Breast Cancer Screening

Robert Largan Excerpts

Wednesday 16th December 2020 Westminster Hall

[Robert Largan (High Peak) (Con)]

I beg to move,

That this House has considered breast cancer screening.

It is a pleasure to serve under your chairmanship, Sir Edward.

I am pleased to have secured this debate on a really important issue that affects so many people in the High Peak and across the country. I am glad to see the Minister in her place today and very grateful to her for meeting me to discuss this issue. I look forward to hearing her response to the debate, as well as the thoughts of colleagues who are in Westminster Hall today. I pay tribute to those colleagues who have worked so hard on this issue over many years, especially through the all-party parliamentary group on breast cancer. I pay particular tribute to my hon. Friend the Member for North Warwickshire (Craig Tracey), who led a debate on this issue just last month.

In my lifetime, we have come a long, long way on breast cancer research, treatment and survival rates. Despite that huge progress, breast cancer remains one of the biggest health challenges facing this country. Every year, one in seven women will develop breast cancer, which is 55,000 women. Also, 370 men will develop breast cancer every year; it is important that we do not forget them. Almost 1,000 women die from breast cancer every month and around 600,000 people are living with or after breast cancer, including 35,000 women living with secondary breast cancer. I will repeat those figures—almost 1,000 women die of breast cancer every month, which is around 11,500 women every year. Just in my small local area, an estimated 223 people develop breast cancer every year and 41 people die from it, almost all of them from secondary breast cancer. Those numbers cannot begin to convey the heartbreak caused to too many families, who grieve the loss of a mother, a sister, a daughter, a wife or a partner.

We know that early diagnosis is the best way of preventing these deaths and increasing the chances of survival. Around 186,000 women a month are screened in England, which prevents an estimated 1,300 deaths every year. However, although it is true that there has been increased uptake of screening nationally, that uptake has not been evenly spread across the country. Of the women aged between 50 and 70 invited for screening in my local area, 69.7% attended within six months. That is lower than the 72.4% average across England.

I fear that the situation in my area has been made worse by the recent commissioning decision by NHS Midlands to withdraw the breast cancer mobile screening unit from Buxton, Chapel-en-le-Frith and New Mills in the High Peak, citing covid as the reason. Instead, my constituents are being asked to travel to appointments at Bakewell in the Derbyshire dales.

I am very worried about the impact that decision is having. To be clear, this is no slight at all on Newholme Hospital in Bakewell and the fantastic staff there; I pay tribute to them and to all NHS staff working in breast cancer screening services. It is a question of accessibility. The Peak district is beautiful, but our transport links are poor, especially in the winter months, when road closures are common because of extreme weather. For example, driving from the village of Rowarth to Bakewell typically takes just under an hour and involves having to drive a good part of the way on single-track country lanes, which are often closed when there is snow or heavy rainfall. Public transport links between the High Peak and Bakewell are even more limited. The railway between Buxton and Bakewell closed in 1968, cutting off the High Peak from the rest of Derbyshire.

I am very worried about how many women in my area will be unable to make screening appointments, which is why I have been campaigning to get the mobile screening unit reinstated in the High Peak as a matter of urgency. In just a few weeks, over 2,000 local people have signed my petition calling for its reinstatement. I hope that the Government will listen and that the Minister can give my constituents good news today. I was very grateful to her for meeting me last week to discuss this issue, when she gave me positive news by assuring me that the current arrangement is temporary. However, it has often been said that there is nothing more permanent than a temporary Government measure, so I hope that she can be more specific today and that we can get a date for when we can expect these services to be reinstated to the High Peak.

More broadly, to help more people get a diagnosis early on, we need the capacity ready in our local health services. Breast Cancer Now found that 40% of hospital trusts and health boards—including Stockport NHS Foundation Trust, which runs Stepping Hill Hospital and so serves a large part of my constituency—could not say how many secondary breast cancer patients were under their care.

Coronavirus has placed immense pressure on our NHS workforce and infrastructure. It is essential that we keep the virus under control, but there is a heavy cost. In March, the breast cancer screening programme was officially paused in Scotland, Wales and Northern Ireland and was paused in all but name in England. Screening has restarted, but access is not rising fast enough nationally, and it is falling in places such as High Peak. Breast cancer screening services in England are running at around 60% of normal capacity, according to Cancer Research UK. As a result, there was a 70% drop in all cancers being reported in some parts of the country, leading to nearly 107,000 fewer breast cancer referrals. Despite the fall in referrals, cancer waiting times have increased. In August, the rate of achieving the two-week wait target fell to 87.8% from 90% the previous month.

I am grateful to the digital engagement team and Breast Cancer Now for reaching out to people affected by breast cancer screening delays caused by covid. I thank everyone who responded ahead of the debate to share their experiences. For example, Gill said:

“My routine screening was rescheduled (twice) from April 2020 to Sep 2020. I was then diagnosed with stage 3 breast cancer spread to a lot of lymph nodes. I can’t help but wonder how much better it would have been to have picked this up 6 months earlier.”

This has been happening to people across the country, with serious consequences that must be addressed. Breast Cancer Now estimates a backlog of nearly 1 million women requiring screening across the UK because of the pause in March. We do not know how long it will take to catch up. Around 8,600 of these women could have been living with undetected breast cancer.

As the general population ages and lives longer, the number of women and men developing breast cancer has increased. Of course, people younger than 50 can also develop breast cancer, and it is important that they also have access to screening. I take this chance to note that more than 13,000 people have signed an e-petition in support of lowering the age at which screening services are offered, including many in High Peak. We clearly need to ramp up capacity to meet the rising demand for screenings. Not doing so will put the NHS workforce infrastructure under incredible strain. I ask the Minister: what action are the Government taking to ensure that women respond to open invitations and make appointments for screening, and how many women have been screened this year compared with last year?

Managing demand for screenings as a result of increased uptake and the backlog created by covid requires a long-term strategy to raise capacity, with a strong focus on the NHS workforce. There is a serious worry of burnout among NHS workers due to the sustained physical, psychological and emotional pressure of this difficult year. A British Medical Association survey revealed that 28% of doctors have found non-covid demand to be higher than before the pandemic, with 58% saying that they are concerned about their ability to care for patients, 44% worried about plans to manage the huge backlog of patients and 65% saying that staffing shortages are the most pressing concern.

That is compounded by the fact that a considerable proportion of the breast cancer screening workforce is approaching retirement. Around half of all mammographers are aged 50 and likely to retire in five to 10 years. This has led to a rise in vacancies for crucial roles. Public Health England has reported a 15% vacancy rate for mammography; that only 18% of screening units are adequately resourced with radiotherapy staff; and that one in four trusts and health boards has at least one vacant consultant breast radiologist post. Ensuring that the breast imaging and diagnostic workforce is fully staffed and trained is critical to the delivery of the commitment in the NHS England long-term plan to ensure that the proportion of cancers diagnosed at stages 1 and 2 rises from around half to three quarters by 2028. I understand that the pandemic delayed the publication of the full implementation plan, but further detailed is needed.

NHS workforce development was not mentioned in the recent spending review, and there has not been a national NHS workforce strategy since 2003. We need to prioritise that work to be sure that the new NHS funding is being used in the best way possible. Long-term solutions cannot be sacrificed because of short-term pressures.

I am therefore glad that the Government asked Professor Sir Mike Richards to review screening programmes as part of the NHS long-term plan. The review concluded that the main obstacle to achieving the commitment on cancer diagnosis is the size of the workforce, and the equipment and facilities available to them. Professor Sir Mike Richards recommended that we recruit 2,000 additional radiologists and 4,000 radiographers, as well as other support staff, and replace outdated testing machines. Those recommendations ought to be a critical part of the next NHS people plan, setting out a long-term strategy for the NHS workforce. I hope that the Minister is able to update us on when she expects to publish a plan to implement the review. It will also be interesting to learn how the new National Institute for Health Protection will affect the breast cancer screening programme.

It is crucial that people are not discouraged from seeking help with a health problem. The NHS’s “Help Us Help You” campaign is a promising initiative that urges people to speak to their GP if they are worried about possible cancer symptoms. I understand that people feel reluctant to come forward, worried that they might catch the virus or be a burden on the health service, but it is more important than ever that women are able to have a regular screening check-up. If the campaign is successful, I hope that the Minister will explain how the Government expect the NHS workforce to cope with increased demand during the winter months.

The Government need to set out how capacity in the diagnostic workforce will be managed; provide funding to grow the workforce and ensure they are properly resourced; and increase the number of facilities where people can be diagnosed. That includes reinstating important services across the country, such as the mobile screening unit in High Peak. Failure to do so will reduce our chances of delivering the early diagnosis, treatment and care that could help thousands of people beat breast cancer.

--- Later in debate ---

[Robert Largan]

It is a pleasure to sum up this debate. It has been very constructive, with a lot of agreement. I appreciate the speeches from both the Opposition speakers, who made a lot of important points in a constructive manner, striking the right tone. I would like to highlight the contribution from my hon. Friend the Member for West Bromwich East (Nicola Richards), who talked of her family’s personal experience. She is a fantastic champion for her constituency.

I would also mention the hon. Member for Westmorland and Lonsdale (Tim Farron). We represent similar constituencies; he represents the Lake district and I represent the Peak district. I am sure we could argue all day about which is better, but they face similar challenges. I am a big admirer of his knowledge of the subject and the work he has done over the years. I must, of course, mention the hon. Member for Strangford (Jim Shannon) who is always an assiduous attendee in this place. He made an important speech, with lots of very good points.

I am grateful to the Minister for her comments. I have listened to her speak before about her personal experience. I know there is no one more committed to this issue. I am reassured that we have such a diligent and committed Minister working for us on this subject. I am pleased with the news that the breast cancer screening service mobile unit will be reinstated to High Peak. I hope the Minister understands that I will be holding her feet to the fire, and making certain that the date is brought forward to be as soon as possible, so that we can get the mobile unit back to New Mills, Chapel-en-le-Frith, Buxton and the rest of the High Peak.

Question put and agreed to.

Resolved,

That this House has considered breast cancer screening.