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Mr. Lansley: Strictly speaking, some clinicians would say no in those circumstances. For example, in the Thames Valley strategic health authority, advice has been derived from a joint professional group that clinicians should say no to herceptin, on the grounds of the risk associated with an increase in coronary heart disease.

Steve Webb: I was talking about primary care trusts saying no when clinicians said yes. If clinicians have a patient whom they believe would be ideally suited to the treatment, they have explained the risks and the patient is prepared to take those risks because the alternative would be worse, the money would be found for herceptin if it were not so expensive. That is cost rationing, and it is no good pretending that this is not about cost. The Secretary of State told trusts not to say no on grounds of cost alone, but that clearly raised expectations that cannot be met. That is the danger of the Secretary of State intervening as she did.

We have all heard about the North Stoke case. How can it be right that one person gets the treatment because they have got on the news, the Secretary of State has thrown her weight around and, the next day, the PCT changes its mind, but another woman, who does not get on the news, does not get the treatment? That is not a rational way to allocate those treatments.

My local PCT in south Gloucestershire does not fund herceptin, on clinical grounds, because there is an academic study that says that four years down the track the chance of surviving is enhanced by only 5 per cent. However, that study was based on a broad category of women. I put that point to the consultants at Addenbrooke's yesterday and they said that out of the big sample one could pick sub-groups who have a far better chance of survival. The drug is ideally suited to some women, for whom the statistics would be much better. My local PCT has picked one study and interpreted it in a particular way and will not prescribe herceptin, but if my constituent who needs the treatment were living in Cambridge, she would get it. That cannot be acceptable.

It is all very well identifying the problem, but what should we do? We need a mechanism for allocating unlicensed and unapproved drugs. We cannot continue with the random and arbitrary approach that we take now. That has to be done nationally. The hon. Member for North Swindon (Mr. Wills) was right to identify a conflict between a belief in localism, local discretion and responsiveness to local circumstances, and consistency and avoiding postcode lotteries. On many things, my colleagues and I are on the side of the localists. We want
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local discretion over patterns of service and provision. However, I do not think that any of our constituents believe that it is right that whether a patient gets a drug should depend on where they live. That does not come into the category of decisions that our constituents believe should be made case by case, on a local basis. Therefore, we need a central evaluation process for such treatment, pre-NICE. The alternative is arbitrariness—randomness, going to court, postcode lottery—on treatments that could save lives. It must be one or the other. We cannot have both.

That arbitrariness so offends our constituents' sense of natural justice that we cannot go on. Yes, the problems with herceptin will be sorted in six months—we hope—but the next set of problems will not be. Clinicians tell me that avastin will be the next cancer wonder drug and that it will make herceptin look cheap, so we have to tackle the issue. Such drugs will first be unlicensed and then licensed but not approved. The faster the NICE approval process, the shorter the pre-NICE process I suggested, but it will have to exist, otherwise there will be only the arbitrariness and unfairness that we all feel offends against our sense of natural justice.

It is no good pretending that there will not always be rationing, but it must be systematic and consistent—

Julia Goldsworthy (Falmouth and Camborne) (LD): And rational.

Steve Webb: Indeed. If there is a national process for a limited period for a limited number of treatments, it will be better than the present arbitrariness. I hope that the Government will give the proposal serious thought.

Several hon. Members rose—

Mr. Deputy Speaker (Sir Michael Lord): Order. Before I call the next speaker, I point out that the 10-minute limit on Back-Bench speeches applies from now on, but as many Members are seeking to catch my eye it would obviously be more than helpful to all of us if people could take a little less than their allocated time.

5.46 pm

Mr. Andrew Smith (Oxford, East) (Lab): I am pleased that the Opposition have chosen to debate the future of cancer services today, because this morning, in my constituency, the groundbreaking ceremony was held for the inauguration of the new Oxford cancer centre at the Churchill hospital site. It would be difficult to find a better pointer to the progress we are making in cancer care and treatment and to further improvement in the future.

The new £109 million centre, due to open in 2008, brings together cancer services that are currently scattered across three sites—the Radcliffe infirmary, the John Radcliffe hospital and outdated buildings on the Churchill site. It will combine all the clinical teams—surgeons, oncologists and support staff—in one place, providing prompt diagnosis and even more effective treatment, thereby contributing to fulfilment of the national cancer plan and improving outcomes by
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enabling more patients to come to Oxford for specialist cancer treatments that can most effectively be provided only in more specialist centres.

Patients will benefit from still closer collaboration with Oxford university, ensuring that their care is informed by the most advanced research into new cancer treatments. The new centre will include a women's health service, with a dedicated ward where patients with gynaecological or breast cancers will be cared for. Like most of the other patients, they will be able to have all diagnostic tests and treatment, whether surgery, chemotherapy or radiotherapy, on the same site.

The building, which will include a geothermal heating system pumping up heat from 120 m below ground level, was designed with advice from cancer patients themselves, who particularly wanted it to be as light as possible and to include many natural materials. Involving cancer patients in the design of such an important new facility is an extremely positive development.

Such a level of investment in cancer services just would not be happening if the Opposition had had their way when they voted against increased funding of the health service and, as my right hon. Friend the Secretary of State said, it would be at risk in the future if they had the chance to bring in their proceeds of growth rule, which would hold public spending to a lower rate of growth than the economy as a whole, regardless of the need for investment in public services. What is more, in Oxford, as elsewhere, cancer patients and services are benefiting from the fulfilment of the ambitious targets that the Opposition want to remove.

In January, every patient referred to the John Radcliffe under the two-week maximum wait rule was seen within the target time, and the number of cancer patients seen within two weeks is three times more than it was as recently as 2000—we cannot go back as far as 1997. That achievement is a result of the extra resources for staff, the better organisation of services and the streamlining and improving of patient access to cancer services across the trust.

In the past three years in Oxfordshire, the NHS has invested an extra £4 million in cancer services. New consultant oncologist, surgical and nurses specialist posts are examples of the investment in the clinical work force who are providing cancer care. The introduction of one-stop clinics, faster access to diagnostics and other improvements have particularly benefited gynaecology and urology services.

Most importantly, though, staff at all levels have gone the extra mile to ensure patients get a better, faster service—for example, by working extra hours to clear any backlog of patients who are awaiting radiotherapy. Since November, they have succeeded in maintaining no waiting time at all for new patients referred for radiotherapy. No praise is high enough for the staff who are achieving that performance through their dedication.

Getting to the current performance has been a challenge, and sustaining it will be a challenge, too. The trust will need to recruit more medical, nursing and other support staff to sustain the highest delivery performance, particularly for some clinical services, such as paediatric oncology and radiotherapy.
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In high cost areas such as Oxford, there is a certain vulnerability to staff shortages in specialisms that are experiencing a national shortage, such as therapy radiologists and physicists. That makes the national drive to train and recruit more people in those specialisms especially crucial. It also means that the battle to provide more homes in central Oxfordshire is not just a housing policy, but a health service priority as well.

Another challenge is to get right the tariff for payment by results, which is particularly crucial for specialist centres as they move towards foundation status. It would be helpful if the Minister said more about the prospects for the announcement of the tariff following its recent withdrawal after it had been sent out. Clearly, it would be better if hospitals avoided such uncertainty just weeks away from the new financial year.

On the funding of new cancer drugs, hospitals and PCTs will clearly face continuing difficult pressures. The NICE procedures are the right way to resolve fairly and objectively which drugs are cost-effective and should therefore be available, but the difficult question remains of where cost-effective might not necessarily mean affordable.

A judgment that is fair to all must take account of what other treatments and which other patients are displaced by the resource consequences of such difficult decisions. That is why the Opposition Front-Bench team's proposition of handing everything over to NICE simply will not work. Surely, commissioners must be ultimately responsible for those decisions, but we all know that the minute that one PCT comes to a different conclusion from another, there will be cries of "postcode lottery".

Unlike the Opposition Front-Bench team, I do not think that there is an easy answer. Clearly, a consensus is needed on how to deal with those difficult choices. Although, as ever, I followed with interest the comments of the hon. Member for Northavon (Steve Webb), I am not sure whether he has necessarily got the answer. Further close attention and public debate must be given to this vital issue.

I could not speak in a health service debate without raising the continuing problem of the current year's financial deficit and its impact in Oxfordshire. I do not for a moment think that the remaining deficit can be eliminated in the weeks that remain of this financial year, and as Ministers come to accept that, the question will shift to one of on whose books the deficit most properly belongs—an issue of more than accountancy significance, because of its impact on finances next year. As things stand at the moment, all the deficit would be left with the Oxford Radcliffe hospitals trust, but that would not be right, given that the financial problems in Oxfordshire are not all of the Radcliffe's making.

A fairer and more rational allocation of the deficit needs to be found. That would be better for patient care, as well as for the finances at the Oxford Radcliffe hospitals trust, which has made enormous progress in recent years in turning round its financial position and costs, as well as in delivering the first-rate cancer care about which I have been speaking, and I am confident that, with the investment that Labour is making, that will go from strength to strength in the future.
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5.54 pm

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