Lung Cancer Screening

Steve Barclay Excerpts

Monday 26th June 2023 Commons Chamber

[The Secretary of State for Health and Social Care (Steve Barclay)]

Thank you, Madam Deputy Speaker. May I first address the remarks you made on behalf of Mr Speaker? Of course, any disappointment expressed by Mr Speaker is a matter of concern. No discourtesy was wished on the part of the Government. It may be helpful to clarify that no change of policy is being announced in the statement; it is an expansion of an existing policy, which I hope the House will regard as good news. However, we very much take on board any concerns that Mr Speaker has expressed.

With permission, Madam Deputy Speaker, I would like to make a statement on our national lung cancer screening programme for England. About a quarter of patients who develop lung cancer are non-smokers. We all remember our much-missed friend and colleague, the former Member for Old Bexley and Sidcup, James Brokenshire. He campaigned tirelessly to promote lung cancer screening and was the first MP to raise a debate on that in Parliament. His wife Cathy is continuing the brilliant work that he started in partnership with the Roy Castle Lung Cancer Foundation.

In 2018, after returning to work following his initial diagnosis and treatment, James told this House that the Government should commit to a national screening programme and use the pilot to support its implementation. I am sure many colleagues in the Chamber will recall him saying:

“If we want to see a step change in survival rates—to see people living through rather than dying from lung cancer—now is the time to be bold.”—[Official Report, 26 April 2018; Vol. 639, c. 1136.]

Despite being a non-smoker, James knew that the biggest cause of lung cancer was smoking and that the most deprived communities had the highest number of smokers. That is why I am delighted that today the Prime Minister and I have announced a national lung cancer screening programme, building on our pilot programme, which will target those who smoke or have smoked in the past.

Lung cancer takes almost 35,000 lives across the UK every year—more than any other cancer. Often, patients do not have any discernible symptoms of lung cancer until it is well advanced; in fact, 40% of cases present at A&E. Since its launch in 2019, and even with the pandemic making screening more difficult, our pilot programme has already given 2,000 lung cancer patients in deprived English areas an earlier diagnosis. That matters because NHS England states that when cancer is caught at an early stage, patients are nearly 20 times more likely to get at least five years to spend with their families.

We all know that smoking is the leading cause of lung cancer. It is responsible for almost three quarters of cases, and in deprived areas people are four times more likely to have smoked. We have deployed mobile lung trucks equipped with scanners to busy car parks in 43 deprived areas across England. Before the pandemic, patients from those areas had poor early diagnosis rates, with only a third of cases caught at stage one or two. To put that in context, while a majority of patients diagnosed at stage one and two get to spend at least five more years with their children and grandchildren, less than one in 20 of those diagnosed at stage four are as fortunate. Thanks to our targeted programme, three quarters of lung cancer cases in those communities are now caught at stage one and two.

Targeted lung cancer checks work. They provide a lifeline for thousands of families.

We need to build on that progress, which is why we will expand the programme so that anyone in England between the ages of 55 and 74 who is at high risk of developing lung cancer will be eligible for free screening, following the UK National Screening Committee’s recommendation that it will save lives. It will be the UK’s first and Europe’s second national lung cancer screening programme. If results match our existing screening—there is no reason to think that they will not—when fully implemented the programme will catch 8,000 to 9,000 people’s lung cancer at an earlier stage each year. That means that each and every year around 16 people in every English constituency will be alive five years after their diagnosis who would not have been without the steps we are taking today. That means more Christmases or religious festivals with the whole family sitting around the table.

Alongside screening to detect conditions earlier, we are investing in technology to speed up diagnosis. We are investing £123 million in artificial intelligence tools such as Veye Chest, which allows radiologists to review lung X-rays 40% faster. That means that suspicious X-rays are followed up sooner and patients begin treatment more quickly.

How will our lung cancer screening programme work? It will use GP records to identify current or ex-smokers between the ages of 55 and 74 at a high risk of developing lung cancer, assessed through telephone interviews. Anyone deemed high risk will be referred for a scan, and will be invited for further scans every two years until they are 75.

Even if they are not deemed at high risk of lung cancer, every smoker who is assessed will be directed towards support for quitting because, despite smoking in England being at its lowest rate on record, tobacco remains the single largest cause of preventable death. By 2030, we want fewer than 5% of the population to smoke. That is why in April we announced a robust set of measures to help people ditch smoking for good, with 1 million smokers being encouraged to swap cigarettes for vapes in a world-first national scheme. All pregnant women will be offered financial incentives to stop smoking, and HMRC is cracking down on criminals who profit from selling counterfeit cigarettes on the black market.

The lung cancer screening programme has been a game changer for many patients: delivering earlier diagnoses, tackling health inequalities and saving lives. We are taking a similar approach to tackle obesity, the second biggest cause of cancer across the UK. The pilot we announced earlier this month will ensure that patients in England are at the front of the queue for innovative treatments by delivering them away from hospital in community settings. Together, this shows our direction of travel on prevention, which is focused on early detection of conditions through screening and better use of technology to speed up diagnosis and then treatment, because identifying and treating conditions early is best for patient outcomes and for ensuring a more sustainable NHS for the future, for the next 75 years. I commend this statement to the House.

[Madam Deputy Speaker (Dame Eleanor Laing)]

I call the shadow Secretary of State.

--- Later in debate ---

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. Before I call the Secretary of State, let me say to the hon. Member for Ilford North (Wes Streeting) that I think the whole House will join him, and me, in sending condolences to the hon. Member for Mitcham and Morden (Siobhain McDonagh).

[Steve Barclay]

On behalf of His Majesty’s Government, Madam Deputy Speaker, I echo your sentiments and those of the shadow Health Secretary in sending the House’s condolences to the hon. Member for Mitcham and Morden (Siobhain McDonagh), and also our fond remembrances of Margaret McDonagh. She played a pivotal role in the 1997 landmark election for the Labour party, and her loss will be keenly felt on the Labour Benches, but also much more widely across the political spectrum.

The hon. Gentleman raised a number of issues relating to screening, on which there is much consensus in the House, but one issue that he did not particularly note is the importance of this programme in closing the health inequality gap. The detection of stage 1 and stage 2 cancers, which has had such a remarkable impact on survival rates, has been targeted at the areas with the highest smoking rates and, therefore, the most deprived communities. I hope there will be a fairly wide consensus across the House that that is a real benefit of the programme. We aim to take the proportion of lung cancer survivors from 15% to 40% over the next 18 months, and to 100% in the years ahead, and we are talking today about a series of measures that have proved to be effective: there is remarkable evidence of the survival rates that they generate.

The hon. Gentleman raised a number of wider issues related to the Government’s record on cancer. The NHS has seen and treated record numbers of cancer patients over the last two years, with cancer being diagnosed at an earlier stage more often and survival rates improving across almost all types of cancer. Indeed, the expansion of the screening programme is a good illustration of the clear progress that the Government are making.

The hon. Gentleman raised the issue of junior doctors—an issue that we have debated a number of times across the House. He says that he does not support the junior doctors in their demand for a 35% pay rise. They have, of course, offered to spread it over an extra year to take 2024-25 into account, but for that they want a 49% pay rise. This is slightly esoteric: the hon. Gentleman says he does not support their demands, but he also criticises the Government for not meeting those demands.

The hon. Gentleman raised the subject of research funding, and I was grateful to him for doing so, because the Government are spending more than £1 billion on research through the National Institute for Health and Care Research. I have met the president of Moderna, with which the Government have signed up to one of our landmark partnerships with the life sciences sector. There is huge potential for us to work with life science partners as part of our health commitment. It is clear that those within the industry see the Government’s commitment and are responding to it, even if Labour Members fail to do so.

We are expanding our programme because it demonstrably works. It is tackling health inequalities and significantly increasing survival rates. It is part of our wider commitment, through our work with Genomics England and our work on the national screening programmes to screen 100,000 babies. The programmes cover not just lung cancer but, for instance, breast cancer. My hon. Friend the Member for Winchester (Steve Brine), the Chair of the Health and Social Care Committee, raised the issue of HIV screening with me last week. That is one of the areas in which early detection is having clear results. We are diagnosing more cases, which is why survival rates are improving in almost all types of cancer.

[Madam Deputy Speaker (Dame Eleanor Laing)]

I call the Chairman of the Health and Social Care Committee.

[Steve Brine (Winchester) (Con)]

I remember dear James Brokenshire saying the words that the Secretary of State repeated today in the House. James made this happen—this is a fantastic prevention announcement. Although this nationally expanded programme cannot prevent lung cancer, will the Secretary of State confirm that we will stick by the principle of making every contact count? When people come forward for a lung risk assessment, we can offer emotional support where a problem has been detected, provide smoking cessation services to those who are still smoking, or just put our arms around people where there are comorbidities. When people come into contact with the health service, will we make every contact count for them?

[Steve Barclay]

I know that my hon. Friend was a Health Minister at the time that James was raising these points, and that he takes a close personal interest in the issue. He is right about the importance of the point at which people come forward. I was having a discussion this morning about the fact that when most patients come forward for screening, they will not be diagnosed with cancer, but it is still an opportunity for smoking cessation services, for example, to work with them on reducing the risk that continued smoking poses. My hon. Friend is right about using the opportunity of screening to pick up other conditions and to work constructively to better empower patients on the prevention agenda.

[Rachael Maskell (York Central) (Lab/Co-op)]

Of course those most at risk must be fast-tracked into diagnostic services, but when we are 2,000 radiologists short, 4,000 radiographers short and 5,000 other health staff short in those diagnostic services, how can people get the diagnostic services they need? When will we have the workforce in place to service this policy?

[Steve Barclay]

Clearly, the earlier we detect cancer, the less pressure it puts on the workforce. There is much more work involved in the treatment of a later cancer than of an earlier cancer. That is why we are investing in our community diagnostic programme, with 108 community diagnostic centres already open and delivering 4 million additional tests and scans. As part of the wider £8 billion investment in our electives recovery, over £5 billion is going into that capital programme. Yes, the workforce plan is a key part of that, but so is getting the CT scanners and the other equipment in place. That is exactly what our community diagnostic programme is doing, and it is being furthered by our screening programme through announcements such as this.

[Maggie Throup (Erewash) (Con)]

Alongside the new lung screening programme, which I welcome, will my right hon. Friend now commit to implementing in full the recommendations made by Dr Javed Khan in his review, so that we can finally stub out the No. 1 cause of preventable cancer and end the suffering for smokers who develop cancer and for their loved ones? Our late colleague requested that we be bold. In taking forward the Khan review in full, I am sure we would be fulfilling his wishes.

[Steve Barclay]

My hon. Friend is quite right to highlight the significance of smoking as a cause of cancer. We have a number of measures, including the programme to move 1 million smokers on to vaping, the financial incentives to encourage pregnant women not to smoke, the tougher enforcement and the consideration of inserts for packaging. The Government are taking a range of measures to address the very important issue that my hon. Friend rightly raises.

[Dan Jarvis (Barnsley Central) (Lab)]

The Secretary of State may be aware that, following work that I have been doing with Cancer Research UK, I have written to him and to the Minister for Social Care to outline my specific concerns about the lack of a cancer strategy. I would be very grateful if he or the Minister came back to me.

As the Secretary of State will know, cancer does not affect everyone equally. When it comes to health outcomes—the Secretary of State made this point—it is often more economically deprived areas, such as coalfield communities like Barnsley, that continue to lag behind. I completely agree and accept his important point about smoking, but studies have also shown that those who worked in the coal industry have a higher risk of lung cancer. I ask the Secretary of State to ensure that ex-miners are considered in the roll-out of the new targeted programme.

[Steve Barclay]

The hon. Gentleman raises a valid and important point on the targeting of mining communities. Of course, the roll-out will be shaped by clinical advice, but I will flag that point as we consider the targeting of the programme as it expands.

On the hon. Gentleman’s first point, the major conditions paper will look at these issues in the round. That matters because one in four adults has two or more conditions, so it is important that we look at conditions. A moment ago, I touched on the fact that obesity is the second biggest cause of cancer after smoking, so it is right that we look at multiple conditions in the round. His point about targeting is well made, and I will make sure the clinical advisers respond.

[Tracey Crouch (Chatham and Aylesford) (Con)]

In Medway, which is an area with high levels of deprivation, mortality rates for lung cancer and chronic obstructive pulmonary disease are significantly higher than the average in England, as is smoking-attributed mortality. Due to the towns’ shipbuilding and heavy industry heritage, to follow on from the point made by the hon. Member for Barnsley Central (Dan Jarvis), we also have one of the highest rates of mesothelioma, which is a type of lung cancer.

Although today’s announcement of the national roll-out is welcome, what plans do the Government have to bring vital lifesaving early detection to the doorstep of the Medway towns, as those most affected by lung disease are probably the least able to afford the 47-mile journey to Dover, where Kent’s screening pilot will be based?

[Steve Barclay]

My hon. Friend speaks with great authority on this issue, and she is right to highlight the importance of mesothelioma. A key theme of the pilots is the importance of convenience of access to screening, and a key part of the programme’s expansion is enabling it to be targeted at those communities that are at highest risk, as we heard a moment ago. I take on board her concerns about some of Medway’s challenges, and I know that she has called for this direction of travel more widely in the past—for the targeting of early detection in the community, because early detection brings far better patient outcomes.

[Sir Chris Bryant (Rhondda) (Lab)]

Screening is obviously important, and early detection is a good thing, but I wish the Secretary of State had not made this announcement today, because it is only a tenth of what we need to do to change things. There is a danger that we will make things worse.

My melanoma was diagnosed late, at stage 3, but my treatment started very quickly, within five days. My anxiety is that if we do not have enough radiographers and radiologists, as my hon. Friend the Member for York Central (Rachael Maskell) said, we will be shifting people from doing one set of tests—those for people who may have a later-stage cancer—to other sets of tests, unless we significantly increase the workforce.

Secondly, as the Secretary of State knows well, the statistics for people starting their treatment when we know they have cancer, because they have been diagnosed, are going in the wrong direction. I wish he had been able to stand at the Dispatch Box today and say, “We are going to have more radiographers and radiologists—I can guarantee that—and we are going to make sure that every single person who gets a diagnosis starts their treatment earlier and on time, otherwise we are failing them.”

[Steve Barclay]

Such is the nature of cancer that it has touched many Members, and I know the hon. Gentleman has taken a long, close interest in this issue. Of course, more than nine in 10 cancer patients get treatment within a month. He is right that it is also about diagnosis, which is why, through the community diagnostic centres, we are rolling out 4 million additional tests and scans, about which I spoke a moment ago. It is also why we have invested over £5 billion through our elective recovery programme, including over £1 billion for the 43 new and expanded surgical hubs. There is additional capacity going in, both on the diagnostic side and on the surgical hub side. We need to do both, and we are making significant progress.

[Miriam Cates (Penistone and Stocksbridge) (Con)]

My constituents in Penistone and Stocksbridge will warmly welcome this initiative to diagnose cancer earlier but, as many hon. Members have said, we also need to reduce the waiting times for cancer treatment after diagnosis. Will my right hon. Friend consider using some of the new community diagnostic centres, such as our amazing flagship centre in the constituency of the hon. Member for Barnsley Central (Dan Jarvis), as radiotherapy treatment centres too, to reduce treatment waiting times?

[Steve Barclay]

As part of expanding our capacity, we are doing both: we are expanding the diagnostic capacity—my hon. Friend is right to highlight that investment in Barnsley, as elsewhere—and boosting the surgical capacity through the expansion of our surgical hubs. In addition, we are looking at the patient pathway and identifying bottlenecks and how we design them out, given the additional capacity that is going into the system. So she is right to highlight the investment that is going in, alongside which we need to look at the patient journey and how we expedite that. The bottom line is that we are treating far more patients, the vast majority of whom—more than nine in 10—are getting treatment within a month.

[Richard Foord (Tiverton and Honiton) (LD)]

We know that 28% of victims of lung cancer have not smoked and do not smoke. My mum was one such victim. She died having contracted lung cancer and having not smoked before. But we were lucky in my family that she was diagnosed early. So, on behalf of the Liberal Democrats, I really welcome today’s announcement. However, on behalf of people in Devon whom I represent, I ask why only 40% of the people who are diagnosed will be subject to screening by 2025? Why do we have to wait until 2030 for the screening to be widespread and available to all?

[Steve Barclay]

First, may I express regret about the hon. Gentleman’s own family experience of this condition? On the roll-out programme, we need to build that capacity and to do so in a sustainable way—that point has been raised by Members across the House. We are following the science in targeting those communities that are most deprived; they have the highest prevalence of smoking. Of course we will look at evidence of other risk factors, which colleagues across the House have highlighted, but it is important that we roll this programme out in a sustainable way. What is clear, however, is that it is making progress and it is welcome that so many communities want the programme to be rolled out to their area as soon as possible.

[Mr Philip Hollobone (Kettering) (Con)]

I welcome the Health Secretary’s announcement. If I heard him correctly, it means that up to 9,000 cases will be caught early, which is equivalent to about a quarter of the 35,000 who sadly die every year from lung cancer. How much will the national lung cancer screening programme cost? Why can it not be paid for in its entirety from the profits of the cigarette companies?

[Steve Barclay]

My hon. Friend, an experienced parliamentarian, opens two different issues there. As he well knows, one is a question of tax, which, rightly, I say as a former Treasury Minister, is a matter for the Treasury. As for the roll-out of the programme, the additional cost of the programme will be £1 billion over the seven years. That is the additional cost of that expansion, but how it is funded will be an issue for the Treasury.

[Derek Twigg (Halton) (Lab)]

Anybody who has lost a loved one through lung cancer will know what a horrible and cruel disease it is. Obviously, we welcome any move to improve screening and get more people screened. But I would be interested to know two things from the Secretary of State. First, in one of my local hospitals—recently, I asked a parliamentary question about this—only 77.8% of patients got an urgent referral within 62 days, so quite a lot of people did not. Secondly, how much of the £1 billion will be used to bring in the extra clinicians and staff who will be needed to do the screening?

[Steve Barclay]

I am sorry, but I missed the second part of the question. On the speed of treatment, that is why significant work is going into the faster diagnosis standard, which was hit for the first time in February. Part of the additional capacity going in—the extra 108 diagnostic centres—is to boost that capacity and speed up that treatment. There has been a surge in demand; a significant uptick in the nature of demand. That is the backlog we have been working through as a consequence of the pandemic, but the additional capacity is to address that exact point.

[Edward Timpson (Eddisbury) (Con)]

I welcome today’s announcement and acknowledge the important contribution made by many charities and organisations that work in the world of cancer, including Cancer Research UK and the Roy Castle Lung Cancer Foundation. The pilot has proved that a national screening programme will make a huge and significant difference to many lives, particularly in places that were not in the pilot areas, such as Eddisbury in Cheshire. One aspect of the pilot programme that enabled a diagnosis to be made more quickly was the screening trucks that went out into the community. Will that continue in the national programme, particularly in rural areas such as the one I represent, where there are health inequalities that need to be addressed?

[Steve Barclay]

My hon. and learned Friend is absolutely right. A key feature of the programme is the use of screening trucks to offer checks within the community. When I was talking to patients this morning, a theme that came through was that the prospect of going to hospital for such a check would have been seen as a more daunting experience. The fact that the check was available, using high-quality equipment, in a vehicle in a supermarket car park made it more accessible to people and, as a result, the uptake was higher than it might have been. He is absolutely right to highlight the proven importance of that in the pilot and that delivering checks through community schemes increases participation; that is a key feature of the programme.

[Nick Smith (Blaenau Gwent) (Lab)]

Will the Secretary of State ask the Treasury if the tobacco companies can stump up for the delivery of the programme?

[Steve Barclay]

All Health Secretaries have regular conversations with the Treasury in terms of wider financing. The departmental budget for Health and Social Care is over £180 billion, which is already a significant investment. Through the long-term plan, we have significantly increased our budget and there are many calls on that, including, as we heard from the Opposition Front Bench, in terms of junior doctors’ pay and other issues. Of course these things need to be looked at in the round, but I am always keen to discuss with Treasury colleagues what more can be done.

[Suzanne Webb (Stourbridge) (Con)]

I thank the Secretary of State for the excellent news about the national targeted lung cancer screening programme. As an ex-smoker, I welcome any intervention and the focus on prevention. When I gave up smoking, it was chewing gum and fizzy drinks that got me through. Today, it is vapes. My concern is that young children are using vapes in the first instance, without having smoked, which can lead them to go on to smoke. Will my right hon. Friend join me in welcoming the recent crackdown on marketing vapes to children and the new illicit vapes enforcement squad, which will clamp down on online shops selling illicit vapes to under-18s?

[Steve Barclay]

My hon. Friend raises an important and topical point. The chief medical officer estimates 50,000 to 60,000 smokers a year may potentially give up through vaping, which is something the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O'Brien), is particularly focused on. However, there is a marked distinction between vaping as a smoking cessation tool and vaping products that are targeted at children, which is why we have both toughened the approach and closed some loopholes. A call for evidence closed a couple of weeks ago and we are looking at what further measures we can take.

[Sir Simon Clarke (Middlesbrough South and East Cleveland) (Con)]

I warmly welcome today’s announcement, and know people across Middlesbrough South and East Cleveland will do likewise. Across Teesside, a targeted lung health check programme has been running for over a year, led by the extraordinary Jonathan Ferguson, who is the clinical lead at the outstanding James Cook University Hospital in my constituency. The programme identified a curable cancer every two days, through scanners operating 12 hours a day, 7 days a week, from mobile units in supermarket car parks. As the new programme is established and proves its value to millions of people across the country, will my right hon. Friend commit to speaking to Mr Ferguson, who has valuable practical lessons about how the pilot has worked on Teesside, which could benefit many other communities?

[Steve Barclay]

I welcome the work that Mr Ferguson and those at James Cook University Hospital have been doing on the programme. We would be very keen to learn from any experience that they have to share. My right hon. Friend also draws attention to the innovative ways of working that are being piloted, including using scanners for 12 hours a day and looking at how they can operate in different ways. That is what this programme is about: delivering far better patient outcomes, much earlier detection and, as a result, far longer survival for those who otherwise may not have realised they have lung cancer and would have been diagnosed at too late a stage.

Bill presented

Relationships and Sex Education (Transparency) Bill

Presentation and First Reading (Standing Order No. 57)

Miriam Cates presented a Bill to make provision to require the sharing with parents and guardians of copies of materials used in relationships and sex education lessons in schools in England; to prohibit schools in England from using externally produced teaching resources for relationships and sex education that have not been published; and for connected purposes.

Bill read the First time; to be read a Second time on Friday 24 November, and to be printed (Bill 334).