Breast Cancer Diagnosis and Services: Covid-19

(Limited Text - Ministerial Extracts only)

Thursday 12th November 2020 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr McCabe. I have an awful lot to cover and less than 10 minutes to respond, if I am going to give my hon. Friend the Member for North Warwickshire (Craig Tracey) time to sum up. I congratulate him on securing the debate and on the important work he does running the APPG on breast cancer with his co-chair. I know that he has been a fundraiser for breast cancer and that, like me, he came to this place with tackling this issue as one of his key ambitions. We will get there.

As my hon. Friend the Member for Winchester (Steve Brine) said, everyone with breast cancer is a mum, a sister, a daughter or a friend. Some 3% of them are now fathers, sons and brothers. I am grateful for the contributions to the debate. A debate such as this allows us to park much of the politics but talk about what is really important here: the patients, and the outcomes for them.

Early diagnosis is key, and hon. Members have outlined the challenge that covid has brought. I thank my hon. Friend the Member for Crewe and Nantwich (Dr Mullan), and indeed the hon. Member for Ellesmere Port and Neston (Justin Madders), for outlining just how challenging covid-19 has been for the NHS and how it has responded to an unprecedented event in an unprecedented way. I reassure all hon. Members that in the second wave, we have made sure, as we have heard from many hon. Members, that cancer services are prioritised and remain.

I pay my own tribute to my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch), who has written to me because she would have liked to be here today and who is currently in treatment, as well as to my hon. Friend the Member for Norwich North (Chloe Smith), who is currently having treatment, the former Member for Dewsbury, who has been mentioned, and the former Member for Eddisbury, who is having her own challenge living with cancer. It is around us all. I well remember the emotional tsunami that diagnosis brings. As my hon. Friend the Member for Chatham and Aylesford said in her letter, because she is always the same with language, “Cancer sucks”. I could not agree more. I wish them all the best on their journey, as I do every patient through their treatment.

I am really aware of how covid-19 has upended our lives, but clinical decisions had to be made in March. We were dealing with the unknown and we had to protect people and highlight priorities. For those who have had their cancer treatment or surgery changed or delayed, I understand the uncertainty and anxiety they have had on top of that diagnosis of cancer. For patients and their families, this is a really tough time. We must have a laser focus on early diagnosis, as was laid out in the manifesto, and we must not veer from that. I do not want covid-19 to be the derailer; I want us to seize some opportunities that have come about.

Although it makes it no less bearable for those affected, the decision to pause some patients’ treatment in the first wave was taken on clinical advice that factored in the risk to the most vulnerable. As soon as it was possible, however, the NHS was charged with restoring cancer services as quickly as possible, and it has risen to that challenge. I meet with Cally Palmer, who was mentioned earlier, and Professor Peter Johnson often—at points weekly—to make sure that we are doing everything we can.

Across the country, there are 21 cancer alliances and their cancer hubs. My hon. Friend the Member for Carshalton and Wallington (Elliot Colburn) outlined the amazing work done at the Royal Marsden to bring hospitals across the capital together to optimise safe theatre space to deliver treatments and so on. We have asked for that approach to happen across the country to ensure that we optimise treatment. I hear my hon. Friends the Members for Wakefield (Imran Ahmad Khan) and for High Peak (Robert Largan), but it cannot always be on the doorstep at this time; we have to have a bit of flex. I will happily meet my hon. Friend the Member for High Peak to talk about his particular concerns.

I join my hon. Friend the Member for North Warwickshire and other hon. Members in recognising the tremendous efforts of the cancer workforce. In forming those cancer hubs and the rapid diagnostic centres, people have moved mountains to care for the patients they look after every day. Ultimately, they are the ones on the frontline to ensure that breast cancer services are there when we need them, and our thanks go to them.

The latest official data for September, which was published only this morning, shows that urgent two-week GP referrals across the entire spectrum of cancers are 2% higher than last year and they continue to rise for all cancers. In breast cancer, we have seen a month-on-month rise of more than 15% from August to September, but we still have work to do; I am not going to stand here and say that we do not. There is still a way to go to meet current demand and improve on that rise for those who are waiting for treatment.

More than 86% of people saw a cancer specialist in September within two weeks of their referral from a GP, and nearly 95% of patients received treatment within 31 days of a decision to treat. I know precisely how long every day feels when people have had a diagnosis. I have had tumours in both breasts and other primary sites. The wait is anxious. It is terrifying. Your mind asks, “Who will pick the children up?”, and, as my hon. Friend the Member for Winchester said, a million other unanswerable questions every single day.

There have been some bright spots and some innovative treatments that have moved the profile of the disease further forward. I personally—this is an ambition of Breast Cancer Now—want to see the eradication of breast cancer by 2050. We must work to that, because it is possible. As we have a 98% ability to treat testicular cancer, we can do better. Breast cancer should not claim the lives of over 11,000 women a year. I want to see it put back in its box.

Breast cancer treatments are advancing. This year has been no exception, with advances in radiotherapy and chemotherapy. We have seen oral chemotherapies that are easier to deliver and better for the patient. We have seen the publication of the FAST trial, which looks at five-fraction radiotherapy to treat early breast cancer. I thank the hon. Member for Easington (Grahame Morris), who is no longer in his place, and the other members of the APPG on breast cancer who came to see me. That treatment enables individuals to be treated quicker with fewer hospital visits. When we are fighting covid-19 and we are trying to keep people out of hospitals, it is better to minimise visits. All radiotherapy providers in England are adopting this approach. Yes, we have challenges with the workforce, but radiotherapy did remarkably well at keeping itself going through the pandemic.

I will try to cover as many of the different issues as I can, but I barely have any time left. They will drag me out of here with my nails pulling on the carpet. Clinical nurse specialists are important, valued and flipping marvellous—we all need one. Some 350 extra clinical cancer nurse specialists were allocated in the long-term plan, but we need to work together. I am working with Andrew Strauss and my right hon. Friend the Member for Old Bexley and Sidcup (James Brokenshire).

Cancer nurse specialists need to come from the existing workforce. They must be encouraged to do further training. We need to ensure that it is seen as a career path that really does have that purpose. Boy, oh boy, when one needs a cancer nurse specialist— they save the oncologist and one can phone them to ask about one’s niggles—they do amazing things. I want to see everyone come together, including the charities, to encourage nurses to come forward and help the community.

I met with the secondary breast cancer women before the pandemic. The situation is variable, and that is not good enough. The journey of a woman who has a cancer nurse specialist by her side is not an easier journey, but it is one where they feel supported. They have someone there. My cancer nurse specialist helped me to get some of the psychological counselling that colleagues have spoken of. I was angry and ticked off that I had that disease again. We need to encourage people to sign up to do that additional training. The money is there.

Data needs to be better. I could go on about data, screening and clinical trials, but I am aware that I have such little time. The majority of clinical trials are open for registration. I am urging local decisions to be made to get people reinstated and on to clinical trials. We have opened up screening with open invitations to try to get more women through. We know we have an issue with women not attending their appointments. We need to make people feel safe when they go to have their screening test in a hospital. Unless they feel safe, they will not go. We must work together to say, “It is open, but you have to go. Our NHS is a really precious resource. If you have an invitation, take it up and go to see the professionals who are there to help you.”

I wish I could say more, but I want to give my hon. Friend the Member for North Warwickshire a second or two to sum up. I thank everyone working on the frontline. Advances are happening; there is more to do. I am happy to work with my hon. Friend on an audit. We need to get better data. It is collected, but not in a good enough format. I want to see us do better in all those areas.