Haemochromatosis Screening
Torcuil Crichton Excerpts(3 days, 13 hours ago)
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Torcuil Crichton (Na h-Eileanan an Iar) (Lab)
I ought to begin with an explanation of what is a very long word. Put simply, haemochromatosis is too much iron in the blood—haemo, blood; chroma, iron; and tosis, too much of it. To save time and the good offices of Hansard, I will refer to it occasionally as HCT in this debate. It is an inherited genetic condition, a disorder often known as the Celtic curse, because it is particularly prevalent in Celtic bloodlines and is common in Wales, Scotland and Northern Ireland. I think it is more probably a Viking phenomenon—an old genetic response to times of famine that we carry into modern times.
Untreated haemochromatosis can lead to several common conditions that we might describe as Scottish diseases of ill health: cirrhosis of the liver, heart disease, arthritis and so on. Once spotted, HCT is easily treated by venesection—another long word—which simply means bloodletting. About 450 ml of blood is taken off the patient at each session to chase down the iron levels in the body to normal levels. Generally haemochromatosis is asymptomatic, and without a test to measure for ferritin levels, it can be easily missed.
I have a bit of knowledge of the bloodletting side of the business, because for the past 17 years, I have been attending the Knutsford ward at the Royal London hospital on a regular basis for venesection. I am grateful to the staff there for the incredible treatment they have given me, including consultants such as Richard Marley. I am also grateful to my younger brother, Donald, who was tested and found he carried the gene in 2008.
Jim Shannon (Strangford) (DUP)
I thank the hon. Gentleman—I am not going to pronounce his constituency, as I would get that all wrong with my Ulster-Scots—for bringing this debate forward. He and I spoke last night about HCT and its prevalence. He is right that it is called the Celtic curse. Some might say that maybe I am a curse on some people. I am sure nobody would come to that conclusion. However, one in 10 people have this disorder, which features strongly among the Northern Irish, the Scots, the Welsh and even Cornish communities —all the Gaelic cousins and people. However, even with that prevalence, screening does not naturally take place and quality of life is impacted for years before someone even goes to their GP. Does the hon. Gentleman not agree that it is unnecessary to live with something that can be easily treated?
Torcuil Crichton
The hon. Gentleman’s interventions are always a blessing, never a curse. I have some information of particular interest to his part of the world later in my speech.
I have declared my interest, as I have haemochromatosis, but it is not just my experience, but that of my constituents and the make-up of my constituency in Na h-Eileanan an Iar that have spurred me to secure this debate. It is not all about me.
A groundbreaking DNA study headed by Professor Jim Flett Wilson of Edinburgh University discovered that the Western Isles are a hotspot for haemochromatosis, this genetic mutation that the body at some stage adopted for survival. People are at risk of developing the condition if both their parents have the faulty gene and they inherit one copy from each of them. They will not get haemochromatosis if only one of their parents carries the gene and they only get one copy, but there is a chance they could pass the gene on to their children. If people inherit two copies—that is, both their parents are carriers—they will not necessarily get haemochromatosis. About half of people with two copies of the faulty gene develop the condition, and it is not known exactly why.
What is known is that the Viking genes DNA study by Professor Jim Flett Wilson took DNA samples from islanders in Orkney, Shetland and the Western Isles, and it threw up some amazing discoveries. People wanted to find out if they had Viking heritage, and many sent in swab samples and filled in the questionnaires in sufficient numbers for the scientists to crunch the numbers. I did not do that myself. Feeling Viking by name and by nature, I did not think it necessary.
Analysis of the data, and cross-examination with other gene studies, showed that in Orkney and Shetland, participants in the study had rare and unique cancer genes, which led to them being alerted to their condition. The study saved lives and is credited with doing so. The good news for the Western Isles—for Na h-Eileanan an Iar—is that no rare cancer genes were found. While the results are still being finalised, it is clear that the Western Isles are a hotspot for haemochromatosis and inherited high cholesterol, which can lead to heart disease.
According to Professor Flett Wilson, the numbers in the Western Isles are sufficiently high to justify population-wide screening. For instance, one in 212 people in the south and east of England carry two copies of the faulty gene, as opposed to one in 62 in the Outer Hebrides.
Rachel Taylor (North Warwickshire and Bedworth) (Lab)
I am a member of the all-party parliamentary group on genetic haemochromatosis, and my constituent Lorraine asked me to attend the debate. She suffers from the disease, and has found a way to manage it by donating blood regularly. She is pleased that genetic testing enabled her to know about her condition so she did not suffer severe organ damage, which can affect many people with the disease. Does my hon. Friend agree that genetic testing for those who are more likely to be diagnosed is essential if we are to help people lead healthy lives without the need for medical intervention?
Torcuil Crichton
I do indeed agree. Haemochromatosis, although widespread, was not widely known about until very recently, but genetic testing, as well as simple ferritin level tests, will inform many more people. Early intervention is vital to preventing people from developing crippling illnesses which might otherwise be wrongly ascribed to a condition other than haemochromatosis.
It is not just people such as my hon. Friend’s constituent who are affected. In Northern Ireland—or the north of Ireland, depending on how we view our maps—the situation is even more stark than it is in the Western Isles. Among the population of “Ulster Scots”, if I can call them that, there is a one in 123 occurrence of two faulty copies of the gene, which is similar to the incidence in mainland Scotland. The Catholic community in the north-west of Ireland have the highest concentration in the British Isles: one in 54 carry two faulty copies. On the basis of Professor Flett Wilson’s work, we can predict that one in 94 men in the Western Isles will develop HCT, and one in 80 men of north-west Irish ancestry—and the Irish diaspora is present in constituencies in Scotland, in London and across the United Kingdom—may have the condition, perhaps undetected and perhaps mis-diagnosed, and are possibly suffering from the long list of illnesses associated with an iron overload.
In Orkney and Shetland, analysis of the Viking genes study uncovered rare cancers and lives were saved. In my constituency, people who were found to have the HCT gene have been alerted by letter. The figures for the Western Isles do not include people who did not take part in the study, but they constitute a timely warning about the advisability of screening, a procedure that is not expensive. In the Hebrides, it looks as though we should act on the spike in iron overload. Professor Flett Wilson has recommended islands-wide screening for this common blood condition, but I want to go further: I think that everyone in the Western Isles, or Na h-Eileanan an Iar, should be screened for too much iron in their blood, but I think they should also be offered DNA tests across the board to show what other inherited conditions they might have.
Jim Shannon
I will be brief, Mr Deputy Speaker. I am descended from the Stewarts of the lowlands of Scotland, and I am probably the hon. Gentleman’s Gaelic cousin. This screening needs to be carried out in Northern Ireland as well as Scotland.
Torcuil Crichton
I do not disagree with that. Screening would be revolutionary. It would save money for the NHS in the short term and the long term, and, more important, it would save lives and put us two decades ahead of the rest of the world in preventive medicine. It would be transformative for my constituency. It would be radical, but only as radical as plans to offer every baby in the UK whole genome sequencing within a decade, a plan backed by the Health Secretary. Genomics, like these tests, would put us on the front foot in preventive medicine, as the Minister well knows. Of course it would cost money—£650 million is earmarked for the boost to genomics by the Department of Health and Social Care—but a smaller and more defined pilot scheme to lead the way in preventive medicine is to hand with the samples of high levels of HCT in the Western Isles. Given the given the cost per head of screening, it is logical that starting in the places with the highest rate of faulty genes would be the most cost-effective option.
Initially at least, the Bill ought not to go to the national health service. The bill for gene testing in the Western Isles should be part of the community payback for the large-scale wind farm developments that are planned for the islands. There are already negotiations for community benefits, community funds and community shares in the many planned wind farm developments in rural Scotland. The renewables revolution is about saving the planet, but right now the consumer offer is simply to reduce bills. By properly harnessing the wealth of wind, we can not only make communities better off but transform the life chances and health chances of people and their children.
The Viking genes results are not limited to haemochromatosis; they also showed high levels of hypercholesterolaemia in the Western Isles. That is simply inherited high cholesterol —a gene fault—that leaves many islanders, and many of my constituents, with high cholesterol and many with heart conditions, which again could be avoided with predictive medicine and early lifestyle and diet changes.
Patricia Ferguson (Glasgow West) (Lab)
My hon. Friend makes an excellent point about the need to test in the Western Isles, and his solution of using the community payback from wind farms is an excellent idea. Would he want to go further thereafter and test more widely? My brother has haemochromatosis, and it was discovered completely by accident. The rest of the family were then tested, and one or two cousins were found to have it, although I fortunately do not. It is much more prevalent than any of us ever imagined, and I had never heard of it until my own brother was diagnosed.
Torcuil Crichton
My hon. Friend anticipates much of the remainder of my argument. As I said, the research and DNA testing in the islands could and should be paid for by community funds from large-scale renewable projects, just as similar screening projects proposed for Orkney and Shetland could be paid for by funding from wind farms there. From those discrete samples, much learning could be had, and then sampling and testing could be rolled out across not just the rest of Scotland but the rest of the UK.
Luckily for me, my siblings and I were spotted early but, as I said, if left untreated and undiagnosed this gene can lead to serious arthritic symptoms, liver cancer and heart disease, the consequences of which are often attributed to other conditions and lifestyle factors but could have been easily prevented by testing. Given the resources, we could test for a wide range of conditions and help this generation and future generations of islanders to live healthy lives. As my hon. Friend the Member for Glasgow West (Patricia Ferguson) said, if it works for a small, discrete population—there are only 21,000 adults in the island chain—the experience and lessons learned could be rolled out across the UK.
I know, as we all know, that health services in Scotland do not fall within the ambit of the Minister, but the future of healthcare is in all our hands, and I urge UK Ministers and their counterparts in Holyrood to seriously consider a pilot screening study in the Western Isles. There is a clearly identifiable risk from haemochromatosis, and we should use the lessons from that screening to roll out haemochromatosis screening across the rest of the UK.
Accessibility of Radiotherapy
Torcuil Crichton Excerpts(4 months, 3 weeks ago)
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Tim Farron
That is a good point. Early diagnosis is vital. We are getting a bit better at it, but it would be a tragedy if we diagnosed people but then did not treat them early enough to cure them. The hon. Gentleman makes a good point on behalf of his communities.
If we cannot cope with treating the number of cancer patients we are seeing now, how will we deal with the projected 30% increase in cancer cases by 2040? The good news—the very, very good news—is that it does not need to be this way. The upcoming cancer plan, of which we have heard an outline today, is an opportunity to supercharge cancer services and transform a culture of normalising unacceptable delays into one that drives continuous cancer care improvements. However, without decisive and radical action and leadership, lives will continue to be lost needlessly.
Torcuil Crichton (Na h-Eileanan an Iar) (Lab)
It is a pleasure to serve under your chairmanship, Sir John. I was very struck by the hon. Gentleman’s comment about longer journeys meaning shorter lives. There is no competition on journeys, of course, but my constituents in Na h-Eileanan an Iar and the Western Isles face some of the longest journeys in Britain to get cancer treatment, outwith and within the constituency. Somebody from Barra, for example, faces a three-day journey to Stornoway by boat, taxi and aeroplane for therapy and then a return journey over three days. I hope that that can be changed by sending people directly to Glasgow or, perhaps even better, by implementing a public service order to restore flights between one end of the island and the other. I commend the hon. Gentleman for securing the debate and for his very telling comment about longer journeys meaning shorter lives.
Tim Farron
I am extraordinarily fond of the hon. Gentleman’s constituency, which he represents well. He makes an important point about travel times. In some parts of my constituency, people need to take a ferry to get from one place to another, but it is not quite as common as in his constituency.
At the heart of the radical, lifesaving transformation that we need through the cancer plan must be the elevation of the unsung hero, the Cinderella of our cancer services: radiotherapy. Lord Darzi found that 30% of patients are waiting more than 31 days for radical radiotherapy. As the incidence of cancer grows, the urgent need for quicker and more efficient treatments such as radiotherapy is only increasing.
As things stand, the replacement and updating of linear accelerators is left to the 52 separate cancer units in England—52 separate procurement operations, 52 different finance officers trying to balance the books and 52 different heads of service all trying to meet increasing demand, often without the time and space to look beyond the horizon. It is time, then, to centralise the commissioning of the technology to ensure a constant focus on updating and expanding radiotherapy. That would immediately start saving lives everywhere.
Radiotherapy UK estimates that simply replacing all the out-of-date LINACs could free up 87,000 additional appointments every single year. Modern radiotherapy is quicker and more accurate than other treatment. It is also by far the cheapest, costing between £3,000 and £7,000 per patient—several times less expensive than equivalent cancer treatments. The Government’s £70 million commitment to radiotherapy services was welcome, but in reality, as the Minister says, that money would cover the cost of only 26 LINAC machines, fewer than half the number that are currently operating beyond their sell-by date. Erratic one-off rounds of funding do not address the need for a sustainable rolling programme of machine replacement to enable planning, support procurement and improve access for patients. Even the new machines are often old technology. What a terrible waste.
In my years of campaigning on this matter, I have found that radiotherapy lacks funding and prominence. Britain therefore lags behind our neighbours, so people tragically die when they do not need to—all because of a lack of leadership and drive from the centre. On more than one occasion, I have almost seen the penny drop on the faces of Ministers of all parties when it comes to our failure on radiotherapy, but every time so far, I have seen that zeal founder on the rocks of bureaucratic sluggishness, indifference and resistance to change within the NHS. If they show the leadership that we desperately need, the Minister and the Secretary of State will have the enthusiastic and active support of the all-party parliamentary group on radiotherapy, and of the army of outstanding clinicians who are out there saving lives.
Professor Mike Richards is a name that many people remember. He was the cancer tsar in the early noughties, under the previous Labour Government; he did great work and his achievements were tangible. If the Government will forgive me for using shorthand, we basically need a Mike Richards for radiotherapy, and we need them, like, yesterday. Failing that, tomorrow morning would just about do. Every day we delay, my constituents—as well as yours, Sir John, and those of the Minister and of all Members present—are dying unnecessarily.
We need new technology as we plan treatments, too. Last May, £15.5 million was announced for AI technology that would save clinicians time and reduce radiotherapy waiting lists. However, we have heard from cancer units around the country that this funding may be withdrawn or diverted, which would be a hammer blow to trusts in the face of the ongoing workforce crisis. Will the Minister take the chance today to reassure our cancer units and confirm that this funding will go, as promised, to radiotherapy departments in full? I hope the Minister will also act swiftly to tackle the perversities of the tariff payments for radiotherapy, which effectively punish trusts for treating cancer patients in the most effective and modern ways.
I ask the Minister to guarantee that radiotherapy will be at the centre of the NHS 10-year cancer plan, and that that plan will be led by people empowered and determined to deliver it. The technology is vital, but the people matter just as much. Our specialist and highly skilled radiotherapy workforce numbers only 6,400 people, yet the survey conducted by Radiotherapy UK shows that one in five cancer doctors may leave the profession in the next five years. We have a 15% shortage in clinical oncologists—set to rise to 21% by the end of this Parliament—and 30% of oncologist training posts were vacant last year. On top of that, 50% of clinical technologists are over 50 years old, and 84% of heads of cancer services reported that they were concerned that workforce shortages affected the quality of patient care.
I ask the Minister to agree that the 10-year cancer plan will include a renewed investment in workforce and infrastructure. A 10-year vision already exists, by the way—drawn up by the experts, via Radiotherapy UK. I simply urge the Minister to consider their findings and borrow the proposals detailed by leading oncologists and cancer experts.
I have asked for two separate meetings today. The first is on the need for a satellite radiotherapy unit at Kendal; the second is a first meeting for the Minister with the all-party parliamentary group on radiotherapy, to look at the national picture. I hope he will grant me both.
The radiotherapy lobby is tiny: 6,400 dedicated professionals within our health service; a compact but awesome group of charities and volunteers; a handful of companies building the technology, many of which are based in the United Kingdom; England’s captain fantastic, Bryan Robson; and a small band of MPs of all parties, seeking to be a voice not just for the radiotherapy sector, but for the thousands and thousands of people living with cancer in our country, who deserve the best treatment that we can give them. For the last generation or more, the UK has let those people down, and so often with tragic consequences. Yet radiotherapy is a cost-effective, easily deliverable technology that will save lives in every community in this country.
We are way behind where we need to be, yet it would be so easy, with the right leadership from Ministers, to catch up with and go beyond our neighbours. Cancer no longer needs to be seen as a death sentence; it is a disease that can be treated and cured, but we cannot do that if our systems and practices prevent us from deploying the best treatments available. Please save lives, Minister, and become our radiotherapy champion.