Covid-19: NHS Support for Prostate Cancer Patients

Maria Caulfield Excerpts

Thursday 10th March 2022 Westminster Hall

[Elliot Colburn (Carshalton and Wallington) (Con)]

I beg to move,

That this House has considered NHS support for prostate cancer patients after the covid-19 pandemic.

Ms McDonagh, as your constituency neighbour, it is a pleasure to serve under your chairmanship for the first time in Westminster Hall. I extend my thanks to the Backbench Business Committee for granting time for such an important debate. I also thank the many Carshalton and Wallington residents who came forward to share their experiences of prostate cancer, either having had it themselves or having supported a loved one or friend through it.

Many people in this room and many of those watching will know a male relative or have a friend in their life who has had prostate cancer. I hope this important debate will raise awareness of the need to get yourself checked. There will be many striking statistics mentioned in the debate that will concern Members present, but I am keen to begin with a positive. Cancer survival rates in the United Kingdom have never been higher. Survival rates have improved each year since 2010. Prostate cancer survival has tripled in the past 40 years, with 85% of men surviving for five years or longer. However, the covid-19 pandemic threatens to derail this progress through a decrease in diagnostics, especially for men over the age of 50.

There are over 47,000 new prostate cancer cases every single year, with a man dying every 45 minutes from the condition. Early diagnosis is the key to fighting this disease. The pandemic has resulted in fewer men coming to their GP to get tested for prostate cancer, with the “stay at home” messaging particularly deterring older men, who are most at risk from prostate cancer, from coming forward. While the referral rate for prostate cancer has recovered to 80% of pre-pandemic levels, it still lags behind those for other forms of cancer, such as breast cancer, which is operating at 120% of pre-pandemic levels.

Stark figures from the charity Prostate Cancer UK reveal that there have been 50,000 fewer referrals for suspected prostate cancer patients than the usual trends would predict. The impact of that is incredibly worrying. Some 14,000 fewer men in the UK started treatment for prostate cancer between April 2020 and December 2021 compared with the equivalent months prior to the pandemic. That means that 14,000 men are living without the knowledge that they have the condition, and it means that 14,000 men have not yet started that all-important treatment plan.

Prostate Cancer UK has warned that, because of that, 3,500 men risk being diagnosed with late-stage prostate cancer. I cannot stress enough the importance of people getting themselves checked if they have symptoms or if they fall into the high-risk categories. Those include men over the age of 50, black African and black Caribbean men, and men with a father or brother who have had prostate cancer.

Sadly, the statistics and anecdotes that many of us will have heard point to the fact that men are far less willing to get themselves checked. Whether that is out of embarrassment or fear, getting diagnosed early can make an enormous difference to survival rates; five-year survival rates for men who are diagnosed with prostate cancer between stages 1 and 3 are over 95%. There are fantastic NHS campaigns, such as the “Help Us Help You” campaign, which has urged people with potential cancer symptoms to come forward for life-saving checks. The second stage of that campaign addresses the fear that often comes with booking the first appointment. Despite the fantastic work that is already being carried out, I hope that the Minister will be able to enlighten us about what more the Government are doing to destigmatise men coming forward to check their symptoms.

While being checked for prostate cancer is important for all men, it is especially important for men of black African or black Caribbean origin. I was taken aback to learn that, while one in eight of all men will get the disease, one in four black men will be diagnosed with prostate cancer in their lifetime; black men are also far more likely to be diagnosed with a more aggressive type. People from black and ethnic minority groups are also 4% less likely to receive radical treatment than people from white ethnic groups.

Through covid-19, we have seen what we can achieve when we work together. Last year, I was proud to host a roundtable in Carshalton and Wallington in collaboration with the NHS, the third sector and community groups to encourage ethnic minority communities to come forward and get the jab. The roundtable was well attended and demonstrated what we could achieve in prostate cancer diagnostics if the Government worked closely with the third sector and community groups to spread awareness.

However, improving awareness requires a corresponding increase in imaging capacity. Imaging services such as multiparametric MRI are critical to achieving earlier diagnoses, which, as I stated earlier, is key to survival. MpMRI scans can confirm or rule out prostate cancer in an accurate and timely manner, reducing the stressful wait for patients and their families. From speaking with cancer charities, I know that the significant variation in access to mpMRI provision is concerning. If we are to bring prostate cancer diagnoses back to pre-pandemic levels—and, indeed, increase them—we must address that postcode lottery. MpMRI provision must, as a minimum, be expanded in line with growth rates prior to the pandemic if we are to get diagnoses back to pre-pandemic levels. The 10-year cancer plan provides a golden opportunity to address this issue.

I have already mentioned the negative impact the pandemic has had on the prostate cancer community, but I am keen to highlight some positives that could be considered in a post-pandemic setting. Prostate Cancer UK has noted that the policy change during the pandemic to grant special access to certain covid-friendly novel hormone therapies for patients was very warmly welcomed by the community. This policy change has been wanted for some time, and it not only kept patients safe at home during the pandemic but improved their care experience, as they spent less time in hospital. Along with the increased interaction between patients and clinicians using technology, the change has made for higher levels of patient satisfaction and experience.

I look forward to seeing greater access to diagnosis and treatment and increased use of technology in my constituency at the London cancer hub, an exceptionally exciting project in the London Borough of Sutton. As a former employee, the Minister will know the Royal Marsden Hospital very well. I will not go over ground that she already knows, as cancer nurse who, I believe, is still practising.

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

indicated assent.

[Elliot Colburn]

The Minister is nodding. The Royal Marsden and the Institute of Cancer Research already form one of the leading cancer research and treatment centres in the world. The development plans for the London cancer hub will double the capacity for cancer research on the site, making the United Kingdom second only to the United States. It will be a game changer and will take our cancer research to the next level. It is a prime opportunity to ensure that the reduction in prostate cancer diagnoses remains a temporary blip in the overall effort to achieve early diagnosis for everyone with the condition.

This effort must include the cancer workforce. The Government have already invested money to address the cancer backlog, but the workforce issue must also be addressed. Patients with prostate cancer and their families go through one of the most difficult things in life to navigate. They are desperate for more clinical nurse specialists, who provide holistic, patient-centred care, with the empathy needed in these very dark times. Having access to clinical nurse specialists means that prostate cancer patients are far more likely to be positive about their care and treatment and to receive more individualised treatment plans.

One suggestion to be considered for the post-pandemic NHS is non-medical practitioner-led prostate cancer clinics. Such clinics would not only enhance the clinical pathways in prostate cancer, but relieve time burdens on oncologists and help to reduce costs that can be cycled back into the system. With one in four consultant clinical oncologists reporting risk of burnout, and with covid-19 exacerbating those issues over the past two years, investing in non-medical practitioners or increasing the number of clinical nurse specialists—or both—could be solutions to workforce concerns. I urge the Government to work with NHS England, Health Education England and the devolved Administrations to ensure that professional working groups in the prostate cancer workforce are addressing the workforce backlogs, including with clear training routes for healthcare professionals wishing to upskill.

I appreciate that there is strong interest in the debate, so I am keen to conclude my remarks. If the Minister takes anything away, I hope it is the need to find those 14,000 men missing from the prostate cancer treatment pathway, and to ensure that workforce issues are looked at by the Government. The pandemic has provided the NHS with a unique opportunity to rethink how we provide care not just to prostate cancer patients but to all cancer patients, with greater use of technology and the benefits of covid-friendly treatments that patients have had access to throughout the pandemic.

Finally, the one message that I hope those watching the debate—especially those in high-risk categories—will take away from it is: “Please get yourself checked”. The support available for patients and their families is fantastic, and it is out there. I say to people watching: “You are never alone”. I urge them to book that vital first appointment. I look forward to hearing the contributions from other hon. Members on this incredibly important issue.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Ms McDonagh. May I start by declaring an interest? I still work, as my hon. Friend the Member for Carshalton and Wallington (Elliot Colburn) said, as a cancer nurse. I was slightly disappointed by the tone of the shadow Minister, the hon. Member for Enfield North (Feryal Clark). I did not want to be political but, for the record, I got into politics because, as a cancer nurse, I was so frustrated with the previous Labour Government’s target-driven approach, which looked good on paper, but in reality did not make a huge difference to patients.

I welcome this debate that was secured by my hon. Friend the Member for Carshalton and Wallington. Prostate cancer absolutely deserves a debate that focuses on the key issues that he described so well. I want to reassure colleagues that cancer treatments and diagnosis have remained a top priority throughout the pandemic—one of the few areas of healthcare where much of it stayed open—with over 330,000 urgent referrals and more than 170,000 treatments for urological cancers between March 2020 and December last year.

I want to thank the amazing work of NHS staff up and down the country who maintained cancer treatment levels at 94%, which is an astonishing record when they had to deal with covid in the workforce and patients undergoing prostate treatment also coming through covid, too. Although treatment levels remained very high during the pandemic, there is no doubt that referrals suffered. We asked men and women to stay away from the NHS to protect it during that time and we saw a huge drop-off in referrals. It is estimated that up to 32,000 fewer people than expected have started cancer treatment because of that, but we are seeing a change with record levels of referrals coming through the system right now. Last month’s figure was around 11,000 cancer referrals a day.

Although people stayed away during the pandemic, they are coming back in their droves now, and the ambition is to try to get as many of those diagnosed as quickly as possible and into treatment. We are trying to get prostate cancer in particular diagnosed as quickly as possible by implementing best practice timed pathways for prostate cancer, including the use of mpMRI, which my hon. Friend the Member for Carshalton and Wallington mentioned. It captures images of the prostate in a much better way than the standard MRI does, so that is a focus and we have seen a major uptake in that. Back in 2016, only 335 people were going through that system, but by 2020 that had gone up to 11,000 people. We are seeing a real shift in the use of that technology, which better diagnoses men with prostate cancer.

Partnering with Prostate Cancer UK, we are delivering a cancer risk-awareness campaign, which started in February and will continue to run until the end of this month. As a number of colleagues have said, we must raise awareness about the symptoms of prostate cancer and encourage men to come forward.

Although I do not wish to generalise, I take the points made by my hon. Friend the Member for Don Valley (Nick Fletcher) and by the hon. Member for Strangford (Jim Shannon) about the differences in how men and women face health issues. When women have an issue, they will come forward, although they often feel as if they are not being heard and that there is a delay in accessing healthcare. Men are slightly different in that often they will not come forward in the first place, so the campaigns let them know about the symptoms, encourage them come forward and reassure them that diagnosis and treatment will happen relatively quickly.

The outcome is good for many men with prostate cancer, but we encourage people to come forward quickly because the prognosis is improved the earlier they can get involved in treatment, and the treatment is often less invasive. There are good reasons to encourage men to come forward.

The purpose of our campaign is to educate people about their risk of prostate cancer. As we have heard, some people are more at risk than others. As a cancer that does not present with many symptoms, particularly at an early stage, it is vital to encourage those at risk to discuss that with their GP and have a prostate-specific antigen test. To address the point made by my hon. Friend the Member for Don Valley, gentlemen over the age of 50 can request a PSA from their GP.

There is no national screening programme at the moment because the PSA test on its own is not foolproof. It is a simple blood test that measures the PSA level in the blood which, if raised, can be indication that prostate cancer could be present. However, many men with prostate cancer do not have a raised PSA, and many men who have a raised PSA that does not change over time do not have prostate cancer. We do not have a national screening programme because it is not a foolproof test in the way that a mammogram is for breast cancer.

A huge amount of research is going on about that right now. The team at University College London is working on PSA and integrating it with another test, to combine them to see if accuracy can be improved. If there were a more accurate screening test, there would be a strong case to bring that forward, but at the moment the accuracy of the test is holding us back.

Prostate Cancer UK has reported that over 310,000 people have completed their risk checker, so obviously a lot of good work is happening that is getting the voice out there. This debate today also helps raise awareness. As many hon. Members have said, we are encouraging men to come forward if they have concerns.

We also have the “Help Us Help You” NHS campaign, which is looking at a number of cancers, including prostate cancer. It has raised awareness of non-specific symptoms, which are often experienced by the patients who we have the hardest time diagnosing. This month, we are launching a campaign specifically about prostate cancer and the barriers to seeking treatment. The phases of the campaign that have run to date have contributed to the high levels of urgent cancer referrals the NHS has seen—around 11,000 referrals per day—as I mentioned earlier. The campaigns are working and people are coming forward, but there is a huge amount more that we can do.

In addition to these national initiatives, we also fund more local awareness raising through cancer alliances, where we specifically target communities who may be more at risk or less likely to come forward if they have symptoms. As part of that plan, every system will need to take ongoing action to support general practice capacity, so that if people come forward they are able to be seen as soon as possible.

We are also working on long-term prostate cancer improvements. Clearly, the covid pandemic had an impact on referrals, but there were long-term issues before the pandemic, as outlined by the shadow Minister, that we are now trying to address. Research is one of those issues. There is a wide range of treatments for prostate cancer. My hon. Friend the Member for Don Valley talked about the watch and wait policy, and it has been quite successful. There are many older men with prostate cancer that may have a less aggressive form, and this is where techniques such as watch and wait and seeing whether PSA is showing in their blood are very helpful. Many of those men will die of things other than prostate cancer. Watch and wait is a useful and robust treatment.

Treatments for prostate cancer are not without their side effects, despite our best efforts. We are working hard to improve treatments, both in terms of their success rate and the impact they have on a man’s quality of life. The use of stereotactic radiotherapy, for example, to target prostate cancer and reduce side effects is making a huge difference to outcomes for men. Better surgical techniques, and state-of-the-art surgery, are also improving outcomes and the side effects from surgery. Hormone treatments are also available; research is pushing the barriers there. However, hormone treatments are not without their side effects. I reassure men that there is a wide range of treatments, depending on the type of prostate cancer that they have, that will not only treat their cancer but reduce the side effects.

In the spending review we announced an extra £5.9 billion of capital to support our recovery programme, particularly in diagnostics. That includes £2.3 billion to increase the volume of diagnostic activity in our community diagnostic centres. What we are trying to create in local communities is a situation where if someone presents with non-specific symptoms to their GP, we can use the community diagnostic centres to refer people so that they can have the tests—whether it is an ultrasound, an MRI, or blood tests—and can get a more rapid diagnosis than has historically been the case. We are rolling out 44 community diagnostic centres to increase our capacity, which could deliver up to 2.8 million scans in the first full year of operation. By 2024-25, the aim is to deliver at least another 56 of those centres. That will allow the NHS to carry out 4.5 million additional scans. The diagnostic centres will make a big difference, diagnosing people as quickly as possible and at as early a stage of their cancer as possible.

There are some pilot works going on that look at self-referral; that is particularly the case with breast and skin cancers. I do not want to speak for cancer alliances, but there could be an argument for prostate cancer to be included too, if people have specific symptoms. Watch this space with regards to self-referral and its ability to get people into the system as quickly as possible.

We also talked about workforce. As someone who has worked as a nurse specialist, I take it on board that a urology nurse specialist will often cover all urology cancers. There is a difference between treating someone for testicular cancer; they often tend to be younger men who need very different treatment. Prostate cancer is a very different type of cancer, but it is often lumped in under urology. I recognise that nurses there have a greater volume of patients to see than nurses treating other types of cancer. There is huge progress being made on that. There is investment going into workforce planning, and we are supporting the training and development of nurses, in particular, to become specialists and practitioners in both screening and diagnostics. It is not just about increasing numbers in our workforce; it is about giving them the skills and training to expand the roles and services that they can go into. That is at the forefront of our mind.

My hon. Friend the Member for Don Valley talked about a men’s health strategy. I will say to him that just by having a women’s health strategy does not mean we are ignoring men at all. We are producing our health disparities White Paper very soon. Some of the issues that he talks about around life expectancy and differences in suicide rates will feature quite heavily in that. However, if he does not feel that that goes far enough, I am very happy to have a further conversation. There are differences, in some areas, for men and, on prostate cancer particularly, we can do more to support them with their diagnoses and treatment.

For many men, prostate cancer will be a chronic illness. We will be able to treat and cure many, but some will need to learn to live with their disease—people can live with quite advanced prostate cancer for many years—and it is about providing them with support. Living with prostate cancer often causes psychological challenges, where people are just getting on and dealing with it but are not getting the support that they need with many of the issues that they face. We fully recognise that that is something that we need to focus on.

I reassure colleagues that prostate cancer is very much top of our agenda in the cancer sphere. We are improving the facility to try to diagnose it much more easily. Treatments for prostate cancer are changing and improving all the time. We must focus on supporting men with prostate cancer through their cancer journey. We must encourage men to come forward and reassure them that they will be diagnosed quickly and receive the treatment that they need for their prostate cancer.