Covid-19: Access to Cancer Diagnosis and Treatment Debate

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Department: Department of Health and Social Care

Covid-19: Access to Cancer Diagnosis and Treatment

Grahame Morris Excerpts
Wednesday 2nd December 2020

(3 years, 3 months ago)

Westminster Hall
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Grahame Morris Portrait Grahame Morris (Easington) (Lab)
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That is a really important point. How do we quantify the scale of the backlog to enable us to have an action plan to address it? Specialists say that whereas the ratio is currently 50:50 in terms of the therapeutic application of radiotherapy for treatable cancers and therapeutic palliative care, last year it was 70% treatable and 30% palliative. Do we not need the release of the datasets to quantify that in an accurate way?

Tim Farron Portrait Tim Farron
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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?

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Grahame Morris Portrait Grahame Morris (Easington) (Lab)
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Thank you very much, Ms McVey, for calling me to speak in this important debate. I also thank my friend, the hon. Member for Westmorland and Lonsdale (Tim Farron), for securing this debate.

I am sure this will seem like groundhog day for the Minister, with a whole phalanx of MPs supporting the calls for more resources for cancer, but this is a very serious issue and I make no apology for rehearsing those arguments. Until we see tangible results arising from our lobbying efforts, I am afraid it will continue. The hon. Member for Westmorland and Lonsdale made an excellent opening speech, setting out the arguments in a thoroughly cogent and thoughtful manner. I also want to pay tribute to the NHS workforce, in particular our cancer workforce, not just the oncologists but the therapeutic radiotherapists, the technical staff who keep the service running, and those key personnel who work behind the scenes, often unacknowledged, whose expertise has the potential to improve cancer outcomes.



The speeches have been excellent so far, but I will take issue with one point raised by the hon. Member for Warrington South (Andy Carter) about our cancer performance. Our focus in this debate is on what we can do immediately to address the cancer backlog, but I would respectfully point out that, even before the pandemic, our performance on cancer outcomes was not world-beating. In fact, for the seven most common cancers, in a direct comparison with similar advanced industrialised countries, we were either bottom or second bottom. There was a job of work to be done even before the pandemic, and the impact of covid has shone a spotlight on that.

I have the great privilege to be vice-chair of the all-party parliamentary group for radiotherapy and vice-chair of the all-party parliamentary group on cancer. The charity Action Radiotherapy estimates the full cancer backlog stands at more than 100,000 patients, and it agrees that it would take cancer services working at over 120% of pre-covid capacity for two years just to catch up. The chair of the Health and Social Care Committee, the right hon. Member for South West Surrey (Jeremy Hunt), agrees with that figure, having done some research of his own.

We need a distinct plan. It cannot be a case of Members simply lobbying Ministers and asking for more resources. We need to quantify the scale of the problem; we need an action plan. I am very much aware that we have a cancer recovery plan, but we need an action plan that addresses all the issues. I also believe that we need somebody with some clout to lead it. Last week the Government announced that the Under-Secretary of State for Business, Energy and Industrial Strategy, the hon. Member for Stratford-on-Avon (Nadhim Zahawi), would be the Minister responsible for driving forward the vaccination programme. Cancer is such an important area of concern to the public and to the broader community that we need to have someone with some clout, preferably a Minister or senior person within the NHS, to be given the responsibility to drive this initiative forward.

Experts are predicting 35,000 deaths and 60,000 lost years of life, with cancer survival rates having been pushed back to where they were 10 to 15 years ago. We need to address this issue. When we have asked questions in previous debates, Ministers have responded, and I mean no disrespect to the Minister who is in her place at the moment, because I know that she fully understands the issue. I do not want to make any apology here, but there is a difference between investing in diagnostics and investing in curative treatments. There is a difference between radiology and radiotherapy, and I am not convinced that the Secretary of State understands those differences. We welcome the additional investment in digital imaging and improved diagnostics, but we must address how we get more resources and improve the number and quality of the skilled cancer workforce to get to grips with the backlog.

It is appropriate to mention the implications of the pandemic for prostate cancer, which was also referred to by the hon. Member for Warrington South. Movember, when men grow a moustache to raise awareness and funds for men’s health during November, ended earlier this week. Prostate Cancer UK has identified two major concerns. The first is the detrimental impact on GP referrals for prostate cancer. That came to mind when my hon. Friend the Member for Gower (Tonia Antoniazzi) mentioned the three referral pathways of A&E, GP referral and screening programmes. There is a massive issue. I suspect that hon. Members present have some experience of how extraordinarily difficult it is, particularly for older people, to get a face-to-face appointment with a GP at this time if they have concerns about possible early symptoms of cancer. Again, that needs to be addressed, because it is having an impact on the backlog.

The second concern is about men accessing support and communication at the time of diagnosis and when living with side effects or advanced disease. Calculations by NHS England and Prostate Cancer UK suggest that there are between 3,000 and 5,000 men with undiagnosed higher risk prostate cancer who would otherwise have been diagnosed had referral rates been at pre-covid levels.

In the time that I have remaining, I will focus on two main areas and I have some specific asks of the Minister. The first area, which I have raised on previous occasions, is data and information. We have heard statements from Ministers in the Department of Health and Social Care and from senior NHS leaders that indicate that they do not have an accurate estimate of the full cancer backlog of delayed treatments, diagnostics and screenings. The publication of the radiotherapy dataset, which is available, would show precisely the extent and character of the backlog, because it would compare the position now with the position 12 months ago.

For reasons that are not apparent to me, the publication has been delayed by NHS England, so my first ask of the Minister is, why is that? Why will those radiotherapy datasets not be published? I do not know whether NHS England is being too slow to act or whether it is some kind of bureaucratic hold up, but it must be driven forward, as it is imperative to ensure that the cancer recovery plan is accurate. That is despite the fact that NHS England and Ministers are fully aware of the effect of the pandemic on cancer services; we have been raising the issue since April.

It is clear that knowledge is power. A lack of accessible data is resulting in an inability to catch up with cancer. Let us be frank: people are dying unnecessarily as a result. There was the awful case of Kelly Smith, one of many tens of thousands of people, who was a 31-year-old mother of three who died as a result of delayed treatment for bowel cancer. It was absolutely tragic. That caused her family to launch the Catch Up With Cancer campaign and petition, which I believe now has almost 400,000 signatures. If that does not concentrate Ministers’ minds, I do not know what will.

The second area is the comprehensive spending review and, in particular, the lack of any detail or specific reference to funding for modernising radiotherapy services. The Chancellor’s announcement last week was most welcome, but when the hon. Member for Westmorland and Lonsdale asked about the cancer backlog and additional resources for advanced radiotherapy, he was referred to Health Ministers and the Secretary of State.

We should be aware that radiotherapy is safer to administer during the pandemic than alternative treatments. I am not attempting to set up a competition, but we have to recognise that radiotherapy is non-invasive and covid-safe, and has a range of applications. It is needed by about half of all cancer patients and is a significant treatment in 40% of cancer cures. I have benefited from it myself on three occasions. It is also hugely cost-effective, curing patients for as little as £5,000 to £7,000 per treatment. It is very efficacious in terms of the curative rate, and it could do much more to clear the backlog, but it is being held up by underfunding and bureaucracy, which have slowed the roll-out of new technology for a number of years.

Despite freedom of information requests showing that nearly half of trusts are using radiotherapy machines that are 10 years old or older, it appears that the spending review includes funding only for diagnostic machine replacements and not radiotherapy treatments. Even before the pandemic, Radiotherapy4Life estimated that 24,000 patients did not have access to radiotherapy and would benefit from it. Will the Minister commit to improving access to local radiotherapy by investing in new networked treatment delivery centres? Furthermore, will he consider all the elements of the six-point plan to transform radiotherapy services to ensure that we have the treatment capacity to catch up? Will he sweep away the bureaucracies that have contributed to the backlog?

There is no doubt about it. We need a supercharged—“super boosted”, to use the Prime Minister’s words—treatment capacity if we are to address this cancer crisis.

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Alex Norris Portrait Alex Norris (Nottingham North) (Lab/Co-op)
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It is a pleasure to serve under your chairship for the first time, Ms McVey, and I commend the hon. Member for Westmorland and Lonsdale (Tim Farron) for securing the debate. When he opened it, he said he thought this was an issue on which we could work through consensus and in a collegiate fashion, which is absolutely right. The tone that he set, and that other hon. Members have followed, reflected that. He also said that he was direct in his contribution, which he was. He was right to be direct, because these are life and death issues, and we in this place need to be really focused on them in the most direct fashion.

I was lucky to meet the hon. Gentleman in July, alongside representatives from the secretariat of the all-party parliamentary group on radiotherapy, to discuss this issue. Of course the situation is not exactly the same as it was in July, but the crux of the issue is the same. It is great to go beyond virtual meetings and the back-channel conversations that we have in Parliament, and to get the subject on to the Floor of the House in order to have a public conversation about what is a very public and important matter. I particularly agreed with the hon. Gentleman’s point about “back to normal” not being good enough, because “back to normal” will not help us clear the backlog. Actually, we do not want to go back to where cancer services were in January. Hon. Members have touched on many ways to make services better—I will do the same later—and we should seek to do so. I share the hon. Gentleman’s anxiety about the gap between some of the rhetoric that we have heard from the Secretary of State, and the reality of what the numbers tell us about where we are at the moment.

Cancer touches us all at some point, as the hon. Member for Strangford (Jim Shannon) said yesterday and again today. For me, it was 33 years ago: I lost my father just before my third birthday. You come to terms with it and learn to live with it, but it is something that you carry around with you every day for the rest of your life. One of my major reasons for wanting to be a Member of Parliament is that I want there to be as few families like mine as possible. We can beat cancer to the best of our ability, so that people need not live their life in the shadow of cancer. I know that the Minister shares that aspiration. That is part of the consensus that we can build on this important issue.

The speeches this morning have been really good. The hon. Member for Warrington South (Andy Carter) started with Helen’s story, which was a really important thing to do. Lots of numbers have circulated—I will be guiltier than anyone else of throwing tens of thousands here and there—but each one of those statistics is a person and a life. That is what really matters. I strongly share the hon. Gentleman’s recognition of the creativity of our NHS.

I nodded and agreed when my hon. Friend the Member for Gower (Tonia Antoniazzi) made the point about undiagnosed cancers. I worry sometimes that when the Secretary of State talks, he is talking about the backlog and dealing with treatment for those who have a diagnosis. That is of course absolutely crucial, but it is only part of the problem that we are dealing with.

My hon. Friend the Member for Easington (Grahame Morris) has been a very good friend to me ever since I was elected in 2017, but particularly in my Front-Bench role over the past eight months. I am grateful to him for his counsel and guidance, and for constantly sharing his information with me to enrich my work. He was right to say that we have to understand the performance picture a year ago—frankly, covid was a very distant and small threat, and we had not really grasped how it would change our lives. We were not happy with cancer performance or with the direction of travel over the last decade. Certainly, as the Opposition, we were very concerned about that. We have to see the current situation in that context.

The hon. Member for Strangford was yesterday the Member in charge of a brilliant debate on cancer in children and young people. Collectively, we raised and analysed really important issues, and I know that the Minister took an awful lot away from that. The hon. Gentleman’s contribution today was very much in the same vein. It was about an holistic approach, across the four nations, all of which are represented today, which is really nice. As the hon. Member for Angus (Dave Doogan), who speaks for the SNP, said, this is of course a devolved issue. But we need to tackle it collectively.

I will make a few points of my own. In yesterday’s debate, I touched on the impact that covid has had on cancer diagnosis and treatment in children and young people—a demographic that is often both reluctant to visit the doctor and diagnosed slowly; it often takes multiple visits for that to happen. We will need to do things differently to tackle the pre-existing issues such as that and to catch up in relation to where we are.

Of course it was right that we prioritised covid during the first wave and have continued to make tackling the pandemic an important priority. We should take real pride in the fact that our NHS has taken such a strong punch to its capacity and stood there; that was not inevitable. We have seen other health services around the world overwhelmed, so we should be really proud of ours. It is a real testament to the institution that it has stood firm.

Nevertheless, we know that we now have an undiagnosed and untreated backlog of cancer. It is hard to estimate its true size because it is unknown. However, working off the best estimates of experts in the field—I shall use many of the numbers that the hon. Member for Westmorland and Lonsdale did in opening the debate—we are talking about a backlog of about 100,000 patients, which it would take about two years, working at 20% higher capacity than pre-covid, to capture. We cannot do that just by wanting it to be better or wanting people to put their shoulders to the wheel even more, after a year in which the NHS has been working flat out. We will have to do things fundamentally differently. If not, the price will be preventable deaths. Every four weeks of delay in starting treatment can cause an increase of up to 10% in the risk of death. The estimate is that the backlog could cause between 30,000 and 60,000 deaths, which starts to become of the same order of magnitude as the number of deaths from covid itself. That is how serious the situation is. As we emerge from the pandemic, we need to tackle cancer with the urgency and focus with which we have tackled covid.

There is particular concern about missed screenings. Cancer Research UK estimates that 3 million screenings were missed over the last year. Also, we know that fewer people went to the GP with symptoms during that time, because they were worried about other issues or capacity issues. As a result, about 350,000 fewer people were referred between April and August than we would normally expect, and there was a consequent 39% drop in the number of key diagnostic tests undertaken in that period.

I was really glad to hear yesterday from the Minister that the numbers of GP referrals are now back around pre-pandemic levels. That is a good sign. Actually, there were more referrals in September 2020 than in September 2019, but the two-week wait target of 93% is not yet being met, so there is definitely some context for that.

We need to understand that this issue will still not apply evenly throughout the population. Cancer does not know who we are when it grows in our bodies, but different demographics are affected differently—yesterday we talked about young people—and there are issues about different cancers, too. The points that the hon. Member for Strangford made about pancreatic cancer were well made.

The scale of the problem is exceptional and it calls on us in this place to make it a real focus and to have really strong, robust plans; so, now that I have talked about the problems, here are my suggested solutions. For me, this goes across four phases—planning, resourcing, new treatments, and workforce.

In August, the Secretary of State said that he very much hoped that the backlog would be cleared

“within a matter of months”.

Since I assumed my role, I have used three out of four sessions of Health questions to ask about cancer and try to get the Government on the record on that, which is why it is so great that we are having this debate. My heart sank when the Secretary of State said he thought the backlog could be cleared within a matter of months, because there is a problem; I do not think it is rude or unkind to say so. It has been recognised, during the pandemic, that some of the rhetoric that comes out of the Department is wishful and not grounded in reality. We are always told that things will be “world-class” and that things will be done “by the end of next month”. People’s hopes are got up and then dashed. We do not need exaggerated rhetoric here; we need exaggerated action.

I cannot see how anybody thinks that we can clear the backlog—the real backlog, which includes the lack of diagnosis as well as delayed treatment—within a matter of months. I do not think it helps anybody to talk in those terms. However, in October, at the Health questions before last, the Secretary of State gave me a categorical assurance that he has a cancer recovery plan that will drive down waiting lists each month for the rest of the year. I welcome that. That could be done and I am keen to hear the Minister reflecting on progress on that.

Similarly, at the most recent Health questions, the Minister for Health, the hon. Member for Charnwood (Edward Argar), said that there was greater capacity to deal with these things.

Grahame Morris Portrait Grahame Morris
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I cannot dispute the answer that my hon. Friend received from the Minister. It was an obvious answer, but the waiting lists have reduced because people are not presenting. There are fewer screening programmes, people are finding it harder to see their GP and things have become more and more difficult, so there is bound to be a reduction in waiting times, but that does not reflect the true picture of the backlog.

Alex Norris Portrait Alex Norris
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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.

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Jo Churchill Portrait The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)
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It is a pleasure to serve under your chairmanship, Ms McVey. I have been given nine minutes to answer an enormous number of questions, so I will canter through in the hope that I answer some of them. We are a group that meets and discusses these things on a fairly regular basis. Indeed, I am back here this afternoon for a lung cancer debate, so this is an ongoing conversation, which I appreciate is vital. It is right that we recognise, as several hon. Members have, that the NHS has stood up during the pandemic, which was a blow to its very belly. We have put much effort into retaining services, not only for cancer, but for stroke patients and others, so that they can go to our NHS in their time of need.

I thank the hon. Member for Westmorland and Lonsdale (Tim Farron) for securing this debate and for all the work he does as chair of the APPG. He has such a formidable set of musketeers supporting him on what is one of the most focused APPGs. We are due to meet in January, but I will try to fit in a short meeting this side of the recess.

I have never said we were world beating—I came to this place because we were not; we had challenges before. Up to March last year, there were 2.4 million patients, which is 1.4 million more than in 2010. We were on a trajectory and covid hit us hard, and I would be the first to say that it has presented major challenges for the entire healthcare system.

The significant impact of shutting down services resulted in a sharp reduction in the number of people being referred urgently with suspected cancer and from screening programmes. That is a statement of fact. I am not going to stand here and say that it did not happen, but I am also not going to say that Herculean efforts have not been made since then.

I am really pleased that the cancer services recovery plan has had input from many cancer charities, including Macmillan, which has been mentioned, as well as many Royal Colleges, including those of General Practitioners, of Pathologists, of Radiologists and of Surgeons. It is vital that the right people make the recovery plan, which is being led by Professor Peter Johnson and Cally Palmer. It is in their hands together—a coalition—and I hope the recovery plan very much leads the way on a route to addressing the backlog and making sure that we take opportunities.

I think we all agree on some of the challenges, including those on data, referral systems and the lack of optimal radiotherapy machines in Westmorland. Again, that is a statement of fact and we need to address how we improve that situation so that every single person has appropriate access to treatments. As treatments advance or are shorter—more oral chemotherapy can be given at home, for example—there is a chance to redesign services to make them better and deliver more for patients. Every single day, I think of those patients. The hon. Member for Easington (Grahame Morris) made a comment about the loss of individuals. Every single day, that is what motivates me.

I thank my hon. Friend the Member for Warrington South (Andy Carter) for his comments about how hard the workforce are working. Whether it is a cancer nurse specialist, a radiotherapist, a radiographer or a surgeon, they are putting their back into this effort, because it could be a member of their family. They are a tremendously committed workforce, to whom I extend enormous thanks—but we need to get more of them. How do we convince a young nurse that his or her route is to become a cancer nurse, even though all the other specialists are also asking for them? We should also be working on that as a coalition, saying, “This is a fantastic area.”

We want to eradicate breast cancer by 2050. The survival rate for testicular cancer is now at a 98%. Pancreatic cancer is a dreadful disease, but we are now seeing not a two-week death sentence, but a couple of years. There are advances all the time and we must optimise that. Each and every person deserves to see that power, particularly on today of all days, when a vaccine has been approved and we know how brilliant this country’s life sciences industry is. We can beat this disease, but it takes time. I am absolutely committed to the patient-centred approach. One in four patients presented at A&E before this crisis—they presented too late. We know what the golden thread is.

There have been some positive announcements. I was encouraged to hear that we will pilot the Grail blood test, which can detect cancer from saliva. I am also pleased that in November’s spending review there was a further £325 million of investment in diagnostic equipment. The allocation of that will be determined in the next few weeks. I cannot give hon. Members any promises, and they would not expect me to say what will be allocated, but I understand the lobbying and the importance of not necessarily having shiny, sparkly front doors to walk through but getting the kit on the ground that can help save people’s lives. We know that no one single thing gives people the best chance of survival—it is the golden thread of swift referrals and screening that gives us early diagnosis—so we need those faecal immuno- chemical tests and to roll out the lung cancer pilots, and we are doing that. We need to ensure that we drive up those workforce numbers. We also need shorter waiting times for optimal treatment that will ultimately turn the tide on this disease.

Our strategy for maintaining services concentrates on stepping up hubs for cancer surgery and optimising independent use, which we have done as a Government. We stood up; we did not shy away from it. There have been no arguments about us using the private sector during the pandemic, have there?

Jo Churchill Portrait Jo Churchill
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I am really sorry but I have only got two minutes.

The NHS will accelerate the roll-out of rapid diagnostic centres. As I said in this Chamber yesterday, in March we had 17 of them and we now have 45—we have stood up 28 of them in the course of the pandemic. Most importantly, they will support early diagnosis, which we know is key. I am pleased that we are concentrating on recovering and maintaining cancer services. Through the newly formed cancer recovery taskforce, led by Professor Peter Johnson, we can drive that commitment forward with everybody.

The workforce have adapted, flexed and cared for individuals in the most challenging of circumstances. Every death concentrates my mind. My first text yesterday was from a friend who told of the passing of someone who had lost her fight against breast cancer after seven years. The disease does not go away. I am sure my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) would be here if she were not going through treatment and, as she would tell us, it sucks. The cancer workforce are a special part of the NHS family and I want us to ensure that they know how special they are so that people come forward to join them.

We know that referral rates have been variable across different cancer types. Arguably, some cancers have really challenged us, and particularly those that need endoscopies and colonoscopies. We are still not there because of the treatment. Lung cancer referrals were poor before we went into the pandemic. What would someone think if they had a persistent cough? They might get a covid test. Actually, if that test is negative, we need to ensure that they are referred by 111 to the system for a lung cancer test.

I have a lot more that I would like to tell hon. Members, but I dare say that we will be back here imminently. On that note, I will hand over to the hon. Member for Westmorland and Lonsdale.