The NHS Cancer Plan (HC 499-i) Public Accounts Committee 23 Mar 2005

Evidence given by Sir Nigel Crisp KCB, Chief Executive and Professor Mike Richards, National Cancer Director, Department of Health

Q39 Mr. Gerry Steinberg (City of Durham): I have got to say, Sir Nigel, that this report was a huge disappointment to me. It is probably my last Committee of Public Accounts and I was fully hoping that I could really put you under pressure for the last meeting as something to remember me by, but I have to say that this is probably the best report that I have read in the last five or six years that I have been a member of this committee, so I am not going to be able to do that. The more I read the report the more I looked to see what I could have a go at and there was very little. This committee is never very political but I have to say I was rather proud when I read this report of the achievements that we have made over the last seven or eight years. I think anybody who denies the fact that this is being well and truly handled now is very churlish. Everybody on this committee knows that where criticism is due I am quite happy to give that criticism, so it is good job we are not talking about the CSA or helicopters or something like that this afternoon when I could have gone out on a really good note. The report is a first-class report. Can I just follow on from what Jim said? He questioned you on the allocation of resources to the PCTs and the cancer networks. I was not certain whether that money went via the PCTs or straight to the networks. Clearly it goes straight to the PCTs and not to the networks. Is this money on top of money that the PCTs would have got anyway for dealing with cancer, or anything else for that matter?

Sir Nigel Crisp: Can I make two responses to that? First, I very much appreciate your comments about this report. It is very significant that we have had Professor Richards dealing with this for the last few years and this is due to an enormous amount of work by a number of people, including several behind me, from around the NHS. A great deal of effort has gone into this, as indeed you know. On the PCTs, this is the money that goes out to PCTs. As again I am sure you know, we want to make sure that we have got as much as we can of the money that is voted to the NHS going to the local community so they make the decisions.

Q40 Mr. Gerry Steinberg (City of Durham): Is this money ring-fenced for cancer?

Sir Nigel Crisp: No. A very small amount is ring-fenced.

Q41 Mr. Gerry Steinberg (City of Durham): That is disappointing.

Sir Nigel Crisp: We are working on the outcomes, not on the inputs. We measure them on things, as the Chairman asked me, such as waiting times.

Q42 Mr. Gerry Steinberg (City of Durham): In the report there are the usual remarks that they do not get enough resources and you always expect to get remarks like that from the National Health Service. Could it be argued, if that is the case, that some PCTs, if it is not ring-fenced, are not passing it down the line and it could be spent on something else?

Sir Nigel Crisp: Over the period of this plan we changed policy slightly. We started off at the beginning of the NHS plan allocating direct sums and ring-fencing them so we did ring-fence some additional money for cancer. In the next spending round we decided it was better to give as much money as possible to the local community so that they made the decisions but we nevertheless have indicative amounts of money -----

Q43 Mr. Gerry Steinberg (City of Durham): Would you name and list those PCTs who are receiving the extra money for cancer networks and are not using that money where it was intended to be spent?

Sir Nigel Crisp: As Professor Richards said a moment ago, he is going to be producing a report on how the extra money has been spent, because it is £570 million on top -----

Q44 Mr. Gerry Steinberg (City of Durham): That is not quite what I am asking though, is it?

Sir Nigel Crisp: ----- and that will undoubtedly identify the areas.

Q45 Mr. Gerry Steinberg (City of Durham): When will that be published?

Sir Nigel Crisp: Not at PCT level. It will identify it at cancer network level, which covers a number of PCTs.

Q46 Mr. Gerry Steinberg (City of Durham): But if the cancer networks are not getting the money from the PCTs how can you then blame the cancer networks?

Sir Nigel Crisp: I am not sure we are blaming anyone on this particular thing.

Q47 Mr. Gerry Steinberg (City of Durham): What I want to know is which PCTs are not handing down the money that they are supposed to hand down? Could we have a list of those PCTs?

Sir Nigel Crisp: I do not think we break down PCT expenditure by cancer. We break it down at the larger level, i.e., at the cancer network level.

Q48 Mr. Gerry Steinberg (City of Durham): In terms of spending the money, and again Jim touched on this, you could get a load of money and you could spend it, as you think, very wisely but at the end of the day you might not be doing that because, for example, you could have X amount of new scanners and not have the staff to use those scanners. Have you got any evidence to show that they know how they are spending the money and if they are spending it wisely?

Sir Nigel Crisp: Part of Professor Richards' role as the National Cancer Director is supervising the activity that is going on across the entire country. The plan is trying to knit together all the features you need to get a really good cancer service. He does have a supervisory role and an oversight of all of that, but perhaps he could give you the level of detail he will be able to produce.

Professor Richards: We are collecting that information at the level of the cancer networks and the networks largely map onto strategic health authorities, not exactly but largely. What we also do is collect information on the number of scanners that are in each strategic health authority so that we can convert that into the number of scanners per million population, the number of radiotherapy machines per million population. We also look at the workforce and so we are in a position to say which parts of the country have relatively more or relatively less, and over the last few years our plan has very deliberately been to even things up. Where we have seen, for example, that there are not as many CT scanners from the money that was allocated to CT scanners in the Cancer Plan, we have targeted those deliberately at the areas that had the least.

Mr. Gerry Steinberg (City of Durham): I do not want to sound like the Prime Minister at Prime Minister's Question Time and in the thrust of politics one never knows whether the statistics are correct. My view has always been to look at the NAO and see what statistics they have given and they are usually correct. If you look at page 17, figure 8, 975 extra consultants in post by 2004, a 36% increase in training places, £1.3 million invested in three training centres, £400 million invested in new facilities, 668 MRI scanners. You can go on and on. This has got to be an excellent record.

Jim Sheridan: Vote Labour.

Chairman: That is enough of that.

Q49 Mr. Gerry Steinberg (City of Durham): This report makes excellent reading. Coming on to the points Mr Field made, I come from the north east of England where we have probably got similar records in terms of deprivation to Merseyside. What I was disappointed about in this report was that there was no indication at all of any priority being given to our areas in specific terms. They were mentioned as disadvantaged areas but there seems to be no priority plan. I am not asking that we should get more resources but there should certainly be a plan set down. What disappointed me as much as that was that in the NAO report itself - and it is not often I criticise the NAO - when I looked at Appendix 2, for example, and where they have gone to do their research, it was Birmingham, Manchester, Humber, London, Peninsula (wherever that is), Surrey, Sussex and West Hampshire, South West London and West Anglia. There is not a mention of the north east of England. I would have thought that would be one of the prime areas you would have gone to.

Dr Robertson: The way we selected these cancer networks to visit was in consultation with the department.

Q50 Mr. Gerry Steinberg (City of Durham): So they did not want you to go there?

Dr Robertson: No: we were taking a view as to those which were regarded as being particularly affected, those that you might regard as in the middle and those that might be viewed as less effective. Our primary requirement was to get a range of networks in terms of their performance and that is what we did.

Q51 Mr. Gerry Steinberg (City of Durham): It is a shame that you did not go to the north east. When you are talking about cancer, everybody knows from that last report that we did a few months ago that it clearly said disadvantaged areas were the ones that had the worst cancer records and then we come to this report and there is no real plan to specify and prioritise the areas that are the worst sufferers. That I find disappointing.

Professor Richards: With regard to the two networks that cover the north east, one is the Northern Cancer Network, which is based on Newcastle but covers a large swathe of the north of the country, and the other is the one for County Durham and Tees Valley, the Cancer Care Alliance there. They are both very effective networks and they are particularly putting effort into things like smoking cessation because they recognise that that is such a problem in the north east.

Q52 Mr. Gerry Steinberg (City of Durham): What about the report that came out from somebody at Newcastle University which said that you were failing miserably on your targets to stop people smoking and you could not achieve your targets?

Professor Richards: If I can be bold, I think it was an entirely mischievous report and it absolutely failed to recognise what is going on in tobacco control in this country. It was saying we will not achieve targets by smoking cessation alone. We have never said we would. We have always said that was one part of a six-strand tobacco policy, and I mentioned the other parts earlier, and also as I said earlier, we are rated second out of 28 countries for our tobacco control strategy, so I think we are doing a lot. They are effective but they are only one part of the solution. There is work being done on taxation and on media campaigns. I am sure you are all aware of the media campaigns. You will have seen the advertisements that show a cigarette with fat in the middle of it looking like a coronary artery. You will have seen the ones about second-hand smoking of children blowing out smoke sitting at the bottom of stairs. Those have been seen by vast numbers of the public and they have been very effective campaigns.

Q53 Mr. Gerry Steinberg (City of Durham): If you look at page 16, figure 8, it says under "Improving treatment", "NICE appraisals of cancer drugs to end the postcode lottery". Can you give us a list of the postcode lottery? I would be very interested to know which PCTs distribute the drugs and allow their practices to do so and those who do not.

Professor Richards: Again, what we can give you is information at the cancer network level, because in June of last year I wrote a report for the secretary of state, on the variations in use of drugs. We looked at all 16 drugs that had been appraised by NICE. We reported on the variations. I made recommendations on what should be done to reduce the variations and I am pleased to say that ministers accepted my recommendations and those are now in action. We can send you a copy of that report. It is probably in the House of Commons library anyway but we will send you another copy.

This is an uncorrected transcript of evidence taken in public and reported to the House. The transcript has been placed on the internet on the authority of the Committee. Neither witnesses nor Members have had the opportunity to correct the record. The transcript is not yet an approved formal record of these proceedings.