Breast Cancer Diagnosis and Services: Covid-19

Justin Madders Excerpts

Thursday 12th November 2020 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr McCabe. I start by thanking the hon. Member for North Warwickshire (Craig Tracey) for securing this important and timely debate and for his excellent introductory speech. He made a number of important points, some of which I hope to return to, and I hope he gets a positive response to his very helpful suggestion on the gathering of data. I also thank all the other hon. Members for their contributions today, and I will go through some of the highlights of those.

My hon. Friend the Member for Barnsley East (Stephanie Peacock) spoke about the need for a cancer recovery plan, which I think we all agree on, and addressed the important point about widening health inequalities and the startling differences in the availability of screening depending on where people live. I agree with her that improvements to the cancer outcomes datasets are an important part of beginning to understand how those disparities work out.

We heard from my hon. Friend the Member for Easington (Grahame Morris); I pay tribute to the work he does on the all-party parliamentary groups in this area. He mentioned the Catch Up With Cancer campaign and drew attention to the backlog, which, of course, many hon. Members have raised today. He also raised the availability of radiotherapy, which, in his own words, he bangs the drum on consistently in this place, and we pay tribute to his persistence.

The hon. Member for High Peak (Robert Largan) made an important point about the availability of mobile screening units and the hon. Member for Strangford (Jim Shannon) , who always speaks with such knowledge on this subject, made some important points about clinical trials and charities, which I hope to be able to return to if time allows.

It was a pleasure to see the hon. Member for Southend West (Sir David Amess) find his spiritual home at last; it is the equivalent of Gary Neville turning out to play for Liverpool, but he is welcome all the same. We have a vacancy in the shadow health team for a Parliamentary Private Secretary at the moment and, if he shows the promise that he demonstrated in his speech today, I think we may be able to find a role for him on this side of the House.

The hon. Gentleman made, as my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) did, an important point about some of the people who are not here today, including the hon. Member for Chatham and Aylesford (Tracey Crouch), who we heard this morning in business questions speaking about her frustration at not being able to participate in this debate. I am sure it would have been enhanced by her presence, given her current battle, alongside the former Member—still our friend—for Dewsbury, Paula Sherriff. I am sure the whole House sends both of them our very best wishes.

I want to speak about the impact the pandemic has had on the early diagnosis of cancer in general, as many Members have referred to already. We know how important early diagnosis is to improving chances of survival and in successful treatment. As we heard, Cancer Research UK estimates around 3 million people are waiting for breast, bowel or cervical screening, and there were over 1.2 million patients waiting for a key diagnostic test by the end of August this year. As my hon. Friend the Member for Easington mentioned, we know from Macmillan’s latest report that there are currently around 50,000 missing diagnoses; that compares to a similar timeframe for this time last year, and means 50,000 fewer people have potentially not been diagnosed with cancer.

We know significant amounts of capacity had to be created during this pandemic, and that meant the cancelling of planned operations, large numbers of patients being discharged back into the community, and staff and patients having to be protected from the transmission of covid-19. What those changes also meant is that, thankfully, intensive care did not have to be rationed so that only covid-19 patients were treated. However, it also caused the shutdown or reduction in many other non-covid services, which, combined with drastic changes in patient behaviour, has led to us facing this huge backlog today. We know that stricter infection control measures—which are absolutely necessary—mean that the backlog of care will probably take much longer to clear than we would like.

My hon. Friend the Member for Dulwich and West Norwood and other hon. Members referred to the Breast Cancer Now report, and how the number of people referred to see a specialist declined dramatically from April. There is an estimate that across the UK, there have been 107,000 fewer breast cancer referrals, and a backlog of almost 1 million women requiring screening has built up during this time. Some of those women may well have been living with undetected breast cancer, and some may still be. Every month that that situation continues, more women could be missing out on the best chance of getting an early diagnosis and the best chance of beating the disease. It is vital—and something that we have been pushing for for a long time—that we get a clear sense of how we are going to tackle that backlog, because it is so important.

The hon. Members for Wakefield (Imran Ahmad Khan) and for Crewe and Nantwich (Dr Mullan) mentioned the importance of mammograms. As we know, they are a key tool in early detection. There is a plan to send open invitations for screening from September to March of next year. That has caused some concern among cancer charities, because some of the research shows that the number of women who make appointments is significantly lower than those who actually attend timed appointments. There is a fear, sadly, that this could actually worsen the persistent decline we have seen in recent years of the uptake of breast cancer screening. We are particularly concerned about the impact that will have on some groups where uptake is already low, such as those living in deprived communities and some BAME groups. We heard a little bit about the impact on BAME groups from my hon. Friend the Member for Dulwich and West Norwood, and both she and the hon. Member for Winchester (Steve Brine) very powerfully put into words the additional mental toll that this disease has during this time, on top of everything else that people ordinarily face when they have received such a diagnosis.

Several hon. Members mentioned the impact of covid-19 on secondary breast cancer patients. It is still, sadly, the case that around 11,500 people—women, mainly—die from breast cancer each year. Most of those are to do with secondary breast cancer, and as we have heard, it is not something that there is a cure for at the moment. It is estimated that around 35,000 people in the UK are living with secondary breast cancer. As the general population ages and people live longer, numbers will continue to increase, so it is really important that we get a better understanding and response to secondary breast cancer. We also need to look at this issue from the patient’s perspective.

I want to mention my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams), who wanted to speak in today’s debate but could not. She wanted to pay tribute to one of her constituents, Jo Taylor, and to METUP UK, which focuses on making positive changes for everyone with metastatic breast cancer. Its “busy living with mets” campaign calls for increased awareness of secondary breast cancer, because catching it earlier leads to better outcomes. It is also campaigning for better access to drugs, clinical trials, radiotherapies and surgical pathways.

As the hon. Member for North Warwickshire mentioned in his opening comments, the national cancer patient experience survey tells us that the experiences of patients with secondary cancer differ greatly. It has identified gaps through the taskforce in the support and services offered to people, including variation in access to clinical nurse specialists, patchy provision of information, patients’ psycho-social needs not being met, and a lack of prompt and timely access to palliative care services.

As we have heard from several hon. Members, clinical nurse specialists play a critical role in co-ordinating care, providing information and helping people to manage their diagnosis and treatment better. In fact, Breast Cancer Now reports that the support of a clinical nurse specialist is the single most important contributing factor to people’s positive experience of care. That is particularly important for secondary cancer patients, who are often on lifelong treatments and have complex needs as a result. Its importance was acknowledged in the long-term plan, with a commitment that by 2021—it is only six weeks away now—all patients, including those with secondary cancers, will have access to a clinical nurse specialist or support worker.

It is very important that we get to a point where everyone is able to take advantage of the expertise that a clinical nurse specialist provides. Prior to the pandemic, the workforce was already overstretched and under pressure due to increased demand and persistent shortages across the workforce. A report by the Public Accounts Committee was highly critical of the Government’s approach to the workforce, finding that the long-term plan was not supported by a detailed workforce plan. Of course, the removal of the NHS bursary in 2017

“signally failed to achieve its ambition to increase student nursing numbers.”

Before I conclude, I want to echo what the hon. Member for Strangford said about the importance of charities in this sector. We know there is a great deal of concern in the sector. I know that some support was announced by the Government back in April, but it falls well short of what was suggested by the associations involved, and only a few have been able to benefit from it. I hope the Government will listen to the sector and look again at what additional financial support can be provided, because we know that clinical trials provide a vital opportunity for patients to access new treatments, which are always in development. We know it is particularly important for patients with secondary breast cancer. We hope that is something the Minister can take on board today, and I look forward to hearing her response.