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Dame Maria Miller (in the Chair)
Before we start, may I point out that there will be some videoing by the education department? Please do not be distracted. The Doorkeepers are aware and the video will simply be used to illustrate how a Westminster Hall sitting works, so just ignore it.
Selaine Saxby (North Devon) (Con)
I beg to move,
That this House has considered the accessibility of radiotherapy.
It is a privilege to serve under your chairmanship, Dame Maria. I thank the Backbench Business Committee for granting this important debate, all colleagues who supported the application, and Professor Pat Price for her tireless work in supporting the all-party parliamentary group for radiotherapy and championing this vital treatment.
We all know that the cancer backlog was affected by the pressures of covid-19, but in May this year there were 7.47 million people waiting for cancer treatments and 3 million of those have been waiting for over 18 weeks. Only 61.7% of patients receive their first treatment within two months, far below the operational standard of 85%. Radiotherapy is a key part of cancer care. It is the second most effective treatment for cancer and is needed in four out of every 10 cancer cures.
Radiotherapy targets the cancer with radiation. The cancerous cells are more affected than the healthy cells, which are better at repairing themselves. Modern radiotherapy has come on leaps and bounds, and within the last 10 years breakthroughs have increased the accuracy and focus of the treatment to within millimetres, significantly reducing collateral damage to healthy cells.
Surgical treatments require intensive care, with all of the hospital resources and emotional trauma that that entails, and chemotherapy has a significant impact on the immune system. In contrast, radiotherapy is an out-patient treatment that requires fewer patient visits to care centres. It only costs between £3,000 and £7,000 per patient, despite being incredibly high tech.
The international recommendation is that 53% to 60% of cancer patients receive radiotherapy treatments. However, in the UK only 27% of cancer patients received radiotherapy treatment in 2019. In my North Devon constituency, only 4.7% of my constituents live within the recommended 45-minute travel time for radiotherapy treatment. The other 95.3% are among the 3.4 million people in England for whom distance from a radiotherapy service effectively limits the availability of treatment.
Margaret Ferrier (Rutherglen and Hamilton West) (Ind)
As the hon. Member said, radiotherapy is the second most effective cancer treatment and is required by half of all cancer patients. However, the ability to access treatment has been described as a postcode lottery, with 3.4 million people unable to access radiotherapy without travelling more than 45 minutes. Does the hon. Member agree that it is unacceptable that there should be such significant disparities in access to radiotherapy?
Selaine Saxby
I do indeed agree with the hon. Member. In my case, North Devon is the fourth worst constituency in the country for access to radiotherapy services. North Devon is home to the smallest and most remote hospital on the UK mainland—and possibly the most loved. An exceptional team works tirelessly to deliver the best care, despite the challenges of rurality and the availability of staff, mostly linked to the availability of affordable housing, which is currently at its most extreme.
Radiotherapy is usually a series of daily treatments over a number of weeks. Far too many of my constituents choose not to have radiotherapy because the 120-mile round trip each day is too much to consider on top of the understandable pressures that patients with a cancer diagnosis already experience.
Radiotherapy is a far less invasive treatment than many others. With such an elderly population in North Devon it is often the best treatment for patients. A further complication that has been brought to my attention by the wonderful volunteer drivers we have in North Devon who help patients to their appointments across the expansive county, often to Exeter—a 120-mile round trip—for many different treatments, including radiotherapy. I do not want to discourage anyone from reaching out for those services, it will be clear to everyone that a daily radiotherapy session involving a journey of that length is a significant undertaking for patients and volunteer drivers alike. We have a declining number of volunteer drivers, which restricts driver availability for other patients.
It is hard to explain to those who have not visited North Devon the remoteness and the distances involved in undertaking all sorts of treatments. We benefit hugely from the merger of our hospital trust with Exeter’s, but that does not bring Exeter any closer. While it is positive that the backlog of patients waiting longer than 62 days for a GP referral is improving, the 62-day wait to start treatment is not. We know that every four weeks of delay in starting cancer treatment can increase the risk of death by 10%. To ensure everyone receives timely cancer care, radiotherapy needs to be an accessible treatment for every patient.
Jim Shannon (Strangford) (DUP)
I commend the hon. Lady for bringing forward a matter that is so important, which I think all of us here recognise. She has set the scene very well.
Another issue, which the hon. Lady is perhaps coming to shortly, is the shortage of radiotherapists across the United Kingdom. I understand that England is some 1,500 shy, and we have vacancies in Northern Ireland as well. The training takes five years, which means that it will be five years before the workforce, who are under pressure now, make gains, and that is if all the vacancies are filled. Furthermore, the age of current radiotherapists is an issue. Does the hon. Lady think that the Government need to take the initiative and put in place a visionary recruitment plan for the five-year period?
Selaine Saxby
I thank the hon. Gentleman for his intervention. We do not talk enough about the lack of specialist staff in this area, and I am indeed going to talk about the need for a proper plan for radiotherapy. Obviously, that involves resources of all types moving forward.
I think we all ask why a treatment as effective as radiotherapy is not used more often. Funding for radiotherapy falls between the cracks, and radiotherapy receives only 5% of the cancer budget. While there has been specific investment in radiotherapy, such as the £162 million in 2016 to replace 64 out-of-date machines, and the additional £32 million in 2019, there will be approximately 74 machines in need of replacement by the end of 2024.
We all know the NHS budget is under strain, but radiotherapy is the closest thing we have to a silver bullet for improving cancer care. An investment of £200 million would update all the machines due to be out of date by the end of next year, benefiting an estimated 50,000 people a year. An investment of £45 million in an innovative British technology—surface guided radiotherapy—could reduce waiting times by 1.8 weeks nationwide, and the use of artificial intelligence tools in radiotherapy could save clinicians two hours per patient.
If radiotherapy received between 10% and 12% of the cancer budget, instead of 5%, we could invest in more machines to bring ourselves up to international standards. In England, we have 4.8 treatment machines per 1 million people, while France has 8.5. and Italy 6.9. New machines and techniques would treat patients more quickly and help to clear the backlog. We need to reap the benefits of successful investment in early diagnosis and increased screening programmes so that early diagnosis leads to timely treatment and improved patients outcomes, rather than long and stressful waits for treatment.
We also need to focus investment in the right areas. Treatments such as proton therapy do not help patients outside Manchester and London. Proton therapy assists only 1% of patients, and my constituents in North Devon do not benefit from more investment in urban centres.
Sir Oliver Heald (North East Hertfordshire) (Con)
Does my hon. Friend agree that satellite radiotherapy centres have an important role to play? People from my area have to travel down to Hillingdon from north Hertfordshire. The journey is supposed to take 40 minutes, but it is actually an hour and a half each way. If we had a satellite radiotherapy centre in north Hertfordshire it would make all the difference.
Selaine Saxby
I thank my right hon. and learned Friend for his intervention, and I agree entirely. Indeed, I believe the Government should look at bringing radiotherapy treatments closer to patients such as those in my constituency of North Devon. I ask the Minister to consider bringing radiotherapy to satellite centres or community cancer treatment centres to complement diagnostic tools such as radiology in community diagnostic hubs.
Furthermore, may I recommend a trial in North Devon? We have a proud history of raising funds locally for cancer care provision, and I would dearly love to work with the Minister to deliver a new radiotherapy machine—on a partnership basis, if necessary—to begin to tackle some of our challenges head on. Indeed, that sounds significantly more achievable than tackling some of the other health inequalities from which my constituents suffer. Not a single NHS dentist across Devon is taking patients, and the last orthodontist has just left Barnstaple. I recognise that dentists are hard to come by but, for anyone listening, the surf is fantastic and you will be the most welcome blow-in we have ever seen in Devon.
Sorting out radiotherapy could be easier with a community-driven fundraising scheme and some assistance from the Minister to facilitate such as trial. I have former community hospitals waiting, and space on the main hospital site that could accommodate the machine and bunker. As we look to 2040, when an estimated 500,000 people will be diagnosed with cancer each year, we need to invest in cost-effective and efficient treatment.
Half of us will get cancer in our lifetime, so one in four of us will require radiotherapy treatment. Access to such treatment should not be limited by someone’s postcode. I ask the Minister not just to look at modernising and supporting radiotherapy, but to ensure that planning for cancer care accounts for rurality and that everyone has access to all available treatments.
Grahame Morris (Easington) (Lab)
It is a pleasure to serve under your chairmanship, Dame Maria, and I congratulate the hon. Member for North Devon (Selaine Saxby) on securing this important debate. Unusually, I agree with absolutely everything that a Conservative MP said, and I hope the Minister is making copious notes.
I hope you will forgive me if there is a bit of repetition, Dame Maria, because we have been trying hard to address this issue. In effect, this is the radiotherapy lobby. Although we do not have the big guns and finances of the pharmaceutical industry, we are the Members of Parliament who argue for the very small, dedicated and highly skilled radiotherapy workforce to be given the tools and facilities to deliver what they want, which is an improvement in cancer outcomes.
I would like to declare an interest: I am a cancer survivor and have had it twice. I have undergone various treatments, including cancer drugs, chemotherapy, surgery, and radiotherapy on three occasions. I am also privileged to be a long-standing vice-chair of the all-party parliamentary groups for radiotherapy and on cancer. Given the current economic climate, characterised by fiscal conservatism and a reluctance to commit to new spending—that is not a criticism of just the governing party, because it is an issue that my own party is addressing—it is crucial that we optimise the opportunities that present themselves to improve cancer outcomes, and the hon. Member for North Devon raised the issue of IT networks and the use of AI software.
Margaret Ferrier
AI technology is proving to be an asset in improving cancer treatment outcomes, and Radiotherapy UK has outlined the fact that a £4 million investment in AI technologies, which equates to £15 to £40 per patient, would immediately enhance NHS workforce capacity and reduce wait times. Does the hon. Member agree that further investment in AI could be vital in increasing access to radiotherapy?
Grahame Morris
That is a really important point, and I hope the Minister is taking note. I do not know whether the term is “low-hanging fruit”, but here is an opportunity to get some synergies from the new technologies that are available now but perhaps were not available even a couple of years ago. I will return to that theme, but AI is potentially a force multiplier, if that is the appropriate term: it can improve the productivity of the small radiotherapy workforce. As the hon. Member for North Devon mentioned, AI can save a consultant oncologist two hours in planning a patient’s treatment. As a couple of hon. Members have said, it is wonderful to have centres of excellence—some of the best hospitals not only in the United Kingdom, but in the world—such as the Royal Marsden in London and the Christie Hospital in Manchester. Now we have the opportunity, through IT networks and AI, for doctors and clinicians, even in remote locations, to access highly qualified oncology specialists, who can plan the treatment to be delivered in satellite centres. There is a huge opportunity here.
As we have heard, almost half of individuals experience cancer at some point in their lives, and about a quarter require radiotherapy. It is quite a disturbing statistic that only 27% of cancer patients in the UK access radiotherapy. The international recommendation is that between 50% and 53% should. Only half the people who would benefit from radiotherapy are accessing it at the moment.
Sir Oliver Heald
One thing of great concern in my constituency is that people start radiotherapy by travelling to Mount Vernon, which is an excellent hospital, but they cannot keep going, because it is such a terrible journey, so they give up.
Grahame Morris
That is a valid point that needs to be addressed. Perhaps part of the solution is the development of more satellite centres. If I have two words for the Minister, if he will forgive me, they are “treatment capacity”; or make that three words: “radiotherapy treatment capacity”. That is what we need—to increase radiotherapy treatment capacity.
Radiotherapy has immense potential for treating various types of cancer. It has been found that a greater number of cancers can be treated effectively using radiotherapy, either exclusively or in combination with other treatments. It has a critical role in four out of 10 cancer cures. As the hon. Member for North Devon said, it is highly accurate, and there is limited damage to healthy cells surrounding the cancerous tumours, particularly with the latest forms and most modern types of radiotherapy, such as stereotactic ablative radiotherapy and so on.
Radiotherapy is particularly useful for treating cancers in vulnerable areas, and requires fewer patient visits compared with other treatments. It does not occupy intensive care capacity, in the way surgery does, nor does it impact the patient’s immune system like chemotherapy. Dame Maria, I am still suffering from the impact of a depressed immune system from the chemotherapy that I had some years ago. That does not happen with radiotherapy. We are not fully utilising the life-saving potential of radiotherapy.
In 2019, Cancer Research UK published a report highlighting inadequate early cancer detection and limited access to the best treatments, resulting in the UK having some of the worst cancer survival rates among western countries. Radiotherapy has been chronically underfunded and under-resourced for a number of years. That is not a political criticism of only this Government, but of previous Governments too, and it needs to be addressed if we are to approach the outcomes and improved survival rates that we all want to see.
As the hon. Member for North Devon said, the UK currently allocates only 5% of its cancer budget to radiotherapy. That is not the whole NHS budget of more than £100 billion; that is just the cancer budget. Most other European countries allocate 10%. That disparity is very telling. It affects patient outcomes, waiting times and the overall NHS budget. Radiotherapy is the most cost-effective of the three main cancer treatments, with a typical cost per cure of £3,000 to £7,000.
However, the lack of investment has left us lagging behind other countries. Our technology is characterised as outdated. As we have heard, within the next year approximately 55 existing radiotherapy machines, which are 10 years old or more, will need replacement. That is about a fifth of the total number of linear accelerators in our NHS. Although the Government talk about record NHS investment, our radiotherapy access falls behind international comparators. As the hon. Member for North Devon said, England has 4.8 radiotherapy treatment machines per million people, while Italy has 6.9 and France has 8.5. The NHS would require another 125 linear accelerators to meet international standards.
It is true that covid-19 had a devastating impact on the NHS and on cancer services, but it is important to note that this problem—the cancer care crisis—predates the pandemic. We had a statement on 3 July from the Health Secretary about the NHS workforce plan. I was rather disappointed, because I raised the issue of the cancer workforce and the 62-day treatment target and he completely avoided giving an answer. The target is that 85% of people should start their first treatment within two months—62 days. However, the latest figures, which have just been published, show that we are hitting that for only 59% of patients. If the Secretary of State does not know that stat, I will be very disappointed. I know a little about Sunderland football club. I know that Jimmy Montgomery, our best ever goalkeeper, made 638 appearances and that we won the FA cup in 1973 and 1937. I would not expect the Health Secretary to know those things, but I would expect him to know the latest key performance indicators in relation to cancer waits, so I hope that the Minister responding today will emphasise the importance of that.
Delays in cancer treatment are not academic. It is not just a question of statistics for our constituents. For every four-week delay—for every month that a treatment is delayed—the chances of survival reduce by 10%, so this is significant. The hon. Member for North Devon mentioned Professor Pat Price. She is a leading authority on cancer, based at the Royal Marsden, and she has warned that up to 45,000 cancer patients could face deadly delays in their treatment by the end of the year. She is consistently reported in the national press, most recently in the Express, and emphasises the need for a cancer-specific plan supported by the requisite investment in improving radiotherapy treatment capacity.
It is great to invest in diagnostics, but this is a hand-in-glove situation: we need to ensure that as the investments in new diagnostic hubs are taking place, we are also making, in parallel, investments in treatment capacity. The Government have access to world-leading cancer specialists such as Professor Price, but we need a greater sense of urgency from Ministers to lift the UK from the bottom of the global cancer outcomes league table to the top. I say to this Minister: that is within our grasp; we have given you the route map for how it can be done.
The NHS has undergone two major reforms in the past 13 years and, although reforming public services is essential, the root causes of the issues sometimes come down to a lack of investment. Investment in cost-effective cancer treatments such as radiotherapy can result in quick gains. Expanding and modernising radiotherapy equipment with a modest—by NHS standards—£200 million investment could update the estimated 76 machines about to become outdated. That would benefit 50,000 patients annually. Then, allocating £45 million for the new surface guided radiotherapy—a fast and accurate British innovative technology—could reduce national waiting times for radiotherapy by almost two weeks. We had a meeting quite recently just along the corridor from this Chamber, and these machines can be installed over a single weekend in a specialist radiotherapy centre. We must utilise new technologies to address the workforce crisis and make access to radiotherapy treatment available across the entire country. Technology is available to the NHS today that was not available 25 years ago, and it is unwise that we are not currently using that technology to its utmost potential. If the NHS made better use of AI software, cancer specialists could plan for radiotherapy treatment two-and-a-half times faster than at present, ensuring that many more patients could be treated sooner. I urge the Minister to reconsider accelerating the roll-out of AI technologies in radiotherapy. There is no shortage of excellent science, technology and innovation in this country, and it is worth noting that most of the advanced radiotherapy machines currently operating all across Europe and in North America are made here in the UK—in Crawley, actually—so we are not making the best use of this British technology.
The Government should be laser-focused on retaining current staff and harnessing the opportunities of AI, up-to-date treatment machines, software and innovation to treat more patients and improve productivity. Some of these technologies could save clinicians up to two hours per patient, which is vital in a health service where we have a workforce crisis and a shortage of specialist oncologists. To bring treatment closer to home, investment is necessary in satellite centres or community cancer treatment centres to complement community diagnostic hubs.
Radiotherapy is a quick and highly effective treatment, and cost-effective radiotherapy services are at the forefront of cancer treatment across the world. It is the first duty of the Government to protect their people. The Minister can demonstrate his commitment to that duty by outlining a workable plan to meet the 62-day cancer treatment target after almost a decade of failure, and ensuring that all patients who will benefit from radiotherapy have access to this lifesaving treatment within 45 minutes of their home.
Tim Farron (Westmorland and Lonsdale) (LD)
It is a pleasure to serve under your guidance this morning, Dame Maria. I pay tribute to the hon. Member for North Devon (Selaine Saxby) for leading the debate and doing so extremely well; I agree with every word she said. I also pay tribute to the hon. Member for Easington (Grahame Morris) for not just his speech, but his ongoing work in this area. He speaks with great authority and obviously with great personal experience. I also thank Professor Pat Price, who has been mentioned by both of my colleagues and leads the cancer charity Radiotherapy UK. She is a specialist who adds enormous value to our campaigns to help those in positions of influence to make wise decisions about this vital technology.
Let me start with another positive, and say a massive thank you to that small but incredibly talented workforce of maybe only 5,000 people who deliver radiotherapy in all the centres around the country, literally saving lives every single day. We are massively, massively grateful to all of them.
I apologise that there will be some repetition, but all good campaigns involve repeating one’s messages. We know that one of the most dark and terrible facts of life is that around half of us at some point in our lives will contract cancer, which means that pretty much all of us have experienced it in our families—some with remarkable and wonderful outcomes, some with tragic and incredibly sad ones. I have experienced both within mine. We know that radiotherapy is a really important tool in tackling cancer in terms of both palliative and curative treatment. As has been said, the international standard for the number of people with cancer who should receive radiotherapy is 53%; in the United Kingdom, it is only 27%. That should ring enormous alarm bells in all parts of the House and in every corner of the national health service, but I am afraid that it does not feel like that is happening. There are many reasons behind that, but one that we have already heard is that we spend only 5% of our cancer budget on radiotherapy, and the average of countries similar to ours in the western world is nearer to 10%.
Again, we have already heard—but I will restate—that in the United Kingdom we have 4.9 linear accelerators per 1 million of population. In France, there are 8.5 linear accelerators per million people. For the UK to become just average, we would need 125 additional linear accelerator machines this year, as has already been said. Put bluntly, the fact that this is quite a balkanised commissioning process is one reason why we are where we are. The lack of central commissioning means that different centres will, or will not, have sinking funds, so there is absolutely a postcode lottery. It also means that, as our survey—through the all-party parliamentary group for radiotherapy, which I am privileged to chair—discovered, 75 machines that are basically past their sell-by dates will be in use in our hospitals next year, many without a plan to replace them.
We are behind not just on the volume of technology but, as has been suggested, on the deployment of new technology, much of which was developed in this country. That makes it all the more inexcusable. For example, AI software could allow clinicians to accurately plan patient care in a few minutes rather than a few hours. Imagine the impact that would have on our workforce.
We absolutely need to invest in our workforce. We need to support them, to ensure that we boost the morale of people who are already in the service to keep them working in the service, and to bring in the perhaps 1,500 additional net posts needed to ensure that we have a properly functioning radiotherapy workforce. Alongside that, the fact that we could allow clinicians to do their planning even more accurately, in a fraction of the time, obviously makes sense because we would get even better use out of the workforce than we currently do, in terms of the hours that they put in.
We could also invest, as has already been mentioned, in surface-guided radiation therapy to reduce waiting times. Again, that was developed in the UK, but has not been deployed much here. When we have 40% of people in north Cumbria and about 30% of people in south Cumbria waiting more than two months for their first treatment—we have already heard that every four weeks of delay means that someone is 10% less likely to survive—then, surely, investing in that capacity in radiotherapy, as well as in new technology, is just a no brainer.
All of that costs peanuts—that is a Treasury term, I think—in comparison with equally worthy but vastly more expensive drug treatments. We are talking just £200 million for those 125 new linear accelerators. I am not knocking those treatments, by the way; chemotherapy and immunotherapy are vital weapons in our fight against cancer. Herceptin has saved so many lives, for example, but I have picked that drug for a reason, because the cost of Herceptin, in one year, is equivalent to two thirds of the entire radiotherapy budget.
That is understandable, because drugs do cost more than kit, but it is a reminder of how relatively straightforward this problem is to solve. For a Government that wanted to shift the dial quickly and do something of long-term value, but that would have an impact in a short period of time and would cost, relatively speaking, very little, it should be an obvious no-brainer, and it frustrates me that we are where we are.
Let us be cross-party in our self-criticism, because I can blame this Government for their inaction, and I can blame the coalition Government, and I can blame the previous Labour Government. It is 30 years of us being behind the curve here. Let all accept that we are all responsible and we will all do something about it, starting right now.
Why are we in this situation? I suspect that it is because decisions are often made when the right people are in the room. I am not knocking the pharmaceutical companies, but they have the resource to be in the room. However, when we have our radiotherapy APPG meetings, and we have clinicians from right across the country—the best people in their profession—huddled into little rooms off Westminster Hall, I realise that that is the radiotherapy industry. That is the radiotherapy “lobby”. That is it. We do not have paid specialists; the lobby is in that room. That is perhaps why radiotherapy has slipped off the radar. This is the moment in which it must go right back on to it.
The situation is even worse in rural communities. Some 3.5 million of us live in what we would refer to as radiotherapy deserts, where we are more than a 45-minute journey away from the nearest radiotherapy treatment centre. The national radiotherapy advisory group says that any trust that allows that to happen is guilty of bad practice. In my constituency, pretty much everybody lives outside that 45-minute guideline distance, and when we are looking at the travel times, they are always those from the best-case scenario—travelling at 2 o’clock in the morning, or not in the middle of the tourist season. Twenty million people visit the lakes every year; the roads get a bit clogged up from time to time. If someone is from Dent, the round trip to Preston to get their treatment will take them about two and a half hours. From Kirkby Stephen, it is two hours to Carlisle, two and a half hours to Preston. From Grasmere and Coniston, the round trips are nearer three hours.
Over my time as an MP it has been a privilege to often take my constituents to their treatment in the Rosemere cancer treatment centre in Preston. By the way, it is absolutely excellent, but just blinking miles away; it is far too far away. I remember taking a young mum—a teaching assistant—and her two young children, for her breast cancer treatment. I remember the impact it had on her, how wearying it was; and she was an otherwise fit and healthy young person. I remember taking an older woman from Kendal, some years later, also for daily treatment, and the impact that had on her and her family. It is not just that travelling those long distances is inconvenient; it is actually dangerous. Sometimes, as has already been said by the right hon. and learned Member for North East Hertfordshire (Sir Oliver Heald), it means that people will choose not to complete their treatment. It is also true—clinicians will sometimes baulk at this, but I am not criticising them—that people will not be recommended or referred for radiotherapy because it is recognised that that person will not cope with the travelling.
Not long ago there was a bus driver in my neck of the woods who gave up work for two months and moved to Preston for his treatment, because he could afford to do so. The economic impact on people, in terms of worsening their poverty because of the distances that people have to travel, is huge. The simple fact is that because of the distance they have to travel to treatment, people do not live as long in rural areas. That is outrageous.
In 2008 we launched a campaign to bring a cancer treatment centre to Westmorland General Hospital in Kendal. We have largely succeeded. We brought chemotherapy there in 2011, there is more and more surgery, and diagnostics is arriving in the coming months. The one thing we wanted that we have not got is that radiotherapy satellite unit. I want to be clear that the Rosemere unit in Preston is fantastic. We do not want to replicate it; we want to be associated with it. That is, we want a satellite unit that is attached to the Rosemere one and operating at the hospital in Kendal—just as Rosemere itself was once a satellite to the Christie. Today, there are centres that are satellites of the Christie at Oldham, Macclesfield and Bolton, all of them doing a fantastic job and allowing people who live in those communities closer access to that important treatment.
The simple reality is that over these last few years the proposal that has been made for a radiotherapy satellite unit at the Westmorland General Hospital in Kendal has been written and proposed, and the trust has been behind it. It was eventually signed off in 2014 and then cancelled in 2016. I often point the finger at Ministers and the NHS for that failure to deliver, but I also encourage the trusts and commissioners locally not to let it drop off their agenda. It has vital importance. I often hear commissioners, local trusts in Morecambe Bay and the Lancashire hospitals teaching trusts say the right things, but it feels not sufficiently urgent—tell you what, it is urgent to my constituents. It is urgent every time that somebody gets that awful diagnosis and then realises that they have weeks and weeks of travelling and might not make it. They might not complete the journeys; that might mean that they do not survive.
Yet if we look at the demographics, our need in Cumbria is increasing. It is recognised that at the moment there is demand for 1.3 linear accelerators, just in the area that is closer to Kendal than to Preston. Sadly, cancer is a disease of ageing, at least in part; as our population ages, we know that that demand will get greater.
Here is a crucial point that I really want the Minister to take on board. The evidence is that when a satellite unit is opened, there is a greater level of demand than was predicted. Why is that? There are reasons why only 27% of people are having radiotherapy treatment when it should be 53%, and access is one of them. The APPG for radiotherapy had a forum for the satellite units a little while ago. What we gained from that was the staggering news that when a new satellite centre opens, rather than just getting the demand from the parent centre that was predicted, there is at least 20% more demand than was expected, in every single one. In some cases, the increase in demand is 50%. That is because those patients were not being referred or were choosing not to complete. If you build them, Minister, they will come, and lives will be saved. That all means that people in Kendal, Grange, Windermere, Kirkby Stephen, Appleby, Sedbergh, Ambleside, Coniston, Grasmere and the rest of our communities in rural Cumbria are facing not just longer journeys, but shorter lives. That is not acceptable.
The United Kingdom needs a radiotherapy boost across the board. It would be relatively inexpensive, and if the Government committed right now, we would see dividends and lives being saved within a matter of months. Rural communities, from Westmorland to the west country and from Northumberland to Norfolk, need it even more. For the 3 million people who live in a radiotherapy desert, as I do, investing in satellite units will make an immense difference.
We are desperate for action in Westmorland. We are desperate to see our satellite radiotherapy unit delivered at the Westmorland General Hospital in Kendal. I ask the Minister to act personally now and look at our bid for a satellite unit. If he acts and instructs commissioners to get on with the business of commissioning, I promise that our community will raise at least £2 million to help him to make that case in a partnership bid. If he commits to helping people in Westmorland to have better treatment, shorter journeys and longer lives, I will be permanently, eternally grateful.
Andrew Gwynne (Denton and Reddish) (Lab)
As ever, it is a pleasure to serve under your chairmanship, Dame Maria. I thank the hon. Member for North Devon (Selaine Saxby) for securing this important debate and for all her work on this issue, which is not a party political one. As we have found today, there is great consensus across the House on this cause, because it is the right thing to do to use our voices as Members of Parliament to champion it. I commend her and other hon. Members present for their work.
We have had a good debate. There has been a lot of repetition, because these issues need reinforcing, and I fear that I will be reinforcing some of the arguments that we have already heard. I commend my hon. Friend the Member for Easington (Grahame Morris) for all his work over a long time. He is always championing the cause of radiotherapy and bending the ear of shadow Ministers, and no doubt of Ministers, about its importance. I also commend the hon. Member for Westmorland and Lonsdale (Tim Farron) for his work as chair of the APPG for radiotherapy. He brings great knowledge to these debates.
This issue is close to my heart, too. As the hon. Member for Westmorland and Lonsdale said, all families are touched by cancer. Some have good experiences, where loved ones survive; others have less good experiences. I lost both my parents to cancer: my mum died from ovarian cancer when I was 19, and my dad died last year. In fact, last week was the first anniversary of his death. He lived to the age of 77. He had a very rare and aggressive form of rectal cancer; sadly, it could not be treated, because by the time even the earliest symptoms had been discovered, the cancer had already spread in various places throughout his body.
I will be forever grateful for the loving care that my dad received, principally from The Christie in Manchester, but also from the satellite at Oldham. He received palliative care, chemotherapy, immunotherapy and, indeed, radiotherapy. It gave him at least a year longer than he should have survived. My dad was a sporting man and a bit of a gambler, so he was willing to take those odds. Anyway, it gave him an extra year with his great-grandson, as well as with the rest of his family. That is precisely why radiotherapy is key. It was a game changer. The chemotherapy and the immunotherapy did not work; it was the radiotherapy that probably prolonged his life for those extra months.
As we know, radiotherapy is a key treatment for many people affected by cancer. It can be used to try to cure cancer completely, it can make other treatments more effective; it can reduce the risk of cancer coming back post surgery, and it can relieve symptoms in palliative care. Unfortunately, as we have heard today, radiotherapy services are under significant pressure, which is all too evident in the treatment statistics that have been cited. For example, the proportion of people in England having their first cancer treatment within two months of an urgent GP referral has fallen to 58.7%, which is down from 61% in April. As we heard from my hon. Friend the Member for Easington, the target is 85%, but that target has not been met on an annual basis since 2013-14. That really needs the Government’s urgent attention. We cannot just blame the pandemic for these statistics, because way before the pandemic the targets were not being met, although I am sure it exacerbated the issue and made the challenge even harder.
My first question to the Minister is what action he is taking to reverse this concerning decline in treatment within two months. We all know that the key to treating cancer is catching it early, but it seems that a significant number of patients are waiting far too long even to begin care, which potentially harms their chances of receiving successful treatment.
There are also serious concerns about technology and infrastructure within radiology services, as we have heard from hon. Members today. In a response to the Government’s long-overdue NHS workforce plan, the Royal College of Radiologists stated that
“we all know how frustrating it is to try and do our jobs with systems and infrastructure that simply aren’t fit for purpose.”
The RCR also cited an interview in which
“Tom Roques, Vice President for Clinical Oncology, talked…about needing to use seven passwords for seven separate systems in order to provide information to one patient”.
When the Opposition talk about embracing new technology and giving NHS staff the tools they need to do their job, that is precisely what we mean. We must embrace new technology. For example, there are tools that can map radiation therapy to cancer cells, avoiding organs more precisely and more quickly than a human can. That is standard technology in the United States of America, but is used by just one in three radiotherapy planning centres in England. Alongside the workforce plan, what is the Minister planning to do to address this problem? Staff already face an uphill battle. The last thing they need is inadequate equipment or overly complex systems.
Regarding the workforce plan, Cancer Research UK has highlighted what it calls
“a lack of detail on cancer-specific professions”.
What assessment has the Minister made of that? Can he set out what engagement his Department is having with organisations such as Cancer Research UK on ensuring that services such as oncology are adequately staffed into the future?
The final point on which I wish to press the Minister relates to the inequality in access that all hon. Members have spoken about. Approximately 30,000 extra cases of cancer in the UK each year are attributable to socioeconomic deprivation. Studies have consistently shown that there is unwarranted variation in radiotherapy access rates. We have heard about poor access in rural parts of England, which is an issue that specific hubs linked to the main centres of excellence would start to tackle. I certainly welcome the calls from the hon. Members for North Devon and for Westmorland and Lonsdale. It is crazy that their constituents are missing out on key treatments because access requires them to travel too far, and some who do access such treatments give up their treatment early. We should be doing everything we can to encourage people to access those treatments and keep on them until they are completed.
There are issues with monitoring the inequalities. Cancer Research UK has called for improvements to be made to radiotherapy data collection so that policymakers can understand the scale of the problem and set about addressing it. Does the Minister agree? What action is he taking to ensure that we eliminate the inequalities in radiotherapy access that we have heard about today, and certainly to try to get England to the average level of kit needed, if not to exceed the average? I do not just want England to be average at these things; I want us to be an exemplar.
The next Labour Government will work tirelessly to improve access to radiotherapy, alongside providing the NHS with the staff it needs. We will reform our health system and embrace new technology that has the potential to transform the way we deliver care. We will build an NHS that is fit for the future, and we aim to achieve all relevant cancer waiting time standards within our first term. That is a pledge that we have made: we have done it before, and there is no reason we cannot do it again, with the political will.
Until then, however, we need to see this Government engaging with clinicians and experts, and doing everything in their power to ensure that the treatment is there for patients when they need it most. As I said, this is not a party political point. We are a responsible Opposition. We encourage the Government to do more. We want them to meet those targets and to expand services—particularly in rural areas, so that access is equal across the country. We encourage Ministers to do that, and to do it at pace. If they do, we will support them.
The Minister for Health and Secondary Care (Will Quince)
It is a pleasure to serve under your chairmanship, Dame Maria. I thank my hon. Friend the Member for North Devon (Selaine Saxby) for securing this important debate on the accessibility of radiotherapy. I agree wholly with the hon. Member for Denton and Reddish (Andrew Gwynne) that there are issues in this place that are not by nature party political. The debate has demonstrated that there is huge consensus on all sides of the House on the need for change, and I thank all right hon. and hon. Members for their contributions today.
Let me turn back to my hon. Friend the Member for North Devon for one moment. Whether it is in the meetings—dare I say it, the many meetings—that I have had with my hon. Friend, or through her public contributions in the House and outside, she has been consistent and powerful in her advocacy on health issues. Her constituents, and patients around the country, are very lucky to have her in their corner.
It is rare for the Front Benchers in a Westminster Hall debate to be allowed so much time to respond. I do not intend to take the entire time available, but I would like to try to answer as many of the questions, points and themes raised as possible. Although Members will know that I am not a new Minister, I am relatively new to this brief, having taken on the cancer portfolio in the last few days. I very much look forward to working with parliamentary colleagues from across the House, including those present today and others who I know have specific interests in cancer, to bring about the changes that we all want to see. I echo the words of the hon. Member for Easington (Grahame Morris) and thank him for sharing his personal experience; I certainly agree with him that we all want to see cancer outcomes improve across the country.
My hon. Friend the Member for North Devon raised the matter of performance levels, which I will touch on briefly before turning to specific points raised in the debate. I echo the hon. Member for Westmorland and Lonsdale (Tim Farron) in paying tribute to the brilliant work of NHS staff in this field. Thanks to them, levels of first treatment following an urgent cancer referral have been consistently above pre-pandemic levels, with activity in May standing at 111% of pre-pandemic levels on a per working day basis. Over 52,000 people had their first or subsequent treatment for cancer in May. In total, over 332,000 people received their first cancer treatment in the 12 months up to May, which is up by more than 18,000 on the same period before the pandemic.
As hon. Members have eloquently pointed out, waiting time performance for radiotherapy is influenced by a range of factors, including workforce and equipment—two subjects that I will come on to address in greater detail. My hon. Friend the Member for North Devon referred to the impact of covid and the recovery of cancer services following the pandemic. In February last year, the Government published the delivery plan for tackling the covid-19 backlog of elective care. We will spend more than £8 billion between now and 2024-25 to drive up elective activity, including cancer diagnosis and treatment. My hon. Friend referred to the community diagnostic centres, which make a huge difference, and the building of surgical hubs.
Grahame Morris
I am grateful to the Minister for taking the time to answer the points that have been made. Over the years, we have seen every single cancer Minister and probably every Secretary of State, but it seems that just when the penny is about to drop for the responsible Minister, they get shuffled off and nothing actually happens. I hope the Minister will stay in post long enough to deliver the improvements that we want to see.
The community diagnostic hubs are, of course, a wonderful thing, and we have been calling for them, but they must go hand in glove with increased treatment capacity. Otherwise, all that will happen is that the waiting lists will get longer as we diagnose more patients who require early treatment, but without having the treatment capacity to make the inroads that we all want.
Will Quince
I will come on to the hon. Gentleman’s specific point, but he is absolutely right. On remaining in post and Government reshuffles, the Prime Minister giveth and the Prime Minister taketh away, but I thank the hon. Gentleman for his best wishes ahead of any future reshuffle. Having been in the Departments of Health and Social Care, for Education and for Work and Pensions, I know that any Minister understandably ends up taking a considerable interest in their work. I assure the hon. Gentleman that whether or not I maintain my position in the Government, I will maintain my interest in all the areas I have worked on as a Minister. I certainly commit to continuing that work from the Back Benches when one day the Prime Minister chooses to dispense with my services.
Selaine Saxby
I thank the Minister for all his time and commitment and for meeting me so regularly. When he takes things away and reflects on them, will he bear in mind that although community diagnostic hubs are fantastic, it is still a 120 mile round trip from my constituency to get to one, so there are issues in respect of rurality. In Ilfracombe in my constituency, the healthy life expectancy is 59. Remote coastal communities need to be able to access services, and we are underdiagnosing because it is so hard to access even a diagnosis, let alone the treatment.
Will Quince
I will come on to this point in greater depth, but many of the conversations that my hon. Friend and I have had on health issues, and previously on education issues as well, were about rurality and the challenges of rural and coastal communities. Her points are well made—I certainly understand them—and she makes a compelling case. I will address them in greater detail later in my speech.
Not only are we building the community diagnostic centres and surgical hubs—and notwithstanding my hon. Friend’s point about the distance that some have to travel to get to them—but we are creating them deliberately closer to communities; they are not just based in district and general hospitals. In each of the next two years they will be supported by an additional £3.3 billion of funding, which was announced in the autumn statement, and that will enable rapid action to improve emergency, elective and primary care performance towards the pre-pandemic levels.
On cancer specifically, NHS England recently set out the progress made on reducing the number of patients with urgent suspected cancer who wait for longer than 62 days, and announced that the faster diagnosis standard was met for the first time in February this year. It also confirmed the ongoing priorities to improve performance and long waits, prioritise diagnostic capacity for cancer and, of course, focus on the cancer pathway redesign.
The Government and NHS England have pushed to improve the early diagnosis of cancer, which is so important to give patients the best chance of receiving successful treatment and in turn see more people living longer following a cancer diagnosis. However, as my hon. Friend the Member for North Devon eloquently and articulately pointed out—the hon. Member for Easington also made this point—we know that early diagnosis needs to be backed up by high-quality treatment options such as radiotherapy, with its remarkable ability to shrink tumours, as has been set out, and often with minimal side effects.
The hon. Members for Easington and for Denton and Reddish referred to the 62-day cancer target and the changes required to improve cancer outcomes. I hear the strong and compelling arguments that have been made, and I am happy, as I set out at the beginning of my speech, to meet hon. Members to discuss the steps that we are already taking and the further steps that can be taken, alongside NHS England, to improve cancer outcomes.
The hon. Member for Denton and Reddish asked specifically about steps to meet the 62-day target. To target support towards the most challenged trusts in the country, NHS England has developed an intervention model that is designed both to maximise and expand capacity. Challenged trusts have been placed into tiers 1 and 2, and all tiered trusts have weekly or fortnightly oversight calls, and they also have visits with the regional and national teams from NHS England. They receive support on things like the development of a co-ordinated support plan, which is monitored by fortnightly progress meetings. The plans have focused on areas such as pathway improvements, workforce support and targeted capacity increases. That supports the trusts that do not have the resource or bandwidth internally to turn around services.
When my hon. Friend the Member for North Devon made the case for a satellite centre in her constituency, she raised specific challenges in relation to North Devon that are translatable to other parts of the country that have rural and coastal characteristics. I will outline the basis on which provision is reviewed, but before I do let me acknowledge the local efforts that she mentioned. She is rightly proud of her constituents’ initiative in terms of support with travel and other things.
The network oversight group, in conjunction with the relevant specialised commissioning team and cancer alliances, is required to review service provision on a regular basis to ensure that optimal access arrangements are in place. That applies to proposals that relate to the expansion or re-provision of existing services, or to the development of any satellite facilities. The development of any new service location requires the development of a business case, as my hon. Friend pointed out, and business cases must demonstrate, among other criteria, the consideration of the effect on the provision of existing cancer pathways, both within and outside the network geography.
As I have mentioned, that responsibility sits not with the Government but with the integrated care boards, cancer alliances and local specialised commissioning teams. I am happy to meet my hon. Friend, alongside the ICB, to understand the challenges and what can be done in this space. I understand from NHS England that around 450 patients a year travel from my hon. Friend’s constituency to Exeter for treatment, but I am cognisant of the point made by the hon. Member for Westmorland and Lonsdale that many more patients might want to access those services but do not because of the travelling and distances involved. That is why a meeting between me, my hon. Friend and the ICB might be a good starting point.
Grahame Morris
The Minister is being generous in giving way. The debate is instructive, and I am glad he has mentioned integrated care boards. As the hon. Member for Westmorland and Lonsdale (Tim Farron) mentioned—sorry, the right hon. Gentleman.
Grahame Morris
Well, I am sure it is only a matter of time.
One of the issues has been commissioning. NHS England is responsible for commissioning without having a sensible plan to replace old machines, and there are bizarre disincentives to using the most modern machines, which require fewer visits. Furthermore, the fractionations are smaller, and the radiotherapy could be delivered in a shorter time. Bizarre commissioning arrangements and tariffs apply. Is the advent of the ICBs, with the responsibilities they hold, an important element in deciding where the new treatment centres are going to be? Will the Minister outline their role in the context of access to radiotherapy services?
Will Quince
I thank the hon. Gentleman for his question and will jump to the part of my speech that covers equipment, because the issue has been raised by all hon. Members during the debate.
We are absolutely focused on improving cancer treatment and supporting advances in radiotherapy using cutting-edge imagery and technology. As my hon. Friend the Member for North Devon pointed out, since 2016 we have invested £162 million in the most cutting-edge radiotherapy equipment, which is designed to replace or upgrade more than 100 radiotherapy treatment machines so that we can deliver the best possible outcomes for patients. As the hon. Member for Westmorland and Lonsdale said, NHS England is carrying out a stocktake of linear accelerator age, which will be completed in the summer. It is also working with partners to undertake a demand and capacity review, which will complete by the end of the year.
On AI specifically, we want to ensure that we have the best possible cutting-edge, innovative equipment and technologies in the NHS, so we have announced an additional £21 million of funding that will speed up the roll out of AI across the NHS. That will enable us to help to improve diagnosis and to reduce waiting times—one of our top priorities—and clinicians will be freed up to spend more time delivering frontline patient care. The point made by the hon. Member for Easington about AI and the benefits thereof is well made.
The hon. Member for Westmorland and Lonsdale has been campaigning on the issue for around a decade, or perhaps longer, and he has met several Ministers. I am yet to meet with the hon. Gentleman, and I know he was due to meet my hon. Friend the Minister for Social Care, but I am happy to honour that meeting. He recently met his local hospital trust to discuss radiotherapy being part of the new hospital programme. Ultimately, that is a matter for commissioners, but we can certainly have that conversation when we meet and try to find a way forward.
A number of hon. Members raised the issue of the workforce. The hon. Member for Strangford (Jim Shannon) is no longer in his place, but he laboured this point, and rightly so. We have made good progress in growing the cancer workforce. The annual growth rate of the workforce remains steady at between 3% and 4%, but we need to go further. As of February, there were 33,174 full-time equivalent staff in the cancer workforce. In trusts, that is an increase of more than 11,300 since February 2010. Specifically, the number of therapeutic radiography staff grew by 17.4% between 2016 and 2021. As has been referenced, we published our long-term workforce plan, which sets out actions that are backed by £2.4 billion of Government funding up to 2028-29, a couple of weeks ago.
On travel, the travel that a patient needs to undertake is dependent on the type of treatment they need. Decisions about treatment locations are made on a case-by-case basis. As hon. Members have pointed out, specialised services are not available in every local hospital, in part because they have to be delivered by specialist teams of health professionals with the necessary skills and experience and access to the necessary equipment and medicines. Patient-specific requirements are based on what each individual can cope with and are discussed between the patient and clinician.
The Government are, of course, striving wherever possible to reduce any necessity to travel unreasonable distances, which is why our priority continues to be to bolster the specialist workforce and ensure ever-expanding coverage of equipment. That includes by investing in new radiotherapy machines, but the responsibility for investing in that equipment sits with local systems—the ICBs, which I suspect we will discuss in greater detail when we meet. I hear the case that has been made about equality and rurality. We can address some of those issues and work with integrated care boards so that they see the benefits to patients and to outcomes, as well as the cost savings, if we get it right.
We are supporting providers to accelerate the delivery of stereotactic ablative body radiotherapy for targeted cancers, thereby lowering the risk of damage to normal cells. Specialised commissioners have allocated £12 million to support providers to deliver SABR.
Tim Farron
The Minister has given a comprehensive response to us all. On the issue of SABR, would he look in particular at the point made by the hon. Member for Easington (Grahame Morris) about commissioning arrangements and the perverse incentives that lead to some cancer treatment centres effectively being paid more for using lesser treatment than they would be for more efficient, less invasive, less frequent but more powerful SABR technology and other similar advanced forms of treatment? It would save an awful lot of money and still do a better job.
Will Quince
In short, the answer is yes. There are perverse incentives that exist across Government, and the NHS is no exception. Wherever we identify them, we have to work to drive them out of the system. We have a tendency, unfortunately, to focus on processes and procedures. I want all trusts—I would like us to do this across Government—to focus more on outcomes than on processes. Perhaps when we meet the hon. Gentleman could set out that exact challenge in more detail, because I would be glad to look at it in detail.
Dame Maria, I am conscious that I have gone on for longer than I should have; you have been very generous. I again thank my hon. Friend the Member for North Devon for bringing this matter to the attention of the House, and I thank all hon. Members for their contributions on this hugely important subject. I hope I can assure my hon. Friend and Members from all parties that with the investments we have made and the innovations the NHS has adopted, and the innovations to come, we will continue to improve access to radiotherapy throughout the country. I look forward to meeting the hon. Members present, alongside NHS England, to see what is within the art of the possible in this space. I look forward to working with parliamentary colleagues throughout the House to bring about the improved cancer outcomes that we all want to see.
Selaine Saxby
It has been a pleasure to participate in a debate with you in the Chair, Dame Maria. I thank the Minister for such a comprehensive response, and I thank all right hon. and hon. Members for participating in the debate. I very much hope that the next time we come together we will be celebrating some successes and improved access for our rural constituents to radiotherapy and other cancer treatments. I thank the Minister once again for his time.
Question put and agreed to.
Resolved,
That this House has considered the accessibility of radiotherapy.