Breast Cancer Screening

Justin Madders Excerpts

Wednesday 16th December 2020 Westminster Hall

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

It is a pleasure to see you in the Chair this afternoon, Sir Edward. I thank the hon. Member for High Peak (Robert Largan) for securing this important debate and for his introductory speech. It is clear that he feels very passionately about improving access to breast cancer screening for his constituents. He was right that tremendous progress has been made in tackling this awful disease in recent years, but there is still an awful long way to go, as we have heard today.

The hon. Gentleman mentioned the importance of screening, as most Members did. I was very sorry to hear that the mobile screening service in his constituency has been temporarily halted. I hope it is a temporary halt and the Minister is able to give us some good news when she responds. It is particularly disappointing because the hon. Member spoke very highly of that service in the last debate we had on this matter, only last month. He certainly set out very clearly why moving to the system that we have at the moment is presenting a particular challenge to his constituents. He also gave some very personal testimony about the consequences of a delay in screening, showing why, of course, access is important.

We have heard some other excellent contributions this afternoon. The hon. Member for West Bromwich East (Nicola Richards) cited her local area’s statistics to point out that the figure for screening appointments in her constituency was lower than the national average; clearly, such a situation is something that all Members can play a role in remedying. She was right to say that the key to all this is being proactive and encouraging people to seek screening and early diagnosis. She gave a very personal example of how that approach had made a real difference to someone very close to her.

The hon. Member for Westmorland and Lonsdale (Tim Farron) extrapolated from his local statistics to state that about one in six people who would ordinarily have received treatment this year are not receiving it. He mentioned his work as the chair of the all-party parliamentary group on radiotherapy and I commend him for his consistent work in that particular forum. He referred, quite rightly, to the 15% drop in the use of radiotherapy treatment, which is of particular concern. He said that he does not believe that there were good medical reasons for that reduction, so there is a challenge for the Minister to go back to trusts to see whether there are reasons beyond medical reasons why these treatments are not taking place. He described the situation as a crisis on the scale of covid and said that it needs a Government response on that scale to tackle the issues that we have discussed today.

Those sentiments were also expressed by the hon. Member for Strangford (Jim Shannon), who gave a typically passionate and well-informed speech. I am sure that we all agreed with him when he said that he would like to read out a different set of statistics in a debate on this issue next year. Like all the hon. Members who have spoken today, he very clearly set out the importance of screening. He also raised a number of other issues, which I will touch on in my remarks.

This is the second Westminster Hall debate on breast cancer in as many months, which reflects the importance of this subject. On both occasions, it has been evident from the testimonies of Members how many people have had their own lives touched by breast cancer. Debates such as this one are important because, as many Members have mentioned, the various statistics out there show that there are very few people whose lives are not touched by this issue in some way. As we have heard from many Members, one in seven women in the UK will develop breast cancer during their lifetime—on average, that is 55,000 women, as well as 370 men, every year. Around 600,000 people in the UK are living with or beyond breast cancer, and, sadly, around 35,000 people have incurable secondary breast cancer.

As the hon. Members for High Peak and for Strangford both said, almost 1,000 women die from breast cancer in the UK every month, almost all of them from secondary breast cancer. The hon. Member for Strangford put things very well when he reminded us that these statistics are about real people and real homes, which may never recover from such a tragic loss. We must never forget the human tragedy behind these figures when we read them out in debates such as this one.

This very important issue affects so many people, but there are also many people who are united in their desire to do all they can to beat this disease. I pay tribute to all the dedicated campaigners, ambassadors and charities, who all do their bit to make life a little bit easier for those suffering with cancer. We must, of course, pay tribute to the NHS staff for everything that they do, not just this year—the most difficult of years—but every year, in the fight against cancer. I also thank Breast Cancer Now for its continuing support for all politicians from all parties in the House and, most importantly, the support it gives to those living with or affected by breast cancer, because, as we have heard, more women, thankfully, are now surviving breast cancer than ever before.

As many Members have already said, the key to that is screening, because we know that the earlier a cancer is diagnosed, the more likely it is that treatment will be successful. We also know that currently around 95% of women diagnosed will survive for more than one year and more than 80% for more than five years.

In the debate on this issue last month, I touched on the impact of coronavirus on early diagnosis, as most Members have today. Cancer Research UK estimates that around 3 million people are waiting for breast, bowel or cervical screening, and Macmillan estimates that there are currently around 50,000 missing diagnoses from this year compared to last year. This is the biggest crisis that cancer has faced in decades.

Breast Cancer Now estimates a significant backlog of nearly 1 million women requiring screening has built up during this year. Among the women still waiting for their screening, we know from the statistics that there will be around 8,600 who do have breast cancer, but it remains undetected. As Members have set out, the reasons for that backlog are numerous. Social distancing and infection control means that many cancer services can operate only at about 60% of their capacity. As the hon. Member for Westmorland and Lonsdale pointed out, that means the situation might get worse rather than better. Services were already under severe strain during the first few months of this year, and we know about the unprecedented steps that the NHS has had to take to deal with the large influx of covid-19 patients, which has led to an effective pausing of breast screening in England.

Of course, not only the screening programme was affected. Breast Cancer Now has also reported that the number of people referred to see a specialist with suspected cancer declined dramatically during the peak of the coronavirus outbreak in April. It estimates that across the UK there are likely to be nearly 107,000 fewer breast cancer referrals. Some of those women could be living with undetected breast cancer, and with every month that passes more women will be missing that early diagnosis that we have all heard today is the key to preventing death.

Although screening programmes have now restarted, we have heard that that has happened more quickly in some parts of the country. Breast cancer charities have raised concerns about the current strategy that has been adopted to clear the backlog, with the plan to send women open invitations to call and make an appointment from September this year to the end of March. As the hon. Member for West Bromwich East said, research has shown that the number of women who make appointments is sometimes lower than the number of women who actually attend for a timed appointment.

Breast Cancer Now fears the strategy could worsen the persistent decline that we have seen in the uptake of screening in recent years. It has also raised concerns, as did the hon. Member for West Bromwich East, about the impact on groups, among which uptake is already low, such as those who live in deprived areas and those from black and minority ethnic groups. This is particularly important at a time when surveys have shown that people are reluctant to come forward with symptoms due to concerns about catching coronavirus and giving it to the family, and putting pressure on an already very busy NHS. When the Minister responds, will she tell us a little more about what steps the Government can take to ensure that the women who have received open invitations for screening are able to take those up in the coming months?

It is very welcome that October’s NHS breast cancer waiting times showed an increase in referrals for people with potential symptoms of breast cancer to see a specialist. However, the crucial targets for women to be seen within two weeks was missed. There are immense pressures on our health service at the moment, but before the pandemic the breast imaging and diagnostic work was already overstretched and under severe pressure because of increased demand on their services—and that of course has been compounded, as many Members have referred to, by the shortages and vacancies in the workforce.

As the hon. Member for High Peak mentioned, Public Health England has previously reported a vacancy rate of 15% for mammography staff. About half of all mammographers are aged 50 or over and therefore likely to retire in the next 10 to 15 years. That is very concerning, given the importance of mammograms in detecting breast cancer.

Of equal concern is what Breast Cancer Now tells us: only 18% of breast screening units are adequately resourced with radiography staff in line with breast screening uptake demand in their area, and one in four trusts and health boards across the UK has at least one vacant consultant breast radiologist post. Sadly, that situation is unlikely to improve any time soon as vacancies are set to increase with about a quarter of breast radiologists forecast to retire over the next five years.

A recent analysis of NHS trust risk registers showed that 83% of trusts surveyed reported a workforce risk, including not having enough staff to manage cancer care, showing the NHS entering the pandemic with huge holes in the workforce.

The Government commissioned reviews that have highlighted some concerns. We heard from the hon. Member for High Peak and various other Members about the independent review of adult screening programmes in England, which found that such programmes are constrained by the size and nature of their workforce and by the equipment and facilities available to them. As we heard, Professor Sir Mike Richards’s review, which was commissioned by Sir Simon Stevens, found that significant investment in facilities, equipment and workforce was needed. That means replacing outdated testing machines and expanding the imaging workforce by about 2,000 additional radiologists and 4,000 radiographers, as well as support staff.

In September, a Public Accounts Committee report called on the Government urgently to prioritise publication of the long-term workforce plan. Unfortunately, that exposed the lack of long-term thinking in the current approach to the NHS workforce. Such thinking is vital if we are to see the NHS perform at the level we all want it to. We need to see a full five-year people plan, with costed actions within it.

The pandemic has shown, as other Members said, just how valuable and appreciated NHS staff are, but it has also highlighted the unaddressed long-term issues of excessive workload, burn-out and the inequalities experienced by staff. The rhetoric on support for our NHS staff needs to be matched by action. As we have heard today, that commitment is vital to ensuring that breast cancer services can safely continue to give all those affected by breast cancer the very best chances of survival. I hope that we will hear from the Minister about how that ambition, which we all share, will be delivered.