Covid-19: Access to Cancer Diagnosis and Treatment

Tonia Antoniazzi Excerpts

Wednesday 2nd December 2020 Westminster Hall

[Tonia Antoniazzi (Gower) (Lab)]

It is an honour to serve under your chairmanship, Ms McVey. I rise as the chair of the all-party parliamentary group on cancer to talk about the worrying backlog of people who have not yet received a diagnosis of cancer. I pay tribute to the hon. Member for Westmorland and Lonsdale (Tim Farron) for securing the debate. We have been working hard cross-party to raise the issue of cancer services and the backlog, which is an issue really close and dear to my heart and one on which we need to make far more progress. I thank him for his excellent speech and his work.

Despite the amazing efforts of clinicians working in the NHS and additional support from the Government, the backlog of cancer is big and it is real. It was caused by the impact of addressing the first wave of the pandemic. I am not just talking about the backlog of people within the cancer system, which are often the figures that the Government deem to be the backlog. The real backlog is of undiagnosed people yet to come forward and present to the NHS through the three main routes: GPs, screening programmes and A&E.

In “The forgotten ‘C’” report by Macmillan Cancer Support, which uses the Government’s own data, it is projected that there are currently 50,000 missing diagnoses. The hon. Member for Warrington South (Andy Carter) has spoken in great detail about the figures, which I have also had from Macmillan. That means that compared to a similar timeframe in 2019, 50,000 fewer people have been diagnosed. That is a huge amount of people that we cannot ignore.

Macmillan Cancer Support estimate that 33,000 fewer people across the UK started treatment this year than in 2019. Working on the current rates, that backlog of undiagnosed cancer could take 18 months to tackle in England alone, not talking about the rest of the United Kingdom. Macmillan says that

“if cancer referrals and screening do not return to pre-pandemic levels, the backlog could grow by almost 4,000 missing diagnoses every month, reaching over 100,000 by October next year.”

That worries me to the pit of my stomach.

Such gravely concerning figures on the cancer backlog are echoed and supported by Action Radiotherapy, which states that the backlog of patients still waiting for potentially life-saving treatment amid the coronavirus pandemic could be as high as 100,000, with cancer services needing to work at around 120% to clear the backlog over the next two years. Those incredibly sobering and worrying statistics concern me.

In a recent parliamentary answer, the Government stated that they do not recognise those figures and they continually give an overly optimistic view of the current state of cancer services. The Government’s latest cancer waiting times from September 2020 state that urgent referrals were at more than 100% of the 2019 levels. That is over 45,000 people who have received cancer treatment, which is 96% of last year’s levels. Across the period from March to September 2020, over 291,000 cancer treatments were carried out, which was 86% of the level in 2019 and 94.5% of patients with a decision to treat received a first treatment for cancer within 31 days. Those are promising and improving statistics from the delays and disruption we saw in the first period of the pandemic. We cannot deny that.

I take this opportunity to thank the incredible and dedicated cancer workforce that has been indispensable in getting services back nearer to pre-covid levels. That is why we have to call on the cancer workforce and we need to keep them there doing their jobs. They are very precious, particularly at this time. Their efforts have been incredible and it is important to acknowledge their service to patients across the country, and their fantastic efforts in continuing cancer care across the second wave.

From all accounts, we are not seeing the delays and disruption across the board that we saw during the first wave of the pandemic. However, despite the improving situation there are many instances where the performance of the cancer system is operating at a slightly lower rate than before the pandemic. To tackle the backlog, the cancer system needs to out-perform its pre-pandemic performance, which it is not doing in all areas.

For every month that the NHS is working at below pre-pandemic levels, the backlog is building and it is not being beaten. Urgent GP referrals appeared to be roughly back to normal in September, but there were still around 338,000 fewer people not seeing a specialist following an urgent referral between March and September this year, compared to last year. I am rightly concerned about the potential for missing diagnoses. Macmillan Cancer Support estimate that it would take 17 months at 10% above 2019 levels to see 338,000 extra patients, which are striking figures.

The real issue is that Ministers are painting an over-rosy picture of the cancer backlog and trying to refute the claims that a large number of people are not having cancer treatment this year compared with previous years. The Government cannot refute their own cancer waiting times data for those starting first cancer treatment. From March to September, there were 31,000 fewer patients starting first cancer treatment in England, which is a drop of 17% compared with the same period last year.

Let us be clear: there are 31,000 people in England who currently could have cancer, and yet, for numerous reasons associated with the pandemic, have not presented to the NHS with symptoms. That is an incredibly worrying and troubling statistic. Without acknowledgement of the scale of the issue, neither the solutions to the problem nor the resources needed to tackle it will materialise.

Again, while September’s monthly activity was improving, it is still down on last year and so the backlog will continue to grow each month. Month by month, performance is below 2019 levels, which is a huge concern—and a huge and daunting task that is currently being underestimated by the Government.

The national cancer recovery plan, which is yet to be published by the Government, and only runs to March 2021, only uses metrics on the backlog that include those on the 62-day and 31-day cancer pathways, as well as those with longer waits for diagnostics or treatments above 104 days. It in no way estimates the significant number of people yet to present to the NHS. That is the real backlog, which the Government are failing to acknowledge and are failing to take significant and timely steps to address.

While the Government have made some welcome steps in adding additional capacity through the independent sector and just recently committed £1 billion extra in the comprehensive spending review to deal with backlogs in the NHS, it is uncertain how much of that money is allocated to the cancer system. Will the Minister confirm how much of that funding will be spent on beating the backlog in cancer care?

It is clear that the restoration of the cancer system is a priority at the highest levels of the Government and that significant resources have already been allocated to that endeavour, but—it is a very big but—until the Government acknowledge and plan to tackle the monumental scale of the real backlog that is still building, the health outcomes of many thousands of people out there yet to be diagnosed with cancer will be significantly grave and the Government will not be able to meet their ambitious targets for cancer within the NHS long-term plan. Will the Minister acknowledge the scale and reality of the problem, commit the strategic and monetary resources needed to tackle it now and work with key stakeholders such as Action Radiotherapy, the different all-party parliamentary groups and Macmillan Cancer Support, which have been working hard to support those living with cancer and who have been severely impacted by the pandemic?

I welcome the previous and the soon-to-be-had engagement with the Minister. We appreciate that we are working in unprecedented times. However, I was a little bit concerned to read a letter dated 30 November from NHS England’s cancer programme to the cancer alliances. The letter, which is advice on maintaining cancer recovery, shows the depth of arrangements and efforts that are being made to restore the cancer system and continue with cancer care, but it fails to acknowledge and deal with the huge backlog of people we have spoken about today—those who are yet to come forward for a diagnosis.

The national cancer recovery plan is too short term and has the wrong priorities to deal with the backlog in the long term. That is what we are concerned about; that is why we have come here today to present the issues to the Minister. I look forward to speaking with her, but I ask that this issue is dealt with immediately.