Cancer Outcomes in the UK

Baroness Bottomley of Nettlestone Excerpts

Tuesday 21st April 2026 Grand Committee

[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)]

It is because of the speaker system.

[Baroness Bottomley of Nettlestone (Con)]

Okay, maybe he can shout a bit.

[Lord Patel (CB)]

Can everyone hear me now? Can the noble Baroness, Lady Bottomley, hear?

[Baroness Bottomley of Nettlestone (Con)]

Yes.

[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.

--- Later in debate ---

[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.