HC Deb 28 March 2003 vol 402 cc639-46

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

2.30 pm
Mr. John Bercow (Buckingham)

It is always a pleasure to address a packed House of Commons. Today, however, I am simply grateful for the opportunity to speak on the subject of prostate cancer in prostate cancer awareness week.

Recently, 18 charities with specialist expertise in this field came together to launch the prostate cancer charter for action. I congratulate them on their initiative in doing so. For my own purposes in the context of this debate, I am appreciative, above all, of the briefing that I have received. I have been advised on this subject in detail by the chief executive of the Prostate Cancer Charity, Mr. John Neate, and by other experts in the field. Specifically, I have had the benefit of the professional assistance of Mike Birtwistle and Nick Laitner. I am grateful to them both.

This is an increasingly important initiative to increase awareness of, and effective action to tackle, prostate cancer. It might help if I start by establishing the context in which the debate takes place. Interest in the subject in the House was reflected in the last parliamentary Session in 35 questions to Ministers. There have been an additional 11 such questions in this Session. More particularly, four early-day motions have been tabled respectively by the hon. Member for Torbay (Mr. Sanders), my hon. Friend the Member for Castle Point (Bob Spink), the hon. Member for Dartford (Dr. Stoate) and my hon. Friend the Member for Woodspring (Dr. Fox). They attracted respectively 26, 114, 146 and 59 signatures. Members on both sides of the House have a legitimate concern to promote greater understanding of, and treatment for, this terrible disease.

Prostate cancer is rapidly becoming the biggest curse for men and particularly, although not exclusively, for older men. The most common cancer among men is lung cancer, but prostate cancer is catching up. Many people believe that it will soon overtake lung cancer.

How many people are sufferers? We know that 25,000 people are now diagnosed in the United Kingdom each year as suffering from this horrific and often fatal disease. Some 10,000 men die each year from the disease, and a man has a one in 13 lifetime chance of suffering from it. In my area of the vale of Aylesbury, within which the Buckingham constituency falls, the incidence of prostate cancer is 29 per cent. higher than for the United Kingdom as a whole.

Moreover, it is not simply a phenomenon of the incidence of the disease, but of the fatalities that flow from it. We know that, over a long period in this country, survival rates have been significantly poorer than elsewhere in the European Union. After five years from diagnosis, only 44.3 per cent. of men in the United Kingdom are still alive by comparison with the average in the European Union of approximately 55.7 per cent.

In the light of those alarming statistics, it is especially worrying that a third of men do not know what the prostate is. Given those statistics, there is a great deal of justifiable interest in, and anxiety about, the subject in the House.

I congratulate the Government on the announcement of the formation of the prostate cancer advisory group, a welcome initiative on which they have rightly been congratulated by all the interested parties in the field. If the Under-Secretary of State for Health, the hon. Member for Salford (Ms Blears), when responding to the debate, can tell me and others interested in the subject something about the composition of that group and its intended terms of reference, that would be helpful. My understanding is that it will be chaired by the distinguished specialist, Professor Mike Richards, and its purpose is to marshal all the resources and expertise of what the Government call the stakeholders in the field to ensure that the approach to the subject in future is more effective than it may have been in the past.

The Minister will be aware that the focus of the Prostate Cancer Charity's charter for action is action on a number of fronts. First, we need action on transparency. We require an interim report on the Government's success or otherwise in fulfilling the targets that they have set. For example, in the recruitment of urologists, we need to know how we are doing and what future plans are. People would be interested to learn from the Minister to what extent there has been compliance with the stated target from December 2000 onwards of ensuring that anyone suspected by his GP of suffering from prostate cancer has the opportunity of an out-patient appointment with a specialist within two weeks. Action on transparency is therefore the first requirement that I put to the Minister on behalf of the charities involved, and on which I would be interested to hear her response.

Secondly, we need action on public awareness in this field. The charities are anxious that a health education campaign should be launched no later than autumn this year. We need a male-friendly, media-oriented, effective public relations and promotional initiative that focuses on different features of this important debate. It should focus on the function of the prostate—that, after all, is what we are discussing first and foremost, and from it everything else follows. That campaign needs to challenge the notion of the inevitability of the increased incidence of the disease. Thirdly, there is a requirement to highlight risk factors, whether behavioural or inherited, which are likely to result in the disease and its detection. Fourthly, there is a terribly important requirement to describe the role of the PSA test—the prostate-specific antigen test.

A lot of people think that there should be a national screening programme. Equally, most of the major charities in the field and people with expertise think that there should not be one at this stage because the test is unreliable. However, we need to put the information on the record and tell sufferers and people who think that they may be sufferers, "These are your options. This is the information that should be available to you." Public awareness is critical, and I remind the hon. Lady that when the Government launched their prostate cancer programme in September 2000 they made a firm commitment to a public information campaign. People expect them to deliver on that commitment, and I look forward to hearing what the Minister has to say about it.

Fourthly, we need action on patient care. That means information for patients, multidisciplinary working and comparing different treatments for this grim disease. There seem to be three main methods of tackling it. One is active monitoring, the second is radiotherapy, and the third is surgery. If memory serves me correctly—and if I am wrong, no doubt the Minister will advise me this afternoon—the Government rightly placed an important focus on clinical trials. Quite properly, they want to be guided by the evidence before spending further public resources.

The Government committed £13 million, I believe, to a clinical trial based in nine separate locations. People who have raised the subject with me in my constituency, either one-to-one or via correspondence, are keen to know the outcome of that trial. Can we have some sort of progress report on it? What conclusions from the study have Ministers so far drawn? We also need an audited education programme for the benefit of primary care providers. That is all part of the package of patient care assistance in respect of which action is needed.

Fourthly, we need action on resources. It is a commonplace for Members of Parliament to call for additional resources in respect of particular problems or areas of Government activity. I am, in a sense, no exception today, though in a good cause. It is worthwhile to stress that I am not calling for the willy-nilly expenditure of resources, which might not yield much of a result. There should be a targeted programme of investment in three areas.

First, there can be no doubt that we need an increase in the number of trained pathologists to cater to the increased demand for treatment that the higher incidence of the disease has brought about. Any information that the hon. Lady can give me today as to what the Government are doing in that regard and what they propose to do in the future would be much appreciated. Secondly, we need more specialist cancer nurses who have a particular expertise in prostate cancer, both for the benefit of the sufferers themselves, and for the purpose of assisting at primary care level.

Thirdly, we need increased resources for the purpose of research into how we can more effectively detect the disease, research into the relative aggressiveness or otherwise of that disease, and research into the respective merits of the different forms of treatment. We need to recognise that there can be individually tailored programmes of treatment, and that we should not take a holistic view and say that one form of treatment is right for everybody. Investment targeted to the ends that I have outlined would be greatly welcomed. That requires, as somebody might have said, action this day.

Finally, we need action on partnership. I recognise that no one can do it all on his or her own. It is no1 a matter only for the Government. It is not a matter only for the national health service professionals. It is not a matter only for the voluntary sector, magnificent accumulated expertise and commitment though that sector can boast. It is a matter for all three. We need a Government commitment. We also need specialist expertise from the national health service, and we will require the integrated role of the voluntary sector. We need to ensure that all those players come together with a common purpose and a common determination to achieve it.

Prostate cancer is one of the most important subjects that a Member of Parliament could identify and address, so far as the male population of this country is concerned. There has been an enormous focus on cancer as a whole, and that is right and proper. There has, in particular, been a strong focus on breast cancer. I make it clear that I in no way criticise or cavil at that. A great deal more probably still needs to be done in relation to that important subject. Nevertheless, there is a sense in which prostate cancer has not, over the years, under Governments of both colours, received the attention or the determined application of resources that are required.

The Government are doing good and valuable work in this area. The Minister will be aware that I have raised the issue on a wholly non-partisan basis. All I am concerned about is improving the detection and treatment of and recovery rates from this ghastly disease. I have said my piece and I look forward to hearing that of the Minister.

2.45 pm
The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears)

I congratulate the hon. Member for Buckingham (Mr. Bercow) on his success in securing the debate. It is particularly appropriate and timely, because, as he said, this is prostate cancer awareness week. I also congratulate the Prostate Cancer Charity, which has done an enormous amount of work in raising the profile of this terrible disease and in helping us to focus our attention on it. I have been particularly pleased to be associated with both the very active all-party men's health group in the House and the Prostate Cancer Charity. I have worked closely with them to see how we can do even more than we are already doing to try to ensure that we have a holistic approach to our policies in this area.

I should be able to respond to virtually all the points that the hon. Gentleman has raised today, which are all important elements of what should be a properly rounded programme to try to meet the needs of men in these circumstances.

First, it is right to acknowledge that prostate cancer has not previously received the attention that it deserves, which is why, in September 2000, we published the prostate cancer programme setting out what is currently known about prostate cancer and establishing a firm framework for action divided into three specific areas—first, research, of which much more is needed in this area; secondly, prostate-specific antigen testing, particularly the inter action of general practitioners with their patients with regard to requests for tests; and, thirdly, improvement in services in terms of waiting times, the work force and streamlining the process that patients have to undergo when they have been diagnosed with prostate cancer. I should like to give hon. Members a sense of the progress that has been made on those three areas and to outline the steps that we still need to take, because much more needs to be done.

First, the hon. Gentleman raised the issue of research and it is fair to say that our knowledge is still quite limited, not only of what causes prostate cancer, but of the variations between slowly developing prostate cancer and the more aggressive forms of cancer, and the likelihood of the disease developing in patients in different circumstances. We have now set a target of directly funded Department of Health research of £4.2 million and we are on track to spend that by the stated date of 2004. I am told that that is a 20-fold increase in the amount spent on research compared with 1999–2000. That is an indication of the low research base from which we started, but I hope that the hon. Gentleman will accept that it is a significant investment by the Department.

Two National Cancer Research Institute prostate cancer research collaboratives have been established—one in Newcastle and one in London—and there is a range of different research projects. One of them is looking into the differences in prostate cancer in different ethnic groups. It is a matter of concern that in the African community in particular the rates of prostate cancer are significantly higher than in other communities, and we must bear down on that research.

We also have a large-scale randomised controlled trial of treatments for localised prostate cancer—the Protec T trial—evaluating different treatments. As the hon. Gentleman said, the trial will cost about £13 million and consists of three arms—active monitoring, radical prostatectomy and radical radiotherapy. The trial began on 1 June 2001 and will last for five years, so it is fairly lengthy. The lead researcher is Professor Freddie Hamdy from Sheffield, and the hon. Gentleman could obtain further details from him if he wishes.

We also have a highly innovative study to create and test a new non-invasive treatment for prostate cancer. Some prostate cancer treatments can be fairly damaging. The new technique uses magnetic resonance imaging to locate the cancer and high intensity focused ultrasound to destroy it inside the body. If that noninvasive technique is successful, it could prove very attractive to many people with the disease.

We have also initiated a study to improve radiotherapy treatment, again using MRI techniques, and a review of new and emerging treatments, including brachyotherapy and cryotherapy, which are being developed in new centres. Some £900,000 is being made available to enable NHS patients to enter the trial conducted by the National Cancer Institute of Canada and the American College of Surgeons Oncology Group, which are considering brachyotherapy—a new and emerging technique to which we want to ensure NHS patients can have access. We are also collaborating with regard to a collection of 3,000 tumour samples that can be used by a range of different researchers to try to take the matter forward. I hope that the hon. Gentleman will be reassured that we are pushing on with a range of research projects.

The second issue that I want to highlight is waiting times for people who have been diagnosed. I can tell the hon. Gentleman that 95.7 per cent. of patients with suspected urological cancers, including prostate cancer, were seen for their first out-patient appointment within two weeks of their GP deciding that they should be urgently referred in the quarter October to December last year—the last quarter for which we have figures. I hope that he will understand that that is a pretty high figure and that it should represent a significant contribution to getting people treated quickly, which is very important.

The Cancer Services Collaborative projects are working across all cancer fields, including prostate cancer. They involve surgeons, clinicians and patients working together to redesign the patient pathway. In some cases, they are reducing waiting times dramatically through some very simple and straightforward steps. Genuine improvements are occurring across the field.

The hon. Gentleman also referred to the work force. I can tell him that there has been a 24 per cent. increase since 1997 in the number of consultant urologists; the number has risen from 343 to 427 in that time. Our current work force projections show that an additional 100 trained specialists should be available to take up consultant posts in urology by 2004. Those are significant increases in the number of consultants. He also referred to nurses and pathologists. He will be aware that some 40,000 extra nurses are now working in the NHS generally, many of whom will be able to work as specialists in the cancer field. I am sure that many of them will want to pursue their interests in prostate cancer in particular.

On pathology, recruitment and development have been difficult in the past, but pathologists are crucial to the diagnosis and treatment of all cancer patients. Diagnostic pathology services are responsible for 60 to 70 per cent. of all NHS diagnoses. We have now provided funding for three histopathology training schools to attract more senior house officers to pursue a career in histopathology. We have designed some innovative training methods. Each new site is now training six people a year. The schools were initially funded for three years and the initial evaluation has proved so positive—people are now almost queueing up to come into the schools—that we are planning to set up an additional nine training schools. Each of those schools will train eight SHOs annually. Three of them will be established in 2004–05 and the remaining six will be established in 2005–06. By 2006, they will be training an extra 96 specialist registrars every year. That will make a significant impact on the ability of the NHS to respond in those areas.

The National Institute for Clinical Excellence guidance will improve treatment for patients. NICE has issued "Improving Outcomes in Urological Cancers: The Manual", which sets out guidelines on the way in which treatment should be provided. That guidance, which was issued in September 2002, clearly states that all patients with urological cancers should be managed by multidisciplinary urological cancer teams. It is of key importance that we get all the different professions to co-operate so that we can streamline services and so that people can get proper information from a range of professionals in that area.

The hon. Gentleman mentioned screening, which is a controversial issue; some parties recommend universal screening programmes, while other clinicians feel that that is not the right way to go as yet. We are committed to introducing a screening programme if and when screening techniques are sufficiently well developed. There is no conclusive evidence from any country that a universal screening programme would reduce the death rate from prostate cancer. We have a National Screening Committee in the UK. It has advised us that, on existing evidence, a national screening programme would not be justified. However, we have asked the committee to keep the matter under review because the decision is not based on cost. When the evidence justifies a proper screening programme, we shall, of course undertake it. However, it must be properly evidence based.

Mr. Bercow

I want to press the Minister on the creation, proposed by the cancer charities, of a national database on the incidence, treatment and outcome of the treatment of the disease. What assessment has the Minister made of the reasons for the difference in incidence of prostate cancer in different parts of the United Kingdom?

Ms Blears

If the charities are proposing to establish a database, the more information we have, the better informed will be our policy decisions. I would encourage gathering as much information as possible on outcomes, treatment and the way in which we improve services for everyone.

We do not yet have sufficient information about the reasons for the differences in incidence to provide definitive views. I draw the hon. Gentleman's attention to the prostate cancer risk management programme pack, which we have issued to all general practitioners for them to discuss with their patients. The materials in the pack set out in detail the existing differences of view about screening, treatment and the reliability of the prostate specific antigen test, which is not an automatic indicator of whether people have prostate cancer and whether it is likely to be aggressive. It is important that patients have a genuine opportunity to sit down with their GP and talk in detail about the options and the support in making the right decision. That theme ruins through many of our programmes. Giving patients the best information and power, thus enabling them to participate in decision making is crucial. I commend the pack to the hon. Gentleman. I do not know whether he has seen it, but it contains a leaflet, a tear-off slip and something to take home and consider before taking the next steps.

The hon. Gentleman mentioned a public awareness campaign. We promised that there would be a public, patient and GP education and information campaign. That is crucial. We do not want to frighten everyone who has no symptoms into believing that they must have the test and that it will tell them everything that they want to know. We must think the matter through carefully and discuss it in consultations. The resource pack is therefore an important tool.

We have funded the charities to undertake awareness-raising campaigns. We funded the Prostate Cancer Charity with £135,000 over three years to disseminate a range of awareness material. We recently granted it a further amount of £106,000 over the next three years to fund a project to improve awareness among men from the African and Afro-Caribbean communities. The Department has therefore made a genuine commitment to ensuring that we disseminate information.

We have also funded the DIPEx—Database of Individual Patient Experiences—website. It is very innovative and I recommend that the hon. Gentleman logs on. It is full of clips from people who have suffered from the disease. It is a fantastic way in which to let people hear the genuine voices of other patients rather than simply those of professionals.

I emphasise that the advisory group that was established under the chairmanship of Mike Richards, the national cancer director, will provide a tremendous opportunity for everybody—the NHS professionals, the voluntary sector, patients—to come together to maximise the skills and expertise that are in the field. The hon. Gentleman was right that the terms of reference are to ensure that our policy presses on. I have no doubt that the group will keep pressing me to make even faster progress. I welcome that and have said so to people who will be involved with the group. There is much more development of NHS practice based on partnership models. The NHS does not always know best or have a monopoly of wisdom. It is important to me to draw people into the process. I do not have precise details of the group's membership, but when the matter has been resolved I should be delighted to let the hon. Gentleman have details of membership, programme and priorities for the first few months.

I hope that I have managed to address most of the hon. Gentleman's points about working practices and recruitment. I hope that he will be satisfied that we have made significant progress, although I am the first to acknowledge that there is a long way to go. The issue is important not only to men but to their families and carers.

Question put and agreed to.

Adjourned accordingly at Three o'clock.