Covid-19: Lung Cancer Pathway

Jo Churchill Excerpts

Wednesday 2nd December 2020 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Ms Fovargue. I congratulate the hon. Member for Halton (Derek Twigg) on securing the debate and sharing patients’ stories, showing not only the huge care delivered by the NHS workforce but the challenges for patients, as they struggle to get a diagnosis and navigate the system. In the patient’s story that the hon. Gentleman articulated, there was already spread: not only was the disease at stage 4 but was metastatic, so affected different sites in the body.

All these things pose a challenge, and the hon. Gentleman very articulately laid out the challenges of late diagnosis and how we can improve. The UK Lung Cancer Coalition report articulated how we must not lose the progress that we have seen over the past 10 to 15 years, but must absolutely focus on the aim to extend survival up to 2025. I hope I can reassure him that the initial measures that we took at the beginning of the pandemic, because we did not know what we were dealing with, have not been the focus since June, when we began to refocus and double our efforts on trying to ensure that cancer patients can have full access to services.

There are still some challenges. I have had conversations with thoracic surgeons. There are particular challenges with the trajectory of this disease, because of where it is on the body and some of the aerosol-generating procedures that are needed in diagnosis and so on. I can say to the hon. Member frankly and honestly that we are aware of those issues and we are working hard to get back not just to where we were, but, as I think Professor Peake said, to a normal that is better than what we had at the start.

I also pay tribute to the constituent of my hon. Friend the Member for Bury North (James Daly), Andrew Jenkinson, and add my condolences for the sad loss of his wife. I congratulate him on his energy in campaigning. It is often the biggest tribute someone can give to a person they love, to try to drive forward and make things better for others.

[James Daly]

I thank the Minister for those kind comments, which will mean a lot to Mr Jenkinson. His petition is titled:

“Ensure access to treatment and screening for all cancer patients during Covid-19”.

We know there have been challenges and the pandemic has thrown up things we never dreamt we would be dealing with. Will my hon. Friend offer some assurance that the issues that Mr Jenkinson highlights in his petition are being addressed and that there are positive signs going forward?

[Jo Churchill]

I will indeed come to that, and hopefully give him and others the reassurance that we are focusing hard on making sure that we not only deliver, but learn from the pandemic. That was highlighted in the Lung Cancer Coalition report as well. Where we can make improvements to speeding up delivery of diagnoses or treatment, we need to make sure that we do so.

Lung cancer is one of the country’s most invidious cancers and it is important that it is diagnosed as early as possible, for treatment to be successful. As the hon. Member for Halton highlighted, it is one of the worst cancers for being diagnosed too late, largely at stage 4, and it has often spread. The challenge then is that treatment options are reduced because of the grade of the cancer.

When someone does present, it is vital that they are referred swiftly for further diagnostics, remembering that we are in a pandemic with a disease that attacks the respiratory system as much as anything. I have stood here talking about teenage cancers and diagnostics and treatments already this week. Not all cancers are the same; they all need a bespoke approach. It is important to remember that.

I spoke to a thoracic surgeon at the cancer hub during the summer. He explained to me in some detail the challenges, but also the opportunities now before us. I thank the cancer workforce for all that they have done through the pandemic and their continued effort to restore services. It has been a herculean effort and they have really flexed the service, joining together in cancer hubs and ensuring that areas are covid-secure for patients. Part of the challenge is to encourage patients to come forward for tests. If someone has a persistent cough, or signs of other cancers, they need to do something about it.

I spoke in the debates yesterday and this morning, and I know only too well the devastation that Mr Jenkinson must be feeling. The particular concern with lung cancer is the overlap with covid-19 symptoms. That was highlighted in the Lung Cancer Coalition report and by a plethora of clinicians. To that end, we have updated 111 protocols. If somebody has received a negative covid test but has a persistent cough, it may indicate lung cancer and they are directed to appropriate clinical care. One challenge has been a sustained fall in people coming forward for lung checks, with the number of people seeking checks at only 76% of pre-pandemic levels. This is about ensuring that we encourage people to come forward, driving forward campaigns such as the Greater Manchester Cancer Alliance and the Northern Cancer Alliance’s campaign “Do It For Yourself”. Ensuring that people are aware of the signs and symptoms is really important, and has an impact on the number of lung cancers diagnosed and treatments started. I cannot stress enough that if individuals do not come forward, we cannot get them into the optimal pathway, which has shown real improvements in how we can help people through their cancer journey.

I was pleased with the £150 million of capital funding issued to regions in October to invest in diagnostic equipment such as MRI and CT scanners. Again, that was very much called for. I know that instant referral to a CT scan is an objective of the report, but getting the equipment so that we can start to deliver quicker routes is part of the issue. The further £325 million for new diagnostic equipment in the spending review, once we know exactly how it is going to be allocated, will, I hope, result in more delivery of diagnostics into cancer care. It is vital that we use that money to maximise equipment in as many places as possible so that individuals can be treated as rapidly as possible.

We know that access to earlier diagnostic screening improves clinical outcomes and that the late stage is really one of the challenges. That is why I am really pleased to see the hugely successful pilots of the targeted lung health check programme rolled out. Those pilots offered places such as supermarket car parks and lorries where people could easily access a check, particularly in areas of high prevalence or high inequalities, making it as simple as possible for somebody to get a check. There were dramatic improvements in those attending and huge upturns in the number of people diagnosed. The pilots were paused due to covid-19, but I am really keen that we turbo-charge them now that we have them back on track, so that they operate more broadly as soon as is safely possible. The programme will be rolled out to 23 clinical commissioning groups, focused on areas with some of the highest rates of mortality from lung cancer.

Because I am short of time, I will not repeat what the hon. Member for Halton said, but we know that we have regional variation, and we need to target more effectively for lung cancer where we have those problems. It is important that we do that geographically in the light of the need to minimise trips to the hospital, particularly for people who may be more vulnerable to covid-19. Radiotherapy services have made use of fewer fraction protocols as evidence has emerged.

The focus on recovery has been on embedding the use of hypofractionated treatment. In addition, the NHS is supporting providers to accelerate the delivery of stereotactic ablative body radiotherapy for non-small cell lung cancer and oligometastatic indications, starting with the treatment of non-small cell lung cancer. In some cases, that is an alternative to surgery. Again, I think the report picked up on that. The challenge is that if someone gets covid-19 at the same time as they are having the surgery, it dramatically increases the mortality rate.

It was right to react at speed. Where clinicians say, “We need to be doing it this way,” we have tried to give the direction so that they can. Individuals can safely go to their GPs. If people have worrying symptoms that could be cancer, GPs are open for business and ready to help patients. It is about ensuring that the “Help us help you” campaign from earlier in the year delivers and gets more people coming through the door so that we can treat them quicker.

[Derek Twigg]

Will the Minister give way?

[Jo Churchill]

Yes, of course. Are we allowed the extra minute or two, Ms Fovargue?

[Yvonne Fovargue (in the Chair)]

I do not think so, no.

[Derek Twigg]

Just on the issue of GPs, it is important that they see these types of patients face to face.

[Jo Churchill]

Indeed, and GPs stand willing and ready to see those patients and give them care. Ensuring that they can refer quickly has been part of this drive.

The cancer recovery taskforce, led by Professor Peter Johnson and involving cancer charities, clinicians and other expert stakeholders, is also driving to meet some of the objectives to which the hon. Gentleman alluded: ensuring that we get people into treatment as quickly as possible, that systems and pathways are clear and understandable for the patient and that we do see that capacity rise.

Motion lapsed (Standing Order No. 10(6)).