Prostate Cancer

Debate between Simon Hoare and Nick Smith

Wednesday 6th February 2019 Commons Chamber

[Simon Hoare (North Dorset) (Con)]

I rise to open this five-hour Adjournment debate—that was a joke, Mr Deputy Speaker. This debate is certainly timely, given that on Monday this week we celebrated the 20th anniversary of World Cancer Day, and many Members will have attended the event held by Cancer Research UK in Portcullis House this morning. It is timely given the more than welcome announcement by the Treasury and the Department of Health and Social Care of record investment coming into the national health service. It is timely because we have the Government’s welcome and focused cancer strategy. It is timely because at no other time in our history have Government and health campaigners and providers had a greater communication platform to reach out to members of the public and explain, inform and educate. Finally, this debate is also timely because this week, under the auspices of my hon. Friend the Member for Lewes (Maria Caulfield), who has considerable nursing experience, we have seen the launch of the all-party parliamentary group on male cancers, including prostate cancer.

We need to recognise that cancer is still feared in this country. Terms such as “battle, “fight” and “lost the crusade” against cancer are used in countless obituaries, which testifies to that fear. I hope that we all take heart from the commitment in this important health area shown by my right hon. Friend the Secretary of State and the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Winchester (Steve Brine). That should provide us with a reservoir of optimism about the seriousness and determination of the Department on these issues.

It may just be something to do with my sex—I am not sure—but all the statistics and all the anecdotes tell us that men appear to have a greater aversion to going to the doctor and asking questions about their health than our female counterparts, and certainly anything below the waist is to be avoided at all costs because it is going to be painful, embarrassing and undignified.

I pause for a moment to reflect on the absolute honesty that we have heard from my hon. Friend the Member for Redditch (Rachel Maclean), and indeed the clarity of my right hon. Friend the Prime Minister at the Dispatch Box during a recent Prime Minister’s questions, about cervical cancer testing—admitting some of the inhibitions, but, given the importance, exhorting people to take those tests. I do not think that I hear such exhortations and frank honesty from men about this health issue.

[Nick Smith (Blaenau Gwent) (Lab)]

I commend the hon. Gentleman for his leadership and for securing this important debate. I have been along to the World Cancer Day event today, where I was told that more than a third of cancer cases can be prevented, and another third can be cured if detected early and treated properly. The message he is sending out today is really important for us to share across the whole country.

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[Simon Hoare]

I agree. In answer to the first part of the hon. Gentleman’s intervention, which I presume was rhetorical, I just want the Minister to carry on with the excellent work he is doing. The hon. Gentleman is right to say that we need to blow away the cloak of secrecy and, sometimes, shame and embarrassment. No family represented in this House will not have heard an aunt or an uncle say, in slightly hushed tones and that silent mouthed way, best exemplified by Les Dawson, that they have the big C. It is as though they cannot quite bring themselves to annunciate the word, in case it brings a plague upon their house. We have to brush all that away.

I am absolutely determined to get on to the issue that I want the Minister to address, which is what I was trying to do about 16 interventions ago. I urge him to grasp the opportunity—provided not least by the additional funding—for efficient, cost-effective and easier diagnosis. I appreciate that there is a whole range of things in the marketplace, but during my research I have been particularly struck by the opportunities presented by the pre-biopsy multiparametric MRI scan. We have a problem, because while demand for MRI scans rose by 30% between 2013 and 2016, this country still has fewer MRI scanners per head of the population than other countries with comparable populations. The additional moneys available provide a golden opportunity to do something about that.

Of course, it is never just a question of cash and kit, so allied with that are the people who can use the kit. The workforce are key. In addressing the issue of money and the benefits it can provide, we should note that we will not realise its full potential if we are short on workforce. The 10% vacancy rate in the national health service cannot be allowed to become the norm. Prostate cancer patients need and would like more clinical nurse specialists, who have the empathy and expertise to provide comfort, hope and a guiding hand. It is difficult to recruit in any specialist nurse area, but that should not put us off the endeavour.

Likewise, we need a recruitment drive for more radiologists. Prostate Cancer UK estimates that an additional 23 to 31 radiologists are needed in the UK. The Royal College of Radiologists estimates that in the financial year 2016-17, a whopping £116 million was spent on the outsourcing and insourcing of radiological skills additional to core contracted hours. To put that in perspective, £116 million would buy about 1,300 full-time consultant radiologists.

As I have said, raising public awareness of prostate cancer—its signs, symptoms, diagnosis and treatment—is pivotal, but so too is the reinforcement of messages from the Department, NHS England and others to our general practitioners. We all know that there is a growing problem of finding people who are interested in and prepared to enter general practice. The myriad drugs that come on to market and myriad other conditions make the already demanding life of a GP ever more so.

I recently met Jim Davis, the chairman of the Dorset branch of the Prostate Cancer Support Organisation, a charity that covers Hampshire, Dorset and Sussex. It is run for men diagnosed with prostate cancer, by patients with prostate cancer. Last year, they held 23 free prostate-specific antigen testing events, which delivered those tests for 4,813 men. They have found that people are more inclined to go into that sort of environment than to their GP surgery. Their work involves—as a Hampshire Member of Parliament, the Minister may already know this—raising money, advertising the tests and hiring village halls and other places. Men then come and have the test, which is sent—in effect, the work is subcontracted—to the local hospital, which analyses it and sends back the results. I will not detain the Minister, but I could read out a whole legion of extracts from letters from grateful men who availed themselves of that opportunity and found their life chances and health much improved.

Although the national health service says that any man over 50 is entitled to a free PSA test, evidence suggests that some GPs—I stress the word “some”, but one is too many—are either unaware of that entitlement or express and demonstrate an unwillingness to refer. Last May, David Radbourne, the director of commissioning operations at NHS England South East, wrote in response to a letter from Jim, who had produced a list of affected patients:

“If there are individuals who feel they are being refused legitimate access to this test…please ask them to file a complaint through the appropriate NHS complaints process.”

I say to my hon. Friend the Minister that in those circumstances, people should not be forced to go through an NHS complaints process. Like other campaigners, I see a lacuna, or an information gap—call it what you will—among certain GPs, and I urge the Department to consider ways in which to plug it. That issue needs to be addressed quickly. The official in the Box is waving a piece of paper and the Parliamentary Private Secretary, my hon. Friend the Member for Erewash (Maggie Throup), is up on her feet with alacrity, as always.

The Public Health England advisory note, “Advising well men aged 50 and over about the PSA test for prostate cancer”, needs to be reviewed and updated. It states:

“GPs should use their clinical judgement”.

That is a pejorative term—it is an open term—so perhaps that language should be revisited. The approach needs to be a little more robust.

[Nick Smith]

The hon. Gentleman is making a really important point. I am over 50, but I did not know about the test. Does he know how many men over 50 as a proportion of the population have had the test?

[Simon Hoare]

I am sure that I have come across that figure in my research, but I do not have it to hand. However, as I mentioned in my introductory remarks, the platforms to inform, encourage and educate us all as health citizens, for want of a better phrase, that we seem to avail ourselves of very much relate to—this is not a criticism; it is perfectly correct—cervical cancer, breast cancer and other cancers. The opportunity presented by additional funding and by the very welcome cancer strategy should now allow us all to give—I do not know whether this is quite the right phrase—parity of esteem between male and female cancers. Cancer has a devastating effect on family irrespective of which member has it. I am afraid I cannot answer that query, but the Minister may have that figure. As it is an entitlement, I urge as many men over 50 as possible to see it as routine and regular as going to the optician or the dentist.

In conclusion, with the cancer strategy, fantastic levels of funding and the active commitment, energy and understanding shown by Ministers in the Department, now is the time to make positive progress.