Breast Cancer

Debate between Philippa Whitford and Sharon Hodgson

Thursday 18th October 2018 Westminster Hall

[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.

Accelerated Access Review

Debate between Philippa Whitford and Sharon Hodgson

Tuesday 13th December 2016 Westminster Hall

[Mrs Hodgson]

My hon. Friend is right to raise those concerns. We do not want to move into a new system that will create new unintended consequences. Perhaps the Minister will touch on that in his speech.

Although some are calling for interim solutions to help people who are stuck waiting for the accelerated access review’s recommendations to be implemented, it is also important that the Government get on with implementing those changes. The review was announced more than a year ago and was published two months ago now. It is important to remember that the transformation that we all want to see will not happen straight away, but it is still right that we keep up the pressure for the recommendations to be implemented. There are many such recommendations, and I hope that the Minister will be able to update us today on the progress on each of them. There are two in particular that illustrate what can be done to resolve the deadlock around Orkambi—the immediate establishment of an accelerated access partnership and the setting up of a new flexible strategic commercial unit.

The accelerated access partnership is one way in which, through co-ordination and collaboration across the system, we could see drugs brought on to the market more quickly to benefit patients who need access to them. I would be interested to hear from the Minister what progress has been made on its creation, especially in conjunction with the issues surrounding the deadlock on Orkambi.

It is clear that the strategic commercial unit could help to benefit those who wish to see Orkambi offered on the NHS. The unit could work with those involved in this dispute to end the current deadlock through facilitation of the flexibility and transformational change promised by the accelerated access review. That would go some way towards helping to access data on drugs such as Orkambi and getting them out to patients. There is a willingness out there for that flexibility to be brought into the system; for example, the Cystic Fibrosis Trust has offered to use the UK cystic fibrosis registry to help to provide essential data that can help to prove how effective drugs can be and what more needs to be done. We have already heard how substantial that registry is; it includes 99% of sufferers. I understand that the trust’s offer has been welcomed by all sides in the negotiations but is blocked due to the lack of progress in implementing the changes set out in the review. I hope that the Minister will give us some clarity on when the unit will be created and when we can see a culture shift within the system that will allow for flexibility to accept data and information that show how much effect these drugs have on people’s lives.

[Dr Philippa Whitford]

Does the hon. Lady share my concern about drugs for other conditions, such as sofosbuvir for hepatitis C? Even after they get NICE approval, those more expensive drugs are now being rationed at the NHS England stage. At the moment we are fighting to get through NICE, but it needs to be a smooth path all the way through.

[Mrs Hodgson]

The cost of drugs sometimes leads the NHS into the terrible and unfortunate situation in which rationing seems to become the norm. There can also be a postcode lottery, which is another element that we need to look at. The price of drugs really is the crux of the issue.

In conclusion, I hope that the Minister will offer some insight into the progress being made on the recommendations of the accelerated access review. The case of Orkambi can help to drive through these changes and to end this deadlock, which, as we have heard, is causing unnecessary suffering for those living with cystic fibrosis. The review has established a space for change and for patients to access new and innovative drugs and treatments. It is important that there is no stalling or delay in transforming the system, because people’s lives depend on the changes called for by the review. I am sure that the Minister will keep that in mind when he goes back to his officials.