Thangam Debbonaire (Bristol West) (Lab)
It is a great honour to follow the hon. Member for Dumfries and Galloway (Mr Jack), who spoke so passionately and knowledgeably for better understanding, treatment and diagnosis of blood cancer.
Like everyone in the House, I could speak about many aspects of cancer, including my own experience. I could speak about the very moving speech made by Baroness Jowell in the other place—a very special moment in Parliament’s history, and one I will always be glad to have been there for, although I am very sad that she had to be there. I could speak about how horrible chemotherapy is and about how deeply a girl can feel the loss of her eyelashes, for example. I could speak about my support for health labelling for alcohol, as so few people are aware of the connections between alcohol and breast, bowel and other cancers.
The Parliamentary Under-Secretary of State for Health (Steve Brine)
indicated assent.
Thangam Debbonaire
The Minister is nodding vigorously from a sedentary position, and I hope that means he will support better labelling.
I could speak about how important healthy habits are generally for reducing cancer, and again I ask the Minister to do more to urge people to take up those healthy habits from an early age. I could speak about how all women should learn how to check their breasts properly, because so many have told me that they do not how to do that. I could talk about what I learned last week in CERN, of all places, where the Large Hadron Collider is, about the contribution that that scientific institute has made to improving diagnoses of cancer. I could mention, for instance, the development of the MRI—the magnetic resonance imaging—machine. I spoke to scientists there who, I am glad to say, are doing what they can to reduce the very frightening knocking that happens when a person is inside the machine. However, today, I am going to speak about the patient experience of a very specific group—children and young people with cancer and their families.
I say to those children and young people, their parents, their brothers and sisters, their clinicians and the charities supporting them, who may be listening, that this speech is for you. I pay tribute in particular to CLIC Sargent and the Teenage Cancer Trust and thank them and all the other charities, too numerous to mention, that help children and young people with cancer every day. I want to give a very personal thanks to my sister-in-law Emilie, whose volunteering, fundraising and work for CLIC Sargent is an inspiration to so many and whose personal knowledge has taught me so much.
Grahame Morris (Easington) (Lab)
I thank the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) for opening this debate on behalf of the hon. Member for Basildon and Billericay (Mr Baron), and I pay tribute to his excellent work over many years as chair of the all-party group on cancer. I am delighted to support this debate, and as someone who has always taken a key interest in cancer strategy, I wish to highlight three issues. Pancreatic cancer has been well covered by my hon. Friend the Member for Scunthorpe (Nic Dakin), so I will refer to it only briefly. I also want to mention transformation funding and make a plea to the Minister, and I will say something about advance radiotherapy—a hobbyhorse of mine.
As hon. Members may be aware, I have recently recovered from a reoccurrence of lymphatic cancer, so I have first-hand knowledge of the importance of getting the cancer strategy right, not least in terms of early diagnosis and appropriate treatment. Delivering the recommendations set out in the cancer strategy is crucial to improving care and support for thousands of people affected by cancer. I do not seek to make a party political point about the nature of that policy, but essentially it requires resources, a plan, a strategy and commitment.
Sadly, pancreatic cancer has taken friends of mine, and it is particularly nasty. It has the worst five-year survival rate of the 20 most common cancers at less than 7% across the UK—a figure that has hardly changed over the past 40 years. In most other types of cancer, survivability has gone up. For pancreatic cancer, however, it has remained fairly flat. We urgently need investment and action, because pancreatic cancer is set, on current trajectory, to become the fourth biggest cancer killer by 2026. Currently, 80% of pancreatic cancer patients are diagnosed at the stage where the disease is advanced. Surgery is the only potential curative treatment, but sadly it is not an option when the disease is at an advanced stage. As far as I am aware, pancreas transplants are not an option. Early diagnosis is therefore absolutely key to improving the appalling survival rates and ensuring that patients are able to live longer following diagnosis.
I looked up the figures for my own area. Between 2010 and 2014, pancreatic cancer took the lives of 188 people in the Easington, Durham dales and Sedgefield clinical commissioning group area. It is clear that much more work is needed to deliver the kind of change we must see for the people affected, and their families, so we can achieve the improvements in survival rates that are so desperately needed.
Not long ago, I had the pleasure of visiting a local National Citizen Service group of young volunteers in my constituency—I think many Members have taken similar opportunities. The House might be interested to note that one group of young people were raising money for a chemotherapy ward because of their personal and family experiences. They thought that the facilities available were inadequate. This was because the ward, although filled with excellent and committed staff, was grappling with an increase in demand and a lack of funds. These young people raised enough money to buy an assortment of things, including floor fans to keep the patients cool. It is an indictment that, when we are putting additional money into the recovery fund and encouraging people to get through the treatment and to go on, we are relying on charitable donations.
At the Britain against Cancer conference 2016, the chief executive of NHS England announced £200 million of funding for treating cancer, along with improving early diagnosis and funding stratified pathways. The money was intended to support the roll-out of the recovery package. However, since this transformation funding was announced, there have been significant delays in its reaching cancer alliances, with only nine of 16 alliances having received funding. At the Britain against Cancer conference in December 2017, the Secretary of State for Health said that the release of funding to cancer alliances would be delayed in areas that were unable to demonstrate an improvement in their 62-day waiting time standard. That was an additional requirement that had not been included as part of the original criteria set during the bidding process.
Every person diagnosed with cancer—it does not matter where they live—should be able to rely on timely diagnosis and treatment when they are told they have cancer. However, as the final report from the all-party group on cancer’s inquiry concluded, the delayed release of funding to the cancer alliances has had a significant impact on their ability to make progress. I hope the Minister is paying attention, because I want to ask him a question.
Grahame Morris
I am very glad to hear it, because this is a serious point. The Department of Health and Social Care must decouple the release of transformation funding to cancer alliances from progress against the 62-day waiting time standard. I hope the Minister will address that point in his remarks. [Interruption.] I look forward with anticipation to his remarks.
It would not be a contribution on health from me if I did not mention advanced radiotherapy. I have raised regularly its benefits and advocated further investment in its research. Investment and research, given the cost, should be evidence-based, but there are some really quite exciting areas: in particular, proton beam therapy—I visited University College Hospital in London for part of my treatment and saw the installation of the proton beam therapy bunker and equipment there; stereotactic ablative body radiotherapy; adaptive radiotherapy based on advanced imaging—a kind of magnetic resonance linear accelerator; combinations of radiotherapy and novel drugs; biomarkers with selections for altered radiotherapy strategies so that radiotherapy can precisely target the cancer cells; and molecular radiotherapy. It is necessary that we evaluate the use of these new radiotherapy techniques and compare them with conventional radiotherapy and some surgical techniques, as radiotherapy is sometimes more effective than surgery and pharmaceutical products. I am advocating that they be used not instead of, but alongside other treatments and following considerable evaluation. This could result in better outcomes and reduced treatment costs.
Finally, I would like to thank all my colleagues on the all-party group on cancer, the cancer charities that continue to do excellent work and all those in our national health service working in cancer prevention and treatment.
The Parliamentary Under-Secretary of State for Health (Steve Brine)
I should like to thank my friend the shadow Minister, the hon. Member for Washington and Sunderland West (Mrs Hodgson), for her remarks. I congratulate the members of the all-party parliamentary group on cancer on securing the debate, in particular the hon. Members for Scunthorpe (Nic Dakin) and for East Kilbride (Dr Cameron)—I shall leave it at that in describing the hon. Lady’s constituency, lest I make a total fool of myself. As the cancer Minister—Members will know that that is the job I always wanted to do—I thank them for the constant work they do on the all-party group and on the Britain Against Cancer conference. Linked to that, I want to extend my appreciation to the Members on both sides of the House who chair the all-party parliamentary groups on different kinds of cancer for the work they do. Some of them are here today. As has been mentioned, I was a co-chair alongside the shadow Minister and the previous Member for Mid Dorset and North Poole and we were quite a team. We were often referred to as Steve and the girls—I found my inner girl. We chaired the group together for five years and I was so proud to do that. We met some amazing people and I think we did some good.
With the shadow Minister, I was also vice-chair of the all-party parliamentary group on ovarian cancer—she still chairs that group—so I know how important it is that Parliament allocates time for this subject, both upstairs in the APPGs and here in the Chamber. Looking at how many people are in the Public Gallery and around the Chamber, this is about quality more than quantity. I say to those watching today who may say, “This is a debate on the cancer strategy. This is so important. Why isn’t the House as full as it is for PMQs?”—this is not all about what goes on in here. This is about what goes on in government, what goes on upstairs in the APPGs and Select Committees and, for so many Members, what goes on within ourselves. I did not know the shadow Minister’s motivation for chairing the APPG. I have never said my motivation—I will one day—but I realise now why she was so passionate.
The hon. Member for East Kilbride pretty much summed things up in the first line of the first speech of this debate when she said that we are all “on the same side” when it comes to cancer—what a brilliant way of putting it. The hon. Member for Coventry North East (Colleen Fletcher) talked about her husband, who lives with cancer. Macmillan has been brilliant with some of its communications, and we have all seen the television adverts saying that a mum with cancer is still a mum. There are so many people who are living with and beyond cancer—they call it “survivorship” in America—and we should always remember that.
Let me start by reassuring the House, if I need to, that cancer is a huge priority for me, for the Secretary of State and for this Government. As several Members have said, cancer survival rates have never been higher, and the latest survival figures show an estimated 7,000 more people surviving cancer after successful NHS cancer treatment compared with three years prior. Our aim is to save 30,000 more lives by 2020 through the cancer strategy that we are debating.
However, I know more than anybody that there is still so much more to do and so much potential, which is why we accepted all 96 recommendations in the cancer strategy. We have backed that commitment with over £600 million of additional funding up to 2021. We are now just two years into the implementation of the strategy, and the fantastic NHS cancer doctors and nurses supporting us to achieve our vision have made tremendous progress in many areas. I echo what many Members have said in their support.
The shadow Minister and others asked whether I will report back on how we are doing on all this. In October, NHS England published its “two years on” report on the day that I gave evidence to the all-party parliamentary group on cancer’s inquiry, which led to its report and to this debate. That was our latest progress report, and I hope that we will be doing something again later this year. NHS England’s national cancer director, Cally Palmer, who is based at the Royal Marsden Hospital and is an incredible lady with whom I enjoy working, is leading the implementation of the strategy. She agrees with me that there are many areas where we agree with the APPG’s report. We do not shy away from scrutiny, which is exactly why we are here. However, progress in many areas was not given sufficient prominence in the APPG’s analysis of progress. We said that at the inquiry. It is important that I put that on the record.
The measure of the strategy’s success will of course be about significant improvements in early diagnosis, which I will come on to, and obviously treatment and research. However, I am increasingly aware in this job that we need to make cancer services even better beyond 2020 and that there needs to be a greater focus on a fourth pillar—the “fourth Beatle”, if you like—which is prevention. Of course, we want to be the best in the world at delivering positive outcomes for patients after a diagnosis, but we have to understand the position. Earlier this week, I responded to a Westminster Hall debate attended by Members from Oxfordshire. There has been a 120% increase in the number of people presenting with cancer in Oxfordshire alone in recent years.
The number of people presenting with cancer continues to rise. We can do very well on the first three pillars, and we are, but prevention is where we will really move the dial. That is why my whole mission as the Minister for primary care and public health, a role created by this Health Secretary, has been to put in place a comprehensive system of measures to reduce the risk of cancer, as well as to treat cancer when it occurs.
As my hon. Friend the Member for Chippenham (Michelle Donelan) and the shadow Minister mentioned, one of my first acts as Minister was to launch the tobacco control plan. Why was I so keen to get it out there? Because we promised we would, but also because tobacco is the biggest preventable killer in our country today. The previous Labour Government and this Government have done well with the legislative framework. It is now about supporting local areas to continue bringing down the number of people who smoke from what are already record lows and to ensure that people do not start smoking in the first place.
Last year, we also launched a cross-Government air quality plan, which has been in the news and in the House this week. That plan is important, too, because it will significantly reduce the carcinogens in the air we breathe, which we know has a big impact on the development of disease. Furthermore, in 2016 we published our child obesity strategy, which was just the start of a conversation about how we will reduce child obesity over the next decade. Our overarching focus in all that work is to ensure that our children are supported to live healthy, active and happy lives, so that they grow into healthy, active adults who are less likely to develop cancer. We have always said that the child obesity strategy is constantly under review—it is part one—and we will go further, if needed, to build on that.
As has been mentioned a few times in this debate, perhaps the biggest game changer in preventing cancer is the world-leading work on genomics happening in our country. The chief medical officer’s 2016 annual report, “Generation Genome,” which was published the year before I was appointed, set out the huge potential for genomics in helping us to understand the inherited and acquired genomic causes of cancer and in shaping future research and future personalised cancer treatment, which is so important—it is something we should talk more about, as we should the whole prevention agenda.
Many subjects have been raised today and I am grateful to you, Madame Deputy Speaker, and to Members for giving me time to respond to them. As I suspect she would like me to do, I will give a couple of minutes to the hon. Member for East Kilbride, who opened the debate.
As I have already said, the workforce is key to our strategy. We have already committed to investing in and expanding our diagnostic workforce to improve survival rates by diagnosing cancer earlier. The first ever cancer workforce plan, which Health Education England published in December, set out how we will expand our workforce, how we will continue to invest in the skills of the staff we have, and how we will use their time and expertise where it is most needed.
HEE has already committed to training 746 more cancer consultants and 1,890 more diagnostic and therapeutic radiographers, which we know are in short supply, by 2021. The plan further commits to the expansion of capacity and skills, including 200 additional clinical endoscopists and 300 reporting radiographers by 2021. HEE will also expand the number of clinical nurse specialists, as the shadow Minister rightly mentioned, and develop common and consistent CNS competences, with a clear route into training, to ensure that every cancer patient has access to a CNS or other support worker by 2021—that subject was constantly raised when I chaired the all-party group. HEE will follow the plan later this year with a longer-term strategy looking at the workforce needs beyond 2021.
The hon. Member for East Kilbride and others, including the hon. Member for Easington (Grahame Morris), talked about the link between the 62-day standard and the performance and phasing in of transformation funding. Cancer alliances, as the House knows, are an important mechanism for improving performance on the 62-day standard from urgent referral through to treatment. They bring together clinicians from primary and secondary care, as is right—one NHS. They ensure collective responsibility for the cancer services they provide, and they provide the necessary leadership for the transformation of services. So £76 million of funding has already been allocated to the cancer alliances.
It is imperative that the alliances have the operational rigour and readiness to achieve the transformation that we need. After all, our constituents’ money is being allocated. So it is only right and proper, as the Secretary of State made clear in the question and answer session at Britain against Cancer, that the alliances demonstrate their preparedness for this funding. That is not to say that the 62-day standard is a requirement, but it does give a basis on which NHS England and NHS Improvement, along with other senior clinical advisers, can assess an alliance’s readiness to transform services. Transforming services is what we want to do.
Grahame Morris
What happens when cancer alliances do not achieve the 62-day target? It seems completely perverse that individuals suffering from cancer in those areas are penalised by lack of funds from the transformation fund. Is the Minister saying that those cancer alliances can still apply for that funding and measures will be put in place to ensure that they do reach that target?
Steve Brine
Yes, this is not hard and fast. I noted that NHS England has written to me as a constituency MP and to all other MPs today with details of the cancer alliances that they have in their individual areas. I bang on about this every time, as the shadow Minister knows, but I implore Members to engage with their local cancer alliances. I suspect that the people in this debate do that, but I would hazard a guess that many other Members do not. Members should know who the cancer alliances are in their areas and should have a relationship with them.
Let me now discuss CPES, which the hon. Member for Strangford (Jim Shannon) mentioned, as did the hon. Member for Lincoln (Karen Lee). On her speech, let me just say, wow. I said to my officials before this debate that there is always one speech in these debates—the shadow Minister was that person a few weeks ago—who leaves not a dry eye in the House, and today it was the hon. Member for Lincoln. I know she is not in her place now and I do not blame her for that. I think the whole House wanted to run over to give her a hug—many Labour Members did, and bless them for doing that. I think that the House, in its own way, gave her a collective hug, and I say well done to her for an amazing speech.
We totally recognise how important CPES is in our continued drive to improve cancer treatment and care, and to monitor that progress. I have always been clear that I want any future survey to continue to deliver the high-quality data that CPES does. I can tell the House that CPES will continue in its current form in 2018-19. We will engage with the cancer community to ensure that any decisions about future delivery and the model to be adopted, should the commissioning arrangements be revised, are informed by all parties and ultimately protect the integrity of the survey and quality of the data. I saw Dame Fiona Caldicott last week in Oxford and discussed the subject with her. Obviously, her work as the patient data guardian led to the challenge we now have—it was necessary work, but it certainly left us with a challenge. Cally Palmer, the national cancer director, and I will meet all the major cancer charities next week at my second roundtable, and this is on the agenda and we will be discussing it with them. I hope Members know that CPES remains very much at the top of my agenda.
Let me touch on early diagnosis, because everybody else has and because it is one of the most important shows in town. In every conversation I have ever had about how we can beat cancer, I have been told, “Early diagnosis”. Historically, our cancer survival rates have lagged behind the best-performing countries in Europe and around the world. The primary reason for that is, without question, late diagnosis. Sir Harpal Kumar will stand down as chief executive officer at Cancer Research UK shortly, but I had the privilege of having lunch with him a few weeks ago, when I asked him what we should think about in terms of the next cancer strategy. He said, “The rock upon which you build your church is early diagnosis.” I will not forget that, which is why one of the key priorities of the strategy is to diagnose cancer earlier, when the disease is more treatable.
How are we doing that? As part of our drive to ensure early diagnosis, we are also introducing the new 28-day faster diagnostic standard from GP referral to diagnosis or the all-clear. I have often said, and I repeat now, that 28 days is not a target; it is a maximum. I well know that when people have a cancer worry, 28 minutes seems like a lifetime, let alone 28 days. However, the 28-day standard is really important. It will be introduced from April 2020. Five pilot sites have started testing the new clinical pathways to ensure that patients find out within 28 days whether they have cancer or the all-clear.
Today, Public Health England, for which I have ministerial responsibility, has launched its 14th “Be Clear on Cancer” campaign, which focuses on breast cancer in women aged over 70, something monitored by my hon. Friend the Member for North Warwickshire (Craig Tracey)—my excellent successor chair of the all-party group on breast cancer—mentioned. That campaign will run until the end of March. It focuses on age-related risk, encouraging older women to be breast aware, and particularly to be aware of non-lump symptoms, which, understandably, have lower levels of awareness.
The other point I want to make on early diagnosis is that we know that the hardest cancers to detect are those where early symptoms can be vague and often symptomatic of less serious illnesses. Patients often see their GP multiple times before that all-important referral. That is why we are piloting 10 multidisciplinary diagnostic centres as part of wave 2 of what we call the ACE— accelerate, co-ordinate and evaluate—programme. Patients presenting to their GP with vague symptoms can be referred to an ACE centre for multiple tests, one after the other, and receive a diagnosis or the all-clear on the same day. The initial findings are incredibly exciting; I do not get easily excited, but I am excited about this. I had the pleasure of visiting one of the ACE pilots at the Churchill Hospital in Oxford last Tuesday, during recess, and I have to say that the enthusiasm and feedback I got from clinicians and patients about the potential of the ACE centres were really quite incredible. I look forward to seeing the analysis on that work in the coming months.
The shadow Minister talked about emergency room presentations, which are something I was quite shocked by as a Back Bencher when I went to all-party group meetings. It is true that emergency room presentations for cancer are horrible, but that is why the 28-day standard and the ACE centres are so important. When I talk to GPs, they tell me that they will refer and that there will then be a wait. Patients who are, understandably, worried and terrified may then present themselves at an A&E, at which point they may be diagnosed with a primary cancer. That then hits the stats around emergency room presentations for cancer. It does not mean that those people have been carried in; they have often walked in. That all explains why we need to grip early diagnosis better than ever.
My hon. Friend the Member for Bosworth (David Tredinnick) talked about Baroness Jowell’s speech in the other place last month. The Secretary of State was there to listen to the speech, and it was incredibly powerful. Baroness Jowell met the Secretary of State and the Prime Minister this morning. Investment in brain cancer research has been limited by a pretty low volume of research proposals focused on the topic in recent years, and we have been working with charities, academics and the pharmaceutical industry to address that over the last 12 months.
To accelerate our efforts in brain tumour research, the Secretary of State has today announced, alongside Cancer Research UK and Brain Tumour Research, a package to boost research and investment into this most harrowing form of cancer. We have announced £20 million through the National Institute for Health Research over the next five years, with the aim of doubling this amount once new high-quality research proposals become available. CRUK has confirmed it will provide £25 million of its money over five years in major research centres and programmes dedicated to brain tumours. Today’s announcement is incredibly positive.
Rachael Maskell (York Central) (Lab/Co-op)
I have listened patiently and, unfortunately, I was not here at the beginning. However, my constituent has a very rare form of cancer. He has had to self-fund his treatment in Germany and Southampton, but he has run out of money. The treatment meant he did not die within the weeks he was given and is now living. However, he needs top-up therapy, and his individual funding request has been refused. Without his treatment, he will not live. Could the Minister look into this case?
Steve Brine
Obviously, I will not comment on the case. I was going to suggest that the hon. Lady gets the clinicians to make an IFR, but she can by all means bring the case to me.
My hon. Friend the Member for North Warwickshire talked about breast density. The UK National Screening Committee commissioned a Warwick University study to investigate the link between breast density and breast cancer. Once complete, if the review suggests that there should be changes to the national breast screening programme, the UK National Screening Committee, which we work with, will consider that under its modification programme. I am in touch with Breast Density Matters, which is a small charity—small but perfectly formed.
The hon. Member for Coventry North East and others talked about blood cancer. We had a very good Westminster Hall debate last month led by my hon. Friend the Member for Crawley (Henry Smith). As has been said, many patients with blood cancer diagnosis will sadly never be cured; they will be on the regime of watch and wait, often over many years, to see whether the cancer has progressed to a point where treatment needs to begin. That can take a huge psychological toll, which Members have mentioned, on the patient and their families.
By 2020, every patient will receive a holistic needs assessment as part of the recovery package, which is excellent. For the blood cancer patient, their recovery plan will be personalised to take account of the unique characteristics of blood cancer and will include their mental health needs. That is why the Secretary of State announced the additional £1.3 billion last July to expand the mental health workforce. My hon. Friend the Member for Dumfries and Galloway (Mr Jack) made that point very well in his speech—I say this as I am passed a note. I love the notes from the Whips.
Steve Brine
No, I will not, because I want to finish.
My hon. Friend the Member for Dumfries and Galloway touched on the cancer dashboard, including, yes, rarer cancers. NHS England and Public Health England are currently considering next steps on how we can expand the dashboard. They know that I am frustrated about its being limited to the top four, and I want to see us expand it and do better, and they have had a very clear direction from me on that.
The hon. Member for Bristol West (Thangam Debbonaire), as always, spoke brilliantly. What a brilliant advertisement for her all-party group and its inquiry. If there is anything that I can do to help—I do not know about the cost of cancer report, but if she sends it to me, I would love to see it—she knows that she only needs to ask.
The hon. Members for Scunthorpe and for Easington talked about pancreatic cancer. NHS services for pancreatic cancer have significantly improved in recent years, with clearer diagnostic pathways, decision making by specialist multi-disciplinary teams and the centralisation of pancreatic surgery with specialised teams. On 7 February, the National Institute for Health and Care Excellence published the final guidance on the diagnosis and management of pancreatic cancer in adults. This will ensure quicker, I think, and more accurate diagnosis referred to specialist MDTs and better access to psychological support. The hon. Member for Scunthorpe mentioned tumour profiling tests. NICE has made a decision on that. I will get it to write to me with an explanation of that decision, as he has asked, and I will share that with him.
Let me conclude by paying tribute to the staff who do so much, the patient groups and the charities that are working so hard as part of team cancer—we are all on the same team when it comes to cancer—to implement the cancer strategy and to save lives. We are on track to deliver, we think, but we need to make more progress, especially on early diagnosis and looking further forward on the subject of prevention, as I have said. I thank all Members for speaking today. The fight goes on.