HC Deb 06 February 2002 vol 379 cc1000-8

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

12.12 am
Sir Teddy Taylor (Rochford and Southend, East)

My apologies to you, Mr. Deputy Speaker, and to the Under-Secretary of State for Health, the hon. Member for Salford (Ms Blears), for raising the subject at this late hour, but I think that you know that it is not my fault.

This debate is about the future of the South Essex cancer network and the Southend cancer care centre, and the scope of the treatment and surgery that they provide. I hope to obtain assurances from the Minister that the 1 million patient rule will not be applied indiscriminately, thereby reducing the scope of treatment at the hospital and undermining the centre's success.

The cancer centre deals with patients from a population of about 680,000, which is represented by four MPs. On the basis of comments made at a meeting with the Southend Hospital NHS Trust and consultants on Monday, which was arranged by hon. Friend the Member for Southend, West (Mr. Amess), we are united in our views. I hope that, following my short speech, it will be possible for my hon. Friend and my hon. Friends the Members for Castle Point (Bob Spink) and for Rayleigh (Mr. Francois) to speak; the Minister has kindly agreed, subject to your approval, Mr. Deputy Speaker, so long as she has good time to reply.

The Minister is subjected to many complaints about the health service, as were the previous Government. I hope that she will be reassured to learn that the service provided by the cancer centre is of a very high standard, is greatly appreciated by the community, and is very successful according to published figures. She will know that while other centres in the region do not, according to the Southend consultants, publish figures, Southend tables, compared with those of regions which do publish figures, show that our centre has a high achievement record, both for routine treatments and for involvement in research. What is the problem? Of course, there is no threat to the centre itself, as the Minister confirmed in a written answer, and there is no immediate threat to the treatment of the more common cancers like lung, breast and colorectal, which make up about 50 per cent. of cases. However, other areas of treatment, such as upper gastro-intestinal, head and neck, haematology, urology, and possibly gynaecology, could be subject to transfer to hospitals as far away as Ipswich, Colchester and London.

What is the basis of the 1 million rule, particularly when it is not applied to sparsely populated areas, where 500,000 is accepted? The argument is that the larger centres will be more successful, on the basis of what is called best evidence. If the evidence shows that Southend is already successful by comparison with other centres, would it not be reasonable to leave the service as it is?

The second argument is that for some cancers such as gastric and oesophageal, the operations should be carried out by surgeons with a sufficiently high number of such procedures for a meaningful audit of outcomes, and the guidance quotes a figure of at least 10 per year. In the case of the South Essex cancer network, however, there are approximately 80 such resections every year, which is well above many of the networks with a population of 1 million.

I hope that the Minister will also consider the impact on the needs of other patients if specialist surgeons are removed to other centres. I could quote many examples, but if we take the case of benign upper gastro-intestinal conditions, and if we remove the two accredited upper GI surgeons from South Essex, a specialty in which there is an acute shortage, how can we be expected to transfer cases to other networks that do not have the capacity to take on extra work?

We have been told that Professor Richards, the national cancer director, has been given the task of reviewing the South Essex situation. I am in no doubt that when he sees the stature and success of the centre, he will wish to help us. The crucial question is whether he has an instruction from the Department to implement the 1 million rule as far as possible.

My hope and that of my colleagues, and the hope of all who work in the hospital, is that the Minister will state clearly and unambiguously this evening that as the centre has achieved success and clinical excellence, the region and the national cancer director will be permitted to recommend that it should be allowed to continue, and thereby to maintain the superb service and safeguard patients from long journeys to other centres.

I know that the Minister continually hears constituency arguments making the case that the situation in one constituency is splendid, but I hope that she will accept that in this case there is a genuine, strong and compelling argument. If something is working well, it is to the benefit of society and all the people in the community if we let well alone.

12.17 am
Mr. David Amess (Southend, West)

Communities are invariably fiercely loyal to their hospitals. In that regard, Southend is no exception. For that reason, I was horrified when Southend hospital was given a one-star rating. Under no criterion was that justified. It is well known that local residents have the highest regard for the hard-working staff at Southend hospital and the wonderful service that they offer. In particular, the cancer service is first class. If the Minister cares to consider the outcomes at Southend compared with others, they are well above the average.

Having looked at the cancer plan, I understand why the Government were minded to draw up the plan. I applaud it. Following the meeting which my three colleagues and I had at Southend hospital on Monday, we have a number of genuine concerns, which we ask the Minister to consider. As she knows, although the hospital is situated in the constituency that I represent, it also serves the constituents of my three colleagues. Unfortunately, since anxiety was raised among the general public—it had nothing to do with local Members of Parliament—there has been an outpouring of concern.

I was delighted that the Secretary of State for Health decided to write a personal letter to the editor of the Evening Echo. That was much appreciated. However, the letter raised a number of concerns. As my hon. Friend the Member for Rochford and Southend, East (Sir Teddy Taylor) said, under the auspices of the new cancer taskforce led by Professor Mike Richards, the reference to areas of 1 million inhabitants is particularly worrying.

Certainly, as far as local residents are concerned, we have a first-class service. The argument that the cancers are minor and that their treatment should take place in other parts of the country would be very distressing to people in an area that is populated by a higher proportion of elderly people than other parts of the country. I ask the Minister to consider that important factor.

As we have a first-class service and that is what the Government want, why change it? Monday's meeting was very productive and educated us on a number of issues. It was not biased at all. It demonstrated that, with a new consultant having been appointed at Southend hospital, some concern has already been expressed about morale generally, because it is argued that if the rarer cancers were taken away from the hospital, there would unfortunately be a knock-on effect.

I say very gently to the Minister that this is a warning shot across the bows. Local people will not just stand idly by and let their service be reduced in any way below the excellent standard that we currently have. I ask her to consider very carefully the pleas that my hon. Friends and I are making.

12.21 am
Bob Spink (Castle Point)

I am very grateful to be given the opportunity to contribute to this debate.

Castle Point people value very highly the cancer services at Southend hospital. Today, I questioned Professor Richards, the cancer tsar, in the Select Committee on Science and Technology, in an evidence session on cancer care and research. He was very well briefed and knew about the situation in Southend. It will be interesting to read the transcript of that exchange. I made a couple of notes. He said: I am absolutely confirming that Southend will be retained as a cancer centre. I suppose that that is the case to some degree, and certainly for the more common cancers. We are grateful for that undertaking, which was extracted by my hon. Friends the Members for Rochford and Southend, East (Sir Teddy Taylor) and for Southend, West (Mr. Amess). However, Professor Richards went on to explain that some patients with less common cancers who need surgery would get better outcomes if they were treated in specialist centres. He quoted much evidence from around the world to illustrate that point. We all know that if we had a child with one of these rare cancers, we would not want them to go to just any hospital, even if it was local. We would want them to go to the very best hospital where they would get the best outcome. We are approaching this matter in a very grown-up manner.

The cancer tsar also said that Southend hospital cancer centre was "excellent". Residents and staff at the hospital are grateful for that acknowledgement, as the hospital really is excellent. He said that he would liaise with the eastern regional office to ensure that we get the best possible solution for local people. That is all we can ask from the Minister. I am delighted to see that she is giving her time tonight to listen to us.

Finally, the Evening Echo, and the two Southend MPs in particular, as well as my hon. Friend the Member for Rayleigh (Mr. Francois), have done a very great community service in drawing attention to the problem and in getting the undertakings that we have so far been given. Castle Point people are indeed indebted to them.

12.24 am
Mr. Mark Francois (Rayleigh)

I congratulate my hon. Friend the Member for Rochford and Southend, East (Sir Teddy Taylor) on securing this debate, which is of great importance to residents throughout south-east Essex. I thank him and other speakers for allowing me to make a quick contribution.

As I have only a short time, I shall concentrate what might be called the thin-end-of-the-wedge issue. If the Government decide to transfer some specialist cancer operations from Southend, perhaps to Ipswich, because Southend is said to lack a catchment area of 1 million patients, what will prevent them, after establishing that precedent, from deciding that other sorts of operations should be done elsewhere?

If several services are moved, it could be argued that the remainder of the services may as well be moved because Southend does not have a catchment area of 1 million. That anxiety has been raised with me by my constituents and people in surrounding areas. I should be grateful if the Minister gave us assurances on that.

My constituents in Rayleigh want the service to be preserved mainly as it is. So do I. Southend hospital's record on cancer treatment is excellent. The service is not broken, so I implore the Minister not to fix it.

12.25 am
The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears)

I congratulate the hon. Member for Rochford and Southend, East (Sir Teddy Taylor) on securing an important debate. Approximately eight times the usual number of hon. Members for Adjournment debates are in the Chamber, and I stress that quality as well as quantity is present. I know that the hon. Gentleman recently tabled a parliamentary question on the matter and that he has pursued it assiduously. Much local concern has been expressed in the local media. My hon. Friends the Members for Basildon (Angela Smith) and for Thurrock (Andrew Mackinlay) have raised the matter with me and sought assurances about the future of the service.

Before I deal with the specific issues in Southend, I should like to place them in the context of the cancer plan, which hon. Members have mentioned, and the continuing work to improve services throughout the country. I shall then explain the effects on Southend. It is wrong to view the matter in isolation; the thrust of the cancer plan is about setting up networks in which people work collaboratively rather than in isolation.

The hon. Member for Castle Point (Bob Spink) made a responsible contribution. He acknowledged the tensions between excellence and access and talked about getting the balance right between services that are close to home and those that are in specialist centres. We all want our constituents to have access to the best services for treating especially complex illnesses.

The contribution of the hon. Member for Castle Point was in marked contrast to that of the hon. Member for Rayleigh (Mr. Francois), who failed to grasp the issue. We are not considering removing services or salami-slicing, but improvements. In the past, our record on cancer has not been wonderful, but it is now improving dramatically, although we have some way to go before we achieve the same outcomes as other European countries. There is no question of reducing the services that are available to local people.

It is now widely accepted that the national health service has been underfunded for decades. That means that it has had too few staff and inadequate facilities, which have not been organised into specialist cancer treatment services of the kind that exist in the rest of Europe. Our outcomes have therefore been poorer than those of many other countries.

People have not had the necessary support through preventive care; patients have had to wait too long for diagnosis and treatment. If we are honest, they have not always received the treatment, care and support that they have a right to expect.

The cancer plan was published only a year ago; we should reflect on the outstanding progress that has been made in that time. The plan sets out a managed way forward. We need more nurses, doctors and, crucially, more radiographers. We also need more equipment. Most of the vital equipment was old and needed replacement. We also needed to ensure that new drugs were available to everybody who could benefit from them.

The cancer plan is backed by the biggest ever increase in funding for cancer services. This year, an extra £280 million is available to improve cancer services; next year, a further £127 million will be available. By 2003–04, the NHS will get £570 million a year more for cancer services than it received last year when we published the cancer plan. I do not think that anybody—Opposition Members or anyone else—could doubt that this represents a massive prioritisation for tackling cancer.

But the cancer plan is not just about money. It is also about putting in place the systems, changes, clinicians and specialist teams to work together to ensure that the new investment results in improved outcomes for patients, which is what we are all interested in.

Treatment also needs to be available much faster. All too often, waiting times have been far too long. The cancer plan sets new targets to cut waiting times, and just over 91 per cent. of people with suspected cancer were seen by a specialist within two weeks of being urgently referred by their GP between July and September 2001. That is a tremendous increase, but, again, it is not quite enough. We want to do much more.

We need more staff and more training. By the end of 2001–02, we expect to increase the number of cancer consultants by 428 compared with 1999. That means that we are on target to reach the cancer plan aim of nearly 1,000 extra cancer consultants by 2006, which represents a tremendous investment but also perhaps illustrates what a low base we were working from before the cancer plan was put into place.

We also need better palliative care, and the new opportunities fund is helping us to ensure that we have more consistent funding for adult hospices, for which funding is variable up and down the country. We also need more modern equipment, and we now have a programme to upgrade equipment. In total, approximately 25 per cent. of MRI scanners, 35 per cent. of CT scanners and 20 per cent. of linear accelerators now in use in the NHS are new since January 2000. There is an awful lot of new equipment now in place in the health service.

Hon. Members have described how these policies are becoming evident in Southend, and it is good to know that the people of Southend and the surrounding area are so appreciative of the improvements. It is particularly good to hear hon. Members' praise for the staff involved in the service, and that they feel that the service is providing excellent care for their constituents.

Hon. Members asked about guidance. I will respond first to the question about the rationale behind setting a network population of 1 million people, and its application with particular reference to Southend and upper gastro-intestinal cancers, which was the specific issue raised. One of the essential features of improving cancer outcomes in this country has been the move to create specialist diagnostic and treatment centres, in which teams of oncologists, surgeons, physicians, specialist nurses, radiologists, pathologists and many others can collectively diagnose and treat the various types of tumour. This is not simply about surgeons but about the whole diagnostic and treatment team coming together to share ideas and good practice.

The teams are being developed within 34 cancer networks throughout the country. They typically serve populations of between 1 million and 2 million people; South Essex is one of the smallest networks, with just 680,000 people. Each cancer network has a cancer centre at its core. There is good evidence to show that specialist teams such as those that I have described produce better results. We have lagged behind Europe on outcomes.

The expert advisory group recommended that a cancer centre should normally serve a population of more than 1 million. When there is a need to consider geographical constraints to ensure a balanced service, however, a population base of two thirds of a million should be considered an absolute minimum. Following the publication of the expert advisory group report, further guidance on individual tumour types has been, and is still being, developed.

Networks have now almost completed the task of implementing the guidance issued on the common cancers. Over the past few years, they have created specialist teams for breast, lung and colorectal cancers. Sadly, these cancers are quite common, but that means that the numbers of patients being seen are substantial enough to warrant the creation of such centres in most district general hospitals.

We are now moving on to develop guidance based on the care of patients with the less common cancers—for example, gynaecological, upper gastro-intestinal, urological, head and neck, and haematological cancers. Because patient numbers are, thankfully, smaller, it will not be possible to provide large multi-disciplinary teams and equipment in each local hospital. Most people would accept that that is common sense.

In relation to the gastro-oesophageal cancers to which hon. Members have referred, the picture in this country is poor. We do not compare well with Europe and average five-year survival for gastric cancer is 12 per cent. against 20 per cent. for the average European patient. That represents a tragic and avoidable loss of life for many patients.

Most studies show that hospitals dealing with large numbers of patients have the best outcomes. Although surgeons are key to that, they are only part of the multi-disciplinary team. Guidance issued in early 2001 to centres that care for patients with upper gastro-intestinal cancers recommended that they serve a minimum population of 1 million and, for pancreatic surgery, 2 million to 4 million. A population of 1 million normally generates about 280 oesophageal and gastric cancers, and radical surgery is appropriate for about 100 patients.

That is the minimum appropriate to improving outcomes and the policy was recently endorsed by the council of the Association of Upper Gastrointestinal Surgeons, so the argument for creating specialist centres is compelling. Retaining small units without proper specialist teams is not an option if we want to improve outcomes for patients.

I want to deal with how all those national initiatives have been applied in Southend, whose hospital is part of the South Essex cancer network, which is one of five such networks in the Eastern region, but one of the smallest in the country. Clinicians across Southend, Basildon and Thurrock have a long tradition of working closely together to deliver good quality cancer care to patients, and the wider community values the holistic care that it receives from the services.

The cancer network recently celebrated its sixth birthday. Its achievements have also been celebrated and delivery of good care for common cancers is well advanced. The care is of extremely good quality and I thank all the clinicians involved for delivering those very high standards.

From time to time, officials review the composition of cancer networks to ensure that they are developing appropriately in accordance with the plan. South Essex was reviewed in 1999 and 2001, and concern was registered about it being very small. There is anxiety that, as it moves on to consider the less common cancers, it might have difficulty supporting an increasing number of specialist teams. It might also have difficulty attracting the high calibre of clinical specialist required. On its own, it might find it more difficult to fund staff and specialist equipment from its per capita income, so high-quality clinical collaboration with other networks must be developed.

It has been recognised that we perhaps have to think more creatively and apply innovative approaches to achieving specialist teams among a small population base. That is exactly the work that Professor Mike Richards is undertaking with colleagues and clinicians in the area. It is not beyond our wit to find a solution that retains the very best of the high quality care that Southend provides for people of the neighbourhood as well as access to specialist teams. We can have the best of both worlds: we can ensure that care is provided close to home where appropriate and that work with neighbouring clinicians is undertaken to establish a wider network or a series of joint networks that co-operate to achieve the outcomes that people rightly want when they deal with more complex cancers.

South Essex has two accredited surgeons towards the overall team and they are treating cases that used to be treated in London or not at all. We do not yet have the figures on outcomes, because it takes at least five years to measure the five-year survival rate. We shall monitor the figures carefully, however, and we look forward to seeing the outcomes produced by the surgeons involved.

There is a regional group in place and it is working on the issues involved with setting up the collaborative networks, such as using ultra-sound in diagnosis to achieve best outcomes. That requires not just state-of-the-art equipment, but a specialist radiologist who would probably have been trained on that equipment in the United States. There is a great deal of development work to be done in the South Essex network. Again, that may be better served by collaboration with other networks in the Eastern region so as to achieve best advantage.

The approach of trying to work with neighbouring networks has been endorsed by Professor Richards, by the surgeons' accrediting body, and by the body responsible for setting national cancer standards. I have every confidence that the managers and clinicians involved will find a way to solve the admittedly difficult problem of developing a gastro-oesophageal centre while conforming with best advice, and will be able to make recommendations.

Let me confirm beyond all doubt that rumours circulating in the press that the Southend cancer centre was due to close are not true. Such a closure has never been on the agenda. The matter was raised with me by Councillor Jennifer Howlett from Castle Point, who was very concerned. I am delighted to reassure her and, indeed, the local community that the centre will not close.

Moreover, the fact that we are considering ways of providing good services to deal with the more specialised cancers does not mean for a moment that we will reduce the services available to local people. Such scaremongering is unhelpful: it makes vulnerable people feel insecure when they or their relations are ill and need quality treatment.

We want cancer services to be improved. That will require new investment, but it will also require change to ensure that we drive up our standards. Members have said, "If the system ain't broke, don't fix it." But we do not want change for its own sake; we want change because we know that people are entitled to better outcomes. For many years, our outcomes have not been comparable with those in other countries. It is time that we secured the investment and reform to ensure that our constituents have the best possible services, and I hope that those services will be available in Southend for many years.

Question put and agreed to.

Adjourned accordingly at eighteen minutes to One o'clock.