Breast Cancer Diagnosis and Services: Covid-19

Neale Hanvey Excerpts

Thursday 12th November 2020 Westminster Hall

[Neale Hanvey (Kirkcaldy and Cowdenbeath) (SNP)]

I thank the hon. Member for North Warwickshire (Craig Tracey) for securing this very important debate, and I congratulate him on his compassion and lucidity in presenting his case. I start by paying tribute to all the NHS, research and charity staff who have been working on the frontline in their respective disciplines to ensure that we move through this challenging time and continue to meet the challenges of breast cancer.

Breast cancer is the most common cancer, with one in seven women affected, and the impact of covid-19 is most keenly felt by those women and has the greatest potential to affect the lives of so many because of its prevalence. Covid has had an impact on almost every aspect of our lives. We have heard that 1 million women have missed their breast cancer screenings, but the covid pandemic has affected all aspects of the cancer pathway, from screening and diagnosis to treatment and follow-up care.

The reasons are varied, and include concern and fear over attending, cancellations due to re-deployment and the impact on the wider NHS services, radiology, surgical, medical and clinical oncology. All of those aspects of the treatment pathway have felt the impact, including, as I mentioned earlier, the capacity for clinical trials and research. In that spirit, I led a cross-party letter to the Chancellor asking for the Government to consider the establishment of the life sciences charity partnership fund to support the charities that have been significantly affected by the covid pandemic.

The design and success of cancer treatment is absolutely reliant on early diagnosis, as it allows rapid progress to treatment, prompt surgical intervention in the case of breast cancer, and onward to radiotherapy or chemotherapy, or indeed both. As such, it maximises the efficacy of those interventions, whilst allowing tissue and immune systems to recover. However, there are challenges.

The Royal College of Radiologists has highlighted that there has been a reduction in referrals for symptomatic breast cancer within the two-week wait standard and a reduction of clinical capacity. There have been some innovative moves, where appropriate, for a hyperfractionation of radiotherapy treatment schedules. The royal college also noted that radiologists are having to deal with attendance anxiety. It has, however, also noted innovative changes to the configuration of services, which have enabled some of the softer aspects of cancer care to continue where possible.

The impact on the challenges that were already present prior to covid also needs to be considered. I remember—more years ago than I would like to mention—when I was involved in peer reviews with a London cancer network there was already a shortage of radiologists within the cancer pathway. That problem has, sadly, not gone away. It is not a problem unique to the English system at all. There is at least one consultant vacancy in clinical oncology. Another important issue to consider is that the attrition rate for consultant posts is greater than the ability to recruit. Thus, there is a pressing need to move these challenges forward.

The new ways of working—telemedicine, Hospital at Home, and other innovations—need investment. There is also a need to reassess the skill base of the workforce and acknowledge chronic excessive workload, which has been highlighted by The King’s Fund. According to Macmillan, there is a need more generally to recruit around 2,500 cancer nurses alone—of course, other disciplines, from GPs to radiographers, also need consideration for recruitment.

The post-covid recovery plan must include significant investment in diagnostics and treatment, radiology, recruitment and training in specialist allied disciplines. Effectively, the covid pandemic has landed a narrow aperture at the point of diagnosis for many cancers and, because of its prevalence, breast cancer is a significant cohort. To widen that aperture, there is a real and pressing need for funding to come forward in the comprehensive spending review; it must deliver an expansion of service to support innovation, fund the NHS plan and support social care.

It is important to acknowledge that staff in hospitals have been working incredibly hard throughout the pandemic, but there is only so much that we can squeeze out of them, and we cannot rely on a never-ending supply of goodwill and extraordinary resilience. My suggestion echoes a plea from my hon. Friend the Member for Central Ayrshire (Dr Whitford), who is a breast cancer specialist herself: clinical audit and quality improvement standards need to be at the heart of the drive forward. That work has been commended by the Nuffield Trust in its “Learning from Scotland’s NHS” paper.

We need to support getting it right first time, while making great strides to enable clinical outcome data to be captured and the impact to be fully understood. In short, substantial investment is no longer optional, and I hope that in the spending review the Government make the necessary investments, as called for by the hon. Member for North Warwickshire, to ensure that that is brought forward.