Published: 03/02/2005, Volume II4, No. 5941 Page 10
One Wednesday afternoon last June there was a sharp exchange at a Commons committee between Labour MP Jon Trickett and two grandees of the NHS, cancer czar Professor Mike Richards and the two-hatted Sir Nigel Crisp, NHS permanent secretarycum-chief executive.
The MP was cross over what he regarded as complacency and obfuscation in the National Audit Office's 2004 report on cancer mortality rates in England. The NAO is the 800-strong team that serves the comptroller and auditor general, Sir John Bourn, whose efforts are in turn monitored by the oldest of Commons panels, the public accounts committee.
As such it is a uniquely powerful watchdog on government waste, just as Mr Gladstone intended.
Mr Trickett, former leader of Leeds Council and MP for Hemsworth since 1996, is a member of the PAC, whose collective reflections on the state of cancer treatment you may have read in last week's newspapers.
Like Mr Trickett the headlines focused on the North-South postcode lottery and social class.
The overall picture is encouraging: the death rate for cancer per 100,000 people has fallen by one eighth in 30 years. But smoking is still lethal (it helps explain the North-South divide) and there are 200,000 new cases a year, including 128,000 deaths. The cancer incidence rate is up by one third since 1971.
But what MPs talk about, especially in an election year, is avoidable death. Particularly among their constituents. The PAC demanded simple guidelines to help people (including GPs) spot symptoms since much of the trouble is caused by patients presenting too late, compounded by assorted delays further down the line.
You know them all: bad prioritisation, wildly varying disparities in diagnostic speed and staffing levels, availability of the costly Herceptin drug for breast cancer, worsening radiotherapy waiting times, and the differing skills of a surgeon who does five prostate jobs a year from one who does 50.
If your voters are poor people in ex-mining communities, as the Hemsworth area is, an MP can easily get angry at the evidence when the NAO report states that their constituents' chances could be almost doubled by moving to Hertfordshire.
Health secretary John Reid was quick to cite the 1,182 extra cancer specialists and the 1,000 new bits of kit - 'we are making good progress.' His Tory shadow, Andrew Lansley, said he ought to be ashamed that British five-year survival rates are still so much poorer than Europe's.
(Older readers will remember that the Black Report on health inequalities, commissioned by the 1974-79 Labour government, was quietly strangled in 1981, by the Conservatives. ) But that was then and no government is blameless. Two things struck me about the PAC report: one is that it sidesteps personal responsibility, now so high on the Reid agenda. As czar Mike said, We have known smoking kills for 40 years. That accounts for one third of cases. Bad diet and no exercise causes another third.
Second, as John Cruddas, Labour MP for south-but-not-so-rich Dagenham, confirmed in the hearing, the stats contain serious evidence that men are much more at risk than women. But, in health and in education, gender biases that hurt men are out of fashion.
Mr Trickett's case is gender-free.
He has his own mother's recent cancer death on his mind (wonderful treatment), but also five badly handled constituency cancer cases. He does not talk about private PAC business, but it is clear that he campaigns against class-based inequalities.
Despite the NAO and PAC reports all being drafted by NAO staff (that troubles him) I am sure his 'enraged' interventions have toughened them up. When he asked why key EU/US cancer figures were not included, he was told by Professor Richards that they are not available.
The MP says many are in the Wanless report and that he found others very easily on the internet. As someone whose coal-board-dominated villages have barely entered the capitalist world yet (so he says) he is also hostile to Mr Reid's NHS choice agenda - on which the minister has made TWO speeches in a week. I promised to e-mail Mr Trickett a copy.
Michael White is political editor of The Guardian.