Question to the Department of Health and Social Care:

To ask His Majesty's Government, further to the findings of the first quarterly report of the National Audit of Metastatic Breast Cancer, published on 10 April, what steps they are taking to address gaps in data collection for secondary breast cancer patients.

Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)

It has not proved possible to respond to this question in the time available before Dissolution. Ministers will correspond directly with the Member.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what steps they are taking to improve the collection and reporting of ethnicity data for breast cancer patients to support understanding of variations in outcomes and patient experience of NHS care.

Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)

Reducing inequalities and improving breast cancer outcomes for ethnic minority women is a priority for the Government. To support this work, NHS England has commissioned six new cancer clinical audits, which will provide timely evidence for cancer service providers of where patterns of care in England may vary, increase the consistency of access to treatments, and help stimulate improvements in cancer treatments and outcomes for patients, including for breast cancer. The Royal College of Surgeons began work on this audit in October 2022, and the first outcomes are expected in September 2024.

NHS England is also leading a programme of work to tackle healthcare inequalities centred around five clear priorities, which are set out in the operational planning guidance for the health system. The Core20PLUS5 approach proactively targets groups that are less likely to engage with services in the most deprived quintile of the population, along with ethnic minority communities and inclusion health groups, across five clinical areas which includes early cancer diagnosis, specifically screening and early referral.

The issue of improving equality monitoring, by reference to ethnicity and the other eight protected characteristics, is being considered at a national level under the programme called the Unified Information Standard for Protected Characteristics (UISPC). Evaluating the use of the 2021 ethnicity census categories is part of this programme. The UISPC Publication Steering Group is reporting to NHS England and the Department this year, which will inform a view on the next steps, including any plans for publication and consultation, and an implementation timetable. Preparatory work has been undertaken by NHS England that would facilitate the introduction of the 2021 ethnicity codes, should a decision be made to adopt the 2021 ethnicity census codes, or to implement an alternative approach to ethnicity, if recommended.

NHS England’s operational planning guidance recognises the importance of improving the quality of data for patient characteristics. This is one of the five strategic priorities in their drive to reduce healthcare inequalities, as improved data quality will help to reveal health inequalities and inform action to address them. NHS England has therefore asked systems to continue to improve the collection and recording of ethnicity data across primary care, outpatients, accident and emergency, mental health, community services, and specialised commissioning.

NHS England’s National Disease Registration Service (NDRS) collects ethnicity data for all cancer patients through a variety of routine, national data feeds, including the Cancer Outcomes and Services Dataset, Hospital Episode Statistics data, and Patient Administration System data. The NDRS publishes key performance indicator data on the national registration statistics for England. The latest published indicator data, for invasive cancer cases excluding non-melanoma skin cancers, diagnosed in 2020, shows that ethnicity data is complete for 94.9% of cases.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what progress has been made on the Government's major conditions strategy with specific reference to breast cancer; and if she will make a statement.

Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)

In the development of the Major Conditions Strategy, we are considering how we improve outcomes for people in this country living with multiple conditions. Aligning work across several groups of conditions including cancer for this strategy, will allow us to focus on where there are similarities in approach and ensure care is better centred around the patient, maximising existing resources both within patient pathways and in integrating between pathways.

Improving early diagnosis of cancer, including breast cancer, is a priority for the Government. The National Health Service has an ambition to diagnose 75% of cancers at stage 1 or 2 by 2028, which will help tens of thousands of people live for longer. We know that breast cancer remains the most common cancer in England, with over 49,000 people being diagnosed each year. Thanks to advances in screening, treatment, and care, alongside NHS awareness campaigns, more women are surviving the disease than ever before.

The NHS Cancer Programme has also commissioned five new cancer clinical audits, including primary and metastatic breast cancers. These will provide timely evidence for cancer service providers of where patterns of care in England may vary, will increase the consistency of access to treatments, and help stimulate improvements in cancer treatment and outcomes for patients.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, whether he plans to provide specific funding for increasing the number of staff in the breast cancer workforce who deliver systemic anti-cancer treatment.

Answered by Will Quince

In 2023/24 NHS England will fund an expansion of cancer and diagnostics specialists, including those who will deliver systemic anti-cancer treatment. This includes, additional medical training places including for clinical/medical oncology, radiology, histopathology, and gastroenterology, grants to enable over 1,000 cancer nurse specialists and chemotherapy nurses to step into these roles or support their development in-role and a wider workforce development through establishing diagnostic training academies, including breast imaging and developing cancer support worker training.

Spending plans for individual budgets for 2024/25, including for the cancer workforce, are subject to a detailed financial planning exercise and will be finalised in due course. Spending plans for subsequent years will be subject to future spending reviews.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what assessment he has made of the adequacy of the number of breast clinical and medical oncologists to meet patient demand.

Answered by Will Quince

No specific assessment has been made. The Government has committed to publishing the NHS Long Term Workforce Plan. This will include independently verified forecasts for the number of healthcare professionals required in future years, taking full account of improvements in retention and productivity. This Plan is due to be published shortly.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what steps he is taking to (a) reduce shortages in the NHS breast cancer workforce and (b) increase the capacity of breast cancer services.

Answered by Helen Whately - Minister of State (Department of Health and Social Care)

Health Education England and NHS England provided £81 million of investment in 2022/23 to support increased capacity and capability in the cancer and diagnostics workforce, many of whom will support breast cancer pathways.

To increase capacity of breast cancer services, the Government provided £10 million of funding for 28 new breast screening units and nearly 60 life-saving upgrades to services in the areas where they are most needed, so more women can be checked for signs of cancer. NHS England is also funding a new clinical audit on breast cancer to provide evidence to increase the consistency of access to treatments and help stimulate improvements in cancer treatment and outcomes for patients.

In addition, the Government has committed to publishing the Long-Term Workforce Plan which will help ensure that we have the right numbers of staff, with the right skills to transform and deliver high quality services fit for the future. This Plan is due to be published shortly.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what discussions they have had with the devolved administrations regarding the accessibility of (1) medicines, and (2) clinical interventions, for secondary metastatic breast cancer.

Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)

The Government is committed to supporting timely patient access to clinically- and cost-effective new drugs, including for metastatic breast cancer. The Medicines and Healthcare products Regulatory Agency, the National Institute for Health and Care Excellence (NICE) and NHS England are working closely together to ensure that there is a joined-up, timely approach to supporting access to new medicines for National Health Service patients, including those licensed through Project Orbis and the creation of the Innovative Licensing and Access Pathway (ILAP). For example, average times taken between licensing and the publication of NICE guidance for new medicines have been reduced from 10.2 months for 2017/18 to 3.1 months for 2022/23. The proportion of positive NICE recommendations increased from 79% in 2017/18 to 92% in 2022/23.

NICE is also able to make recommendations through the cancer drugs fund (CDF), which has benefitted over 88,000 patients as of March 2023. The CDF has allowed patients with metastatic breast cancer to access new medicines like trastuzumab deruxtecan and palbociclib, while allowing for the collection of further data on their clinical and cost effectiveness to inform a final NICE recommendation.

NICE published a surveillance review of its guideline on advanced breast cancer in January 2023. It concluded that the recommendations on biological therapy, chemotherapy, psychological support and preventing and managing complications will be updated. These updates will be scheduled into NICE’s work programme and will include equality impact assessments and consultation with stakeholders to ensure access issues are fully considered.

The NHS Cancer Programme has commissioned five new cancer clinical audits, which will provide timely evidence for cancer service providers of where patterns of care in England may vary, increase the consistency of access to treatments and help stimulate improvements in cancer treatment and outcomes for patients. The Royal College of Surgeons began work on this audit in October 2022 with the first outcomes expected in 2023/24. One of the five audits will cover primary and metastatic breast cancer.

The Department has not had specific discussions with the Devolved Governments. However, the Welsh Government and the Northern Ireland Department of Health have agreements in place with NICE to use their technology appraisals and clinical guidelines. NICE will engage with them to support implementation. Both NICE and the Scottish Medicines Consortium are permanent partners in ILAP. Decisions on how guidance is implemented is a matter for each Government.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what assessment they have made of the accessibility of (1) medicines, and (2) clinical interventions, for secondary metastatic breast cancer in England.

Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)

The Government is committed to supporting timely patient access to clinically- and cost-effective new drugs, including for metastatic breast cancer. The Medicines and Healthcare products Regulatory Agency, the National Institute for Health and Care Excellence (NICE) and NHS England are working closely together to ensure that there is a joined-up, timely approach to supporting access to new medicines for National Health Service patients, including those licensed through Project Orbis and the creation of the Innovative Licensing and Access Pathway (ILAP). For example, average times taken between licensing and the publication of NICE guidance for new medicines have been reduced from 10.2 months for 2017/18 to 3.1 months for 2022/23. The proportion of positive NICE recommendations increased from 79% in 2017/18 to 92% in 2022/23.

NICE is also able to make recommendations through the cancer drugs fund (CDF), which has benefitted over 88,000 patients as of March 2023. The CDF has allowed patients with metastatic breast cancer to access new medicines like trastuzumab deruxtecan and palbociclib, while allowing for the collection of further data on their clinical and cost effectiveness to inform a final NICE recommendation.

NICE published a surveillance review of its guideline on advanced breast cancer in January 2023. It concluded that the recommendations on biological therapy, chemotherapy, psychological support and preventing and managing complications will be updated. These updates will be scheduled into NICE’s work programme and will include equality impact assessments and consultation with stakeholders to ensure access issues are fully considered.

The NHS Cancer Programme has commissioned five new cancer clinical audits, which will provide timely evidence for cancer service providers of where patterns of care in England may vary, increase the consistency of access to treatments and help stimulate improvements in cancer treatment and outcomes for patients. The Royal College of Surgeons began work on this audit in October 2022 with the first outcomes expected in 2023/24. One of the five audits will cover primary and metastatic breast cancer.

The Department has not had specific discussions with the Devolved Governments. However, the Welsh Government and the Northern Ireland Department of Health have agreements in place with NICE to use their technology appraisals and clinical guidelines. NICE will engage with them to support implementation. Both NICE and the Scottish Medicines Consortium are permanent partners in ILAP. Decisions on how guidance is implemented is a matter for each Government.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, whether he is taking steps to ensure awareness of metastatic breast cancer among NHS staff involved in primary care.

Answered by Helen Whately - Minister of State (Department of Health and Social Care)

In April 2020, NHS England introduced the 'early cancer diagnosis service specification' for Primary Care Networks (PCNs), which 99% of general practices (GPs) are signed up to. This is designed to support improvements in rates of early cancer diagnosis by requiring PCNs to review the quality of their practices’ referrals for suspected cancer and take steps to improve this.

NHS England is supporting GPs to diagnose more cancers early by making funding available to embed clinical decision support tools within general practice. These tools are designed to support GPs in clinical decision making, such as whether to refer or request further diagnostic investigation in patients where they believe there is a risk of cancer, and identifying patients who may be at risk of cancer based on the symptoms they present with.

Cancer education programmes such as ‘Gateway C’ are available online and include specific courses on breast cancer, and face-to-face education sessions have now resumed and are offered by a range of providers.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, if he will take steps to ensure that all patients with primary breast cancer have an end of treatment summary in order to speed up detection of secondary breast cancer.

Answered by Helen Whately - Minister of State (Department of Health and Social Care)

The NHS Long Term Plan states that, where appropriate, every person diagnosed with cancer will have access to personalised care, including a needs assessment, a care plan and health and wellbeing information and support. This includes provision of end of treatment summaries, empowering people to manage their care and the impact of their cancer.

The introduction of tailored follow up pathways for people after their initial breast cancer treatment has ensured there are clear access points for people with worrying symptoms or concerns to speak immediately to someone in the cancer team. Breast cancer-tailored follow up, which includes ‘patient initiated follow up’ or ‘open access follow up’ for suitable patients, is now in place in 95% of trusts.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, whether her Department is meetings its two-week wait target for breast cancer referrals.

Answered by Will Quince

The cancer waiting times statistics published by NHS England for August 2022 show that 76.43% of urgent general practitioner referrals for suspected breast cancer meet the current two-week wait target, against an operational standard of 93%.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what steps he is taking to ensure NHS trusts meet the 93 percent target for two-week referrals for breast cancer.

Answered by James Morris

The Department has provided £2.3 billion for diagnostic services, including the launch of up to 160 community diagnostic centres to deliver additional diagnostic capacity in England, including for breast cancer. NHS England is also developing a best practice timed pathway for breast cancer, which states the sequence of events and maximum timeframes in which triage, diagnostic tests and assessments should be delivered, to support delivery of the two week wait and Faster Diagnosis Standards.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what recent steps he has taken to help ensure that people who present with breast cancer symptoms are seen by a specialist within two weeks of referral.

Answered by Maria Caulfield - Parliamentary Under Secretary of State (Department for Business and Trade) (Minister for Women)

The ‘Delivery plan for tackling the COVID-19 backlog of elective care’ states that the number of patients waiting more than 62 days to start treatment from an urgent referral for cancer will return to pre-pandemic levels by March 2023. We are providing more than £8 billion from 2022/23 to 2024/25 to support the recovery of elective services, including cancer treatment. This is in addition to the existing £2 billion Elective Recovery Fund and £700 million Targeted Investment Fund.

This investment is also supporting the launch of community diagnostic centres which will deliver additional capacity for co-ordinated diagnostic checks, enabling faster diagnosis on a range of a clinical pathways, including cancer.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, whether the (a) upcoming 10-year cancer plan for England and (b) long-term NHS workforce strategy, will include specific steps to support the recruitment, training and educational needs of the breast imaging and diagnostic workforce.

Answered by Maria Caulfield - Parliamentary Under Secretary of State (Department for Business and Trade) (Minister for Women)

I refer the hon. Member to the answer I gave to the hon. Member for Richmond Park (Sarah Olney MP) on 20 June to Question 18007.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what steps he is taking to improve (a) diagnosis and (b) treatment of breast cancer in younger women.

Answered by Maria Caulfield - Parliamentary Under Secretary of State (Department for Business and Trade) (Minister for Women)

The NHS Long Term Plan’s ambitions for early diagnosis includes improvements for breast cancer patients of all ages. Rapid diagnostic centres (RDCs) have two models: for specific symptoms, which will include most women with suspected breast cancer; and for non-specific symptoms. As of October 2021, there were 159 live RDC pathways in England, compared to 12 in March 2020. Of these, nine are for breast cancer symptoms, with evaluation showing that breast cancer has been diagnosed through non-specific symptom pathways.

The NHS Long Term Plan sets the ambition to offer personalised care to all cancer patients and transform follow-up care, giving people choice and control over the way their care is planned and delivered, includes younger patients with breast cancer. NHS England’s Cancer Quality of Life Survey identify patients’ views on their care and if any new services are needed. The first data from this survey was published in October 2021.