Cancer Workforce and Early Diagnosis

Nick Thomas-Symonds Excerpts

Tuesday 8th January 2019 Westminster Hall

[Jim Fitzpatrick (Poplar and Limehouse) (Lab)]

I beg to move,

That this House has considered early diagnosis and the cancer workforce in the NHS long-term plan.

It is a pleasure to see you presiding over our business this morning, Mr Howarth. I wish everyone a happy new year. I thank the Backbench Business Committee for supporting the bid of a number of colleagues for this debate, and the Chairman of Ways and Means for allowing it. I was lucky enough to be chosen as the chief sponsor, but I recognise the support of other Members in this Chamber. I will try to keep my remarks to 10 minutes or thereabouts.

I am grateful for the many briefings we have had—we have had briefings from the House of Commons Library, Barts Health NHS Trust, Cancer Research UK, Breast Cancer Care, the Fire Brigades Union, Macmillan Cancer Support, Breast Cancer Now, the Royal College of Pathologists, Maggie’s, the British Lung Foundation, the Royal College of Physicians, CLIC Sargent and the Royal College of Nurses. I have had more briefings from interested parties on this debate than on any other in my 21 years here. Interestingly, they virtually all agreed on two basic points. First, they welcomed the fact that the Government have addressed their issues in the 10-year review and, secondly, they welcomed the new investment but asked for more detail about staff training, recruitment and retention.

Running through most of the briefings I received were questions about the publication of the NHS long-term plan, which was promised by the end of 2018. In very timely fashion, the Government published it yesterday. It has focused the debate but not eliminated the need for it.

I want to highlight some of the issues raised in the briefings. The Royal College of Pathologists cited disturbing statistics. Notably, just 3% of services reported that they have enough staff to meet clinical needs, and more than three quarters of departments reported vacancies for consultants. The royal college emphasised the need for early diagnosis and called for increased investment in pathology services, particularly in the recruitment and training of pathologists and scientists. It said that histopathologists should be listed on the shortage occupation list as there is a shortfall in that speciality. The Migration Advisory Committee currently includes no pathology specialities on the shortage occupation list. Placing histopathology on that list would help overseas qualified pathologists to obtain a visa to work in the UK.

[Nick Thomas-Symonds (Torfaen) (Lab)]

I lost my mother to bowel cancer last year, and I have been campaigning to reduce the bowel cancer screening age to 50. I understand from my campaign and the debates I have had that it is important that we get the pathology capacity right. Otherwise the reduction in the screening age will not work. Does my hon. Friend agree?

[Jim Fitzpatrick]

I certainly do. I am sorry to hear about the fatality in my hon. Friend’s family. I am sure the Minister will talk about staff and I will come to it later in my speech. Without staff in diagnosis and pathology services, the reduction in the screening age will be pointless.

The Royal College of Pathologists identified a growing demand for pathology services and predicted a 28% shortfall in staff by 2010. Cancer Research UK said, as we all know, that the earlier a cancer is diagnosed, the more likely it is that it will be treated successfully. The Labour Government’s initiative to reduce the time between an urgent GP referral to seeing a cancer consultant to two weeks was a success in ensuring swifter treatment, but 2018 was the first year in which that target was not met. I would be grateful if the Minister told us how the Government expect to address that slippage.

Cancer Research UK added that it expects new cancer cases to reach 500,000 a year by 2035—right now, it is 350,000. With more cases and more thorough screening measures, our NHS will need more diagnostic and treatment staff. Cancer Research UK highlighted that the promise to produce a workforce implementation plan after the 2019 spending review leaves the status of Health Education England’s upcoming cancer workforce plan unclear. Will the Minister give us more information about how the two initiatives relate to each other?

Macmillan said that it recognises and welcomes the focus on cancer in the NHS long-term plan, including the Prime Minister’s commitment radically to improve early diagnosis. However, it has concerns that the long-term plan will not adequately address the immediate and long-term pressures facing the NHS cancer workforce. It also asked when the workforce implementation plan can be expected this year. I note that the Health Secretary said yesterday that he expects Baroness Dido Harding to report to him by the end of March. I would be grateful therefore if the Minister can confirm that we can expect the publication of the workforce implementation plan by summer this year.

Breast Cancer Now made the point that only 18% of breast cancer screening units are adequately resourced with radiography staff, in line with breast screening uptake in its area. My area of north-east London is covered by Barts Health NHS Trust, the NHS North East London Commissioning Alliance and the East London Health and Care Partnership. Many of the points made by the national charities are apparent locally. Those bodies have made their concerns clear. They have raised the basic issue that cancer outcomes in north-east London are among the poorest in London and the country, and that presentation via the emergency route remains high and is clearly associated with advanced cancer and low one-year survival rates.

In my borough of Tower Hamlets, the one-year survival index of people diagnosed with cancer is 4% lower than the England average, and diagnosis through the emergency route remains high. The local NHS trust has plans to attack that problem with a new early diagnosis centre, which is due to open in December; the introduction of multi-diagnostic clinics, which were first introduced in Denmark and were supported here in the pilot phase by Cancer Research UK; and new faecal immunochemical testing for colorectal cancer in primary care from April this year. It plans a health and wellbeing school spread across the whole of north-east London, based on the principle of making every contact count. It is raising population awareness and screening initiatives, including placing staff to promote screening in GP practices, promoting text reminders for cervical cancer screening, video competitions for schools to promote vaccinations, prostate cancer targets, breast and bowel cancer target ads on Muslim TV channels, and the reintroduction of bowel screening reminder calling and other initiatives.

The North East London NHS Foundation Trust conclusions are relatively simple. The workforce is a key factor in delivering a faster diagnosis standard, expected by 2020 and beyond; earlier diagnosis of cancer needs a resilient and sustainable radiology, endoscopy and pathology workforce; the high cost of living, the lack of affordable housing and the disparity in salaries across London are barriers to recruitment; and there is a need to look at technology such as artificial intelligence and digital pathology, and innovations in careers.

CLIC Sargent raised the problem of diagnosing child cancer and said, worryingly, that more than half of young people diagnosed visited their GP with their parents at least three times before their cancer was diagnosed. That is of particular concern.

Breast Cancer Care also raised the workforce plan, and asked how the commitments of the current cancer strategy and the ambitions of the long-term plan will be met. The Royal College of Physicians told me that, in London in 2018, 27% of physician consultant posts advertised were not filled, and that across the UK a total 45% of advertised consultant posts went unfilled due to a lack of suitable applicants.

The British Lung Foundation made two key points: that early diagnosis is essential because almost half of lung cancers are diagnosed at stage 4 when survival rates are very poor; and that there is an urgent need to train and employ more NHS staff to diagnose lung cancer earlier. The Royal College of Nursing stated that in England there are nearly 41,000 vacant registered nursing posts in the NHS. It predicts that the number will increase to almost 48,000 by 2023 if the Government do not take action.

The Commons Library briefings said that the cancer workforce plan devised in 2017 recommended that action be taken to ensure that enough staff with the right skills are trained to deliver the cancer strategy by 2021. In November last year, the highly respected Professor Sir Mike Richards—NHS England’s cancer director—announced that cancer screening would be overhauled as part of the long-term plan. He also announced a review team to assess current screening programmes and a report is due this summer. I ask the Minister whether that timetable might coincide with the publication of the Government’s workforce plan. The Library stated that there is no measure of the total NHS cancer workforce. Will the Minister comment on that anomaly?

I would be grateful if the Minister addresses the fundamental issue raised in all the briefings: how the workforce implementation plan fits in with the strategy, and when it can be expected. I look forward to his response. He is highly regarded in his post. I look forward to the responses from the hon. Member for Central Ayrshire (Dr Whitford), the Scottish National party spokesperson, and from my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson), the shadow Health Minister, and to other colleagues’ contributions.