Breast Cancer

Philippa Whitford Excerpts

Thursday 18th October 2018 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is always a pleasure to speak in any health debates—as my party’s health spokesperson, I am interested in them—but it is particularly pleasing to speak in this debate. I thank the hon. Member for Crewe and Nantwich (Laura Smith) for presenting the case so well and, through having secured the debate, giving us other MPs the opportunity to make a contribution. It is also always a pleasure to follow the hon. Member for Lincoln (Karen Lee). All of us in the Chamber today, or who were in the main Chamber when she spoke on this topic some time ago, will remember her contributions. I thank her for them.

I am pleased that we again have an opportunity to highlight breast cancer issues while we have the Minister’s attention. We all know he is deeply interested in this subject, and we look forward to his response. I also look forward to the contribution by the shadow Minister, the hon. Member for Washington and Sunderland West (Mrs Hodgson), because I know she has an interest in the subject, too. There may be few of us here, but I know everyone’s contribution will be significant.

Some 55,000 people in the UK are diagnosed with breast cancer every year. Breast Cancer Now’s new 55000Reasons campaign calls for investment in breast cancer to feature in the NHS’s long-term plan. That beseechment is worthy of the Minister’s attention. Some 11,500 women and 80 men in the UK still lose their lives to breast cancer every year. I know men are a smaller proportion of sufferers, but we sometimes forget that they can be susceptible to breast cancer; I was given a salient reminder of that while researching for the debate. We sometimes do not think about that, but we should be aware of it.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Does the hon. Gentleman recognise that although far fewer men suffer from breast cancer, because services—particularly support services—are designed for women, men often delay coming forward with concerns and find it difficult to access support? Because they still see breast cancer as a women’s issue, they are almost afraid to be open about it.

[Jim Shannon]

As always, the hon. Lady makes an intelligent contribution; I do not mean to say that nobody else does, but she always brings her knowledge of her subject to our debates. I told her beforehand that I looked forward to her contribution, because, as always, it will be full of information we can learn from.

The hon. Lady is right: as the men present will know, we hide our health problems. We do not go to the doctor as often as we should. We just grin and bear it—except in the case of man flu, when we are probably dying almost before it starts. I should not be facetious—that is not right. I am just saying we do not react in the way we should. As the hon. Lady said, when we do go to the health service, the services are not there. We need to address that.

Between 2012 and 2016, an average of 66 women a year were diagnosed with breast cancer in the Strangford constituency. On average, 20 of those women—almost 30%—lost their battle with breast cancer in each of those years. As the MP for Strangford, that puts the issue into perspective for me, but it also tells me that the survival rate is not as good as we would like. The hon. Member for Bexhill and Battle (Huw Merriman) referred to early diagnosis, which I will come to. That statistic represents 20 homes deprived of a mother, a daughter, a sister, an aunt or a friend.

Outcomes vary tremendously among clinical commissioning groups. We continue to lag behind other European countries, such as Sweden, Portugal, Malta, Germany and France, on breast cancer survival. Projections indicate that if current trends continue and we do not address the increase in the number of people diagnosed with the disease, the number of breast cancer deaths will begin to increase within four years. I know the Minister has a cancer strategy in place and is addressing these issues, but perhaps he will indicate what is happening.

Those projections are shocking when we consider how far cancer diagnostics and treatment have progressed. My colleague the hon. Member for North Down (Lady Hermon) told me this week that a good friend of hers—a 42-year-old—has just died from cancer. Again, the reality is pertinent for us all.

I said to the hon. Member for Crewe and Nantwich that these debates always seem to come at the time when we can relate to them best. A very good friend of our family was diagnosed with breast cancer and is going through all the radiotherapy treatment. She has lost all her hair, as so often happens, and wears a scarf. The treatment is quite harsh. She is a friend of my son and the wife, and she works just down the road from us. Her employers have been good with her—they have ensured that she can at least do some part-time work. It is important for people to have something to focus their mind on when things are difficult.

Breast cancer is no respecter of the person. The large number of people affected by it means that even seemingly incremental changes have a huge potential to save more lives. Before I highlight some of the Breast Cancer Now recommendations, let me thank the Library for its work on the excellent briefing for the debate, which outlines the things we need, including public awareness and screening. It states:

“On 2 May 2018 the Secretary of State for Health and Social Care reported to Parliament a serious failure in the national breast screening programme in England and announced an independent review to investigate.”

Again, perhaps the Minister will indicate where we are with that review.

I underline the need for access to breast cancer drugs for people who are going through the most difficult times. We all know it is not just the patient who suffers—their family suffer, too. The hon. Member for Lincoln referred to that in a very personal way, which we all understand. The cancer care strategy refers to earlier diagnosis. One of its priorities is:

“A shift towards faster testing and responding more quickly to patients who present with symptoms. A target that by 2020, 95% of patients referred by a GP will be definitively diagnosed and receive test results within four weeks.”

If we reach that wonderful target, we will certainly be going the right way.

I often say to the hon. Member for Central Ayrshire, (Dr Whitford) who speaks for the Scottish National party, that she genuinely—she knows I mean this—brings a wealth of knowledge to our debates. I also tell her that, in many cases, Scotland leads the way with some of its health strategies and plans. We should look at its cancer strategy, which was published in 2016 and deals with prevention, detection, diagnosis and treatment—and aftercare, too, which is so important.

People who suffer from breast cancer often worry about financial issues, because they have a mortgage to pay and a family to look after, and sometimes the lady is the breadwinner. We must have all those things in place, so I encourage the Minister to look at Scotland’s cancer strategy, which I know the hon. Lady will refer to, probably in some detail. We look forward to that.

The excellent Breast Cancer Now recommendations include: specific lifestyle interventions; optimising the screening programme through increased uptake; strengthening the workforce; introducing new technologies; developing a screening programme tailored to an individual’s risk so cancers may be detected earlier; and reducing variation by reinforcing the position and ambition of cancer alliances. We will do this better if we do it together—I often say we are better together in everything. We can certainly learn from one another.

We should provide long-term funding and look at funding specific CNS posts to support secondary breast cancer patients in trusts where there is not a dedicated secondary CNS. We should ensure access to clinically effective drugs at a price that is affordable for the NHS. Let us have a price system. The Minister knows about the issues with the price structure for some drugs, and I know he is pursuing that matter so we get good drugs at a fair price.

I will take the time to list Breast Cancer Now’s recommendations. Its first priority is to fund

“specific interventions to prevent the 23% of breast cancer cases that are attributable to lifestyle factors in England every year.”

We should address the avoidable cancers.

The second priority is:

“Prevent over 1,200 breast cancer deaths by increasing breast screening uptake from the current decade low of 71.1% to the 80% standard set for breast screening units.”

It is so important to have that in place.

The third priority is:

“Urgently invest £39 million in recruitment to the breast imaging and diagnostic workforce to enable breast services to cope with increasing demand over the next ten years.”

I welcome, as we all should, the Government’s commitment to spend an extra £20 billion on health; it is a step in the right direction and it is quite a commitment.

The fourth priority is:

“Adopt new technologies, such as tomosynthesis and Artificial Intelligence, into the breast screening and symptomatic services as soon as proven effective.”

The fifth priority is:

“Transform breast screening to risk stratified screening to spearhead the prevention and earlier diagnosis of breast cancer over the next ten years based on evidence as it emerges.”

As evidence indicates the trends and how to respond to them, we should make the changes to make that happen.

The sixth priority is:

“Ensure that innovative, clinically effective cancer treatments are quickly available to NHS patients at a price that is fair and affordable, including by reviewing the NICE appraisal methodology.”

The seventh priority is:

“Introduce a Catalyst Fund worth £3 million to incentivise generic manufacturers to make it quicker and easier for patients to routinely access cheap, off-patent drugs found to be effective in new uses.”

The eighth priority is:

“Fund new Clinical Nurse Specialist posts to support secondary breast cancer patients in over 120 Hospital Trusts without a dedicated post.”

Those things can make a difference.

[Dr Whitford]

The hon. Gentleman talks about having a separate secondary breast cancer nurse as opposed to the breast cancer nurses who are involved in the initial treatment, but that is a discussion about local set-up. The hardest thing is to tell a patient, “It’s back.” To have a nurse to support her, who she knows from five or three years ago, is a big contribution. At our hospital, there was a conscious decision not to have a separate nurse—if a patient got sent to her, that would be a bad sign—but to have the nurse they already knew.

[Jim Shannon]

The hon. Lady is right and I accept that we should look at what is being done in Scotland. If there is a better of way of doing something, let us do it that way.

The ninth priority is:

“Improve the Cancer Dashboard by including more detailed data on performance across Cancer Alliance geographies to identify inequalities within and between Alliances.”

The tenth priority is:

“Provide multi-year funding for Cancer Alliances, to increase confidence and encourage long-term thinking to drive investment in innovation, including a dedicated fund to address pathway variation.”

It would be remiss of us all not to thank the charities, which work so hard. We all know them and I will mention just a few I am aware of: Cancer Focus Northern Ireland; CancerCare; and Marie Curie—I met a Marie Curie lady at the Northern Ireland Affairs Committee yesterday. I know Marie Curie’s work because some of my constituents have been referred there in the last month. Its end-of-life care is incredible, as is that of Macmillan Cancer Support.

We need a plan of action and we must have the funding for that plan of action to be put into place. I support so fervently the English reforms that the Minister will put forward, in the hope that the ethos and the funding for my constituents will follow. We are in a different place in Northern Ireland; health is a devolved matter and the responsibility falls under the Northern Ireland Assembly, but it is not functioning correctly at this moment. Men and women need to know that there is a way forward, to ensure that no one dies of breast cancer anywhere in the UK in the not-so-distant future.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I pay tribute to the hon. Member for Crewe and Nantwich (Laura Smith) for securing this debate. I am sorry that it is not more highly subscribed, but it is competing with other debates elsewhere. I also pay tribute to the hon. Member for Bexhill and Battle (Huw Merriman) and particularly to the hon. Member for Lincoln (Karen Lee), whose daughter did not survive. I am sure that that was very difficult for her to speak about; I know she has done so before, and it is very brave of her. I am sure her daughter would be proud.

I declare an interest, which most people know about—I was a breast cancer surgeon for 33 years before coming to this place. Naturally, I am one of the co-chairs of the all-party parliamentary group on breast cancer and I am a Breast Cancer Now ambassador. In my previous life, I was part of its clinical advisory group. In Scotland, I led on developing the quality improvement standards, which we set up in 2000 and which helped to drive up the quality of breast cancer care across Scotland. It was one of the most rewarding periods in my career, because not only did I have the incredible satisfaction that anyone who has worked in the NHS gets from looking after a patient one-to-one—it is an honour to get to do that—but I knew I was contributing every year to cranking up the standards across the country. We have annually gathered peer-reviewed data right back to 2003. It has been great to see that driven up.

The subject of the debate is the future of breast cancer, but being such an old, crusty breast cancer surgeon, I could not resist talking a little about where we have come from. When I started as a medical student, the five-year survival rate was 53%; now, it is more than 80%. That is the journey we have made—a huge journey for the patients, too. It just so happened that my first job on qualifying, and the first three units that I worked in over my first three years, were breast cancer units. I learned so much from the patients on the ward.

Those were the old days, when my light week was 75 hours and my heavy week was 132 hours. My bedroom was on the ward, so I had my tea with the breast ladies. I learned so much about what they hated: people undressing them and not covering them up while starting to talk about them; people talking over their heads. I watched women come back from theatre on a trolley, groping themselves—if they had a lot of bandages and a drip, that meant it was cancer, because the diagnosis was done at surgery. They took out the lump; it went to the lab; they looked at it; they phoned the theatre; and the woman had a mastectomy. No breast care nurse, no pre-operative diagnosis, no discussion and no plan.

There were no women surgeons in Scotland at that time; I remember one of my professors saying, “You should do breast surgery.” I thought it was a bit clichéd for a woman surgeon to do breast surgery, but I looked at my three years’ experience and I thought that the experience of those women was so awful that I could not do anything other than make it better. We have transformed that. By the mid-’80s, we were able to diagnose it at a clinic. Lots of breast surgeons were still not interested in having breast care nurses, but I was involved in the research in Glasgow into the critical need for social and psychological support for women who were going through that journey, looking at the impact of mastectomy on women.

Eventually, we learned that we are kind of not stupid. We are not stressed just because we lose a breast, but because we have cancer; we have kids and we want to see them grow up. We understood that there are two sides that create pressure on women: the change to their body image and the simple stress of the disease, and how to support that. We offered reconstruction; eventually, we moved from mastectomy to preserving the breast when we could. We also know that to support a woman psychologically is to be utterly and completely honest—not to be cruel or rude, but utterly honest. If a patient is lied to, whether by a doctor or family member, that creates a barrier. I have always tried to be utterly and totally honest about what we are facing. We should be part of the patient’s team.

In the late ’70s, tamoxifen came in. Scotland did a lot of the research on that and it looked like it did not make a big difference, until they started doing what we now call meta-analysis—putting a lot of studies together and realising that all the little gains were adding up to an awful lot of lives saved. That has been borne out. There is no magic wand that will get rid of breast cancer; it is about early diagnosis, detailed diagnosis, good surgery, good radiotherapy, good chemotherapy, good hormone treatment and good immunotherapy.

We are talking about the future of breast cancer, and genomics and personalised therapies are in all of the briefs. Tamoxifen was one of the first personalised therapies for a solid tumour to come into existence because it worked only for patients with hormone-sensitive cancers: by testing that tumour, we could tell whether tamoxifen would work. As part of the trial way back in the 1980s, the University of Glasgow did a huge amount looking at how we could test to see whether a cancer was hormone-sensitive. We now do it in a much more efficient way, which is much less time-intensive. Of course, Herceptin, which we discussed so much in the 2000s, works only on patients who carry the human epidermal growth factor receptor 2 marker that makes them sensitive to that drug. We already have that personalised medicine, and a test for it.

My MD thesis was in breast cancer immunology. I utterly believe that immunotherapy will dominate the future of cancer treatment because it is so much better tolerated than chemo and often has a much bigger impact. However, the antibody that became Herceptin was discovered in the second half of the ’80s, when I was in the lab—not that lab, but it was the talk of the steamie because it was an utter breakthrough for everyone studying cancer immunology. That drug went into general trial in 2001. In Scotland, we got access to it routinely on the NHS in 2006, and down here, south of the border, it was the following year—20 years from the bench to routine access. That is one of the challenges we will face in the future.

New treatments have come in, including many in the ’90s, with newer chemotherapy in the form of taxanes, new endocrine treatments, better surgery and better staging. All of that has added up to get us over the 80%. However, as was mentioned, our rates are below the European average.

I remember seeing an interesting paper that compared the UK with Denmark: in all the lower stages and less aggressive diseases, the UK held its own comfortably, particularly because way back in 1988 to 1990 we were one of the early adopters of breast screening whereas other European countries came on only in the second half of the 2000s. However, for the people with really aggressive or advanced disease, we were not matching up. That simply comes back to drug access.

We may get the drug discovered. Scotland plays a significant role—we punch above our weight—within life sciences research in taking things forward and finding new drugs. However, I can say, as one who was routinely involved in trials for years, that it is really demoralising to take on all that extra unpaid time to do the paperwork, sit and explain trials to patients only to find that, as soon as that drug is passed and licensed, we do not get access to it any more.

That is one of the challenges. We are talking about all the amazing new treatments that may come over the hill, but we need to look for an utterly different way of trying to bring them onstream and make them affordable for the NHS. We need a different discussion with the pharmaceutical industry. In exchange, we can offer not personalised data but real-world information thanks to having a joined-up national health service in each of our four nations while many other systems in Europe simply do not. Similarly, our cancer registries are highly accurate.

We face challenges in the future; it is not just that magical treatments will come. Access to drugs is important—and not just new ones. As the hon. Member for Crewe and Nantwich said, there are off-patent drugs such as bisphosphonates, which are cheap in the scale of things, yet only one in five commissioning groups in England are funding that. In Scotland, it is funded in all health boards—my unit took part in that trial.

The idea that something that protects against bone metastasis or strengthens the bones of those driven into the menopause could prevent the spread of breast cancer in all patients was fantastic. In comparison to all the treatments we use, and the one we would use if that patient were to develop metastasis, frankly the cost-benefit is very positive. That should be driven up in England and made routinely accessible. As the hon. Lady mentioned, the report that looked at variation across England showed shocking postcode prescribing.

One of the biggest challenges we face in general in the NHS right across all four systems is workforce. I mention it all the time. It is a challenge in every single NHS specialty, but we have a particular issue in breast cancer and a particular problem in radiology—the mammographic or MRI scanning diagnosis. Many of the consultants who went into breast cancer when screening was developed all became consultants around the late ’80s and early ’90s, and they are all retiring. We are losing a huge cohort, and apparently for every three that retire only two are lined up to replace them. Less than one in five breast screening units report having a full cohort of staff.

Patients cannot be treated in any way if they have not been diagnosed. The issue that led to patients not getting called at the end of breast screening, referred to by the hon. Member for Strangford (Jim Shannon), was partly because of slippage. If those patients had been screened on the correct date, they probably would have been called correctly, but because they slipped past the ages of 70 or 71 without being called, they missed their appointments.

We need to look at that problem, and that includes promoting this specialty. I spent 33 years in it. Yes, sometimes other surgeons are patronising about breast surgery—maybe it is not quite exciting enough for them; there is not enough blood on the floor or enough glamour—but it is one of the most holistic surgical specialties. We look at how to support the patient to recover, getting them back to normal life through exercise, integrating them into their community, providing support groups and having cancer nurse specialists. It is important that those of us in the specialty or who have been in it reach out and attract our younger colleagues to think of it as a life’s job. Cut me through the middle and it’ll still say breast cancer doctor, not MP, and that will never change.

Finally, we do not give remotely enough attention to prevention. The same things that prevent breast cancer will prevent bowel cancer, lung cancer and so many others. The public sometimes get so many conflicting messages, so they go, “Do I drink coffee or not? Do I use a roll-on deodorant or not?” I always say, “There are only five things you need to think about. Don’t do drugs and don’t smoke. If you don’t do either of them, you’ve only got three. They are: keep your booze under control, because we know that contributes directly to breast cancer; watch your diet, because we know that fats and saturated fats in particular contribute to a rise in breast cancer; and be active and healthy.”

If we were to focus much more of our attention on that handful of things that people should do, we could look at reducing the incidence of all of those cancers, whereas they are currently rising. Instead of thinking about hundreds of thousands of pounds at the end of someone’s treatment journey to try to buy another half a year or a year, why do we not try prevention in the first place?

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is a pleasure to serve under your chairmanship, Mr McCabe. I thank my hon. Friend the Member for Crewe and Nantwich (Laura Smith) for leading this timely debate during Breast Cancer Awareness Month and for her excellent speech. It is timely because it is on the same day as Baroness Jowell’s moving memorial service, which I attended prior to this debate. I will say more about why that is relevant later.

I also thank other hon. Members for their excellent contributions—the hon. Members for Bexhill and Battle (Huw Merriman), for Strangford (Jim Shannon) and for Central Ayrshire (Dr Whitford), and my hon. Friend the Member for Lincoln (Karen Lee). I also thank the amazing campaigners, ambassadors and charities, especially Breast Cancer Now and Breast Cancer Care, for their unswerving support to us as politicians campaigning on the issue, but more importantly to the women, men and families who are living with breast cancer, before, during and after treatment.

As we have heard so movingly today, so many of us, especially those here today, have had our lives touched by breast cancer. I lost my mother-in-law to breast cancer 21 years ago—I have spoken about this before—and that is what inspired me to join the all-party parliamentary group on breast cancer when I became an MP. As the hon. Member for Bexhill and Battle so astutely spotted, I served as co-chair of the group, with the Minister and the hon. Member for Central Ayrshire, and I still serve as the vice-chair. That shows how close breast cancer is to the heart of the health spokespersons of each party and how important it is to work in a cross-party, collaborative way on such an important issue.

More women are surviving breast cancer than ever before. Around 95% of women will survive for one year and more than 80% survive for five years or more. However, the UK still lags behind countries such as Sweden, Portugal, Malta, Germany and France. It is clear that more must be done. Many different issues have been mentioned, but I will specifically talk about breast screening, the workforce and prevention, which others have touched on.

We all know how important early diagnosis is to improving the chances of survival. Breast cancer screening has a huge part to play in this, yet uptake is the lowest it has been in ten years, with stark variations across the country. According to Breast Cancer Now, increasing breast screening uptake from the current decade low of 71.1% to the 80% standard set for breast screening units could prevent over 1,200 breast cancer deaths per annual cohort of eligible women. Will the Government be taking steps to increase breast cancer screening, so that over 1,200 breast cancers deaths can be prevented each year?

The Prime Minister’s commitment as part of the NHS long-term plan to see three out of four cancers detected at an early stage by 2028 included a plan to make screening programmes more accessible and easier to use. Can the Minister elaborate on those plans? Will they include outreach services to groups who are less likely to attend screenings, such as those from certain demographic groups or those with learning disabilities?

Earlier this year it was announced that there had been a serious breast screening invitation error, which meant that over 10 years more than 174,000 women did not receive an invitation to their final breast screening appointment. A review into this error is expected to be published next month. Can the Minister provide an update on that review and is it expected to report on time?

Every year over 55,000 people in the UK are diagnosed with breast cancer, but the failure to address those increasing numbers means that, according to Breast Cancer Now, the number of breast cancer deaths is set to rise within four years. That is why pressure on the workforce needs to be addressed as a matter of urgency. Demand on the breast imaging and diagnostic workforce is set to increase over the next 10 years. We already have a workforce crisis with growing demand, but the problem is only going to get worse if it is left unaddressed. For every three breast radiologists who retire over the next five years, only two are expected to replace them. What plans do the Government have to deal with the growing pressure on an overstretched workforce?

Leaving the EU could also have an impact on our NHS workforce: 5.6% of the NHS workforce in England are from the EU. Changes to immigration rules may exacerbate existing workforce problems for breast cancer patients, particularly among the nursing workforce. Can the Minister provide any clear guarantees to EU citizens working in our NHS? What steps is his Department taking to ensure that the UK continues to attract nurses from the EU?

The current cancer strategy for England includes a recommendation that all patients diagnosed with cancer are supported by a clinical nurse specialist, but this support is not widely available. We heard from my hon. Friend the Member for Lincoln how devastating that is and what it means in reality, when she talked about her experience with her daughter. That support is not available to the majority of the 35,000 people in the UK living with secondary breast cancer. Nearly 72% of hospital organisations in England, Scotland and Wales do not have a dedicated secondary breast cancer clinical nurse specialist. I share Breast Cancer Care’s belief that incurable should not mean unsupported. Does the Minister share that belief and what steps will he take to close the stark disparities and support between primary and secondary breast cancer patients?

[Dr Whitford]

The hon. Lady has recognised the comment I made earlier, that our patients all have the support of a cancer nurse specialist, but they do not have a title of secondary nurse specialist. That is something that requires looking into in more detail, so that we can identify places where there really is no support versus places where support is linear, and the decision has been made to follow patients through their whole journey rather than make a decision on a title.

[Mrs Hodgson]

That is an important point and the model that is used in Scotland should perhaps be looked at. I took on board the hon. Lady’s point, when she said that patients who are assigned a secondary breast cancer nurse know what that might mean, whereas if it were someone who had been with the patient on their whole journey, that would be a different experience.

[Dr Whitford]

It varies in Scotland. We are a huge and rural country, so we will have some areas where there is a cancer nurse specialist and, for example, islands where there is someone who has the training to act in that role. In Glasgow and Edinburgh there may well be nurses who are different. It was a decision that we took as a team, as we felt it would be hard on the patients to suddenly move to someone new. It is also hard to sustain the nurse, if they are only ever involved in that part of the journey and do not have other days when they see patients get discharged, be well or be diagnosed.

[Mrs Hodgson]

The challenge to the Minister is whether improvements to the breast cancer workforce will include recruiting and training additional secondary breast cancer nurses, clinical nurse specialists—whatever we may decide to call them—so that patients have the vital support they need and no one has to witness their loved ones suffering in agony, with only over-the-counter painkillers to ease the pain, as my hon. Friend the Member for Lincoln so bravely testified to earlier.

--- Later in debate ---

[Steve Brine]

Oh yes; the hon. Lady has already said Chancellor today. I am not sure about that one.

As the cancer Minister, I want a future where there is no breast cancer. The hon. Member for Strangford (Jim Shannon) mentioned that, and I think all hon. Members who have contributed this afternoon would like to see a future where there was no breast cancer. One day, perhaps—but the statistics show that we are making good progress. That is why I said that there are things to celebrate. We are ensuring that more people than ever survive breast cancer. As has been said, 10-year survival rates have almost doubled, from around 40% to nearly 80%, in the last 40 years.

I hope I do not need to say it, but cancer is a huge priority—the priority—for me. The Prime Minister chose to make it a central point of her party conference speech this month, and there was a reason for that; it is a huge priority for her and for her Government. Survival rates have never been higher, and they have been increasing year on year. Of course the Prime Minister celebrates that, but it is also why she announced a very ambitious package of measures for cancer care and treatment, showing that cancer will be absolutely central to the long-term plan for the NHS, which she has challenged NHS England to write before the end of this year and of which I will say more later. We are committed to investing an extra £20 billion a year in our NHS. The investment will build on the success we have already achieved through the implementation of the cancer strategy for England. I pay tribute to Harpal Kumar and those at Cancer Research UK who put that strategy together. We will build on that legacy and take it forward into the long-term plan.

In opening the debate, the hon. Member for Crewe and Nantwich raised a number of good points. She talked about secondary breast cancer data collection—a number of people did so, but she raised it first. She is right that the robust and timely collection and sharing of data is vital for improvements in breast cancer services. If we do not measure it, we do not know, and if we do not know, we cannot act. The National Cancer Regulation and Analysis Service, or NCRAS, collects data on all cancers diagnosed in England, with the data collection specified by the cancer outcomes and services dataset. That data collection of secondary breast cancers was mandated as part of the COSD for diagnoses from April 2013 onwards.

I remember, with my shadow Minister, taking a delegation to see Prime Minister David Cameron in No. 10 to talk about that exact issue just before Christmas; I remember our photo by the tree. It is good that that happened, but it is evident, comparing the collected data with sources in academic literature, that a large proportion of cases are still not being reported in the COSD. That is of great frustration to me. NCRAS continues to work with NHS trusts to improve the completion of the data, and we have redesigned aspects of the COSD to allow more relevant information on occurrence to be captured, but I do not for one minute shirk the fact that there is more to do in this area, and I assure the House and colleagues that I will constantly redouble my efforts in that regard.

[Dr Whitford]

I touched on the quality improvement project that we started in 2000 in Scotland, looking at many measures right along the pathway that the patient went through. In essence, it was assessing the whole team: how the team functioned, what the surgery was like, what the diagnosis was like and what the chemotherapy was like. The problem is that that sort of audit has not happened, other than for screening patients, in England for quite some time. While I welcome the collection of data on secondary cancer, we need units to have the ability to look at their performance on patients the first time around, to try to prevent that secondary cancer.

[Steve Brine]

The hon. Lady is right. That is why COSD stands for the cancer outcomes and services dataset. It is not specific to breast cancer, nor should it be, because there are sadly lots of different cancers, but she is right that it should be measuring, judging and analysing both the outcomes and the services that lead to that outcome. As ever, she is dead right.

The point was made about off-patent drugs being found to be effective in new uses. The Prime Minister set out, both in her party conference speech and when we launched the new NHS long-term plan, how a key ambition of that plan will be to speed up access to groundbreaking treatments, with a quicker translation of new breakthroughs into practice through investment in world-leading cancer research centres.

Although bisphosphonates—I always struggle to say that—are not licensed for the treatment or prevention of secondary breast cancer, clinicians can prescribe them off-licence or off-label, subject to local funding policies, if they consider them to be clinically appropriate for an individual. The hon. Lady was right to raise that point.

[Dr Whitford]

Will the Minister give way?

[Steve Brine]

Not at the moment. The hon. Lady and others also talked about the long-term funding of cancer alliances. NHS England and I are absolutely committed to the cancer alliances. We have backed them with significant funding and we will continue to support their development fully, ensuring that they have the funding that they need—in this cycle, at the very least—to transform cancer services in the long run.

I take a close and continued interest in the cancer alliances, as Members would expect. Just this week, I sat down with Cally Palmer, the NHS England’s national cancer director, to do what I call a deep dive, going through each cancer alliance in England. I want to know who runs them, where there are leadership challenges, where they struggle to meet the 62-day target and why, and I want to know their turnaround plans for that, including replacing people who are not performing. We do not expect or accept poor performance in a trust, and we do not expect or tolerate it in schools. Cancer alliances spend a lot of public money and they should not be treated any differently.

I want much greater transparency from the cancer alliances. I suspect that if I asked every Member here whether they knew the name of their local health trust chief executive, they would say that they did—and they probably have them on speed dial, as I do. If I asked those Members whether they knew the name and number of the person who leads their cancer alliance, I doubt that they would. I assure Members that that will change.

[Dr Whitford]

Bisphosphonates and other off-patent drugs are usually old drugs, which ought to be cheaper and therefore very cost-effective. The Minister and another Member mentioned that these drugs are not relicensed. A private Member’s Bill to set up a method for relicensing drugs for a new purpose was unfortunately talked out by the then Minister, the right hon. Member for North East Bedfordshire (Alistair Burt), in November 2016. We have agreement that these drugs will go into the “British National Formulary”, which will hopefully increase their use. However, I notice that the shocking increase in prices of off-patent drugs that led to the introduction of the Health Service Medical Supplies (Costs) Act 2017 has not changed. The regulations are not being used. NHS England is being charged ridiculous prices for old drugs and for specials that are made up for individuals. Why are we not using that legislation to drive down those prices, so that all women in England could access drugs that are not—or should not be—actually that expensive?

[Steve Brine]

There is so much more that I want to get on to, so I will not go into that in any great deal, but I will give the hon. Lady a note on that. Lord O’Shaughnessy, who is part of the Department’s drugs team and who speaks on health in the other place, is working on the implementation of that legislation. The hon. Lady has asked me about this before, and it frustrates me incredibly that that Act is not being implemented more quickly, but that should not be taken as any indication of a lack of desire on our part to do so. However, I take the hon. Lady’s point.

It is still right for those prescribing decisions to be made by clinicians. However, I want breakthrough drugs to make it on to the market more quickly, instead of staying in the cancer drugs fund. There are good examples of that related to breast cancer, and we want to see it happen much more quickly.

My dear hon. Friend the Member for Bexhill and Battle (Huw Merriman) spoke personally and passionately —as always—about these matters, and I thank him for that. He raised lots of issues, including the screening programme. Everyone says that the breast cancer screening programme is a critical tool in ensuring that we catch breast cancers as early as possible, when there is a higher chance of successful treatment. However, we know that there is much more to do to improve uptake. In her party conference speech, the Prime Minister set out that we would transform our screening programmes, making them more accessible and easier to use and utilising the best research and technology. Further detail on that will be set out in the long-term plan later this year.

My hon. Friend also asked about technology in screening. I will come on to the screening scandal in a moment, but it is very much our aim that in the future patients will be able to make much greater use of technology to be informed of things, such as GP or screening appointments, rather than relying on Royal Mail. Our NHS app is being piloted and will be rolled out from December this year. That is just the start of the technology revolution that we want to see and that the Secretary of State has made one of his priorities. We expect the independent breast screening inquiry to make recommendations in that area.

Several Members asked about the inquiry into the breast screening problems that we had. We expect that to report shortly. I do not have an expected date, but several Members, including the hon. Member for Central Ayrshire and the shadow Minister, asked whether it is on schedule. I believe that it is, and I look forward to that report very much. With somebody as serious as the Macmillan chief executive leading that review, alongside others, I know that it will challenge us, as it is meant to; the former Secretary of State set it up to do so.

My hon. Friend the Member for Bexhill and Battle mentioned the importance of early diagnosis. I am proud of Public Health England’s Be Clear on Cancer campaign, which I am responsible for. PHE ran its 14th Be Clear on Cancer campaign through February and March of this year, focusing on breast cancer in women aged over 70—a subject that is very close to the hearts of members of the APPG. Research shows that older women are more likely to delay presenting to their GP with breast cancer symptoms.

The campaign previously ran in 2014 and 2015, and an evaluation showed an increased awareness of the key messages that it promoted and, even more importantly, that more cancers were diagnosed during the campaign period. We are running the “Blood in Pee” campaign at the moment—I have all the glamourous things in my portfolio—and Be Clear on Cancer will go forward and from strength to strength.