Cancer Strategy

George Freeman Excerpts

Thursday 22nd February 2018 Commons Chamber

[George Freeman (Mid Norfolk) (Con)]

I know, having been a Health Minister, of my hon. Friend’s assiduous commitment to this cause. He mentioned the noble Baroness Jowell. Does he agree that, with the sight of her and the Prime Minister together embracing, the Prime Minister’s announcement of £40 million for brain cancer is good news and that that is being done in the spirit of cross-party commitment to tackling disease? It will give a lot of hope to that community.

On the point about alternative therapies, does my hon. Friend agree that it is very important that the medical community and, through the Government, the National Institute for Health Research do the research to examine those therapies? Although they might not be rooted in a tradition of empirical science, if there is data that shows that they help patients’ recovery time, that is worthy of consideration.

[David Tredinnick]

My hon. Friend has helped me on my path. Various trials have taken place: randomised control trials, observational studies and quality-of-life studies. The person who came up with the notion of evidence-based medicine, Professor Sackett, said:

“The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence”.

In plain language, that means, “You have to look at the patient and see what the patient thinks and what the patient’s experience is.” We are often told by Ministers and others that we need more evidence—that there must be evidence. The trouble is that when evidence is produced on the basis of proper trials, it is often ignored.

The subject on which I have chosen to focus this afternoon is healing—therapeutic touch; call it what you like. There is very good evidence that people are able to use their hands to transfer some kind of energy. I have studied reiki myself—I have done it twice—as well as another Japanese tradition. I once ended up speaking to 5,000 therapists at a conference in Japan, believe it or not, many years ago.

According to Cancer Research UK, a study conducted in 2007 found that up to 40% of people in America used some kind of what they termed spiritual healing. In this country, there is good evidence to suggest that seeing a healer helps people. In the UK, long-term hormone therapy for women with breast cancer can be enhanced and patients can be helped if they are given healing therapy for the side-effects of their treatment. A study showed that a number of women who were given the therapy for 10 weeks experienced fewer side-effects.

In the national health service, there was a two-year trial involving 200 hospital patients with long-standing illnesses. It was the largest clinical trial of its kind, and was funded by the national lottery and supervised by the University of Birmingham, a Russell Group university known for its first-rate research. The methodology was used to assess the effectiveness of healing in dealing with irritable bowel system and inflammatory bowel disease in 200 patients. After the assessment, the Measure Yourself Medical Outcome Profile showed a significant improvement after six, 12 and 24 weeks.

That trial was scientific and properly carried out, and I think that if healing worked for those problems, it would almost certainly work for cancer. I suggest to my hon. Friend the Minister that if a drug showed the same results, especially at such minimal costs, it would be recommended by the National Institute for Health and Care Excellence. More research and trials are needed.

Some of the Government’s efforts to bring about more rigorous assessments of therapies have involved the Professional Standards Authority, which was set up to oversee the UK’s nine health and care professional regulatory bodies. It was previously known as the Council for Healthcare Regulatory Excellence. In February 2013, it launched a Government-backed accredited register scheme. There are now 24 accredited registers covering 31 occupations and 80,000 practitioners. They include the Association of Child Psychotherapists, the British Acupuncture Council, the British Association of Sport Rehabilitators and Trainers, the Federation of Holistic Therapists, the National Hypnotherapy Society, and many others. In its summary, Harry Clayton, chief executive of the Professional Standards Authority, said that

“a key recommendation is for practitioners”

whom the PSA is regulating

“to have the authority to make direct NHS referrals—in appropriate cases—thereby reducing the administrative burden on GP surgeries.”

I ask the Minister to take note of that: it is saying that practitioners on that PSA register should have the authority to make direct NHS referrals. If that were possible, we would bring into the service 30,000 practitioners.

Madam Deputy Speaker, I am trying to figure out how long I have been speaking for; perhaps you can guide me.

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[Nic Dakin (Scunthorpe) (Lab)]

It is a pleasure to follow the hon. Member for North Warwickshire (Craig Tracey), who reminds us of the importance of using the expertise and knowledge we have in the system to accelerate improvements in outcomes.

I thank the hon. Member for Basildon and Billericay (Mr Baron), who I know is disappointed not to be here, for securing the debate and for his time and dedication in chairing the all-party parliamentary group on cancer so well and so impressively over the past nine years.

This debate focuses on the cancer strategy and the current challenges it faces. It is important to reflect on the positives, too. In the space of my lifetime, the progress on understanding, diagnosing and treating cancer has been remarkable. In the 1950s, there was limited knowledge of cancer and of the associated risk factors, the NHS had only recently emerged and there was no co-ordinated plan to treat cancer. We have come a very long way since those early days.

Cancer survival rates have doubled in the UK since the 1970s, which is a real credit to the countless health professionals, researchers, volunteers, charities and, of course, patients who have pioneered progress and who continue to do so every day. It is because of them that we are where we are today, where a person in the UK is more likely to survive cancer than to die from it.

However, massive challenges remain. My constituent Maggie Watts came to see me after losing her husband, Kevin, to pancreatic cancer in 2009. It is her fault that I have ended up as chair of the all-party parliamentary group on pancreatic cancer—thank you, Maggie. Kevin’s mother died of pancreatic cancer 40 years earlier, and the shocking thing is that Kevin’s chances of survival were no better than his mother’s. In most parts of life, the world has moved on rapidly in 40 years, but it has not done so in that part. In fact, at less than 7% in the UK, pancreatic cancer has the worst five-year survival rate of the 20 most common cancers, with the UK ranked 26th out of the 27 EU countries, according to the Association of the British Pharmaceutical Industry. Sadly, pancreatic cancer is on course to become the fourth biggest cancer killer by 2026, so action is needed now.

[George Freeman]

Does the hon. Gentleman agree that, if we are to tackle such cancer outliers, it is vital that, as well as the great research we do in the UK, we make sure that the NHS is better at adopting and taking up innovative medicines? A large part of the accelerated access review, the genomics programme and the informatics programme is about making sure that the NHS is capable not just of doing the research but of enlightened procurement to take up more quickly the drugs that work.

[Nic Dakin]

Absolutely, and I will come on to that later.

As the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), who introduced the debate so well, pointed out, we are now almost halfway into the five-year implementation plan of the Government’s cancer strategy for England. At this mid-point, there are concerns about the rate of progress being made, and the workforce plan is not yet as effective as we would wish.

For example, as the Royal College of Pathologists has said, it can take up to 15 years to train a pathologist. Pathology services are unable to recruit to vacant posts today, and it is anticipated that a third of consultant histopathologists will retire in the next five years, which is just one example of the challenges we face.

The lack of workforce capacity must be addressed to change survival outcomes for pancreatic cancer patients. It would be good if the Minister were able to update us on what his Department is doing to prioritise workforce planning and to provide the funding needed, based on England’s cancer workforce plan.

Fast access to quick and accurate diagnostic tests is also crucial. Many pancreatic cancer patients are diagnosed too late, when surgery—the only curative option—is no longer available. The early diagnosis inquiry by the all-party parliamentary group on pancreatic cancer, “Time to Change the Story,” heard anecdotal evidence from a healthcare professional that a CT scan can be done quite quickly but that the report can sometimes take 10 weeks. It would be helpful if the Department were able to respond to the recommendations of the all-party group’s report and to update us on the progress being made in that area.

The diagnosis of not only pancreatic cancer but other cancers, such as blood cancer, can be complex because symptoms such as back pain or tiredness are often misunderstood or misdiagnosed. Delays in blood cancer diagnosis can have a major impact on a patient’s quality of life and overall outcome, and earlier diagnosis would make a difference for many, but not all, blood cancers. To change this, recommendations for early diagnosis in the cancer strategy should be reviewed to ensure that all people with blood cancer are benefiting from early, accurate diagnosis. GPs could be encouraged to ask for a simple blood test for people displaying one or more blood cancer symptoms.

Diagnostic techniques also have the potential to guide what treatment options are likely to be effective. Last month, NICE provisionally rejected the use of five tumour profiling tests to guide treatment decisions on whether patients with a particular type of early breast cancer should also receive chemotherapy following surgery, reversing its previous guidance recommending Oncotype DX as an option. This goes to the heart of the point made by the hon. Member for Mid Norfolk (George Freeman) about using genomics effectively and precisely. Breast Cancer Now is concerned that this could be a backwards step for some breast cancer patients, especially in the context of the current cancer strategy’s welcome ambition to enable more personalised treatment.

[George Freeman]

Does the hon. Gentleman agree that on this subject of accelerated, earlier diagnosis and treatment, the work of the Institute of Translational Medicine in Birmingham, led by Professor Charlie Craddock, and the Cure Leukaemia team, working on blood cancers, has written the playbook on how we do early diagnosis? They have pulled in £200 million of free drugs for NHS patients by doing accelerated access.

[Nic Dakin]

There is some wonderful work going on, and this goes back to what the hon. Member for North Warwickshire said about the need to grab this wonderful work and move it forward, and not be held back by frameworks that are not quick enough to move with the times.

The ability to personalise treatment based on tumour profiling, which would allow many women to avoid the gruelling side effects of chemotherapy, is an essential part of improving patient care and has the potential to reduce costs associated with chemotherapy—that is a win-win. It can also give both clinicians and patients invaluable reassurance that they may safely not have chemotherapy, thus reducing overtreatment. NICE has not communicated clearly enough the reasons behind provisionally rejecting the future use of the Oncotype DX tumour profiling test, as it is unclear whether this is a result of additional clinical evidence, the cost or a combination of both. Will the Minister ask NICE to clarify the clinical and economic drivers behind the recent provisional rejection of tumour profiling tests to guide treatment decisions in a specific group of breast cancer patients?

The cancer strategy calls on Public Health England to continue to invest in “Be Clear on Cancer” campaigns to raise awareness of possible symptoms of cancer. Symptom awareness is a big challenge in terms of pancreatic cancer, as well as other cancers. A ComRes poll carried out by Pancreatic Cancer UK in 2017 found that 35% of adults in the UK would not be worried if they had a few of the potential symptoms of pancreatic cancer. Last year, Public Health England launched an exciting regional pilot on vague abdominal symptoms, including persistent diarrhoea, bloating and discomfort. Although the results for the campaign were positive, it has not yet been rolled out nationally. I would be keen to know when the Minister plans a national roll-out of the vague abdominal symptoms “Be Clear on Cancer” campaign.

In conclusion, much has been done and much is happening, but there is much more to do. Cancer alliances have a significant role to play in delivering effective change, and many are clearly making a difference. Workforce planning, early diagnosis and greater symptom awareness are key areas where we need to up our game as we move into the second half of this five-year cancer strategy.

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[Michelle Donelan (Chippenham) (Con)]

I thank the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) for securing this debate. It is an honour to follow the hon. Member for Bristol West (Thangam Debbonaire) in her passionate and very well-informed speech.

We all have loved ones who have been affected by cancer. I lost my maternal grandparents to breast cancer and oesophageal cancer. Many in my family have suffered from melanoma, including my mother, and one of my friends is currently battling cancer. We have all heard harrowing stories from constituents. Cancer is indiscriminate: it does not care whether you are young or old, or someone’s mother or brother. Yes, we can make dietary and lifestyle changes to try to avoid it, and be aware of the symptoms, but advances in medicine mean that we can fight it more effectively and detect it earlier to increase the odds of survival, although there are still no guarantees.

Cancer survival rates are at a record high, with about 7,000 people alive today who would have not have been had mortality rates been the same as in 2010. This is a fantastic step in the right direction, but we are not at our destination. That is the point that I want to labour. For all those who lose their mother or child or friend today and hear of this debate, I want them to know that the Government, and all MPs, do “get it”. We get that we are on the right track, but equally that there is a long way to go, because cancer is still the most dangerous serial killer that remains at large in our communities. That is why we must continue to prioritise this area.

The formation of the £1.2 billion cancer drugs fund in 2010 was a massive step forward and has helped more than 95,000 people to access the life-extending drugs that they need, as was the implementation of the independent cancer taskforce’s strategy, seeking to save a further 30,000 lives by 2020. As I said, we are on the right track. In 2010, we had some of the worst survival rates in Europe, but we are now closing that gap. Last year, there were 7 million more diagnostic tests than in 2010, and 57,000 more patients started cancer treatment.

When it comes to cancer, prevention is key. I welcome the increased investment in cancer research by the National Institute for Health Research since 2010 and the work that the Government have done with Cancer Research UK, including a jointly funded network of 18 experimental cancer medicine centres aimed at driving the development and testing of new anti-cancer treatments.

I would like to draw attention to the high uptake of the HPV vaccination among teenage girls, which can prevent around 600 cancers per year and 99% of cervical cancer cases. I have spoken before in the Chamber on Public Health England’s tobacco control plan, which aims to usher in the first smoke-free generation by 2022.

Improving diagnosis is equally essential. Public health campaigns such as “Be Clear on Cancer” are vital to raise awareness of early symptoms, especially of less common cancers. Crucially, the £200 million that has been invested to ensure that patients receive a diagnosis or the all-clear within 28 days by 2020 will make a huge difference.

That would have benefited my constituent, whose symptoms were initially dismissed as irritable bowel syndrome. She then waited a long time for testing. She is now terminally ill with bowel cancer, but inspiringly, she is trying to work hard every day to raise awareness and help others to get diagnosed quickly. Nearly everyone will survive bowel cancer if diagnosed early—in fact, nine in 10 people—yet shockingly and sadly, only 15% of people are diagnosed at that stage.

[George Freeman]

I thank my hon. Friend for giving way; she is making a powerful point. On early diagnosis, prevention and screening, the 100,000 Genomes Project that we launched here in the UK, focused on cancer and rare diseases, is seeking volunteers for genome sequencing to combine with patient data, to identify people at risk. That is a brilliant way for people to get involved, and if anyone is concerned, they should contact the NHS and enrol. We still need another 50,000 patients, and that is a marvellous way of getting access to early diagnosis. Does she agree?

[Michelle Donelan]

I thank my hon. Friend for making that point. Unfortunately, time does not permit me to cover that, so I am delighted that he has.

I welcome the new bowel cancer test, the faecal immunochemical test, known as FIT, which will be rolled out in April. It is more sensitive and accurate and can detect twice as many cancers as the current test. Currently only half of those invited to take part in bowel cancer testing do, but FIT is proven scientifically to increase the number participating in the programme, especially as it is easier and more hygienic to post than the current test.

However, new awareness of symptoms, coupled with the new test and the ageing population, is leading charities within the sector to voice concerns of a looming endoscopy workforce crisis. Bowel Cancer UK and Beating Bowel Cancer question the realism of getting 400 non-medical clinical staff by 2020 to carry out the 450,000 procedures, especially as only 48 have been trained so far. I would like to hear more from the Minister in response to that, so that my constituent can be assured that others may be diagnosed earlier than she was.

A key issue when it comes to beating cancer and preventing cancer is getting screened regularly when applicable. That is especially the case with cervical cancer. The NHS cervical screening programme in England offers screening to women aged 25 to 49 every three years and women aged 50 to 64 every five years. Every year in the UK, around 3,000 women are diagnosed with cervical cancer, but research shows that the number of women using the service has dropped to a 20-year low, with more than 1.2 million not attending their screening in the last year. A recent report by Jo’s Cervical Cancer Trust showed that embarrassment is a key barrier to attendance for between a third and a half of all women, as is the desire not to miss work. There is also a severe lack of understanding about the importance of screening. Shockingly, one in three women aged between 25 and 29 miss their smear, yet cervical cancer is the most common cancer for women under 35. We must address this.

I note that Imperial College has conducted a trial to assess the effectiveness of texting non-responders to improve coverage, but I think that we should just do this—it can only help. I also welcome the fact that the Department of Health and Social Care’s behavioural insight team has undertaken a trial to investigate the use of behavioural insights to optimise the content of the invitation letter for cervical screenings.

I must admit that I was one of these women: I put off my screening for years. I left it at the bottom of my to-do list until I could fit it in around my job, and it just kept slipping year on year. I must admit, if I am honest, that I really did not realise that cervical cancer is most common in women under the age of 35. When I did have my screening, I had to go through the processes necessary after abnormal cells show up. As my results showed high-grade abnormalities, I am extremely thankful that I went when I did. I want to take this opportunity to praise the work of Jo’s Cervical Cancer Trust, which provides women with information and support, which I found extremely helpful.

We seem to be very British about cervical smear tests. We do not really like to talk much about them, and that does not promote women going for them. Yes, it is not nice—it hurts a little, it is awkward and a bit embarrassing —but it could save your life. That is the message we need to get out. We need to promote cervical screening from school age, so that women recognise all the risks and the importance of going from the age of 25.

In September and October 2017, Jo’s Cervical Cancer Trust sent freedom of information requests to all upper-tier and unitary local authorities and clinical commissioning groups in England to ask what activities they had undertaken to increase cervical screening coverage from August 2016 to August 2017, along with the outcomes of those activities. Of the 149 local authorities that responded, 32% had not undertaken any activities at all. I ask the Minister to commission a review—and to adopt a strategy to increase the falling rate of cervical screenings—looking at availability and the challenges of reaching all women and at the need for awareness of cervical cancer.

To conclude, Macmillan claims that, by 2020, 47% of people will get cancer at some point in their life, which is almost one in two. That is the scale of the problem we face. While we have come so far since 2010 in terms of diagnosis and treatment, there is still so far to go.