Breast Cancer

Sharon Hodgson Excerpts

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.

[Karen Lee]

Does my hon. Friend agree that the withdrawal of nursing bursaries cannot fail to have impacted on the numbers of nurses training? There are figures out today—I have been on the radio this morning. I think there has been more than a 30% drop in the number of people training to be nurses since the nursing bursary was withdrawn. That cannot fail to have had an impact. It impacts on radiographers as well, because they train for three years, then for another year after that to do mammograms. Does she agree that those bursaries absolutely must be reinstated?

[Mrs Hodgson]

Yes, I agree. Obviously, that is why it is in our manifesto that we would reinstate those nursing bursaries. I would urge the Government to look at this closely, especially in light of Brexit, and what might happen post Brexit, with regard to the EU workforce, as I already mentioned.

Finally, I will move on to prevention. It is a challenge to us all to live healthier lives. I do not stand here saying I am doing a very good job, but we know that regularly drinking alcohol, as the hon. Member for Central Ayrshire mentioned earlier, and being overweight or obese, can increase the risk of developing breast cancer—and most cancers—as can smoking and lack of exercise. Regular physical exercise and reducing all the above can reduce the risk. Researchers estimated that 23% of breast cancers are preventable through lifestyle changes. That means there were approximately 10,600 preventable cases in 2016. Turning that into money, approximately £102 million in treatment costs could have been saved in 2016 if all those cases had been prevented. I know that may not be completely achievable, but since 2015, public health budgets have been cut by 3.9% a year until 2020-21. Has the Minister made any assessment of the effect that cuts to public health budgets have had on the incidence of breast cancer, and will he commit, as much as he can, to an increase in public health funding to help to prevent more cases of breast cancer? I know that might be above his pay grade; he is not the Chancellor—yet.

In closing, I will touch on secondary breast cancer. More than half of women are given no information about the signs and symptoms of breast cancer returning. Will the Minister look into ensuring that all patients are advised at the end of their primary breast cancer treatment about lifestyle and symptoms, so that where possible all cases of incurable secondary breast cancer can be prevented? I know that, like me, the Minister is incredibly passionate about breast cancer and that he will take much if not all of what he has heard today back to his Department to work on, so that he can achieve the best future for breast cancer.

On the day of Dame Tessa Jowell’s memorial, I will end by quoting from her magnificent last speech in the House of Lords in January this year, when she said:

“In the end, what gives a life meaning is not only how it is lived, but how it draws to a close.”

She said that she hoped the debate would give hope to other cancer patients,

“so that we can live well together with cancer—not just dying of it”.—[Official Report, House of Lords, 25 January 2018; Vol. 788, c. 1170.]

Perhaps her most precious legacy will be not only Sure Start and the Olympics, as wonderful as they are, but a better future for everyone with any form of cancer.

[The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)]

Thank you for chairing our session today, Mr McCabe. I add my congratulations to the hon. Member for Lincoln (Karen Lee) on securing the debate and the hon. Member for Crewe and Nantwich (Laura Smith) on leading us off today. Breast cancer sadly affects so many of us so personally. It is always a privilege to respond to any debate in this House, especially on cancer and more especially on breast cancer, and this has been a constructive, small and perfectly formed debate.

It is always a pleasure to follow my shadow Minister and friend, the hon. Member for Washington and Sunderland West (Mrs Hodgson); I think this is the first time that a debate has been led by all three chairs of the same all-party parliamentary group, speaking for their respective parties. It was important to us when we chaired the group that we had the three main parties in the chair. The third chair was then held by the Liberal Democrats—remember them?—[Laughter.] Stop it. When the hon. Member for Central Ayrshire (Dr Whitford) joined the House, it was a real pleasure that she came on board and took that seat.

I will start by saying, “Happy BCAM!” There is much to celebrate, as hon. Members have said, and it is Breast Cancer Awareness Month, or BCAM for short. I pay tribute to all the people who are here, the survivors—survivorship is very important—and to all the people who have gone. Macmillan Cancer Support ran a heartfelt campaign earlier this year on the idea that “A mum with cancer is still a mum”, which was one of the best pieces of advertising I have seen in the health space for a long time. The reason I say, “Happy BCAM!” is that the people who have gone were still mums, daughters and sisters, even while they were going through their challenges. That is very important. Even children who lose their battle with cancer after being on this earth for a matter of days leave an indelible mark, because they were here for a few days. It is important to me that we always remember that, and I always do.

The title of today’s debate on the Order Paper is “Future of breast cancer”. The hon. Member for Washington and Sunderland West said to me once in one of our group meetings, “You will be cancer Minister one day.” If she could predict something else great for me, that would be excellent.

[Mrs Hodgson]

Chancellor.

[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.