Covid-19: Access to Cancer Diagnosis and Treatment

Wednesday 2nd December 2020 Westminster Hall

00:00

[Esther McVey (in the Chair)]

I remind hon. Members that there have been some changes to the normal practice in order to support the new call list system. Members should sanitise their microphones and then remove and dispose of the material used for that when they leave the room. Members are asked to observe the one-way system and should speak only from the horseshoe. Members may speak only if they are on the call list. That applies even if the debate is undersubscribed. Members may not join the debate if they are not on the call list. This is a slight change, but I want to remind Members that they must arrive for the start of the debates in Westminster Hall, although they are not expected to remain for the winding-up speeches. Members may wish to stay beyond their speech, but they should be aware that doing so may prevent other Members from speaking if it is a full debate.

09:31

[Tim Farron (Westmorland and Lonsdale) (LD)]

I beg to move,

That this House has considered access to cancer diagnosis and treatment during the covid-19 outbreak.

It is a great pleasure to serve under your chairmanship, Ms McVey. I am grateful to have the opportunity to raise this issue. Of the many vital issues discussed in this place in recent months, the impact of covid-19 on cancer treatment must be at the very top of the list for importance to families right across the United Kingdom. I want to start by saying very clearly that there is a national cancer crisis—a backlog that we need to catch up with urgently—so I will be concluding my speech by asking the Minister to meet me and the clinical advisers who support the Catch Up With Cancer campaign as a matter of priority in the coming days.

Since the start of the pandemic, organisations, charities, frontline NHS staff and MPs have been urging the Government to invest in cancer services to prevent a national tragedy in cancer. Indeed, the experts we work with warned at the start of the pandemic that tens of thousands of people were set to die as a result of cancellations, delays and disruptions to their treatment. Sadly, it looks as though those warnings have been proved right, although for thousands of families it is not yet too late for us to catch up with cancer.

I have two main points to address. Both relate in large part to the covid-induced backlog and the apparent failure to make addressing it a central feature of the Chancellor of the Exchequer’s comprehensive spending review just last week. The first point I would like to address today is the scale of the cancer backlog itself. All the feedback from the frontline and from our expert clinical advisers strongly suggests that the Government and NHS management are repeatedly failing to grasp the true size and scale and danger of the backlog. The Government and senior NHS managers keep saying that services are back to normal levels and that good progress is being made on the backlog, but all the evidence from frontline staff provides a clear picture that it is just not true to say that we are back to normal.

Even then, the simple fact remains that, with the scale of the backlog, “back to normal” is nowhere near good enough anyway. Even if services were back to pre-covid levels—we contend that they are not—it would be mathematically impossible to have caught up. Why? Because the flow of patients was all but stopped for several months, but cancer, of course, did not take a break. It kept striking people at the same rate it always does, so the only way we can catch up with cancer is to have services super-boosted to levels in excess of pre-covid capacity. We estimate that cancer services need to be running at something like 120% of pre-covid levels for two solid years to catch up. That view is shared by other keen observers of this problem, such as the chair of the Health and Social Care Committee, the right hon. Member for South West Surrey (Jeremy Hunt). But the brutal reality is that services are not yet even at their pre-covid capacity. In September, treatment was at only 94.5% capacity, and as long as the treatment rate continues to be below 2019 levels, the cancer backlog will continue to grow.

We are hearing from frontline staff that services were not yet back to normal before the recent lockdown in November. One cancer centre has told us that during that lockdown, referrals have yet again “fallen off a cliff”. Analysis from Macmillan Cancer Support, using the Government’s own monthly cancer waiting times data, shows that during the pandemic around 1,000 fewer people in south Cumbria and Lancashire will have had their first cancer treatment, compared with the same period last year—a 17% drop—which suggests we are missing one in six people with cancer. There is no serious doubt about what is happening to those missing people. Their cancers will have grown and spread and, in many cases, become incurable by the time they are identified and by the time, if at all, they are treated. Across the country we hear of patients presenting with more advanced cancers due to not being seen early enough. Some staff tell us that they have never seen such advanced cases.

The all-party parliamentary group on radiotherapy, like all the all-party groups on cancer, is strenuous in its insistence on a consensual and collegiate approach, and sees Ministers, especially the Minister here today, as partners and not opponents. I am grateful to the Minister for her courtesy, her willingness to engage and her very clear concern. I am also grateful to all Members here and to those who are not present but who dearly wanted to be. Many are absent because this Chamber is not yet enabled for virtual participation. They include the hon. Members for North Devon (Selaine Saxby), for West Lancashire (Rosie Cooper), for Rhondda (Chris Bryant), for Central Ayrshire (Dr Whitford), for Liverpool, Riverside (Kim Johnson) and for Bootle (Peter Dowd).

Our collective view is that we need urgent action to catch up with cancer. I mentioned the figures for my own area, but Macmillan estimates that across England as a whole there are a terrifying 50,000 missing diagnoses. Clinicians report that more patients are now coming through needing palliative rather than curative care—people who could have survived who are now on end-of-life pathways and are simply being treated to alleviate the pain.

[Grahame Morris (Easington) (Lab)]

That is a really important point. How do we quantify the scale of the backlog to enable us to have an action plan to address it? Specialists say that whereas the ratio is currently 50:50 in terms of the therapeutic application of radiotherapy for treatable cancers and therapeutic palliative care, last year it was 70% treatable and 30% palliative. Do we not need the release of the datasets to quantify that in an accurate way?

[Tim Farron]

I am extremely grateful to the hon. Gentleman for making a very important point. I have heard the same reports from the frontline that treatment would normally be 70:30 curative to palliative and that now it is 50:50. That is a blindingly obvious consequence of the fact that when we catch cancer, we catch it too late.

I have a request of the Department, which we have made before, including in face-to-face meetings with the Secretary of State. I want the Department of Health and Social Care team responsible to sit down with the frontline experts—we can provide them this afternoon—and go through the evidence of the backlog. There is no way of tackling the problem if the NHS management and the Department are not cognisant of it and prepared to listen to the people working their socks off in cancer units all over the United Kingdom.

I want to make another important point. Whoever was in power during this time would have been handed the same challenge and would have made many mistakes. The Government have rightly sought to control the virus so that we can protect the NHS and save lives. The lives that we seek to save are those at risk from not just covid but other illnesses, including, of course, cancer.

We as a country have stood together and defended our NHS so that it has the ability to fight cancer in the midst of a pandemic, which is what every clinician is desperate to do. The great success of this year, for which Ministers should rightly be proud, is that our NHS has not collapsed and did not fall over. Our doctors, nurses, paramedics and clinicians of every sort have saved lives, defeated the odds and kept our NHS on its feet so that it can fight cancer, and yet a failure at senior levels of NHS England and in Government to recognise the scale and nature of the cancer backlog means that people are dying today who did not need to die.

We have terminal diagnoses for cancers that could have been treatable among my constituents and yours, Ms McVey—among all our constituents. Their lives have been cut short when earlier, more urgent and more ambitious action from our leaders could have saved them. What troubles me so much is that we hear statements from some in senior management in the NHS, and from within the Department, that suggest they do not quite get the scale of the backlog problem. They freely admit that they do not know how big the backlog is. On more than one occasion, I have heard the Secretary of State seek to reassure us by saying that progress has been made on recovering the 62-day wait. If people understand what is happening, however, that does not reassure them. It does the exact opposite: it sends a shiver down their spine—it confirms the problem.

Surely Ministers know that the 62-day waiting time target for treatment does not give a complete snapshot of the situation, because it captures only patients who are already in the system. I am sorry to be brutal, but as more people die, there are fewer people in the system. The target does not take into account the tens of thousands of undiagnosed patients who may be going about their daily life completely unaware that they are living with cancer.

I fear that the Government hugely underestimate the cancer backlog, and the consequence will be thousands of unnecessary deaths and lost life years. An article last month in The BMJ estimated that there will be 60,000 lost years of life as a result. Does the Minister recognise the significant fall in people receiving cancer treatment this year compared with 2019? Like me, is she worried that this will mean there are thousands of people out there with undiagnosed cancer who have yet to come forward?

I move on now to my second point, which relates to the Chancellor’s recent comprehensive spending review, which was a pivotal opportunity to signal that the Government, the Department of Health and Social Care, the Chancellor and NHS leaders understood the need for investment in the techniques and treatment required to quickly build capacity in order to clear the cancer backlog and ensure a resilient service going forward—to build the capacity that is vitally needed if we are to make sure cancer patients are not the collateral damage of covid. Far from seizing that pivotal opportunity, the Government appear to have turned it into a missed opportunity. As far as we can tell, there is no boost to cancer treatments in the comprehensive spending review. There is no increase in capacity to catch up with cancer, and there is no plan to do what is needed to save thousands of cancer patients’ lives.

The Action Radiotherapy charity estimates that the true cancer backlog could be as high as 100,000 patients. It supports the estimate of the Chair of the Health and Social Care Committee that it would take cancer services working at over 120% pre-covid capacity two years just to catch up. Members of all political persuasions, working with clinicians and experts who are desperate to make a difference, are clear about how the Government could provide the boost required to catch up with cancer and to save thousands of lives. The answer is not to exhort our heroic frontline staff to work harder—they continue to be inspirational, straining every sinew. It is not to carry on doing what we have always done, but just doing it a little better. It requires some new thinking. It requires taking an axe to some of the internal bureaucracy that has held back some treatments, such as radiotherapy. Crucially, it requires investment, but that critical investment seems to be missing from the comprehensive spending review. That is a missed opportunity on a massive scale, and I hope it is not too late to make a change.

I have to say that there has been a collective gasp of disbelief across the oncology and radiotherapy sector, as it appears—unless we are all mistaken—that there is not even an explicit mention of radiotherapy in the spending review, never mind of the investment in it. Radiotherapy is covid-safe and is required by over 50% of cancer patients. It already plays a significant role in 40% of cancer cures and is able, where clinically appropriate, to substitute for chemotherapy and surgery at times when they are deemed not to be appropriate because of the fact that we are in a pandemic. It is hugely cost-effective: it cures patients for as little as £5,000 to £7,000 apiece.

The reality is that radiotherapy has huge untapped potential to do even more to clear the backlog. For many reasons, however, it has been actively restricted and held back for years. Although radiotherapy treats 50% of cancer patients, it receives just 5% of the annual cancer budget—something for which recent Governments of all parties must share the blame. That is why the UK is massively behind on technology that could empower the workforce to do more. Pre-pandemic it was estimated that as many as 24,000 patients were missing access to radiotherapy treatment each year. It is worse now.

Faced with the current crisis, the radiotherapy community came together to put together a transformation plan for consideration at the comprehensive spending review. The six-point plan would deliver a super-boost to cancer services to clear the backlog, with innovative technology and digital solutions to deploy linear accelerators at the many covid-clean hospital sites in England, such as the Westmorland General Hospital in my constituency, that are perfectly suited to adding satellite capacity to their main cancer units while protecting patients and clinicians from covid infection risk. The plan would also see an immediate boost in precision radiotherapy at existing cancer units, upgrading linear accelerators to perform curative treatment over shorter periods. However, on our reading of the spending review, that appears to have been totally ignored. In fact, as far as we can tell, there is no clear plan of investment in cancer treatment capacity at all.

While the investment in diagnostic machines over 10 years is truly welcomed by all of us here, it is not enough. According to Freedom of Information Act requests carried out by the Radiotherapy4Life campaign, more than half of NHS trusts are using radiotherapy machines that are more than 10 years old. To replace only the machines that deliver diagnostics, or radiology, and not those that actually cure people—the radiotherapy machines—is a baffling decision, to me and, more importantly, the experts. Patients and the public will be shocked to learn that immediate solutions presented by expert professionals to the covid-induced cancer crisis are being overlooked.

Every week that we delay giving an immediate boost to cancer services—capacity, diagnostics and treatments —we increase the risk of losing cancer patients needlessly. Recent data shows that for every four weeks of delay in starting treatment there is as much as a 10% increase in deaths. Some departments report a 20% drop in the number of patients classified as curable, leading to downgrading to palliative treatment instead. Patients—our constituents, families and friends—are being told that their cancer now cannot be cured and that their treatment will be palliative instead. Yet the decision to catch up urgently with cancer has been either delayed or ignored. We will pay a huge cost for missing out on the chance to correct things at the spending review. That is why I hope it is not too late to do so. The public inquiry, when it happens, will reveal the situation. The cost of the understandable litigation by patients and families who have been failed will be needlessly huge.

We first wrote to the Secretary of State about the growing crisis in April, and we have not stopped warning of the devastating impact that there will be on the lives of cancer patients. Three hundred and seventy-five thousand people have signed the Catch Up With Cancer petition and have hundreds of patients shared their heartbreaking stories. Experts are saying that there will be as many as 35,000 unnecessary deaths and, as I have said, 60,000 life years lost to cancer because of the impact of the covid crisis. Cancer survival rates have been pushed back to where they were more than a decade ago.

I know that the Minister cares. She is a good person seeking to do a good job. I hope that she will forgive me for being direct today, but thousands of people could have their lives lengthened or saved, and their families could be spared unspeakable grief, if we acted urgently to catch up with cancer. I conclude by repeating my plea in the strongest possible terms. Will the Minister meet me and, most importantly, the expert clinicians who advise the Catch Up With Cancer campaign, in the next few days so that we can turn the tide on the crisis?

[Esther McVey (in the Chair)]

Just for the ease of colleagues, I will say that I am looking to call the Front-Bench speakers at 10.30 am, so divide the time among yourselves.

00:06

[Andy Carter (Warrington South) (Con)]

Thank you, Ms McVey. I will do a quick calculation.

[Esther McVey (in the Chair)]

You have quite a few minutes.

[Andy Carter]

It is a pleasure to serve under your chairmanship, and I am delighted to follow the hon. Member for Westmorland and Lonsdale (Tim Farron). I congratulate him on securing this important debate, and pay tribute to his excellent opening speech. I agree with many of the points that he made. The issue is incredibly important for families up and down the UK, and I am delighted to be able to join him in speaking in the debate.

I want to thank those who work in oncology in Warrington—the consultants, nurses, radiographers and, of course, GPs who are right at the frontline as the primary gateway into cancer services. Their work, and that of those in their sector across the UK, has continued through the pandemic.

Early on, I spoke to the chief executive of Warrington hospital, Professor Simon Constable, who outlined the steps his team were taking to try to maintain cancer care services in as near normal fashion as possible. Their ability to operate across two campuses, with a covid-free site in Halton, has meant that procedures such as breast cancer could operate very close to normal. The partnership formed with Spire hospital in Stretton, where the NHS has contracted bed space and use of operating theatres to give capacity for critical operations, has meant that referrals for urgent treatment in Warrington have continued.

I think that talking to real people is when we hear the true stories. Last Friday, I spoke to a constituent called Helen who lives in Lymm. It was one of the more pleasant conversations that I have had with her over the last few weeks. She very sadly discovered that her breast cancer had returned in April, which was the same week we hit the peak of the first wave. Understandably, she was incredibly concerned when she contacted her GP. Helen was referred back to a consultant and, after tests, was told that she needed a double mastectomy. I remember talking to her earlier in the year, when she told me the news, and she explained in detail her fears of catching covid when she went into hospital to undergo radiotherapy and tests. She was asked to isolate and follow detailed guidance, and she was superbly cared for by her son at home, who went out of his way to make sure she had everything that she needed. She went into hospital in Halton for treatment and last week, some eight weeks after the operation, told me that she was looking forward to going back to work as a supply teacher in one of our local schools. Her description of the care that she received from the NHS was incredible, and she said that they could not have done more for her. I highlight this story because I think we have not heard enough about the work that has continued over the last few months—but that does not mean we do not have a problem with cancer care services.

The local hospital in Warrington was treating 170 patients for covid at the start of November. It was one of the most under pressure hospitals in the entire country. The team has only been able to operate about 80% of normal services. I say only but I actually think that is pretty good, given that we are in a global pandemic and that is roughly in line with services across the north-west of England. I suspect though that the 80% headline masks many true and worrying statistics that we will discover over the next five years.

Last week I also spoke to executives at Macmillan Cancer about the local situation in Warrington, as well as the national picture. I pay tribute to the Macmillan nurses who have continued to work with patients in their homes through lockdown, particularly those who have supported families of loved ones who are near their end of life. Macmillan estimates that across the UK there are currently 50,000 missing diagnoses, meaning that, around 33,000 fewer people started treatment compared to a similar timeframe last year. That backlog of undiagnosed cancer could take 18 months to tackle in England alone. Most worryingly, if cancer referrals and screenings do not return to pre-pandemic levels, the backlog could grow by 4,000 missing diagnoses, reaching over 100,000 by October next year.

During much of the pandemic, the NHS has been open for business, and we should be proud of that. Anyone who needs care and treatment can continue to access it. When they need it, they can go to their GP and be seen, especially where delays could impose an immediate and long-term risk. I think the most worrying statistics are on urgent GP referrals in July and August. They were 72,000 lower than last year. In some ways, that highlights the most stark problem that the pandemic is storing up for us.

We have seen a significant reduction in people starting their cancer treatment in 2020. Between March and September, around 31,000 fewer people started their first cancer treatment, which is a drop of 17% compared to 2019. More than 650,000 people with cancer in the UK have also experienced disruption to their cancer treatment or care because of covid-19. For about 150,000 people, that included delayed or rescheduled cancer treatment.

I welcome the announcement of £3 billion of extra funding to support NHS recovery from covid-19 and to help tackle and ease some of the pressures in all our hospitals, allowing them to carry out more checks, scans, operations and procedures. That will help to ensure that cancer patients can access the care they need as quickly as possible, but we need to tackle the backlog, and we cannot afford to undo the great work and investment that has gone into cancer treatments in recent years. I am delighted to speak in a health debate today because of the news we have heard that a vaccine has been approved and is on the way. That is incredibly welcome, but we must put that alongside the challenges that exist in every single branch of medicine, and particularly in cancer care, where the patient backlog is extending.

One of the biggest challenges we face is caused not by money or pressure on NHS services but by putting things off. We all do it—mainly due to a fear of going into hospital. I mentioned Helen earlier, who talked about her greatest fear being to go into hospital. Lumps and bumps are not treated because we think it does not really matter at the moment. I am afraid that is particularly true for us men, and the pandemic has highlighted that. We really do need a public information campaign that says, “If you spot a problem, don’t leave it for a later date.”

As the hon. Member for Westmorland and Lonsdale said, since 2010, survival rates from cancer have increased year on year. We have a really good story to tell in this country—about 7,000 people are alive today who would not have been here if mortality rates had stayed the same—but to sustain that drop, the NHS and Government will have to take action like they have never done before. It is critical that the cancer workforce is ring-fenced against any further redeployment to ensure that cancer care continues and further avoidable cancer deaths are averted.

Before the pandemic, there were about 3,000 specialist cancer nurses, which Macmillan modelling indicates is around 2,500 below the level required to deliver basic cancer care—and given the backlogs, that figure is probably closer to 3,500. Patient feedback to Macmillan was that, though its nurses work incredibly hard, they are not getting the support that they need. I really welcome the 14,000 additional nurses we have recruited in the last 12 months as I do the additional £260 million fund allocated for Health Education England in the one-year spending review, which will go towards the Government’s commitment to train 50,000 more nurses. However, my hon. Friend the Minister will know that that alone will not address the significant shortfalls in specialist cancer care nurses. I am therefore really keen to hear from her how the Government can commit to further long-term funding support for the next iteration of the NHS people plan to eliminate the gap in the cancer workforce.

It is hugely important that the Government back the national cancer recovery plan and the additional resource needed to build capacity and help beat the backlog now and in the long-term, getting the right skills and resources in the right places to make sure we have the biggest impact possible and, most importantly, encourage people to get the treatment that they need. Getting all of us to feel comfortable with reaching out to our GPs early on, so that we can get treatment, must be our No. 1 priority.

09:59

[Tonia Antoniazzi (Gower) (Lab)]

It is an honour to serve under your chairmanship, Ms McVey. I rise as the chair of the all-party parliamentary group on cancer to talk about the worrying backlog of people who have not yet received a diagnosis of cancer. I pay tribute to the hon. Member for Westmorland and Lonsdale (Tim Farron) for securing the debate. We have been working hard cross-party to raise the issue of cancer services and the backlog, which is an issue really close and dear to my heart and one on which we need to make far more progress. I thank him for his excellent speech and his work.

Despite the amazing efforts of clinicians working in the NHS and additional support from the Government, the backlog of cancer is big and it is real. It was caused by the impact of addressing the first wave of the pandemic. I am not just talking about the backlog of people within the cancer system, which are often the figures that the Government deem to be the backlog. The real backlog is of undiagnosed people yet to come forward and present to the NHS through the three main routes: GPs, screening programmes and A&E.

In “The forgotten ‘C’” report by Macmillan Cancer Support, which uses the Government’s own data, it is projected that there are currently 50,000 missing diagnoses. The hon. Member for Warrington South (Andy Carter) has spoken in great detail about the figures, which I have also had from Macmillan. That means that compared to a similar timeframe in 2019, 50,000 fewer people have been diagnosed. That is a huge amount of people that we cannot ignore.

Macmillan Cancer Support estimate that 33,000 fewer people across the UK started treatment this year than in 2019. Working on the current rates, that backlog of undiagnosed cancer could take 18 months to tackle in England alone, not talking about the rest of the United Kingdom. Macmillan says that

“if cancer referrals and screening do not return to pre-pandemic levels, the backlog could grow by almost 4,000 missing diagnoses every month, reaching over 100,000 by October next year.”

That worries me to the pit of my stomach.

Such gravely concerning figures on the cancer backlog are echoed and supported by Action Radiotherapy, which states that the backlog of patients still waiting for potentially life-saving treatment amid the coronavirus pandemic could be as high as 100,000, with cancer services needing to work at around 120% to clear the backlog over the next two years. Those incredibly sobering and worrying statistics concern me.

In a recent parliamentary answer, the Government stated that they do not recognise those figures and they continually give an overly optimistic view of the current state of cancer services. The Government’s latest cancer waiting times from September 2020 state that urgent referrals were at more than 100% of the 2019 levels. That is over 45,000 people who have received cancer treatment, which is 96% of last year’s levels. Across the period from March to September 2020, over 291,000 cancer treatments were carried out, which was 86% of the level in 2019 and 94.5% of patients with a decision to treat received a first treatment for cancer within 31 days. Those are promising and improving statistics from the delays and disruption we saw in the first period of the pandemic. We cannot deny that.

I take this opportunity to thank the incredible and dedicated cancer workforce that has been indispensable in getting services back nearer to pre-covid levels. That is why we have to call on the cancer workforce and we need to keep them there doing their jobs. They are very precious, particularly at this time. Their efforts have been incredible and it is important to acknowledge their service to patients across the country, and their fantastic efforts in continuing cancer care across the second wave.

From all accounts, we are not seeing the delays and disruption across the board that we saw during the first wave of the pandemic. However, despite the improving situation there are many instances where the performance of the cancer system is operating at a slightly lower rate than before the pandemic. To tackle the backlog, the cancer system needs to out-perform its pre-pandemic performance, which it is not doing in all areas.

For every month that the NHS is working at below pre-pandemic levels, the backlog is building and it is not being beaten. Urgent GP referrals appeared to be roughly back to normal in September, but there were still around 338,000 fewer people not seeing a specialist following an urgent referral between March and September this year, compared to last year. I am rightly concerned about the potential for missing diagnoses. Macmillan Cancer Support estimate that it would take 17 months at 10% above 2019 levels to see 338,000 extra patients, which are striking figures.

The real issue is that Ministers are painting an over-rosy picture of the cancer backlog and trying to refute the claims that a large number of people are not having cancer treatment this year compared with previous years. The Government cannot refute their own cancer waiting times data for those starting first cancer treatment. From March to September, there were 31,000 fewer patients starting first cancer treatment in England, which is a drop of 17% compared with the same period last year.

Let us be clear: there are 31,000 people in England who currently could have cancer, and yet, for numerous reasons associated with the pandemic, have not presented to the NHS with symptoms. That is an incredibly worrying and troubling statistic. Without acknowledgement of the scale of the issue, neither the solutions to the problem nor the resources needed to tackle it will materialise.

Again, while September’s monthly activity was improving, it is still down on last year and so the backlog will continue to grow each month. Month by month, performance is below 2019 levels, which is a huge concern—and a huge and daunting task that is currently being underestimated by the Government.

The national cancer recovery plan, which is yet to be published by the Government, and only runs to March 2021, only uses metrics on the backlog that include those on the 62-day and 31-day cancer pathways, as well as those with longer waits for diagnostics or treatments above 104 days. It in no way estimates the significant number of people yet to present to the NHS. That is the real backlog, which the Government are failing to acknowledge and are failing to take significant and timely steps to address.

While the Government have made some welcome steps in adding additional capacity through the independent sector and just recently committed £1 billion extra in the comprehensive spending review to deal with backlogs in the NHS, it is uncertain how much of that money is allocated to the cancer system. Will the Minister confirm how much of that funding will be spent on beating the backlog in cancer care?

It is clear that the restoration of the cancer system is a priority at the highest levels of the Government and that significant resources have already been allocated to that endeavour, but—it is a very big but—until the Government acknowledge and plan to tackle the monumental scale of the real backlog that is still building, the health outcomes of many thousands of people out there yet to be diagnosed with cancer will be significantly grave and the Government will not be able to meet their ambitious targets for cancer within the NHS long-term plan. Will the Minister acknowledge the scale and reality of the problem, commit the strategic and monetary resources needed to tackle it now and work with key stakeholders such as Action Radiotherapy, the different all-party parliamentary groups and Macmillan Cancer Support, which have been working hard to support those living with cancer and who have been severely impacted by the pandemic?

I welcome the previous and the soon-to-be-had engagement with the Minister. We appreciate that we are working in unprecedented times. However, I was a little bit concerned to read a letter dated 30 November from NHS England’s cancer programme to the cancer alliances. The letter, which is advice on maintaining cancer recovery, shows the depth of arrangements and efforts that are being made to restore the cancer system and continue with cancer care, but it fails to acknowledge and deal with the huge backlog of people we have spoken about today—those who are yet to come forward for a diagnosis.

The national cancer recovery plan is too short term and has the wrong priorities to deal with the backlog in the long term. That is what we are concerned about; that is why we have come here today to present the issues to the Minister. I look forward to speaking with her, but I ask that this issue is dealt with immediately.

10:09

[Grahame Morris (Easington) (Lab)]

Thank you very much, Ms McVey, for calling me to speak in this important debate. I also thank my friend, the hon. Member for Westmorland and Lonsdale (Tim Farron), for securing this debate.

I am sure this will seem like groundhog day for the Minister, with a whole phalanx of MPs supporting the calls for more resources for cancer, but this is a very serious issue and I make no apology for rehearsing those arguments. Until we see tangible results arising from our lobbying efforts, I am afraid it will continue. The hon. Member for Westmorland and Lonsdale made an excellent opening speech, setting out the arguments in a thoroughly cogent and thoughtful manner. I also want to pay tribute to the NHS workforce, in particular our cancer workforce, not just the oncologists but the therapeutic radiotherapists, the technical staff who keep the service running, and those key personnel who work behind the scenes, often unacknowledged, whose expertise has the potential to improve cancer outcomes.



The speeches have been excellent so far, but I will take issue with one point raised by the hon. Member for Warrington South (Andy Carter) about our cancer performance. Our focus in this debate is on what we can do immediately to address the cancer backlog, but I would respectfully point out that, even before the pandemic, our performance on cancer outcomes was not world-beating. In fact, for the seven most common cancers, in a direct comparison with similar advanced industrialised countries, we were either bottom or second bottom. There was a job of work to be done even before the pandemic, and the impact of covid has shone a spotlight on that.

I have the great privilege to be vice-chair of the all-party parliamentary group for radiotherapy and vice-chair of the all-party parliamentary group on cancer. The charity Action Radiotherapy estimates the full cancer backlog stands at more than 100,000 patients, and it agrees that it would take cancer services working at over 120% of pre-covid capacity for two years just to catch up. The chair of the Health and Social Care Committee, the right hon. Member for South West Surrey (Jeremy Hunt), agrees with that figure, having done some research of his own.

We need a distinct plan. It cannot be a case of Members simply lobbying Ministers and asking for more resources. We need to quantify the scale of the problem; we need an action plan. I am very much aware that we have a cancer recovery plan, but we need an action plan that addresses all the issues. I also believe that we need somebody with some clout to lead it. Last week the Government announced that the Under-Secretary of State for Business, Energy and Industrial Strategy, the hon. Member for Stratford-on-Avon (Nadhim Zahawi), would be the Minister responsible for driving forward the vaccination programme. Cancer is such an important area of concern to the public and to the broader community that we need to have someone with some clout, preferably a Minister or senior person within the NHS, to be given the responsibility to drive this initiative forward.

Experts are predicting 35,000 deaths and 60,000 lost years of life, with cancer survival rates having been pushed back to where they were 10 to 15 years ago. We need to address this issue. When we have asked questions in previous debates, Ministers have responded, and I mean no disrespect to the Minister who is in her place at the moment, because I know that she fully understands the issue. I do not want to make any apology here, but there is a difference between investing in diagnostics and investing in curative treatments. There is a difference between radiology and radiotherapy, and I am not convinced that the Secretary of State understands those differences. We welcome the additional investment in digital imaging and improved diagnostics, but we must address how we get more resources and improve the number and quality of the skilled cancer workforce to get to grips with the backlog.

It is appropriate to mention the implications of the pandemic for prostate cancer, which was also referred to by the hon. Member for Warrington South. Movember, when men grow a moustache to raise awareness and funds for men’s health during November, ended earlier this week. Prostate Cancer UK has identified two major concerns. The first is the detrimental impact on GP referrals for prostate cancer. That came to mind when my hon. Friend the Member for Gower (Tonia Antoniazzi) mentioned the three referral pathways of A&E, GP referral and screening programmes. There is a massive issue. I suspect that hon. Members present have some experience of how extraordinarily difficult it is, particularly for older people, to get a face-to-face appointment with a GP at this time if they have concerns about possible early symptoms of cancer. Again, that needs to be addressed, because it is having an impact on the backlog.

The second concern is about men accessing support and communication at the time of diagnosis and when living with side effects or advanced disease. Calculations by NHS England and Prostate Cancer UK suggest that there are between 3,000 and 5,000 men with undiagnosed higher risk prostate cancer who would otherwise have been diagnosed had referral rates been at pre-covid levels.

In the time that I have remaining, I will focus on two main areas and I have some specific asks of the Minister. The first area, which I have raised on previous occasions, is data and information. We have heard statements from Ministers in the Department of Health and Social Care and from senior NHS leaders that indicate that they do not have an accurate estimate of the full cancer backlog of delayed treatments, diagnostics and screenings. The publication of the radiotherapy dataset, which is available, would show precisely the extent and character of the backlog, because it would compare the position now with the position 12 months ago.

For reasons that are not apparent to me, the publication has been delayed by NHS England, so my first ask of the Minister is, why is that? Why will those radiotherapy datasets not be published? I do not know whether NHS England is being too slow to act or whether it is some kind of bureaucratic hold up, but it must be driven forward, as it is imperative to ensure that the cancer recovery plan is accurate. That is despite the fact that NHS England and Ministers are fully aware of the effect of the pandemic on cancer services; we have been raising the issue since April.

It is clear that knowledge is power. A lack of accessible data is resulting in an inability to catch up with cancer. Let us be frank: people are dying unnecessarily as a result. There was the awful case of Kelly Smith, one of many tens of thousands of people, who was a 31-year-old mother of three who died as a result of delayed treatment for bowel cancer. It was absolutely tragic. That caused her family to launch the Catch Up With Cancer campaign and petition, which I believe now has almost 400,000 signatures. If that does not concentrate Ministers’ minds, I do not know what will.

The second area is the comprehensive spending review and, in particular, the lack of any detail or specific reference to funding for modernising radiotherapy services. The Chancellor’s announcement last week was most welcome, but when the hon. Member for Westmorland and Lonsdale asked about the cancer backlog and additional resources for advanced radiotherapy, he was referred to Health Ministers and the Secretary of State.

We should be aware that radiotherapy is safer to administer during the pandemic than alternative treatments. I am not attempting to set up a competition, but we have to recognise that radiotherapy is non-invasive and covid-safe, and has a range of applications. It is needed by about half of all cancer patients and is a significant treatment in 40% of cancer cures. I have benefited from it myself on three occasions. It is also hugely cost-effective, curing patients for as little as £5,000 to £7,000 per treatment. It is very efficacious in terms of the curative rate, and it could do much more to clear the backlog, but it is being held up by underfunding and bureaucracy, which have slowed the roll-out of new technology for a number of years.

Despite freedom of information requests showing that nearly half of trusts are using radiotherapy machines that are 10 years old or older, it appears that the spending review includes funding only for diagnostic machine replacements and not radiotherapy treatments. Even before the pandemic, Radiotherapy4Life estimated that 24,000 patients did not have access to radiotherapy and would benefit from it. Will the Minister commit to improving access to local radiotherapy by investing in new networked treatment delivery centres? Furthermore, will he consider all the elements of the six-point plan to transform radiotherapy services to ensure that we have the treatment capacity to catch up? Will he sweep away the bureaucracies that have contributed to the backlog?

There is no doubt about it. We need a supercharged—“super boosted”, to use the Prime Minister’s words—treatment capacity if we are to address this cancer crisis.

00:00

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Westmorland and Lonsdale (Tim Farron) on securing the debate and setting the scene, and all hon. Members on their incredible contributions. I look forward—I said this yesterday and need to get away from saying it again—to the Minister’s response and the contributions of the shadow Minister and the Scots Nats spokesperson.

I have been contacted by many constituents asking me to attend and speak in this debate, and as my party’s health spokesperson I am very happy to do so. One of the heartbreaking stories I have heard in the past couple of difficult days is a widow saying:

“my husband only died of cancer—he isn’t important”.

I honestly could have cried when I heard those words, because I believe that she genuinely felt that no one cared, and that is what she told me. I felt that hardness; I had a compassionate understanding of what she was saying.

We are in unknown territory and undoubtedly we are distracted. How can we save people from contracting covid? How do we treat those who have it? How do we keep people in contact with others for their mental health? How do we ensure economic viability to pay for the future health needs of this nation? We are distracted, but when we have widows and cancer patients telling us how left behind and unimportant they feel, we know that in our distraction we have got this wrong. It pains me to say that.

Throughout this pandemic, I and others have lost loved ones. Two of the girls in my office have lost loved ones: one lost a sister and the other lost two uncles. We know the devastation, but we have all lost loved ones to cancer too. It is not that one is less important than the other, so that is why this debate is so important. I am thankful for this debate, which allow me to come alongside my colleagues and friends—that is what they are—to discuss how better we can do this together.

I was contacted by a radiotherapist who highlighted the massive problems they are dealing with daily. There are two main radiotherapy centres in Northern Ireland. I know this is not the Minister’s responsibility, but I am saying this to give some context to the debate. One is in Belfast, and the other is the newer, smaller North West Cancer Centre at Altnagelvin. I am told that the main issues in radiotherapy are the result of the lack of investment and funding. There are major problems as a result of staffing—doctors, therapy radiographers and physics—including recruitment, training and retention. That has a knock-on effect on service delivery, development and research. Investment is needed to replace old radiotherapy treatment machines.

Northern Ireland would like to feel more connected to mainland UK radiotherapy, through sharing best practice, training support, data sharing, peer review and so on, and that is what we are asking for. It is important that we take an holistic approach to this across the whole of the United Kingdom of Great Britain and Northern Ireland.

The covid problems found also included more patients having their treatments disrupted in many centres in the United Kingdom and a higher proportion than average reporting a poor or very poor experience. That also worries me greatly. We have members of the all-party parliamentary group for radiotherapy in the Chamber today, and I know that every one of us understands these issues, including the hon. Member for Westmorland and Lonsdale, who set the scene. One hundred per cent of responders said they were treating patients who would usually be having chemotherapy or surgery. The additional referrals were for a range of cancers, including oesophagus, lung, breast, head and neck, upper gastro- intestinal and bladder, and also included palliative cases.

I want to speak about one specific cancer, pancreatic cancer. It has been highlighted that there was already an emergency before covid-19. This was a critical issue back in March and it is even more critical today, in December. Surgery is the only potential cure for pancreatic cancer. Before the pandemic, only one in 10 people received surgery. With pancreatic cancer, a six-month delay to surgery means a 30% reduction in survival and a three-month delay a reduction of over 17%. Unfortunately, that sets the scene, with pancreatic cancer progressing from a curative to a non-curative disease while treatment is delayed. Surgery, for some, is no longer an option. That is greatly disturbing.

Reports of service restoration are encouraging. We hear from clinicians that, in most parts of the UK, surgery and treatment are now back up and running at near normal levels, but for so many people with pancreatic cancer and their families the damage has already been done. For those diagnosed in the future, the continued delays to the restoration of clinical trials are stunting crucial improvements in treatments and outcomes.

People with pancreatic cancer have also experienced an information gap, with 40% of patients who were impacted by the pandemic reporting having received insufficient information and support about treatment, symptom management or palliative care. We have had multiple reports of people being sent home from hospital with a new diagnosis without any further information on the disease, their prognosis or treatment options. Anyone facing something incredibly dark such as pancreatic cancer at an advanced stage will want the person opposite them to tell them what is wrong and give them some light on a way forward. All of us in this Chamber today, and all of us outside it, have been touched by cancer. For every two people we meet, one of them, or someone in their family, will have had it. Unfortunately we are continually confronted by this, each and every day.

Calls and emails to Pancreatic Cancer UK’s support line nurses have been up 58% on the normal weekly average, and there has been a 34% increase in the number of people being supported each week. Again, I think those figures are the critical factor in where we are on this. Pancreatic Cancer UK has also been contacted by a larger proportion of palliative patients than normal, because that is unfortunately what pancreatic cancer often leads to. If people do not get an early diagnosis and early surgery, they are confronted with end-of-life care. For families, that is incredibly difficult and complex, and a very difficult time in their lives. People with pancreatic cancer have reported feeling forgotten and isolated, at a time when they are also unable to see friends and family due to the risk of covid-19 transmission.

We are all heartened by the tremendous news today that we are going to roll out the covid-19 vaccine late this year and into next, given the time it will take to get to everyone. That is good news, but we have to address the issues for those with cancer now. I believe we need to do better, and the changes must be implemented from here at Westminster and across the whole of the United Kingdom of Great Britain of Northern Ireland. On behalf of all those cancer patients—all the ones who have contacted us, and all those facing an incredibly difficult time—I look, as I often do, to the Minister for a response. I know we will get that, but we really do need to be reassured. We need early diagnosis and extra care, and we need to show compassion in this place for those outside.

[Esther McVey (in the Chair)]

We now move to the Front Benchers.

10:29

[Dave Doogan (Angus) (SNP)]

It is a pleasure to serve under your chairmanship, Ms McVey. I am grateful, as all our constituents will be, that this issue has been brought to the fore in the way that the hon. Member for Westmorland and Lonsdale (Tim Farron) has done in securing this debate. My only regret is that my hon. Friend the Member for Central Ayrshire (Dr Whitford), who is a cancer specialist, cannot be here to share her wisdom and knowledge on such matters because she cannot participate remotely. You have got me instead, Ms McVey.

As we see from our inbox, there is concern that the reconfiguration of our national health services to meet the projected clinical demands of the pandemic went too far, and has come at a cost to non-covid patients. There are serious concerns about a cancer backlog. Gravely ill patients were, and clearly continue to be, cared for by our four national health services consistently throughout the pandemic, thanks to the dedication of clinicians and nursing and support staff. That is not to say that the pandemic preparedness had no consequences, but to defend the qualified and proportionate repositioning of the health services in the face of we knew not what exactly, back in March. The backlog is a consequence. How can we address it now?

As we have heard, Action Radiotherapy has suggested that there have been 100,000 missed diagnoses. That is a serious challenge for us to address across these islands. The Scottish Government undertook extensive work to improve cancer treatment over the last decade, and have made every effort to ensure that it was minimally disrupted throughout the pandemic. There has been disruption, however—of course there has.

Macmillan has expressed its concern that 50,000 diagnoses have been missed. When Macmillan speaks on these issues, Ministers in all four Administrations should listen to that message. A drop of 72% in cancer referrals as a result of covid is a cause for serious concern; we do not need to be specialists to understand that. Even though only a percentage of those referrals will result in a cancer diagnosis, there will nevertheless be a backlog of referrals and resulting care plans to be worked up as a result of covid. Dr Gregor Smith and many across these islands have insisted that people should report and present to their GPs when they notice something unusual. The First Minister of Scotland has also stressed that the NHS remains available to those who need it. Advice has been sent to all cancer service centres in Scotland, including the key message that health boards are expected to maintain full and urgent cancer services.

Who among us is unfamiliar with those in our communities, usually from an older generation, who do not like or want to trouble people, so do not present to their GP? For some, particularly men, there is a somewhat understandable reticence to present for healthcare in the middle of the pandemic. We can therefore see significant presentation deferral, which needs to be acknowledged, accepted and resourced. That needs to be resolved quickly, acknowledging the time-critical nature of some of the conditions. Cancer treatment services in Scotland—and, I assume, in the other three nations—have continued as much as possible throughout lockdown, using modified operational models. I thank NHS Tayside, which employs many of my constituents and looks after the healthcare of all my Angus constituents. I especially thank those at the cancer centre in Dundee, who have worked tremendously hard. The Scottish Government invested a great deal in additional MRI scanners and CT scanners to aid diagnosis, but I accept the important difference that other hon. Members have highlighted between diagnosis approaches and resource, and treatment.

Many challenges persist in this priority issue, not least the staffing of specialist consultants. That is especially challenging now because recruiting from EU countries is challenging as a result of Brexit, and retaining domestic consultants is also challenging. At the start of covid, the average age of NHS returnees—those who nobly answered the call to assist with covid and its consequences—was 57. Many of those doctors are retired because of the punitive implications of Her Majesty’s Revenue and Customs rules on pension allowance. That really needs to be addressed soon, to allow that dormant domestic capacity to keep their shoulders to the wheel should they wish to, without being unduly penalised. That issue of doctors’ pensions is one of the most hopeless instances of the total failure of a whole-system approach in modern governance, with HMRC tying the hands of our NHS behind its back. That is a really easy win—low-hanging fruit—that we can resolve quite soon.

The UK Government must ensure that cancer treatment does not move backwards in the aftermath of coronavirus, and must focus proper additional investment on our NHS. Despite the work of the NHS in Scotland and across the UK, there is a backlog of people seeking cancer screening and/or treatment. At this stage, we have three priorities: satisfying the routine cancer demand; the health commitments in and around covid; and the cancer backlog. To ensure that this does not spiral into an enduring secondary health crisis, significant and defined supplementary investment is needed to clear the backlog of screening and treatment, and to get cancer services restored to at least the level seen before the pandemic. It is important for colleagues in England to keep a weather eye on what the Barnett consequentials are for the devolved nations as a result of funding announcements. To be clear, if there are no Barnett consequentials for the devolved Administrations, what we are seeing is simply relabelled money rather than new investment. That will not fly.

The hon. Members for Strangford (Jim Shannon) and for Gower (Tonia Antoniazzi) do not need the clinical direction of the Department of Health and Social Care—that is taken care of by the devolved Administrations—but we are umbilically connected to the funding settlement for NHS England. That is why it is so essential. The £3 billion offered for next year is a third of what the SNP has been calling for on a yearly basis. After a prolonged period of austerity, £3 billion is not even enough to cover the outstanding hospital repairs required in England alone, much less to restore cancer services. Regardless of where we live on these islands, we have all convened here this morning to try to restore cancer services and protect those affected. I respectfully look forward to any specific indications that the Minister can give us of additional funding to address this very serious and pressing issue.

10:36

[Alex Norris (Nottingham North) (Lab/Co-op)]

It is a pleasure to serve under your chairship for the first time, Ms McVey, and I commend the hon. Member for Westmorland and Lonsdale (Tim Farron) for securing the debate. When he opened it, he said he thought this was an issue on which we could work through consensus and in a collegiate fashion, which is absolutely right. The tone that he set, and that other hon. Members have followed, reflected that. He also said that he was direct in his contribution, which he was. He was right to be direct, because these are life and death issues, and we in this place need to be really focused on them in the most direct fashion.

I was lucky to meet the hon. Gentleman in July, alongside representatives from the secretariat of the all-party parliamentary group on radiotherapy, to discuss this issue. Of course the situation is not exactly the same as it was in July, but the crux of the issue is the same. It is great to go beyond virtual meetings and the back-channel conversations that we have in Parliament, and to get the subject on to the Floor of the House in order to have a public conversation about what is a very public and important matter. I particularly agreed with the hon. Gentleman’s point about “back to normal” not being good enough, because “back to normal” will not help us clear the backlog. Actually, we do not want to go back to where cancer services were in January. Hon. Members have touched on many ways to make services better—I will do the same later—and we should seek to do so. I share the hon. Gentleman’s anxiety about the gap between some of the rhetoric that we have heard from the Secretary of State, and the reality of what the numbers tell us about where we are at the moment.

Cancer touches us all at some point, as the hon. Member for Strangford (Jim Shannon) said yesterday and again today. For me, it was 33 years ago: I lost my father just before my third birthday. You come to terms with it and learn to live with it, but it is something that you carry around with you every day for the rest of your life. One of my major reasons for wanting to be a Member of Parliament is that I want there to be as few families like mine as possible. We can beat cancer to the best of our ability, so that people need not live their life in the shadow of cancer. I know that the Minister shares that aspiration. That is part of the consensus that we can build on this important issue.

The speeches this morning have been really good. The hon. Member for Warrington South (Andy Carter) started with Helen’s story, which was a really important thing to do. Lots of numbers have circulated—I will be guiltier than anyone else of throwing tens of thousands here and there—but each one of those statistics is a person and a life. That is what really matters. I strongly share the hon. Gentleman’s recognition of the creativity of our NHS.

I nodded and agreed when my hon. Friend the Member for Gower (Tonia Antoniazzi) made the point about undiagnosed cancers. I worry sometimes that when the Secretary of State talks, he is talking about the backlog and dealing with treatment for those who have a diagnosis. That is of course absolutely crucial, but it is only part of the problem that we are dealing with.

My hon. Friend the Member for Easington (Grahame Morris) has been a very good friend to me ever since I was elected in 2017, but particularly in my Front-Bench role over the past eight months. I am grateful to him for his counsel and guidance, and for constantly sharing his information with me to enrich my work. He was right to say that we have to understand the performance picture a year ago—frankly, covid was a very distant and small threat, and we had not really grasped how it would change our lives. We were not happy with cancer performance or with the direction of travel over the last decade. Certainly, as the Opposition, we were very concerned about that. We have to see the current situation in that context.

The hon. Member for Strangford was yesterday the Member in charge of a brilliant debate on cancer in children and young people. Collectively, we raised and analysed really important issues, and I know that the Minister took an awful lot away from that. The hon. Gentleman’s contribution today was very much in the same vein. It was about an holistic approach, across the four nations, all of which are represented today, which is really nice. As the hon. Member for Angus (Dave Doogan), who speaks for the SNP, said, this is of course a devolved issue. But we need to tackle it collectively.

I will make a few points of my own. In yesterday’s debate, I touched on the impact that covid has had on cancer diagnosis and treatment in children and young people—a demographic that is often both reluctant to visit the doctor and diagnosed slowly; it often takes multiple visits for that to happen. We will need to do things differently to tackle the pre-existing issues such as that and to catch up in relation to where we are.

Of course it was right that we prioritised covid during the first wave and have continued to make tackling the pandemic an important priority. We should take real pride in the fact that our NHS has taken such a strong punch to its capacity and stood there; that was not inevitable. We have seen other health services around the world overwhelmed, so we should be really proud of ours. It is a real testament to the institution that it has stood firm.

Nevertheless, we know that we now have an undiagnosed and untreated backlog of cancer. It is hard to estimate its true size because it is unknown. However, working off the best estimates of experts in the field—I shall use many of the numbers that the hon. Member for Westmorland and Lonsdale did in opening the debate—we are talking about a backlog of about 100,000 patients, which it would take about two years, working at 20% higher capacity than pre-covid, to capture. We cannot do that just by wanting it to be better or wanting people to put their shoulders to the wheel even more, after a year in which the NHS has been working flat out. We will have to do things fundamentally differently. If not, the price will be preventable deaths. Every four weeks of delay in starting treatment can cause an increase of up to 10% in the risk of death. The estimate is that the backlog could cause between 30,000 and 60,000 deaths, which starts to become of the same order of magnitude as the number of deaths from covid itself. That is how serious the situation is. As we emerge from the pandemic, we need to tackle cancer with the urgency and focus with which we have tackled covid.

There is particular concern about missed screenings. Cancer Research UK estimates that 3 million screenings were missed over the last year. Also, we know that fewer people went to the GP with symptoms during that time, because they were worried about other issues or capacity issues. As a result, about 350,000 fewer people were referred between April and August than we would normally expect, and there was a consequent 39% drop in the number of key diagnostic tests undertaken in that period.

I was really glad to hear yesterday from the Minister that the numbers of GP referrals are now back around pre-pandemic levels. That is a good sign. Actually, there were more referrals in September 2020 than in September 2019, but the two-week wait target of 93% is not yet being met, so there is definitely some context for that.

We need to understand that this issue will still not apply evenly throughout the population. Cancer does not know who we are when it grows in our bodies, but different demographics are affected differently—yesterday we talked about young people—and there are issues about different cancers, too. The points that the hon. Member for Strangford made about pancreatic cancer were well made.

The scale of the problem is exceptional and it calls on us in this place to make it a real focus and to have really strong, robust plans; so, now that I have talked about the problems, here are my suggested solutions. For me, this goes across four phases—planning, resourcing, new treatments, and workforce.

In August, the Secretary of State said that he very much hoped that the backlog would be cleared

“within a matter of months”.

Since I assumed my role, I have used three out of four sessions of Health questions to ask about cancer and try to get the Government on the record on that, which is why it is so great that we are having this debate. My heart sank when the Secretary of State said he thought the backlog could be cleared within a matter of months, because there is a problem; I do not think it is rude or unkind to say so. It has been recognised, during the pandemic, that some of the rhetoric that comes out of the Department is wishful and not grounded in reality. We are always told that things will be “world-class” and that things will be done “by the end of next month”. People’s hopes are got up and then dashed. We do not need exaggerated rhetoric here; we need exaggerated action.

I cannot see how anybody thinks that we can clear the backlog—the real backlog, which includes the lack of diagnosis as well as delayed treatment—within a matter of months. I do not think it helps anybody to talk in those terms. However, in October, at the Health questions before last, the Secretary of State gave me a categorical assurance that he has a cancer recovery plan that will drive down waiting lists each month for the rest of the year. I welcome that. That could be done and I am keen to hear the Minister reflecting on progress on that.

Similarly, at the most recent Health questions, the Minister for Health, the hon. Member for Charnwood (Edward Argar), said that there was greater capacity to deal with these things.

[Grahame Morris]

I cannot dispute the answer that my hon. Friend received from the Minister. It was an obvious answer, but the waiting lists have reduced because people are not presenting. There are fewer screening programmes, people are finding it harder to see their GP and things have become more and more difficult, so there is bound to be a reduction in waiting times, but that does not reflect the true picture of the backlog.

[Alex Norris]

Those points are very well made and get to the heart of what we as an Opposition want, what all Back Benchers want—and in fact, everyone. We do not want to beat cancer on paper and in statistics; we want to beat it in reality. We are not making this an issue of politics. It has to be an issue of coming together, as the hon. Member for Westmorland and Lonsdale said in opening the debate, with new and challenging things. Critically, at the heart of this, there is an indication of a plan, so I hope that today the Minister will commit to publishing it, give us greater detail on what is in it, update us on its progress in recent months and tell us whether it works through the full pathway, from symptoms to treatment, or whether it is just a diagnostics plan. To what extent is it being maintained in the second wave, and, with the national cancer recovery plan expiring next March, will there be a longer-term successor? I know that is a peppering of questions, but this is our best opportunity to ask, so I hope the Minister will take that in the spirit intended.

On resources, there was £1 billion in the spending review to tackle backlogs. Will the Minister clarify how much of that will go to cancers? Although the money is welcome, it is less than all the health experts have called for. The Chancellor has promised to give the NHS what it needs, and this is a “what it needs” issue, so resources are important.

On innovation, I am lucky enough to have lots of innovative companies contact me to talk about their treatments. It cheers the spirit to hear about developments in chemotherapy that will make it possible for drugs to be tailored to individuals. That is remarkable. However, I will make a point about radiotherapy because of the hon. Members between me and the door; I will not get out unless I do. Radiotherapy is safe to deliver in a pandemic, is significant in 40% of cures and is cost-effective. That is an area where we can make a real impact. Will the Minister commit to follow what my hon. Friend the Member for Easington said and publish the delayed radiotherapy dataset? That would be a nice step forward.

Macmillan has raised concerns that the long-term plan for the NHS will not be matched by the workforce available. It thinks we need a further 2,500 specialist cancer nurses. Where are we up to with that?

The most important message that any of us can send today is to a person listening to this, watching this or following the coverage who has a hacking cough, a lump or bump or blood in the stool, and has previously used the pandemic—as perhaps many of us would—as a reason not to access care. I ask them to please not do that. The NHS is there for them. We need them to access it. It will be there.

[Esther McVey (in the Chair)]

I am about to call the Minister, but am mindful that Tim Farron needs time to wind up.

10:44

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

It is a pleasure to serve under your chairmanship, Ms McVey. I have been given nine minutes to answer an enormous number of questions, so I will canter through in the hope that I answer some of them. We are a group that meets and discusses these things on a fairly regular basis. Indeed, I am back here this afternoon for a lung cancer debate, so this is an ongoing conversation, which I appreciate is vital. It is right that we recognise, as several hon. Members have, that the NHS has stood up during the pandemic, which was a blow to its very belly. We have put much effort into retaining services, not only for cancer, but for stroke patients and others, so that they can go to our NHS in their time of need.

I thank the hon. Member for Westmorland and Lonsdale (Tim Farron) for securing this debate and for all the work he does as chair of the APPG. He has such a formidable set of musketeers supporting him on what is one of the most focused APPGs. We are due to meet in January, but I will try to fit in a short meeting this side of the recess.

I have never said we were world beating—I came to this place because we were not; we had challenges before. Up to March last year, there were 2.4 million patients, which is 1.4 million more than in 2010. We were on a trajectory and covid hit us hard, and I would be the first to say that it has presented major challenges for the entire healthcare system.

The significant impact of shutting down services resulted in a sharp reduction in the number of people being referred urgently with suspected cancer and from screening programmes. That is a statement of fact. I am not going to stand here and say that it did not happen, but I am also not going to say that Herculean efforts have not been made since then.

I am really pleased that the cancer services recovery plan has had input from many cancer charities, including Macmillan, which has been mentioned, as well as many Royal Colleges, including those of General Practitioners, of Pathologists, of Radiologists and of Surgeons. It is vital that the right people make the recovery plan, which is being led by Professor Peter Johnson and Cally Palmer. It is in their hands together—a coalition—and I hope the recovery plan very much leads the way on a route to addressing the backlog and making sure that we take opportunities.

I think we all agree on some of the challenges, including those on data, referral systems and the lack of optimal radiotherapy machines in Westmorland. Again, that is a statement of fact and we need to address how we improve that situation so that every single person has appropriate access to treatments. As treatments advance or are shorter—more oral chemotherapy can be given at home, for example—there is a chance to redesign services to make them better and deliver more for patients. Every single day, I think of those patients. The hon. Member for Easington (Grahame Morris) made a comment about the loss of individuals. Every single day, that is what motivates me.

I thank my hon. Friend the Member for Warrington South (Andy Carter) for his comments about how hard the workforce are working. Whether it is a cancer nurse specialist, a radiotherapist, a radiographer or a surgeon, they are putting their back into this effort, because it could be a member of their family. They are a tremendously committed workforce, to whom I extend enormous thanks—but we need to get more of them. How do we convince a young nurse that his or her route is to become a cancer nurse, even though all the other specialists are also asking for them? We should also be working on that as a coalition, saying, “This is a fantastic area.”

We want to eradicate breast cancer by 2050. The survival rate for testicular cancer is now at a 98%. Pancreatic cancer is a dreadful disease, but we are now seeing not a two-week death sentence, but a couple of years. There are advances all the time and we must optimise that. Each and every person deserves to see that power, particularly on today of all days, when a vaccine has been approved and we know how brilliant this country’s life sciences industry is. We can beat this disease, but it takes time. I am absolutely committed to the patient-centred approach. One in four patients presented at A&E before this crisis—they presented too late. We know what the golden thread is.

There have been some positive announcements. I was encouraged to hear that we will pilot the Grail blood test, which can detect cancer from saliva. I am also pleased that in November’s spending review there was a further £325 million of investment in diagnostic equipment. The allocation of that will be determined in the next few weeks. I cannot give hon. Members any promises, and they would not expect me to say what will be allocated, but I understand the lobbying and the importance of not necessarily having shiny, sparkly front doors to walk through but getting the kit on the ground that can help save people’s lives. We know that no one single thing gives people the best chance of survival—it is the golden thread of swift referrals and screening that gives us early diagnosis—so we need those faecal immuno- chemical tests and to roll out the lung cancer pilots, and we are doing that. We need to ensure that we drive up those workforce numbers. We also need shorter waiting times for optimal treatment that will ultimately turn the tide on this disease.

Our strategy for maintaining services concentrates on stepping up hubs for cancer surgery and optimising independent use, which we have done as a Government. We stood up; we did not shy away from it. There have been no arguments about us using the private sector during the pandemic, have there?

[Grahame Morris]

rose—

[Jo Churchill]

I am really sorry but I have only got two minutes.

The NHS will accelerate the roll-out of rapid diagnostic centres. As I said in this Chamber yesterday, in March we had 17 of them and we now have 45—we have stood up 28 of them in the course of the pandemic. Most importantly, they will support early diagnosis, which we know is key. I am pleased that we are concentrating on recovering and maintaining cancer services. Through the newly formed cancer recovery taskforce, led by Professor Peter Johnson, we can drive that commitment forward with everybody.

The workforce have adapted, flexed and cared for individuals in the most challenging of circumstances. Every death concentrates my mind. My first text yesterday was from a friend who told of the passing of someone who had lost her fight against breast cancer after seven years. The disease does not go away. I am sure my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) would be here if she were not going through treatment and, as she would tell us, it sucks. The cancer workforce are a special part of the NHS family and I want us to ensure that they know how special they are so that people come forward to join them.

We know that referral rates have been variable across different cancer types. Arguably, some cancers have really challenged us, and particularly those that need endoscopies and colonoscopies. We are still not there because of the treatment. Lung cancer referrals were poor before we went into the pandemic. What would someone think if they had a persistent cough? They might get a covid test. Actually, if that test is negative, we need to ensure that they are referred by 111 to the system for a lung cancer test.

I have a lot more that I would like to tell hon. Members, but I dare say that we will be back here imminently. On that note, I will hand over to the hon. Member for Westmorland and Lonsdale.

10:58

[Tim Farron]

The hon. Members for Warrington South (Andy Carter), for Gower (Tonia Antoniazzi), for Easington (Grahame Morris), for Strangford (Jim Shannon), for Angus (Dave Doogan) and for Nottingham South (Alex Norris), and indeed the Minister, all made excellent points, and I am extremely grateful. I thank the Minister for what she said and for agreeing to meet us this side of the recess. To be specific, we are after a meeting with her, of course, and departmental finance officials so that we can revisit the investment decision—that decision is problematic—and have our experts meet hers to get to the bottom of the data. We need to see the datasets so that we can explore the extent to which there is an urgent crisis—we are certain that there is one.

Finally, the Minister talked about the importance of diagnosis. The Government are making progress on diagnostics. Of course, in the NHS long-term plan, we see the desire to find more cancers earlier so that we can treat them. If we find more cancers early, however, we will have more people to treat. That is why the radiotherapy investment that we have called for is essential, not just now but in the long term.

Motion lapsed (Standing Order No. 10(6)).

[Esther McVey (in the Chair)]

I will suspend the sitting for two minutes so that hon. Members can exit safely and the next lot can come in safely.

11:00

Sitting suspended.