HC Deb 12 March 2004 vol 418 cc1825-34

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

2.31 pm
Dr. Howard Stoate (Dartford)

Thank you, Madam Deputy Speaker, for giving me the opportunity to raise this debate in the House. This is a subject of great importance to many hon. Members and to many of our constituents across the country. This debate is timely because prostate cancer is highly relevant to two of the main themes that have dominated the policy debate on health care over the past year. They are the concepts of extending patient choice and of promoting greater engagement by the public in their health care.

Today I would like to focus on the potential benefits that extending choice can bring to prostate cancer patients, as well as on some of the challenges that we will face if this goal is to be delivered effectively. The undoubted opportunity presented by choice is that it can, in a way that is consistent with the values of the NHS, give a patient and his family a greater range of treatment options throughout the patient journey, allowing him to become more involved in decisions on his own care. The challenge is that, if all men are to benefit, these treatment options must be readily available to all, regardless of where a patient lives, and that accessible and understandable information setting out both the benefits and risks of different treatment approaches should be readily available.

In fact, men have been quietly exercising choice in regard to prostate cancer for a considerable time. Should they have a prostate specific antigen—PSA— test? If they are diagnosed with the condition, what course of treatment should they have? What impact will this have on their quality of life? What will be the impact on life expectancy? Should they, in fact, have any treatment at all? Unfortunately, in the past, these choices have often been exercised without adequate support or advice. The challenge that we all face is to change that, and I am pleased to report that good progress has been made, although there is still a lot to do.

The Government took an innovative step forward on choice, even before the concept assumed its current high political profile. The prostate cancer risk management programme was introduced following the publication of the NHS prostate cancer programme in 2000. It introduced the principle of informed choice for men thinking about taking a PSA test. As a practising GP, and chair of the parliamentary all-party group on men's health, I know only too well that the issue of PSA testing is a controversial one. Last year, I chaired a debate on the subject and it was clear that there were strong feelings on both sides. The issue lies in the reliability of the test, which unfortunately throws up many false positives and negatives. This obviously has implications both for men and for the health service as a whole. In my view it is therefore right that a man's decision on whether to take a PSA test should be a personal choice. However, for choice to work, accurate and impartial information is essential. The prostate cancer risk management programme, which is intended to enable a man to discuss both the advantages and potential drawbacks of taking a test in an impartial way with his GP, is a welcome step forward.

In the absence of a more reliable test—and I welcome the Government's commitment to introduce universal screening when such a test becomes available—informed choice offers many potential advantages, and I know that it is generally welcomed throughout the field of prostate cancer Inevitably, some teething problems exist, but I am sure that those can be overcome. The focus is mainly on awareness and the understanding of the risk management programme, on which I will touch later.

The NHS prostate cancer programme, which incorporates the risk management programme, has been widely welcomed, and has led to real service improvements. The two-week maximum waiting time between a GP suspecting that a patient has cancer and that patient being seen by a consultant has offered timely reassurance to many men at a time when they face great uncertainty. Many of my patients have benefited from that, and it is difficult to overestimate its importance both in boosting confidence and in giving reassurance to people at a very difficult time.

We are now some four years on from the launch of the programme, and as we seek to take the next step forward in prostate cancer policy, it is important to assess exactly what impact the risk management programme and the wider NHS prostate cancer programme has had. Certainly, I would welcome a commitment by the Minister to producing an interim report on the prostate cancer programme, including an appraisal of the risk management programme. Clearly, substantial progress has been made in ten ns of waiting times and investment, but we now need a clear and realistic assessment of exactly what has been achieved, and what remains to be done, so that we can move forward in a constructive way that benefits patients.

The case for action is clear. Prostate cancer is now the most common form of cancer in men in the United Kingdom, with more than 27,000 men being diagnosed every year. It is also a major killer: prostate cancer kills about 10,000 men each year in the UK. That is approximately one man every hour. The political desire for action is also overwhelming. The prostate cancer charter for action, which has been very effective in making the case for action on prostate cancer, has the support of 232 parliamentarians on both sides of the House, including Front-Bench health spokesmen in each of the major parties. An early-day motion that I tabled back in January now has more than 130 signatures, and I know that the charities involved in prostate cancer are very grateful for this clear demonstration of support.

Effective action requires a joint commitment from the Government, health professionals and the voluntary sector. All stakeholders need to work together in partnership to share ideas and expertise and, where necessary, to pool resources to deliver improvements in services for men. In this sense, the establishment of the prostate cancer charter for action, which brings together the key organisations with an interest in prostate cancer, is a vital step. I take this opportunity to thank the prostate cancer charter for action for the briefing that it provided for me ahead of this debate, as well as the efforts that it takes to keep me informed about its work. I know that the signatories to the charter, which now number 21 different organisations, all undertake a great deal of good work on behalf of men and their families, and I am sure that the whole House will join me in thanking them for their efforts.

The Minister is no doubt aware that the prostate cancer charter for action was both facilitated and funded by the GUS charitable trust—an organisation that has no commercial interest in prostate cancer and yet has recognised the pressing need for action to tackle this high-incidence male cancer, as well as the potential that is offered by greater collaboration. I am sure that the Minister will join me in congratulating the GUS charitable trust—the charitable arm of GUS plc—on its commitment. I can only hope that other charitable trusts and organisations will follow its lead in promoting greater collaboration among the many voluntary sector organisations that do such valuable work.

I know that the charter signatories were very encouraged by the Government's decision to act on their call by establishing the Prostate Cancer Advisory Group, chaired by Professor Mike Richards, to facilitate collaboration and advise Ministers on the development of policy. It seems to me that both the advisory group and the charter for action have a great deal of potential for improving collaboration—both within the voluntary sector and in the formulation of Government policy —for a wide variety of diseases and conditions. I have previously heard Professor Mike Richards praise this model, and the Minister may wish to outline her vision for rolling it out to other disease areas.

Since the advisory group's establishment, it has taken on an ambitious programme of work, all of which, if delivered, will help to extend choice in a positive way. The group has proposed the establishment of a national prostate cancer website. That completely independent site will create a focus of information for patients, professionals and policymakers, providing intelligent signposting to all sources of information. The Prostate Cancer Advisory Group agreed that, in the spirit of partnership, and to ensure genuine independence, the voluntary sector should make a contribution to the costs of developing the website. I understand that this contribution has now been secured by the prostate cancer charter for action. I would therefore welcome a commitment from the Minister that her Department will indeed fund the remainder of the development costs for the national prostate cancer website.

The group is also developing a decision-making tool to enable men to make an informed and independent choice about what form of treatment is best for them, taking into account the trade-off I that may have to be made between quality of life and eradication of the cancer. At present, no such tool exists, and this often leads to a patient having to rely on the advice of a clinician, which may be based more on what the clinician knows or believes than on what will necessarily suit the individual patient's circumstances.

I understand that the Prostate Cancer Advisory Group is planning to convene a workshop for experts on prostate cancer and other diseases from around the world to help develop such a tool. Hopefully that will enable the NHS to lead the world in terms of treatment decision-making tools for patients. I ask the Minister to use her influence to enable the conference to be convened as soon as possible, and to ensure that all the relevant experts are invited. I also ask her to commit herself, once it has taken place, to early piloting of the tool so that NHS patients can benefit from it as soon as possible.

The advisory group is considering public awareness. Information and awareness are an important precursor to informed choice. It is very difficult for a patient to decide whether to have a PSA test, or indeed what course of treatment to opt for, if he does not even realise that he has a prostate. Public awareness of the prostate, however, is a difficult issue to tackle owing to the problematic nature of the disease and our relative lack of knowledge about it. There is no definitive form of treatment, and, as I said earlier, the poor reliability of the PSA test remains an obstacle. What should be the message or call for action contained in any campaign is therefore a matter for debate.

In his recent report, Derek Wanless made a number of helpful observations. In particular, he said that any campaign would have to have clear and measurable objectives, and that we would need to ensure that public awareness or information campaigns reached all sections of society, not just those who could be considered "health-literate". Those issues must obviously be resolved if public awareness of the prostate and its function is to be effective.

The work on public awareness will be an important test of the ability of the Prostate Cancer Advisory Group model to develop accepted solutions to difficult problems, and advance the quality and effectiveness of policy. I ask the Minister to throw the Department's weight behind the principle of public awareness of prostate cancer, and to urge all parties involved to work together to develop solutions.

National men's health week between 14 and 20 June, which will focus on men and cancer, will give us an ideal opportunity to raise public awareness of prostate cancer. A men and cancer manual featuring a section on prostate cancer, produced in the same format as a Haynes car manual, will form the center piece of this year's men's health week. I am grateful to the Minister for her Department's contribution of £30,000 towards the production of the manual.

I also welcome the Prostate Cancer Advisory Group's plans to develop multidisciplinary training mechanisms for the whole health care team. Improving the team's understanding of each other's roles can only help to improve the quality of impartial advice given to the patient, so increasing the ability to make an informed choice as well as enhancing the quality of care ultimately delivered.

I was speaking to Dr Nav Chana, a fellow GP, earlier this week. He made the important point that patient choice will only ever work if the NHS has the necessary capacity to provide a full choice of treatment options, underpinned by high-quality impartial information, for every man throughout the patient journey. I know that that sentiment is shared by the vast majority of patients and health professionals.

The sustained increase in investment provided by this Labour Government is building the capacity necessary to deliver a world-class health service for all, fit for the 21st century. That is vital to everything I have raised today. I know how committed the Minister is to sustaining the investment, and I hope that she will take this opportunity to reaffirm that the Government will not waver in their determination to build the necessary capacity to achieve that goal.

I hope that in a few years I shall be able to stand in the House and praise this Government for successfully developing a cure for a disease which, after all, affects the lives of so many men and their families. I know that we are still some way from achieving that, but then again I know that I shall be in the House for a considerable time! The large increases in funding for research into prostate cancer that the Government have already delivered are a very important step in the right direction. I hope very much that it will deliver results, both in moving towards a cure and, in the meantime, in providing more effective treatment options and therefore greater choice. A commitment from the Minister that the increases in funding for research that have been delivered so far will be sustained would be welcomed by stakeholders.

Let me end by reaffirming that patient choice presents a number of promising opportunities to improve the deal for men with prostate cancer. As a GP and as one who is committed to improving men's health, I am greatly encouraged by the progress that the Government are making, in partnership with voluntary and professional organisations, in taking practical and positive steps to extend choice. Although there is still much to be done, I am sure that the mature and constructive attitude taken by the Government and the prostate cancer charter for action, working together through the Prostate Cancer Advisory Group, will pay dividends.

As the voluntary sector seeks to work with the Government to deliver on the important calls to action embodied in the charter for action and the terms of reference of the advisory group, I am sure that it would welcome the Minister's comments on the issues I have raised today. It would particularly welcome the possibility of an interim report on the NHS prostate cancer programme, an update on the progress being made in securing funding for the national prostate cancer website, and the Minister's support for an expert conference to advance thinking on patient decision-making tools.

I thank the Minister for her ongoing commitment to improving public health, and in particular for the part that she has played in tackling this disease, which disrupts the lives of so many men and their families.

2.45 pm
The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson)

I congratulate my hon. Friend the Member for Dartford (Dr. Stoate) on securing this debate, on his enthusiasm for this subject and on his re-election. I am sure that that enthusiasm is infectious in both cases. The debate is particularly timely, as prostate cancer awareness week falls at the end of this month. I take this opportunity to congratulate the signatories to the prostate cancer charter for action on all their efforts in combating this terrible disease.

We acknowledge that prostate cancer has not previously received the attention that it deserves, which is why we published the NHS prostate cancer programme in September 2000. It set out what was known about prostate cancer and established a framework for future action, and it explained the action that the Government propose to take in three relevant areas: research; prostate specific antigen testing; and improvement of services for patients with urological cancers, including prostate cancer. I will briefly review the progress that has been made in each of these areas in the past three and a half years.

Prostate cancer is the only cancer that has a Department of Health funding target for research, and we are on track to spend the promised £4.2 million on research into prostate cancer in 2003–04. That is a twenty fold increase compared with 1999–2000. I can confirm that this level of funding will remain for future years—scientific quality of research proposals permitting, of course. Two National Cancer Research Institute prostate cancer research collaboratives have been established, in Newcastle and London. Funded research includes studies on various treatments for prostate cancer, on improving the prostate specific antigen test and on ethnic differences in prostate cancer incidence.

As part of the prostate cancer risk management programme, evidence-based primary care resource packs were sent to all general practitioners in England in September 2002 to aid them in counselling men who are worried about prostate cancer. The PSA test for prostate cancer is not perfect, and men need to know the advantages and disadvantages of the test to make an informed choice on whether to have it. Other elements of the risk management programme include ensuring that a systematic and standardised follow-up pathway is available for men whose test result is above the PSA threshold, and action to improve the quality of laboratory testing of PSA samples.

The Cancer Research UK primary care education research group is evaluating the programme. The evaluation focuses on GPs' use of the packs and their views, on the views of men and on the reasons given for taking a PSA test. It will be funded by the Department of Health via NHS cancer screening programmes, and the results are expected during the next year. They will inform the continuing use of the packs and any appropriate changes will be made in response.

On waiting times, between October and December 2003, 98.6 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.

The cancer services collaborative is modernising cancer care, including prostate cancer care, by reducing unnecessary delays in the system for patients throughout the cancer journey. "Action on Urology", which is sponsored by the Department of Health, is a programme that aims to improve access to, and delivery of, patient-focused services for urology patients. New approaches to urology care are being piloted in 15 pilot sites across England and Wales, at a cost of £1.4 million. Examples of work under way on prostate cancer include using specialist nurses and GPs to carry out prostate assessment clinics in primary care; redesigning the pathway for patients undergoing transurethral resection, so that they can go home within 24 hours; and using the skills of specialist nurses to follow up patients after PSA testing and cancer surgery.

There has been a 40 per cent. increase in the number of consultant urologists since 1997, the figure having risen from 343 to 473. National Institute for Clinical Excellence guidance on urological cancers, including prostate cancer, entitled "Improving Outcomes in Urological Cancers: the Manual", was published in September 2002.

The guidance states that all patients with urological cancers should be managed by multidisciplinary urological cancer teams. Patients should be assured of streamlined services, balanced information about management options and improved management of progressive and recurrent disease In addition, nurse specialists should be trained to take key roles in providing the services. The guidance is being implemented across all cancer networks in England and Wales.

We are committed to introducing a screening programme if and when screening and treatment techniques are sufficiently well developed. There is no conclusive evidence from any country that screening for prostate cancer would reduce the death rate from it. The UK National Screening Committee has advised the Government that, on existing evidence, a national screening programme for prostate cancer would not be justified. The Government have asked the NSC to keep this work under review and to look at any developments in testing techniques or technology that would make a screening programme effective.

Much has been achieved since the prostate cancer programme was published in 2000, but we recognise that there is still much to be done. That is why we welcomed the launch of the prostate cancer charter for action on 29 January 2003. To ensure better collaboration and communication between the charter members and Government, we have set up the Prostate Cancer Advisory Group, chaired by Professor Mike Richards, the national cancer director, with a membership including representatives of the charter, allowing us to combine the expertise of the voluntary sector with that of the NHS for the benefit of patients. We are determined that stakeholders should be at the heart of policy making.

The model of the advisory group and the charter for action is a good one. As my hon. Friend knows, advisory groups have been set up for both bowel and lung cancer, and the Department it is continuing to encourage, build on and improve partnership work between stakeholders such as the NHS, the voluntary sector and professional organisations.

That brings me to the subject of choice. One size does not fit all, and we should ensure that services are shaped to meet people's needs rather than expecting people to fit the system. The Government believe that it is right that people should have the power to choose what is appropriate and convenient for them and how they want to be treated. That is why much of the work of the advisory group is centred on patient choices. Prostate cancer is perhaps unique in the amount of choices to be made along the patient pathway. There is the choice of whether to have the PSA test in the first place, which I have already spoken about in relation to the prostate cancer risk management programme. There are also treatment choices to be made, and issues of public awareness—men need to be educated about prostate cancer in order to make choices.

That is why four working groups have been set up under the advisory group, focusing on information for prostate cancer patients, improving the treatment of prostate cancer, public awareness and, as my hon. Friend mentioned, a national prostate cancer website.

Patients diagnosed with prostate cancer face a number of choices. That is why the working group looking at information for prostate cancer patients quickly decided that the greatest difference could be made by helping men diagnosed with localised prostate cancer to decide which treatment course to follow.

Each of the treatment options—radical prostatectomy, radical radiotherapy, the emerging brachytherapy, or active monitoring—has advantages and disadvantages. The decision that a man takes must be based on his values and lifestyle. Decision-making aids can help that process. The working group has teamed up with "Action on Urology", which has been building on work based on the American experience in Boston. We are also aware of other work in Canada. We therefore propose to hold a workshop in May to decide on the best way forward for the NHS decision-making aids for men diagnosed with localised prostate cancer.

Improving the treatment of prostate cancer is another important area. A working group on the issue, chaired by Professor David Neale of Cambridge university, will meet for the first time later this month. One of the first things that it will consider is multi-disciplinary team training, following the model developed for cancer of the rectum at the Pelican centre in Basingstoke. Although the training concentrates on one new technique, total mesorectal excision, not only the surgeon benefits. All the members of the MDT learn how their role benefits from the new procedure, including the specialist cancer nurse, who will be able to explain the procedure to patients. There is also the added benefit of their spending time together away from the pressures of their local hospital.

Public awareness is another key issue, already identified by my hon. Friend. Men cannot make choices unless they understand what the choices are. We want men to be aware of their bodies and know what their prostate gland does, and also what can go wrong with it. We need to raise awareness in a responsible way and not scare men into rushing to see their GPs when there may be nothing wrong with them. The public awareness working group has been reviewing what information is out there for men about prostate cancer, along with assessing the evidence over public awareness interventions, and it will shortly be making recommendations on the way forward for men and the NHS in England.

The Department of Health is funding other work on public awareness of prostate cancer: a section 64 grant to the Prostate Cancer Charity to increase further information about prostate cancer; another section 64 grant to the same charity to improve awareness of the risks and symptoms of prostate cancer among men from African and Afro-Caribbean communities in Britain; and the database of individual patient experiences website on prostate cancer.

The fourth working group has been looking at the possibility of a national prostate cancer website for use by the general public. Plans are well developed, and it is envisaged that the site will contain essential information for prostate cancer patients alongside information for members of the general public who just want to find out more about the disease. The website will be key in helping men make informed choices about prostate cancer right along the patient pathway, and I am delighted to be able to confirm to my hon. Friend today that the Government will provide two thirds of the funding for the website. That amounts to some £40,000 in the current financial year, with further funding over the next two years. The website will be developed in close collaboration with NHS Direct and the coalition for cancer information. The final third of the funding will be provided by signatories to the prostate cancer charter for action, a great example of the Government and the voluntary sector working together for the benefit of the people of this country.

My hon. Friend raised another point that I have not yet dealt with—the interim report on the prostate cancer programme. In the interests of collaboration, I am asking the Prostate Cancer Advisory Group to discuss the merits of having a three-year progress report, in addition to the three-year NHS cancer plan report. That will be debated at the next meeting in April—not far away.

On sustaining the investment to build the necessary capacity, the planned future investment combined with reform will provide further improvements for the NHS, including expanding capacity, increasing staff and training numbers and reducing waiting times. On the basis of a headcount from September 2001, we envisage major staff increases by 2008—for example, 15,000 more consultants and general practitioners; 35,000 more nurses, midwives and health visitors; and 30,000 more therapists and scientists. We also envisage an increase in treatment capacity to more than 10,000 beds, 42 additional major hospital schemes and 750 primary care one-stop centres to establish a broad range of services.

Against that background and in the light of the current work going on, I am sure that my hon. Friend would agree that we have come a long way since the publication of the HHS prostate cancer programme in 2000. We know that there is much more to do and we look forward to continuing to work in partnership with key stakeholders from the prostate cancer charter for action to tackle the challenges ahead, including making sure that informed choice is a reality for men with prostate cancer.

Question put and agreed to

Adjourned accordingly at two minutes to Three o'clock