Cancer Outcomes in the UK

Lord Stevens of Birmingham Excerpts

Tuesday 21st April 2026 Grand Committee

[Lord Stevens of Birmingham (CB)]

My Lords, I pile on to the congratulations to the noble Lord, Lord Patel, on this fantastic session. Given the excellence of the contributions that we have already heard, I will just draw out a small number of things. I will try not to be duplicative of the brilliant contributions that the Committee has heard.

I declare my interests as chair of Cancer Research UK and chair of King’s College London’s council. Cancer Research UK has a proud tradition of supporting research in the UK as well as internationally. Some eight out of 10 medicines that NHS cancer patients use were either developed by or with Cancer Research UK. CRUK has pointed out that we are indeed the beneficiaries of that research. We have seen a 29% reduction in the death rate from cancer since 1989. The Government’s very welcome new NHS cancer plan points out that five-year survival rates increased from about 50% to 60% between 2008 and 2022. Your chances of dying from cancer on an age-adjusted basis are lower now than they were five years ago, 10 years ago or 15 years ago, but for all the reasons we have heard, there are no grounds for complacency. There is an enormous opportunity in front of us, and the cancer plan is right to set that out.

As other noble Lords have pointed out, in order for it to succeed it must meet two signature commitments: that three-quarters of people get diagnosed at stage 1 or 2 by 2035 and, linked to that, the expectation that three-quarters of people will survive five years as a consequence. That makes complete sense, but we should reflect on what have been the barriers to achieving that up to now, so that we get it right over the next decade.

There is a caveat: we need to be careful that we do not just increase the proportion of stage 1 or 2 diagnoses by detecting a lot of what would otherwise have been indolent cancers that would not have gone on to cause people problems. That has got to be matched by seeing an age-standardised reduction in the number of people diagnosed at stage 3 or 4, so we really are clear that we are getting stage shift and not just expanding into a wider group for whom the diagnosis would not necessarily have been a problem.

That is significant, because our understanding of cancer biology continues to evolve. The standard assumption that individual mutations at cellular level grow, spread and develop into advanced disease or systemic diseases such as cachexia turns out to be not quite right. My colleague Professor Charlie Swanton at the Francis Crick Institute has pointed out, for example, that a typical 60 year-old will probably have 100 billion cells in their body with some form of cancer mutation. So, in a sense, the question is, why is cancer not more common, given that underlying fact?

Continuing to invest in research to understand the tumour microenvironment and the way in which oncogenes and suppressor mechanisms interact and cancer spreads is what we are going to have to achieve if we are going to make the progress needed to get to the 75% target. That cannot be achieved just by sweating the NHS assets, as it were. For important conditions—the glioblastomas, pancreatic cancers and ovarian and oesophageal cancers—we need to continue to shift the frontier of research in order to produce those benefits.

The research and life sciences environment in this country continues to be hugely important. We are a bit of an outlier as a country in that of our non-commercial cancer research, two-thirds is funded by charities and slightly less than one-third by government. That is a lower proportion than for other major conditions and a lower proportion than is seen in other countries. So it is vital that we think about the entire research infrastructure and, as the noble Baroness, Lady Bottomley, briefly alluded to, we cannot be blind to the pressures on our brilliant British universities, which have done so much. However, in order to sustain that, we are going to have to, through the broader set of approaches that the Government take, make sure that they have the resourcing to do that.

We are not going to get to the goals in the new cancer plan without further progress on some of the cancers of unmet need through the research enterprise, but it is also the case that there are several things inside the NHS that have got to work, and I suspect that my colleague the noble Baroness, Lady Gerada, will shortly talk about the pressures on primary care, given that that represents the first point of contact for most cancer patients.

It is the case, of course, that, whereas the share of NHS resources going on primary medical care increased between 2015 and 2020, it has since fallen back. I am anticipating that the Minister may say that the Government do not think that spending-share targets are a good way of measuring these things: that is certainly their position on mental health, although it appears not to be their position when it comes to pharmaceutical spending, where there is a novel commitment that we will spend an extra 0.3% of GDP on our medicines pricing, linked to the deal done with the Trump Administration. Nevertheless, for primary care and mental health, apparently that logic does not apply.

We will want to really understand how we make the primary care element of the NHS robust over the coming 10 years. We want to understand the referral thresholds. The reality is that about 22% of cancers are diagnosed in patients from a GP referral on a non-cancer referral pathway, not the urgent suspected cancer pathway, so we need to make sure that the new GP contract, which incentivises a 25% reduction in referrals, is not cutting across the referrals that we need to detect cancer early, including in the specialities that are covered by the scheme—gastroenterology, gynaecology and urology. The NICE referral pathway, NG12, needs a refresh to make sure that people are getting referred appropriately and that the filtration is not artificially stopping people from getting checked up as they should be.

The Government are to be commended on the expansion of the community diagnostic centres—that is an excellent model, and we need more of them. There is capex and other support to do it. That is good. The lung health check programme, to which the noble Baroness, Lady Ramsey, referred, has been a brilliant success. The long-term plan in 2019 gave us the rollout for that. More than 2.5 million people have been invited. As she said, it has produced the extraordinary result that 76% of people getting a lung cancer diagnosis through that lung health check do so at stage 1 or stage 2. That is the kind of stage shift we are looking for overall, achieved through that novel programme. As she also rightly said, it has, unlike most other screening programmes, produced another extraordinary result: poorer people are more likely to get an early diagnosis through that screening programme than better-off people. That is a direct impact on health inequalities that we do not see elsewhere.

Those kinds of models are hugely important. We need to see continued innovation in that area. If we pull all these pieces together—the resourcing, continued research and the focus on what has and has not worked in the NHS—I see no reason why we cannot continue to make really significant progress on cancer over the decade ahead.