Select Committee on Science and Technology Minutes of Evidence

Supplementary memorandum submitted by the Department of Health following the evidence session of 6 February

  At the Committee's hearing on 6 February, Yvette Cooper MP answered the questions posed on this and other aspects of the Committee's short inquiry, and undertook to let you have some further information. This reply covers all the issues, by repeating the answers given orally, and by amplifying them where appropriate.

  All the figures that follow are for 2000-01, and are rounded to the first decimal point, except where they are described as estimates, or—in one case—where they are too small. It is impossible to give any meaningful figure for 2001-02 because too many of the components are unavailable.

  The Department of Health spent £83.8 million. This includes £73.2 million on NHS support for projects funded by the research councils and the charities, £5.2 million on NHS R&D, £2.7 million on the Policy Research Programme, £1.4 million on public health programmes, and £1.2 million on Non-Departmental Public Body programmes.

  The health departments of the devolved administrations spent a total of £12.4 million (not £12.2 million), comprising £2.8 million in Wales, £8.6 million in Scotland and an estimated £1 million in Northern Ireland.

  The Medical Research Council (MRC) have estimated their expenditure to be £58 million, and have said that they should be able to provide a more accurate figure very soon. The NCRI is setting up a database of cancer-related research projects that are funded by its members, including the MRC. Inclusion of projects in this database will be determined independently by NCRI. Any contentious ones will be referred to arbitration, involving the charities. The MRC has every confidence in this system and will abide by the decision taken.

  The Higher Education Funding Council for England (HEFCE) have estimated that the universities spent £26 million. HEFCE also produced an estimate of £30 million, but the lower figure was used.

  The other research councils spent a total of £9.9 million. This comprises £3.5 million by the Engineering and Physical Sciences Research Council and £6.3 million by the Biotechnology and Biological Sciences Research Council (who did a database search using cancer-related terms to arrive at this figure), together with £43,000 by the Economic and Social Research Council.

  These figures add up to £190.1 million; but the grand total does not include expenditure on cancer research by universities in Scotland, Wales and Northern Ireland, which is estimated at £10 million in total; and it does not include expenditure by other bodies such as the Food Standards Agency (which spent about £1 million on cancer research) and the Health and Safety Executive.

  The Government is content for the figure to be quoted as about £190 million, which is roughly equal to the charities expenditure of £180 million in the same year.

  As was made clear at the Committee hearing, the Department of Health will still be investing an additional £20 million a year by 2003-04 on the infrastructure for cancer research. That will be spent mainly on the National Cancer Research Network (NCRN) and the National Translational Cancer Research Network (NTRAC).

  I can now confirm there are some small charities that are members of NCRI that make no direct contribution to its running costs.

John Stewart

Private Secretary to Yvette Cooper

11 February 2002

Request from the Committee for further information, following the evidence session of 6 February

  Could you let us know in rather greater detail how the figure of £73.2 million on NHS support for projects is arrived at? What exactly is this money spent on? How much of it is a proportion of NHS overheads?

  What cancer research programmes are supported by the Police Research Programme? Which public health programmes are you taking into account? And which non-Departmental Public Bodies are involved in cancer research programmes?

  The Department's letter confirms that the Department will be investing an additional £20 million a year by 2003-04 in infrastructure for cancer research, mainly on the National Cancer Research Network and the National Translational Cancer Research Network. Can you confirm that the £0.25 million on each of the new NTRAC centres is included in this £20 million—not additional to it, as we had hoped?

14 February 2002

Supplementary memorandum submitted by the Department of Health in response to questions from the Committee

  You asked first about the figure of £73.2 million. This is the amount of NHS R&D Support Funding estimated to have been spent in 2000-01 on research that was relevant to cancer.

  The NHS R&D Levy is currently split into two components: NHS R&D Support Funding (sometimes referred to as "Budget 1"), and NHS R&D Programme Funding (sometimes referred to as "Budget 2"). NHS R&D Support Funding is allocated to NHS providers to enable them to meet the NHS service support costs (eg extra blood tests, extra scans, extra bed-days) of research funded by external non-commercial research funders. These costs are directly associated with research and stop when the research stops. R&D Support Funding also supports NHS providers' "own account" research, ie pre-protocol research and NHS provders' own research projects. Each NHS provider in receipt of R&D Support Funding is required to produce an annual report which sets out, among other things, the way in which they have disbursed their R&D Support Funding to support research in areas of activity that they have identified. We have estimated the amount of R&D Support Funding used to support research relevant to cancer from these annual reports. It was not, therefore, derived as a proportion of NHS overheads.

  Second, you asked about cancer projects in the Policy Research Programme. Much of this work directly addresses commitments made in the NHS Plan (Section 14.5) and in the NHS Cancer Plan (Chapter 3).

  The Cancer Screening Evaluation Unit (CSEU) at the Institute of Cancer Research, Sutton, works on the evaluation of screening, primary prevention studies and analyses of clinical trials. The PRP programme grant has supported a range of work on screening particularly for breast cancer and colorectal cancer. This includes monitoring of the NHS Breast Screening Programme, and a recently-published study which estimated how much of the decline in breast cancer mortality in England and Wales since 1988 is due to screening. The unit is also commissioned by the PRP to evaluate the NHS Cervical Screening Programme.

  The current work progamme (until the end of 2005) includes:

    —  observational individual-based epidemiological studies of the efficacy of the breast screening and cervical screening programmes; and

    —  the analysis of rates of interval breast cancers nationally. Studies on the screening of high risks groups for cancer will also be developed.

  One cancer screening pilot has recently finished (breast screening pilot on women aged 64-69), and two are in progress (the UK colorectal cancer screening pilot and the HPV/LBC cervical screening pilot). The PRP has commissioned independent evaluations of all three and has also set up advisory groups to advise on the conduct of these.

  The colorectal cancer screening pilot is taking place at one Scottish and one English site. The evaluation (led by Professors D Weller and F Alexander from the University of Edinburgh) will be completed in 2003. As an adjunct to this evaluation a project has been funded on ethnicity and uptake in the pilot. The HPV/LBC cervical screening pilot started in January 2001; the evaluation team is multidisciplinary and is being led by Dr Sue Moss (CSEU) (3.20, NHS Cancer Plan).

  The PRP also provides joint support (with the MRC, CRC and ICRF) for clinical trials on screening, including the Frequency Trial, which compares yearly with three-yearly breast screening, and the Age Trial, which looks at the effect on breast cancer mortality of annual screening from age 40. This work may help to increase further the effectiveness of the National Breast Screening Programme in reducing breast cancer mortality.

  The CSEU are funded by the PRP has been commissioned to undertake a 2-year study which will use laboratory data to investigate changes in the levels of Prostate specific antigen (PSA) testing over time, and in different areas, and the reasons for testing.

  The PRP provides programme funding to the Childhood Cancer Research Group (CGRG), University of Oxford. Funding has recently been renewed until the end of 2005. The CCRG runs the national registry of childhood tumours. It also carries out important epidemiological research on genetic (including retinoblastoma, neurofibromatosis, Down's syndrome) and environmental (eg radiation) factors which may influence the incidence of cancer.

  The CCRG is also involved in studying geographical variations in incidence as well as in international comparisons of incidence and survival, including collaboration in the ECLIS and ACCIS studies. Much of this is long-term work which is likely to continue, but the capacity exists for undertaking shorter projects, should the need arise.

  The PRP also funded a recently-published meta-analysis on vitamin K and childhood leukaemia, and has also commissioned an analysis of the UK Childhood Cancer Study Group data on vitamin K and risk of childhood cancer which is due to report later this year. Concerns were raised in the early 1990's that intra-muscular vitamin K increased the risk of leukaemia.

  Subsequent studies gave variable results. A Working Group set up in 1997 concluded that overall there was no clear evidence to support an increased risk of cancer, although it was not possible to exclude the possibility of a small increased risk of leukaemia (which might equally have arisen by chance). These studies were commissioned by the PRP to provide further information on this issue.

  A number of studies commissioned by the PRP are directly aimed at improving access to, and equality of, service delivery. These include the production of the research evidence component of three further cancer guidance documents—on urological, head and neck, and haematological cancers, and the updating of existing guidance on colorectal and breast cancer (paragraph 6.5 of the NHS Cancer Plan). Their purpose is to help health authorities and NHS trusts improve cancer services. The "clinical guidance" component is being commissioned by NICE.

  An evaluation of the Cancer Services Collaborative (paragraph 5.11 of the NHS Cancer Plan) is taking place. The Collaborative is part of the National Booked Admissions Programme, which is seeking to improve the delivery of care for patients with suspected or diagnosed cancer. Also, the "Health in Partnership" programme of studies on user involvement in health service decision-making includes studies of best practice in relation to cancer services. A further project on the provision of palliative care in the community by members of the primary care health team is comparing patients' assessment of their symptoms and needs with those of their lay carers, GPs and district nurses.

  A group of five projects has recently been comissioned to help inform GPs' referral strategies in primary care for patients at risk of cancer. The aim is to reduce delays in referral, to promote equitable access and to increase early diagnosis. The total spending on these is over £500K.

  The PRP has also funded a study that looks at the evidence base for cancer nursing in the UK, including a literature review and a survey of current research in the NHS.

  In addition, there are two cancer projects related to IT. One is about the acceptability and usefulness of the web as a cancer information source, and the other is about tele-medicine assisted multi-disciplinary decision-making in breast cancer.

  Finally, the PRP is funding a study on socio-economic and socio-demographic inequalities in cancer incidence and survival in the population of England and Wales aged over 45 years.

  Public health programmes are the Small Area Health Statistics Unit and Public Health Radiation Research.

  The Non-Departmental Public Bodies involved in cancer research are the National Radiological Protection Board (NRPB) and the Centre for Applied Microbiology and Research (CAMR).

  In reply to your final question, I can confirm that the £0.25 million for each of the NTRAC centres, is, of course, included in the £20 million a year additional investment in the infrastructure for cancer research that we will be making by 2003-04.

John Stewart

Private Secretary to Yvette Cooper

27 February 2002

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