NHS Fife (Cancer Waiting Times)
The final item of business today is a members' business debate on motion S2M-3825, in the name of Iain Smith, on NHS Fife waiting times. The debate will be concluded without any question being put.
Motion debated,
That the Parliament welcomes progress made on the reduction in waiting times for treatment of cancer patients in Scotland but notes with concern that 40% of patients in the NHS Fife area are waiting longer than two months for treatment and believes that the Scottish Executive should meet NHS Fife to discuss ways to cut waiting times for Fife cancer patients.
First, I thank the members who signed my motion; those who have stayed to participate in the debate; the minister; and the Parliamentary Bureau for allowing me to raise this important issue in the Scottish Parliament this evening.
I should make it clear at the outset that in promoting this debate I am not implying that the Scottish Executive—or indeed NHS Fife—is failing to improve our national health service in general and the treatment of cancer in particular. Instead, I seek to highlight concerns that NHS Fife's rate of improvement appears to be lagging behind that of the rest of Scotland and that such a situation must be putting my constituents' lives at risk.
No one can deny that the earlier cancer is detected, the earlier treatment can start and the greater the chances of survival. As a result, the Liberal Democrat and Labour partnership Government has set tough targets to ensure that no one has to wait more than two months from an urgent referral by a general practitioner to the start of treatment.
In recent years, there has been substantial investment in our health services. Year-on-year cash increases in health board budgets have been well ahead of inflation. Over the past five years, the funding in Fife will have increased by almost 50 per cent to more than £450 million this year.
Throughout Scotland, there has been substantial investment in new and replacement diagnostic equipment. Moreover, specific investment has been made to implement the measures in the "Cancer in Scotland: Action for Change" document, which was published in 2001. That programme currently provides NHS Fife with an additional £640,000 per year to support extra consultants, nurses and other staff to improve cancer services and, since 2001, it has made available more than £400,000 for equipment, training and needs assessments.
In 1998, the death rate in Fife for cancer was nearly 160 per 100,000. In 2003, that figure had fallen to 140, which was in line with the target of a 75 per cent reduction in cancer death rates by 2010. However, I am concerned that recently published figures suggest that Fife is now failing to meet those targets. The latest published figures for national cancer waiting times for April 2005 to June 2005 show that, in nearly 40 per cent of all referrals across the six key target cancer groups, NHS Fife is failing to meet the crucial target of commencing treatment within 62 days of urgent GP referral. More worrying, those second quarter figures show that, instead of getting closer to complying with the two-month target by the end of 2005, NHS Fife was in a worse situation than in the first quarter in 2005, in which it had achieved 64 per cent compliance.
Direct comparisons with 2004 are not possible across the full range of the cancers that are now measured. However, I want to highlight particular concerns about breast cancer, which is the largest of the six key groups and the second-largest cancer killer of women. It is clear that, in this respect, the service in Fife has seriously declined. For example, in the second quarter of 2004, 93 per cent of women in Fife received treatment within two months and, by the final quarter, that figure had reached 100 per cent. By March 2005, the figure had fallen to 59 per cent—although by June 2005 it had improved to 77 per cent.
However, a parliamentary answer given on 13 December 2005 by the Minister for Health and Community Care, Andy Kerr, paints a worrying picture of the increase in waiting times for breast cancer treatment at Queen Margaret hospital in Dunfermline between the first and second quarters of 2005. The median wait in the first quarter was 42 days, with 90 per cent of patients seen within 57 days. By the end of the second quarter, the median wait had risen to 55 days and it took 75 days for 90 per cent of patients to be seen. The longest wait rose from 61 days to 114.
The picture is similar for many of my constituents in North East Fife who receive their treatment at Ninewells hospital in Dundee, where the median wait is 41 days, the longest is 104 days and it takes 72 days for 90 per cent of patients to be seen. In comparison, the Scottish median is 38 days. Indeed, by any comparison, my constituents and other patients in Fife are getting a raw deal.
There are similarly worrying figures for the biggest cancer killer—lung cancer. Within the two-month period, only 54 per cent of patients were treated, compared with a Scottish average of 70 per cent.
It is crystal clear from these statistics that NHS Fife is failing to meet the targets for treating cancer and is failing to match the best in Scotland. NHS Fife needs to get better at detecting and treating cancer. I make no apology for suggesting that, given that early detection and treatment are vital, lives in Fife are being put at risk by NHS Fife's failure to meet the targets.
As a result, I seek certain assurances from the minister. First, are he and the Scottish Executive taking this issue seriously? In his closing remarks, will he outline the action that he has already taken and intends to take to ensure that NHS Fife ups its game and starts to deliver on its responsibilities to improve cancer treatment and cut waiting times? In particular, will he investigate why waiting times for breast and lung cancer treatment have significantly deteriorated? Moreover, will he establish why waiting times at Queen Margaret hospital increased so significantly in the second quarter of 2005 and what action NHS Fife has taken to address that situation?
Will the minister also establish why Ninewells hospital in Dundee has longer than average waiting times for the treatment of breast cancer? Given that NHS Tayside has a significantly better record in meeting the two-month target than Fife, can I have a specific assurance from him that patients from North East Fife are not being disadvantaged in favour of patients from Tayside?
There is considerable frustration in Fife at the length of time that it is taking to implement the "Right for Fife" redesign proposals. In many ways that document, which was approved by the Scottish Executive in 2002, was ahead of its time in going down the route that is now recommended by the Kerr report. However, implementation of the proposals is interminably slow, so I would welcome any action that the minister can take to help NHS Fife to progress more quickly in implementing the proposals in "Right for Fife".
I also ask that he do what he can to ensure that the proposed new hospital and health centre for St Andrews and the east neuk can commence on site more quickly than is planned. That is vital to ensure that local diagnostics and treatment are available to my constituents and it will help to ensure that in future Fife can meet its targets for cancer treatment.
I am grateful to Iain Smith for securing this members' business debate. It is true that cancer patients in Fife wait longer for treatment than patients in almost every other part of Scotland. The figures released by the Scottish Executive show that, despite Executive promises that all cancer patients will receive treatment within two months of being diagnosed, only 61 per cent of cancer patients in Fife are treated within two months. That is the third worst treatment rate of any health board in the country. The figures indicate that only the Western Isles NHS Board and the extinct Argyll and Clyde NHS Board areas have worse treatment rates. Fife is also well behind the national average rate of 74 per cent.
Although there may be individual problems within Fife, it is clear that comparing like with like—health board with health board—Fife NHS Board is failing the patients of Fife. Patients with colorectal cancer are particularly badly served, as a mere 20 per cent receive treatment within two months of diagnosis. Only 55 per cent of lung cancer patients in Fife are treated within the Executive's target period of two months.
As Iain Smith rightly says, at Queen Margaret hospital the median wait is 57 days compared to a median wait of 31 days throughout Scotland. The increase in waiting times in the second quarter of 2005 is extremely worrying because the issue of cancer treatment is one that members of the Scottish Parliament have raised with Fife NHS Board. We sought and were given assurances that the health board was well aware of the issue and was taking steps to address it.
The people of Fife are losing out in the Executive's postcode lottery—it is difficult to define it in any other way—for cancer treatment. Early diagnosis and treatment of cancer are crucial to maximise the chances of survival, yet patients in every other part of Scotland receive treatment quicker than patients in Fife. The Labour and Liberal party Executive has manifestly failed to fulfil the promise that it made in 2001 that all cancer patients would receive treatment within two months of diagnosis. Cancer patients in Fife are paying the price for that failure to deliver. For only one in five colorectal cancer patients to receive treatment within two months for a potentially fatal illness is nothing short of a scandal. Cancer patients in Fife cannot wait any longer. There can be no more excuses. The Executive has a moral duty to ensure that all cancer patients in Fife receive treatment as quickly as patients in other parts of Scotland.
Like Iain Smith, I will be interested to hear the minister's response. Given that the figures that we are discussing are the Executive's figures, I would like to know what representations it has made to Fife NHS Board about its appalling cancer treatment rate to date, what action it has asked Fife NHS Board to take and, if Fife NHS Board has failed to react to Executive pressure, what the minister intends to do about that.
Having cancer is distressing; it is particularly distressing that people in Fife who have cancer have to wait so long for treatment. For a moment, I will hark back to the previous debate and tell the story of a young woman and a young man who lived together. He was diagnosed with cancer. Although they were not married and he was not working, because she was working and bringing an income into the house, they had to pay for all their prescriptions. As if it is not bad enough that someone has a potentially fatal illness, the Executive condemns them to the serious financial difficulty of trying to pay for their prescriptions.
I repeat that Fife NHS Board's record on cancer treatment is simply not acceptable to me or the people of Fife. I want to know from the minister what he has done about that record and what he intends to do about it in the future.
I, too, congratulate Iain Smith on securing a debate on such an important topic. He chose to highlight waiting times and targets specifically for cancer, but I wish to record my view that one of the best things that the Executive has done is to set target times for waiting and for treatment for a range of conditions. Little is more worrying or debilitating than to have, or suspect that one might have, a condition that requires a hospital appointment. Whether it be a relatively trivial matter or something more serious, the anxiety someone suffers while lying awake in the hours between two and five in the morning during the waiting period is enormous. No matter how much they try to avoid it, different scenarios play out in their mind, each worse than the last.
The setting of targets by the Executive was welcomed by all who use the national health service and by those who advocate on their behalf. However, targets must be challenging to be of any use. They should be, and are, difficult to achieve. Once they are achieved, they should be strengthened and extended wherever possible. It is unacceptable that those who can afford to pay get almost instant access and treatment while the rest must wait. My aim would be to have that same level of access and treatment for everybody.
Significant funding has been put in place to help NHS Fife and other boards to achieve their targets. Under the right for Fife investment programme, there has been substantial investment this year alone in new facilities in the Queen Margaret and Victoria hospitals. A new radiology suite, a one-stop colorectal unit and a new acute medical admissions unit are being provided. I agree that the right for Fife programme has taken far too long to implement; nevertheless, I think that we are now on track and that we are getting that investment.
I turn now specifically to cancer waiting times in Fife. It is true, as Iain Smith and Tricia Marwick said, that the waiting time figures have fallen significantly below what has been achieved in previous years, which is very worrying. Cancer patients in Fife have the same right to treatment as other cancer patients in Scotland, but they are not being given it. However, the magnetic resonance imaging facility at the Victoria hospital in Kirkcaldy is being expanded, following pressure from the community and my colleague Marilyn Livingstone. The Executive acted quickly to make available waiting times funding and specific staffing money.
If we consider how people and health boards seek to meet targets, we must factor in matters such as staff changes, retiral and other human factors. Of course, that makes the targets even more challenging. However, bearing in mind my earlier comments about stress, while the factors to which I referred must be taken into account, they are not acceptable excuses for missing the targets by the rate that they have been missed in Fife. The dip in performance, particularly for the treatment of breast, colorectal and lung cancer, is worrying to us as representatives of our constituents and, most of all, to those who are not getting the level of service and treatment that they should be getting. The figures for meeting breast cancer targets in 2004 were 100 per cent in some quarters. However, the figure in Fife for the lung cancer target dropped to an unacceptable 55 per cent, as Tricia Marwick and Iain Smith said, so it is right that we raise these concerns.
I hope that I would be wrong to suggest that either NHS Fife or the Executive were complacent or inactive in relation to their recognition of the issue and of the need to deal with it. I trust that we will hear from the minister that, rather than waiting until this evening to raise the issue with his officials and spur them into action, he has talked to NHS Fife and has agreed courses of remedial action and sought explanations. I hope that he is able to tell us that the explanations have been furnished and that an action plan has been agreed to bring matters in Fife back on track.
I also recognise that, in relation to certain cancers, there might be only a small statistical sample in Fife. If there are only two or three cases of a cancer, a delay in treatment of only one individual can mean a dip in performance of 50 per cent. However, each of those cases is a person much more than a statistic. We must be concerned with the effect on the individual. Everyone in Scotland has the right to expect a level of quality service and treatment from their national health service, wherever they live. Anything less should not be acceptable. That would be my ambition for NHS Scotland. I hope that the minister will confirm that that is also his ambition and that he will explain what is happening in Fife in order to get matters back on track.
I welcome this debate and thank Iain Smith for lodging the motion, which welcomes the progress that has been made in the reduction in waiting times for the treatment of cancer patients in Scotland. Of course, I echo that. However, Scottish waiting times for cancer treatment still lag far behind those in England and NHS boards now need to drive forward their efforts to deliver faster cancer care for patients.
I remind the chamber that, in 2001, the Executive set the goal that
"no patient should wait longer than 2 months from urgent referral to treatment for all cancer cases by the end of 2005."
Why is it then, that according to the latest figures for Scotland, only an average of 74 per cent of cancer cases reached that treatment target? How is it that 80 per cent of cancer cases were dealt with on time south of the border? Given the fact that £150 million has been invested in cancer services since 2001 throughout Scotland, it is surely disgraceful that people are still waiting and perhaps needlessly dying, especially in Fife, which has always prided itself on its high standards of health provision.
As we have heard, the picture in Fife is no longer just concerning, it is unacceptable, especially in the light of the extra funding that NHS Fife has received. As we have heard, only 20 per cent of colorectal cancer patients in the kingdom are treated two months after diagnosis, compared with a national figure of 56 per cent. Melanoma cancer sufferers fare no better, with 75 per cent of sufferers in Fife waiting more than two months, against the Scottish average of 86 per cent. As we have heard, the situation is similar in relation to breast cancer, with 76 per cent of sufferers in Fife being treated two months after diagnosis in comparison with the national average of nearly 86 per cent. Most alarmingly, in relation to those suffering from lung cancer, which is the biggest killer in Scotland, nationally 70 per cent are treated two months after diagnosis, but only 55 per cent in Fife.
Those figures are all the more disturbing in view of the fact that, earlier this month, as Christine May said, it was revealed that the MRI scanner at the Victoria hospital in Kirkcaldy sat idle for three quarters of the time when it could have been used for the early detection of tumours.
I have been trying to contact NHS Fife since yesterday afternoon to put some of those points to it so that I might fairly represent its case. I regret that my calls have not been returned.
As a Fifer who lost both parents to cancer, I am appalled that my family, friends and constituents might be disadvantaged should they require urgent treatment for cancer. Clearly, early diagnosis and treatment is absolutely crucial in maximising the chances of survival, yet patients in virtually every other part of Scotland receive treatment more quickly.
However, simply setting an arbitrary target of treatment within two months also leads to other concerns. Unlike Christine May, we believe—as do most of the physicians to whom I have spoken—that it should be up to the local health professionals to set their own targets, which should be realisable. Patients should be treated according to clinical need, not to meet arbitrary Government targets. What use are those targets if they are not achieved?
Unless I misheard him, Mr Brocklebank was complaining about the failure to meet Government targets but now he is saying that they should not exist. Could Mr Brocklebank clarify his position?
The Executive set the targets, but none of them has been achieved in Fife. In addition, we are not even sure that the Executive is setting the right targets; it should be up to local health professionals to decide the clinical necessity of cases.
NHS Fife argues that the kingdom is on target to achieve a 20 per cent reduction in cancer-related deaths by 2010. However, what we require is evidence that the management of health resources in relation to cancer is being tackled now—not promises for four years hence. Iain Smith specifically criticises NHS Fife, but he is part of an Executive that has contributed to the problem by refusing to embrace all the health care options that are available, such as the independent sector. That means that the best possible use has not been made of the available resources. Staff shortages and a lack of well-designed services are key problems, and bureaucracy is strangling the NHS. It is little wonder that we have a depressed NHS workforce, with people leaving the health profession at worrying rates.
I am just concluding.
I commend Iain Smith's motion and urge the minister to meet NHS Fife as a matter of urgency to see what can be done to alleviate the present serious situation. I look forward to hearing the reassurances that the minister can offer to those whose lives have been blighted by the scourge of cancer in the kingdom of Fife.
I congratulate Iain Smith on securing the debate, which is on an issue of pressing importance for many. As Christine May said, cancer patients can face a period of anguish and anxiety before treatment has begun. It is therefore right that the Government sets targets to limit that period as far as it can. We have set challenging targets, including a target of two months from urgent referral by a general practitioner to first treatment. As has been pointed out, in the quarter to June last year, four out of 10 cancer patients in Fife were not treated within that target period. The challenge for NHS Fife is to ensure that it can meet its targets in the future. Fife NHS Board can and, no doubt, will speak for itself, but it may be helpful to members if I indicate the current position.
Progress has been made. Over the next few months, we expect to see continuing improvements in Fife and throughout Scotland. In Fife, as elsewhere, the Scottish Executive and its officials will continue to work closely with Fife NHS Board to support it in meeting its targets. That is a continuous and a continuing process. Members will be interested to know that, in response to the figures that have been debated this evening, my officials contacted the chief executive of NHS Fife on 6 January to discuss our concerns about the board's performance. My officials sought assurances that action was under way to rectify problems and they agreed to discuss problems with senior clinicians and managers. That was done by conference call on 16 January and it will be done again, in person, on 7 February. In all their engagements in supporting NHS Fife to meet the targets that we have set it, officials act for and on behalf of Scottish—Labour and Liberal Democrat—ministers in the coalition.
These are not party-political matters, so I am slightly disappointed by some of the tone and comment of a party-political nature in a members' debate on an area of common concern.
I want to lay out the position as I understand it from our discussions with NHS Fife. Christine May referred to the fact that, not so long ago, breast cancer waiting times were 100 per cent on target in Fife. That figure slipped significantly to less than 60 per cent in the second quarter of last year. The cause of that disappointing result is largely a gap in surgical capacity following a retirement and the time taken to recruit a replacement. An increase in the number of referrals has put extra pressure on mammography time. Additional staff and extended working hours are now in place and a new referrals system is being introduced to speed up the issuing of appointments.
Elsewhere, there is a five-week waiting time for endoscopy, which is impacting on the two-month target for first treatment of colorectal cancer patients. NHS Fife therefore is considering the provision of additional endoscopy sessions for the short term and, in the long term, will review its management of surgical and medical capacity to see whether the two can be brought together to maximise the available capacity. On lung cancer, arrangements will be approved to shorten patient pathways and work is under way to make that happen.
The targets that have been set are challenging for boards, doctors, nurses, support staff and everyone in the multidisciplinary teams who work together to deliver the best possible care for patients with cancer. It is important to recognise that each of the different tumour types needs different investigations and treatments and that every patient needs the assessment and treatment that are best suited to them. We are always concerned when problems arise but, in this case, we are pleased that NHS Fife has taken rapid action to restore services to their previous high level.
The figures with which we are dealing are for the period up to June 2005, but they were not published until December 2005, which is a five-month gap. As part of the action that is being taken, will we consider ensuring that statistics become available earlier so that problems are identified and action is taken more quickly?
I accept that there can be a lag in the production of the statistics. I will come to Iain Smith's point in a moment, but it is important that members should not overstate the extent to which the waiting time figures here are behind those in England. People can be misled by the lag in publication of the statistics. For April to June 2005, Scotland was 74 per cent on target, compared with 77 per cent for England, not the 88 per cent that was mentioned, which was for the third quarter. The optimum targets that we have set are for the end of 2005, but the figures for that period are not yet available. I understand Iain Smith's point. We are of course keen to be as well informed as possible, but it is appropriate that boards take time to get the matter right and to ensure that they provide accurate figures. We will track and work with NHS Fife in its process of improving the figures. We look forward to receiving further information from the board in that regard.
We have made significant investments in Fife and throughout Scotland. It is worth recording that many patients are treated within the two-month target, consistent with their clinical and personal needs. As has been noted, in dealing with breast, colorectal and lung cancer, Fife was better than Scotland as a whole. I am confident that, with the measures that NHS Fife is taking, it can be again. For the period to June last year, there was a 74 per cent success rate throughout Scotland in relation to waiting time targets. We expect NHS Fife and other boards to drive continuous improvement.
In response to Iain Smith's query about patients from North East Fife who are treated by NHS Tayside, I reassure him that there is no disadvantage for patients from Fife. However, as part of the process of examining how to address the situation in Fife, on 7 February my officials will meet NHS Tayside as well as NHS Fife, recognising the significance of that wider resource. We also recognise the role that the national waiting times centre in Clydebank and the Golden Jubilee national hospital can play in supporting boards throughout the country.
All of us are touched by cancer at some time in our lives, if not personally then through our family and friends. We all agree that it is unacceptable for patients to wait any longer than is absolutely necessary for diagnosis and treatment of cancer. We look forward to sustainable reductions in waiting times in Fife and throughout Scotland. I give all members who have sought it the assurance that we will keep on the case and continue to work with NHS Fife to ensure that the situation that arose in the second quarter of last year is rectified as quickly and efficiently as possible.
Meeting closed at 17:34.