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.

Covid-19 Update

Grahame Morris Excerpts

Monday 5th October 2020 Commons Chamber

[Matt Hancock]

My hon. Friend makes an important point. Getting the right geography for any particular action is an important and difficult consideration. Last week’s example, when we took two of the Teesside boroughs into local action but not the other three, demonstrates that we are absolutely prepared to do as my hon. Friend wishes for London. On the other hand, on the same day we took the whole of the Liverpool city region into the same measures, because that was what was appropriate there. We have to take into account travel patterns and socialising patterns, as well as the pure data from the epidemiology and the number of cases, but it is absolutely something that we look at because we want to minimise the number of restrictions that are in place, subject to the need to keep the virus under control.

[Grahame Morris (Easington) (Lab)]

The Secretary of State is full of bravado and bluster, despite a catalogue of mistakes and regular statements. When the truth is spread thinly, people start to see through it. We hear the expression “world-beating test and trace system”—how would Ricky Tomlinson describe it?

[Matt Hancock]

I don’t know.

Covid-19 Update and Hospitality Curfew

Grahame Morris Excerpts

Thursday 1st October 2020 Commons Chamber

[Matt Hancock]

Of course, as we keep this under review, we will consider all the options. The clarity of the rule that was brought in was one of the reasons that it commends itself, but I would be happy to talk to my hon. Friend about the future.

[Grahame Morris (Easington) (Lab)]

We all agree that suppressing the virus is essential in saving lives, and as a scientific socialist, I think we should apply basic public health principles. It seems absolutely clear to me that it is problematic that we have a 10 o’clock curfew, when large numbers of people are all coming out into the street at the same time. Night-time entertainment businesses such as comedy and live music venues, which are based in covid-secure premises such as pubs and clubs, are seriously impacted, and like—

[Mr Speaker]

Order. Come on, Secretary of State. We have got to get a grip.

Coronavirus Response

Grahame Morris Excerpts

Monday 20th July 2020 Commons Chamber

[Matt Hancock]

I will do better than that: when we get scientific evidence on the impact of cold weather on this virus, we will publish it.

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

I hope the Secretary of State is aware of the tragic case of Kelly Smith, who sadly died when her cancer treatment was stopped during the covid lockdown. The Government’s aspiration to get cancer services back to normal by the end of the year is simply not acceptable. Too many cancers are incurable within a few weeks. Will he address this issue, and will he look at transforming radiotherapy services, which have emerged as being highly effective as a cancer treatment and can be delivered even if there is a second spike in the pandemic?

[Matt Hancock]

Yes, the hon. Gentleman is absolutely right about the importance of this. We are getting cancer services back up and running as fast as possible. The idea that we are waiting until the end of the year before doing anything is completely wrong. We are going as fast as we can. During the peak, some of the services did have to be stopped for clinical reasons. My heart goes out to those whose treatment was stopped because of covid and who died of cancer, The judgments were made on an individual clinical basis as to whether it was safer to go ahead with the treatment or to stop it, because, of course, many treatments for cancer are much more dangerous when there is a high volume of infectious disease. I understand that that explanation will be of no comfort to Kelly’s family and friends who mourn her, but I also understand why the NHS made that decision and I support them in the decision that it made. We must get this going again as fast as possible. This is something on which I am working very closely with the NHS. In fact, I had a meeting on it only last week. I also entirely agree on the point about radiology services, too.

Oral Answers to Questions

Grahame Morris Excerpts

Tuesday 28th January 2020 Commons Chamber

[Matt Hancock]

My hon. Friend is spot on. We are driving interoperability so that the right people can see the right records at the right time. We will mandate that technology used in the NHS must allow for such interoperability, and we will set standards.

My hon. Friend started the “axe the fax” campaign, in which I was happy to play my part. Faxes are terrible for efficiency and for data security—even straightforward email is so much better—and we will drive up data security by axing the fax across the NHS.

[Grahame Morris (Easington) (Lab)]

What specific investment is being directed to supporting the 11 new radiotherapy IT networks that are required to provide a world-class radiotherapy service and improve cancer outcomes and survivability?

[Matt Hancock]

Radiotherapy is a good example of part of the NHS that can benefit hugely from improved technology now and from the cutting-edge artificial intelligence-type technologies that are coming down the track. I am happy to look at any specific proposals the hon. Gentleman has. We have a broad programme to support the technology needed in radiotherapy.

NHS Funding Bill

Grahame Morris Excerpts

2nd reading & 2nd reading: House of Commons
Monday 27th January 2020 Commons Chamber

[Matt Hancock]

Yes. That just shows how sensible the British people were to elect a majority Conservative Government. The funding will also allow the NHS to invest in innovative technology, such as genomics and artificial intelligence, to create more precise, more personalised and more effective treatments. That will help the life sciences industry, which is one of our fastest growing industries, and in turn, help to support growth.

[Grahame Morris (Easington) (Lab)]

I want to make a point about new technologies and what is not in the Bill—namely, capital and training budgets. That is vital to address our woeful performance on cancer outcomes, which I want to touch on in more detail later. Specifically, what will the Secretary of State do about the under-investment in advanced radiotherapy? We are spending £383 million but we should be spending considerably more if we are going to provide a world-class service.

[Matt Hancock]

The hon. Gentleman is absolutely right that we need earlier diagnosis of cancer—I entirely agree. Rolling out the 200 extra diagnostics facilities and increasingly making them available in the community, rather than just in big hospital centres, is an absolutely mission-critical part of that. The funding will also allow us to upgrade our outdated frontline technology—that is tied to what he just called for—which will save time for staff and save the lives of patients. Within the financial settlement, mental health spending will increase the fastest so that we can transform how we prevent, diagnose and treat mental ill health across the country. Within that allocation, funding for children’s mental health will go up faster still.

--- Later in debate ---

[Grahame Morris (Easington) (Lab)]

It is a pleasure to follow the hon. Member for Dover (Mrs Elphicke), who made powerful arguments in support of improving maternity services in her area, as well as other hon. Members who made their maiden speeches this evening. I am sure that we will hear a lot more from them.

I want to make a familiar argument about access to and funding of radiotherapy services. The Minister for Health, the hon. Member for Charnwood (Edward Argar), has heard this argument on previous occasions, but I am going to make it again because I am not convinced that the Secretary of State understands it. It is not rocket science: in the United Kingdom, radiotherapy accounts for just £383 million of the NHS resource budget, despite the fact that one in four of us is going to need it at some point in our lives. In his opening remarks, the Secretary of State referred to the Government’s commitment to invest in new diagnostic equipment and scanners. I very much welcome that, but he did not seem to get—I did not hear the penny dropping—the important link between diagnosis and treatment.

I must declare an interest: I am vice-chair of the all-party parliamentary group on radiotherapy. I am a cancer survivor myself and have benefited from this particular treatment. Basically, I want to make three points. I want to cover the cancer challenge, to briefly discuss the current state of radiotherapy and to set out a future vision for NHS radiotherapy. I am talking in the context of the Bill. I have tried to make key points in interventions about how vital workforce planning and capital budgets are. This is not just a case of replacing hospital car parks; it is about vital equipment. It is essential to improve cancer outcomes for our patients.

About 50% of people develop cancer at some time in their lives, and I am sure that even those fortunate enough to be spared the disease will all have a loved one who has been touched by cancer. I am not arguing from a completely selfish point of view, here—putting a case for me, my constituency or my region. As a magnanimous sort of individual who recognises the sentiment in the House, I am arguing that we should improve cancer services across the whole country. Access to world-class cancer treatment really matters to every single one of our constituents in every constituency in the United Kingdom.

I want to take issue with a statement that the Secretary of State has made on more than one occasion about cancer survival rates. Figures comparing nine comparative countries were published in The Lancet in November last year, just before the election. They showed that the United Kingdom had the lowest survival rates for breast cancer and colon cancer and the second lowest for rectal cancer and cervical cancer. Some 24% of early-diagnosed lung cancer patients are not getting any treatment at all.

In truth, although our cancer survival rates are improving—the Secretary of State is not telling a lie—we still have the worst cancer outcomes in Europe; the baseline is very low. I welcome the Government’s commitment to considering ways to improve cancer diagnosis, with a plan to set new targets so that patients receive cancer results within 28 days. That is great. But we still need to address issues of staff capacity and there is a desperate need for more radiologists and more skilled people in the imaging teams to address shortages in endoscopy, pathology and the vital IT networks.

Unlike chemotherapy, which I have also had on a couple of occasions, which impacts the entire body with chemicals, advanced radiotherapy targets tumours precisely, to within fractions of millimetres, limiting damage to healthy cells in close proximity to the tumour. Improved radiotherapy technology allows us to treat cancers previously treatable only with surgery, chemotherapy or a combination of both. Radiotherapy is also cost-effective for patients, the NHS and Ministers, who are obviously very keen to ensure that we get value for money. A typical course of radiotherapy costs between £3,000 and £6,000—far less than most chemotherapy and immunotherapy cures—and patients experience very few side effects.

The problem is that access to radiotherapy centres and this life-saving treatment is not evenly distributed across the United Kingdom. A 2019 audit showed that 32% of men with locally advanced prostate cancer in the UK had been potentially undertreated, with 15% to 56% of trusts in the survey not offering the sort of radical radiotherapy that those patients really required. In England, advanced curative radiotherapy is actively restricted for no good reason, with only half the 52 centres having been commissioned by NHS England to deliver advanced radiotherapy—stereotactic ablative radiotherapy, or SABR. That is despite the fact that its use is specifically recommended by the National Institute for Health and Care Excellence.

We are coming up to World Cancer Day on 4 February. The Minister understands this issue because we have spent a deal of time on it. I want him to make a commitment on behalf of the Government that the UK will become a world-class centre for patient-first radiotherapy so that we can improve our cancer survival rates. That will require an increase in investment. We need to address the issue of capital funding. Currently, radiotherapy gets 5% of the cancer treatment budget; we need that to be closer to the European average of 11%. There is an immediate need for £140 million of investment to replace the 50 or so radiotherapy machines—the old linear accelerators—that are still in use despite being beyond their recommended 10-year life by the end of 2019. We need investment in IT and to help establish the 11 new radiotherapy networks, which the Minister touched on. Again, that comes under capital and workforce training.

The all-party parliamentary group’s manifesto for radiotherapy is calling for a modest increase in the annual radiotherapy budget, from 5% to 6.5% of the revenue budget, and for the Government to establish some basic standards to secure our vision for radiotherapy. We need to recruit and train highly skilled clinicians, radiographers, medical physicists and healthcare professionals and to guarantee that every cancer patient has access to a radiotherapy centre within a 45-minute travel time. In 2020, the Government should set themselves a 2030 target for the UK to go from having the worst cancer outcomes to the best cancer survival rates in the world. We could do that, and we could make a start by delivering a world-class radiotherapy service.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I am afraid that I have to reduce the time limit to eight minutes.

Health Infrastructure Plan

Grahame Morris Excerpts

Monday 30th September 2019 Commons Chamber

[Edward Argar]

I know that, since my hon. Friend was first elected to this House, he has made health and the NHS his No. 1 priority. He served with distinction as a Minister in the Department and continues to champion his constituents’ interests in this respect. On the seed funding, we have made the announcement and are keen to get the money to those trusts as swiftly as possible so they can work with us to develop their plans. I agree entirely that its inclusion in this list is a vote of confidence from us and the NHS in the work his local hospital is doing.

[Grahame Morris (Easington) (Lab)]

I thank the Minister for his statement. He said that the Government would focus on outcomes, and he mentioned £200 million for new CT scanners for diagnosis, but The Times recently published the details of answers to freedom of information requests indicating that half of NHS trusts are treating cancer patients with out-of-date radiotherapy machines. The UK will remain at the bottom of the cancer survival league until we dramatically improve our radiotherapy services, so what steps is he taking to implement the “Manifesto For Radiotherapy”, invest in modern radiotherapy equipment and train personnel in IT networks, to provide modern radiotherapy services to cancer patients in every region of the UK, not just those in London and the south-east?

Non-invasive Precision Cancer Therapies

Grahame Morris Excerpts

Thursday 18th July 2019 Commons Chamber

[Grahame Morris (Easington) (Lab)]

I beg to move,

That this House recognises the vital role that radiotherapy plays in cancer treatment across the UK with an estimated one in four people needing that treatment at some stage of their life; notes that there is a significant body of expert opinion that up to 24,000 people may be missing out on the radiotherapy they need, resulting in many hundreds of unnecessary or premature deaths; further notes that the UK spend on radiotherapy as a percentage of the overall cancer budget is approximately five per cent which compares badly with most other advanced economies where the percentage varies from nine per cent to 11 per cent; notes that the current commissioning system for radiotherapy is sub-optimal as exemplified by a tariff regime which discourages NHS Trusts from implementing advanced modern effective radiotherapy; calls on the Government to provide an immediate up-front £250 million investment in the service, an ongoing extra £100 million per annum investment in personnel and skills and IT, and to introduce a sustainably, centrally and fully funded rolling programme for Linac machine replacements; and further calls on the Government to appoint a single person to oversee the commissioning and implementation of radiotherapy services.

I thank the Backbench Business Committee and its Chair, my hon. Friend the Member for Gateshead (Ian Mearns), for granting this debate, and all the Members on both sides of the House who supported the application. I must declare an interest as one of the vice-chairs of the all-party group on radiotherapy, and also as a cancer survivor—[Hon. Members: “Hear, hear.”] Thank you. Thanks to early diagnosis, I was successfully treated with both chemotherapy and, crucially, precision radiotherapy.

I want to point out to the Minister that there is currently a crisis—there is no other word for it—in the management and funding of radiotherapy in the United Kingdom. Indeed, the charity Action Radiotherapy estimates that as many as 20,000 people across the UK may be missing out on the radiotherapy they need. Many of these patients will die prematurely or unnecessarily as a result of this shortfall. Given that one in four people receives some form of radiotherapy during their lives, and that almost half of us in the United Kingdom will be diagnosed with cancer at some point in our lifetimes, I hope the Government will realise just how important it is that we invest in modern and, importantly, accessible cancer diagnosis—and not just in diagnosis, but in cancer treatments.

[Jeff Smith (Manchester, Withington) (Lab)]

I am very proud to have the Christie Hospital in my constituency of Manchester, Withington. It has a fantastic proton beam therapy unit, which is going to be the future of cancer treatment. However, when I speak to the staff at the Christie, their biggest worry is the workforce. Does my hon. Friend agree with me that the challenge is not just funding for treatment, but actually investing in our cancer workforce as well?

[Grahame Morris]

Absolutely, and I am grateful to my hon. Friend for pointing that out. Indeed, that is one of the four basic requirements, as the all-party group, the charity Radiotherapy4Life and Action Radiotherapy have pointed out. That is clearly demonstrated in the “Manifesto for Radiotherapy”, which I commend to the Minister and to all hon. Members.

I appreciate that the Minister will want to refer to chapter 3 of “The NHS Long Term Plan”, particularly paragraph 3.62 on more precise treatments using advanced radiotherapy techniques. In anticipation of that, I would like to say, on investment, that the Government have promised to complete the £130 million investment in radiotherapy machines and, as my hon. Friend has just mentioned, to commission the proton beam machines at University College Hospital in London and the Christie Hospital in Manchester. However, I respectfully point out to the Minister that that is not a new announcement of additional resources, but the recycling of previous announcements. The money has already been spent or committed, so it is not part of the comprehensive 10-year plan for radiotherapy that we advocated for in the “Manifesto for Radiotherapy”.

The £250 million for proton beam facilities, while welcome, will only treat 1,500 patients a year. I accept that many of them will be children with brain cancers, but the number represents only 1% of patients needing radiotherapy. As indicated in the manifesto, we recommend that the same sum that was spent on proton beam facilities—a relatively modest sum given the size of the budget as a whole—is all that is needed to renew radiotherapy centres and to ensure that all patients, not just those who live in London or near to major conurbations, can receive treatment within the recommended 45-minute travel time. I know that other hon. Members will say a little more about that.

We are also asking for an additional £100 million a year, increasing the cancer funding for radiotherapy from the current 5% a year to 6.5% a year, to ensure sufficient funding for workforce planning, including ensuring that there is suitable training, and ensuring that there is an effective IT network, equipment upgrades and a rolling programme to ensure that all radiotherapy machines across the UK are up to date. According to analysis of freedom of information requests made by Action Radiotherapy, more than 40% of NHS trusts in England—all bar six responded to the requests—that provide radiotherapy have machines that are past their recommended lifespan, leading to less efficient and effective care.

The current system of commissioning for radiotherapy often incentivises trusts not to use their most modern precision radiotherapy machines to their full capability. That means that some patients are treated more often and less effectively, even though there are modern stereotactic ablative radiotherapy machines that could treat them more effectively. Precision radiotherapy is needed to cure 40% of cancers, and all that we want is to ensure that all patients can get to a radiotherapy machine and that the professionals are allowed to switch on the machines and provide the appropriate treatment. However, chronic underfunding and the complications of radiotherapy commissioning and delivery are preventing that from happening.

Radiotherapy receives only 5% of the cancer treatment budget. At £383 million a year, that represents 0.025% of the total NHS budget, and I want to compare that with the cost of just two cancer drugs. The NHS budget for Herceptin—an effective drug that is used to treat about 15% to 20% of breast cancer patients—is £160 million. A recent UK trial showed that only six months, not 12 months, of adjuvant Herceptin may be needed for adjacent therapy, which is when the drug is used in combination with radiotherapy. In financial terms, the NHS could therefore save up to £80 million a year, offsetting much of the additional radiotherapy costs.

It is time to put radiotherapy back at the top of the NHS agenda, and we need someone to advocate for that. We are urging the Department to appoint a radiotherapy tsar who will ensure that the NHS has a world-class radiotherapy service. Many other MPs want to speak in the debate, so I will keep my remarks short. I am pleased that the Government have accepted that advanced precision radiotherapy is more effective and has fewer side-effects.

In summary, I want to see a modest increase in the budget for advanced radiotherapy, rising from 5% to 6.5% of the cancer budget. That would enable large numbers of cancer patients to live longer and more fulfilling lives and would achieve better outcomes and more positive economic benefits. I am keen to ensure that Members have an opportunity to participate in the debate. There are many issues that we need to highlight, including in relation to commissioning, workforce planning and IT networks, so I will leave it at that to allow others to participate.

[Several hon. Members rose—]

--- Later in debate ---

[Grahame Morris]

I thank the Minister for that considered and helpful response. I can assure her that the spirit of our contributions, and of the all-party parliamentary group, is intended to help, not to hinder progress. We certainly give her credit for the aspiration to improve cancer outcomes and to see a first-class service. We want to see that in all parts of the United Kingdom.

I thank all Members who participated in the debate. The hon. Member for Chichester (Gillian Keegan) highlighted the perverse incentives, which have been identified in the all-party parliamentary group’s inquiries. The hon. Member for Westmorland and Lonsdale (Tim Farron) mentioned the satellite centres and the number of people being denied life-saving therapy. My hon. Friend—my dear friend—the hon. Member for Blackburn (Kate Hollern), in a deeply moving contribution, talked of her personal experience. My hon. Friend the Member for Rhondda (Chris Bryant) talked about the importance of workforce planning and early diagnosis. My hon. Friend the Member for Heywood and Middleton (Liz McInnes) also mentioned workforce issues. My hon. Friend the Member for Manchester, Withington (Jeff Smith) talked about the exciting developments in proton beam therapy at the Christie Hospital. My hon. Friend the Member for Dewsbury (Paula Sherriff) gave an excellent response on behalf of the Opposition.

I also want to thank all the staff involved in delivering cancer services. We value the contribution they make—each and every one of them—and we are absolutely dedicated to ensuring that the issues we have raised here are followed through.

I have one point to make on tariffs and perverse incentives. As part of our efforts, we have met extensively with NHS England. Addressing that is potentially a quick win for the Government, because it would not involve evaluating new techniques and could be done quickly. My suspicion is that NHS England does not intend to implement that for some time—in years rather than months—so I hope that the Minister will take that up immediately.

Question put and agreed to.

Resolved,

That this House recognises the vital role that radiotherapy plays in cancer treatment across the UK with an estimated one in four people needing that treatment at some stage of their life; notes that there is a significant body of expert opinion that up to 24,000 people may be missing out on the radiotherapy they need, resulting in many hundreds of unnecessary or premature deaths; further notes that the UK spend on radiotherapy as a percentage of the overall cancer budget is approximately five per cent which compares badly with most other advanced economies where the percentage varies from nine per cent to 11 per cent; notes that the current commissioning system for radiotherapy is suboptimal as exemplified by a tariff regime which discourages NHS Trusts from implementing advanced modern effective radiotherapy; calls on the Government to provide an immediate up-front £250 million investment in the service, an ongoing extra £100 million per annum investment in personnel and skills and IT, and to introduce a sustainably, centrally and fully funded rolling programme for Linac machine replacements; and further calls on the Government to appoint a single person to oversee the commissioning and implementation of radiotherapy services.

Interim NHS People Plan

Grahame Morris Excerpts

Wednesday 5th June 2019 Commons Chamber

[Stephen Hammond]

I welcome Labour’s commitment to publish a paper, but the hon. Lady will know that the Department is going to publish a Green Paper on adult social care. We are finalising that. [Interruption.] The hon. Member for Leicester South (Jonathan Ashworth) shouts at me. I know he makes a lot of promises without detail. We want to make promises that have detail and can work.

[Grahame Morris (Easington) (Lab)]

This is an important report into NHS people planning. It is an interim report, so there is an opportunity to identify any deficiencies. My particular concern is about the cancer workforce, in particular the point made by my hon. Friend the Member for Leicester South about the loss of bursaries not just for nurses but for therapeutic radiographers. May I draw the attention of the Minister, with due respect, to the fact that the radiotherapy and oncology course at Portsmouth University recently closed? Concerns are being expressed and not just by politicians on the Opposition Benches. Mr Richard Evans, chief executive of the Society of Radiographers, said that he has concerns about whether our hospitals and specialist cancer centres will be able to recruit enough skilled and trained personnel. This could even threaten the delivery of cancer treatment and the ambitious plans that the Minister has in the new cancer strategy.

[Stephen Hammond]

The hon. Gentleman is right: this is a serious plan. As he rightly points out, it is an interim plan. It sets out a number of specific actions for this year. It also sets out a number of clear action paths and trajectories to ensure that the people plan is achieved. I would be delighted to meet him and other officers of the all-party group to ensure that we get the skills in the right places to ensure that the ambitious and deliverable plans in the long-term plan can happen.