Breast Cancer Screening

(Limited Text - Ministerial Extracts only)

Wednesday 16th December 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, Sir Edward.

I thank my hon. Friend the Member for High Peak (Robert Largan) for securing this important debate. As he and many Members know, breast health—diagnosis, treatment and research, as well as screening—is a matter that is close to my heart. I am honoured to respond on this important issue on behalf of the Government, and on behalf of women and the 3% of men who are diagnosed with breast cancer every year.

I want to state clearly that screening services are back up and that the availability of breast screening to everyone who needs it is there. However, the recovery of those services from the disruption this year is not only a priority for me, but an enormous challenge, for exactly the reasons that have been laid out so eloquently by all contributors to the debate. We know that our cancer workforce had challenges before we went into the pandemic.

Let me remind Members of something that only the hon. Member for Strangford (Jim Shannon) briefly referred to: yesterday, 506 families lost a loved one to covid. It is still with us. We are in a covid-tinged world, and that affects how quickly we can drive other services. However, the resumption of cancer services across the piece—be they treatment, diagnosis or screening—has been the No. 1 priority for me from the time we understood and were able to drive those things in.

I am glad that hon. Members who have taken part in the debate recognise the importance of breast screening in the early detection of breast cancer. As with any diagnosis of cancer, early detection gives people a better chance. The simple fact is that screening saves lives.

I very gently take the Member for Westmorland and Lonsdale (Tim Farron) to task on the statistic that every four weeks represents a 10% lower chance of survival. Cancers, as he well knows, vary enormously in type, grade and everything else. I do not want people not to come forward for screening, diagnosis or treatment because they feel that any loss of time will have had a negative impact. It has to be that as soon as you have a symptom, you come forward. Campaigns such as “Be Clear on Cancer” and “Help Us Help You” are driving at giving people confidence.

We have ensured that services are safe, and our aim is for people to be able to access them as quickly as possible, secure in the knowledge that they are safe. I will cover this later, but while I understand what my hon. Friend the Member for West Bromwich East (Nicola Richards) and the hon. Member for Ellesmere Port and Neston (Justin Madders) were saying, the whole point of open appointments is to maximise the use of available capacity versus fixed-time appointments. A health inequality impact assessment has been done to try to make sure that nobody is disproportionately impacted, and I have asked for a specific eye to be kept on that. Now, if you like—

[Sir Edward Leigh (in the Chair)]

Order. As a matter of courtesy, it is normal for Ministers to address the Chair.

[Jo Churchill]

I am so sorry, Sir Edward. As I was saying, the challenge is that there is variation in the system. That variation occurs for a plethora of reasons, not only those that are covered by an impact assessment on accessibility via open appointments. It is important to keep an eye on all the data.

I am proud that we have a national breast screening programme that offers every woman between the ages of 50 and 70 an appointment every three years. We will strain every sinew to ensure that nobody waits longer than 36 months. We will not step back from that, even with the challenge of driving the backlog down. The programme reaches millions of women and detects approximately 20,000 cancers each year. I recognise the challenge, but every single individual provider has been asked to produce a recovery plan, which should help us to understand the variation. I recognise that about half a million women are waiting, but there are also 500,000 women who have not replied. They will need to be re-approached and encouraged into the system. It is incumbent on everyone to give women the confidence to come forward.

We have also had to look at making sure that women are asked to come forward in accordance with priority by targeting the women who are most likely to have an occurrence of breast cancer. High-risk women will not have open appointments; they will be called immediately. We will then screen positive women in the pathway, followed by screening results that have not been processed, routine open episodes, those who have previously been invited but not screened, and the delays. It is important that we prioritise, so that we target the women we are most worried about.

I am aware that this year, the national breast screening programme could not maintain the service that it normally provides. In March, as the NHS responded to one of the biggest challenges that has faced our healthcare system in a generation, many local providers made the decision to pause appointments so that arrangements could be put in place to protect staff and patients from covid-19. We were unaware at that point what we were dealing with. Staff and facilities were redeployed to tackle the outbreak of the pandemic, but as soon as it was possible to do so, it was made an absolute priority that they were brought back in to do the job that we need them to do.

I am sure that there is not a single Member in this Chamber, or indeed the House, who does not pay tribute to the hard work of all NHS staff. Cancer staff and their teams have done a particularly incredible job of making sure that people across the cancer family have received treatment. Earlier today, I talked to a young man about the treatment he has had, and I talked to a young woman who experienced chimeric antigen receptor T-cell treatment earlier this year. The redeployment of staff left a shortfall in the breast screening programme, and screening appointments for many women have been delayed. I know that that wait, and the anxiety it drives, is incredibly difficult. For those who are looking for reassurance from their routine screen, or who are waiting to receive an all-clear or an early warning that something is wrong, this is undoubtedly a challenging time. However, I want to be absolutely clear that no woman has been left behind, and no woman ever will be. It is a priority to ensure that services are there. Improvements are being driven by the heroic efforts of staff, who have been working longer days and over weekends. They have gone above and beyond to schedule as many appointments as possible to help to drive down the backlog that was created earlier this year.

The first priority is to screen women aged 53 who have not yet had their first screening appointment; those who have passed their 71st birthday and have not yet received their final breast screen; those at very high risk of breast cancer, as I said; and those who have been identified for further treatment. I am pleased to say that the tremendous efforts of screening staff—the nurses, the radiographers and the whole team—are succeeding and the backlog is steadily reducing. The number of women waiting for screening, having received an invitation prior to the first wave, decreased by 98% between 1 June and 4 November.

Screening has been made a clear priority this winter and NHS commissioners have been instructed, where humanly possible, not to redeploy their staff or their facilities away from screening services. It is a priority, and that is absolutely the right approach. My message to everyone is that breast screening services are running, they are safe, they will continue to run through the winter and they are standing up to the increased capacity that is coming towards them.

When people receive an appointment to attend, I urge them to go. “Do not attends” are so frustrating. Those appointments could be taken by a woman who—although she would not want a diagnosis—might get into the stream quicker.

[Jim Shannon]

I suspect that on some occasions, ladies are not attending because of the fear of catching covid-19 at the hospital. I have spoken to some ladies back home and that was one of their concerns. How can we address that?

[Jo Churchill]

Essentially, by constantly reassuring them that the reason why we can do elective operations, have out-patient clinics open and carry on doing some of the business as usual is because heroic efforts have been made to make sure that there are safe places. I pay tribute to Dame Cally Palmer, who has made sure that rapid diagnostic centres have been stood up to ensure that patients can access care safely. We had 17 at the start of the pandemic, and we now have 45. The cancer alliances have worked extremely hard in all our regions. There is no one silver bullet, but it is important that we do what we can for patients.

If people have any concerns or notice any abnormal changes in their breasts, they should contact their GP. I pay tribute to my hon. Friend the Member for West Bromwich East, and I am pleased that her mum is now in good health. CoppaFeel! is a great charity and its website shows how to do a good check. Breast Cancer Awareness Month still went on—I did wear it pink—although it did not quite have the same profile as usual. It is every woman’s responsibility to make sure that they check their breasts monthly. If they see anything unusual that they are concerned about, such as puckering or discharge from the nipple, GPs are open and there to help women.

One thing that can help is to make sure that people go, but we are here to talk predominantly about screening services. Cancer diagnostics and treatments are back on track. The latest official data for October 2020 suggests that GP referrals are back to almost 85% of pre-pandemic levels, compared with August 2019. I appreciate that that leaves a lag, but we are heading in the right direction.

Urgent referrals were 156% higher in October than in April, which is when they were most affected. That shows that we are not only getting there, but beginning to go beyond. Nearly 88% of cancer patients saw a specialist within two weeks following their referral, and nearly 96% of patients received their treatment within 31 days of a decision to treat. In October, 83.5% of breast cancer patients received their first treatment within 62 days, and breast cancer treatment activity was at 101% of last year’s levels. However, these figures do not hide the fact that there is a backlog and we have to work as hard as we can to address that. The “Help Us Help You” campaign, launched in October, is a key part of this and reinforces that message of seeking help. We will closely monitor the effect of covid restrictions on referral rates to ensure that the number of people coming forward with symptoms remains high, because it is about confidence. Some pathways are more problematic than others, but the important thing is to make sure that we get as many people as possible through the pathway.

I turn to the theme of breast screening for younger women. As the hon. Member for Midlothian (Owen Thompson) has said, this has been found not to be evidenced-based. There is a risk in referring women for unnecessary tests, in over-treatment, and in operating on women who have diseases that mean that that is likely to cause harm. Women with a very high risk of breast cancer, such as those with a family history, may well be offered screening earlier and more frequently. Sometimes, in life, we just have to ask a question, and I recently asked a breast cancer specialist about this. My hon. Friends the Members for Chatham and Aylesford (Tracey Crouch) and for Norwich North (Chloe Smith), and the former Members for Dewsbury and for Eddisbury, all of whom are in the younger age group, are going through treatment—I think one of them is post treatment—and I was their age when I was diagnosed. Just because something looks right, it does not necessarily mean that it is, and we have to act on the evidence. That is where we are at the moment for young women.

We published the people plan in July, and I recognise, as Sir Mike Richards did, that the screening workforce is a challenge and it is important that we drive more individuals into the areas of radiography, mammography, pathology, nursing and cancer specialist nursing. The spending review provided another £260 million to continue to grow the workforce and support those commitments, which were so important in the NHS long-term plan.

Health Education England has also provided £5 million to support training and development programmes through the National Breast Imaging Academy, which aims to improve breast screening recruitment targets and early diagnosis. It has already made significant progress, launching the mammography level 4 apprenticeship; recruiting the first of the NBIA radiology fellows, who will benefit from specialist training in breast radiology; and developing e-learning for health programmes on the breast.

To improve screening uptake, we need to work with cancer alliances, primary care networks and the regional teams to promote the uptake of breast screening and to get to as many people as possible. As I said, the open appointments systems is something that we are looking at, and we hope that the result will be that we get more women through. The national cancer recovery plan was released this week. It is a joint effort from cancer charities, royal colleges, national teams and patient voices, and it was led by the national clinical director for cancer, Professor Peter Johnson. Its whole ethos is to outline the actions that need to be taken to restore demand to at least pre-pandemic levels by raising national public awareness through campaigns; ensuring that there are efficient routes into the NHS for people who are at risk of cancer; improving referral management practice in primary and secondary care; and setting out immediate steps to reduce the number of people who wait more than 62 days from urgent referral, so that patients are seen as quickly and safely as possible. Finally, it ensures sufficient capacity to meet demand through maximising the use of available capacity in both symptomatic and screening pathways, which both feed into the same funnel, optimising the use of the available independent sector capacity, enabling the restoration of other services, and protecting service recovery during winter.

This is an excellent plan, which will work towards the long-term plan ambitions for cancer services to continue during the pandemic. I am fully committed to seeing it through and working with Dame Cally Palmer and all the others to ensure that we can get to a better place. I recognise that, as the hon. Member for Westmorland and Lonsdale said, there have been some remarkable changes to treatments with radiography and other treatments in cancer. We must take those silver linings where we can.

I pay tribute to my hon. Friend the Member for High Peak for coming to me to say that High Peak was special due to its geography, and he did not want the women he serves in his constituency to be disadvantaged in any way by a loss of service. I understand that the decision to put breast screening services into static positions was taken to maximise capacity. I was quite amazed that, pre pandemic, 70% to 80% of screening happened in mobile units. They are particularly helpful in dispersed rural areas, but with some of the challenges of providing covid-secure spaces—some of those units did not even have running water—a decision was made to bring them back to a static site. The static units can stay open longer and at the weekend, making about 1,000 more appointments possible in a three-month period, so a lot more women can be seen.

Although I take on board the point about travel, I am asking women to bear with us—to work with us. These are temporary changes, but they are a vital measure in the recovery of breast cancer screening services, allowing more women to be seen, particularly those who may have missed an appointment this year. I know that longer travel times are difficult. I know that those beautiful hills that my hon. Friend’s constituency is blessed with do not have particularly good bus services either. This is not always an easy proposition, but it was decided that, for now at least, optimising the service to see as many people as possible should take priority over optimising a mobile service.

When my hon. Friend came and met me, I could not give him any assurance, and he has pressed me again today. I assure him that this is a short-term measure. The increase of appointment availability will assist us in in being able to resume mobile screening for High Peak, safety permitting, by July 2021. I have been reassured by the Chesterfield Royal Hospital NHS trust that it is monitoring attendance, that this compromise is temporary, while services recover, and that the usual screening locations will be reinstated in the longer term to ease access. I take this opportunity to stress that the screening services are safe to attend and a range of measures have been put in place to ensure that people go.

I thank my hon. Friend and all other hon. Members who have participated today. I pay tribute to all the incredible staff across the country who are working so hard on the backlog and to make sure that cancer services stand up and catch up over the winter period. Hon. Members have my absolute commitment that we are focused not only on the short-term recovery of screening services, but on their long-term improvement too. Prevention, public health and early diagnosis continue to be a huge priority for me. We will continue to bear down on screening services, making sure we have the right kit in the right place and that we are delivering the different parts of the cancer pathway for men and women to have the best treatment.