Brain Tumours: Detection and Treatment (Hansard, 28 March 1983)

§ Lord Auckland
My Lords, I beg to leave to ask the Question which stands in my name on the Order Paper.

§ The Parliamentary Under-Secretary of State, Department of Health and Social Security (Lord Trefgarne)
My Lords, scanning facilities are available in about 100 centres in the National Health Service in England, Wales and Scotland. There are some 40 neurosurgical centres where operations to remove brain tumours are normally performed.

§ Lord Auckland
My Lords, I thank my noble friend the Minister for that generally satisfactory Answer. Perhaps I may put to him three very brief supplementary questions. First, in the case of the child in Sussex who went to America for treatment at large cost, can my noble friend say what liaison took place between the local area health authority, the child's doctor and other relevant bodies as to the availability of treatment in this country? Secondly, what is the general liaison between area health authorities and general practitioners, particularly in the case of those on hospital waiting lists for treatment of this kind? Thirdly, is there any chance of more hospitals being able to treat this condition, which, if it is treated in its early stages, can often, I understand, be completely cured?

§ Lord Trefgarne
My Lords, with regard to the particular case to which my noble friend referred, I understand that the consultant was fully aware that the kind of treatment which the parents appeared to prefer was available in the United Kingdom, but it was the parents themselves who chose to have their child treated in the United States—as, of course, they were absolutely entitled to do. As for the second point which my noble friend raised about liaison between doctors and these facilities, it is of course open to consultants to refer a patient to a particular hospital where he knows a particular kind of treatment is available, even if that hospital is outside the region within which the consultant happens to work. As for the general availability of these facilities to which my noble friend referred, as I said in my original Answer, there are already quite a number. More are certainly planned, but this is principally a matter for the regions and the districts.

§ Lord Wells-Pestell
My Lords, may I ask the noble Lord the Minister if he is in a position to say whether the scanners are strategically placed so that it is possible for a person with a suspected tumour on the brain (I have an emotional involment in this, going back some years) to be scanned within a reasonable period of time?

§ Lord Trefgarne
My Lords, I cannot claim that these facilities are available in each and every region. There are two regions at present which do not have these facilities but in both cases they are planning to acquire them within the reasonably near future. As for the even spread of these facilities, I have to give an unsatisfactory answer to the noble Lord: It is not perfect at present. That is why it is possible for consultants to refer patients to other facilities outside their region.

§ Baroness Bacon
My Lords, is not one of the difficulties the difficulty to which my noble friend Lady Masham of Ilton referred some time ago; namely, that if a hospital which is giving specialised treatment is open to an area much wider than the area which the health authority covers the cost has to come out of the total amount of money allocated to that area?

§ Lord Trefgarne
My Lords, that is a rather different problem. When the noble Baroness, Lady Masham of Ilton, referred to that matter she was thinking of hospitals which might perhaps be unique in the National Health Service, being the only places in the country which can provide a particular service, or perhaps one of just two or three. As I said in my original Answer, there are at least 100 of these facilities in the National Health Service. Therefore, the kind of problems which the noble Baroness described do not apply.

§ Lord Auckland
My Lords, may I ask my noble friend one further question? He mentioned that further hospital facilities are being provided. It was very good to hear that, but can my noble friend say whether any improvement is foreseen in the outlying areas of the country? I am thinking of the North of Scotland and North Wales, for example.

§ Lord Trefgarne
My Lords, in the National Health Service it is of course necessary to use the funds that we can make available in the best possible way. I am not sure that providing one of these facilities in every location where it could possibly be needed would be the best use of scarce funds. The scanning facilities cost upwards of £½ million to install and something like £90,000 a year to run. If there are just a few patients to be examined in this way, there may be better uses for sums of that kind.

§ Baroness Masham of Ilton
My Lords, may I ask the Minister whether he is aware that a great deal of money for scanners has been raised voluntarily by the public? This shows how important early detection is. Would the Minister agree that, for patients from the Outer Hebrides, North Wales and the rural areas, a good cross flow across district and regional boundaries is very important?

§ Lord Trefgarne
My Lords, I agree with the last part of the noble Baroness's supplementary question: that where facilities cannot be made available in every location, then patients should be facilitated to be moved to other locations for the purposes of these particular diagnostic procedures or, in due course, operations, if that is proved necessary. I also agree with the noble Baroness that voluntary funds have played a very important part in financing some of these facilities, and I think that is a most admirable thing.

The Earl of Halsbury
My Lords, can the noble Lord the Minister give the House any information on the annual incidence of these operable tumours as a background to one's judgment of the adequacy of the facilities about which we have been speaking?

§ Lord Trefgarne
Not without notice, my Lords. Perhaps I might find what figures I can and then write to the noble Earl.

§ Lord Cledwyn of Penrhos
My Lords, the noble Lord, Lord Trefgarne, has been extremely helpful in the replies he has given. Can he confirm to the House that there is no difficulty about patients crossing boundaries between one health authority and another? As I understand it, patients who suffer in this way in North Wales are able to cross the boundary into Merseyside, where these facilities are available.

§ Lord Trefgarne
My Lords, I can confirm what has been said by the noble Lord, Lord Cledwyn of Penrhos. It is open to the consultant to refer the patient to whichever hospital he considers necessary for the examination or treatment of the patient concerned.

Lord Wallace of Coslany
My Lords, in order to assist the many noble Lords who have put supplementary questions of some importance, can the noble Lord the Minister prepare a list of the hospitals where these facilities are available—not only scanners but operations as well? If it is impossile to publish this information in Hansard, perhaps a list can be made available in the Library in due course.

§ Lord Trefgarne
My Lords, one of the difficulties of proceeding along that course is that the list could be changing constantly, because these facilities are being added to all the time, as I said. Also, some facilities are not the same as others; that is to say, some of the scanners have high resolution attachments which are not available in every case. I am not certain, therefore, that such a list would be as helpful as the noble Lord imagines; but perhaps I might look into the matter and write to him.

§ Lord Elwyn-Jones
My Lords, I believe that what concerns my noble friend Lady Bacon is: who will foot the bill when a case is transferred to another regional authority? Will it be the regional authority who receives the patient, or will it be the referring authority? I believe that was the point which worried my noble friend Lady Bacon.

§ Lord Trefgarne
My Lords, the RAWP formula, as it is called—the Resource Allocations Working Party formula—provides for what are called cross-boundary 1340 flows. Any significant action of this kind would therefore be covered by that formula. I understand that in individual cases it is open to the relevant local health authorities to agree between themselves the funds to be transferred.