Cancer Targets

Justin Madders Excerpts

Tuesday 1st May 2018 Westminster Hall

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Streeter. I congratulate the hon. Member for Basildon and Billericay (Mr Baron) on securing the debate and on his considered and balanced speech. As chair of the all-party parliamentary group on cancer, he commands a great deal of respect on both sides of the House for his commitment to improving the way we deal with cancer, as has been reflected in the tributes paid to him by hon. Members.

I also pay tribute to my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson), the shadow Public Health Minister. She contributes a huge amount through her work as co-chair of the APPG on breast cancer and as chair of the APPG on ovarian cancer, and through her involvement with countless other organisations. Were it not for a long-standing, important commitment, she would be responding to the debate.

We have heard several contributions. My hon. Friend the Member for Lincoln (Karen Lee) spoke movingly from personal experience about the difficulty of getting the right care for her daughter. She described feeling a lack of support when the condition moved away from traditional treatments. I hope that her time in the House and her experiences will enable an improvement in the treatment experience of patients, particularly those suffering from secondary breast cancer. She made an important point about the geographical inequalities in treatment for secondary breast cancer. She also said that the transformation funding should be decoupled from the targets, as did most other hon. Members. The hon. Member for Basildon and Billericay talked about retrospective conditionality, which neatly highlights the absurdity of the situation.

I pay tribute to my hon. Friend the Member for Scunthorpe (Nic Dakin) for his work on the APPG on pancreatic cancer. He spoke in defence of the 62-day target and set out very well why it is important, not just for measuring some elements of performance, but because the wait between first being suspected of a condition and receiving treatment is probably the most anxious time for a patient. He also said that the link between the 62-day target and access to the transformation fund should be broken, and that funding should be available for conditions that are harder to treat, such as pancreatic cancer. He spoke in some detail about the fast-track surgery pathway. I am pleased to hear that the NICE guidelines have been amended to reflect the success of that initiative, but it was disappointing to hear about the funding difficulties and the fact that it has not yet been rolled out to other areas of the country.

As all hon. Members have said, cancer is a difficult subject to talk about. It touches all our lives in some way. One in two people will be affected by cancer at some point in their lifetime. Every two minutes, someone in this country is diagnosed with cancer. It is right that the tone of the debate has been about trying to do the best we can to improve outcomes for people touched by cancer.

As has been said, there has been a steady and welcome improvement in cancer survival rates in this country, which can partly be attributed to considerable improvements in early diagnosis, but the sad and inconvenient truth is that we still lag far behind our European counterparts, as the hon. Member for Basildon and Billericay said. Five-year survival rates in the UK are far behind European averages in nine out of 10 cancers. Of the five largest EU countries, we have the highest mortality rates and the lowest survival rates. It is estimated that up to 10,000 deaths a year in England could be attributed to lower survival rates compared with those in the best- performing countries. The OECD has said that our survival rates for certain types of cancer are near the bottom of the table. Several hon. Members made the point that although we have improved, other countries have progressed at a similar rate, so our relative performance is still a considerable challenge.

There is an international element, but there is also a local one within England. If all clinical commissioning groups were able to achieve the level of early diagnosis in lung cancer that the best CCGs manage, 52,000 people would be diagnosed earlier, which could save lives. The introduction of the CCG dashboard has helped to raise the visibility of such issues and, as the hon. Member for Basildon and Billericay said, the flexibility afforded to CCGs has enabled them to adjust their approach and take account of local priorities.

The hon. Gentleman was right to express the concern that process targets can have funding consequences, which sometimes have a distorting effect on priorities. My hon. Friend the Member for Scunthorpe raised an important issue about the applicability of blood cancers to the CCG dashboard.

We all agree that the most important element of any cancer treatment is time; as hon. Members have said, it is key to a successful outcome. It is generally agreed to be the single most important reason for lower survival rates in England, so it is vital that we do better not only on early diagnosis, but on prevention and awareness. The hon. Member for Central Ayrshire (Dr Whitford) spoke well about the challenge we face in encouraging people to go and see their GP as soon as symptoms present.

That is why it is vital that early diagnosis continues to be a priority. As the hon. Member for Basildon and Billericay said, we should take a wider view about longer-term survival rates. We know that 35% of lung cancer patients are diagnosed only after presenting as an emergency, and one in 20 are not diagnosed until after they have died. The Roy Castle Lung Cancer Foundation found that if a person is treated early, their chance of surviving for five years or more is up to 73%, but the current five-year survival rate is only 10%. For ovarian cancer, the National Cancer Registration and Analysis Service found that more than 25% of women are diagnosed through an emergency presentation. Of those, just 45% will go on to live for a year or more, compared with more than 80% of women who survive beyond a year if they are diagnosed following a referral from their GP.

We also know that once patients have been diagnosed, they have an agonising wait for treatment, as my hon. Friend the Member for Scunthorpe said. The 62-day target has now been met only once in the last four years since January 2014, and more than 100,000 people have had to wait longer than two months for their treatment to start. Although we are talking about some of the merits of those targets, it is important to ask the Minister if he can update us about the steps that are being taken to meet them in future.

One of the key elements in meeting those targets is having an adequately staffed workforce. From our experiences of visiting hospitals, we all know how reliant we are on the members of staff who go above and beyond the call of duty each day. Without them, the staff shortages that we are experiencing would have a much more significant impact on the services that are offered. Across the workforce, we have immediate challenges and demographic issues that are likely to have a significant impact in the near future, and that is before we consider the implications of Brexit.

Cancer Research UK has observed that the vacancy level across diagnostic radiographers, radiologists, gastroenterologists and histopathologists is at least 10%. In the cancer patient experience survey, 7% of cancer patients said that there were rarely or never enough nurses to care for them properly. The most recent report by the APPG on cancer highlights that 28% of radiographers are forecast to leave the profession by 2021. There are also reports that visa restrictions are hampering trusts’ recruitment plans.

[Karen Lee]

This is not meant to be a political point, but if we want people to train as medical staff, we need to look at the funding for that, such as the nursing bursary, which has now gone. It has been noted that the number of people applying for training has fallen since the bursaries were withdrawn.

[Justin Madders]

I thank my hon. Friend for that intervention. We have touched on the impact of the nursing bursary on a number of occasions, and Labour has a commitment to restore it. There are also implications for the ongoing training and continuing professional development for nurses and other health professionals who wish to specialise. The budgets available for those kinds of initiatives are being continually squeezed.

Turning back to the issue of overseas recruitment, it is worrying to hear that there is a block on recruiting trained and “ready to go” staff from other parts of the world, because it is evident from the numbers we have talked about today, and not only in this area but in other areas across the NHS, that there is a funding crisis and a recruitment crisis. Actually, staff in some of the disciplines that we have talked about do the essential behind-the-scenes work that helps us to reach patients that bit quicker and makes the targets easier to meet.

Only yesterday, Macmillan Cancer Support released research showing that hospitals in England have more than 400 specialist vacancies for cancer nurses, chemotherapy nurses, palliative care nurses and cancer support workers. Macmillan said that cancer patients were losing out, with delays in their receiving chemotherapy, and that cancer nurses were being “run ragged”, as they were forced to take on heavier workloads because of rota gaps. It also reported that vacancy rates for some specialist nurses are as high as 15% in some areas. Clearly, those kinds of gaps will have an impact on our efforts to achieve the outcomes that we all want to deliver.

There is little doubt that we would enjoy much more success in meeting some of our aims, particularly in the cancer strategy, if the workforce had the resources they need. We welcomed the publication of the cancer workforce plan in December, although we would have liked to have seen it much earlier. I shall be grateful if the Minister will update us on the progress of that plan, if he has time to do so when he responds to the debate.

More generally, the “two years on” progress report on the cancer strategy was published last October, and it set out some of the progress that has been made, but we are now six months on from that. Again, if the Minister has an opportunity, I shall be grateful if he will provide us with an update. If he is unable to do so today, could he indicate when the next formal update will be available?

In conclusion, it is wholly unacceptable that we continue to lag behind many of our neighbours with regard to outcomes, but I believe that, with the right funding, the right strategy and support from the Government, the situation can change. I hope that the Minister, when he responds to the debate, will confirm that there are plans to put in place the world-class services that our patients truly deserve.

[Mr Gary Streeter (in the Chair)]

I call the Minister. If he could leave two minutes at the end for Mr Baron to respond, that would be most helpful.