Cancer Outcomes in the UK

Baroness Watkins of Tavistock Excerpts

Tuesday 21st April 2026 Grand Committee

[Baroness Watkins of Tavistock (CB)]

My Lords, I congratulate my noble friend Lord Patel on securing this important debate, to which it is a pleasure to contribute. I declare my interest as a fellow of the Royal College of Nursing, and I am delighted that I will be followed by a previous president of the same organisation—making at least three in the Room. I intend to cover elements of the themes identified in the plan on community services, the value of screening, the workforce necessary to deliver for patients and the worried well, and an emphasis on psychological support, as well as the protection of patient data and the control of its use for UK-led research and prevention of cancer.

I join others in welcoming the ambitious plan, which will require cultural change across the workforce to improve the communication between assessment, diagnostic and treatment teams, as well as the use of AI and digital information. The aim is to provide seamless delivery of care closer to patients’ homes. This, of course, should be cost effective. The plan has been described as a revolution, and it is vital that the strategy for implementation and delivery is clearly led and monitored to ensure that the change actually happens. With the emphasis on community-based care, the current workforce will, in many instances, need the opportunity to refresh and enhance its skills and knowledge for delivering care outside acute hospital settings. As many people know, I help lead some of that, closing a large mental hospital into community care. The challenge may be similar to achieve this plan—not that I am suggesting we can shut the Royal Marsden.

Clinical staff often work alone in the community, which can be challenging for staff who spent most of their careers with easy access to other multi-professional team members for support and guidance, particularly when a patient’s condition suddenly rapidly deteriorates. Staff must be confident and skilled to provide care in the community, which will call for professional development and dedicated preparation time. The King’s Fund argued that a persistent shortage of radiologists, pathologists and severely overstretched nursing teams often results in haphazard organisation and innovation, rather than planned organisational change. The cancer plan highlights some excellent examples of innovation from the Humber and North Yorkshire Cancer Alliance pilot, using nursing and pharmacy teams to introduce home-based delivery of some subcutaneous chemotherapy drugs. The Christie supportive oncology services demonstrate the value of integrated care provision, from psychology support to dietary advice and symptom management.

The issue at hand is how such innovation can be rapidly and efficiently scaled up nationwide. One patient using the Christie service said:

“The cancer treatment helped, but it was the wider support that”


the service

“gave and continue to give that had the most impact on my quality of life … The team saw me as a whole person, not just as someone with cancer”.

Yet age-standardised premature cancer mortality is twice as high in some areas of the UK than in the best performing ones. The plan acknowledges the need to increase investment in research and open clinical trials more widely, so that patients who want to do so can have the opportunity to participate. Patients from deprived areas, particularly in rural and coastal parts of the country, such as where I live, are less likely to be offered the opportunity to be in trials, as are those from Black, Asian and other ethnic minority groups, who remain underrepresented.

With NHS digital systems advancing and patients’ individual records stored in their NHS app, protecting personal data is crucial. Data should be used only for British research to drive new knowledge and enhance care. The future workforce plan aims to equip managers and clinical and support staff for effective delivery. Staff need dedicated time for training and research, particularly in fields such as nursing. This protected time would support professional growth, boost morale and help retain staff.

Action 23 states that

“every patient will have a clinical nurse specialist or other named lead to support them through diagnosis and treatment”.

As such, clinical nurse specialists will need to be more central in workforce models and must be adequately trained in psychological support for patients with long-term physical and mental health care needs, because people now live with cancer for long periods. Many people who live with cancer fear recurrence, so it is important to focus on living happily and productively for the best quality of their lives, including working, where it is feasible to do so, as the plan states.

The NHS is, rightly, free at the point of delivery for screening, diagnosis and treatment, yet there is little mention in the plan of the need to consider withdrawing some screening programmes at a certain age—for example, for breast cancer over the age of 70—because the cost benefit, many would argue, is unjustifiable. A small cohort would of course benefit, so the NHS allows an opt-in mechanism. However, that has the potential to increase health inequalities, with the worried well requesting the service, which the private and contributory healthcare systems of many other countries would not pay for as a benefit.

Withdrawal of treatment is always a difficult issue and requires delicate conversations between the patient, their family and significant others and the clinical team involved. Such withdrawal must be decided on sound guidance based on relevant research knowledge. British universities are central to cancer research, but there is very little information about their role in this plan.

It is estimated that nearly 40% of cancers are preventable by reducing tobacco and alcohol use, increasing exercise, improving diet and lowering obesity. The Government must be congratulated on the Tobacco and Vapes Bill but, as the noble Lord, Lord Patel, said, the plan makes no reference to the fact that a minimum unit price for alcohol could make inroads too.

Will the Government consider mandating protected time for continued professional development for clinical healthcare staff to support their adoption of the new technologies, the faster treatments and the vision of this plan? Can the Minister say whether screening programmes will be reviewed to ensure cost-effective investment for specific cohorts, and whether appointing a named national lead for screening innovation should be considered? In addition, can she confirm that the use of patients’ clinical records for research will be led by British universities, in partnership with the NHS, using clinical trials that recruit from the whole country, and that they will not be sold for commercial use?