Covid-19: Access to Cancer Diagnosis and Treatment

Esther McVey Excerpts

Wednesday 2nd December 2020 Westminster Hall

[Esther McVey (in the Chair)]

I remind hon. Members that there have been some changes to the normal practice in order to support the new call list system. Members should sanitise their microphones and then remove and dispose of the material used for that when they leave the room. Members are asked to observe the one-way system and should speak only from the horseshoe. Members may speak only if they are on the call list. That applies even if the debate is undersubscribed. Members may not join the debate if they are not on the call list. This is a slight change, but I want to remind Members that they must arrive for the start of the debates in Westminster Hall, although they are not expected to remain for the winding-up speeches. Members may wish to stay beyond their speech, but they should be aware that doing so may prevent other Members from speaking if it is a full debate.

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[Tim Farron]

I am extremely grateful to the hon. Gentleman for making a very important point. I have heard the same reports from the frontline that treatment would normally be 70:30 curative to palliative and that now it is 50:50. That is a blindingly obvious consequence of the fact that when we catch cancer, we catch it too late.

I have a request of the Department, which we have made before, including in face-to-face meetings with the Secretary of State. I want the Department of Health and Social Care team responsible to sit down with the frontline experts—we can provide them this afternoon—and go through the evidence of the backlog. There is no way of tackling the problem if the NHS management and the Department are not cognisant of it and prepared to listen to the people working their socks off in cancer units all over the United Kingdom.

I want to make another important point. Whoever was in power during this time would have been handed the same challenge and would have made many mistakes. The Government have rightly sought to control the virus so that we can protect the NHS and save lives. The lives that we seek to save are those at risk from not just covid but other illnesses, including, of course, cancer.

We as a country have stood together and defended our NHS so that it has the ability to fight cancer in the midst of a pandemic, which is what every clinician is desperate to do. The great success of this year, for which Ministers should rightly be proud, is that our NHS has not collapsed and did not fall over. Our doctors, nurses, paramedics and clinicians of every sort have saved lives, defeated the odds and kept our NHS on its feet so that it can fight cancer, and yet a failure at senior levels of NHS England and in Government to recognise the scale and nature of the cancer backlog means that people are dying today who did not need to die.

We have terminal diagnoses for cancers that could have been treatable among my constituents and yours, Ms McVey—among all our constituents. Their lives have been cut short when earlier, more urgent and more ambitious action from our leaders could have saved them. What troubles me so much is that we hear statements from some in senior management in the NHS, and from within the Department, that suggest they do not quite get the scale of the backlog problem. They freely admit that they do not know how big the backlog is. On more than one occasion, I have heard the Secretary of State seek to reassure us by saying that progress has been made on recovering the 62-day wait. If people understand what is happening, however, that does not reassure them. It does the exact opposite: it sends a shiver down their spine—it confirms the problem.

Surely Ministers know that the 62-day waiting time target for treatment does not give a complete snapshot of the situation, because it captures only patients who are already in the system. I am sorry to be brutal, but as more people die, there are fewer people in the system. The target does not take into account the tens of thousands of undiagnosed patients who may be going about their daily life completely unaware that they are living with cancer.

I fear that the Government hugely underestimate the cancer backlog, and the consequence will be thousands of unnecessary deaths and lost life years. An article last month in The BMJ estimated that there will be 60,000 lost years of life as a result. Does the Minister recognise the significant fall in people receiving cancer treatment this year compared with 2019? Like me, is she worried that this will mean there are thousands of people out there with undiagnosed cancer who have yet to come forward?

I move on now to my second point, which relates to the Chancellor’s recent comprehensive spending review, which was a pivotal opportunity to signal that the Government, the Department of Health and Social Care, the Chancellor and NHS leaders understood the need for investment in the techniques and treatment required to quickly build capacity in order to clear the cancer backlog and ensure a resilient service going forward—to build the capacity that is vitally needed if we are to make sure cancer patients are not the collateral damage of covid. Far from seizing that pivotal opportunity, the Government appear to have turned it into a missed opportunity. As far as we can tell, there is no boost to cancer treatments in the comprehensive spending review. There is no increase in capacity to catch up with cancer, and there is no plan to do what is needed to save thousands of cancer patients’ lives.

The Action Radiotherapy charity estimates that the true cancer backlog could be as high as 100,000 patients. It supports the estimate of the Chair of the Health and Social Care Committee that it would take cancer services working at over 120% pre-covid capacity two years just to catch up. Members of all political persuasions, working with clinicians and experts who are desperate to make a difference, are clear about how the Government could provide the boost required to catch up with cancer and to save thousands of lives. The answer is not to exhort our heroic frontline staff to work harder—they continue to be inspirational, straining every sinew. It is not to carry on doing what we have always done, but just doing it a little better. It requires some new thinking. It requires taking an axe to some of the internal bureaucracy that has held back some treatments, such as radiotherapy. Crucially, it requires investment, but that critical investment seems to be missing from the comprehensive spending review. That is a missed opportunity on a massive scale, and I hope it is not too late to make a change.

I have to say that there has been a collective gasp of disbelief across the oncology and radiotherapy sector, as it appears—unless we are all mistaken—that there is not even an explicit mention of radiotherapy in the spending review, never mind of the investment in it. Radiotherapy is covid-safe and is required by over 50% of cancer patients. It already plays a significant role in 40% of cancer cures and is able, where clinically appropriate, to substitute for chemotherapy and surgery at times when they are deemed not to be appropriate because of the fact that we are in a pandemic. It is hugely cost-effective: it cures patients for as little as £5,000 to £7,000 apiece.

The reality is that radiotherapy has huge untapped potential to do even more to clear the backlog. For many reasons, however, it has been actively restricted and held back for years. Although radiotherapy treats 50% of cancer patients, it receives just 5% of the annual cancer budget—something for which recent Governments of all parties must share the blame. That is why the UK is massively behind on technology that could empower the workforce to do more. Pre-pandemic it was estimated that as many as 24,000 patients were missing access to radiotherapy treatment each year. It is worse now.

Faced with the current crisis, the radiotherapy community came together to put together a transformation plan for consideration at the comprehensive spending review. The six-point plan would deliver a super-boost to cancer services to clear the backlog, with innovative technology and digital solutions to deploy linear accelerators at the many covid-clean hospital sites in England, such as the Westmorland General Hospital in my constituency, that are perfectly suited to adding satellite capacity to their main cancer units while protecting patients and clinicians from covid infection risk. The plan would also see an immediate boost in precision radiotherapy at existing cancer units, upgrading linear accelerators to perform curative treatment over shorter periods. However, on our reading of the spending review, that appears to have been totally ignored. In fact, as far as we can tell, there is no clear plan of investment in cancer treatment capacity at all.

While the investment in diagnostic machines over 10 years is truly welcomed by all of us here, it is not enough. According to Freedom of Information Act requests carried out by the Radiotherapy4Life campaign, more than half of NHS trusts are using radiotherapy machines that are more than 10 years old. To replace only the machines that deliver diagnostics, or radiology, and not those that actually cure people—the radiotherapy machines—is a baffling decision, to me and, more importantly, the experts. Patients and the public will be shocked to learn that immediate solutions presented by expert professionals to the covid-induced cancer crisis are being overlooked.

Every week that we delay giving an immediate boost to cancer services—capacity, diagnostics and treatments —we increase the risk of losing cancer patients needlessly. Recent data shows that for every four weeks of delay in starting treatment there is as much as a 10% increase in deaths. Some departments report a 20% drop in the number of patients classified as curable, leading to downgrading to palliative treatment instead. Patients—our constituents, families and friends—are being told that their cancer now cannot be cured and that their treatment will be palliative instead. Yet the decision to catch up urgently with cancer has been either delayed or ignored. We will pay a huge cost for missing out on the chance to correct things at the spending review. That is why I hope it is not too late to do so. The public inquiry, when it happens, will reveal the situation. The cost of the understandable litigation by patients and families who have been failed will be needlessly huge.

We first wrote to the Secretary of State about the growing crisis in April, and we have not stopped warning of the devastating impact that there will be on the lives of cancer patients. Three hundred and seventy-five thousand people have signed the Catch Up With Cancer petition and have hundreds of patients shared their heartbreaking stories. Experts are saying that there will be as many as 35,000 unnecessary deaths and, as I have said, 60,000 life years lost to cancer because of the impact of the covid crisis. Cancer survival rates have been pushed back to where they were more than a decade ago.

I know that the Minister cares. She is a good person seeking to do a good job. I hope that she will forgive me for being direct today, but thousands of people could have their lives lengthened or saved, and their families could be spared unspeakable grief, if we acted urgently to catch up with cancer. I conclude by repeating my plea in the strongest possible terms. Will the Minister meet me and, most importantly, the expert clinicians who advise the Catch Up With Cancer campaign, in the next few days so that we can turn the tide on the crisis?

[Esther McVey (in the Chair)]

Just for the ease of colleagues, I will say that I am looking to call the Front-Bench speakers at 10.30 am, so divide the time among yourselves.

[Andy Carter (Warrington South) (Con)]

Thank you, Ms McVey. I will do a quick calculation.

[Esther McVey (in the Chair)]

You have quite a few minutes.

[Andy Carter]

It is a pleasure to serve under your chairmanship, and I am delighted to follow the hon. Member for Westmorland and Lonsdale (Tim Farron). I congratulate him on securing this important debate, and pay tribute to his excellent opening speech. I agree with many of the points that he made. The issue is incredibly important for families up and down the UK, and I am delighted to be able to join him in speaking in the debate.

I want to thank those who work in oncology in Warrington—the consultants, nurses, radiographers and, of course, GPs who are right at the frontline as the primary gateway into cancer services. Their work, and that of those in their sector across the UK, has continued through the pandemic.

Early on, I spoke to the chief executive of Warrington hospital, Professor Simon Constable, who outlined the steps his team were taking to try to maintain cancer care services in as near normal fashion as possible. Their ability to operate across two campuses, with a covid-free site in Halton, has meant that procedures such as breast cancer could operate very close to normal. The partnership formed with Spire hospital in Stretton, where the NHS has contracted bed space and use of operating theatres to give capacity for critical operations, has meant that referrals for urgent treatment in Warrington have continued.

I think that talking to real people is when we hear the true stories. Last Friday, I spoke to a constituent called Helen who lives in Lymm. It was one of the more pleasant conversations that I have had with her over the last few weeks. She very sadly discovered that her breast cancer had returned in April, which was the same week we hit the peak of the first wave. Understandably, she was incredibly concerned when she contacted her GP. Helen was referred back to a consultant and, after tests, was told that she needed a double mastectomy. I remember talking to her earlier in the year, when she told me the news, and she explained in detail her fears of catching covid when she went into hospital to undergo radiotherapy and tests. She was asked to isolate and follow detailed guidance, and she was superbly cared for by her son at home, who went out of his way to make sure she had everything that she needed. She went into hospital in Halton for treatment and last week, some eight weeks after the operation, told me that she was looking forward to going back to work as a supply teacher in one of our local schools. Her description of the care that she received from the NHS was incredible, and she said that they could not have done more for her. I highlight this story because I think we have not heard enough about the work that has continued over the last few months—but that does not mean we do not have a problem with cancer care services.

The local hospital in Warrington was treating 170 patients for covid at the start of November. It was one of the most under pressure hospitals in the entire country. The team has only been able to operate about 80% of normal services. I say only but I actually think that is pretty good, given that we are in a global pandemic and that is roughly in line with services across the north-west of England. I suspect though that the 80% headline masks many true and worrying statistics that we will discover over the next five years.

Last week I also spoke to executives at Macmillan Cancer about the local situation in Warrington, as well as the national picture. I pay tribute to the Macmillan nurses who have continued to work with patients in their homes through lockdown, particularly those who have supported families of loved ones who are near their end of life. Macmillan estimates that across the UK there are currently 50,000 missing diagnoses, meaning that, around 33,000 fewer people started treatment compared to a similar timeframe last year. That backlog of undiagnosed cancer could take 18 months to tackle in England alone. Most worryingly, if cancer referrals and screenings do not return to pre-pandemic levels, the backlog could grow by 4,000 missing diagnoses, reaching over 100,000 by October next year.

During much of the pandemic, the NHS has been open for business, and we should be proud of that. Anyone who needs care and treatment can continue to access it. When they need it, they can go to their GP and be seen, especially where delays could impose an immediate and long-term risk. I think the most worrying statistics are on urgent GP referrals in July and August. They were 72,000 lower than last year. In some ways, that highlights the most stark problem that the pandemic is storing up for us.

We have seen a significant reduction in people starting their cancer treatment in 2020. Between March and September, around 31,000 fewer people started their first cancer treatment, which is a drop of 17% compared to 2019. More than 650,000 people with cancer in the UK have also experienced disruption to their cancer treatment or care because of covid-19. For about 150,000 people, that included delayed or rescheduled cancer treatment.

I welcome the announcement of £3 billion of extra funding to support NHS recovery from covid-19 and to help tackle and ease some of the pressures in all our hospitals, allowing them to carry out more checks, scans, operations and procedures. That will help to ensure that cancer patients can access the care they need as quickly as possible, but we need to tackle the backlog, and we cannot afford to undo the great work and investment that has gone into cancer treatments in recent years. I am delighted to speak in a health debate today because of the news we have heard that a vaccine has been approved and is on the way. That is incredibly welcome, but we must put that alongside the challenges that exist in every single branch of medicine, and particularly in cancer care, where the patient backlog is extending.

One of the biggest challenges we face is caused not by money or pressure on NHS services but by putting things off. We all do it—mainly due to a fear of going into hospital. I mentioned Helen earlier, who talked about her greatest fear being to go into hospital. Lumps and bumps are not treated because we think it does not really matter at the moment. I am afraid that is particularly true for us men, and the pandemic has highlighted that. We really do need a public information campaign that says, “If you spot a problem, don’t leave it for a later date.”

As the hon. Member for Westmorland and Lonsdale said, since 2010, survival rates from cancer have increased year on year. We have a really good story to tell in this country—about 7,000 people are alive today who would not have been here if mortality rates had stayed the same—but to sustain that drop, the NHS and Government will have to take action like they have never done before. It is critical that the cancer workforce is ring-fenced against any further redeployment to ensure that cancer care continues and further avoidable cancer deaths are averted.

Before the pandemic, there were about 3,000 specialist cancer nurses, which Macmillan modelling indicates is around 2,500 below the level required to deliver basic cancer care—and given the backlogs, that figure is probably closer to 3,500. Patient feedback to Macmillan was that, though its nurses work incredibly hard, they are not getting the support that they need. I really welcome the 14,000 additional nurses we have recruited in the last 12 months as I do the additional £260 million fund allocated for Health Education England in the one-year spending review, which will go towards the Government’s commitment to train 50,000 more nurses. However, my hon. Friend the Minister will know that that alone will not address the significant shortfalls in specialist cancer care nurses. I am therefore really keen to hear from her how the Government can commit to further long-term funding support for the next iteration of the NHS people plan to eliminate the gap in the cancer workforce.

It is hugely important that the Government back the national cancer recovery plan and the additional resource needed to build capacity and help beat the backlog now and in the long-term, getting the right skills and resources in the right places to make sure we have the biggest impact possible and, most importantly, encourage people to get the treatment that they need. Getting all of us to feel comfortable with reaching out to our GPs early on, so that we can get treatment, must be our No. 1 priority.

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[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Westmorland and Lonsdale (Tim Farron) on securing the debate and setting the scene, and all hon. Members on their incredible contributions. I look forward—I said this yesterday and need to get away from saying it again—to the Minister’s response and the contributions of the shadow Minister and the Scots Nats spokesperson.

I have been contacted by many constituents asking me to attend and speak in this debate, and as my party’s health spokesperson I am very happy to do so. One of the heartbreaking stories I have heard in the past couple of difficult days is a widow saying:

“my husband only died of cancer—he isn’t important”.

I honestly could have cried when I heard those words, because I believe that she genuinely felt that no one cared, and that is what she told me. I felt that hardness; I had a compassionate understanding of what she was saying.

We are in unknown territory and undoubtedly we are distracted. How can we save people from contracting covid? How do we treat those who have it? How do we keep people in contact with others for their mental health? How do we ensure economic viability to pay for the future health needs of this nation? We are distracted, but when we have widows and cancer patients telling us how left behind and unimportant they feel, we know that in our distraction we have got this wrong. It pains me to say that.

Throughout this pandemic, I and others have lost loved ones. Two of the girls in my office have lost loved ones: one lost a sister and the other lost two uncles. We know the devastation, but we have all lost loved ones to cancer too. It is not that one is less important than the other, so that is why this debate is so important. I am thankful for this debate, which allow me to come alongside my colleagues and friends—that is what they are—to discuss how better we can do this together.

I was contacted by a radiotherapist who highlighted the massive problems they are dealing with daily. There are two main radiotherapy centres in Northern Ireland. I know this is not the Minister’s responsibility, but I am saying this to give some context to the debate. One is in Belfast, and the other is the newer, smaller North West Cancer Centre at Altnagelvin. I am told that the main issues in radiotherapy are the result of the lack of investment and funding. There are major problems as a result of staffing—doctors, therapy radiographers and physics—including recruitment, training and retention. That has a knock-on effect on service delivery, development and research. Investment is needed to replace old radiotherapy treatment machines.

Northern Ireland would like to feel more connected to mainland UK radiotherapy, through sharing best practice, training support, data sharing, peer review and so on, and that is what we are asking for. It is important that we take an holistic approach to this across the whole of the United Kingdom of Great Britain and Northern Ireland.

The covid problems found also included more patients having their treatments disrupted in many centres in the United Kingdom and a higher proportion than average reporting a poor or very poor experience. That also worries me greatly. We have members of the all-party parliamentary group for radiotherapy in the Chamber today, and I know that every one of us understands these issues, including the hon. Member for Westmorland and Lonsdale, who set the scene. One hundred per cent of responders said they were treating patients who would usually be having chemotherapy or surgery. The additional referrals were for a range of cancers, including oesophagus, lung, breast, head and neck, upper gastro- intestinal and bladder, and also included palliative cases.

I want to speak about one specific cancer, pancreatic cancer. It has been highlighted that there was already an emergency before covid-19. This was a critical issue back in March and it is even more critical today, in December. Surgery is the only potential cure for pancreatic cancer. Before the pandemic, only one in 10 people received surgery. With pancreatic cancer, a six-month delay to surgery means a 30% reduction in survival and a three-month delay a reduction of over 17%. Unfortunately, that sets the scene, with pancreatic cancer progressing from a curative to a non-curative disease while treatment is delayed. Surgery, for some, is no longer an option. That is greatly disturbing.

Reports of service restoration are encouraging. We hear from clinicians that, in most parts of the UK, surgery and treatment are now back up and running at near normal levels, but for so many people with pancreatic cancer and their families the damage has already been done. For those diagnosed in the future, the continued delays to the restoration of clinical trials are stunting crucial improvements in treatments and outcomes.

People with pancreatic cancer have also experienced an information gap, with 40% of patients who were impacted by the pandemic reporting having received insufficient information and support about treatment, symptom management or palliative care. We have had multiple reports of people being sent home from hospital with a new diagnosis without any further information on the disease, their prognosis or treatment options. Anyone facing something incredibly dark such as pancreatic cancer at an advanced stage will want the person opposite them to tell them what is wrong and give them some light on a way forward. All of us in this Chamber today, and all of us outside it, have been touched by cancer. For every two people we meet, one of them, or someone in their family, will have had it. Unfortunately we are continually confronted by this, each and every day.

Calls and emails to Pancreatic Cancer UK’s support line nurses have been up 58% on the normal weekly average, and there has been a 34% increase in the number of people being supported each week. Again, I think those figures are the critical factor in where we are on this. Pancreatic Cancer UK has also been contacted by a larger proportion of palliative patients than normal, because that is unfortunately what pancreatic cancer often leads to. If people do not get an early diagnosis and early surgery, they are confronted with end-of-life care. For families, that is incredibly difficult and complex, and a very difficult time in their lives. People with pancreatic cancer have reported feeling forgotten and isolated, at a time when they are also unable to see friends and family due to the risk of covid-19 transmission.

We are all heartened by the tremendous news today that we are going to roll out the covid-19 vaccine late this year and into next, given the time it will take to get to everyone. That is good news, but we have to address the issues for those with cancer now. I believe we need to do better, and the changes must be implemented from here at Westminster and across the whole of the United Kingdom of Great Britain of Northern Ireland. On behalf of all those cancer patients—all the ones who have contacted us, and all those facing an incredibly difficult time—I look, as I often do, to the Minister for a response. I know we will get that, but we really do need to be reassured. We need early diagnosis and extra care, and we need to show compassion in this place for those outside.

[Esther McVey (in the Chair)]

We now move to the Front Benchers.

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[Alex Norris]

Those points are very well made and get to the heart of what we as an Opposition want, what all Back Benchers want—and in fact, everyone. We do not want to beat cancer on paper and in statistics; we want to beat it in reality. We are not making this an issue of politics. It has to be an issue of coming together, as the hon. Member for Westmorland and Lonsdale said in opening the debate, with new and challenging things. Critically, at the heart of this, there is an indication of a plan, so I hope that today the Minister will commit to publishing it, give us greater detail on what is in it, update us on its progress in recent months and tell us whether it works through the full pathway, from symptoms to treatment, or whether it is just a diagnostics plan. To what extent is it being maintained in the second wave, and, with the national cancer recovery plan expiring next March, will there be a longer-term successor? I know that is a peppering of questions, but this is our best opportunity to ask, so I hope the Minister will take that in the spirit intended.

On resources, there was £1 billion in the spending review to tackle backlogs. Will the Minister clarify how much of that will go to cancers? Although the money is welcome, it is less than all the health experts have called for. The Chancellor has promised to give the NHS what it needs, and this is a “what it needs” issue, so resources are important.

On innovation, I am lucky enough to have lots of innovative companies contact me to talk about their treatments. It cheers the spirit to hear about developments in chemotherapy that will make it possible for drugs to be tailored to individuals. That is remarkable. However, I will make a point about radiotherapy because of the hon. Members between me and the door; I will not get out unless I do. Radiotherapy is safe to deliver in a pandemic, is significant in 40% of cures and is cost-effective. That is an area where we can make a real impact. Will the Minister commit to follow what my hon. Friend the Member for Easington said and publish the delayed radiotherapy dataset? That would be a nice step forward.

Macmillan has raised concerns that the long-term plan for the NHS will not be matched by the workforce available. It thinks we need a further 2,500 specialist cancer nurses. Where are we up to with that?

The most important message that any of us can send today is to a person listening to this, watching this or following the coverage who has a hacking cough, a lump or bump or blood in the stool, and has previously used the pandemic—as perhaps many of us would—as a reason not to access care. I ask them to please not do that. The NHS is there for them. We need them to access it. It will be there.

[Esther McVey (in the Chair)]

I am about to call the Minister, but am mindful that Tim Farron needs time to wind up.

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[Tim Farron]

The hon. Members for Warrington South (Andy Carter), for Gower (Tonia Antoniazzi), for Easington (Grahame Morris), for Strangford (Jim Shannon), for Angus (Dave Doogan) and for Nottingham South (Alex Norris), and indeed the Minister, all made excellent points, and I am extremely grateful. I thank the Minister for what she said and for agreeing to meet us this side of the recess. To be specific, we are after a meeting with her, of course, and departmental finance officials so that we can revisit the investment decision—that decision is problematic—and have our experts meet hers to get to the bottom of the data. We need to see the datasets so that we can explore the extent to which there is an urgent crisis—we are certain that there is one.

Finally, the Minister talked about the importance of diagnosis. The Government are making progress on diagnostics. Of course, in the NHS long-term plan, we see the desire to find more cancers earlier so that we can treat them. If we find more cancers early, however, we will have more people to treat. That is why the radiotherapy investment that we have called for is essential, not just now but in the long term.

Motion lapsed (Standing Order No. 10(6)).

[Esther McVey (in the Chair)]

I will suspend the sitting for two minutes so that hon. Members can exit safely and the next lot can come in safely.