Prostate Cancer Treatment

Debate between Carla Lockhart and Karin Smyth

Tuesday 17th June 2025 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

I thank my hon. Friend the Member for Ealing Central and Acton (Dr Huq) for securing the debate, and I thank the other Members who have spoken.

As my hon. Friend has said, more than 50,000 men are diagnosed with prostate cancer every year, and one in eight will be diagnosed with it during their lifetime. I commend her for raising an issue that I know is very personal to her, as she has articulated so well. I am sure that her late father is watching her carefully. She was also right to support her constituent Peter by raising this issue, which affects so many men, and to highlight the number of black and minority ethnic men presenting with the disease. That is something on which we have all campaigned very strongly.

Timely and equitable diagnosis and access to innovative medicines for the treatment of prostate cancer are of the utmost importance. To support faster diagnosis, NHS England has redesigned pathways to maximise capacity. We are also aware of very early-stage trials of the use of artificial intelligence in prostate cancer detection, and we look forward to a formal report on those trials, so that the evidence can be considered carefully.

[Carla Lockhart (Upper Bann) (DUP)]

The effects of prostate cancer have been well noted tonight, as has the number of men who are affected. About 12,000 die from it each year, more than 300 of them in Northern Ireland. Does the Minister agree that Northern Ireland should be included in the commissioning, and will she undertake to speak to the Health Minister in Northern Ireland about the issue? Does she also agree that this needs to sit alongside a UK-wide prostate cancer screening programme, targeting in particular people with a family history of the disease?

[Karin Smyth]

We talk regularly with our colleagues in Northern Ireland, and I am always happy to do so. As the hon. Lady knows, this matter is devolved, so it is a matter for Northern Ireland, and we respect the devolution settlement.

Our elective reform plan, published in January 2025, builds on the investments already made with an ambitious vision for the future of diagnostic testing. This will include more straight-to-test pathways, increasing and expanding community diagnostic centres, and better use of technology. With nearly 170 community diagnostic centres up and running, they can take on more of the growing diagnostic demand in elective and cancer care. We will also deliver additional capacity in 2025-26 by expanding some existing centres and building up to five new ones. We will address the challenges in diagnostic waiting times, providing the CT, MRI and other tests that are needed to reduce the elective and cancer waits.

Members know that the National Institute for Health and Care Excellence—we have heard a little about it this evening—is an independent body responsible for assessing whether new licensed medicines can be recommended for routine use in England, based on a thorough assessment of their clinical and cost effectiveness. The NHS is legally required to fund NICE recommended medicines, ensuring consistency of access for NHS patients wherever they live in England.

NICE is able to recommend promising new cancer medicines for use through the cancer drugs funds, which supports patient access while real-world evidence is generated to address clinical uncertainties. Through the cancer drugs fund, NHS patients also benefit from access to cancer medicines from the point of positive draft NICE guidance, accelerating access to clinically and cost effective medicines by up to five months. Through this process, many thousands of patients, including patients with prostate cancer, have been able to benefit from effective new treatments at prices that represent value to the NHS.

The drug that is the subject of this debate, abiraterone, is licensed, as my hon. Friend the Member for Ealing Central and Acton said. It is recommended by NICE for use in the treatment of certain types of metastatic prostate cancer, and it is now routinely available to NHS patients in England in line with the NICE recommendation. NHS England has recently put in place an interim commissioning policy that makes abiraterone available for men with high-risk, hormone-sensitive metastatic prostate cancer, pending the outcome of NICE’s update of its negative guidance. I am pleased that this approach was agreed between NICE and NHS England late last year to ensure uninterrupted access to abiraterone for men leaving the STAMPEDE trial.

My hon. Friend raised particular concerns about access to this drug for men with non-metastatic prostate cancer. First, it is important to note that abiraterone is not licensed by the MHRA for use in this indication, and it is therefore off-label. NICE does not evaluate the off-label uses of medicines, and the drug is also now off-patent and available generically, which means there is no single manufacturer that could sponsor an MHRA licence application or NICE evaluation. It is therefore for NHS organisations to take decisions on funding based on the available evidence.

NHS England considered abiraterone for the treatment of non-metastatic prostate cancer through its clinical prioritisation process last year. Through this process, NHS England concluded that evidence supported the routine commissioning of the drug in this indication. Approximately 7,000 men per year could be eligible for this drug, and it is estimated that it would cost an additional £20 million per year to fund that.

While, as my hon. Friend said, there may be some cost savings in the pathway from preventing the disease’s progression, these are unlikely to materialise for about five years and would not impact the up-front costs of the £20 million per year for the additional out-patient monitoring and drug cost. I had not heard the figures she outlined, but I will get back to her on some of the questions she asked, and it would be helpful to know where those figures are from.

Unfortunately, it has not been possible to identify the necessary current funding to support the commissioning of abiraterone for this purpose or any other treatments in this prioritisation round. I know that is disappointing for those affected, and I want to acknowledge that this is a really difficult and unusual situation. However, I want to assure my hon. Friend and other hon. Members that the funding position for this treatment does not mean that there are no treatment options. The NICE guideline on prostate cancer recommends the treatment of non-metastatic prostate cancer with surgery and radiotherapy.

I want to assure hon. Members that NHS England is keeping this position under review, and would reconsider funding for abiraterone for non-metastatic prostate cancer if the funding position changes. Earlier this month, NHS England met Prostate Cancer UK, which shared its financial model of the expected cost impacts. NHS England is reviewing this in more detail, and I encourage it to continue those discussions.

In closing, I recognise how hard it is when patients want access to effective treatments. I also recognise the distress and worry it causes not only for patients, but for their families and friends. The Government are committed to ensuring that we provide access to the most innovative and effective medicines, but it has to be in a way that is sustainable and affordable for the NHS. It is right that NHS England continues to engage with Prostate Cancer UK, and I know that my hon. Friend and other Members will keep an eye on this and similar issues with drugs coming forward. The national cancer plan will seek to improve every aspect of cancer care, to better the experience and outcomes of people with cancer. Our goal is to reduce the number of lives lost to cancer over the next 10 years. I am grateful for the opportunity to respond to the debate this evening.

Question put and agreed to.

Attention Deficit Hyperactivity Disorder

Debate between Carla Lockhart and Karin Smyth

Tuesday 10th June 2025 Westminster Hall

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship, Ms Jardine.

I thank the hon. Member for Henley and Thame (Freddie van Mierlo) for securing this important debate on support for people with ADHD, and for sharing the experiences of his constituents in Oxfordshire. I know that the hon. Gentleman and others wrote to the Minister for Care, my hon. Friend the Member for Aberafan Maesteg (Stephen Kinnock) about many of the issues he raised today; I hope he found the Department’s response to that letter useful. I thank other colleagues for their interventions. These issues also affect my own constituents, and I see them in my inbox, so I understand their impact on families and communities.

First, we must be honest about the challenges. The Government inherited a broken NHS with too many patients facing long waits to access services, including ADHD assessments and support. Lord Darzi’s report laid bare that the growth in demand for ADHD assessments nationally has been so significant in recent years that it risks completely overwhelming the scarce resources available. The report also shows that, at current rates, it would take on average eight years to clear the backlog of adult ADHD assessments and that for many trusts the backlog would not be cleared for decades. We absolutely recognise the need to better understand the factors behind the rise in demand for services to ensure that we offer the right support.

The hon. Member for Henley and Thame asked why his trust has closed its waiting list. In preparing for the debate, I asked officials to give me a clearer understanding of what is happening in the Buckinghamshire, Oxfordshire and Berkshire West ICB, which saw a near 50% increase in referrals year on year between 2019 and 2024. I am pleased that the hon. Gentleman has had contact with the chief executive. The trust felt that it could not cope with that level of demand because it viewed it as an unmanageable risk to patient safety and staff wellbeing. That is why it made the difficult decision to close the waiting list for new adult ADHD assessments in February last year. That was the trust’s decision.

As someone who worked in the system over the peak years of austerity—some people may remember them—I completely understand how trusts are often confronted with such decisions. The recent growth in demand seems quite exceptional. Integrated care boards are responsible for commissioning services in line with the health and care needs of the people they serve. It is up to local decision makers to make tough choices, because they know the situation on the ground better than Ministers in Whitehall.

I understand that the ICB has established an ADHD programme steering group to stabilise its services, and it is working with local partners, including people with lived experience, to develop a new service model aimed at addressing health inequalities, providing a single-service model across the ICB, with a single provider, and providing support for people who do not benefit from medication. I understand that the trust is working to open a service for 18 to 25-year-olds as an interim measure to help those who transition from children and young people’s services to adult services, which we know is a difficult time in their lives. I am sure that the hon. Gentleman will maintain a close watch on those commitments.

[Carla Lockhart (Upper Bann) (DUP)]

Following on from the intervention by the hon. Member for North Down (Alex Easton), I know that this is a devolved matter, but the issues are exactly the same in Northern Ireland as in GB, with long waiting lists and a lack of access to services. Does the Minister agree that people with ADHD are being discriminated against right across the United Kingdom because of the lack of access to services? Does she also agree that, in the interim, those who go for a private diagnosis should be able to enter into a shared care arrangement so that they can access the medication that assists them to function day to day, live normal lives and be part of our society?

[Karin Smyth]

I will come on to shared care agreements. As the hon. Member says, this is a devolved matter, and I am focusing on support for issues facing ADHD services in England and what we are doing to support trusts to get back on top of waiting lists and improve access to services.

First, NHS England has commissioned an independent ADHD taskforce, which is working to bring together those with lived experience and experts from the NHS, education, charity and justice sectors. The taskforce is developing a better understanding of the challenges affecting those with ADHD, including timely and equal access to services and support. I can confirm today—I know that this will be of interest to many hon. Members—that the taskforce will publish its interim findings shortly, with a final report expected after the summer recess. The interim report will helpfully focus on recommendations that support a needs-based approach, beyond just the health system, in which people can access support based on their needs, not their diagnosis. The report will also set out recommendations for support to be provided beyond medication, and by healthcare professionals other than specialists.

Secondly, NHS England recently published an ADHD data improvement plan to inform future service planning, and on 29 May it published management data on ADHD waiting lists. Thirdly, it has been capturing examples from ICBs that are trialling innovative ways of delivering ADHD services and using that information to support systems to tackle waiting lists and provide support.

Fourthly, as part of the Government’s five long-term missions, we have launched the 10-year plan to deliver the three big shifts that our NHS needs to be fit for the future: from hospital to community, from analogue to digital, and from sickness to prevention. All those shifts are relevant to supporting people in all parts of the country with a range of conditions such as ADHD.

Fifthly, we are supporting innovation. Earlier this year, at a parliamentary event, many of us will have met innovators who are supported by NHS partners. I heard about the QbTest technology that complements the knowledge and skills of clinicians as part of the ADHD assessment process. I understand that 70% of NHS children’s ADHD services already use that technology, and the evidence suggests that it has a positive impact in making the assessment process swifter and simpler.

Abortion (Northern Ireland) Regulations 2021

Debate between Carla Lockhart and Karin Smyth

Monday 26th April 2021 General Committees

[Carla Lockhart]

I am sorry; I really do want to make progress.

Northern Ireland has been overruled not because of a human rights imperative, but because the majority of Members of Parliament have decided to overrule the wishes of the people of and representatives in Northern Ireland. In that context, the Government have to confront another dimension of the sovereignty of Parliament: the fact that no Parliament can bind its successors. Most GB MPs who were persuaded to vote for section 9 thought that they were voting for a measure for the time when there was no functioning Assembly. As custodians of the Union, rather than welcoming the restoration of Stormont by imposing more regulations on us through a power that rests on what can only be described as a humiliating majority, the Government should read the introduction to the Act in which section 9 is located, which states that it makes certain changes

“subject to the formation of an Executive”.

Now that the Executive have reformed and the timeframe of the Act has passed, rather than saying, “There is nothing we can do apart from introduce new regulations,” the Government should do the responsible, Union-affirming thing, which is to recognise that times have changed, that Stormont has been restored, and that the Parliament that voted for section 9 no longer exists. In that context, it is incumbent on the Secretary of State not to place the Union under the intolerable pressure of yet more regulations resting on the anti-Northern Ireland majority of 9 July 2019, but to ask this new Parliament to repeal section 9.

[Karin Smyth]

I am grateful to the hon. Lady for giving way. I have listened to her talk a great deal about this undermining the Union. How does she feel that 1,000 women a year seeking refuge in Britain strengthens the Union? We were proud to support those women in their hour of need, but surely it is time for Northern Ireland to take on its responsibilities as a mature society and support its own people.

[The Chair]

Before we move on, I remind all Members please to wear masks when they are not speaking, unless there is a reason not to.

--- Later in debate ---

[Karin Smyth]

We do not have time to debate this issue now, but it is a well-debated issue. However, of the people whom we are talking about, many of them do not choose for many reasons—that is their choice, in my view; the hon. Lady and I disagree about that—to continue a pregnancy, for whatever reason. Of course, what this process catches—it is why it is cruel and barbaric—is also those women who are desperate to have a family, but their child is going to die. They are carrying back those foetal remains in the most barbaric of circumstances. Nobody had concern for those women. In conclusion—

[Carla Lockhart]

Will the hon. Lady give way?

[Karin Smyth]

I will finish; I need to finish now. Practical steps are needed. In Britain, for example, there are many good examples of third-sector provision of sexual health services. I have pressed the Minister on this issue before. We need to learn the lessons about sexual health services from the rest of Britain. For over 20 years, we have been commissioning third-sector providers to run our sexual health services in Britain and I think that Northern Ireland deserves that quality of service.

I echo the points made by the right hon. Member for Basingstoke, because the CEDAW recommendations do not just apply to abortion; they apply to sexual health services and education, particularly for young people, in general. When we hear so much currently about violence against women and girls, and the prevalence of pornography and so on in images for young people and how young people are targeted, there is real and deep concern about education provision for young people in Northern Ireland, and how they will understand their own sexual health, and how we ensure that they have a good attitude to sexual health and relationships. That is more crucial now after the pandemic than it was before, and these regulations also allow us to do that.