Asked by: Baroness Merron (Labour - Life peer)
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.
Asked by: Baroness Merron (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what progress they have made in reducing inequalities in outcomes for breast cancer patients from black and minority ethnic backgrounds over the past (1) 10 years, (2) five years, and (3) two years.
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.
Asked by: Baroness Merron (Labour - Life peer)
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.
Asked by: Lord Bishop of St Albans (Bishops - Bishops)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what assessment they have made of the impact of low rates of breastfeeding on incidences of breast cancer.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
Improving early diagnosis of cancer, including breast cancer, is a priority for the National Health Service. The public health benefits of breastfeeding for child and maternal health are significant and well established. Evidence suggests a range of potential benefits, for example, research published in the British Medical Journal found breastfeeding gave protection against breast cancer.
We want to ensure that every parent and carer understands the benefits of breastfeeding and has access to the high-quality infant feeding services they need, in their local area, to achieve their breastfeeding goals. Through the Family Hubs and Start for Life Programme, we are investing £50 million to increase the range of specialist support, which is enabling parents to access face-to-face and virtual support whenever they need it.
Asked by: Baroness Ritchie of Downpatrick (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what steps they are taking to ensure that the 15 per cent shortfall in clinical oncologists, as estimated in the Royal College of Radiologists workforce census, does not impact the operational performance of radiotherapy services.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
According to the latest data, of those 10,328 cancer patients referred for first or subsequent treatment for radiotherapy in March 2024, 89.7% were treated within 31 days. The proportion of patients waiting more than 31 days for radiotherapy treatment in March 2024 was therefore 10.3%. This has decreased by 4.5% since January 2024.
We are aware of regional disparities in wait times for cancer treatment through NHS England’s data, and are considering the findings made by the Royal College of Radiologists. Tackling inequalities in outcomes, experience, and access of cancer diagnostics, including regional disparities, is a key focus of the Government. NHS England has commissioned six new cancer clinical audits in breast cancer, both primary and metastatic, as well as ovarian, pancreatic, non-Hodgkin lymphoma, and kidney cancer. These 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. The first outcomes of these audits are expected in September 2024.
The Department is working closely with NHS England to make sure we have the right workforce with the right skills up and down the country. In 2023/24, NHS England invested an additional £50 million to increase the number of cancer and diagnostic specialists.
The Government is also backing the NHS Long Term Workforce Plan, with over £2.4 billion over the next five years to fund additional education and training places. The plan sets out an aim to double the number of medical school places in England to 15,000 places a year by 2031/32, and to work towards this expansion by increasing places by a third, to 10,000 a year, by 2028/29.
We are building our cancer workforce. In January 2024 there were over 35,200 full-time equivalent (FTE) staff in the cancer workforce, an increase of over 13,300, or 60.7% since January 2010. Regarding clinical oncology specifically, as of January 2024, there are currently over 1,600 FTE doctors working in the speciality of clinical oncology in National Health Service trusts and other core organisations in England. This is over 30, or 2.2%, more than last year, over 300, or 27.7%, more than 2019, and over 600, 66.5%, more than in 2010. This includes over 900 FTE consultants. This is over 40, or 5.1%, more than last year, over 100, 22.0%, more than in 2019, and over 400, 80.2%, more than in 2010.
Asked by: Navendu Mishra (Labour - Stockport)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what recent assessment she has made of performance against the 62-day referral to treatment cancer standard in England.
Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)
In February 2024, 63.9% of patients, against the standard of 85%, received treatment within 62 days of an urgent suspected cancer or breast symptomatic referral or consultant upgrade, to a first definitive treatment for cancer. This is 1.6% higher than performance in January 2024, and 1.4% higher than the same time last year.
The pandemic and recent industrial action placed significant pressure on elective services, including cancer care. We are seeing record levels of referrals, with over 12,000 urgent referrals seen for suspected cancer per working day in February 2024.
As outlined in the 2024/25 NHS England Planning Guidance, NHS England is providing over £266 million in cancer service development funding to Cancer Alliances to support delivery of the operational priorities for cancer, which includes increasing and prioritising diagnostic and treatment capacity. The Government remains committed to continuing its recovery from the pandemic, and specifically, to reduce local and national waiting times for cancer treatment.
Asked by: Dawn Butler (Labour - Brent Central)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what recent assessment she has made of trends in the level of uptake for breast cancer screenings amongst ethnic minority women.
Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)
The national breast screening programme does not currently have the capability to routinely cross reference patient’s ethnicity data with uptake data. NHS England has started work to improve its data collection capabilities as part of the development of the new screening IT system, through the Digital Transformation of Screening programme. This will support the collection of population-level data on protected characteristics such as ethnicity, to support services in improving uptake.
More widely, NHS England has developed a national plan to improve uptake, including interventions to address inequalities and screening barriers. This includes ensuring appointments are as convenient as possible, and efforts are focused on areas and groups with low uptake.
Asked by: Rachael Maskell (Labour (Co-op) - York Central)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what steps she is taking to ensure that patients at high risk of developing breast cancer are recalled for MRI screening.
Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)
Women at very high risk (VHR) of breast cancer are eligible to be screened from the age of 25 years old upwards, and should be invited every year. The screening includes mammography or magnetic resonance imaging (MRI), depending on age and risk criteria.
In March, NHS England wrote to a small number of VHR women who had not been referred for annual MRI surveillance, and the National Health Service has been working hard to ensure these women are checked as a matter of urgency, as described in their individual letters. To support screening of VHR women, a new central database is planned to ensure all referrals reach NHS breast screening services.
Asked by: Dawn Butler (Labour - Brent Central)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what steps she is taking to help ensure the Major Conditions Strategy improves breast cancer outcomes for ethnic minority women.
Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)
Reducing inequalities and improving breast cancer outcomes for ethnic minority women, including black 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 metastatic 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 operational planning guidance for the health system. The Core20PLUS5 approach for adults has been rolled out as an NHS England framework to focus action on reducing inequalities on issues within the National Health Services’ direct influence, which are major contributors to inequalities in life expectancy through major conditions like cancer, cardiovascular disease, respiratory disease, and others, or Long-Term Plan priorities where stark inequalities are evident, such as maternity or severe mental illness.
The key actions for systems as highlighted in NHS England’s planning guidance for 2024/25 is to continue to deliver against the five strategic priorities for tackling health inequalities. Additionally, by the end of June 2024, NHS England aims to publish joined-up action plans to address health inequalities, and implement the Core20PLUS5 approach.
Improving earlier diagnosis of cancers, including breast cancer, is also a priority for the Government. The NHS 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. Additionally, the new cancer standards developed and supported by cancer doctors and implemented in October 2023, will ensure patients are diagnosed faster, and that treatment starts earlier. In the 2023/24 Operational Planning Guidance, NHS England announced that it is providing over £390 million in cancer service development funding to Cancer Alliances in each of the next two years, to support the delivery of the strategy and the operational priorities for cancer, which includes increasing and prioritising diagnostic and treatment capacity.
Whilst the Major Conditions Strategy does not seek to describe everything that is being done, or could be done, to meet the challenges of individual conditions in silo, it instead focuses on the changes likely to make the most difference across the six groups of major conditions, including cancer.
Asked by: Dawn Butler (Labour - Brent Central)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what steps her Department is taking to improve breast cancer outcomes amongst Black women.
Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)
Reducing inequalities and improving breast cancer outcomes for ethnic minority women, including black 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 metastatic 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 operational planning guidance for the health system. The Core20PLUS5 approach for adults has been rolled out as an NHS England framework to focus action on reducing inequalities on issues within the National Health Services’ direct influence, which are major contributors to inequalities in life expectancy through major conditions like cancer, cardiovascular disease, respiratory disease, and others, or Long-Term Plan priorities where stark inequalities are evident, such as maternity or severe mental illness.
The key actions for systems as highlighted in NHS England’s planning guidance for 2024/25 is to continue to deliver against the five strategic priorities for tackling health inequalities. Additionally, by the end of June 2024, NHS England aims to publish joined-up action plans to address health inequalities, and implement the Core20PLUS5 approach.
Improving earlier diagnosis of cancers, including breast cancer, is also a priority for the Government. The NHS 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. Additionally, the new cancer standards developed and supported by cancer doctors and implemented in October 2023, will ensure patients are diagnosed faster, and that treatment starts earlier. In the 2023/24 Operational Planning Guidance, NHS England announced that it is providing over £390 million in cancer service development funding to Cancer Alliances in each of the next two years, to support the delivery of the strategy and the operational priorities for cancer, which includes increasing and prioritising diagnostic and treatment capacity.
Whilst the Major Conditions Strategy does not seek to describe everything that is being done, or could be done, to meet the challenges of individual conditions in silo, it instead focuses on the changes likely to make the most difference across the six groups of major conditions, including cancer.