Grand Committee
Cancer Outcomes in the UK
(1 day, 7 hours ago)
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Lord Patel
That the Grand Committee takes note of cancer outcomes in the UK and of plans to improve them including diagnostic care and research.
Lord Patel (CB)
My Lords, sitting on the same side as the Minister does not mean that I am on her side. I thank all noble Lords taking part in the debate and look forward to their contributions. There is a formidable array of talent, so the Minister should get a good response. I thank her for making time to respond to the debate, although, at the end, she might wish that she had not done so.
No one can be in any doubt that poor outcomes for patients with cancer in the UK need urgent attention. Today is World Acute Myeloid Leukaemia Day, which observes a blood cancer with low survival rates, primarily because of late diagnosis. One in two people in the UK—
Baroness Bottomley of Nettlestone (Con)
Is it possible for the noble Lord to speak a bit louder? We old, deaf people back here find it quite hard to hear him.
Lord Patel (CB)
Can everyone hear me now? Can the noble Baroness, Lady Bottomley, hear?
Lord Patel (CB)
Thank you. One in two people in the United Kingdom will develop cancer. Being born with cancer is rare, but a new cancer diagnosis is made every 75 seconds. The UK consistently ranks near the bottom of the table for survivals and deaths from cancers. That is despite several cancer plans and strategies for change, which are often heralded as world class. In 2011, we had Improving Outcomes: A Strategy for Cancer; in 2015, we had Achieving World Class Cancer Outcomes; and in 2019, we had a plan to make cancer a priority. None of those plans delivered the promises made. The result is that cancer outcomes have not improved much in England for nearly two decades.
Cancer care is a touchstone of the wider NHS, which itself is also delivering poor performances. It is in that environment that we will discuss the plan. We now have the Government’s National Cancer Plan for England: Delivering World Class Cancer Care. What is different about this plan? The Government say that
“it heralds a full modernisation of our approach to cancer care … fit for the future”.
The report is ambitious but lacks detail on implementation plans, which I hope the Minister will tell us about today.
What are the key commitments? The first is to improve five-year survival rates, so that, by 2035, three in four people with cancer will live more than five years, either cured or living well. The second is to restore performance in meeting cancer waiting-time standards by 2029. The third is to expand screening programmes, including lung cancer screening, by 2030. The fourth is to increase genomic and genetic testing, so that genetic tests are to be reported within 10 days for 96% of patients. The fifth is to accelerate the use of AI, robotics and modern imaging for early diagnosis. The sixth is to reduce variation in accessing new treatments and technologies and to address inequalities. The seventh is to strengthen cancer alliances among system leaders and to boost research and clinical trials.
I have mentioned but a few. All of that and more is being promised when cancer services are under immense pressure. Demand continues to rise, with a complex case mix. Most importantly, staff shortages persist, particularly in radiology, oncology, cellular pathology and cancer specialist nurses.
The shortfall in workforce in critical areas of cancer care is significant. In radiology, it will be 39% by 2029; in oncology, it will be 19%. For nursing and specialist nurses in cancer care, there is a 10% shortage in most trusts. There is a shortage of 4,000 specialist cancer nurses and 6,000 nurses in community diagnostic centres. In histopathology, only 3% of departments say that they have adequate staffing. The Royal College of Radiologists and the Royal College of Pathologists say that, with the shortage, the workforce will not be able to deliver on the needs in the cancer plan. To do so, the workforce may need to grow by as much as 45% by 2035. In radiology alone, that may cost £1.5 billion a year. I ask the Minister when the Government will publish a fully funded workforce plan for cancer care. We look forward to that soon.
I will now pick up on some of the key commitments, as I do not have time to go through them all. On the commitment for three in four patients to survive five years by 2035, the current average survival for five years is 55% to 60%. Of course, it varies with cancer types: it is good for prostate and skin melanoma, but survival rates are much lower than in many other countries for equivalent cancers across the board. On restoring performance for standards of, for instance, early diagnosis at stages 1 and 2 in 80% of cases by 2029, that is improving: it has now improved to 72.8%. Sixty days from the first referral to treatment is a standard that has not been met since 2015. For treatment in 31 days from diagnosis, the target is 96%; currently, it is not doing badly at 93%.
On expanding screening programmes and eliminating cervical cancer by 2040, the increase in HPV vaccination and self-diagnosis HPV kits is the way that the Government hope to meet that target. The current uptake of the HPV vaccine is 75.5% in girls and 70.5% in boys, with huge regional variation: for instance, in London, it is only about 64%. What plans do the Government have to improve uptake of vaccination and how will the elimination target be met? As far as the HPV kits are concerned, what happens if a woman self-tests and finds that she is HPV positive? The services need to match up to what the patient might need.
Another target is increased genetic and genomic tests. The plan suggests that there might be value in testing whole-genome sequences, the so-called polygenic risk scores aligned with the lifestyle, but they are of no value because the risk is not yet identified or valued. It is different if you are testing for inherited genetic diseases, such as if a patient has a BRCA gene, as then you might follow up with others in families. But the value of whole-genome sequences as polygenic risk scores cannot be right.
Genome testing for mutations in cancer, of course, is important for personalised treatment, and the target is for 98% in 10 days. Currently, it meets this for 68% of patients, because of the workforce issues. What might be the implications if the treatment is delayed because these tests are not reported in time? For instance, a four-week delay in treatment increases risk of death by 6% to 8%, so it is important that these tests are reported quickly. These days, without genomic mutation testing, treatment cannot be started with cancers.
Another target is to accelerate use of AI, robotics and modern imaging for early detection. It is true that in the trials carried out using the triad—it is important to use the triad of AI, robotics and modern imaging—it is quicker to obtain a tissue sample, for instance, but these have to be done together and there are costs of equipment, training and robotics.
The Government hope in the report to increase the use of robotics from 70,000 currently to half a million by 2035. Small studies show benefits, because it fuses metabolic and structural data for better staging and treatment of cancers, but the digital pathology staff remain a key workforce required for this. Can this be standardised across the whole NHS rather than in specialist units alone?
The next issue is funding. Together with staffing, funding is a critical issue. The Government have made a commitment of about £6.5 billion, rising to £15 billion depending on progress. However, estimates from the Health Foundation suggest that, to roll out AI, robotics, modern imaging and digitisation across the NHS, we will need £14.5 billion to digitise the NHS, capital infrastructure worth £5 billion, one-off implementation costs of £2.5 billion and recurring costs of £1.5 billion. Does the Minister think that this is realistic and that the Government will be prepared to fund it?
The main other issue is reducing inequalities in cancer care. We must reduce inequalities in cancer outcomes for deprived populations. The biggest challenge is in the 20% of deprived people, because there is a 60% higher death rate in this population. Late diagnosis is more common in this population, there are low treatment rates, people are more likely to have cancer diagnosed in an emergency in the A&E department and there are low screening rates. Focusing on reducing inequalities in cancer care will be key to meeting the targets set in the plan.
Who is going to do this? The suggestion is that the cancer alliances will be responsible for planning and tracking the delivery of cancer services in deprived areas with an extra £200 million in funding. Is that likely to be adequate funding, knowing that it will require new staff to man these services? I ask the Minister, therefore, what the metrics for the improvement in care of the deprived population will look like.
The developments in technology, drugs and diagnostics in healthcare and cancer care come thick and fast. Many are mentioned in the report. Some of them are not even yet validated. Treatments are very expensive. For instance, CAR T-cell immunotherapy would cost in the region of £280,000 per treatment per patient. The technology is expensive. The current percentage of people getting chemotherapy, radiotherapy, cell and gene therapy and immunotherapy in England is lower than in countries with better cancer outcomes. Implementing what works and improves outcomes for the whole of the population—early diagnosis and prompt treatment, with the workforce to deliver that—will result in better outcomes. I repeat that, knowing what we know, early diagnosis and prompt treatment will improve outcomes well before we use these technologies. They are important, but we need to do that first. Patchy introduction of state-of-the-art technology, early-phase research into the practice of untested diagnostics, science fiction and a promise of personalised nirvana tomorrow will not be the answer.
The plan is thin on the prevention of cancers apart from on tobacco control, which I applaud—and we all applaud. Treatment using GLP-1 and GLP-2 blockers for obese people is not stopping obesity; it is treating obesity, at a cost. In the plan, there is nothing about what the Government will do to reduce obesity, or on the reduction of alcohol consumption, but we know that 40% of cancers are related to lifestyle issues. Can the Minister explain why the report is so thin on prevention?
I will make a comparison to one country. Much of the cancer plan comes from learning from the Danish model. Denmark, some 25 years ago, had similarly poor outcomes for cancers. It embarked on an incremental cancer plan to the point that it is now recognised as the country with the best cancer outcomes. Its latest plan is to focus on helping people living with cancer and those in end-of-life and hospice care. I am sure that the noble Baroness, Lady Finlay, wants to know when England will get such a plan. To invest in this, Denmark is to spend 690 million Danish kroner. It does not sound like big money, although its population is small.
The key feature of the Danish plan and the better results is political consensus. The noble Earl, Lord Howe, might remember that, in a debate that we had about the long-term sustainability of the NHS, I said that the NHS’s survival depends on a political consensus. The then opposition Health Minister, the noble Lord, Lord Hunt of Kings Heath, laughed and said, “Dream on”. I guess that that is still the problem. If we do not have political consensus, we will just have more problems.
Funding was the other issue. All the five-yearly plans in Denmark were funded. Importantly, there was a promise to the people that the service would deliver early diagnosis within 14 days or less and that treatment would start within 14 days or less. The promise was that, if you did not get that, you could go to any other region in Denmark for your treatment or even another country. Would the Government make such a promise to the population of England?
The Government’s plans are ambitious, but will the Government maintain a consistent commitment to delivery no matter what it takes? Otherwise, in three to four years’ time, we will debate a new cancer plan that will be even better and world-class. However, I wish the plan well and I hope that we begin to get results quickly.
Baroness Warwick of Undercliffe (Lab)
My Lords, I thank the noble Lord, Lord Patel, for securing the debate and pay tribute to his indefatigable commitment to improving health outcomes and championing research and to his powerful and moving speech. I am pleased to have the opportunity to contribute to the debate. I know that I will not be the only speaker whose family has been touched by cancer. Seeing much-loved family members or friends suffer is the reason we can all agree that patients deserve timely diagnosis and the best possible treatment. In the past, I have spoken about pancreatic cancer and brain cancer from my own family perspective. I will focus my remarks on these and other cancers, including cancers of the liver, lungs, oesophagus and stomach, which are grouped, rather grimly, as the least-survivable cancers.
I warmly welcome the recently published national cancer plan, which has brought these rarer cancers into focus. For the first time, we have a national plan that makes specific commitments to less common cancers and I commend the Government for that. The plan aims to have three out of four people diagnosed with cancer survive five or more years by 2035, as the noble Lord, Lord Patel, pointed out. It recognises that progress for people affected by less survivable cancers is key to this aim. As the Less Survivable Cancers Taskforce notes,
“these cancers account for a disproportionate number of cancer deaths and require focused action if overall survival targets are to be met”.
Earlier detection and faster diagnosis for all forms of cancer are critical to improving people’s access to treatment and, ultimately, their chance of survival, but progress on the rarer cancers still lags behind progress on others. Survival rates for these cancers have remained largely static over the last 25 years, partly because their often vague and non-specific symptoms can make early diagnosis very difficult. Just 28% of less survivable cancers are diagnosed at stages 1 or 2, compared to 54% of all cancers. A large proportion of people with less survivable cancers are diagnosed in A&E, so the national cancer plan’s strong focus on early diagnosis is welcome.
It is an excellent and ambitious plan informed by cancer professionals, patients and their families but, as ever, it will take funding to secure real improvement and change. Like others, I am aware that this plan is launched at a time when there seem to be substantial economic growth problems and demand on public spending is being stretched in all directions. We need to be realistic about what can be done here and now. Our efforts must be focused on what will have the greatest impact. I was therefore very pleased to read last week that we are making progress in our efforts to cut set-up times for clinical trials. Approval processes in the UK have been slow and bureaucratic, so faster access to new treatments and medicines can be only a good thing. Will the Minister say more about how we can now encourage people to access clinical trials and tackle historically low patient recruitment?
We need to prioritise research, particularly into the less survivable cancers. We know that rare cancers account for some 47% of UK cancer diagnoses and some 55% of cancer deaths, yet they receive a fraction of research funding and clinical trial work. The Rare Cancers Act, passed last month, is a huge step towards addressing this imbalance, and I pay tribute to Scott Arthur MP, who saw it through its passage in the House of Commons, and my noble friend Lady Elliott of Whitburn Bay, who steered it through its final stages in this House. It will drive research innovation to improve treatments and survival for rare cancers, including brain tumours and pancreatic cancer. Can the Minister give us any encouragement on moves to appoint a national clinical lead for rare cancers, as called for in the Act and in the National Cancer Plan for England? I am very conscious of the substantial funds made available only eight years ago, following the death of our noble friend Lady Jowell. A very small proportion of that money has yet been spent, and that was eight years ago.
In finishing, I want to highlight some encouraging developments in diagnosing a cancer that currently has a UK survival rate of just over 8% and that has affected my family particularly. Innovative diagnostic tests and emerging AI technologies have real potential to help GPs triage patients with vague symptoms. For example, the VAPOR breath test for pancreatic cancer being developed at Imperial College and part funded by Pancreatic Cancer UK can detect volatile organic compounds released from tumours at an early stage. Results are showing that this quick test, which involves breathing into a bag at the GP’s surgery, can pinpoint whether a person is likely to have pancreatic cancer, with the results available to GPs in three days. This would put an end to the patient going backwards and forwards to the GP many times with non-specific symptoms and allow for earlier treatment. The test is now undergoing national clinical trials, and it could be in GP surgeries within the next five years. I end by saying: we live in hope.
Baroness Bottomley of Nettlestone (Con)
My Lords, I, too, most warmly congratulate the noble Lord on securing this debate. I always think health matters should be handled by a former president of a royal college, and it is excellent that we have another former president of a royal college with us today. This should be a criterion for joining the Lords, and we should have far more of them. I declare my interests. Many noble Lords know that I have been involved in the appointment of key leaders of eminent health and academic institutions for the past 26 years or so. I should also say that I am the mother of a gynaecologist and the grandmother of a medical student.
Cancer is one of those issues that tells us quickly and clearly whether a health system can turn scientific excellence into public benefit. The Government are right to call cancer performance a tide on which all ships rise. They are also right to say that science and innovation will be the engine of our reinvention. I thought the noble Baroness was going to talk about universities and academic research, which she would have had greater right to do.
These are not casual phrases; they are statements of national ambition and they are fully justified. England remains a country of distinguished scientific and clinical strength. We are capable of world-class discovery, trials and research leadership. The challenge now is whether that strength is translated reliably into public benefit—faster diagnosis, quicker access to treatment and more equal outcomes, as the noble Lord said, for patients across the country.
There is much in the national cancer plan that deserves genuine welcome. It is more serious than many previous strategies about research, clinical trials and innovation. It commits to research remaining
“an enabler for the lifetime of the plan”.
It promises annual progress reporting and sets out in-depth three-year reviews, which is the right direction. It also sharpens the real test before us: it is no longer simply whether England can produce excellent cancer research, which we can; the tough question is whether we are as good at adoption as we are at discovery. It is whether Ministers can show, in practical terms, who is responsible for each research priority, by when and by what measure of success they will be judged.
As noble Lords are aware, the central issue is translation. We know that this country can lead in genomics, diagnostics, cancer biology and trial design. The harder test is whether innovation travels quickly enough from the laboratory bench to the clinic, and then from the great research centres to the district hospitals and the patient, who is anxiously and often fearfully waiting. This is the point at which scientific strength either becomes public benefit or remains trapped as potential.
The Institute of Cancer Research puts this with admirable clarity. Professor Kristian Helin warns:
“Cancer research cannot succeed in isolation. It relies on a strong life sciences and higher education ecosystem, underpinned by world-class infrastructure, sustainable investment and access to the best skills and talent”.
Can the Minister say who, across government, is responsible for making sure that research, universities, immigration, infrastructure and NHS reform are pulling in the same direction? I quickly pay credit to the noble Lord, Lord Vallance, who has been the most wonderful advocate and leader in this sector. Ministers of whichever department would pay respect to his contribution.
Cancer Research UK—I pay tribute to its chair, who will have much more to say on this, or he may talk about his experience as chief executive of the NHS—makes a similar point in more practical language. Will this plan be the turning point for cancer that patients deserve? It will require much faster progress. The next step must be translating it into delivery—a telling phrase: delivery, not declaration. Have we heard it before? We have, but this time it needs to happen. When will we see the full implementation architecture behind the research and innovation elements of the plan? In plain English, when will we know where responsibility sits, what resources are attached and what would count as success or failure by the midpoint of the plan?
We have been warned before that the problem is not only strategy but consistency. I was interested in what the noble Baroness said about Denmark. Summarising research from the International Cancer Benchmarking Partnership, Professor Ellen Nolte said that
“sustained and consistent strategic planning and investment are crucial”.
That is not a throwaway line; it is one of the clearest lessons from comparative success. Countries that improved did not merely publish attractive plans. They backed them, refreshed them and stayed with them. Can the Minister assure noble Lords that this cancer plan will be treated not as a launch but as a governing discipline? What protections are there against the familiar pattern in which bold strategic language is followed by uneven implementation and fading attention?
Clinical trials are crucial, and this is where it becomes real for patients. The plan says that
“every cancer patient gets the opportunity to access relevant clinical trials quickly, fairly and easily”.
I pay tribute to my noble friend Lord O’Shaughnessy’s important review, which set out 27 recommendations and argued that the NHS should become
“the world’s leading platform for health and life sciences research”.
There has indeed been genuine progress, for which I pay tribute to the Government.
The Government report that the average set-up time for commercial, interventional, clinical trials has fallen from 169 to 122 days. That is dramatic. The latest UK clinical research delivery data shows that 71% of commercial contract CTIMPs applying between April and September 2025 recruited a first participant within 150 days. These are steps in the right direction.
The MHRA and the wider system also deserve credit. The Government say that trial applications received rose by 9% between January and November last year, compared with the previous year. Scientific advice meetings on clinical trials rose by 75%. This is real improvement and should be acknowledged, but of course speed is only one part of the story; fairness also matters. Who hears about the trial? Who lives near enough to join it? Who can manage the travel, time off work and family pressures that participation involves? Can the Minister commit to publishing participation data by geography, deprivation and ethnicity—the noble Lord made this point—so that the House can judge whether access is truly widening?
The question becomes sharper still. Cancer Research UK warns that around 90% of patients are recruited to non-commercial studies. The plan gives too little assurance that these trials will not be left behind. The ABPI’s latest report shows why that matters. The number of new industry trials initiated in the UK encouragingly rose last year.
I see that I need to speak faster. I want to say something about workforce, because the Minister has been asked very clearly about that. Obviously, it is a critical factor. I cite the Royal College of Physicians, the Society of Radiographers and many others. We need the people to make it happen. Were the Minister able to have another debate, I could give the rest of my speech.
England’s cancer challenge is less about what we can discover and more about what we can translate. We know that this requires the NHS, industry, academia and charities working together, and I believe that, with determination, we can see real progress.
Baroness Watkins of Tavistock (CB)
My Lords, I congratulate my noble friend Lord Patel on securing this important debate, to which it is a pleasure to contribute. I declare my interest as a fellow of the Royal College of Nursing, and I am delighted that I will be followed by a previous president of the same organisation—making at least three in the Room. I intend to cover elements of the themes identified in the plan on community services, the value of screening, the workforce necessary to deliver for patients and the worried well, and an emphasis on psychological support, as well as the protection of patient data and the control of its use for UK-led research and prevention of cancer.
I join others in welcoming the ambitious plan, which will require cultural change across the workforce to improve the communication between assessment, diagnostic and treatment teams, as well as the use of AI and digital information. The aim is to provide seamless delivery of care closer to patients’ homes. This, of course, should be cost effective. The plan has been described as a revolution, and it is vital that the strategy for implementation and delivery is clearly led and monitored to ensure that the change actually happens. With the emphasis on community-based care, the current workforce will, in many instances, need the opportunity to refresh and enhance its skills and knowledge for delivering care outside acute hospital settings. As many people know, I help lead some of that, closing a large mental hospital into community care. The challenge may be similar to achieve this plan—not that I am suggesting we can shut the Royal Marsden.
Clinical staff often work alone in the community, which can be challenging for staff who spent most of their careers with easy access to other multi-professional team members for support and guidance, particularly when a patient’s condition suddenly rapidly deteriorates. Staff must be confident and skilled to provide care in the community, which will call for professional development and dedicated preparation time. The King’s Fund argued that a persistent shortage of radiologists, pathologists and severely overstretched nursing teams often results in haphazard organisation and innovation, rather than planned organisational change. The cancer plan highlights some excellent examples of innovation from the Humber and North Yorkshire Cancer Alliance pilot, using nursing and pharmacy teams to introduce home-based delivery of some subcutaneous chemotherapy drugs. The Christie supportive oncology services demonstrate the value of integrated care provision, from psychology support to dietary advice and symptom management.
The issue at hand is how such innovation can be rapidly and efficiently scaled up nationwide. One patient using the Christie service said:
“The cancer treatment helped, but it was the wider support that”
the service
“gave and continue to give that had the most impact on my quality of life … The team saw me as a whole person, not just as someone with cancer”.
Yet age-standardised premature cancer mortality is twice as high in some areas of the UK than in the best performing ones. The plan acknowledges the need to increase investment in research and open clinical trials more widely, so that patients who want to do so can have the opportunity to participate. Patients from deprived areas, particularly in rural and coastal parts of the country, such as where I live, are less likely to be offered the opportunity to be in trials, as are those from Black, Asian and other ethnic minority groups, who remain underrepresented.
With NHS digital systems advancing and patients’ individual records stored in their NHS app, protecting personal data is crucial. Data should be used only for British research to drive new knowledge and enhance care. The future workforce plan aims to equip managers and clinical and support staff for effective delivery. Staff need dedicated time for training and research, particularly in fields such as nursing. This protected time would support professional growth, boost morale and help retain staff.
Action 23 states that
“every patient will have a clinical nurse specialist or other named lead to support them through diagnosis and treatment”.
As such, clinical nurse specialists will need to be more central in workforce models and must be adequately trained in psychological support for patients with long-term physical and mental health care needs, because people now live with cancer for long periods. Many people who live with cancer fear recurrence, so it is important to focus on living happily and productively for the best quality of their lives, including working, where it is feasible to do so, as the plan states.
The NHS is, rightly, free at the point of delivery for screening, diagnosis and treatment, yet there is little mention in the plan of the need to consider withdrawing some screening programmes at a certain age—for example, for breast cancer over the age of 70—because the cost benefit, many would argue, is unjustifiable. A small cohort would of course benefit, so the NHS allows an opt-in mechanism. However, that has the potential to increase health inequalities, with the worried well requesting the service, which the private and contributory healthcare systems of many other countries would not pay for as a benefit.
Withdrawal of treatment is always a difficult issue and requires delicate conversations between the patient, their family and significant others and the clinical team involved. Such withdrawal must be decided on sound guidance based on relevant research knowledge. British universities are central to cancer research, but there is very little information about their role in this plan.
It is estimated that nearly 40% of cancers are preventable by reducing tobacco and alcohol use, increasing exercise, improving diet and lowering obesity. The Government must be congratulated on the Tobacco and Vapes Bill but, as the noble Lord, Lord Patel, said, the plan makes no reference to the fact that a minimum unit price for alcohol could make inroads too.
Will the Government consider mandating protected time for continued professional development for clinical healthcare staff to support their adoption of the new technologies, the faster treatments and the vision of this plan? Can the Minister say whether screening programmes will be reviewed to ensure cost-effective investment for specific cohorts, and whether appointing a named national lead for screening innovation should be considered? In addition, can she confirm that the use of patients’ clinical records for research will be led by British universities, in partnership with the NHS, using clinical trials that recruit from the whole country, and that they will not be sold for commercial use?
Baroness Rafferty (Lab)
My Lords, it is a pleasure to follow the noble Baroness, Lady Watkins, a fellow nurse. I add my congratulations to the noble Lord, Lord Patel, on securing such a timely debate. There is a lot to commend in the National Cancer Plan for England, but, speaking as a nurse and a workforce researcher, I think that there are definitely challenges, as we have heard, to be met in ensuring that services meet the physical, psychological and social impact of cancer care.
Cancer detection rates are increasing alongside survival rates and complexities of diagnostics as well as care pathways in a population with growing co-morbidities. The national cancer plan advocates for every cancer patient to have access to a clinical nurse specialist, as we have heard. However, it is uncertain how likely it is that this will be achieved with the lack of nurse specialists currently available in the workforce, as the noble Lord, Lord Patel, highlighted.
There is strong evidence that specialist and advanced practice nurses are cost-effective and clinically effective. These highly skilled and educated nurses lead clinical services and the administration of complex chemotherapy protocols. Anyone in contact with chemotherapy services will be aware that this is nurse-led and stressful work, as the pressure is on to ensure that high volumes of patients are treated safely. Burnout rates for chemotherapy nurses remain high. Specialist and advanced practice nurses are a precious human resource that needs to be supported.
One of the challenges to accessing treatment is the availability of training and education for specialist nurses, as highlighted by the noble Baroness, Lady Watkins. According to a recent survey by the UK Oncology Nursing Society, training and education is patchy across the country. Two factors constrain the expansion of this highly skilled cancer workforce: the limited supply of supervisors to support advanced practice nurses and funded opportunities to develop their capacity. Access to training and education is essential to build the necessary confidence and competence in delivering ever more complex care. Core to these skills are expertise in advanced communication, psychological support skills, which the noble Baroness, Lady Watkins, highlighted, and symptom assessment and management.
Nurses are also integral to cancer research, especially the running of clinical trials, as the noble Baroness, Lady Bottomley, highlighted. The MRC trials infrastructure demonstrates a high reliance on research nurses for patient recruitment, and the review conducted by the noble Lord, Lord O’Shaughnessy, into commercial trials showed a worrying decline in the number of such trials conducted in the UK. This has profound implications for our standing as a life science destination and the part that that plays in our economic growth.
Oncology nurses are also researching patient outcomes and filling important gaps in the evidence base of symptom management through their research. I shall provide some examples from my experience as a supervisor of doctorates—one of my students happens to be here today, which is brilliant. One student undertook a co-design study with patients who had developed peripheral neuropathy from chemotherapy, which is a horrible side effect. She was intent on mitigating some of the further complications of this painful—terribly painful, in fact—and debilitating condition. Another is currently examining the sexual recovery of women after bladder removal for cancer. It is quite staggering that this remains largely a hidden problem yet has profound impacts on the women concerned and their partners, often traumatising women in the process. Another student pioneered a new way of measuring workload for cancer nurses. Strong evidence links patient mortality and education in acute care, so it is not inconceivable that the same principles might apply to cancer patients.
Despite the value placed on specialists and advanced practice nurses, it is worth noting that the British Medical Association has recently raised concerns about the expansion of advanced practice nurses substituting for medical roles, arguing that some employers are using them to replace doctors and that that poses a threat to patient safety. It is unclear what the specifics of this evidence might be but, based on my own and colleagues’ research, nurse autonomy poses no threat to multidisciplinary teamwork. On the contrary, it is an essential underpinning for enhanced interprofessional working between nurses and doctors.
Turning the plan into a reality requires a workforce that is supported, skilled and enabled to work differently. The Government’s forthcoming NHS long-term workforce plan refresh will be a pivotal moment to set the direction for cancer care. It must set out how nursing roles will be funded and supported to deliver the plan. Can the Minister confirm what support the Government are putting in place to enable the professional career development of cancer nurses?
Baroness Bloomfield of Hinton Waldrist (Con)
My Lords, I, too, thank the noble Lord, Lord Patel, for securing this debate and for introducing it so powerfully in his usual inimitable fashion. I declare my interests as a trustee of the Royal Marsden Cancer Charity, as a former patient and as someone married to a current patient.
We all recognise the ambition behind the National Cancer Plan for England. It sets out a vision of earlier diagnosis, faster treatment and improved survival—goals that command universal support across this House. But ambition, however welcome, is not the same as delivery, and it is on delivery that this plan invites scrutiny.
First, on early diagnosis, the plan rightly emphasises catching cancer sooner, when outcomes are far better. The new 28-day faster diagnosis standard is a meaningful step forward and the UK is improving five-year survival rates across a range of cancers, with particularly strong performance in breast and some children’s cancers. Yet the plan leans heavily on expanding screening and awareness, without adequately addressing the capacity constraints already facing primary care and diagnostic services. General practitioners are overstretched and diagnostic hubs, though welcome and promising, remain unevenly distributed. Without a credible workforce strategy, radiologists, pathologists and specialist nurses, the aspiration of earlier diagnosis risks becoming little more than a slogan.
Secondly, on children’s cancer, we have seen important advocacy, including the Solving Kids’ Cancer response to the 10-year plan, which rightly highlights that childhood cancers are biologically distinct and require tailored approaches. Yet the national plan does not fully reflect that specificity. Children’s cancer should be treated as a dedicated priority, not simply folded into a general cancer narrative. Survival rates for some paediatric cancers have improved, but progress has stalled in others, particularly rare and aggressive forms. Families still face fragmented pathways, limited access to trials and inconsistent genomic testing. If we are serious about improving outcomes, this requires dedicated investment, co-ordinated research infrastructure and guaranteed access to specialist centres and innovative therapies.
On specialist centres, the plan must not blur the distinction between general cancer care and specialist excellence. The Royal Marsden and the Institute of Cancer Research remain among the world’s leading cancer institutions, with the Marsden identified as one of the top five cancer centres globally for research impact and the country’s only specialist NIHR biomedical research centre for cancer. That matters because a serious national cancer strategy must support both broad improvement across the NHS and world-leading specialist research that drives the next generation of treatments. We should not ask our flagship centres to carry international responsibility without giving them the sustained support that they need.
Thirdly, the plan speaks of reducing waiting times and meeting treatment targets. But we must be candid: the NHS has struggled to meet its existing cancer waiting time standards for several years. Simply restating targets does not make them achievable. What is missing is a clear funded pathway to recovery, one that accounts for workforce shortages, ageing equipment and the persistent backlog exacerbated by the pandemic. Targets without tools will not deliver results.
Fourthly, as many have mentioned, there is the question of inequality. Cancer outcomes in England vary significantly by geography, socioeconomic status and ethnicity. The plan acknowledges these disparities, but its remedies remain broad and underspecified. We hear of targeted interventions and community engagement, yet there is little detail on how these resources will be shifted to the areas of greatest need or how success will be measured. Without a sharper focus and accountability, inequality risks being noted but not narrowed.
Fifthly, on innovation and infrastructure, particularly the overlooked issue of medical radioisotopes, modern cancer care increasingly depends on nuclear medicine, both for diagnostics and targeted therapies, yet the UK remains heavily reliant on international supply chains for key medical radioisotopes, which are vulnerable to disruption. A serious national cancer plan should address this strategic gap. Developing a domestic supply, whether through research, reactors, cyclotrons or alternative production methods is not merely an industrial question but a matter of clinical resilience and patient safety.
We have a plan, project ARTHUR, to site a reactor at the old Trawsfynydd site in north-west Wales, supported by the Welsh Government and the local skilled population. I urge the Minister to look seriously at this plan. Without secure access to these materials, some of the very innovations that the plan champions cannot be reliably delivered.
Sixthly, on patient experience, the plan speaks of holistic care, mental health support, rehabilitation and survivorship, and this is welcome. Maggie’s, the independent charity that I know well, helps to provide this support across the country in its 24 centres sited alongside hospitals. Yet many patients today still report fragmented care, poor communication and insufficient support after treatment ends. These are not peripheral concerns; they are central to outcomes and quality of life. A truly patient-centred plan would embed these elements as core standards, not optional extras.
Finally, on accountability, the plan sets out ambitions over the coming years, but it lacks clear milestones and transparent reporting mechanisms. Parliament and the public must be able to track progress in real time to understand not only what is promised but what is delivered. Without this, there is the risk that the plan will become another well-intentioned document that fades from view.
None of this is to dismiss the importance of having a national cancer plan. On the contrary, it is precisely because cancer care is so vital that we must hold such plans to the highest standard. We need a strategy that is not only ambitious but credible, not only comprehensive but deliverable, and not only forward-looking but grounded in the realities of today’s NHS. If this plan is to succeed, it must be strengthened with a robust workforce strategy and a serious commitment to children’s cancer; securing domestic capabilities in critical technologies, such as radioisotopes; realistic funding; targeted action on inequality; equitable access to innovation; and clear mechanisms for accountability. Without these, we risk raising expectations that cannot be met, and that is something that neither patients nor clinicians can afford. The challenge before us, as ever, is not to write plans but to make them work.
Baroness Nargund (Lab)
My Lords, I thank the noble Lord, Lord Patel, for securing this important debate and for his excellent introduction. I declare my interest as the founder and a trustee of Health Equality Foundation, a UK national charity.
I welcome the Government’s National Cancer Plan for England and pay tribute to the Secretary of State, Wes Streeting, for his moving forward. I and many others are grateful for his openness about his own cancer experience and his dedication to improving cancer outcomes. The scale of the challenge is clear: cancer is the biggest killer in our country. The UK ranked 26th out of 36 developed countries in cancer mortality rates in 2021. The latest NHS digital data shows lower survival rates in the most deprived areas. As such, I applaud the Secretary of State’s unapologetically bold plan. Such determination is needed.
The last Labour Government’s introduction of the two-week referral pathway in 1999 was a landmark moment. It is encouraging to see the Government building on that legacy, with a goal of saving 320,000 more lives by 2035. I speak with over 40 years’ experience in the health service and 30 years’ experience as a consultant gynaecologist at St George’s Hospital. I served as a junior doctor on medical oncology wards, and I have close friends and family who have faced cancer.
I shall focus specifically on gynaecological cancers and the inequalities that run from incidence to outcomes. Gynaecological cancers affect more than 22,000 women each year in the UK. Around 60 women get a diagnosis every single day. Ovarian cancer alone causes more deaths than the other four gynaecological cancers combined, yet only about one-third of cases are diagnosed early, according to Ovarian Cancer Action. The inequalities are glaring. Research from Target Ovarian Cancer found that Black, Asian, minority and ethnic women wait, on average, six days longer than white women to begin treatment after their referral for ovarian cancer.
Uterine cancer, the fourth most common cancer in the UK for women, shows higher incidence rates among Black women. Data from Cancer Research UK shows the impact of socioeconomic deprivation on cancer rates: mortality from cervical and uterine cancers is 61% higher in the most deprived communities, while vaginal cancer has one of the steepest deprivation gradients, with 88% higher incidence in the most deprived areas of our country.
To improve outcomes and tackle deep-rooted inequalities, I shall raise areas where ambition must be matched by delivery. On screening and innovation, the ambition to eliminate cervical cancer by 2040 is world leading, and I welcome the rollout of HPV self-sampling. However, for other gynaecological cancers, our early-detection tools remain inadequate. The UK Collaborative Trial of Ovarian Cancer Screening with the protein biomarker CA125 and ultrasound scans demonstrated that detecting more early-stage disease did not translate into fewer deaths. On the other hand, cell-free DNA screening for ovarian cancer is emerging as the most promising screening tool for the general population. Investment in this area, and in biomarker research, early detection algorithms and clinical trials should be encouraged. As the renewed women’s health strategy highlights, femtech has a role to play, but it must be clinically evaluated with peer-reviewed research and linked to NHS pathways to reach all women, not just those with the means to seek it out.
On HPV vaccination, when misinformation reduced uptake in Ireland, disadvantaged schools were hit hardest and recovered slowest, according to a report in Vaccine. Having led a British Red Cross vaccine campaign for ethnic minorities in our country, I know that communities place their trust in friends, families and local organisations. Will the Minister ensure that the Department of Health and Social Care works closely with the voluntary sector and local government to counter misinformation in underserved communities?
On clinical research, a Target Ovarian Cancer survey found that only 23% of women with gynaecological cancer were asked about joining a clinical trial, despite 60% wanting to. I applaud the plan’s commitment to accessible trials, but access must not be determined by postcode. As the King’s Fund has highlighted, this requires the expansion of trial workforce capacity across the country. Will the Minister confirm how the Government intend to ensure that capacity keeps pace, particularly in deprived areas?
Finally, on community diagnostic centres, I welcome the £2.3 billion investment in diagnostics in the community and the commitment to post-menopausal bleeding clinics. We need genuine one-stop diagnostic facilities in community centres. By repurposing the existing resources from secondary care to communities and using the single purchasing power of the NHS to procure ultrasound machines and other testing facilities, this could be achieved in the community. Will the Minister confirm that community diagnostic clinics will be implemented as genuine one-stop shops for gynaecological cancer diagnosis, with particular attention to deprived communities in our country?
The Government’s ambition that three in four people survive cancer by 2035 is one that I support whole- heartedly, but it must reach every woman in our country—those in deprived communities, those from ethnic minority backgrounds and those with the gynaecological cancers that have been underfunded for far too long.
This plan can be the turning point to bridging the gender health gap and addressing inequalities in access and outcomes for the biggest killer in healthcare. I fully endorse the national cancer plan and look forward to its implementation.
Lord Kakkar (CB)
My Lords, I join other noble Lords in congratulating and thanking my noble friend Lord Patel for having secured this important debate and having introduced it, as he always does, in such a thoughtful and sensitive fashion. In so doing, I remind noble Lords of my own interests as the chairman of King’s Health Partners and of the King’s Fund.
I start by congratulating, through the Minister, His Majesty’s Government for having established such a thoughtful, comprehensive and forward-looking national cancer plan, and for having described a substantial ambition extending, as we have heard, over 10 years. It covers so much of what is essential in ensuring that we have a joined-up strategy that can potentially achieve the impact and ambition so rightly described.
In its initial description, the ambition covers the problem that we currently face: we experience, as a nation, untimely delays in diagnosis, access to imaging and access to a proper histopathological evaluation of biopsy samples; and an inability, therefore, to apply advanced diagnostic and characterisation techniques to targeting therapeutic intervention in an increasingly precise fashion. There are delays in establishing treatment for patients and in ensuring that patients are able to participate in clinical trials. We have done little of what needs to be done to drive a proper national programme for prevention in the area of cancer. It is of course vital, and there is a necessity—because, actually, we are making substantial progress and we must not be too gloomy—to start focusing on survivorship and how we are able to help patients beyond that initial therapeutic intervention when they are potentially not cured and have to continue to live with their cancer.
As we have heard, it is also very clear that previous Administrations have made substantial efforts to secure improved clinical outcomes for patients with cancer. Much of that innovative and imaginative approach to improving clinical outcomes in cancer has happened at a time in our national history when the NHS has benefitted, as have many other public services, from the so-called peace dividend—the period since the end of the Cold War. In 1990-91, NHS spending was some 4% of GDP, and in the year 2023-24, it was some 8%: a near doubling from £1 in every £25 of public expenditure some 30-odd years ago to £1 in every £12 of public expenditure.
That was a period of substantial plenty, when strategies and plans were presented but, regrettably, did not achieve absolutely what was intended and expected. As a result, this new cancer plan now lands at a time when our fiscal situation in the country, with the demands for increased defence expenditure, makes it highly unlikely that the substantial increases in public funding that have previously been devoted to healthcare will be available in the future.
It is therefore right that in this Grand Committee debate so many noble Lords have identified the question of how this plan will be implemented. What are the potential restrictions, not only financial but organisational and structural, that are likely, regrettably, to ensure that much of this great ambition that is absolutely necessary for the future health and well-being of our fellow citizens will not come to pass?
In this respect, it is very important, as we heard from the noble Lord, Lord Patel, to look at examples from other national experiences. The International Cancer Benchmarking Partnership has looked at these questions. As we have heard, the jurisdiction of Denmark represents an important example of what can be achieved: the clear lesson is that there has been consistency after a national cancer plan was adopted. That consistency manifests itself over many decades in political consensus. At a time when there was substantial opportunity for various Administrations to make further and increasing commitments to healthcare expenditure, it was possible that our country could live without consensus about the long-term delivery of health strategies, but we are no longer in that luxurious position.
I would therefore be interested to hear from the Minister how, in taking forward this impressive plan, His Majesty’s Government propose to achieve the substantial consensus—not only political but professional and, more generally, among the general public—that will see this strategy live through its 10 years, modified if it requires modification, but without wholesale dismissal. Those who deliver have to be in a position to do so with some certainty.
Secondly, in the circumstance we find ourselves with the economy and our fiscal constraint, how do His Majesty’s Government propose to find the substantial additional investment that is inevitably required when one looks at the ambition of this plan? As we have heard from other noble Lords, there are so many areas that we would all support, but each will require substantial investment—beyond the investment that is already made in delivering the day-to-day care that is required for cancer patients today and the increasing demands on that care through the adoption of already available innovation—to be provided at scale and pace across the entire country. Therefore, we need clarity about the approach to funding, the approach that will be taken in the Department of Health and Social Care now that it has incorporated the functions of NHS England back into the department and the approach that will be taken to prioritise funding on cancer over other priorities that will inevitably be identified for other disciplines and for the management of other clinical conditions.
Finally, so much of what is described in this impressive plan is predicated on the basis of ensuring that research is no longer an adjunct to the delivery of cancer care, but central to it. One of the points that we have heard, which is absolutely correct, is about accelerating the opportunity for clinical trials. We know that patients managed on clinical trial protocols, or in the clinical environment where they can access clinical trial protocols, have improved clinical outcomes. There is a need to drive broader equity in access to those clinical trials.
In addition, it will be vital to ensure that there is consensus on the use of data. Data will be critical to drive the innovation agenda and the implementation agenda. Can the Minister give a view on the approach of His Majesty’s Government to ensure that there is broad societal consensus on the use of data, on a routine and regular basis, to achieve so much of this ambition?
Lord Drayson (Lab)
My Lords, it is a privilege to follow the noble Lord, Lord Kakkar, and to contribute to this debate on the National Cancer Plan. I thank my colleague on the Science and Technology Committee, the noble Lord, Lord Patel. I draw the Committee’s attention to my declared interests in the register, and also my 30 years’ experience as a life sciences entrepreneur, covering vaccines, medical devices and, most recently, AI.
The Government’s National Cancer Plan is to be welcomed, as it sets out the ambition for earlier diagnosis, faster access to treatment and more personalised care. However, it does this at a time when the UK’s economic circumstances make the ability to fund this ambition challenging, to say the least. There is a growing appreciation, as a number of noble Lords have already mentioned, that the nation’s health is linked to the nation’s wealth, and cancer survival rates provide a potent measure of both. Increasingly, the public are aware that, as our economy stagnates, our ability to fund the most advanced and effective treatments declines. The rationing of drugs and treatment in hospital corridors are as much a symbol of our failure to create the wealth needed to fund a first-class healthcare system as they are a symbol of dysfunction within the NHS system itself.
The National Cancer Plan is comprehensive in its description of the importance of embracing the potential of modern life sciences, across genomics, AI and robotics, to name just a few. The plan is heavy on aspirational actions, such as:
“Action 3. We will harness AI to speed up lung cancer diagnosis”.
But it is light on details of implementation.
In my opinion, the UK does not have an innovation problem in cancer care, and the plan describes many terrific examples of such innovation in islands of improvement across the country. We have a world-class life sciences industry, but it increasingly struggles to scale. So often, the impact of new technologies such as AI and genomic medicine depends not on scientific potential but on how quickly they are adopted across the NHS as a whole and then embedded into the routine care of patients. Time and again, we make the discoveries but then do not have the will or the money to adopt and benefit from them. So our life science innovators drift abroad or get acquired, and the innovation that should improve patient care and help fund our NHS is lost.
My eldest daughter, hearing that I was giving this speech today, happened to visit the Science Museum yesterday. She is currently doing a post-doc studying the effect of radiation treatments on the brain. She was struck in the current exhibition in the Science Museum by how many innovations UK science has delivered to the world, but how few of them have led to the industrial capacity that generates the wealth to help fund our NHS.
Poor procurement of technology by the NHS is at the heart of the problem. It is a balkanised and fragmented process across the trusts and other groups involved in procurement at both national and local level. It lacks a joined-up approach based on evidence, and it lacks a clear, long-term strategy for procurement that aligns health outcomes with the nation’s economic growth.
There is a shortage of expertise in the NHS in technology adoption and management, in particular of AI, and an overreliance on very expensive management consultants that charge huge fees. Failures in NHS procurement not only undermine the quality of care and waste taxpayers’ money but create a barrier to businesses and investors wishing to invest in UK life sciences. Life is particularly hard for small companies. The unwillingness of NHS trusts to accept evidence from other trusts means that companies spend ages repeatedly doing pilots across multiple trusts, never getting to a critical mass of business in the UK market.
The fact is that the NHS determines the fate of our UK life sciences industry, an industry in which we have had a great track record of science innovation but now lack scale. Just look at the life sciences sector that was listed on the London Stock Exchange 20 years ago compared with the list now. It is a pale shadow of its former self.
Much is said in the cancer plan about how artificial intelligence will have an enormous impact on cancer detection and the discovery of new cancer medicines. However, if the UK does not develop the onshore expertise to create software systems aligned with the values of our NHS and our society, the NHS will have no choice but to continue to buy systems that, like Palantir’s, are closed, cause vendor lock-in and lead to wealth being created elsewhere. We will then continue to import the biases that were embedded in those systems when their AI algorithms were trained on the US healthcare system. Our NHS will become less fair and less aligned with the values of our society, and the wealth created by the AI wave will accrue overseas.
We must scale the innovations in cancer treatment that we know work, ensuring that our pension money is invested at home in innovative British companies that can supply them, and we must invest in the infrastructure needed to support the adoption of these innovations. Only then will we enable our NHS to deliver the high-quality cancer care that people want and help create the wealth needed to pay for it.
Lord Taylor of Warwick (Non-Afl)
My Lords, I also thank the noble Lord, Lord Patel, for securing this timely debate. One of the lessons of history is that, so often, we fail to learn the lessons of history. I say this particularly in relation to prostate cancer. It is the most diagnosed cancer in men aged over 45 in England. There are higher risks of prostate cancer linked to ageing, black men and family history. Early diagnosis is critical. Survival is nearly 100% when detected early, but it drops to around 50% at stage 4. Yet one in five men—that is 10,000 annually—is still diagnosed too late. Despite these earlier warning signs, there is still no UK-wide screening programme for prostate cancer.
This is a cancer that affects men from every social and professional class. Some of the most well-known names in the world have spoken of their prostate cancer diagnosis. Some of them are still with us; others are not. They include Robert De Niro, Warren Buffett, Colin Powell and Nelson Mandela. Closer to home, this cancer has affected Ian McKellen, Stephen Fry, Rod Stewart, Andrew and Julian Lloyd Webber, and, another knight of the realm, Chris Hoy. I mention these names because the fact that these famous men have been prepared to discuss their personal diagnosis has helped expose the need for more active screening.
Although prostate cancer is the most frequently diagnosed cancer among men in 112 nations, the testing procedures vary greatly from country to country. For example, some nations, such as Sweden, have trialled organised screening programmes involving PSA—prostate-specific antigen blood tests—and subsequent MRI, or magnetic resonance imaging, tests for men of a certain age. But America and Australia have elective individual decision-making approaches. My first question to the Minister is: what analysis of other nations’ prostate cancer treatment strategies are the Government carrying out? Have they come to any conclusions about the way forward for the United Kingdom? Organisations such as Prostate Cancer UK, Prostate Cancer Research and the British Association of Urological Surgeons all support the introduction of a screening programme. The Telegraph has been campaigning in recent months for men with the highest risk of the disease to be offered a test.
According to Prostate Cancer Research and Deloitte, targeted screening is not only life-saving but cost-effective. Their modelling shows that it could deliver a £14,000 net socioeconomic benefit for every high-risk man diagnosed. Bearing in mind the reluctance of some men to submit themselves to rectal examinations, what assessment have the Government made of the BARCODE 1 study on the early detection of prostate cancer using saliva samples to identify high-risk patients? I am pleased that the UK National Screening Committee has now recommended national screening for men aged 45 to 61 with certain confirmed gene mutations, but when will it next be considering whether to extend this to other men at risk of prostate cancer?
As for cancer more generally, NHS England has advised caution when making comparisons between historic and latest available data on cancer. This is because cancer registrations in England can take up to five years after the end of a given calendar year to reach 100% completeness due to continuing late registrations. If we cannot get the data right, how can we have confidence in the information being provided? Additionally, diagnoses of cancer are registered for each separate cancer, so this means that a person diagnosed with more than one type of cancer would appear more than once in the total data. As the noble Lord, Lord Kakkar, said, data is vital. I am a vice-chairman of the All-Party Parliamentary Group on Artificial Intelligence. Can the Minister indicate what plans there are to improve medical data collection, because this is key, perhaps by using more AI technology? Also, what plans do the Government have to invest more in AI and robotics to help spot cancers earlier and increase access to innovative cancer treatments as soon as they become available?
Regarding international comparisons, the UK has lagged behind other countries on mortality rates. According to the Organisation for Economic Co-operation and Development—OECD—data on deaths from cancer in developed countries showed that we presently rank 26th out of 36 countries for cancer mortality rates. It is against that background that I welcome the Government’s publication on 4 February of this year of their 10-year National Cancer Plan for England, but I note that some cancer and public health academics have been critical. For example, the London School of Hygiene and Tropical Medicine has raised concerns with the plan’s delivery model, arguing that it lacks clarity on what additional resources and leadership capacity would be required to achieve its ambitious goals.
A relevant issue is the Terminally Ill Adults (End of Life) Bill. An important factor in end-of-life management is palliative care and pain relief, yet in the UK some independent hospices rely on charity to fund up to 70% of their costs. The quality of palliative care is very much a postcode lottery. Will the Government consider putting more funding into palliative care?
The good thing is that, on average, we are all living longer, but our life should be measured on its quality, not only on its length. So much of cancer care depends on the power of the purse, but we also need more emphasis on prevention and early detection. As the saying goes, cancer can be a dark place to be in, but we can bring light.
Baroness Redfern (Con)
My Lords, it is a privilege to have the opportunity to contribute to this important debate regarding improving cancer outcomes and diagnostic care and research. I congratulate the noble Lord, Lord Patel, on securing it.
I shall first concentrate on the importance of early diagnosis, which, as we are all aware, can and does improve cancer outcomes. I note that in the 12 months to September 2025, early diagnosis rates were 3.5 percentage points above the pre-pandemic level, equating to around 10,000 more people being diagnosed at stages 1 and 2.
I also welcome the commitment to reducing the significant number of rare and less survivable cancers that are diagnosed in an emergency setting. I specifically mention children and young people whose cancers are often more aggressive and faster growing, and which require specialist intervention to ensure that the right treatment is given at the right time in the right place.
When patients receive a cancer diagnosis, everything is fluid and seems uncontrollable. They are desperate for treatment to begin but, all too often, patients living in rural and coastal communities have longer waiting times for a preliminarily diagnosis. As research shows, for some cancers, a four-week delay in starting treatment increases the risk of death by 10%.
All sides of this Room desperately want to see clear improvements in cancer survival and outcomes, so this plan has to demonstrate commitment to a detailed trajectory for improvement against real-time scale settings.
I will also focus on radiotherapy. I very much welcome more diagnostic centres with more community diagnostic centres being opened on evenings and weekends, and investments in 28 cutting-edge radiotherapy machines engaging in a more fluid process. But the crux of the matter is that we urgently need many more radiographers. This would make it easier for radiotherapy centres to use cutting-edge, stereotactic ablative radiotherapy, which is crucial to so many patients. An end of radiotherapy deserts is what we all want to see.
The national figure for access to radiotherapy is 53%, which does not seem particularly high in itself. However, compare this figure to that in my area, Yorkshire and the Humber region: it is 35%, which cannot be fair. Improved data transparency on the quality of care and performance of trusts’ cancer outcomes should not be dependent on someone’s location in the country, so much more work is required to bring postcode lotteries to an end.
Targets in the plan are also welcomed but, if they are to be met, there is a need for workforce expansion, especially in radiology and clinical nurse specialists. The radiotherapy workforce stands at approximately 6,400, with a 15% vacancy rate for clinical oncologists and a 10% vacancy rate for therapeutic radiographers and healthcare science workers. We also need improved training and pathways into oncology and radiotherapy specifically.
The withdrawal of the previously agreed £15.5 million to support the implementation of AI auto-contouring across England was a damaging blow to progress in radiotherapy, as this software can reduce the planning process, saving consultants lots of precious time. It is estimated that there are at least 22 machines currently operational past the 10-year recommended lifespan and, by the end of 2026, that increases by an additional 27, so the need for a rolling programme of machine replacement is very clear. It is urgently required.
Finally, more outlining of operational details and milestones is required to deliver these cancer ambitions. As many others do, I look forward to future early diagnosis in this field, which will fundamentally improve outcomes for all cancer patients, wherever they live. I look forward to the Minister’s response.
Baroness Finlay of Llandaff (CB)
My Lords, like others I am most grateful to my noble friend Lord Patel for securing this debate today, which is acute myeloid leukaemia day—so it seems very appropriate. I declare my interests as a professor of palliative medicine at Cardiff University and am employed at Velindre cancer centre, as well as my vice-president roles with various hospices, particularly City Hospice, Marie Curie and Hospice UK. I also declare my position with Cicely Saunders International, because its research in palliative care is the main research point not only for the UK but across the world. My other declaration must be as chair of the Bevan Commission in Wales, because I am mentoring one of our fellows on a project on early diagnosis of post-menopausal bleeding.
I will take a slightly historic view on this. The Calman-Hine report came out in 1995; it was the first report on cancer services and set out a cancer plan to take things forward. The current cancer plan reflects the importance of having vision and ambition because, without that, things will not change. One has to set a path forwards, and the Calman-Hine report did. It changed the organisation and structure of cancer services at the time, started multidisciplinary team working, and created centres and units.
That report was also the first time that palliative care was recognised as an integral component of cancer services from the time of diagnosis through all stages, not only in end-of-life care. It tried to set uniform standards and ensure a holistic approach, with early intervention that recognised the physical, psychological and social support needed by people from the time of diagnosis onwards. There is evidence in oncology that, usually within eight to 12 weeks of diagnosis, if palliative care services are available in parallel with the cancer services, there are improvements in quality of life and mood, patient and caregiver satisfaction, and cancer survival overall.
Unfortunately, though, the NICE guidance recommendations on 24/7 access to specialist palliative care services have not been fully implemented, neither those from 2004 nor from 2011. So will this plan integrate with the palliative care plan and strategy that we anticipate will come forward in the autumn? Without that integration, we will not meet patient need. It has already been said that two-thirds of hospice funding is from the charitable sector, yet Marie Curie estimates that about a third of people dying have unmet palliative care needs. It has been estimated that up to 90% of people dying in hospital without any specialist palliative care support available have their needs unmet.
Frailty, of course, makes everything worse in cancer treatment, from diagnosis right through to outcomes. As has been said by the noble Baroness, Lady Nargund, and the noble Lord, Lord Patel, for the ethnic minorities there is poorer access to everything, including palliative care. There is poorer access to emergency palliative care in both deprived areas and rural areas.
Where financial data is available, it has been shown by Peter May and colleagues from Hull York that, in England in 2022, specialist palliative care supported over 20,000 patients to leave hospital and have their care outside it. They calculated that, overall, this input from specialist palliative care saved £800 million, with a saving of 1.5 million hospital bed days. That is not insignificant at all. For each patient with home specialist palliative care involved, there was a saving of almost £8,000, with quality-adjusted life years also improved. For hospital patients, it was not quite as much: it was £6,500 in cost savings, but with that same improvement in quality of life.
One of the problems has already been alluded to: although the faster diagnostic standard had been met, the delays from the decision to treat, and indeed from referral to start treating, has meant that targets have not been met to date. Almost half of young people later diagnosed with cancer attend three or more GP appointments before receiving a referral to cancer services for diagnosis, meaning that teenagers have the longest time to diagnosis, with 67% diagnosed as an emergency. This puts huge pressure on parents in particular, who have to provide emotional support and take time off from work, and it of course has an enormous financial drain on the whole family.
At this point, I point out that some of these young people have very rare tumours. If we look at ocular melanoma, which is a very rare tumour, there is a subgroup of patients who will respond extremely well to some treatments that are not yet NICE-approved and not available on the NHS, even though they have been used and developed for over 20 years. Therefore, families—here I declare an interest as having a family member involved—are having to support their treatment, because the dramatic response means that they are living, rather than having already died, leaving young families.
As well as putting pressure on NICE to review the way it looks at the management of some rare cancers, will the Minister also look at the workforce training needs? Sadly, there is evidence that, even though over 90% of those dying will have some palliative care needs at some level—which is often adequately provided by generalist services when they have back-up from specialist services—the electronic staff record of nursing staff in the community shows that only a small number have actually had palliative care and end-of-life role training. The problem is that this means that about 78%—over three-quarters—of home care workers report insufficient training in pain management or anticipatory prescribing, while two-thirds have never received formal training and do not have access to palliative care services during their shifts out of hours.
There is much to be done, but much that can be improved. I hope that this plan will move us forward with better integration. The evidence shows that where we have better integration of services, it costs less and the clinical outcomes are improved.
Baroness Ramsey of Wall Heath (Lab)
My Lords, I too congratulate the noble Lord, Lord Patel, on securing this important debate. I declare my interest as a member of the General Medical Council.
Like many other noble Lords, my interest in this very important subject is personal. My father and older sister both died of lung cancer. My father became addicted to smoking back in the days when tobacco companies pretended that the products they were selling were not killers. By the time he showed symptoms, it was too late to operate on him, even though he was otherwise very fit and healthy. He died at the age of 66, only one year into his retirement. I was pregnant with my firstborn, so he never got to meet his grandchildren. I have spoken about my sister before in the House. She had profound and multiple learning and physical disabilities and lived for years in an NHS mental hospital, before she went into the community, where staff and patients were smoking everywhere. She may well have been a victim of passive smoking.
Given this background, noble Lords can see why I very much welcome today’s debate and the Government’s national care plan. My interest is also a professional one: I have had a nearly 20-year career as a non-executive in various NHS organisations in local, regional and national roles, including as chair of the Lambeth Primary Care Trust and Addenbrooke’s Hospital in Cambridge, plus being on the board of UCLH in London.
I remember well the previous Labour Government’s efforts to tackle cancer. I became the chair of Lambeth Primary Care Trust during the period of the 2000 plan, which introduced national targets to speed up treatment: no more than a two-week wait from GP referral to diagnosis and no more than a month from diagnosis to treatment. Great progress was made. In 2005, even the always sceptical National Audit Office reported that:
“Substantial progress has been made in implementing the NHS Cancer Plan, with many targets in the Plan met … This should contribute to the downward trend in cancer mortality rates and continue to bring significant benefits to patients”.
That Labour Government were surely right to start with speeding up treatment. Once you know that someone may well have cancer, time is of the essence.
However, we all know that this is only one leg of a three-legged stool, with early diagnosis and prevention completing the set. Prevention of lung cancer is, of course, why the Tobacco and Vapes Bill, steered through the House so effectively by the Minister, is such an important piece of legislation. I have been hugely proud to support it, and I have spoken about it in this Room, as I know many others here have. It is too late for my father and sister, but it will save the lives of thousands of others. Early diagnosis of lung cancer is a key and enormously welcome commitment in this Labour Government’s new cancer plan.
It is not before time. It is shocking to learn that early diagnosis rates were flat for the best part of the past decade. It is little wonder that the Cancer Survival Group at the London School of Hygiene & Tropical Medicine reported last year that,
“the speed of improvement in the survival index for all cancers combined has slowed – it increased nearly three times faster in the early 2000s than in the early 2010s”,
placing us 21st out of 28 European countries when it comes to five-year lung cancer survival rates, for example.
However, early diagnosis rates have increased significantly in the past few years, and successful implementation of the National Cancer Plan for England will enable us to build on this welcome improvement, particularly when it comes to lung cancer. As the plan points out, lung cancer screening is already proving transformational. Critically, three-quarters of patients whose lung cancer has been diagnosed as a result of screening are at stage 1 or two, in contrast to fewer than one-third of those diagnosed outside the programme. That programme would probably have saved my father’s life. The most encouraging news is that it is tackling inequality too, as screening can be targeted to where it most needed. This is why the plan is able to point out that the use of lung cancer screening has helped to reduce the overall gap in cancer early diagnosis between the richest and poorest areas by one-quarter.
I am delighted to hear the commitment to complete the rollout of lung cancer screening within the next four years, meaning that
“meaning every eligible person in England will have received their first invitation for a check”
by 2030, with the intention that at least 23 cancers will be diagnosed earlier by 2035, potentially saving thousands of lives, and that,
“because smoking is a risk factor for other cancers, trials are under way to check whether ‘moving the scanner down’ may be a cost-effective way to look for other cancers when people are receiving lung cancer scans”.
Of course, writing these commitments down does not make them happen. Delivery is a hugely complex task, as others have referred to, requiring the hard work and commitment of huge numbers of dedicated people and the resources they need to succeed. Labour delivered well on its last cancer plan, and I very much look forward to it doing so again this time around.
Lord Stevens of Birmingham (CB)
My Lords, I pile on to the congratulations to the noble Lord, Lord Patel, on this fantastic session. Given the excellence of the contributions that we have already heard, I will just draw out a small number of things. I will try not to be duplicative of the brilliant contributions that the Committee has heard.
I declare my interests as chair of Cancer Research UK and chair of King’s College London’s council. Cancer Research UK has a proud tradition of supporting research in the UK as well as internationally. Some eight out of 10 medicines that NHS cancer patients use were either developed by or with Cancer Research UK. CRUK has pointed out that we are indeed the beneficiaries of that research. We have seen a 29% reduction in the death rate from cancer since 1989. The Government’s very welcome new NHS cancer plan points out that five-year survival rates increased from about 50% to 60% between 2008 and 2022. Your chances of dying from cancer on an age-adjusted basis are lower now than they were five years ago, 10 years ago or 15 years ago, but for all the reasons we have heard, there are no grounds for complacency. There is an enormous opportunity in front of us, and the cancer plan is right to set that out.
As other noble Lords have pointed out, in order for it to succeed it must meet two signature commitments: that three-quarters of people get diagnosed at stage 1 or 2 by 2035 and, linked to that, the expectation that three-quarters of people will survive five years as a consequence. That makes complete sense, but we should reflect on what have been the barriers to achieving that up to now, so that we get it right over the next decade.
There is a caveat: we need to be careful that we do not just increase the proportion of stage 1 or 2 diagnoses by detecting a lot of what would otherwise have been indolent cancers that would not have gone on to cause people problems. That has got to be matched by seeing an age-standardised reduction in the number of people diagnosed at stage 3 or 4, so we really are clear that we are getting stage shift and not just expanding into a wider group for whom the diagnosis would not necessarily have been a problem.
That is significant, because our understanding of cancer biology continues to evolve. The standard assumption that individual mutations at cellular level grow, spread and develop into advanced disease or systemic diseases such as cachexia turns out to be not quite right. My colleague Professor Charlie Swanton at the Francis Crick Institute has pointed out, for example, that a typical 60 year-old will probably have 100 billion cells in their body with some form of cancer mutation. So, in a sense, the question is, why is cancer not more common, given that underlying fact?
Continuing to invest in research to understand the tumour microenvironment and the way in which oncogenes and suppressor mechanisms interact and cancer spreads is what we are going to have to achieve if we are going to make the progress needed to get to the 75% target. That cannot be achieved just by sweating the NHS assets, as it were. For important conditions—the glioblastomas, pancreatic cancers and ovarian and oesophageal cancers—we need to continue to shift the frontier of research in order to produce those benefits.
The research and life sciences environment in this country continues to be hugely important. We are a bit of an outlier as a country in that of our non-commercial cancer research, two-thirds is funded by charities and slightly less than one-third by government. That is a lower proportion than for other major conditions and a lower proportion than is seen in other countries. So it is vital that we think about the entire research infrastructure and, as the noble Baroness, Lady Bottomley, briefly alluded to, we cannot be blind to the pressures on our brilliant British universities, which have done so much. However, in order to sustain that, we are going to have to, through the broader set of approaches that the Government take, make sure that they have the resourcing to do that.
We are not going to get to the goals in the new cancer plan without further progress on some of the cancers of unmet need through the research enterprise, but it is also the case that there are several things inside the NHS that have got to work, and I suspect that my colleague the noble Baroness, Lady Gerada, will shortly talk about the pressures on primary care, given that that represents the first point of contact for most cancer patients.
It is the case, of course, that, whereas the share of NHS resources going on primary medical care increased between 2015 and 2020, it has since fallen back. I am anticipating that the Minister may say that the Government do not think that spending-share targets are a good way of measuring these things: that is certainly their position on mental health, although it appears not to be their position when it comes to pharmaceutical spending, where there is a novel commitment that we will spend an extra 0.3% of GDP on our medicines pricing, linked to the deal done with the Trump Administration. Nevertheless, for primary care and mental health, apparently that logic does not apply.
We will want to really understand how we make the primary care element of the NHS robust over the coming 10 years. We want to understand the referral thresholds. The reality is that about 22% of cancers are diagnosed in patients from a GP referral on a non-cancer referral pathway, not the urgent suspected cancer pathway, so we need to make sure that the new GP contract, which incentivises a 25% reduction in referrals, is not cutting across the referrals that we need to detect cancer early, including in the specialities that are covered by the scheme—gastroenterology, gynaecology and urology. The NICE referral pathway, NG12, needs a refresh to make sure that people are getting referred appropriately and that the filtration is not artificially stopping people from getting checked up as they should be.
The Government are to be commended on the expansion of the community diagnostic centres—that is an excellent model, and we need more of them. There is capex and other support to do it. That is good. The lung health check programme, to which the noble Baroness, Lady Ramsey, referred, has been a brilliant success. The long-term plan in 2019 gave us the rollout for that. More than 2.5 million people have been invited. As she said, it has produced the extraordinary result that 76% of people getting a lung cancer diagnosis through that lung health check do so at stage 1 or stage 2. That is the kind of stage shift we are looking for overall, achieved through that novel programme. As she also rightly said, it has, unlike most other screening programmes, produced another extraordinary result: poorer people are more likely to get an early diagnosis through that screening programme than better-off people. That is a direct impact on health inequalities that we do not see elsewhere.
Those kinds of models are hugely important. We need to see continued innovation in that area. If we pull all these pieces together—the resourcing, continued research and the focus on what has and has not worked in the NHS—I see no reason why we cannot continue to make really significant progress on cancer over the decade ahead.
Baroness Paul of Shepherd’s Bush (Lab)
My Lords, like many before me, I thank my noble friend Lord Patel for securing this debate and other noble Lords for the excellent contributions that have been made so far. I beg your Lordships’ indulgence—my comments are of a more personal nature than some of the others we have heard. I hope that noble Lords will accept that. The themes and targets in the cancer plan are among the many things I will touch on in my more personal remarks.
I want to focus on clinical trials, one of the great engines of medical progress. They underpin the medicines that extend lives, relieve suffering, and in many cases deliver cures that would have been unthinkable a generation ago. They also support the UK’s ambition to be a global leader in clinical research and can be an engine for much-needed economic growth in our country.
But today I draw attention to a group of patients for whom the current clinical trial system does not really work properly: those who are diagnosed with life-limiting conditions and for whom time is short. I know that rare cancers are for the first time mentioned in the cancer plan. I also know that there is a significant commitment to clinical trials. I want to make certain that those who have rare cancers that are diagnosed late have access to those clinical trials. For those individuals, time is not abstract—it is measured in months, not years—and it is about the quality of life, not just the length of it. Our trial infrastructure is not really built for that reality. Normally, you have to fail standard treatments and then navigate complex rules in order to participate in any of the trials.
As I speak today, I remember our much-missed colleague Baroness Margaret McDonagh. She was my great friend, and watching her die from glioblastoma, a rare and devastatingly aggressive cancer, brought home to me the reality of what a rapidly progressing, life-limiting illness can be. It exposed the gap between the urgency faced by patients and their families and the pace at which our systems operate.
The brutal truth is that a patient diagnosed with glioblastoma today will, in almost all cases, be offered the same treatment, delivering the same average expectancy of nine months, as they were offered 40 years ago. That stasis cannot be explained by lack of scientific promise, because we have seen extraordinary advances in medicines, diagnostics and data in that time. Yet far too few of the solutions reach patients with the most aggressive and rare cancers.
Since Margaret’s death, her sister Siobhain McDonagh and her outstanding clinician, Dr Paul Mulholland, based in UCLH, have worked tirelessly to improve outcomes for glioblastoma patients, raising funds for trials when the NHS has not been able to pay for them, championing research and repeatedly confronting the many barriers that stand in the way of progress. Their experience shows a culture stacked against urgency and innovation, with long lead-in times for decisions, inertia, caution and conservatism in the system, slow processes and obstacles that deter clinicians from pushing the frontier of treatment and offering patients new and innovative treatments.
Dr Mulholland has been running immunotherapy trials using medicines that have transformed outcomes in other cancers to test whether they can help with glioblastoma too. Immunotherapy, as many noble Lords know much more than me, works by triggering the body’s own immune system to fight cancer, and it has transformed outcomes in conditions once considered untreatable. Dr Mulholland is trialling a new approach in which some glioblastoma patients receive immunotherapy before tumour removal, when their body is at its strongest, to see if that produces better outcomes. One patient who has been widely reported in the press, Ben Trotman, who was part of that trial, has lived for more than two years beyond his nine months’ diagnosis of glioblastoma, and his cancer remains under control. During that two-year period, he and his wife have had a baby, Mabel. I regard her as a miracle made possible by this innovative trial.
But such breakthroughs require patients to reach trials early enough and a system willing to test new approaches with urgency and ambition. We need to be honest about risk. Many of these patients are already dying, so why not let them, with full consent and proper safeguards, try promising new treatments where there is a scientific case to give them a go? The potential benefits for them are more time and a better life, and increased knowledge for us about what does or does not work. What greater legacy could there be than that?
I ask the Minister: what specific steps are the Government going to take under the cancer plan to ensure that the increased clinical trials are also available to those with the shortest timescales and in the most urgent period of need?
Lord Evans of Rainow (Con)
My Lords, I thank the noble Lord, Lord Patel, for securing this important debate. When I was a Minister, the noble Lord used to stand up and ask me extremely searching questions—well, they were searching questions to me—to which I did not always know the answer. Come to think of it, there are a couple of noble Lords in the House who used to do something similar: the noble Lord, Lord Sikka, and the noble Baroness, Lady Finlay. I used to go back to the department and ask for answers to these legitimate searching questions, but sometimes the answer was not forthcoming. So I used to press and stretch the civil servants to come back, because I had to come back and report to the noble Lord, Lord Patel.
But I started thinking for myself and looking into some of this, and the answer came down to technology. The noble Lord, Lord Drayson, has really made my speech—one of the problems with speaking at the end is that everything has been said. He is right that, two or three years ago, artificial intelligence was just starting to make an impact in certain industries. He made a very powerful point.
Time is short and I have a few things to say. I am speaking as a former Minister who looked into this matter and as a Member of Parliament to whom constituents used to come, pleading for treatment or to get assessment and diagnosis. Not knowing is a problem if you have a lump but you do not know what it is. They used to come to MPs’ surgeries, not just mine, to see if they could cut through the red tape to try to get an answer from the local NHS trust. I used to do my best to help, but it happened frequently.
As I say, I am a family man and have had two experiences of cancer. The first was my late sister, who died of pancreatic cancer. I was listening attentively to the comments of the noble Baroness, Lady Warwick, who mentioned a spray that can detect pancreatic cancer. That was not available until relatively recently. Pancreatic cancer is a terrible disease.
The second was my late mother, who lived to quite a good age. Ovarian cancer is not always easy to detect. I was surprised as a carer that it took a while for the GP to make a referral and, once you got the referral, to secure a scan and get communication from the hospital to the patient—that is, my mother, who had dementia. In a way, she could not understand that; they should talk to the carer. I thought it was old-fashioned to write a letter to someone who could not read it rather than dealing with them directly, perhaps using artificial intelligence, via the NHS app to speed things along.
My contribution to this is that early and timely diagnosis is important to ensure that the right treatment can be given at the right time to get the best possible outcomes, especially for children and young people, whose cancers are often more aggressive and faster growing and require specialist treatment. Despite this, young cancer patients regularly report needing multiple visits to doctors before a cancer diagnosis is given. Data shows that the median time for under-18s to be diagnosed after first symptoms is 4.16 weeks; it takes longer than this for half of them. Teenagers from 15 to 18 years of age have the longest time to diagnosis—a median of 8.7 weeks. Some 60% are diagnosed as an emergency. On average, 14 different healthcare professionals are consulted.
This is further reflected in the NHS cancer patient experience surveys, which show that more than two in five children and young people, 42%, see their GPs three or four times after their cancer symptoms before being told to go to hospital. This compares to the majority of adults, 62%, seeing their GP just once. Not only does this prolong receiving a diagnosis but it can impact trust and relationships with healthcare professionals throughout treatment and after. This experience can be worse for minoritised groups. Data on time to diagnosis is not routinely monitored for children and young people nationally, despite those issues. It is crucial that a diagnostic interval measure is introduced for young cancer patients, as was committed to in the national care plan, to consistently track and improve time to diagnosis.
I have a question for another special person, the Minister, whom we are very lucky to have in your Lordships’ House—she does a fantastic job as Minister. The noble Lord, Lord Stevens, talked about sweating NHS assets, but I am not asking about that. The noble Lord, Lord Patel, and others referred to the Danish model. Denmark has a population of 6 million. In London the figure is 10 million, in Manchester it is 3 million and England as a whole it is 60 million. The noble Lord, Lord Drayson, made a point about artificial intelligence—he talked about economic growth, wealth creation, NHS trusts not talking to one another and scaling up our own domestic industry—and he is exactly right.
My question is not original but is about a pilot scheme to implement artificial intelligence, in order to establish best practice and set international standards of early diagnosis for all cancers but particularly those of low survivability. There are 36 integrated care boards—there were 42 in my day, but I understand that they have been condensed. Not all are the same: we have different populations, rural areas, seaside communities, post-industrial towns and metropolitan areas. We should appoint the best and the brightest from the NHS or industry to implement artificial intelligence throughout the NHS.
What does success look like and how do you measure it? I respectfully say that the best survival rates in the G7 would be a good starter, but artificial intelligence is an opportunity for the NHS to modernise its back-office administrative processes. As noble Lords have pointed out throughout this debate, there is so much good research out there that AI has to have an impact. That is not about sweating the assets but about improving the current workforce, certainly in the back office, so that they can at least communicate with those hard-to-reach populations and communities in the country.
That is my question to the Minister: can we have a pilot scheme of hand-picked individuals and integrated care boards in select areas of the country, to see whether we can introduce this to the NHS to make a difference and the world-beating healthcare system that we all want?
Baroness Gerada (CB)
My Lords, I am grateful to contribute to this debate, and I too thank the noble Lord, Lord Patel. I declare my interest: I am a practising GP just across the river, and, over the past 40 years, I have diagnosed and cared for many tens of thousands of patients with cancer. We currently use AI to help us: we use it with our e-consultation system, which can identify red flags. Together with our electronic medical records, that explodes at us and asks, “Have you thought of cancer?” We already have the brightest and the best; they are just located in general practice. As has been alluded to, I disclose that I am a former chair and president of the Royal College of General Practitioners.
I agree with many of the contributions that have already been made. In the contributions that I have made already in my short time here, I have drawn attention to the mounting pressures facing general practice and the implications for patients and the wider NHS, and I will focus briefly on that. I worry that initiatives such as the national cancer plan, which rightly place primary care at the forefront of early diagnosis and referral, are in danger of overestimating what general practice can realistically deliver in its current state for the patients we serve.
Without addressing the underlying constraints in the workforce, funding and capacity, we risk placing further pressure on a system that is already under real strain, as has been mentioned. In so doing, we may undermine the very ambitions that the plan is trying to achieve. These pressures are compounded in some areas by outdated or inadequate premises, which further restrict GPs’ ability to expand capacity and to do what is expected of us.
The Royal College of General Practitioners has repeatedly warned that general practice has not received a sufficient share of NHS funding to match rising demand. Without increased investment, the shift of care into the community will not be sustainable. The King’s Fund, which has been mentioned several times today, has highlighted a persistent structural imbalance in the NHS, with a higher proportion of funding and staff allocated to hospital services than to primary and community care.
Despite general practice being the front door of the NHS, the workforce remains heavily concentrated in hospital services. As highlighted in the Health Service Journal—HSJ—last week, the proportion of NHS doctors working as GPs has fallen significantly, from one in five a decade ago to closer to one in seven today. Less than 15% of the workforce—GPs and nurses—are now located in primary care, with 80% of the nursing and medical workforce now working in hospital settings. This cannot be right, given that evidence published over the past 70 years, both in this country and across the water, shows that placing GPs at the front door of any health service results in more accessible, higher-quality and more cost-effective care, including cancer care. Moreover, evidence from the Royal College of General Practitioners shows that strengthening continuity of care—the bedrock of my profession—can reduce avoidable hospital admissions and improve cancer diagnosis, treatment and prevention. Patients prefer continuity of care.
Recent figures published in Parliament, and highlighted in the Health Service Journal just last week, show that the share of NHS spending on general practice has fallen to about 8%—its lowest level in the past decade, down from 9% around five years ago. It always amazes me that there are currently 360 million consultations per year—GPs are about 180 million of those—for an average cost of £150 per patient per year. Noble Lords can do the maths: every man, woman and child on average consults six to seven times per year with their GP for £150. These figures reflect a long-standing structural imbalance in how care is resourced and delivered, and it is becoming increasingly difficult to ignore. To me, that raises a very clear implementation risk for the cancer plan, which relies heavily on GPs for early diagnosis and cancer pathways. Without adequate investment in primary care capacity, we will not be able to do that.
We need more GPs. Health Foundation modelling indicates that we need an additional 6,500 GPs by 2030 to meet the needs of our ageing, increasingly complex population. We need more GPs spending longer with their patients and communities to achieve the ambitions laid out in the cancer plan. I would be grateful to hear from the Minister how the Government intend to address the current imbalance, whereby general practice receives a relatively small share of NHS funding while delivering a substantial proportion of patient contacts.
Delays in accessing primary care risk translating directly into delays in cancer detection, where, as we have heard, earlier diagnosis is often critical to outcomes. Ultimately, if we expect earlier cancer diagnosis to be delivered through general practice, we must ensure that general practice has the capacity to deliver it.
Baroness Ritchie of Downpatrick (Lab)
My Lords, it is a pleasure to follow the noble Baroness, Lady Gerada. I congratulate my noble friend Lord Patel on securing this important debate, which places emphasis on diagnostic care, research and the necessary delivery mechanisms to implement the National Cancer Plan.
I am a breast cancer survivor who was on a clinical trial—the add-aspirin double-blind trial—for five years. The result of that trial in both Britain and Ireland will be revealed next year, with the aim of showing—I hope—that taking aspirin can help in the reduction of breast cancer. That is what I hope the research will show; we will see in time.
There is no doubt that research needs meaningful government and charitable investment, which in turn requires sound management. I acknowledge those who have provided briefings for us all today, including the Institute of Cancer Research, Young Lives vs Cancer, Leukaemia UK, Breast Cancer Now and the Royal Pharmaceutical Society—to name just a few. All the briefings highlight the importance of frequent and early screening, diagnostics and equitable access to more effective treatments, as well as the need to strengthen clinical trial infrastructure and create closer links between trials and clinical practice. They also highlight the importance of research and innovation, including the need to improve genomic testing in the UK by mandating faster test turnaround times and to standardise and make accessible a centralised data collection linked to other databases.
Undoubtedly, the National Cancer Plan for England sets out ambitious and necessary targets to improve cancer outcomes, which I welcome. Research is fundamental to delivering all these outcomes, but we will not hit these targets if they are not driven by the latest research. Universities are the primary delivery mechanism for this research, and they are under significant financial strain. The financial health of the universities is the litmus test for the UK’s scientific future. The key challenge is delivery, as was pointed out by Professor Kristian Helin of the ICR and in a subsequent blog by Ollie Richards, the advocacy manager for the Institute of Cancer Research.
The ambitious targets in the National Cancer Plan will not be met without cutting-edge cancer research to drive new standards of care, alongside time-saving and cost-saving efficiencies. The plan aims for 75% of people diagnosed with cancer to survive at least five years: a 25% increase on current levels. Achieving this will require more than incremental gains; it will depend on better treatments, more precise targeting of therapies and a deeper understanding of cancer biology, all of which is rooted in research. At the time of my diagnosis eight years ago, I was told that they were able to diagnose the content of a tumour and direct the treatment to the tumour: that was the difference and the improvement. It encouraged me to go on my treatment plan.
The ambition to diagnose 75% of cancers at stage 1 or 2 cannot be achieved through awareness of existing screening alone. It will require new screening approaches, more sensitive diagnostics, and improved risk stratification—again, all driven by research. This work is already under way at the Institute of Cancer Research at the Royal Marsden, and there is an exploration of saliva tests to assess the genetic risk of prostate cancer, showing that, for some men, it can outperform the current PSA test.
The National Cancer Plan includes targets on diagnosis and treatment times and an additional 9.5 million diagnostic tests by 2029, but volume alone is insufficient. Faster pathways depend on innovation and technologies that streamline diagnosis and reduce treatment burden. Therefore, research is critical here. Dr Matthew Blackledge’s quickDWI project is developing a five-minute MRI scan with the potential of transforming the patient experience, which frees up NHS capacity. Similarly, the PACE-B trial at the Royal Marsden and ICR demonstrated that higher-dose radiotherapy can cut treatment time by up to 75% for some prostate cancer patients. We cannot ignore the importance of early-stage research and discovery science helping to answer key biological questions. It is often the least visible and most vulnerable part of the system—a concern increasingly voiced across the sector in recent months.
The bottom line is that cancer research does not happen in a vacuum. It depends on sustained investment, policy stability and access to the best talent. If we want research to deliver the National Cancer Plan’s ambitions on survival, early diagnosis and faster treatment, all of us—Parliament, the Government, research institutions and clinical practitioners—have to ensure that the system that underpins it is strong enough to deliver what the National Cancer Plan requires. In this respect, I ask my noble friend the Minister what plans the Government have to do just that. I welcome the National Cancer Plan and I want to see it implemented, but I want to see how it will be implemented and the resources revealed to do just that: to ensure that this National Cancer Plan is capable of implementation with sufficient resources in research and innovation and within the universities.
Baroness Walmsley (LD)
My Lords, I am very grateful to the noble Lord, Lord Patel, for giving us the opportunity to talk about cancer today, because I am a very lucky woman: like the noble Baroness, Lady Ritchie, I am a cancer survivor. My cancer was picked up by routine screening, so I am just as much of a fan as the noble Lord, Lord Stevens, of routine screening.
I am delighted to be able to talk about the National Cancer Plan, which covers improvements in targets for prevention, diagnosis, treatment, care and research. Yet, of course, all these are underpinned by a sufficient, properly trained workforce—with ongoing CPD, since the science is constantly changing. The Government have promised the NHS workforce plan by this spring, yet, despite the sunshine outside, for the Government, spring has not yet quite sprung. Will the Minister be able to confirm when we will get it, and can she say whether it will deal with not just clinicians but technicians, and not just initial training but a reliable system of CPD to keep practitioners up to date, as the noble Baroness, Lady Watkins, has also requested?
There are many areas where efficient workforce planning is vital for achievement of not just the cancer plan but the 10-year health plan, including, as it does, moving from hospital to community, and many examples have been raised by speakers today.
A couple of hours ago, I raised an Oral Question about the issue of newly qualified midwives being without a post despite the issues of unsafe staffing levels in maternity services. In Wales, paramedic students are being told there are no posts for them in Wales when they qualify; they will have to go and work somewhere else. The number of posts for health visitors has been halved over 10 years, leading to some having enormous case loads, which were highlighted in the media this week. These are just a few examples of poor workforce planning in the general NHS workforce, but I recognise that this is not easy.
There are of course many examples of shortages in the cancer workforce, including of GPs, as the noble Baroness, Lady Gerada, just told us. They are all vital to early diagnosis, which we know leads to better outcomes. Yet the role of some groups is underestimated: last week, I went to my local dentist for a check-up; she checked me for oral cancer, and for any swellings in the lymph nodes in my neck, which might indicate cancer. Thousands of people cannot get an NHS dentist and cannot afford to pay, as I did, and therefore do not get these cancer checks, as well as having their teeth fall out. Dentists also part of the cancer workforce.
The Government plan for 28 more radiotherapy machines, which—as the noble Baroness, Lady Redfern, said—are probably enough only to replace the outdated ones. My party has proposed that the ambition should be more like 200, but we are aware that this would have to go alongside training more technicians. Is there a plan to do so across the health service?
This brings me to diagnosis and the question of investment in haematology, pathology and several other sectors which noble Lords have mentioned. Many years ago, I worked as a cytologist in the pathology lab of a major cancer hospital in Manchester. I was screening cervical smears for cancer and pre-cancer cells so that patients could have further examination and timely treatment. Since then, productivity has vastly improved with mechanisation of slide preparation and AI-assisted interpretation of samples. There is even more potential for this sort of improved productivity today, so that patients can get their results quickly and proceed to treatment. The noble Lord, Lord Kakkar, talked about the importance of doing this kind of investment when we have a cash shortage.
However, while this requires some investment, it is certainly cost-effective, as indicated by many studies. Waiting for test results is very stressful for patients—as I am sure has been experienced by several noble Lords at some points in their lives—and can be dangerous, as mentioned by the noble Baroness, Lady Redfern. Consultants need these test results to aid early diagnosis, but most areas are unfortunately well behind the targets.
Turning to prevention, there are three major areas I will mention. First, there is a long list of cancers that could be prevented by lifestyle changes. Smoking tobacco has long been the most common cause of cancer, and we are grateful to the noble Baroness, Lady Ramsey of Wall Heath, for her speech on this. Over recent years we have had legislation which has helped to reduce smoking and secondary smoking, the most recent of which was the Tobacco and Vapes Bill which finally went through your Lordships’ House yesterday. I congratulate the Minister and the Government on this legislation, which will certainly protect young people from taking up smoking and increase the opportunity for smokers who wish to quit to get help, thereby reducing their risk of getting lung and mouth cancer.
However, it is vital that community-based stop-smoking services have sufficient resources to be able to offer the full range of help. For example, most do not have the funding to afford prescriptions for the drugs which are proven to help smokers for whom other methods have failed. Vapes have proved to be a very effective quitting tool and should be widely available as such, including on prescription. However, I am pleased that the Government have taken powers to restrict the opportunity of manufacturers to attract, through advertising and marketing, children and non-smokers to start vaping, and I look forward to the regulations to put these into practice. We do not yet have enough information about any long-term dangers of vaping, especially on young and developing lungs.
The second lifestyle factor is diet. In addition to diabetes and musculoskeletal problems associated with overweight, there is a very long list of cancers caused by bad diet and obesity. In response to an inquiry in your Lordships’ House in 2024, which I had the honour to chair, the Government have put a number of our recommendations in place—thank you very much—but a great deal more needs to be done, and more quickly. The effect on the economy of the lost years of life and the lost working years due to illness caused by obesity has been well documented. It is tempting for some to suggest that it is all down to willpower, but that is not the case. We make our decisions on diet in an obesogenic environment, and many people cannot afford a healthy diet, so they are susceptible to a whole list of cancers. My committee proposed a comprehensive cross-government, long-term strategy to improve the nation’s diet.
Last year, the Government set up a national food strategy led by Defra, but we are not hearing much about it. It should cover a whole raft of government departments, so can the Minister say how her department is contributing to that? It really affects the budget of the NHS in the long term. Legislation on healthy food is undoubtedly required, and the Government will no doubt soon hear proposals for a healthy food Bill in the debate on the King’s Speech.
Having formerly worked in the area of cervical cancer, I was thrilled when a vaccine against the human papillomavirus was developed. It is offered free to teenagers as part of the school-based vaccination programme. As chair of your Lordships’ current ad hoc committee on childhood vaccination rates in England, I have heard evidence that the uptake of the HPV vaccine has fallen from 90% when it was first offered to only 72% now, and this puts the Government’s objective of eliminating cervical cancer by 2040 in great danger—the noble Baroness, Lady Nargund, mentioned that. Therefore, what is the Minister’s department doing about that, and how is she working with the Department for Education to improve the situation? I am hearing that some schools are refusing to work with the vaccination services offered to their pupils, and some find getting parental consent very time-consuming. Perhaps the Minister will write to me about that when she has spoken to her colleague.
Finally, on research, as I mentioned, vaccines have already been developed to prevent or treat cancer, and there will be more. Only yesterday, the media reported a vaccine that considerably extends the survival of patients with pancreatic cancer. This raises the question as to what the Government are doing to enable more of this sort of work and the clinical trials that are basic to it, as mentioned by the noble Baronesses, Lady Bottomley and Lady Paul. Clinical trials are absolutely vital in order to bring treatments to patients, and we need to make them easier.
I served on another of your Lordships’ committees—the Science and Technology Committee—with the noble Lord, Lord Drayson, who mentioned some of the findings of one of its most recent reports. But, in addition to the report on the difficulties of scaling up small businesses in this country, including life science businesses and other scientific businesses, the committee wrote an urgent letter to the Secretary of State for Health about the missed opportunity of attracting more researchers from the United States to come here if they are unhappy with the situation there. I am hearing that it would cost an American researcher £18,000 to come with a spouse and one child, to get visas and to pay the NHS charge in advance. This is more of a barrier than an encouragement. The committee heard that other countries are being much more opportunistic than us on this matter. Why are we lagging behind, when other countries have managed to strengthen their cancer research workforce? We need to get good people from wherever they are willing to come to us. Let us stop pussyfooting around and get on with it.
Earl Howe (Con)
My Lords, I declare my interest as an honorary fellow of the Royal College of Physicians. If I have learned one thing during my time in the House of Lords, it is that any pronouncement emanating from the lips of the noble Lord, Lord Patel, should be listened to with the utmost care and attention. I therefore say at the outset that his analysis of where we stand as a country in our ability to diagnose and treat cancer in all its forms can surely not be bettered. We have since heard some excellent speeches from around the Room, which have usefully developed the messages that the noble Lord, Lord Patel, so capably articulated.
Our starting point, as all others have said, must be the Government’s recently published national cancer plan, which I for one found an inspiring read. I very much welcome the ambitions set out in it, particularly because they are not only outcome-based but based on outcomes that are in many cases pretty challenging to achieve. That has to be the right approach, but every challenging target carries with it an implicit invitation to the wider world to hold the system to account for its delivery. With the cancer plan, that is not entirely a straightforward matter.
The ambitions in the plan are, quite rightly, many. They cover not only the desired ends but the means. We can measure success, or the lack of it, in the traditional way, by reference to the waiting time standards, and those are extremely important, but when we look at some of the other boxes that the plan sets out to tick—for example, quality of life improvements; reducing regional inequalities, which the noble Lord, Lord Patel, emphasised; reducing inequalities for children and young people; as well as such things as fostering a whole-society approach to prevention—we begin to see how many areas there are to be monitored and for which credible metrics will need to be devised.
I was glad to see that the Government have thought about this in the area of diagnostics, which will of course be crucial to the success of the plan. The four new key metrics that have been designed to track improvements in early-stage cancer diagnosis are excellent but, as the plan sets out, there is a whole set of measures on which such improvements will themselves depend: for instance, the expansion and wider take-up of screening; the enhancing of the NHS app and getting people to use it; and the general speeding up of the patient pathway.
As the plan concedes, quite refreshingly, a lot will also depend on basic improvements in administrative efficiency across the NHS, which, I am afraid, has been a depressingly difficult nut to crack in a number of areas. Let us not forget that put together, these ambitions, if they are to be met to their fullest degree, will require a focus on that rather elusive concept, championed so effectively by the noble Lord, Lord Darzi, in the last Labour Government, of quality—quality of process, quality of care and quality of outcomes. So it is good news that the National Quality Board will be taking it as part of its remit to adopt what the plan calls a
“more rigorous and evidence-based approach to quality improvement”.
Much will also depend, though, on local commissioners and providers monitoring their own performance and being swift to pounce on system weaknesses where these appear. For that, they will need the tools to do the job, chief among which are data and modern IT to deliver it. There are NHS trusts that are still dependent on slow and outdated software which, from a manager’s point of view, makes life extremely frustrating. The chief executive of the King’s Fund, Sarah Woolnough, was right to point out that many hospitals still cannot share imaging or pathology results in a timely way for that very reason. I hope the Government have this problem within their sights: it is important.
After all the consultation that took place on the cancer plan, which was considerable, it was not surprising to see that criticism of the plan from around the health community has been almost entirely of a constructive nature. The questions that have been posed have largely centred on the obvious challenges around delivery.
The King’s Fund, Cancer Research UK, the Royal College of Physicians and the London School of Hygiene & Tropical Medicine, to take just four examples, have expressed very similar anxieties, many but not all of which can be placed under the broad heading of “resources”.
The main anxiety, which I share, and which is shared by other noble Lords today, is that of human resources. There is a section of the cancer plan which addresses workforce issues, but it frankly put me off by being overly political, which was not at all necessary. The Government seem determined to rubbish the long-term workforce plan published by the previous Government, but I remind the Minister that it was a plan that, like the cancer plan, was widely consulted upon and widely welcomed when it came out. It most certainly did not focus simply on expanding workforce numbers but went into detail on where in the system more staff were needed, along with their skills and training, including continuing professional development. It also talked about clinical leadership, which I did not see much referred to in the cancer plan.
The elephant in the room is the demand curve. Doing better on prevention and early diagnosis will take cost out of the system, but with the best will in the world, the effects will not be felt for a number of years. Meanwhile, the demand for cancer services will continue to rise, as it has done inexorably over recent years. As noble Lords have said, our cancer outcomes as a country are nothing like as good as they should be. Nevertheless, and contrary to what you might think reading the cancer plan, the Government of which I was a member made considerable progress in cancer care and treatment. Mortality in many of the major cancers fell significantly, despite rising incidence.
However, as we know, the NHS struggled to meet its targets because of constraints around capacity. I very much welcome the sections of the plan that address capacity in diagnostics, one of the main areas in which the NHS has struggled, but at the same time, we are asked to accept that training and better equipment will in due course reduce the need to recruit staff. I am willing to believe that, but only up to a point. The efficiencies that the Government rightly want to see cannot and will not be delivered overnight or in short order.
Further down the patient pathway, we will need more clinical and medical oncologists, and we will need to train them. The Government have already pledged to create several thousand more specialty training places, but following the recent breakdown of negotiations with the BMA, we now learn that these places will not be on offer until next year at the earliest, which is not a very encouraging start to the cancer plan’s workforce ambitions.
Therefore, delivery at pace is a concern. That applies to another area: research and innovation. We have made progress in the setting up time for clinical trials, as others have said, and I welcome the Government’s plan for a clinical trials accelerator. The expansion of genomic science and facilities such as the UK Biobank have enabled major advances over the past 15 years, but again, it is about people. Our homegrown pipeline of research graduates is simply not going to be sufficient for our national needs. For the UK to remain competitive, we have to keep attracting international talent into our laboratories, and the costs associated with this are far higher than in other developed countries.
Of course, that is only part of the challenge. To have an effect on cancer outcomes—which is in the end what matters—the fruits of research need to be accessed by NHS patients. The National Healthtech Access Programme is a welcome concept, but to achieve success, it must spread proven new technologies beyond the bounds of our major teaching hospitals and somehow overcome the ingrained resistance towards innovation on the part of the wider NHS. How will it do that?
The National Cancer Plan for England is an excellent document, but because of that, it is a complex jigsaw with many pieces. For the Government’s ambitions around cancer to be achieved, all those jigsaw pieces must be put in the right places and seamlessly joined up. For that to happen, the system as a whole must contain the right accountability mechanisms to ensure delivery over a period of years. I look forward to seeing how those delivery and accountability mechanisms take shape over the course of the coming months.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, I congratulate the noble Lord, Lord Patel, on securing this excellent debate. I thank him for bringing his considerable expertise and careful consideration—as he always does, as other noble Lords have said—to these matters. He has assembled a pretty daunting selection of noble Lords, for which I am also grateful.
I thank all noble Lords for their contributions, which have been incredibly well informed, personally felt and thoughtful. There is much that I will share and examine further with my ministerial colleagues. Sharon Hodgson, the Minister for Public Health and Prevention, is driving forward the implementation of the cancer plan. To pick up the specific point about GPs, I note that Stephen Kinnock, the Minister for Care, is the responsible Minister for that area; I will raise the searching comments from the noble Baroness, Lady Gerada, with him.
I appreciate how personal and affecting the debate is for so many—if not everybody—whether they have said it or not, either directly or indirectly. That has inspired us much. By using the word “inspired”, I am quoting the noble Earl, Lord Howe; I was delighted to hear him talk about the cancer plan as an “inspiring read”—he really should review books—and “excellent”. The noble Earl’s assessment of it being a jigsaw is absolutely spot on, and that has been acknowledged throughout.
I will do my best to respond to a number of points. I suspect that I will not manage to do so entirely, but I hope noble Lords will be assured that their comments and questions will be taken up.
For me and noble Lords here today, strategy is one thing but implementation is the main thing. Many noble Lords, including the noble Baronesses, Lady Bottomley and Lady Bloomfield, the noble Lord, Lord Patel, and others challenged the point about implementation, so I will speak briefly about that. There will be a reformed national cancer board. It will be accountable for delivery and include cancer experts. It will track progress, update Ministers and monitor the impact, including—following the points raised by my noble friend Lady Nargund—by dealing with inequalities; that will be key in its monitoring. Updates will be published annually on the national cancer plan’s progress. I look forward to more challenge and engagement from noble Lords in relation to that.
On outcomes, as we have heard, the best way is to diagnose and to treat early to improve outcomes, which is why the cancer plan sets an ambitious goal to meet all cancer waiting times standards by 2029. We are already making strides towards this goal—not least by reducing the NHS waiting list overall by 405,000 since July 2024—but we have a very long way to go in this area of cancer.
The point about inequalities—whether we are talking about race, deprived communities or any other significant factor—came up so much, and rightly so. The noble Baronesses, Lady Redfern, Lady Bottomley and Lady Nargund, and the noble Lord, Lord Patel, among others, referred to this. As was said, the improvement of care for deprived, disadvantaged or less equal communities will be monitored through the NHS cancer waiting time standards. Data is published at integrated care board and provider level, and the NHSE acute provider table of all 134 providers supports this transparency. It is about getting attention to where it is needed most.
The cancer plan’s central ambition is to transform survival rates, committing to 75% of patients diagnosed from 2035 being cancer-free or living well within five years. What an ambition that will be to achieve. It will be the fastest rate of improvement in cancer outcomes this century and lead to an additional 320,000 lives saved over the course of this plan—and of course, for every life saved, many more are affected.
On diagnostics, one way in which we can achieve our ambitions is by improving cancer diagnosis in the community—the noble Lord, Lord Taylor, spoke to this point. As noble Lords have acknowledged, last week we announced plans to open four new community diagnostic centres in England over the next year, while also announcing that a further 32 of the 170 CDCs that are currently providing valuable diagnostic capacity will be expanded and enhanced. They are a major move towards a neighbourhood health service.
By extending new capacity—which was referred to by the noble Baroness, Lady Bloomfield—we are also optimising our cancer screening programmes to catch it earlier. I make particular reference to HPV, which was raised by the noble Baronesses, Lady Watkins and Lady Walmsley, and the noble Lord, Lord Patel. From this year, young people who missed out on the vaccination at school can have it administered from a pharmacy. That is to help us move to the elimination of cervical cancer by 2040. I really welcome that. It is about recognising that some people have missed out and providing the service easily and locally in the trusted pharmacy.
My noble friend Lady Ramsey and the noble Lord, Lord Stevens, referred to the national lung cancer screening programme. This will be fully rolled out by 2030, inviting more than 6 million people and identifying at least 23,000 cancers at an earlier stage. I am glad that the noble Lord, Lord Stevens, made the point that those who are more disadvantaged are benefiting from this to a greater degree. Disadvantage is being matched with greater and disproportionate—as in the right amount of—care and attention, and I hope we will see more of that.
On the matter of treatment, I say to the noble Baroness, Lady Redfern, that we will be taking a new approach: more patients will be able to access specialist training centres; by 2028 the NHS app will be the front door for managing our healthcare, and it will have a particular resonance for cancer care; and by 2035 we will bring together genomic and lifestyle data with the all-important single patient record, which will provide the kind of joining up that noble Lords have referred to.
I turn to the important matter of workforce, which was referred to by many noble Lords, including the noble Baroness, Lady Walmsley. I share the frustration of the noble Earl, Lord Howe, about the effect of industrial action on the service to patients and the kind of progress that we seek to make.
The noble Baroness, Lady Walmsley, almost asked me, “When is spring?”, and my noble friend Lady Blake whispered, “It’s still quite cold outside”. But there is indeed to be the publication of the 10-year workforce plan, which will set out a multi-disciplinary approach and will pay greater attention to the role of the workforce. I very much look forward to it supporting this cancer plan, as well as others.
My noble friend Lady Rafferty asked about the training of clinical staff. We will establish new national training standards for surgeons, in particular surgeons in robotic surgery. Over the first three years of the cancer plan, we seek to create some 5,000 learning and training opportunities for people per year in cancer-critical roles. That shows its importance in our approach.
As noble Lords have said, we have to take steps to seize and embrace research breakthrough. I am sure that the noble Lord, Lord Stevens, will take this back, but Cancer Research UK has rightly pointed out that, if we shift the dial on outcomes, that requires us to target rarer cancers, which noble Lords have referred to, where progress has often been slow. As your Lordships will know, we are fully implementing the Rare Cancers Act and are glad to do so. That will make it easier for patients to take part in cutting-edge clinical trials, the importance of which my noble friend Lady Paul spoke to. I can tell my noble friend Lady Warwick that we will appoint a national specialty lead who will advocate for rare cancer patients and oversee the delivery of research in England.
A new cancer trials accelerator will increase the speed and reach of trials. Up to 10,000 personalised cancer vaccine doses will be delivered through clinical trials by 2030. To respond to my noble friend Lady Paul, the Government have committed to reducing the set-up time for clinical trials to under 150 days, to earn the UK the real honour and practicality of being a world leader. We will streamline the implementation of proven technology, as well as boosting access via our new national healthtech access programme.
Just as we are targeting rarer cancers, we will also target specific groups—to which I have already referred—to ensure greater progress. That requires the use of data and data collection, which the noble Lord, Lord Kakkar, spoke about. The national cancer plan includes, for example, real-time pathway analytics, streamlined cancer metrics to expose unwanted variation, which is absolutely crucial, and providing trusts and cancer alliances with more granular and actionable data. Without data we cannot target where we need to go.
As noble Lords know, April is not just part of spring; it also marks the publication, last week, of our renewed women’s health strategy, in which we set out actions to expand genomic testing for those with a lifetime risk of breast and ovarian cancers. We will also look to improve the detection of endometrial cancer. I am grateful to my noble friend Lady Nargund, who spoke to the important matter of gynae cancers.
On linking women’s health to AI, I hope noble Lords will recall that we now have the EDITH—Early Detection using Information Technology in Health—trial, which will see nearly 700,000 women take part in a world-leading trial to test whether AI can increase the number of cancers detected in the national breast screening programme. To the point on workforce, this will also mean that the radiographers will be key, but we will need not two but one for each case—that is how we can harness AI. I agree with the noble Lord, Lord Evans, about the great improvements that AI can make, including in back-office functions. My noble friend Lord Drayson also spoke to the importance of harnessing the benefits of AI, and I assure noble Lords that we will continue to do that.
I will make a couple of final comments on innovation, productivity and funding, but, before I do, I will comment on prevention. Noble Lords have referred to this. We will stop as many cancers as we can by—these are just examples—cracking down on illegal underage sunbed use, eliminating cervical cancer through HPV vaccination, tackling obesity and creating the world’s first smoke-free generation. I am grateful to noble Lords, including the noble Baronesses, Lady Ramsey and Lady Walmsley, for welcoming the Tobacco and Vapes Bill. It is a step change in our work and will save thousands of lives.
On productivity, and on a point raised by the noble Lord, Lord Patel, we estimate that we will see up to a 21% gain in productivity as we invest in digital and robotic automation-enabled histopathology—pronouncing that is where I need the noble Lord, although it is also my writing—pathways, with further capability enhancement by AI. So we are not standing still on productivity and workforce, and I agree with the noble Baroness, Lady Finlay, about the importance of bringing together strategies and approaches. We will achieve in the cancer plan only by doing that. The noble Baroness rightly raised the issue of palliative care.
On funding and resources—the noble Lord, Lord Kakkar, raised this—there are significant commitments, and I will mention just some of them: £10 million a year for children and young people to be able to access their treatment without financial penalty; £200 million for cancer alliances to improve performance; and £2.3 billion in diagnostics, which should deliver 9.5 million additional tests by 2029. I think that gives a sense of our commitment.
My noble friend Lady Ritchie asked about resourcing for innovation. I assure my noble friend that we are working with education colleagues in the way that she asked, and there will also be a plan in place, which we are developing, for how we resource innovation. I am grateful for her comments.
This was such a rich debate. I feel I have picked out themes, and I will reflect, as will my ministerial colleagues, on the very real and informed points that noble Lords have made. The thing I did sense is that we all want this national cancer plan to work. I look forward to continued scrutiny, contribution and expertise from noble Lords. Lastly, I once again thank the noble Lord, Lord Patel.
Lord Patel (CB)
My Lords, I thank the Minister for her comprehensive response. She might reflect on some of the other points that she was not able to answer, such as the one on isotopes, which is very important. We have debated that before. One or two noble Lords quite rightly mentioned children’s cancers, which the report mentions very thinly. There is an issue with children’s cancers, including the suggestion that a well-run, efficient children’s cancer unit is under threat of being shut down. That cannot be so, and it needs to be investigated.
Aside from that, I thank all noble Lords. The Minister is quite right: there is a daunting array of them, even to me, and I have six double-sided pages of the important contributions made. If I were to summarise, your Lordships would not like me because they would be here for a long while, so I will not. Each and every contribution was brilliant. I thank noble Lords not just for turning up but for making such a good contribution. To me, the summary of it was that there were constructive, helpful comments to help this national plan, which on the whole each and every speaker welcomed. They were not criticising it overtly—apart from me—and I am sorry that I teased them at the beginning.
The noble Earl, Lord Howe, made a comment about me and the way I have engaged with him over time in debates. The problem is that, with his silken charm, you never know whether he is being kind to you or about to put a dagger in you. But it is always delightful to listen to him, and he made some important points, again in a helpful way. I hope we will soon see the workforce plan. It is absolutely crucial to have a workforce plan focusing on cancers again to deliver the workforce we require for all the things we want to do. I thank all noble Lords, and I thank the Minister very much. I agree with the comment made by one Member that we are lucky to have her as a Minister.