Breast Cancer Screening

Tim Farron Excerpts

Wednesday 16th December 2020 Westminster Hall

[Tim Farron (Westmorland and Lonsdale) (LD)]

It is a pleasure to serve under your chairmanship, Sir Edward. I thank the hon. Member for High Peak (Robert Largan) for securing this debate. The hon. Member for West Bromwich East (Nicola Richards) made a remarkably good speech, citing her own family’s experience.

Both hon. Members have spoken about Breast Cancer Now’s assessment that almost 1 million women have missed a screening during this period. Its assessment is that that would mean 8,650 women may be out there with undetected breast cancer. Cancer Research UK assesses that screening services are running at 60% capacity. That means the situation is getting worse week by week. A hundred fewer women started treatment for breast cancer each day in May and June than during those months in 2019.

If we look beyond breast cancer, in my county of Cumbria there is a 17% reduction in the number of people starting cancer treatment this year compared to 2019. It is fair to assume, therefore, that roughly one in six people who would have been diagnosed with cancers of all kinds is out there undiagnosed. We know that for every four weeks treatment is delayed, for whatever reason, the chances one has of survival fall by 10%. That delay in treatment can be due to a delay in people coming forward, a delay in diagnosis and a delay in treatment.

Any Government of any combination of colours would have been thrown by the coronavirus. In those early months the messaging was really good and powerful: “Stay at home. Protect the NHS. Save lives.” It often occurs to me that the position of the NHS in British society, the affection in which it is held, was a key driver. I suspect that in another country, where the message might have been, “Protect the expensive private healthcare that you use, through exorbitant insurance models,” would probably have been less compelling. The NHS was a key driver and the Government deployed it well.

Why were we protecting the NHS? We were doing so not only so that we could tackle covid, but so that the NHS could carry on its lifesaving work in every other area. People not coming forward for treatment, for reasons that have been mentioned, such as being scared of being infected or nervousness about being a burden and troubling staff, is a huge part of the reason why the backlog exists.

There were treatment cancellations for perfectly good clinical reasons, as well as those for not good clinical reasons. I am chair of the all-party parliamentary group on radiotherapy, and Members would be staggered if I did not talk about radiotherapy as a treatment for breast cancer and other forms. Radiotherapy is the clean form of cancer treatment. It does not affect immunity and is not likely to open up someone to infection. The amount of radiotherapy being delivered during that period should not have been changed, because people are at no more risk of covid from taking it and, because it is a clean form of treatment, it should be substitutionary. It could be used, and in some cases has been, as a substitute for more risky forms of cancer treatment, such as chemotherapy and surgery, where that was necessary. In some cases, that has happened, which should be noted.

For example, bladder radiotherapy treatment is now at 160% of normal levels and capacity. In that area at least, we are using that clean technology to catch up with cancer in that area. The problem is that it is not the case across the board. We do not have figures since summer, but Public Health England has just released figures from April to the summer, which showed a 15% drop in radiotherapy treatments started during that time. That includes starting in April, so that cannot have been a response to fewer people coming through.

The National Institute for Health and Care Excellence recommendations and guidance at the beginning of coronavirus were to stop, postpone or delay radiotherapy treatment—for no clinical reason whatsoever. Some cancer centres followed that advice and people did not get treatment. We know what that means for people’s likelihood of surviving. That 15% drop in radiotherapy treatment will have cost lives. It was unnecessary and it means that the backlog is even greater than it would have been.

Cancer Research UK has estimated that we will unnecessarily lose 35,000 lives to cancer because of the crisis. The British Medical Journal published research a few weeks ago that showed we would lose, as a country, 60,000 additional years of life to cancer, because of the coronavirus crisis.

When breast cancer screening services are running at just 60% of capacity and we are witnessing a 50% reduction in the number of people starting radiotherapy treatment, we see a backlog that can only be getting worse as we speak. I want to endorse what has been said by the Chair of the Health and Social Care Committee, the right hon. Member for South West Surrey (Jeremy Hunt)—that it will take NHS cancer screening, diagnostics and treatment services, as a piece, operating at 120%usb capacity for two solid years to catch up fully with the backlog, to catch up with cancer.

Members will have been as deeply moved as I was by the recent sad death of Sherwin Hall, a 27-year-old father of two, as a result of delayed treatment. His family have been supported by the Catch Up With Cancer campaign, launched by the family of Kelly Smith, who also died far too young as a result of delays to her treatment during this process. Catch Up With Cancer estimates that the backlog might be up to 100,000 people. This is a national crisis on the scale of covid—different, but on the same scale—and it needs a response as ambitious and as urgent as the NHS’s correct response to covid. However, in the comprehensive spending review there was just a single mention of cancer in the entire document.

There are three issues at play here, the first of which is people having the confidence and awareness to come forward, as has been mentioned. The second is the diagnostic process and the third is the treatment. Issue one, the issue of people being brought forward or encouraged to come forward for treatment, is about strong public health and public information messages, and all of us getting behind them and being open about the necessity—as was mentioned, rightly, by the hon. Member for West Bromwich East—for a person to come forward if they have the slightest hint of a doubt that something might be wrong or unusual with any part of their body.

Issues two and three, diagnostics and treatment, need more than an ad campaign. They need more than good public relations and public information: they need money. It has been mentioned that within the CSR, £325 million was set aside for diagnostic machines, but the CSR says that that is

“enough funding to replace over two thirds of imaging equipment that is over 10 years old.”

In other words, it is money to replace some of the stuff that ought to have already been replaced. It is not new—it is not expanded capacity—and yet, when it comes to treatment, we have not got even that.

This was the Government’s opportunity. As chair of the all-party parliamentary group on radiotherapy, along with the Catch Up With Cancer campaign and the all-party parliamentary group on cancer—which I am proud to also be a member of—we made a submission to the Department of Health and Social Care and to the Treasury, calling for an immediate fund to catch up with cancer. That did not arrive, and I am going to shock the Minister by reminding her of a promise that she made me in this place a couple of weeks ago—to meet me and the Catch Up With Cancer team before Christmas, to look at how we can get that urgently needed ring-fenced investment through the spending review and into additional cancer diagnosis and treatments. I would like to hold her to that promise, and I hope she will refer to it in her closing remarks.

Alongside covid, the early diagnosis of women with breast cancer, so that we can treat them and cure them, is an ongoing problem. The United Kingdom is towards the bottom of the league tables for most of the major cancers when it comes to survival. To the Government’s credit, they acknowledged that in the NHS long-term plan released two years ago. Its fundamental aim—the headline part of that NHS long-term plan—was to diagnose more people early with all cancers, including breast cancer, so that we could treat them and cure them, and so that survival rates would be far better than the terrible situation that we have for most cancers in this country now.

I say to the Minister that if we are successful in diagnosing more people sooner, earlier—and we must be successful—we will then need the capacity to treat those people, and we do not have that. Radiotherapy is part of the solution, so it is absolutely essential to invest now in the kit, the technology and—as has been mentioned—the workforce, in order to be able to deliver treatments to those people who have been diagnosed early. How tragic would it be to diagnose maybe tens of thousands more people earlier than we do at the moment, and then not have the kit, the capacity, the staff or the technology to treat them? That is a challenge that the Government can meet, and I hope the Minister will take that on board and do just that.