Cancer Workforce and Early Diagnosis

George Howarth Excerpts

Tuesday 8th January 2019 Westminster Hall

[Several hon. Members rose—]

[Mr George Howarth (in the Chair)]

Order. This is an important subject and many Members have signified that they wish to speak in the debate. I will not impose a time limit straight away. I will see how it goes. If hon. Members co-operate, I am sure that everybody will be able to speak.

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[Several hon. Members rose—]

[Mr George Howarth (in the Chair)]

I call Grahame Morris.

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[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Howarth. In case anyone wonders why I am shivering a bit, I have to say it is a bit cold in here.

[Mr George Howarth (in the Chair)]

But it is a very warm atmosphere.

[Mrs Hodgson]

Oh, good—we do try.

I start by congratulating my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick) on securing this important and timely debate and on his excellent speech. I wonder whether he has a crystal ball and knew something that we did not; I am sure if he does, it will be much in demand, because we have an important vote next week and somebody might want to have a borrow. I thank all the other hon. Members who have spoken this morning—the hon. Members for Westmorland and Lonsdale (Tim Farron), for Eastbourne (Stephen Lloyd), for Strangford (Jim Shannon) and for Central Ayrshire (Dr Whitford), and my hon. Friends the Members for Easington (Grahame Morris), for Bristol West (Thangam Debbonaire), for Scunthorpe (Nic Dakin) and for Enfield, Southgate (Bambos Charalambous)—for their excellent contributions to the debate.

As we know, the long-term plan was launched yesterday. We had waited several months for it to be published, but I am pleased that, after a few setbacks and delays, we now have it and are able to move forward. I was also pleased to see that cancer is a key priority in the plan; I am sure the Minister played a large part in that. Cancer is important, but it is an emotive issue. One in two of us will face a cancer diagnosis in our lifetime, which is a sobering thought, and many of us in this Chamber will know someone who has been affected by cancer. Some of us, I know, have been affected by cancer individually, and no doubt some of us will have lost someone to cancer.

What led me initially to join the all-party parliamentary group on breast cancer as a new MP was losing my mother-in-law to breast cancer over 20 years ago. I notice that in this debate there is a gathering of former co-chairs of the all-party parliamentary group on breast cancer, as well as the current co-chairs of that group and the current chair of the all-party parliamentary group on cancer. Once this subject takes hold and catches our interest, it stays with us for the whole of our parliamentary career—as it should, because it is so important.

It is estimated that by 2035, one person every minute will be diagnosed with cancer. That is why cancer diagnosis, treatment and care and their workforces should play an important role in our NHS now and in the future. The Prime Minister set out in her conference speech last September the Government’s ambition to see three in four cancer patients diagnosed at an early stage within the next decade. Currently, just more than half of the people diagnosed with cancer are diagnosed early in England, so the Government have a long way to go to achieve that welcome ambition.

Early diagnosis improves the likelihood of survival, as we all know. For example, if bowel cancer is diagnosed at an early stage, nine in 10 people will survive, but if it is diagnosed late, at stage 4, only one in 10 will survive. Early diagnosis also increases the likelihood of responding well to treatment. Target Ovarian Cancer, which I am proud to say I am the chair of the all-party parliamentary group for, found that as many as one in every five women in England are too ill to treat by the time they receive their ovarian cancer diagnosis. Awareness and screening programmes are crucial to early diagnosis, but breast screening uptake, for example, is the lowest it has been in 10 years, with stark variations across the country. The percentage of women taking up their screening invitation within six months fell from 71.1% in 2016-17 to 70.5% in 2017-18. Some might say that is only 0.6%, but analysis by Breast Cancer Now has found that upward of 1,200 additional deaths could be prevented per annual cohort of eligible women if we were to increase screening uptake to the current target of 80% for individual breast cancer screening units. With 500,000 people projected to be diagnosed with cancer in 2035, it is clear that we must do more to ensure that cancer is diagnosed early so that it can be treated effectively.

The long-term plan, as I am sure everyone has read and the Minister will be aware, says:

“We will build on work to raise greater awareness of symptoms of cancer, lower the threshold for referral by GPs, accelerate access to diagnosis and treatment and maximise the number of cancers that we identify through screening. This includes the use of personalised and risk stratified screening and beginning to test the family members of cancer patients where they are at increased risk of cancer.”

That is all great, but the Government cannot make those improvements without improving the workforce, and they must not be complacent about the role our NHS workforce have to play in this. As we all know, that workforce do a wonderful job every day, treating, caring for and supporting us and our loved ones, as those who have witnessed it at first hand will attest. Unfortunately, the cancer workforce is at breaking point and already struggles to keep up with increasing demand. There are chronic staff shortages across the NHS, with vacancies for 102,000 staff, including nearly 41,000 nurses. As anyone who has ever worked somewhere with staff shortages will know, the pressure that places on an individual is huge. I cannot imagine what it is like for the NHS staff who work day in, day out under those pressures, when so much depends on their being able to do their job properly.

Cancer Research UK has pointed to chronic shortages in the diagnostic workforce, with more than one in 10 positions unfilled nationally. According to Breast Cancer Now, for every three breast radiologists who retire over the next five years, only two are expected to replace them. I know that others have already stated a lot of these facts, but they are worth stating twice. There is a similar problem with breast cancer clinical nurse specialists; Breast Cancer Care states that they are an ageing part of the workforce, with 45% of breast cancer clinical nurse specialists aged 50 or above. The Royal College of Radiologists has warned of a shortage of cancer doctors, with 5% of clinical oncologist posts vacant during the course of last year, up from a 3% vacancy rate in 2015. The Royal College of Nursing also warns that in England there are nearly 41,000 vacant registered nursing posts, and it predicts a dangerous increase to almost 48,000 by 2023 if the Government fail to take urgent action now.

The Government must take the issue of the cancer workforce incredibly seriously, as nearly every person who has spoken so far in the debate has said. Will the Minister provide a progress report on Health Education England’s cancer workforce plan, which was published just over a year ago? Additionally, will he please provide us with a date for when he expects the second workforce plan to be published? As others have said, “soon” is not good enough. The NHS long-term plan makes it clear that the funding available for additional investment in the workforce, in the form of training, education and continuing professional development through the Health Education England budget, has yet to be set by the Government. Can the Minister assure us that any workforce plan will be properly funded, so that the workforce gap can be filled as a matter of urgency?

The NHS long-term plan says:

“We will complete the £130 million upgrade of radiotherapy machines across England and commission the NHS new state-of-the-art Proton Beam facilities in London and Manchester”,

but staff will need to be trained on both how to use those new facilities and how to read the results. Education and training must be high on the agenda for the second workforce plan, including the reinstatement of the training bursary, removing any financial burdens and barriers so that we can recruit the nurses that we need for the future. It also means offering further training opportunities once qualified, so that staff can keep up to date with technological advances.

Our NHS should be the most attractive employer in the country, but without the financial backing and support from the Government we are failing to recruit and retain our hard-working NHS staff. Of course, as the Secretary of State continues to say, prevention is better than cure, but £96 million has been cut from public health budgets this financial year.

[Mr George Howarth (in the Chair)]

Order. I call the Minister.

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[Steve Brine]

Yes. That is why the House gave all upper-tier local authorities the power to be effective public health authorities with ring-fenced public health budgets—£16 billion during this spending review period. Decisions will obviously be made about that going forward. One reason why we did that was our belief that, for example, my right hon. Friend’s borough will have different priorities and demographics from mine in Hampshire.

It is a statement of fact that I will clearly not be able to respond to every Member’s points in the short time that we have left. I will respond to everybody in writing, as I always assiduously do. I will try to take a few themes in the minutes that I have.

The hon. Members for Easington (Grahame Morris) and for Westmorland and Lonsdale (Tim Farron) touched on radiotherapy. I very much enjoyed our meeting, and I thank them again for their work. I will send the hon. Member for Easington a note with more detail on his point on tariffs, because I know that he and the hon. Member for Westmorland and Lonsdale are concerned about it.

The hon. Gentlemen also talked about the manifesto response. We await the publication of the new radiotherapy specification before we respond. It is an excellent piece of work that will address many of the recommendations made, and we expect it to be published very shortly. I am afraid to say that the long-term plan makes no commitment to a one-off investment. However, it commits to improving access to safer and more precise medicines, including advanced radiotherapy. That document is not the final word. It is a living document that I will work on while listening to all-party parliamentary groups such as their own.

The hon. Member for Westmorland and Lonsdale also talked about the radiotherapy review. There was a phenomenal response to NHS England’s consultation, not surprisingly—a lot of those were from the west country of England. The NHS will plough through that. I am putting great pressure on it to publish its report in response to that, which I am hoping, and am told, will be in early 2019.

The hon. Member for Central Ayrshire (Dr Whitford), otherwise known as the Member for the Irish sea a body of water, talked about prevention and smoking and child obesity and humour. I loved her reference to “poo in the post”. There is a great charity that talks about men’s bits called It’s in the Bag, which is good at promoting awareness of testicular cancer. She is right to talk about prevention. I am the Minister for Public Health and Primary Care, looking at prevention. The Secretary of State has made prevention one of his top three priorities, and she knows that it is key for me.

Smoking is still the biggest preventable killer in our country today, as I said in the House last night in the statutory instrument debate. We have published a world-leading plan on child obesity. We will consult very shortly. I try to be honest with the House at all times, and I hoped to get it out before Christmas, but there is an awful lot else going on and there is only so much I can get out the door at one time. However, I will get the 9 pm watershed consultation out the door. It is damned important that we do that. We said that we will, so we will.

The hon. Lady is absolutely right that prevention is better than cure, which is why the child obesity plan and Cancer Research UK’s work in that space has been very helpful.

[Mr George Howarth (in the Chair)]

I remind the Minister that he ought to leave a little bit of time for the mover of the motion to speak.