Access to Radiotherapy

Feryal Clark Excerpts

Wednesday 12th January 2022 Westminster Hall

[Feryal Clark (Enfield North) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Davies.

I start by thanking my hon. Friend the Member for Easington (Grahame Morris), both for securing this important debate and for being such a consistent champion on this issue. We have heard some excellent contributions and I pay tribute to all hon. Members who have spoken—my hon. Friend the Member for Bedford (Mohammad Yasin) and the hon. Members for Strangford (Jim Shannon) and for Westmorland and Lonsdale (Tim Farron)—for raising issues about investment, the workforce and the bureaucracy that surrounds radiotherapy. I pay tribute to my hon. Friends the Members for Rhondda (Chris Bryant) and for Easington, who speak with authority on the issue as a result of their experiences.

We have heard that radiotherapy is a vital tool in our fight against cancer and that it is one of the three pillars of treatment alongside surgery and chemotherapy. The fact that radiotherapy is needed by one in four of us across our lifetime should be a stark reminder of how important today’s debate is. I join my hon. Friend the Member for Easington in paying tribute to the work of charities such as Radiotherapy UK and the Catch Up With Cancer campaign for keeping this important issue on the agenda.

Hon. Members will know the impact the pandemic has had on cancer treatments and the devastating backlog that it has caused. In my own constituency of Enfield North, data from Macmillan shows that 73 people are missing a cancer diagnosis and a further 57 are waiting for their first cancer treatment. The backlog in treatment, coupled with the severe workforce crisis, which every Member has highlighted and which is rapidly stretching across our health service, means that we are facing a situation where outcomes for cancer patients are being put at risk. As we have heard, radiotherapy is a vital tool in our fight against cancer and should play a key part in our work to help overcome the backlog that affects both patients and staff.

As highlighted by all hon. Members, with the pandemic impacting so much of the NHS’s operations, radiotherapy provides a covid-resilient form of cancer treatment by not having an impact on the immune system or requiring admission into intensive care. It is very cost-effective, as mentioned by my hon. Friend the Member for Easington, with the average cost of radiotherapy care ranging from £4,000 to £7,000, making it cheaper than the often costly options of surgery or chemotherapy. Despite that, radiotherapy has been consistently overlooked when it comes to policy, so it has often faced a lack of investment and understanding by policymakers and successive Governments.

As we have heard, just 5% of the cancer budget in the UK is spent on radiotherapy. That means that despite significant global advancements in radiotherapy technology, patients in the UK are continuing to miss out. Half of all NHS trusts are using machines that are older than the recommended 10-year life span.

[Grahame Morris]

I apologise for breaking the flow of my hon. Friend, but these are important statistics. One worth remembering is that in over 50% of cancers, radiotherapy or precision radiotherapy would be effective as part of treatment—perhaps not exclusively. Actually, when I had my treatment, I had everything: I had surgery, chemotherapy and radiotherapy. However, it would be effective in over 50% of cases. It is currently only given to 27% of cases, so even before we start tackling the backlog, there is a huge capacity issue, and I hope my hon. Friend recognises that, and that the Minister will address it.

[Feryal Clark]

I thank my hon. Friend for his intervention; I absolutely agree with him. As was mentioned, many patients do not even have the luxury of being treated by old technology. More than 3.5 million people in the UK do not have radiotherapy centres within the recommended 45 minutes of their home, as mentioned by my hon. Friend the Member for Bedford and others. That has led to a situation where, rather than meeting the international guidance of 57% to 60%, just 27% of cancer patients in the UK are given radiotherapy. Patients are receiving a raw deal at every turn in the UK, putting their treatment and their long-term outcome at risk.

It is not just patients who are feeling the strain; radiotherapy staff, like many of their colleagues across the NHS, are feeling undervalued and under-resourced. A workforce survey carried out by Radiotherapy UK showed that 80% of radiotherapy staff were considering, or knew of someone considering, leaving the profession; 90% felt that the Government did not recognise the significant role that radiotherapy plays in reducing the cancer backlog; and 75% felt that they did not have the capacity to reach a pre-pandemic service level. A plan to improve provision of radiotherapy, or any other treatment across the NHS, will not be successful if there is not a robust workforce strategy behind it.

[Grahame Morris]

We need a plan.

[Feryal Clark]

Absolutely. I ask the Minister what other hon. Members have also asked today: how do the Government expect to tackle the cancer backlog when staff feel like no-one is listening to them? NHS staff have made immense sacrifices during this pandemic; they deserve to be heard and respected instead of having their concerns ignored.

The staff who remain in radiotherapy are met with barrier after barrier when it comes to improving the experience of patients and the effectiveness of treatment. I run the risk of repeating points, but these are key issues and need repeating. In order to justify investment to fund a new and updated machine, NHS trusts are required to conduct 9,000 treatments per year. During the pandemic, when we have seen referrals plummet and services stretched to breaking point, that target is plainly unrealistic for many trusts. It leaves staff with faulty, unreliable equipment that frequently breaks down, and patients with delays, postponements, cancellations and a much more challenging experience of treatment. I join with many other Members who spoke this morning in urging the Minister to carefully examine the situation, and look at what can be done to remove the bureaucracy that is stopping the advancement in equipment that is evidently needed.

When we know that every four-week delay in treatment for a cancer patient increases the mortality rate by 10%, the lack of investment in such a core pillar of cancer treatment is putting lives at risk. The failure to address these issues will leave the 40% of cancer patients who need radiotherapy as a curative treatment, either on its own or in combination with other methods, in a grave situation. Failure will also have a knock-on effect across all treatment pathways, increasing the pressure on already stretched cancer services as well as primary care providers.

Finally I ask the Minister, do the Government accept that radiotherapy needs an increased level of support to properly fulfil the important role it plays in overcoming the backlog in cancer treatments? Furthermore, will the Minister commit to a plan to improve both workforce numbers and satisfaction, given the increased pressure that the situation is producing on services such as radiotherapy? Cancer patients have suffered so much over the course of the pandemic; they deserve better than this. It is about time that the Government acted.

--- Later in debate ---

[Maria Caulfield]

There are satellite services—absolutely. We have seen them not just for radiotherapy, but for chemotherapy and even surgery. But it has to be a local decision, because local oncologists have to feel that they are able to support the multidisciplinary team who support the radiotherapy process, ranging from diagnostics through to the treatment itself. That has to be in place, so it does absolutely need to be done on a local basis, but I am happy to meet colleagues if they feel that the case is not being heard locally.

I want to emphasise this point, because a number of hon. Members talked about the commitment to cancer services. Our elective recovery programme has committed £2 billion this year and £8 billion over the next three years to step up activity and tackle backlogs. That will have a knock-on effect in improving radiotherapy access, because some patients cannot have radiotherapy until they have had surgery. Ensuring that we are tackling some of the backlogs to treatment resulting from covid is absolutely important.

There have been huge improvements in radiotherapy over recent years, not just in provision but in technique. We are able to deliver more targeted treatment, resulting in fewer hospital visits, because we can now give radio- therapy to a more targeted area of the body, resulting in fewer side effects from the treatment, and also give fewer fractions of radiotherapy, so that patients can get their total dose much more quickly. That maximises service capacity and minimises patient time in hospital.

Furthermore, we have invested £250 million into two proton beam therapy facilities, one based at the Christie in Manchester and the other at University College London. In addition, all radiotherapy centres in England are now able to deliver stereotactic ablative body radiotherapy. Both these treatments are able to target radiation at cancer cells more accurately, improving patient outcomes. I am really pleased to say that, as part of this year’s spending review, £32 million was made available to support the replacement of 17 linear accelerators aged over 10 years, all of which are on order and will be delivered by the end of March 2022.

NHS England is committed to improving the facilities for cancer patients, and has also offered NHS radiotherapy providers the opportunity to participate in a cloud-based technology called ProKnow. To date, 43 of the 49 radio- therapy providers have joined up. This technology, which will help satellite units, enables clinicians to collaborate virtually within and across organisations, to plan treatments, undertake peer-review assessments and participate in large-scale audits and quality improvement processes, ultimately benefiting patients.

A number of Members talked about the cancer workforce, because it is great to have state-of-the-art technology and multiple units providing radiotherapy, but if we do not have the staff to manage them and provide treatment we shall not make progress. Health Education England is continuing to take forward the cancer priorities identified in the NHS’s long-term plan. It is prioritising the training of 250 nurses to become cancer nurse specialists, 100 chemotherapy nurses and 58 biomedical scientists, and it is updating the advanced clinical practice qualification in oncology.

Further than that, particularly around radiotherapy, Health Education England is investing £52 million in the cancer and diagnostic workforce, increasing the number of clinical endoscopists and training more radiographers in image interpretation. That is all part of the radiotherapy process. As of August there have been an additional 4% of doctors working in clinical oncology, which is the field that manages radiotherapy, and there have been a further 5% working in radiology since August 2020.

We are making progress, but it is not just about the numbers of staff; it is about the skill mix and ongoing staff training. Very often, not being able to expand a role or take on exciting and innovative developments can make staff feel frustrated, but the cancer workforce is growing. Between 2016-17 and 2019-20, the cancer workforce grew by 3,342 full-time equivalents, compared with the ambition of 2,943. We are ensuring that there are more staff coming through into the workforce to deliver radiotherapy.

The shadow Minister touched on the importance of not only recruiting staff but retaining and developing them. I fully take on board colleagues’ comments and concerns. We are committed to investing in radiotherapy equipment, the staff that deliver radiotherapy and the innovation in radiotherapy. We are also committed to making it more accessible to patients, and to reducing the side effects—there are side effects from radiotherapy as well—and to making sure it is a fundamental part of cancer treatment, whether that is in the neoadjuvant setting, adjuvant or for those with metastatic cancer as part of the palliative treatment service.

[Feryal Clark]

I thank the Minister for all the information about the machines and investment into radiotherapy. Are the figures that she set out for replacing what is already out of date, or is there a plan to increase investment in radiotherapy treatment? As we have all said, radiotherapy accounts for 5% of the cancer budget. Is there a plan to increase that, or is it about replacement and keeping up what we already have?

[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.