Cancer Diagnoses: Young People in Hertfordshire
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The Minister for Health (Edward Argar)
I thank and pay tribute to my hon. Friend the Member for Hertford and Stortford (Julie Marson) for bringing this debate before us, and for raising this difficult issue in a typically dignified and sensitive way. She has done justice to Jessica and her family.
I join my right hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald) and my hon. Friend the Member for South West Hertfordshire (Mr Mohindra), who intervened, in sending my condolences to Andrea and Simon, and to Jessica’s family and friends, following her death. We know that the passage of time can help, but it can never totally remove that sense of loss. I pay tribute to them for the work that they are doing to highlight the issue. It must be very difficult for them and it is humbling that they—through their excellent Member of Parliament, but also in person—have been willing to share this deeply upsetting experience to seek to build a better future for others. I put on record my tribute and gratitude to them.
As my hon. Friend the Member for Hertford and Stortford has set out, Jessica sadly had a very rare form of cancer. I am advised that the timescale and complexity of diagnosis in this case was due to the rarity of the cancer, especially in younger people, but we are always willing to look more broadly and holistically at other factors that we may have some control over that could help to improve diagnosis in the future. It is absolutely right that we do so because, as my hon. Friend said, sadly no one is too young to fall victim to cancer, so it behoves all of us in this House and beyond to do all we can to improve diagnosis.
As my hon. Friend alluded to, we are working nationally on achieving the long-term plan commitment towards early diagnosis of cancer, including rarer cancers or those that are harder to diagnose, in order hopefully to avoid situations such as Jessica’s being repeated in the future. Hertfordshire’s hospital trusts are working extremely hard to that aim. In delivering the long-term plan for cancer, we have the aim of diagnosing three quarters of cancers at stage 1 or 2, and increasing cancer survival rates so that an additional 55,000 people survive their cancer for five years or more. Delivering those ambitions through earlier and faster diagnosis, rapid adoption of innovation and, crucially, the roll-out of personalised care—looking at someone as an individual—will benefit children and young adults across the country.
Alongside this, as my hon. Friend set out, all cancer systems continue to roll out rapid diagnostic centres or rapid diagnostics services, which are an important part of the clinical commissioning groups’ broader strategy to deliver faster and earlier diagnosis, and an improved patient experience. By summer 2021, there were 102 live rapid diagnostic centre pathways across hospitals in England and a further 98 in development, compared to just 12 in March 2020.
To make the discussion rather more local, in East and North Hertfordshire NHS Trust, the services to support and assist patients whose cancer is of unknown primary origin and those who have what are clinically known as “vague symptoms” are being brought together to make best use of clinical resource. Multi-disciplinary team co-ordinators will track patients on their pathways and ensure that the new 28-day faster diagnosis standard is met. Funding has also been put in place to provide psychological support to support patients earlier, at a time when they may be worried about receiving a potentially life-changing—or, tragically in some cases, life-ending—diagnosis.
Herts Valleys CCG is developing services for patients with non-specific symptoms that could indicate cancer—for example, a 12-month pilot of a primary care-led vague symptoms pathway, with direct access to CT scanning. This began in February and is reported to be working well, and the CCG is looking further to develop this work and integrate it more with the acute trust. There is also a significant amount of work on the site-specific pathways through more efficient diagnostic pathways. This goes to what my hon. Friend was saying, as it supports earlier and faster cancer diagnosis by assessing patients’ symptoms holistically—bringing all the symptoms together when considering them, rather than looking at them in isolation, when it would be understandable if a misdiagnosis were made.
Sir Oliver Heald
I want to follow up on the point that I made when intervening on my hon. Friend the Member for Hertford and Stortford (Julie Marson). The project that the Minister is talking about is very good, but I just wonder about disseminating best practice more widely in GP surgeries. Does he think that the idea of having one GP in a practice who takes a lead on cancer—ensuring that the practice is up to date with the latest diagnostics, treatment and so on—is worth pursuing?
Edward Argar
My right hon. and learned Friend is also an old friend, so I suspect that he has a slight insight into where I was to be going in a few minutes. I hope to be able to answer that point specifically.
On education in cancer diagnosis within Hertfordshire and on GPs having the necessary skills and keeping them up to date, GPs in the region are encouraged to maintain their knowledge and skills in the field and are supported by Macmillan GPs, who are specialists in cancer care. Cancer education programmes such as Gateway C are available online, and face-to-face education sessions have now resumed, including monthly seminars offered by providers and by Cancer Research UK. A primary care network cancer clinical leads group has also been established to share the latest local issues and best practice.
I turn to specific points highlighted by my hon. Friend the Member for Hertford and Stortford. On face-to-face appointments and the ability to diagnose in that context, £20 million of elective recovery funding has been distributed to cancer alliances in this financial year to help accelerate the implementation of service models that streamline the front end of the pathway and support the management of high referral volumes. Throughout the pandemic, NHS England and Improvement has provided guidance to general practice and continually updated standard operating procedures to ensure that changing services could operate safely. NHS England and Improvement set out clear expectations that general practices offer face-to-face appointments alongside remote appointments—telephone or online—and that clinical necessity and patient preference should be taken into account to determine the most appropriate method.
My hon. Friend raised research and how it could help save lives in the future. NHS England and Improvement is supporting GRAIL’s Galleri trial, where studies have shown the ability to detect more than 50 types of cancers through a single blood test. The Galleri test can, as she said, detect chemical changes in blood as cancer can release small particles of DNA into the blood—known as circulating tumour DNA—which leak from tumours into the bloodstream, to give a vital early warning. The Cancer Research UK and King’s College London cancer prevention trials unit is conducting a randomised control trial along with the NHS and GRAIL. The blood samples from the first subjects in the trial are being obtained at mobile testing clinics in retail parks as well as at various convenient community locations. The trial’s participants must not have had a cancer diagnosis in the last three years. The main trial has now started. As hon. Members will know, I am always cautious about such things, but I am cautiously optimistic and genuinely hope that the trial will yield innovation that will make a huge difference in the ways mentioned by my hon. Friend.
My hon. Friend also raised the central point of GPs handling cases in their entirety or of having a point of contact who can look at a case holistically from the individual’s point of view, with knowledge of all their symptoms, medical history and so on. The general practice contract requires practices to provide a named accountable general practitioner to all registered patients. That GP must take the lead in ensuring that any primary medical services considered necessary to meet the needs of a patient, including appropriate referrals to specialist care and liaison with other health professionals involved in the patient’s care, are co-ordinated and delivered to that patient.
As of 1 April last year, we introduced the supporting early cancer diagnosis service specification for primary care networks to support improvements in rates of early cancer diagnosis. The 2021-22 quality and outcomes framework, which is a reward and incentive scheme for general practices, includes five indicators related to cancer care, including a quality improvement module on early cancer diagnosis. That improvement module was designed specifically to improve referral and safety net practices.
I hope that that answers some of my hon. Friend’s questions. She rightly highlights that there is always more to do in this space, and as we think of Jessica and her family it behoves all of us to continue to work to improve the quality of care provided, improve research, improve early diagnosis and look at each person who comes forward with symptoms or concerns as an individual, bringing all those factors together.
One of the privileges for the Minister responding to the Adjournment debate on a Friday is to speak on a subject outside of their usual portfolio, and this is one such opportunity. It has been a humbling experience, and one that I hope will inspire us all to renewed efforts, thinking of Jessica, to improve services as we go forward.
Question put and agreed to.