Select Committee on Science and Technology Minutes of Evidence


Examination of Witnesses (Questions 60-79)

PROFESSOR MIKE RICHARDS, PROFESSOR SIR JOHN PATTISON AND PROFESSOR SIR GEORGE RADDA

WEDNESDAY 12 DECEMBER 2001

  60. Yes; so in the National Cancer Plan it actually lists the new or replacement equipment which is being provided. Are you saying that, basically, you have replaced only old equipment, so there is nothing extra in there, it is just equipment . . .

  (Professor Richards) I believe you have been sent details of equipment, or, if you have not, you can be. There is a huge, long list of CT scanners, MRI scanners, linear accelerators, that are being put in across the country, and it identifies exactly which ones are replacement and which ones are additional equipment.

  61. So that information is available?
  (Professor Richards) That information is all on a database.

Geraldine Smith

  62. Can I ask, when you provide equipment such as scanners to hospitals, do you actually consult with them to see if it is what they actually need and does it meet the needs of their area; what sort of consultation, before equipment is put into hospitals?

  (Professor Richards) Absolutely, yes, we do, and the officials in that particular department within the Department of Health have very, very close contacts with the hospitals across the country, and we talk both at the trust level, we talk to regional cancer co-ordinators, we consult widely about where the greatest need is and what machinery is actually needed there.

  63. Have any hospitals had to refuse equipment because they did not have properly-trained staff, or because they did not have ancillary equipment?

  Dr Turner: Or funds?

Geraldine Smith

  64. Or funds; thank you?

  (Professor Richards) I am not aware of any cases. That is not to say there are not cases, but I am not aware of any cases; and if you are aware of any and can bring those to my attention I would be grateful.

Dr Turner

  65. I will tell you afterwards about my Trust and you can promise to address the situation?
  (Professor Richards) I will promise to look into it, I can certainly promise to do that; but I would also just remind you that there is the extra funding going into the Health Service, and into cancer, and if the problem is about needing extra staff to run that new equipment then I would hope that this extra funding can be used for that purpose.

Geraldine Smith

  66. Just continuing on this subject; if we get the new equipment, are there actually any funds in place to train staff to use the equipment in the Cancer Plan? Is there a budget somewhere, that if you get this equipment people will be trained to use it; there must be a cost associated with that?
  (Professor Richards) No; because the Cancer Plan cannot attempt to be a Plan for the whole NHS. What we have done in the Cancer Plan is to identify certain key areas where we knew there was not training going on at an adequate level, such as the endoscopy programme, the histopathology programme, the therapy radiographer programme. There, we have put in place particular training programmes, also in the breast-screening programme, where we have got training of radiographers to go to advanced practitioner level, so that they can actually report on the mammograms as well as taking them, and bringing in assistant practitioners, who have not necessarily done the full three years of a university course in radiography, who will be able to take mammograms. And those training programmes have been centrally-driven, as a result of the Cancer Plan. But, of course, training goes on within the whole of the Health Service, and if there are problems in getting people training, again, I would hope that people would let me know about that so that I can make sure that we rectify that problem. But usually I find that where there are problems people are only too ready to let me know about it.

  67. Finally, can I just ask you, the extra staff that healthcare trusts may be able to obtain through the National Cancer Plan, what sort of guidance is given to those trusts to let them know that they may be able to apply for extra staff to work in their areas?
  (Professor Richards) What we have been doing is that we have been asking Networks to produce their Service Delivery Plans, and a key component of the Service Delivery Plan is the Workforce Plan; and that, again, at Network level, looking at what the opportunities are at Network level, because it may be that you need one extra consultant between two hospitals, working as a Network you will be able to see that. And so they will be producing their Workforce Plan as part of the Service Delivery Plan. Equally, I think what is very important is that Cancer Networks need to work with the Workforce Development Confederations across the country, and they roughly map onto each other, it is never a perfect fit, but they roughly map onto each other. So when you have got the Network Service Delivery Plan and you clearly see that across this Network we need 20 extra radiographers, or whatever it may be, you can then work with the Workforce Development Confederations to make sure that those training slots are put in place. And, now, at a national level, we have got a cancer workforce team that brings together the people from Workforce Development Confederations with myself and my team, so that we can actually facilitate that process.

Chairman

  68. So when the Network Plans are brought all together, you add the figures up and know the number of people?
  (Professor Richards) That is our intention, yes.

  69. And when will that be, roughly?
  (Professor Richards) The Service Delivery Plans are coming in now; of course, they have not all been written in exactly the same way, and so whether we will be able to extract the actual workforce numbers in the way we had hoped I do not know, but I will be looking at those very soon, and then we will be going back to Networks where we need further information. So I cannot, at this stage, give you an exact timing on when we will have information for you, but we are planning—

  70. Could you let us know when you have got those figures, when you are going to have them, please, and the numbers; because politicians at all levels keep announcing 3,000 consultants here, 3,500 there, and it has got nothing to do with what you are saying, there are no real figures, but everybody talks about them?
  (Professor Richards) I think, on consultants, we do have figures, because we have those figures from the annual census.

  71. Please give us what you have then, Professor Richards?
  (Professor Richards) I can give you the consultant figures that we have now, well not now but immediately afterwards, but, the other areas, the difficulties are, for example, with cancer nurses, that they have never been previously separately identified as such, but they are just within the nursing workforce.

  72. It is ironic, consultants always seem to be first in the queue?
  (Professor Richards) They are also the most expensive.

Mr McWalter

  73. I just want to say that in the Cancer Plan it actually says, a remark about the staffing problems, and so on, and you say, in paragraph 8.8 of the report, that other action is necessary to get additional staffing in, and this will include extending the careers of staff currently working in the NHS, recruiting staff from overseas, extending the roles of staff, introducing new assistant practitioner grades, you have talked a bit about that, and action to retain existing staff by improving their career prospects and opportunities. All of that is like a wish-list, but there is no quantification of any of that, and there is no indication as to what contribution that strategy and tactic makes to the numbers that are elsewhere in the report, and there is no indication either how you are going to do that. Because I think a lot of the people working in a highly-pressurised hospital environment, or whatever, who have got to retiring age, the last thing they want to be told is that they are going to carry on doing much the same thing for another five or six years. That needs to be made very clear, how you do that, and I think that ought to be a supplementary part of the Plan?
  (Professor Richards) I think, actually, we are making progress on all of the items that you have just mentioned. To have put numbers against how many we might get from overseas recruitment, or how many we might get from there, I think that would have been a rash thing to do, because we simply do not know. What we did know was the numbers of specialist registrars in training, in the medical branches, and so that we were able to say what we expected the consultant expansion to be, and we knew what the retirement profile was likely to be, and so why we were able to give the consultant numbers, they are in a table in the Plan, was because of that. I think, to have given other numbers would have been speculative. But what I can say is, we are working on all of those areas, and we are having success in all of those areas.

Chairman

  74. I think the picture that the Committee is getting is one of indecision about numbers at this stage, because you are confident you are going to get the numbers, there is an indecision in being able to specify the actual numbers; are we going to need more radiographers in East Anglia than we are in Wales, for example? And, surely, a Plan is a Plan with numbers attached?
  (Professor Richards) Yes, but a Plan has also got to be realistic, and what we put in the Plan was the best data that we had at the time. What we are now doing, as I indicated, is working with the Cancer Networks so that they develop their local planning, and we will then amalgamate that to see what the national picture is. But this is the first time this has ever been done in the NHS, and it is a huge job of work, actually doing that.

Mr McWalter

  75. Whilst I agree the details might be difficult, the vague numbers will be welcome, it does seem to me that here you have got all sorts of scope for a strategy. To give an example. One of the ways in which you might encourage people, who are in the latter part of their careers, who are very valuable to you, to stay on, say, nurses, is to have a system of, say, extending the nurses' scale, say, so, I do not know, to a point J, or something, and make more use of Grade I nursing as well, to the point at which you then say, `if you do stay on, your pension will be significantly enhanced, because this, after all, is going to be a final salary-related pension,' or whatever. And you actually make the whole profession more attractive, that there is a clear incentive for people to behave in the way that the Plan hopes that they will behave. And I think you could have had more detail on that front, without, as it were, giving very precise figures, or a strategy to accompany paragraph 8.8 would have been very welcome?
  (Professor Richards) I would prefer to keep a Plan to what I know I can deliver and can actually give hard numbers, where hard numbers can be delivered. I think, your point J on a scale, we have, of course, now got nurse consultants, and we have, of course, got some of those nurse consultants in cancer, and that is extremely welcome. These are also issues that go well beyond cancer, and they are issues about the whole of the workforce of the NHS, and they are really issues about the NHS Plan as much as they are about the Cancer Plan.

Chairman

  76. Thank you. Professor Radda, we turn to you now, but, of course, one of the previous Committee's big ideas was the National Cancer Research Institute. I wonder if you could talk to us about how it is working out, how your role, as leading the MRC and Chairman of that Institute, works out, is there a problem, is it a success, is it going anywhere, what has it done, what is it going to do? If you could start off that way, and we will all pitch in?
  (Professor Sir George Radda) In my view, the National Cancer Research Institute is one of the success stories, it is actually extremely exciting. We started off as the Cancer Research Funders Forum, very much catalysed by your own discussions and your previous report seeing the need to bring people together who fund cancer. That Forum, which initially consisted of just the main funders of cancer, charities as well as MRC and Departments of Health, did some extremely good work in a relatively short time, reviewing prostate cancer, identifying the need to do something about it, and coming up with a call for a proposal for prostate cancer consortia which was jointly funded through a single review procedure of the CRFF. That was sufficient encouragement for us to go further, and, I think, for the Department of Health and the Minister there to give the go-ahead to try to build up a more formal structure of the National Cancer Research Institute. Essentially, we met on 15 March 2001, and decided that we wanted to go ahead with that, with considerable encouragement from Mr Milburn, and we started the Institute on 1 April. We set up a secretariat, we have an Administrative Director and two staff.

  77. Did you say how the funding is organised?
  (Professor Sir George Radda) It is jointly funded, between charities and Government, on a 50-50 basis, and the secretariat is three people. They are housed in 20 Park Crescent, at the MRC, where we provided the offices, and they have also seconded staff from both the Department of Health, on a part-time basis, and from the CRC. So we now have a working organisation that actually works as a Cancer Research Institute, co-ordinating the activities of the different funders, and has a work plan, and at the last meeting, which we had only a few weeks ago, has outlined what we are going to do and how fast. The first thing it is going to put together is a cancer database, with help from the National Cancer Institute in the USA, whom some of you visited, who helped a great deal in setting up a common framework, or common way of analysing cancer research.

  78. Can I interrupt just one minute. Has anybody excluded themselves from the Research Institute because of the funding arrangements, or are not being allowed into this what might be seen as an exclusive club?
  (Professor Sir George Radda) The membership was very carefully thought out; it certainly extended from the Cancer Research Funders Forum. One of the points I think your Committee made was why do we not have an industrial member on it. We do now, on the Institute; we did not have in the Funders Forum. We did this by asking the ABPI and other industries to nominate one individual who could represent them, and they came up with a very good name and we are very pleased about that. We have extended the membership much more widely than we had in the Forum, and essentially we are currently limiting it to people who have an annual budget of about £1 million for cancer research; and so that now includes, besides the major funders, Breakthrough Breast Cancer Association for International Cancer Research, Yorkshire Cancer Research, and other funders like BBSRC will be coming in, so it now includes a very wide membership. There is a Board, that does not include all of them, so that we have a working Board of the chief executives and directors of these different funders, and the smaller charities have two memberships on that Board, in rotation. The chairmanship will rotate, in two years' time, from my chairmanship to one of the charities, and that we have agreed also to do. And the work plan and what has already been achieved is quite considerable. We actually, obviously, through the NCRN, have been working on how to do clinical trials, and perhaps I think you might be pleased to hear, because I think your Committee criticised the way that we do clinical trials, in your previous report, of what we have done there. We have now agreed, that is the NCRI members, and particularly MRC and CRC, we have developed a joint approach for assessment of clinical trials, and a single entry, single route, into all kinds of clinical trials, whether they are phase 1, phase 2, small trials, that normally in the past have only been funded by the CRC, or whether they are the large sort of MRC trials.

  79. So the funding now is organised how?
  (Professor Sir George Radda) The route is such that the Joint Clinical Trials Advisory Committee, which is actually run by CRC but with membership from the other funders, assesses the applications and decides whether this is something that should go into the small trials portfolio, or should go towards the MRC, which is the major funder of phase 3, expensive clinical trials. MRC actually now puts money into the CRC to fund the small trials, and we accept their peer review on that one; and the large trials, which go through this initial trials committee, of course, have to go through a longer procedure, partly because these are only outline proposals and the full proposals are invited by this Joint Committee and then directed to the MRC for peer review.


 
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