Supplementary memorandum submitted
by the Department of Health in response to questions from the
Committee
You asked first about the figure of £73.2
million. This is the amount of NHS R&D Support Funding estimated
to have been spent in 2000-01 on research that was relevant to
cancer.
The NHS R&D Levy is currently split into
two components: NHS R&D Support Funding (sometimes referred
to as "Budget 1"), and NHS R&D Programme Funding
(sometimes referred to as "Budget 2"). NHS R&D Support
Funding is allocated to NHS providers to enable them to meet the
NHS service support costs (eg extra blood tests, extra scans,
extra bed-days) of research funded by external non-commercial
research funders. These costs are directly associated with research
and stop when the research stops. R&D Support Funding also
supports NHS providers' "own account" research, ie pre-protocol
research and NHS provders' own research projects. Each NHS provider
in receipt of R&D Support Funding is required to produce an
annual report which sets out, among other things, the way in which
they have disbursed their R&D Support Funding to support research
in areas of activity that they have identified. We have estimated
the amount of R&D Support Funding used to support research
relevant to cancer from these annual reports. It was not, therefore,
derived as a proportion of NHS overheads.
Second, you asked about cancer projects in the
Policy Research Programme. Much of this work directly addresses
commitments made in the NHS Plan (Section 14.5) and in the NHS
Cancer Plan (Chapter 3).
The Cancer Screening Evaluation Unit (CSEU)
at the Institute of Cancer Research, Sutton, works on the evaluation
of screening, primary prevention studies and analyses of clinical
trials. The PRP programme grant has supported a range of work
on screening particularly for breast cancer and colorectal cancer.
This includes monitoring of the NHS Breast Screening Programme,
and a recently-published study which estimated how much of the
decline in breast cancer mortality in England and Wales since
1988 is due to screening. The unit is also commissioned by the
PRP to evaluate the NHS Cervical Screening Programme.
The current work progamme (until the end of
2005) includes:
— studies of the factors in radiological
and pathological practice that may enhance the performance of
the screening programme;
— observational individual-based epidemiological
studies of the efficacy of the breast screening and cervical screening
programmes; and
— the analysis of rates of interval
breast cancers nationally. Studies on the screening of high risks
groups for cancer will also be developed.
One cancer screening pilot has recently finished
(breast screening pilot on women aged 64-69), and two are in progress
(the UK colorectal cancer screening pilot and the HPV/LBC cervical
screening pilot). The PRP has commissioned independent evaluations
of all three and has also set up advisory groups to advise on
the conduct of these.
The colorectal cancer screening pilot is taking
place at one Scottish and one English site. The evaluation (led
by Professors D Weller and F Alexander from the University of
Edinburgh) will be completed in 2003. As an adjunct to this evaluation
a project has been funded on ethnicity and uptake in the pilot.
The HPV/LBC cervical screening pilot started in January 2001;
the evaluation team is multidisciplinary and is being led by Dr
Sue Moss (CSEU) (3.20, NHS Cancer Plan).
The PRP also provides joint support (with the
MRC, CRC and ICRF) for clinical trials on screening, including
the Frequency Trial, which compares yearly with three-yearly breast
screening, and the Age Trial, which looks at the effect on breast
cancer mortality of annual screening from age 40. This work may
help to increase further the effectiveness of the National Breast
Screening Programme in reducing breast cancer mortality.
The CSEU are funded by the PRP has been commissioned
to undertake a 2-year study which will use laboratory data to
investigate changes in the levels of Prostate specific antigen
(PSA) testing over time, and in different areas, and the reasons
for testing.
The PRP provides programme funding to the Childhood
Cancer Research Group (CGRG), University of Oxford. Funding has
recently been renewed until the end of 2005. The CCRG runs the
national registry of childhood tumours. It also carries out important
epidemiological research on genetic (including retinoblastoma,
neurofibromatosis, Down's syndrome) and environmental (eg radiation)
factors which may influence the incidence of cancer.
The CCRG is also involved in studying geographical
variations in incidence as well as in international comparisons
of incidence and survival, including collaboration in the ECLIS
and ACCIS studies. Much of this is long-term work which is likely
to continue, but the capacity exists for undertaking shorter projects,
should the need arise.
The PRP also funded a recently-published meta-analysis
on vitamin K and childhood leukaemia, and has also commissioned
an analysis of the UK Childhood Cancer Study Group data on vitamin
K and risk of childhood cancer which is due to report later this
year. Concerns were raised in the early 1990's that intra-muscular
vitamin K increased the risk of leukaemia.
Subsequent studies gave variable results. A
Working Group set up in 1997 concluded that overall there was
no clear evidence to support an increased risk of cancer, although
it was not possible to exclude the possibility of a small increased
risk of leukaemia (which might equally have arisen by chance).
These studies were commissioned by the PRP to provide further
information on this issue.
A number of studies commissioned by the PRP
are directly aimed at improving access to, and equality of, service
delivery. These include the production of the research evidence
component of three further cancer guidance documents—on
urological, head and neck, and haematological cancers, and the
updating of existing guidance on colorectal and breast cancer
(paragraph 6.5 of the NHS Cancer Plan). Their purpose is to help
health authorities and NHS trusts improve cancer services. The
"clinical guidance" component is being commissioned
by NICE.
An evaluation of the Cancer Services Collaborative
(paragraph 5.11 of the NHS Cancer Plan) is taking place. The Collaborative
is part of the National Booked Admissions Programme, which is
seeking to improve the delivery of care for patients with suspected
or diagnosed cancer. Also, the "Health in Partnership"
programme of studies on user involvement in health service decision-making
includes studies of best practice in relation to cancer services.
A further project on the provision of palliative care in the community
by members of the primary care health team is comparing patients'
assessment of their symptoms and needs with those of their lay
carers, GPs and district nurses.
A group of five projects has recently been comissioned
to help inform GPs' referral strategies in primary care for patients
at risk of cancer. The aim is to reduce delays in referral, to
promote equitable access and to increase early diagnosis. The
total spending on these is over £500K.
The PRP has also funded a study that looks at
the evidence base for cancer nursing in the UK, including a literature
review and a survey of current research in the NHS.
In addition, there are two cancer projects related
to IT. One is about the acceptability and usefulness of the web
as a cancer information source, and the other is about tele-medicine
assisted multi-disciplinary decision-making in breast cancer.
Finally, the PRP is funding a study on socio-economic
and socio-demographic inequalities in cancer incidence and survival
in the population of England and Wales aged over 45 years.
Public health programmes are the Small Area
Health Statistics Unit and Public Health Radiation Research.
The Non-Departmental Public Bodies involved
in cancer research are the National Radiological Protection Board
(NRPB) and the Centre for Applied Microbiology and Research (CAMR).
In reply to your final question, I can confirm
that the £0.25 million for each of the NTRAC centres, is,
of course, included in the £20 million a year additional
investment in the infrastructure for cancer research that we will
be making by 2003-04.
John Stewart
Private Secretary to Yvette Cooper
27 February 2002
