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1.20 pm
The Parliamentary Under-Secretary of State for Health (Mr. John Horam): I am pleased to have the opportunity to respond to the debate launched by the hon. Member for Bristol, South (Ms Primarolo) and I congratulate her on raising a serious subject. I know that she takes a keen interest in health service provision in Bristol, especially that affecting the United Bristol Healthcare NHS trust. The hon. Member for Bristol, East (Ms Corston) also spoke briefly. My right hon. Friend the Member for Northavon (Sir J. Cope) and my hon. Friend the Member for Woodspring (Dr. Fox) have both approached me about the matter and are extremely concerned.
In the short time available for me to respond, I should briefly put the debate into context. The demand for cancer treatment has risen over the years for several reasons. People live longer and cancer incidence increases as people age, so the number of patients with cancer is also rising. As the hon. Member for Bristol, South said,the range of options available for treating patients has also risen as chemotherapy drugs have improved. Technological developments in radiotherapy mean that treatments can be more highly targeted and much more effective.
None the less, cancer places a heavy burden on society and the national health service. The bald statistics are appalling. One in three people will develop cancer and one in four will die from it. To speak of cancer as a single disease is unhelpful because it is a range of diseases that affect different parts of the body in different ways. Cancer's multiple sites and the complexity of its treatment and care pose a major challenge for the NHS.
That the NHS has responded, and continues to respond, well to the challenge cannot be disputed. There has, of course, been substantial investment in research over the years into new forms of treatment and care for cancer. Surgical and radiotherapy techniques have improved in recent years, bringing benefits to patients and there have been dramatic improvements in the management of some of the less common cancers, such as childhood leukaemia. With some cancers, new drug treatments have brought about modest but significant cure rates--perhaps most dramatically with testicular cancer, which now has a90 to 95 per cent. cure rate. There have also been
significant advances in the palliation of symptoms, especially pain control, so improving the quality of life of people who have to live daily with the disease.
As the hon. Member for Bristol, South knows, "The Health of the Nation" strategy, which was launched in 1992, set national objectives and targets in five key areas, including cancer. After coronary heart disease, cancers are the most common cause of death in England and accounted for one in four deaths in 1991.
To further emphasise our commitment to improved cancer services, my right hon. Friend the Secretary of State for Health, on 24 May 1995, after wide consultation, unveiled a strategic framework for the development of cancer services based on the report, "A Policy Framework for Commissioning Cancer Services", to which the hon. Member for Bristol, South referred at some length. The report recommended that cancer services be organised at three levels: primary care, which is regarded as the focus of cancer care; cancer units, created in local hospitals; and cancer centres, situated in larger hospitals which will treat the less common cancers and support cancer units by providing services, including radiotherapy, not available in smaller hospitals.
I am glad to say that detailed guidance for health authorities will be issued shortly by the Department of Health on the implementation of the cancer strategic framework, building on the substantial work already in hand in the NHS. That will include recent evidence,where available, on the benefits of specialisation in cancer sites.
Simultaneously, to support work that is being taken forward regionally, the NHS executive has commissioned work to prepare evidence-based guidance in a rolling programme of work starting with the commoner cancers. That work is being done by a sub-group of the Department of Health's clinical outcomes group. The sub-group is multidisciplinary and chaired by the professor of cancer studies at Leeds university.
Palliative care is equally important in many respects. Since 1990-91, we have provided specific extra funding for specialist palliative care services. By 1994-95,that funding had increased sixfold, from £8 million to£48 million, the last year in which it was separately identified; it is now built into health authorities' allocations.
I appreciate the concern of the hon. Member for Bristol, South about the Bristol oncology centre. I am sure that all hon. Members agree that it is an acknowledged centre of excellence in oncology and cancer. Over the years, clinical audit and clinical trials have been carried out so that treatment protocols are highly defined to be the best for the patient and the most efficient available. The centre holds the renowned ISO 9002 international award.
The number of treatments carried out at the centre has increased dramatically in recent months. Since 1993-94, radiotherapy treatments have increased by almost 25 per cent. and chemotherapy treatments rose by 47 per cent.in the period to Christmas last year compared with the same period in 1994. Avon referrals to the centre averaged159 per month in the eight months to December last year.In January this year, that figure rose to 203. Inevitably,the pressure caused by increasing demand brings problems.
I am pleased to note that in March 1996, a new information resource room will open at the oncology centre. It will provide patients and their families with much-needed information about treatment, self-help groups and welfare benefits. I am sure that all hon. Members welcome that.
Resources are finite and can never be otherwise. Unfortunately, we shall never have sufficient money to do all that we would like to in a perfect way. Nevertheless, there is no question of Avon patients who require palliative care being refused treatment. Patients who are not treated at the centre receive palliative care in the community through their GPs, district nurses or atSt. Peter's hospice, with appropriate support and advice from the palliative care team at the oncology centre.I accept that that is not ideal in many cases.
I shall now reply to the points made by the hon. Member for Bristol, South. I am assured by the trust and Avon health authority that intensive discussions on funding are continuing. My hon. Friend the Minister for Health mentioned that in the remarks that she said that he had made. I have asked South and West regional health authority to monitor closely the discussions between the trust and the health authority and report back to me personally about their nature and outcome. I am sure that all hon. Members will be pleased to hear that. We will monitor them closely and hope to achieve a reasonable outcome to those continuing discussions.
Finally, in the last two minutes, I come to financing.
Mrs. Audrey Wise (Preston):
About time.
Mr. Horam:
I have mentioned it already and said that we consider the matter daily. It is being monitored closely and the outcome of the discussions will be reported to me directly. I do not see how I could say any more than that on the issue.
On funding, the hon. Member for Bristol, South did not mention that Avon Health's planned allocation for next year is £337.3 million, a cash increase of £10.6 million, a substantial increase, and an increase in real terms.
Ms Primarolo
indicated dissent.
Mr. Horam:
It is a substantial increase; £10.6 million is a substantial increase by any reckoning, on what is already a very large figure.
Moreover, contrary to the impression that the hon. Lady sought--at length--to give, according to our methods of calculation Avon is ahead of its target: it is receiving more than it is strictly entitled to receive. In such circumstances, the "market factor" is irrelevant. As for the allocation of money, any sensible Department--such as ours--will always keep the position under review. If sensible evidence suggests that we should alter it, we shall seek to do so.
Ms Primarolo:
Will the Minister give way?
Mr. Horam:
Not now. I want to make my point very forcefully.
Madam Deputy Speaker (Dame Janet Fookes):
Order. No more points can be made now; we must move to the next debate.
Ms Primarolo:
On a point of order, Madam Deputy Speaker. The Minister said that Avon had received an increase of £10.6 million. On 2 February, he wrote to me saying that--
Madam Deputy Speaker:
Order. I am sorry, but the hon. Lady is not raising a point of order; she is raising a point of debate, which cannot be dealt with as a point of order. We must now move to the next debate.
Mr. David Atkinson (Bournemouth, East):
Let me begin by declaring a non-interest. I have no interest in gambling. I have never bet or played bingo, and I am one of the 6 million people left in the country who have yet to play the national lottery. Only an occasional premium bond win keeps me going.
I do, however, declare a constituency interest. Although Bournemouth is one of our most successful tourist resorts, it needs to keep abreast of the competition and respond to the demands of visitors if it is to continue to succeed. That is also in the national interest, as it would enable the country to retain its place in the league table of countries visited by tourists. Sadly, however, it is not currently managing to do so: although the number of tourists continues to rise, our share in that hugely increasing world market is slipping as more and more countries open up to tourists at affordable prices.
Great Britain plc can no longer afford to operate restrictive practices and archaic laws in response to attitudes that are neither popular nor necessary. That applies no less to its leisure and entertainments industry than to any other. Three aspects to be found in my constituency supply the main argument in favour of deregulation: casinos, bingo clubs and public dancing.
I planned today's debate some weeks ago. I presume--as I am not a betting man, I did not even compute the odds--that it is pure chance that my striking lucky in the ballot coincided not only with the opening of Martin Scorsese's new film "Casino", but, more important, with the publication yesterday of the Department's consultation paper on casinos and bingo clubs. As that Green Paper correctly anticipated much of what I intended to say today, I have had to revise my speech somewhat.
Let me explain what led me to choose this topic. I had represented my constituency for more than 10 years before I ventured into one of its casinos--the Bournemouth casino club at the Royal Bath hotel. I note from the most recent edition of The Sunday Times that, until recently, my hon. Friend the Minister exhibited the same reticence.
Although, as I have stressed, this is not my scene, I was impressed by the quality of the establishment, the dining facilities for members, and the quiet professionalism that was evident in the conduct of the games. Today it is known as the Grosvenor; it is one of three casinos in Bournemouth. Last month, I visited the most recently established, the Stakis Regency casino, and was equally impressed--not least by the surveillance and security systems that had been introduced to detect cheating and fraud.
On both those occasions, I was appalled by the pettiness of the restrictions placed on casinos. Those restrictions clearly prevent them from realising their commercial potential. Not only are they unable to respond to the obvious change in public attitudes to such places of entertainment in recent years; they cannot make the contribution that they could otherwise make to the local economy and jobs, as well as to the Exchequer. We continue to deny ourselves that contribution as long as we turn away customers from both home and abroad by maintaining the current restrictions.
Any reasonably open-minded person would surely agree that some of those restrictions are now unnecessary. The most obvious is the 48-hour rule. Under the present law, no one can enter a casino for the first time--except as the guest of a member--without a "cooling-off" period of 48 hours. Any prospective customer must complete a membership form on the premises, and then wait two days before being admitted to game. In practical terms, that makes it impossible to play on a weekend away. It also means that the country is turning away foreign tourists and business men in droves.
Such restrictions apply in no other country where gaming is legal. They are unquestionably a drag on Britain's foreign earnings, and on employment in the casino industry. When a player has joined one casino,he cannot enter another without repeating the whole peculiar process, even if he is already eligible to play in another casino owned by the same company. Why should British casinos--while remaining clubs--not be allowed to judge for themselves whether a potential customer is acceptable for registration on completion of the required application forms, and admit that customer without delay?
There is also a ban on advertising of any kind, apart from limited information outside the casino itself. Even listings in trade and telephone directories are prohibited other than for recruitment purposes. Casinos cannot even advertise in British Airways' High Life magazine. The Stakis hotel in my constituency cannot even advertise in its brochure the fact that a casino is attached to it.
I accept that there is a case against wholesale deregulation--allowing, for instance, broadcast advertising. Surely, however, it is reasonable to publish information about casinos--perhaps in a prescribed form--in tourist magazines, classified advertisements in regional newspapers and directories such as Yellow Pages and notices at United Kingdom points of entry and in hotels. At present, many foreign visitors are unaware that casinos exist in Britain, while the short-stay business man who finds one for the first time is then confronted with the 48-hour rule.
1.30 pm
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