Cancer Strategy

Rebecca Harris Excerpts

Thursday 8th December 2016 Commons Chamber

[Rebecca Harris (Castle Point) (Con)]

I should like to add my words of thanks to my hon. Friend the Member for Basildon and Billericay (Mr Baron) for securing the debate. I very much regret the circumstances that mean he cannot be here today. It is unusual to be having a debate on cancer without him, as he works diligently on these matters. I send him my best wishes.

As chair of the all-party parliamentary group on brain tumours, I very much welcomed the new cancer strategy that was announced in the Chamber just over a year ago, and I am delighted that we have this opportunity to scrutinise it again now. I congratulate the Government on their focus and their direction of travel, and on the fact that survival times are constantly going up. We are absolutely going in the right direction, but like all hon. Members, I want to push the Government to go further, particularly in relation to brain tumours.

We heard earlier from my hon. Friend the Member for Crawley (Henry Smith) about the difficulty of early diagnosis of blood cancers and from the hon. Member for Scunthorpe (Nic Dakin) about pancreatic cancers. Early diagnosis, about which we hear time and again, is also a problem with brain tumours. People are often turned away by doctors and the cancer is found at the last moment. The hon. Member for Poplar and Limehouse (Jim Fitzpatrick) spoke about prevention, but unfortunately we think that only 1% of brain tumours may be preventable, so it is not really an area of exploration for us.

For patients with brain tumours, the only hope of a cure is through research and innovation into the many types of tumour. While such tumours represent just slightly under 3% of all cancers, they are the biggest killer among cancers of children and people under the age of 40. As for years of life lost, it is a devastating disease. Surprisingly, just 1% of the national cancer spend has gone into research into this area of cancer since 2002, which is clearly an injustice for those suffering from brain tumours and is why survival times have not been improving. Brain tumour research remains perennially underfunded, which was highlighted by the excellent Petitions Committee report—its first ever—into brain tumour research funding and the fine Westminster Hall debate. As a result, the Government set up a “task and finish” working group, for which I am extremely grateful. I look forward to the work that that brings forward, but we are not there yet and more must be done.

From reading the NHS’s “One year on” progress report, it appears that there has been much focus on meeting the clinical service recommendations set out in the original strategy. That should be welcomed, but there has been rather less focus on the research and innovation recommendations. While I recognise the importance of clinical services and their potential to improve outcomes in the diagnosis, treatment and care of people affected by brain tumours, we need equal, if not more, focus on research and innovation into potential cures. To that end, I have a few observations to make about several of the research points in the progress report and how realistic they are for patients with brain tumours and about research into the disease.

The report mentions a focus on modernising radiotherapy services and embedding research in the latest investment. Given the location, brain tumour radiotherapy comes with complex side effects, including increases in cranial pressure for some patients, alongside the more common side effects. More precise stereotactic radiotherapy is welcome, but it still does not represent a cure for many brain tumour patients, only an extension of life. The report states that a key 2020-21 metric is an

“Increase in five and ten year survival, with 57% surviving ten years or more”.

However, Brain Tumour Research’s latest report on national research funding, released in October, shows that five-year survival for brain tumour patients is a mere 19.7% in England, lagging far behind other cancers. With a one year survival rate of 46.5%, which is well below the NHS’s 2020 target of 75%, the NHS looks set not to meet its own key measure on brain tumours. In doing so, it is letting down brain tumour patients.

A key paragraph from the NHS progress report states:

“Although a commitment has been made, NHS England has yet to publish its 2016/17 research plan, leaving the NHS without an up-to-date strategy for research. Now that the Accelerated Access Review has been published, we hope that the NHS England research plan is also delivered without delay.”

That appears to be an admission of prioritising other objectives over research. Clinical services are important in the here and now but without proper planning and investment into medical research, ongoing improvements in health outcomes of many diseases will not be realised, and brain tumour patient outcomes will continue to stagnate when compared with other cancers. I welcome many aspects of the progress report, including the launch of a new integrated cancer dashboard to ensure greater analysis of patient outcomes in local areas. I would be grateful to know whether phase 2 of the dashboard will include data on brain tumours, as they do not appear to have been collected in phase 1.

The launch of the national “Be Clear on Cancer” campaign will also hopefully lead to faster diagnosis of cancer for all patients. However, Brain Tumour Research’s latest report shows that, according to the National Cancer Research Institute, the Government spend on brain tumour research represents just 0.52% of its total spend on cancer. It is clear that brain tumour research continues to be drastically underfunded, even with the cancer strategy in place. Therefore, although the strategy is a major step in the right direction, it will need to be made to work for all types of cancer, including the rarer ones and, in particular, brain tumours. Every week, a family loses a child to brain tumour and, as with many cancers, the incidence of brain tumour is rising. I very much hope that that will be taken on board by the new Minister, and he will hear more from me in future about the need to increase brain tumour research.

[Bob Blackman (Harrow East) (Con)]

Thank you for calling me in this debate, Madam Deputy Speaker. It is always a pleasure to follow my hon. Friend the Member for Castle Point (Rebecca Harris), and one benefit of this type of debate is that we learn something that we did not know before. I, too, congratulate the hon. Member for Scunthorpe (Nic Dakin), who introduced the debate. I know that he has been a doughty campaigner, particularly on behalf of pancreatic cancer sufferers, since we were both elected, and the way he introduced the debate was fitting and appropriate. I also pass on my best wishes to my hon. Friend the Member for Basildon and Billericay (Mr Baron) and his family at this difficult time. It is a surprise not to see him in this Chamber for a debate such as this, but we understand the circumstances.

I want to start by paying tribute to Greg Lake, the rock star who, sadly, died yesterday after a long battle with cancer. To me, he was one of the icons. He founded King Crimson, and one of the first albums I bought was “In the Court of the Crimson King”. He then went on to form the supergroup Emerson, Lake and Palmer, and he also produced the iconic hit “I believe in Father Christmas”, which we hear at this time of year. I want to put that on the record because it is appropriate that we remember that people are suffering and dying as a result of cancer literally every day.

I declare my interest as chair of the all-party group on smoking and health, and I note that the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) raised a number of the issues set out in the briefing that has been circulated quite widely. I want, however, to build on some of the things that have taken place. One of the key recommendations of the UK cancer strategy, which was founded not a year ago, as the title of this debate suggests, but 18 months ago, was that the replacement tobacco control plan should be published within a year. The last tobacco control plan expired a year ago, and we were promised a replacement in the summer. I know that “the summer” can stretch, but stretching it to Christmas is a bit of a long stretch. We recently had an excellent debate in Westminster Hall, where we briefed the new Minister, the Under-Secretary of State for Health, my hon. Friend the Member for Oxford West and Abingdon (Nicola Blackwood), on all the key issues relating to tobacco control. She promised that the new plan would be published soon, and she did so again when I raised it with her at Health questions. It will not surprise today’s Minister to learn that the one thing I have to ask is to be given a date for the new plan—he should not tell me, “Soon”.

I now come to a significant fact. The Prime Minister said in her first major speech, on the steps of Downing Street, that she would be

“fighting against the burning injustice that, if you’re born poor, you will die on average nine years earlier than others.”

Smoking is responsible for half the difference in life expectancy between rich and poor in this country, so if we can cut smoking rates, we will help deliver the Prime Minister’s ambition. I ask the Minister to make sure that we get this tobacco control plan as quickly as possible.

We know that smoking is the greatest preventable cause of cancer worldwide. It accounts for more than one in four cancer deaths in the UK and for a fifth of all cancer cases. Smoking increases the risk of getting 14 other cancers and is responsible for more than 80% of cases of lung cancer—the cancer that is the biggest killer in this country. It also has the worst five-year survival rate. Therefore, from that perspective, if we can cut smoking, we will cut the causes of cancer.

I wish to declare an interest in this matter. As I have said in this place on more than one occasion, both of my parents died, in 1979, of smoking-related diseases. They both died of cancer because they smoked virtually every day of their lives. I heard the hon. Member for Poplar and Limehouse say that he gave up in 1980. I still remember those terrible days when my parents died, and I want us to get to a position where no one has to suffer what my family and I had to suffer.

[Rebecca Harris]

Does my hon. Friend agree that those Members who said that we should not bring in a ban on smoking in cars with children because it was unpoliceable may now regret that? Children are policing that measure very well indeed.

[Bob Blackman]

When the change in law came through, a number of people objected to it, saying that it would not be enforceable. I remember back to my childhood when both of my parents were smoking in the car in front of me. It was difficult then as a child to say, “Please, will you not smoke, because I do not like it?” It was just easier to open the window. I do not want children to go through that. It is right and important that we changed the law in that way, as we know that second-hand smoke is a key killer of young lungs. It was a significant development—and a development that people did not think would happen. People did not think that we could introduce this change and get it through both Chambers, but I am delighted to say that we did it and that it was the right thing to do.

--- Later in debate ---

[Jo Churchill (Bury St Edmunds) (Con)]

I, too, thank the Backbench Business Committee for allowing this debate. I also thank the hon. Member for Scunthorpe (Nic Dakin) for the way he introduced it, which has allowed us to conduct it in the tone that we have.

I came to this place after a journey with this disease, but I have been amazed since I have been here. The hon. Member for Bristol West (Thangam Debbonaire) has fought the disease and now sits back in her place, and very welcome that is. The news about the hon. Member for Blyth Valley (Mr Campbell), too, is welcome. I have heard my hon. Friend the Member for Lichfield (Michael Fabricant) talk about his journey with the disease. My best wishes go to my hon. Friend the Member for Grantham and Stamford (Nick Boles), who is on the journey at the moment. It is unusual not to see my hon. Friend the Member for Basildon and Billericay (Mr Baron) in the Chamber, and my thoughts and prayers go out to him and his wife at this time.

Cancer is interesting: you don’t pick it, it picks you. We have heard from many Members that some cancers are preventable, but there are over 200 cancers. The debate often gets channelled towards rare diseases or prolific diseases such as breast cancer, prostate cancer or lung cancer—one of the big four. However, the debate we have had today is very broad, and I welcome that.

My hon. Friend the Member for Bosworth (David Tredinnick) said we are doing better, which we are, but we could do even better, and I would like to return to the issue of research, which was brought up by my hon. Friend the Member for Castle Point (Rebecca Harris), to see how we might do better there.

I welcome the commitment to the strategy. Implemented, it could be transformational, which is why I hope we will hear about better implementation. The “Five Year Forward View” shows that funding for cancer services will go up by 9%, reaching £13 billion by 2020-21.

As we have heard, one in two of us will suffer from cancer by the end of this Parliament, and 2.5 million people in this country are living with the disease. A question the strategy does not necessarily address properly is how we will care for those people. How will we deal with the survivors affected by it—625,000 people will be, as was mentioned earlier—who will carry forward some form of disability or hardship from having the disease? How will we deal with palliative care? Have the sustainability and transformation plans looked into palliative care and how we can address the needs of people who are looking towards the end of their lives?

I would also like to highlight teenage cancers, although it is usually breast cancer that I talk about in this place. I have a young friend for whom a year on means something different. She wrote to me on Sunday, after I said I was talking in this debate. I thought of her because, on 11 December last year, young Emily was diagnosed with cancer.

She said:

“Last year in December I was diagnosed with ALL Leukaemia. It was a very scary time for me and my family. But something that makes going to hospital that little bit nicer is how lovely the nurses are.

However, there were a lot of horrid bits during the start of treatment, such as hair loss and sickness.

Although, I still have two years to go of treatment to go on treatment, it is a lot less intense now I am in maintenance. The majority of chemo is in tablet form at home, one hospital visit a month and the HORRID, HORRID steroids, also once a month for five days!

I know that the steroids work as one of the main chemo therapy treatment - but they make me put on weight, feel emotional for no reason and sometimes cross and angry at my mum, who is my absolute rock and is always there for me, so that makes me feel very sad!

If I could change anything about the chemo it would definitely be; to not feel sick and not take steroids!”

Emily is a year on in her journey. I am sure I can speak for everybody in wishing her lots of success for a great journey.

One of the best things we can do for young people is to educate them. Education is a theme that has come out of this debate. I will not go over the comments by my hon. Friend the Member for Harrow East (Bob Blackman) and the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) about smoking, which they discussed so well, but merely say that education in that regard is important. Nor will I go over education around food and nutrition, which, as we have heard, is worked on by the Penny Brohn institute and The Haven.

The hon. Member for Strangford (Jim Shannon) mentioned diet. Every oncologist I have ever had through all three of my journeys has spoken about the need to look after oneself through a good diet, keeping fit and exercise. We do our young people a disservice if we do not help them to lead better and healthier lives. I want to understand how the Minister is looking across Departments to make sure that this is addressed in the policies of the Department for Communities and Local Government and the Department for Transport through cycle paths, trim trails, and right across the piece so that we can all lead healthier lives.

I am pleased that the industry is responding by reducing adverts for children and so on, and I would like this to go further, but parents have a huge part to play in their children’s lives. We have a huge part to play in our own lives with regard to what we eat and how we make choices about whether we smoke or have that extra beer or extra pie. There is some self-responsibility involved. If the Minister will do his bit by helping to educate people a little more through public health information, I am sure that we will step up to the mark and do our bit as well.

I welcome the setting up of cancer alliances and the appointment of Cally Palmer, the excellent head of the cancer taskforce. Early diagnosis is fundamental, as the hon. Member for Scunthorpe pointed out, because it gives us better outcomes, but the Government must set out, with NHS England, how funding will be strategically allocated. For example, will we be able to use mobile diagnostics and molecular diagnostics? I note my interest as chair of the all-party parliamentary group on personalised medicine, and vice-chair of the cancer APPG and the breast cancer APPG. If we could see who would benefit from the use of drugs, we would stop waste. For example, only 20% of women with breast cancer would benefit from Herceptin. Will the Minister address the point about the use of innovative technologies raised by my hon. Friend the Member for Castle Point?

How can we utilise the workforce in a more strategic approach? Macmillan, Cancer Research UK and 20 other organisations have developed eight principles on this. We need a workforce that is fit for the future, with people who understand the changing landscape that we are dealing with. I welcome the £130 million put into radiotherapy machines, but I would like to know that we have the radiographers who can work those machines and optimise their use.

More of us survive living with and beyond cancer, but metastatic cancer, in particular, is a type that we need to learn more about. That brings me on to the use of data. The Teenage Cancer Trust would welcome clinical trials with young people. There is a lack of data on metastatic breast cancer.

[Rebecca Harris]

My mother-in-law passed away from secondary metastatic breast cancer after opportunities to diagnose her were missed. It has been brought to my attention that we do not keep very good records or data on metastasized breast cancer. The cancer pathway does not provide a specialist nurse for those with breast cancer, and we do not seem to provide a specialist nurse for those with metastasized breast cancer, either.

[Jo Churchill]

I agree with my hon. Friend. People who are diagnosed with metastatic cancers—not only of the breast, but across the piece—feel like they are dropping through the cracks. They do not necessarily get a clinical nurse specialist, so that is another area for the specialist workforce to address. We need to make sure that we catch people on the journey, because it may be iterative. People may feel fit and well, but then find that they have to use the services again, so our approach needs to be flexible.

My hon. Friend has mentioned the importance of the ecosystem of research, hospitals and patients. My hon. Friend the Member for Crawley works hard with the Bloodwise charity, which is truly emblematic of an empowering organisation that works with the patient, clinician and researcher to help drive understanding. That is one way of giving UK plc a huge advantage. The hon. Member for Strangford has said that we need to look at the ecosystem, which is not just about cancer treatment at the end, but about researchers, universities, those brilliant students and staff whom we welcome from Europe and everyone in the pharmaceutical industry and charities working collaboratively to get the best outcome possible. That is how we will start to rise up the table and be as good as Sweden and other countries whose patients have truly fantastic outcomes.

Timely interventions can help recovery. I want to understand how recovery packages are being rolled out, because the issue of the workforce is critical.

The hon. Member for Bosworth (David Tredinnick) has mentioned alternative therapies, which can be useful, but this is a space in which charities can help people. Only this week, the Countryside Alliance Foundation took women who have received treatment fly-fishing. They find that the experience of being outside, doing something physical and enjoying nature gives them a huge sense of wellbeing. Personally, I do not think that it is a question of either/or; it is a question of joining them together.

Finally, I know that this is not the Minister’s area, but I would like him to take it back with him. I welcome the cancer drugs fund, but I am worried about those who benefit from combined treatments. Melanoma Focus has said that people on combined treatments may be disadvantaged, because not all of them will have access to the cancer drugs fund. I hope that the fund will be flexible and that the matter will be addressed.