Breast Cancer Diagnosis and Services: Covid-19

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I beg to move,

That this House has considered the effect of the covid-19 outbreak on breast cancer diagnosis and the future of breast cancer services.

It is a pleasure to serve under your chairmanship, Ms McVey. As co-chair of the all-party parliamentary group on breast cancer, I am delighted to raise these hugely important issues. It is great to see the Minister in her place; she brings great expertise and knowledge to this topic. This has all the hallmarks of an excellent debate.

To set the scene, as hon. Members will know, the pandemic has had a major impact on breast cancer services, with Breast Cancer Now estimating that almost 1 million women in the UK missed out on their screening appointment as a result of a pause in the programme. There was a worrying drop at the peak of the pandemic in referrals of suspected breast cancer and breast-related symptoms.

We also know that some breast cancer patients had their treatments changed or temporarily paused to protect their immune system, or had their surgery delayed. That caused, understandably, huge anxiety, particularly for patients with incurable cancers, such as secondary breast cancer, and that was passed on to their families. Recruitment to many clinical trials was paused. The sustained pressure on staff as a result of dealing with the covid-19 pandemic alongside the existing challenges for the breast cancer workforce, has the potential to overwhelm the system for the foreseeable future.

There is some good news. Despite a dip in August, referrals have been steadily recovering. Although there is some way to go before they reach pre-pandemic levels, breast screenings are restarting and the number of people beginning treatment is rising. I am sure hon. Members across the House will join me in thanking the NHS for its effort in treating people and finding ways to deal with cancer patients during the pandemic. I would particularly like to thank my local hospital, the George Eliot Hospital, and Kristy and her team in palliative care. They do such amazing work, in difficult circumstances.

The recovery plan set out how we will restore breast cancer services to pre-pandemic levels, but we also need to look to the future, to ensure that the progress we made in treating cancer is not allowed to stall or be forgotten. As I mentioned, the pandemic has raised several urgent issues in relation to cancer. It is fair to say that many of those needed tackling prior to the pandemic, and they still need addressing.

In 2018, a report by the APPG on breast cancer showed that while breast cancer outcomes were good and outperforming those of other cancers, inequalities in diagnosis, treatment and care across the country were being masked, impacting the experience and outcomes of patients. Our inquiry also found significant variations across England in the support that women with secondary breast cancer received, particularly in access to a clinical nurse specialist, patchy provision of information, psychosocial needs not being met, and a lack of prompt and timely access to specialist palliative care services.

The hon. Gentleman is making an important and powerful point, and I hope the Minister is taking note. As he rightly says, many older people—particularly older women—with breast cancer were not prioritised to receive breast radiotherapy over the past six months. Data is available in the radiotherapy datasets that are held by Public Health England, but they have not been published so far. Does he agree that the Minister should seek to persuade NHS England to publish that data?

The hon. Gentleman raises an interesting point, which I am sure the Minister will address. It makes perfect sense that we are seeing the lack of cohesion in data. We know that data is power in everything—without the data, how can we plan a strategy? Wherever we get it from, it should be imported into the system. In the 2015 debate, I asked the Minister to lead the way on ensuring that the data was collected uniformly in every hospital, and not just collected, but collected in a format that enables us to interpret it. We need that now more than ever.

I felt that we were making some headway at the start of the year. I had a productive meeting with my right hon. Friend the Secretary of State for Health and Social Care, where we brought in some secondary breast cancer patients and had a really good discussion on a number of topics. Data was one of the key things that we addressed. The Secretary of State made very positive noises about the potential for a national secondary breast cancer audit. Unfortunately, shortly after that, we ended up in the grip of the pandemic and I appreciate that the Department’s focus has been pulled into different areas.

To return to the point that I have made, without accurate figures for the number of people living with secondary breast cancer, it is nigh-on impossible for the NHS to plan and commission services effectively to meet patients’ needs. Equally, without understanding the level of service and care that patients were accessing before the pandemic, it will be challenging to know how to improve outcomes when we get back to pre-pandemic levels. How can we hope to do that without knowing where we started?

Inadequate collection and sharing of data acts as a barrier to service improvement. We are missing out on an incredibly powerful tool that we should be using to spot variation and hold services to account, and to better understand the secondary breast cancer population and the service it requires. At a time when long-term local and national plans are being drawn up, we want to ensure that the NHS can fully deliver on its commitments, and that we have a clear understanding of the experiences of people with secondary breast cancer.

I ask the Minister to follow up on the delivery of a national secondary breast cancer audit, which would cover things such as diagnosis, treatment and access to support. That could transform our insight into this key area and provide the missing information that is desperately needed to ensure that the NHS can meet the needs of those living with secondary breast cancer.

The second point that I will touch on is the importance of increasing access to clinical nurse specialists. In the 2015 debate, I said that the cancer patient experience survey showed that when a clinical nurse specialist contributes to a patient’s care, it is the biggest driver in improving their experience. That measure could save money in the long term, by keeping patients out of hospital and highlighting problems before they become crises in A&E. That is particularly true for secondary breast cancer patients, because they are on a lifelong treatment pathway and often have complex emotional and supportive care needs. A recent survey found that less than a third of secondary breast cancer patients had seen a CNS regularly. With the number of men and women developing breast cancer increasing, and people with secondary breast cancer living longer with the disease, there was already a high demand for CNSs. With covid-19 resulting in changes to people’s treatment and care, however, while also having an impact on their emotional wellbeing, access to CNSs for secondary breast cancer patients has never been more urgent.

It might be helpful for colleagues to know that I intend to get to the Front-Bench speakers no later than 2.30 pm, so, to enable everybody to get in and speak, speeches will be limited to four minutes. Also, will the Front-Bench speakers be mindful of the time, because we want to hear Craig Tracey again?

It is a pleasure to serve under your chairmanship, Ms McVey. I pay tribute to the hon. Member for North Warwickshire (Craig Tracey) for securing this important debate. He has spoken incredibly passionately and covered a wide range of issues relating to breast cancer. I want to focus my remarks on two issues. First, I want to speak about the need for a cancer recovery plan to deal with the backlog in breast cancer screening tests and get cancer treatments up and running again. Secondly, I want to speak about the need for urgent action to prevent the widening health inequality gap in this country.

Over the past few months, we have seen spiralling wait lists, the longest since records began. That has had a direct and devastating impact on people’s health. I have heard stories of frontline workers who have had their cancer screen test delayed, only to find out months later that their cancer has spread. It is a simple fact that the sooner someone has a cancer diagnosis, the more likely they are to survive. In March, breast cancer screening programmes were put on hold. One week into the second national lockdown, people are worried that that might happen again, and they fear for loved ones who might not get the care that they need.

In response to a parliamentary question that I asked, the Government revealed that nearly 10,000 women are waiting for a breast cancer screening in Barnsley alone, and more than 30,000 women in South Yorkshire. We have a postcode lottery in this country when it comes to breast cancer screening and mortality rates. Depending on where someone lives, they can be up to a third less likely to have attended a breast cancer screening in the last three years. Staffing pressures have directly impacted the capacity of the NHS to screen patients for suspected cancer, affecting the speed at which patients are diagnosed.

A Public Health England report found that the number of empty consultant breast radiologist posts in the country doubled between 2010 and 2016. The same report revealed that all breast radiologists in Yorkshire and the Humber are due to retire by 2025. Has the Minister’s Department assessed the impact of the pandemic on recruitment, and will she outline the Department’s plans to deal with the staffing crisis?

It is a pleasure to serve under your chairmanship, Ms McVey. I add to the tributes to my hon. Friend the Member for North Warwickshire (Craig Tracey) for calling this important debate and speaking so powerfully at the outset about this issue.

This subject is especially pertinent because cancer, sadly, will touch each of our lives in some form. If we are not personally diagnosed, we will know someone close to us who is. It is one of the biggest long-term health challenges we face as a country, notwithstanding the current pandemic. Coronavirus has impacted on breast cancer services, as it has impacted on every part of our lives. Breast Cancer Now has described coronavirus as “the biggest crisis” that breast cancer has faced in decades.

As the hon. Member for Barnsley East (Stephanie Peacock) outlined, the earlier breast cancer is diagnosed, the more likely treatment is to be successful. Earlier this year, the screening programme was officially paused in Scotland, Wales and Northern Ireland, and it was effectively paused in England from March. Screening has now restarted, but it is patchy across the country, with some having quicker access than others. With each month that passes, more women with breast cancer could be missing the chance of an early diagnosis, which is key to preventing deaths from the disease.

As my hon. Friend the Member for North Warwickshire pointed out, Breast Cancer Now estimates that nearly a million women who require screening are currently waiting across the United Kingdom, and around 8,600 of them could be living with undetected breast cancer. This has been exemplified in my Carshalton and Wallington constituency. As part of the London borough of Sutton, we are lucky to be home to the world-leading Royal Marsden Hospital. I want to put on record my thanks to Dame Cally Palmer and the amazing staff at the Royal Marsden whom I had the pleasure of visiting recently.

Thank you for calling me in this important debate, Ms McVey. I thank the hon. Member for North Warwickshire (Craig Tracey) for securing it. We are from the same part of the country, but from different tribes; I am red and white.

This is an important subject, and it is important that we address it. We are living through an unprecedented pandemic. I was saddened and alarmed to read yesterday that the UK had become one of only five countries to exceed 50,000 deaths from covid-19. In the fullness of time, no doubt, we will have a public inquiry into covid-19 that will examine the flaws in the Government’s covid-19 response. I certainly believe that the Government will acknowledge that they were not properly prepared for a pandemic and did not have a proper and effective plan to manage infectious disease and routine day-to-day healthcare.

The impact on breast and other cancers has already cost lives and will continue to do so, but I want to focus on the cancer recovery plan. The Government can take steps to avoid unnecessary cancer deaths arising from the backlog of delayed diagnosis and treatment. I have met the Minister on several occasions in my capacity as vice-chair of the all-party group for radiotherapy and the all-party group on cancer, and we have had constructive dialogue, so I am afraid she will not be able to argue that solutions were not put forward to address this issue and mitigate potential deaths arising from delayed treatment.

The Catch Up With Cancer campaign, which Radiotherapy4Life is supporting, has identified that the cancer backlog stands at more than 100,000 patients. I recently had a meeting via Zoom with Macmillan cancer support—I am one for badges; I am wearing Radiotherapy4Life’s and Macmillan’s—to discuss what needs to be done to address the cancer backlog. It estimates that there are 50,000 missing diagnoses for cancer across the UK—it calls them the forgotten C. An estimated 100 fewer women started treatment for breast cancer each working day in May and June, compared with last year. Breast cancer two-week wait referrals are down 25% in March to August this year, compared with 2019.

It is a pleasure to serve under your chairmanship, Ms McVey. I congratulate my hon. Friend the Member for North Warwickshire (Craig Tracey) on securing this timely and important debate. I pay tribute to the work that he and the all-party parliamentary group have done on this issue over a number of years. It has been really important.

We have come a long way in this country on breast cancer survival rates over the past few years, but about 11,500 women still die every year from the disease. We know that early diagnosis is absolutely vital when it comes to survival rates, so I am very concerned about the impact that the pandemic has had and continues to have.

In my constituency in the High Peak, a commissioning decision was recently taken by NHS Midlands to withdraw the breast cancer mobile screening units from three towns—Buxton, Chapel-en-le-Frith and New Mills—and to move that service outside the High Peak to Bakewell. This is no slight at all on Newholme Hospital in Bakewell and the fantastic staff there—I pay tribute to them and to all the NHS staff working in breast cancer screening services—but there is a question of accessibility. The Peak district does not have the best roads; we are heading into winter, when those roads become even more inaccessible. Public transport is patchy at best, and I am incredibly concerned about how many women will feel unable to make appointments if they have to go all the way to Bakewell. I am alarmed about this decision, and it is one that I disagree with. I really hope that we can reinstate the mobile screening units in the High Peak as soon as possible. My message to the Minister is clear: we desperately need to get those units reinstated, and I hope that I can meet her to talk about this in the near future.

It is a pleasure to serve under your chairship, Ms McVey. I, too, congratulate the hon. Member for North Warwickshire (Craig Tracey) on securing this important debate.

This year has been incredibly difficult and challenging for everyone working in our national health service, for the patients they serve and for the staff and volunteers at the many charities and community organisations that help to support patients and carry out critical research, including Breast Cancer Now, Breast Cancer UK, Macmillan Cancer Support and Cancer Research UK. I pay tribute to them, and to every one of the staff who work in King’s College Hospital in my constituency for their incredibly hard work since the start of the coronavirus pandemic. Our nurses, doctors, care assistants, allied health professionals, porters, cleaners and admin staff have all worked with extraordinary commitment in exceptionally challenging times.

Breast cancer is a devastating condition, and every year across the UK more than 50,000 women, as well as approximately 400 men, receive their first diagnosis of it. I pay tribute to the hon. Member for Chatham and Aylesford (Tracey Crouch) and to my friend Paula Sherriff, the former Member for Dewsbury, for speaking publicly about their recent experience of diagnosis and treatment during coronavirus—an experience that is made all the more difficult by the restrictions on contact with friends and family, who are often so vital in providing comfort during a difficult time.

Although our NHS staff have worked so incredibly hard this year, as always, the coronavirus pandemic has exposed the impact of 10 years of austerity on our healthcare system. In many parts of the country, including my constituency, our NHS was not able simultaneously to care for patients impacted by coronavirus and to maintain the array of other critical services, including cancer screening. Our local hospital worked extraordinarily hard to maintain cancer treatment, but across the NHS the need to cope with the huge influx of coronavirus patients and prevent further infection spread, particularly among clinically vulnerable people, caused significant disruption to surgery pathways.

Another debate about breast cancer. There have been many—too many. For my first five years in this place, I was proud to lead the all-party parliamentary group on breast cancer, and it is in good hands now with my hon. Friend the Member for North Warwickshire (Craig Tracey). For more than two years, it was the privilege of my life to serve as the cancer Minister and to be part of what I call team cancer. Heaven knows, I spent my fair share of time sitting in the Minister’s seat in Westminster Hall, as she—the current Public Health Minister—now knows.

For each of the 10 years that I have been an MP, we have lost around 11,500 women a year in the UK to this menace, as has been said. That number has come down thanks to advances that we have made and investments that all Governments have put in, but we have to do so much better. That is 115,000 mums, sisters, grans, aunties and friends over the decade that I have served in this place. I have never spoken before about which one of them it was for me, and I do not think I will go there today, but I will say this: I have fought and lost to breast cancer more than I have won.

And let us not forget the guys. I was glad that the previous speaker, the hon. Member for Dulwich and West Norwood (Helen Hayes), mentioned them. Yes, breast cancer is rare in men, but around 370 men a year are diagnosed in the UK. It still kills, so I welcome the Male Breast Cancer Study that was established to pinpoint some genetic and environmental lifetime causes in men.

Going back to the title of today’s debate, it is true that covid has not helped, but the breast cancer toll goes on regardless. That is as true today as it was pre-pandemic. Breast cancer remains a largely beatable and treatable cancer if it is detected early. Primary breast cancer can be fatal, but we know that almost all deaths are attributable to the development of metastatic, or secondary, breast cancer. As Breast Cancer Now puts it so well—this has been quoted before, but it is worth saying it again—coronavirus is the biggest crisis secondary breast cancer has faced in decades.