Covid-19: Access to Cancer Diagnosis and Treatment

Grahame Morris Excerpts

Wednesday 2nd December 2020 Westminster Hall

[Grahame Morris (Easington) (Lab)]

That is a really important point. How do we quantify the scale of the backlog to enable us to have an action plan to address it? Specialists say that whereas the ratio is currently 50:50 in terms of the therapeutic application of radiotherapy for treatable cancers and therapeutic palliative care, last year it was 70% treatable and 30% palliative. Do we not need the release of the datasets to quantify that in an accurate way?

[Tim Farron]

I am extremely grateful to the hon. Gentleman for making a very important point. I have heard the same reports from the frontline that treatment would normally be 70:30 curative to palliative and that now it is 50:50. That is a blindingly obvious consequence of the fact that when we catch cancer, we catch it too late.

I have a request of the Department, which we have made before, including in face-to-face meetings with the Secretary of State. I want the Department of Health and Social Care team responsible to sit down with the frontline experts—we can provide them this afternoon—and go through the evidence of the backlog. There is no way of tackling the problem if the NHS management and the Department are not cognisant of it and prepared to listen to the people working their socks off in cancer units all over the United Kingdom.

I want to make another important point. Whoever was in power during this time would have been handed the same challenge and would have made many mistakes. The Government have rightly sought to control the virus so that we can protect the NHS and save lives. The lives that we seek to save are those at risk from not just covid but other illnesses, including, of course, cancer.

We as a country have stood together and defended our NHS so that it has the ability to fight cancer in the midst of a pandemic, which is what every clinician is desperate to do. The great success of this year, for which Ministers should rightly be proud, is that our NHS has not collapsed and did not fall over. Our doctors, nurses, paramedics and clinicians of every sort have saved lives, defeated the odds and kept our NHS on its feet so that it can fight cancer, and yet a failure at senior levels of NHS England and in Government to recognise the scale and nature of the cancer backlog means that people are dying today who did not need to die.

We have terminal diagnoses for cancers that could have been treatable among my constituents and yours, Ms McVey—among all our constituents. Their lives have been cut short when earlier, more urgent and more ambitious action from our leaders could have saved them. What troubles me so much is that we hear statements from some in senior management in the NHS, and from within the Department, that suggest they do not quite get the scale of the backlog problem. They freely admit that they do not know how big the backlog is. On more than one occasion, I have heard the Secretary of State seek to reassure us by saying that progress has been made on recovering the 62-day wait. If people understand what is happening, however, that does not reassure them. It does the exact opposite: it sends a shiver down their spine—it confirms the problem.

Surely Ministers know that the 62-day waiting time target for treatment does not give a complete snapshot of the situation, because it captures only patients who are already in the system. I am sorry to be brutal, but as more people die, there are fewer people in the system. The target does not take into account the tens of thousands of undiagnosed patients who may be going about their daily life completely unaware that they are living with cancer.

I fear that the Government hugely underestimate the cancer backlog, and the consequence will be thousands of unnecessary deaths and lost life years. An article last month in The BMJ estimated that there will be 60,000 lost years of life as a result. Does the Minister recognise the significant fall in people receiving cancer treatment this year compared with 2019? Like me, is she worried that this will mean there are thousands of people out there with undiagnosed cancer who have yet to come forward?

I move on now to my second point, which relates to the Chancellor’s recent comprehensive spending review, which was a pivotal opportunity to signal that the Government, the Department of Health and Social Care, the Chancellor and NHS leaders understood the need for investment in the techniques and treatment required to quickly build capacity in order to clear the cancer backlog and ensure a resilient service going forward—to build the capacity that is vitally needed if we are to make sure cancer patients are not the collateral damage of covid. Far from seizing that pivotal opportunity, the Government appear to have turned it into a missed opportunity. As far as we can tell, there is no boost to cancer treatments in the comprehensive spending review. There is no increase in capacity to catch up with cancer, and there is no plan to do what is needed to save thousands of cancer patients’ lives.

The Action Radiotherapy charity estimates that the true cancer backlog could be as high as 100,000 patients. It supports the estimate of the Chair of the Health and Social Care Committee that it would take cancer services working at over 120% pre-covid capacity two years just to catch up. Members of all political persuasions, working with clinicians and experts who are desperate to make a difference, are clear about how the Government could provide the boost required to catch up with cancer and to save thousands of lives. The answer is not to exhort our heroic frontline staff to work harder—they continue to be inspirational, straining every sinew. It is not to carry on doing what we have always done, but just doing it a little better. It requires some new thinking. It requires taking an axe to some of the internal bureaucracy that has held back some treatments, such as radiotherapy. Crucially, it requires investment, but that critical investment seems to be missing from the comprehensive spending review. That is a missed opportunity on a massive scale, and I hope it is not too late to make a change.

I have to say that there has been a collective gasp of disbelief across the oncology and radiotherapy sector, as it appears—unless we are all mistaken—that there is not even an explicit mention of radiotherapy in the spending review, never mind of the investment in it. Radiotherapy is covid-safe and is required by over 50% of cancer patients. It already plays a significant role in 40% of cancer cures and is able, where clinically appropriate, to substitute for chemotherapy and surgery at times when they are deemed not to be appropriate because of the fact that we are in a pandemic. It is hugely cost-effective: it cures patients for as little as £5,000 to £7,000 apiece.

The reality is that radiotherapy has huge untapped potential to do even more to clear the backlog. For many reasons, however, it has been actively restricted and held back for years. Although radiotherapy treats 50% of cancer patients, it receives just 5% of the annual cancer budget—something for which recent Governments of all parties must share the blame. That is why the UK is massively behind on technology that could empower the workforce to do more. Pre-pandemic it was estimated that as many as 24,000 patients were missing access to radiotherapy treatment each year. It is worse now.

Faced with the current crisis, the radiotherapy community came together to put together a transformation plan for consideration at the comprehensive spending review. The six-point plan would deliver a super-boost to cancer services to clear the backlog, with innovative technology and digital solutions to deploy linear accelerators at the many covid-clean hospital sites in England, such as the Westmorland General Hospital in my constituency, that are perfectly suited to adding satellite capacity to their main cancer units while protecting patients and clinicians from covid infection risk. The plan would also see an immediate boost in precision radiotherapy at existing cancer units, upgrading linear accelerators to perform curative treatment over shorter periods. However, on our reading of the spending review, that appears to have been totally ignored. In fact, as far as we can tell, there is no clear plan of investment in cancer treatment capacity at all.

While the investment in diagnostic machines over 10 years is truly welcomed by all of us here, it is not enough. According to Freedom of Information Act requests carried out by the Radiotherapy4Life campaign, more than half of NHS trusts are using radiotherapy machines that are more than 10 years old. To replace only the machines that deliver diagnostics, or radiology, and not those that actually cure people—the radiotherapy machines—is a baffling decision, to me and, more importantly, the experts. Patients and the public will be shocked to learn that immediate solutions presented by expert professionals to the covid-induced cancer crisis are being overlooked.

Every week that we delay giving an immediate boost to cancer services—capacity, diagnostics and treatments —we increase the risk of losing cancer patients needlessly. Recent data shows that for every four weeks of delay in starting treatment there is as much as a 10% increase in deaths. Some departments report a 20% drop in the number of patients classified as curable, leading to downgrading to palliative treatment instead. Patients—our constituents, families and friends—are being told that their cancer now cannot be cured and that their treatment will be palliative instead. Yet the decision to catch up urgently with cancer has been either delayed or ignored. We will pay a huge cost for missing out on the chance to correct things at the spending review. That is why I hope it is not too late to do so. The public inquiry, when it happens, will reveal the situation. The cost of the understandable litigation by patients and families who have been failed will be needlessly huge.

We first wrote to the Secretary of State about the growing crisis in April, and we have not stopped warning of the devastating impact that there will be on the lives of cancer patients. Three hundred and seventy-five thousand people have signed the Catch Up With Cancer petition and have hundreds of patients shared their heartbreaking stories. Experts are saying that there will be as many as 35,000 unnecessary deaths and, as I have said, 60,000 life years lost to cancer because of the impact of the covid crisis. Cancer survival rates have been pushed back to where they were more than a decade ago.

I know that the Minister cares. She is a good person seeking to do a good job. I hope that she will forgive me for being direct today, but thousands of people could have their lives lengthened or saved, and their families could be spared unspeakable grief, if we acted urgently to catch up with cancer. I conclude by repeating my plea in the strongest possible terms. Will the Minister meet me and, most importantly, the expert clinicians who advise the Catch Up With Cancer campaign, in the next few days so that we can turn the tide on the crisis?

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[Grahame Morris (Easington) (Lab)]

Thank you very much, Ms McVey, for calling me to speak in this important debate. I also thank my friend, the hon. Member for Westmorland and Lonsdale (Tim Farron), for securing this debate.

I am sure this will seem like groundhog day for the Minister, with a whole phalanx of MPs supporting the calls for more resources for cancer, but this is a very serious issue and I make no apology for rehearsing those arguments. Until we see tangible results arising from our lobbying efforts, I am afraid it will continue. The hon. Member for Westmorland and Lonsdale made an excellent opening speech, setting out the arguments in a thoroughly cogent and thoughtful manner. I also want to pay tribute to the NHS workforce, in particular our cancer workforce, not just the oncologists but the therapeutic radiotherapists, the technical staff who keep the service running, and those key personnel who work behind the scenes, often unacknowledged, whose expertise has the potential to improve cancer outcomes.



The speeches have been excellent so far, but I will take issue with one point raised by the hon. Member for Warrington South (Andy Carter) about our cancer performance. Our focus in this debate is on what we can do immediately to address the cancer backlog, but I would respectfully point out that, even before the pandemic, our performance on cancer outcomes was not world-beating. In fact, for the seven most common cancers, in a direct comparison with similar advanced industrialised countries, we were either bottom or second bottom. There was a job of work to be done even before the pandemic, and the impact of covid has shone a spotlight on that.

I have the great privilege to be vice-chair of the all-party parliamentary group for radiotherapy and vice-chair of the all-party parliamentary group on cancer. The charity Action Radiotherapy estimates the full cancer backlog stands at more than 100,000 patients, and it agrees that it would take cancer services working at over 120% of pre-covid capacity for two years just to catch up. The chair of the Health and Social Care Committee, the right hon. Member for South West Surrey (Jeremy Hunt), agrees with that figure, having done some research of his own.

We need a distinct plan. It cannot be a case of Members simply lobbying Ministers and asking for more resources. We need to quantify the scale of the problem; we need an action plan. I am very much aware that we have a cancer recovery plan, but we need an action plan that addresses all the issues. I also believe that we need somebody with some clout to lead it. Last week the Government announced that the Under-Secretary of State for Business, Energy and Industrial Strategy, the hon. Member for Stratford-on-Avon (Nadhim Zahawi), would be the Minister responsible for driving forward the vaccination programme. Cancer is such an important area of concern to the public and to the broader community that we need to have someone with some clout, preferably a Minister or senior person within the NHS, to be given the responsibility to drive this initiative forward.

Experts are predicting 35,000 deaths and 60,000 lost years of life, with cancer survival rates having been pushed back to where they were 10 to 15 years ago. We need to address this issue. When we have asked questions in previous debates, Ministers have responded, and I mean no disrespect to the Minister who is in her place at the moment, because I know that she fully understands the issue. I do not want to make any apology here, but there is a difference between investing in diagnostics and investing in curative treatments. There is a difference between radiology and radiotherapy, and I am not convinced that the Secretary of State understands those differences. We welcome the additional investment in digital imaging and improved diagnostics, but we must address how we get more resources and improve the number and quality of the skilled cancer workforce to get to grips with the backlog.

It is appropriate to mention the implications of the pandemic for prostate cancer, which was also referred to by the hon. Member for Warrington South. Movember, when men grow a moustache to raise awareness and funds for men’s health during November, ended earlier this week. Prostate Cancer UK has identified two major concerns. The first is the detrimental impact on GP referrals for prostate cancer. That came to mind when my hon. Friend the Member for Gower (Tonia Antoniazzi) mentioned the three referral pathways of A&E, GP referral and screening programmes. There is a massive issue. I suspect that hon. Members present have some experience of how extraordinarily difficult it is, particularly for older people, to get a face-to-face appointment with a GP at this time if they have concerns about possible early symptoms of cancer. Again, that needs to be addressed, because it is having an impact on the backlog.

The second concern is about men accessing support and communication at the time of diagnosis and when living with side effects or advanced disease. Calculations by NHS England and Prostate Cancer UK suggest that there are between 3,000 and 5,000 men with undiagnosed higher risk prostate cancer who would otherwise have been diagnosed had referral rates been at pre-covid levels.

In the time that I have remaining, I will focus on two main areas and I have some specific asks of the Minister. The first area, which I have raised on previous occasions, is data and information. We have heard statements from Ministers in the Department of Health and Social Care and from senior NHS leaders that indicate that they do not have an accurate estimate of the full cancer backlog of delayed treatments, diagnostics and screenings. The publication of the radiotherapy dataset, which is available, would show precisely the extent and character of the backlog, because it would compare the position now with the position 12 months ago.

For reasons that are not apparent to me, the publication has been delayed by NHS England, so my first ask of the Minister is, why is that? Why will those radiotherapy datasets not be published? I do not know whether NHS England is being too slow to act or whether it is some kind of bureaucratic hold up, but it must be driven forward, as it is imperative to ensure that the cancer recovery plan is accurate. That is despite the fact that NHS England and Ministers are fully aware of the effect of the pandemic on cancer services; we have been raising the issue since April.

It is clear that knowledge is power. A lack of accessible data is resulting in an inability to catch up with cancer. Let us be frank: people are dying unnecessarily as a result. There was the awful case of Kelly Smith, one of many tens of thousands of people, who was a 31-year-old mother of three who died as a result of delayed treatment for bowel cancer. It was absolutely tragic. That caused her family to launch the Catch Up With Cancer campaign and petition, which I believe now has almost 400,000 signatures. If that does not concentrate Ministers’ minds, I do not know what will.

The second area is the comprehensive spending review and, in particular, the lack of any detail or specific reference to funding for modernising radiotherapy services. The Chancellor’s announcement last week was most welcome, but when the hon. Member for Westmorland and Lonsdale asked about the cancer backlog and additional resources for advanced radiotherapy, he was referred to Health Ministers and the Secretary of State.

We should be aware that radiotherapy is safer to administer during the pandemic than alternative treatments. I am not attempting to set up a competition, but we have to recognise that radiotherapy is non-invasive and covid-safe, and has a range of applications. It is needed by about half of all cancer patients and is a significant treatment in 40% of cancer cures. I have benefited from it myself on three occasions. It is also hugely cost-effective, curing patients for as little as £5,000 to £7,000 per treatment. It is very efficacious in terms of the curative rate, and it could do much more to clear the backlog, but it is being held up by underfunding and bureaucracy, which have slowed the roll-out of new technology for a number of years.

Despite freedom of information requests showing that nearly half of trusts are using radiotherapy machines that are 10 years old or older, it appears that the spending review includes funding only for diagnostic machine replacements and not radiotherapy treatments. Even before the pandemic, Radiotherapy4Life estimated that 24,000 patients did not have access to radiotherapy and would benefit from it. Will the Minister commit to improving access to local radiotherapy by investing in new networked treatment delivery centres? Furthermore, will he consider all the elements of the six-point plan to transform radiotherapy services to ensure that we have the treatment capacity to catch up? Will he sweep away the bureaucracies that have contributed to the backlog?

There is no doubt about it. We need a supercharged—“super boosted”, to use the Prime Minister’s words—treatment capacity if we are to address this cancer crisis.

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[Alex Norris (Nottingham North) (Lab/Co-op)]

It is a pleasure to serve under your chairship for the first time, Ms McVey, and I commend the hon. Member for Westmorland and Lonsdale (Tim Farron) for securing the debate. When he opened it, he said he thought this was an issue on which we could work through consensus and in a collegiate fashion, which is absolutely right. The tone that he set, and that other hon. Members have followed, reflected that. He also said that he was direct in his contribution, which he was. He was right to be direct, because these are life and death issues, and we in this place need to be really focused on them in the most direct fashion.

I was lucky to meet the hon. Gentleman in July, alongside representatives from the secretariat of the all-party parliamentary group on radiotherapy, to discuss this issue. Of course the situation is not exactly the same as it was in July, but the crux of the issue is the same. It is great to go beyond virtual meetings and the back-channel conversations that we have in Parliament, and to get the subject on to the Floor of the House in order to have a public conversation about what is a very public and important matter. I particularly agreed with the hon. Gentleman’s point about “back to normal” not being good enough, because “back to normal” will not help us clear the backlog. Actually, we do not want to go back to where cancer services were in January. Hon. Members have touched on many ways to make services better—I will do the same later—and we should seek to do so. I share the hon. Gentleman’s anxiety about the gap between some of the rhetoric that we have heard from the Secretary of State, and the reality of what the numbers tell us about where we are at the moment.

Cancer touches us all at some point, as the hon. Member for Strangford (Jim Shannon) said yesterday and again today. For me, it was 33 years ago: I lost my father just before my third birthday. You come to terms with it and learn to live with it, but it is something that you carry around with you every day for the rest of your life. One of my major reasons for wanting to be a Member of Parliament is that I want there to be as few families like mine as possible. We can beat cancer to the best of our ability, so that people need not live their life in the shadow of cancer. I know that the Minister shares that aspiration. That is part of the consensus that we can build on this important issue.

The speeches this morning have been really good. The hon. Member for Warrington South (Andy Carter) started with Helen’s story, which was a really important thing to do. Lots of numbers have circulated—I will be guiltier than anyone else of throwing tens of thousands here and there—but each one of those statistics is a person and a life. That is what really matters. I strongly share the hon. Gentleman’s recognition of the creativity of our NHS.

I nodded and agreed when my hon. Friend the Member for Gower (Tonia Antoniazzi) made the point about undiagnosed cancers. I worry sometimes that when the Secretary of State talks, he is talking about the backlog and dealing with treatment for those who have a diagnosis. That is of course absolutely crucial, but it is only part of the problem that we are dealing with.

My hon. Friend the Member for Easington (Grahame Morris) has been a very good friend to me ever since I was elected in 2017, but particularly in my Front-Bench role over the past eight months. I am grateful to him for his counsel and guidance, and for constantly sharing his information with me to enrich my work. He was right to say that we have to understand the performance picture a year ago—frankly, covid was a very distant and small threat, and we had not really grasped how it would change our lives. We were not happy with cancer performance or with the direction of travel over the last decade. Certainly, as the Opposition, we were very concerned about that. We have to see the current situation in that context.

The hon. Member for Strangford was yesterday the Member in charge of a brilliant debate on cancer in children and young people. Collectively, we raised and analysed really important issues, and I know that the Minister took an awful lot away from that. The hon. Gentleman’s contribution today was very much in the same vein. It was about an holistic approach, across the four nations, all of which are represented today, which is really nice. As the hon. Member for Angus (Dave Doogan), who speaks for the SNP, said, this is of course a devolved issue. But we need to tackle it collectively.

I will make a few points of my own. In yesterday’s debate, I touched on the impact that covid has had on cancer diagnosis and treatment in children and young people—a demographic that is often both reluctant to visit the doctor and diagnosed slowly; it often takes multiple visits for that to happen. We will need to do things differently to tackle the pre-existing issues such as that and to catch up in relation to where we are.

Of course it was right that we prioritised covid during the first wave and have continued to make tackling the pandemic an important priority. We should take real pride in the fact that our NHS has taken such a strong punch to its capacity and stood there; that was not inevitable. We have seen other health services around the world overwhelmed, so we should be really proud of ours. It is a real testament to the institution that it has stood firm.

Nevertheless, we know that we now have an undiagnosed and untreated backlog of cancer. It is hard to estimate its true size because it is unknown. However, working off the best estimates of experts in the field—I shall use many of the numbers that the hon. Member for Westmorland and Lonsdale did in opening the debate—we are talking about a backlog of about 100,000 patients, which it would take about two years, working at 20% higher capacity than pre-covid, to capture. We cannot do that just by wanting it to be better or wanting people to put their shoulders to the wheel even more, after a year in which the NHS has been working flat out. We will have to do things fundamentally differently. If not, the price will be preventable deaths. Every four weeks of delay in starting treatment can cause an increase of up to 10% in the risk of death. The estimate is that the backlog could cause between 30,000 and 60,000 deaths, which starts to become of the same order of magnitude as the number of deaths from covid itself. That is how serious the situation is. As we emerge from the pandemic, we need to tackle cancer with the urgency and focus with which we have tackled covid.

There is particular concern about missed screenings. Cancer Research UK estimates that 3 million screenings were missed over the last year. Also, we know that fewer people went to the GP with symptoms during that time, because they were worried about other issues or capacity issues. As a result, about 350,000 fewer people were referred between April and August than we would normally expect, and there was a consequent 39% drop in the number of key diagnostic tests undertaken in that period.

I was really glad to hear yesterday from the Minister that the numbers of GP referrals are now back around pre-pandemic levels. That is a good sign. Actually, there were more referrals in September 2020 than in September 2019, but the two-week wait target of 93% is not yet being met, so there is definitely some context for that.

We need to understand that this issue will still not apply evenly throughout the population. Cancer does not know who we are when it grows in our bodies, but different demographics are affected differently—yesterday we talked about young people—and there are issues about different cancers, too. The points that the hon. Member for Strangford made about pancreatic cancer were well made.

The scale of the problem is exceptional and it calls on us in this place to make it a real focus and to have really strong, robust plans; so, now that I have talked about the problems, here are my suggested solutions. For me, this goes across four phases—planning, resourcing, new treatments, and workforce.

In August, the Secretary of State said that he very much hoped that the backlog would be cleared

“within a matter of months”.

Since I assumed my role, I have used three out of four sessions of Health questions to ask about cancer and try to get the Government on the record on that, which is why it is so great that we are having this debate. My heart sank when the Secretary of State said he thought the backlog could be cleared within a matter of months, because there is a problem; I do not think it is rude or unkind to say so. It has been recognised, during the pandemic, that some of the rhetoric that comes out of the Department is wishful and not grounded in reality. We are always told that things will be “world-class” and that things will be done “by the end of next month”. People’s hopes are got up and then dashed. We do not need exaggerated rhetoric here; we need exaggerated action.

I cannot see how anybody thinks that we can clear the backlog—the real backlog, which includes the lack of diagnosis as well as delayed treatment—within a matter of months. I do not think it helps anybody to talk in those terms. However, in October, at the Health questions before last, the Secretary of State gave me a categorical assurance that he has a cancer recovery plan that will drive down waiting lists each month for the rest of the year. I welcome that. That could be done and I am keen to hear the Minister reflecting on progress on that.

Similarly, at the most recent Health questions, the Minister for Health, the hon. Member for Charnwood (Edward Argar), said that there was greater capacity to deal with these things.

[Grahame Morris]

I cannot dispute the answer that my hon. Friend received from the Minister. It was an obvious answer, but the waiting lists have reduced because people are not presenting. There are fewer screening programmes, people are finding it harder to see their GP and things have become more and more difficult, so there is bound to be a reduction in waiting times, but that does not reflect the true picture of the backlog.

[Alex Norris]

Those points are very well made and get to the heart of what we as an Opposition want, what all Back Benchers want—and in fact, everyone. We do not want to beat cancer on paper and in statistics; we want to beat it in reality. We are not making this an issue of politics. It has to be an issue of coming together, as the hon. Member for Westmorland and Lonsdale said in opening the debate, with new and challenging things. Critically, at the heart of this, there is an indication of a plan, so I hope that today the Minister will commit to publishing it, give us greater detail on what is in it, update us on its progress in recent months and tell us whether it works through the full pathway, from symptoms to treatment, or whether it is just a diagnostics plan. To what extent is it being maintained in the second wave, and, with the national cancer recovery plan expiring next March, will there be a longer-term successor? I know that is a peppering of questions, but this is our best opportunity to ask, so I hope the Minister will take that in the spirit intended.

On resources, there was £1 billion in the spending review to tackle backlogs. Will the Minister clarify how much of that will go to cancers? Although the money is welcome, it is less than all the health experts have called for. The Chancellor has promised to give the NHS what it needs, and this is a “what it needs” issue, so resources are important.

On innovation, I am lucky enough to have lots of innovative companies contact me to talk about their treatments. It cheers the spirit to hear about developments in chemotherapy that will make it possible for drugs to be tailored to individuals. That is remarkable. However, I will make a point about radiotherapy because of the hon. Members between me and the door; I will not get out unless I do. Radiotherapy is safe to deliver in a pandemic, is significant in 40% of cures and is cost-effective. That is an area where we can make a real impact. Will the Minister commit to follow what my hon. Friend the Member for Easington said and publish the delayed radiotherapy dataset? That would be a nice step forward.

Macmillan has raised concerns that the long-term plan for the NHS will not be matched by the workforce available. It thinks we need a further 2,500 specialist cancer nurses. Where are we up to with that?

The most important message that any of us can send today is to a person listening to this, watching this or following the coverage who has a hacking cough, a lump or bump or blood in the stool, and has previously used the pandemic—as perhaps many of us would—as a reason not to access care. I ask them to please not do that. The NHS is there for them. We need them to access it. It will be there.

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[The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)]

It is a pleasure to serve under your chairmanship, Ms McVey. I have been given nine minutes to answer an enormous number of questions, so I will canter through in the hope that I answer some of them. We are a group that meets and discusses these things on a fairly regular basis. Indeed, I am back here this afternoon for a lung cancer debate, so this is an ongoing conversation, which I appreciate is vital. It is right that we recognise, as several hon. Members have, that the NHS has stood up during the pandemic, which was a blow to its very belly. We have put much effort into retaining services, not only for cancer, but for stroke patients and others, so that they can go to our NHS in their time of need.

I thank the hon. Member for Westmorland and Lonsdale (Tim Farron) for securing this debate and for all the work he does as chair of the APPG. He has such a formidable set of musketeers supporting him on what is one of the most focused APPGs. We are due to meet in January, but I will try to fit in a short meeting this side of the recess.

I have never said we were world beating—I came to this place because we were not; we had challenges before. Up to March last year, there were 2.4 million patients, which is 1.4 million more than in 2010. We were on a trajectory and covid hit us hard, and I would be the first to say that it has presented major challenges for the entire healthcare system.

The significant impact of shutting down services resulted in a sharp reduction in the number of people being referred urgently with suspected cancer and from screening programmes. That is a statement of fact. I am not going to stand here and say that it did not happen, but I am also not going to say that Herculean efforts have not been made since then.

I am really pleased that the cancer services recovery plan has had input from many cancer charities, including Macmillan, which has been mentioned, as well as many Royal Colleges, including those of General Practitioners, of Pathologists, of Radiologists and of Surgeons. It is vital that the right people make the recovery plan, which is being led by Professor Peter Johnson and Cally Palmer. It is in their hands together—a coalition—and I hope the recovery plan very much leads the way on a route to addressing the backlog and making sure that we take opportunities.

I think we all agree on some of the challenges, including those on data, referral systems and the lack of optimal radiotherapy machines in Westmorland. Again, that is a statement of fact and we need to address how we improve that situation so that every single person has appropriate access to treatments. As treatments advance or are shorter—more oral chemotherapy can be given at home, for example—there is a chance to redesign services to make them better and deliver more for patients. Every single day, I think of those patients. The hon. Member for Easington (Grahame Morris) made a comment about the loss of individuals. Every single day, that is what motivates me.

I thank my hon. Friend the Member for Warrington South (Andy Carter) for his comments about how hard the workforce are working. Whether it is a cancer nurse specialist, a radiotherapist, a radiographer or a surgeon, they are putting their back into this effort, because it could be a member of their family. They are a tremendously committed workforce, to whom I extend enormous thanks—but we need to get more of them. How do we convince a young nurse that his or her route is to become a cancer nurse, even though all the other specialists are also asking for them? We should also be working on that as a coalition, saying, “This is a fantastic area.”

We want to eradicate breast cancer by 2050. The survival rate for testicular cancer is now at a 98%. Pancreatic cancer is a dreadful disease, but we are now seeing not a two-week death sentence, but a couple of years. There are advances all the time and we must optimise that. Each and every person deserves to see that power, particularly on today of all days, when a vaccine has been approved and we know how brilliant this country’s life sciences industry is. We can beat this disease, but it takes time. I am absolutely committed to the patient-centred approach. One in four patients presented at A&E before this crisis—they presented too late. We know what the golden thread is.

There have been some positive announcements. I was encouraged to hear that we will pilot the Grail blood test, which can detect cancer from saliva. I am also pleased that in November’s spending review there was a further £325 million of investment in diagnostic equipment. The allocation of that will be determined in the next few weeks. I cannot give hon. Members any promises, and they would not expect me to say what will be allocated, but I understand the lobbying and the importance of not necessarily having shiny, sparkly front doors to walk through but getting the kit on the ground that can help save people’s lives. We know that no one single thing gives people the best chance of survival—it is the golden thread of swift referrals and screening that gives us early diagnosis—so we need those faecal immuno- chemical tests and to roll out the lung cancer pilots, and we are doing that. We need to ensure that we drive up those workforce numbers. We also need shorter waiting times for optimal treatment that will ultimately turn the tide on this disease.

Our strategy for maintaining services concentrates on stepping up hubs for cancer surgery and optimising independent use, which we have done as a Government. We stood up; we did not shy away from it. There have been no arguments about us using the private sector during the pandemic, have there?

[Grahame Morris]

rose—

[Jo Churchill]

I am really sorry but I have only got two minutes.

The NHS will accelerate the roll-out of rapid diagnostic centres. As I said in this Chamber yesterday, in March we had 17 of them and we now have 45—we have stood up 28 of them in the course of the pandemic. Most importantly, they will support early diagnosis, which we know is key. I am pleased that we are concentrating on recovering and maintaining cancer services. Through the newly formed cancer recovery taskforce, led by Professor Peter Johnson, we can drive that commitment forward with everybody.

The workforce have adapted, flexed and cared for individuals in the most challenging of circumstances. Every death concentrates my mind. My first text yesterday was from a friend who told of the passing of someone who had lost her fight against breast cancer after seven years. The disease does not go away. I am sure my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) would be here if she were not going through treatment and, as she would tell us, it sucks. The cancer workforce are a special part of the NHS family and I want us to ensure that they know how special they are so that people come forward to join them.

We know that referral rates have been variable across different cancer types. Arguably, some cancers have really challenged us, and particularly those that need endoscopies and colonoscopies. We are still not there because of the treatment. Lung cancer referrals were poor before we went into the pandemic. What would someone think if they had a persistent cough? They might get a covid test. Actually, if that test is negative, we need to ensure that they are referred by 111 to the system for a lung cancer test.

I have a lot more that I would like to tell hon. Members, but I dare say that we will be back here imminently. On that note, I will hand over to the hon. Member for Westmorland and Lonsdale.

Breast Cancer Diagnosis and Services: Covid-19

Grahame Morris Excerpts

Thursday 12th November 2020 Westminster Hall

[Craig Tracey (North Warwickshire) (Con)]

I beg to move,

That this House has considered the effect of the covid-19 outbreak on breast cancer diagnosis and the future of breast cancer services.

It is a pleasure to serve under your chairmanship, Ms McVey. As co-chair of the all-party parliamentary group on breast cancer, I am delighted to raise these hugely important issues. It is great to see the Minister in her place; she brings great expertise and knowledge to this topic. This has all the hallmarks of an excellent debate.

To set the scene, as hon. Members will know, the pandemic has had a major impact on breast cancer services, with Breast Cancer Now estimating that almost 1 million women in the UK missed out on their screening appointment as a result of a pause in the programme. There was a worrying drop at the peak of the pandemic in referrals of suspected breast cancer and breast-related symptoms.

We also know that some breast cancer patients had their treatments changed or temporarily paused to protect their immune system, or had their surgery delayed. That caused, understandably, huge anxiety, particularly for patients with incurable cancers, such as secondary breast cancer, and that was passed on to their families. Recruitment to many clinical trials was paused. The sustained pressure on staff as a result of dealing with the covid-19 pandemic alongside the existing challenges for the breast cancer workforce, has the potential to overwhelm the system for the foreseeable future.

There is some good news. Despite a dip in August, referrals have been steadily recovering. Although there is some way to go before they reach pre-pandemic levels, breast screenings are restarting and the number of people beginning treatment is rising. I am sure hon. Members across the House will join me in thanking the NHS for its effort in treating people and finding ways to deal with cancer patients during the pandemic. I would particularly like to thank my local hospital, the George Eliot Hospital, and Kristy and her team in palliative care. They do such amazing work, in difficult circumstances.

The recovery plan set out how we will restore breast cancer services to pre-pandemic levels, but we also need to look to the future, to ensure that the progress we made in treating cancer is not allowed to stall or be forgotten. As I mentioned, the pandemic has raised several urgent issues in relation to cancer. It is fair to say that many of those needed tackling prior to the pandemic, and they still need addressing.

In 2018, a report by the APPG on breast cancer showed that while breast cancer outcomes were good and outperforming those of other cancers, inequalities in diagnosis, treatment and care across the country were being masked, impacting the experience and outcomes of patients. Our inquiry also found significant variations across England in the support that women with secondary breast cancer received, particularly in access to a clinical nurse specialist, patchy provision of information, psychosocial needs not being met, and a lack of prompt and timely access to specialist palliative care services.

I know that hon. Members will all have their own angles that they want to address in today’s debate, and I take the opportunity to thank the many organisations that have been in touch with their views on what we could discuss. However, I want to focus my remaining remarks on secondary breast cancer, which is an issue that the APPG has had a particular focus on. For hon. Members who are not aware, secondary breast cancer occurs when breast cancer has spread to other parts of the body. Critically, it cannot be cured, but it can still be treated. To put that in context, about 1,000 women still die every month from breast cancer in this country, and pretty much all those deaths are from secondary breast cancer, so it is a considerable issue that we need to address.

Five years ago, in October 2015, I hosted my first ever Westminster Hall debate, which was on the subject of secondary breast cancer. I spoke about the inequalities in the system, and the fact that secondary breast cancer patients were often overlooked. It was in that debate that the present Minister, my hon. Friend the Member for Bury St Edmunds (Jo Churchill)—then a Back Bencher—spoke so powerfully about her experiences and battles with cancer. I know this is an issue that she is really passionate about getting right, but sadly, for various different reasons, since my 2015 speech nothing much has changed. I know that that frustrates the Minister as much as it does me.

The research continues to show that although many secondary breast cancer patients receive inadequate care, it is all too often even worse than that which they received when they had their primary diagnosis. That cannot be right in this day and age. The 2015 debate noted how much of the current discussion and debate on cancer focuses on promoting early diagnosis of primary breast cancer and improving survival outcomes, which is absolutely right; we should be dealing with that, but a crucial part of any strategy has to be that we do not forget about people who are living with incurable cancers. They should be given parity of care in our system.

There are many things that we could do, including focusing on earlier diagnosis of secondary breast cancer and increasing knowledge and understanding of the signs and symptoms of it. However, I want to focus on two areas; if we addressed them, it would make such a difference to patients who have secondary breast cancer. The first is around data, which is one of the key issues. One of our problems that is that we have a real lack of understanding of the data on secondary breast cancer. At the moment, we do not know how many people are diagnosed with it each year, how long they are living for, how the disease spreads or what kind of treatment and support they are receiving.

Where data on secondary breast cancer is collected, there is variation in what is recorded and how that is done. That is despite its being mandatory since 2013 for hospitals to collect data on their new diagnoses of metastatic cancer. Research by Breast Cancer Now in 2016, repeated in 2018, showed that that is still routinely not happening. In the 2018 study, a staggering 40% of hospital trusts and health boards across the UK were still unable to tell Breast Cancer Now how many secondary breast cancer patients were under their care.

I brought up that issue in the 2015 debate on secondary breast cancer. I highlighted some of the practical barriers to data collection, which often include IT constraints, constraints of time within hospitals, their structures, a lack of awareness about what data is required, and confusion in the trusts and hospitals about who was responsible for inputting the various data items.

[Grahame Morris (Easington) (Lab)]

The hon. Gentleman is making an important and powerful point, and I hope the Minister is taking note. As he rightly says, many older people—particularly older women—with breast cancer were not prioritised to receive breast radiotherapy over the past six months. Data is available in the radiotherapy datasets that are held by Public Health England, but they have not been published so far. Does he agree that the Minister should seek to persuade NHS England to publish that data?

[Craig Tracey]

The hon. Gentleman raises an interesting point, which I am sure the Minister will address. It makes perfect sense that we are seeing the lack of cohesion in data. We know that data is power in everything—without the data, how can we plan a strategy? Wherever we get it from, it should be imported into the system. In the 2015 debate, I asked the Minister to lead the way on ensuring that the data was collected uniformly in every hospital, and not just collected, but collected in a format that enables us to interpret it. We need that now more than ever.

I felt that we were making some headway at the start of the year. I had a productive meeting with my right hon. Friend the Secretary of State for Health and Social Care, where we brought in some secondary breast cancer patients and had a really good discussion on a number of topics. Data was one of the key things that we addressed. The Secretary of State made very positive noises about the potential for a national secondary breast cancer audit. Unfortunately, shortly after that, we ended up in the grip of the pandemic and I appreciate that the Department’s focus has been pulled into different areas.

To return to the point that I have made, without accurate figures for the number of people living with secondary breast cancer, it is nigh-on impossible for the NHS to plan and commission services effectively to meet patients’ needs. Equally, without understanding the level of service and care that patients were accessing before the pandemic, it will be challenging to know how to improve outcomes when we get back to pre-pandemic levels. How can we hope to do that without knowing where we started?

Inadequate collection and sharing of data acts as a barrier to service improvement. We are missing out on an incredibly powerful tool that we should be using to spot variation and hold services to account, and to better understand the secondary breast cancer population and the service it requires. At a time when long-term local and national plans are being drawn up, we want to ensure that the NHS can fully deliver on its commitments, and that we have a clear understanding of the experiences of people with secondary breast cancer.

I ask the Minister to follow up on the delivery of a national secondary breast cancer audit, which would cover things such as diagnosis, treatment and access to support. That could transform our insight into this key area and provide the missing information that is desperately needed to ensure that the NHS can meet the needs of those living with secondary breast cancer.

The second point that I will touch on is the importance of increasing access to clinical nurse specialists. In the 2015 debate, I said that the cancer patient experience survey showed that when a clinical nurse specialist contributes to a patient’s care, it is the biggest driver in improving their experience. That measure could save money in the long term, by keeping patients out of hospital and highlighting problems before they become crises in A&E. That is particularly true for secondary breast cancer patients, because they are on a lifelong treatment pathway and often have complex emotional and supportive care needs. A recent survey found that less than a third of secondary breast cancer patients had seen a CNS regularly. With the number of men and women developing breast cancer increasing, and people with secondary breast cancer living longer with the disease, there was already a high demand for CNSs. With covid-19 resulting in changes to people’s treatment and care, however, while also having an impact on their emotional wellbeing, access to CNSs for secondary breast cancer patients has never been more urgent.

Yet Breast Cancer Now’s most recent report said that 41% of breast cancer patients felt they had had less contact with their CNS during the lockdown period. That was partly down to the fact that, in common with other parts of the workforce, many CNSs were moved elsewhere in the NHS during the peak of the pandemic. As an example, 400 Macmillan NHS professionals, including Macmillan-funded CNSs, were among those redeployed.

I am sure all hon. Members agree that it is encouraging that the NHS long-term plan commits that everyone, including those with secondary cancers, should have access to a CNS. There was also an additional commitment in the recent people plan 2020-21 to offer grants for 250 nurses to become cancer nurse specialists. That is another step in the right direction, which we really applaud, but the commitments made by the Government require investment in training and expanding of the CNS workforce to meet both the current and future challenges. I am sure we all want that to be addressed when the full NHS people plan is published, and I am sure we all want it to be matched in its intent by receiving the necessary funding in the upcoming spending review.

I realise many people want to speak. There is much more that I could talk about, but I will conclude and recap the asks, which are pretty straightforward. We need a secondary breast cancer audit and a fully funded long-term workforce plan to ensure that the Department of Health has the appropriate tools and structures to honour its commitments to deliver the best possible outcomes for all cancer patients, and to build back breast cancer services better following the pandemic.

--- Later in debate ---

[Grahame Morris (Easington) (Lab)]

Thank you for calling me in this important debate, Ms McVey. I thank the hon. Member for North Warwickshire (Craig Tracey) for securing it. We are from the same part of the country, but from different tribes; I am red and white.

This is an important subject, and it is important that we address it. We are living through an unprecedented pandemic. I was saddened and alarmed to read yesterday that the UK had become one of only five countries to exceed 50,000 deaths from covid-19. In the fullness of time, no doubt, we will have a public inquiry into covid-19 that will examine the flaws in the Government’s covid-19 response. I certainly believe that the Government will acknowledge that they were not properly prepared for a pandemic and did not have a proper and effective plan to manage infectious disease and routine day-to-day healthcare.

The impact on breast and other cancers has already cost lives and will continue to do so, but I want to focus on the cancer recovery plan. The Government can take steps to avoid unnecessary cancer deaths arising from the backlog of delayed diagnosis and treatment. I have met the Minister on several occasions in my capacity as vice-chair of the all-party group for radiotherapy and the all-party group on cancer, and we have had constructive dialogue, so I am afraid she will not be able to argue that solutions were not put forward to address this issue and mitigate potential deaths arising from delayed treatment.

The Catch Up With Cancer campaign, which Radiotherapy4Life is supporting, has identified that the cancer backlog stands at more than 100,000 patients. I recently had a meeting via Zoom with Macmillan cancer support—I am one for badges; I am wearing Radiotherapy4Life’s and Macmillan’s—to discuss what needs to be done to address the cancer backlog. It estimates that there are 50,000 missing diagnoses for cancer across the UK—it calls them the forgotten C. An estimated 100 fewer women started treatment for breast cancer each working day in May and June, compared with last year. Breast cancer two-week wait referrals are down 25% in March to August this year, compared with 2019.

I was joined on the call by a representative from Macmillan’s Joining the Dots campaign—a lady called Chloe Shaw, who is doing excellent work. That brilliant local service, which may be available in other parts of the country, offers practical help and support to people affected by cancer—in my case, those living in County Durham and my constituency of Easington. Joining the Dots has supported people in my constituency living with cancer throughout the pandemic. At the moment, it is having to work primarily through telephone and video calls.

Macmillan estimates that there are currently almost 18,000 people in County Durham living with and beyond cancer—people who have already been diagnosed may be fearful that there will be a recurrence. It is estimated that that figure could rise to almost 29,000 by 2030.

As vice-chair of the all-party parliamentary group on radiotherapy, I am particularly interested in this issue. In the Chamber today we have a number of former Ministers who have been banging this drum for some time. The issue now is the impact of the pandemic on the availability of radiotherapy treatment. We really must do something for the many older women with breast cancer who have not been prioritised to receive radiotherapy over the past six months. The data is available and should be acted upon. Will the Minister publish those datasets? We certainly need smart solutions and investment, but they must be reflected in a comprehensive spending review, so I hope the Minister will make the necessary representations to the Treasury.

Public Health

Grahame Morris Excerpts

Wednesday 7th October 2020 Commons Chamber

[Grahame Morris (Easington) (Lab)]

It is an honour to follow my hon. Friend the Member for Hartlepool (Mike Hill), who made some terrific points. In the short time that I have, I would just like to make some specific points and ask the Minister a few questions, if I may. And if I may I just say to the Minister, with all due respect, that we are all in the same business. No one in the House wants to do anything other than stop the spread of the virus, save lives, and support jobs and businesses. Those are not mutually exclusive objectives and I am sure we can do all those things.

I want to share a comment with the Minister and ask her a particular question. I spoke yesterday with a senior source from within Durham constabulary, who raised with me a specific concern: advice had been given that additional resources promised for policing the local lockdown restrictions were dependent on taking robust enforcement action and pursuing prosecutions. He felt that that was too prescriptive and likely to sour existing good community and local business relations. He, like me, feels that the local authority and police are working well and collaboratively in County Durham, and that to be effective we need policing by consent. Additional police funding should not be dependent on demonstrating more prosecutions. I hope the Minister agrees with me and responds to that if that is not correct.

To be aware of the consequences for jobs, Minister, the pub and hospitality trade in my constituency, as in many others, is withering under Government restrictions. I am still unconvinced of the evidence for the nonsensical 10 pm very strict hospitality curfew, which throws large groups of people on to the street all at the same time, who then crowd on to public transport all at the same time. I do not believe that that protects public health and it does not protect businesses. Performance venues of all types are closing their doors, the community is losing amenities, and people are out of work at the start of what may well be a very bleak winter.

Further down the supply chain, local breweries are losing orders. The Chancellor seems to have a vendetta against the smaller British brewers: he has excluded them from support for the hospitality industry. They may struggle in the covid crisis through the winter, but the Chancellor seems determined to run them out of business with his proposals on small brewers relief. Will the Minister please look into that?

Relying on local restrictions and lockdowns moves the pressure to support businesses affected from national to local government. Minister, specific industries need specialist support—please, hear our plea.

Covid-19 Update

Grahame Morris Excerpts

Monday 5th October 2020 Commons Chamber

[Matt Hancock]

My hon. Friend makes an important point. Getting the right geography for any particular action is an important and difficult consideration. Last week’s example, when we took two of the Teesside boroughs into local action but not the other three, demonstrates that we are absolutely prepared to do as my hon. Friend wishes for London. On the other hand, on the same day we took the whole of the Liverpool city region into the same measures, because that was what was appropriate there. We have to take into account travel patterns and socialising patterns, as well as the pure data from the epidemiology and the number of cases, but it is absolutely something that we look at because we want to minimise the number of restrictions that are in place, subject to the need to keep the virus under control.

[Grahame Morris (Easington) (Lab)]

The Secretary of State is full of bravado and bluster, despite a catalogue of mistakes and regular statements. When the truth is spread thinly, people start to see through it. We hear the expression “world-beating test and trace system”—how would Ricky Tomlinson describe it?

[Matt Hancock]

I don’t know.

Covid-19 Update and Hospitality Curfew

Grahame Morris Excerpts

Thursday 1st October 2020 Commons Chamber

[Matt Hancock]

Of course, as we keep this under review, we will consider all the options. The clarity of the rule that was brought in was one of the reasons that it commends itself, but I would be happy to talk to my hon. Friend about the future.

[Grahame Morris (Easington) (Lab)]

We all agree that suppressing the virus is essential in saving lives, and as a scientific socialist, I think we should apply basic public health principles. It seems absolutely clear to me that it is problematic that we have a 10 o’clock curfew, when large numbers of people are all coming out into the street at the same time. Night-time entertainment businesses such as comedy and live music venues, which are based in covid-secure premises such as pubs and clubs, are seriously impacted, and like—

[Mr Speaker]

Order. Come on, Secretary of State. We have got to get a grip.

Coronavirus Response

Grahame Morris Excerpts

Monday 20th July 2020 Commons Chamber

[Matt Hancock]

I will do better than that: when we get scientific evidence on the impact of cold weather on this virus, we will publish it.

[Grahame Morris (Easington) (Lab) [V]]

I hope the Secretary of State is aware of the tragic case of Kelly Smith, who sadly died when her cancer treatment was stopped during the covid lockdown. The Government’s aspiration to get cancer services back to normal by the end of the year is simply not acceptable. Too many cancers are incurable within a few weeks. Will he address this issue, and will he look at transforming radiotherapy services, which have emerged as being highly effective as a cancer treatment and can be delivered even if there is a second spike in the pandemic?

[Matt Hancock]

Yes, the hon. Gentleman is absolutely right about the importance of this. We are getting cancer services back up and running as fast as possible. The idea that we are waiting until the end of the year before doing anything is completely wrong. We are going as fast as we can. During the peak, some of the services did have to be stopped for clinical reasons. My heart goes out to those whose treatment was stopped because of covid and who died of cancer, The judgments were made on an individual clinical basis as to whether it was safer to go ahead with the treatment or to stop it, because, of course, many treatments for cancer are much more dangerous when there is a high volume of infectious disease. I understand that that explanation will be of no comfort to Kelly’s family and friends who mourn her, but I also understand why the NHS made that decision and I support them in the decision that it made. We must get this going again as fast as possible. This is something on which I am working very closely with the NHS. In fact, I had a meeting on it only last week. I also entirely agree on the point about radiology services, too.

Oral Answers to Questions

Grahame Morris Excerpts

Tuesday 28th January 2020 Commons Chamber

[Matt Hancock]

My hon. Friend is spot on. We are driving interoperability so that the right people can see the right records at the right time. We will mandate that technology used in the NHS must allow for such interoperability, and we will set standards.

My hon. Friend started the “axe the fax” campaign, in which I was happy to play my part. Faxes are terrible for efficiency and for data security—even straightforward email is so much better—and we will drive up data security by axing the fax across the NHS.

[Grahame Morris (Easington) (Lab)]

What specific investment is being directed to supporting the 11 new radiotherapy IT networks that are required to provide a world-class radiotherapy service and improve cancer outcomes and survivability?

[Matt Hancock]

Radiotherapy is a good example of part of the NHS that can benefit hugely from improved technology now and from the cutting-edge artificial intelligence-type technologies that are coming down the track. I am happy to look at any specific proposals the hon. Gentleman has. We have a broad programme to support the technology needed in radiotherapy.

NHS Funding Bill

Grahame Morris Excerpts

2nd reading & 2nd reading: House of Commons
Monday 27th January 2020 Commons Chamber

[Matt Hancock]

Yes. That just shows how sensible the British people were to elect a majority Conservative Government. The funding will also allow the NHS to invest in innovative technology, such as genomics and artificial intelligence, to create more precise, more personalised and more effective treatments. That will help the life sciences industry, which is one of our fastest growing industries, and in turn, help to support growth.

[Grahame Morris (Easington) (Lab)]

I want to make a point about new technologies and what is not in the Bill—namely, capital and training budgets. That is vital to address our woeful performance on cancer outcomes, which I want to touch on in more detail later. Specifically, what will the Secretary of State do about the under-investment in advanced radiotherapy? We are spending £383 million but we should be spending considerably more if we are going to provide a world-class service.

[Matt Hancock]

The hon. Gentleman is absolutely right that we need earlier diagnosis of cancer—I entirely agree. Rolling out the 200 extra diagnostics facilities and increasingly making them available in the community, rather than just in big hospital centres, is an absolutely mission-critical part of that. The funding will also allow us to upgrade our outdated frontline technology—that is tied to what he just called for—which will save time for staff and save the lives of patients. Within the financial settlement, mental health spending will increase the fastest so that we can transform how we prevent, diagnose and treat mental ill health across the country. Within that allocation, funding for children’s mental health will go up faster still.

--- Later in debate ---

[Grahame Morris (Easington) (Lab)]

It is a pleasure to follow the hon. Member for Dover (Mrs Elphicke), who made powerful arguments in support of improving maternity services in her area, as well as other hon. Members who made their maiden speeches this evening. I am sure that we will hear a lot more from them.

I want to make a familiar argument about access to and funding of radiotherapy services. The Minister for Health, the hon. Member for Charnwood (Edward Argar), has heard this argument on previous occasions, but I am going to make it again because I am not convinced that the Secretary of State understands it. It is not rocket science: in the United Kingdom, radiotherapy accounts for just £383 million of the NHS resource budget, despite the fact that one in four of us is going to need it at some point in our lives. In his opening remarks, the Secretary of State referred to the Government’s commitment to invest in new diagnostic equipment and scanners. I very much welcome that, but he did not seem to get—I did not hear the penny dropping—the important link between diagnosis and treatment.

I must declare an interest: I am vice-chair of the all-party parliamentary group on radiotherapy. I am a cancer survivor myself and have benefited from this particular treatment. Basically, I want to make three points. I want to cover the cancer challenge, to briefly discuss the current state of radiotherapy and to set out a future vision for NHS radiotherapy. I am talking in the context of the Bill. I have tried to make key points in interventions about how vital workforce planning and capital budgets are. This is not just a case of replacing hospital car parks; it is about vital equipment. It is essential to improve cancer outcomes for our patients.

About 50% of people develop cancer at some time in their lives, and I am sure that even those fortunate enough to be spared the disease will all have a loved one who has been touched by cancer. I am not arguing from a completely selfish point of view, here—putting a case for me, my constituency or my region. As a magnanimous sort of individual who recognises the sentiment in the House, I am arguing that we should improve cancer services across the whole country. Access to world-class cancer treatment really matters to every single one of our constituents in every constituency in the United Kingdom.

I want to take issue with a statement that the Secretary of State has made on more than one occasion about cancer survival rates. Figures comparing nine comparative countries were published in The Lancet in November last year, just before the election. They showed that the United Kingdom had the lowest survival rates for breast cancer and colon cancer and the second lowest for rectal cancer and cervical cancer. Some 24% of early-diagnosed lung cancer patients are not getting any treatment at all.

In truth, although our cancer survival rates are improving—the Secretary of State is not telling a lie—we still have the worst cancer outcomes in Europe; the baseline is very low. I welcome the Government’s commitment to considering ways to improve cancer diagnosis, with a plan to set new targets so that patients receive cancer results within 28 days. That is great. But we still need to address issues of staff capacity and there is a desperate need for more radiologists and more skilled people in the imaging teams to address shortages in endoscopy, pathology and the vital IT networks.

Unlike chemotherapy, which I have also had on a couple of occasions, which impacts the entire body with chemicals, advanced radiotherapy targets tumours precisely, to within fractions of millimetres, limiting damage to healthy cells in close proximity to the tumour. Improved radiotherapy technology allows us to treat cancers previously treatable only with surgery, chemotherapy or a combination of both. Radiotherapy is also cost-effective for patients, the NHS and Ministers, who are obviously very keen to ensure that we get value for money. A typical course of radiotherapy costs between £3,000 and £6,000—far less than most chemotherapy and immunotherapy cures—and patients experience very few side effects.

The problem is that access to radiotherapy centres and this life-saving treatment is not evenly distributed across the United Kingdom. A 2019 audit showed that 32% of men with locally advanced prostate cancer in the UK had been potentially undertreated, with 15% to 56% of trusts in the survey not offering the sort of radical radiotherapy that those patients really required. In England, advanced curative radiotherapy is actively restricted for no good reason, with only half the 52 centres having been commissioned by NHS England to deliver advanced radiotherapy—stereotactic ablative radiotherapy, or SABR. That is despite the fact that its use is specifically recommended by the National Institute for Health and Care Excellence.

We are coming up to World Cancer Day on 4 February. The Minister understands this issue because we have spent a deal of time on it. I want him to make a commitment on behalf of the Government that the UK will become a world-class centre for patient-first radiotherapy so that we can improve our cancer survival rates. That will require an increase in investment. We need to address the issue of capital funding. Currently, radiotherapy gets 5% of the cancer treatment budget; we need that to be closer to the European average of 11%. There is an immediate need for £140 million of investment to replace the 50 or so radiotherapy machines—the old linear accelerators—that are still in use despite being beyond their recommended 10-year life by the end of 2019. We need investment in IT and to help establish the 11 new radiotherapy networks, which the Minister touched on. Again, that comes under capital and workforce training.

The all-party parliamentary group’s manifesto for radiotherapy is calling for a modest increase in the annual radiotherapy budget, from 5% to 6.5% of the revenue budget, and for the Government to establish some basic standards to secure our vision for radiotherapy. We need to recruit and train highly skilled clinicians, radiographers, medical physicists and healthcare professionals and to guarantee that every cancer patient has access to a radiotherapy centre within a 45-minute travel time. In 2020, the Government should set themselves a 2030 target for the UK to go from having the worst cancer outcomes to the best cancer survival rates in the world. We could do that, and we could make a start by delivering a world-class radiotherapy service.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I am afraid that I have to reduce the time limit to eight minutes.

Health Infrastructure Plan

Grahame Morris Excerpts

Monday 30th September 2019 Commons Chamber

[Edward Argar]

I know that, since my hon. Friend was first elected to this House, he has made health and the NHS his No. 1 priority. He served with distinction as a Minister in the Department and continues to champion his constituents’ interests in this respect. On the seed funding, we have made the announcement and are keen to get the money to those trusts as swiftly as possible so they can work with us to develop their plans. I agree entirely that its inclusion in this list is a vote of confidence from us and the NHS in the work his local hospital is doing.

[Grahame Morris (Easington) (Lab)]

I thank the Minister for his statement. He said that the Government would focus on outcomes, and he mentioned £200 million for new CT scanners for diagnosis, but The Times recently published the details of answers to freedom of information requests indicating that half of NHS trusts are treating cancer patients with out-of-date radiotherapy machines. The UK will remain at the bottom of the cancer survival league until we dramatically improve our radiotherapy services, so what steps is he taking to implement the “Manifesto For Radiotherapy”, invest in modern radiotherapy equipment and train personnel in IT networks, to provide modern radiotherapy services to cancer patients in every region of the UK, not just those in London and the south-east?

Non-invasive Precision Cancer Therapies

Grahame Morris Excerpts

Thursday 18th July 2019 Commons Chamber

[Grahame Morris (Easington) (Lab)]

I beg to move,

That this House recognises the vital role that radiotherapy plays in cancer treatment across the UK with an estimated one in four people needing that treatment at some stage of their life; notes that there is a significant body of expert opinion that up to 24,000 people may be missing out on the radiotherapy they need, resulting in many hundreds of unnecessary or premature deaths; further notes that the UK spend on radiotherapy as a percentage of the overall cancer budget is approximately five per cent which compares badly with most other advanced economies where the percentage varies from nine per cent to 11 per cent; notes that the current commissioning system for radiotherapy is sub-optimal as exemplified by a tariff regime which discourages NHS Trusts from implementing advanced modern effective radiotherapy; calls on the Government to provide an immediate up-front £250 million investment in the service, an ongoing extra £100 million per annum investment in personnel and skills and IT, and to introduce a sustainably, centrally and fully funded rolling programme for Linac machine replacements; and further calls on the Government to appoint a single person to oversee the commissioning and implementation of radiotherapy services.

I thank the Backbench Business Committee and its Chair, my hon. Friend the Member for Gateshead (Ian Mearns), for granting this debate, and all the Members on both sides of the House who supported the application. I must declare an interest as one of the vice-chairs of the all-party group on radiotherapy, and also as a cancer survivor—[Hon. Members: “Hear, hear.”] Thank you. Thanks to early diagnosis, I was successfully treated with both chemotherapy and, crucially, precision radiotherapy.

I want to point out to the Minister that there is currently a crisis—there is no other word for it—in the management and funding of radiotherapy in the United Kingdom. Indeed, the charity Action Radiotherapy estimates that as many as 20,000 people across the UK may be missing out on the radiotherapy they need. Many of these patients will die prematurely or unnecessarily as a result of this shortfall. Given that one in four people receives some form of radiotherapy during their lives, and that almost half of us in the United Kingdom will be diagnosed with cancer at some point in our lifetimes, I hope the Government will realise just how important it is that we invest in modern and, importantly, accessible cancer diagnosis—and not just in diagnosis, but in cancer treatments.

[Jeff Smith (Manchester, Withington) (Lab)]

I am very proud to have the Christie Hospital in my constituency of Manchester, Withington. It has a fantastic proton beam therapy unit, which is going to be the future of cancer treatment. However, when I speak to the staff at the Christie, their biggest worry is the workforce. Does my hon. Friend agree with me that the challenge is not just funding for treatment, but actually investing in our cancer workforce as well?

[Grahame Morris]

Absolutely, and I am grateful to my hon. Friend for pointing that out. Indeed, that is one of the four basic requirements, as the all-party group, the charity Radiotherapy4Life and Action Radiotherapy have pointed out. That is clearly demonstrated in the “Manifesto for Radiotherapy”, which I commend to the Minister and to all hon. Members.

I appreciate that the Minister will want to refer to chapter 3 of “The NHS Long Term Plan”, particularly paragraph 3.62 on more precise treatments using advanced radiotherapy techniques. In anticipation of that, I would like to say, on investment, that the Government have promised to complete the £130 million investment in radiotherapy machines and, as my hon. Friend has just mentioned, to commission the proton beam machines at University College Hospital in London and the Christie Hospital in Manchester. However, I respectfully point out to the Minister that that is not a new announcement of additional resources, but the recycling of previous announcements. The money has already been spent or committed, so it is not part of the comprehensive 10-year plan for radiotherapy that we advocated for in the “Manifesto for Radiotherapy”.

The £250 million for proton beam facilities, while welcome, will only treat 1,500 patients a year. I accept that many of them will be children with brain cancers, but the number represents only 1% of patients needing radiotherapy. As indicated in the manifesto, we recommend that the same sum that was spent on proton beam facilities—a relatively modest sum given the size of the budget as a whole—is all that is needed to renew radiotherapy centres and to ensure that all patients, not just those who live in London or near to major conurbations, can receive treatment within the recommended 45-minute travel time. I know that other hon. Members will say a little more about that.

We are also asking for an additional £100 million a year, increasing the cancer funding for radiotherapy from the current 5% a year to 6.5% a year, to ensure sufficient funding for workforce planning, including ensuring that there is suitable training, and ensuring that there is an effective IT network, equipment upgrades and a rolling programme to ensure that all radiotherapy machines across the UK are up to date. According to analysis of freedom of information requests made by Action Radiotherapy, more than 40% of NHS trusts in England—all bar six responded to the requests—that provide radiotherapy have machines that are past their recommended lifespan, leading to less efficient and effective care.

The current system of commissioning for radiotherapy often incentivises trusts not to use their most modern precision radiotherapy machines to their full capability. That means that some patients are treated more often and less effectively, even though there are modern stereotactic ablative radiotherapy machines that could treat them more effectively. Precision radiotherapy is needed to cure 40% of cancers, and all that we want is to ensure that all patients can get to a radiotherapy machine and that the professionals are allowed to switch on the machines and provide the appropriate treatment. However, chronic underfunding and the complications of radiotherapy commissioning and delivery are preventing that from happening.

Radiotherapy receives only 5% of the cancer treatment budget. At £383 million a year, that represents 0.025% of the total NHS budget, and I want to compare that with the cost of just two cancer drugs. The NHS budget for Herceptin—an effective drug that is used to treat about 15% to 20% of breast cancer patients—is £160 million. A recent UK trial showed that only six months, not 12 months, of adjuvant Herceptin may be needed for adjacent therapy, which is when the drug is used in combination with radiotherapy. In financial terms, the NHS could therefore save up to £80 million a year, offsetting much of the additional radiotherapy costs.

It is time to put radiotherapy back at the top of the NHS agenda, and we need someone to advocate for that. We are urging the Department to appoint a radiotherapy tsar who will ensure that the NHS has a world-class radiotherapy service. Many other MPs want to speak in the debate, so I will keep my remarks short. I am pleased that the Government have accepted that advanced precision radiotherapy is more effective and has fewer side-effects.

In summary, I want to see a modest increase in the budget for advanced radiotherapy, rising from 5% to 6.5% of the cancer budget. That would enable large numbers of cancer patients to live longer and more fulfilling lives and would achieve better outcomes and more positive economic benefits. I am keen to ensure that Members have an opportunity to participate in the debate. There are many issues that we need to highlight, including in relation to commissioning, workforce planning and IT networks, so I will leave it at that to allow others to participate.

[Several hon. Members rose—]

--- Later in debate ---

[Grahame Morris]

I thank the Minister for that considered and helpful response. I can assure her that the spirit of our contributions, and of the all-party parliamentary group, is intended to help, not to hinder progress. We certainly give her credit for the aspiration to improve cancer outcomes and to see a first-class service. We want to see that in all parts of the United Kingdom.

I thank all Members who participated in the debate. The hon. Member for Chichester (Gillian Keegan) highlighted the perverse incentives, which have been identified in the all-party parliamentary group’s inquiries. The hon. Member for Westmorland and Lonsdale (Tim Farron) mentioned the satellite centres and the number of people being denied life-saving therapy. My hon. Friend—my dear friend—the hon. Member for Blackburn (Kate Hollern), in a deeply moving contribution, talked of her personal experience. My hon. Friend the Member for Rhondda (Chris Bryant) talked about the importance of workforce planning and early diagnosis. My hon. Friend the Member for Heywood and Middleton (Liz McInnes) also mentioned workforce issues. My hon. Friend the Member for Manchester, Withington (Jeff Smith) talked about the exciting developments in proton beam therapy at the Christie Hospital. My hon. Friend the Member for Dewsbury (Paula Sherriff) gave an excellent response on behalf of the Opposition.

I also want to thank all the staff involved in delivering cancer services. We value the contribution they make—each and every one of them—and we are absolutely dedicated to ensuring that the issues we have raised here are followed through.

I have one point to make on tariffs and perverse incentives. As part of our efforts, we have met extensively with NHS England. Addressing that is potentially a quick win for the Government, because it would not involve evaluating new techniques and could be done quickly. My suspicion is that NHS England does not intend to implement that for some time—in years rather than months—so I hope that the Minister will take that up immediately.

Question put and agreed to.

Resolved,

That this House recognises the vital role that radiotherapy plays in cancer treatment across the UK with an estimated one in four people needing that treatment at some stage of their life; notes that there is a significant body of expert opinion that up to 24,000 people may be missing out on the radiotherapy they need, resulting in many hundreds of unnecessary or premature deaths; further notes that the UK spend on radiotherapy as a percentage of the overall cancer budget is approximately five per cent which compares badly with most other advanced economies where the percentage varies from nine per cent to 11 per cent; notes that the current commissioning system for radiotherapy is suboptimal as exemplified by a tariff regime which discourages NHS Trusts from implementing advanced modern effective radiotherapy; calls on the Government to provide an immediate up-front £250 million investment in the service, an ongoing extra £100 million per annum investment in personnel and skills and IT, and to introduce a sustainably, centrally and fully funded rolling programme for Linac machine replacements; and further calls on the Government to appoint a single person to oversee the commissioning and implementation of radiotherapy services.