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Cancer Treatment

My Lords, I am sure that we can depart for the summer Recess on a note of optimism. We are all grateful to my noble friend Lord Campbell-Savours for raising this important issue and for his excellent exposition on the benefits of PET scanning and the issues involved. We all have huge sympathy for my noble friend over the loss of his son. It demonstrates that cancer touches many people in our society; that is why as a Government we have made preventing cancer and improving the care of people diagnosed with that disease such a priority. It is why we have put in place a major 10-year programme of work, the NHS Cancer Plan, supported by record levels of investment. A key element of that investment is the unprecedented expansion of modernisation of cancer diagnostic and treatment equipment that we have seen in the NHS over the past five years, which the noble Earl, Lord Howe, graciously acknowledged. Since April 2000, 115 new MRI scanners, 209 CT scanners, 109 linear accelerators and over 730 items of breast-screening equipment have been delivered to hospitals in the NHS through central funding. A further 23 CT scanners, 48 MRI scanners and 58 linear accelerators are due to be installed by the end of December 2006. That is a major investment, which means that 64 per cent of MRI scanners, 73 per cent of CT scanners and 67 per cent of linear accelerators now in use in the NHS are new since January 2000. Cancer survival rates have been increasing under this Government and waiting times are coming down. I say to the noble Earl, Lord Howe, that we are planning in detail the work on delivering our manifesto commitment to removing hidden waits for GP referrals for treatment to 18 weeks. However, I have to say to the noble Baroness, Lady   Tonge, that hidden waits cannot be delivered in such a timescale without some diagnostic assistance from the independent sector. The arithmetic is incontrovertible: it cannot be done simply by doing it through the NHS. We need that level of assistance from the independent sector to stop the hidden waits and to give diagnosis and treatment to NHS patients faster. That is an inevitable consequence of trying to get rid of hidden waits and bring down waiting times rapidly for our citizens. The equipment that we put in place is having a real impact on the care of patients. The NHS can now provide an extra 240,000 more CT scans and 175,000 more MRI scans each year as well as offering patients the latest in radiotherapy treatment and techniques. This is the context in which I wish to say a little more about PET CT scanners and respond to the points of my noble friend and other noble Lords. My noble friend described extremely well some of the clinical benefits of using PET scanning, such as determining the extent of the spread of cancer which helps in assessing the suitability of patients for radical surgery; seeing how well a patient has responded to treatment; and detecting any recurrence of cancer under treatment. As noble Lords have indicated, PET scanning can do a great deal to help prevent unnecessary surgery. Although PET scanning has been used in clinical practice for some time, it is only more recently that robust evidence has begun to emerge about its benefits in terms of improved outcomes for patients. We now have this evidence, as well as reports from other countries’ early experiences of using this technology. We know there is particularly strong evidence for the use of PET CT scanning for lung cancer, bowel cancer and lymphoma. There is also growing evidence for the use of PET CT for other cancers such as head and neck, oesophageal, brain tumours and a range of less common cancers. Let me reassure my noble friend that we will not hesitate to modify guidance as new evidence emerges of the benefits of PET CT scanning. As part of our commitment to establish an evidence base to support further investment in this technology, we are establishing processes which would enable us to monitor emerging evidence of new applications for PET CT scanning. As my noble friend has indicated, we know that PET facilities are expensive to build and run. The capital cost of a PET CT scanner, including building costs, is in the region of £2 million to £2.5 million. The costs of building a cyclotron, the machine needed to produce the radio-pharmaceuticals required for PET CT scanning, is another £3 million to £3.5 million. In addition, the annual costs for each scanner are likely to be in the region of a further £2 million. As other noble Lords have said, this is not just a matter of money. It is about the human resources required to make this very complicated equipment work. We need a wide range of qualified and well trained staff—technicians, radiographers, scientists and others—to get the benefits of these capital investments. These resources are not easy to turn on overnight; there needs to be training and help to maintain the up-to-date nature of some of these areas. It is not like popping down to Tesco and collecting a few more. So there is a big job to do in workforce planning terms. There are currently six PET CT scanners and one PET scanner routinely available for clinical work in the NHS. These provide more than 6,500 scans per year—that is about 60 per cent of total scans. In addition, around 4,000 scans—40 per cent—are either referred individually to privately run centres or are provided by independent sector mobile scanners under contracts negotiated locally by the NHS. These mobile units currently visit 11 sites around the country. So as of today, without doing anything more, we have NHS patients receiving about 40 per cent of their scans from the independent sector. If we told the independent sector not to provide these services, the only people we would be damaging would be NHS patients. I acknowledge that the location of PET equipment is currently biased towards London and the south east, as my noble friend rightly indicated. However, this is changing. A PET CT scanner at Queen Elizabeth Hospital in Birmingham, as the noble Earl, Lord Howe, mentioned, started scanning patients earlier this month. This facility is a partnership scheme between the NHS and the independent sector. It hopes to scan around 4,000 patients a year when fully operational. There are also similar advanced NHS and independent sector plans to bring PET CT scanners online at Nottingham City Hospital and the Lancashire Teaching Hospital in Preston within the coming year, with other schemes still in development. I am very grateful to my noble friend for raising these important issues; it gives me the opportunity to explain the work that is going on. I should like to pick up on a point made about the number of scanners in other countries. We are now in a position to learn from other countries’ knowledge and experience of using PET scanners. This is helping us to gauge demand for PET scanners, as well as enabling us to select the best service model to meet that need. It also helps us to learn from mistakes made elsewhere. My noble friend mentioned Germany. We know that a number of PET scanners in Germany in the past couple of years have been lying idle because of the lack of funding and resources to operate them. We do not want to put ourselves in the same position. I can reassure my noble friend and other noble Lords that we intend to issue a national framework for the development of PET scanning services in England. The framework has been drawn up following requests from strategic health authorities, NHS commissioners, clinicians and the research community to look at how the NHS can fund the high cost of PET scanning as well as ending the current geographical inequities of provision. The framework will aim to provide guidance to specialist commissioners and potential service providers on the development of PET services and to ensure that there is equitable access to scans for patients across the country. The framework has been drawn up using a number of different national and international strands of evidence and expert advice, such as the Intercollegiate Standing Committee on Nuclear Medicine, expert groups established by NICE, both of which my noble friend Lord   Campbell-Savours mentioned and the Centers for Medicare & Medicaid Services in the USA. The framework also reflects the many comments received from major stakeholders when a draft of the document was sent for consultation last year, to which my noble friend rightly drew attention. I reassure my noble friend Lady Golding that we have gone to a great deal of effort to do this on a partnership and fully consultative basis, so that in this complicated area we take full account of all the professional expertise available. The National Cancer Research Institute, which includes the major research organisations in the NHS, has established a working group to co-ordinate future research in response to a recommendation in the draft framework. The aim of this group is to ensure that future research into PET CT scanning for cancer is co-ordinated through a UK-wide research strategy. That will ensure that research funding is targeted to have the greatest scientific impact on health policy and service delivery. We intend to issue the framework shortly to coincide with the publication of a report from a working group of major stakeholders on the use of PET CT in the UK. The working group includes the Royal College of Radiologists, the Royal College of Physicians, the Intercollegiate Standing Committee on Nuclear Medicine, the British Nuclear Medicine Society and the Institute of Physics and Engineering in Medicine. My noble friend Lady Golding is right to remind us of the safety issues and the importance of radiologists. As she acknowledged, we are working hard to increase the number of radiographers, with some success, and I am very glad that efforts have been made to lure her back into practice. I echo her recognition of the contribution that radiographers make to the NHS. The Royal College of Radiologists-led working party report has addressed many of the workforce and training issues on this and includes health and safety of all the staff involved. That report will be published early in September. On other staffing issues, we have something like 13   per cent—about 1,600 more NHS radiographers—than in 1997. The number of students entering training to become radiographers has more than doubled since 1996–97. The NHS staff vacancy rates in this area are also dropping. They certainly were between 2003 and 2004; I do not have any information later than that. So the position on radiographers is improving, but I acknowledge that it is an area we need to continue working away at very hard. The report that I have mentioned will provide a strategy for the development and the integration of this leading-edge technology within routine clinical practice. It will recommend a model of service provision and provide guidance on the staffing of facilities, as well as standards and protocols for the delivery of the service.