Covid-19: Access to Cancer Diagnosis and Treatment

Dave Doogan Excerpts

Wednesday 2nd December 2020 Westminster Hall

[Dave Doogan (Angus) (SNP)]

It is a pleasure to serve under your chairmanship, Ms McVey. I am grateful, as all our constituents will be, that this issue has been brought to the fore in the way that the hon. Member for Westmorland and Lonsdale (Tim Farron) has done in securing this debate. My only regret is that my hon. Friend the Member for Central Ayrshire (Dr Whitford), who is a cancer specialist, cannot be here to share her wisdom and knowledge on such matters because she cannot participate remotely. You have got me instead, Ms McVey.

As we see from our inbox, there is concern that the reconfiguration of our national health services to meet the projected clinical demands of the pandemic went too far, and has come at a cost to non-covid patients. There are serious concerns about a cancer backlog. Gravely ill patients were, and clearly continue to be, cared for by our four national health services consistently throughout the pandemic, thanks to the dedication of clinicians and nursing and support staff. That is not to say that the pandemic preparedness had no consequences, but to defend the qualified and proportionate repositioning of the health services in the face of we knew not what exactly, back in March. The backlog is a consequence. How can we address it now?

As we have heard, Action Radiotherapy has suggested that there have been 100,000 missed diagnoses. That is a serious challenge for us to address across these islands. The Scottish Government undertook extensive work to improve cancer treatment over the last decade, and have made every effort to ensure that it was minimally disrupted throughout the pandemic. There has been disruption, however—of course there has.

Macmillan has expressed its concern that 50,000 diagnoses have been missed. When Macmillan speaks on these issues, Ministers in all four Administrations should listen to that message. A drop of 72% in cancer referrals as a result of covid is a cause for serious concern; we do not need to be specialists to understand that. Even though only a percentage of those referrals will result in a cancer diagnosis, there will nevertheless be a backlog of referrals and resulting care plans to be worked up as a result of covid. Dr Gregor Smith and many across these islands have insisted that people should report and present to their GPs when they notice something unusual. The First Minister of Scotland has also stressed that the NHS remains available to those who need it. Advice has been sent to all cancer service centres in Scotland, including the key message that health boards are expected to maintain full and urgent cancer services.

Who among us is unfamiliar with those in our communities, usually from an older generation, who do not like or want to trouble people, so do not present to their GP? For some, particularly men, there is a somewhat understandable reticence to present for healthcare in the middle of the pandemic. We can therefore see significant presentation deferral, which needs to be acknowledged, accepted and resourced. That needs to be resolved quickly, acknowledging the time-critical nature of some of the conditions. Cancer treatment services in Scotland—and, I assume, in the other three nations—have continued as much as possible throughout lockdown, using modified operational models. I thank NHS Tayside, which employs many of my constituents and looks after the healthcare of all my Angus constituents. I especially thank those at the cancer centre in Dundee, who have worked tremendously hard. The Scottish Government invested a great deal in additional MRI scanners and CT scanners to aid diagnosis, but I accept the important difference that other hon. Members have highlighted between diagnosis approaches and resource, and treatment.

Many challenges persist in this priority issue, not least the staffing of specialist consultants. That is especially challenging now because recruiting from EU countries is challenging as a result of Brexit, and retaining domestic consultants is also challenging. At the start of covid, the average age of NHS returnees—those who nobly answered the call to assist with covid and its consequences—was 57. Many of those doctors are retired because of the punitive implications of Her Majesty’s Revenue and Customs rules on pension allowance. That really needs to be addressed soon, to allow that dormant domestic capacity to keep their shoulders to the wheel should they wish to, without being unduly penalised. That issue of doctors’ pensions is one of the most hopeless instances of the total failure of a whole-system approach in modern governance, with HMRC tying the hands of our NHS behind its back. That is a really easy win—low-hanging fruit—that we can resolve quite soon.

The UK Government must ensure that cancer treatment does not move backwards in the aftermath of coronavirus, and must focus proper additional investment on our NHS. Despite the work of the NHS in Scotland and across the UK, there is a backlog of people seeking cancer screening and/or treatment. At this stage, we have three priorities: satisfying the routine cancer demand; the health commitments in and around covid; and the cancer backlog. To ensure that this does not spiral into an enduring secondary health crisis, significant and defined supplementary investment is needed to clear the backlog of screening and treatment, and to get cancer services restored to at least the level seen before the pandemic. It is important for colleagues in England to keep a weather eye on what the Barnett consequentials are for the devolved nations as a result of funding announcements. To be clear, if there are no Barnett consequentials for the devolved Administrations, what we are seeing is simply relabelled money rather than new investment. That will not fly.

The hon. Members for Strangford (Jim Shannon) and for Gower (Tonia Antoniazzi) do not need the clinical direction of the Department of Health and Social Care—that is taken care of by the devolved Administrations—but we are umbilically connected to the funding settlement for NHS England. That is why it is so essential. The £3 billion offered for next year is a third of what the SNP has been calling for on a yearly basis. After a prolonged period of austerity, £3 billion is not even enough to cover the outstanding hospital repairs required in England alone, much less to restore cancer services. Regardless of where we live on these islands, we have all convened here this morning to try to restore cancer services and protect those affected. I respectfully look forward to any specific indications that the Minister can give us of additional funding to address this very serious and pressing issue.