Cancer: Older People
Baroness Ritchie of Downpatrick Excerpts(1 day, 4 hours ago)
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Baroness Ritchie of Downpatrick
To ask His Majesty’s Government what steps they are taking to ensure a UK-wide approach to improving outcomes for older people with cancer.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, sadly, the risk of developing cancer increases as a person gets older. Health is a devolved matter, as your Lordships’ House will know, and the department is working with the NHS in England to improve outcomes for people of all ages with cancer. On my noble friend’s specific point, we are working to bring England in line with other nations by delivering a new national cancer strategy next year following the publication of the 10-year health plan.
Baroness Ritchie of Downpatrick (Lab)
I thank my noble friend for her Answer. I am sure she is aware that the UK’s cancer burden is projected to rise by around one-third by 2040, and 60% of those cancer diagnoses are expected to be among those aged 70 and above. Yet there is evidence that older people’s cancer care is not always provided to the level that it should be. Therefore, what assurances can she give me of actions the Government will take as part of the forthcoming cancer plan and the 10-year NHS plan to address these health inequalities in cancer care and treatment throughout the UK?
Baroness Merron (Lab)
My noble friend is quite right that the incidence of cancer is expected to rise across the UK, especially in older people. I agree that older people can face specific barriers when accessing care. Following on from the independent review by the noble Lord, Lord Darzi, I assure my noble friend that the 10-year health plan and the subsequent cancer strategy for England, both to be published next year, will help us do more to prevent cancer, identify it early and treat people quickly. They will have regard to older people.
Type 2 Diabetes: Continuous Glucose Monitors
Baroness Ritchie of Downpatrick Excerpts(1 day, 4 hours ago)
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Baroness Merron (Lab)
I must confess that is something that I will need to look into—it may be with my ministerial colleagues in the Department for Transport. But I will look into it, and I will be pleased to write to the noble Baroness.
Baroness Ritchie of Downpatrick (Lab)
My Lords, as part of ongoing research, would my noble friend talk to her ministerial colleagues about possible research that is required into the causes of type 1 diabetes, and if more updated research could therefore provide new types of technologies and treatment? There is no particular cure at this moment in time, and people live with it on a daily basis, hour by hour.
Baroness Merron (Lab)
Through the National Institute for Health and Care Research, £206 million was awarded to diabetes research in the last five years through its research programme. The NIHR and Diabetes UK have developed a joint strategy which will inform diabetes research in the UK. I hope that can get us to the place that my noble friend refers to.
NHS Hospitals: Apheresis
Baroness Ritchie of Downpatrick Excerpts(1 month, 1 week ago)
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Baroness Ritchie of Downpatrick
To ask His Majesty’s Government what steps they are taking to support increasing apheresis capacity in NHS hospitals in England.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
The Government are aware of the issues around apheresis capacity within the National Health Service impacting patient services, including stem cell donations. A departmentally led working group met for the first time last month to examine existing apheresis capacity and to develop solutions, and it will report in the spring. This working group includes members of the UK stem cell register, health professionals and service providers, and it aims to develop an evidence base by which strategic decisions around capacity can be established.
Baroness Ritchie of Downpatrick (Lab)
My Lords, I thank my noble friend Lady Merron for her very helpful reply. Only last month I chaired a round table in your Lordships’ House on apheresis capacity. Therefore, given the rapid developments in cell and gene therapies and related international regulation over the last few years, what plans do the Government have to update legislation governing the use of substance of human origin and the development of advanced therapeutical medicinal products to better utilise modern technologies such as apheresis platforms?
Baroness Merron (Lab)
I am grateful to my noble friend for her work in this regard. I certainly share the view that there have been very rapid developments in cell and gene therapies over the past few years, and there is tremendous potential for these therapies to address the root cause of diseases and to offer life-changing outcomes for patients. So, we are working with devolved Governments and with key stakeholders to review the EU standards and requirements, and to consider our approach in light of the changes introduced by the EU SoHO regulations, which will take account of innovation within the sector.
NHS: Breast Screening Programme
Baroness Ritchie of Downpatrick Excerpts(2 months, 2 weeks ago)
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Baroness Merron (Lab)
The measures that the noble Lord refers to did indeed assist, but as I mentioned earlier we have a stubborn problem in returning to pre-Covid rates. The improvement plan that exists sets out the priorities and the interventions, but also the monitoring of what is working and what is not. The kinds of things that are being tested and introduced now include, for example, new IT systems to enable communication with women in 30 different languages, and new IT systems that mean people know when their appointment is and are reminded of it. All these things sound quite straightforward, but they have not been in place across the country and it is important that they are. I mentioned the importance of addressing fears and embarrassment, improving information and reassurance to women, as well as more convenient times and booking systems. It is very important that we make better use of mobile screening units, so that screening is near to where women are.
Baroness Ritchie of Downpatrick (Lab)
My Lords, undoubtedly breast screening is vital—I know that from a personal perspective—but I ask my noble friend whether consideration could be given to lowering the breast cancer screening age to 40, to include for diagnosis those with triple-negative breast cancer, because many in the younger cohort are diagnosed with it.
Baroness Merron (Lab)
As my noble friend will be aware, we keep a very close eye on the science and the advice, and we will continue to follow that. I emphasise, and it was raised in an earlier question as well, that the NHS has been proactively writing to those women at very high risk of breast cancer who may not have been referred. I give an assurance that women who are at greater risk are not forgotten.
Northern Ireland Dentists: Amalgam Fillings
Baroness Ritchie of Downpatrick Excerpts(4 months ago)
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Baroness Ritchie of Downpatrick (Lab)
My Lords, I refer to my entry in the Register of Lords’ Interests. I welcome the derogation on amalgam fillings, because that issue has been persisting for some time. It proves that a Labour Government are working to find solutions to the outstanding matters relating to the Windsor Framework. In that respect, will the Minister and her colleagues undertake to provide us with details of the resetting of the relationship between the UK and the EU? There are several outstanding matters relating to veterinary medicines and the EU’s carbon floor.
Baroness Merron (Lab)
I am glad that my noble friend welcomes today’s announcement. I am sure the House will appreciate the particular set of circumstances surrounding amalgam, which are extremely complex. This has required considerable collaboration between several departments, as well as the devolved Administrations. I hope it will be regarded as something very positive, but I can assure my noble friend and your Lordships’ House that I will discuss with my ministerial colleagues the points being raised about the Windsor Framework and the relationships that that entails.
Immunisation: RSV
Baroness Ritchie of Downpatrick Excerpts(7 months, 1 week ago)
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Baroness Ritchie of Downpatrick
To ask His Majesty’s Government when a decision on eligibility for a potential 2024 respiratory syncytial virus immunisation programme will be confirmed, and whether this will be aligned to the Joint Committee on Vaccination and Immunisation’s September 2023 advice.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
The Government have made a policy decision on the eligibility of a potential RSV programme, which is in line with the JCVI’s September 2023 advice. We are working through the full business case, with costing and operational delivery, for final agreement in line with an autumn start.
Baroness Ritchie of Downpatrick (Lab)
I thank the Minister for his Answer, but what plans and resources, both staff and finance, are in place to enable the immediate implementation of any RSV immunisation programme for young infants and older adults, in line with the JCVI’s advice, once the ongoing market engagement and tender process is complete?
Lord Markham (Con)
That process is absolutely going on at the moment, as well as operational delivery aspects. For infants, it depends on whether we choose a vaccine that goes into the pregnant mother or the infant, as the delivery mechanisms are obviously different. We are looking at the effectiveness of not just one vaccination versus the other but the delivery mechanism. There is a different delivery mechanism for the group aged 75-plus. The full programme business case is considering exactly that to make sure that we can deliver in the autumn.
Lord Markham (Con)
Of course, the communication needed for each one is different, and that is a vital consideration. As I said, we found that, often, it is easier to put RSV in the infant rather than the pregnant mother. It is a question of considering which is the most effective way to get the best outcome and the highest take-up rate. That is one of the key criteria we are looking at. Regarding general communication, the noble Baroness will be aware that, on MMR, we have challenges in both London and the West Midlands. That has shown that you need other communication routes to get to some ethnic minority groups, using technology such as the app. There is no one silver bullet —you need a series of measures in place.
Baroness Ritchie of Downpatrick (Lab)
My Lords, is the Minister confident that the implementation programme will take place before the 2024-25 winter period, as promised in previous iterations of this Question?
National Immunisation Programme
Baroness Ritchie of Downpatrick Excerpts(10 months, 1 week ago)
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Baroness Ritchie of Downpatrick
To ask His Majesty’s Government what plans they have to accelerate the adoption of new innovative vaccines by the National Immunisation Programme.
Baroness Ritchie of Downpatrick (Lab)
My Lords, I was delighted to secure this debate as it is a subject of significant importance and one in which I have a close interest. Noble Lords will be aware of my particular interest in RSV, on which I had a Question only yesterday. But this is more about the global issue of which vaccines can get accelerated on to the national immunisation programme.
Undoubtedly, vaccines have contributed significantly to health and prosperity around the world ever since the pioneering work of Edward Jenner, who developed the world’s first vaccines for smallpox. The World Health Organization has said that vaccinations are
“one of the best health investments money can buy”.
Vaccines are critical to the prevention and control of infectious disease outbreaks, and they underpin global health security.
The Covid-19 pandemic imposed enormous pressure in 2020 and 2021, and it showed the importance of having robust plans and systems in place to address emergencies. Despite some setbacks, what both the UK and other countries achieved was remarkable. The pace at which vaccines were developed, manufactured and rolled out to patients was excellent. It was good that government, industry and the NHS came together to collaborate in order to accelerate existing timetables, taking months rather than years to get the job done.
I welcome the recently published NHS Vaccination Strategy and its emphasis on improving uptake rates and optimising the quality of the delivery of clinical trials. However, the strategy focuses on the better rollout of existing vaccines but does not include what more can be done to ensure that the UK has in place the right infrastructure for approvals and delivery, in order to enable new vaccines to reach patients as quickly as possible. I believe this is a mistake: we should focus on both. Put simply, we must improve the delivery of existing vaccines and spend existing money more effectively and efficiently in order to get new vaccines to patients more quickly and effectively. In fact, I received briefings this week from the Royal Pharmaceutical Society about the value of community pharmacies—their work had already been seen in the rollout during Covid-19—and how they can be used in this new deployment.
I was delighted recently to chair a round-table discussion with key stakeholders, hosted by GSK in your Lordships’ House on 19 October. It looked at this issue, lessons learned from Covid and how they could be applied to the national immunisation programme as we move forward. That discussion was very timely, following the Health and Social Care Committee’s report on vaccination, in which it said:
“It would be incredibly disappointing to reach a point where the vaccines themselves were ready but the infrastructure to approve and deliver them was still some time away”.
Our round table concluded many things, such as that quicker availability and increased uptake of vaccines would lead to a healthier nation, which in turn would have direct and immediate benefits for our economy.
Rather than looking at vaccines as a cost, we should see them as an investment. Recent studies have shown that the return on investment for vaccines can be as high as 14:1. Slow and low uptake of vaccines can cost the NHS money and soak up valuable resource. Each month that vaccine rollout is delayed means more patients attending general practice and A&E, and being there for hours on end, as well as more patients being admitted to hospital.
Working together, the Government, the NHS and industry can deliver a first-class national immunisation programme that gets new vaccines to patients as quickly as possible and delivers significant financial, operational and economic benefits. At a time when the Prime Minister has said that reducing waiting lists is a key priority for his Government, we must not forget the role that vaccines can play in helping to deliver this. I hope the Government are listening and will act. I am happy to share the round table’s report and its key recommendations with Members of your Lordships’ House, but we must turn words into action. We should be ambitious for patients, because we want to deal with all the health implications. We also want to address the new diseases that have not been subject to vaccines and could be readily dealt with.
We need a clear commitment from the Government to accelerate the NIP, and a clear and timetabled plan to achieve that. We need a commitment to work with industry and other stakeholders to deliver that plan. We must not let capacity or capability determine the speed at which vaccines enter the programme. That will mean a commitment to resourcing the JCVI adequately, and we need to improve JCVI horizon scanning and the liaison with industry. As we did during Covid-19, we should also establish a single front door to help industry navigate across government on routine vaccines.
I have some questions for the Minister. Will he give concrete commitments today to ensure the acceleration of the NIP, with a clear and timetabled plan to achieve it, and to work with industry and other stakeholders to develop that plan? If such commitments are given, can the Minister provide us with the timetabled plan, including an indication of the resources—staff and money—to deliver it? I know that there are many competing priorities for the Government, but there are also many for the National Health Service, not least the need to keep people well. However, these recommendations are all based on valuable lessons learned during Covid. I therefore seek your Lordships’ support for delivering them, as they will benefit patients, the NHS and the economy.
The UK built a world-leading vaccine development and deployment system during Covid-19 that enabled it to be at the forefront of global pandemic efforts. It is vital that the lessons learned during the pandemic are built on, to ensure that the UK has the right infrastructure in place for the approval and delivery of new vaccines on to the NIP, reaching patients as quickly as possible. We have the proven wherewithal to do it through the NHS and all the associated bodies.
Finally, when will the acceleration and accompanying works for NIP take place, and when will the funding be in place? I look forward to the Minister’s response and the contributions of other noble Lords on this very important issue, which impacts right across the UK. It relates specifically to NHS England, but I come from Northern Ireland, where this is a devolved matter. I am sure Scotland, Wales and Northern Ireland would like to do the same and see these approvals on to the national immunisation programme. It is vital for our health, our economy and our society.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
I too thank the noble Baroness, Lady Ritchie, for allowing us to have this debate today. To my mind, this is the right way to do business—for want of a better word. We have smart people who know about the subjects as well as people who have personal experience, and we are having a good conversation about how we can learn the lessons from the situation, make improvements and make sure that we are up to speed with the latest that is going on. Again, I thank the noble Baroness and all the contributors to this debate. I hope that I respond in the right vein.
As many have mentioned, we have a good track record in terms of the standing of the immunisation programme. NIHR is a fundamental piece of that. As mentioned on a few occasions, the horizon scanning by the JCVI is obviously a key part as well. I want to talk later about some of the Covid dividends that I am starting to see in terms of point-of-care medicines, with Moderna and BioNTech using messenger RNA. That goes right to what the noble Baroness, Lady Merron, said about the need to look at the new delivery mechanisms.
The JCVI is key to it all. This debate gave me the opportunity to understand more about the process that it goes through in trying to do that horizon scanning and make sure that we understand what is coming through in the pipeline, what differences it will make and how we evaluate that quickly. We have also commissioned the National Immunisation Schedule Evaluation Consortium to undertake policy research, going upstream even further, looking at the use of different vaccines and schedules.
As I mentioned before, probably the best thing we are doing in terms of the heritage is putting in place the new agreements, which I very much call a Covid dividend, knowing that we will be spending hundreds of millions a year on Covid vaccines for the foreseeable future. Let us make a benefit out of that necessity and get both BioNTech and Moderna to invest in the infrastructure in the UK so that we can do more of this research going forward. That is what I mean by the Covid dividend, as the noble Baroness, Lady Twycross, mentioned. It means looking at the point of care for some cancers, which is particularly exciting. It looks at a person’s particular cancer and cells and then alters and gives personalised treatment. I am sure we are all familiar with some of this. The beauty is that a person’s own body attacks the affected cells, without the blunt instrument of chemo, which kills lots of cells around the cancer as well.
The challenge—this goes right to the point made by the noble Baronesses, Lady Ritchie and Lady Merron, who asked how we deliver and whether the infrastructure is right for doing these sorts of things—is that all of our sudden you are moving from a model of mass production of vaccines in a big factory to individual, tailored creation of vaccines, and often some of the substances are very unstable. In one example I was given, you have only 20 minutes to use it. In that environment, you need to look much more at the real point of care and have a point-of-presence delivery that is not a big factory but where the capability is very close to the patient, whether in a GP or hospital environment, to produce and then deliver those sorts of drugs. In terms of our main learnings, that will be a major dividend from Covid and will transform the whole way in which we deliver our medicines. I hope that, in time, we will see the replacement of chemo in a lot of places with much more specific, delivered medicines.
As I said, I will write about anything I may have missed—as noble Lords will be able to hear, I am very croaky, and I have another debate after this one. In reply to the noble Baroness, Lady Ritchie, I would indeed be interested in hearing the GSK results from the round table. I hope that I have given some reassurance on the infrastructure, but I will give more detail on that as well.
The key point is that, while we can talk about all the sexy stuff in terms of the innovation and treatments, the point made by the noble Baroness, Lady Twycross, from her own experience of issues around MMR, really shows the importance of this. As I mentioned in the debate the other day, I spoke to Chris Whitty specifically about this. It is the most infectious disease out there. We all got used to R rates of 1.1 and 1.2 during Covid. That is a really big R rate, where you know it will be exponential. Noble Lords heard me mention that the R rate on measles is 13, which is massive. One in 1,000 people suffer from brain damage from it, so I completely agree with the noble Baroness that the idea of chickenpox parties is very outdated. I remember them from my childhood. I know that they are reviewing the chickenpox vaccine as we speak.
As I said, we are gearing up on the RSV process. The tender is going out as we speak, and we are looking at delivery this autumn. As I mentioned the other day, it is a different process depending on whether it is for maternal or baby use, or for the over-75s, but we are going through that process.
I will come on to some of the other questions. Thank you for the research; I agree on Steve Russell. The main point made by the noble Lord, Lord Allan, was about user-friendliness. I had my own experience of this when, knowing that I had these debates coming up, I asked the team to get me a schedule of everything that the JCVI has approved. They gave me a list of all these vaccinations, and I had to go back with my tail between my legs and ask, “Can you tell me what all these things are for?”. The noble Lord mentioned AF—I like to think that, similarly, I know quite a few of the abbreviations these days, but I needed them to give me the Noddy guide. The language for those using the app is vital. It is a critical piece to help inform people, especially when they are looking at their records. As the noble Lord is probably aware, the records are currently forward-looking: we need to start getting them to go back historically, and that is something I see a real utility in; it is not there today but it needs to be. The beauty of that is it can be optimised for the target audience. On the question of how we increase uptake in those hard-to-reach areas—as the noble Baroness, Lady Merron, mentioned—the most effective way of doing that to date has been ringing up the parents of under-5s, and then moving on to under-11s and under-25s. Doing that through the app will clearly be more effective in terms of time and money, so that must be the way forward.
The role of community pharmacies is a vital part of delivering point-of-care medicines. I was really interested to hear on one of my trips that GPs in America are really struggling as a profession these days. They cannot recruit them; I asked why not, and they said the problem was that many of the routine things that GPs were making money from had been mass-industrialised by the likes of CVS and Walgreens. This really resonated when the noble Baroness mentioned the app; we need to make sure these vital medicinal and well-being hubs are thriving, and that we do not repeat the American experience. That is why Pharmacy First is a very positive thing for promoting community pharmacies as a place for patients to get care and as a way of improving the finances and commercial viability of these places that I see as key assets.
The question about the AMR benefits of these vaccines was interesting; I do not know the answer off the top of my head, but I will take it away and try to come back with a detailed answer. To conclude—
Baroness Ritchie of Downpatrick (Lab)
I thank the noble Lord for giving way. In the fullness of time—I know time is short today—could he give some thought, along with his ministerial colleagues, to the acceleration of the NIP programme so that it is possible to get other vaccines on to it, because of the infrastructure, the funding, the investment and the staff in it, so that we can use the good practice we have to benefit our economy, health and patients generally?
Lord Markham (Con)
Yes, I must admit that I need to write to the noble Baroness on the NIP programme because I do not have the detail, but I undertake to do that.
In conclusion, I thank noble Lords; these informed debates have real value. I will take up those points about the use of clear language and acronyms, and make sure that we are accelerating those basic vaccines, which is a vital part of this.
Dementia
Baroness Ritchie of Downpatrick Excerpts(10 months, 1 week ago)
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Baroness Ritchie of Downpatrick (Lab)
My Lords, I welcome the ability to participate in this debate and I congratulate the noble Baroness, Lady Browning, on securing it. I wanted to participate in it as I have family members and political colleagues who, sadly, have either died as a result of dementia or are currently living with it. For me, one of the keys is diagnosis and the need for greater levels of investment in diagnostic tools and then medicine to slow down the progression of the illness.
More than a quarter of a million people are living with undiagnosed dementia in England. More than one-third of people with dementia in England and Northern Ireland do not have access to a diagnosis and, therefore, to the vital care and support it unlocks. Like the noble Lord, Lord Weir, I am a member of the APPG. We readily know the problem in Northern Ireland, and I agree with him that there is definitely a measure of equality in the integration of health and social care.
Part of the problem to do with diagnostic tools is the lack of magnetic resonance imaging and computed tomography scanning capacity in the memory assessment pathway, and lack of positron emission tomography scanners for accurate diagnosis of dementia subtypes. We have one of the lowest per capita ratios of these scanners in the OECD; we are behind Russia, Slovakia and Chile. Can the Minister advise on what steps the Government are taking to further invest in diagnostic infrastructure for dementia?
Furthermore, with the Government’s proposed reforms to the MHRA, cutting-edge medicines could be made available in the UK much more quickly than previously. This includes drugs such as lecanemab and donanemab—the first drugs proven to slow down the progression of Alzheimer’s disease. This means that the NHS must also be supported to prepare for this prospect. I therefore ask the Minister to provide details on what steps the Government are taking to prepare the NHS to deliver ground-breaking treatments such as those already mentioned. There is also a need for an adequate long-term social care workforce strategy, which has already been referred to by the noble Baroness, Lady Browning.
I look forward to the Minister’s answers. I hope that he will be able to provide a pathway to better investment in diagnostic tools and the provision of medicine to slow down the progression of dementia.
Health: RSV Immunisation
Baroness Ritchie of Downpatrick Excerpts(10 months, 1 week ago)
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Baroness Ritchie of Downpatrick
To ask His Majesty’s Government what steps are being taken to ensure that appropriate funding is in place to deliver immunisation programmes for respiratory syncytial virus by the 2024/25 winter season, and when an implementation plan will be published.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
The Government published a prior information notice on 27 November 2023 outlining the market’s intention to tender against its requirements for infant and adult RSV programmes in 2024. Following the tender and the confirmed potential budget implications, a final decision on programme designs will be taken alongside an implementation plan for autumn 2024.
Baroness Ritchie of Downpatrick (Lab)
My Lords, I thank the Minister for his Answer. For the avoidance of doubt, can he explain to your Lordships’ House what funding has been allocated to the national immunisation programme for the 2024-25 winter season; what proportion of that funding has been allocated for immunisation programmes for adult, infant and neonate RSV; and what conversations have been held with NHS England regarding readiness to implement the RSV immunisation programme, as advised by the JCVI?
Lord Markham (Con)
First, I thank the noble Baroness. She has been a tireless campaigner on this issue and very good—quite rightly—at holding our feet to the fire. The exciting news is that the new vaccines that are coming along for both mothers and infants, as well as the over-75s, are now cost effective; that was recognised in the JCVI’s analysis. As part of that, we have plans to fund the programme, as mentioned. I would rather not go into the details of the actual budgets, because they depend on the tender and I do not want to give that information out to the market—but I can reassure the noble Baroness that plans are in place.
Cancer Research UK Report
Baroness Ritchie of Downpatrick Excerpts(11 months, 3 weeks ago)
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Baroness Ritchie of Downpatrick
To ask His Majesty’s Government what assessment they have made of the report Longer, Better Lives: A Manifesto for Cancer Research and Care, published by Cancer Research UK on 28 November, regarding their priorities for investment in clinical research and innovation.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
The Government welcome the Cancer Research UK report Longer, Better Lives, which rightly highlights progress made against cancer. We have invested over £100 million in cancer research in 2021-22 through the National Institute for Health and Care Research. We are working closely with research partners in all sectors, and I am confident that the Government’s continued commitment to cancer research will help us to build on that progress, leading to continued improvement for all cancer patients.
Baroness Ritchie of Downpatrick (Lab)
I thank the Minister for his Answer. The CRUK manifesto clearly highlights the priorities required for tackling rising cancer rates with a growing ageing population, including the need for more investment in research, greater disease prevention, earlier diagnosis through screening, better tests and treatments, as well as cutting NHS waiting lists and investing in more staff. Can the Minister outline what steps the Government will take to implement this strategy, allied with resources and updated infra- structure in all hospitals?
Lord Markham (Con)
Absolutely. I thank the noble Baroness for the work that she does in this field. I welcome the manifesto, specifically on rebuilding the global position in research. We have done a good job on that: we have gone from a position of 26% of the clinical trial responses being in time to international standards to over 80%. The biggest prevention method that anyone could take is to stop smoking because, as we know, that is the biggest cause of lung cancer, so we are introducing steps to prevent smoking. On early diagnosis, we have introduced an excellent example in lung cancer. Some 60% of people used not to be detected until they were stage 4, which is often too late. Now, through the mobile lung cancer units, we are detecting 70% at stage 1 or 2, where they have a 60% chance of survival. Across the field, we are doing a lot on this that we can feel proud of.