Cancer Care: Young Adults

Debate between Maria Caulfield and Julie Marson

Wednesday 8th June 2022 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Paisley. I thank my hon. Friend the Member for Hertford and Stortford (Julie Marson) for securing the debate, which as she said is not one we want to have but is one we need to have. I offer my apologies and condolences to Simon and Andrea, who are with us today. Nothing we say in the debate will make things easier for them, but if we can prevent a similar tragedy from happening to another family, we must do absolutely everything we can to make sure we do.

In Jess’s case, it is true that two factors did not help her diagnosis. First, cancer is not as common in children and young people as it is in the rest of the population. It is not unusual for a GP, or even a GP practice, to see only one or two cases across the lifespan of their service. Just under 4,000 young adults between 15 and 29 are diagnosed with cancer in England each year; across the country, those are small numbers, so GPs often do not have experience of dealing with young people who present with symptoms that—as the right hon. Member for Alyn and Deeside (Mark Tami) said—are often non-specific and can be attributed to other causes. The other factor is that if there is an unknown primary, those cases are more difficult to diagnose across the board for all age groups, because there is not an obvious breast lump, an obvious shortness of breath or an obvious mole that has changed. That often makes it difficult for GPs to get to the bottom of what is happening.

Despite that, it is very clear from Jess’s case that there were many opportunities where further investigation could have revealed what was going on. She should not have had to go back so many times with the same symptoms without being investigated further. That is precisely why the Government have put a lot of funding—£2.3 billion—into the roll-out of community diagnostic centres, so that patients with non-specific symptoms that GPs cannot get to the bottom of can be referred straightaway. They do not need a hospital referral to an oncologist or a surgeon to investigate: GPs can refer those patients directly to the community diagnostic centre, where a range of tests is available, including MRI scans, ultrasounds and CT scans, to get that early diagnosis as quickly as possible. If it is not cancer, those patients can then pop back to the GP for further referrals elsewhere, but if it is, they can get started with treatment as quickly as possible. We are also introducing non-specific symptoms pathways, in order to do exactly what my hon. Friend the Member for Hertford and Stortford has said: bring together diagnostic equipment, expertise and support, so that discussions do happen about patients who are coming back on a frequent basis and for whom a diagnosis has not been helpful.

To mention two additional things that the Government are doing, my hon. Friend is absolutely correct that the nub of this issue is getting people diagnosed as early as possible, so we have now set a target that, by 2028, 75% of all cancers should be diagnosed at stages 1 or 2. Doing that means diagnosing people as early as possible. Screening will help, although it would not have helped in Jess’s case. However, the rapid diagnostic and community diagnostic centres definitely will help. This is about enabling pathways through which, if GPs are not able to find the source of a problem, they can get some extra expertise or diagnostic tests that will help them to do so.

Meeting that 75% target means addressing all cancers, not just the ones that are easier to spot, either because they have screening tests in place or because they give rise to more obvious symptoms. It includes the rarer cancers and those that have no known origin, so I hope that that gives some reassurance that we are absolutely focused on trying to diagnose people as early as possible. We are also piloting a nurse specialist route into pathways, so if someone like Jess was meeting their GP regularly and still not feeling that they were getting to the bottom of their problems, they would be able to phone the cancer nurse hotline. If the cancer nurse feels that that person needs to be seen by a cancer specialist or to go into the cancer pathway, they can do so as quickly as possible. Again, this is not about blaming GPs, but it will be another route through which patients can access specialist services.

Turning to Jess’s law, the Secretary of State is currently formulating the 10-year cancer strategy. We are looking at that in detail, and I can reassure my hon. Friend the Member for Hertford and Stortford that the strategy will contain a section on children and young people, because they have specific needs, particularly around diagnosis but also around treatment. I am very happy to discuss a flag-style system with the Secretary of State, as my hon. Friend has. There may be some technical difficulties with that: I am doing work with GPs on a flag system for gun licensing, and the issue we have, from a purely practical point of view, is that most GPs have their own independent IT system—they are not part of a national IT system—so if we introduce one nationally it will be quite difficult for each GP practice to implement it. My hon. Friend has made some suggestions, and it is not beyond the realms of possibility to introduce a system that ensures that, if a young person is seen four times and is still coming back with the same symptoms, that is raised to another level—a red flag level, as my hon. Friend said—to indicate that interventions need to take place.

Many of the points that my hon. Friend made, particularly on named GPs, are very important and I will certainly follow them up with her. In terms of the timing of this debate and the 10-year strategy, including some of work she has done within the cancer strategy would be a real opportunity.

[Julie Marson]

The Minister makes a really important point about the practicalities and technicalities of implementing something such as Jess’s law, and I absolutely appreciate that. The example she gave of IT systems being different across GP practices illustrates how important it is to standardise procedure. Patients should not be reliant on whether a GP has a particularly efficient or good procedure; practice should be standardised across the board.

[Maria Caulfield]

My hon. Friend is absolutely right. We are introducing non-specific pathways so that if someone does not have a specific, clear diagnosis and the GPs are not sure what to do, there is a pathway to follow, consistent across every GP practice throughout the country, and people do not slip through the net. Early cancer diagnosis is one of the priority areas in the Core20PLUS5 approach, which we introduced last year to reduce health inequalities across the country. It is crucial that we use that opportunity to flag some of the issues that my hon. Friend raised.

Crucially, GP training across the board is important. Because many GPs will not have come across a young person with cancer in the course of their practice, Macmillan Cancer Support, CLIC Sargent and Cancer Research UK are doing work to roll out training with regular updates—it is not just one-off training—for GPs and other members of the primary care team. It is much more common now for people to be seen by the practice nurse, the paramedic or the physio if they have back pain or joint problems. It may seem like a physio problem, but there could be an underlying cancer diagnosis. It is important that we educate and keep up to date the whole team, not just the GP.

I am very happy to take away my hon. Friend’s suggestions and to see whether we can put in place some proper measures that will reduce the chances of this happening again. We will not necessarily be able to make sure that no one is missed, but my hon. Friend raises some flags that cause me concern and that suggest we are not where we should be. There are certainly things that we can put in place to stop cancer diagnoses being missed in young people with non-specific symptoms.

Question put and agreed to.