§ Mr. Deputy Speaker (Mr. Nicholas Winterton)After a lengthy and unexpected suspension, we come to the debate initiated by the hon. Member for Crawley (Laura Moffatt), on the diagnosis and care of bowel cancer.
§ Laura Moffatt (Crawley)I have great pleasure in introducing the debate, particularly as it takes place in this special week, which is bowel cancer awareness week. The British are funny about mentioning bowels. As someone who was a nurse for 25 years, I have never had that problem—I spent most of my working life talking to people about their bowels. Therefore I am pleased to be able to do so legitimately today.
I shall run through the reasons why the debate is so important and give some facts and figures on bowel cancer in the United Kingdom. Bowel cancer is the third commonest cancer, excluding non-melanoma skin cancer, and the second commonest cause of cancer death—after lung cancer. For men, it is the third commonest cancer after lung and prostate cancer.
§ Dr. Desmond Turner (Brighton, Kemptown)In the context of the Government's target of preventing 100,000 deaths from cancer over the next few years, does my hon. Friend agree that there is an enormous opportunity to be seized with regard to bowel cancer, given that our current survival rates are so much poorer than the best in other countries, and that we do not have screening, apart from a pilot project that is under way?
§ Laura MoffattI thank my hon. Friend for that intervention. I agree that screening will become an important factor in reducing not only deaths from bowel cancer, but the misery of people going through the process. It will be important to the way in which we tackle bowel cancer. In 1997, 17,349 people died of bowel cancer and each year there are 34,000 new cases. The five-year survival rate is 37.9 per cent for men and 40.6 per cent for women, compared with around 60 per cent. in the United States of America—a statistic that highlights my hon. Friend's point. The majority of people affected are over 50, but bowel cancer can strike at a much earlier year. Despite its frequent occurrence, bowel cancer has had a low public profile—lower than that of other cancers. I hope that that is changing. I believe that a week such as this, in which awareness has been raised, will stimulate that change.
Yesterday, there was a superbly supported launch, hosted by my hon. Friend the Member for Norwich, North (Dr. Gibson), at which many speakers debated the issues surrounding cancer. Ten leading cancer charities came under one umbrella, led by Colon Cancer Concern, which has brought together the concerns of those charities to ensure that they all point in the right direction and give similar advice, to prevent confusion. What I found most heartening about that launch, which was attended by my hon. Friend the Minister and which was warmly welcomed by people involved in caring for those with cancer, was the fact that it was hosted by Ladbroke, the betting people. It seemed important that an organisation whose raison d'etre is often escapism, having fun and opting out of the nitty-gritty of life felt able to support bowel cancer week. I congratulate Ladbroke on that.
14WH There is good news. Bowel cancer is one of the most preventable cancers and one of the more curable if caught early. We can reduce the risk of it through diet, which should be high in fruit, vegetables and fibre. I strongly support campaigns to introduce more fruit into children's school diets. I congratulate the Education Sub-Committee of the Select Committee on Education and Employment on its recent report on school meals, which highlighted the importance of fruit in children's diet. Many hon. Members signed a recent early-day motion to ensure that fruit is made available to children as part of school meals. That is an important step in the encouragement of better eating.
The Early Cancer Research Campaign submitted research findings that explained and supported the protective properties of fibre. These are early findings, but they could also demonstrate that there is a protective link with aspirin. Approximately 10 per cent. of bowel cancers are genetic, but there is no genetic testing despite the fact that family history is becoming increasingly important. However, most sufferers unfortunately do not have a family history of bowel cancer, which is why screening is most important. Regular screening is recommended, especially for those who are at risk.
Professor Gordon McVie, the director-general of the Cancer Research Campaign, said:
£84 million of the NHS spend on bowel cancer treatment and diagnosis and the incalculable cost of human suffering could be saved each year if only people knew about prevention.We are here precisely to prevent the pain and misery and, of course, to save national health service spending on cancer.Diagnosis is key. I pay tribute to Lyn Faulds-Wood, who is fronting a national helpline that people may call to talk about their symptoms, so that they have an idea of whether they have something to be worried about. My right hon. Friend the Secretary of State and the Department of Health have supported the helpline, which is an important move.
I hope that I will not offend anyone in the Chamber if I outline a few important symptoms. Hon. Members and colleagues may read what I have said and this may strike a note with them. It is important to take notice of persistent changes to bowel movements. Frequent bowel action, a need to go to the toilet again and again and diarrhoea-like stools are important indicators that must be heeded. Piles, itching in the anal area and a sore anus must be taken seriously if they last for more than six weeks. Unexplained anaemia, a lump or mass in the abdomen and severe colicky pain are all important indicators.
Treatment is available. Surgery is the primary treatment and, if the disease is caught early enough, is often the only treatment that is needed. However, drugs play a part. I want to raise the subject of drugs with the Minister. There are concerns that some anti-bowel cancer drugs may not be being offered to all the patients who need them. In particular, the Campaign for Effective and Rational Treatment—CERT—is concerned that there may still be some postcode prescribing, although it and I warmly welcome the ability of the National Institute for Clinical Excellence properly to evaluate drugs and make them available. I hope that we shall soon have good news about Taxol 15WH and Taxitere. However, it appears that not enough bowel cancer sufferers are being offered treatment. It is important that that be done. There have been some enormous advances in cancer, especially since the appointment of the national cancer director and the setting up of NICE. It would be wrong for NICE to be used by the health authorities as an excuse for not providing drugs while awaiting a decision. I hope that the Minister will comment on that. CERT is looking for central funding for many of those drugs, to take away the fear that patients may not have access to them.
Bowel cancer is low profile, but I believe that, after this week, this debate and the launch of the helpline, that will change. I certainly hope so.
§ Mr. Deputy SpeakerOrder. The hon. Member for Norwich, North (Dr. Gibson) has obtained the permission of the initiator of the debate, the Minister and myself to take part.
§ Dr. Ian Gibson (Norwich, North)I congratulate my hon. Friend the Member for Crawley (Laura Moffatt) on securing the debate, especially as it is national bowel cancer week and the 10 groups in the consortium are really raising the awareness of the issue. Men and women throughout the country will learn about the issue, which previously has been a quiet area. I have recently returned from the United States, where we visited cancer institutes as part of the investigation by the Select Committee on Science and Technology. We were made ultra-aware of how the Americans can do everything better than us—some of us have learned to live with that, but it is true in the case of their survival rates, which, at one year and five years, are greater than ours. They are just better at it, despite their problems with private insurance and so on. The Select Committee will pronounce on the situation. They can get about 90 per cent. recovery with early-stage detection of colorectal cancer, and that is simply not attained in this country.
There is agreement on both sides of the great pond that the decrease in incidence of bowel cancer—and there is a decrease—is due to increased screening practices and the removal of early-stage polyps from individuals who visit their doctor early. Mortality rates are also decreasing, and it is agreed that that is also due to decreasing trends in incidence rates and increasing survival rates. As my hon. Friend points out, 17,000 people still die every year and 32,000 people contract bowel cancer.
Detection at an early stage usually means surgery when polyps are removed. That prevents them becoming invasive, and that is imperative. However, there is great success with drugs such as Campto, as well as at later stages of the disease. Hopefully, with the good news that Taxotere has been approved, NICE will be looking at these drugs too, and the Government's plan to spread equality across the country in the availability of these drugs will penetrate into the colorectal drug scene as well. I congratulate the campaigning zeal of groups such as CancerBACUP, Cancer Link and CERT, and particularly within CERT the campaigning zeal of Hugh McKinney, who has kept us on our toes about drugs and that issue for some time.
16WH I would like to say something about the risk factors. As my hon. Friend said, it is quite clear that there are genetic factors, family history problems and individual problems with those who have had irritable bowel syndrome for some time, which, in some cases, can be a preamble to some cancers. However, I should like to say a few words on the other risk factor—diet—to which my hon. Friend alluded. I have always known and been brought up to believe that in Scotland we have a terrible diet. There is no doubt that the bowel cancer rate is twice that in England. No doubt the Scottish Parliament will handle that in its own way. It is a diet that is short on vegetables and low in fibre, with delicacies such as fried Mars bars and chips. It has moved on to this year's model—Jaffa cakes and chips. The chips are advertised as coming from organic potatoes. That is all right, then; it will be thought that the incidence of bowel cancer syndrome will be less. I doubt that very much.
I am also pleased with Delia, Jamie and Nigel, who have taught a nation how to cook and got them interested in food and how to prepare it. I am much more impressed by local community groups—I should not say "more" because Delia and I support the same football team and I shall not be allowed to sit beside her. Nevertheless, I am impressed by local groups that teach young people about food and nutritional value. It is particularly impressive, when one visits schools, to see what used to be the domestic science classes—now food technology—in which young men and women discuss nutritional values and compete with each other to make the best delicacies. There is now a breakdown in genders, and both men and women make very good cooks, which is a real step forward, which is being encouraged.
I am also impressed by the research undertaken at the Institute of Food Research in Norwich at which the value of eating broccoli is being correlated with the decrease in the incidence of bowel cancer. Much exciting work is being undertaken at the genetic level, too. We, in the cancer field, are all imbued with such enthusiasm and excitement because we are learning so much more about its genetic basis and how to prevent other factors from moving it on to such deadly stages. During the past few years, the Government have taken some amazing initiatives in moving cancer up the agenda and I am sure that everyone in the House agrees that my hon. Friend the Minister was right to ask for more support for screening, that drugs be available throughout the country and that those who need such drugs will receive them. In the next two years, Britain's war against cancer will be at its most vigorous.
§ The Parliamentary Under-Secretary of State for Health (Yvette Cooper)I congratulate my hon. Friend the Member for Crawley (Laura Moffatt) on securing such a timely debate in what is national bowel cancer week. I was delighted to attend its official launch yesterday, which was hosted by my hon. Friend the Member for Norwich, North (Dr. Gibson). I take the opportunity to pay tribute to the work of both my hon. Friends, the organisations involved in yesterday's launch and the voluntary sector charities and patient groups, the professionals and those companies that have worked so hard with us. We rely on them to help us deliver the improvements that we must make.
17WH If we are to make further steps forward in bowel cancer, it is clear that we must take action across the board on prevention, screening, early detection, high-quality treatment and care, palliative care and research. We have set clear targets for saving the lives of those suffering from cancer. During the next 10 years, we want to reduce the death rate by 20 per cent. for those under 75 years. That is an ambitious target, and whether we achieve it will depend on improvements in prevention as well as in treatment.
We can make large gains on the prevention side. Deaths from bowel cancer can be reduced by changes in people's life styles, such as improvements in diet, keeping active and, particularly, fruit and vegetable consumption. We are investing £750,000 from the public health development fund in a diet and cancer-reduction project. It will test approaches to increasing fruit and vegetable consumption and produce a guide setting out best practice that we can replicate throughout the country. Five pilot sites for the project have been identified. It will be launched in July; we look forward to receiving the results. It is important that it provides to children and adults information not only on diet, but on how to improve access to certain foods. It is not much good knowing that we must increase our fruit and vegetable consumption if it takes three bus rides to reach the nearest shop that sells affordable fruit and vegetables. We must reduce not only the number of deaths from bowel cancer, but the inequalities.
This year's European week on cancer, which will be in October, will focus on increasing fruit and vegetable consumption among children aged from five to 10 years, and their families. We will be providing funding to health promotion activities in respect of that initiative. However, we must go further, and I shall ask the new modernisation action team on prevention and inequalities to look at issues that surround diet and to examine what more can done to improve access to fruit and vegetables.
My hon. Friends mentioned awareness, which is extremely important. We know that colorectal cancer is one of our major cancer killers. Men and women who are diagnosed early, before it has spread to other parts of the body, have a good survival rate. However, we know that too many people ignore their symptoms, self-treat, or are too embarrassed to go to their doctor. I welcome the Cancer Research Campaign's appeal on breaking the taboo, and the work being carried out for national bowel cancer week to raise awareness and encourage people to discuss openly symptoms that they might otherwise have been too embarrassed to consider.
The problem is not simply about patients being aware of their symptoms. We must ensure that their symptoms are identified quickly, referred appropriately and treated speedily. That is why, from July, all patients whose symptoms could suggest bowel cancer and who are referred urgently by their general practitioners will be offered out-patient appointments within two weeks. Although bowel cancer is a common problem nationally, an individual GP is unlikely to see more than one or two cases a year. We therefore need to provide support for GPs so that they can distinguish between patients whose symptoms may be cancer and a larger number of patients who have similar symptoms arising from other causes.
18WH We have been working with primary and secondary care groups, voluntary organisations and patient groups to develop cancer referral guidelines to help primary care teams identify patients who need to be urgently referred for specialist appointments. The guidelines will also help GPs to identify patients unlikely to have cancer, who can then be reassured and safely watched in primary care. Those guidelines are being sent to GPs, primary care groups, trusts and health authorities this week. They were launched on the internet at the end of March and will be widely available.
My hon. Friend the Member for Crawley mentioned screening, and we are anxious to know the merits of introducing a national screening programme. Following advice from the United Kingdom National Screening Committee, the Government are piloting bowel cancer screening. The pilot will provide valuable information on the effectiveness, feasibility and public acceptability of screening for bowel cancer in an ordinary national health service setting rather than a specialist research environment. The pilot will run until 2002 and its results will provide the basis for a decision on the introduction of any national population screening on bowel cancer.
We want all cancer patients, wherever they live, to have access to the same high-quality services. Since 1997, we have invested significant extra resources on colorectal cancer to support the implementation of an evidence-based guidance programme. That has been enormously successful in improving early diagnosis and quality of treatment for patients. We are also investing nearly £200 million in cancer equipment to improve diagnosis and treatment services and cut delays. We will work closely with health authorities and hospitals to ensure that those additional resources are used for those in the greatest need.
Cancer patients also want certainty and choice about the care that they receive. We must ensure that we place patients at the centre of the process, so we shall invest £6 million over the next two years in a national project to improve the process of care for patients with suspected or diagnosed cancer. Nine cancer collaboratives centres have been based across the national health service to cover 14 million people, and have been selected to take part in a national programme to streamline every stage in the patient's journey, from diagnosis to treatment and follow-up care. The aim is to create a gold standard of care for cancer patients and to spread the new ideas across the NHS.
All the experts in the field—everyone who is part of the cancer journey—must work together to identify problems and bottlenecks, and to ensure that the patient is central to the process. It will mean the earliest possible appointments with specialists for patients whose GPs suspect that they have cancer, a speedy diagnostic process and, perhaps, attending one-stop clinics where all the diagnostic tests are carried out on the same day, thereby removing the need for repeated visits. It means obtaining results quickly, booking appointments so that patients know when and where they will be treated, and providing a choice of dates for the convenience of the patient. It means co-ordinating aspects of treatment to speed up the process. For example, a patient who requires radiotherapy following surgery should not experience delays between the various components of treatment. Having visited the cancer collaboratives 19WH centre in Birmingham, I was impressed by the progress being made to improve support and treatment for patients.
My hon. Friends expressed concerns about the availability of drug treatments. I share their concerns about the postcode lottery, whereby certain drugs are available in one health authority and not others. The Government firmly believe that treatment should be based on people's ability to benefit, wherever they live. We are considering additional topics for appraisal by the National Institute for Clinical Excellence during the following year, and anti-cancer drugs are among them. Professor Mike Richards, the national cancer director, is leading urgent discussions with NICE to decide on the order and level of priority. I take seriously the points made by my hon. Friends. The resources available to health authorities have increased—a 6.8 per cent. cash increase was announced in December, and, since the Budget, an extra £600 million has been allocated to health authorities for this financial year. Additional resources for drugs are being made available, and investment must be improved and increased in future.
Concerns have also been expressed about work force issues. We need better information for work force planning, more flexible training and development, and innovative solutions to some long-standing problems. Work force development is one of our priorities in terms of improving cancer services. Professor Mike Richards will be working closely with the profession to ensure that there are sufficient trained personnel in diagnosis, treatment and care, and that working practices are modernised to best effect.
20WH High-quality research, in prevention and treatment, is a vital element in our cancer strategy. In 1998–99, the Government spent £5.5 million on research into colorectal cancer. Research included studies of how bowel cancer treatment and referral delays vary across services in the Yorkshire area, and what patient and service factors affect those variations. Other research included systematic collection and analysis of existing evidence on surgery and palliative chemotherapy for older people who have bowel cancer, the results of which are currently under review. It is important that we do not forget the importance of palliative care, which is an essential part of improving cancer services and support for patients.
Following the Downing street seminar last year, which was hosted by the Prime Minister, the cancer research funders forum was established with the main aim of ensuring that a co-ordinated approach to research funding is pursued wherever possible, in order to obtain the best results. My hon. Friends will be aware that a broad consultation and national debate will take place during the next three months, which will enable us to draw up a national plan in the summer. Discussion of cancer and bowel cancer issues will be part of that process. We have made it clear that cancer is one of our top priorities.
As my hon. Friends said, survival rates must be increased. We should not only consider what is happening elsewhere in the world but tackle inequalities in this country. We are making progress on colorectal cancer. Survival rates are improving, but we have a long way to go. My hon. Friends are right to be optimistic about the progress that we can make. We know that huge challenges lie ahead, but I believe that we can make a real difference in better prevention, awareness and treatment and swifter diagnosis, which will ultimatelty mean that we can save lives.