Radiotherapy: Accessibility

Debate between Oliver Heald and Grahame Morris

Tuesday 18th July 2023 Westminster Hall

[Grahame Morris]

That is a really important point, and I hope the Minister is taking note. I do not know whether the term is “low-hanging fruit”, but here is an opportunity to get some synergies from the new technologies that are available now but perhaps were not available even a couple of years ago. I will return to that theme, but AI is potentially a force multiplier, if that is the appropriate term: it can improve the productivity of the small radiotherapy workforce. As the hon. Member for North Devon mentioned, AI can save a consultant oncologist two hours in planning a patient’s treatment. As a couple of hon. Members have said, it is wonderful to have centres of excellence—some of the best hospitals not only in the United Kingdom, but in the world—such as the Royal Marsden in London and the Christie Hospital in Manchester. Now we have the opportunity, through IT networks and AI, for doctors and clinicians, even in remote locations, to access highly qualified oncology specialists, who can plan the treatment to be delivered in satellite centres. There is a huge opportunity here.

As we have heard, almost half of individuals experience cancer at some point in their lives, and about a quarter require radiotherapy. It is quite a disturbing statistic that only 27% of cancer patients in the UK access radiotherapy. The international recommendation is that between 50% and 53% should. Only half the people who would benefit from radiotherapy are accessing it at the moment.

[Sir Oliver Heald]

One thing of great concern in my constituency is that people start radiotherapy by travelling to Mount Vernon, which is an excellent hospital, but they cannot keep going, because it is such a terrible journey, so they give up.

[Grahame Morris]

That is a valid point that needs to be addressed. Perhaps part of the solution is the development of more satellite centres. If I have two words for the Minister, if he will forgive me, they are “treatment capacity”; or make that three words: “radiotherapy treatment capacity”. That is what we need—to increase radiotherapy treatment capacity.

Radiotherapy has immense potential for treating various types of cancer. It has been found that a greater number of cancers can be treated effectively using radiotherapy, either exclusively or in combination with other treatments. It has a critical role in four out of 10 cancer cures. As the hon. Member for North Devon said, it is highly accurate, and there is limited damage to healthy cells surrounding the cancerous tumours, particularly with the latest forms and most modern types of radiotherapy, such as stereotactic ablative radiotherapy and so on.

Radiotherapy is particularly useful for treating cancers in vulnerable areas, and requires fewer patient visits compared with other treatments. It does not occupy intensive care capacity, in the way surgery does, nor does it impact the patient’s immune system like chemotherapy. Dame Maria, I am still suffering from the impact of a depressed immune system from the chemotherapy that I had some years ago. That does not happen with radiotherapy. We are not fully utilising the life-saving potential of radiotherapy.

In 2019, Cancer Research UK published a report highlighting inadequate early cancer detection and limited access to the best treatments, resulting in the UK having some of the worst cancer survival rates among western countries. Radiotherapy has been chronically underfunded and under-resourced for a number of years. That is not a political criticism of only this Government, but of previous Governments too, and it needs to be addressed if we are to approach the outcomes and improved survival rates that we all want to see.

As the hon. Member for North Devon said, the UK currently allocates only 5% of its cancer budget to radiotherapy. That is not the whole NHS budget of more than £100 billion; that is just the cancer budget. Most other European countries allocate 10%. That disparity is very telling. It affects patient outcomes, waiting times and the overall NHS budget. Radiotherapy is the most cost-effective of the three main cancer treatments, with a typical cost per cure of £3,000 to £7,000.

However, the lack of investment has left us lagging behind other countries. Our technology is characterised as outdated. As we have heard, within the next year approximately 55 existing radiotherapy machines, which are 10 years old or more, will need replacement. That is about a fifth of the total number of linear accelerators in our NHS. Although the Government talk about record NHS investment, our radiotherapy access falls behind international comparators. As the hon. Member for North Devon said, England has 4.8 radiotherapy treatment machines per million people, while Italy has 6.9 and France has 8.5. The NHS would require another 125 linear accelerators to meet international standards.

It is true that covid-19 had a devastating impact on the NHS and on cancer services, but it is important to note that this problem—the cancer care crisis—predates the pandemic. We had a statement on 3 July from the Health Secretary about the NHS workforce plan. I was rather disappointed, because I raised the issue of the cancer workforce and the 62-day treatment target and he completely avoided giving an answer. The target is that 85% of people should start their first treatment within two months—62 days. However, the latest figures, which have just been published, show that we are hitting that for only 59% of patients. If the Secretary of State does not know that stat, I will be very disappointed. I know a little about Sunderland football club. I know that Jimmy Montgomery, our best ever goalkeeper, made 638 appearances and that we won the FA cup in 1973 and 1937. I would not expect the Health Secretary to know those things, but I would expect him to know the latest key performance indicators in relation to cancer waits, so I hope that the Minister responding today will emphasise the importance of that.

Delays in cancer treatment are not academic. It is not just a question of statistics for our constituents. For every four-week delay—for every month that a treatment is delayed—the chances of survival reduce by 10%, so this is significant. The hon. Member for North Devon mentioned Professor Pat Price. She is a leading authority on cancer, based at the Royal Marsden, and she has warned that up to 45,000 cancer patients could face deadly delays in their treatment by the end of the year. She is consistently reported in the national press, most recently in the Express, and emphasises the need for a cancer-specific plan supported by the requisite investment in improving radiotherapy treatment capacity.

It is great to invest in diagnostics, but this is a hand-in-glove situation: we need to ensure that as the investments in new diagnostic hubs are taking place, we are also making, in parallel, investments in treatment capacity. The Government have access to world-leading cancer specialists such as Professor Price, but we need a greater sense of urgency from Ministers to lift the UK from the bottom of the global cancer outcomes league table to the top. I say to this Minister: that is within our grasp; we have given you the route map for how it can be done.

The NHS has undergone two major reforms in the past 13 years and, although reforming public services is essential, the root causes of the issues sometimes come down to a lack of investment. Investment in cost-effective cancer treatments such as radiotherapy can result in quick gains. Expanding and modernising radiotherapy equipment with a modest—by NHS standards—£200 million investment could update the estimated 76 machines about to become outdated. That would benefit 50,000 patients annually. Then, allocating £45 million for the new surface guided radiotherapy—a fast and accurate British innovative technology—could reduce national waiting times for radiotherapy by almost two weeks. We had a meeting quite recently just along the corridor from this Chamber, and these machines can be installed over a single weekend in a specialist radiotherapy centre. We must utilise new technologies to address the workforce crisis and make access to radiotherapy treatment available across the entire country. Technology is available to the NHS today that was not available 25 years ago, and it is unwise that we are not currently using that technology to its utmost potential. If the NHS made better use of AI software, cancer specialists could plan for radiotherapy treatment two-and-a-half times faster than at present, ensuring that many more patients could be treated sooner. I urge the Minister to reconsider accelerating the roll-out of AI technologies in radiotherapy. There is no shortage of excellent science, technology and innovation in this country, and it is worth noting that most of the advanced radiotherapy machines currently operating all across Europe and in North America are made here in the UK—in Crawley, actually—so we are not making the best use of this British technology.

The Government should be laser-focused on retaining current staff and harnessing the opportunities of AI, up-to-date treatment machines, software and innovation to treat more patients and improve productivity. Some of these technologies could save clinicians up to two hours per patient, which is vital in a health service where we have a workforce crisis and a shortage of specialist oncologists. To bring treatment closer to home, investment is necessary in satellite centres or community cancer treatment centres to complement community diagnostic hubs.

Radiotherapy is a quick and highly effective treatment, and cost-effective radiotherapy services are at the forefront of cancer treatment across the world. It is the first duty of the Government to protect their people. The Minister can demonstrate his commitment to that duty by outlining a workable plan to meet the 62-day cancer treatment target after almost a decade of failure, and ensuring that all patients who will benefit from radiotherapy have access to this lifesaving treatment within 45 minutes of their home.

Child and Adolescent Mental Health Services

Debate between Oliver Heald and Grahame Morris

Tuesday 3rd March 2015 Commons Chamber

[Sir Oliver Heald (North East Hertfordshire) (Con)]

In listening to the hon. Member for Stoke-on-Trent South (Robert Flello), I recognised some important themes that were also evident in the speech of the Select Committee Chairman, my hon. Friend the Member for Totnes (Dr Wollaston). Both touched on what we can do to help people with mental health problems through volunteering, mentoring and bringing services together so that we have a more substantial whole that will help to tackle the fragmentation between different services and make something more rational and more joined up.

I was a governor of a residential school for young people with emotional and behavioural difficulties in the 1980s—Shaftesbury House in Royston. It was an Inner London education authority school, which did extremely good work with some very troubled young people. At that time, however, there was a different understanding of mental health issues from what we saw a few years later in 2001 when I was my party’s spokesman on mental health. By that time, there was much greater recognition that deep-seated mental health problems start at ages much younger than adulthood. Previously, there was a feeling that some of these issues were emotional, behavioural and developmental, but they were not seen in their true context.

I thus slightly disagree with the hon. Member for Stoke-on-Trent South. I think our understanding of mental health issues and what they mean for children and adolescents has changed over the period that he spoke about—and certainly since 2001, we know far more about the onset of these illnesses and about how they should be treated. I agree with him, however, that we are seeing a great number of young people affected by these issues. The hon. Member for Southport (John Pugh) talked about the ups and downs of adolescence and whether there was such a thing as a normal period of adolescence.

I believe that issues such as family breakdown, drugs, social media, and domestic violence put considerable pressure on young people, and it gets to the point where some adolescents have a series of crises. They can be intermittent, but there is often a recognisable crisis for which help is needed. It is more than just highs and lows; it is something more serious. In those circumstances, the delays about which we have heard can be particularly acute.

Two young people contacted me recently to raise issues about how child and adolescent mental health is dealt with. They were both very unhappy with the current situation. I thank the Minister for meeting one of them—a young lady who has been through CAMHS —to talk through the issues. She was very appreciative of hearing about the taskforce that has been set up, and it does the Minister great credit that he was prepared to meet her and that he has accepted that there are problems in the system that need tackling. Delay is certainly one of them. Another is the amount of help available, and particularly whether there are sufficient numbers of trained staff—psychiatrists, community psychiatric nurses, therapists and so forth. We have never had the numbers we need, and I hope the taskforce will consider that issue.

The Hertfordshire Partnership Foundation Trust has a youth panel that is deliberately aimed at revealing concerns. The young lady who came to see the Minister had been on that youth panel. She had suffered from anxiety, bulimia and depression; she had been bullied, but got no proper response from her school. She waited nine months for CAMHS, and had still not been given an appointment when she attempted suicide. Even after she had been in hospital, she had to wait for six weeks. She had only five sessions of therapy in 20 months at a time when she was experiencing serious crises. Another young lady who has been in touch with me was taken into an in-care unit, and it was three weeks before she saw a psychiatrist, although she too had experienced a bad crisis.

[Grahame M. Morris]

I cannot disagree with what the hon. and learned Gentleman is saying or the examples that he is giving, but does he accept the general point that one of the problems when it comes to planning effective interventions is the lack of current and accurate prevalence data that would enable the relevant agencies to plan and commission services that meet local requirements?

[Sir Oliver Heald]

I agree. I am sorry that action to deal with that problem was cancelled some years ago, because such action is definitely needed.

I was talking about the young woman who was taken to an in-care unit. She said that the staff always seemed to be overworked, and she was given no opportunity to exercise. She felt that, although she had been placed in the unit, nothing was being done to address her condition. I think that a great deal needs to be done to improve child and adolescent mental health services.

On page 76 of its excellent report, the Select Committee refers to the Minister’s taskforce, and says that the “current fragmented commissioning arrangements” must change

“to allow rational and effective use of resources in this area, which incentivises early intervention.”

That is an extremely important point. On page 77, the Committee deals with education and GP services and makes another important point, namely that this is not just about specialist CAMHS, but about school-based counselling. It quotes Mick Cooper, professor of counselling psychology at the university of Roehampton, as saying:

“Due to its short waiting times, convenient location, and broad intake criteria, school-based counselling is perceived by many stakeholder groups as a highly accessible intervention. It is able to offer a wide range of young people professional therapeutic support in a direct and immediate way.”

I think it is time that we joined up those services, using schools as a platform. In my constituency, there is an initiative called the North Herts Emotional Health Support Service, which aims to make a start with that. It has estimated that one in 10 young people aged between five and 16 is likely to be affected by a

“clinically significant mental health problem”

at some point, and has calculated on that basis that 18,000 school-aged children in north Hertfordshire are affected, including about 6,000 with emotional disorders. It has looked at the schools in question, and says:

“Evidence suggests that vulnerable children, young people and their families find it easier to access services”

at a school. It has trained a team of mentors consisting of teaching assistants, teachers and volunteers, and has identified a

“bank of quality-assured local counsellors and…therapists”

who can provide the sort of art and drama therapy that was described by the hon. Member for Stoke-on-Trent South. It has two local lead therapists whose job is to oversee the training and supervising of the mentors. It speaks of the importance of “offering consultancy and training” and “co-ordinating”, and hopes to engage a “part-time administrator”. It has made considerable progress with that model, and, although it will need to be evaluated, I think that we should do something similar.

The service is harnessing the good will of people who volunteer, and there are people who will do that—when I was a mental health spokesman, I met people who volunteered to work for Rethink and MIND—but it also uses the skills of professionals to train the individuals concerned, under supervision. It is giving us a lot of coverage and an ability to help young people relatively cheaply. That is a consideration in these times. I therefore suggest to the Minister that looking at such initiatives and those described on that page of the report is a possible way forward.

Many young people spend a lot of their time using social media of course—thumbs clicking at great speed. This is not necessarily a bad thing. People with anxiety or depression or another mental health condition could find online services that could help them and they could reinforce the coping techniques that they have been taught. I hope the taskforce will look at that. I think it might be fruitful.

--- Later in debate ---

[Grahame M. Morris (Easington) (Lab)]

I congratulate the hon. Member for Brigg and Goole (Andrew Percy), with whom I serve on the Health Committee, and the hon. Member for Totnes (Dr Wollaston), who so ably chairs the Committee. Although this report is the third report of the 2014-15 Session, I think it was the first report produced under the hon. Lady’s chairmanship, so it is quite an historic document. It is an important piece of work on a subject that has been neglected.

As time is short, I shall try to stick to a particular structure. I thank the Royal College of Paediatrics and Child Health for providing a briefing and for asking us to highlight some of its concerns about variations in services and funding for transition services and mental health care provision for prevention and early intervention. A number of right hon. and hon. Members have referred to those issues. I also want to make a few points from the perspective of local government. As we have heard and as the hon. Member for Brigg and Goole observed, this is an area of joint responsibility where local government, given the correct support and resourcing, can make a significant difference.

On the scale of the problem, it is a shocking statistic that 50% of mental illness in adult life, excluding dementia, starts before the age of 15, and 75% of mental illness starts before the age of 18. Apart from the mental health manifestations, there are often increased physical health problems associated with the deterioration in mental health. Disturbingly, since 1980, as others have mentioned, there has been no decline in the number of deaths caused by self-harm, suicide or assault, with more than 1,000 10 to 18-year-olds dying this way every year in the United Kingdom. The problem is particularly prevalent among boys.

An hon. Member spoke about the value of prevention and early intervention and alluded to a cost-benefit analysis, and he was absolutely right. Quite apart from the fact that it is the right thing to do, if we look at it purely in terms of the opportunity cost, we see that mental health problems that start in childhood and adolescence result in increased costs of between £11,000 and £59,000 per child annually, according to figures provided by the Royal College of Paediatrics and Child Health. Those are huge additional costs. With upstream interventions of the kind other Members have argued for, early identification of mental health difficulties should be established as a core capacity of all health, social care and educational professionals who work with children and young people, because the benefits would be considerable.

Another issue that has been talked about, and which I feel I must mention, is the provision of an evidence base on which to plan interventions. Indeed, the chief medical officer highlighted the lack of accurate prevalence data in evidence to the Committee. I fully understand that the Minister is carrying the can and making the arguments, but that survey had not been carried out for quite a few years. Although it has now been commissioned, my understanding is that the data will not be available for use until 2017. If we are to have a scientific or empirical basis on which to plan commissioning and resources, either in early years or in whichever tier is thought appropriate, we need an up-to-date and relevant evidence base of data.

[Sir Oliver Heald]

On the hon. Gentleman’s point about prevalence data, with which I agree, is not the real point that many of the contracts in mental health are block contracts, whereby a fixed amount of activity is purchased? If we do not know exactly what the prevalence really is, that is a bit of a shot in the dark.

[Grahame M. Morris]

I cannot disagree with that. I come from the perspective that we need to plan interventions on the basis of evidence, but how can we do that without current and relevant data on child and adolescent mental health? We certainly need that data. On the structure of the contracts, I am a firm believer in integration. There may well be issues with block contracts. The Health Committee received evidence from the south-west indicating that there are vast areas of the country where there is very little access to certain types of in-patient mental health provision, which is clearly unacceptable. One might have thought that a large block contract would make that less likely, but apparently that is not so. However, I am not an expert in commissioning; I am simply trying to identify the policy areas.

Having spent a number of years in local government, I have no doubt that local authorities wish to tackle some of the barriers that young people face in accessing mental health services. It is a complicated area, and we need to enable local areas—the hon. and learned Member for North East Hertfordshire (Sir Oliver Heald) just referred to larger block contracts—to commission better services, and perhaps that is better done on a more local level.

Oral Answers to Questions

Debate between Oliver Heald and Grahame Morris

Tuesday 9th July 2013 Commons Chamber

[Grahame M. Morris (Easington) (Lab)]

7. What recent discussions he has had with the Director of Public Prosecutions and the director of the Serious Fraud Office on the feasibility of introducing an offence of reckless management of a financial institution.

[The Solicitor-General (Oliver Heald)]

None.

[Grahame M. Morris]

In view of the recent announcement on this, I wonder whether the Minister can give us any indication of which prosecuting agency would be responsible for enforcing the new offence of reckless mismanagement of a financial institution, and what steps are being taken to ensure that the agency has sufficient resources to tackle what are likely to be complex cases?

[The Solicitor-General]

As the hon. Gentleman will know, this Government set up the commission on banking which has come up with the recommendation that there should be such an offence. The Government have accepted that recommendation and the drafting process is in hand. I cannot go further than that, but he will see the draft when it is ready.