Breast Cancer

Huw Merriman Excerpts

Thursday 18th October 2018 Westminster Hall

[Huw Merriman (Bexhill and Battle) (Con)]

It is a pleasure to serve under your chairmanship, Mr McCabe. I thank the hon. Member for Crewe and Nantwich (Laura Smith) for leading the debate with such care, passion and expertise. It is a great pleasure to note that the three Front-Bench spokespeople—the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Winchester (Steve Brine), the hon. Member for Washington and Sunderland West (Mrs Hodgson) and the hon. Member for Central Ayrshire (Dr Whitford) —have all served as chairs of the all-party parliamentary group on breast cancer. It is a rarity for all three Front-Bench spokespeople to have so much knowledge and, indeed, to care so much about the issue that they have spent their time campaigning on it in Parliament. I salute all three of them for their work on this matter and I very much look forward their contributions.

The statistics are well known and well rehearsed, but I want to put them on record. In the UK, 55,000 women and 350 men are diagnosed with breast cancer every year. Sadly, one in eight women will be diagnosed with breast cancer, 35,000 women are living with secondary breast cancer, and nearly 1,000 women die from breast cancer every month. Nearly 700,000 people in the UK are living either with or beyond breast cancer treatment. The positive that we can look at now is that 80% of women survive for five years or more. The title of the debate on the Order Paper, “Future of breast cancer”, is crucial, because it is all about the future. The progress made so far has been absolutely extraordinary, but we must not rest on that progress; we must look further forward and do even more, as science and medical developments allow us to.

I would probably have trotted out those statistics a couple of years ago when speaking on this matter, because it impacts on my constituents. However, personal experience of a loved one being struck down with breast cancer makes me more determined to be here to represent their cause and that of the thousands of women across the country who have to go through the same experience. I salute the courage and bravery of all who have been diagnosed with breast cancer and who have gone through the treatment. To watch those people undertake that brave journey is a humbling experience, because when I saw it with my own eyes, I thought, “Could I actually do this? Would I have the bravery and the strength to go through this myself?” It was the most extraordinary experience for me to see that.

I pay tribute to all the carers and those who provide support. They feel helpless, at times, and they wish that they could go through the wretched experience instead. They would do anything to change places, but they cannot. Those people do the most amazing job. On behalf of those who have been through the treatment, I salute all the brave families, friends and loved ones who went through it with them. The inner strength that their support must give to sufferers is absolutely tremendous.

Breast screening uptake is at its lowest level for 10 years, which is very concerning. Uptake is at 71%; the aim is to make that figure at least 80%, which would save 1,200 lives per year. If the Minister has time, I would like him to reassure us that the Government will take action in their attempt to reach that target. Screening is, of course, still age-based, and it was sad for me to note that the entry-level screening age would have been too high for the family member I referred to, who was only 42 when they were diagnosed.

It is incredibly exciting to meet groups such as Breast Cancer Now, which is carrying out a generation study, following 113,000 women from the UK over 40 years. I was absolutely blessed and fascinated to meet the people involved in that study at a recent all-party parliamentary group meeting. Of course, age is one profile, but we need to look at high-risk scenarios and investigate the genetic, lifestyle and environmental factors that can change the likelihood of a woman developing breast cancer. That study, which I think is exciting, identifies 160 common genetic changes associated with the development of breast cancer, as well as showing how various life events—such as the menopause—and lifestyle factors can have a great impact. The future is bright, because rather than just looking at age ranges, we are now really going into the detail with those studies to show how certain factors can lead to risk and then, where there is risk, providing screening. That is hugely important.

I paid tribute to those who go through breast cancer treatment and to their carers, who go through it with them, but I also want to touch on the phenomenal work that NHS staff do for everyone who goes through that journey. I thank them; they are the most extraordinary people, in terms of their sheer intelligence. It is incredibly reassuring to meet such bright, dedicated people. The other great thing about them is that they deal with everything in black and white—there is no messing around—and tell people exactly what is going on. It can sometimes be stark, but it reassures people that they are being led to the right conclusion.

Of course, there are workload impacts. We know that the NHS faces challenges, and cancer departments absolutely share those challenges. A Macmillan Cancer Support survey from last year highlighted the increased workloads, complex patient needs and vacancies in key roles that are putting pressure on the cancer care workforce. Certainly, in my experience with the Maidstone and Tunbridge Wells NHS Trust, the staff were absolutely phenomenal. When things did not work, it was often because they did not have what is called back-office support. As a result, consultants have to run around doing admin work instead of focusing on their medical and clinical expertise, making them very expensive and overqualified admin resources. We often talk quite clinically about back-office savings, but perhaps we need to look very carefully before making such savings if they will have an impact on frontline services.

Some of the NHS communications systems can be incredibly clunky. Finding out via Royal Mail that one has an appointment after the appointment is due to take place—not just once, but twice—is maddening. These days, we embrace technology. We are told about dentist appointments via text messages to which we can respond to confirm, and the NHS should be doing the same thing. Before my journey with breast cancer, I was critical of people who missed appointments, but I had not reflected that people might miss appointments because they have not been told that they are taking place. It is maddening for consultants, because once people have received their notification, they are not even required to reply to confirm that they will attend their appointment. Of course, no one in the hospital thinks, “Someone has not got back to me; perhaps they have not received the letter.” We sat waiting in the hospital for hours, because the system did not know we were there despite the fact that we had booked in. That is maddening for patients, and maddening for consultants and staff.

Such issues may seem quite trivial, but they caused me to go back to the hospital to meet the heads of service to ensure that I could convey the concerns of frontline staff to senior management. I thought that that was the least I could do after the care and attention that the staff had given us.

I therefore ask my hon. Friend the Minister to think about the support staff, the systems that are in place and how we can better support the staff who help us to get better. I express my immense gratitude for those people and the support, expertise and help that they provide, not just during the treatment but on the journey beyond. That is the other thing that I have noticed: once a patient is given the all-clear, which is the best news, all of a sudden they face another journey, on which they will not necessarily be with clinicians. They will still have support staff from organisations such as Macmillan, who take great care of people.

I find myself speaking from experience, having been on an incredible journey that taught me a great deal about those who go through cancer and those who care for us through cancer. It has made me vow that I will always do everything I can in Parliament to try to make the situation better. I look forward to those on the Front Benches reassuring us that they will do the same.

--- Later in debate ---

[Steve Brine]

There is so much more that I want to get on to, so I will not go into that in any great deal, but I will give the hon. Lady a note on that. Lord O’Shaughnessy, who is part of the Department’s drugs team and who speaks on health in the other place, is working on the implementation of that legislation. The hon. Lady has asked me about this before, and it frustrates me incredibly that that Act is not being implemented more quickly, but that should not be taken as any indication of a lack of desire on our part to do so. However, I take the hon. Lady’s point.

It is still right for those prescribing decisions to be made by clinicians. However, I want breakthrough drugs to make it on to the market more quickly, instead of staying in the cancer drugs fund. There are good examples of that related to breast cancer, and we want to see it happen much more quickly.

My dear hon. Friend the Member for Bexhill and Battle (Huw Merriman) spoke personally and passionately —as always—about these matters, and I thank him for that. He raised lots of issues, including the screening programme. Everyone says that the breast cancer screening programme is a critical tool in ensuring that we catch breast cancers as early as possible, when there is a higher chance of successful treatment. However, we know that there is much more to do to improve uptake. In her party conference speech, the Prime Minister set out that we would transform our screening programmes, making them more accessible and easier to use and utilising the best research and technology. Further detail on that will be set out in the long-term plan later this year.

My hon. Friend also asked about technology in screening. I will come on to the screening scandal in a moment, but it is very much our aim that in the future patients will be able to make much greater use of technology to be informed of things, such as GP or screening appointments, rather than relying on Royal Mail. Our NHS app is being piloted and will be rolled out from December this year. That is just the start of the technology revolution that we want to see and that the Secretary of State has made one of his priorities. We expect the independent breast screening inquiry to make recommendations in that area.

Several Members asked about the inquiry into the breast screening problems that we had. We expect that to report shortly. I do not have an expected date, but several Members, including the hon. Member for Central Ayrshire and the shadow Minister, asked whether it is on schedule. I believe that it is, and I look forward to that report very much. With somebody as serious as the Macmillan chief executive leading that review, alongside others, I know that it will challenge us, as it is meant to; the former Secretary of State set it up to do so.

My hon. Friend the Member for Bexhill and Battle mentioned the importance of early diagnosis. I am proud of Public Health England’s Be Clear on Cancer campaign, which I am responsible for. PHE ran its 14th Be Clear on Cancer campaign through February and March of this year, focusing on breast cancer in women aged over 70—a subject that is very close to the hearts of members of the APPG. Research shows that older women are more likely to delay presenting to their GP with breast cancer symptoms.

The campaign previously ran in 2014 and 2015, and an evaluation showed an increased awareness of the key messages that it promoted and, even more importantly, that more cancers were diagnosed during the campaign period. We are running the “Blood in Pee” campaign at the moment—I have all the glamourous things in my portfolio—and Be Clear on Cancer will go forward and from strength to strength.

[Huw Merriman]

I am incredibly impressed by what the Minister has said so far. Will he keep an open mind on the age limits for screening—particularly the entry age? I know that it has been reduced, but will he keep an open mind on reducing it further?

[Steve Brine]

I always keep an open mind. The truth is—the hon. Member for Central Ayrshire knows exactly what I will say—that although the screening review will no doubt make recommendations on that, there is a very heated and divided debate within the breast cancer community around screening, and not just about the age at which to begin it. We had the AgeX age extension trial, which broadened the range of ages at which we screen, but there is absolutely no consensus within the breast cancer community on the benefit of screening. That debate continues and rages strongly, and it is for policy makers to listen to all the different views, as the screening review will do.

Several Members, including the shadow Minister, rightly mentioned clinical nurse specialists and the cancer workforce. Last December, Health Education England published its first ever cancer workforce plan, which committed to the expansion of capacity and skills in fighting the big C.