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The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
It is, as always, a pleasure to serve under your chairmanship, Mr Davies.
I begin by acknowledging and thanking the many thousands of people who have supported the petition in memory of Poppy-Mai Barnard. I extend my deepest sympathies to Poppy-Mai’s family and friends. I also thank my hon. Friend the Member for Bath (Ben Howlett) for the thoughtful way in which he presented the petition. The debate has been moving. I shall do my best to respond to as many comments as possible; if I fail, I shall write in response.
I acknowledge the success of Poppy-Mai’s family in raising more than £100,000 in her name, with the aim of building a sanctuary for children with terminal illnesses and their families to make memories. I know that they would, in the spirit of the petition, want action to ensure that fewer and fewer children have to suffer from cancers, and that they would want to know that the Government are investing in key research and innovation to that end. I hope that there is some comfort to be derived from hearing of the work of the NHS and its partners to benefit children and their families in the future. I thank colleagues on both sides of the House for their moving and highly informed contributions and all who have bravely shared personal stories. They remind us forcefully of why we must fight harder in the battle against childhood cancer. The importance of that cannot be overstated.
At this point, I want particularly to respond to the hon. Member for Alyn and Deeside (Mark Tami), who made some extremely important and pertinent points, in particular about ensuring that there is the right support for families. They must battle on many fronts, not only at the point of diagnosis but in the longer term. As the Minister responsible for mental health I share the hon. Gentleman’s view that we must do better in taking into account the mental health implications of long-term and critical illness. I shall certainly take up his challenge to consider the issue of higher suicide rates among childhood cancer survivors. At the moment we are in the process of refreshing the suicide strategy, targeting vulnerable groups. I shall consider the issues that the hon. Gentleman raised.
We can take heart from the fact that we are making progress in a number of areas. National statistics reveal a general trend of increasing five-year survival for children aged up to 14 diagnosed with cancer in England. In 1990 only 67% of children diagnosed with cancer survived five years; in 2009 that had increased to 80.9% of children. The figure was about 40% in the 1970s, which enables us to understand how far we have come. However, some types of children’s cancers, as we have heard, remain hard to treat, with longer-term physical and psychological consequences. In the past few decades we have improved our understanding of the consequences and have been able to manage them better; but we must and can do better. As the hon. Member for Birmingham, Selly Oak (Steve McCabe) said, we need to speed up the translation of basic research into patient care, and to improve the quality of survivorship.
As my hon. Friend the Member for Bath said, the five-year cancer strategy for England is at the forefront of our efforts. That was produced on behalf of the whole cancer community by the independent cancer taskforce. It is our aim through that strategy to save an extra 30,000 lives of all ages by 2020. The taskforce, as hon. Members would expect, brings together all the major players supporting people with or at risk of cancer. It includes patient groups and voluntary sector organisations, which we know are crucial to the support of cancer patients. I join colleagues in paying tribute to Oliver, the nephew of the hon. Member for Barnsley East (Michael Dugher), and to Be Child Cancer Aware, Anthony Nolan, Cancer Research UK and many other charities that do so much in this area. Without the outstanding work of many medical charities, our work would be less robust and innovative and there would be less hope of bringing about the step change that we need.
The strategy was published in July 2015 and was followed by an implementation plan to take it forward in May 2016. The first annual report was published last month. The Government accepted all 96 recommendations of the strategy, some of which are directly related to children, including a review of children’s and young people’s cancer services to inform actions. The aim is to deliver improvements across the cancer pathway and to improve the quality of care and survival rates—to make exactly the Herculean effort, and with the same co-ordination, called for by my hon. Friend the Member for North Thanet (Sir Roger Gale).
I am relieved that the taskforce found that cancer services for children and adults, and the outcomes in those services, have improved in recent years. The strategy is specifically designed to build on that momentum. Many of the recommendations relate to all cancers and cancer services; but of course some are relevant to, and greatly benefit, children and their families in their experience of care, and improve outcomes.
NHS England is leading the health and care system in delivering the strategy and investment is being targeted to support that. Key elements include: investing up to £300 million a year by 2020 to increase diagnostic capacity to meet a new faster diagnostic target—many people have spoken of the importance of early diagnosis —so that all cancer patients will be given a diagnosis or the all-clear within 28 days of GP referral; investing £130 million to modernise radiotherapy across England, ensuring that over the next two years older Linac radiotherapy equipment being used in hospitals will be upgraded or replaced, so that patients get access to the latest leading-edge technology regardless of where they live; establishing cancer alliances throughout the country to drive clinical leadership; and supporting the national cancer vanguard to test new models of care.
A theme of the strategy is the improvement of information on services and outcomes, including, from 2017-18, exploring approaches to collecting data on the experience of care of children who are cancer patients.
Thangam Debbonaire
On the point about upgrading Linac machines for radiotherapy, one of the key problems that Cancer Research UK raised with me was radiographer and radiologist staffing shortages. Can the Minister add anything to reassure us that when the Linac machines are upgraded there will be sufficient staff?
Nicola Blackwood
There is also work being done on making sure the workforce are in place; and there is an overall strategy with Health Education England to do that. I am happy to write to the hon. Lady to give her details. I am slightly concerned that I have a lot to get through and I am going to bore everyone.
The taskforce has also recommended a new drive to deliver chemotherapy e-prescribing, which makes a significant difference to the experience of families who are supporting children being treated for cancer. Providers are working to implement plans for children by September 2017. Under the strategy, proposals will have been developed by March 2017 to improve the transition of young patients with cancer between children’s and adult services. As the hon. Member for Bristol West (Thangam Debbonaire) has said, transitions continue to pose a problem in some areas, with paediatric services stopping at 16 in some hospitals, but adult services not starting until 18. In addition, pathways between specialist centres and shared care units currently cause great difficulty for patients. The strategy says that there is a need to address that, and I hope that the hon. Lady will be reassured that work is being done on it.
An important recommendation of the strategy is that NHS England, the National Institute for Health Research and cancer research charities should work together to consider how to achieve a significant increase in access to clinical trials for teenagers and young adults with cancer—the shadow Minister, the hon. Member for Burnley (Julie Cooper) spoke about that. A far smaller proportion of teenaged and young adult patients than of younger children take part in clinical trials. There is obviously an opportunity that we need to grasp. The strategy recommends that we explore ways in which clinical trials for children and young adults with cancer could be significantly increased. As the shadow Minister said, NHS England should set an expectation that all centres should aim to recruit at least 50% of their patients for those trials by 2025. That is the target that we are reaching for.
Outside London, only four centres treat more than 100 children with cancer a year, across all types of cancer. The strategy recommends that NHS England, working through the children, teenagers and young adults clinical reference group, should consider whether outcomes could be improved through further reconfiguration of services, as the shadow Minister said. Any review should again be based on patient outcomes, including patient experience, as few centres offer comprehensive specialist services for children at the moment.
Many hon. Members have rightly called for research to be prioritised in that context. It is good that, since 2010-11, we have increased annual investment in cancer research through the National Institute for Health Research, including research into childhood cancers, from £101 million to £142 million. However, we know that a lot more needs to be done if we are to deliver the changes that we want to see. That is why the Government announced the largest ever investment in health research in September— £816 million over five years from April 2017. Some 20 NHS and university partnerships across England have each been awarded funding through the NIHR, and we expect to see significant research activity in childhood cancers within that programme of investment.
The NIHR is also collaborating with three charities—Teenage Cancer Trust, Children with Cancer UK and CLIC Sargent—to identify gaps and unanswered questions in research into young peoples’ cancer and to then prioritise those gaps that patients and clinicians agree are the most important. The initial survey opened just last month, so we expect to see progress on that soon.
A new working group has brought together clinicians, charities and officials to discuss how we can increase the level and impact of research into brain tumours, including those in children. The group first met in October and the Government anticipate that it will complete its tasks by September. I will be co-chairing the next meeting in January with the Department of Health’s chief scientific adviser, Professor Chris Whitty, to make sure that we make the progress needed.
Julie Cooper
Does the Minister agree with the important comments made by brain tumour charities that EU funding is fundamental, and will she commit to ensuring that, should we not have access to EU research funding post-Brexit, the UK Government will make sure that that gap is filled?
Nicola Blackwood
The shadow Minister has made some important points about the EU, as have a number of colleagues, and I will come on to them before I finish. First, let me complete my remarks on the amount of funding that we have put into research, because it is important that it is seen as a package. Less than two weeks ago, the Government announced a further £112 million of funding to support the skilled personnel and cutting-edge facilities needed to help at the forefront of clinical research—experimental clinical research in particular, including research into child cancers. I visited one of those facilities myself, and they are an important aspect of the research we are supporting. The Chancellor announced £2 billion additional funding per year for research and development by 2020-21 in the autumn statement, including for scientific research at universities and businesses. That is another part of the picture.
The hon. Member for Birmingham, Selly Oak, who is not in his place, spoke of the importance of precision cancer medicines. The Government agree, which is why we have funded the 100,000 genomes project, to diagnose, treat and prevent rare disease and cancer, including childhood cancers. The Government have invested hundreds of millions of pounds in that project to date and it is already making a difference—the first children with rare diseases have received diagnoses through the project at Great Ormond Street Hospital. The project promises to offer a genuine step-change in diagnosis and precision treatment, which is encouraging.
Ben Howlett
The Minister is being very generous with her time. I am pleased about the rare diseases aspect of what she has just mentioned. However, when engagement exercises are being undertaken with charities, it is often the case that the larger cohorts are focused on. Will she give assurances that in those engagement exercises with charities, some of the rarer cancers will also be a focus?
Nicola Blackwood
My hon. Friend is absolutely right. It is important to make sure that all different groups and diseases get the attention that they deserve. That takes me on to the issue of patient cohorts and the importance of collaboration across Europe.
For particularly rare diseases or cancers, it is sometimes necessary to look across borders to make sure that research includes the right numbers of patients. That has been a particular focus of the Department, and I am confident, owing to the work that we have been doing, that international—particularly European—networks and data sharing for research purposes will continue. We need to make sure that initiatives that have facilitated research, such as the paediatric medicines regulations, continue. My noble Friend Lord Prior is leading on that area of policy. I know that he is closely involved in all of those issues, and I am going to ensure that the specific concerns that have been raised today are passed on to him and are not dropped.
I assure the shadow Minister that the Chancellor has guaranteed that the UK will continue to have all of the rights, obligations and benefits that EU membership brings, including EU funding—up until the point that we leave, obviously. The Treasury has also committed to underwrite the payment of awards to UK organisations that make competitive bids to the European Commission —for example, for universities bidding for Horizon 2020. In addition to all of the funding I have spoken of, those moneys are protected.
My hon. Friend the Member for Bath made a couple of points about reviewing the work undertaken by NHS England to ensure that more children receive the treatment that they deserve. We will be working closely with NHS England and all partners to make sure that the strategy we have put in place becomes a reality and that the right performance metrics are in place, although that is a challenging process. Our best measure of success will be the cancer survival statistics. Those are currently provisional, but the Office for National Statistics will hopefully be assessed by the UK Statistics Authority in the future.
We have heard from many hon. Members of some deeply moving cases of young people battling cancer. We have heard of their courage and resilience, and of the fortitude of their parents and siblings.
Wes Streeting
I am grateful to the Minister for giving such a thorough and thoughtful response to the debate. As I mentioned, Kaleigh’s family are campaigning on DIPG. It would mean a lot to them if the Minister or one of her Departmental colleagues met them to talk about their experience and their hopes for how research funding in this area might improve the search for a cure going forward. Is the Minister able to make that commitment?
Nicola Blackwood
I am sure that either I or a Departmental colleague will be delighted to meet the hon. Gentleman and his constituents. It was moving to hear of their campaign.
Holding the Government and the NHS to account in this way could not be more important. I hope that my response has made completely clear not only my personal commitment but the Government’s wholehearted commitment to funding life-changing innovation and research into cancer, to delivering the cancer strategy in a way that transforms cancer care for current and future generations and to improving the long-term quality of life of childhood cancer survivors. That is surely the greatest memorial that we can offer to each and every one of those brave children who, like Poppy-Mai, have lost their battle with cancer. That is our task, and as I look around the Chamber, it is clear to me that each and every Member here will work as hard as they possibly can to make sure that they hold us to it.