Examination of Witnesses (Questions 60-79)|
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
61. So that information is available?
(Professor Richards) That information is all on a
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
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?
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.
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.
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
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
(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.
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
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
(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
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.
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.