David Amess

Conservative Party | Southend West

Cancer Service

James Duddridge (Rochford and Southend, East) (Con): I am grateful for the opportunity to raise the subject of cancer services in south Essex, which is a subject that I have been working on over the past few months with my hon. Friends the Members for Southend, West (Mr. Amess), for Castle Point (Bob Spink) and for Rayleigh (Mr. Francois), co-ordinating some of the activity in south Essex on our collective behalf.
I am acutely aware that cancer is an emotive subject, with one in three people directly affected by it and virtually all of us indirectly affected. It was with some trepidation that I began to engage with the subject matter locally, but the bottom line is that, without being sensationalist, I genuinely believe that there will be a materially worse service in south Essex as a result of the changes that are taking place.
Those changes are the merger of the South Essex cancer network with the Mid Anglia network. I shall give a bit of the history of what has been happening. As far back as the mid-1980s, there was a threat of merger, which disappeared following a local campaign. The Calman Hine report in 1995 rightly suggested introducing cancer networks, and a year later the South Essex cancer network was created. In 2001-02, the network came under threat and mergers were proposed across the whole of Essex. There was a lot of local debate, and a large campaign was run by the Southend Echo and a number of colleagues who were in the House at the time to keep hands off the cancer network and to leave it as it was.
This morning, I was reading the papers from back then and Mike Richards, the cancer tsar, said that he could barely come to the House of Commons without someone mentioning Southend to him. He kindly agreed to come down to Southend and decided that it was right for south Essex and for cancer patients that the merger did not go ahead at that point. More recently, in December 2005, the strategic health authority started a consultation, which although it was extensive was fundamentally flawed and a bit of a sham. I will explain the distinction later and go into the consultation process in more detail.
In terms of parliamentary activity, we have been doing an awful lot. We spoke in the Opposition day debate on cancer, have met the strategic health authority a number of times and a petition has gained about 5,000 signatures. Collectively and individually, we have made formal consultation submissions to the SHA and, of course, as one would expect, we have been corresponding with the main players and have visited the cancer centre a number of times. Unfortunately, on 29 March the SHA decided to press ahead with the change. Since then I have tabled a number of written questions and written to the Secretary of State. The Minister was kind enough to reply to those, and I shall go into those matters on which I was disappointed by the lack of detail in the reply and those on which I was looking to tease out whether the merger will be good for patients. The case has certainly not been proved and, on balance, would be adverse at the moment.
In summary, the South Essex cancer network was created 10 years ago. I hope that the Minister will consider not effectively abolishing it through merger. The network covers a population of approximately 730,000 and the main hospitals of Southend and Basildon. In many ways, the merger has been brought about because of activities outside south Essex, specifically the decision by Norfolk, Suffolk and Cambridgeshire to pull Ipswich out of the Mid Anglia network to the north. Crucially, the South Essex network had no involvement in that decision but was fundamentally affected by the knock-on effect.
The South Essex and Mid Anglia networks are two of the three smallest cancer networks in the United Kingdom. I wrote to the Minister asking for details of the population size, but I could not get definitive figures, so perhaps she can correct me and give some figures on the smaller cancer networks.
I want to prove, first, that there was no need for change, secondly, that one size does not fit all, in terms of cancer network sizes, and, thirdly, that the consultation was fundamentally flawed and that the decision had been taken well before the start of the consultation. I also have a number of questions that I hope that the Minister will answer either today or in writing, as she considers appropriate.
There are things that I shall not touch on. Essex cancer services is a broad subject, and I shall focus primarily on the network and the merger. I shall not talk in detail about changes to upper gastrointestinal, urological and head and neck cancer services, although other Members may want to contribute on those subjects in more detail, as they are not uncontroversial. However, very few people are affected by those cancers, and the big issue for me is the network overall, rather than the merger of services for those specific cancers.
My hon. Friend the Member for Rayleigh, when introducing me to the subject, summarised the whole issue by saying, “If it ain’t broke, don’t fix it.” That is probably a fair reflection of the overall feeling in south Essex. The cancer network is doing a fantastic job. In fact, it is one of the leading cancer networks in the United Kingdom, and I would like to pay particular tribute to the lead clinician, Dr. Colin Trask, and the lead manager, Kevin McKenny, who I am sure will read the report of the debate with great interest. The service has a fantastic reputation not only locally, but among its peers. I could quote a whole series of barometer statistics about cancer care, but suffice it to say that statistically it does an excellent job.
At the moment, most of the cancer care network, and most transport communications, in Essex go east-west, not north-south, because when people are treated in Essex and are looking for specialist services, they look to London. There are no significant patient flows north-south or south-north, so the merger is inappropriate, given the movement of people.
Early on, our campaign talked about saving the cancer centre. A few people have called us sensationalist. It is true that the cancer centre will not close tomorrow, next week, next month or even next year, but I feel that this is a case of death by a thousand cuts. A salami-slice approach is being taken to reducing things—a little bit is taken off here, and a little bit is taken off there. There will be a reduction until a critical mass is reached, which will mean that Southend cancer centre will not be able to attract the excellent clinicians that it does at the moment and maintain its excellent reputation.
Also, we are told that the change is purely administrative. If it is purely an administrative matter, then given that there is so much public opinion against the change in south Essex, and given that we are talking about only 20 or 30 people in terms of gastrointestinal cases, why press ahead with it? I have a sinister suspicion that the change is not purely administrative, but is a stepping stone to other changes, and I seek the Minister’s reassurance that that is not the case.
I need to be careful when talking about the Mid Anglia cancer network, because clearly we south Essex MPs are proud of our services, but perhaps I could quote what other people have said, rather than making a judgment on the network myself. Some people have told me that the Mid Anglia network is unstable at the moment, and others say that there are lots of problems with Ipswich having left. I recognise that there may be benefits for Mid Anglia in the merger, but there are certainly no benefits for my residents in Rochford and Southend, East, or for constituents generally across south Essex. Perhaps the strategic health authority is formulating an equation for the greater good of the residents of Essex, but the equation does not work for me. South Essex loses a little and Mid Anglia gains a lot. That may work overall, but it does not work for my constituents.
There is a feeling that bigger is better, but I am not sure that that is right when it comes to cancer networks. It seems from speaking to some patient groups and GPs that the opposite might be true and that some cancer centres may be too large. One of the greatest challenges is to identify cancer early at GP level and to refer patients to the correct person for a proper diagnosis. A closer relationship between the cancer networks and individual GP practices would be more easily facilitated if the networks were slightly smaller. I am suggesting not a radical change, but a change in direction, and it may be better to keep them as they are or to reduce them slightly.
The cancer centre made the point that it is already working across boundaries in some cases and sharing best practice. I shall go into more detail about how one size does not fit all. I mentioned the 1995 Calman Hine report. It is 10 years old but is still relevant and still resonates. I want to draw attention to some quotes from the report. The first is about the size of the population and states:
“The size of a population served by a Cancer Unit cannot be inflexibly defined but will be determined by the number of cases of each cancer type being seen there”.
It is critical that a network is based on the number of cancer incidents rather than the population. South Essex has pockets of deprivation with, sadly, a higher incidence of cancer and demographically it has a much older population. Those were the two reasons given by the Government’s cancer tzar for not going ahead with the decision to merge the network in 2002. Those reasons remain true today.
Secondly, the report states:
“Decisions will have to be taken forward in the light of local circumstances and take account of the views of patients”—
patients do not want this—
“and their carers as well as the professionals involved in providing care.”
It continues:
“The Group recognise that the development of the ideal pattern of service should build upon existing patterns of referral and care and should take account of geographical constraints.”
That is the opposite of what is happening. There are no existing patterns of referral north and south and there are transport constraints. It is normally quite difficult to travel around south Essex and people who need cancer care do not want to be stuck in traffic for hours before receiving important treatment.
Mr. Mark Francois (Rayleigh) (Con): I apologise for interrupting my hon. Friend because he is making a good speech.
To amplify what my hon. Friend said about the quota being under 1 million, when the network was established it was specifically given a derogation from the 1 million level because the NHS accepted that there was a higher than average number of elderly people and that actuarially, unfortunately, cancer would be slightly more prevalent in that population group. There was enough business to make a cancer network of 750,000 viable. The point that I want to stress is that that was built in from the day when the network was established. It was looked at from day one and accepted, so it should not be overturned.
James Duddridge: I thank my hon. Friend for raising that. He has been involved in the matter for a considerable period, more so than I have. I completely agree that the 1 million figure is largely arbitrary and inappropriate for the South Essex cancer network. It does not take account of the local situation.
I explained why I found one of the replies to a written question unhelpful. I was trying to probe whether there was a statistical correlation between the size of the cancer network, the number of treatments and the success rate. I also asked the Secretary of State for the population catchment size for each cancer network in England and the Minister replied:
“The Department does not hold the population catchment size for each cancer network. However, a typical cancer network services a population of around one to two million.”—[Official Report, 18 April 2006; Vol. 445, c. 385W.]
That statistic perhaps went into the first column of some form of analysis. The second column would have been the actual cancers identified each year. Around 3,500 cancers are identified in the South Essex cancer network. The following column would be an indicator of the success of those units—for example, long-term survival rates. I appreciate that that is a much harder figure to obtain, but nevertheless it is important. I seek the Minister’s guidance on the exact measure that she could take within the Department.
The final column would be the statistical correlation between those first three numbers. Nowhere in my discussions, the circulated paperwork or the responses to my questions have I seen that statistical analysis for the cancer network. Following a meeting, the medical director of the strategic health authority kindly provided details for the three specific cancers, and although I cannot engage in the detail of the medical situation, there seemed to be a case that bigger might be better. However, no one has tried to prove, in anything that has been provided to us, that bigger is better for cancer networks, and many of us have been extensively involved in this subject for the past few months, and some of us for much longer.
I am concerned that this is dÃ(c)jà vu in respect of 2001-02. I feel embarrassed that back then, before I was an MP, colleagues were successful and that I do not seem to be getting a very good deal for my constituents. I worry about that, and I ask the Minister to give me a ray of hope, or at least an explanation. I do not want the cancer network 10-year birthday to be celebrated with effective abolition by merger.
To call the consultation a sham would perhaps be unprofessional, and such language might be unparliamentary. I use those words in anger, because I was very upset by the way I was treated, not individually but as an MP—as a statutory consultee—and, more importantly, by the way all the patient groups were treated. There was overwhelming opposition, which I think is best summarised by the people at the front line who are running the network.
The South Essex cancer network did not support the SHA’s proposals to merge. It gave a number of reasons why: there
“is no demonstrable patient benefit”;
there is a great risk of losing the clinical cohesiveness and ownership that exists in south Essex; patient flows should determine network configurations, and there are virtually no patient flows from south to north or vice versa; current network arrangements meet national peer review measures already; the restructuring of cancer networks is not required to meet national cancer site-specific guidance, with south Essex plans already either approved or well advanced; the south Essex network currently has arrangements that are working perfectly well; and the merger will produce only marginal cost savings. Finally, the cancer network pinpoints a distinct lack of clarity about the future of the Mid Anglia cancer network based on current arrangements. Therefore, there is strong opposition from the people who actually run the network.
Other key authorities also opposed the merger. The two primary care trusts within my constituency—Castle Point and Rochford PCT and Southend PCT—did so. The two local authorities in my area wrote to ask me to raise the matter. They did not just send in a consultation; they passed council motions saying that they did not want it, because it was bad for constituents. That view came from both Southend and Rochford. Patients’ groups have also come to me both formally and informally and said that they oppose the merger.
As I am an inexperienced MP, the petition that we put together was my first one. I sent it to a number of doctors’ surgeries—about 20—as well as to a number of pharmacies in my area, because I thought that that would be a way of demonstrating the size of support to the Government. I am not sure what level of support I thought would be successful, but I was thinking in terms of a couple of hundred names, and that if there were more than 1,000 I would be celebrating. However, 5,000 people responded. There is a massive amount of local support and concern.
I wrote to the Secretary of State. The Minister was kind enough to reply, saying that the merger was a local matter, that the Secretary of State would not intervene, and that I should raise any concerns with Essex SHA. In many ways I agree; it is a local matter, but I do not consider the SHA to be local. To me, local is Southend, Rochford and the wider cancer network. I find the strategic health authority somewhat out of touch in that regard, and in regard to other matters as well. I hesitate to go into more detail, but I do not think that it has a role as things progress. It certainly does not add value for my constituents. I want more people on the front line. However, I apologise, Mr. Atkinson, for going slightly off on a tangent, and I shall return to the subject of cancer.
The Minister has a role. When the Government’s cancer tsar last came to Southend and examined the problem it paid dividends. I do not demand, or even ask, that the Minister should come to Southend, although it would be very welcome. I am more concerned that she should review the matter. [Interruption.] My hon. Friends are asking whether she will come; she would be more than welcome.
What I said about the consultation being a sham involves a key point. When Ipswich left the Mid Anglia cancer network, the writing was on the wall. It was always going to be difficult to justify maintaining two smaller networks, if, indeed, it was Government policy and advice that 1 million-plus should be the population number. That has produced upwards leverage.
Following the Minister’s letter, I telephoned the strategic health authority to check that it had not been missed the letter in the post in early May, prior to the debate, and it kindly faxed its response to me this morning. In fairness, its representatives are disappointed that I consider the consultation to have been a sham, but not nearly as disappointed as I feel about the whole consultation process.
I am not criticising a lack of activity in the consultation; there was lots of activity and lots of money was spent on it. However, I believe that the decision was taken well before the consultation. Several more seasoned—perhaps one could say more cynical—colleagues told me not to bother to get involved. They said, “We see this time and again; consultations take place but the decision has already been taken.” Furthermore, in the health sector locally there is some consultation overload. I was considering five or six NHS consultations in south Essex in January, so things are quite difficult. Also, in each case the questions being considered were mergers, and getting bigger. I cannot help thinking that there is an underlying philosophy that bigger is better, but I do not think that that is right. Both on the specific cancer issue and on other things, bigger may be considerably worse. We should reduce the size of some of our operating units.
I said that I would try to include some questions to make it clear what I want to achieve in raising the debate. The best thing would be for the Minister to say, “Ah, yes, there has been a terrible mistake and we shall sort it out.” I do not imagine in my wildest imagination that that will happen, but a ray of hope for my constituents would be most appreciated. I should like to find out more about why change is needed. I think that I have demonstrated that the cost benefits will be marginal, that there are no demonstrable patient benefits and there will be much administrative disruption, and that there is much opposition.
I should be interested to know more about the 1 million figure and why there is no flexibility, when the cancer tsar showed flexibility in 2001-02. Has there been a policy change since then, or has more information, of which I am not aware, become available? As to the tabular information, I do not ask the Minister to provide anything in that exact format. However, something a little more solid statistically, which correlates population numbers, cancer incidence and survival rates would be helpful to enable us to go forward. If the Minister is right that bigger is better, why should the figure be 2 million? Perhaps it should be 4 million? We need a strong evidence base to enable us to proceed.
I hesitated before putting my questions, because the issue that they raise is, “What if the merger does go ahead?” I should like the Minister to confirm that what is happening is 100 per cent. about administration. The South Essex cancer network and the doctors in Southend would like a promise that there will be no patient movements south to north or north to south, other than in the three specialist cancer centres, without consultation.
I should also like more information about the consultation. I talked about the cancer centre suffering death by 1,000 cuts, and one concern is that smaller changes will happen below the radar, and without the involvement of local community leaders and community groups, once we are part of a bigger cancer network.
Macmillan Cancer Relief raised the problem of the travel costs that would be involved should patient flows be significant. Bus routes are poor, and there are virtually no rail routes north and south—certainly not from my part of south Essex. The charity is concerned about the extra costs, and that is a valid concern, although time is also a great worry.
I said that I would not talk in detail about upper GI, but I have had several letters from people in Basildon asking why there is no options appraisal for upper GI in Basildon. I simply throw that issue out to the Minister, and she might want to comment on it. That might be helpful for members of public in that part of the world.
In summary, the merger of the South Essex and Mid Anglia cancer networks is opposed locally and represents a threat to the longer-term future of the Southend cancer centre. The case for the merger is weak at best and fundamentally flawed at worst.
Mr. David Amess (Southend, West) (Con): I congratulate my hon. Friend the Member for Rochford and Southend, East (James Duddridge) on the way in which he introduced this debate and on his temperate language.
The Minister is genuine in her intention to do the best that she can for the health service, but how could she possibly know the details of the services that we enjoy in Essex, when she depends on advice? I gently ask her, therefore, to put out of her mind for a moment the thought that she will hear mainly from Conservative Members this afternoon. Instead, I ask her to consider carefully the advice that she is being given, because it was wrong four years ago, and nothing whatever has changed the argument today. I also hope that she will accept my hon. Friend’s invitation to visit Southend, and I would be delighted to buy her a Rossi’s ice cream, which I can thoroughly recommend, on our newly refurbished pier. She will, however, be very proud of the services that we enjoy.
The Minister should know that there is great pride in cancer services in our part of Essex, and that is particularly clear from the support for local hospices. Last week, I was proud to accompany Vera and Ivan Heath, both of whom are 90. They have no children and little family, so they have decided to benefit others by giving their money to the local community now, rather than waiting until they die. I was honoured to be with Ivan at Little Haven hospice, which he presented with a cheque for £250,000. I was also honoured to accompany him to St. Luke’s hospice, which was opened by the late Princess Diana of Wales and the Duchess of Norfolk when I was the Member of Parliament for Basildon. Ivan gave St. Luke’s £50,000, which is a wonderful gesture.
On Fridays, I sometimes go round my colleagues’ constituencies. Last Friday, I was at Stock Brook Manor in the constituency of my hon. Friend the Member for Billericay (Mr. Baron). I enjoyed a charity golf day, which was organised by the Donovan family, and a whole number of celebrities attended. The event raised in excess of £60,000 for Little Haven hospice. I just want the Minister to appreciate, if she does not already, that there is an enormous amount of good will towards cancer services in Essex generally. In particular, we are very proud of the services at Southend hospital, which really is a true centre of excellence.
In the debate in February 2002, to which a different Minister replied, I applauded the cancer plan, and I do so now. It is right that cancer, an illness that affects one in three people in the UK, should be given the priority status that it already enjoys in the national health service. However, as I said in that debate,
“As we have a first-class service and that is what the Government want, why change it?”—[Official Report, 6 February 2002; Vol. 379, c. 1002.]
That is the issue, and it must not be clouded by anything else. We have a first-class service and it should not be changed, whatever briefing the Minister has been given.
Professor Richards decided that, given the high number of cases treated by the centre and the high proportion of elderly residents in the area, the benchmark figure of 1 million inhabitants ought not to apply to the South Essex cancer network. I represent the constituency with the most people between the ages of 100 and 112 in the UK. For the reasons that I mentioned, Professor Richards decided to support the arguments advanced by my colleagues and me.
The factors have not changed, so why, four years later, is the size of the network a reason for merging it with Mid Anglia? It seems absolutely implausible— how can the argument have changed in four years? So far, Essex strategic health authority has been totally unable to provide me and my colleagues with any evidence to show that small centres are less effective in treating certain sorts of cancer than larger ones.
A press release issued by Essex strategic health authority on Tuesday, 21 February 2006—still within the period of the public consultation—made the case for large specialist surgical centres. It stated:
“National guidance recommends that the surgical part of treatment of gynaecological, upper GI, urological and head and neck cancers should be provided in centres serving at least one million people. The national guidance is known as Improving Outcomes.”
The recommendation to replace what the release calls “fragmented” services with other clinical set-ups is made without statistical evidence to back up the assertion that bigger is better.
The Essex strategic health authority consultation on the reconfiguration of cancer services was conducted from 12 December 2005 to 13 March 2006, after which it was decided that the changes proposed in the document—that is, the merger of the cancer networks and the relocation of specialist cancer operations—should go ahead. As my hon. Friend the Member for Rochford and Southend, East asked, what was the point of the consultation? Members of Parliament and our constituents have been treated like complete idiots and I, for one, will put up with it no longer.
If the strategic health authority had already made up its mind, what on earth was the point of going through the consultation? It was more of a gesture towards openness than real dialogue; it did not take into account the views of the south Essex hospitals, the South Essex cancer network, the 5,000 members of the public—who, as my hon. Friend mentioned, signed the petition—or the Members of Parliament and councillors who represent those people and all opposed the strategic health authority’s proposal.
The Minister values the work of the Health Committee, on which I am privileged to serve. She knows that it recently conducted an inquiry on the reorganisation of primary care trusts. Our report found that consultation was woefully inadequate, mainly because of the top-down nature of the process, which imposed change, even when it overrode the needs of local communities, to make financial savings.
I say to my hon. Friends that that is what the issue is all about. It has nothing to do with best practice. The argument, accepted four years ago, is even stronger today.
I end by saying that I had the pleasure of visiting, with a number of my hon. Friends, the Southend cancer centre at Southend hospital on 31 March. We were absolutely in awe of the quality of the services; the centre is meeting not only its targets for breast and cervical screening, but the national cancer waiting times: 100 per cent. of its patients receive their first appointment within two weeks and their first treatment 31 days after the decision to treat. I know that the Minister, when she replies to the debate, will congratulate the hard-working staff on their achievements.
Waiting times and clinical targets are, however, only half the story of cancer treatment. Macmillan Cancer Relief has been making the case for a more comprehensive cancer plan than the one that the Government launched in 2000. The plan would provide for vital supportive and palliative aspects of cancer care as well as diagnosis and treatment. The additional investment in specialist palliative care at Southend cancer centre is already making a difference in that area, along with an agreed framework for implementing the National Institute for Health and Clinical Excellence guidance on supportive and palliative care and for establishing a network user partnership group and a network patient information project.