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Westminster Hall

Wednesday 6 November 2002

[Sir Alan Haselhurst in the Chair]

Cancer Networks

Motion made, and Question proposed, That the sitting be now adjourned.—[Joan Ryan.]

9.30 am

Dr. Ian Gibson (Norwich, North): This morning's debate on cancer networks is rather appropriate, as the all-party group on cancer is holding a major conference called "Britain against cancer" not far from here in the Queen Elizabeth II Centre. The first day of the conference has been exceptionally successful. The participants have interacted well and have discussed major problems. They believe that progress is being made in the delivery of better services to treat cancer, but the point of today's debate is to discuss what more we can do to assist that progress along the pathways that we all want.

I shall begin with a little history of cancer and its treatment. In 1995, Calman-Hine produced a report with the objective of creating a network of care in England and Wales that would enable patients, wherever they live, to be sure that the treatment and care that they receive is of a uniformly high standard. The report contained several principles around which the delivery of cancer care should be built. It stated that all patients should enjoy access to high-quality care, that care should be provided as close to patients' homes as possible, and that patients, their families and carers should be given clear information about their condition so that they can understand treatment options and outcomes.

The previous Government set the ball rolling. In September 2000, however, this Government signalled a major change by publishing the first comprehensive report for improving cancer care in England, which went much further than the Calman-Hine report. The national health service cancer plan brought together prevention, screening, diagnosis, treatment and research, and set out the Government's plans for future investment in cancer treatment and care. New funding of some £570 million a year extra was provided to support the plan. Clearly, delivering better health services in this country is a major priority. Cancer care is at the forefront, and the Government are demonstrating how to deliver it.

The Government recognised that the quality of cancer care varies throughout England and Wales. In some areas, it rivals the best in the world; in others, it is in urgent need of improvement. Some serious problems need to be addressed—out-of-date equipment, too few cancer specialists, geographical variations in access to treatment, and poor communication with patients. The aim, which we would all endorse, is to save more lives and to ensure that people with cancer receive the right professional support and care as well as the best treatments throughout their cancer journey.

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Tackling inequalities in cancer survival rates needs to be a glorious ambition. Among the problems that the plan addressed was the need to invest in specialist staff, research and preparation for the genetics revolution that is with us now, and to adapt to all the major changes taking place. There were commitments to reduce smoking rates and waiting times, and to improve access to hospitals, hospices and palliative care. Since the publication of that plan, we have seen initiatives such as a ban on tobacco advertising, an extension of breast cancer screening programmes, a national fruit scheme, and investment in primary care with GPs at the forefront with responsibility for cancer services.

We have also seen investment in research. The National Cancer Research Institute has already started to develop strategic plans on how we fund world-class research in this country. Nobel prize winners pour out almost daily as a result of the work that is going on. I predict that there will be more, such as David Lane of the university of Dundee, who, at this very moment, is speaking in the Queen Elizabeth II Centre. His work on a particular oncogene is very important in developing new strategies to tackle the rogue cells of cancer.

Much is happening. There have been improvements in information for patients and in drug assessment and analysis by the Commission for Health Improvement. There have also been visits to different hospitals to look at cancer services and monitor what is happening. Indeed, there is so much activity in this area that it has almost become a paradigm for other services in the health service. Mental health services will build on the back of our experience, and I believe that heart disease services will do the same. We are at the forefront and things are happening, but that activity must be considered in the context of the strategy and the plan for what we are trying to achieve.

One in three people in the United Kingdom will be diagnosed with cancer, and one in four will die of it. At yesterday's conference, Peter Boyle, an epidemiologist of great distinction, presented figures that clearly show that the incidence of, and mortality from, breast cancer and the other major cancers have been gradually decreasing over the past five or six years in Britain. As a result, there is a real feeling that some of the things being done are beginning to pay off in the form of improving rates. It is perhaps not surprising that in other countries, such as Spain, Portugal and Greece, there have been amazing increases in the incidences of cancer. We can all guess the reasons for that; they include smoking, diet and other habits.

We have taken an amazing step forward, but my aim in this debate is to ask, as is my wont, whether we can do more and better. How do we move the situation on? It is no use saying that we have done it all, sitting back and hoping that things will happen. The work force is enthusiastic and determined, although there may not be enough people in certain areas. In a poll at the conference, more than 60 per cent. of the 500 or more people there said that things had got better, which must be music to the ears of some of our friends in Downing street who have to think up these slogans. There is some proof that something is beginning to happen.

However, more could be done in many areas. I do not want to talk about passive smoking, but it is clear that moves are being made on that. There is no definite evidence that passive smoking causes certain types of

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cancer, but there is a suspicion and more work needs to be done. We have started to think about our diets, and more needs to be done on that with the industry. Perhaps companies should be compelled to watch what they put in foods, particularly those given to our young people in school dinners.

Habits and cultures will take time to change, but the process is beginning. I doubt that we will get rid immediately of the culture in Scotland of pizza and chips and everything being fried in batter. That will take a few years, but even the Scots will come round in the end.

I want to concentrate on cancer networks, because they are the organisational model for cancer services to implement the cancer plan, to which I referred. They bring together health service commissioners—health authorities, primary care groups and trusts—and providers, which comprise primary community care groups, hospitals, the voluntary sector and local authorities. Bringing together that group of people, with all the differences in personality and style, is difficult and therefore a real achievement.

I guess that the 34 cancer networks are moving at different speeds, and no doubt some of my colleagues will wish to talk about that. Throughout the country, the networks are working to consider prevention, diagnosis, screening, supportive care, specialist palliative care and so on. I think that they are meant to have reviewed their service provision by now and identified where they need to develop and invest for the future. I challenge my hon. Friend the Minister to say whether all 34 networks have produced their plans, whether they are up and running, and whether there are different tiers or speeds. If there are, what can we do to make them all move at the speed and level of the best?

This is about establishing a patient partnership. Patients have taken centre stage in the NHS. Everyone wants to involve them and their carers in decision making on shaping services, particularly cancer treatment. We shall reform delivery systems by asking people in the networks to collaborate and initiate things in new, fresh and exciting ways. The United States is rather good at that, but we have not been very good at it in many walks of life.

Recently, 17 cancer groups got together. They were from the care and cancer charities, and drug companies such as Aventis and Eli Lilly. One is often cynical about drug companies, thinking that they are interested only in making profits. That is okay but, surprisingly, they have also said in a statement that there should be

In each network, the individual tumour-specific working groups—colo-rectal, breast and so forth—are examining how to develop their programmes. Patients need to be involved fully, not just on an ad hoc basis. To enhance public and patient involvement, patient representatives should sit on the individual working parties as well as the networks.

A Department of Health official, Harry Cayton, well known for his work in the Alzheimer's Society, heartened me yesterday when he stressed the importance of three simple messages about patients. The most

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important was "Trust me, I'm a patient. Listen to me. Please tell me the truth about my condition and don't do anything without involving me." That is the spirit of the age and we have to try to deliver it through the networks. The determination and involvement of patients will enrich the networks' work.

Each network covers about 2 million people. Evidence suggests that they may be moving at different speeds. On 19 December 2001, Hansard recorded that the national health service planning and performance framework required the national health service organisations to work together through the cancer networks to deliver the cancer programme in line with the strategic plans of each of the networks. Everything is in place; the words are written; the people are there. How is it all working out?

We heard evidence yesterday of good work in the Avon, Somerset and Wiltshire cancer network. The secret is that people there are talking together and the important people who deliver the services and carry the cheque books also attend the meetings. They know about the spirit at loose there and that many positive developments are taking place.

I shall refer to some of the issues reported at yesterday's conference. Because the Avon, Somerset and Wiltshire network receives funding from the health authorities, it has five research nurses, five data managers, a research co-ordinator, pharmacy support and additional equipment. It plans to double recruitment by 2004 and to invest more in education and support for all research staff. I suspect that it is the best network in the country: it is working and doing well. It would be good to see it doing even better.

The networks throughout the country also meet and talk to each other through the cancer services collaborative: they audit each other and discuss best practice among themselves. That reveals the positive indicators. We have seen quite a few success stories and I should like to hear colleagues telling me more about success stories in their networks.

Two further initiatives are required. I am sorry to be a bore on cancer again, but I remain committed to a national cancer Act in this country, akin to that in the US, which is currently being revised. It has proved the key to delivering support to all the cancer services in the US: it is the model that we should follow for the next stage of our cancer strategy. I argued in favour of that in a 10-minute Bill in May this year.

It is great to have a national cancer director—the so-called tsar—and Mike Richards has done a sterling job across the country, stimulating and organising the services. But why just one? Why not also have, as the Americans would say, a quarter-back in every network? It would be good to have more tsar-type leaders with the authority to drive and push forward the agenda.

The time has truly come for a national cancer Act, which would ensure that funding is delivered into cancer services year-in, year-out. Services must not be allowed to stutter because of lack of resources.

I chair the Select Committee on Science and Technology. As the Minister knows, we investigated where the extra investment in cancer services has gone. I am unsure how the Minister will react in reply, but we stimulated awareness of the fact that the money does not always get to the coal face, to the people who need it.

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However, that is not quite true. Current evidence shows that at least some of it is getting through to the coal face, and that people are seeing a difference. I do not believe that 60 per cent. of people would say that there was a difference unless they had seen a change, so some of the money is getting there.

However, we need an audit trail of that money so that when we say that it is going to a particular target, it reaches the cancer service that we want it to. Sadly, health authorities can use some of the money to meet wage increases and pay off debts. That is not good enough. If we are to deliver the cancer service that we know is possible, we need to ensure that that money gets through.

Again, at the conference yesterday, when the question was asked and the keypads were pushed, more than 60 per cent. of people agreed that the money was not getting through. I was heartened that 70 per cent. also said that they wanted a national cancer Act, so I have some support for that at present, even if it does not last. I see in the Gallery today that there are people from various networks throughout the country that are doing fine work. It is important that the people from networks, as well as those at the conference and practitioners, agree with me that much of the money that is given to cancer services by the Government is not getting through. Will the Minister assure us that the audit trail is being sharpened up?

We should ask why the radical and bold solution of giving the money straight to the cancer networks should not be adopted. If the people in those networks are doing a good job, and know the priorities in their areas, they will know what is most important and will take decisions on that basis.

The Government are determined to make sure that decisions are taken as close to the point of delivery as possible. This is a real opportunity to do what has been done so brilliantly in schools. Giving head teachers, who may not agree with what I am about to say, a sum of money, say £150,000 or £30,000, sends a strong message to them. It says that they can choose whether to use that money to hire a teacher or a classroom assistant, to put up a partition or to sort out the playground, and they know that they will receive that money every year, so they can plan on that basis. I believe that all cancer networks would engage much more sharply if they had a sum of money about which to decide in their locality so that they could be seen to be delivering for local people. There is no doubt that money brings influence, and I ask the Minister to consider that radical move.

The Government must preside over the resources and monitor the work that takes place. I should like the assurance that all the networks are being examined, and that those that are lagging behind are asked the reasons for that—whether it is leadership or some other factor that means that they are not delivering in the way in which, for example, Avon has.

We must be bold and radical. Our health service is on its way to delivering the best cancer services in the world. The messages that we receive and the lessons that we learn from that area will impinge on our delivery of the mental health Act when it is eventually considered in this place. I am enthused and excited by what we have done. I would not have expected, during my lifetime, to have reached the stage that we have attained during the

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past three or four years. The 500 people at the conference who represent people throughout the country feel the same.

The debate and the issues have changed. We are enthusiastic, perhaps too much so, but if that is the case, the Minister will no doubt slow us down.

Several hon. Members rose—

Mr. Deputy Speaker : Order. Before I call the next hon. Member, I draw hon. Members' attention to the grammatically challenged notice on the Annunciator, and assure them that we are not under orders to evacuate at present. We are cleared to continue.

9.48 am

Mr. David Tredinnick (Bosworth): Indeed, there is quite a to-do outside with the fire brigade all over the place.

May I say what a privilege it is to follow the hon. Member for Norwich, North (Dr. Gibson), who modestly said that he never would have believed that in his lifetime the pace of change would have increased so much in the House? I am glad that he does not represent Leicestershire because I would probably have to campaign against him. He has made a great contribution to cancer care from the Back Benches, and has relentlessly driven that agenda. It is a pleasure for me to follow him. It will be no surprise to hon. Members that I will focus on an area that I have focused on for most of my 15 years in the House and consider some of the complementary aspects of health care for cancer. The Minister's task would be infinitely easier if she were to take more account of the 60,000 complementary practitioners, who generally work in the private sector, and who are always prepared to help cancer patients.

I was struck by what the hon. Gentleman said about the 34 cancer networks. What an opportunity they provide to roll out some of the care listed in the wonderful directory of complementary therapy services in UK cancer care, which is published by Macmillan Cancer Relief. He said that he could not believe how far the cancer treatment movement has come in a few years, and I, too, find it hard to believe how the wind has got behind the complementary movement. The Government themselves are taking some of these issues seriously, perhaps because they have been raised relentlessly and repeatedly in the Chamber. The hon. Member for Oxford, West and Abingdon (Dr. Harris) smiles, as he always does, which is a good thing. Perhaps he is agreeing with me—we shall find out soon.

It is instructive to go to the directory, which lists available treatments on every page. I shall read one or two passages, although I know that we must not read out too much, as I have been called to order in the Chamber in the past and I will not make the same mistake again. The directory quotes a cancer patient who states:

That is very true. A patient who took part in a relaxation therapy group said:

Another patient said:

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therapeutic touch, the transmission of energy through a person who is trained to do it, usually because they are able to focus on light—

The patient now feels much better. A lady who was treated with aromatherapy said:

Roy, a patient describing reflexology, said

A great friend of mine was diagnosed as suffering from cancer by a reflexologist in the private sector who simply said, "I can sense that you've got a major problem." My friend went in for emergency treatment and has survived.

If the Minister can draw these therapies progressively towards the health services it will make her life in trying to deliver a health service on which there are ever increasing demands that much easier. When respectable organisations are involved in producing this type of directory—Michelle Kohn has done so much with Macmillan Cancer Relief—the Government must sit up, take notice and think closely and carefully about what the different treatments can do.

I now want to draw hon. Members' attention to Chinese medicine, which is going through a process of regulation, which I welcome. There are many shops throughout the country where people purport to do things that they are not necessarily doing. There have been some scares about Aristolochia, which we all know about, and it is right to move towards regulation. However, there also needs to be a better rollout in the health service, because the pain relief that acupuncture can provide is desperately important for cancer patients.

The use of Chinese herbs is also important in arresting cancer symptoms and keep PSA—prostate-specific antigen—levels down. It may help hon. Members to think of Chinese medical herbs as being like the Whips Office, because they work in the same way: there is a chief herb—

Dr. Gibson : Does the hon. Gentleman mean poison?

Mr. Tredinnick : We hope to avoid the Aristolochia effect. The hon. Gentleman refers to his own Whips, and I will not prejudice his career, as no doubt they are listening.

There is an assistant, or deputy, herb and a messenger, which all work together and help each other. Chinese medicine is fantastically powerful in prevention. The Government should take much more notice of that.

I have referred to acupuncture. There is also homeopathy, a hugely important range of treatments that is available to everyone now. A couple of weekends ago I presented the homeopathic awards at the Society of Homeopaths for those who had trained over four years. Then there is the whole healing movement. The Minister should also be aware of other simple devices that can go a long way towards relieving pain. One

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example is this transcutaneous electrical nerve stimulation machine. It sends an electronic current from one part of a limb to another and is very effective in dealing with acute pain.

Mr. Deputy Speaker : Order. The hon. Gentleman knows that aids of that kind are not normally brought into our proceedings.

Mr. Tredinnick : I have never sought to invoke aids that are forbidden in Parliament. I apologise. What I was hoping to demonstrate, which I now will be unable to do, was a simple TENS machine. Other pieces of equipment are coming on the market now, which look very similar and contain the frequencies of up to 20,000 homeopathic medicines. By connecting them to a wrist strap it is possible for the person to invoke the signature of that remedy and the body automatically interacts with it. It has been developed by a scientist. This is looking at the horizon. This is where I think we will be going in future.

Another area on which the Minister should focus more carefully is the whole healing movement. The group of people who have perhaps done the most with the least recognition for those suffering from cancer, particularly in hospices, are those in the healing movement, the therapeutic touch people. Whether or not one believes in channelled energy or in the results of the extensive trials that have been carried out, anyone who has had it will generally notice an effect of heat going through hands. Such treatment is very effective in reducing symptoms and bringing about well-being. It can give someone who is on their way out an extension of life. I should also like to pay tribute to Lucy Bell and her cancer care team at Charing Cross and Hammersmith hospitals. They well illustrate how complementary therapies can and should be combined in the cancer networks. This successful practice uses massage, aromatherapy, reflexology, relaxation and even an art therapy to treat patients. Its results have been demonstrable and significant.

Let me turn to more general health service issues, but still within the context of cancer care. I have always thought that one of the Government's fundamental problems is that they do not focus enough on preventive medicine. The hon. Member for Norwich, North touched on the issue of diet, which is crucial. We should pay more attention to the problems of obesity and lack of exercise. I welcome the new parliamentary groups that are springing up to address these issues.

The Government should be persuaded to make more of an effort to encourage people to take responsibility for their own health, for example using these little machines. The other machine with the homeopathic remedies that I was going to demonstrate looks very similar to the TENS machine. If people tried homeopathic remedies, which they can now get over the counter at chemists, it would reduce the pressure on doctors' surgeries. If that 5 per cent. of so-called heart-sink patients could be got away from the surgeries, there would be a better turnover of patients who can most likely receive effective treatment. About 5 million people in this country regularly use the treatments that I have described, not just cancer patients.

There is a fundamental problem of staff shortages in the health services. The Government spend £300 million a year on agency staff to fill the gaps. I am not saying

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that complementary therapists can fill all those gaps, but a more effective use of therapists in hospitals would take the pressure off hard-pressed nurses and help improve patients' health.

Regulation has been mentioned. The Government are supporting the efforts of the Foundation for Integrated Health to draw together the various representative bodies of complementary health care. I pay tribute, in particular, to the work of Professor Pittillo, not to be confused with my right hon. Friend who has been in the news recently.

Dr. Gibson : Are you supporting him?

Mr. Tredinnick : I shall not be sidetracked down that path.

The speedy introduction of regulation would be most welcome, and it would be worth while in the long term if the Minister could find a small amount of money with which to speed up the process. We need to complete the regulation of Chinese and herbal medicine, as well as of aromatherapy. Then doctors would find it easier to make referrals, because they would feel less threatened.

That leads me to the training of doctors. There has been a welcome move in medical schools to ensure that newly trained doctors are made more aware of the important issues. Every year, 5 million prescriptions for painkillers are issued at a cost of £265 million. Furthermore, £370 million of health service money is spent on painkillers in supermarket pharmacies. Treatment of the side effects of painkillers costs the NHS between £170 million and £350 million. The Government should focus on those costs and consider the alternatives that are available, such as acupuncture or methods recommended by the healing movement, represented by the Confederation of Healing Organisations. In that way, Mr. Deputy Speaker, the Government would find it easier to meet patients' demands as well as their own targets.

Mr. James Cran (in the Chair): For the avoidance of doubt, I am not Mr. Deputy Speaker, but merely Mr. Cran.

Mr. Tredinnick : On a point of order, Mr. Cran. I was under the impression that, in this Chamber, it was our duty to call you Mr. Deputy Speaker regardless.

Mr. James Cran (in the Chair): No, it should be Mr. Cran.

10.2 am

Dr. Desmond Turner (Brighton, Kemptown): I thank the hon. Member for Bosworth (Mr. Tredinnick) for providing us with a new insight. I now know that the role of the Government Whips Office is to add a little flavour to our dull lives in this place.

I endorse the comments made by my hon. Friend the Member for Norwich, North (Dr. Gibson) about cancer networks, cancer centres and the cancer Act. Now that we have them, we can say that cancer networks are obviously a good thing—the wisdom of hindsight is marvellous—but we cannot prove it because there have been no double-blind trials to show how much the cancer networks contribute to the improvement of

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cancer survival rates. However, it would defy logic if they did not help because the reasons for their effectiveness are obvious. Nevertheless, they have not always been obvious to the public or to general practitioners, and there is a substantial job to be done educating people.

That is one of the reasons why I support a national cancer Act, which would bring the matter firmly to the public attention and to the attention of all those in the health service who have not yet got the message. The Department of Health is reluctant to select disease areas for special treatment, but there is a case for doing so with cancer, which is uniquely biologically complex. Furthermore, it can be regarded as a paradigm for all health care: if one achieves success with cancer, one can transfer the methods and organisational and scientific approaches that one uses, and massive parts of the knowledge that one gains, to the rest of health care. One can then raise standards throughout.

It is obvious that centres of excellence with full multidisciplinary teams to cover all the areas of specialisation relevant to cancer promote interaction and the more rapid development of clinical procedures. They also promote better results for patients, which is the key to it all—if patients benefit, our approach must be right. That is the way to proceed, and it is increasingly recognised across medicine that people who encounter more cases—whether surgeons, oncologists or whatever—will provide more efficient and quicker treatment, with better results. It is as basic as that.

There must also be a concentration of heavy physical facilities, such as imaging equipment, which is becoming increasingly expensive, and radiotherapy equipment. We cannot spread such equipment around, with isolated machines in different general hospitals; we must concentrate facilities in regional centres for sheer cost-effectiveness—we should never forget the importance of cost-effectiveness in delivering a health service. All the logic therefore points to cancer centres, with a collaborative network around them; they are the obvious way to proceed.

I wish that I could say that that view was universally appreciated, but local experience tells me that it is not. It is not appreciated by local elected representatives in Sussex, by all doctors or by all members of the public. I am glad to have in my constituency a general hospital, which is about to become a teaching hospital. It is also a regional cancer centre. It is still developing, and it has quite a long way to go. It ran into a problem, however, because it is on an awful site and it has grown like Topsy in a place where, ideally, it should not be. One day, the trust's chief executive suddenly thought, "Oh dear! Under phase 2 of the development plan the portakabin that houses the breast assessment centre needs to be moved. Where shall we put it? Oh dear, we can't find anywhere. Oh well, we've got a sister hospital in Haywards Heath; let's build a new breast cancer unit there." In other words, the plan was to remove facilities for treating the most common single form of cancer from the cancer centre. All medical practice and logic tells us that that is nonsense, but that was the idea, although it started as a purely administrative device. Fortunately, another site was chosen 20 ft away; it is just over the road from the main cancer centre, so it is perfect. However, there was an incredibly parochial campaign by people from the hinterland of mid-Sussex

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and Haywards Heath who wanted their own centre of excellence. They clearly had not understood the simple message that one should concentrate services for specialist areas such as cancer if one wants results. Had those people succeeded, cancer patients in Sussex would have been the sufferers in the long term because the service would probably—I believe undoubtedly—not have been as good as the service that will now be maintained in Brighton, although that cannot be proved. There would have been a loss for patients: in cancer cases, they would have died—the issue is as basic as that.

The message still needs to be drummed home to the public that that is the way that matters are developing. The message also needs to be drummed into GPs, although that is not a universal criticism. I am a member of the Select Committee on Science and Technology, and when we were doing our cancer report, we were made aware of the variability of knowledge of cancer among GPs. In the first instance, patients go to their GP. If they are lucky and their GP recognises the signs and refers them, that is all right, although that does not necessarily happen. All too many patients go for many months presenting with cancer symptoms and being misdiagnosed. Although cancer is very common—one in three of us will at some time be diagnosed with cancer—the individual GP does not see that many cancer patients in a given year. GPs need a lot of support and education if they are to play their part in the cancer networks, and benefit patients.

The principle of the cancer network is a good paradigm for other specialist areas. The time has long passed when we could expect every district general hospital to do everything. Life has become more complicated and problems more specialised. There are fields for which the equivalent of cancer networks and cancer centres are appropriate. Cardiology is an obvious example—I am happy to say that there is a cardiology centre in my constituency also. Some types of surgery are appropriate for that approach. I would nominate orthopaedics. Orthopaedic surgeons who do a lot of hip replacements on a factory basis produce magnificent results. Those who do one once in a blue moon inevitably do not produce quite the same results. It is best to centre developing technologies so that there is the throughput to make them work effectively. Neurosurgery is another complex surgical field in which the same approach is inevitable.

Cancer networks are a leading example of a principle that we should apply carefully throughout acute health provision. We should not expect every district general hospital to specialise in everything. In a given district, one may nominate one district general hospital to be the leading centre for a given medical condition. In the long term, that will lead to more effective and efficient health care and better outcomes for patients. Cancer networks are leading the way. I ask the Minister not to reject out of hand the notion of a national cancer Act, because it has a lot to offer.

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10.13 am

Mrs. Patsy Calton (Cheadle): I congratulate the hon. Member for Norwich, North (Dr. Gibson). As other hon. Members have said, he has made a great contribution to the debate on this subject in the House and elsewhere. On a personal note, I want to thank him for his interest in the development of my thinking on the matter since I came to the House. I am a relatively new Member, and I am grateful to him for the time that he has spent ensuring that I understand what is happening.

The Government published their NHS cancer plan in September 2000. It acknowledged that cancer treatment, although excellent in places, was not of the same high quality or accessibility for all patients. Ten years ago, services were fragmented, as Professor Peter Boyle suggested yesterday in his speech at the "Britain against cancer" conference, hosted by the all-party parliamentary group on cancer. There was no national guidance and there were no multi-disciplinary teams, except in breast cancer.

Cancer networks were expected to take responsibility for implementing the NHS cancer plan. Health authorities, primary care trusts and service providers would have to work together to plan for the investment in cancer services needed to implement the network strategy. The cancer plan set clear targets for cancer networks. By 2001, they were expected to develop strategic service delivery plans to cover all aspects of cancer services. In the document, those aspects were defined as prevention, screening, diagnosis, treatment, supportive care, and specialist palliative care. Again by 2001, the networks were expected to have developed underpinning strategies on work force, education and training, and cancer facilities. Emerging network plans were expected to be reflected in health improvement plans and service and financial frameworks by 2001.

It is now 2002 and 34 cancer networks are in place, but there is a vast difference in the level of implementation achieved. Yesterday, we heard that the Avon, Somerset and Wiltshire network seemed to be working as a joint enterprise, although it was a little unhappy about the word "seemed". Clearly, it has come a long way. It serves a population of 2.1 million people, with seven trusts, two strategic health authorities, 12 PCTs, five hospices and 65 groups from the voluntary sector.

When a network is pulled together, no doubt the commitment of professionals, support staff and those in the voluntary sector—including those involved in complementary medicine and hospices—can be harnessed to produce a sum greater than the parts, and to improve services for patients. However, the Greater Manchester and Cheshire network, which serves more than 3 million people in my area, has only just got going. When preparing for the debate, I thought that there was nowhere better to start than my own area. I was surprised that I knew nothing of the cancer network that served Cheadle; having been a patient, I have a particular interest. I searched the cancer network website, and found only the name and associated trusts, so that network has a long way to catch up.

In "The NHS Cancer Plan: Making Progress", which was published by the Department of Health in 2001, the Government claimed that progress was being made on faster treatment. However, they failed to publish any statistics on efforts to meet the treatment targets. A

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parliamentary answer to my hon. Friend on 11 February 2002 suggested that the Government did not know whether they had met the target set for December 2001 of a maximum one-month wait for breast cancer treatment. It is also clear that the Government drive for patients to be seen within two weeks does not reduce anxiety when treatment takes more than three months to arrange.

The Avon, Somerset and Wiltshire network has put patients at the centre of the service. The intention must be to provide a seamless service for patients, who have enough to cope with being ill and having to face treatments that are at least unpleasant. Although doctors and nurses work hard within the resources available, too often it can appear that hospitals and services are run around the needs of the service providers. Cancelled clinics are the norm. Patients trail all over the hospital site or from clinic to clinic, clutching inadequate information. Tests are delayed.

In a Government survey of cancer patients published in 2002 and based on data collected between 1999 and 2000, 16 per cent. of patients could not understand all or most of doctors' answers to questions about cancer, 10 per cent. had to wait seven months between diagnosis and treatment and a further 16 per cent. had to wait between three and six months. Among prostate cancer patients, 22 per cent. had to wait for seven months, while 87 per cent. of all patients had to wait for more than a month between noticing symptoms and being treated, 21 per cent. for seven months. Nursing needs on discharge from hospital were not even discussed with 37 per cent. of patients.

In my experience, patients' suggestions are often treated as complaints. A hospital with which I was involved had a policy of phoning patients to ask whether they were satisfied with their treatment. I said that I was, but that I had some suggestions and that I would write in with them. I did that—they were simple and patient-focused, but I received a reply that said that if I wished to make a formal complaint, the hospital would be happy for me to send it in. I considered throwing it in the bin, but decided to write back to say that I was not complaining but answering the question about whether there could have been improvements in the treatment, and when I did so there was a sudden assumption that I was making a complaint. I was not; I was simply making helpful suggestions and I wanted to hear that the hospital authorities were going to take notice of them. Sadly, that did not happen.

As the hon. Gentleman mentioned, Harry Cayton said yesterday that patients need to be listened to. The vast majority of patients are supportive of their doctors and nurses and of the national health service. They recognise how hard the professionals are working just to stand still. The complaints system treats patients as nuisances to be worn down with lengthy, unnecessary procedures that leave those without stamina exhausted and frustrated and those with stamina angrier than when they started. The Liberal Democrats believe that the NHS can be reformed—our vision is of an NHS that is decentralised, easily able to adapt to the needs of local people and accountable. Cancer networks should provide strategic development plans to ensure that the hard work and commitment of the professionals is supported with up-to-date equipment, trained support staff and a streamlined service to patients.

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For there to be accountability, there must be clarity about where funding goes. The Liberal Democrats are concerned about the health service's culture of secrecy about how funds are allocated and diverted between budget headings. Even health professionals are not convinced about whether cancer moneys have reached the services for which they were intended. As the hon. Gentleman said earlier, at yesterday's all-party cancer conference, 14.1 per cent. thought that the moneys were reaching the services for which they were intended, but 41.6 per cent. said that they were not and a further 44.2 per cent. did not know. That was a poll of people who were mainly health professionals and volunteers supporting those with cancer. Nearly 86 per cent. of the people who should know best what is happening either do not know or think that funds have been diverted. The Government should be very worried by that statistic.

Lack of co-ordination is at its most stark in research into the prevention and cure of cancer. Prevention should be at the forefront of research, yet I hear of the struggle in my area to obtain funding for research into the lifestyle causes of breast cancer—work on exercise and diet that could give much-needed pointers to the one in nine women who need to reduce their risk of getting the disease.

Those at the Europa Donna lecture last week heard from Dr. Martine Piccart, a consultant oncologist, who referred to the lack of co-ordination in chemotherapy research trials. In far too many duplicated studies, the same questions are being asked of far too many people; what is needed is different questions and a pooling of information.

The hon. Gentleman referred to a national cancer Act. The Liberal Democrats would not oppose such an Act, but we would want it to be clear about what was envisaged—and especially whether it would produce more centralisation and prescription rather than enabling local areas to take responsibility for local matters.

We do not believe that tsars are an answer; the very word has almost come to mean that those areas that appoint one will probably not get the attention that they deserve. Resources should support those who deliver the service, and I absolutely agree with the hon. Gentleman that there needs to be a transparent audit trail, showing how the resources get to where they are needed.

The hon. Members for Bosworth (Mr. Tredinnick) and for Brighton, Kemptown (Dr. Turner)—the latter has left the Chamber—spoke of complementary medicine. We very much support complementary medicine, but it should be exactly that—complementary to the support given by recognised, acknowledged and tested treatments. It undoubtedly brings great benefits to patients and should be part of the seamless service on offer to patients.

The Liberal Democrats have supported the vision of cancer networks since the cancer national services framework was published in 2000. The networks have the potential to offer patients modern, streamlined services that reflect local priorities and local needs. Health service professionals provide excellent service when they can, but their work is frustrated by poor resources, and inadequate buildings and equipment. They have to run in order to stand still. Cancer networks could provide them with the opportunity to work

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smarter rather than harder. However, two years on there is still a long way to go before patients will see sustained benefits. I hope that the Minister will tell us how she expects to inject fresh drive into areas such as mine that have only just started.

10.27 am

Tim Loughton (East Worthing and Shoreham): First, I add my congratulations to those already expressed to the hon. Member for Norwich, North (Dr. Gibson). It is with a sense of déjà vu that we debate cancer in this Chamber, because the hon. Gentleman is always here even if he has not instigated the debate. He has a fantastic track record on the subject, and it is a shame that more hon. Members are not here this morning. I presume that they are at the Queen Elizabeth II centre attending the conference that he has organised.

I also congratulate the hon. Member for Cheadle (Mrs. Calton) on her performance on the Liberal Democrat Front Bench. I am sure that we shall cross swords on many occasions on health as well as other subjects.

As usual, the hon. Member for Norwich, North made some interesting points. He is right that much progress on cancer care has been made over the past few years, but there are still many gaps and much progress still needs to be made. The hon. Gentleman is quite rightly always pressing the Minister—as we all do—for more. However, there are still enormous inequalities in cancer survival rates throughout the country, which compares badly with countries on the continent. Indeed, from the examples that he gave, Scotland may be the toughest nut to crack.

The hon. Gentleman's idea for a family of cancer tsars is slightly alarming. The Government already have more tsars than the Romanovs ever had in Russia—and, taking after that country, the Government have already started to give some of them the metaphorical bullet. It is not necessary to add to the fleets of tsars—or tsarettes—in order to put them in charge of cancer networks.

Mr. Tredinnick : Tsarinas.

Tim Loughton : A tsarina is a female tsar. A tsarette is a little tsar of either sex. It would be difficult to see that as a universal panacea for what might be going on in cancer care.

I agree that we need to sharpen up the audit trail—and I might come back to the business of the missing funds. I also have great sympathy with the suggestion that more money should go directly to cancer networks; that is a very attractive proposal, and it is in keeping with the policy to cut out far more of the middle ranges of management, which we are researching and following. We want to see much more money going directly from the Secretary of State to local providers such as cancer networks.

No debate on cancer—or on almost any aspect of health care—would be complete without the contribution on complementary medicines of my hon. Friend the Member for Bosworth (Mr. Tredinnick). It is sad that Mr. Deputy Speaker did not permit him to

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bring out his little devices to give us an audio-visual display, but he can show them after the debate to anyone who is interested in them. My hon. Friend likened the Whips' Office to a herb patch or herb garden; I have never thought of it in that way. It has always been the duty of the Whips to keep rebels at bay, and it is always sensible for one to heed the sage advice of one's Whips, but he has put that in a new perspective. He also raised some serious points about the need to regulate complementary medicines; where they are scientifically proven, they have a great role to play—not least in the areas highlighted in Macmillan Cancer Relief's new book.

The hon. Member for Brighton, Kemptown (Dr. Turner)—who is no longer present—spoke about the cancer network that covers the area that he represents: it also covers my constituency, which is next door to Brighton. He is right that we need to centralise some of the cancer infrastructure and machinery—in this case, it is being centred in Brighton. He also mentioned what he referred to as a parochial campaign by people in my area who did not want their cancer centre to be removed from Haywards Heath to Brighton. However, that had great implications for the longer-term rundown of the Princess Royal hospital at Haywards Heath. There were also many implications for the transport infrastructure in our part of the world; it is difficult for people to travel across what is a rural county into the city of Brighton and Hove. However, I largely agree with his conclusions.

We have heard much about the structure of the cancer networks. There are 34 of them, and they are organised into 11 regions. Within each network, every primary care organisation—the primary care trust, for instance—will have a lead clinician whose job will be to provide strategic leadership in the development of services for cancer patients within the PCT, and to contribute to the development of the network. They will also be responsible for ensuring that services are responsive to patients' needs, which is very important. They will have joint funding from the Department of Health and Macmillan Cancer Relief: that will mean that each PCT will have about £5,000 to fund the lead clinician post. However, Glen Purland, the head of policy development at Macmillan Cancer Relief, said:

The Runcorn GP Cliff Richards—not to be confused with Cliff Richard—is very involved with his cancer network. He commented:

He makes important points that must be taken on board. However good cancer networks are in principle, only when they are put into practice will we be able to establish whether they will be successful in the delivery of services, which is all-important.

We hear much about performance targets, not least in the area of cancer treatment. Performance targets—including maximum one-month waits, targets on the

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time from urgent GP referral to treatment for children's and testicular cancers and acute leukaemia, targets from diagnosis to treatment for breast cancer, which were supposedly introduced last year, and targets from diagnosis to treatment for all cancers—will be in force by 2005. By this year, there should be a maximum two-month wait from urgent GP referral to treatment for breast cancers, and the Prime Minister, in his speech at the Labour party conference, said that he could tick that box. By 2005 there should be a maximum two-month wait from urgent GP referral to treatment for all cancers.

Reeling off a list of plans, targets and schemes that have been published and "met" should not be the benchmark of the Government's success in tackling the causes and treatment of cancer. What should be measured is the output and outcome, not the amount of paperwork, which the Government are so good at producing. Professor Gordon McVie, the director general of the Cancer Research campaign, said that the targets are reasonable given the state of the NHS, but very soft compared with Holland or France, for example. In France, one can expect a consultant appointment in a couple of days, not a couple of weeks. Let us not delude ourselves about the distance that we still have to travel to catch up in that regard.

Cancer patients and the cancer networks themselves are in no way immune to the problems throughout the NHS. Cancer specialists have asked for 600 oncologists—specialist cancer doctors—during the next three years, but they have been promised 1,000 in six years. The Government need to be going further abroad rather more aggressively to recruit those extra doctors. I shall return to that question at the end of my speech.

There is little point in reducing the waiting time to see a consultant if there is a delay in access to diagnostic equipment or the treatment is simply not available within the NHS. Specialists must now concentrate their valuable time and resources on consultations for diagnosis, which leaves them little time for treatment thereafter.

The great problem, especially in my area, is the shortage of radiographers and radiologists, as the hon. Member for Brighton, Kemptown would agree if he was still here. The Department of Health figures from a few months ago show that 130 consultant radiology posts have been vacant for more than three months. There is a severe shortage of consultants in that speciality, with the breast screening service alone believed to be short of no fewer than 200 consultants. In the hospital in my constituency, only recently were we able to fill a consultant radiologist vacancy after three years. The vacancy rate is stark for radiographers in our part of the world: there is a 5.1 per cent. vacancy rate for diagnostic radiographers in the south-east and a 13.1 per cent. vacancy rate for therapeutic radiographers. That means that we are missing about 30 therapeutic radiographers.

As we heard earlier, there is a problem with cancer funding being siphoned off. The Committee chaired by the hon. Member for Norwich, North did the House a great service in producing a hard-hitting report that brought the issue to everyone's attention. Money promised to improve cancer care appears to have been siphoned off by the NHS to pay for other priorities, not least to cover shortfalls on accumulated debts or carried-over debts. In the Government's cancer plan,

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published in September 2000, the Government promised to increase spending on cancer care by £570 million a year by 2003–04, but the hon. Gentleman's Committee identified £280 million or so in the first round of funding that had been diverted by NHS trusts to pay off debt or to meet administration costs or other targets. The Department of Health itself admitted that it was not entirely sure where the money had gone.

That is evidence of a lack of funding reaching the front line. Professor Jonathan Waxman, professor of oncology at London's Imperial college, said that the money was

Locally, Stuart Welling, the chief executive of Brighton and Sussex University Hospitals NHS trust, which got very little from the cancer care plan, said:

Jo Yardley, the general manager of the Kent oncology centre in Maidstone, said that the centre had asked for in excess of £1 million for this financial year. She said:


Hilary Thomas, a professor of oncology at the Royal Surrey County hospital, said:

As The Sunday Times said,

who does not appear on the waiting list,

There are many examples from around the country of senior oncologists within cancer networks feeling that they do not see the money at the sharp end where it is really needed. Progress has been made, but the system still militates against much more progress being made in future.

Has the Department of Health yet worked out where the missing money went, and is it prepared to account for it? What progress has the Department made in recruiting new oncologists, and at what level? What success is it having in recruiting from abroad? Press reports say that there has been an increase of only 45 medical staff—doctors—recruited from the continent, and already we are hearing stories about German and French teams leaving after only a few weeks or months in the country.

What progress has been made in recruiting radiologists and radiographers, particularly in the south-east, where shortages are greatest? What progress has the modernisation agency made in extending the cancer services collaborative programme to all cancer networks by 2003, and what practical effect will that

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have on delivery of cancer services? Will the Minister also give an update on the progress made in integrating prevention work into the cancer networks, not least in relation to alcohol—we still eagerly await the Government's alcohol strategy—diet and obesity links to cancer?

What progress has there been on the development of software for a cancer database at primary care level, and which Minister is leading on information technology in the national health service now? What assessment have the Government made of the great diversity in service delivery between the networks, and how will they communicate that information to the House? Those are interesting questions, which will give pointers to how far and how fast the Government are progressing the cancer networks.

The subject is important. Cancer networks are important developments, but the networks are not the be-all and end-all of progress in eliminating cancer in this country. Surely it is what the networks deliver that is all-important to our constituents, and surely it is delivery progress that we need to know more about, rather than progress in setting up yet more structures.

10.42 am

The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears) : I, too, congratulate my hon. Friend the Member for Norwich, North (Dr. Gibson) on yet again raising the issue of cancer services. He does us all a service by speaking in Westminster Hall and the Chamber on a regular basis and reminding us that we have made progress on cancer but still have a lot more to do. I am genuinely grateful for the constructive pressure that he puts on me in relation to both funding and service delivery.

I welcome the hon. Member for Cheadle (Mrs. Calton) to the Liberal Democrats' Front Bench. I shall come to her comments later, but the picture of misery that she painted is not one that I particularly recognise in cancer networks. I hope that, as time goes on, she will become a little more optimistic about the progress that the Government are making. People from various networks across the country who are daily involved in trying to improve cancer care are present today and I am sure that they too welcome the debate.

My hon. Friend the Member for Norwich, North is chairing the all-party group on cancer's fourth "Britain against cancer" conference. I understand that yesterday, on its first day, the conference was extremely well attended. A number of high-profile speakers, including my right hon. Friend the Secretary of State for Health, made a contribution. Professor Peter Boyle, from the European Institute of Oncology, presented data showing that, among EU member states, the United Kingdom was one of the top performers in reducing cancer mortality since 1960. That confirms the findings of Professors Sir Richard Doll and Sir Richard Peto, who last summer reported that, since the 1970s, Britain's men have had the world's sharpest fall in premature death from lung cancer, and, in the past decade, British women have had the world's biggest decrease in deaths from breast cancer. There is more work to be done, but

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we must acknowledge that Britain is certainly moving in the right direction in beginning to tackle cancer, one of the biggest killers.

Mrs. Calton : There have undoubtedly been improvements, particularly in the prevention of men's cancers. There is, however, a long way to go with regard to women's cancers, particularly that associated with smoking. In fact, the position of women is very different from that of men. Will the Minister comment on the steps that the Government are taking to ensure that women here see the same reductions as have occurred in other parts of Europe?

Ms Blears : I was about to say that the data confirm that we are right to invest in preventive services. Several hon. Members raised the importance of prevention, in addition to treatment and research into a cure. The hon. Lady must acknowledge that this country now has some of the world's leading smoking cessation services. Both Zyban and nicotine replacement therapy are available on prescription and 40 per cent. of such prescriptions are free, so we are clearly getting through to people in poorer communities who smoke more than those in better-off communities. We should also consider the issue of women's smoking and alcohol consumption. The shift to preventive measures is, therefore, a top priority for the Government.

But we are not complacent. I simply want to set the scene and say that we are going in the right direction. I recognise, however, that we have a lot more to do. The Secretary of State reiterated yesterday at the conference that cancer is a top priority for the Government. That has been made evident by the cancer plan and the significant extra investment in cancer resources. I shall come later to the issue of the audit trail and the need to ensure that that money is spent on cancer care.

Just over two years ago we published the NHS cancer plan. That was the first time that any Government had drawn up a major programme of action to link prevention, diagnosis, treatment, care and research to follow the patient pathway through all stages of treatment. It is not an exaggeration to say that that was an almost revolutionary approach to patient care and that it has informed not only cancer care, but a range of other disease pathways. We are undergoing a complete reconfiguration of the organisation of our health services. Patients are being put at the centre of the services and provided with those that they need, rather than having to fit in, regardless of whether the services meet their needs or those of their communities. The cancer plan was a turning point in our reconfiguration of the NHS.

I want to acknowledge the work and commitment of the thousands of staff who are working together across organisations to try to modernise cancer services. It is important for people to be able to take time out from their day-to-day practice to think through new ways of working to try to shorten waiting times and to bring in new and innovative approaches, but that is not always easy when people are working outside their organisations, collaborating with colleagues, working in virtual organisations and attending meetings, and I am conscious of the hard work that is taking place across the service.

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I would also like to thank the 65,000 cancer patients who responded to the first ever cancer survey. Some might say that people do not want to respond to surveys, but we had an incredible response. It is a courageous Government who decide to ask patients what they think about the service, where it is good and bad, where it is working and not working, and to use, for the first time, the results of such surveys to feed into the performance management framework for the service. At long last, we are beginning to measure the success of the NHS by what the patients themselves tell us is going on in their area.

We do not pretend that there are no problems. Of course, there are problems. We do not pretend that the service is not working under incredible pressure, because it is, in every part. We must, however, be clear that patients are benefiting from improvements and cancer is one of our success stories. We are extending the breast screening service to over-65s and piloting new screening technologies. More than 95 per cent. of people with suspected cancer are seen by a specialist within two weeks, more than 31,000 extra people are benefiting from cancer drugs that have been appraised by the National Institute for Clinical Excellence, and more than 500 of the most modern pieces of equipment with which to diagnose and treat cancer have been delivered to hospitals since April 2000. By 2004, a further 385 pieces of equipment will be delivered and used in the NHS. Those are tremendous improvements, but there is a long way to go. We have said that the cancer plan will take five to 10 years to implement and, even though we are in only the first two years, we are beginning to see significant progress.

The current increase in funding for cancer services—an extra £280 million in 2001–02, £407 million in 2002-03, and £570 million by 2003–04—is the largest ever. Concerns have been expressed about how much of that money is getting through to the front line. My hon. Friend the Member for Norwich, North conducted a searching inquiry in the Select Committee, in which I was delighted to take part. It raised interesting questions and, as a result, the national clinical director for cancer, Mike Richards, is now working with the strategic health authorities to bear down on the audit trail to determine where funds have gone. We are also working with voluntary organisations in the hospice movement to see what has happened to the money for palliative care—where investment has been made and whether there are any gaps.

We recently announced that an extra £10 million would come from central funds this year to ensure that there is a swift injection into vital services relating to palliative care and I am determined that the extra investment from the Government will make a difference to cancer patients. I can tell the hon. Member for East Worthing and Shoreham (Tim Loughton) that our targets for treatment times are of key importance because early diagnosis and treatment mean better outcomes and survival rates for patients. Investment has been made in cancer services even in the most pressured authorities, and we are on track to meet important targets to improve services for patients.

Tim Loughton : I take the Minister's point, but will she admit that setting strict targets—especially for initial

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referral—ties up consultant time, which adds to the time delays for people needing treatment. In some cases, it distorts the system because of staff shortages.

Ms Blears : It is important at every stage of the patient pathway to try to ensure that the waiting time is as short as possible. Prioritising one part at the expense of another is not the way to design a proper holistic system that meets the needs of patients. We need to bear down on waiting times in diagnosis, screening, treatment—at all stages in the patient pathway. That is why the Government have developed a coherent programme, rather than caved in to pressures of the moment.

My hon. Friends the Members for Norwich, North and for Brighton, Kemptown (Dr. Turner) have pressed for the introduction of a cancer Bill for some time, and the hon. Member for Cheadle was not sure of the Liberal Democrat position, but the right way forward is through the cancer plan. Cancer treatment is a top priority for the Government, but it is one of a number of clinical priorities. I do not want our system to be fragmented and drawn to specific disease groups. Through the cancer plan, we can allocate funding, gather the work force, shorten waiting times and improve treatment for patients without fragmenting the infrastructure that is crucial to supporting action throughout the NHS, not only in the important area of cancer treatment.

Dr. Gibson : Why then, is there a draft Mental Health Bill?

Ms Blears : My hon. Friend knows very well that the Mental Health Bill will deal not only with treatment, but with several important areas relating to the assessment and identification of individuals needing care and support within the care system. I am sure that he recognises that the area of mental health is significantly different from that of diseases such as cancer. Ring-fencing funds for specific disease groups would cause significant problems for the NHS. As he knows, issues surrounding diagnosis, research, equipment and staff are not always identified only for cancer treatment, but for a range of different diseases—we have had some interesting discussions about the way in which research into disease groups applies not only to cancer. Therefore, it is important to integrate cancer treatment and keep it connected to the rest of the NHS. I have no doubt that we shall continue to debate the cancer plan but, at the moment, we are trying to shift the centre of gravity in the NHS to ensure that money goes to the front line and that, as far as possible, all services are kept together and integrated.

Several hon. Members spoke about patient involvement, and I hope that they know of my absolute commitment to public and patient involvement. Changing the NHS to take account of patients' priorities will allow us to improve services dramatically. I was pleased to appoint Harry Caton as the director of public involvement in patient experience. In highlighting such issues, he is making a tremendous contribution to the NHS. I understand that all the networks now have patient involvement, although some are more developed than others. We want to bring everyone up to the level of the best.

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In December, I shall speak at a conference that has been organised by Macmillan Cancer Relief. The conference will focus on ways in which we can bring together carers, patients and professionals to ensure that we learn from the experience of patients. Some of the best suggestions for change come from people who are going through the service, and we have a great deal to learn from them. I love the phrase "Trust me, I'm a patient." We could all happily support that.

The hon. Member for Bosworth (Mr. Tredinnick) spoke about complementary therapists. He will know that we are preparing NICE guidance on supportive and palliative care. Draft guidance, which will include guidance on complementary therapies, will go out to consultation next summer. Such therapies are becoming more mainstream in the NHS; I know that the hon. Gentleman has been pressing for that for a long time. Such mainstreaming occurs especially in cancer care and palliative care—pain relief. The role that acupuncture can play is fairly well established. We have funded research projects to try to obtain more evidence. Many cancer networks already involve complementary therapists in a range of services. The hon. Gentleman is therefore pushing at an open door, but we must be sure that the therapies work and are based on good evidence, and that investment in them is worth while.

Several Hon. Members spoke about diet and exercise, which are key issues for the Government. They will know about the national school fruit scheme, which will give a free piece of fruit to primary school children every day in an effort to encourage healthy eating habits early in life, and that scheme is expanding throughout the country. I think that 300,000 children are now receiving their free piece of fruit; by 2004, every primary school child will be receiving it.

We are about to launch some exercise pilot schemes to find innovative ways of involving people in exercise—in particular, we will work with people from poorer communities who traditionally have not been able to go to expensive leisure centres. I look forward to the results

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of those schemes. The Department for Culture, Media and Sport has a huge programme of investment in school sports co-ordinators to try to involve young people and children in good exercise early in life.

My hon. Friend the Member for Norwich, North suggested that we might have tsars in every clinical network to ensure progress in cancer care. As he knows, we have clinical leads in every network who have taken on that role and who have done an extremely good job. My hon. Friend said that, in America, they were known as quarter-backs; in my part of the country, they would probably be scrum halves, so some of my clinical leads may see themselves in that role. It is important that clinical ownership is embedded in our networks. We are talking about the people on the front line and they know what needs to be done. Giving them power and influence in the service is key.

The hon. Member for Cheadle read out some fairly depressing statistics on waiting times; however, from April to June of this year, almost 95 per cent. of women with breast cancer received their first treatment within a month of diagnosis. That is not a bad achievement. I therefore urge the hon. Lady to consider the glass half full rather than half empty. In the same period, 93 per cent. of patients with testicular cancer, 100 per cent. of children with cancer and 99 per cent. of patients with acute leukaemia received their treatment within one month. We are making significant progress in tackling cancer and patients are delighted that such improvements are beginning.

The hon. Member for East Worthing and Shoreham mentioned radiology. We are increasing the number of training places, we have more consultants and we are going out to recruit. I remind him that under the Conservative Government, training places in every profession were cut. We cannot create radiologists and radiographers overnight. We are creating extra training places that will come through to the service in due course. At least this Government have a commitment to extra investment—

Mr. James Cran (in the Chair): Order. Time is up.

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