Lung Cancer: Screening
(10 months ago)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
My Lords, with the leave of the House I shall now repeat a Statement made earlier in the other place by my right honourable friend Steve Barclay, the Secretary of State.
“With permission, I would like to make a Statement on our national lung cancer screening programme for England. Around a quarter of patients who develop lung cancer are non-smokers. We all remember our much-missed friend and colleague, the former Member for Old Bexley and Sidcup, James Brokenshire. He campaigned tirelessly to promote lung cancer screening and was the first MP to raise a debate on this in Parliament. His wife Cathy is continuing the brilliant work that he started in partnership with the Roy Castle Lung Cancer Foundation.
In 2018, after returning to work following his initial diagnosis and treatment, James told this House that the Government should commit to a national screening programme and use the pilot to support its implementation. As I am sure many colleagues in the Chamber will recall, he said:
‘If we want to see a step change in survival rates—to see people living through rather than dying from lung cancer—now is the time to be bold.’—[Official Report, Commons, 26/4/18; col. 1136.]
Despite being a non-smoker, James knew that the biggest cause of lung cancer was smoking and that the most deprived communities had the highest number of smokers. That is why I am delighted that today the Prime Minister and I have announced targeted lung cancer screening programmes at a national level, building on our pilot, which will be targeted at those who smoke or have smoked in the past.
Lung cancer takes almost 35,000 lives across the UK every year—more than any other cancer. Often, patients do not have any discernible symptoms of lung cancer until it is well advanced; in fact, 40% of cases present at A&E. Since its launch in 2019, and even with the pandemic making screening more difficult, our pilot programme has already given 2,000 lung cancer patients in deprived English areas an earlier diagnosis. That matters because when cancer is caught at an early stage, NHS England states that patients are nearly 20 times more likely to get at least five years more of life to spend with their families.
We all know that smoking is the leading cause of lung cancer. It is responsible for almost three quarters of cases, and in deprived areas people are four times more likely to have smoked. We have deployed mobile lung trucks equipped with scanners to busy car parks in 43 deprived areas across England. Before the pandemic, patients from those areas had poor early diagnosis rates, with only a third of cases caught at stage one or two. To put that in context, while a majority of patients diagnosed at stage one and two get to spend at least five more years with their children and grandchildren, less than one in 20 of those diagnosed at stage four are as fortunate. Thanks to our targeted programme, three quarters of lung cancer cases in those communities are now caught at stage one and two.
Targeted lung cancer checks work. They provide a lifeline for thousands of families. We need to build on that progress, which is why we will expand the programme so that anyone in England between the ages of 55 and 74 who is at high risk of developing lung cancer will be eligible for free screening, following the UK National Screening Committee’s recommendation that it will save lives. It will be the UK’s first and Europe’s second national lung cancer screening programme. If results match our existing screening—there is no reason to think that they will not—when fully implemented the programme will catch 8,000 to 9,000 people’s lung cancer at an earlier stage each year. That means that each and every year around 16 people in every English constituency will be alive five years after their diagnosis who would not have been without the steps we are taking today. That means more Christmases or religious festivals with the whole family sitting around the table.
Alongside screening to detect conditions earlier, we are investing in technology to speed up diagnosis. We are investing £123 million in AI tools such as Veye Chest, which allows radiologists to review lung X-rays 40% faster. That means that suspicious X-rays are followed up sooner and patients begin treatment more quickly.
How will our lung cancer screening programme work? It will use GP records to identify current or ex-smokers between the ages of 55 and 74 who are at a high risk of developing lung cancer, assessed through telephone interviews. Anyone deemed high risk will be referred for a scan and will be invited for further scans every two years until they are 75.
Even if they are not deemed at high risk of lung cancer, every smoker who is assessed will be directed towards support for quitting because, despite smoking in England being at its lowest rate on record, tobacco remains the single largest cause of preventable death. By 2030, we want fewer than 5% of the population to smoke. That is why in April we announced a robust set of measures to help people ditch smoking for good, with one million smokers being encouraged to swap cigarettes for vapes in a world-first national scheme. All pregnant women will be offered financial incentives to stop smoking, and HMRC is cracking down on criminals who profit from selling counterfeit cigarettes on the black market.
The lung cancer screening programme has been a game changer for many patients: delivering earlier diagnoses, tackling health inequalities and saving lives. We are taking a similar approach to tackle obesity, the second biggest cause of cancer across the UK. The pilot we announced earlier this month will ensure that patients in England are at the front of the queue for innovative treatments by delivering them away from hospital in community settings. Together, this shows our direction of travel on prevention, which is focused on early detection of conditions through screening and better use of technology to speed up diagnosis and then treatment, because identifying and treating conditions early is best for patient outcomes and for ensuring a more sustainable NHS for the next 75 years. I commend this Statement to the House.”
Baroness Merron (Lab)
My Lords, I thank the National Screening Committee for its work and welcome this Statement, which outlines the only response that makes any sense: the establishment of a national targeted lung cancer screening programme. I also pay tribute to the many individuals and organisations that have worked over many years for this, in particular the Roy Castle Lung Cancer Foundation, which, in addition to campaigning, has been delivering its own scans since 2016.
I very much wish to associate these Benches with the thoughts of the late and much-missed MP for Old Bexley and Sidcup, James Brokenshire. I acknowledge the work he did in bringing this cancer screening programme about, which was continued by his wife Cathy. This is a very fitting Statement with which to honour his memory.
There is no doubt that diagnosing more people earlier is absolutely crucial. This programme will certainly improve that, but it does have to go hand in hand with treatment that is available rather quicker than is currently the case. The UK currently lags behind the European average for five-year survival rates for lung cancer. More broadly, since 2010, ever more cancer patients have waited longer than is safe to see a specialist. The target of 85% of patients to start treatment from initial GP referral within 62 days has not been met since 2015.
Can the Minister tell your Lordships’ House whether this extension of screening will be matched by the necessary improvements in access to treatment? If the treatment programme is to be improved—as surely it must be—how will this be done, and when? Will it be new money or a diversion from existing resources that funds the programme and any associated improvements in treatment?
Turning to the areas where lung disease is most prevalent, notably those with the greatest deprivation and health inequality, can the Minister give an assurance that resources for the screening programme will continue to be targeted at the areas that need it most? With existing health structures already worse in these areas, how will they be improved to support the delivery of the lung cancer screening programme?
Despite the Government’s support today, it has taken nearly nine months to act on the recommendation of the National Screening Committee, and there is now a timeline to reach 40% of the eligible population by March 2025, with full coverage by March 2030. Can the Minister say whether work is going on to hasten the timeline of this rollout?
The Health and Social Care Select Committee’s report last year into cancer services concluded that a lack of serious effort on cancer workforce shortages risks a reversal in cancer survival rates. While we have been promised the NHS workforce plan this week, after many years of waiting, I note that the Government’s press release had just one line on the workforce necessary to make the screening programme a reality, saying that additional radiographers are due to be appointed. Can the Minister assure the House that when we do get the workforce plan, it will address the major shortages that were outlined by the British Thoracic Society, whose report identifies workforce shortages as the main challenge in the provision of healthcare to those with lung conditions?
As the Minister rightly pointed out in the Statement, smoking is indeed the leading cause of cancer, causing 150 cancer cases every day and one person’s death every five minutes due to smoking-related ill health. It is therefore important that alongside diagnosis, we work to stop people smoking in the first place and support those who do smoke to quit. Yet the number of people quitting has slumped since 2010 and smoking cessation services have been cut. Can the Minister confirm when we will get the awaited Government response to the review of tobacco control policies, led by Dr Javed Khan?
It is not only smokers who have lung cancer and other lung conditions. The context in which all of this takes place is a range of other factors in addition to smoke and smoking, and that includes air quality. It would be helpful if the Minister indicated what is being done to tackle these broader challenges. Furthermore, it is not the diagnosis of lung cancer only that will improve through the screening programme, but also that of conditions such as cystic fibrosis. What expectation does the Minister have in this regard?
My Lords, I am sure we all want to see this national, targeted lung cancer screening programme save lives, and I hope the Minister can give the reassurances I seek today.
Lord Allan of Hallam (LD)
My Lords, I would like to follow the noble Baroness, Lady Merron, in welcoming the Government’s acceptance of the National Screening Committee’s recommendation to introduce a targeted lung cancer screening programme, and echo her tribute to the late James Brokenshire, whom I dealt with in a previous capacity when he was a Minister advocating for child safety online. I found him to be very effective; a firm Minister who was also very pleasant to deal with—the most effective model for all of us.
The new programme is especially welcome as a step towards addressing the glaring health inequalities we face in the United Kingdom. I hope the Minister will reassure us that sufficient data will be collected in order to understand whether it is having the kind of impact the Government intend, as he outlined in the Statement.
I hope the Minister can also provide more information about how it can be delivered, given that we already have dire shortages in capacity to deliver diagnostic tests. This shortfall is reflected in today’s report from the King’s Fund, which shows a serious gap in CT and MRI scanner capacity between the UK and comparable countries. When can we expect to see investment from the Government in additional scanners, to bring us up to something more like the international mean? As well as the lack of machines, we do not have sufficient people to operate them or to assess the test results. I invite the Minister to refresh his formula for when we may see the long-awaited NHS workforce plan, including the element that relates to radiologists, perhaps updating it from “shortly” to “in the next week”, as it surely has to come before the 75thanniversary of the NHS on 5 July.
The concern we continually have with announcements of new services by the NHS in the current context is that they will come at the expense of existing services; the noble Baroness, Lady Merron, also referred to this. I believe this is a rational and reasonable concern to have, given the evidence of missed targets and unacceptable wait times that is all around us. I hope the Minister can give us further assurances that, as the Government will the end of catching more cancers earlier, they will also be willing to will the means to deliver on this promise.
Anyone with eyes in their head can see that vaping is being cynically promoted to young teenagers; it is all around us in high street shops and in the evidence from the litter around schools. The Statement refers to the role of vaping as a tool to help existing smokers give up their harmful habit, but there is increasing evidence that vaping is creating new nicotine addicts, with associated risks. The Australian Government have found that young people who vape are three times as likely to take up smoking, and they have plans to bring in a range of measures to suppress vaping among young non-smokers. Can the Minister explain what assessment the UK Government have made of the Australian evidence of vaping leading to higher smoking prevalence among young people, and are the UK Government considering similar measures to reduce vaping use here? It took us five years to follow Australia in introducing plain packaging for cigarettes. I hope we can follow faster here, on vaping.
The new screening programme is welcome, but it must be properly resourced with both machines and people. I hope the Minister can give us some insights into how that will happen, and at the same time explain what action the Government intend to take to reduce vaping among non-smokers, so that we do not end up creating a new wave of people who are at risk of lung cancer.
Lord Markham (Con)
I will start with a small correction to the Statement. It should have said:
“We are investing £123 million in AI tools such as Veye Chest, which allows radiologists to review lung”
scans, not X-rays. I do not whether the etiquette is that I should have said that during the Statement. I repeated the Statement verbatim because I was told I should, but the correct word is “scans”.
I thank both the noble Baroness and the noble Lord for their comments and support. I too had the pleasure of working with James Brokenshire, and I realise what an effective and kind person he was. Like others, I am delighted that we are making these positive steps today and welcome the constructive and supportive comments.
Regarding trying to show that we are matching the will with the means on MRI scanners, that is exactly what the 100-plus CDCs are all about. It is a recognition that we do not have the same diagnostic capability, as highlighted by the King’s Fund report. That is what the investment in those centres is all about. My understanding is that about four million tests have already been done, so we are looking to match that. We will need 184 radiographers and 75 radiologists to do this work, but the other big support will be the use of AI. We are seeing some promising technology, which will help to a large degree. I am glad to say that a lot of this will be set out in the long-term workforce plan in the coming days—a new formulation. In other words, pretty soon.
In terms of the comments about screening being targeted at those most in need, that is where I have been most pleased by the pilots. Use of the mobile trucks really made a difference in those areas most in need. It really made a difference in the most deprived areas, which, as the noble Baroness, Lady Merron, mentioned, have higher levels of smoking. I am glad that it is targeting those areas.
Can we work to hasten the timetable? I think we would all like to but what we are trying to do here is to put down plans that we are confident we can hit. To answer the money question, it is £1 billion of extra investment during that time and that increases over time so that by the end it is about £270 million extra per annum.
What does that mean in terms of the Dr Khan responses? As I mentioned, we are committed to the smoking cessation results. As part of that we are considering all the points in the Khan review. I think we all accept that vaping is much better than smoking. We are very much trying to encourage vaping over smoking. But you have to be careful of the side-effects of that. As we have seen, vaping can be used in a somewhat cynical way—to borrow the phrase—with young people. More work undoubtedly needs to be done in that space but it is recognised that there needs to be a balance. I think I will need to come back in writing on air quality and cystic fibrosis.
I have tried to cover the points at this stage and look forward to further questions.
Baroness Bennett of Manor Castle (GP)
My Lords, I have two questions. My first question is about the timeframe and the role of GPs. The Statement says that, using GP records, current and ex-smokers aged 55 to 74 will be assessed by telephone interviews. Will that require resources from GPs? We all know that there are many different computer systems so where are the resources going to come from? Specifically on GPs, I can well imagine at many GP surgeries tomorrow morning at that terrible time of 8.30 am as everyone frantically tries to hit the dial button that a lot of people will be asking for a scan. Have GPs been equipped to handle that? Do they know what to say and how to manage that kind of scenario?
My other question follows on from the questions about the Khan review. That said that we are grossly underfunding things. Mass media campaigns in particular are funded at 90% under what is needed, while other services are about 50% underfunded. Surely we have to stop these cases happening. Can we see a commitment from the Government within some sort of timeframe to say that we are going to put more money into this?
Lord Markham (Con)
I thank the noble Baroness. In terms of identifying the smokers, the telephone is just one way of doing it. The hope is that using the digital data and the app means that more of these things will be on people’s records and identified with them. As ever with these things, electronic means will be the best way to do that, albeit those telephone resources in terms of supporting the GPs are very much part of the plan. It is understood that GPs have a large burden at the moment.
There is not a lot more to add about the Khan review. The ambition is still there to be smoke-free by 2035 and investment has gone behind that. The best example of that, as has been mentioned, is people swapping cigarettes for vapes as one means to do it. Undoubtedly, a lot more needs to be done in that direction as well.
Lord Kennedy of Southwark (Lab Co-op)
My Lords, I join noble Lords in paying tribute to James Brokenshire. I met him a few times, and it was a tragedy when he lost his life after a brave fight. I also pay tribute to the work his wife continues to do in his name.
This progress is to be welcomed, but can I say—if nobody else is going to come in—that cancer takes many forms? One area of cancer where we need to make much more progress is that of brain tumours and glioblastomas. We all remember our dear friend Tessa Jowell, who died on 12 May 2018 of a brain tumour. My brother John was a cab driver. Many people would not know my brother; he was just a cheeky, funny London cab driver who had a view on everything and who was loved by his family. He died on 26 March this year at 57, having fought a brain tumour for nearly three years. Our dear friend Baroness McDonagh was mentioned in the other place today. She died on 24 June at 61. She was my friend for 42 years; I met her when I was 18.
It is devastating. There has been no progress in this area of cancer treatment. There are quite clear inequalities, partly because only about 3,500 people a year get glioblastomas, so there are not huge numbers. There is no research, no trials and no hope—it is a death sentence. That cannot continue. We are no further than we were 30 years ago in this area. What happened today is brilliant, and I think there is now an 85% survival rate for breast cancer and that the rate for bowel cancer is 55%. However, brain tumours are virtually a death sentence. We have to improve that. It is an outrage that people can die so young from them and that there is no hope.
I do not expect an answer from the Minister today; I just want to put down a marker that I and other colleagues here and in the other place will keep mentioning this. I refer all colleagues here to the wonderful speech made by my honourable friend Siobhain McDonagh MP—my friend Margaret’s sister—when she talked about her sister and the treatment she had to undergo. I saw Margaret about three or four days before she died; it is a real tragedy, as is my brother’s case. I hope we can all work together and with the cancer charities, and that we can get some research done, put some money in and improve the situation. It cannot carry on.
Lord Markham (Con)
I thank the noble Lord, Lord Kennedy, and I am sorry for the loss of his brother. I agree with his sentiment that while this is good news today and is welcomed by all, it shows that this is a journey and that we need to do more in lots more areas. I take on that point and say, from our point of view, that we agree that we must work together to make further progress.
Baroness Merron (Lab)
Could I give the Minister another opportunity to pick up on the key point I raised? We very much welcome the improved diagnosis rates—and my noble friend Lord Kennedy makes a very pertinent point that, of course, we are talking not just about one cancer. I thank him for sharing his views and feelings with your Lordships’ House. That takes me to my reminder to the Minister: I asked about matching improvements in diagnosis with improved access to treatment; otherwise, we are leaving people diagnosed but not matching it by giving them the treatment they need in a timely manner. Could the Minister assist with that point?
Lord Markham (Con)
I am sorry; I was answering in a generic format in terms of the new CDCs. The noble Baroness is quite right that diagnosis is one thing—and we all know that the early stages are key—but you then have to follow that up with treatment. Of course, the good news is that if you can detect cancer in people at the earlier stages, they need less treatment. The resources I mentioned, in terms of what is being spent on the programme, take into account the treatment required as well.
Of the people being identified at this stage, only 1.4% from the pilot were then positive and needed treatment, thankfully. Obviously, those resources are in place. There is a second interesting category of people—about 17% or so—who are fine but we want to make sure that what has been noticed is in an okay state.
I am going to grab my notes to make sure I am referring exactly to the right term at this stage. I apologise; about 1.7% have nodules, which is not a problem per se, but it is a problem if those are growing. The idea is that we will be getting those people back in for frequent scans on a three- to six-monthly basis and using AI technology to see whether or not the nodules are growing. If they are not growing, it is not a problem, but we then keep up the frequency of scans. Obviously, if they are growing, that would be a concern at the early stages, and that would then move them into the treatment category.
The other 80% or so of people fortunately will not have any concerns from the scan at all. At that stage, they will be put into this continual programme, where they will be reviewed every couple of years to make sure that we keep on top of it. I hope that this shows that this is a well thought-out, entwined service, with the idea being that for the 1.4% who are identified as needing cancer treatment, the treatment is there to back them up.