Cancer Workforce and Early Diagnosis

Bambos Charalambous Excerpts

Tuesday 8th January 2019 Westminster Hall

[Bambos Charalambous (Enfield, Southgate) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Howarth. I congratulate my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick) on securing this important and timely debate.

Lives are saved when cancer is diagnosed early. I know we all are united in wanting all cancers to be caught early so that survival rates can be drastically increased. However, to diagnose and detect cancer early, we need a sufficiently skilled workforce and full staffing. NHS staff do amazing work, but they are under extreme pressures. We are one of the richest countries in the world, but lives are being lost because of under-investment in our NHS workforce. If we are to come anywhere near to achieving the Prime Minister’s target of diagnosing three in four cancers at their early stages by 2028, we will need to have a long-term plan that will deal with the staffing shortages, which will no doubt get worse post Brexit.

Cancer Research UK estimates that by 2035 a person will be diagnosed with cancer every minute. At present nine out of 10 people will survive bowel cancer if it is diagnosed at an early stage, but that figure reduces to only one in 10 if it is not diagnosed until stage 4. Currently between 46% and 61% of cancer sufferers are diagnosed at stage 1 or 2, which means that people are slipping through the net and dying needlessly owing to a lack of resources. With 40% more people being referred for diagnostic cancer tests than four years ago, cancer diagnostic services are struggling to keep up with demand. They have already missed their cancer waiting time targets over the past three years.

I am the co-chair of the all-party parliamentary group on breast cancer. The rest of my comments will focus on breast cancer, for which the situation is even worse than I have been outlining. The breast imaging and diagnostic workforce are critical for the early diagnosis of breast cancer, but Breast Cancer Now has discovered that only 18% of breast screening units are adequately resourced with radiography staff to meet demand. Taking into account the ageing workforce of breast imaging radiographers and the increase in demand, we have an exacerbation of pressures that will only get worse. For every three breast radiographers who retire over the next five years, only two are expected to replace them, which means that imaging and diagnostic services will be unable to keep up with demand. That will cause delays, which in turn will cause greater anguish for those waiting to be tested.

Fifty-five thousand people are diagnosed with breast cancer in the UK every year, yet the survival rates lag behind those of Sweden, Portugal, Germany and France. We have a declining workforce and an increase in demand. Unless the Government invest in a fully funded workforce plan, patients will suffer. We need a new approach to workforce planning based on best practice and clinical need. Health Education England must produce phase 2 of the cancer workforce plan, which looks at how many staff are needed to meet growing patient demand, and set out a 10-year cancer workforce strategy. The plan must be backed with appropriate funding. Breast Cancer Now has called for the Government to invest £39 million in recruitment to the breast imaging and diagnostic workforce as part of the plan to cover the cost of training to fill clinical radiologist vacancies and to address the current shortfall in radiographer numbers.

The Government’s decision to scrap bursaries for allied health professionals and nurses is a factor in making it harder to recruit. Someone who wants to become a mammographer must self-fund an MSc following a three-year radiography degree. Prior to the 2017 bursary cuts to allied health professionals courses, including for diagnostic radiographers, the undergraduate degree was covered by a bursary. Following that disastrous cut, there was a 20% decrease in the number of applications to allied health professionals courses and a further 9% cut in 2018. That under-resourcing, directly linked to the Government’s bursary cuts, has undoubtedly cost lives. I urge the Minister to reverse the cut to bursaries to ensure that the financial barriers to becoming a mammographer are removed and that more applicants are encouraged to apply for allied health professionals courses.

Funding for early diagnosis is not just about staffing levels and recruitment. It is also about new technology. There are new improved ways of detecting breast cancer, such as via tomosynthesis, which is far more effective in detecting breast cancer in some women. Artificial intelligence could also be used to assist in analysing the vast data capture involved in screening, but that would require the commitment by the Government of investment in new technologies and training. Risk-stratified breast screening is another way of making better use of technology to assess a woman’s individual level of risk by using algorithms to assess various risk factors. Once an assessment has been done, a more personalised service can be given for women at higher risk, which could again help to save lives.

I will finish by asking the Minister whether he will commit to getting Health Education England to produce phase 2 of the cancer workforce plan, which will be based on need, and confirm that it will be properly funded. Will he reverse the cuts to bursaries for courses for allied health professionals and nurses, and make sure that recruitment levels are up to the levels that are required, especially with Brexit looming? Finally, will he commit to exploring and funding new technologies and training that will help to detect cancer earlier, target those who are at higher risk, and alleviate the pressures on the workforce? If the Government do not get things right in relation to the shortfall in funding for early diagnosis and the cancer workforce, some people will inevitably die an avoidable death from cancer.