Elective Care Recovery in England

Grahame Morris Excerpts

Monday 7th February 2022 Commons Chamber

[Edward Argar]

I am grateful, I think, to my right hon. Friend for his question. As I set out, it is important that this is the right plan and that it does the job for which it is intended. We are working closely with other Departments to make sure the plan, when it is published, does the job for which it is intended, and I look forward to its imminent publication.

[Grahame Morris (Easington) (Lab)]

It is essential that we address cancer treatment capacity. The Minister talks about diagnostics, which is important, but it is a horse and cart or a hand and glove. I know he is aware of the enormous unharnessed potential of high-tech radiotherapy as a solution to time-critical cancer backlogs, but it still receives only 5% of the cancer budget. Such investment could take enormous pressure off the NHS, especially at this time. Will he arrange a meeting with the Secretary of State so that we can explain to him the important role that advanced radiotherapy could play in tackling the cancer backlog?

[Edward Argar]

The hon. Gentleman and I have previously met to discuss this issue, and I share his view on the value of radiotherapy in helping to tackle the cancer backlog, and more broadly as a treatment. Ministers and I are always happy to meet him.

Covid-19 Update

Grahame Morris Excerpts

Thursday 13th January 2022 Commons Chamber

[Sajid Javid]

My hon. Friend is absolutely right to raise this most important of issues. In the way he phrased his question, he reflects just how difficult it is to strike the right balance in care homes between protecting the residents but also making sure that they can get the visits that are so important for them. The approach that we have taken in England is different from that in other parts of the country. We do allow more visitors. We are supplying a record number of tests to care homes, not only for the residents but for the staff. For the reasons that he has so clearly laid out, we keep this under review and will remove restrictions as soon as it is safe to do so.

[Grahame Morris (Easington) (Lab)]

I welcome the Secretary of State’s statement, particularly his reference to cancer patients and his commitment to apply the latest technology. May I respectfully draw his attention to yesterday’s excellent debate in Westminster Hall about access to radiotherapy services? In particular, I draw his attention to the fact that modern radiotherapy is extremely precise, cost-effective and non-invasive, and it does not affect the immune system. Can I urge the Secretary of State to provide the required additional resources needed to modernise radiotherapy services throughout the UK and to catch up with cancer?

[Sajid Javid]

I very much agree with what the hon. Gentleman has shared with the House. Unfortunately, I was not able to attend that debate, but the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield) did, and she will also be meeting the all-party parliamentary group on radiotherapy and listening more. I know the hon. Gentleman agrees with me that it has been absolutely right during this very difficult time for the NHS to direct more resources especially to looking after more covid patients and to the booster programme, but it has also been right to protect cancer care.

Access to Radiotherapy

Grahame Morris Excerpts

Wednesday 12th January 2022 Westminster Hall

[Philip Davies (in the Chair)]

Before we begin, I remind Members that they are expected to wear face coverings when they are not speaking in the debate. This is in line with current guidance from the House of Commons Commission. I remind Members that they are asked by the House to have a covid lateral flow test before coming on to the estate. Please also give each other and members of staff space when seated and when entering and leaving the room. I call Grahame Morris to move the motion.

[Grahame Morris (Easington) (Lab)]

I beg to move,

That this House has considered access to radiotherapy.

It is always a pleasure to serve under your chairmanship, Mr Davies, and if it is not too late I would like to wish you and the Officers of the House a happy new year.

I am delighted to have secured this vital and timely debate on access to radiotherapy services. On occasion, it may seem like groundhog day: we come here on a fairly regular basis and outline the case for more investment in radiotherapy services. However, the covid crisis has brought many of these issues into sharp focus, and indeed there is a growing cancer backlog crisis that the Government really must address.

I also want to thank the Chamber engagement team for its fantastic work. This is the first time that I have had any interaction with the team, but it has been most helpful in engaging the public ahead of this debate. I am immensely grateful to the team for carrying out a survey over the course of only a few days—over this weekend, really. We had over 800 responses, and I thank all the respondents for taking the time to express and submit their views and experiences. I believe that those contributions, a couple of which I will refer to, will significantly enrich the debate. I am eagerly anticipating what I am sure will be comprehensive and compelling contributions from colleagues in the Chamber, many of whom I have served with and been involved with in debates like this previously.

It is only right that I begin by declaring an interest. I have the privilege of serving as vice chair of the all-party parliamentary group for radiotherapy, and I am also one of the vice chairs of the all-party parliamentary group on cancer. I also want to thank Macmillan Cancer Support and Radiotherapy UK, the charity with which I am associated, for their assistance in preparing for today’s debate. I am immensely grateful to colleagues from the all-party groups who have come along today; I know that there are many pressing demands on Members’ time.

The reason the debate is so important is that cancer will affect all of us at some point in our lifetimes. I want to take this opportunity to mention a good friend of mine, Nick Munting, who, as some might know, is a chef in the House of Commons and has very recently been diagnosed with cancer. I wish him all the very best for his speedy recovery.

I have personally had cancer on three occasions—a type of lymphatic cancer called non-Hodgkin lymphoma. Without the care and treatment that I received from the NHS, I would not be here today. I thank the dedicated staff at the Macmillan cancer centre at the Freeman Hospital in Newcastle, and those working at cancer hospitals throughout the country, for the excellent work that they do in diagnosing and treating cancer patients. I have received a plethora of cancer treatment. I have had the works: surgery, chemotherapy and radiotherapy—including advanced radiotherapy.

There is a reason why I am concentrating on radiotherapy today. Radiotherapy is by far the least understood of the three pillars of cancer treatment, with chemotherapy and surgery far more widely understood and referred to in public life. Despite that, one in four of us will have radiotherapy at some time in our lifetime. I want to begin by highlighting the many advantages of this highly specialised treatment and the major breakthroughs that there have been over the last 10 years.

Unlike other cancer treatments, modern radiotherapy is accurate to within millimetres, limiting damage to healthy cells around the cancer. A specialist in the field and a dear friend, Professor Pat Price, explained in simple terms to me, as a layman, the concept of a banana in a box. Imagine that the tumour is a banana in the box. With older, less precise forms of radiotherapy, the whole box would be irradiated and there would be considerable collateral damage to healthy cells. With modern, advanced precision radiotherapy techniques, just the banana would receive the high dose of radiation, and there would be no collateral damage. That significant advance has come about because of digital technologies and advances in this form of treatment. It is especially useful for treating cancers in areas vulnerable to damage, and it requires fewer patient visits than other treatments. Unlike surgery, it does not take up intensive care capacity, and unlike chemotherapy, it does not impact on the immune system.

Furthermore, radiotherapy is the most cost-effective treatment. Typically, a patient can be cured at a cost of about £6,000. If we contrast that with the cost of some chemotherapy drugs, which for individual treatments may run into hundreds of thousands of pounds, there is a cost argument for expanding radiotherapy, in addition to its effectiveness as a treatment. In many respects, it is a silver bullet. It is often referred to as a “Cinderella” service: it is immensely effective, but it suffers from chronic under-investment and suboptimal clinical commissioning. Let me remind the Minister that the UK spends only about 5% of the cancer budget—I do not mean the entire NHS budget; I mean just the cancer budget—on radiotherapy. Compared with what is spent in many other advanced European countries, that is a very small proportion; the European average is about 10% of the cancer budget.

In England, access to treatment can depend on people’s postcode; often, patients in more affluent, urban areas benefit from the most modern equipment, and from ease of access because of excellent public transport provision. In contrast, patients in less affluent, more rural areas, such as mine—Easington in County Durham—do not enjoy the same levels of access. My constituents make up a proportion of the 3.5 million people in England who do not have a radiotherapy centre within the recommended 45 minutes of their home.

That statement of the situation was supported and confirmed by a number of the respondents to the survey carried out by the Chamber engagement team. If I may, I will refer to a couple of their contributions. A lady called Penelope had positive experiences of accessing the service herself, but feared for others who might not be so fortunate. She said:

“In my experience, which involves my father’s radiotherapy last summer, he did not have to wait long, but he lives in Berkshire…near several hospitals, and I think the situation is very different in other areas of the country.”

Similarly, David said:

“My own wait time…before the covid situation was only weeks, and by that time I had already started other treatment regimes as well. I am lucky to be close to a centre of excellence: the University Hospital Coventry and Warwick. This is not normal though, a close friend, now passed on, had to drive from their home near Boston in Lincolnshire to the Leicestershire Infirmary for treatment, when there was a possible ‘slot’. That was a 4-hour round trip as neither the Boston nor Lincoln hospital had”

radiotherapy

“facilities. Lack of facilities meant the cancer spread out of control and he died.”

Radiotherapy is needed in almost half of treatments, but according to Cancer Research UK, only 27% of UK cancer patients actually receive it. I respectfully point out to the Minister that we will never level up the country while access to life-saving treatment depends on people’s postcode—where they live—entrenching already existing regional health inequalities.

Let me also address some of the workforce issues. The radiotherapy workforce are at breaking point. A survey conducted by Radiotherapy UK and the Institute of Physics and Engineering in Medicine in October 2021 found that almost 80% of professionals were considering leaving their position or knew a colleague who was. That was echoed by members of the radiotherapy workforce who submitted their views to the survey. A lady called Lauren said:

“Most radiotherapy staff can travel over an hour as that is their nearest radiotherapy centre. Increasing working hours and increasing workload is leading to more staff wanting to leave the profession in addition to the fact most of us have to travel long distances to find a centre to work at. Due to housing not being affordable in the locations of radiotherapy centres,”

which are often in big city centres. The Minister can address that fairly simply, and we have a solution—investment in IT networks, which I will come to in a moment—that we have put to successive Ministers who have occupied the post.

The tariff system generating income to trusts is based on the number of patient visits. Those perverse tariffs mean that radiotherapy trusts with advanced machines that can treat patients in fewer sessions are incentivised to treat patients less effectively over more treatments. That is a ludicrous, perverse incentive that I am sure the Minister could do something about.

Similarly, trusts seeking to replace ageing machines—the advice is to replace radiotherapy machines after 10 years—are required to conduct 9,000 treatments even to be considered for funding. The pandemic saw referrals plummet and services overstretched, so centres are not reaching that threshold and are therefore blocked from providing patients with access to the latest life-saving technologies. We have poor patient access and exhausted, demoralised staff, with senseless bureaucracy and a tariff system promoting less effective treatment. That is a pretty poor report card.

That was the state of radiotherapy even before the covid-19 pandemic. Holly, a radiotherapy professional, said:

“Currently we are having to delay patients due to poor staffing levels, this started way before the current surge in omicron cases. We have been understaffed for some time, and this has been made so much worse by omicron, we are having to close machines to make sure we have staff to cover”

the covid patients. She added that

“those that are in are getting burnt out by having to work longer, more days and harder each shift, meaning it’s a cycle of being off ill.”

Covid has created a cancer crisis that the current system cannot effectively manage. On that note, I want to pay tribute to the Catch Up With Cancer campaign, which was launched in conjunction with Craig and Mandy Russell, who very sadly lost their daughter Kelly to bowel cancer when her treatment was delayed owing to resources being transferred to the treatment of covid patients. Some of us here today handed in to 10 Downing Street a petition, signed by more than 300,000 members of the public, calling for action on the issue.

Of all the health backlogs, the cancer backlog is the most time-sensitive because, for every month that diagnosis of treatment is delayed, cancer survival rates can drop by as much as 10%. These are life-and-death issues for many tens of thousands of people. Without urgent action, cancer experts predict that survival rates in the UK may fall back to where they were 15 years ago, resulting in tens of thousands of extra cancer deaths. I know the Minister is new to her post, and I do not want to be unfair, but there is a crisis. I have been with colleagues to see a succession of Health Ministers, on many occasions, to set out proposals to improve the position. The lack of action is frankly lamentable, and many thousands of people will pay the price.

Before the pandemic, the all-party parliamentary group for radiotherapy branded radiotherapy “Britain’s secret lifesaver”. Ministers and NHS leaders need to recognise that it could be a game changer; it could have an immense impact on tackling the covid-induced cancer backlog, but to do that, it needs sufficient investment.

The all-party group has put together a six-point covid-19 recovery programme. I urge the Minister to look at that and to implement its proposals, which were developed not by me or other parliamentarians but by experts in the field—radiotherapy specialists and oncologists—who understand their patients and understand the service and how we can improve it.

The first point in our six-point plan is that we need to appoint a Minister in charge of and accountable for the transformation of radiotherapy. We need to invest in IT solutions to modernise radiotherapy. The problem that radiotherapy is available in only relatively few urban centres could be mitigated, to a degree, with modern IT that allowed specialists hundreds of miles away to interpret digital imagery and advise on the appropriate treatment.

We need to replace ageing machines—those that are more than 10 years old—and forget the bureaucratic nonsense about machines having to have done 9,000 treatments, because referrals for treatment have reduced due to covid. We need to invest approximately £200 million in the highly specialised workforce, where staff redeployment will be insufficient to fill the gaps.

We need to improve capacity and access by placing radiotherapy machines in some of the planned new diagnostic hubs. Ministers often respond to debates such as this one by referring to the £130 million that the Government promised to improve diagnostic services. That is welcome, but we need to address not just diagnosis but treatment. Radiotherapy is a quick and highly effective treatment, so I urge the Minister to consider using these machines in the diagnostic hubs.

Finally, we need to raise the profile of radiotherapy, ensuring full awareness among the public of the treatment’s curative and palliative potential. The six-point plan is underpinned by a need for a national strategy. The lack of a cohesive national approach has caused unacceptable inequality and disparities between trusts in different parts of the country.

It comes down to this: every day, every week and every month that the Government fail to take sufficient action, the public suffer, money is wasted and patients die. The Government are in denial about the situation and there is a huge disconnect in ministerial statements. Just last week, I heard the Leader of the House say that the situation had been normalised, but that is far from the truth. We cannot ignore the cancer crisis any longer.

I want to ask the Minister a number of questions, which I hope she will address in her response. I hope she understands the frustration felt by radiotherapy staff, but I want her to make a commitment to investigate the bureaucracy that is holding back radiotherapy trusts and denying patients the most effective treatment. Will she act urgently on that? Is she aware that the Government have not reported radiotherapy-specific data, which we refer to as the radiotherapy datasets, since May 2021? Will she publish the datasets that are available next month? Those will show clearly the levels of treatment that radiotherapy machines have been involved in during this period compared with previous years. That will make perfectly clear the level of the backlog, which estimates from the frontline put at between 50,000 and 60,000.

Will the Minister outline the plan in the event that radiotherapy services find they are no longer able to cope? Finally, will she agree to a meeting with radiotherapy commissioners, the Secretary of State and representatives of the radiotherapy community, in order to address these essential life-or-death issues? It has been useful for me to open the debate, but I know colleagues have issues that they would like to put to the Minister, so with that, I will conclude.

--- Later in debate ---

[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.

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

It is a pleasure to serve under your chairmanship, Mr Davies. I should declare an interest before I start: I am still working as a cancer nurse in the Royal Marsden Hospital in London. I have spent 20 years looking after patients who are having chemotherapy, radiotherapy and surgery, so no one is more passionate than I am about this issue.

I congratulate the hon. Member for Easington (Grahame Morris) on securing this important debate, raising the profile of radiotherapy and the important work that the all-party parliamentary group does. Very few of us have not been impacted by cancer in some way, whether as a patient—the hon. Gentleman and the hon. Member for Rhondda (Chris Bryant) eloquently described their experiences—or as a relative, friend or healthcare professional. We know the devastation that cancer can bring, whether through the diagnosis and living with the disease, experiencing the side effects of treatment or, unfortunately for some, the effects it can have on life expectancy.

I reassure colleagues that during the pandemic, cancer has remained an absolute priority. We have kept cancer services going throughout periods of lockdown. There is no doubt, though, that patients were reluctant to come forward with signs and symptoms, particularly during the first lockdown. We actively encouraged many patients with a cough not to come and see their GP as a first point of contact. Since then, however, an absolute tsunami of patients has come forward—so much so that we are working through more than 10,000 cancer referrals a day.

I encourage Members to look at the data for actual treatment. Data such as that about the 62-day rule shows that the cancer backlog is not necessarily in treatment—in patients waiting for surgery, chemotherapy or radiotherapy—but in the diagnostics procedures. They are where the greatest pressure is at the moment.

[Grahame Morris]

I appreciate the Minister’s giving way. Statistics are important as a tool to identify where the obstructions are in the system. I completely agree about the importance of early diagnosis, but will the Minister publish the radiotherapy datasets that will be available next month, so that we can see the true nature of the backlog?

The profession—the frontline—tell a story rather different from the impression that the Minister has just given: that there are issues with treatment, and not just with diagnosis. The radiotherapy datasets, which have not been published for over a year but are available, will clarify that position.

[Maria Caulfield]

I thank the hon. Gentleman. I am not saying that there are no pressures on the treatments for cancer patients, but the greatest pressure is at the diagnostic end. We will be publishing data, but I caution Members on the data for radiotherapy. A lot of the cancer data is based on first treatment and, as Members will know, radiotherapy is often an adjuvant treatment given further down the line. The measurement of access to radiotherapy, compared with treatments such as surgery or chemotherapy, is much more difficult to establish.

I also caution colleagues, a number of whom have said similar things in this morning’s debate. Radiotherapy is a specific specialist treatment. As the hon. Member for Rhondda pointed out, for many cancers it cannot necessarily be given instead of surgery or chemotherapy; it is part of a package of treatment and these are clear, clinical decisions that need to be made jointly by the oncologist and their patient.

[Grahame Morris]

We have a little bit of time and these are important points. Many of us have been making them, not just to this Minister—who, to be fair, is newly in place—but to her predecessors.

There are points of contention about the effectiveness of radiotherapy, but there have been some incredible advances in recent years. I am not claiming expert technical knowledge, but radiotherapy has been applied very effectively against lung cancers; that was never the case before. There is now a possibility of expanding the service to provide much more effective treatments, for cases which previously could be treated only through surgery and chemotherapy.

[Maria Caulfield]

I do not disagree with the hon. Gentleman. I may be a new Minister, in post for weeks rather than years, but I have 20 years of oncology experience, and in my experience radiotherapy has a fantastic role to play. It is indeed the case that significant progress has been made, particularly in the field of lung cancer, with stereotactic radiotherapy to specific areas. However, radiotherapy will target a specific area; it will not give systemic treatment, like adjuvant treatment to prevent recurrence or neoadjuvant treatment for metastatic disease, where the disease is in multiple parts of the body. As Members of Parliament, we need to be cautious that we do not give patients the impression that they should be asking for radiotherapy instead of surgery and chemotherapy. There needs to be a discussion with their oncologist and their medical teams as to the appropriateness of radiotherapy. Yes, it is often cheaper than chemotherapy to give. Yes, it is a quicker treatment and sometimes—not always—has fewer side effects. But it has to be a clinical decision. There are important reasons why radiotherapy is given to some patients and not others. That is something that patients really need to have a discussion—

--- Later in debate ---

[Grahame Morris]

This has been a really good debate. It is one we have had on a number of previous occasions.

I thank my hon. Friends the Members for Bedford (Mohammad Yasin) and for Rhondda (Chris Bryant) and the hon. Members for Westmorland and Lonsdale (Tim Farron) and for Strangford (Jim Shannon) for their excellent contributions. I also welcome and thank my hon. Friend the Member for Enfield North (Feryal Clark), and pay tribute to her predecessor, my hon. Friend the Member for Nottingham North (Alex Norris), who did an excellent job and had a terrific understanding of the issue. I also thank the Minister for her response.

It has been an honour to open this debate. Once again, I thank those members of the public who shared their experience, and I thank the Chamber engagement team for their excellent work. It is the radiotherapy patients, their loved ones, the workforce, and, indeed, those who live with the everyday reality of this situation, whose interests we serve and whose insight is so valuable.

I hope the Minister, who has not answered all the questions—I know it is difficult—will have a look at the debate in Hansard and respond to them. I am grateful that she has agreed to have a meeting, but I want her to bring an end to radiotherapy’s status as a Cinderella service and give it the time, focus and investment required to put the UK on a path to ensuring that we have truly world-class cancer services.

Question put and agreed to. 

Resolved,  

That this House has considered access to radiotherapy.

Covid-19 Update

Grahame Morris Excerpts

Monday 6th December 2021 Commons Chamber

[Sajid Javid]

I would encourage everyone to look seriously at the national Government guidance. Our guidance is clear. Even before the emergence of the new variant, we all knew that covid-19 likes the colder, darker days that winter brings. There is plenty of guidance. I would encourage people to go ahead whether with nativity plays or Christmas parties, but to continue to follow the guidance that was always there.

[Grahame Morris (Easington) (Lab)]

Recent, quite staggering, figures from the respected charity Macmillan Cancer Support show that nearly 50,000 people in the UK are still missing a cancer diagnosis compared with the pre-pandemic period. I know the Secretary of State is new to his post, but there is a whole weight of evidence, including petitions and letters from MPs. Will he commit to address the severe capacity pressures within cancer services in the imminent elective recovery plan?

[Sajid Javid]

Yes.

Covid-19 Update

Grahame Morris Excerpts

Monday 19th July 2021 Commons Chamber

[Nadhim Zahawi]

My hon. Friend is absolutely right that we take this step confidently but cautiously. I remind the House that this is probably the most infectious respiratory virus known to humankind, with aerosol transmission, so we need to ensure that we are careful as we head into step 4.[Official Report, 21 July 2021, Vol. 699, c. 7MC.] I outlined the action that we are taking on key workers and critical workers, and of course the police fall within that.

[Grahame Morris (Easington) (Lab) [V]]

I congratulate the Catch Up with Cancer campaign, which I hope to join tomorrow in delivering a petition to No. 10 Downing Street, and thank them for their tireless work over the last year, pressing, petitioning and lobbying the Government to deliver urgently needed ring-fenced investment for our NHS cancer infrastructure so that cancer patients can get the timely diagnosis and treatment they need. The Minister mentioned the expert advice in his opening remarks. Will he outline his plans to ensure future protection for immunocompromised or immunosuppressed groups, such as those living with cancer, like me, who may still be at risk from covid-19, despite the vaccine roll-out?

[Nadhim Zahawi]

The hon. Gentleman attends the Friday briefings that I offer colleagues. He is absolutely right. Last week, Public Health England published some encouraging real-world data that showed that two doses of the vaccines offer around 74% protection for those who are immunosuppressed or immunocompromised. That comes with a caveat that that group of people is not homogenous and we need to unpack some of the data. The JCVI has already recommended in its interim advice on the booster campaign in September that that group goes top of the list for the third dose as a boost. Of course, we have a large clinical trial, which will report imminently on the immunosuppressed and the immunocompromised. We will look at that data with the JCVI. The chief medical officer continues to ask the JCVI to look at what else we can do to protect that group, including through the therapeutics taskforce, which is doing some tremendous work.

Covid-19

Grahame Morris Excerpts

Monday 22nd February 2021 Commons Chamber

[Grahame Morris (Easington) (Lab) [V]]

I would like to cover three areas: inequality, covid-secure workplaces, and, briefly, cancer services, which I raised with the Prime Minister during his statement this afternoon.

I was rather concerned, following the Prime Minister’s statement, that the Government may not have learned the lessons from their previous mistakes, in that there is a direct and undeniable correlation between covid-19 and inequality. The many heat maps that have been published over the past year showing covid infections, hospitalisations and fatalities have illustrated the close correlation between covid prevalence and areas of deprivation and high inequality. Indeed, in recent days a worrying trend has emerged of a high covid infection rate in some of the communities that I represent in the Easington constituency. While infection rates across County Durham continue to fall, there are higher rates in Peterlee East and Horden compared with other areas.

One reason is that in many cases the poorest have no option but to continue to work, even in conditions that are not covid secure. Those in insecure employment or on zero-hours contracts—agency workers, for example—do not have the finances or security that they need to self-isolate. The poorest are facing greater poverty if the Government do not listen to the likes of my own trade union, Unite, which is calling for them to retain the £20 uplift in universal credit and for the uplift to be extended to the legacy benefits—a call supported by many organisations, including the charity, Macmillan Cancer Support. Remarkably, there are many instances of workplaces that staff believe are still not covid secure. PCS union members at the DVLA headquarters in Swansea are balloting for strike action today after senior managers and ministers, some of whom appeared before the Transport Committee, which I serve on, have consistently refused to listen to their concerns. This is despite the fact that there have been over 550 covid cases in recent months and we have seen the tragic death from covid of one staff member.

We need to change our approach to cancer services and the need for a dedicated cancer budget. The cancer backlog after the first wave could be 50,000 patients, and we could emerge from the pandemic with a backlog of 100,000. We all want a safe and orderly return to normal, but one of the biggest obstacles throughout this pandemic has been the Government’s inability to follow the science and their turning a deaf ear to criticism.

Childhood Cancers: Research

Grahame Morris Excerpts

Monday 7th December 2020 Westminster Hall

[Grahame Morris (Easington) (Lab)]

Thank you for calling me, Mr Mundell. I thank my hon. Friend the Member for Gower (Tonia Antoniazzi) not only for securing this important debate on childhood cancer, but for all the excellent work that she does as chair of the all-party parliamentary group on cancer. I also thank the petitioners who promoted this debate today.

I want to talk about the work of the Bradley Lowery Foundation, which is based in my constituency, and I want to concentrate on the need, as other hon. Members have, for Government collaboration with smaller charities and research and funding into less common cancers. The Bradley Lowery Foundation was established in August 2017 after my constituent, six-year-old Bradley Lowery, lost his fight for life to stage 4 high-risk neuroblastoma, a rare and aggressive form of childhood cancer.

In 2013, Bradley’s mother, Gemma, started a fundraising campaign to raise funds so that Bradley could get treatment in the United States—treatment that was not available here in the UK. The foundation—one of its patrons is the former Sunderland and England footballer, Jermain Defoe—supports research on neuroblastoma and other childhood cancers, is developing plans to support a £600,000 holiday home in Scarborough, and runs a support line for families of children with cancer in the north-east. The Bradley Lowery Foundation has given £200,000 to neuroblastoma research and has just pledged another £15,000 to sarcoma research. It collaborates with other research charities to ensure that more funding can be put into the right places.

We have heard from my hon. Friend the Member for Islwyn (Chris Evans) and others about the prognosis for patients who have brain stem cancer, particularly children. The prognosis is really quite dark. I point out to the Minister, for whom I have the highest regard, that the Bradley Lowery Foundation wrote to the Chancellor of the Exchequer around June of this year and is still awaiting a response. In the letter, the foundation expressed its willingness to set up a meeting with the Chancellor regarding funding for childhood cancer research, and it was seeking to secure some support through matched funding from Government.

The charity finds that although the most common incurable cancers rightly receive a lot of funding, the rarer and harder-to-treat cancers get little funding. The funding that they receive is from smaller charities and organisations that, like the Bradley Lowery Foundation, might have been set up as a legacy for families who have lost children to a particularly rare cancer. I urge the Minister to speak to the smaller charities. I am sure she does so on a regular basis, but will she speak to the smaller charities and organisations that fund this vital research, such as the Bradley Lowery Foundation? After all, it is the smaller charities that fund the harder-to-treat cancers.

If the covid-19 pandemic has proven anything, it is that, with the will and the right funding and resources, treatment and vaccines can be developed. If the Government can pledge even a fraction of the funding that has been allocated for covid towards childhood cancer research, we could no doubt find better, safer treatments a lot faster.

Covid-19: Access to Cancer Diagnosis and Treatment

Grahame Morris Excerpts

Wednesday 2nd December 2020 Westminster Hall

[Grahame Morris (Easington) (Lab)]

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]

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?

--- Later in debate ---

[Grahame Morris (Easington) (Lab)]

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.

--- Later in debate ---

[Alex Norris (Nottingham North) (Lab/Co-op)]

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]

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]

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.

--- Later in debate ---

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

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?

[Grahame Morris]

rose—

[Jo Churchill]

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.

Breast Cancer Diagnosis and Services: Covid-19

Grahame Morris Excerpts

Thursday 12th November 2020 Westminster Hall

[Craig Tracey (North Warwickshire) (Con)]

I beg to move,

That this House has considered the effect of the covid-19 outbreak on breast cancer diagnosis and the future of breast cancer services.

It is a pleasure to serve under your chairmanship, Ms McVey. As co-chair of the all-party parliamentary group on breast cancer, I am delighted to raise these hugely important issues. It is great to see the Minister in her place; she brings great expertise and knowledge to this topic. This has all the hallmarks of an excellent debate.

To set the scene, as hon. Members will know, the pandemic has had a major impact on breast cancer services, with Breast Cancer Now estimating that almost 1 million women in the UK missed out on their screening appointment as a result of a pause in the programme. There was a worrying drop at the peak of the pandemic in referrals of suspected breast cancer and breast-related symptoms.

We also know that some breast cancer patients had their treatments changed or temporarily paused to protect their immune system, or had their surgery delayed. That caused, understandably, huge anxiety, particularly for patients with incurable cancers, such as secondary breast cancer, and that was passed on to their families. Recruitment to many clinical trials was paused. The sustained pressure on staff as a result of dealing with the covid-19 pandemic alongside the existing challenges for the breast cancer workforce, has the potential to overwhelm the system for the foreseeable future.

There is some good news. Despite a dip in August, referrals have been steadily recovering. Although there is some way to go before they reach pre-pandemic levels, breast screenings are restarting and the number of people beginning treatment is rising. I am sure hon. Members across the House will join me in thanking the NHS for its effort in treating people and finding ways to deal with cancer patients during the pandemic. I would particularly like to thank my local hospital, the George Eliot Hospital, and Kristy and her team in palliative care. They do such amazing work, in difficult circumstances.

The recovery plan set out how we will restore breast cancer services to pre-pandemic levels, but we also need to look to the future, to ensure that the progress we made in treating cancer is not allowed to stall or be forgotten. As I mentioned, the pandemic has raised several urgent issues in relation to cancer. It is fair to say that many of those needed tackling prior to the pandemic, and they still need addressing.

In 2018, a report by the APPG on breast cancer showed that while breast cancer outcomes were good and outperforming those of other cancers, inequalities in diagnosis, treatment and care across the country were being masked, impacting the experience and outcomes of patients. Our inquiry also found significant variations across England in the support that women with secondary breast cancer received, particularly in access to a clinical nurse specialist, patchy provision of information, psychosocial needs not being met, and a lack of prompt and timely access to specialist palliative care services.

I know that hon. Members will all have their own angles that they want to address in today’s debate, and I take the opportunity to thank the many organisations that have been in touch with their views on what we could discuss. However, I want to focus my remaining remarks on secondary breast cancer, which is an issue that the APPG has had a particular focus on. For hon. Members who are not aware, secondary breast cancer occurs when breast cancer has spread to other parts of the body. Critically, it cannot be cured, but it can still be treated. To put that in context, about 1,000 women still die every month from breast cancer in this country, and pretty much all those deaths are from secondary breast cancer, so it is a considerable issue that we need to address.

Five years ago, in October 2015, I hosted my first ever Westminster Hall debate, which was on the subject of secondary breast cancer. I spoke about the inequalities in the system, and the fact that secondary breast cancer patients were often overlooked. It was in that debate that the present Minister, my hon. Friend the Member for Bury St Edmunds (Jo Churchill)—then a Back Bencher—spoke so powerfully about her experiences and battles with cancer. I know this is an issue that she is really passionate about getting right, but sadly, for various different reasons, since my 2015 speech nothing much has changed. I know that that frustrates the Minister as much as it does me.

The research continues to show that although many secondary breast cancer patients receive inadequate care, it is all too often even worse than that which they received when they had their primary diagnosis. That cannot be right in this day and age. The 2015 debate noted how much of the current discussion and debate on cancer focuses on promoting early diagnosis of primary breast cancer and improving survival outcomes, which is absolutely right; we should be dealing with that, but a crucial part of any strategy has to be that we do not forget about people who are living with incurable cancers. They should be given parity of care in our system.

There are many things that we could do, including focusing on earlier diagnosis of secondary breast cancer and increasing knowledge and understanding of the signs and symptoms of it. However, I want to focus on two areas; if we addressed them, it would make such a difference to patients who have secondary breast cancer. The first is around data, which is one of the key issues. One of our problems that is that we have a real lack of understanding of the data on secondary breast cancer. At the moment, we do not know how many people are diagnosed with it each year, how long they are living for, how the disease spreads or what kind of treatment and support they are receiving.

Where data on secondary breast cancer is collected, there is variation in what is recorded and how that is done. That is despite its being mandatory since 2013 for hospitals to collect data on their new diagnoses of metastatic cancer. Research by Breast Cancer Now in 2016, repeated in 2018, showed that that is still routinely not happening. In the 2018 study, a staggering 40% of hospital trusts and health boards across the UK were still unable to tell Breast Cancer Now how many secondary breast cancer patients were under their care.

I brought up that issue in the 2015 debate on secondary breast cancer. I highlighted some of the practical barriers to data collection, which often include IT constraints, constraints of time within hospitals, their structures, a lack of awareness about what data is required, and confusion in the trusts and hospitals about who was responsible for inputting the various data items.

[Grahame Morris (Easington) (Lab)]

The hon. Gentleman is making an important and powerful point, and I hope the Minister is taking note. As he rightly says, many older people—particularly older women—with breast cancer were not prioritised to receive breast radiotherapy over the past six months. Data is available in the radiotherapy datasets that are held by Public Health England, but they have not been published so far. Does he agree that the Minister should seek to persuade NHS England to publish that data?

[Craig Tracey]

The hon. Gentleman raises an interesting point, which I am sure the Minister will address. It makes perfect sense that we are seeing the lack of cohesion in data. We know that data is power in everything—without the data, how can we plan a strategy? Wherever we get it from, it should be imported into the system. In the 2015 debate, I asked the Minister to lead the way on ensuring that the data was collected uniformly in every hospital, and not just collected, but collected in a format that enables us to interpret it. We need that now more than ever.

I felt that we were making some headway at the start of the year. I had a productive meeting with my right hon. Friend the Secretary of State for Health and Social Care, where we brought in some secondary breast cancer patients and had a really good discussion on a number of topics. Data was one of the key things that we addressed. The Secretary of State made very positive noises about the potential for a national secondary breast cancer audit. Unfortunately, shortly after that, we ended up in the grip of the pandemic and I appreciate that the Department’s focus has been pulled into different areas.

To return to the point that I have made, without accurate figures for the number of people living with secondary breast cancer, it is nigh-on impossible for the NHS to plan and commission services effectively to meet patients’ needs. Equally, without understanding the level of service and care that patients were accessing before the pandemic, it will be challenging to know how to improve outcomes when we get back to pre-pandemic levels. How can we hope to do that without knowing where we started?

Inadequate collection and sharing of data acts as a barrier to service improvement. We are missing out on an incredibly powerful tool that we should be using to spot variation and hold services to account, and to better understand the secondary breast cancer population and the service it requires. At a time when long-term local and national plans are being drawn up, we want to ensure that the NHS can fully deliver on its commitments, and that we have a clear understanding of the experiences of people with secondary breast cancer.

I ask the Minister to follow up on the delivery of a national secondary breast cancer audit, which would cover things such as diagnosis, treatment and access to support. That could transform our insight into this key area and provide the missing information that is desperately needed to ensure that the NHS can meet the needs of those living with secondary breast cancer.

The second point that I will touch on is the importance of increasing access to clinical nurse specialists. In the 2015 debate, I said that the cancer patient experience survey showed that when a clinical nurse specialist contributes to a patient’s care, it is the biggest driver in improving their experience. That measure could save money in the long term, by keeping patients out of hospital and highlighting problems before they become crises in A&E. That is particularly true for secondary breast cancer patients, because they are on a lifelong treatment pathway and often have complex emotional and supportive care needs. A recent survey found that less than a third of secondary breast cancer patients had seen a CNS regularly. With the number of men and women developing breast cancer increasing, and people with secondary breast cancer living longer with the disease, there was already a high demand for CNSs. With covid-19 resulting in changes to people’s treatment and care, however, while also having an impact on their emotional wellbeing, access to CNSs for secondary breast cancer patients has never been more urgent.

Yet Breast Cancer Now’s most recent report said that 41% of breast cancer patients felt they had had less contact with their CNS during the lockdown period. That was partly down to the fact that, in common with other parts of the workforce, many CNSs were moved elsewhere in the NHS during the peak of the pandemic. As an example, 400 Macmillan NHS professionals, including Macmillan-funded CNSs, were among those redeployed.

I am sure all hon. Members agree that it is encouraging that the NHS long-term plan commits that everyone, including those with secondary cancers, should have access to a CNS. There was also an additional commitment in the recent people plan 2020-21 to offer grants for 250 nurses to become cancer nurse specialists. That is another step in the right direction, which we really applaud, but the commitments made by the Government require investment in training and expanding of the CNS workforce to meet both the current and future challenges. I am sure we all want that to be addressed when the full NHS people plan is published, and I am sure we all want it to be matched in its intent by receiving the necessary funding in the upcoming spending review.

I realise many people want to speak. There is much more that I could talk about, but I will conclude and recap the asks, which are pretty straightforward. We need a secondary breast cancer audit and a fully funded long-term workforce plan to ensure that the Department of Health has the appropriate tools and structures to honour its commitments to deliver the best possible outcomes for all cancer patients, and to build back breast cancer services better following the pandemic.

--- Later in debate ---

[Grahame Morris (Easington) (Lab)]

Thank you for calling me in this important debate, Ms McVey. I thank the hon. Member for North Warwickshire (Craig Tracey) for securing it. We are from the same part of the country, but from different tribes; I am red and white.

This is an important subject, and it is important that we address it. We are living through an unprecedented pandemic. I was saddened and alarmed to read yesterday that the UK had become one of only five countries to exceed 50,000 deaths from covid-19. In the fullness of time, no doubt, we will have a public inquiry into covid-19 that will examine the flaws in the Government’s covid-19 response. I certainly believe that the Government will acknowledge that they were not properly prepared for a pandemic and did not have a proper and effective plan to manage infectious disease and routine day-to-day healthcare.

The impact on breast and other cancers has already cost lives and will continue to do so, but I want to focus on the cancer recovery plan. The Government can take steps to avoid unnecessary cancer deaths arising from the backlog of delayed diagnosis and treatment. I have met the Minister on several occasions in my capacity as vice-chair of the all-party group for radiotherapy and the all-party group on cancer, and we have had constructive dialogue, so I am afraid she will not be able to argue that solutions were not put forward to address this issue and mitigate potential deaths arising from delayed treatment.

The Catch Up With Cancer campaign, which Radiotherapy4Life is supporting, has identified that the cancer backlog stands at more than 100,000 patients. I recently had a meeting via Zoom with Macmillan cancer support—I am one for badges; I am wearing Radiotherapy4Life’s and Macmillan’s—to discuss what needs to be done to address the cancer backlog. It estimates that there are 50,000 missing diagnoses for cancer across the UK—it calls them the forgotten C. An estimated 100 fewer women started treatment for breast cancer each working day in May and June, compared with last year. Breast cancer two-week wait referrals are down 25% in March to August this year, compared with 2019.

I was joined on the call by a representative from Macmillan’s Joining the Dots campaign—a lady called Chloe Shaw, who is doing excellent work. That brilliant local service, which may be available in other parts of the country, offers practical help and support to people affected by cancer—in my case, those living in County Durham and my constituency of Easington. Joining the Dots has supported people in my constituency living with cancer throughout the pandemic. At the moment, it is having to work primarily through telephone and video calls.

Macmillan estimates that there are currently almost 18,000 people in County Durham living with and beyond cancer—people who have already been diagnosed may be fearful that there will be a recurrence. It is estimated that that figure could rise to almost 29,000 by 2030.

As vice-chair of the all-party parliamentary group on radiotherapy, I am particularly interested in this issue. In the Chamber today we have a number of former Ministers who have been banging this drum for some time. The issue now is the impact of the pandemic on the availability of radiotherapy treatment. We really must do something for the many older women with breast cancer who have not been prioritised to receive radiotherapy over the past six months. The data is available and should be acted upon. Will the Minister publish those datasets? We certainly need smart solutions and investment, but they must be reflected in a comprehensive spending review, so I hope the Minister will make the necessary representations to the Treasury.

Public Health

Grahame Morris Excerpts

Wednesday 7th October 2020 Commons Chamber

[Grahame Morris (Easington) (Lab)]

It is an honour to follow my hon. Friend the Member for Hartlepool (Mike Hill), who made some terrific points. In the short time that I have, I would just like to make some specific points and ask the Minister a few questions, if I may. And if I may I just say to the Minister, with all due respect, that we are all in the same business. No one in the House wants to do anything other than stop the spread of the virus, save lives, and support jobs and businesses. Those are not mutually exclusive objectives and I am sure we can do all those things.

I want to share a comment with the Minister and ask her a particular question. I spoke yesterday with a senior source from within Durham constabulary, who raised with me a specific concern: advice had been given that additional resources promised for policing the local lockdown restrictions were dependent on taking robust enforcement action and pursuing prosecutions. He felt that that was too prescriptive and likely to sour existing good community and local business relations. He, like me, feels that the local authority and police are working well and collaboratively in County Durham, and that to be effective we need policing by consent. Additional police funding should not be dependent on demonstrating more prosecutions. I hope the Minister agrees with me and responds to that if that is not correct.

To be aware of the consequences for jobs, Minister, the pub and hospitality trade in my constituency, as in many others, is withering under Government restrictions. I am still unconvinced of the evidence for the nonsensical 10 pm very strict hospitality curfew, which throws large groups of people on to the street all at the same time, who then crowd on to public transport all at the same time. I do not believe that that protects public health and it does not protect businesses. Performance venues of all types are closing their doors, the community is losing amenities, and people are out of work at the start of what may well be a very bleak winter.

Further down the supply chain, local breweries are losing orders. The Chancellor seems to have a vendetta against the smaller British brewers: he has excluded them from support for the hospitality industry. They may struggle in the covid crisis through the winter, but the Chancellor seems determined to run them out of business with his proposals on small brewers relief. Will the Minister please look into that?

Relying on local restrictions and lockdowns moves the pressure to support businesses affected from national to local government. Minister, specific industries need specialist support—please, hear our plea.