Access to Radiotherapy

Tim Farron Excerpts

Wednesday 12th January 2022 Westminster Hall

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

It is a huge pleasure to serve under your chairmanship, Mr Davies. I pay tribute to my friend, the hon. Member for Easington (Grahame Morris), for securing this debate and for an excellent speech, which contained some points that I make no apology for repeating because this issue matters hugely.

I lost my mum at the age of just 54. Eighteen years on, of course I still miss her massively; I miss especially the grandmother she would have been. Few issues that we deal with in this place are more personal than cancer. Half of us will have the disease at some point in our lives. Cancer touches absolutely every family.

The good news is that, increasingly, cancer is a disease that need not be a death sentence, partly because of the advances in radiotherapy. Radiotherapy kills cancer cells through radiation targeted at a tumour. It is becoming more and more precise, and is able to cure cancers that would otherwise be untreatable, with fewer side effects, as the hon. Member for Easington set out.

Just over 50% of people with cancer should expect to receive radiotherapy, yet, as has been said, Cancer Research UK estimates that only 27% of cancer patients in the UK actually receive it. The clue to why that is is that the UK spends only about 5% of the cancer budget on radiotherapy. The equivalent average spend of similar countries in Europe, Australia and so on is about 11%. The total budget for radiotherapy each year is £383 million; compare that to the £2 billion spent on cancer drugs every year, even though radiotherapy is eight times more likely to be curative than chemotherapy.

That historic underinvestment—the responsibility of lots of Governments of all colours—is undoubtedly a reason why the UK has some of the worst cancer survival rates in Europe. Lives are being lost needlessly because the UK is so painfully slow at keeping up with and grasping the opportunities that radiotherapy provides. That is why we set up the all-party parliamentary group for radiotherapy, which I am privileged to chair. I send huge thanks to Members from all parties, especially the hon. Member for Easington, to leading clinicians across the country and to the charity Radiotherapy UK, which is led by the rightly much esteemed Professor Pat Price, who has already been mentioned.

We set up the APPG in spring 2018. We booked a room in 1 Parliament Street. A handful of MPs turned up, but 50 or 60 of the leading oncologists in the country turned up and crammed into the room—they would not be allowed in today because of covid restrictions. Why had those people left their massively important jobs for the day, just to come to London for that meeting? It struck me then that it was because there is no radiotherapy lobby. I am not in any way going to criticise pharmaceutical companies, but we know that they are large and they have large coffers. We all get letters most weeks from constituents asking for this drug or that drug to be commissioned, and very often that is right. There is no such lobby for radiotherapy.

Lobbying, in its purest and most fair form, is about being in the room with the people who make the decisions. Radiotherapy has not had someone in the room with the people who make decisions. That is the best I can come up with as an excuse for why this Government and previous Governments, including the one I was part of, have not taken radiotherapy anything like as seriously as it should be taken, why we are investing such a paltry amount in radiotherapy, and why we are so far behind comparable countries.

At the local level, a bad situation is made worse because access to radiotherapy is simply not fair or equal. In south Cumbria, cancer patients have to travel each day all the way to Preston to our nearest radiotherapy centre. The Rosemere unit at Preston is excellent, but dangerously distant. The National Radiotherapy Advisory Group stated that it is bad practice for patients to have to travel for more than 45 minutes for treatment, yet not a single person in my huge constituency reliably lives within 45 minutes of radiotherapy.

Over the years, I have had the privilege of driving constituents to Preston for their treatment. I have seen how people from Kendal, Windermere, Grasmere, Grange, Coniston, Sedbergh and other communities have to make round trips of between two and four hours every day for weeks on end. I have seen their exhaustion and the impact on their health. I have seen people whose lives would have been longer if they had had radiotherapy turn it down, because they physically could not cope with the travelling. I have seen clinicians who have chosen not to refer people for radiotherapy, understandably but sadly, because they knew that their patient’s condition would be made worse by those long, gruelling journeys. In Cumbria, because NHS England and the Department of Health and Social Care will not act, those longer journeys mean shorter lives.

For 13 years, we have run a campaign collectively in Westmorland, calling relentlessly for a radiotherapy satellite unit to be placed at Westmorland General Hospital. We also campaigned to bring chemotherapy to Kendal and were successful in that fight. I am proud of everyone who supported our radiotherapy campaign, but we have submitted petitions with more than 10,000 signatures; I have had numerous Westminster Hall debates; I have met countless Ministers from all three parties that have been in government during my time in Parliament; we have marched for the hospital in our thousands; a team walked from Preston to Kendal just to make the point; 1,000 people wrote detailed, personal, heartbreaking stories to explain why we need the unit in Kendal; and we have demonstrated that there is clearly enough demand for at least one linear accelerator at Kendal, drawing patients from the south lakes, Furness and the western dales. With an ageing population in our community, there is also clearly a growing need.

We have the space at the hospital, designs have been done, the bid has been written and rewritten, and the inaction of managers in NHS England and Ministers in the Department of Health is inexcusable. It is a reminder of why rural communities feel so taken for granted and ignored by the Government and by NHS bosses nationally and regionally. Talk of levelling up the north is meaningless when Ministers appear not to realise that there is 100 miles of England north of Preston until the next nearest cancer centre.

Networked satellite radiotherapy units have been a huge success elsewhere in the country and, once they open, have been shown to increase the number of people able to take up that life-saving treatment. Satellites save more lives. Today, I ask the Minister to instruct NHS England to work with our local trusts in Cumbria and Lancashire finally to deliver our long-awaited satellite radiotherapy unit at Kendal. Our community will listen carefully to her response.

Radiotherapy, as the hon. Member for Easington said, provides the Government and the NHS with their best way through the cancer backlog. Owing to the pandemic, 740,000 cancer referrals have been missed. Therefore, at least 60,000 people are out there with cancer, but undiagnosed. That is terrifying. There is also an enormous backlog for treatment, with people dying as a result. In the Morecambe bay area, about half of cancer patients are having to wait for more than the scheduled 62-day limit to get their first treatment. As the Chair of the Health and Social Care Committee, the right hon. Member for South West Surrey (Jeremy Hunt), rightly said, it would take the NHS working at 120% of its existing capacity for two solid years just to get back to where we were in March 2020. The need for an urgent and ambitious boost to cancer care is therefore obvious, but we see next to nothing specific from the Government.

Money was pledged for diagnostic hubs, but just on Monday this week, I discovered that in South Lakeland we will not see ours until next year. Where is the urgency? The Government and the NHS have done so well—commendably—on the vaccine roll-out. Why will they not treat cancer and the cancer backlog in the same way, with a ring-fenced and targeted programme to catch up with cancer?

Radiotherapy is covid-secure and non-invasive, carries no infection risk, does not need intensive therapy unit beds or precious operating theatre time, does not compromise one’s immunity, is curative, palliative and, per capita, incredibly inexpensive. We could massively increase capacity very quickly. It has been the stand-out treatment in covid, often substituting for surgery, and it is the obvious first choice for getting through the backlog of cancer cases.

As an all-party group, we first wrote to the Secretary of State on 1 April 2020 to highlight the key role that radiotherapy needed to play to tackle the covid-induced cancer backlog. Since then, multiple spending reviews and Budgets have been passed with no significant investment in radiotherapy. The oft-repeated £130 million announced in 2016 as part of the long-term plan was spent long, long ago, so I hope that the Minister will not trot that out again. Yet a relatively modest investment of £850 million over three years could have a guaranteed and dramatic impact on cancer survival. I hope the Minister will take up the hon. Member for Easington’s request that she meet us as an all-party group and, more importantly, the clinicians, so that we may talk her through this all-party plan backed by the clinicians, which will help her out and help her deal with the backlog.

The Minister should tackle perverse tariffs that do active harm to cancer treatment, and she could do so at no cost whatsoever to the taxpayer—it is about spending the money differently and less foolishly. Staff are restricted from using centres with more modern, precise kit that can treat patients in fewer sessions; instead, they must treat less effectively and over more sessions because, stupidly, the tariff rewards the number of visits, not the precision or effectiveness of treatment. The Government must be pragmatic and accept the offer from the private sector to centrally commission its capacity—at cost and not for profit—to deliver treatment on the NHS to clear the backlog and to save lives.

We must especially care for, value and boost the work- force. Radiotherapy oncologists, radiographers, engineers and physicists—dedicated, passionate professionals —are close to breaking point. The survey by Radiotherapy UK and the Institute of Physics and Engineering in Medicine, to which the hon. Member for Easington referred, showed that 75% of those professionals believe that their unit could not meet pre-covid capacity with the kit they have. Some 80% reported seeing more advanced tumours than ever before in their careers and, as has been said, nearly 80% had thought about leaving the profession.

In Cumbria and right across the UK, radiotherapy treatment and the outstanding workforce have so much more to offer in the fight to save lives than successive Governments have seen fit to acknowledge. All parties bear responsibility for that. I ask the Minister to be a laser trailblazer and to deploy radiotherapy at its full capacity, so we can end needless deaths and catch up with cancer.

--- Later in debate ---

[Maria Caulfield]

I absolutely take that point on board. There are clinical reasons, if a patient has presented later, why radiotherapy may or may not be suitable. Again, they are clinical decisions that a patient needs to be discussing with their oncologist.

The hon. Member for Westmorland and Lonsdale (Tim Farron) raised the issue of satellite units. Again, I would just be slightly careful. Cancer alliances are mapping out cancer services in their areas, and I am very happy to meet colleagues who would like better provision in their local area, but they also need to meet their cancer alliances, which are looking at service provision locally.

I would just caution Members on the issue of having multiple sites for radiotherapy. These are specialist treatments, needing specialist equipment and specialist staff. I went into oncology more than 20 years ago, when surgery was done by general surgeons. They were doing mastectomies on women and colostomies on bowel cancer patients. Moving surgery into being a specialist field, with specialist provision, has transformed the way that we are able to look after women who are going through mastectomies, and bowel cancer patients, who may not necessarily need a colostomy now, because surgical treatments have advanced so much. There is sometimes a rationale for those services to be offered by specialist units, rather than multiple satellite sites.

[Tim Farron]

I want to answer a point that the Minister made earlier. Obviously, during the pandemic, radiotherapy has been used as substitutionary treatment for people who would otherwise have had chemotherapy or surgery, because it is a covid-secure treatment. But my main point is with regard to what the Minister just said about satellites. Has she looked at the data and evidence from those satellite centres that have been opened in the last few years?

For instance, at Hereford, we saw a doubling of the number of patients being treated at that new satellite centre. Why? Well, there was an assumption that the parent centre people, from that postcode, were simply transferred to Hereford. No, it turned out that a lot more people, who would not travel or who were not referred because of the travelling distance for treatment at the original place, were then referred for treatment and therefore had a longer life expectancy because of the satellite centre. With more networking capability, it is of course possible now to treat in specialist ways, with the best people, remotely and through these satellite centres. The Christie has just opened its third satellite, so surely, for more rural communities such as mine, and also in east Lancashire, the time has come to ensure that no one is left behind.

[Maria Caulfield]

There are satellite services—absolutely. We have seen them not just for radiotherapy, but for chemotherapy and even surgery. But it has to be a local decision, because local oncologists have to feel that they are able to support the multidisciplinary team who support the radiotherapy process, ranging from diagnostics through to the treatment itself. That has to be in place, so it does absolutely need to be done on a local basis, but I am happy to meet colleagues if they feel that the case is not being heard locally.

I want to emphasise this point, because a number of hon. Members talked about the commitment to cancer services. Our elective recovery programme has committed £2 billion this year and £8 billion over the next three years to step up activity and tackle backlogs. That will have a knock-on effect in improving radiotherapy access, because some patients cannot have radiotherapy until they have had surgery. Ensuring that we are tackling some of the backlogs to treatment resulting from covid is absolutely important.

There have been huge improvements in radiotherapy over recent years, not just in provision but in technique. We are able to deliver more targeted treatment, resulting in fewer hospital visits, because we can now give radio- therapy to a more targeted area of the body, resulting in fewer side effects from the treatment, and also give fewer fractions of radiotherapy, so that patients can get their total dose much more quickly. That maximises service capacity and minimises patient time in hospital.

Furthermore, we have invested £250 million into two proton beam therapy facilities, one based at the Christie in Manchester and the other at University College London. In addition, all radiotherapy centres in England are now able to deliver stereotactic ablative body radiotherapy. Both these treatments are able to target radiation at cancer cells more accurately, improving patient outcomes. I am really pleased to say that, as part of this year’s spending review, £32 million was made available to support the replacement of 17 linear accelerators aged over 10 years, all of which are on order and will be delivered by the end of March 2022.

NHS England is committed to improving the facilities for cancer patients, and has also offered NHS radiotherapy providers the opportunity to participate in a cloud-based technology called ProKnow. To date, 43 of the 49 radio- therapy providers have joined up. This technology, which will help satellite units, enables clinicians to collaborate virtually within and across organisations, to plan treatments, undertake peer-review assessments and participate in large-scale audits and quality improvement processes, ultimately benefiting patients.

A number of Members talked about the cancer workforce, because it is great to have state-of-the-art technology and multiple units providing radiotherapy, but if we do not have the staff to manage them and provide treatment we shall not make progress. Health Education England is continuing to take forward the cancer priorities identified in the NHS’s long-term plan. It is prioritising the training of 250 nurses to become cancer nurse specialists, 100 chemotherapy nurses and 58 biomedical scientists, and it is updating the advanced clinical practice qualification in oncology.

Further than that, particularly around radiotherapy, Health Education England is investing £52 million in the cancer and diagnostic workforce, increasing the number of clinical endoscopists and training more radiographers in image interpretation. That is all part of the radiotherapy process. As of August there have been an additional 4% of doctors working in clinical oncology, which is the field that manages radiotherapy, and there have been a further 5% working in radiology since August 2020.

We are making progress, but it is not just about the numbers of staff; it is about the skill mix and ongoing staff training. Very often, not being able to expand a role or take on exciting and innovative developments can make staff feel frustrated, but the cancer workforce is growing. Between 2016-17 and 2019-20, the cancer workforce grew by 3,342 full-time equivalents, compared with the ambition of 2,943. We are ensuring that there are more staff coming through into the workforce to deliver radiotherapy.

The shadow Minister touched on the importance of not only recruiting staff but retaining and developing them. I fully take on board colleagues’ comments and concerns. We are committed to investing in radiotherapy equipment, the staff that deliver radiotherapy and the innovation in radiotherapy. We are also committed to making it more accessible to patients, and to reducing the side effects—there are side effects from radiotherapy as well—and to making sure it is a fundamental part of cancer treatment, whether that is in the neoadjuvant setting, adjuvant or for those with metastatic cancer as part of the palliative treatment service.

--- Later in debate ---

[Maria Caulfield]

My understanding is that it is available for stage 3 melanoma, as the hon. Gentleman has highlighted, and that it is still in clinical trials for stage 2. It is available within clinical trials. We expect the data to come forward shortly and then a decision will be made. That is where we are with melanoma.

[Tim Farron]

Will the Minister give way?

[Maria Caulfield]

I will give way one more time.

[Tim Farron]

The Minister is being very kind and I really appreciate it. I have two quick points that I do not think she has mentioned. First, will she take up the request from myself and the hon. Member for Easington for a meeting with the APPG for radiotherapy? We would love to meet her.

Secondly, I do not think she referred to the tariff situation. A lot of the issue is that we need more money. We want the Minister to accept—it is not just her fault; it is the fault of every party in this place, over decades—that we are behind comparable countries and we need to strengthen radiotherapy. The reality is that there are lots of state-of-the-art machines out there, in trusts up and down the country, that are not being used because the tariff is stupid. It incentivises trusts to do second-division radiotherapy, if I can put it that way, because more visits equal more cash, rather than targeted and specific radiotherapy—stereotactic, as she mentioned, for many cancers—because the tariff rewards number of visits, not precision or effectiveness of treatment. Would she look at that? It is free.

[Maria Caulfield]

I am very happy to look at the tariff situation, but my experience is that when a clinical oncologist is referring someone for radiotherapy, that decision is not based on whether they have smaller numbers of fractions as opposed to traditional courses. I am very happy to meet the all-party parliamentary group to discuss that further. I reassure patients that clinical decisions are what decide the type and the number of fractions that a patient needs for their treatment.

Radiotherapy is a priority cancer treatment and this Government are absolutely committed to investing not just in the equipment, but in the workforce that provides it. I say a huge thank you to all the staff across the NHS, particularly in cancer services, who kept going through all the pandemic lockdowns, made sure that cancer patients got their treatment, and helped to support them and their families through what is a very difficult time.