Access to Radiotherapy

Chris Bryant Excerpts

Wednesday 12th January 2022 Westminster Hall

[Chris Bryant (Rhondda) (Lab)]

I congratulate my hon. Friend the Member for Easington (Grahame Morris) on securing this important debate, and not for the first time—he is a repeat offender. His determination and laser focus on this issue are really important in trying to save lives.

I hope it is not too mawkish if I say a few words about my own experience of cancer, even though I have not had radiotherapy, because radiotherapy is not normally used to treat my form of cancer—melanoma—although it is for other forms of skin cancer such as squamous and basal cell carcinomas. The timing of my cancer was amazingly fortunate. It was three years ago yesterday that I went to my GP with a dodgy mole—I urge anyone who ever worries about a mole to get it checked out, because my hon. Friend is absolutely right that early detection saves lives. I was very fortunate that my GP sent me straight to a dermatologist, who cut it out for the first time within 10 days. The second bout was two weeks after that.

I was fortunate that all that could happen very quickly. If I had gone to the doctor on my birthday last year or this year, I do not think I would have got the same speedy response. I had a stage 3B melanoma—incidentally, I must say to the hon. Member for Westmorland and Lonsdale (Tim Farron) that satellites are not always good. A microsatellite from a melanoma is a really bad thing. If I had left it another three months, it would probably have been a stage 4, and there are only four stages.

I was also fortunate that two weeks before I went to the doctor, the National Institute for Health and Care Excellence allowed the use of immunotherapy for melanoma in an adjuvant setting at stage 3, rather than just at stage 4. I hope the Minister will confirm that NICE is looking at the use of the various kinds of immunotherapy in an adjuvant setting for people with stage 2 melanoma.

I say all that because I was told at the time I had a 40% chance of living a year—three years have now passed so I am very grateful that the immunotherapy I received has dramatically improved my chances of living. I say gently to the hon. Member for Westmorland and Lonsdale that, sometimes, the drugs are a really important part of the cancer treatment package. I do not think there is a competition between different parts of the package; there are clearly instances where drugs, chemotherapy or radiotherapy is the right route.

My anxieties are that, first, we have a massive catch-up job to do, and secondly, that I do not think we had the capacity needed to tackle the problem even before we went into covid. We have a growing population in this country, and a growing number of cancers, but last year’s figures show a nearly 10% fall in the number of people receiving radiotherapy. That is not good news in any shape or form. There may be people whose deaths from cancer are unknown to us because they ended up not being diagnosed and then died with or of covid, so they may not appear in the statistics, but they will certainly appear in many people’s family statistics and life experiences.

There are things that the Government could do immediately, many of which have already been laid out by hon. Members. Something needs to be done about the workforce, because every part of the cancer pathway has a shortage of staff. A lot of staff have been redeployed during covid to help run A&E departments. Nurses, hospital orderlies and receptionists from the same teams have ended up being redeployed to other parts of the operation. They have been very happy to do that, but it has meant that, in nearly every cancer discipline—the one I know best relates to dermatology, obviously—there is now a series of vacancies.

A lot of staff are burnt out, exhausted, demoralised and uncertain whether they want to stay in the profession. I think this is the fifth Minister to whom I make the same plea: that she and the Government look at the series of things we could do to enable people who have recently left the profession to come back. That might include financial rewards. We could do more to enable people to stay all the way through to retirement age. A significant number retire early, partly because of that sense of burn-out. They do not necessarily want a financial reward; they would actually quite like a sabbatical of a couple of months or something like that, simply to recharge their batteries so they can come back into the profession and not retire early. We certainly need to do something about the problem that doing extra hours or sessions is now barely worth it for many people, because the financial reward is minimal. A major issue will come up very shortly relating to pensions and pension funds for many doctors in many of these disciplines.

In all those areas, the Government could do far more to increase capacity now, then they have to look at increasing capacity for the future. One of the most important parts of the process is diagnosis. We do not have enough radiologists, radiographers, histopathologists and pathologists in the UK. There is a massive shortage—something like a 10% vacancy rate. We are not even allowing enough people to train this year to fill the vacancies that exist now, let alone the additional vacancies that there will be in five or 10 years’ time, so we are building up a bigger problem for ourselves.

That takes me to my biggest concern of all. Before covid, every winter we were running the NHS at 95% capacity. It is pretty difficult to run anything at 95% capacity, because the moment you have a crisis of any kind whatsoever, you are stuffed. It is a bit like those baggy gym shorts that have an elastic band in them. When someone gets beyond a 34-inch, 36-inch or 38-inch waist, suddenly there is no more stretch in the pants, as you know, Mr Davies—[Laughter]—because you understand the science of elastic bands, obviously. However, I make a serious point. We have run the NHS far too close to complete capacity for far, far too long, and not only in intensive care units, where we have many fewer beds per 100,000 people than any country in the European Union or any advanced country in the world. We also have many fewer hospital beds per 1,000 people than any other advanced country in the world. We need to look at the long-term issues and say to ourselves that, if we really want an NHS that will not be crippled by a pandemic or by winter, we have to invest significantly in the future. Every single time a Minister stands up, they always say very nice things. The Minister who is here today has lots of clinical experience of her own, and we are enormously grateful for the work that she has done in the NHS during the pandemic. However, in the end, warm words butter no parsnips—not that one really wants butter on parsnips. I love a parsnip, although it is odd that we are the only country in Europe that actually eats them—mostly they are fed to cattle, but that is by the by.

The serious point is that we need to invest in every single part of the NHS. The cancer catch-up is a matter of life and death. I think that, if I had gone to the GP yesterday, my life would not have been saved. That is a distressing thing to be able to say to one’s constituents. I hope that the Minister will come up with some answers for us.

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[Maria Caulfield]

I do not disagree with the hon. Gentleman. I may be a new Minister, in post for weeks rather than years, but I have 20 years of oncology experience, and in my experience radiotherapy has a fantastic role to play. It is indeed the case that significant progress has been made, particularly in the field of lung cancer, with stereotactic radiotherapy to specific areas. However, radiotherapy will target a specific area; it will not give systemic treatment, like adjuvant treatment to prevent recurrence or neoadjuvant treatment for metastatic disease, where the disease is in multiple parts of the body. As Members of Parliament, we need to be cautious that we do not give patients the impression that they should be asking for radiotherapy instead of surgery and chemotherapy. There needs to be a discussion with their oncologist and their medical teams as to the appropriateness of radiotherapy. Yes, it is often cheaper than chemotherapy to give. Yes, it is a quicker treatment and sometimes—not always—has fewer side effects. But it has to be a clinical decision. There are important reasons why radiotherapy is given to some patients and not others. That is something that patients really need to have a discussion—

[Chris Bryant]

We all understand that clinical decisions have to be made. Our anxiety is that clinical decisions sometimes end up being made because there is not enough availability of facilities or staff, or—the third aspect to this—because lots of patients simply are not presenting at the moment. They are not coming in the doors of the NHS because of covid. That potentially means—for instance, in relation to bowel cancers, lung cancers and melanoma—that we will see people presenting much later and therefore there will be a much more dangerous prognosis for them.

[Maria Caulfield]

I absolutely take that point on board. There are clinical reasons, if a patient has presented later, why radiotherapy may or may not be suitable. Again, they are clinical decisions that a patient needs to be discussing with their oncologist.

The hon. Member for Westmorland and Lonsdale (Tim Farron) raised the issue of satellite units. Again, I would just be slightly careful. Cancer alliances are mapping out cancer services in their areas, and I am very happy to meet colleagues who would like better provision in their local area, but they also need to meet their cancer alliances, which are looking at service provision locally.

I would just caution Members on the issue of having multiple sites for radiotherapy. These are specialist treatments, needing specialist equipment and specialist staff. I went into oncology more than 20 years ago, when surgery was done by general surgeons. They were doing mastectomies on women and colostomies on bowel cancer patients. Moving surgery into being a specialist field, with specialist provision, has transformed the way that we are able to look after women who are going through mastectomies, and bowel cancer patients, who may not necessarily need a colostomy now, because surgical treatments have advanced so much. There is sometimes a rationale for those services to be offered by specialist units, rather than multiple satellite sites.

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[Maria Caulfield]

It is about replacing existing equipment, but also investing in new. Some of the equipment is 10 years old. Radiotherapy has changed a lot over those 10 years, so the replacement equipment can do more than what it replaces. As I pointed out, we are also investing in new radiotherapy equipment, with £250 million into two proton beam therapy facilities at Christie’s and at UCL—new facilities that will be able to provide state-of-the-art radiotherapy treatment. I hope I have reassured Members that we are addressing this as a top priority.

[Chris Bryant]

Will the Minister give way before she sits down? She sounds very like she is finishing.

[Maria Caulfield]

I was finishing, but I will give way one more time.

[Chris Bryant]

The Minister may not be able to answer the question today about adjuvant provision of immunotherapy for people with stage 2 melanoma, but if she could write to me, I would be very grateful.

[Maria Caulfield]

My understanding is that it is available for stage 3 melanoma, as the hon. Gentleman has highlighted, and that it is still in clinical trials for stage 2. It is available within clinical trials. We expect the data to come forward shortly and then a decision will be made. That is where we are with melanoma.