Cancer Mortality Rates (Hansard, 20 October 2004)

§ Baroness Andrews
My Lords, we have made significant progress towards the 2010 target, with a 10.3 per cent fall in cancer mortality rates since 1996. As part of our commitment to reducing inequalities in health, we will target communities and areas where action is most needed to improve cancer outcomes through a number of measures, including reducing smoking prevalence, tackling obesity, improving screening coverage and ensuring that patients with symptoms that could be cancer present earlier to their GPs.

§ Baroness Morgan of Drefelin
My Lords, I thank my noble friend for her full Answer and in doing so, I wish to declare an interest as chief executive of Breakthrough Breast Cancer.
We have experienced a welcome decline in the mortality rates for breast cancer, but is the Minister aware that a deprivation gap is forming between the poorer socio-economic groups and those better off in terms of survival for breast cancer? Is she also aware that today the All-Party Group on Breast Cancer launched a report highlighting the fact that in key areas of deprivation the uptake of screening falls well below the desired targets for those areas? Does the Minister agree that by targeting those specific areas more could be done to reduce that deprivation gap?

§ Baroness Andrews
Yes, my Lords. This is an opportunity for me to say how much we appreciate the work that the noble Baroness has done over the years, and continues to do, in Breakthrough Breast Cancer. We have some of the fastest-falling cancer mortality 768 rates in Europe, but we still have a persistent deprivation gap. It is our job now to focus on that and is why the PSA target will make our work focus on improving access and services in the one fifth of local authorities which have the highest deprivation rates. A list will be published later this autumn.
I am aware of today's report. Yes, take-up of screening and communication with those groups of men and women who are less likely to come forward is extremely important. We are putting in place a range of programmes. Much of the new money that is now being spent on new equipment and staffing is also being directed to those areas.

§ Lord Chan
My Lords, does the Minister agree that areas with the worst health indicators contain many people whose first language is not English and many first-generation migrants? What is the Government's plan for correcting cancer inequalities in those areas?

§ Baroness Andrews
My Lords, it is a serious problem and the noble Lord is quite right, because we know that black and ethnic communities have the lowest rates in terms of coming forward for screening. At both local and national levels we are trying to address that. For example, in the NHS Cancer Plan all PCTs were told to review screening and put specific plans in place. So we are beginning to see more training of receptionists from ethnic minority backgrounds, more working with community advocates and health educators, and providing more interpreters. But the London Health Observatory report in July confirmed exactly what the noble Lord said, and we clearly need to be doing much more regarding ethnic languages and outreach programmes.

§ Lord Skelmersdale
My Lords, does the Minister accept that speed of treatment, especially radiographic treatment, is of the essence? Does she agree with a recent report by the Royal College of Radiologists that the maximum acceptable waiting times for both radical and palliative treatment have more than doubled since 1998?

§ Baroness Andrews
My Lords, we certainly know that the crucial bottleneck is in waiting times for radiography. There is a world-wide shortage of radiographers. We are taking specific action. The National Cancer Director, Mike Richards, is currently conducting a stock take into what further measures we can take, but in the mean time the good news is that the number of therapy radiographers has increased by 18 per cent and that we have more than doubled the number of training places at university. Before those people come on stream, in the interim we will introduce a four-tier skill-mix programme to allow therapeutic radiographers to extend their roles. So we are urgently trying to address the capacity issue in a number of ways.

§ Lord McColl of Dulwich
My Lords, does the Minister agree that the way to reduce those mortality figures is to prevent cancer? What are the Government doing to try to prevent the incidence of colon cancer and cervical cancer?

§ Baroness Andrews
My Lords, regarding colon cancer, I understand that physical activity programmes can play 769 an important role. We have a programme to reduce obesity and to improve diet and activity, which will be important. Regarding prevention, it is important to get across the message that people should report concerns or worries early to the doctor. Some people are very reluctant to do that. Achieving that would be a major step forward.

§ Lord Addington
My Lords, does the Minister agree that, since there is a strong link between general health and fitness and tackling such problems as obesity, the Government should consider moving responsibility for matters such as sports facilities and gymnasium activities to the Department of Health, where the linkage could be used to great advantage and would thus save money in the long term?

§ Baroness Andrews
My Lords, increasing access to sport is an important part of our physical activity programme, as part of the public health strategy as a whole. I know that the noble Lord is particularly keen on this matter. We have never been able to give him a satisfactory answer. I usually say that we have slowed down the sale of playing fields. We are encouraging, with billions of pounds going into sport, more activity in and out of school. I hope that that will have an important effect in the long term.

§ Baroness Hayman
My Lords, my noble friend mentioned the importance of tobacco control in terms of reducing tobacco-related cancers. I remind the House of my non-financial interests as chairman of Cancer Research UK. Will the Minister look carefully at the effects that a workplace smoking ban would have on reducing the deprivation gap in cancer prevalence and deaths, given that of the 2 million workers who are exposed to second-hand smoke with no protection whatever at the workplace, 1.5 million are from the lowest socio-economic groups?

§ Baroness Andrews
My Lords, when setting up the smoking cessation programme, we targeted it on manual socio-economic groups with the highest rates of smoking. Our evidence suggests that we are beginning to have an effect on those groups. However, the point she raises is important. This year, as part of the "Choosing Health" consultation, the Government talked to a wide range of people to obtain their views and proposals on how health might be improved. That consultation included how best to protect people from second-hand smoke. We have clearly said that we do not believe the status quo is an option and our conclusions will be covered in the forthcoming White Paper.

§ Baroness O'Cathain
My Lords—

§ Baroness McIntosh of Hudnall
My Lords, this side I think.

Noble Lords
Order!

§ The Lord President of the Council (Baroness Amos)
My Lords, we have time for both questions.

§ Baroness O'Cathain
My Lords, I congratulate the Minister on her comments about environmental tobacco smoke, or passive smoking. The reality is exactly as has been said; that the people in the lowest socio-economic groups are most exposed to it. There is one simple way; that is to ban smoking in public places. Will the White Paper specifically recommend that?

§ Baroness Andrews
My Lords, that is a tempting question, but I can hardly pre-empt what will be in the White Paper. I ask the noble Baroness to be patient for a little while on this issue.

§ Baroness McIntosh of Hudnall
My Lords, the Minister will be aware that the report to which she and my noble friend Lady Morgan referred draws attention to the persistence of the so-called postcode lottery in the provision of cancer services in the UK, despite NICE guidance which attempts to deal with that inequality. How do the Government propose to strengthen the monitoring of this issue?

§ Baroness Andrews
My Lords, NICE has issued nine separate pieces of guidance, which is part of the whole collaborative process of raising standards and keeping all practices up to date and the best possible. In terms of reducing inequalities and improving services, the evaluation process is more rigorous. NHS trusts are reviewed on a peer basis and we have a regular report on, for example, the Cancer Plan. The last one was published in July and the next is imminent. Furthermore, regular monitoring takes place by the strategic health authorities in the system and that will tell us whether we are meeting our targets. However, as we are half way to meeting our targets of 2010, which is a drop of 20 per cent, we are optimistic that we can see that wonderful improvement, with the tremendous work that is being put in by NHS staff.