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Jim Fitzpatrick (Poplar and Limehouse) (Lab)
I beg to move,
That this House has considered early diagnosis and the cancer workforce in the NHS long-term plan.
It is a pleasure to see you presiding over our business this morning, Mr Howarth. I wish everyone a happy new year. I thank the Backbench Business Committee for supporting the bid of a number of colleagues for this debate, and the Chairman of Ways and Means for allowing it. I was lucky enough to be chosen as the chief sponsor, but I recognise the support of other Members in this Chamber. I will try to keep my remarks to 10 minutes or thereabouts.
I am grateful for the many briefings we have had—we have had briefings from the House of Commons Library, Barts Health NHS Trust, Cancer Research UK, Breast Cancer Care, the Fire Brigades Union, Macmillan Cancer Support, Breast Cancer Now, the Royal College of Pathologists, Maggie’s, the British Lung Foundation, the Royal College of Physicians, CLIC Sargent and the Royal College of Nurses. I have had more briefings from interested parties on this debate than on any other in my 21 years here. Interestingly, they virtually all agreed on two basic points. First, they welcomed the fact that the Government have addressed their issues in the 10-year review and, secondly, they welcomed the new investment but asked for more detail about staff training, recruitment and retention.
Running through most of the briefings I received were questions about the publication of the NHS long-term plan, which was promised by the end of 2018. In very timely fashion, the Government published it yesterday. It has focused the debate but not eliminated the need for it.
I want to highlight some of the issues raised in the briefings. The Royal College of Pathologists cited disturbing statistics. Notably, just 3% of services reported that they have enough staff to meet clinical needs, and more than three quarters of departments reported vacancies for consultants. The royal college emphasised the need for early diagnosis and called for increased investment in pathology services, particularly in the recruitment and training of pathologists and scientists. It said that histopathologists should be listed on the shortage occupation list as there is a shortfall in that speciality. The Migration Advisory Committee currently includes no pathology specialities on the shortage occupation list. Placing histopathology on that list would help overseas qualified pathologists to obtain a visa to work in the UK.
Nick Thomas-Symonds (Torfaen) (Lab)
I lost my mother to bowel cancer last year, and I have been campaigning to reduce the bowel cancer screening age to 50. I understand from my campaign and the debates I have had that it is important that we get the pathology capacity right. Otherwise the reduction in the screening age will not work. Does my hon. Friend agree?
Jim Fitzpatrick
I certainly do. I am sorry to hear about the fatality in my hon. Friend’s family. I am sure the Minister will talk about staff and I will come to it later in my speech. Without staff in diagnosis and pathology services, the reduction in the screening age will be pointless.
The Royal College of Pathologists identified a growing demand for pathology services and predicted a 28% shortfall in staff by 2010. Cancer Research UK said, as we all know, that the earlier a cancer is diagnosed, the more likely it is that it will be treated successfully. The Labour Government’s initiative to reduce the time between an urgent GP referral to seeing a cancer consultant to two weeks was a success in ensuring swifter treatment, but 2018 was the first year in which that target was not met. I would be grateful if the Minister told us how the Government expect to address that slippage.
Cancer Research UK added that it expects new cancer cases to reach 500,000 a year by 2035—right now, it is 350,000. With more cases and more thorough screening measures, our NHS will need more diagnostic and treatment staff. Cancer Research UK highlighted that the promise to produce a workforce implementation plan after the 2019 spending review leaves the status of Health Education England’s upcoming cancer workforce plan unclear. Will the Minister give us more information about how the two initiatives relate to each other?
Macmillan said that it recognises and welcomes the focus on cancer in the NHS long-term plan, including the Prime Minister’s commitment radically to improve early diagnosis. However, it has concerns that the long-term plan will not adequately address the immediate and long-term pressures facing the NHS cancer workforce. It also asked when the workforce implementation plan can be expected this year. I note that the Health Secretary said yesterday that he expects Baroness Dido Harding to report to him by the end of March. I would be grateful therefore if the Minister can confirm that we can expect the publication of the workforce implementation plan by summer this year.
Breast Cancer Now made the point that only 18% of breast cancer screening units are adequately resourced with radiography staff, in line with breast screening uptake in its area. My area of north-east London is covered by Barts Health NHS Trust, the NHS North East London Commissioning Alliance and the East London Health and Care Partnership. Many of the points made by the national charities are apparent locally. Those bodies have made their concerns clear. They have raised the basic issue that cancer outcomes in north-east London are among the poorest in London and the country, and that presentation via the emergency route remains high and is clearly associated with advanced cancer and low one-year survival rates.
In my borough of Tower Hamlets, the one-year survival index of people diagnosed with cancer is 4% lower than the England average, and diagnosis through the emergency route remains high. The local NHS trust has plans to attack that problem with a new early diagnosis centre, which is due to open in December; the introduction of multi-diagnostic clinics, which were first introduced in Denmark and were supported here in the pilot phase by Cancer Research UK; and new faecal immunochemical testing for colorectal cancer in primary care from April this year. It plans a health and wellbeing school spread across the whole of north-east London, based on the principle of making every contact count. It is raising population awareness and screening initiatives, including placing staff to promote screening in GP practices, promoting text reminders for cervical cancer screening, video competitions for schools to promote vaccinations, prostate cancer targets, breast and bowel cancer target ads on Muslim TV channels, and the reintroduction of bowel screening reminder calling and other initiatives.
The North East London NHS Foundation Trust conclusions are relatively simple. The workforce is a key factor in delivering a faster diagnosis standard, expected by 2020 and beyond; earlier diagnosis of cancer needs a resilient and sustainable radiology, endoscopy and pathology workforce; the high cost of living, the lack of affordable housing and the disparity in salaries across London are barriers to recruitment; and there is a need to look at technology such as artificial intelligence and digital pathology, and innovations in careers.
CLIC Sargent raised the problem of diagnosing child cancer and said, worryingly, that more than half of young people diagnosed visited their GP with their parents at least three times before their cancer was diagnosed. That is of particular concern.
Breast Cancer Care also raised the workforce plan, and asked how the commitments of the current cancer strategy and the ambitions of the long-term plan will be met. The Royal College of Physicians told me that, in London in 2018, 27% of physician consultant posts advertised were not filled, and that across the UK a total 45% of advertised consultant posts went unfilled due to a lack of suitable applicants.
The British Lung Foundation made two key points: that early diagnosis is essential because almost half of lung cancers are diagnosed at stage 4 when survival rates are very poor; and that there is an urgent need to train and employ more NHS staff to diagnose lung cancer earlier. The Royal College of Nursing stated that in England there are nearly 41,000 vacant registered nursing posts in the NHS. It predicts that the number will increase to almost 48,000 by 2023 if the Government do not take action.
The Commons Library briefings said that the cancer workforce plan devised in 2017 recommended that action be taken to ensure that enough staff with the right skills are trained to deliver the cancer strategy by 2021. In November last year, the highly respected Professor Sir Mike Richards—NHS England’s cancer director—announced that cancer screening would be overhauled as part of the long-term plan. He also announced a review team to assess current screening programmes and a report is due this summer. I ask the Minister whether that timetable might coincide with the publication of the Government’s workforce plan. The Library stated that there is no measure of the total NHS cancer workforce. Will the Minister comment on that anomaly?
I would be grateful if the Minister addresses the fundamental issue raised in all the briefings: how the workforce implementation plan fits in with the strategy, and when it can be expected. I look forward to his response. He is highly regarded in his post. I look forward to the responses from the hon. Member for Central Ayrshire (Dr Whitford), the Scottish National party spokesperson, and from my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson), the shadow Health Minister, and to other colleagues’ contributions.
Several hon. Members rose—
Mr George Howarth (in the Chair)
Order. This is an important subject and many Members have signified that they wish to speak in the debate. I will not impose a time limit straight away. I will see how it goes. If hon. Members co-operate, I am sure that everybody will be able to speak.
Tim Farron (Westmorland and Lonsdale) (LD)
Thank you, Mr Howarth. It is a pleasure to serve under your chairmanship. I wish everyone a happy new year and congratulate the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) on securing this incredibly important debate, which is timely in the light of yesterday’s announcement of the NHS long-term plan.
I will restrict my remarks on the cancer workforce to the radiotherapy workforce and other issues relating to radiotherapy. Sadly, at some point in our lives, one in two of us will have cancer of some form or other, and one in two of those with cancer will receive radiotherapy treatment, so one in four of us will need radiotherapy. Roughly speaking, 1,500 people—clinicians, medical physicists and therapeutic radiographers—make up the entire radiotherapy workforce of the United Kingdom. In the plan that we have been digesting since yesterday, there are many things worthy of remark and which are to be welcomed, but many questions remain unanswered.
On radiotherapy, the focus on survival and early detection is clearly crucial. The United Kingdom is very low down in the league table of European countries when it comes to early detection of cancer, which is the chief reason why survival is so poor compared with other nations of similar prosperity. That is tragic on a personal level and deeply humiliating on a national level. If the Government, the National Health Service and we all are successful in our bid to detect cancer earlier at stage one and stage two, treat it effectively and cure patients—radiotherapy is eight times more likely to be curative than chemotherapy and 50% of those with cancer are already having radiotherapy—it stands to reason that the need for capacity for radiotherapy will increase manifold.
There are 52 radiotherapy centres in England with a number of other satellites. There is nothing in the plan that scopes forward how the national health service will cope with the additional work required if early diagnosis becomes more successful. It is worth bearing in mind that, as things stand, there are significant pressures with a workforce of 1,500. There are two ways of looking at it: one is that the workforce is a very small and precious resource that we need to protect, and the other is to remind ourselves that those are relatively small figures, and that with a relatively small amount of investment, we could make a significant difference to increase that workforce. Relatively small numbers equals a huge percentage, which equals the ability to tackle many more cancers and, indeed, to cure many of them.
I will focus briefly on one profession within the radiotherapy workforce—therapeutic radiographers. I do not know whether hon. Members are aware, but in the current academic year, there has been a 50% drop in applications to therapeutic radiography courses at UK universities. One of the leading universities had to cancel its entire intake altogether due to under-recruitment. The cause is almost certainly—99% certainly—the removal of the bursary from that programme. The standard applicant is a mature student who chooses to do something different with their life, having done something else first, and the withdrawal of the bursary has had a huge impact on those people. If the Minister wanted to do something quickly to tackle that workforce issue, I will throw out there the suggestion that he could reinstate the bursary for radiographers.
I am chair of the all-party parliamentary group on radiotherapy, and one of our vice-chairs is here—the hon. Member for Easington (Grahame Morris). We and many other hon. Members had a really good meeting with the Minister at the end of November last year. I am very grateful to him and to his staff for their time and attention. They have yet to respond to the manifesto that we presented to them that day, although I did not expect them to have done so by now. That manifesto calls for a number of things: new investment and more money—it would be surprising if we did not ask for that, but I will put it in context.
As I have said, half of those who have cancer in the United Kingdom will require radiotherapy, yet only 5% of the cancer budget goes on radiotherapy. That compares poorly with other countries. In Australia, the figure is about 5% but the European average is something like 7% or 8%. Our cross-party proposition is that the Government invest £100 million every year into machine upgrades for high-quality, targeted, stereotactic, and other advanced forms of radiotherapy. That fund would cover all trusts, which would not have to delve into their own reserves. We also propose a £250 million up-front, one-off investment so that people who live in communities like mine an awful long way from the nearest treatment can have a satellite unit developed close to them.
Many of my constituents in South Lakeland have to make three or four-hour round trips to get good treatment at Preston, but a large percentage—up to 50%—of those who could have radiotherapy in my constituency and in other parts of south Cumbria do not get it because they are considered to be too far away for it to be a reasonable journey time. Radiotherapy is so often more curative than chemotherapy, ergo people do not live as long because they live too far from treatment. That is why the radiotherapy satellite centre at Westmorland General Hospital in Kendal is a key example. Access and travel times are a problem in other parts of the country, which is why investment in satellite units is important. They do not necessarily involve that much more staffing because, with proper IT networking, we would be able to do many of those things remotely.
In conclusion, the NHS plan announced yesterday contains much that is interesting, but when it comes to radiotherapy, it is entirely a rehash of things that we already know. Some things are welcome, but there is nothing new. I look forward to the Government’s response to its consultation on radiotherapy, which closed 12 months ago, and I ask for an update on that. I also ask that the National Cancer Advisory Group’s 2018 report is released as soon as possible. Finally, I very much look forward to the Government’s response to the manifesto by the all-party parliamentary group on radiotherapy, which was presented to them in November.
Several hon. Members rose—
Grahame Morris (Easington) (Lab)
Thank you very much for calling me to speak in this important debate, Mr Howarth. I congratulate my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick), and I thank my friend the hon. Member for Westmorland and Lonsdale (Tim Farron), who chairs the all-party parliamentary group on radiography, of which I am also a member.
I do not want to repeat the arguments that have just been made, but some key threads run through the whole of the debate. Although the motion refers to “early diagnosis and the cancer workforce in the NHS long-term plan”, we have to marry some concepts. Yes, early diagnosis is important, but it has to be married with a skilled and effective workforce, as well as the most effective treatment available, by which I do not mean the treatment available in our capital city only, but across the whole country. I will touch on that issue as well.
I declare an interest: I am a cancer survivor. I was successfully treated with both chemotherapy and radiotherapy, thanks to a relatively early diagnosis. I am vice-chair of the all-party parliamentary group on radiotherapy. I am not alone in having benefited from radiotherapy. As was mentioned earlier, during the course of our lifetimes, almost half of us will suffer from cancer at least once, and about half of those people will receive radiotherapy.
Although I was fortunate and count my lucky stars, I am acutely concerned about particular cancers, notably prostate cancer, pancreatic cancer—yesterday, we heard a terrible story from the hon. Member for Crawley (Henry Smith) about his caseworker who passed away as a consequence of pancreatic cancer—and lung cancers and breast cancer. For a modern industrial nation, our cancer outcomes are poor. They should be far better. I hope that the 10-year forward plan that was published yesterday is an opportunity to address some of those fundamental problems. It is important for us to invest in modern accessible cancer diagnosis and treatments.
I want to talk about the long-term plan that the Prime Minister announced yesterday, on which we had a statement in the House. I will refer in particular to chapter 3, especially section 3.62, on treatment and radiotherapy. I must admit that I was optimistic after meeting the Minister, who I have known for some years. I think he is a decent and honourable individual, and he and his staff were very positive in our meetings. I therefore hoped that, based on the evidence presented, we would have a much more positive outcome from the 10-year plan.
The Government have promised to complete the £130 million investment in radiotherapy machines and to commission the proton machines—the two proton-beam machines, at the Christie in Manchester and at University College Hospital, London—but, in all honesty, that is not a new commitment. Those machines are already or almost completed, so the commitment is a recycling of an existing announcement.
If we are to have a step change and to achieve a world-class set of outcomes and a world-class cancer treatment service, we need a modest increase—modest in relative terms—for advanced radiotherapy. As set out in the “Manifesto for Radiotherapy”—which I recommend that all Members read, because if they are not affected themselves, many of their constituents certainly will be—we ask for an initial one-off investment of £250 million, with an additional £100 million in each successive year for workforce, running costs and so on.
Radiotherapy is required in 50% of cases, but access is patchy. Access varies from 25% to 49%. For example, the hon. Member for Westmorland and Lonsdale represents a rural area, where the figures are low. The average is about 38%. Ideally, according to Cancer Research UK, patients should not have to travel more than 45 minutes to access such treatment and, if we are to achieve that, considerable investment is required. The Minister might be able to elaborate on this, but I do not think that anything concrete in the plan addresses that serious issue.
I welcome the Government commitment on early diagnosis to increase the number of patients diagnosed with stage 1 and 2 cancer by 25% and, for lung cancer, to increase the diagnosis of stage 1 patients by 47%. In practical terms, however, the Government will need more advanced radiotherapy machines to ensure that many of those stage 1 tumours can be cured, as well as additional radiotherapy machines to treat the stage 2 patients. The Government will need to rapidly expand the number of advanced radiotherapy facilities around the country, and how to do that is set out in the manifesto, which would achieve not only early diagnosis but improved survival and outcomes.
I want to give the Minister credit—he is looking a bit quizzical, but I had not intended to beat him up, because we are trying to be helpful. The aspiration and wish to improve cancer outcomes and to see a first-class service is shared in all parts of the House. I am therefore very pleased that he has recognised the representations made on hypofractionated treatment and the perverse incentive in relation to the tariff. The Government have said that they will address that issue, but I would like an assurance that it will be addressed quickly and not in 10 years’ time. The evidence is clear about that disincentive to the most appropriate form of treatment.
Many people want to speak in the debate, so I will wind up. I am pleased that the Government have admitted and accept that advanced radiotherapy is more effective and has fewer side effects. I would like to see a specification come out and to ensure that, when it comes out, we do not see what we have in effect at the moment, which is the rationing of effective treatment. Specialists in the field have told me that the specification under discussion now is in essence no different from that available a year ago. I therefore press the Minister to respond to our submissions.
I want to see an increase in the budget for advanced radiotherapy—fairly modest as part of the NHS budget, or even the cancer budget—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 NHS outcomes and positive economic benefits. I commend that proposal to the Minister, and I urge him to look at it as part of the ongoing cancer strategy and the NHS 10-year plan.
Thangam Debbonaire (Bristol West) (Lab)
It is a pleasure to serve with you in the Chair, Mr Howarth. I thank my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick) and other hon. Members for their contributions.
I will focus on cancer affecting children, teenagers and young adults. As hon. Members know, I have personal experience of breast cancer, but more expert people in the Chamber will talk about that, so I will discuss the form of cancer for which I recently set up the all-party parliamentary group on children, teenagers and young adults with cancer.
I set up the group because each year in the UK, 4,450 children and young people under 25 are diagnosed with cancer—that is 12 children and young people every day somewhere in the UK. Four out of five of them will survive for five years or more, but for the parent of a child such a survival rate seems minuscule. Most of us expect our children to survive far longer than that, so the survival rate can seem quite hard. Those of us who have had adult cancer might think, “Oh good—five years! I’ll still be around in five years’ time.” For adults, that feels like a success; for children, not so much.
Cancer remains the biggest killer by disease of children and young people under 25 in the UK. That is important, because one of the reasons why cancer is the biggest killer is that other diseases have declined. That is a good thing, but cancers still affect many children. We want the incidence to decrease, and the number of children surviving and being diagnosed earlier to increase. The all-party parliamentary group wants things to be better. The Minister knows that, because he has been good to the group and worked closely with us. We understand that the small number of children affected can make it difficult to identify real specifics that could make a big difference, but because the number is small, some of the things that we want might be relatively straightforward to do.
Last year, we held an inquiry into young people’s experience of childhood and young adult cancer. We now call on the Government and the NHS long-term plan to look at the impact of a young person’s route to diagnosis. Recent research by CLIC Sargent found that more than half of young people had to visit their GP at least three times before their cancer diagnosis. Katie, the young woman who was a panel member in our inquiry, said that because childhood and young people’s cancer is so rare, GPs did not expect to see it, so frequently signs and symptoms were misunderstood. I have the greatest sympathy for GPs and clinicians, and because those cancers are so rare, we would like a training and e-learning module for healthcare professionals.
CLIC Sargent and the Teenage Cancer Trust have teamed up to create such a module on the signs of cancer in children and young people, developed in partnership with the Royal College of GPs. We would like more support in the NHS workforce to improve recognition of the signs, whether that is the e-learning module or something different. I hope the Minister will say something about that when he sums up. In the NHS long-term plan published yesterday I was really pleased to see a specific mention of childhood cancer, but I was disappointed that there was not more emphasis on skilling up the healthcare workforce to recognise the signs and symptoms. We all know that often the consequence of failing to make an early diagnosis is a very poor survival rate.
In our inquiry we recommended many measures, which the Minister has very kindly agreed to go through with his officials and respond to in some detail. Perhaps after the debate, will he liaise with my office about a time to meet? I am grateful to him for his willingness to do that, but we would like to make some progress in the first half of this year. Some of our recommendations are relevant to this debate. We say that the Secretary of State for Education should ensure that every young person receives health education that includes cancer signs and symptoms, done in an appropriate way. The Teenage Cancer Trust has developed an education module, which many of us will have seen recently when it was demonstrated in Parliament. I would like to see something such as that being used.
Craig Tracey (North Warwickshire) (Con)
The hon. Lady makes an excellent case for education. As co-chair of the all-party parliamentary group on breast cancer, I want to raise the fact that about 3,500 breast cancers go undetected each year due to women not understanding the risk due to breast density. Education would seem critical as part of the long-term plan to get world-class outcomes, so that people understand their personal risk.
Thangam Debbonaire
The hon. Gentleman is absolutely right; education is critical across all cancers, particularly breast cancer. Many young women need more under- standing of how their risk can be reduced by certain lifestyle choices. I say that carefully, without wishing to blame cancer survivors, because there is a difficult balance. Education is important, because the health service we want for the 21st century is about health rather than sickness. I wanted to see more emphasis in the NHS long-term plan on prevention.
Will the Minister respond to some of our recommendations in his reply to the debate? The all-party group thinks that an emphasis on prevention is critical to young people’s long-term survival and long-term health—not long-term sickness. We are concerned about the shortage of radiographers and radiologists, but other Members will discuss that. If more children and young people with cancer are to survive longer than five years, early diagnosis is critical. Health professionals may see only one childhood cancer in their entire professional life, so they will need help. I ask the Minister to talk to us and to his officials about how to help the professionals to do better. We would like more education for young people on a range of cancer indicators and on ways to change their lifestyle, such as exercising more, reducing alcohol consumption and so on. We all know about those actions, but quite often it is too late; we could do with knowing them from an early age and building them into our way of life, starting when we are young.
I want to conclude, without getting too emotional, by paying tribute to CLIC Sargent and to the Teenage Cancer Trust in particular. They do so much, not just for children and young people but for parents and families. Members of my family received help from CLIC Sargent. My dear sister-in-law works for CLIC Sargent and she has been an inspiration to me on childhood cancer. I want the work they have done to be embraced by Ministers other than this Minister, who already has embraced it, to take that forward in the NHS long-term plan.
Stephen Lloyd (Eastbourne) (Ind)
It is a privilege to serve under your chairmanship, Mr Howarth. I thank the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) for securing this important debate.
I will keep my remarks brief because quite a lot of people want to speak, so I will focus on one area of early diagnosis—that of bowel cancer. There are two reasons for that: bowel cancer is the fourth most common cancer, and it is the second biggest cancer killer, yet bowel cancer is not only treatable but curable, especially if diagnosed early. The Minister will know that since my re-election I have pressed him and the Department hard to reduce the bowel cancer screening age in England from 60 to 50. I was delighted when, a few months ago, the Minister agreed to that and announced that the reduction would take place.
I pay tribute to my constituent Lauren Backler, who started the campaign to reduce the screening age three years or so ago. Sadly, her mother died in her mid-fifties; it is very likely she would not have died had she lived in Scotland and had an early diagnosis. That prompted Lauren to launch a campaign, and it has been an unbelievable success in numbers alone: more than half a million people across the country have signed her petition. Colleagues in the Chamber and I have campaigned avidly for it for the last couple of years, and the Minister and the Department of Health announced the change a few months ago.
David Simpson (Upper Bann) (DUP)
The hon. Gentleman will be pleased to know that in Northern Ireland, following the introduction of bowel cancer screening kits, participation is 60%. It is a fantastic result for Northern Ireland and we need to do more of it.
Stephen Lloyd
The hon. Gentleman is right. The introduction of the new faecal immunochemical test kits will make a huge difference.
I am speaking in this debate because, as the Minister will know and one or two people have alluded to, in yesterday’s announcement there was no clear announcement about additional staff and capacity to ensure that the bowel screening age is brought down from 60 to 50. I commend the Government for listening to Lauren, hundreds of thousands of people across the country, my colleagues here and me, and reducing the age—it is quite clear statistically that many thousands of lives will be saved—but I am anxious that there was no announcement yesterday about the additional budget that will be required for new staff, and a plan for it to happen. I am keen to hear from the Minister not just that the Department of Health is behind it, but detail of when the announcement will be made about additional staff capacity. I urge that particularly because, as the Minister knows, the budget decisions will be announced in March. I want some flesh to be put on the bones.
This is an issue where we know we have a solution. We in this Chamber understand that there are capacity and finance issues. We applaud the Government and the Department of Health for publicly stating that they will bring down the screening age limit. What we all need now is flesh on the bone and detail, so that Lauren Backler, following her remarkable campaign in tribute to her mother, can see in the next few months the first roll-out of the age reduction in screening for bowel cancer.
Nic Dakin (Scunthorpe) (Lab)
I congratulate my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick) on securing this important and timely debate.
We very much welcome the NHS long-term plan. It is a once-in-a-generation opportunity to improve cancer care significantly in this country. The plan rightly recognises that one of the biggest actions the NHS can take to improve cancer survival is to diagnose cancers earlier, and sets out welcome commitments to radically improve early diagnosis. I hope that as the plan develops there will be more specific plans for the less survivable cancers—pancreatic, brain, lung, stomach, liver and oesophagus—that account for more than 50% of all cancers.
As chair of the all-party group on cancer I was pleased to chair the Britain Against Cancer conference last month, which focused on future priorities for cancer care. There were many reasons to be cheerful, but one big concern was whether the workforce will be sufficient to deliver the care that will be needed in the future. There is still a lack of clarity about that, despite efforts in the long-term plan, so it is useful to have this opportunity to focus on that.
We know that the number of people diagnosed with cancer in the UK is increasing and that the changing needs of cancer patients present a challenge for professionals working in cancer care, who are dealing with rising case loads, and increasingly complex needs. The plan’s ambition to diagnose three in four cancer cases at an early stage by 2028 is welcome, but unless we have a plan to deal with staffing shortages, backed up by significant investment, the NHS will struggle to maintain today’s standards.
In NHS North Lincolnshire clinical commissioning group, only 71.9% of cancer patients receive their first treatment within 62 days of an urgent GP referral. That is well below the England average and below the national target of 85%. Delays to cancer waiting times are often caused by a diagnostic bottleneck, where there is not enough capacity to carry out the tests needed to confirm a cancer diagnosis so that the patient can begin treatment. I therefore welcome the announcement made just before Christmas of capital investment for Northern Lincolnshire and Goole NHS Foundation Trust, and of diagnostic equipment for Diana, Princess of Wales Hospital in Grimsby and Scunthorpe General Hospital. I hope that will make a significant difference.
To improve early diagnosis and match the best cancer outcomes in Europe, it is crucial to have the workforce in place to support growing patient need. Although the NHS long-term plan sets out ambitions for the future workforce, funding available for additional investment in that workforce in the form of training, education and continuing professional development through the Health Education England budget, has yet to be set out by the Government. Will the Minister—he is an excellent Minister—set out when that budget will be confirmed and say whether the Government intend to set out further funding arrangements as part of the comprehensive spending review?
NHS staff shortages in primary and acute settings have been consistently highlighted by organisations in the sector in recent years, and there is an urgent need to grow the cancer workforce. Cancer Research UK estimates that the cancer workforce needs to double by 2027. Similarly, Macmillan Cancer Support has estimated that the supply of adult cancer nurses must increase by 45% in the next 10 years. Those are big numbers.
Macmillan’s workforce census last year highlighted considerable variation in vacancy rates for cancer nurse specialists across the country. That is also true for specialist chemotherapy nurses, with vacancy rates as high as 15% in some areas. A recent survey of healthcare professionals working in breast care in hospitals by the charity Breast Cancer Care painted a worrying picture, with 87% of respondents stating that job shortages in their hospital could affect breast cancer patients. A freedom of information request from that charity found that two thirds of hospital trusts in England do not provide a dedicated nurse for people living with incurable breast cancer. It is therefore crucial that a fully costed plan is produced to demonstrate how the health and care workforce will be sustained and grown. The long-term plan states that there will be a separate workforce implementation plan in 2019, but more detail is needed about the timeframes. Will the Minister say when the plan will be published? “Soon” is not quite good enough. We would like a date, please.
The 2015 cancer strategy recommended the publication of a cancer workforce plan, yet the sector is still waiting for the publication of phase 2 of that plan by Health Education England. Will the Minister outline how the implementation plan relates to the long-promised phase 2 HEE plan on the cancer workforce? If the ambitions of the long-term plan and the 2015 cancer strategy are to be realised, a comprehensive and fully funded workforce plan must set out how the cancer workforce can be upskilled and developed to meet the needs of the growing number of people living with cancer.
Jim Shannon (Strangford) (DUP)
I thank the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) for securing this debate, and for giving us the opportunity to discuss this important issue. I am the Democratic Unionist party spokesperson on health, so such matters are at the top of the tree for me. I am pleased that the Minister and shadow Minister are here to respond to our concerns, and we appreciate the Backbench Business Committee kindly granting us this debate.
Cancer is a word I hate; it is a disease I hate. A respecter of no person, it indiscriminately attacks and takes from us those who we love and rely on. I truly believe that a cure must be found and found soon for this dreaded disease, but while that work is taking place, we must focus on the best use of the limited resources available. I congratulate the Government on their NHS 10-year plan and their commitment to a cancer strategy within it.
As hon. Members have said, we all have family members and friends who have been stricken by cancer. I have a good friend who will have breast cancer surgery on Friday, and my father survived cancer on three occasions due to the expertise of the surgeon, the nurse’s care and, critically, the prayer of God’s people. My hon. Friend the Member for Upper Bann (David Simpson) referred to the bowel cancer testing kit in Northern Ireland, and probably because of my father’s history, I carry out screening with that kit every year, and therefore I would know early on whether any cancer has been detected. That is what we are doing in Northern Ireland, and hopefully it is something that other parts of the United Kingdom can take on board.
Mr Gregory Campbell (East Londonderry) (DUP)
Does my hon. Friend agree that, given the almost universal acceptance of the importance of early detection, the long-term plan, like any other plan, will be judged against an increase in early detection? That is the key.
Jim Shannon
I agree wholeheartedly with my hon. Friend and colleague, and although many people are dying from cancer, a larger number are surviving that diagnosis.
I wish to thank the tremendous staff who work well above their paygrade and the hours they are paid to make a difference to the quality of care and support for cancer sufferers. I also thank the wonderful charities that aim to step into the breach where at all possible. We all know of such charities, and if I do not mention some of them that does not make them any less important. Many charities, including Marie Curie, do tremendous work.
Macmillan Cancer Support is an amazing charity. In 2017, it had more than 5,700 nurses supporting 658,000 people, with a further 2,000 healthcare professionals throughout the United Kingdom. In 2017, 1.6 million people received personal, high-impact support from one or more Macmillan professionals or services. While broadly welcoming the Government scheme, Macmillan has expressed serious concerns that the plan does not adequately address the immediate and longer-term pressures facing the NHS cancer workforce. Those concerns are put forward in a constructive fashion, as they should be:
“The NHS long-term plan makes clear that the funding available for additional investment in the workforce, in the form of training, education and continuing professional development through the HEE budget has yet to be set by the Government. This is a key priority and must be urgently addressed. The plan states that there will be a separate Workforce Implementation Plan in 2019, but more detail is needed about the timeframes, and how the implementation plan relates to the long-promised phase 2 HEE plan on the cancer workforce. It is essential that we build on the ambitious foundations of the NHS long-term plan and put in place a fully-funded strategy for the workforce that will deliver truly world-class cancer care.”
That is what Macmillan Cancer Support expressed before this debate. Perhaps the Minister will respond to those points.
I agree with the sentiments expressed by Macmillan, and more detail is needed to deal with funding gaps to address the issue of speed of diagnosis in quick-moving cancers such as pancreatic cancer. My hon. Friend the Member for East Londonderry (Mr Campbell) and the hon. Member for Bristol West (Thangam Debbonaire) spoke about early diagnosis, and nearly every Member who has spoken in the debate has said it is critical—and so it is. Pancreatic cancer is the quickest-killing cancer, with one in four people dying within a month, so we need a faster pathway to diagnose and treat it, as the hon. Member for Scunthorpe (Nic Dakin), who is particularly interested in it, will know. Early diagnosis is essential in the case of pancreatic cancer, as it offers the only chance for potentially curative surgery. However, fewer than 20% of people with pancreatic cancer are diagnosed at an early stage, and fewer than 10% will receive surgery. The capacity does not currently exist, and there must be an increase in the cancer workforce to ensure timely diagnosis and treatment. Every Member who has spoken in the debate has supported the point of view expressed by Macmillan, and it is critically important.
Prostate cancer has been mentioned. When men are ill we are, by our nature, the illest people in the world, but sometimes we just do not know when we are ill. I make that point in relation to prostate cancer because we do not do the checks, although we know what has to be done. Needing the toilet more frequently, a burning sensation and passing blood are some of the symptoms, and men perhaps need to look out more for them. We need to raise awareness of prostate cancer. To be fair, I think that the Government do that, but perhaps there is a need to do more.
I hope I will be forgiven for repeating some comments that have been made, but these issues are important. The hon. Member for Bristol West referred to CLIC Sargent, and I want to make some comments on children’s cancers. CLIC Sargent is a wonderful charity and has asked me to use this opportunity to stress something that shocked me when I first read it, and which underlines the point about the workforce. Children make up the highest proportion of cancer patients diagnosed through emergency admissions, and many young people and parents have a poor experience of diagnosis. The 2016 “Best Chance from the Start” research report on experiences of diagnosis found that more than half of young people and almost half of parents had visited their GP at least three times before the cancer diagnosis.
As the hon. Member for Bristol West said, there is a particular need for early diagnosis for children. Nearly half of young people felt their GP did not take their concerns seriously. I do not think that is a criticism; it is how they felt. A third of parents felt that their GP did not take into account their knowledge of their child. We should not ignore what parents know and say about their child. It is important to do something to raise GPs’ awareness in relation to children. Just over a third of young people and a quarter of parents felt that their GP did not have enough time to listen to them talk about their symptoms. I want to ask the Minister what has been done about that. I am mindful of the pressure on GPs, who have a lot of work to do. However, something needs to happen for children diagnosed with cancer and their parents. Like the hon. Member for Bristol West, I am requesting that something be done. The urgent change that is needed can be achieved only through funding to take the pressure off diagnostics, allowing GPs to refer before the third repeat visit. They must be allowed to go with their gut and send anything suspicious to be tested further, rather than playing a numbers and probability game. Cancer does not respect the numbers game—it strikes where it might be least expected.
This is my last paragraph, Mr Howarth. Time has beaten me. I heartily welcome the strategy, but we need more detail and more action, and soon, to make a difference, and so that we can make a worthwhile attack on the plague of cancer, which affects families throughout the United Kingdom. That is why the debate is so important.
Bambos Charalambous (Enfield, Southgate) (Lab)
It is a pleasure to serve under your chairmanship, Mr Howarth. I congratulate my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick) on securing this important and timely debate.
Lives are saved when cancer is diagnosed early. I know we all are united in wanting all cancers to be caught early so that survival rates can be drastically increased. However, to diagnose and detect cancer early, we need a sufficiently skilled workforce and full staffing. NHS staff do amazing work, but they are under extreme pressures. We are one of the richest countries in the world, but lives are being lost because of under-investment in our NHS workforce. If we are to come anywhere near to achieving the Prime Minister’s target of diagnosing three in four cancers at their early stages by 2028, we will need to have a long-term plan that will deal with the staffing shortages, which will no doubt get worse post Brexit.
Cancer Research UK estimates that by 2035 a person will be diagnosed with cancer every minute. At present nine out of 10 people will survive bowel cancer if it is diagnosed at an early stage, but that figure reduces to only one in 10 if it is not diagnosed until stage 4. Currently between 46% and 61% of cancer sufferers are diagnosed at stage 1 or 2, which means that people are slipping through the net and dying needlessly owing to a lack of resources. With 40% more people being referred for diagnostic cancer tests than four years ago, cancer diagnostic services are struggling to keep up with demand. They have already missed their cancer waiting time targets over the past three years.
I am the co-chair of the all-party parliamentary group on breast cancer. The rest of my comments will focus on breast cancer, for which the situation is even worse than I have been outlining. The breast imaging and diagnostic workforce are critical for the early diagnosis of breast cancer, but Breast Cancer Now has discovered that only 18% of breast screening units are adequately resourced with radiography staff to meet demand. Taking into account the ageing workforce of breast imaging radiographers and the increase in demand, we have an exacerbation of pressures that will only get worse. For every three breast radiographers who retire over the next five years, only two are expected to replace them, which means that imaging and diagnostic services will be unable to keep up with demand. That will cause delays, which in turn will cause greater anguish for those waiting to be tested.
Fifty-five thousand people are diagnosed with breast cancer in the UK every year, yet the survival rates lag behind those of Sweden, Portugal, Germany and France. We have a declining workforce and an increase in demand. Unless the Government invest in a fully funded workforce plan, patients will suffer. We need a new approach to workforce planning based on best practice and clinical need. Health Education England must produce phase 2 of the cancer workforce plan, which looks at how many staff are needed to meet growing patient demand, and set out a 10-year cancer workforce strategy. The plan must be backed with appropriate funding. Breast Cancer Now has called for the Government to invest £39 million in recruitment to the breast imaging and diagnostic workforce as part of the plan to cover the cost of training to fill clinical radiologist vacancies and to address the current shortfall in radiographer numbers.
The Government’s decision to scrap bursaries for allied health professionals and nurses is a factor in making it harder to recruit. Someone who wants to become a mammographer must self-fund an MSc following a three-year radiography degree. Prior to the 2017 bursary cuts to allied health professionals courses, including for diagnostic radiographers, the undergraduate degree was covered by a bursary. Following that disastrous cut, there was a 20% decrease in the number of applications to allied health professionals courses and a further 9% cut in 2018. That under-resourcing, directly linked to the Government’s bursary cuts, has undoubtedly cost lives. I urge the Minister to reverse the cut to bursaries to ensure that the financial barriers to becoming a mammographer are removed and that more applicants are encouraged to apply for allied health professionals courses.
Funding for early diagnosis is not just about staffing levels and recruitment. It is also about new technology. There are new improved ways of detecting breast cancer, such as via tomosynthesis, which is far more effective in detecting breast cancer in some women. Artificial intelligence could also be used to assist in analysing the vast data capture involved in screening, but that would require the commitment by the Government of investment in new technologies and training. Risk-stratified breast screening is another way of making better use of technology to assess a woman’s individual level of risk by using algorithms to assess various risk factors. Once an assessment has been done, a more personalised service can be given for women at higher risk, which could again help to save lives.
I will finish by asking the Minister whether he will commit to getting Health Education England to produce phase 2 of the cancer workforce plan, which will be based on need, and confirm that it will be properly funded. Will he reverse the cuts to bursaries for courses for allied health professionals and nurses, and make sure that recruitment levels are up to the levels that are required, especially with Brexit looming? Finally, will he commit to exploring and funding new technologies and training that will help to detect cancer earlier, target those who are at higher risk, and alleviate the pressures on the workforce? If the Government do not get things right in relation to the shortfall in funding for early diagnosis and the cancer workforce, some people will inevitably die an avoidable death from cancer.
Dr Philippa Whitford (Central Ayrshire) (SNP)
It is a pleasure to serve under your chairmanship, Mr Howarth. I, too, congratulate the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) on securing the debate. It is a slight pity that it is less than 24 hours after the publication of the long-term plan, but people seem to have done lots of fast reading last night.
Like others, I welcome the plan and particularly the extra funding for the NHS, but it is important to remember that this brings it back to 3.4%, which was the average over many years—indeed, below the average over many years—prior to 2010. As the Secretary of State highlighted yesterday, with a million extra patients, the money per head of the population is actually going down. That is something that should be looked at, because it is a much better comparative measure.
In Scotland, we spend £163 per head more on health than here in England, and £113 per head more on elderly social care. We know that if we do not fix social care, then unfortunately any money put into the NHS is haemorrhaging out because of elderly people trapped in hospital, where they do not want to be. We see money focused on the NHS, because that sounds good to the public, but also further reductions in public health, despite all the talk in the plan about prevention. That does not make sense.
I welcome the Making Every Contact Count initiative. In Scotland, we have had Making Every Contact Count for years. As a breast cancer surgeon, I have discussed issues around smoking with all of my patients, because they inevitably ask, “Why did I get breast cancer?” We do not have the answer for breast cancer, but we do have the answer for the majority of lung cancers. I do not make my patients give up smoking immediately, when they are under stress, but I get them to promise me that they will do it in the long term, and quite a number of them do that. I do not have time to support them through that journey. We still need smoking cessation services, to which they can be referred. Those services are being cut, and that is a problem.
In the plan and in the Secretary of State’s letter yesterday, we again have a focus on cancer, which, as a breast cancer surgeon for over 30 years, I welcome. In his letter he talks about early diagnosis, but not about prevention, yet smoking is still the biggest cause of cancer, with obesity chasing it up as a close second. We need to tackle childhood obesity and we need a 9 pm watershed for advertising foods that encourage it.
Half of us will get cancer. As all the speakers have said, early diagnosis is crucial. It is particularly important to avoid diagnosis as part of an emergency admission, as that tends to result in a very poor outlook. For symptomatic cancers, as the Member for Shannon highlighted—[Interruption.] I keep saying that; I mean the hon. Member for Strangford (Jim Shannon). It is because the Shannon is another body of water in Ireland; I always get mixed up. We will just change it—you can be the Member for Shannon. [Laughter.] As the hon. Gentleman said, it is important to know the symptoms, but the public and sometimes GPs are too focused on late symptoms. Weight loss, jaundice and even, for some cancers, bleeding are not early enough. We need to educate people about that.
In Scotland, we have used humour. There was a testicular cancer advert over Christmas talking about men’s baubles. I do not care what kind of humour people need, whether it is toilet humour for bowel cancer or talking about boobs for breast cancer. If it gets people talking about it, that makes it easier for them to come forward. Many years ago we did an audit in Scotland looking at the whole patient pathway. It showed that for particular cancers, including bowel cancer, the longest step was from the first sign or symptom to going to the GP. The plan talks a lot about the pathway after going to the doctor, but there are only a couple of lines about educating the populous about what to look out for. That means we have to get people talking about it.
In Scotland, we have had bowel cancer screening starting at the age of 50 right from the beginning. I am sorry that the hon. Member for Torfaen (Nick Thomas-Symonds), who is no longer in his place, lost his mother in her 50s. In the last year or so we have also had celebrities diagnosed late with bowel cancer, who might well have been picked up if the screening had started at the age of 50. Last August, I welcomed the Government’s commitment to making that change, but there has been no discussion in any announcements or in the plan about when that change will happen.
When I turned 50 and the poo-in-the-post envelope landed on the mat within two days, I found it a bit harsh. As my birthday is Christmas eve, I got another one last week. I would not mind if they were a bit more sensitive, but it is something that people have to do. In Scotland, we have already changed completely to the faecal immunochemical test, which involves only one sample. We have already seen a 10% increase in uptake. Again, the Government have committed to that and the roll-out has commenced, but when will it be complete?
It is important to be prepared for the impact that that will have on the NHS here. If the starting age for bowel screening is dropped from 60 to 50, there will be an increase of two thirds in the screening population. If there is then the same 10% increase with FIT, together that will mean an increase of three quarters in the colonoscopies required. The NHS will have to be prepared with endoscopists and, as mentioned earlier, pathologists, who will analyse the samples. In Scotland, we have seen an increase in waiting times for colonoscopies, just with the change to FIT, so it is important to be prepared.
There is a similar impact with public education campaigns. Intense campaigns alone are no use. When we did the first Detect Cancer Early campaign, an audit of the breast cancer units across Scotland found that there had been a doubling in referrals, but not a significant change in the number of cancer diagnoses. Women are pretty breast aware, but the adverts need to be trickled throughout the year, or the chances are that there still will not be an advert when someone is sitting and ignoring a symptom.
As well as endoscopists and pathologists, the other workforce is radiologists. Not all radiologists can be identified as cancer radiologists; they will find cancer in all sorts of parts of the body. This diagnostic workforce is critical. If we look at the waiting time performance across the UK, we see that people are struggling, particularly with the 62-day target, which has fallen below 80% in England. Everyone is struggling with it. Looking at the 31-day target—from diagnosis to treatment—we see that most cancers are at over 90%, or indeed 95%. Once the NHS knows that someone has cancer, the pathway is relatively swift, but there is long gap to be diagnosed.
In my own speciality of breast cancer, radiologists are critical for the initial test, the investigation and the follow-up. For every three breast cancer radiologists who will retire in the next five years, they will be replaced by only two. The problem is that breast screening came in around 1990, so all the young consultants who were appointed at almost the same time will all, sadly, be retiring at the same time. The clinical radiology workforce census report shows that the UK has a shortfall of 1,000 full-time radiologists at the moment, which will grow to 1,600 by 2022. Some £116 million is being spent on outsourcing and overtime. The issue is not even money, because that amount would fund 1,300 full-time radiologists; the issue is that we do not have the workforce. Yet we see in the plan that health education has had its funding cut over recent years, despite grand statements about all the extra nurses, radiographers, allied health professionals and doctors who will be trained.
The plan talks a lot about IT, but instead of focusing on digital GPs it should be focusing on internal IT. We have had electronic prescribing, referral and response letters for years in Scotland, and one of the things we have that can help with the radiology shortage is the picture archiving and communication system, where imaging is shared right across Scotland. Every hospital uses the same system, which means that if one place is short of radiologists or is very rural, an image can be sent hundreds of miles to be looked at by someone else. The plan talks about generalists, and they are needed, but we also need specialists. The workforce plan is critical.
Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)
It is a pleasure to serve under your chairmanship, Mr Howarth. In case anyone wonders why I am shivering a bit, I have to say it is a bit cold in here.
Mrs Hodgson
Oh, good—we do try.
I start by congratulating my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick) on securing this important and timely debate and on his excellent speech. I wonder whether he has a crystal ball and knew something that we did not; I am sure if he does, it will be much in demand, because we have an important vote next week and somebody might want to have a borrow. I thank all the other hon. Members who have spoken this morning—the hon. Members for Westmorland and Lonsdale (Tim Farron), for Eastbourne (Stephen Lloyd), for Strangford (Jim Shannon) and for Central Ayrshire (Dr Whitford), and my hon. Friends the Members for Easington (Grahame Morris), for Bristol West (Thangam Debbonaire), for Scunthorpe (Nic Dakin) and for Enfield, Southgate (Bambos Charalambous)—for their excellent contributions to the debate.
As we know, the long-term plan was launched yesterday. We had waited several months for it to be published, but I am pleased that, after a few setbacks and delays, we now have it and are able to move forward. I was also pleased to see that cancer is a key priority in the plan; I am sure the Minister played a large part in that. Cancer is important, but it is an emotive issue. One in two of us will face a cancer diagnosis in our lifetime, which is a sobering thought, and many of us in this Chamber will know someone who has been affected by cancer. Some of us, I know, have been affected by cancer individually, and no doubt some of us will have lost someone to cancer.
What led me initially to join the all-party parliamentary group on breast cancer as a new MP was losing my mother-in-law to breast cancer over 20 years ago. I notice that in this debate there is a gathering of former co-chairs of the all-party parliamentary group on breast cancer, as well as the current co-chairs of that group and the current chair of the all-party parliamentary group on cancer. Once this subject takes hold and catches our interest, it stays with us for the whole of our parliamentary career—as it should, because it is so important.
It is estimated that by 2035, one person every minute will be diagnosed with cancer. That is why cancer diagnosis, treatment and care and their workforces should play an important role in our NHS now and in the future. The Prime Minister set out in her conference speech last September the Government’s ambition to see three in four cancer patients diagnosed at an early stage within the next decade. Currently, just more than half of the people diagnosed with cancer are diagnosed early in England, so the Government have a long way to go to achieve that welcome ambition.
Early diagnosis improves the likelihood of survival, as we all know. For example, if bowel cancer is diagnosed at an early stage, nine in 10 people will survive, but if it is diagnosed late, at stage 4, only one in 10 will survive. Early diagnosis also increases the likelihood of responding well to treatment. Target Ovarian Cancer, which I am proud to say I am the chair of the all-party parliamentary group for, found that as many as one in every five women in England are too ill to treat by the time they receive their ovarian cancer diagnosis. Awareness and screening programmes are crucial to early diagnosis, but breast screening uptake, for example, is the lowest it has been in 10 years, with stark variations across the country. The percentage of women taking up their screening invitation within six months fell from 71.1% in 2016-17 to 70.5% in 2017-18. Some might say that is only 0.6%, but analysis by Breast Cancer Now has found that upward of 1,200 additional deaths could be prevented per annual cohort of eligible women if we were to increase screening uptake to the current target of 80% for individual breast cancer screening units. With 500,000 people projected to be diagnosed with cancer in 2035, it is clear that we must do more to ensure that cancer is diagnosed early so that it can be treated effectively.
The long-term plan, as I am sure everyone has read and the Minister will be aware, says:
“We will build on work to raise greater awareness of symptoms of cancer, lower the threshold for referral by GPs, accelerate access to diagnosis and treatment and maximise the number of cancers that we identify through screening. This includes the use of personalised and risk stratified screening and beginning to test the family members of cancer patients where they are at increased risk of cancer.”
That is all great, but the Government cannot make those improvements without improving the workforce, and they must not be complacent about the role our NHS workforce have to play in this. As we all know, that workforce do a wonderful job every day, treating, caring for and supporting us and our loved ones, as those who have witnessed it at first hand will attest. Unfortunately, the cancer workforce is at breaking point and already struggles to keep up with increasing demand. There are chronic staff shortages across the NHS, with vacancies for 102,000 staff, including nearly 41,000 nurses. As anyone who has ever worked somewhere with staff shortages will know, the pressure that places on an individual is huge. I cannot imagine what it is like for the NHS staff who work day in, day out under those pressures, when so much depends on their being able to do their job properly.
Cancer Research UK has pointed to chronic shortages in the diagnostic workforce, with more than one in 10 positions unfilled nationally. According to Breast Cancer Now, for every three breast radiologists who retire over the next five years, only two are expected to replace them. I know that others have already stated a lot of these facts, but they are worth stating twice. There is a similar problem with breast cancer clinical nurse specialists; Breast Cancer Care states that they are an ageing part of the workforce, with 45% of breast cancer clinical nurse specialists aged 50 or above. The Royal College of Radiologists has warned of a shortage of cancer doctors, with 5% of clinical oncologist posts vacant during the course of last year, up from a 3% vacancy rate in 2015. The Royal College of Nursing also warns that in England there are nearly 41,000 vacant registered nursing posts, and it predicts a dangerous increase to almost 48,000 by 2023 if the Government fail to take urgent action now.
The Government must take the issue of the cancer workforce incredibly seriously, as nearly every person who has spoken so far in the debate has said. Will the Minister provide a progress report on Health Education England’s cancer workforce plan, which was published just over a year ago? Additionally, will he please provide us with a date for when he expects the second workforce plan to be published? As others have said, “soon” is not good enough. The NHS long-term plan makes it clear that the funding available for additional investment in the workforce, in the form of training, education and continuing professional development through the Health Education England budget, has yet to be set by the Government. Can the Minister assure us that any workforce plan will be properly funded, so that the workforce gap can be filled as a matter of urgency?
The NHS long-term plan says:
“We will complete the £130 million upgrade of radiotherapy machines across England and commission the NHS new state-of-the-art Proton Beam facilities in London and Manchester”,
but staff will need to be trained on both how to use those new facilities and how to read the results. Education and training must be high on the agenda for the second workforce plan, including the reinstatement of the training bursary, removing any financial burdens and barriers so that we can recruit the nurses that we need for the future. It also means offering further training opportunities once qualified, so that staff can keep up to date with technological advances.
Our NHS should be the most attractive employer in the country, but without the financial backing and support from the Government we are failing to recruit and retain our hard-working NHS staff. Of course, as the Secretary of State continues to say, prevention is better than cure, but £96 million has been cut from public health budgets this financial year.
The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
That was very decisive of you, Mr Howarth. It is quite cold in here, but the ministerial radiator next to me is doing very nicely. Note to the Box: must get radiator for shadow Minister.
It is a pleasure to serve under your chairmanship, Mr Howarth. I wish everybody a happy new year. I congratulate the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) on securing the debate. It is good to see him again. He has impeccable timing; I am not sure if he knew that the plan would be published when he applied for the debate. If he could let me know how he managed that, I would be very grateful.
The hon. Gentleman and everybody else talked about cancer survival rates. The truth is that they have never been higher and have increased year on year over the last decade or so. The reason for that is not only the investment and policy decisions by the last Government and this Government but, as the shadow Minister said, the hard work of NHS staff up and down our country. They work tirelessly, going over and above to give cancer patients the care and compassion that they need. I place on the record my thanks to them, which was perhaps not said enough in the Chamber yesterday. We are not in the slightest bit complacent, though. At the end of the day, one death from cancer still devastates somebody’s life and their family’s life. We know that we need to do so much more to ensure that we deliver the world-class cancer outcomes in England that all of us want and expect for our constituents.
In introducing the debate, the hon. Gentleman set the tone when he talked about the workforce. He said that the workforce are, in a way, the rock on which to build the church. I will start with that. Where we cannot prevent cancer, which I will come on to, we must ensure that we have the right staff with the appropriate skills and expertise to ensure that patients receive the best care. The NHS is nothing without its 1.3 million staff. It is the biggest employer of trained staff in the world. In 2017, Health Education England published the first ever cancer workforce plan, in which we set out ambitious plans to expand the capacity and skills of the NHS cancer workforce, committing to invest in 200 clinical endoscopists in addition to the 200 already committed to, as well as an extra 300 reporting radiographers, by 2021. However, we know that we need to go much further and do more than that. The Prime Minister set out our new ambitions on cancer in her party conference speech, and we also set out our early diagnosis targets in the long-term plan and our survival targets. As the Secretary of State set out yesterday, the long-term plan is the next step in our mission to make the NHS the world-class employer that delivers the cancer survival rates that we want.
To deliver on those commitments, we have asked Baroness Dido Harding, chair of NHS Improvement, to chair a rapid programme of work for the Secretary of State. She will engage with staff, employers, professional organisations, trade unions, charities in this space, think-tanks, Members and all-party parliamentary groups to build a workforce implementation plan that matches the ambition set out in the long-term plan. She will provide interim recommendations to the Secretary of State by the end of March on how supply, reform, culture and leadership challenges can be met, and then final recommendations later in the year, around the time of the spending review, as part of the broader implementation plan that will be developed at all levels to make the long-term plan a reality.
The hon. Gentleman and others asked about the work of HEE and Baroness Harding. The announcement of the long-term plan superseded HEE’s plans to publish a longer-term cancer workforce plan. HEE will now work with NHS England and Baroness Harding’s NHS Improvement under the plan, led by the baroness, to understand the longer workforce implications for the development of the plan. As I said, recommendations will be made in March, with a full implementation plan published later in the year. I did not say, “Soon.” I cannot give the House an exclusive this morning.
The hon. Gentleman also talked about Sir Mike Richards’s screening review. That will make initial recommendations by Easter this year and be finalised in the summer to, as it says in the plan,
“further improve the delivery of the screening programmes, increase uptake—
I know that the shadow Minister is concerned about that; I am too—
“and learn the lessons from the recent issues around breast and cervical screening, and modernise and expand diagnostic capacity.”
Steve Brine
I will, but it will mean that other Members will not get a response.
Theresa Villiers
Does the Minister agree that a crucial part of success in early diagnosis is for both the NHS and local authorities, with their public health budgets, to have specific strategies to engage with minority ethnic communities to raise awareness of cancer symptoms, and to encourage them to take part in screening programmes? That is an essential part of an effective strategy to improve cancer treatment in this country.
Steve Brine
Yes. That is why the House gave all upper-tier local authorities the power to be effective public health authorities with ring-fenced public health budgets—£16 billion during this spending review period. Decisions will obviously be made about that going forward. One reason why we did that was our belief that, for example, my right hon. Friend’s borough will have different priorities and demographics from mine in Hampshire.
It is a statement of fact that I will clearly not be able to respond to every Member’s points in the short time that we have left. I will respond to everybody in writing, as I always assiduously do. I will try to take a few themes in the minutes that I have.
The hon. Members for Easington (Grahame Morris) and for Westmorland and Lonsdale (Tim Farron) touched on radiotherapy. I very much enjoyed our meeting, and I thank them again for their work. I will send the hon. Member for Easington a note with more detail on his point on tariffs, because I know that he and the hon. Member for Westmorland and Lonsdale are concerned about it.
The hon. Gentlemen also talked about the manifesto response. We await the publication of the new radiotherapy specification before we respond. It is an excellent piece of work that will address many of the recommendations made, and we expect it to be published very shortly. I am afraid to say that the long-term plan makes no commitment to a one-off investment. However, it commits to improving access to safer and more precise medicines, including advanced radiotherapy. That document is not the final word. It is a living document that I will work on while listening to all-party parliamentary groups such as their own.
The hon. Member for Westmorland and Lonsdale also talked about the radiotherapy review. There was a phenomenal response to NHS England’s consultation, not surprisingly—a lot of those were from the west country of England. The NHS will plough through that. I am putting great pressure on it to publish its report in response to that, which I am hoping, and am told, will be in early 2019.
The hon. Member for Central Ayrshire (Dr Whitford), otherwise known as the Member for the Irish sea a body of water, talked about prevention and smoking and child obesity and humour. I loved her reference to “poo in the post”. There is a great charity that talks about men’s bits called It’s in the Bag, which is good at promoting awareness of testicular cancer. She is right to talk about prevention. I am the Minister for Public Health and Primary Care, looking at prevention. The Secretary of State has made prevention one of his top three priorities, and she knows that it is key for me.
Smoking is still the biggest preventable killer in our country today, as I said in the House last night in the statutory instrument debate. We have published a world-leading plan on child obesity. We will consult very shortly. I try to be honest with the House at all times, and I hoped to get it out before Christmas, but there is an awful lot else going on and there is only so much I can get out the door at one time. However, I will get the 9 pm watershed consultation out the door. It is damned important that we do that. We said that we will, so we will.
The hon. Lady is absolutely right that prevention is better than cure, which is why the child obesity plan and Cancer Research UK’s work in that space has been very helpful.
Mr George Howarth (in the Chair)
I remind the Minister that he ought to leave a little bit of time for the mover of the motion to speak.
Steve Brine
Okay. I will have to close. There is a lot of ambition in the long-term plan, which some people have very kindly said I may have had something to do with. That may be so. However, that ambition is matched by finances, and finances need to be matched by people. We understand that, but it is also about the much wider, holistic approach to prevention, and about staff being part of that. We get that. I hope I have given some reassurances around the work that will be done on that. I will write to Members on the rest of the points raised. I thank everybody for their—as usual—incredible and passionate contributions.
Jim Fitzpatrick
I am grateful to all colleagues for their contributions, which were pertinent, personal, knowledgeable and clinical. I thank the Front-Bench spokespeople for their contributions. The Minister knows that we all want the same things—success for the Government’s programme, better and earlier diagnoses, adequate and professional staff and better survival rates. We are here to help him.
Motion lapsed (Standing Order No. 10(6)).