Covid-19: Access to Cancer Diagnosis and Treatment

Tim Farron Excerpts

Wednesday 2nd December 2020 Westminster Hall

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

I beg to move,

That this House has considered access to cancer diagnosis and treatment during the covid-19 outbreak.

It is a great pleasure to serve under your chairmanship, Ms McVey. I am grateful to have the opportunity to raise this issue. Of the many vital issues discussed in this place in recent months, the impact of covid-19 on cancer treatment must be at the very top of the list for importance to families right across the United Kingdom. I want to start by saying very clearly that there is a national cancer crisis—a backlog that we need to catch up with urgently—so I will be concluding my speech by asking the Minister to meet me and the clinical advisers who support the Catch Up With Cancer campaign as a matter of priority in the coming days.

Since the start of the pandemic, organisations, charities, frontline NHS staff and MPs have been urging the Government to invest in cancer services to prevent a national tragedy in cancer. Indeed, the experts we work with warned at the start of the pandemic that tens of thousands of people were set to die as a result of cancellations, delays and disruptions to their treatment. Sadly, it looks as though those warnings have been proved right, although for thousands of families it is not yet too late for us to catch up with cancer.

I have two main points to address. Both relate in large part to the covid-induced backlog and the apparent failure to make addressing it a central feature of the Chancellor of the Exchequer’s comprehensive spending review just last week. The first point I would like to address today is the scale of the cancer backlog itself. All the feedback from the frontline and from our expert clinical advisers strongly suggests that the Government and NHS management are repeatedly failing to grasp the true size and scale and danger of the backlog. The Government and senior NHS managers keep saying that services are back to normal levels and that good progress is being made on the backlog, but all the evidence from frontline staff provides a clear picture that it is just not true to say that we are back to normal.

Even then, the simple fact remains that, with the scale of the backlog, “back to normal” is nowhere near good enough anyway. Even if services were back to pre-covid levels—we contend that they are not—it would be mathematically impossible to have caught up. Why? Because the flow of patients was all but stopped for several months, but cancer, of course, did not take a break. It kept striking people at the same rate it always does, so the only way we can catch up with cancer is to have services super-boosted to levels in excess of pre-covid capacity. We estimate that cancer services need to be running at something like 120% of pre-covid levels for two solid years to catch up. That view is shared by other keen observers of this problem, such as the chair of the Health and Social Care Committee, the right hon. Member for South West Surrey (Jeremy Hunt). But the brutal reality is that services are not yet even at their pre-covid capacity. In September, treatment was at only 94.5% capacity, and as long as the treatment rate continues to be below 2019 levels, the cancer backlog will continue to grow.

We are hearing from frontline staff that services were not yet back to normal before the recent lockdown in November. One cancer centre has told us that during that lockdown, referrals have yet again “fallen off a cliff”. Analysis from Macmillan Cancer Support, using the Government’s own monthly cancer waiting times data, shows that during the pandemic around 1,000 fewer people in south Cumbria and Lancashire will have had their first cancer treatment, compared with the same period last year—a 17% drop—which suggests we are missing one in six people with cancer. There is no serious doubt about what is happening to those missing people. Their cancers will have grown and spread and, in many cases, become incurable by the time they are identified and by the time, if at all, they are treated. Across the country we hear of patients presenting with more advanced cancers due to not being seen early enough. Some staff tell us that they have never seen such advanced cases.

The all-party parliamentary group on radiotherapy, like all the all-party groups on cancer, is strenuous in its insistence on a consensual and collegiate approach, and sees Ministers, especially the Minister here today, as partners and not opponents. I am grateful to the Minister for her courtesy, her willingness to engage and her very clear concern. I am also grateful to all Members here and to those who are not present but who dearly wanted to be. Many are absent because this Chamber is not yet enabled for virtual participation. They include the hon. Members for North Devon (Selaine Saxby), for West Lancashire (Rosie Cooper), for Rhondda (Chris Bryant), for Central Ayrshire (Dr Whitford), for Liverpool, Riverside (Kim Johnson) and for Bootle (Peter Dowd).

Our collective view is that we need urgent action to catch up with cancer. I mentioned the figures for my own area, but Macmillan estimates that across England as a whole there are a terrifying 50,000 missing diagnoses. Clinicians report that more patients are now coming through needing palliative rather than curative care—people who could have survived who are now on end-of-life pathways and are simply being treated to alleviate the pain.

[Grahame Morris (Easington) (Lab)]

That is a really important point. How do we quantify the scale of the backlog to enable us to have an action plan to address it? Specialists say that whereas the ratio is currently 50:50 in terms of the therapeutic application of radiotherapy for treatable cancers and therapeutic palliative care, last year it was 70% treatable and 30% palliative. Do we not need the release of the datasets to quantify that in an accurate way?

[Tim Farron]

I am extremely grateful to the hon. Gentleman for making a very important point. I have heard the same reports from the frontline that treatment would normally be 70:30 curative to palliative and that now it is 50:50. That is a blindingly obvious consequence of the fact that when we catch cancer, we catch it too late.

I have a request of the Department, which we have made before, including in face-to-face meetings with the Secretary of State. I want the Department of Health and Social Care team responsible to sit down with the frontline experts—we can provide them this afternoon—and go through the evidence of the backlog. There is no way of tackling the problem if the NHS management and the Department are not cognisant of it and prepared to listen to the people working their socks off in cancer units all over the United Kingdom.

I want to make another important point. Whoever was in power during this time would have been handed the same challenge and would have made many mistakes. The Government have rightly sought to control the virus so that we can protect the NHS and save lives. The lives that we seek to save are those at risk from not just covid but other illnesses, including, of course, cancer.

We as a country have stood together and defended our NHS so that it has the ability to fight cancer in the midst of a pandemic, which is what every clinician is desperate to do. The great success of this year, for which Ministers should rightly be proud, is that our NHS has not collapsed and did not fall over. Our doctors, nurses, paramedics and clinicians of every sort have saved lives, defeated the odds and kept our NHS on its feet so that it can fight cancer, and yet a failure at senior levels of NHS England and in Government to recognise the scale and nature of the cancer backlog means that people are dying today who did not need to die.

We have terminal diagnoses for cancers that could have been treatable among my constituents and yours, Ms McVey—among all our constituents. Their lives have been cut short when earlier, more urgent and more ambitious action from our leaders could have saved them. What troubles me so much is that we hear statements from some in senior management in the NHS, and from within the Department, that suggest they do not quite get the scale of the backlog problem. They freely admit that they do not know how big the backlog is. On more than one occasion, I have heard the Secretary of State seek to reassure us by saying that progress has been made on recovering the 62-day wait. If people understand what is happening, however, that does not reassure them. It does the exact opposite: it sends a shiver down their spine—it confirms the problem.

Surely Ministers know that the 62-day waiting time target for treatment does not give a complete snapshot of the situation, because it captures only patients who are already in the system. I am sorry to be brutal, but as more people die, there are fewer people in the system. The target does not take into account the tens of thousands of undiagnosed patients who may be going about their daily life completely unaware that they are living with cancer.

I fear that the Government hugely underestimate the cancer backlog, and the consequence will be thousands of unnecessary deaths and lost life years. An article last month in The BMJ estimated that there will be 60,000 lost years of life as a result. Does the Minister recognise the significant fall in people receiving cancer treatment this year compared with 2019? Like me, is she worried that this will mean there are thousands of people out there with undiagnosed cancer who have yet to come forward?

I move on now to my second point, which relates to the Chancellor’s recent comprehensive spending review, which was a pivotal opportunity to signal that the Government, the Department of Health and Social Care, the Chancellor and NHS leaders understood the need for investment in the techniques and treatment required to quickly build capacity in order to clear the cancer backlog and ensure a resilient service going forward—to build the capacity that is vitally needed if we are to make sure cancer patients are not the collateral damage of covid. Far from seizing that pivotal opportunity, the Government appear to have turned it into a missed opportunity. As far as we can tell, there is no boost to cancer treatments in the comprehensive spending review. There is no increase in capacity to catch up with cancer, and there is no plan to do what is needed to save thousands of cancer patients’ lives.

The Action Radiotherapy charity estimates that the true cancer backlog could be as high as 100,000 patients. It supports the estimate of the Chair of the Health and Social Care Committee that it would take cancer services working at over 120% pre-covid capacity two years just to catch up. Members of all political persuasions, working with clinicians and experts who are desperate to make a difference, are clear about how the Government could provide the boost required to catch up with cancer and to save thousands of lives. The answer is not to exhort our heroic frontline staff to work harder—they continue to be inspirational, straining every sinew. It is not to carry on doing what we have always done, but just doing it a little better. It requires some new thinking. It requires taking an axe to some of the internal bureaucracy that has held back some treatments, such as radiotherapy. Crucially, it requires investment, but that critical investment seems to be missing from the comprehensive spending review. That is a missed opportunity on a massive scale, and I hope it is not too late to make a change.

I have to say that there has been a collective gasp of disbelief across the oncology and radiotherapy sector, as it appears—unless we are all mistaken—that there is not even an explicit mention of radiotherapy in the spending review, never mind of the investment in it. Radiotherapy is covid-safe and is required by over 50% of cancer patients. It already plays a significant role in 40% of cancer cures and is able, where clinically appropriate, to substitute for chemotherapy and surgery at times when they are deemed not to be appropriate because of the fact that we are in a pandemic. It is hugely cost-effective: it cures patients for as little as £5,000 to £7,000 apiece.

The reality is that radiotherapy has huge untapped potential to do even more to clear the backlog. For many reasons, however, it has been actively restricted and held back for years. Although radiotherapy treats 50% of cancer patients, it receives just 5% of the annual cancer budget—something for which recent Governments of all parties must share the blame. That is why the UK is massively behind on technology that could empower the workforce to do more. Pre-pandemic it was estimated that as many as 24,000 patients were missing access to radiotherapy treatment each year. It is worse now.

Faced with the current crisis, the radiotherapy community came together to put together a transformation plan for consideration at the comprehensive spending review. The six-point plan would deliver a super-boost to cancer services to clear the backlog, with innovative technology and digital solutions to deploy linear accelerators at the many covid-clean hospital sites in England, such as the Westmorland General Hospital in my constituency, that are perfectly suited to adding satellite capacity to their main cancer units while protecting patients and clinicians from covid infection risk. The plan would also see an immediate boost in precision radiotherapy at existing cancer units, upgrading linear accelerators to perform curative treatment over shorter periods. However, on our reading of the spending review, that appears to have been totally ignored. In fact, as far as we can tell, there is no clear plan of investment in cancer treatment capacity at all.

While the investment in diagnostic machines over 10 years is truly welcomed by all of us here, it is not enough. According to Freedom of Information Act requests carried out by the Radiotherapy4Life campaign, more than half of NHS trusts are using radiotherapy machines that are more than 10 years old. To replace only the machines that deliver diagnostics, or radiology, and not those that actually cure people—the radiotherapy machines—is a baffling decision, to me and, more importantly, the experts. Patients and the public will be shocked to learn that immediate solutions presented by expert professionals to the covid-induced cancer crisis are being overlooked.

Every week that we delay giving an immediate boost to cancer services—capacity, diagnostics and treatments —we increase the risk of losing cancer patients needlessly. Recent data shows that for every four weeks of delay in starting treatment there is as much as a 10% increase in deaths. Some departments report a 20% drop in the number of patients classified as curable, leading to downgrading to palliative treatment instead. Patients—our constituents, families and friends—are being told that their cancer now cannot be cured and that their treatment will be palliative instead. Yet the decision to catch up urgently with cancer has been either delayed or ignored. We will pay a huge cost for missing out on the chance to correct things at the spending review. That is why I hope it is not too late to do so. The public inquiry, when it happens, will reveal the situation. The cost of the understandable litigation by patients and families who have been failed will be needlessly huge.

We first wrote to the Secretary of State about the growing crisis in April, and we have not stopped warning of the devastating impact that there will be on the lives of cancer patients. Three hundred and seventy-five thousand people have signed the Catch Up With Cancer petition and have hundreds of patients shared their heartbreaking stories. Experts are saying that there will be as many as 35,000 unnecessary deaths and, as I have said, 60,000 life years lost to cancer because of the impact of the covid crisis. Cancer survival rates have been pushed back to where they were more than a decade ago.

I know that the Minister cares. She is a good person seeking to do a good job. I hope that she will forgive me for being direct today, but thousands of people could have their lives lengthened or saved, and their families could be spared unspeakable grief, if we acted urgently to catch up with cancer. I conclude by repeating my plea in the strongest possible terms. Will the Minister meet me and, most importantly, the expert clinicians who advise the Catch Up With Cancer campaign, in the next few days so that we can turn the tide on the crisis?

[Esther McVey (in the Chair)]

Just for the ease of colleagues, I will say that I am looking to call the Front-Bench speakers at 10.30 am, so divide the time among yourselves.

--- Later in debate ---

[Tim Farron]

The hon. Members for Warrington South (Andy Carter), for Gower (Tonia Antoniazzi), for Easington (Grahame Morris), for Strangford (Jim Shannon), for Angus (Dave Doogan) and for Nottingham South (Alex Norris), and indeed the Minister, all made excellent points, and I am extremely grateful. I thank the Minister for what she said and for agreeing to meet us this side of the recess. To be specific, we are after a meeting with her, of course, and departmental finance officials so that we can revisit the investment decision—that decision is problematic—and have our experts meet hers to get to the bottom of the data. We need to see the datasets so that we can explore the extent to which there is an urgent crisis—we are certain that there is one.

Finally, the Minister talked about the importance of diagnosis. The Government are making progress on diagnostics. Of course, in the NHS long-term plan, we see the desire to find more cancers earlier so that we can treat them. If we find more cancers early, however, we will have more people to treat. That is why the radiotherapy investment that we have called for is essential, not just now but in the long term.

Motion lapsed (Standing Order No. 10(6)).

[Esther McVey (in the Chair)]

I will suspend the sitting for two minutes so that hon. Members can exit safely and the next lot can come in safely.