Radiotherapy: Accessibility

Selaine Saxby Excerpts

Tuesday 18th July 2023 Westminster Hall

[Dame Maria Miller (in the Chair)]

Before we start, may I point out that there will be some videoing by the education department? Please do not be distracted. The Doorkeepers are aware and the video will simply be used to illustrate how a Westminster Hall sitting works, so just ignore it.

[Selaine Saxby (North Devon) (Con)]

I beg to move,

That this House has considered the accessibility of radiotherapy.

It is a privilege to serve under your chairmanship, Dame Maria. I thank the Backbench Business Committee for granting this important debate, all colleagues who supported the application, and Professor Pat Price for her tireless work in supporting the all-party parliamentary group for radiotherapy and championing this vital treatment.

We all know that the cancer backlog was affected by the pressures of covid-19, but in May this year there were 7.47 million people waiting for cancer treatments and 3 million of those have been waiting for over 18 weeks. Only 61.7% of patients receive their first treatment within two months, far below the operational standard of 85%. Radiotherapy is a key part of cancer care. It is the second most effective treatment for cancer and is needed in four out of every 10 cancer cures.

Radiotherapy targets the cancer with radiation. The cancerous cells are more affected than the healthy cells, which are better at repairing themselves. Modern radiotherapy has come on leaps and bounds, and within the last 10 years breakthroughs have increased the accuracy and focus of the treatment to within millimetres, significantly reducing collateral damage to healthy cells.

Surgical treatments require intensive care, with all of the hospital resources and emotional trauma that that entails, and chemotherapy has a significant impact on the immune system. In contrast, radiotherapy is an out-patient treatment that requires fewer patient visits to care centres. It only costs between £3,000 and £7,000 per patient, despite being incredibly high tech.

The international recommendation is that 53% to 60% of cancer patients receive radiotherapy treatments. However, in the UK only 27% of cancer patients received radiotherapy treatment in 2019. In my North Devon constituency, only 4.7% of my constituents live within the recommended 45-minute travel time for radiotherapy treatment. The other 95.3% are among the 3.4 million people in England for whom distance from a radiotherapy service effectively limits the availability of treatment.

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

As the hon. Member said, radiotherapy is the second most effective cancer treatment and is required by half of all cancer patients. However, the ability to access treatment has been described as a postcode lottery, with 3.4 million people unable to access radiotherapy without travelling more than 45 minutes. Does the hon. Member agree that it is unacceptable that there should be such significant disparities in access to radiotherapy?

[Selaine Saxby]

I do indeed agree with the hon. Member. In my case, North Devon is the fourth worst constituency in the country for access to radiotherapy services. North Devon is home to the smallest and most remote hospital on the UK mainland—and possibly the most loved. An exceptional team works tirelessly to deliver the best care, despite the challenges of rurality and the availability of staff, mostly linked to the availability of affordable housing, which is currently at its most extreme.

Radiotherapy is usually a series of daily treatments over a number of weeks. Far too many of my constituents choose not to have radiotherapy because the 120-mile round trip each day is too much to consider on top of the understandable pressures that patients with a cancer diagnosis already experience.

Radiotherapy is a far less invasive treatment than many others. With such an elderly population in North Devon it is often the best treatment for patients. A further complication that has been brought to my attention by the wonderful volunteer drivers we have in North Devon who help patients to their appointments across the expansive county, often to Exeter—a 120-mile round trip—for many different treatments, including radiotherapy. I do not want to discourage anyone from reaching out for those services, it will be clear to everyone that a daily radiotherapy session involving a journey of that length is a significant undertaking for patients and volunteer drivers alike. We have a declining number of volunteer drivers, which restricts driver availability for other patients.

It is hard to explain to those who have not visited North Devon the remoteness and the distances involved in undertaking all sorts of treatments. We benefit hugely from the merger of our hospital trust with Exeter’s, but that does not bring Exeter any closer. While it is positive that the backlog of patients waiting longer than 62 days for a GP referral is improving, the 62-day wait to start treatment is not. We know that every four weeks of delay in starting cancer treatment can increase the risk of death by 10%. To ensure everyone receives timely cancer care, radiotherapy needs to be an accessible treatment for every patient.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady for bringing forward a matter that is so important, which I think all of us here recognise. She has set the scene very well.

Another issue, which the hon. Lady is perhaps coming to shortly, is the shortage of radiotherapists across the United Kingdom. I understand that England is some 1,500 shy, and we have vacancies in Northern Ireland as well. The training takes five years, which means that it will be five years before the workforce, who are under pressure now, make gains, and that is if all the vacancies are filled. Furthermore, the age of current radiotherapists is an issue. Does the hon. Lady think that the Government need to take the initiative and put in place a visionary recruitment plan for the five-year period?

[Selaine Saxby]

I thank the hon. Gentleman for his intervention. We do not talk enough about the lack of specialist staff in this area, and I am indeed going to talk about the need for a proper plan for radiotherapy. Obviously, that involves resources of all types moving forward.

I think we all ask why a treatment as effective as radiotherapy is not used more often. Funding for radiotherapy falls between the cracks, and radiotherapy receives only 5% of the cancer budget. While there has been specific investment in radiotherapy, such as the £162 million in 2016 to replace 64 out-of-date machines, and the additional £32 million in 2019, there will be approximately 74 machines in need of replacement by the end of 2024.

We all know the NHS budget is under strain, but radiotherapy is the closest thing we have to a silver bullet for improving cancer care. An investment of £200 million would update all the machines due to be out of date by the end of next year, benefiting an estimated 50,000 people a year. An investment of £45 million in an innovative British technology—surface guided radiotherapy—could reduce waiting times by 1.8 weeks nationwide, and the use of artificial intelligence tools in radiotherapy could save clinicians two hours per patient.

If radiotherapy received between 10% and 12% of the cancer budget, instead of 5%, we could invest in more machines to bring ourselves up to international standards. In England, we have 4.8 treatment machines per 1 million people, while France has 8.5. and Italy 6.9. New machines and techniques would treat patients more quickly and help to clear the backlog. We need to reap the benefits of successful investment in early diagnosis and increased screening programmes so that early diagnosis leads to timely treatment and improved patients outcomes, rather than long and stressful waits for treatment.

We also need to focus investment in the right areas. Treatments such as proton therapy do not help patients outside Manchester and London. Proton therapy assists only 1% of patients, and my constituents in North Devon do not benefit from more investment in urban centres.

[Sir Oliver Heald (North East Hertfordshire) (Con)]

Does my hon. Friend agree that satellite radiotherapy centres have an important role to play? People from my area have to travel down to Hillingdon from north Hertfordshire. The journey is supposed to take 40 minutes, but it is actually an hour and a half each way. If we had a satellite radiotherapy centre in north Hertfordshire it would make all the difference.

[Selaine Saxby]

I thank my right hon. and learned Friend for his intervention, and I agree entirely. Indeed, I believe the Government should look at bringing radiotherapy treatments closer to patients such as those in my constituency of North Devon. I ask the Minister to consider bringing radiotherapy to satellite centres or community cancer treatment centres to complement diagnostic tools such as radiology in community diagnostic hubs.

Furthermore, may I recommend a trial in North Devon? We have a proud history of raising funds locally for cancer care provision, and I would dearly love to work with the Minister to deliver a new radiotherapy machine—on a partnership basis, if necessary—to begin to tackle some of our challenges head on. Indeed, that sounds significantly more achievable than tackling some of the other health inequalities from which my constituents suffer. Not a single NHS dentist across Devon is taking patients, and the last orthodontist has just left Barnstaple. I recognise that dentists are hard to come by but, for anyone listening, the surf is fantastic and you will be the most welcome blow-in we have ever seen in Devon.

Sorting out radiotherapy could be easier with a community-driven fundraising scheme and some assistance from the Minister to facilitate such as trial. I have former community hospitals waiting, and space on the main hospital site that could accommodate the machine and bunker. As we look to 2040, when an estimated 500,000 people will be diagnosed with cancer each year, we need to invest in cost-effective and efficient treatment.

Half of us will get cancer in our lifetime, so one in four of us will require radiotherapy treatment. Access to such treatment should not be limited by someone’s postcode. I ask the Minister not just to look at modernising and supporting radiotherapy, but to ensure that planning for cancer care accounts for rurality and that everyone has access to all available treatments.

--- Later in debate ---

[Will Quince]

I will come on to the hon. Gentleman’s specific point, but he is absolutely right. On remaining in post and Government reshuffles, the Prime Minister giveth and the Prime Minister taketh away, but I thank the hon. Gentleman for his best wishes ahead of any future reshuffle. Having been in the Departments of Health and Social Care, for Education and for Work and Pensions, I know that any Minister understandably ends up taking a considerable interest in their work. I assure the hon. Gentleman that whether or not I maintain my position in the Government, I will maintain my interest in all the areas I have worked on as a Minister. I certainly commit to continuing that work from the Back Benches when one day the Prime Minister chooses to dispense with my services.

[Selaine Saxby]

I thank the Minister for all his time and commitment and for meeting me so regularly. When he takes things away and reflects on them, will he bear in mind that although community diagnostic hubs are fantastic, it is still a 120 mile round trip from my constituency to get to one, so there are issues in respect of rurality. In Ilfracombe in my constituency, the healthy life expectancy is 59. Remote coastal communities need to be able to access services, and we are underdiagnosing because it is so hard to access even a diagnosis, let alone the treatment.

[Will Quince]

I will come on to this point in greater depth, but many of the conversations that my hon. Friend and I have had on health issues, and previously on education issues as well, were about rurality and the challenges of rural and coastal communities. Her points are well made—I certainly understand them—and she makes a compelling case. I will address them in greater detail later in my speech.

Not only are we building the community diagnostic centres and surgical hubs—and notwithstanding my hon. Friend’s point about the distance that some have to travel to get to them—but we are creating them deliberately closer to communities; they are not just based in district and general hospitals. In each of the next two years they will be supported by an additional £3.3 billion of funding, which was announced in the autumn statement, and that will enable rapid action to improve emergency, elective and primary care performance towards the pre-pandemic levels.

On cancer specifically, NHS England recently set out the progress made on reducing the number of patients with urgent suspected cancer who wait for longer than 62 days, and announced that the faster diagnosis standard was met for the first time in February this year. It also confirmed the ongoing priorities to improve performance and long waits, prioritise diagnostic capacity for cancer and, of course, focus on the cancer pathway redesign.

The Government and NHS England have pushed to improve the early diagnosis of cancer, which is so important to give patients the best chance of receiving successful treatment and in turn see more people living longer following a cancer diagnosis. However, as my hon. Friend the Member for North Devon eloquently and articulately pointed out—the hon. Member for Easington also made this point—we know that early diagnosis needs to be backed up by high-quality treatment options such as radiotherapy, with its remarkable ability to shrink tumours, as has been set out, and often with minimal side effects.

The hon. Members for Easington and for Denton and Reddish referred to the 62-day cancer target and the changes required to improve cancer outcomes. I hear the strong and compelling arguments that have been made, and I am happy, as I set out at the beginning of my speech, to meet hon. Members to discuss the steps that we are already taking and the further steps that can be taken, alongside NHS England, to improve cancer outcomes.

The hon. Member for Denton and Reddish asked specifically about steps to meet the 62-day target. To target support towards the most challenged trusts in the country, NHS England has developed an intervention model that is designed both to maximise and expand capacity. Challenged trusts have been placed into tiers 1 and 2, and all tiered trusts have weekly or fortnightly oversight calls, and they also have visits with the regional and national teams from NHS England. They receive support on things like the development of a co-ordinated support plan, which is monitored by fortnightly progress meetings. The plans have focused on areas such as pathway improvements, workforce support and targeted capacity increases. That supports the trusts that do not have the resource or bandwidth internally to turn around services.

When my hon. Friend the Member for North Devon made the case for a satellite centre in her constituency, she raised specific challenges in relation to North Devon that are translatable to other parts of the country that have rural and coastal characteristics. I will outline the basis on which provision is reviewed, but before I do let me acknowledge the local efforts that she mentioned. She is rightly proud of her constituents’ initiative in terms of support with travel and other things.

The network oversight group, in conjunction with the relevant specialised commissioning team and cancer alliances, is required to review service provision on a regular basis to ensure that optimal access arrangements are in place. That applies to proposals that relate to the expansion or re-provision of existing services, or to the development of any satellite facilities. The development of any new service location requires the development of a business case, as my hon. Friend pointed out, and business cases must demonstrate, among other criteria, the consideration of the effect on the provision of existing cancer pathways, both within and outside the network geography.

As I have mentioned, that responsibility sits not with the Government but with the integrated care boards, cancer alliances and local specialised commissioning teams. I am happy to meet my hon. Friend, alongside the ICB, to understand the challenges and what can be done in this space. I understand from NHS England that around 450 patients a year travel from my hon. Friend’s constituency to Exeter for treatment, but I am cognisant of the point made by the hon. Member for Westmorland and Lonsdale that many more patients might want to access those services but do not because of the travelling and distances involved. That is why a meeting between me, my hon. Friend and the ICB might be a good starting point.

--- Later in debate ---

[Selaine Saxby]

It has been a pleasure to participate in a debate with you in the Chair, Dame Maria. I thank the Minister for such a comprehensive response, and I thank all right hon. and hon. Members for participating in the debate. I very much hope that the next time we come together we will be celebrating some successes and improved access for our rural constituents to radiotherapy and other cancer treatments. I thank the Minister once again for his time.

Question put and agreed to.

Resolved,

That this House has considered the accessibility of radiotherapy.