Speech: 13 December, 2011, Andrew Lansley, Britain Against Cancer

Check Against Delivery

Thank you John [Baron MP, Chair of the APPG] and thank you again for the opportunity to be at the Britain Against Cancer Conference.

For me, this is one of the key events of the year.

Bringing together patients, charities, health professionals, councils and politicians and many others.

Partnerships which also work effectively together in cancer networks. I really value what cancer networks do which is why we support them.

Demonstrating the partnership the All Party Parliamentary Group has brought together – supported so ably by Macmillan.

The strength and depth of this partnership are vital because cancer is an issue that matters so much to so many people.

This year over a quarter of a million people were told that they have cancer.

One in three of us will develop it at some point in our lifetime.

We, all of us personally, amongst our friends and family know what it is to experience the effects of cancer in our lives.

There have been many improvements over the years that allow us to be so much more hopeful.

People live six times longer after diagnosis than they did 40 years ago.

But as we’ve discussed before, and indeed the APPG on cancer has pointed out many times, survival rates are not where they should be – we still don’t compare positively and consistently with the best in Europe.

For example, while we’ve made good progress on breast cancer, there’s no sign yet we’re closing the survival gap on other common cancers, for example lung and colorectal cancers.

Almost a year ago we published the Cancer Outcomes Strategy.

This was unequivocal in its ambition to save 5000 more lives per year by 2014/15 – by bringing the outcomes in the NHS up to European average.

Now politicians are usually warned off making such emphatic statements – they are, we’re told they’re a hostage to fortune.”

Or in a reference to ‘Yes Minister’ you could be called ‘courageous.’

All as if the prospect of failure should be an excuse for not trying at all.

Far easier to focus on the mechanics of treating patients – waiting times and referral times – and turn aside from the bigger prize, which is ultimately what matters most to patients and their families.

Far easier to shrug our shoulders and accept the clear inequalities in cancer care, than to think that by doing things differently or better, we can change and improve.

When it’s a matter of life and death – as in the case of improving NHS care – we must not settle for anything less than the best outcomes.

So, our starting point is “too many people die from cancer who should live, and this is what we should focus on” it will drive us to respond in a different way.

Now the NHS Outcomes Framework we published last week, we were explicit in what we expected from the NHS. Indeed both David Cameron and I were very clear about what we want the NHS to achieve.

We wanted to see improvement in survival rates for colorectal, breast and lung cancer – the most common cancers, measured in terms of 1 and 5-year survival rates.  We also have an indicator around cancer mortality rates.

These indicators will enable us to demonstrate progress in improving survival and mortality rates, and enable us to see how earlier diagnosis, and prevention – as well as treatment improvements, are contributing to improvements in outcomes.

We’re now nearly one year on from the publication of the cancer outcomes strategy.

The annual report we publish today shows we’ve made progress against the five domains in the outcomes framework that define the NHS’s responsibilities, and where we need to do more.

On preventing people from dying prematurely, the key is both prevention and early diagnosis.

As we know from Cancer Research UK’s report, if more people gave up smoking, ate better, drank less, smoked less, we could prevent over 40 per cent of cancers.

Smoking alone is responsible for 29 per cent of all deaths related to cancer.

It’s why the Tobacco Control Plan sets out how we will tackling smoking – stopping the uptake of smoking by young people, supporting smokers that want to quit and reduce exposure to second-hand smoke.

The vending machine ban began in October.

Tobacco displays will come to an end in supermarkets in April next year, and in all shops in 2015.

And we will go on to consult on the introduction of plain packaging for cigarettes.

And to tackle late diagnosis of cancer we’re improving public awareness of the signs and symptoms of cancer.

The pilot campaigns on bowel cancer have led to more people going to see their GP, and being referred for diagnostic tests.

Based on the increase in demand for diagnostic tests, we estimate that, in these small scale pilots, a minimum of 23 additional bowel cancers will have been prevented, because cancer-causing polyps will have been discovered and removed.

And 14 lives will have been saved by diagnosing cancers earlier. And these were small scale pilots. We have to do more.

So we will roll out the national bowel cancer campaign in January.

This will create greater demand in the NHS for endoscopy services as more people are likely to be referred for diagnostic tests. The East of England – one of the pilot areas – saw a 28.5  per cent increase in the number of people waiting for a colonoscopy, and there was a 16.4 per cent increase in the South West.

It’s why in the cancer strategy, we provided an additional £450 million to support earlier diagnosis – including for additional diagnostic investigations and treatments.

And why when we published just a few weeks ago in this year’s Operating Framework, we have again stressed that one of the NHS’s priorities for next year must be to make sure there is capacity in diagnostic services, so that endoscopy services can meet the demand that the campaign and bowel cancer screening will stimulate.

So I want to make clear today: I see the year ahead as a major opportunity to make a big difference in the diagnosis of bowel cancer. More access, more referrals, more tests, more successful interventions and more survival.

Also the regional pilot on lung cancer which ran in November in the Midlands and border areas was promising too – we already know that there have been very significant increases in referrals for chest x-rays.

That too, will create appetite for successful treatments and improved outcomes.

On to the second domain – improving the quality of life of people with long term conditions.

As more people survive cancer, cure on its own isn’t enough. We need people who recover from cancer to have as good a quality of life as possible – to be in good health so they can get on with their lives.

Part of this is about investing in treatments that are more effective, and have fewer long term side effects.

We’re only beginning to see the potential of genetic testing of tumours to develop more targeted treatments for patients. As our knowledge develops, we will make sure that the NHS is well-placed to offer these benefits to all cancer patients.

With the help of Cancer Research UK, we are exploring how the NHS can offer genetic testing of tumours routinely, so patients don’t have to undergo drawn out and painful treatments that won’t necessarily benefit  them.

Quality of treatment is vital to this too.

We know the benefits of proton beam therapy in the treatment of rare and complex cancers – in particular, for cancer in children.

This year, the NHS will pay for around 80 people – mainly children – to have proton beam therapy abroad, and the numbers are increasing. By 2014, we estimate we will be spending £30 million to send around 400 patients abroad for treatment.

However, those overseas centres often do not have the space to treat our patients as we would like.

And there are clinical issues too.

Not so much because of cost, but because doctors have to weigh up the impact that travelling many miles for treatment might have.

So I can announce today that we will be taking forward plans for the development of a national Proton Beam Therapy service capable of treating up to 1500 patients a year in this country, meeting our potential need.

These are large and technically complex facilities which we cannot expect Trusts to fund and develop alone.

Therefore, we are looking at various options, including using public capital, to help ensure that a national service is fully integrated, provides access to all and offers taxpayers good value for money in the longer term.

We will proceed after a vigorous scrutiny of plans to secure the best possible use of NHS resources.

By supporting this major development we will put the UK at the forefront of the latest and most promising developments in technology, to help us in our goal to deliver among the best cancer outcomes anywhere in the world.

On the third domain, helping people recover from ill health, we know there is more to do to improve both quality and productivity of cancer services.

Yesterday, we published the second NHS Atlas of Variation.

The Atlas is an incredibly powerful tool for driving improvements in the quality of care.

The first five maps in the Atlas are dedicated to cancer.  They show significant variation across the NHS.

Some of that variation will be down to different populations and their health needs, but the size of the variation clearly shows that while in some areas of the country people are receiving first rate cancer care in other areas, they are not getting the care they need or should expect from the NHS.

For example, patients in some PCTs are two and a half times more likely to have an urgent GP referral for suspected cancer than in others.

There are almost twice [1.9x] as many emergency cancer bed days in some PCTs than in others.

And for breast cancer surgery – where unless they are having breast reconstruction surgery at the same time, women should be in and out in a day, or at most with just one overnight stay – in some primary care trusts, it’s the norm to be in hospital for a week.

The Atlas of Variation is changing the NHS.

Already, around the country, primary care trusts are using the Atlas to understand how what they do, their activity levels and the outcomes they achieve compare with their peers.
They are using this information to identify where they can make improvements and then transforming their services for patients.

In Warrington for example, led by the new Warrington Health Consortium, an aspiring Clinical Commissioning Group.

The PCT was under considerable financial pressure and, on several indicators in the first Atlas, classed as an “outlier” in terms of clinical care.

Using the Atlas to find the primary care trusts that were delivering more effective care, they reviewed their approach and made changes.

They now expect not only to tackle those financial pressures; they also expect to see rapid improvement in areas like mental health, trauma care, respiratory and musculoskeletal care.

The same changes will be possible across the country, covering all 71 maps of the Atlas. Including the five dedicated to cancer. So we can bring to the rest the experience of the best.

Warrington’s experience shows the role that good information plays in improving the quality of care.

It links to the fourth domain in the outcomes framework – improving patient experience.

Today, the National Cancer Intelligence Network publishes its cancer intelligence framework.

It’s significant because it sets out in no uncertain terms the importance of good information in improving cancer outcomes – not just in how services are delivered, but how patients are involved in decisions about their care.

A few weeks ago I launched the Patient Decision Aids, I saw what this meant to patients.

I met a man who had used them to make decisions about his prostate cancer.

He told me how important it was for him to make the decision. I was very interested in his perspective, his wife was a nurse, but for him it was important that he shared the decision making as he didn’t want for anyone else to be blamed if it was wrong.  That the consequences of the different options were too important to simply hand it over to someone else.

He said, “I could never have lived with feeling like I was blaming others”.

And there should be no question about access to the most effective drugs and treatments.

As a direct result of the Mike Richards report, the cancer drugs fund has now helped over 7,500 patients access the cancer drugs their doctors recommended.

Over three years, the fund will improve the lives of many thousands more.

And for 2014 and beyond through developing a new value-based system of pricing for branded medicines. So licensed and effective drugs will be available on the NHS  at a price to the NHS that reflects the value they bring to patients and society .

To promote innovation and benefit to patients, the new Early Access Scheme in the Life Sciences Strategy the Prime Minister launched last week will also help more people  secure access promising new treatments more quickly on the NHS.

Seriously ill patients – those who have no other hope of treatment or having their life extended – could benefit from promising new drugs around a year before they are licensed.

It means that exciting new developments could be given to patients in the UK before anywhere else in the world.

On the final domain of the outcomes framework, treating and caring for people in a safe environment and protecting them from harm, we are now better able to benchmark how safe cancer services are.

In April this year, for the first time, we published 30-day mortality rates for colorectal surgery at trust level, so local NHS services were able to fully understand how well they were performing and make changes if necessary.

The National Cancer Intelligence Network will provide an update by March 2012, and carry out similar analyses for other cancers.

There is no doubt that the outlook for people with cancer in this country is getting better.

But we can make it better still.

There’s no intrinsic reason why we can’t do as well on cancer as those countries that frequently top the international league tables.

No excuses for limiting the scope of our ambition.

I know it wont be easy. And we won’t see miracles overnight.

But our focus on outcomes will bring new energy and drive on the issues that can really make a difference – prevention, earlier diagnosis, better quality treatment using the best available medicines and technology, more information and choice for patients.

Our objectives are clear.

Enhanced Prevention

Improved Recovery and Survivorship.

Quality of Life gained.

Better information

Improved outcomes for patients  and, for all of us to move from fear to hope.

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