Alan Milburn – 2002 Speech on Cancer

Below is the text of the speech made by Alan Milburn, the then Secretary of State for Health, on 5 November 2002.

Introduction

May I first of all thank Ian Gibson and my colleagues in the All-Party Parliamentary Group on Cancer for sponsoring this important Conference today and inviting me to speak this morning.

I would also like to thank Professor Boyle for his interesting and encouraging presentation.

Too often Britain is portrayed as the poor relation in European cancer care. It is encouraging to see that overall we are heading in the right direction.

When I became Secretary of State for Health three years ago I said then that reducing the number of deaths from cancer and improving the care and treatment cancer patients receive was a personal priority for me.

Over the last 3 or 4 year, the priority we have placed on winning the fight against cancer is beginning to deliver some results. Of course, that’s with the enormous caveat that there is still a long way to go. The people who deliver cancer services – doctors, nurses, radiographers, pharmacists, scientists, therapists and so many others – are still working under huge pressure in the NHS. Overall, patients get good quality care but sometimes patients still do not get the services they deserve.

Putting right years, and in some cases, frankly, decades even, of under-investment takes time and effort as well as sustained resources. That is why we have a ten year Cancer Plan. And today it is paying dividends in improved services and better outcomes. Today in our country we have the fastest improving cancer services of any major country in Europe. We are catching up – and catching up fast. Death rates are falling faster here than in other countries. Britain is starting to win the fight against cancer although there’s a long way to go.

I want to put on record today my thanks to those who are making this progress possible: the thousands of NHS staff across the country who are working together across organisations to modernise cancer services and whose commitment to excellence is, in my view, quite unrivalled in any other country in the world; the cancer charities, research bodies and voluntary sector and patient organisations who are now working together as never before to improve services for cancer patients. And of course, to Mike Richards – a lot of things only happen because of good leaderhip – Mike is leading this process of change – and is the best possible champion for cancer care any country could have.

The Cancer Plan is unashamedly a ten year programme. We are just two years in to it. Everybody – including me – wants to go more quickly. But – we have to be honest – we would simply be kidding ourselves, and misleading the British public, if we said turning round decades of neglect could be sorted with a quick fix. It can’t.

We should have the courage to acknowledge – to the press and to the public – that getting world class cancer care is a battle for the long term not the short term. It is a journey best completed step-by-step – recruiting staff, renewing equipment, changing attitudes, reforming services.

And, as we are honest about the scale of the challenge, we should also be determined to celebrate every single successful step along that journey. There is considerable progress to report. Investment in cancer care is rising and, in line with the Cancer Plan, by next year NHS spending on cancer will be £570 million more than it was just two years ago. I know – in this audience and elsewhere – sometimes there have been concerns about whether this extra funding is all getting through to frontline cancer teams. I take those concerns extremely seriously. We are putting in place work to better track that the investment is going in to where it is most needed but there is already growing evidence that extra resources are beginning to produce results for patients.

To begin with, the capacity problems faced by NHS cancer services are at last starting to be addressed. There are 500 more cancer consultants today than there were in 1999 – an increase of 15%. There are nearly 500 more to come.

There are still skill shortages of course – I think most acute in the all important area of diagnostic services. Again however progress is underway. The number of radiographers in training, for example, has risen by 28% in the last five years after it had fallen in the years before that. So we are making progress towards a long term solution.

The same is true for the other main capacity problem we face today in securing better cancer treatment services – shortages of the most up to date technology. Here the progress has been even more rapid. Since 1997 the number of new linear accelerators has increased by 20%, CT scanners by 50% and MRI scanners by 100%. Almost half the CT scanners currently working in the NHS are new since January 2000

There will be a further 100 additional scanners and 45 linacs for the NHS over the course of the next couple of years. We are currently working with local health services to decide where best the scanners should be located in order to plug the gaps in capacity that otherwise produce a lottery in cancer services. I will be making announcements about their location within the next few weeks so that the first of them can be delivered and imaging patients before next summer. This investment is essential to tackle the health inequalities which scar our nation and which are so evident in cancer care.

The lottery in funding for cancer drugs is already coming to an end. It is worth recalling that just a few years ago taxanes, for example, were available – not according to clinical need – but according to the local chance of whether a GP or a health authority had decided to make them available to patients. Today they are available to all who need them, not just some. Indeed, thanks to the work of the National Institute for Clinical Excellence, the NHS today is making available new cancer drugs for the treatment of ovarian, lung, brain, pancreatic, breast and bowel cancers as well as leukaemia and follicular lymphoma. Over 30,000 patients are already benefiting from these drugs. Many more will do so in the years to come. I can also tell the conference today that NICE are already appraising the next generation of new cancer drugs and will continue to make cancer a core priority of its work programme. And through the extra effort going into cancer research – particularly the establishment of the National Cancer Research Network – we can now aim to double the number of patients entering clinical trials of the latest drugs.

And, step by step, the NHS is making progress in tackling waiting times for treatment especially the time taken to see a cancer specialist Today 95% of urgent referrals are seen within a fortnight.

The extension of breast screening for 65-70 year olds is on schedule. So far 130,000 women have been invited. By 2004, 400,000 women will be benefitting each year.

And it is in this area of screening and prevention that we should now look to make further progress. So many of the 125,000 premature cancer deaths in the UK each year are preventable. Early intervention can make all the difference. Cutting down on tobacco consumption and improving diet could help to save up to 75,000 lives. In a few weeks time I will be outlining our proposals to place greater emphasis on prevention, alongside treatment, in the fight against cancer, when I speak to the Faculty of Public Health Medicine.

Today I want to suggest one way in which we can take this approach forward and use it to build on the progress that is already underway in improving cancer services.

Colorectal cancer, as Peter Boyle quite rightly said, is the second biggest cancer killer in our country. Each year it kills over 14,000 a year in England. Here – more than in any other area – earlier intervention can save lives. Patients with colorectal symptoms need to be diagnosed and treated without delay and research has shown that screening people who are asymptomatic can reduce the death rate from this cancer. In the Coventry and Warwickshire area good progress is being made with a bowel screening pilot and we are awaiting the results of the MRC funded Cancer Research UK flexible sigmoidoscopy trial with interest.

Today I can confirm to this conference my commitment to introduce a national bowel cancer screening programme. It will take several years to get there. It will not happen overnight. It will take time, but in preparation for this I am asking Professor Mike Richards to start work now with all the relevant experts to determine the best way forward. This work will consider specifically the workforce and training needs both for symptomatic services and for a screening programme.

Our overall aim is to cut deaths from cancer by one-fifth by 2010. Already, over a three year period the death rate from cancer has fallen by 6%. If we can maintain this rate of progress the ambitious target we have set for 2010 for our country should not just be hit, it could be exceeded. I believe we have a unique opportunity to do so.

No one questions how far we still have to go and I do not pretend meeting the challenge of creating world class cancer services in our country will be easy. But I believe we have every reason today to be optimistic about the future. I say that for five principal reasons.

Firstly, because the foundations have already been laid and I’ve said a word or two about that already.

Secondly, because the resources are available now and for the foreseeable future. This year’s Budget marked, in my view, a watershed for the NHS. Five years of real terms growth averaging 7.5% will take health spending in our country beyond the EU average – an average which, it’s worth remembering, the cynics said we couldn’t even get near. It is worth remembering that just six years ago spending on the NHS was falling in real terms. By 2008, because of these extra resources, it will have doubled in real terms. Britain now has the fastest growing health care system of any major country in Europe. The Budget laid to rest a decades old fallacy that we’ve had in this country – that we in Britain could have world class health care on the cheap. We can’t and nowhere is that fallacy more starkly demonstrated than in cancer services. If you want world class health care the resources must go in.

When we put taxes up to get more resources for the NHS we entered into a new contract with the people of our country. In exchange for extra resources we have to deliver better results. I believe that by delivering the NHS Cancer Plan – health services, charities, voluntary sector, universities, Government and patients organisations together – we can demonstrate the value for cancer patients of every pound of extra investment. That is why improving cancer care is and will remain a top priority for the NHS. It is also why reforms in these services are as important as the resources.

Thirdly, because of the commitment of cancer professionals to the reform of cancer services. Cancer services are already leading the way in reforming how the NHS works. The Cancer Services Collaborative is one of the most innovative means of reforming services I have ever seen. It has not only a national, but also an international reputation. By bringing together clinicians, managers and crucially patients to re-assess and redesign the way care is provided it is cutting waiting times for treatment and improving standards of care. It is all about empowering local clinicians so that they have the scope to bring about improvement for patients.

In the South East London Cancer Network the waiting time for radiology ultrasound services is down from 12 weeks to 11 days. And in the Queens Medical Centre in Nottingham the waiting time for patients with prostate cancer is down from 81 days to just 7 days.

Across the whole of the National Health Service the Collaborative has brought some 1,500 changes in around 500 individual projects. By the end of March next year we estimate that 30 per cent of diagnosed cancer patients will benefit from redesign work in breast, colorectal, lung, gynaecology and urology care. The Collaborative approach however is so successful that, in my view, it should not just benefit some cancer patients. It should benefit all. So I can confirm today that the NHS Modernisation Agency is now planning to spread this approach into the heart of mainstream service delivery for all cancers.

The Collaborative is just one example of how cancer services are leading the way in working across boundaries and devolving power to the frontline. Cancer networks have been successfully drawing together primary, secondary, tertiary and voluntary service providers and are showing just what can be achieved when staff across organisations work together to deliver frontline services.

Fourthly then, because the commitment to reform in the NHS is reflected in the Government’s commitment to put more power and resources in the hands of frontline professionals. As the Collaborative proves, the NHS works best when it harnesses the commitment of staff in order to improve care for patients. We are now at the start of a transition where more and more decisions about health care in our country are taken locally rather than nationally. Where standards are national but control is local. And it is precisely because we have put in place such a rigorous framework of national standards that the centre of gravity can now move to the NHS frontline.

The more overall performance improves – as I am confident it will as the reforms and the resources bite – the more autonomy will be earned across the whole NHS. That is what I want to see. Where we move from a 1940s NHS – top down and centralised – to a more modern system where standards are national but control is local. Where those who are doing less well get more help and those that are doing best get more freedom.

That process will now gather pace. From next April Primary Care Trusts will be in charge of three-quarters of the NHS budget, able to commission services as they see fit.

What is important about financial allocations to PCTs later this year will be not just for one year but for three. This will allow PCTs to plan with certainty increases in capacity not just for the short, but over the medium and longer term. Short term funding has hindered long term planning, not least in the provision of cancer services. Now the local health service will be able to decide which local developments will take place, when. Three year budgets will allow PCTs to decide longer term agreements not only with hospitals but with other providers too.

PCTs now have the explicit freedom to purchase care from the most appropriate provider – whether public, private, voluntary or not for profit.

That brings me to the fifth reason why I believe we should be optimistic about the future of cancer care in our country. Because of the development of new forms of partnership to improve care for cancer patients.

The principal partnership in health care is between the clinician and the patient. A modern NHS must do more to fully engage patients as partners in their health care. I am grateful to the 65,000 patients who’ve helped us do that by responding to the NHS Cancer Patient Survey. I am grateful too, for the time and commitment of people up and down the country involved in user groups and other partnership initiatives. I want to see these partnerships go from strength to strength and flourish in every part of the country.

Partnership with the voluntary sector is vital too. The role of the voluntary and charity sector in the development of health care in our country – whether in research, patient representation, health promotion or direct provision – is essential as we move into a more diverse, less centralised, more patient-centred NHS.

In cancer services that partnership is already well developed. The most visible arena for this partnership has been in palliative care where the NHS, in my view, has a great deal to learn from the voluntary sector. I am not one of those who support the “nationalisation” of the hospice movement through a wholesale takeover through government funding but we do need to address the long-standing difficulties in securing appropriate levels of NHS investment in specialist palliative care. That’s why I have asked Mike Richards – working with the National Council for Hospices, Help the Hospices, Macmillan and Marie Curie – to take forward this work in time for the 2003 planning round.

But involving the voluntary has to extend beyond to palliative care. We have to go further to mainstream voluntary sector involvement across the whole health service – especially in cancer care.

That is why I am particularly grateful to Breakthrough Breast Cancer and Macmillan Cancer Relief for their involvement with the taskforce which oversees implementation of the NHS Cancer Plan. CancerBACUP and Macmillan are key members of the National Coalition for Cancer Information.

And, of course, the major cancer research charities – serving alongside the Government and Medical Research Council – now play a central role in the National Cancer Research Institute (NCRI) which co-ordinates Britain’s research effort in the fight against cancer.

This partnership approach has to be the basis for making further progress in Britain’s fight against cancer.

That fight – as Professor Boyle has rightly indicated this morning – is now beginning to be won. Don’t get me wrong: we do have a long, long way to go but we are now putting in place all the elements necessary to achieve that victory.

We have a health service in our country that is absolutely right in its fundamentals – based on the right principles – care that is free, according to need not ability to pay.

We have a Cancer Plan in place and the long-term investment necessary to deliver it.

We have a shared commitment across the professions, amongst patients, charities and the government and a radical reform programme to get the best from all, the best for patients.

And we have some sure signs of progress with new equipment, ground-breaking research, shorter waiting times, and falling cancer death rates.

So my message today to this Conference, is that we can deliver world class cancer services in our country. We can, and now – with the right level of investment, the right programme of reform and a firm commitment to partnership – in time we will.