Bowel Cancer Screening

Steve Brine Excerpts

Tuesday 1st May 2018 Westminster Hall

[Sir Roger Gale (in the Chair)]

Order. The situation we are in is entirely of my making, and for that I can only apologise. Given that there are so many Members present who might wish to intervene, I am prepared to stay in the Chair for six minutes of injury time to enable the hon. Gentleman to take interventions. I am sure that is illegal, but I am willing to do it, provided that the Minister and the hon. Gentleman, who are in charge of the debate, are prepared to accept that.

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

indicated assent.

[Nick Thomas-Symonds]

I am grateful for that kind offer, Sir Roger. I am delighted to hear that we can continue for an extra six minutes.

The hon. Member for Eastbourne (Stephen Lloyd) is absolutely right. This is a cross-party issue. I believe that his predecessor spoke in favour of the system that he proposes, and the hon. Member for Hexham (Guy Opperman) contacted me to draw attention to the debate that he led back in 2011. There is broad cross-party consensus for looking at the screening age and at more accurate screening methods, which I will come on to.

Participation rates remain an issue. We should send a very simple message to people: “Please do not ignore your bowel cancer screening kit, which could save your life.” There is no doubt that we must also do more to raise awareness of symptoms. Bowel cancer is often mistaken for other conditions, such as irritable bowel syndrome. That only reinforces the point that a number of hon. Members have made about the importance of highly accurate screening.

Previously, the standard screening test was considered to be the faecal occult blood test—the FOB test, as it is known—and all men and women between 60 and 74 received a home test kit, but that has been changing across the country. The best available test is now the faecal immunochemical test—the FIT—which can detect more cancers and can be set to different sensitivity levels, enabling any traces of human blood that are found to be investigated. The Royal College of Pathologists sent me a useful briefing, in which it indicates that it would expect a 45% increase in demand on pathology if the test were set at one level, but a 480% increase if it were set at a more sensitive level. That sensitivity level is important.

The Welsh Government are introducing the FIT from March 2019. I believe that it was due to be introduced in England in April. I hope that the Minister can update the House on when that will happen. I hope that there will be a decision for Northern Ireland soon. Of course, Scotland already screens people using the FIT at age 50.

--- Later in debate ---

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

I congratulate my friend the hon. Member for Torfaen (Nick Thomas-Symonds) on securing the debate. I pass on my condolences, as others have, for his loss just a few months ago. It takes a great deal of bravery to stand up in the House of Commons and talk about the passing of a mother so soon after it happened—I am not sure that I could have done so when it happened to me. As the Minister with responsibility for public health and cancer, I thank him for his interest in this subject and for the support he has shown. He mentioned the runs he has done—I am sure I could not do that—and his support for our excellent bowel cancer charities, Beating Bowel Cancer and Bowel Cancer UK, which recently joined together to become one charity. We await with interest what the new name will be—answers on a postcard to the Department of Health and Social Care.

Let me start by assuring the hon. Gentleman that bowel cancer is a priority for me, the Government and NHS England. That is simply because it affects so many of our constituents—about one in 20—during their lifetimes. It is the fourth most common cancer in the UK and the second leading cause of cancer deaths, with up to 16,000 people sadly losing their lives to the disease each year. If we want to improve on what are the best ever cancer survival figures, we need to do better with bowel cancer and, indeed, with all other cancers. Thankfully, more than 76% of men and women now survive for one year, which is a crucial landmark, and about 60% survive for five years. It is encouraging that survival in those detected and treated following bowel cancer screening is about 97%.

Let me talk about FIT, the subject of our discussion. Rolling out FIT—faecal immunochemical testing for haemoglobin, to give its full title—is recommended in the independent cancer taskforce’s strategy for England. We have much more to do to catch bowel cancer early and achieve better figures, which is why the Government accepted the recommendation of the UK National Screening Committee, which provides the Government with independent, internationally regarded evidence relating to screening, that FIT should replace the current home test. The pilot work showed that FIT will increase by about 7% the proportion of people taking part. Importantly, we expect those communities not returning the current home test kits to show the most interest in using the new ones. That is an important part of England’s cancer strategy. I am sure we will all welcome that contribution to the reduction of inequalities in screening and cancer mortality for those communities.

NHS England, Public Health England and NHS Digital are working together to finalise a number of practical arrangements regarding sensitivity, rightly mentioned by the hon. Gentleman, as well as production and distribution of FIT kits and diagnostic and pathology workforce capacity—I will return to that—to ensure that when FIT is implemented, it is, critically, sustainable.

It was important to get this right first time. When I was appointed last June, I was aware of the issue. One of the first questions I asked was about it, and I am as frustrated as anyone that it has taken so long. However, I am pleased to say that we fully expect that FIT will begin to be rolled out in the autumn. The hon. Gentleman mentioned NHS Wales and next spring and it being great that devolved Administrations follow best practice. Perhaps NHS Wales could follow NHS England’s best practice and bring forward its timetable.

[Nick Thomas-Symonds]

I am grateful to the Minister for his tone and constructive approach. May I press him for a little more detail? He said that FIT will be introduced in England in the autumn, but when will we get closer to a precise date?

[Steve Brine]

I cannot give the hon. Gentleman the precise date today, but I know of his and other Members’ interest in the matter, and as soon as I can give that date I will tweet it and tag him. I assure Members that I will let the House know as soon as I have the date, and I have a funny feeling that Members will be watching closely for that.

On lowering the age for screening, many right hon. and hon. Members and their constituents are concerned that the age at which we invite people for bowel screening should be 50 rather than 60. Such concern is sometimes driven by personal experience of the impact of cancer on families as well as on constituents. The hon. Member for Eastbourne (Stephen Lloyd) feels particularly strongly about the issue and has worked on it for a long time—I worked with him a lot during his first iteration as an MP, and it is good to see him in his second chapter. I thank him and his constituent Lauren Backler, who sadly lost her mum to bowel cancer, for personally delivering to my Department last week a petition on the screening age with, as he said, 400,000-plus signatures. I was in my constituency; otherwise, I would have come down and got it myself. I saw him on “ITV News Meridian”, our local news, walking up Victoria Street with the petition. I thank him for that and will take great note of the petition. We will, of course, consider it carefully and respond in due course, but I hope what I will say today will give him some cause for optimism.

When the bowel cancer programme was introduced in 2006, it focused in the first instance on those aged 60 to 69, and then in 2010 it was extended to 70 to 74-year-olds. When we consider that eight in 10 cases are in over-60s, we can understand why that was the starting point, but that does not have to be the end point. It is therefore crucial that the clinician looking at the bowel following a finding of blood in a stool is as skilled an expert as possible, and the NHS has to make sure there is enough clinical capacity to follow up referrals.

The hon. Member for Torfaen rightly mentioned NHS England capacity, which is critical. To boost clinical capacity in the NHS in England, Health Education England has recently pledged to fund the training of 400 clinical endoscopists by 2021, which will significantly increase the endoscopy capacity in England and is a key part of the jigsaw.

This decision to screen from the age of 60 was also based on the fact that, as I have said, the risk of bowel cancer increases with age and people in their 60s are found to be most likely to complete a testing kit. However, that does not have to be the end of the conversation. Therefore, five years ago, in 2013, we started to introduce bowel scope screening for those aged 55. In the research that underpinned that decision, those who took up the offer of a bowel scope test and follow-on treatment reduced their chances of dying from bowel cancer by more than 40%. Those are good stats. Now, with the introduction of FIT, we have an important, evidence-supported opportunity to consider the totality of the bowel cancer screening programme and maximise the benefits of bowel cancer screening.

[Nick Thomas-Symonds]

One of the issues with the scope test is its geographical spread: as I understand it, at the moment only about half of England is covered. First, will the Minister comment on when it will be extended? Secondly, I would welcome his commitment to reviewing screening in its totality.

[Steve Brine]

I will indeed ask the question that the hon. Gentleman raises about geographical spread. It is a key point.

I am pleased to say that the UK National Screening Committee is now considering how to optimise bowel cancer screening using those two evidence-based testing methods, namely bowel scope screening and FIT. It will advise on the optimal strategy—the hon. Gentleman rightly used that term—for England, this summer. To inform that advice, it ran a consultation, which ended on 9 April. That focused on whether the current evidence supports a change to the current tests approved for use in bowel screening programmes. In particular, it considered whether an optimal bowel screening programme should use both BSS and FIT. Both those screening methods require significant numbers of highly trained people and significant amounts of hospital resources in the NHS. With the introduction of FIT, it is therefore timely to carry out further work to decide the best combination of tests for the English programme; that includes the issue of sensitivity. I know that there is a lot of debate in the clinical community about the range and the number of people affected. We must get that right.

I am pleased that as part of its deliberations, UKNSC will also consider the most appropriate age at which FIT screening will start. It would be wrong of me, however, to pre-empt its recommendations or, as the hon. Member for Eastbourne said, to announce an exclusive from Westminster Hall. However, it is being considered and Ministers, including the Secretary of State, take a close interest. That is as clear as I can be. We are clear that recommendations must be achievable, so the availability of high-quality follow-on tests—colonoscopy and pathology—will be central to ensuring that we can turn the benefits of a better test into thousands fewer people getting and dying from bowel cancer. I am asking NHS England to consider that carefully. It knows of my clear interest in the matter.

I am thankful that survival rates are improving year on year, with about 60% of bowel cancer patients now surviving for five years or more, compared with about 25% 40 years ago. That is a significant change. As hon. Members have said, early diagnosis is vital—for all cancers, but certainly for bowel cancer—which is why the independent cancer taskforce included driving a national ambition to achieve earlier diagnosis among its six strategic priorities in the cancer strategy for England, which I am passionate about implementing. We remain on track to deliver that priority and to deliver every one of the 96 recommendations in the strategy by 2021. We are, of course, thinking about post-2021 as part of the long-term vision for the NHS, which the Prime Minister spoke about at the Liaison Committee recently.

We hope that the introduction of FIT as the primary test in the bowel cancer screening programme later this year will further enhance the drive towards early diagnosis and ensure that we catch more cases of bowel cancer early and allow for better treatment outcomes.

[Lady Hermon]

Northern Ireland has not had a Health Minister since January 2017. It would be enormously encouraging if the Minister would confirm that he has spoken to the permanent secretary for the Northern Ireland Department of Health about introducing the FIT technology in Northern Ireland, which is a part of the United Kingdom.

[Steve Brine]

I personally have not, but I will do so, as a takeaway from this debate. The hon. Member for Strangford (Jim Shannon), who is no longer in his place, has made the same point to me in other contexts. I shall speak to my officials and make sure that happens. I will keep the hon. Lady informed.

I have mentioned the bowel cancer charities. I have a regular roundtable with all the cancer charities—it is one of the great privileges of my position. They have worked on the narrative of needing, as they put it, to talk about poo. When mainstream drive time presenters talk, as they did on BBC Radio 5 Live last week, about looking at poo and “taking a look back” as the presenter put it, it shows how far we have come. Breaking down barriers and Members talking about their experience is important, as is the way in which charities approach the subject. We look forward to seeing what the new combined charity can do. It is an important part of changing the narrative and culture, in addition to the Government’s work with NHS England to change the testing regime and the other issues I have mentioned. The battle is long, as it always is with cancer, but with the support of “Team Cancer”, in which I count all hon. Members present, I think we are winning.

Question put and agreed to.