Select Committee on Science & Technology Minutes of Evidence

Examination of witnesses (Questions 40-54)



  40. So from that point of view you are understating, because you are building a cancer centre for 100 million quid, it is entirely devoted to cancer, and it is not included in these figures?
  (Professor Richards) With the exception of the capital funds I mentioned to do with the specific cancer equipment, that is correct, we are understating it because there are major developments in various parts of the country relating to cancer.

  41. Sorry, chair, for this but it seems quite a key point. Does that apply also to infrastructural projects for cancer research as well?
  (Dr Hamilton) The figures we have given are only revenue spent on cancer research. The NHS R&D budget for research is not a capital budget except for minor items.

  42. But there will be interest payments on accounts and so on that will need to be factored in, will there not? We are facing the criticisms made by the charities that basically the Government does not fund one-for-one in terms of cancer research. Now we are starting to find that maybe there are some hidden figures, that maybe the Government is putting more in than we thought because some of the commitments you are making have got buried somewhere else.
  (Ms Blears) My understanding on this funding is that this funding, other than the equipment, is about revenue funding, so it is funding for consultants and for radiotherapists to increase the capacity of the service because that is what the Cancer Plan is about—which is better screening, diagnosis, treatment and after care—and all of that is about increasing the capacity of the service which has been underfunded and so has not got enough capacity to treat people. This is really about revenue expenditure.

  43. But debt servicing is revenue and linked to infrastructural investment.
  (Professor Richards) Going back to when you were talking about the research side of it—and I will look to my colleague for confirmation on this—our figures are related to the revenue costs of research but so too, I believe, are the charities' figures.
  (Dr Hamilton) That is my understanding.

  Mr McWalter: They are an exactly like but confusing accounting standards?

Dr Turner

  44. Can I bring us back to the Cancer Plan for a minute. If cancer centres do not meet Cancer Plan targets, what will happen? Will there be sanctions? Will there be special measures to help them? What will happen? How will you make sure that the targets are met?
  (Professor Richards) That is through the process of performance management. This is where I as the National Cancer Director will work closely with the strategic health authorities and if, for example, we identify particular hospitals that are not meeting targets, let's say, on waiting times for diagnosis and treatment of cancer, I would want to work with the strategic health authority chief executive to look at what the problems are in that locality and to make sure we can put that right, because the whole idea of the Cancer Plan is to ensure equal access across the whole country to high-quality services.

  45. Would it then mean that you would apply additional funding if you find that through no fault of a particular cancer centre they had not got the staff to deliver the targets because it had not come through because of the problems it started out with? Will you put in more resources to make sure that the target happened?
  (Ms Blears) I think we will take this one step at a time. What we will be doing is, as I have said, meeting every cancer network lead, going through what they have got for their money, and if they have been able to spend it, as some of them have, very well, then that will be fine. If they have not spent it, what are the gaps? Let us have a look at that information and then we can take some rational decisions about what steps we need to take. We will be monitoring the Cancer Plan very closely indeed through the performance management system. I hope it is very much a hypothetical situation that they are not meeting the targets but then clearly we would need to take action in terms of extra capacity or whatever other steps we can take in the system. We are some steps down the road to that. My information is that, broadly speaking, we are meeting the requirements of the plan. As far as the data that we have got so far—and this is early days trying to get at the data—we have got some of the hard data about the two week referral times but the data from first diagnosis to treatment is obviously more difficult to get. As we get through the Cancer Plan we will be getting more information so that we can monitor properly. We will take this one step at a time. Clearly our top priority is to make sure that the commitments we have put out in the Cancer Plan are met because those will be the top priorities of the patients who need treatment.

Mr Dhanda

  46. A slight change of tack—cancer registration. The Follow-up Report was quite critical of the Department in terms of cancer registration. How do you feel yourselves now in terms of the cancer registries and how secure do you feel they are now that the Control of Patient Information Regulations are at last in force, although it has taken quite a long time to get there?
  (Ms Blears) I am acutely aware of the timescale that it took to get the Regulations in force. We had to go through the Nolan procedure for appointing the members of the PIAG which was quite a lengthy procedure. I took the regulations through the House and members may know that they were incredibly controversial. 20 Members attended the Statutory Instrument Committee and raised a series of very deeply held points about patient confidentiality. It was necessary, again, to try to strike a balance. So much in this field is about striking a balance between patient confidentiality and the need to protect cancer registries. I am pleased that Members did accept the need to protect the registry and clearly they have now gone through, but I think there was an application for registries as a whole to be included in the Regulations and that was rejected by PIAG because they wanted to see specific applications coming to them so that they could keep up the pressure for patient confidentiality. What PIAG want to see is that wherever practicable—I think that is the word in the Regulations—then information should be used that is not confidential or is anonymised or encrypted to ensure patient confidentiality. They want to keep the momentum on rather than just approving the status quo and I think that is the right thing to do. PIAG then have a responsibility every 12 months for their decisions to be kept under review. As I said at the outset, the cancer registries are now meeting to see if there is anything further they can do to make more progress on encryption and anonymisation because Section 60 is meant to be a transitional power until we can get to the stage, if we possibly can, of having information which is not patient confidential. In terms of the registries we might not get to that point. The registries were a top priority to be protected through the Regulations. They are now there and they will be reviewed on an annual basis, but I am content at the moment that the registries had broad support across the clinical field and even across the patient group fields because of the essential work that they undertake.

  47. You mentioned how controversial it was getting it through the House and Members were quite upset about certain parts of it. Is that in any way a failure of the Department in terms of getting across to Members the importance of cancer services?
  (Ms Blears) No, I do not think it is. I say that fairly, having thought about it, because in a way there was criticism from some of the research community that we were not doing things fast enough in order to protect the very essential public health research as well as cancer research and then there was criticism from the patient groups that we were going far too far in encroaching on patient confidentiality. There was criticism, if you like, from both sides and in those circumstances I suppose the conclusion can be that you have not managed to please anybody so maybe you have struck the right balance. I do not know. I do not feel it is a failure to get the arguments across. There are deeply held views from conviction on these matters at both ends of the spectrum and, therefore, trying to make sure people are aware of the essential work carried out by cancer registries was very important. I think it was MacMillan which provided some good information to Members during that debate about how valuable the registries were, how they helped us look at the extent of disease, how they helped us do prevention work as well and I think that was quite an important factor in persuading Members to support the Regulations.

  48. There seems to be a bit of a difference between the report's position and your own guidance with regard to the GMC's guidance in this. I gather your response said it was for the GMC itself to decide for itself when and if guidance is issued to clinicians. Do you stand by that?
  (Ms Blears) It is for the GMC to decide when it issues guidance to clinicians because clearly it will decide its own procedures and that is what it was doing in that case. I am pleased to say that during the debate on the Regulations, if I recall correctly, the GMC did give support to cancer registries being maintained with protection under the law. We say in our response that the "GMC's guidance on confidentiality was an accurate reflection of common law requirements." Unfortunately, the common law does give a great deal of emphasis to confidentiality, the importance of informed consent, and that is what makes it so difficult for clinicians to operate in an atmosphere before we had the Regulations. Now we have got the Regulations, clinicians can feel a lot more secure in the work they are undertaking.

  49. Another thing that was called for in the report was a National Cancer Act on the back of one in the United States of America back in 1971 and the Department is not of the same view. Is that still the case and, if so, why?
  (Ms Blears) It is the case that we remain of the view that we have got sufficient levers and powers to make sure that cancer remains a priority for the National Health Service. As I say, it is one of our top priorities that we set out as soon as we came into government, together with coronary heart disease, mental health and care for older people. The situation is different than that in America. They do not have a publicly-funded national health service and therefore sometimes they have to have special provisions for special circumstances and they have to vote appropriations into particular services. We have powers to make directions. We have had a long discussion about hypothecation, ear-marking and ring-fencing and that debate will no doubt go on. In our current legislative framework and the way in which we organise the National Health Service we do not need to have special legislation for particular diseases. Again, this brings us back to the broader debate about shifting the balance of power, about trying to say that as a health service and a national health service that people are entitled to certain levels and standards of service not just for cancer but for a range of conditions, and that what we need to set in frame as a government is national standards for the whole range of services so that people can see in a transparent fashion what I am entitled to and then, equally, for that to be delivered at local level. Simply to single out one disease such as cancer, no doubt it is a priority absolutely for the Government, but to single that out for a special legislative framework would be invidious, and I do not think we have any need to do it because we can devote resources under our current legislative framework.

Mr McWalter

  50. Part of what has been concerning this Committee is the general business about how effective the NHS is at interacting with the voluntary sector and to try to clarify some of the issues that are involved there. I do not want to throw this at you cold now but I would be grateful if you could review the current arrangements for hospice funding where currently some hospices maybe fund more than 70 per cent of their own operating costs from voluntary money and the Government puts in less than 30 per cent. Where that kind of imbalance has occurred, particularly given the fact hospices are more and more dependent on having NHS-trained and paid staff, the Government will look carefully at that with a view to seeing if in the end we have got our act together on the cancer research side—and I am not convinced yet as to whether we might—to see if we need to apply that principle of one-to-one funding in all those other areas as well so that precious and important relationship is protected.
  (Ms Blears) I am acutely conscious of the tremendous contribution made by hospices to palliative care in this country. I am very aware of their concerns about the resources getting to them and their services. We have received a number of representations from Help the Hospices and from a number of Members and I think I am to attend the All-Party Hospice Group later this week to carry on discussing—

  51. See you there.
  (Ms Blears)—And having a dialogue on this with Members, which I will continue to do. I am acutely conscious as well of the need to try and make sure that palliative care receives as much attention as all of our other cancer services. Palliative care has increasingly become recognised as a clinical priority that perhaps it was not 20 or 30 years ago. We are real world leaders in palliative care due to the efforts of the hospice movement largely, and therefore seeking to draw those into the service.

  52. You are not prepared at this stage to make a general commitment to a one-for-one funding regime when possible or when that seems to be most appropriate? I would be grateful if you would reflect on whether that might be a general policy.
  (Ms Blears) I am certainly not in a position to make that commitment here today but I certainly hear what Members have said.

Dr Turner

  53. If the new Regulations do not succeed in getting 100 per cent or near 100 per cent registration, will you look again at the possibility of making cancer is notifiable disease to ensure registration?
  (Ms Blears) As I outlined earlier, the cancer registries have been approved under the regulations, they do now have the protection of a regulatory regime in Section 60 and in the regulations rather than having to rely on the common law position, so they have a greater degree of recognition and security now. I think there is an acknowledgement that the work carried out by cancer registries is absolutely fundamental to our understanding and our monitoring and increasing services and prevention agenda and therefore I think at this stage I am satisfied that cancer registries are now under the umbrella of those Regulations and have security for their future actions.

  54. Do we know what percentage of cancer patients are registered?
  (Professor Richards) It is a slightly unanswerable question because if you do not know that they have got cancer they are not in the registry. What we do do is to see how many patients come through on death certificates that we had not previously known about and we are constantly striving to decrease that proportion. They are referred to as "patients recorded by death certificate only" and we are striving to decrease that figure, which varies across the country. We are working on that all the time and that proportion is going down. I think we can be confident that the quality of our cancer registration has been going up over the past few years.

  Chairman: Minister, you can tell that this Committee has got the ball in and it is waggling it about. We are interested in seeing what happens over the next few months. We do welcome you coming here and telling us about your plans to ensure that the money does get through to where I am sure you and I would both like it to go. Thank you too, Professor Richards and Dr Hamilton, for contributing to our session. We hope we do not see you for a while but we will wait and see how the cancer networks, which are very new, work out. Thank you very much for giving us your time.

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