Breast Cancer Screening

Debate between Edward Leigh and Jo Churchill

Wednesday 16th December 2020 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)]

It is a pleasure to serve under your chairmanship, Sir Edward.

I thank my hon. Friend the Member for High Peak (Robert Largan) for securing this important debate. As he and many Members know, breast health—diagnosis, treatment and research, as well as screening—is a matter that is close to my heart. I am honoured to respond on this important issue on behalf of the Government, and on behalf of women and the 3% of men who are diagnosed with breast cancer every year.

I want to state clearly that screening services are back up and that the availability of breast screening to everyone who needs it is there. However, the recovery of those services from the disruption this year is not only a priority for me, but an enormous challenge, for exactly the reasons that have been laid out so eloquently by all contributors to the debate. We know that our cancer workforce had challenges before we went into the pandemic.

Let me remind Members of something that only the hon. Member for Strangford (Jim Shannon) briefly referred to: yesterday, 506 families lost a loved one to covid. It is still with us. We are in a covid-tinged world, and that affects how quickly we can drive other services. However, the resumption of cancer services across the piece—be they treatment, diagnosis or screening—has been the No. 1 priority for me from the time we understood and were able to drive those things in.

I am glad that hon. Members who have taken part in the debate recognise the importance of breast screening in the early detection of breast cancer. As with any diagnosis of cancer, early detection gives people a better chance. The simple fact is that screening saves lives.

I very gently take the Member for Westmorland and Lonsdale (Tim Farron) to task on the statistic that every four weeks represents a 10% lower chance of survival. Cancers, as he well knows, vary enormously in type, grade and everything else. I do not want people not to come forward for screening, diagnosis or treatment because they feel that any loss of time will have had a negative impact. It has to be that as soon as you have a symptom, you come forward. Campaigns such as “Be Clear on Cancer” and “Help Us Help You” are driving at giving people confidence.

We have ensured that services are safe, and our aim is for people to be able to access them as quickly as possible, secure in the knowledge that they are safe. I will cover this later, but while I understand what my hon. Friend the Member for West Bromwich East (Nicola Richards) and the hon. Member for Ellesmere Port and Neston (Justin Madders) were saying, the whole point of open appointments is to maximise the use of available capacity versus fixed-time appointments. A health inequality impact assessment has been done to try to make sure that nobody is disproportionately impacted, and I have asked for a specific eye to be kept on that. Now, if you like—

[Sir Edward Leigh (in the Chair)]

Order. As a matter of courtesy, it is normal for Ministers to address the Chair.

[Jo Churchill]

I am so sorry, Sir Edward. As I was saying, the challenge is that there is variation in the system. That variation occurs for a plethora of reasons, not only those that are covered by an impact assessment on accessibility via open appointments. It is important to keep an eye on all the data.

I am proud that we have a national breast screening programme that offers every woman between the ages of 50 and 70 an appointment every three years. We will strain every sinew to ensure that nobody waits longer than 36 months. We will not step back from that, even with the challenge of driving the backlog down. The programme reaches millions of women and detects approximately 20,000 cancers each year. I recognise the challenge, but every single individual provider has been asked to produce a recovery plan, which should help us to understand the variation. I recognise that about half a million women are waiting, but there are also 500,000 women who have not replied. They will need to be re-approached and encouraged into the system. It is incumbent on everyone to give women the confidence to come forward.

We have also had to look at making sure that women are asked to come forward in accordance with priority by targeting the women who are most likely to have an occurrence of breast cancer. High-risk women will not have open appointments; they will be called immediately. We will then screen positive women in the pathway, followed by screening results that have not been processed, routine open episodes, those who have previously been invited but not screened, and the delays. It is important that we prioritise, so that we target the women we are most worried about.

I am aware that this year, the national breast screening programme could not maintain the service that it normally provides. In March, as the NHS responded to one of the biggest challenges that has faced our healthcare system in a generation, many local providers made the decision to pause appointments so that arrangements could be put in place to protect staff and patients from covid-19. We were unaware at that point what we were dealing with. Staff and facilities were redeployed to tackle the outbreak of the pandemic, but as soon as it was possible to do so, it was made an absolute priority that they were brought back in to do the job that we need them to do.

I am sure that there is not a single Member in this Chamber, or indeed the House, who does not pay tribute to the hard work of all NHS staff. Cancer staff and their teams have done a particularly incredible job of making sure that people across the cancer family have received treatment. Earlier today, I talked to a young man about the treatment he has had, and I talked to a young woman who experienced chimeric antigen receptor T-cell treatment earlier this year. The redeployment of staff left a shortfall in the breast screening programme, and screening appointments for many women have been delayed. I know that that wait, and the anxiety it drives, is incredibly difficult. For those who are looking for reassurance from their routine screen, or who are waiting to receive an all-clear or an early warning that something is wrong, this is undoubtedly a challenging time. However, I want to be absolutely clear that no woman has been left behind, and no woman ever will be. It is a priority to ensure that services are there. Improvements are being driven by the heroic efforts of staff, who have been working longer days and over weekends. They have gone above and beyond to schedule as many appointments as possible to help to drive down the backlog that was created earlier this year.

The first priority is to screen women aged 53 who have not yet had their first screening appointment; those who have passed their 71st birthday and have not yet received their final breast screen; those at very high risk of breast cancer, as I said; and those who have been identified for further treatment. I am pleased to say that the tremendous efforts of screening staff—the nurses, the radiographers and the whole team—are succeeding and the backlog is steadily reducing. The number of women waiting for screening, having received an invitation prior to the first wave, decreased by 98% between 1 June and 4 November.

Screening has been made a clear priority this winter and NHS commissioners have been instructed, where humanly possible, not to redeploy their staff or their facilities away from screening services. It is a priority, and that is absolutely the right approach. My message to everyone is that breast screening services are running, they are safe, they will continue to run through the winter and they are standing up to the increased capacity that is coming towards them.

When people receive an appointment to attend, I urge them to go. “Do not attends” are so frustrating. Those appointments could be taken by a woman who—although she would not want a diagnosis—might get into the stream quicker.