Access to Radiotherapy

Philip Davies Excerpts

Wednesday 12th January 2022 Westminster Hall

[Philip Davies (in the Chair)]

Before we begin, I remind Members that they are expected to wear face coverings when they are not speaking in the debate. This is in line with current guidance from the House of Commons Commission. I remind Members that they are asked by the House to have a covid lateral flow test before coming on to the estate. Please also give each other and members of staff space when seated and when entering and leaving the room. I call Grahame Morris to move the motion.

[Grahame Morris (Easington) (Lab)]

I beg to move,

That this House has considered access to radiotherapy.

It is always a pleasure to serve under your chairmanship, Mr Davies, and if it is not too late I would like to wish you and the Officers of the House a happy new year.

I am delighted to have secured this vital and timely debate on access to radiotherapy services. On occasion, it may seem like groundhog day: we come here on a fairly regular basis and outline the case for more investment in radiotherapy services. However, the covid crisis has brought many of these issues into sharp focus, and indeed there is a growing cancer backlog crisis that the Government really must address.

I also want to thank the Chamber engagement team for its fantastic work. This is the first time that I have had any interaction with the team, but it has been most helpful in engaging the public ahead of this debate. I am immensely grateful to the team for carrying out a survey over the course of only a few days—over this weekend, really. We had over 800 responses, and I thank all the respondents for taking the time to express and submit their views and experiences. I believe that those contributions, a couple of which I will refer to, will significantly enrich the debate. I am eagerly anticipating what I am sure will be comprehensive and compelling contributions from colleagues in the Chamber, many of whom I have served with and been involved with in debates like this previously.

It is only right that I begin by declaring an interest. I have the privilege of serving as vice chair of the all-party parliamentary group for radiotherapy, and I am also one of the vice chairs of the all-party parliamentary group on cancer. I also want to thank Macmillan Cancer Support and Radiotherapy UK, the charity with which I am associated, for their assistance in preparing for today’s debate. I am immensely grateful to colleagues from the all-party groups who have come along today; I know that there are many pressing demands on Members’ time.

The reason the debate is so important is that cancer will affect all of us at some point in our lifetimes. I want to take this opportunity to mention a good friend of mine, Nick Munting, who, as some might know, is a chef in the House of Commons and has very recently been diagnosed with cancer. I wish him all the very best for his speedy recovery.

I have personally had cancer on three occasions—a type of lymphatic cancer called non-Hodgkin lymphoma. Without the care and treatment that I received from the NHS, I would not be here today. I thank the dedicated staff at the Macmillan cancer centre at the Freeman Hospital in Newcastle, and those working at cancer hospitals throughout the country, for the excellent work that they do in diagnosing and treating cancer patients. I have received a plethora of cancer treatment. I have had the works: surgery, chemotherapy and radiotherapy—including advanced radiotherapy.

There is a reason why I am concentrating on radiotherapy today. Radiotherapy is by far the least understood of the three pillars of cancer treatment, with chemotherapy and surgery far more widely understood and referred to in public life. Despite that, one in four of us will have radiotherapy at some time in our lifetime. I want to begin by highlighting the many advantages of this highly specialised treatment and the major breakthroughs that there have been over the last 10 years.

Unlike other cancer treatments, modern radiotherapy is accurate to within millimetres, limiting damage to healthy cells around the cancer. A specialist in the field and a dear friend, Professor Pat Price, explained in simple terms to me, as a layman, the concept of a banana in a box. Imagine that the tumour is a banana in the box. With older, less precise forms of radiotherapy, the whole box would be irradiated and there would be considerable collateral damage to healthy cells. With modern, advanced precision radiotherapy techniques, just the banana would receive the high dose of radiation, and there would be no collateral damage. That significant advance has come about because of digital technologies and advances in this form of treatment. It is especially useful for treating cancers in areas vulnerable to damage, and it requires fewer patient visits than other treatments. Unlike surgery, it does not take up intensive care capacity, and unlike chemotherapy, it does not impact on the immune system.

Furthermore, radiotherapy is the most cost-effective treatment. Typically, a patient can be cured at a cost of about £6,000. If we contrast that with the cost of some chemotherapy drugs, which for individual treatments may run into hundreds of thousands of pounds, there is a cost argument for expanding radiotherapy, in addition to its effectiveness as a treatment. In many respects, it is a silver bullet. It is often referred to as a “Cinderella” service: it is immensely effective, but it suffers from chronic under-investment and suboptimal clinical commissioning. Let me remind the Minister that the UK spends only about 5% of the cancer budget—I do not mean the entire NHS budget; I mean just the cancer budget—on radiotherapy. Compared with what is spent in many other advanced European countries, that is a very small proportion; the European average is about 10% of the cancer budget.

In England, access to treatment can depend on people’s postcode; often, patients in more affluent, urban areas benefit from the most modern equipment, and from ease of access because of excellent public transport provision. In contrast, patients in less affluent, more rural areas, such as mine—Easington in County Durham—do not enjoy the same levels of access. My constituents make up a proportion of the 3.5 million people in England who do not have a radiotherapy centre within the recommended 45 minutes of their home.

That statement of the situation was supported and confirmed by a number of the respondents to the survey carried out by the Chamber engagement team. If I may, I will refer to a couple of their contributions. A lady called Penelope had positive experiences of accessing the service herself, but feared for others who might not be so fortunate. She said:

“In my experience, which involves my father’s radiotherapy last summer, he did not have to wait long, but he lives in Berkshire…near several hospitals, and I think the situation is very different in other areas of the country.”

Similarly, David said:

“My own wait time…before the covid situation was only weeks, and by that time I had already started other treatment regimes as well. I am lucky to be close to a centre of excellence: the University Hospital Coventry and Warwick. This is not normal though, a close friend, now passed on, had to drive from their home near Boston in Lincolnshire to the Leicestershire Infirmary for treatment, when there was a possible ‘slot’. That was a 4-hour round trip as neither the Boston nor Lincoln hospital had”

radiotherapy

“facilities. Lack of facilities meant the cancer spread out of control and he died.”

Radiotherapy is needed in almost half of treatments, but according to Cancer Research UK, only 27% of UK cancer patients actually receive it. I respectfully point out to the Minister that we will never level up the country while access to life-saving treatment depends on people’s postcode—where they live—entrenching already existing regional health inequalities.

Let me also address some of the workforce issues. The radiotherapy workforce are at breaking point. A survey conducted by Radiotherapy UK and the Institute of Physics and Engineering in Medicine in October 2021 found that almost 80% of professionals were considering leaving their position or knew a colleague who was. That was echoed by members of the radiotherapy workforce who submitted their views to the survey. A lady called Lauren said:

“Most radiotherapy staff can travel over an hour as that is their nearest radiotherapy centre. Increasing working hours and increasing workload is leading to more staff wanting to leave the profession in addition to the fact most of us have to travel long distances to find a centre to work at. Due to housing not being affordable in the locations of radiotherapy centres,”

which are often in big city centres. The Minister can address that fairly simply, and we have a solution—investment in IT networks, which I will come to in a moment—that we have put to successive Ministers who have occupied the post.

The tariff system generating income to trusts is based on the number of patient visits. Those perverse tariffs mean that radiotherapy trusts with advanced machines that can treat patients in fewer sessions are incentivised to treat patients less effectively over more treatments. That is a ludicrous, perverse incentive that I am sure the Minister could do something about.

Similarly, trusts seeking to replace ageing machines—the advice is to replace radiotherapy machines after 10 years—are required to conduct 9,000 treatments even to be considered for funding. The pandemic saw referrals plummet and services overstretched, so centres are not reaching that threshold and are therefore blocked from providing patients with access to the latest life-saving technologies. We have poor patient access and exhausted, demoralised staff, with senseless bureaucracy and a tariff system promoting less effective treatment. That is a pretty poor report card.

That was the state of radiotherapy even before the covid-19 pandemic. Holly, a radiotherapy professional, said:

“Currently we are having to delay patients due to poor staffing levels, this started way before the current surge in omicron cases. We have been understaffed for some time, and this has been made so much worse by omicron, we are having to close machines to make sure we have staff to cover”

the covid patients. She added that

“those that are in are getting burnt out by having to work longer, more days and harder each shift, meaning it’s a cycle of being off ill.”

Covid has created a cancer crisis that the current system cannot effectively manage. On that note, I want to pay tribute to the Catch Up With Cancer campaign, which was launched in conjunction with Craig and Mandy Russell, who very sadly lost their daughter Kelly to bowel cancer when her treatment was delayed owing to resources being transferred to the treatment of covid patients. Some of us here today handed in to 10 Downing Street a petition, signed by more than 300,000 members of the public, calling for action on the issue.

Of all the health backlogs, the cancer backlog is the most time-sensitive because, for every month that diagnosis of treatment is delayed, cancer survival rates can drop by as much as 10%. These are life-and-death issues for many tens of thousands of people. Without urgent action, cancer experts predict that survival rates in the UK may fall back to where they were 15 years ago, resulting in tens of thousands of extra cancer deaths. I know the Minister is new to her post, and I do not want to be unfair, but there is a crisis. I have been with colleagues to see a succession of Health Ministers, on many occasions, to set out proposals to improve the position. The lack of action is frankly lamentable, and many thousands of people will pay the price.

Before the pandemic, the all-party parliamentary group for radiotherapy branded radiotherapy “Britain’s secret lifesaver”. Ministers and NHS leaders need to recognise that it could be a game changer; it could have an immense impact on tackling the covid-induced cancer backlog, but to do that, it needs sufficient investment.

The all-party group has put together a six-point covid-19 recovery programme. I urge the Minister to look at that and to implement its proposals, which were developed not by me or other parliamentarians but by experts in the field—radiotherapy specialists and oncologists—who understand their patients and understand the service and how we can improve it.

The first point in our six-point plan is that we need to appoint a Minister in charge of and accountable for the transformation of radiotherapy. We need to invest in IT solutions to modernise radiotherapy. The problem that radiotherapy is available in only relatively few urban centres could be mitigated, to a degree, with modern IT that allowed specialists hundreds of miles away to interpret digital imagery and advise on the appropriate treatment.

We need to replace ageing machines—those that are more than 10 years old—and forget the bureaucratic nonsense about machines having to have done 9,000 treatments, because referrals for treatment have reduced due to covid. We need to invest approximately £200 million in the highly specialised workforce, where staff redeployment will be insufficient to fill the gaps.

We need to improve capacity and access by placing radiotherapy machines in some of the planned new diagnostic hubs. Ministers often respond to debates such as this one by referring to the £130 million that the Government promised to improve diagnostic services. That is welcome, but we need to address not just diagnosis but treatment. Radiotherapy is a quick and highly effective treatment, so I urge the Minister to consider using these machines in the diagnostic hubs.

Finally, we need to raise the profile of radiotherapy, ensuring full awareness among the public of the treatment’s curative and palliative potential. The six-point plan is underpinned by a need for a national strategy. The lack of a cohesive national approach has caused unacceptable inequality and disparities between trusts in different parts of the country.

It comes down to this: every day, every week and every month that the Government fail to take sufficient action, the public suffer, money is wasted and patients die. The Government are in denial about the situation and there is a huge disconnect in ministerial statements. Just last week, I heard the Leader of the House say that the situation had been normalised, but that is far from the truth. We cannot ignore the cancer crisis any longer.

I want to ask the Minister a number of questions, which I hope she will address in her response. I hope she understands the frustration felt by radiotherapy staff, but I want her to make a commitment to investigate the bureaucracy that is holding back radiotherapy trusts and denying patients the most effective treatment. Will she act urgently on that? Is she aware that the Government have not reported radiotherapy-specific data, which we refer to as the radiotherapy datasets, since May 2021? Will she publish the datasets that are available next month? Those will show clearly the levels of treatment that radiotherapy machines have been involved in during this period compared with previous years. That will make perfectly clear the level of the backlog, which estimates from the frontline put at between 50,000 and 60,000.

Will the Minister outline the plan in the event that radiotherapy services find they are no longer able to cope? Finally, will she agree to a meeting with radiotherapy commissioners, the Secretary of State and representatives of the radiotherapy community, in order to address these essential life-or-death issues? It has been useful for me to open the debate, but I know colleagues have issues that they would like to put to the Minister, so with that, I will conclude.