Cancer Care

Peter Dowd Excerpts

Tuesday 14th March 2023 Westminster Hall

[Peter Dowd (Bootle) (Lab)]

It is a pleasure to be in the Chamber under your stewardship, Mr Paisley. I offer my condolences to the hon. Member for West Bromwich East (Nicola Richards). Cancer is a dreadful disease that needs to be tackled in the most empathetic yet robust way.

There is no question that cancer care is in crisis. We have heard the figures relating to NHS waiting lists generally. Given that 7 million people are waiting for treatment, that equates to about 13,000 people waiting for care in my constituency alone, many of whom will, without doubt, be waiting for cancer-related care. One of my constituents wrote to me—I will not mention her name—exhorting me to come to the debate, because she said that she was deeply concerned about the latest waiting times for cancer treatment. They show that in England, in January, nearly one in two cancer patients missed life-saving treatment targets. That brings us to the crux of the issue: what are we going to do about that? What do the Government intend to do about that? Notwithstanding what they are trying to do, frankly I am not sure that that is sufficiently robust to take us forward.

We are replete with statistics from organisations such as the Royal College of Radiologists, which states that the best way to improve cancer survival rates is by diagnosing and treating patients earlier and more rapidly, as the hon. Lady said, and by ensuring that there are enough radiologists and oncologists to provide cancer care today. That is essential, but there is a shortfall across those areas. Having determined that that is a crucial part of the pathway to diagnosing or treating cancer patients, we find that the shortfall in the number of clinical radiology consultants is 30%, or 1,453 people, and the shortfall in the number of clinical oncology consultants is 17%, or 163 people, which is predicted to rise to 26%, or 317, by 2026. The reality is that the line is going down. Meanwhile, demand is increasing. By 2035, it is estimated that more than half a million people a year will be diagnosed with cancer in the UK, an increase of 40% since 2015. That is why we have to tackle this situation.

As the hon. Lady said, without sufficient investment, chronic workforce shortages will continue to be an issue and will limit the capacity and capability for innovation. I hope that the Government’s long-term workforce plan will move us along. However, it was like dragging a screaming child to get the Government to agree to a long-term plan. We do not know when that will come out—I hope that it will appear pretty soon, but I am not sure. We need that plan as soon as practicable.

For the first time in the history of the NHS, nearly half of all cancer patients fail to receive treatment within two months of an urgent referral. That figure comes from January 2023. It is damning but, more importantly, for the individual patients concerned, the situation is life-threatening. I am not sure that the Government have quite grasped that fact. To do so, they would have to realise the seriousness and challenges they face and I am genuinely not sure that they have grasped the seriousness.

The same is true for bowel cancer. Bowel cancer is the fourth most common cancer in the UK and the second biggest cancer killer. It kills more than 16,500 people a year. A targeted long-term plan for cancer is the best way to improve outcomes for those patients. The Government have to commit, as has been requested, to an ambitious, fully funded, dedicated plan for cancer, which addresses current issues in cancer care and equips services to meet future demand. Yet more organisations are, in effect, asking the Government to pull their finger out.

The organisations that I mentioned are external to Parliament, but Parliament’s Public Accounts Committee also said, in relation to the management of NHS backlogs and waiting times in England:

“Cancer waiting times are at their worst recorded level and NHS England will not meet its first cancer recovery target.”

It stated that, in August 2022,

“there were 2,600 patients who had been waiting more than two years.”

Let me repeat that: 2,600 patients had been waiting more than two years. A record 7 million people, of course, are on the waiting list. The Committee also said that NHS England—and the Government are as guilty on this point—

“made unrealistic assumptions about the first year of recovery, including that there would be low levels of COVID-19…The NHS is still not planning properly for the staffing and other resources it needs to deliver additional diagnostic and treatment capacity.”

I could go on—I will not—but I hope that those points give a flavour of the crisis that the NHS tends to be in, generally, and that particular services are in, whether that is radiology, dentistry or pharmacy. Frankly, the list goes on and on, and that means that our constituents are not getting the care they need.

I hope the Minister has read the documents from all the organisations that I have mentioned, as well as those from a plethora of other health and health service organisations. I hope she has read all the submissions because it seems to me that, to use a hackneyed old phrase, we are getting warm words. No doubt the Minister will tell us what the Government are doing, have been doing, might do and are planning to do. The reality is, however, that the situation is not moving along and, in the meantime, patients are suffering, families are suffering, and patients are dying. Let us not beat about the bush; that is the reality.

I exhort the Minister to look at all the documents and evidence she wants and to consider it as much as she can, but the Government have to accept, realise and recognise that there is a crisis in cancer care for which they—along with all the professionals and organisations in the NHS; I completely accept that—are primarily responsible. They are the ones responsible for the funding and organisation. I hope the Minister bears that in mind during these deliberations.

[Tim Farron (Westmorland and Lonsdale) (LD)]

It is an honour to serve under your guidance today, Mr Paisley, and to follow the hon. Member for Bootle (Peter Dowd), who made some important points, for which I thank him. I express massive congratulations to the hon. Member for West Bromwich East (Nicola Richards) not just on securing an important debate, but on making an excellent speech. I commiserate, console and offer my condolences to her on the loss of her mother. I also lost my mum to cancer. The hon. Lady is a bit younger than I am, so I assume we lost our mums at about the same age.

My mum, Dr Susan Farron—she would like me to mention her title, I am sure—passed away from ovarian cancer 19 years ago. Although we are here to represent our constituents and do what is right, whether we are personally affected or not, there is an element of honouring our mothers in what we seek to do today. I am sure the hon. Lady’s mother would be massively proud of her, not just for what she has done today.

This is a huge issue. It is said that half of us will get cancer at some point in our lives, and 100% will be affected by it in one way or another. We deal at the moment with terrifying waiting times for cancer treatment. They are not quite as awful as they were a month or so ago. The Minister may say that, and we will grab some positives where they exist, but they are still deeply troubling.

In my constituency, in south Cumbria, 27% of people with cancer are not being seen within two months of being diagnosed. Someone who has cancer and has been told they have this dangerous thing within them that is potentially going to kill them then waits for two months for treatment. In north Cumbria, 44% of people diagnosed with cancer are waiting more than two months for their first intervention. What terror does that spark in an individual with cancer and all their loved ones? What frustration does that lead to within the clinical community, who desperately want to care for those people? To add substance to that terror, we know that on average—although there is no average cancer—for every four weeks that treatment is delayed, there is a 10% reduction in life expectancy. That is disastrous and massively worrying for everybody who faces that challenge.

Covid has played a part, with its massive impact on our health service. People perhaps did not come forward with symptoms during the pandemic as soon as they might have done. I have many disagreements with the Government about how they handled the pandemic, but it is important to say that, if they had not locked down, the situation would have been far, far worse. Let us remember that many of the pressures that we face are because we sought to protect the NHS to save lives, and we did just that. However, the waiting times are unacceptable. They are explicable but not excusable.

I want to focus my remarks on radiotherapy. I chair the all-party parliamentary group on radiotherapy. One reason for doing that is that I recognise that radiotherapy is one of an important range of tools that can be used to treat, and often cure, that terrible disease of cancer. Across the world, in countries with similar levels of GDP to ours, such as other European countries, Australia and New Zealand, there is an average international target that 53% of patients living with cancer should receive radiotherapy. In the UK, the proportion is 27%. One reason is the lack of investment from Governments of all colours represented in this room. I will point the finger at this Government for not taking the action they need to now, but I could point the finger inwards at the coalition Government and the Labour Government. We have collectively neglected this situation, I am afraid.

Only 27% of people with cancer who should or could receive radiotherapy are getting it. For a clue as to why that is the case, let us look at Australia, where the five-year survival rates for lung cancer are a third better than those in the UK. Australia spends around 10% or 11% of its cancer budget on radiotherapy; in the UK, we spend just 5%.

[Peter Dowd]

I am pleased that the hon. Gentleman raised that. Radiotherapy UK provided some figures indicating that

“by the end of 2024 there will be 74 out of date machines in the NHS,”

and that

“by 2025 it will be 90.”

Does he agree that that is a pretty grim statistic?

[Tim Farron]

It is, and in a moment, I will come on to how we might tackle that. It is a real problem, and not all of it is down to money—some of it is down to where and how the money is spent.

The all-party parliamentary group on radiotherapy has been working with the charity Radiotherapy UK, which the hon. Gentleman rightly referred to. We have been delighted with the coverage that we have received recently through the Daily Express, which has run a campaign alongside us calling for a £1 billion boost in radiotherapy. The Minister can read all about it not just in the Express, but in the manifesto put together by the all-party group, which details that.

To put it bluntly, in the run-up to the Budget this week, we know that the Chancellor has something like £30 billion more to spend than he thought because of underspend on energy support and an increase in tax revenues, not least because of people spending more money on goods due to inflation, and therefore spending more VAT. The Government therefore have that windfall to play with. I am asking for one thirtieth of that to be spent on radiotherapy, so that we can save thousands and thousands of lives.

What would we spend that money on? We would spend it on new kit. Not all of that would need to be new money; it could just be money that is spent more wisely. As the hon. Member for Bootle alluded to, part of the problem is that we have ancient kit. He mentioned the 74 machines—linear accelerators—that will be out of date by the end of next year. Why do we have so many out-of-date linear accelerators and other bits of radiotherapy kit? It is largely because the funding for those machines is feast and famine, and because it is devolved to 42 different specialist commissioners, when we actually need a central, national, well-funded rolling programme to replace and update linear accelerators. It is not rocket science—though it is science—and the Government could do that without spending an absolute fortune.

I want to ask the Minister again about the issue regarding tariffs. Many of our cancer centres are using second-division kit, to put it crudely. The tariff for using a second-division piece of kit means that centres can be paid for the 30 fractions a person might need to deal with their cancer, whereas with a first-division piece of kit, it might take only four, five or six trips to treat someone. Centres are paid per fraction, so there are perverse incentives whereby trusts are more likely to be rewarded if they use poorer kit more often than better kit less often. That has been fixed in part, but not for every cancer, not for every machine and not for every unit. That needs to be dealt with, and again, it could be done freely.

We talked about the workforce. The radiotherapy workforce is really small—about 6,400 individuals. There are 30% fewer entrants coming into the sector than there are places available, which has an impact on the morale of the people already working there. We are losing people as a consequence. Retention is becoming a problem because recruitment is such a problem. People feel under such weight. With such a small workforce, it would not involve an awful lot of effort to significantly increase that. We need to invest in training to bring clinical oncologists and clinical radiologists into the profession, and also to alleviate the pressure that staff are under now by supporting new admin staff up-front, which could be done very quickly, to allow people currently in the profession to be able to concentrate more on their frontline duties, rather than on admin.

I will make a final remark regarding radiotherapy, which is about access. Among the reasons why only 27% of people with cancer are getting radiotherapy in England—as opposed to the 53% who really should—is that many people, particularly in my community, are just too far away from the treatment. In our communities, the majority of patients using our nearest radiotherapy centre are making two or three-hour round trips every single day. The national radiotherapy advisory group says that it is bad practice for people to have to travel more than 45 minutes for treatment—never mind three-hour round trips every day for 30 days. As a consequence, some people do not get referred for treatment at all, or may even make the choice themselves not to finish that treatment. There is no doubt that that is having an impact on survival rates.

We have built a strong case, in our community, for a radiotherapy satellite unit from the Rosemere unit in Preston—our nearest unit—to be deployed at the Westmorland General Hospital in Kendal. A solid clinical and business case was put for that, and I would be grateful if the Minister might agree to meet with me, even for just 15 minutes, to review that and consider the extent to which the Department might be able get behind it and other satellite units around the country that could cut waiting times and save lives.

There are no silver bullets to many problems that we face in this place, but this is quite close to being one. For a relatively small amount of money, the UK Government could do something that would save lives, and do so quickly. I encourage them to do so.

--- Later in debate ---

[The Minister for Social Care (Helen Whately)]

It is a pleasure, Mr Paisley, to serve under your chairmanship.

I thank my hon. Friend the Member for West Bromwich East (Nicola Richards) for securing this debate on cancer care. According to Cancer Research UK, one in two people—half of us—will develop cancer at some point in their lives. There are around 290,000 new cancer diagnoses a year, or nearly 800 every day.

When we cite statistics such as these—as is the case with NHS waiting lists, for instance, across the board—I always remember that every one of the figures is about a human being. Whether it is a parent, a child or a grandparent, they are someone’s loved one. And every one of them will be worried, or even scared, about their diagnosis; their lives are disrupted and they may be living in pain.

My hon. Friend brought that to life in her speech from her own personal experience. May I express my very sincere condolences to her for the loss of her mother? Such a loss is so sad, especially as it came too soon; I believe that her mother was only in her 50s when she died last year. My thoughts are also with her staff member Bradley, who she mentioned, whose mother would have been 58 today. Also, the hon. Member for Westmorland and Lonsdale (Tim Farron) mentioned his mother, who very sadly died of cancer. So this is a moment to think about mothers, perhaps particularly with mother’s day coming up. My best friend in childhood lost her mother to cancer when we were in our teens, and I clearly remember how that was for her. And there are so many other people who have lost loved ones to cancer, too often before their time. That is why diagnosis and treatment of cancer is so important to so many of us.

My hon. Friend rightly spoke about the importance of early diagnosis and prompt treatment. They are important for everybody. However, she particularly talked about areas with higher rates of cancer and the above-average levels of cancer in her own area. As she said, health disparities are part of the problem and they must be tackled, too.

Clearly, and rightly, my hon. Friend keeps a close eye on the performance in her area. I see my job as a Minister to look across the whole country and to help our healthcare system to tackle variation in performance, and indeed to level up where there are inequalities, because everybody should have access to early diagnosis of cancer and effective treatment for it.

Right now, I have three priorities for cancer: one is to recover from the pandemic and reduce the pandemic backlog; the second is to improve early diagnosis and treatment, using the tools and technologies that we have; and the third is for there to be investment in research and innovation, and for those innovations to be developed to make a difference to people’s lives and to the diagnosis and treatment of cancer. We know that technologies such as genomics and artificial intelligence, for instance, have the potential to truly transform our ability to diagnose and treat cancer effectively as a society.

[Peter Dowd]

Yesterday, I received an email from Sarah Taylor on behalf of the #CatchUpWithCancer and Radiotherapy4Life campaign. Among other things, she indicated that in May 2022 over half the heads of radiotherapy departments wrote to the Health Secretary and warned that

“radiotherapy is at crisis point”.

However, to our knowledge, so far they have not had a reply from the Department. Will the Minister try to chase that up if I provide her with further information?

[Helen Whately]

I will come on to talk about radiotherapy, but I can say to the hon. Gentleman here and now that I will indeed look into what has happened to the response to that letter.

However, I will start by talking about the waiting times, recovery from the pandemic and reduction of the pandemic backlog. Our elective recovery plan included the ambitious target to return the number of people waiting for more than 62 days for an urgent cancer referral back to pre-pandemic levels by this month. Since the publication of that recovery plan, the NHS has seen enormously high demand for cancer checks. More than 2.8 million people were seen in the 12 months to January 2023—up by 19% compared with the same period before the pandemic. The return in demand, with people coming forward for cancer checks, is very positive after the falls we saw in the pandemic.

When giving evidence to the Health and Social Care Committee last week, Dame Cally Palmer, NHS England’s national cancer director, said that

“we are not going to meet the pre-pandemic target by the end of March, simply because of those record levels of demand.”

That is already in the public domain. However, I assure hon. Members that we are working closely with NHS England to reduce the time people are waiting to receive a diagnosis, or an all-clear, and to start treatment, and we are making progress on that. The latest published figures show that the 62-day cancer backlog for the week ending 26 February stood at just over 22,000, which is a fall of 35% since its peak in the pandemic. However, that is 22,000 people too many who have had to wait 62 days, and many of them will have had to deal with the anxiety of waiting for a diagnosis or an all-clear, which is why we are working so hard on this issue with NHS England.

As I said, it is good that more people have come forward for cancer checks but, in response, we must increase our capacity to diagnose and treat cancer. That is one reason why we have been investing in community diagnostic centres, and we have more than 93 centres open and operational. That is why the NHS is rolling out what we call fit tests to speed up diagnosis for people who may have, for instance, bowel cancer. That is why the NHS is rolling out teledermatology to speed up diagnosis for people who may have skin cancer, and speeding up access to MRI scans for people who might have prostate cancer. Those are the three types of cancer with the most people waiting for a diagnosis or an all-clear or, if they have a diagnosis, to start treatment, and I am determined to reduce those waits.

When I meet charities and clinicians, the one message I consistently hear is how important early diagnosis is for improving patient outcomes and care, and that was something my hon. Friend the Member for West Bromwich East referred to. She talked about the ambition in our long-term plan to be diagnosing 75% of cancers at stages 1 or 2 by 2028. As part of achieving that, we are extending targeted lung health checks, with more than double the number of community lung truck sites. The targeted lung health checks programme had diagnosed 1,625 lung cancers by the end of December 2022, with 76% of those diagnosed at an earlier stage.

To help people get a cancer diagnosis or an all-clear more quickly, since November GPs have been able to directly order diagnostic tests such as CT scans, ultrasounds or brain MRIs for patients with concerning symptoms who fall outside the National Institute for Health and Care Excellence’s guideline threshold for urgent referral. Alongside that, community pharmacists in pilot areas are helping to spot signs of cancer in people who might not have noticed symptoms or realised their significance, and we continue to see non-specific symptom pathways rolled out. As of December 2022, more than 100 are live across the 21 cancer alliances.

To encourage people to contact their GP if they notice, or are worried about, symptoms that could be cancer, NHS England has run the “Help Us, Help You” campaign, which seeks to address the barriers deterring patients from accessing the NHS if they are concerned they might have cancer. In March and June 2022, we saw a 1,600% increase in the number of visits to the NHS website’s cancer symptoms landing page, so the campaign had a huge impact on the number of people looking to see whether they might have cancer symptoms. NHS England is in the process of planning “Help Us, Help You” activity for 2023-24, to make sure we continue the momentum and continue to encourage people to come forward if they have worrying symptoms of something that might be cancer.

However, we all know that diagnosis is just the first step on a patient’s journey, so we are also taking steps to improve cancer outcomes by rolling out innovative new treatments, such as the potentially life-saving drug pembrolizumab for one of the most aggressive forms of breast cancer, and mobocertinib to treat a specific form of lung cancer. The National Institute for Health and Care Excellence has made positive recommendations in all 18 of its appraisals of breast cancer medicines since March 2018, and those medicines are now available to NHS patients. NICE is also able to make recommendations to the cancer drugs fund, which has benefited more than 88,000 patients, with 102 medicines receiving funding for treating 241 different cancers.

My hon. Friend the Member for West Bromwich East mentioned radiotherapy equipment, as did the hon. Members for Westmorland and Lonsdale and for Bootle (Peter Dowd). Since 2016, more than £160 million has been invested in radiotherapy equipment so that every radiotherapy provider has access to modern, cutting-edge radiotherapy equipment. That investment enabled the replacement or upgrade of around 100 radiotherapy treatment machines and in some cases the roll-out of new techniques, such as stereotactic ablative radiotherapy. On top of that, £260 million has been invested in establishing two services to deliver proton beam therapy in London and Manchester.

On the workforce, from 2016 to 2021, the number of therapeutic radiotherapy staff grew by more than 17%, and the number of clinical oncologists by more than 24%. From 2021, there has also been an uplift in the number of entry-level places available, with 108 in clinical oncology, up from an average of around 60 per year in previous years.

I want to pick up on the claim that only 27% of cancer patients are treated with radiotherapy. That claim is outdated and incorrect, as it includes radiotherapy only as part of a patient’s primary treatment for cancer and does not capture a substantial proportion of patients who receive radiotherapy as a subsequent treatment. Also, I am told that the data is from 2013-14, so that is also out of date. NHS England has assured me—I have looked into this—that those who need radiotherapy treatment can access it.