Radiotherapy: Accessibility

Will Quince Excerpts

Tuesday 18th July 2023 Westminster Hall

[The Minister for Health and Secondary Care (Will Quince)]

It is a pleasure to serve under your chairmanship, Dame Maria. I thank my hon. Friend the Member for North Devon (Selaine Saxby) for securing this important debate on the accessibility of radiotherapy. I agree wholly with the hon. Member for Denton and Reddish (Andrew Gwynne) that there are issues in this place that are not by nature party political. The debate has demonstrated that there is huge consensus on all sides of the House on the need for change, and I thank all right hon. and hon. Members for their contributions today.

Let me turn back to my hon. Friend the Member for North Devon for one moment. Whether it is in the meetings—dare I say it, the many meetings—that I have had with my hon. Friend, or through her public contributions in the House and outside, she has been consistent and powerful in her advocacy on health issues. Her constituents, and patients around the country, are very lucky to have her in their corner.

It is rare for the Front Benchers in a Westminster Hall debate to be allowed so much time to respond. I do not intend to take the entire time available, but I would like to try to answer as many of the questions, points and themes raised as possible. Although Members will know that I am not a new Minister, I am relatively new to this brief, having taken on the cancer portfolio in the last few days. I very much look forward to working with parliamentary colleagues from across the House, including those present today and others who I know have specific interests in cancer, to bring about the changes that we all want to see. I echo the words of the hon. Member for Easington (Grahame Morris) and thank him for sharing his personal experience; I certainly agree with him that we all want to see cancer outcomes improve across the country.

My hon. Friend the Member for North Devon raised the matter of performance levels, which I will touch on briefly before turning to specific points raised in the debate. I echo the hon. Member for Westmorland and Lonsdale (Tim Farron) in paying tribute to the brilliant work of NHS staff in this field. Thanks to them, levels of first treatment following an urgent cancer referral have been consistently above pre-pandemic levels, with activity in May standing at 111% of pre-pandemic levels on a per working day basis. Over 52,000 people had their first or subsequent treatment for cancer in May. In total, over 332,000 people received their first cancer treatment in the 12 months up to May, which is up by more than 18,000 on the same period before the pandemic.

As hon. Members have eloquently pointed out, waiting time performance for radiotherapy is influenced by a range of factors, including workforce and equipment—two subjects that I will come on to address in greater detail. My hon. Friend the Member for North Devon referred to the impact of covid and the recovery of cancer services following the pandemic. In February last year, the Government published the delivery plan for tackling the covid-19 backlog of elective care. We will spend more than £8 billion between now and 2024-25 to drive up elective activity, including cancer diagnosis and treatment. My hon. Friend referred to the community diagnostic centres, which make a huge difference, and the building of surgical hubs.

[Grahame Morris]

I am grateful to the Minister for taking the time to answer the points that have been made. Over the years, we have seen every single cancer Minister and probably every Secretary of State, but it seems that just when the penny is about to drop for the responsible Minister, they get shuffled off and nothing actually happens. I hope the Minister will stay in post long enough to deliver the improvements that we want to see.

The community diagnostic hubs are, of course, a wonderful thing, and we have been calling for them, but they must go hand in glove with increased treatment capacity. Otherwise, all that will happen is that the waiting lists will get longer as we diagnose more patients who require early treatment, but without having the treatment capacity to make the inroads that we all want.

[Will Quince]

I will come on to the hon. Gentleman’s specific point, but he is absolutely right. On remaining in post and Government reshuffles, the Prime Minister giveth and the Prime Minister taketh away, but I thank the hon. Gentleman for his best wishes ahead of any future reshuffle. Having been in the Departments of Health and Social Care, for Education and for Work and Pensions, I know that any Minister understandably ends up taking a considerable interest in their work. I assure the hon. Gentleman that whether or not I maintain my position in the Government, I will maintain my interest in all the areas I have worked on as a Minister. I certainly commit to continuing that work from the Back Benches when one day the Prime Minister chooses to dispense with my services.

[Selaine Saxby]

I thank the Minister for all his time and commitment and for meeting me so regularly. When he takes things away and reflects on them, will he bear in mind that although community diagnostic hubs are fantastic, it is still a 120 mile round trip from my constituency to get to one, so there are issues in respect of rurality. In Ilfracombe in my constituency, the healthy life expectancy is 59. Remote coastal communities need to be able to access services, and we are underdiagnosing because it is so hard to access even a diagnosis, let alone the treatment.

[Will Quince]

I will come on to this point in greater depth, but many of the conversations that my hon. Friend and I have had on health issues, and previously on education issues as well, were about rurality and the challenges of rural and coastal communities. Her points are well made—I certainly understand them—and she makes a compelling case. I will address them in greater detail later in my speech.

Not only are we building the community diagnostic centres and surgical hubs—and notwithstanding my hon. Friend’s point about the distance that some have to travel to get to them—but we are creating them deliberately closer to communities; they are not just based in district and general hospitals. In each of the next two years they will be supported by an additional £3.3 billion of funding, which was announced in the autumn statement, and that will enable rapid action to improve emergency, elective and primary care performance towards the pre-pandemic levels.

On cancer specifically, NHS England recently set out the progress made on reducing the number of patients with urgent suspected cancer who wait for longer than 62 days, and announced that the faster diagnosis standard was met for the first time in February this year. It also confirmed the ongoing priorities to improve performance and long waits, prioritise diagnostic capacity for cancer and, of course, focus on the cancer pathway redesign.

The Government and NHS England have pushed to improve the early diagnosis of cancer, which is so important to give patients the best chance of receiving successful treatment and in turn see more people living longer following a cancer diagnosis. However, as my hon. Friend the Member for North Devon eloquently and articulately pointed out—the hon. Member for Easington also made this point—we know that early diagnosis needs to be backed up by high-quality treatment options such as radiotherapy, with its remarkable ability to shrink tumours, as has been set out, and often with minimal side effects.

The hon. Members for Easington and for Denton and Reddish referred to the 62-day cancer target and the changes required to improve cancer outcomes. I hear the strong and compelling arguments that have been made, and I am happy, as I set out at the beginning of my speech, to meet hon. Members to discuss the steps that we are already taking and the further steps that can be taken, alongside NHS England, to improve cancer outcomes.

The hon. Member for Denton and Reddish asked specifically about steps to meet the 62-day target. To target support towards the most challenged trusts in the country, NHS England has developed an intervention model that is designed both to maximise and expand capacity. Challenged trusts have been placed into tiers 1 and 2, and all tiered trusts have weekly or fortnightly oversight calls, and they also have visits with the regional and national teams from NHS England. They receive support on things like the development of a co-ordinated support plan, which is monitored by fortnightly progress meetings. The plans have focused on areas such as pathway improvements, workforce support and targeted capacity increases. That supports the trusts that do not have the resource or bandwidth internally to turn around services.

When my hon. Friend the Member for North Devon made the case for a satellite centre in her constituency, she raised specific challenges in relation to North Devon that are translatable to other parts of the country that have rural and coastal characteristics. I will outline the basis on which provision is reviewed, but before I do let me acknowledge the local efforts that she mentioned. She is rightly proud of her constituents’ initiative in terms of support with travel and other things.

The network oversight group, in conjunction with the relevant specialised commissioning team and cancer alliances, is required to review service provision on a regular basis to ensure that optimal access arrangements are in place. That applies to proposals that relate to the expansion or re-provision of existing services, or to the development of any satellite facilities. The development of any new service location requires the development of a business case, as my hon. Friend pointed out, and business cases must demonstrate, among other criteria, the consideration of the effect on the provision of existing cancer pathways, both within and outside the network geography.

As I have mentioned, that responsibility sits not with the Government but with the integrated care boards, cancer alliances and local specialised commissioning teams. I am happy to meet my hon. Friend, alongside the ICB, to understand the challenges and what can be done in this space. I understand from NHS England that around 450 patients a year travel from my hon. Friend’s constituency to Exeter for treatment, but I am cognisant of the point made by the hon. Member for Westmorland and Lonsdale that many more patients might want to access those services but do not because of the travelling and distances involved. That is why a meeting between me, my hon. Friend and the ICB might be a good starting point.

[Grahame Morris]

The Minister is being generous in giving way. The debate is instructive, and I am glad he has mentioned integrated care boards. As the hon. Member for Westmorland and Lonsdale (Tim Farron) mentioned—sorry, the right hon. Gentleman.

[Grahame Morris]

Well, I am sure it is only a matter of time.

One of the issues has been commissioning. NHS England is responsible for commissioning without having a sensible plan to replace old machines, and there are bizarre disincentives to using the most modern machines, which require fewer visits. Furthermore, the fractionations are smaller, and the radiotherapy could be delivered in a shorter time. Bizarre commissioning arrangements and tariffs apply. Is the advent of the ICBs, with the responsibilities they hold, an important element in deciding where the new treatment centres are going to be? Will the Minister outline their role in the context of access to radiotherapy services?

[Will Quince]

I thank the hon. Gentleman for his question and will jump to the part of my speech that covers equipment, because the issue has been raised by all hon. Members during the debate.

We are absolutely focused on improving cancer treatment and supporting advances in radiotherapy using cutting-edge imagery and technology. As my hon. Friend the Member for North Devon pointed out, since 2016 we have invested £162 million in the most cutting-edge radiotherapy equipment, which is designed to replace or upgrade more than 100 radiotherapy treatment machines so that we can deliver the best possible outcomes for patients. As the hon. Member for Westmorland and Lonsdale said, NHS England is carrying out a stocktake of linear accelerator age, which will be completed in the summer. It is also working with partners to undertake a demand and capacity review, which will complete by the end of the year.

On AI specifically, we want to ensure that we have the best possible cutting-edge, innovative equipment and technologies in the NHS, so we have announced an additional £21 million of funding that will speed up the roll out of AI across the NHS. That will enable us to help to improve diagnosis and to reduce waiting times—one of our top priorities—and clinicians will be freed up to spend more time delivering frontline patient care. The point made by the hon. Member for Easington about AI and the benefits thereof is well made.

The hon. Member for Westmorland and Lonsdale has been campaigning on the issue for around a decade, or perhaps longer, and he has met several Ministers. I am yet to meet with the hon. Gentleman, and I know he was due to meet my hon. Friend the Minister for Social Care, but I am happy to honour that meeting. He recently met his local hospital trust to discuss radiotherapy being part of the new hospital programme. Ultimately, that is a matter for commissioners, but we can certainly have that conversation when we meet and try to find a way forward.

A number of hon. Members raised the issue of the workforce. The hon. Member for Strangford (Jim Shannon) is no longer in his place, but he laboured this point, and rightly so. We have made good progress in growing the cancer workforce. The annual growth rate of the workforce remains steady at between 3% and 4%, but we need to go further. As of February, there were 33,174 full-time equivalent staff in the cancer workforce. In trusts, that is an increase of more than 11,300 since February 2010. Specifically, the number of therapeutic radiography staff grew by 17.4% between 2016 and 2021. As has been referenced, we published our long-term workforce plan, which sets out actions that are backed by £2.4 billion of Government funding up to 2028-29, a couple of weeks ago.

On travel, the travel that a patient needs to undertake is dependent on the type of treatment they need. Decisions about treatment locations are made on a case-by-case basis. As hon. Members have pointed out, specialised services are not available in every local hospital, in part because they have to be delivered by specialist teams of health professionals with the necessary skills and experience and access to the necessary equipment and medicines. Patient-specific requirements are based on what each individual can cope with and are discussed between the patient and clinician.

The Government are, of course, striving wherever possible to reduce any necessity to travel unreasonable distances, which is why our priority continues to be to bolster the specialist workforce and ensure ever-expanding coverage of equipment. That includes by investing in new radiotherapy machines, but the responsibility for investing in that equipment sits with local systems—the ICBs, which I suspect we will discuss in greater detail when we meet. I hear the case that has been made about equality and rurality. We can address some of those issues and work with integrated care boards so that they see the benefits to patients and to outcomes, as well as the cost savings, if we get it right.

We are supporting providers to accelerate the delivery of stereotactic ablative body radiotherapy for targeted cancers, thereby lowering the risk of damage to normal cells. Specialised commissioners have allocated £12 million to support providers to deliver SABR.

[Tim Farron]

The Minister has given a comprehensive response to us all. On the issue of SABR, would he look in particular at the point made by the hon. Member for Easington (Grahame Morris) about commissioning arrangements and the perverse incentives that lead to some cancer treatment centres effectively being paid more for using lesser treatment than they would be for more efficient, less invasive, less frequent but more powerful SABR technology and other similar advanced forms of treatment? It would save an awful lot of money and still do a better job.

[Will Quince]

In short, the answer is yes. There are perverse incentives that exist across Government, and the NHS is no exception. Wherever we identify them, we have to work to drive them out of the system. We have a tendency, unfortunately, to focus on processes and procedures. I want all trusts—I would like us to do this across Government—to focus more on outcomes than on processes. Perhaps when we meet the hon. Gentleman could set out that exact challenge in more detail, because I would be glad to look at it in detail.

Dame Maria, I am conscious that I have gone on for longer than I should have; you have been very generous. I again thank my hon. Friend the Member for North Devon for bringing this matter to the attention of the House, and I thank all hon. Members for their contributions on this hugely important subject. I hope I can assure my hon. Friend and Members from all parties that with the investments we have made and the innovations the NHS has adopted, and the innovations to come, we will continue to improve access to radiotherapy throughout the country. I look forward to meeting the hon. Members present, alongside NHS England, to see what is within the art of the possible in this space. I look forward to working with parliamentary colleagues throughout the House to bring about the improved cancer outcomes that we all want to see.