Breast Cancer

Karen Lee Excerpts

Thursday 18th October 2018 Westminster Hall

[Karen Lee (Lincoln) (Lab)]

It is a pleasure to serve under your chairmanship, Mr McCabe.

I thank my hon. Friend the Member for Crewe and Nantwich (Laura Smith), my good friend, for introducing this debate. It is vital for us to have the opportunity to discuss the future of breast cancer care and treatment. I also place on the record my thanks to Breast Cancer Now, a fantastic organisation without which this debate would not be possible. I am an ambassador for Breast Cancer Now.

As people probably know by now, in 2010 my daughter, aged 35, was diagnosed with triple negative breast cancer. She was dead within 13 months. When I first came to Parliament, one of my aims was to do anything I could to ensure that that did not happen to other people and whatever I could to make things better.

This month is Wear it Pink Month. The timing of the debate could not be better—in Breast Cancer Awareness Month, with a new cancer strategy announced by the Prime Minister at her recent party conference and while the long-term economic plan for the NHS is being decided. This is an unprecedented opportunity to ensure that the way in which we prevent, diagnose and treat breast cancer, and care for those who have it, truly benefits all patients in every part of the country.

Every year about 55,000 people in the UK are diagnosed with breast cancer, making it the most common cancer in the country. One in eight women in the UK will develop breast cancer in their lifetime, and nearly 11,500 women and 80 men in the UK still lose their lives to breast cancer each year. Progress has been made, but survival outcomes vary significantly between regions across the country, and Britain continues to trail other European countries on breast cancer survival. As Members can imagine, that sort of statistic hits home with me.

Debates such as this one, along with the necessary commitments from the Government, are crucial if we are to work towards a future in which everyone with breast cancer can live, and live well. After three decades of progress in the UK, however, within four years the number of women dying from breast cancer each year is projected to rise, according to recent analysis. We have to address that—an increase simply cannot be allowed to happen.

What we need is action; we do not need platitudes or promises, because neither of those leads to improvements in care. We need some real action. I appreciate that the hon. Member for Bexhill and Battle (Huw Merriman) means well, and it is all very well to praise NHS staff, but at the end of the day we cannot spend a pat on the back. Someone needs to go back to the Prime Minister to tell her that we actually need to pay NHS staff properly.

Incidence rates are projected to increase in the next decade, but waiting times still vary widely, screening attendance is at a record low, secondary patient needs are still too often unmet, and the quality of care still depends far too much on where someone happens to live. My daughter did not have a cancer clinical nurse specialist, a CNS, and when her cancer metastasised—she was diagnosed at the end of April, and it metastasised by the following February—she tried to get her GP to visit her. The GP lived quite a distance away and would not come out; even after I made a number of phone calls, she still would not come out.

My daughter lay in that bedroom with a cancer metastasising to her brain, but only had paracetamol and ibuprofen to take because she could not get a doctor out to her. Had she had a CNS, that would not have happened. For women to get nursing from a cancer specialist is crucial. Again, I know that the hon. Member for Bexhill and Battle means well, but seeing that and having to care for someone in that position did not give me inner strength—it broke my heart, and I hope that it never happens to anyone ever again.

It is not too late to prevent the projected decline in breast cancer survival rates. For example, were 10% of breast cancers diagnosed a stage earlier, an estimated 290 lives could be saved in just one year. My daughter could have been one of those. It is therefore vital that we raise awareness. A couple of weeks ago, I went out to our local shopping centre, the Waterside. My office manager and I had loads of leaflets from Breast Cancer Now—the little ones, which tell people how to check their breasts—and a stack of chocolate brownies that my younger daughter had made. I have to say that the leaflets went faster than the chocolate brownies, but we gave it all out in the end.

We could also prevent more than 1,200 breast cancer deaths by increasing breast screening uptake from the current low of 71% to the 80% standard set for breast screening units. Those figures show that if the Government act now, and act decisively, progress can continue to be made, more lives can be saved and quality of life can be improved.

The progress made on breast cancer over the years masks stark regional inequalities in diagnosis, treatment and care across the country. Having worked in our NHS, I am so proud of the values of universality, equality and fairness that are hardwired into the delivery of life-saving care. Under our national health service, your postcode should have no bearing on the care you receive.

Last Friday, I visited Lincoln’s breast unit and saw the brilliant staff doing an amazing job. To do such a fantastic job, they often leave late at night. They have an answerphone, so people can ring up and leave a message if they are worried about anything. Those girls do not go home at night until they have emptied all the messages on that machine—it does not matter what time it is, or if they were meant to have gone home an hour ago: they stay. I do not think they get paid for staying.

In Lincoln, the average incidence rate for breast cancer is slightly above the English average. Most worrying, however, is that Lincoln’s premature mortality rate was higher than the English average, and significantly higher than that of the neighbouring area of North Lincolnshire.

Having worked at first hand on hospital wards—I am an ex-nurse—I know how essential it is for patients, staff and quality of care that teams are appropriately staffed, and that regular, trained nurses are working—not agency staff. Staff should be in an area all the time, so they know what they are looking for, and to do that we need the reinstatement of nursing bursaries. That does not only go for nurses; we need them for radiographers as well, because the people who do the mammograms need three years of training in radiography and then an extra year on top of that. I was told that only last week, and there is a real shortage of them. The Government talk about their apprenticeships, but it takes four years to train an apprentice nurse, and people are just not taking up the training.

Only 21% of trusts in England have a dedicated clinical nurse specialist for secondary breast cancer patients. As I said just now, having a CNS is vital, so that is a shockingly bad statistic. Our dedicated NHS staff work around the clock to provide expert care. The minimum that they deserve is not to have to worry about filling the gaps in understaffed departments. I do not know whether people realise, but when nurses go to work in a hospital that is understaffed—that is, most of them—and another ward is short, they can be moved from one ward to another. They are still nurses, but they might not know quite as much about exactly what they are doing. That is really bad. Bursaries need to be reinstated so that we have enough nurses.

The Government must invest £39 million in recruitment to the breast imaging and diagnostic workforce, and they must provide funding for the 120 hospital trusts without a dedicated CNS post. To the first person who asks, “How do we do that in a time of austerity?”, I will say how—fair taxation is how. Every year, 23% of breast cancer cases could be avoided by simple lifestyle changes but, owing to austerity, public health budgets in 2017-18 were 5% less in real terms than they were in 2013-14. Over the same period, this Government have reduced corporation tax and taxes for the very rich.

The cut in public health budgets drastically reduces the capacity of local public health services to deliver life-saving preventive action. Not only is underfunding local public health services putting people’s lives at risk, but cost-cutting measures fail on their own terms. Investing in public health locally would not only save lives but result in long-term savings for our NHS. It is therefore essential that the NHS long-term plan secures the future of cancer alliances through a continued commitment of at least £200 million per year, in line with inflation. I hope that the Minister will make a real commitment to that. I do not want to hear how we all have to live within our means: we can do that and we ought to do it.

To conclude, it is fantastic to see this crucial debate receive the participation and thoughtful consideration that it deserves. I hope that the Government take on board the excellent range of proposals from Members in all parts of the House. Breast cancer is, after all, an issue that affects all of us. It would be a travesty if we allowed decades of progress to be undone, especially when the pathway to continued improvement is already laid out.

I urge the Government to support fully the delivery of breast cancer diagnosis, treatment and care. Ever since I was elected, I have wanted to work towards a future in which everyone with breast cancer can live, and live well. Breast Cancer Now has a pledge: that by 2050 no one should be dying of breast cancer. I hope that everyone across the House can join in that aim and that, in future years, we will look back on debates such as this as a crucial step in the eradication of breast cancer as a fatal disease.

--- Later in debate ---

[Mrs Hodgson]

The challenge to the Minister is whether improvements to the breast cancer workforce will include recruiting and training additional secondary breast cancer nurses, clinical nurse specialists—whatever we may decide to call them—so that patients have the vital support they need and no one has to witness their loved ones suffering in agony, with only over-the-counter painkillers to ease the pain, as my hon. Friend the Member for Lincoln so bravely testified to earlier.

[Karen Lee]

Does my hon. Friend agree that the withdrawal of nursing bursaries cannot fail to have impacted on the numbers of nurses training? There are figures out today—I have been on the radio this morning. I think there has been more than a 30% drop in the number of people training to be nurses since the nursing bursary was withdrawn. That cannot fail to have had an impact. It impacts on radiographers as well, because they train for three years, then for another year after that to do mammograms. Does she agree that those bursaries absolutely must be reinstated?

[Mrs Hodgson]

Yes, I agree. Obviously, that is why it is in our manifesto that we would reinstate those nursing bursaries. I would urge the Government to look at this closely, especially in light of Brexit, and what might happen post Brexit, with regard to the EU workforce, as I already mentioned.

Finally, I will move on to prevention. It is a challenge to us all to live healthier lives. I do not stand here saying I am doing a very good job, but we know that regularly drinking alcohol, as the hon. Member for Central Ayrshire mentioned earlier, and being overweight or obese, can increase the risk of developing breast cancer—and most cancers—as can smoking and lack of exercise. Regular physical exercise and reducing all the above can reduce the risk. Researchers estimated that 23% of breast cancers are preventable through lifestyle changes. That means there were approximately 10,600 preventable cases in 2016. Turning that into money, approximately £102 million in treatment costs could have been saved in 2016 if all those cases had been prevented. I know that may not be completely achievable, but since 2015, public health budgets have been cut by 3.9% a year until 2020-21. Has the Minister made any assessment of the effect that cuts to public health budgets have had on the incidence of breast cancer, and will he commit, as much as he can, to an increase in public health funding to help to prevent more cases of breast cancer? I know that might be above his pay grade; he is not the Chancellor—yet.

In closing, I will touch on secondary breast cancer. More than half of women are given no information about the signs and symptoms of breast cancer returning. Will the Minister look into ensuring that all patients are advised at the end of their primary breast cancer treatment about lifestyle and symptoms, so that where possible all cases of incurable secondary breast cancer can be prevented? I know that, like me, the Minister is incredibly passionate about breast cancer and that he will take much if not all of what he has heard today back to his Department to work on, so that he can achieve the best future for breast cancer.

On the day of Dame Tessa Jowell’s memorial, I will end by quoting from her magnificent last speech in the House of Lords in January this year, when she said:

“In the end, what gives a life meaning is not only how it is lived, but how it draws to a close.”

She said that she hoped the debate would give hope to other cancer patients,

“so that we can live well together with cancer—not just dying of it”.—[Official Report, House of Lords, 25 January 2018; Vol. 788, c. 1170.]

Perhaps her most precious legacy will be not only Sure Start and the Olympics, as wonderful as they are, but a better future for everyone with any form of cancer.

--- Later in debate ---

[Steve Brine]

I always keep an open mind. The truth is—the hon. Member for Central Ayrshire knows exactly what I will say—that although the screening review will no doubt make recommendations on that, there is a very heated and divided debate within the breast cancer community around screening, and not just about the age at which to begin it. We had the AgeX age extension trial, which broadened the range of ages at which we screen, but there is absolutely no consensus within the breast cancer community on the benefit of screening. That debate continues and rages strongly, and it is for policy makers to listen to all the different views, as the screening review will do.

Several Members, including the shadow Minister, rightly mentioned clinical nurse specialists and the cancer workforce. Last December, Health Education England published its first ever cancer workforce plan, which committed to the expansion of capacity and skills in fighting the big C.

[Karen Lee]

Will the Minister give way?

[Steve Brine]

Let me make this point. That plan includes an ambition to attract qualified people back to the NHS through domestic and international recruitment. HEE also plans to expand the number of clinical nurse specialists and to develop clear CNS competencies and routes into training. This will see every breast cancer patient having access to a CNS or other support worker by 2021.

We are committed to ensuring that all that happens. I saw a lot of news coverage last weekend on access to CNSs, and I completely accept that we have more to do. However, I have been very interested in listening. These debates are not only about me sitting here and waiting to read out my speech; they inform me, as much as anything. I was very interested in the discussion between the Labour and Scottish National party Front Benchers about what CNSs are called and the multidisciplinary team that they could be part of to offer support to women as they are going on this journey. I will definitely take that away.

[Karen Lee]

May I ask the Minister to respond directly to my comment that according to the figures out this morning—I know, because I was given them and asked to comment on them—the numbers of people training to be a nurse have dropped by just over 30% since the bursaries were withdrawn? The Government talk and talk about associate nurses and apprentice nurses, but there is not the take-up for those posts, and an apprentice nurse takes four years to train, so will he respond directly to my comments? Of course, the issue affects not just nurses but radiographers, as I said.

[Steve Brine]

The general point I would make is this. The hon. Lady said that people cannot live on good will; they have to have pay rises, and that is why I am very pleased that we have lifted the public sector cap pay. The significant pay rise that will be coming is welcome. Also, as well as expanding the number of nurse training places by 5,170, we are expanding the skills of specialist cancer nurses. There are 52,000 nurses training in the NHS, with more to come, thanks to our 25% increase in training places. The debate on bursaries is very live. That is discussed every single time we have Health questions—I dare say it will be again on Tuesday—but the Government have been very clear about our vision for the health education workforce and where we see nurse training places and the nurse apprenticeship scheme sitting in that. That is probably all I can add at the moment on that issue.

I want to touch on so many other different things. The hon. Member for Central Ayrshire, the shadow Minister and everyone else who spoke in the debate talked about prevention, and of course the title of the debate on the Order Paper is “Future of breast cancer”, so yes, we need to do a lot more to prevent people from developing cancer—not just breast cancer, but cancer—in the first place. As the Minister responsible for public health and dealing with cancer, I know that encouraging people to live healthier lifestyles can be one of the most effective ways to prevent cancer. Yes, there have been challenging budgets since we took office in 2010, but I refuse to bring politics into the cancer debate. All I will say is that Governments do have to live within their means. Governments do not have any money of their own; they have only our constituents’ money. We are spending £16 billion on the public health budget in England during this spending review period, but difficult decisions have been made. Clearly, I cannot pre-empt the spending review next year. I know what the NHS is getting, because we have pre-empted that ourselves, but we will make our announcements around the future of the public health grant, which obviously comes through a different Department, in due course.

I want to talk about the prevention point. Better prevention is not a silver bullet. I wish it were, but the truth is that cancer is indiscriminately cruel. We have had statistics today on the number of cancers that are preventable. Some two thirds of cancers are just down to bad luck. That is a horrid fact of life, and a horrid fact of life that every Member in this Chamber lives with every day. Cancer can have devastating effects on children, and on people who have lived the healthiest of lives, but we can have a huge impact and ensure that more people live their lives free of cancer if we focus on the prevention message.

Obesity is relevant. We talk a lot about childhood obesity. That is obviously because big children become big adults. Cancer Research UK has been very good in this space in making the connection between obesity and cancer. When we made the connection between smoking and lung cancer, it was a game changer. CRUK makes the connection between obesity and cancer. I am not fat shaming in saying that; it is just a matter of fact that obesity is a contributing factor to cancers. I am told that 8% of breast cancer cases in 2015 were the result of being too heavy. We need to do better on obesity, and we could talk for hours about the childhood obesity strategy alone. There are of course the issues of diet and physical activity. Earlier this month I was at the G20, talking about strengthening health systems, obesity and physical activity, and everyone around the world concurs on that.

I shall close on prevention by talking about alcohol, which the hon. Member for Central Ayrshire mentioned. It is a big breast cancer risk. That is the truth. Women who drink more alcohol have higher rates of breast cancer; women who do not drink have a lower risk of breast cancer compared with those who do. Risk rises with alcohol consumption, and no particular level of intake is risk free. That is the truth.

I want to return to the screening failure, because screening was referred to by the hon. Member for Strangford. He is in his place as always—God bless him. However well we are doing, we cannot be complacent. I constantly look at and worry about the screening figures. With regard to the failing in the national breast screening programme in England, many things come across our desk as Ministers that we wish did not come across our desk, and there are many things that we lie awake at night and worry about. Some things kick you where you do not want to be kicked as a man, and the breast screening programme failure in England kicked me very hard there when it happened. It resulted in thousands of women between the ages of 68 and 71 not being invited to their final screening. That is a stark reminder that however well we think we are doing, we have to do better. The former Secretary of State apologised unreservedly for it. He said that all we can do is put it right, and we are putting it right in terms of inviting people back for screening. We are determined; the independent review was set up to investigate and report on the circumstances of breast screening failure. That is expected to report shortly. It will challenge us and make very challenging recommendations. I look forward to discussing that with hon. Members.

The five-year survival rate for breast cancer is already 86%, as has been said. Some in the breast cancer community worry that the long-term plan and the Prime Minister’s new 75% early-stage detection ambition for cancer mean that we have no ambition left for breast cancer. Earlier this week the national cancer director and I discussed the long-term plan. I was absolutely clear with her, and she agrees, that our long-term ambitions cover all cancers, including breast cancer. The 75% five-year survival aim is ambitious—we would love many cancers to be even remotely there—but it is not the limit of our ambition.

As I said, I want a future in which there is no breast cancer. The NHS does well at diagnosing breast cancer, but it must do a lot better at preventing it. We must continue until the five-year survival figure is 100%, and I do not say that as a naive ambition. I want to make that point clear, because I know that some in the breast cancer community are concerned about that.

I pay tribute to the selfless work done by the people who will deliver the vision in the cancer strategy and the wider long-term plan. Obviously, doctors and nurses are at the sharp end, and I visit them when I go out and about. They, not Ministers, are the people behind the highest ever survival rates. I also want to add my thanks to the charities, which I have enjoyed working with. Breakthrough Breast Cancer joined with the Breast Cancer Campaign to become Breast Cancer Now. I enjoy working with Delyth, Baroness Morgan, of Breast Cancer Now and with Breast Cancer Care and Breast Cancer Haven. I have a lot of time for Breast Cancer Haven, which creates havens to help women to feel human and normal again after treatment. It does a lot of good work.

NHS England and I, with the support of what I always call Team Cancer, are utterly committed to making the ambitions that we set out in our long-term plan and our new cancer strategy a reality. That will ensure that we take a huge leap forward, over the next 10 years, to a future in which cancer has no future.