House of Lords debate on dermatology (July 2015)

Health: Skin Cancer (22nd July 2015)


11.23 am

Asked by Lord Clark of Windermere

To ask Her Majesty’s Government what has been the increase in diagnosed skin cancer over the past 10 years.

The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con): My Lords, over the past 10 years in England, there has been a 61% increase in new cases of melanoma, the most serious form of skin cancer, and an increase of 41% in non-melanoma skin cancers. In 2012 there were 11,281 new cases of melanoma and 79,743 new cases of non-melanoma skin cancer.

Lord Clark of Windermere (Lab): My Lords, I thank the Minister for that Answer, which shows an alarming increase in skin cancer. I understand that NICE is in the process of issuing new guidelines in this respect, due out this month. Will the Minister advise the House whether these guidelines are mandatory because they are so central to the Government’s campaign in fighting skin cancer, or are they merely “guidelines” and need not be followed? Secondly, is the Minister aware that there is concern among consultant dermatologists in hospitals that the clinical commissioning process may not be sufficiently robust to deal with this increased spate of skin cancers?

Lord Prior of Brampton: The NICE guidelines are due to come out at the end of July or in August. I believe that they are guidelines, not mandatory, although they should be read in the context of the report by Harpul Kumar, Achieving World-Class Cancer Outcomes. Cancer is a very high priority for this Government, and this may come out in further questions. In commissioning these services, we have to be very careful that we do not disaggregate dermatology services in hospitals; the provision of routine and complex emergency dermatology services and, of course, the training of dermatologists should be commissioned as a whole.

Baroness Walmsley (LD): My Lords, is the Minister aware that consultant dermatologists often see patients who have been told by their GP that their mole was benign and did not require a biopsy? In the UK, the mortality rate is 20% compared with 12% in Australia for a similar number of cases. Given that outcomes are so closely linked to the thickness of the lesion and early diagnosis, what are the Government doing to make sure that GPs are trained to recognise the benign skin lesions and to refer the more dubious ones to consultants? I am aware that we ask a great deal of GPs, but what matters is training them to recognise these things and not wasting money and compromising patients by not referring them early enough.

Lord Prior of Brampton: Health Education England is aware that insufficient time is spent on dermatology issues in the training of junior doctors, and it is considering that very seriously.

Baroness Gardner of Parkes (Con): My Lords, as someone who had skin cancer 40 years ago, I have a check-up every year. The services are excellent but the most important thing in the context of this Question is that we are now getting the early diagnosis. Does the Minister agree that the most important thing is to raise public awareness, as has been done in Australia, where malignant melanoma, it is believed, can pretty well be eliminated? The important thing is to raise public awareness so that the public go to their doctors and demand to be referred. That is how we will continue to catch more cases at a stage when they can be treated.

Lord Prior of Brampton: I agree with my noble friend. What is needed is a combination of public awareness and early diagnosis.

Baroness Masham of Ilton (CB): My Lords, are there enough dermatologists in England?

Lord Prior of Brampton: The noble Baroness makes a very interesting point. It is recognised that there are not enough trained dermatologists in England—I think the figure I have seen is 177. To put it in context, there are 650 consultant dermatologists in England, so the answer is that there are not enough. The growth in the problem, if I can put it that way, seems to be running at about 3.5% a year. We are behind on this and need to catch up.

Baroness Wall of New Barnet (Lab): My Lords, will the noble Lord share with us the discussion going on in the Department of Health about the many young people being treated for skin cancer because of the sunbed culture that has come about? Regrettably, we have noticed in my hospital in Milton Keynes that that is becoming an increasing problem. We did a grand job in making people aware of the dangers of smoking, and we still are, but nobody seems to be explaining just how dangerous some of these things are.

Lord Prior of Brampton: The noble Baroness is right but a law was passed in 2010, I think, banning the use of sunbeds on commercial premises by children under the age of 18. That law has had an impact but, in a sense, one can never do too much to raise public awareness, and we should do more.

Baroness Sharples (Con): I have very recently had two areas of skin cancer. If you have any suspicions, is it not absolutely vital to see your doctor?

Lord Prior of Brampton: My noble friend makes a very sound point. Harpal Kumar’s task force produced a report entitledAchieving World-Class CancerOutcomes. If anyone wants a little bit of holiday reading, it is well worth reading at least the three-page letter at the front of the report. He recommends in the report that if a GP has a 3% or greater suspicion of cancer, the person in question should be referred for further investigations.

Lord Bradley (Lab): My Lords, there is a clinical trial known as Matilda at the world-renowned Christie Hospital in Manchester, funded by the Medical Research Council and the National Institute for Health Research. This aims to treat patients with melanoma using their own white cells, which can recognise and destroy cancer cells. It was approved in 2014 but then halted because excess treatment costs, which should be funded by the NHS, were not forthcoming. I understand that the Secretary of State for Health has said that this issue will be sorted by early 2015. Can the Minister advise the House when this crucial clinical trial for the treatment of skin cancer will be progressed?

Lord Prior of Brampton: I am not aware of the trial at the Christie called Matilda; I will take this issue away and write to the noble Lord.