Cancer Workforce and Early Diagnosis

Craig Tracey Excerpts

Tuesday 8th January 2019 Westminster Hall

[Thangam Debbonaire (Bristol West) (Lab)]

It is a pleasure to serve with you in the Chair, Mr Howarth. I thank my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick) and other hon. Members for their contributions.

I will focus on cancer affecting children, teenagers and young adults. As hon. Members know, I have personal experience of breast cancer, but more expert people in the Chamber will talk about that, so I will discuss the form of cancer for which I recently set up the all-party parliamentary group on children, teenagers and young adults with cancer.

I set up the group because each year in the UK, 4,450 children and young people under 25 are diagnosed with cancer—that is 12 children and young people every day somewhere in the UK. Four out of five of them will survive for five years or more, but for the parent of a child such a survival rate seems minuscule. Most of us expect our children to survive far longer than that, so the survival rate can seem quite hard. Those of us who have had adult cancer might think, “Oh good—five years! I’ll still be around in five years’ time.” For adults, that feels like a success; for children, not so much.

Cancer remains the biggest killer by disease of children and young people under 25 in the UK. That is important, because one of the reasons why cancer is the biggest killer is that other diseases have declined. That is a good thing, but cancers still affect many children. We want the incidence to decrease, and the number of children surviving and being diagnosed earlier to increase. The all-party parliamentary group wants things to be better. The Minister knows that, because he has been good to the group and worked closely with us. We understand that the small number of children affected can make it difficult to identify real specifics that could make a big difference, but because the number is small, some of the things that we want might be relatively straightforward to do.

Last year, we held an inquiry into young people’s experience of childhood and young adult cancer. We now call on the Government and the NHS long-term plan to look at the impact of a young person’s route to diagnosis. Recent research by CLIC Sargent found that more than half of young people had to visit their GP at least three times before their cancer diagnosis. Katie, the young woman who was a panel member in our inquiry, said that because childhood and young people’s cancer is so rare, GPs did not expect to see it, so frequently signs and symptoms were misunderstood. I have the greatest sympathy for GPs and clinicians, and because those cancers are so rare, we would like a training and e-learning module for healthcare professionals.

CLIC Sargent and the Teenage Cancer Trust have teamed up to create such a module on the signs of cancer in children and young people, developed in partnership with the Royal College of GPs. We would like more support in the NHS workforce to improve recognition of the signs, whether that is the e-learning module or something different. I hope the Minister will say something about that when he sums up. In the NHS long-term plan published yesterday I was really pleased to see a specific mention of childhood cancer, but I was disappointed that there was not more emphasis on skilling up the healthcare workforce to recognise the signs and symptoms. We all know that often the consequence of failing to make an early diagnosis is a very poor survival rate.

In our inquiry we recommended many measures, which the Minister has very kindly agreed to go through with his officials and respond to in some detail. Perhaps after the debate, will he liaise with my office about a time to meet? I am grateful to him for his willingness to do that, but we would like to make some progress in the first half of this year. Some of our recommendations are relevant to this debate. We say that the Secretary of State for Education should ensure that every young person receives health education that includes cancer signs and symptoms, done in an appropriate way. The Teenage Cancer Trust has developed an education module, which many of us will have seen recently when it was demonstrated in Parliament. I would like to see something such as that being used.

[Craig Tracey (North Warwickshire) (Con)]

The hon. Lady makes an excellent case for education. As co-chair of the all-party parliamentary group on breast cancer, I want to raise the fact that about 3,500 breast cancers go undetected each year due to women not understanding the risk due to breast density. Education would seem critical as part of the long-term plan to get world-class outcomes, so that people understand their personal risk.

[Thangam Debbonaire]

The hon. Gentleman is absolutely right; education is critical across all cancers, particularly breast cancer. Many young women need more under- standing of how their risk can be reduced by certain lifestyle choices. I say that carefully, without wishing to blame cancer survivors, because there is a difficult balance. Education is important, because the health service we want for the 21st century is about health rather than sickness. I wanted to see more emphasis in the NHS long-term plan on prevention.

Will the Minister respond to some of our recommendations in his reply to the debate? The all-party group thinks that an emphasis on prevention is critical to young people’s long-term survival and long-term health—not long-term sickness. We are concerned about the shortage of radiographers and radiologists, but other Members will discuss that. If more children and young people with cancer are to survive longer than five years, early diagnosis is critical. Health professionals may see only one childhood cancer in their entire professional life, so they will need help. I ask the Minister to talk to us and to his officials about how to help the professionals to do better. We would like more education for young people on a range of cancer indicators and on ways to change their lifestyle, such as exercising more, reducing alcohol consumption and so on. We all know about those actions, but quite often it is too late; we could do with knowing them from an early age and building them into our way of life, starting when we are young.

I want to conclude, without getting too emotional, by paying tribute to CLIC Sargent and to the Teenage Cancer Trust in particular. They do so much, not just for children and young people but for parents and families. Members of my family received help from CLIC Sargent. My dear sister-in-law works for CLIC Sargent and she has been an inspiration to me on childhood cancer. I want the work they have done to be embraced by Ministers other than this Minister, who already has embraced it, to take that forward in the NHS long-term plan.

Oral Answers to Questions

Craig Tracey Excerpts

Tuesday 23rd October 2018 Commons Chamber

[Steve Brine]

Let me just pay tribute to the hon. Gentleman for the work that he has done, bringing this matter to the fore and really pushing it forward. The answer is as soon as possible. I also want to make sure that I can involve the other agencies. Public Health England will be very important in this, because, of course, not every woman eats bread and therefore takes the flour supplement.

[Craig Tracey (North Warwickshire) (Con)]

I am sure that the Minister is aware that October is breast cancer awareness month. I welcome the ambition that the Prime Minister set out at the party conference for 75% early-stage diagnosis. There is some concern that, as breast cancer is already above that, there is no ambition left for it to do even better. Can he assure me and the breast cancer community that that is not the case?

[Steve Brine]

That is certainly not the case. We had a very good debate on breast cancer last week. It is BCAM still this month for another week. The 75% was a target, a new national ambition. It most certainly is not the limit of our ambition.

Mental Health Units (Use of Force) Bill

Craig Tracey Excerpts

3rd reading: House of Commons
Friday 6th July 2018 Commons Chamber

[Craig Tracey (North Warwickshire) (Con)]

It is a pleasure to follow my hon. Friend the Member for Horsham (Jeremy Quin). I echo many of the points that have been raised by colleagues today and in the debate three weeks ago, at which I was present although unfortunately did not get the opportunity to speak.

I congratulate the hon. Member for Croydon North (Mr Reed) on the work he has done and the success he has had in gaining support not only across the House, but from Government, for this Bill, which I think we all agree is incredibly important.

I fully respect the intentions behind the Bill and the potential impact it could have for families affected by mental health. I would like to pay tribute to the hon. Gentleman’s endeavour to honour Seni Lewis’s memory in this way. I understand that Seni’s law, as the Bill is known, is personally important to the Lewis family, who have campaigned tirelessly on this issue with considerable success. These are important proposals for people in all our constituencies, and particularly those who have a family member or relative suffering with mental health issues. They need to know that the mental health units that their loved ones are in the care of are providing a safe and secure environment. That is a basic and fundamental right and expectation.

Around 9,000 people are restrained in mental health settings a year in England. The Bill is a significant piece of legislation, as it will serve as an important reform of the way in which we treat those detained under the Mental Health Act. It also represents significant progression in this area. It is about ensuring trust and accountability in the mental health system—something that tragic case studies have sadly shown is not always in place. I think every Member in the Chamber today would like to see a reduction in the use of force, and the Bill will help to provide that reduction.

However, while targets are all well and good, in certain circumstances—for example, when a patient is violent—the people caring for a patient might need to be able to protect themselves from harm and might have to resort to some form of force to do so. Assuming that use of force is a last resort, proportionate and does not risk the patient’s health, it is reasonable that they are afforded that protection. I appreciate that this is a delicate area, but it is important that clarity is provided in the published policies and that balance is sought.

I think it is fair to say that we cannot foresee every violent and threatening situation that may arise. Clearly we want a reduction in the use of force, and we can question the frequency of its use, but we must also consider a mental health carer who may find themselves attacked by a patient who may not understand what they are doing. We do not want to put people off undertaking this important role, for fear of prosecution. While these are obviously courses of action that we hope will never be needed, it is impossible to rule out situations arising in which one of them is a necessary last resort, in the best interests of both patient and carer.

Mind, the mental health charity, which does such important work in this area, makes a useful contribution to this consideration, saying:

“Healthcare staff and police do a challenging job and sometimes need to make difficult decisions very quickly. Often they use force to control someone’s behaviour, which can include physically restraining someone against their will, injecting them with medication and using seclusion to confine and isolate someone on the ward. For the person in crisis, this can be humiliating, traumatising and even life-threatening.”

A balance must be found in the interests of the wellbeing and safety of all of those involved.

The Bill complements the real focus we have seen from this Government on mental health, and in particular the treatment, priority, stigma and people costs of mental health matters. In October 2017, the Prime Minister announced that the Government would embark on a comprehensive review of the Mental Health Act, with a final report later this year. I am encouraged that the review will examine existing practices and address the disproportionately high rate of detention of people from ethnic minorities. As a country, we have taken progressive steps to improve the mental health sector, and the Bill is another step in the right direction. The Parliamentary Under-Secretary of State for Health and Social Care summed it up pretty well in Committee when she said:

“Perhaps one of the most important aspects of the Bill is that it enshrines accountability for ensuring that any institution fulfils its responsibilities. The buck needs to stop somewhere, and it is important that happens with someone at board level.”––[Official Report, Mental Health Units (Use of Force) Public Bill Committee, 28 March 2018; c. 7.]

I wholeheartedly agree with that sentiment, so I am pleased to support the Bill today.

Oral Answers to Questions

Craig Tracey Excerpts

Tuesday 19th June 2018 Commons Chamber

[Mr Hunt]

I am grateful to the hon. Lady for raising that issue. She is introducing a debate on it in Westminster Hall on Thursday. I have met a number of families who have suffered very badly as a result of ME, and we would all like better research, so I hope that her campaign is successful.

[Craig Tracey (North Warwickshire) (Con)]

6. What recent assessment he has made of the public health benefits of participation in sport.

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

There is a strong body of evidence on the health benefits of participating in sport— possibly not watching it, if last night is anything to go by. Last year, a review by Sport England brought together evidence to show the association between sport and physical and mental wellbeing.

[Craig Tracey]

As the Minister may be aware, I co-chair the all-party parliamentary group for golf—a sport sometimes labelled, rather unfairly, a good walk spoiled. Does he agree that there are many positive health benefits associated with participation in golf, especially for people with long-term conditions?

[Steve Brine]

I certainly would, as someone who used to work in the golf industry before coming to the House. I was at Wentworth last month for the PGA, and a good example of what my hon. Friend refers to is a social enterprise that I met called Golf in Society led by an inspirational chap called Anthony Blackburn. He founded a project at Lincoln Golf Centre that works with people with dementia and Parkinson’s disease to show that golf is one of the best leisure activities out there, and gives people with those long-term conditions a sense that their life is not over and that they can still play golf, and play it rather well—probably better than me.

Breast Cancer Screening

Craig Tracey Excerpts

Wednesday 2nd May 2018 Commons Chamber

[Mr Hunt]

PHE has given clear assurances that the problem has been fixed, but it is open to any suggestions that the review makes as to how things could have been handled better.

[Craig Tracey (North Warwickshire) (Con)]

I thank the Secretary of State for his statement. As co-chair of the all-party parliamentary group on breast cancer, I know that his Department takes breast cancer seriously, so the Secretary of State and the ministerial team will no doubt be as disappointed as I am that the statement was necessary today. However, will he set out what the women affected need to do and, importantly, what additional steps can be taken to reassure and support those women?

NHS Staff Pay

Craig Tracey Excerpts

Wednesday 21st March 2018 Commons Chamber

[Mr Hunt]

What the hon. Lady chose not to tell the House was that since the time of the last Labour Government, we now have 5,500 more nurses and 15,000 more doctors in the NHS, and there has been a 9% rise in NHS funding. [Interruption.] I hear the shadow Secretary of State talking about vacancies from a sedentary position. I hope that he will also welcome the 25% increase in the number of doctors and nurses whom we are training precisely so that we can fill those vacancies.

[Craig Tracey (North Warwickshire) (Con)]

I welcome the announcement, and it was great to see the Secretary of State meeting staff at my excellent local hospital, the George Eliot, recently. What will be particularly welcomed is the hugely progressive nature of this deal, with its focus on the lowest paid. What exactly does it mean for those at the very bottom of the pay scale?

[Mr Hunt]

For people starting off in nursing, there will be a rise of about £2,000, which will make a very big difference, and we are increasing the minimum starting salary for anyone working in the NHS by about £2,500. This is completely in line with the Government’s policies over a whole range of areas. We have prioritised increasing the amount people can earn tax-free before paying any income tax at all. We have taken millions of people out of income tax. That is because this Government are committed to helping the lowest paid.

Oral Answers to Questions

Craig Tracey Excerpts

Tuesday 20th March 2018 Commons Chamber

[Steve Double (St Austell and Newquay) (Con)]

16. What steps he is taking to increase the capacity and availability of GP services.

[Craig Tracey (North Warwickshire) (Con)]

21. What steps he is taking to increase the capacity and availability of GP services.

[The Parliamentary Under-Secretary of State for Health (Steve Brine)]

We of course recognise the shortages in general practice, which is why we remain committed to delivering an additional 5,000 doctors working in general practice by 2020 compared with 2015.

--- Later in debate ---

[Craig Tracey]

It is great to see that record numbers of medical students are going into general practice this year, but far too many GPs are choosing to retire and leave the NHS when they are in their 50s because of tax penalties on their pension scheme. Does the Minister agree that we need to address that situation so that experienced GPs are not penalised for staying in the NHS?

[Steve Brine]

Along with concerns about workload and, for example, indemnities, pensions are an issue that older GPs often bring up with me. Ultimately, it is a matter for Her Majesty’s Treasury. My hon. Friend the Member for South West Bedfordshire (Andrew Selous) raised a similar issue at Prime Minister’s Question Time last week, and the Chancellor was on the Bench to hear it. I am sure he will read the report of these exchanges, too.

Cancer Strategy

Craig Tracey Excerpts

Thursday 22nd February 2018 Commons Chamber

[Craig Tracey (North Warwickshire) (Con)]

I am delighted to be taking part in today’s debate. I know that this is an important area for the Government. I congratulate the members of the all-party parliamentary group on cancer on securing time for the debate today. Since 2010, the Government have recognised the need to improve cancer services offered by the NHS and to make the UK a world leader in cancer research, diagnosis, treatment and care. Many innovations have been introduced, including the cancer drugs fund and the implementation of the independent cancer taskforce’s strategy. Cancer survival rates are at a record high, and access to the world’s leading cancer drugs continues to improve. It is clear that a lot of great work is already being done.

I would like to focus specifically on breast cancer. It has been a real honour for me to be co-chair of the all-party parliamentary group on breast cancer for the past three years. This has given me the chance to meet and work with a range of really inspirational people, from patients through to clinicians. It is great to see two former chairs of the group representing both Front Benches here today. During his time as chair, the Minister in particular did some really good work on age-related risk, and it is good to see that he is carrying that on. I hope that we will be able to tempt him to talk about some of the work he is doing when he speaks later.

As we know, breast cancer is the UK’s most common cancer, with 11,500 women and 80 men dying from the disease every year. That said, great strides are being made in diagnosis and treatment, leading to survival rates doubling in the past 40 years. One of the key recommendations in the cancer strategy is on early diagnosis, with a target that, by 2020, 95% of patients will be diagnosed and receive results within four weeks. I want to concentrate my remarks on an area that is critical to achieving that ambition and that is often referred to as the biggest breast cancer risk that women are not aware of—namely, breast density.

During my work with the APPG, issues surrounding breast density have become clear, particularly the increased risk and the masking of cancers in mammography. Mammograms are obviously the main method of national screening and, while considered the gold standard, evidence shows that they are not as effective for women with dense breasts. Before I move on, it is important to understand the implications of breast density. It is not uncommon, with 40% of women aged over 40 having dense breast tissue. Although it is completely normal to have, it is also a well-established predictor of developing breast cancer. Women with the highest density are between four and six times more likely to develop the disease than those with less dense breasts.

The challenge is that tumours show up as white on a mammogram, but so does the dense tissue, meaning that the cancer is missed in more than 50% of cases. To illustrate the significance of that, it is useful to recount a couple of examples given to me by patients that highlight the importance of the issue and the differences in approach by country. One lady living in the UK underwent mammogram screening from 2004 to 2012, receiving a clean bill of health each time. Shortly after her fourth mammogram, she found a lump, which was later found to be 7 cm in size and had been missed for over 10 years due to her breast tissue being 75% dense. She underwent a mastectomy and, as a result of her illness, was forced to give up her business. Six years later, she continues to undergo breast construction surgery. Compare that experience with that of another patient I met who lives in France. In 2016, her first ever mammogram was clear. However, as she was also diagnosed as having dense tissue, she was immediately referred for an ultrasound scan, which revealed an 8 mm invasive tumour. As a result of the early detection, she received minimal treatment and an extremely positive outcome. Sadly, the first experience is not unusual, with 3,500 breast cancers going undetected each year in the UK alone.

I am aware that there is a global movement to educate not only women, but also health professionals about the implications of density, with a view to ultimately saving lives by promoting earlier diagnosis, so that tumours can be found when they are small. In the USA, 30 states have passed legislation to provide women with some level of information on breast density, detailing the increased risk they face and how effective mammograms are likely to be for them. Having raised it with the Minister previously, I know that he has a great deal of interest in this area, and it is pleasing that some action is already being taken in the UK, with the Government commissioning research from the University of Warwick. However, clear evidence shows that high breast density eclipses family history as a risk factor for actually developing breast cancer.

What are the solutions? In an ideal world, the answer would be to change screening guidelines and offer further screening to those women at risk. For changes on this scale, I appreciate that we need to await the outcome of the research so that long-term decisions can be reached, but a relatively straightforward solution can be achieved right now. We should not ignore the breast cancer experts in the UK, who are already educating about breast density, as there is a definite need to promote awareness not only to women, but health professionals, including GPs, who are the usual first port of call for women concerned about their health. The simple task of educating about breast density can potentially promote more positive health outcomes, lead to less harsh treatments, reduce mastectomies, avoid secondary cancers and, ultimately, save lives.

In conclusion, I have learned an awful lot about breast density over the past two years, and I would like to think that more people will be informed about its potential impact as a result of today’s debate. However, the following questions remain. Do the women in your family or among your friends know the risk from breast density? Does your mother, wife, sister or daughter know that a clear mammogram may not actually be clear? Those potentially life-saving pieces of information should be available to every single woman to ensure that the Government’s excellent ambition to deliver world class cancer outcomes and even better cancer survival rates can be achieved.

Oral Answers to Questions

Craig Tracey Excerpts

Tuesday 6th February 2018 Commons Chamber

[Mr Hunt]

The hon. Lady always speaks powerfully about the social care system. One of the key parts of the social care Green Paper that we are currently working through is on market stabilisation. We have seen a number of care homes go under, although the number of beds overall has remained broadly stable, but our particular concern is, as she rightly points out, people in the advanced stages of dementia who might not be able to get the care that they want. This is a key focus of our work.

[Craig Tracey (North Warwickshire) (Con)]

T7. I have had concerns highlighted to me over the national cancer patient experience survey in the light of the introduction of a new national opt-out model. Can the Minister confirm that the survey will continue to deliver the same high-quality data annually and can he tell me when a final decision on its format is likely to be made?

[The Parliamentary Under-Secretary of State for Health (Steve Brine)]

I have listened carefully to cancer charities, clinicians and patients on the importance of the cancer patient experience survey. I have been clear that, whatever form the CPES takes as a result of the changes to how confidential data is shared, we want the survey to continue with a methodology as close to that of the current survey as possible.

Oral Answers to Questions

Craig Tracey Excerpts

Tuesday 19th December 2017 Commons Chamber

[Mr Hunt]

If we decide that we want more nurses following Mid Staffs, that creates vacancies. If we want to transform mental health provision, that creates vacancies. That is why we announced a workforce plan, which I notice the Welsh Government have not had time to do yet. But I will finish by wishing the hon. Gentleman a merry Christmas. If he wants to take a bit longer off and stay away for January, we are happy to hold the fort.

[Craig Tracey (North Warwickshire) (Con)]

T2. Research shows that breast density is a strong predictor of developing breast cancer, yet many women remain unaware of the risk. Will the Minister confirm what steps are being taken to educate women with this potentially life-saving information?

[The Parliamentary Under-Secretary of State for Health (Steve Brine)]

My hon. Friend asks an important question. We have just commissioned Warwick University to investigate the links between breast density and breast cancer. If the findings suggest that there should be any changes to the national breast screening programme, the UK national screening committee will of course consider that, as it does with any new evidence that helps it to target screening appropriately and make women aware of any increased risk of breast cancer. I will be watching this like a hawk.