National Cancer Plan

Baroness Merron Excerpts

Monday 10th February 2025 Lords Chamber

[Lord Scriven (LD)]

My Lords, I thank the Minister for the Statement. Like the noble Lord, Lord Kamall, I thank those individuals who work day in, day out with people who have been diagnosed with cancer, and with their families, for the great work they do. This cancer plan represents an opportunity to make significant progress in the country’s fight against this terrible disease. The Statement and the plan, while containing some promising elements, require careful scrutiny. In the view of these Benches, further action is required if we are truly to make the necessary strides in the fight against this devastating disease.

Cancer, as we all know, touches every family in the country. It is a relentless adversary and our response must be equally determined. The plan before us rightly acknowledges the importance of early diagnosis and I commend the focus on initiatives such as the expansion of screening programmes and the innovative use of technology to detect cancers earlier. Early detection is, without question, the single most powerful tool we have to improve patient outcomes.

However, we have some concerns. While the rhetoric around early diagnosis is welcome, the plan lacks sufficient detail on how we will address the very real workforce shortages that plague the NHS. We cannot diagnose cancers early if we do not have the radiologists, pathologists and oncologists to interpret results and deliver timely treatment. The Government need a concrete plan for recruitment and retention of these vital professionals. I urge them to address these critical gaps and ask the Minister exactly how these gaps will be plugged.

Furthermore, the plan’s ambition for personalised medicine is laudable, but it seems somewhat detached from the realities on the ground. Access to cross-cutting treatments and clinical trials remains uneven across the country. We must ensure that one’s postcode does not determine a patient’s access to the most innovative therapies. This requires not only increased funding for research and development but a streamlined process for bringing new treatments to patients as quickly and safely as possible. What plans do the Government have to ensure that these treatments are brought forward quickly across the country?

Another area of concern is the plan’s approach to palliative care. While the focus on early diagnosis is crucial, we must not forget those for whom a cure is no longer possible. Palliative care is not simply about end-of-life care; it is also about maximising quality of life for patients and their families throughout their cancer journey. What are the Government doing to ensure a renewed focus on funding and resourcing for palliative care services, ensuring that every patient receives the compassion and holistic care they deserve?

We need to do more to tackle what is happening. I will ask two further questions and give the Minister a suggestion that may be taken forward. First, it is pleasing to see that radiotherapy is in the Statement, which is a step forward. However, evidence shows that currently the United Kingdom allocates only 5% of its cancer budget to radiotherapy, compared with the OECD average of 9%. This discrepancy is a contributing factor to the UK’s low cancer survival rates, particularly in cancers such as lung and colorectal. Countries such as Australia and Canada, which allocate a higher percentage of their cancer budgets to radiotherapy, have seen improvements in survival outcomes. Will the Minister commit to addressing this funding gap and set specific targets for cancer budget allocation for radiotherapy to ensure better survival rates for patients in the UK?

Secondly, with over 500,000 people waiting more than two weeks for vital cancer treatment, how do the Government intend to tackle these extensive delays in the immediate term? What concrete measures will be taken to ensure that the national cancer plan leads to real improvements, rather than remaining a set of unmet promises?

I wish to give the Minister a suggestion, which I hope she will take forward. Many of us in this House understand the significant difference in outcomes between early and late-stage diagnosis of cancers. On these Benches, we are strong advocates of utilising AI in early detection. The UK, with its unique history of the National Health Service, benefits from a collection of historical tissue samples. Given this, would the Government implement a programme in which AI performs a retrospective analysis of these samples in order to identify patterns that would improve the speed and accuracy of cancer diagnosis in the future?

I urge the Government to listen to the concerns raised by healthcare professionals and, most importantly, by patients and their families during the consultation period. These insights will strengthen this plan and ensure that it delivers real and lasting improvements to the lives of those affected by cancer.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, I am most grateful to both Front Benches for welcoming the plan and coming forward with very constructive points to strengthen our hand. I am sure we all agree that the prevalence of cancer and the way it touches everybody’s lives, either directly or indirectly, are considerable; cancer affects one in two people in this country. I also thank the staff, volunteers, researchers and everybody who is involved, including carers—paid and unpaid—for their work in this area.

The Statement was made on World Cancer Day. There were two aspects to it; both have been raised, but the one on which I want to focus is the national cancer plan. We have opened a call for evidence to gather views from the public, health partners and parliamentarians on what should go in the national cancer plan, because it seeks to improve every aspect of cancer care and to improve the experience and outcomes for people with cancer, including key goals and actions. The call for evidence is open until 29 April and, to the question raised by the noble Lord, Lord Kamall, it will report in the second half of this year, which, as I hope the noble Lord will agree, in government terms is quite prompt. It will follow the publication of the 10-year plan. In the Front-Bench questions, there was reference to various plans. They all chime in with and build on each other, but we feel that, as noble Lords have said, cancer is absolutely something on which we have to focus.

On radiotherapy access—an important point raised by the noble Lord, Lord Scriven—this is a priority, which is why this year we will spend £70 million in investment to replace older radiotherapy machines with newer and more efficient models. This will mean at least 27 machines to trusts across England, because we are keen that improvement is made.

It has come up in previous debates that NHS England and integrated care boards are responsible for ensuring that the healthcare needs of local communities are met. I take on board the point raised by the noble Lord, Lord Scriven, about concerns over differences of availability of care. In my view it is a good thing to move to give more decision-making and powers locally to meet the needs of local communities, rather than be instructed from the centre. Responsibilities for local provision include considering adequate healthcare provision, such as radiotherapy treatment, care and wider support, including in remote and rural areas. Of course, addressing healthcare inequity is a core focus of the 10-year health plan. We have established working groups focused on how care should be designed and delivered to improve equity and make sure that services are effective and responsive.

Cancer survival is indeed an area in which this country lags behind. That is a consequence of a number of issues, including diagnosis not being where it should be. Improving early diagnosis of cancer is integral for improving survival rates, and it is a priority both for the Government and for the cancer plan. The noble Lord, Lord Kamall, talked about recent successes, including the CDCs, but there is also, for example, the targeted lung cancer screening programme, which has been a tremendous boost to survival rates and to diagnosing cancer earlier in the groups and individuals who are more at risk and yet were not coming forward. We will continue to work from that.

The noble Lords, Lord Kamall and Lord Scriven, both raised rare cancers and research. There will be careful consideration of how the plan is going to deal with rare cancers so that they are not left behind. We absolutely recognise the importance of research and harnessing the powers of new technology to improve outcomes. That is why we invest more than £1.5 billion per year through the National Institute for Health and Care Research, which will help that prevention and detection.

The noble Lord, Lord Scriven, raised the important matter of AI. Your Lordships’ House will be pleased to hear that the other part of the cancer plan was to launch a world-leading artificial intelligence trial, involving nearly 700,000 women and using the latest AI technologies to catch breast cancer earlier. The noble Lord asked a specific question about the use of AI retrospectively, which I would be pleased to look into and get back to him on.

With regard to shortages in the workforce, we have already announced plans for a revised NHS Long Term Workforce Plan for the summer of this year, to make sure that the NHS has the right people in place.

To go back to the point raised by the noble Lord, Lord Scriven, on clinical trials, I should add that the TRANSFORM trial will look for better ways to detect prostate cancer and address the health inequalities that we know are there by ensuring that one in every 10 of the participants are black men.

The noble Lord, Lord Scriven, raised the important matter of palliative care. We will consider palliative care and other care for people living with and beyond cancer as a part of the cancer plan. We would very much welcome responses to our call for evidence on this.

On waiting lists, on 6 January 2025, a new elective reform plan was published to set out a whole-system approach to reaching and meeting the 18-week referral to treatment target by the end of this Parliament.

The noble Lord, Lord Kamall, asked about harnessing data, which is very important. As I mentioned, we have launched a world-leading AI trial, which will provide us with the kind of data we need to improve women’s health screening.

I am grateful to noble Lords for their support and suggestions. I look forward to this cancer plan making significant changes for so many in this country.

[Lord Kakkar (CB)]

My Lords, I thank the Minister for bringing this Statement to the House today. I remind noble Lords of my interests as chairman of the Office for Strategic Coordination of Health Research and King’s Health Partners.

The Minister will recognise well that one of the most important determinants of achieving improved outcomes for cancer patients is access to innovative therapies. It has recently been suggested by the major pharma industry that there are fiscal and regulatory matters that impede the adoption of such innovative therapies across the NHS in England. Can the Minister confirm that, when His Majesty’s Government start to develop the cancer plan, they will look at matters of regulation and fiscal intervention to ensure not only the opportunity for broader support for clinical research but that a continued enthusiasm will be provided for those who have developed innovations to bring them to the UK and make them available to our fellow citizens?

[Baroness Merron (Lab)]

The noble Lord makes an important point about what I would call unnecessary obstacles to innovation and technology—something which the noble Lord, Lord Kamall, also raised. I assure the noble Lord, Lord Kakkar, that engagement with industry is extensive. We seek to identify blocks to improving healthcare provision in this country so that we can take the necessary steps. I agree that there are obstacles. We will continue to identify them—working with industry, which is crucial—and to seek to fix them.

[Lord Winston (Lab)]

My Lords, the Minister mentions the amount of money being spent on cancer research, but it is a small proportion compared with what the life sciences actually earn in Britain through patent and basic research. As UKRI recently pointed out, £3.7 billion has been raised as a result. Does the Minister agree that the Government should perhaps consider reinvesting some more of that money into much-needed basic research, which is currently regarded as being underfunded, with very many projects not being funded as they should be?

[Baroness Merron (Lab)]

As my noble friend is aware, the NIHR very much welcomes funding applications for research into any aspect of human health, including all cancers. As with other government funders of health research, it does not allocate funding for specific disease areas. My noble friend is well aware that applications are subject to peer review and judged in open competition—in other words, to make awards on the basis of the importance of the research to patients and on value for money. I appreciate his observation about investment. It is an area to which we are committed and will continue to be.

[The Lord Bishop of St Albans]

My Lords, a year ago this very afternoon, this very moment, I was in a surgery having a radical prostatectomy. I pay tribute to Professor Vasdev and his amazing team at Lister Hospital for the exceptional treatment I received. He is one of many fabulous people working in our NHS. The discrepancies, though, of diagnosis and treatment are stark in different parts of the country. Having worked in some of the more disadvantaged areas in the past, I am acutely aware of those. What are His Majesty’s Government’s going to do, as the plan is developed, to ensure that we look at the religious, social and ethnic barriers which are stopping groups coming forward to receive diagnosis and treatment? Will they particularly focus on how we can address these to try to support those in the most disadvantaged parts of our country?

[Baroness Merron (Lab)]

This is an extremely important point which will very much feature in the cancer plan. I am sure all noble Lords will join me in being glad to see the right reverend Prelate in rude health. I share his comments about the quality of care that is offered. I was fortunate enough to visit the Royal Marsden NHS Foundation Trust and Institute of Cancer Research on the day of the launch of the national cancer plan and the AI-assisted trial for women to tackle breast cancer. I assure the right reverend Prelate that that is crucial. I say from the Dispatch Box that I would expect any plan and work to take account of inequalities. I mentioned earlier targeting lung cancer; that is exactly what it does, and we need to see more of that.

[Lord Patel (CB)]

My Lords, the fact is that our best cancer services deliver as good a result as any in the world; they are second to none. We do not need to focus on what might happen in the future, with the promise of AI, etcetera. It may promise utopia, but we need the same degree of care as our best delivery provided universally to every cancer patient in our health service. That is what I hope the cancer plan will focus on, and not get carried away by a future that may look promising and bright but which may not deliver. I am delighted that there will be a separate children’s cancer plan, because that is needed. I hope that, in the meantime, it will stop any discussion about shutting down about our best children’s cancer hospital, for whatever reasons—which I think might be political.

[Baroness Merron (Lab)]

I want to clarify that while the cancer plan is not specifically aimed at children and young people, such evidence will be welcomed. Also, the taskforce will be relaunched this year, alongside the national cancer plan. As we do with adults, equally, we want to identify ways to improve outcomes and patient experience.

I hear the noble Lord’s point about AI. It is not a utopia, but it is a tool in the box that we would absolutely be right to look at. I am also struck by how AI is not something separate from human beings; it is human beings who guide it, and it has great potential. On the noble Lord’s point about tackling inequalities in access, which was also made by the right reverend Prelate, he is absolutely right. It is not acceptable that some people, because of where they live or who they are, are not accessing care. This is a constant issue for us, and we continue to tackle it.

[Lord Trefgarne (Con)]

My Lords, I have to start by declaring an interest. I lost my wife of 55 years in April last year due to breast cancer. I have a simple question for the Minister: when, oh when, are we going to find a cure for this dreadful disease?

[Baroness Merron (Lab)]

My condolences to the noble Lord; I am sorry to hear of the loss of his dear wife. I am afraid I cannot say when there will be a cure, but I can reassure him, as I have said previously, about the importance of research and research expenditure. We continue to make great strides, and we will continue on that trajectory.

[Lord Beamish (Lab)]

My Lords, I begin by declaring an interest as someone who is going through cancer treatment; I add my thanks to the doctors and our wonderful NHS workers. I agree with the noble Lord, Lord Scriven, who said that early detection is the main thing affecting whether someone survives cancer or not. I urge the Government to look at prostate cancer, particularly the PSA test, which we have to ask for now. Clearly, there is inequality throughout the country: in middle-class communities, where people ask for it, they get it; in poorer communities—certainly in Afro-Caribbean communities, which the right reverend Prelate referred to—detection is later and survival rates are poorer. If we cannot have a national screening plan straight away, can we not have a pilot to start with?

[Baroness Merron (Lab)]

I wish my noble friend well with his treatment. Screening for prostate cancer is not currently recommended in the UK because of the inaccuracy of the current best test available, which is the PSA. The advice we are given is that the PSA-based screening programme could harm men, as some could be diagnosed with a cancer that would not have caused them problems during their life; equally, some cancers may be missed. That is why we are investing £16 million towards the Prostate Cancer UK-led TRANSFORM programme, which is the name of the screening trial. On health inequalities, as I mentioned earlier, the trial is seeking to find better ways to detect prostate cancer, which is necessary, and to address the health inequalities.

[Baroness Laing of Elderslie (Con)]

My Lords, the Minister mentioned screening for lung cancer, and I am sure the whole House will welcome the progress made in recent years. Can she confirm whether the Government now commit to taking forward the plans for earlier screening of lung cancer, as recommended by the Roy Castle Lung Cancer Foundation?

[Baroness Merron (Lab)]

The Roy Castle Lung Cancer Foundation does excellent work and keeps our minds very focused. The point raised by the noble Baroness will be considered as part of the cancer plan.

[Baroness Watkins of Tavistock (CB)]

My Lords, the Cancer Research UK website clearly says:

“Drinking less alcohol can prevent”


at least seven types of cancer. The Statement refers to the Tobacco and Vapes Bill. Will the Government seriously consider a minimum unit price for alcohol to further reduce cancers across the board, particularly throat and bowel cancers?

[Baroness Merron (Lab)]

I cannot give that specific commitment to the noble Baroness. However, as I know your Lordships’ House is aware, one of the three major shifts we seek through the 10-year plan—this is very relevant to the noble Baroness’s point—is from sickness to prevention. Improved health absolutely is preventive for a number of conditions, including cancer. We need to get that message across, as well as supporting people to make improvements to their health.

[Baroness Tyler of Enfield (LD)]

My Lords, I pay tribute to all the staff at the Whittington Hospital and the Royal Free Hospital for the excellent treatment and ongoing care I have received for my own skin cancer. I will return to the question of early detection. What additional steps are being taken to try to counter the reluctance people sometimes feel to participate in screening programmes? I am thinking of bowel cancer screening and the embarrassment some people still feel, and cervical cancer screening, which many women find a very painful procedure. There is evidence that some younger women are no longer having this screening because they find it too painful. What steps are being taken to try to alleviate that?

[Baroness Merron (Lab)]

I am glad to hear the noble Baroness making statements about the quality of care she continues to receive, and I wish her well. She makes a good point about screening; some 15 million people are invited to screenings and about 10 million take them up. For bowel cancer screening, we have reduced the age to 50 to incorporate more people. That is very welcome, but I take on board exactly what the noble Baroness said: the tests that are painful or embarrassing all have to be dealt with. As part of the review of screening programmes, there is a constant, repeated look at how communications can be improved to target those who need the screening, and to try to be more creative. I refer again to the community diagnostic centres, which are where people need them to be and are less worrying than, for example, going to a hospital. I take the point about painful screenings, but, for us, it is also important to talk about the alternative, because without that screening I am afraid that the outcomes will be far worse.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I am grateful to the health service for saving me. Come this Friday, it will be six months since I was in the Royal Marsden—last summer, on my holiday—having my bladder and prostate removed. Here I am now, surviving. I had to struggle today to get into Parliament; farmers are protesting about money that needs to be raised to fund the NHS.

I return to the point about honesty that the noble Lord, Lord Kamall, raised at the beginning. You can have all the plans under the sun, but if you do not have the money or the will—and the plans to raise the money—you will not deliver them. I believe there is a question missing at the end of this invitation on the consultation: “Could you please suggest some ideas on how to raise the additional funds required to deliver these plans?” There are alternatives to those that we currently use. It is beholden on both the Conservative Party and the Liberal Democrats to be giving some attention to suggestions—which they would support—whereby we would raise additional money to fund the NHS, as our Government are endeavouring to do at the moment.

I would like the Minister to consider exploring a variety of options: how we might be more flexible in raising funds for the NHS, get the private sector more involved in new experimentation that needs to take place, and get the wider public more involved—perhaps by share interest in PPPs to fund particular operations and exercises; say, for a hospital such as the Chelsea and Westminster. Ask all the hospitals around the country what they would like to have. Could they involve their people? Could they involve the private sector? Could we explore a new model? It will not be done overnight but it needs to be done.

--- Later in debate ---

[Baroness Merron (Lab)]

I am glad that my noble friend is in the health that he is. I am sure that those who have supported him will appreciate his thanks and ours.

The considerations my noble friend raises are very much part of the considerations of the national cancer plan and the 10-year plan. With respect to funding, the allocation to healthcare in the recent Budget has allowed us to take steps to arrest a continuing decline and to fix the foundations. The fact is we are spending more and we are getting less. We have to do things differently. That will mean not just looking at money but reforming care, using solutions such as technology and AI to go further still.

[Baroness McIntosh of Pickering (Con)]

My Lords, I refer to my interests in the register. I warmly welcome the national cancer plan. The Minister will be aware that there still is an unacceptable wait time of 62 days. Will she use her good offices to ensure that there is early referral from GPs and that more funding is made available—for this purpose and longer appointments with GPs—if that is needed to make the case for earlier diagnosis and referral?

[Baroness Merron (Lab)]

I say to the noble Baroness that the overall trend for cancer performance is improving but it still needs to improve further. We will take all the necessary steps. The planning guidance set stretching targets for cancer, which will see around 100,000 more people every year having cancer confirmed—or ruled out—within 28 days, and about 17,000 more people beginning treatment within two months of diagnosis. The key to all of this has to be early diagnosis and treatment and ensuring that people do not get missed out, as we have discussed earlier. The trajectory is in the right direction, but they are small steps and we need to ratchet it up.