HL Deb 07 November 2002 vol 640 cc865-8

11.13 a.m.

Baroness Northover

asked Her Majesty's Government:

When they intend to implement the key recommendations in the National Institute for Clinical Excellence guidance, Improving outcomes in breast cancer.

The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath)

My Lords, the NHS has already largely implemented the improving outcomes guidance for breast cancer published in 1996. The guidance has recently been reviewed to take account of latest evidence. Implementation of this and other NICE cancer guidance has been set as a priority in the priorities and planning framework for the NHS.

Baroness Northover

My Lords, I thank the noble Lord for that reply. But does he share with me a depressing sense of déjà vu in looking at the report? How can it be that it still needs to be said that all breast cancer patients, indeed, all cancer patients, should be treated by teams of specialists? All the evidence shows that ensuring that every cancer patient is treated by a specialist is the one thing that will make a difference at the moment to outcomes. How soon will the Government fully implement not only this blueprint for breast cancer but also similar blueprints for the other cancers that are lagging behind?

Lord Hunt of Kings Heath

My Lords, I am sorry that the noble Baroness takes such a negative view of the progress that has been made over the past four or five years. The Government have shown great determination to improve services for people with cancer and to improve preventive programmes. We agree with the report that the noble Baroness mentioned that, of course, multidisciplinary team working is important. But if the noble Baroness looks at all the statistics, the improved outcomes, the improved access to treatment, the reduction in waiting times and the development of screening programmes, surely she will acknowledge that considerable progress has been made.

Baroness Gardner of Parkes

My Lords, will the Minister comment on the reports in today's press that mammogram screening might in itself cause breast cancer? That could cause much confusion with regard to whether or not people should present themselves for screening. Does the Minister agree that it is important for people who are considering presenting themselves for screening to be given some reassurance on that point?

Lord Hunt of Kings Heath

My Lords, I very much agree with that. Screening programmes that are proven to be effective need a great deal of support. Some of the results of screening programmes introduced over the past decade have been spectacular. We very much need to encourage people to present themselves for screening where it is appropriate. However, it is also important that screening programmes are introduced only where they are shown to be effective. That is why we have an expert National Screening Committee that advises the Government on those matters. When those kind of issues are raised we always look to that committee for further advice.

Lord Ezra

My Lords, will the noble Lord indicate whether NICE has turned its attention to the equally important issue of prostate cancer and whether there is the prospect of a more effective test being introduced?

Lord Hunt of Kings Heath

My Lords, that is, of course, a matter of great debate. However, there is no good evidence to date to indicate that screening for prostate cancer using the PSA test—I suspect that that is the test to which the noble Lord referred—reduces mortality. It is controversial and professionals disagree on its usefulness. However, when seeking advice from their general practitioners, patients should be given the most robust advice possible. We have recently sent a pack to GPs that provides such advice. I believe that it will be helpful in the future when GPs are asked for their view on the matter.

Baroness Hayman

My Lords, my noble friend is obviously right to point out the progress that has been made in cancer treatment but he will be well aware that survival rates for breast cancer, as for other cancers, are far lower among deprived groups of the community than they are among affluent groups of the community. Can he give us some assurance that the funds necessary to bring services up to the level in affluent areas will not only be earmarked but will actually be delivered to the front line? In asking the question, I should, of course, declare my interest as chairman of Cancer Research UK whose primary care research group work underpinned some of the NICE guidelines.

Lord Hunt of Kings Heath

My Lords, I cannot commit myself to earmarking in the future. However, the decentralisation of funding allocations to primary care trusts from 2004 will allow greater focus to be given to the funding of programmes that tackle deprived communities. My noble friend will also know that we are currently reviewing the formula under which resources are allocated to the NHS. One factor is the extent to which funding recognises deprivation. As regards survival rates, I refer my noble friend to the comments of Professor Boyle of the Milan-based European Institute of Oncology who told the Britain Against Cancer conference on 5th November that Britain's attempts to prevent and cure cancer have indeed been a success story.

Lord Renton

My Lords, why do we have to wait until the year 2004 for the improvement that the noble Lord suggested?

Lord Hunt of Kings Heath

My Lords, we are not waiting for 2004 for the improvements that I have suggested because money is being allocated to the NHS. I was saying that from 2004 the resources that currently go to health authorities will go to primary care trusts. I believe that because GPs will be much more involved in those decisions, the targeting of funds towards deprived communities will be that much more effective. Much effort is also currently going on.

Baroness Walmsley

My Lords, is the Minister aware that much of the funding that has been announced by the Government for cancer services is not getting through to the front line? Is he aware that many of the priorities identified by cancer specialist teams are not being funded? Is he also aware that in one area, of which an oncologist of my acquaintance is a member, none of the priorities has been funded?

Lord Hunt of Kings Heath

My Lords, again, the noble Baroness is extremely gloomy and depressing about what is happening. The reality is different. Of course I know that there is concern about whether all of our intended funding is getting through to front-line services. That is why we are discussing that question with strategic health authorities. Our cancer director, Professor Richards, is working with those strategic health authorities to ensure that the money gets through. Great progress has been made, services have been expanded, waiting has been cut and new equipment has been introduced. As Professor Boyle said, the UK is one of only a handful of countries that have attained, or nearly attained, targets for cutting cancer deaths by 15 per cent by 2000. We have brought down male cancer deaths from the third highest in Europe to the fifth lowest. At the same time as tackling problems, we should acknowledge the success that has been achieved.