Access to Radiotherapy

Wednesday 12th January 2022 Westminster Hall

00:00

[Philip Davies (in the Chair)]

Before we begin, I remind Members that they are expected to wear face coverings when they are not speaking in the debate. This is in line with current guidance from the House of Commons Commission. I remind Members that they are asked by the House to have a covid lateral flow test before coming on to the estate. Please also give each other and members of staff space when seated and when entering and leaving the room. I call Grahame Morris to move the motion.

[Grahame Morris (Easington) (Lab)]

I beg to move,

That this House has considered access to radiotherapy.

It is always a pleasure to serve under your chairmanship, Mr Davies, and if it is not too late I would like to wish you and the Officers of the House a happy new year.

I am delighted to have secured this vital and timely debate on access to radiotherapy services. On occasion, it may seem like groundhog day: we come here on a fairly regular basis and outline the case for more investment in radiotherapy services. However, the covid crisis has brought many of these issues into sharp focus, and indeed there is a growing cancer backlog crisis that the Government really must address.

I also want to thank the Chamber engagement team for its fantastic work. This is the first time that I have had any interaction with the team, but it has been most helpful in engaging the public ahead of this debate. I am immensely grateful to the team for carrying out a survey over the course of only a few days—over this weekend, really. We had over 800 responses, and I thank all the respondents for taking the time to express and submit their views and experiences. I believe that those contributions, a couple of which I will refer to, will significantly enrich the debate. I am eagerly anticipating what I am sure will be comprehensive and compelling contributions from colleagues in the Chamber, many of whom I have served with and been involved with in debates like this previously.

It is only right that I begin by declaring an interest. I have the privilege of serving as vice chair of the all-party parliamentary group for radiotherapy, and I am also one of the vice chairs of the all-party parliamentary group on cancer. I also want to thank Macmillan Cancer Support and Radiotherapy UK, the charity with which I am associated, for their assistance in preparing for today’s debate. I am immensely grateful to colleagues from the all-party groups who have come along today; I know that there are many pressing demands on Members’ time.

The reason the debate is so important is that cancer will affect all of us at some point in our lifetimes. I want to take this opportunity to mention a good friend of mine, Nick Munting, who, as some might know, is a chef in the House of Commons and has very recently been diagnosed with cancer. I wish him all the very best for his speedy recovery.

I have personally had cancer on three occasions—a type of lymphatic cancer called non-Hodgkin lymphoma. Without the care and treatment that I received from the NHS, I would not be here today. I thank the dedicated staff at the Macmillan cancer centre at the Freeman Hospital in Newcastle, and those working at cancer hospitals throughout the country, for the excellent work that they do in diagnosing and treating cancer patients. I have received a plethora of cancer treatment. I have had the works: surgery, chemotherapy and radiotherapy—including advanced radiotherapy.

There is a reason why I am concentrating on radiotherapy today. Radiotherapy is by far the least understood of the three pillars of cancer treatment, with chemotherapy and surgery far more widely understood and referred to in public life. Despite that, one in four of us will have radiotherapy at some time in our lifetime. I want to begin by highlighting the many advantages of this highly specialised treatment and the major breakthroughs that there have been over the last 10 years.

Unlike other cancer treatments, modern radiotherapy is accurate to within millimetres, limiting damage to healthy cells around the cancer. A specialist in the field and a dear friend, Professor Pat Price, explained in simple terms to me, as a layman, the concept of a banana in a box. Imagine that the tumour is a banana in the box. With older, less precise forms of radiotherapy, the whole box would be irradiated and there would be considerable collateral damage to healthy cells. With modern, advanced precision radiotherapy techniques, just the banana would receive the high dose of radiation, and there would be no collateral damage. That significant advance has come about because of digital technologies and advances in this form of treatment. It is especially useful for treating cancers in areas vulnerable to damage, and it requires fewer patient visits than other treatments. Unlike surgery, it does not take up intensive care capacity, and unlike chemotherapy, it does not impact on the immune system.

Furthermore, radiotherapy is the most cost-effective treatment. Typically, a patient can be cured at a cost of about £6,000. If we contrast that with the cost of some chemotherapy drugs, which for individual treatments may run into hundreds of thousands of pounds, there is a cost argument for expanding radiotherapy, in addition to its effectiveness as a treatment. In many respects, it is a silver bullet. It is often referred to as a “Cinderella” service: it is immensely effective, but it suffers from chronic under-investment and suboptimal clinical commissioning. Let me remind the Minister that the UK spends only about 5% of the cancer budget—I do not mean the entire NHS budget; I mean just the cancer budget—on radiotherapy. Compared with what is spent in many other advanced European countries, that is a very small proportion; the European average is about 10% of the cancer budget.

In England, access to treatment can depend on people’s postcode; often, patients in more affluent, urban areas benefit from the most modern equipment, and from ease of access because of excellent public transport provision. In contrast, patients in less affluent, more rural areas, such as mine—Easington in County Durham—do not enjoy the same levels of access. My constituents make up a proportion of the 3.5 million people in England who do not have a radiotherapy centre within the recommended 45 minutes of their home.

That statement of the situation was supported and confirmed by a number of the respondents to the survey carried out by the Chamber engagement team. If I may, I will refer to a couple of their contributions. A lady called Penelope had positive experiences of accessing the service herself, but feared for others who might not be so fortunate. She said:

“In my experience, which involves my father’s radiotherapy last summer, he did not have to wait long, but he lives in Berkshire…near several hospitals, and I think the situation is very different in other areas of the country.”

Similarly, David said:

“My own wait time…before the covid situation was only weeks, and by that time I had already started other treatment regimes as well. I am lucky to be close to a centre of excellence: the University Hospital Coventry and Warwick. This is not normal though, a close friend, now passed on, had to drive from their home near Boston in Lincolnshire to the Leicestershire Infirmary for treatment, when there was a possible ‘slot’. That was a 4-hour round trip as neither the Boston nor Lincoln hospital had”

radiotherapy

“facilities. Lack of facilities meant the cancer spread out of control and he died.”

Radiotherapy is needed in almost half of treatments, but according to Cancer Research UK, only 27% of UK cancer patients actually receive it. I respectfully point out to the Minister that we will never level up the country while access to life-saving treatment depends on people’s postcode—where they live—entrenching already existing regional health inequalities.

Let me also address some of the workforce issues. The radiotherapy workforce are at breaking point. A survey conducted by Radiotherapy UK and the Institute of Physics and Engineering in Medicine in October 2021 found that almost 80% of professionals were considering leaving their position or knew a colleague who was. That was echoed by members of the radiotherapy workforce who submitted their views to the survey. A lady called Lauren said:

“Most radiotherapy staff can travel over an hour as that is their nearest radiotherapy centre. Increasing working hours and increasing workload is leading to more staff wanting to leave the profession in addition to the fact most of us have to travel long distances to find a centre to work at. Due to housing not being affordable in the locations of radiotherapy centres,”

which are often in big city centres. The Minister can address that fairly simply, and we have a solution—investment in IT networks, which I will come to in a moment—that we have put to successive Ministers who have occupied the post.

The tariff system generating income to trusts is based on the number of patient visits. Those perverse tariffs mean that radiotherapy trusts with advanced machines that can treat patients in fewer sessions are incentivised to treat patients less effectively over more treatments. That is a ludicrous, perverse incentive that I am sure the Minister could do something about.

Similarly, trusts seeking to replace ageing machines—the advice is to replace radiotherapy machines after 10 years—are required to conduct 9,000 treatments even to be considered for funding. The pandemic saw referrals plummet and services overstretched, so centres are not reaching that threshold and are therefore blocked from providing patients with access to the latest life-saving technologies. We have poor patient access and exhausted, demoralised staff, with senseless bureaucracy and a tariff system promoting less effective treatment. That is a pretty poor report card.

That was the state of radiotherapy even before the covid-19 pandemic. Holly, a radiotherapy professional, said:

“Currently we are having to delay patients due to poor staffing levels, this started way before the current surge in omicron cases. We have been understaffed for some time, and this has been made so much worse by omicron, we are having to close machines to make sure we have staff to cover”

the covid patients. She added that

“those that are in are getting burnt out by having to work longer, more days and harder each shift, meaning it’s a cycle of being off ill.”

Covid has created a cancer crisis that the current system cannot effectively manage. On that note, I want to pay tribute to the Catch Up With Cancer campaign, which was launched in conjunction with Craig and Mandy Russell, who very sadly lost their daughter Kelly to bowel cancer when her treatment was delayed owing to resources being transferred to the treatment of covid patients. Some of us here today handed in to 10 Downing Street a petition, signed by more than 300,000 members of the public, calling for action on the issue.

Of all the health backlogs, the cancer backlog is the most time-sensitive because, for every month that diagnosis of treatment is delayed, cancer survival rates can drop by as much as 10%. These are life-and-death issues for many tens of thousands of people. Without urgent action, cancer experts predict that survival rates in the UK may fall back to where they were 15 years ago, resulting in tens of thousands of extra cancer deaths. I know the Minister is new to her post, and I do not want to be unfair, but there is a crisis. I have been with colleagues to see a succession of Health Ministers, on many occasions, to set out proposals to improve the position. The lack of action is frankly lamentable, and many thousands of people will pay the price.

Before the pandemic, the all-party parliamentary group for radiotherapy branded radiotherapy “Britain’s secret lifesaver”. Ministers and NHS leaders need to recognise that it could be a game changer; it could have an immense impact on tackling the covid-induced cancer backlog, but to do that, it needs sufficient investment.

The all-party group has put together a six-point covid-19 recovery programme. I urge the Minister to look at that and to implement its proposals, which were developed not by me or other parliamentarians but by experts in the field—radiotherapy specialists and oncologists—who understand their patients and understand the service and how we can improve it.

The first point in our six-point plan is that we need to appoint a Minister in charge of and accountable for the transformation of radiotherapy. We need to invest in IT solutions to modernise radiotherapy. The problem that radiotherapy is available in only relatively few urban centres could be mitigated, to a degree, with modern IT that allowed specialists hundreds of miles away to interpret digital imagery and advise on the appropriate treatment.

We need to replace ageing machines—those that are more than 10 years old—and forget the bureaucratic nonsense about machines having to have done 9,000 treatments, because referrals for treatment have reduced due to covid. We need to invest approximately £200 million in the highly specialised workforce, where staff redeployment will be insufficient to fill the gaps.

We need to improve capacity and access by placing radiotherapy machines in some of the planned new diagnostic hubs. Ministers often respond to debates such as this one by referring to the £130 million that the Government promised to improve diagnostic services. That is welcome, but we need to address not just diagnosis but treatment. Radiotherapy is a quick and highly effective treatment, so I urge the Minister to consider using these machines in the diagnostic hubs.

Finally, we need to raise the profile of radiotherapy, ensuring full awareness among the public of the treatment’s curative and palliative potential. The six-point plan is underpinned by a need for a national strategy. The lack of a cohesive national approach has caused unacceptable inequality and disparities between trusts in different parts of the country.

It comes down to this: every day, every week and every month that the Government fail to take sufficient action, the public suffer, money is wasted and patients die. The Government are in denial about the situation and there is a huge disconnect in ministerial statements. Just last week, I heard the Leader of the House say that the situation had been normalised, but that is far from the truth. We cannot ignore the cancer crisis any longer.

I want to ask the Minister a number of questions, which I hope she will address in her response. I hope she understands the frustration felt by radiotherapy staff, but I want her to make a commitment to investigate the bureaucracy that is holding back radiotherapy trusts and denying patients the most effective treatment. Will she act urgently on that? Is she aware that the Government have not reported radiotherapy-specific data, which we refer to as the radiotherapy datasets, since May 2021? Will she publish the datasets that are available next month? Those will show clearly the levels of treatment that radiotherapy machines have been involved in during this period compared with previous years. That will make perfectly clear the level of the backlog, which estimates from the frontline put at between 50,000 and 60,000.

Will the Minister outline the plan in the event that radiotherapy services find they are no longer able to cope? Finally, will she agree to a meeting with radiotherapy commissioners, the Secretary of State and representatives of the radiotherapy community, in order to address these essential life-or-death issues? It has been useful for me to open the debate, but I know colleagues have issues that they would like to put to the Minister, so with that, I will conclude.

09:50

[Mohammad Yasin (Bedford) (Lab)]

I thank my hon. Friend the Member for Easington (Grahame Morris) for securing this important debate. The Mount Vernon Cancer Centre in Middlesex provides non-surgical specialist cancer care to a population of more than 2 million in the UK. About a third of the Bedfordshire clinical commissioning group’s cancer patients attend the service to receive radiotherapy. My constituents have to travel more than 50 miles to access treatment. Between 2019 and 2020, 800 patients undertook the three-hour round trip across Bedfordshire multiple times to reach lifesaving care.

A survey undertaken by the Mount Vernon Cancer Centre heard from many patients who have chosen not to have radiotherapy. The biggest factor in people’s decision on whether to go ahead with the lifesaving treatment was the location of the treatment centre. Some patients simply cannot afford to travel so far, others are in too much pain, and some could not find the time due to family and work commitments.

The inaccessibility of radiotherapy is stopping people getting the care they need. One patient with stenosis of the spine found it so difficult to travel that they opted for a watch-and-wait approach rather than radiotherapy. Another reported a journey time of five hours door to door. The average radiotherapy uptake in Luton and Bedfordshire sits at under 35%, which is lower than many other CCGs. There is an undeniable crisis in the accessibility of radiotherapy in the UK, and lives are literally on the line.

Many of us will be familiar with the heartbreaking statistics being shared. Fewer referrals to a specialist doctor mean that the proportion of cancers diagnosed while still highly curable has fallen to 41%. Waiting lists stand at a record level and the backlog of care is only growing. Of course, the pandemic has had a major impact on NHS waiting times, but the cancer waiting time crisis is rooted in underfunding, under-resourcing and understaffing. The pandemic has only illuminated the problems. The 18-week waiting time target has not been met for five years. This is not new, but it is getting worse.

There are proposals for a more local additional cancer care unit, alongside Mount Vernon Cancer Centre, to offer treatment services that are more accessible for those in need, but that requires equipping new centres, recruiting more doctors and tackling chronic staff shortages. Cancer care needs proper investment. Funding is at the crux of whether patients can receive radiotherapy and whether they survive. It is down to the Government to step up and ensure that cancer patients can access the care they need and deserve.

09:54

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

It is a huge pleasure to serve under your chairmanship, Mr Davies. I pay tribute to my friend, the hon. Member for Easington (Grahame Morris), for securing this debate and for an excellent speech, which contained some points that I make no apology for repeating because this issue matters hugely.

I lost my mum at the age of just 54. Eighteen years on, of course I still miss her massively; I miss especially the grandmother she would have been. Few issues that we deal with in this place are more personal than cancer. Half of us will have the disease at some point in our lives. Cancer touches absolutely every family.

The good news is that, increasingly, cancer is a disease that need not be a death sentence, partly because of the advances in radiotherapy. Radiotherapy kills cancer cells through radiation targeted at a tumour. It is becoming more and more precise, and is able to cure cancers that would otherwise be untreatable, with fewer side effects, as the hon. Member for Easington set out.

Just over 50% of people with cancer should expect to receive radiotherapy, yet, as has been said, Cancer Research UK estimates that only 27% of cancer patients in the UK actually receive it. The clue to why that is is that the UK spends only about 5% of the cancer budget on radiotherapy. The equivalent average spend of similar countries in Europe, Australia and so on is about 11%. The total budget for radiotherapy each year is £383 million; compare that to the £2 billion spent on cancer drugs every year, even though radiotherapy is eight times more likely to be curative than chemotherapy.

That historic underinvestment—the responsibility of lots of Governments of all colours—is undoubtedly a reason why the UK has some of the worst cancer survival rates in Europe. Lives are being lost needlessly because the UK is so painfully slow at keeping up with and grasping the opportunities that radiotherapy provides. That is why we set up the all-party parliamentary group for radiotherapy, which I am privileged to chair. I send huge thanks to Members from all parties, especially the hon. Member for Easington, to leading clinicians across the country and to the charity Radiotherapy UK, which is led by the rightly much esteemed Professor Pat Price, who has already been mentioned.

We set up the APPG in spring 2018. We booked a room in 1 Parliament Street. A handful of MPs turned up, but 50 or 60 of the leading oncologists in the country turned up and crammed into the room—they would not be allowed in today because of covid restrictions. Why had those people left their massively important jobs for the day, just to come to London for that meeting? It struck me then that it was because there is no radiotherapy lobby. I am not in any way going to criticise pharmaceutical companies, but we know that they are large and they have large coffers. We all get letters most weeks from constituents asking for this drug or that drug to be commissioned, and very often that is right. There is no such lobby for radiotherapy.

Lobbying, in its purest and most fair form, is about being in the room with the people who make the decisions. Radiotherapy has not had someone in the room with the people who make decisions. That is the best I can come up with as an excuse for why this Government and previous Governments, including the one I was part of, have not taken radiotherapy anything like as seriously as it should be taken, why we are investing such a paltry amount in radiotherapy, and why we are so far behind comparable countries.

At the local level, a bad situation is made worse because access to radiotherapy is simply not fair or equal. In south Cumbria, cancer patients have to travel each day all the way to Preston to our nearest radiotherapy centre. The Rosemere unit at Preston is excellent, but dangerously distant. The National Radiotherapy Advisory Group stated that it is bad practice for patients to have to travel for more than 45 minutes for treatment, yet not a single person in my huge constituency reliably lives within 45 minutes of radiotherapy.

Over the years, I have had the privilege of driving constituents to Preston for their treatment. I have seen how people from Kendal, Windermere, Grasmere, Grange, Coniston, Sedbergh and other communities have to make round trips of between two and four hours every day for weeks on end. I have seen their exhaustion and the impact on their health. I have seen people whose lives would have been longer if they had had radiotherapy turn it down, because they physically could not cope with the travelling. I have seen clinicians who have chosen not to refer people for radiotherapy, understandably but sadly, because they knew that their patient’s condition would be made worse by those long, gruelling journeys. In Cumbria, because NHS England and the Department of Health and Social Care will not act, those longer journeys mean shorter lives.

For 13 years, we have run a campaign collectively in Westmorland, calling relentlessly for a radiotherapy satellite unit to be placed at Westmorland General Hospital. We also campaigned to bring chemotherapy to Kendal and were successful in that fight. I am proud of everyone who supported our radiotherapy campaign, but we have submitted petitions with more than 10,000 signatures; I have had numerous Westminster Hall debates; I have met countless Ministers from all three parties that have been in government during my time in Parliament; we have marched for the hospital in our thousands; a team walked from Preston to Kendal just to make the point; 1,000 people wrote detailed, personal, heartbreaking stories to explain why we need the unit in Kendal; and we have demonstrated that there is clearly enough demand for at least one linear accelerator at Kendal, drawing patients from the south lakes, Furness and the western dales. With an ageing population in our community, there is also clearly a growing need.

We have the space at the hospital, designs have been done, the bid has been written and rewritten, and the inaction of managers in NHS England and Ministers in the Department of Health is inexcusable. It is a reminder of why rural communities feel so taken for granted and ignored by the Government and by NHS bosses nationally and regionally. Talk of levelling up the north is meaningless when Ministers appear not to realise that there is 100 miles of England north of Preston until the next nearest cancer centre.

Networked satellite radiotherapy units have been a huge success elsewhere in the country and, once they open, have been shown to increase the number of people able to take up that life-saving treatment. Satellites save more lives. Today, I ask the Minister to instruct NHS England to work with our local trusts in Cumbria and Lancashire finally to deliver our long-awaited satellite radiotherapy unit at Kendal. Our community will listen carefully to her response.

Radiotherapy, as the hon. Member for Easington said, provides the Government and the NHS with their best way through the cancer backlog. Owing to the pandemic, 740,000 cancer referrals have been missed. Therefore, at least 60,000 people are out there with cancer, but undiagnosed. That is terrifying. There is also an enormous backlog for treatment, with people dying as a result. In the Morecambe bay area, about half of cancer patients are having to wait for more than the scheduled 62-day limit to get their first treatment. As the Chair of the Health and Social Care Committee, the right hon. Member for South West Surrey (Jeremy Hunt), rightly said, it would take the NHS working at 120% of its existing capacity for two solid years just to get back to where we were in March 2020. The need for an urgent and ambitious boost to cancer care is therefore obvious, but we see next to nothing specific from the Government.

Money was pledged for diagnostic hubs, but just on Monday this week, I discovered that in South Lakeland we will not see ours until next year. Where is the urgency? The Government and the NHS have done so well—commendably—on the vaccine roll-out. Why will they not treat cancer and the cancer backlog in the same way, with a ring-fenced and targeted programme to catch up with cancer?

Radiotherapy is covid-secure and non-invasive, carries no infection risk, does not need intensive therapy unit beds or precious operating theatre time, does not compromise one’s immunity, is curative, palliative and, per capita, incredibly inexpensive. We could massively increase capacity very quickly. It has been the stand-out treatment in covid, often substituting for surgery, and it is the obvious first choice for getting through the backlog of cancer cases.

As an all-party group, we first wrote to the Secretary of State on 1 April 2020 to highlight the key role that radiotherapy needed to play to tackle the covid-induced cancer backlog. Since then, multiple spending reviews and Budgets have been passed with no significant investment in radiotherapy. The oft-repeated £130 million announced in 2016 as part of the long-term plan was spent long, long ago, so I hope that the Minister will not trot that out again. Yet a relatively modest investment of £850 million over three years could have a guaranteed and dramatic impact on cancer survival. I hope the Minister will take up the hon. Member for Easington’s request that she meet us as an all-party group and, more importantly, the clinicians, so that we may talk her through this all-party plan backed by the clinicians, which will help her out and help her deal with the backlog.

The Minister should tackle perverse tariffs that do active harm to cancer treatment, and she could do so at no cost whatsoever to the taxpayer—it is about spending the money differently and less foolishly. Staff are restricted from using centres with more modern, precise kit that can treat patients in fewer sessions; instead, they must treat less effectively and over more sessions because, stupidly, the tariff rewards the number of visits, not the precision or effectiveness of treatment. The Government must be pragmatic and accept the offer from the private sector to centrally commission its capacity—at cost and not for profit—to deliver treatment on the NHS to clear the backlog and to save lives.

We must especially care for, value and boost the work- force. Radiotherapy oncologists, radiographers, engineers and physicists—dedicated, passionate professionals —are close to breaking point. The survey by Radiotherapy UK and the Institute of Physics and Engineering in Medicine, to which the hon. Member for Easington referred, showed that 75% of those professionals believe that their unit could not meet pre-covid capacity with the kit they have. Some 80% reported seeing more advanced tumours than ever before in their careers and, as has been said, nearly 80% had thought about leaving the profession.

In Cumbria and right across the UK, radiotherapy treatment and the outstanding workforce have so much more to offer in the fight to save lives than successive Governments have seen fit to acknowledge. All parties bear responsibility for that. I ask the Minister to be a laser trailblazer and to deploy radiotherapy at its full capacity, so we can end needless deaths and catch up with cancer.

10:06

[Chris Bryant (Rhondda) (Lab)]

I congratulate my hon. Friend the Member for Easington (Grahame Morris) on securing this important debate, and not for the first time—he is a repeat offender. His determination and laser focus on this issue are really important in trying to save lives.

I hope it is not too mawkish if I say a few words about my own experience of cancer, even though I have not had radiotherapy, because radiotherapy is not normally used to treat my form of cancer—melanoma—although it is for other forms of skin cancer such as squamous and basal cell carcinomas. The timing of my cancer was amazingly fortunate. It was three years ago yesterday that I went to my GP with a dodgy mole—I urge anyone who ever worries about a mole to get it checked out, because my hon. Friend is absolutely right that early detection saves lives. I was very fortunate that my GP sent me straight to a dermatologist, who cut it out for the first time within 10 days. The second bout was two weeks after that.

I was fortunate that all that could happen very quickly. If I had gone to the doctor on my birthday last year or this year, I do not think I would have got the same speedy response. I had a stage 3B melanoma—incidentally, I must say to the hon. Member for Westmorland and Lonsdale (Tim Farron) that satellites are not always good. A microsatellite from a melanoma is a really bad thing. If I had left it another three months, it would probably have been a stage 4, and there are only four stages.

I was also fortunate that two weeks before I went to the doctor, the National Institute for Health and Care Excellence allowed the use of immunotherapy for melanoma in an adjuvant setting at stage 3, rather than just at stage 4. I hope the Minister will confirm that NICE is looking at the use of the various kinds of immunotherapy in an adjuvant setting for people with stage 2 melanoma.

I say all that because I was told at the time I had a 40% chance of living a year—three years have now passed so I am very grateful that the immunotherapy I received has dramatically improved my chances of living. I say gently to the hon. Member for Westmorland and Lonsdale that, sometimes, the drugs are a really important part of the cancer treatment package. I do not think there is a competition between different parts of the package; there are clearly instances where drugs, chemotherapy or radiotherapy is the right route.

My anxieties are that, first, we have a massive catch-up job to do, and secondly, that I do not think we had the capacity needed to tackle the problem even before we went into covid. We have a growing population in this country, and a growing number of cancers, but last year’s figures show a nearly 10% fall in the number of people receiving radiotherapy. That is not good news in any shape or form. There may be people whose deaths from cancer are unknown to us because they ended up not being diagnosed and then died with or of covid, so they may not appear in the statistics, but they will certainly appear in many people’s family statistics and life experiences.

There are things that the Government could do immediately, many of which have already been laid out by hon. Members. Something needs to be done about the workforce, because every part of the cancer pathway has a shortage of staff. A lot of staff have been redeployed during covid to help run A&E departments. Nurses, hospital orderlies and receptionists from the same teams have ended up being redeployed to other parts of the operation. They have been very happy to do that, but it has meant that, in nearly every cancer discipline—the one I know best relates to dermatology, obviously—there is now a series of vacancies.

A lot of staff are burnt out, exhausted, demoralised and uncertain whether they want to stay in the profession. I think this is the fifth Minister to whom I make the same plea: that she and the Government look at the series of things we could do to enable people who have recently left the profession to come back. That might include financial rewards. We could do more to enable people to stay all the way through to retirement age. A significant number retire early, partly because of that sense of burn-out. They do not necessarily want a financial reward; they would actually quite like a sabbatical of a couple of months or something like that, simply to recharge their batteries so they can come back into the profession and not retire early. We certainly need to do something about the problem that doing extra hours or sessions is now barely worth it for many people, because the financial reward is minimal. A major issue will come up very shortly relating to pensions and pension funds for many doctors in many of these disciplines.

In all those areas, the Government could do far more to increase capacity now, then they have to look at increasing capacity for the future. One of the most important parts of the process is diagnosis. We do not have enough radiologists, radiographers, histopathologists and pathologists in the UK. There is a massive shortage—something like a 10% vacancy rate. We are not even allowing enough people to train this year to fill the vacancies that exist now, let alone the additional vacancies that there will be in five or 10 years’ time, so we are building up a bigger problem for ourselves.

That takes me to my biggest concern of all. Before covid, every winter we were running the NHS at 95% capacity. It is pretty difficult to run anything at 95% capacity, because the moment you have a crisis of any kind whatsoever, you are stuffed. It is a bit like those baggy gym shorts that have an elastic band in them. When someone gets beyond a 34-inch, 36-inch or 38-inch waist, suddenly there is no more stretch in the pants, as you know, Mr Davies—[Laughter]—because you understand the science of elastic bands, obviously. However, I make a serious point. We have run the NHS far too close to complete capacity for far, far too long, and not only in intensive care units, where we have many fewer beds per 100,000 people than any country in the European Union or any advanced country in the world. We also have many fewer hospital beds per 1,000 people than any other advanced country in the world. We need to look at the long-term issues and say to ourselves that, if we really want an NHS that will not be crippled by a pandemic or by winter, we have to invest significantly in the future. Every single time a Minister stands up, they always say very nice things. The Minister who is here today has lots of clinical experience of her own, and we are enormously grateful for the work that she has done in the NHS during the pandemic. However, in the end, warm words butter no parsnips—not that one really wants butter on parsnips. I love a parsnip, although it is odd that we are the only country in Europe that actually eats them—mostly they are fed to cattle, but that is by the by.

The serious point is that we need to invest in every single part of the NHS. The cancer catch-up is a matter of life and death. I think that, if I had gone to the GP yesterday, my life would not have been saved. That is a distressing thing to be able to say to one’s constituents. I hope that the Minister will come up with some answers for us.

10:15

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to speak in the debate, Mr Davies, and also a pleasure to follow the hon. Member for Rhondda (Chris Bryant). We in this House are very blessed that he is here today because he had early treatment and was able to respond to it. I spoke to him personally at the time, and I know that others did. We are very thankful to God that he is here today and able to participate in this and many other debates in the House on a regular basis. We thank him for that.

I also thank the hon. Member for Easington (Grahame Morris) for setting the scene. We are greatly indebted to him for his leadership, for his interest in this subject matter and for every occasion on which he comes forward. We are also indebted to the hon. Member for Westmorland and Lonsdale (Tim Farron) as well. We are all on the all-party parliamentary group on cancer together, so we have regular contact with one another and with others as well. I give credit to both hon. Gentlemen for their leadership and contributions, and to others on the APPG for bringing this forward.

It is nice to see the shadow Minister, the hon. Member for Enfield North (Feryal Clark), in her place. I always look forward to the Minister’s contribution. I believe that we will get a response that helps us to address the issues that we are raising today. I believe that we are greatly blessed to have the Minister in her place; she has a particular interest in this subject matter and is eager to secure change.

The debate today is about change; it is about making sure that we can move forward. I probably cannot even quantify—the hon. Member for Easington might be able to—the number of times we have asked about radiotherapy services. We have asked about these services before, met the Minister before and sent letters before, but we do not seem to be getting to where we want to be. That is what the hon. Gentleman said in his introduction. That is where we are.

There is a staggering backlog of an estimated 47,000 people missing a cancer diagnosis in the UK, and Macmillan estimates that the backlog of those waiting for a first treatment stands at 32,000 in England alone. Only last week in my constituency—this is not the Minister’s responsibility, to be fair, as it is a devolved matter—I met someone who was eagerly seeking an early meeting with a consultant and doctor about cancer. It is so important that she gets that; she is very worried about her circumstances. When I became aware of them, I was also concerned. We need to address that issue.

Radiotherapy in particular is one of the mainstays of cancer treatment. Modelling suggests that between 40% and 50% of people diagnosed with cancer should receive radiotherapy as part of their treatment. If it is part of their treatment and they cannot get it, we have a severe problem. The difficulty lies in workforce shortages, to which the hon. Member for Easington referred. They remain the biggest challenge facing the NHS and access to radiotherapy today. The Chancellor’s October Budget, unfortunately, missed a key opportunity to tackle this issue. Can the Minister give us some indication of the discussions that she has had with the Chancellor about what can be done to address the shortfall?

Macmillan Cancer Support says:

“The pandemic has both laid bare and exacerbated the terrible strain the cancer workforce has been under for many years.”

I know that the pandemic has exacerbated that incredibly. It is frustrating to know that the waiting lists that we had in 2019 are the waiting lists of 2021—and now 2022. It is essential that the budget for Health Education England is confirmed immediately, ensuring an increase in funding to train the cancer workforce that the NHS desperately needs.

Too few cancer patients have full access to a cancer nurse specialist, which is crucial in reducing costs and improving patient outcomes. It is very clear that in the reform of the NHS priority must be given to training these nurse specialists and ensuring that the funding is there to pay them for the extra responsibility that they take on and for the workload that they take off their colleagues, the doctors. Perhaps the Minister could give us some idea of what is going to happen in relation to that issue in the reform of the NHS.

Again, I am deeply grateful to Macmillan Cancer Support for the information that it has sent me. It estimates that in order to help meet the Government’s NHS long term plan, we need an additional 3,371 cancer nurse specialists, which means doubling the number of cancer nurses by 2030. In introducing the debate, the hon. Member for Easington mentioned that issue and I mention it again now, not simply to repeat it but to underline gently the importance of having those nurses in place. It is a major ask but not an impossible one, or at least it should not be impossible.

How do we get those nurses? First, we get the finance in place. An estimated total of £124 million is needed to train the next generation of cancer nurses by 2030. Again, what has happened in the discussions that the Minister has hopefully already had, or will be able to have, with the Chancellor? That process must begin with bursaries, which give the incentive and encouragement, if it is needed, to enable not just young students but mature students—those with mortgages and debts to pay, and perhaps children to care for as well—to be able to take the step into nursing. I make that comment because of a particular example that I know of. The dream of one of my constituents was to go into nursing. She worked in a shoe shop and her husband worked in landscaping; both of them had low-paid jobs. When she made the decision to follow her dream and go into nursing, she simply could not make ends meet, which is why bursaries are important.

I know this girl personally, so I know that she has endless compassion. She worked to become an intensive care nurse. She is a clever lady who wanted to make a difference in this world, but simply could not do so. She went into care work during covid and is making a difference in a nursing home, but will she ever become an ICU nurse, as she wanted? She thinks not, but I would like to think that the differences we make in this place and the decisions that we take will enable people such as Sarah to do the good that they want to do in the world, because there are many people out there who just love to help other people. We in this House—you, Mr Davies, and the rest of us here—are MPs who wish to help people; indeed, that is our job.

In 2020, the all-party parliamentary group for radiotherapy reported that a fifth of radiotherapy machines were older than their recommended lifespan of 10 years. NHS England must ensure a sustainable future so that machines are upgraded on a rolling basis and when they need to be. That process must be continuous, so we need an action plan to make it happen. Again, I ask the Minister a question: what has been done to address the need for that additional investment? Unfortunately, it is a fact that this comes down to finance.

Additional investment in radiotherapy would be best spent on upgrading existing machines and software rather than on increasing the overall number of radiotherapy machines or centres. Cancer Research UK has said that even if new centres were built, it would be very difficult to find the staff to run them. We need a co-ordinated and strategic plan that considers all the potential issues for the future, especially in rural areas such as the one that the hon. Member for Westmorland and Lonsdale represents. As he often says, in rural areas staff shortages are often the most severe that they are anywhere.

In the long term, consideration must be given to introducing innovative technology to transform care. For example, there are a limited number of magnetic resonance linear accelerators, or MR linacs for short, in the UK. They significantly increase the precision of analysis and therefore the effectiveness of treatment, which is really important. The Government must consider how to manage funding over a long term, to expand access to MR linacs and other cutting-edge technologies. That also includes purchasing new radiotherapy technology to evaluate its efficacy as a cancer treatment.

I will finish with this comment: the fact is that much greater investment is needed. We should remember that radiotherapy is used for half of cancer treatments, so it is critical for addressing cancer. Cancer affects many people and we need to give radiotherapy the priority that it deserves, getting the nurses and the equipment in place urgently. Unfortunately, there are literally millions of people whom radiotherapy can save and thereby extend their life. It seems to be agreed by all those who have spoken in this debate, and I believe that it will also be agreed by all those who will speak after me, that we must do all that is possible to do in this place in that regard.

10:24

[Feryal Clark (Enfield North) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Davies.

I start by thanking my hon. Friend the Member for Easington (Grahame Morris), both for securing this important debate and for being such a consistent champion on this issue. We have heard some excellent contributions and I pay tribute to all hon. Members who have spoken—my hon. Friend the Member for Bedford (Mohammad Yasin) and the hon. Members for Strangford (Jim Shannon) and for Westmorland and Lonsdale (Tim Farron)—for raising issues about investment, the workforce and the bureaucracy that surrounds radiotherapy. I pay tribute to my hon. Friends the Members for Rhondda (Chris Bryant) and for Easington, who speak with authority on the issue as a result of their experiences.

We have heard that radiotherapy is a vital tool in our fight against cancer and that it is one of the three pillars of treatment alongside surgery and chemotherapy. The fact that radiotherapy is needed by one in four of us across our lifetime should be a stark reminder of how important today’s debate is. I join my hon. Friend the Member for Easington in paying tribute to the work of charities such as Radiotherapy UK and the Catch Up With Cancer campaign for keeping this important issue on the agenda.

Hon. Members will know the impact the pandemic has had on cancer treatments and the devastating backlog that it has caused. In my own constituency of Enfield North, data from Macmillan shows that 73 people are missing a cancer diagnosis and a further 57 are waiting for their first cancer treatment. The backlog in treatment, coupled with the severe workforce crisis, which every Member has highlighted and which is rapidly stretching across our health service, means that we are facing a situation where outcomes for cancer patients are being put at risk. As we have heard, radiotherapy is a vital tool in our fight against cancer and should play a key part in our work to help overcome the backlog that affects both patients and staff.

As highlighted by all hon. Members, with the pandemic impacting so much of the NHS’s operations, radiotherapy provides a covid-resilient form of cancer treatment by not having an impact on the immune system or requiring admission into intensive care. It is very cost-effective, as mentioned by my hon. Friend the Member for Easington, with the average cost of radiotherapy care ranging from £4,000 to £7,000, making it cheaper than the often costly options of surgery or chemotherapy. Despite that, radiotherapy has been consistently overlooked when it comes to policy, so it has often faced a lack of investment and understanding by policymakers and successive Governments.

As we have heard, just 5% of the cancer budget in the UK is spent on radiotherapy. That means that despite significant global advancements in radiotherapy technology, patients in the UK are continuing to miss out. Half of all NHS trusts are using machines that are older than the recommended 10-year life span.

[Grahame Morris]

I apologise for breaking the flow of my hon. Friend, but these are important statistics. One worth remembering is that in over 50% of cancers, radiotherapy or precision radiotherapy would be effective as part of treatment—perhaps not exclusively. Actually, when I had my treatment, I had everything: I had surgery, chemotherapy and radiotherapy. However, it would be effective in over 50% of cases. It is currently only given to 27% of cases, so even before we start tackling the backlog, there is a huge capacity issue, and I hope my hon. Friend recognises that, and that the Minister will address it.

[Feryal Clark]

I thank my hon. Friend for his intervention; I absolutely agree with him. As was mentioned, many patients do not even have the luxury of being treated by old technology. More than 3.5 million people in the UK do not have radiotherapy centres within the recommended 45 minutes of their home, as mentioned by my hon. Friend the Member for Bedford and others. That has led to a situation where, rather than meeting the international guidance of 57% to 60%, just 27% of cancer patients in the UK are given radiotherapy. Patients are receiving a raw deal at every turn in the UK, putting their treatment and their long-term outcome at risk.

It is not just patients who are feeling the strain; radiotherapy staff, like many of their colleagues across the NHS, are feeling undervalued and under-resourced. A workforce survey carried out by Radiotherapy UK showed that 80% of radiotherapy staff were considering, or knew of someone considering, leaving the profession; 90% felt that the Government did not recognise the significant role that radiotherapy plays in reducing the cancer backlog; and 75% felt that they did not have the capacity to reach a pre-pandemic service level. A plan to improve provision of radiotherapy, or any other treatment across the NHS, will not be successful if there is not a robust workforce strategy behind it.

[Grahame Morris]

We need a plan.

[Feryal Clark]

Absolutely. I ask the Minister what other hon. Members have also asked today: how do the Government expect to tackle the cancer backlog when staff feel like no-one is listening to them? NHS staff have made immense sacrifices during this pandemic; they deserve to be heard and respected instead of having their concerns ignored.

The staff who remain in radiotherapy are met with barrier after barrier when it comes to improving the experience of patients and the effectiveness of treatment. I run the risk of repeating points, but these are key issues and need repeating. In order to justify investment to fund a new and updated machine, NHS trusts are required to conduct 9,000 treatments per year. During the pandemic, when we have seen referrals plummet and services stretched to breaking point, that target is plainly unrealistic for many trusts. It leaves staff with faulty, unreliable equipment that frequently breaks down, and patients with delays, postponements, cancellations and a much more challenging experience of treatment. I join with many other Members who spoke this morning in urging the Minister to carefully examine the situation, and look at what can be done to remove the bureaucracy that is stopping the advancement in equipment that is evidently needed.

When we know that every four-week delay in treatment for a cancer patient increases the mortality rate by 10%, the lack of investment in such a core pillar of cancer treatment is putting lives at risk. The failure to address these issues will leave the 40% of cancer patients who need radiotherapy as a curative treatment, either on its own or in combination with other methods, in a grave situation. Failure will also have a knock-on effect across all treatment pathways, increasing the pressure on already stretched cancer services as well as primary care providers.

Finally I ask the Minister, do the Government accept that radiotherapy needs an increased level of support to properly fulfil the important role it plays in overcoming the backlog in cancer treatments? Furthermore, will the Minister commit to a plan to improve both workforce numbers and satisfaction, given the increased pressure that the situation is producing on services such as radiotherapy? Cancer patients have suffered so much over the course of the pandemic; they deserve better than this. It is about time that the Government acted.

10:34

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

It is a pleasure to serve under your chairmanship, Mr Davies. I should declare an interest before I start: I am still working as a cancer nurse in the Royal Marsden Hospital in London. I have spent 20 years looking after patients who are having chemotherapy, radiotherapy and surgery, so no one is more passionate than I am about this issue.

I congratulate the hon. Member for Easington (Grahame Morris) on securing this important debate, raising the profile of radiotherapy and the important work that the all-party parliamentary group does. Very few of us have not been impacted by cancer in some way, whether as a patient—the hon. Gentleman and the hon. Member for Rhondda (Chris Bryant) eloquently described their experiences—or as a relative, friend or healthcare professional. We know the devastation that cancer can bring, whether through the diagnosis and living with the disease, experiencing the side effects of treatment or, unfortunately for some, the effects it can have on life expectancy.

I reassure colleagues that during the pandemic, cancer has remained an absolute priority. We have kept cancer services going throughout periods of lockdown. There is no doubt, though, that patients were reluctant to come forward with signs and symptoms, particularly during the first lockdown. We actively encouraged many patients with a cough not to come and see their GP as a first point of contact. Since then, however, an absolute tsunami of patients has come forward—so much so that we are working through more than 10,000 cancer referrals a day.

I encourage Members to look at the data for actual treatment. Data such as that about the 62-day rule shows that the cancer backlog is not necessarily in treatment—in patients waiting for surgery, chemotherapy or radiotherapy—but in the diagnostics procedures. They are where the greatest pressure is at the moment.

[Grahame Morris]

I appreciate the Minister’s giving way. Statistics are important as a tool to identify where the obstructions are in the system. I completely agree about the importance of early diagnosis, but will the Minister publish the radiotherapy datasets that will be available next month, so that we can see the true nature of the backlog?

The profession—the frontline—tell a story rather different from the impression that the Minister has just given: that there are issues with treatment, and not just with diagnosis. The radiotherapy datasets, which have not been published for over a year but are available, will clarify that position.

[Maria Caulfield]

I thank the hon. Gentleman. I am not saying that there are no pressures on the treatments for cancer patients, but the greatest pressure is at the diagnostic end. We will be publishing data, but I caution Members on the data for radiotherapy. A lot of the cancer data is based on first treatment and, as Members will know, radiotherapy is often an adjuvant treatment given further down the line. The measurement of access to radiotherapy, compared with treatments such as surgery or chemotherapy, is much more difficult to establish.

I also caution colleagues, a number of whom have said similar things in this morning’s debate. Radiotherapy is a specific specialist treatment. As the hon. Member for Rhondda pointed out, for many cancers it cannot necessarily be given instead of surgery or chemotherapy; it is part of a package of treatment and these are clear, clinical decisions that need to be made jointly by the oncologist and their patient.

[Grahame Morris]

We have a little bit of time and these are important points. Many of us have been making them, not just to this Minister—who, to be fair, is newly in place—but to her predecessors.

There are points of contention about the effectiveness of radiotherapy, but there have been some incredible advances in recent years. I am not claiming expert technical knowledge, but radiotherapy has been applied very effectively against lung cancers; that was never the case before. There is now a possibility of expanding the service to provide much more effective treatments, for cases which previously could be treated only through surgery and chemotherapy.

[Maria Caulfield]

I do not disagree with the hon. Gentleman. I may be a new Minister, in post for weeks rather than years, but I have 20 years of oncology experience, and in my experience radiotherapy has a fantastic role to play. It is indeed the case that significant progress has been made, particularly in the field of lung cancer, with stereotactic radiotherapy to specific areas. However, radiotherapy will target a specific area; it will not give systemic treatment, like adjuvant treatment to prevent recurrence or neoadjuvant treatment for metastatic disease, where the disease is in multiple parts of the body. As Members of Parliament, we need to be cautious that we do not give patients the impression that they should be asking for radiotherapy instead of surgery and chemotherapy. There needs to be a discussion with their oncologist and their medical teams as to the appropriateness of radiotherapy. Yes, it is often cheaper than chemotherapy to give. Yes, it is a quicker treatment and sometimes—not always—has fewer side effects. But it has to be a clinical decision. There are important reasons why radiotherapy is given to some patients and not others. That is something that patients really need to have a discussion—

[Chris Bryant]

We all understand that clinical decisions have to be made. Our anxiety is that clinical decisions sometimes end up being made because there is not enough availability of facilities or staff, or—the third aspect to this—because lots of patients simply are not presenting at the moment. They are not coming in the doors of the NHS because of covid. That potentially means—for instance, in relation to bowel cancers, lung cancers and melanoma—that we will see people presenting much later and therefore there will be a much more dangerous prognosis for them.

[Maria Caulfield]

I absolutely take that point on board. There are clinical reasons, if a patient has presented later, why radiotherapy may or may not be suitable. Again, they are clinical decisions that a patient needs to be discussing with their oncologist.

The hon. Member for Westmorland and Lonsdale (Tim Farron) raised the issue of satellite units. Again, I would just be slightly careful. Cancer alliances are mapping out cancer services in their areas, and I am very happy to meet colleagues who would like better provision in their local area, but they also need to meet their cancer alliances, which are looking at service provision locally.

I would just caution Members on the issue of having multiple sites for radiotherapy. These are specialist treatments, needing specialist equipment and specialist staff. I went into oncology more than 20 years ago, when surgery was done by general surgeons. They were doing mastectomies on women and colostomies on bowel cancer patients. Moving surgery into being a specialist field, with specialist provision, has transformed the way that we are able to look after women who are going through mastectomies, and bowel cancer patients, who may not necessarily need a colostomy now, because surgical treatments have advanced so much. There is sometimes a rationale for those services to be offered by specialist units, rather than multiple satellite sites.

[Tim Farron]

I want to answer a point that the Minister made earlier. Obviously, during the pandemic, radiotherapy has been used as substitutionary treatment for people who would otherwise have had chemotherapy or surgery, because it is a covid-secure treatment. But my main point is with regard to what the Minister just said about satellites. Has she looked at the data and evidence from those satellite centres that have been opened in the last few years?

For instance, at Hereford, we saw a doubling of the number of patients being treated at that new satellite centre. Why? Well, there was an assumption that the parent centre people, from that postcode, were simply transferred to Hereford. No, it turned out that a lot more people, who would not travel or who were not referred because of the travelling distance for treatment at the original place, were then referred for treatment and therefore had a longer life expectancy because of the satellite centre. With more networking capability, it is of course possible now to treat in specialist ways, with the best people, remotely and through these satellite centres. The Christie has just opened its third satellite, so surely, for more rural communities such as mine, and also in east Lancashire, the time has come to ensure that no one is left behind.

[Maria Caulfield]

There are satellite services—absolutely. We have seen them not just for radiotherapy, but for chemotherapy and even surgery. But it has to be a local decision, because local oncologists have to feel that they are able to support the multidisciplinary team who support the radiotherapy process, ranging from diagnostics through to the treatment itself. That has to be in place, so it does absolutely need to be done on a local basis, but I am happy to meet colleagues if they feel that the case is not being heard locally.

I want to emphasise this point, because a number of hon. Members talked about the commitment to cancer services. Our elective recovery programme has committed £2 billion this year and £8 billion over the next three years to step up activity and tackle backlogs. That will have a knock-on effect in improving radiotherapy access, because some patients cannot have radiotherapy until they have had surgery. Ensuring that we are tackling some of the backlogs to treatment resulting from covid is absolutely important.

There have been huge improvements in radiotherapy over recent years, not just in provision but in technique. We are able to deliver more targeted treatment, resulting in fewer hospital visits, because we can now give radio- therapy to a more targeted area of the body, resulting in fewer side effects from the treatment, and also give fewer fractions of radiotherapy, so that patients can get their total dose much more quickly. That maximises service capacity and minimises patient time in hospital.

Furthermore, we have invested £250 million into two proton beam therapy facilities, one based at the Christie in Manchester and the other at University College London. In addition, all radiotherapy centres in England are now able to deliver stereotactic ablative body radiotherapy. Both these treatments are able to target radiation at cancer cells more accurately, improving patient outcomes. I am really pleased to say that, as part of this year’s spending review, £32 million was made available to support the replacement of 17 linear accelerators aged over 10 years, all of which are on order and will be delivered by the end of March 2022.

NHS England is committed to improving the facilities for cancer patients, and has also offered NHS radiotherapy providers the opportunity to participate in a cloud-based technology called ProKnow. To date, 43 of the 49 radio- therapy providers have joined up. This technology, which will help satellite units, enables clinicians to collaborate virtually within and across organisations, to plan treatments, undertake peer-review assessments and participate in large-scale audits and quality improvement processes, ultimately benefiting patients.

A number of Members talked about the cancer workforce, because it is great to have state-of-the-art technology and multiple units providing radiotherapy, but if we do not have the staff to manage them and provide treatment we shall not make progress. Health Education England is continuing to take forward the cancer priorities identified in the NHS’s long-term plan. It is prioritising the training of 250 nurses to become cancer nurse specialists, 100 chemotherapy nurses and 58 biomedical scientists, and it is updating the advanced clinical practice qualification in oncology.

Further than that, particularly around radiotherapy, Health Education England is investing £52 million in the cancer and diagnostic workforce, increasing the number of clinical endoscopists and training more radiographers in image interpretation. That is all part of the radiotherapy process. As of August there have been an additional 4% of doctors working in clinical oncology, which is the field that manages radiotherapy, and there have been a further 5% working in radiology since August 2020.

We are making progress, but it is not just about the numbers of staff; it is about the skill mix and ongoing staff training. Very often, not being able to expand a role or take on exciting and innovative developments can make staff feel frustrated, but the cancer workforce is growing. Between 2016-17 and 2019-20, the cancer workforce grew by 3,342 full-time equivalents, compared with the ambition of 2,943. We are ensuring that there are more staff coming through into the workforce to deliver radiotherapy.

The shadow Minister touched on the importance of not only recruiting staff but retaining and developing them. I fully take on board colleagues’ comments and concerns. We are committed to investing in radiotherapy equipment, the staff that deliver radiotherapy and the innovation in radiotherapy. We are also committed to making it more accessible to patients, and to reducing the side effects—there are side effects from radiotherapy as well—and to making sure it is a fundamental part of cancer treatment, whether that is in the neoadjuvant setting, adjuvant or for those with metastatic cancer as part of the palliative treatment service.

[Feryal Clark]

I thank the Minister for all the information about the machines and investment into radiotherapy. Are the figures that she set out for replacing what is already out of date, or is there a plan to increase investment in radiotherapy treatment? As we have all said, radiotherapy accounts for 5% of the cancer budget. Is there a plan to increase that, or is it about replacement and keeping up what we already have?

[Maria Caulfield]

It is about replacing existing equipment, but also investing in new. Some of the equipment is 10 years old. Radiotherapy has changed a lot over those 10 years, so the replacement equipment can do more than what it replaces. As I pointed out, we are also investing in new radiotherapy equipment, with £250 million into two proton beam therapy facilities at Christie’s and at UCL—new facilities that will be able to provide state-of-the-art radiotherapy treatment. I hope I have reassured Members that we are addressing this as a top priority.

[Chris Bryant]

Will the Minister give way before she sits down? She sounds very like she is finishing.

[Maria Caulfield]

I was finishing, but I will give way one more time.

[Chris Bryant]

The Minister may not be able to answer the question today about adjuvant provision of immunotherapy for people with stage 2 melanoma, but if she could write to me, I would be very grateful.

[Maria Caulfield]

My understanding is that it is available for stage 3 melanoma, as the hon. Gentleman has highlighted, and that it is still in clinical trials for stage 2. It is available within clinical trials. We expect the data to come forward shortly and then a decision will be made. That is where we are with melanoma.

[Tim Farron]

Will the Minister give way?

[Maria Caulfield]

I will give way one more time.

[Tim Farron]

The Minister is being very kind and I really appreciate it. I have two quick points that I do not think she has mentioned. First, will she take up the request from myself and the hon. Member for Easington for a meeting with the APPG for radiotherapy? We would love to meet her.

Secondly, I do not think she referred to the tariff situation. A lot of the issue is that we need more money. We want the Minister to accept—it is not just her fault; it is the fault of every party in this place, over decades—that we are behind comparable countries and we need to strengthen radiotherapy. The reality is that there are lots of state-of-the-art machines out there, in trusts up and down the country, that are not being used because the tariff is stupid. It incentivises trusts to do second-division radiotherapy, if I can put it that way, because more visits equal more cash, rather than targeted and specific radiotherapy—stereotactic, as she mentioned, for many cancers—because the tariff rewards number of visits, not precision or effectiveness of treatment. Would she look at that? It is free.

[Maria Caulfield]

I am very happy to look at the tariff situation, but my experience is that when a clinical oncologist is referring someone for radiotherapy, that decision is not based on whether they have smaller numbers of fractions as opposed to traditional courses. I am very happy to meet the all-party parliamentary group to discuss that further. I reassure patients that clinical decisions are what decide the type and the number of fractions that a patient needs for their treatment.

Radiotherapy is a priority cancer treatment and this Government are absolutely committed to investing not just in the equipment, but in the workforce that provides it. I say a huge thank you to all the staff across the NHS, particularly in cancer services, who kept going through all the pandemic lockdowns, made sure that cancer patients got their treatment, and helped to support them and their families through what is a very difficult time.

10:54

[Grahame Morris]

This has been a really good debate. It is one we have had on a number of previous occasions.

I thank my hon. Friends the Members for Bedford (Mohammad Yasin) and for Rhondda (Chris Bryant) and the hon. Members for Westmorland and Lonsdale (Tim Farron) and for Strangford (Jim Shannon) for their excellent contributions. I also welcome and thank my hon. Friend the Member for Enfield North (Feryal Clark), and pay tribute to her predecessor, my hon. Friend the Member for Nottingham North (Alex Norris), who did an excellent job and had a terrific understanding of the issue. I also thank the Minister for her response.

It has been an honour to open this debate. Once again, I thank those members of the public who shared their experience, and I thank the Chamber engagement team for their excellent work. It is the radiotherapy patients, their loved ones, the workforce, and, indeed, those who live with the everyday reality of this situation, whose interests we serve and whose insight is so valuable.

I hope the Minister, who has not answered all the questions—I know it is difficult—will have a look at the debate in Hansard and respond to them. I am grateful that she has agreed to have a meeting, but I want her to bring an end to radiotherapy’s status as a Cinderella service and give it the time, focus and investment required to put the UK on a path to ensuring that we have truly world-class cancer services.

Question put and agreed to. 

Resolved,  

That this House has considered access to radiotherapy.

10:56

Sitting suspended.