Radiotherapy: Accessibility

Debate between Margaret Ferrier and Selaine Saxby

Tuesday 18th July 2023 Westminster Hall

[Selaine Saxby (North Devon) (Con)]

I beg to move,

That this House has considered the accessibility of radiotherapy.

It is a privilege to serve under your chairmanship, Dame Maria. I thank the Backbench Business Committee for granting this important debate, all colleagues who supported the application, and Professor Pat Price for her tireless work in supporting the all-party parliamentary group for radiotherapy and championing this vital treatment.

We all know that the cancer backlog was affected by the pressures of covid-19, but in May this year there were 7.47 million people waiting for cancer treatments and 3 million of those have been waiting for over 18 weeks. Only 61.7% of patients receive their first treatment within two months, far below the operational standard of 85%. Radiotherapy is a key part of cancer care. It is the second most effective treatment for cancer and is needed in four out of every 10 cancer cures.

Radiotherapy targets the cancer with radiation. The cancerous cells are more affected than the healthy cells, which are better at repairing themselves. Modern radiotherapy has come on leaps and bounds, and within the last 10 years breakthroughs have increased the accuracy and focus of the treatment to within millimetres, significantly reducing collateral damage to healthy cells.

Surgical treatments require intensive care, with all of the hospital resources and emotional trauma that that entails, and chemotherapy has a significant impact on the immune system. In contrast, radiotherapy is an out-patient treatment that requires fewer patient visits to care centres. It only costs between £3,000 and £7,000 per patient, despite being incredibly high tech.

The international recommendation is that 53% to 60% of cancer patients receive radiotherapy treatments. However, in the UK only 27% of cancer patients received radiotherapy treatment in 2019. In my North Devon constituency, only 4.7% of my constituents live within the recommended 45-minute travel time for radiotherapy treatment. The other 95.3% are among the 3.4 million people in England for whom distance from a radiotherapy service effectively limits the availability of treatment.

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

As the hon. Member said, radiotherapy is the second most effective cancer treatment and is required by half of all cancer patients. However, the ability to access treatment has been described as a postcode lottery, with 3.4 million people unable to access radiotherapy without travelling more than 45 minutes. Does the hon. Member agree that it is unacceptable that there should be such significant disparities in access to radiotherapy?

[Selaine Saxby]

I do indeed agree with the hon. Member. In my case, North Devon is the fourth worst constituency in the country for access to radiotherapy services. North Devon is home to the smallest and most remote hospital on the UK mainland—and possibly the most loved. An exceptional team works tirelessly to deliver the best care, despite the challenges of rurality and the availability of staff, mostly linked to the availability of affordable housing, which is currently at its most extreme.

Radiotherapy is usually a series of daily treatments over a number of weeks. Far too many of my constituents choose not to have radiotherapy because the 120-mile round trip each day is too much to consider on top of the understandable pressures that patients with a cancer diagnosis already experience.

Radiotherapy is a far less invasive treatment than many others. With such an elderly population in North Devon it is often the best treatment for patients. A further complication that has been brought to my attention by the wonderful volunteer drivers we have in North Devon who help patients to their appointments across the expansive county, often to Exeter—a 120-mile round trip—for many different treatments, including radiotherapy. I do not want to discourage anyone from reaching out for those services, it will be clear to everyone that a daily radiotherapy session involving a journey of that length is a significant undertaking for patients and volunteer drivers alike. We have a declining number of volunteer drivers, which restricts driver availability for other patients.

It is hard to explain to those who have not visited North Devon the remoteness and the distances involved in undertaking all sorts of treatments. We benefit hugely from the merger of our hospital trust with Exeter’s, but that does not bring Exeter any closer. While it is positive that the backlog of patients waiting longer than 62 days for a GP referral is improving, the 62-day wait to start treatment is not. We know that every four weeks of delay in starting cancer treatment can increase the risk of death by 10%. To ensure everyone receives timely cancer care, radiotherapy needs to be an accessible treatment for every patient.

Plastic Pollution in the Ocean

Debate between Margaret Ferrier and Selaine Saxby

Thursday 18th May 2023 Westminster Hall

[Selaine Saxby]

Yes, in many ways I agree. I will certainly come on to speak far more about the global implications of the situation. While we are doing so much on our own island, we need to do so much more. In particular, the upcoming deposit return scheme, confirmed in the environment improvement plan, will bring the UK in line with similar nations, and recycle 90% or more of relevant containers.

Alongside reducing use and recycling as much as possible, we also need to look at the hierarchy of waste and reusing plastic products where possible. I ask the Minister to look at setting a target for the reuse of packaging, alongside our work on recycling. By setting a target, we would incentivise businesses to invest in reuse schemes that reduce the amount of resources required in our packaging supply chains. A recent UN report on reducing plastic pollution found that proper reuse systems could reduce plastic pollution by 30% by 2040, compared with 20% for recycling. Investing in and facilitating a reuse system would also reduce the cost of waste management and increase jobs in the sector. Unfortunately, despite UK efforts, plastic has been entering the ocean for decades and continues to do so.

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

I congratulate the hon. Lady on securing this debate. Microplastics continue to threaten our marine ecosystems, with research showing that fishing net pollution is deadly for sharks, seabirds and seals. Does she agree that the solution to this must be found through balancing industry productivity while increasing necessary regulation?

[Selaine Saxby]

Of course, it is vital that we find a balance. Fishing materials continue to be an issue, which is why I think that some of the initiatives that are already under way to help the industry to recycle more are so vital.

As I was saying, plastics have been entering the ocean for decades and continue to do so. Between modern-day plastic and legacy plastic—the oldest piece of plastic that has been found is a buoy from 1966—there are trillions of pieces of plastic floating in our oceans. They affect our entire ocean’s ecosystem at every stage, from turtles getting trapped in nets to plastic breaking down into microplastics and slowly building up in our food chain.

Although we do not know as much about our seas as we should, we know that plastic has negatively affected almost 700 marine species. Microplastics also slowly sink down through our oceans to settle on the ocean floor, forming plastic deserts that kill wildlife and can stretch up to hundreds of kilometres. The largest floating patch is the great Pacific garbage patch, which contains more than 100 million kg of plastic over an area three times the size of France. It is the largest example of an ocean gyre where the currents draw flotsam to a point. As the convergence spot of the currents from the south Pacific and the Arctic, the zone is a plastic superhighway. It takes an average of only seven years for plastic floating in the ocean to reach the great Pacific garbage patch.

We know that the next generation care passionately about the planet, particularly their oceans and beaches. As a coastal MP, I know how engaged our schools are with this issue, and it often acts as an introduction to wider conservation work. Last year, I attended Greenpeace’s big plastic count, which almost a quarter of a million people took part in, including more than 9,500 school students. That shows just how seriously our youngest constituents take plastic pollution. Books such as “Ruby Rockpool”, which was written by the mermaid Hannah Pearl, suggest ways that youngsters can help. They bring the problems to life, but unfortunately solutions are not as simple as in Hannah’s excellent book, in which the ocean is healed with a sea star’s power.

Of course, no matter what we do domestically, this is ultimately a global issue requiring a global solution. The UK is responsible for almost 7 million sq km of the world’s oceans, and one of our overseas territories in the south Pacific demonstrates the challenge. Henderson island in the Pitcairn Islands is both uninhabited and thousands of miles from the nearest population centre. Despite that, an estimated 40 million pieces of plastic rubbish have landed on its shores. The island is home to the endangered Henderson petrel and the flightless Henderson crake, and is an important breeding ground for many other large seabirds. As we saw in Sir David Attenborough’s excellent “Blue Planet II”, the impact of plastic in the ocean extends to seabirds and can lead to parents feeding their offspring plastic instead of fish.

To limit the continuing impact of plastic on our oceans and food chain, we need not only to reduce how much plastic waste irresponsibly reaches our environment, but work to remove it. Fortunately, there are innovative start-ups such as the Ocean Cleanup, which undertakes the only efforts to remove legacy plastics from our oceans. It aims to remove 90% of floating plastic from the ocean by 2040.

[Margaret Ferrier]

As we know, tiny microfibres are entering the sea due to us washing our clothes. The company CLEANR is now turning to 3D printing technology to create microplastic filters for washing machines. Does the hon. Member agree that we must continue to use new technologies available to develop innovative solutions to this environmental crisis?

[Selaine Saxby]

Indeed, I sponsored the Bill of my hon. Friend the Member for South Leicestershire (Alberto Costa) on that topic. Although there is much work to do on microfibres, the plastics I will talk about are significantly more dramatic, in terms of their magnitude and the skills that are needed to clean them up.

To remove the waste from the gyres, the Ocean Cleanup is using a combination of computer modelling, artificial intelligence and space-borne plastic detection to identify the densest areas of plastic to optimise clean-up. It has created a trawler-type solution that pulls a semi-circular 4 metre-high net system very slowly—half walking speed— through the garbage patch into a funnel called a retention zone, which takes the plastic on to ships to be taken back to shore. It sounds very simple, but it is in fact highly complex to work in the open seas of the Pacific and protect wildlife—it has several active systems to prevent bycatch—as it removes different types and sizes of plastic pieces. As it scales up the system, it is reducing the cost, and it aims to reach €10 per kilo of plastic waste.

As 80% of marine plastics are estimated to have come from land-based sources—the remaining 20% are from fishing and other marine sources—the Ocean Cleanup is also focused on preventing waste from reaching the ocean in the first place, predominantly from rivers. It has identified that 1% of the world’s rivers are responsible for transmitting 80% of those land-based plastics to the ocean. To prevent that plastic from entering the oceans, it has developed the Interceptor system, which is currently focused on the most polluting rivers. Its Trashfence system is used in the Rio Motagua in Guatemala, which currently emits approximately 20,000 megatonnes of plastic into the Caribbean each year, or 2% of all the plastic emitted into the world’s oceans annually. That is a key scheme for the Ocean Cleanup to be working on.

For the Ocean Cleanup to achieve its aims, it needs long-term, dependable funding. So far, it has raised more than $250 million from private donations. It is asking the UK to become the first Government to support it financially. At present, it needs $37 million to fund one of its new systems per year.

As a founding member of the High Ambition Coalition to end plastic pollution, which called for a target in the UN global plastics treaty to stop plastics entering our oceans by 2040, the UK Government are leading the way in a global effort to clean up our oceans. They could signal a greater dedication to cleaning up the great Pacific garbage patch ahead of a legal obligation. They could also help with mapping the problems around the world, such as in the Atlantic and Indian oceans, where the UK has permanent naval bases.

The UK has an excellent capability in oceanographic research, and could work with the Ocean Cleanup to help it with the vital mapping of the gyres so that we know where to find the plastic, how much is there, what it likely consists of, where it is coming from and so on. The Ocean Cleanup has proven know-how, as it was the first to fully map the great Pacific garbage patch.

Although plastics have a significant impact on our wildlife, they also affect island nations smaller than our own. The Pacific island nations are not just on the frontline of rising sea levels; they are among those most affected by the increase in plastic in our oceans. China is working hard to court them and extend its influence and power projection, but the UK still has significant interests in the region. China is one of the world’s largest polluters, and the UK can strengthen its ties in the region by supporting measures to limit plastic pollution and help clean up other island nations’ waters.

The UN global plastic treaty second round negotiations next week are another opportunity for the UK to push for positive changes to our environment as a global leader. At COP26, we secured the Glasgow climate pact, and at COP15 in Montreal, we pushed for global protections of biodiversity and nature. We need to add our voice to negotiations to secure limits to virgin plastic production and unnecessary plastic use. With the fifth largest marine estate in the world, and a population dedicated to protecting our environment and wildlife, we are well placed not only to cut down on our own plastic waste but to lead global efforts in cleaning up our oceans.

We need to remove legacy plastics while they are retrievable. If we wait too long, they will break down into microplastics and we will have a far harder job of removing plastic from our environment. I hope the Government will not only continue to implement their environment improvement plan, but will lead support for projects such as the Ocean Cleanup.

Decarbonising Rural Transport

Debate between Margaret Ferrier and Selaine Saxby

Tuesday 7th March 2023 Westminster Hall

[Selaine Saxby]

My hon. Friend is entirely right that all of us in rural constituencies have plans that we need our councils to deliver to facilitate the decarbonisation of our rural transport network. The challenge we face is that, unfortunately, there is not always the funding to support those fantastic rural transport schemes, although I hope the Minister will reassure us on that point. I will come to some of my own suggestions for the bus network in Devon.

Active travel is an opportunity for some, but the distances involved in rural commuting by bike mean that it is not always an option for everyone. In my constituency of North Devon, 2.4% of work journeys are made by bike, which is a surprisingly high percentage for such a rural area, but realistically, active travel is unlikely to replace huge numbers of car journeys unless it is integrated into a wider transport solution.

I will return to the opportunities to tackle the issues of public transport and active travel, but we need to be realistic: rural Britain will continue to rely on its cars for the foreseeable future.

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

I congratulate the hon. Lady on securing the debate. Limited public transport options in rural communities mean that, as the hon. Lady says, many residents depend on their car for everything—getting to work, going to the doctor, seeing family and friends. Does she agree that any strategy to decarbonise rural transport needs to improve connectivity so that social isolation is not inadvertently increased?

[Selaine Saxby]

I agree entirely that there are so many more challenges around rural connectivity. If we are to continue to rely on our cars, we need to decarbonise them, but the roll-out of electric charging points in rural Britain lags behind that in towns, and when the distances we travel per day are so much greater, investing in an electric vehicle is a far harder decision to take.

Only 1.5% of North Devon residents have gone fully electric, compared with 2.1% nationally. I have a hybrid, as the majority of electric vehicles would not get me to Westminster each week, and I am not sure I would ever get to Exmoor in my constituency and back home as there are no charging points where I live. The nearest one is 5 miles away. To plug in at home, I would need to lay my own cable down 20 feet of path every evening, and I am not sure my schedule accommodates that.

While the Transport Minister is here, I want to highlight the appalling state of the roads in Devon. I am fully aware that we have the longest road network in the United Kingdom by 2,000 miles and that the council is working flat out to try to repair the proliferation of potholes that we have seen this winter. Not only has the weather contributed but we need to recognise that in rural Britain we have enormous farm vehicles on tiny lanes and we therefore create even more potholes, yet our council is not assigned long-term funding solutions to tackle them.

The short-term approach to funding, with inadequate rural weighting, makes the cost of repairing each pothole far higher. At this time, Devon is moving teams off scheduled roadworks as we cannot take on full-time highways teams due to the uncertainty around long-term funding. I hope that the Minister will be able to take that away and see what more can be done to address the entirely unacceptable state of our roads. If there were an Ofsted inspection of roads, I suspect we would go into special measures, yet the current funding mechanism contributes to that. The damage that potholes do to vehicles is also hugely expensive to motorists and the council, which is no doubt reimbursing a growing number of inconvenienced motorists with damaged tyres. And it deters people from switching to active travel solutions because of the potential risk of falling due to a pothole.

I spend a lot of time in this place talking about connectivity, often the communication kind, but our transport connections are vital. The lack of decarbonised public transport is impacting on decarbonising our travel.