Breast Cancer

Debate between Karen Lee and Steve Brine

Thursday 18th October 2018 Westminster Hall

[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to comment on them—the numbers of people training to be a nurse have dropped by just over 30% since the bursaries were withdrawn?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.