What will the Minister do to ensure that, once NICE has approved a drug as appropriate for a certain class of treatment, health authorities make that drug available?
I am not bashing health authorities; we know that some of them labour under very serious financial pressures and have deficits to pay off. However, will the Minister consider the solution that the Opposition propose: an exceptional medicines fund, which would take the funding of those expensive but efficacious medicines out of the local health authority budget? Patients throughout the country may then be assured of equality of treatment in the knowledge that a national fund is available to support treatment with proven, efficacious drugs that have been through the rigorous NICE appraisal procedure.
I shall use the last couple of minutes available to talk about the problem of data transfer and the cancer registries, which several hon. Members mentioned. I hope that the Minister can tell us specifically what solution the Government propose. It was not clear yesterday, on Second Reading of the Health and Social Care Bill, whether clause 59, on patient information, is intended to be the basis of the solution.
Will the Minister confirm, for the benefit of some of her hon. Friends who may not have heard this remark, that Lord Falconer advised the other place that the Data Protection Act 1998 presents no impediment to the transmission of data to the cancer registries, and that it is the GMC's interpretation of that Act that has proved to be the problem? I understand the difficulty of obtaining patient consent at a particularly sensitive moment—the moment of diagnosis—but I am sure that it will be interesting for the House to know whether the Minister believes that, to overcome this problem, some form of 1284 statutory compulsion in relation to the registration of cancer will be required. It would also help if the Minister could tell the House what arrangements she will propose—I understand that there was a commitment to do so in the new year—to finance and fund cancer registries. That will give some flesh to the statement in the national cancer plan, which says:The public health benefits depend on the completeness of cancer registration in the population. The government is determined to secure the future of cancer registration and will take the necessary action to ensure this.When we deal with something as important as cancer registries and the part that they play in the battle against cancer, it is vital that we do not allow the issue of transmission of confidential patient data to become muddied with other issues. Is the Minister aware that, during the recent Court of Appeal hearing in which the Department of Health initially sought to overturn the decision of the courts that pharmacists and doctors could supply anonymised patient data to drug companies, counsel for the Department admitted openly in court that the Department of Health's motive for wishing to deny the freedom to pass such Information, suitably anonymised, to drug companies was that it believed that it would increase the drugs bill? Will the Minister look into that question? I can assure her that, whereas we all want to co-operate with the Government to ensure that the cancer registries and the work that they do are protected, when the Government's own counsel openly admits that ulterior motives are in play, We become a little more sceptical.
I have asked plenty of questions and many issues have been raised today. We were already aware of a number of those, but we owe a debt to the Committee for having collated those questions and put them together clearly and coherently. I look forward to the Minister's speech and hope that she can answer many of the questions that have been posed.
§ The Parliamentary Under-Secretary of State for Health (Yvette Cooper)
I join hon. Members in congratulating members of the Select Committee on Science and Technology on their report into cancer research, and on today's debate. The report and the debate have been far-reaching on the subject of cancer, which is extremely important because lives are at stake. I congratulate the hon Member for Rayleigh (Dr. Clark) on his able and expert chairmanship of the Committee in complex scientific and medical territory, and on producing a well-informed and thoughtful report.
The Committee's deliberations, hearings and conclusions have contributed to the Government's developing work on cancer, particularly in the run-up to the publication of the national cancer plan. I believe that today's debate will also make a contribution, as it is an area where a considerable amount of work is under way.
The national cancer plan was published after the report and, for the first, time drew together as part of a single strategy work on prevention, screening, treatment, support for patients, palliative care and research. It is the first time that this country has had a national overarching strategy on cancer. We should not underestimate the significance of that because, although it does not sound like rocket science to draw together all those strands, it is fundamentally important, to improve treatment, care and 1285 research across the board, that we co-ordinate properly our work on cancer, which is one of Britain's biggest killers.
It is in the context of the national cancer plan that I want to reply to many of the issues raised today. The Committee's report makes it clear that we face a serious problem. Each year, 200,000 people are diagnosed with cancer and 120,000 die of it.
This country's strengths include research, children's cancers, rapidly developing prevention services such as smoking cessation, national health service screening programmes and palliative care, particularly as a result of the tradition of the hospice movement and the voluntary sector. However, the Committee and the House are right that some aspects give cause for concern. Survival rates for some cancers do not match those in the rest of Europe. We have huge inequalities in who gets cancer and who survives it. Those on low incomes are more likely to get cancer, and they are also less likely to survive it. The quality of care varies across the country and there is a long legacy of underinvestment in cancer infrastructure, equipment and staffing, which reduces the quality of care.
The national cancer plan aims to produce a turnaround—to build on progress that has been made so far but to go further and deliver the fastest improving cancer services in Europe, and to push our survival rates up to match the best in Europe.
We have already made considerable progress in cutting waiting times, in new international standards, new investment, new equipment and in bringing new services on stream, but it is absolutely right, and the Committee is right to say so, that we have much to do.
We have set out in the national cancer plan proposals for extra spending of £570 million on cancer each year by 2003, expanding capacity with 1,000 extra cancer specialists in the pipeline; new equipment; extra services, such as extending breast cancer screening; new prevention and palliative care services; new research programmes; reform of cancer collaboration to speed up care; and new national standards and guidelines to improve the way in which we provide services and raise quality, too. That is the greatest focus on cancer in the history of the NHS, and it provides a huge opportunity. Today's debate reflects the priority given to cancer in the House as well as by the public.
We have had a good debate. The hon. Member for Rayleigh kicked off by referring to the importance of increasing investment and the importance of the National Cancer Research Institute. Concerns about the cancer registries were raised by many hon. Members. My hon. Friend the Member for Middlesbrough, South and Cleveland, East (Dr. Kumar) referred to the importance of patient involvement and the geographical spread of research, and of ensuring that research takes place throughout the country.
The hon. Member for Ruislip-Northwood (Mr. Wilkinson) spoke in detail and with expertise about the work being done at Mount Vernon. My hon. Friend the Member for Norwich, North (Dr. Gibson), who has done much in the House to promote the debate on cancer, described articulately the need to improve cancer survival rates and to cut waiting times. The hon. Member for Isle of Wight (Dr. Brand) referred to thy, importance of basic research and proper networks for research and cancer care.
1286 My hon. Friend the Member for Birmingham, Selly Oak (Dr. Jones) rightly referred to the excellent work under way in Birmingham, which I have seen for myself and applaud. She also raised concerns about the cancer registries, with which I shall deal later. The hon. Member for Bosworth (Mr. Tredinnick) spoke of the potential for complementary and alternative medicines in helping patients to deal with cancer.
My hon. Friend the Member for Brighton, Kemptown (Dr. Turner) spoke in detail about the importance of the national cancer research institute and of further co-ordinating cancer research. My hon. Friend the Member for Bolton, South-East (Dr. Iddon) referred to the need to spread new technology and to ensure that staff are properly trained to deal with it. The hon. Member for Runnymede and Weybridge (Mr. Hammond) referred in detail to a series of matters, including research on the cancer registries and treatment, to which I shall attempt to respond.
I shall deal first with research, as that formed the core of the Committee's report and has been referred to in detail today. Many forms of research are needed. Laboratory research helps us to understand the genetic and cellular changes. Genetics research is needed into who is at risk of cancer; epidemiological studies are required into the causes of cancer; and clinical trials are needed to find better ways of treating cancer.
This country makes a major contribution to all aspects of cancer research. We have world-renowned scientists, doctors and many others, working in centres of excellence funded by the Government, the cancer research charities and the pharmaceutical industry. Although we should be proud of the excellence in place across the country, three major concerns about cancer research emerge from the Committee's report: first, the research needs greater co-ordination and strategic direction, given the many different organisations involved; secondly, improved research infrastructure is needed; and, thirdly, there are concerns about the level of investment. I shall deal with each of those concerns in turn.
We very much recognise the need for greater co-ordination. The initial step in tackling that was the setting up of the Cancer Research Funders Forum in 1999. The forum includes the Department of Health, the Medical Research Council, the Imperial Cancer Research Fund, the Cancer Research Campaign, the Ludwig Institute and Marie Curie Cancer Care. It has been a considerable success in starting better to co-ordinate cancer research across the country. It has done a lot of work in developing the national cancer research network. We asked it to conduct a review not only of the gaps in prostate cancer research, but of the direction that should be taken in the key areas and the overall strategy for prostate cancer research.
That is an example of the potential to take forward research through the Cancer Research Funders Forum, but the Committee was absolutely right to say that we need to go further. That is why we set out in the national cancer plan proposals to create the national cancer research institute, picking up the Committee's work on the subject. Like the Committee and most of the charities and researchers, we agree that a single bricks-and-mortar facility would not be the best way to make progress in co-ordinating cancer research. However, it will be an organisation in its own right, with staff and the weight to 1287 work consensually with all the different organisations to develop an over-arching strategy and to ensure that all cancer research is properly co-ordinated.
The Government would disagree with the Committee in that all Government funding needs to flow through that organisation. We believe that the institute can co-ordinate the funding from the different organisations and that there are advantages—for example, for the Medical Research Council—in linking basic cancer research with other forms of basic research. For example, the human genome project will be beneficial to cancer research as well as having considerable benefits for other research.
The second concern that has been raised about research is the importance of improving the infrastructure. We strongly believe that we need to improve the clinical research infrastructure in this country. That is why we have announced the creation of a national cancer research network. Two groups will work together to achieve the overall aims. A consortium involving the universities of Leeds and York and the MRC clinical trial unit will concentrate on operating a network for controlled trials.
Professor David Kerr will lead the NHS contribution to early studies translating advances in basic science into promising new treatments for cancer through a network of centres. That research network will be integrated into, and work closely with, the National Cancer Research Institute. That approach has been broadly welcomed by the charities and represents a huge step forward, and we are putting an extra £20 million into it.
We strongly agree on the need to boost investment. That is why we are boosting the investment through the science budget by an average of 7 per cent. a year in real terms over the next three years. It is also why we are increasing the money specifically for cancer research. In 1995–96, £50 million was spent on directly commissioned cancer research from the Department of Health and the MRC. That spending increased to £73 million in 1998–99, before the plan, and it will be £105 million by 2002–03, doubling the direct investment since the election. Of course, as we set out in the plan, we are increasing the overall Government funding to match voluntary sector funding.
I shall briefly deal with the cancer registries. Clause 59 of the Health and Social Care Bill includes a regulation-making power, which will allow the Secretary 1288 of State to require information to be passed on for important purposes. That will provide a legislative solution to the problem of the cancer registries. It is important, however, that the cancer registries also recognise issues of patient confidentiality. That is why work is under way to consider the use of anonymised data and to develop technical solutions to the problems of linking records, which may help us to find alternative ways to deal with patient confidentiality. It is certainly true that clause 59 will provide a legislative solution, and there will be time to discuss that in detail in Committee.
Let me deal briefly with the other treatment and care issues that have been raised. We set new targets for waiting times across the board, not simply those to see a specialist, but those for diagnosis and treatment. Those targets are coming into place this year. There is a one-month target for the wait between diagnosis and treatment for breast cancer. If the hon. Member for Runnymede and Weybridge remains so opposed to the two-week target for the wait to see a consultant, does he plan to state in the Conservative manifesto that he would abolish it?
§ Yvette Cooper
I apologise for asking that question so late in the debate, but the hon. Gentleman needs to answer before the election, because that target provides patients with a lot of reassurance.
We are also providing investment to increase the number of oncologists, as my hon. Friend the Member for Middlesbrough, South and Cleveland, East said. There will be an extra 1,000 new consultant posts, including hundreds of extra oncologists. However, our proposals are about not just extra investment, but reform involving the work of the cancer collaboratives, NICE and the new national cancer standards.
A huge amount of work is going on to improve cancer care in this country. It will take time; we must be realistic about that. It is about extra investment, but also about reforming the way we proceed—
It being Four o'clock, and there being private business set down by direction of THE CHAIRMAN OF WAYS AND MEANS under Standing Order No. 20 (Time for taking private business), further proceedings stood postponed.