Cancer Care: Young Adults

Debate between Julie Marson and Oliver Heald

Wednesday 8th June 2022 Westminster Hall

[Julie Marson]

I thank the right hon. Gentleman for his intervention. I will go on to talk about the danger of not expecting to find symptoms of cancer in children and young adults, and the terrible consequences that delays and misdiagnoses can have, as they did in Jess’s case—it is too often the case.

I want to talk about Jess, because to understand how important this is, and why the Brady family are so committed to this approach, it is important that I tell Jess’s story. In mid-2020, Jess was feeling unwell with abdominal and back discomfort. It was during the pandemic, and Jess was given an online consultation at her GP surgery, and prescribed antibiotics for a suspected kidney infection. Over the ensuing weeks she was prescribed numerous other medications, including more antibiotics and steroids. Jess contacted her surgery on more than 20 occasions in five months. None of the four GPs who provided her with a consultation—17 of which were conducted remotely—took her symptoms seriously. Her requests for blood tests were granted, but a raised D-dimer was dismissed after a preliminary scan, and not investigated further. Blood results showing poor liver function were left for a six-week follow-up review, which proved fatal.

Jess was told for months that she was suffering from long covid, despite two negative coronavirus tests. She was finally diagnosed with cancer following a private referral on 26 November. Her dependency on oxygen from that date meant that she did not leave the hospital or ever return home. Jess discovered that she had stage 4 adenocarcinoma with an unknown primary. It had spread throughout her body to her spine, liver, stomach, lungs and lymph nodes. Jess was a talented satellite engineer for Airbus. She had so much potential and so much life to live. Her loss has shattered her family’s world.

Devastatingly, had someone taken the initiative to closely review Jess’s case and examine the evidence, cancer screening would have been an obvious requirement. A consultant recently said to her parents:

“If a diagnosis cannot be made from initial tests then not enough tests are being carried out”.

In Jess’s case, a request to be referred to an ear, nose and throat specialist was laughed off. Letters written to the surgery listing her symptoms, including dramatic weight loss and vomiting, were ignored. Jess felt powerless and distressed. She tried so hard to be heard and taken seriously. It was heartbreaking for her family to watch her deterioration.

It is obvious really, but when people are desperately ill and at their lowest ebb, they do not possess the stamina to fight the system—nor should they have to. Jess’s age was a key issue. Many people, including GPs, do not expect to see, as the right hon. Member for Alyn and Deeside (Mark Tami) said, a young adult with cancer, and that affects their diagnostic processes and judgment.

[Sir Oliver Heald (North East Hertfordshire) (Con)]

I join my hon. Friend is expressing admiration for the way in which the Brady family have campaigned on this issue. In reality, is it not necessary for each general practice to have at least one doctor who is seriously knowledgeable about cancer diagnosis and able to take a lead, so that if the symptoms are not diagnosed that doctor gets to look at the case and perhaps send it to a rapid diagnosis centre? Otherwise the patient is being let down. The Health and Social Care Committee, in its report on cancer services, said that we need more support for GPs in that area. I commend my hon. Friend for what she is doing and ask if she agrees with me?

[Julie Marson]

I appreciate my right hon. and learned Friend’s intervention. I will come on to talk about some of the things he raised, because he puts his finger on some of the most important aspects of how GPs manage their diagnosis process. The diagnostic centres are fantastic, but they need to have patients referred to them, which goes back to what we are trying to achieve with Jess’s law.

Cancer charity CLIC Sargent found that around half of young people visited their GP at least three times before their cancer was diagnosed. Almost 10% of all new cancers are diagnosed in people aged between 25 and 49, with almost twice as many cases in females as in males in that group.

Simon and Andrea Brady created a petition in Jess’s name. My right hon. and learned Friend the Member for North East Hertfordshire and I joined them to hand it into Downing Street. Its plea was to increase the awareness of diagnosis of cancer in young adults. It currently has an incredible 240,000 signatures, and has highlighted the scale of the problem for young adults. The petition makes for heartbreaking reading. Countless people tell stories of their young family members who have had their lives curtailed by late or non-existent cancer diagnoses. The disproportionate occurrence of females is also deeply troubling.

Being told you are too young for cancer has been happening for years, and it is simply not acceptable. Young people have their symptoms explained away with other diagnoses. As I said, Jess was told she had long covid, despite never having tested positive. The explanations given to other patients for poor health are endless: irritable bowel syndrome, pulled muscles, fatigue, stress, migraine—the list goes on.

I welcome the significant roll-out of rapid diagnostic centre pathways across hospitals in England. I know we have just achieved one million tests and scans via our community diagnostic centres, which is a huge achievement and critical in tackling the covid backlog. Of course, patients still have to be referred by a GP, and that vital link is what we are focusing on here today, particularly the escalation of patients with undiagnosed symptoms within a GP’s surgery or to a specialist, as per Jess’s law.

There are other issues that relate to GPs, including having a dedicated GP lead for a patient. The general practitioners’ contract requires practices to provide a named accountable general practitioner to all registered patients. That GP must take the lead in ensuring that any primary medical services considered necessary to meet the needs of a patient, including appropriate referrals to specialist care and liaison with other health professionals involved in the patient’s care, are co-ordinated and delivered to that patient.

However, Jessica’s case demonstrates that that does not always happen. Jessica was not seen by just one GP at her surgery. In her case, four doctors spoke to her and prescribed medication. Although Jess was told on one occasion that she had been discussed at a practice meeting, it was obvious that there was no one person overseeing her case. She was never seen or contacted by her named GP. It is also vital that GPs are required to maintain their continuing professional development through up-to-date training and awareness of cancer, including in young people.

CLIC Sargent’s Young Lives vs Cancer is a charity dedicated to supporting children and young people with cancer, and ensuring that their voices are heard in the context of cancer care. It has identified several challenges faced by GPs that hamper early diagnosis. Those include limited training and awareness, and time pressures. Of course, the effect of the pandemic is exacerbating existing issues. One third of GPs reported inadequate opportunities to gain experience in the care of children and young people during their initial training as one of the top barriers to identifying cancer in children and young people.

The Health and Social Care Committee’s review into cancer services, published on 5 April, concluded:

“The single most effective way to improve overall survival rates will be to diagnose more cancers earlier. Diagnosing bowel cancer at stage 1 means that 90% of people will live for five years compared to just 10% of people diagnosed at stage 4.”

Cancer Diagnoses: Young People in Hertfordshire

Debate between Julie Marson and Oliver Heald

Friday 19th November 2021 Commons Chamber

[Julie Marson (Hertford and Stortford) (Con)]

I wish to start by pointing out that this debate really does not belong to me. It belongs to Jessica Brady, as it is her tragic story that brings us all here today. The first thing I want to do is pay tribute to Jessica’s parents, Andrea and Simon Brady. They could not be here today, but I know they are watching, even though it is very difficult for them to do so. The pain they have experienced, and the pain they face every day of coping with their daughter’s illness and death, is unimaginable. They have told me that they are utterly broken, yet with dignity and determination they have committed to improving the diagnosis of cancer among young adults. They wish to ensure, in Jess’s name, that others do not have to go through what they have gone through. They have already done much to raise awareness of Jessica’s story. I was honoured, along with Simon and Andrea, and my right hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald), to hand in their petition calling for better awareness and diagnosis of cancer in young people to No. 10 Downing Street. The petition currently has more than 213,000 signatures, which is remarkable and sobering. I am grateful that my right hon. and learned Friend is in the Chamber for this debate and grateful for all of his support.

[Sir Oliver Heald (North East Hertfordshire) (Con)]

I pay tribute to my hon. Friend for securing the debate. My thoughts, as hers, are with Andrea and Simon Brady on the sad loss of their daughter Jess. Does my hon. Friend agree that at least two areas need to be improved in the way that we deal with cancer in young people? First, in general practice, we need to concentrate much more on young people and perhaps have a lead in each practice who looks at it and makes sure that every doctor is up to speed with the latest thinking. Secondly, we need to improve blood tests. There have been recent innovations, so perhaps a blood test could help with diagnosis.

[Julie Marson]

I thank my right hon. and learned Friend for those comments. He has followed the case closely and has supported me. He puts his finger on some of the key lessons that we want to learn from the Brady’s tragic experience to improve the situation for the future. I will expand on the exact points that he has made.

Andrea and Simon first got in touch with me in April. They told me how Jessica, their 27-year-old daughter, had been unwell since mid-2020 suffering with abdominal and back discomfort. We know how difficult it has been to get a face-to-face appointment with a GP during the pandemic, so Jessica had an online consultation and was diagnosed with a kidney infection and prescribed antibiotics.

Over the ensuing weeks, Jessica was prescribed numerous medications, including countless courses of antibiotics and steroids, all without an examination. For months, she was told that she was suffering from long covid, despite the fact that she had never tested positive. Unconvinced by the assessments and desperately worried, Andrea and Simon decided to go down the private healthcare route.

On 26 November 2020, Jessica received the worst news imaginable: she was diagnosed with an extremely aggressive stage 4 adenocarcinoma with an unknown primary. Jessica’s dependency on oxygen from that date meant that she did not leave the hospital or ever return home. By the time the cancer was discovered, it had already spread to her spine, liver, stomach, lungs, bones and lymph nodes. Jessica passed away on 20 December 2020.

I never had the pleasure of meeting Jessica, but by all accounts she was a remarkable young woman. She worked as a satellite engineer for Airbus in Stevenage and on the day of her funeral, a satellite that she helped to design was launched into space from Cape Canaveral inscribed with the words, “Thank you, Jess!”.

Environment Bill

Debate between Julie Marson and Oliver Heald

Report stage & 3rd reading
Wednesday 26th May 2021 Commons Chamber

[Julie Marson (Hertford and Stortford) (Con)]

It is a pleasure to follow the hon. Member for Westmorland and Lonsdale (Tim Farron), and it is a real pleasure to speak in this debate. It was over a year ago that I made my maiden speech specifically so that I had the opportunity to contribute to the Second Reading of this Bill, so it is a pleasure to be back here again.

It is worth reflecting on the context of where we are now, because in the intervening time, the pieces of our country and the world have been almost thrown into the air, and we still do not quite know where they will land. The pandemic makes the Bill even more important than it was over a year ago. It is fair to say that all of us have had time to reassess priorities. We have considered our priorities in life—our quality of life, our family, our health and our friends—and this Bill has become even more important, because many of us, with the roads quiet and having limited time to get out, have reflected on the importance of our natural environment and what is around us. Our appreciation of nature and the need to focus on species loss and the things that make our environment unique to our localities are even more important than they were.

With respect, I must disagree with the shadow Secretary of State’s characterisation of this as not being a landmark Bill, because it is a landmark Bill. It is a bold Bill. I particularly reject the characterisation that it is a mark of a Government or, indeed, any Member on the Government Benches not caring about the environment, because it absolutely is not that.

[Sir Oliver Heald]

In our area, there are a lot of chalk streams. Does my hon. Friend agree that for our population and our area, points that the Government have agreed on, such as not having sewage overflows into the streams and treating low flows as damage that has to be restored, are incredibly valuable things?

[Julie Marson]

I thank my right hon. and learned Friend and neighbour, because I will come on to mention chalk streams, which are such a vital part of our environment as a country, particularly in Hertford and Hertfordshire. In Hertford and Stortford—I may be biased—we have one of the most beautiful places in the world to live and work, and this Bill is important to me and my constituents.

We are going to rely on many of the Bill’s provisions. Development is a major driver of species loss and environmental degradation, so the biodiversity net gain requirements will be critical for us in protecting our environment. We have swathes of green belt that will be developed, and there is lots of infill development. This Bill will be really important to help us to retain our environment in those circumstances. I thank the Minister for her engagement with the all-party parliamentary group on chalk streams, because that has produced some strong commitments and practical solutions.

In my constituency in Hertfordshire, we have five amazing chalk streams: the Stort, the Mimram, the Beane, the Ash and the River Lea. We all know that they have been called the rainforests of the environment, because they are so key to diversity in the ecosystem. I absolutely agree with my right hon. and learned Friend that the provisions in the Bill about chalk streams are extremely welcome and important.

I am pleased to speak also as the RSPB champion for the kestrel, because these things are inextricably linked. In Rye Meads nature reserve in my constituency, the kestrel has declined drastically, but focus on chalk streams and the wildlife they produce will help the kestrel as well. The environment is so complex, and I welcome the progress we have made and thank the Minister for her engagement on that.

When I spoke last time, I quoted Rudyard Kipling, and although I will not overuse his beautiful words, what he said is that we cannot just sit back and expect everything—our beautiful land—to happen without us playing our part. I believe that this Bill is very much us playing our part.