Cancer Diagnoses: Young People in Hertfordshire

Motion made, and Question proposed, That this House do now adjourn.—(Rebecca Harris.)

I wish to start by pointing out that this debate really does not belong to me. It belongs to Jessica Brady, as it is her tragic story that brings us all here today. The first thing I want to do is pay tribute to Jessica’s parents, Andrea and Simon Brady. They could not be here today, but I know they are watching, even though it is very difficult for them to do so. The pain they have experienced, and the pain they face every day of coping with their daughter’s illness and death, is unimaginable. They have told me that they are utterly broken, yet with dignity and determination they have committed to improving the diagnosis of cancer among young adults. They wish to ensure, in Jess’s name, that others do not have to go through what they have gone through. They have already done much to raise awareness of Jessica’s story. I was honoured, along with Simon and Andrea, and my right hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald), to hand in their petition calling for better awareness and diagnosis of cancer in young people to No. 10 Downing Street. The petition currently has more than 213,000 signatures, which is remarkable and sobering. I am grateful that my right hon. and learned Friend is in the Chamber for this debate and grateful for all of his support.

I pay tribute to my hon. Friend for securing the debate. My thoughts, as hers, are with Andrea and Simon Brady on the sad loss of their daughter Jess. Does my hon. Friend agree that at least two areas need to be improved in the way that we deal with cancer in young people? First, in general practice, we need to concentrate much more on young people and perhaps have a lead in each practice who looks at it and makes sure that every doctor is up to speed with the latest thinking. Secondly, we need to improve blood tests. There have been recent innovations, so perhaps a blood test could help with diagnosis.

I thank my right hon. and learned Friend for those comments. He has followed the case closely and has supported me. He puts his finger on some of the key lessons that we want to learn from the Brady’s tragic experience to improve the situation for the future. I will expand on the exact points that he has made.

Andrea and Simon first got in touch with me in April. They told me how Jessica, their 27-year-old daughter, had been unwell since mid-2020 suffering with abdominal and back discomfort. We know how difficult it has been to get a face-to-face appointment with a GP during the pandemic, so Jessica had an online consultation and was diagnosed with a kidney infection and prescribed antibiotics.

Over the ensuing weeks, Jessica was prescribed numerous medications, including countless courses of antibiotics and steroids, all without an examination. For months, she was told that she was suffering from long covid, despite the fact that she had never tested positive. Unconvinced by the assessments and desperately worried, Andrea and Simon decided to go down the private healthcare route.

On 26 November 2020, Jessica received the worst news imaginable: she was diagnosed with an extremely aggressive stage 4 adenocarcinoma with an unknown primary. Jessica’s dependency on oxygen from that date meant that she did not leave the hospital or ever return home. By the time the cancer was discovered, it had already spread to her spine, liver, stomach, lungs, bones and lymph nodes. Jessica passed away on 20 December 2020.

I never had the pleasure of meeting Jessica, but by all accounts she was a remarkable young woman. She worked as a satellite engineer for Airbus in Stevenage and on the day of her funeral, a satellite that she helped to design was launched into space from Cape Canaveral inscribed with the words, “Thank you, Jess!”.

I commend my hon. Friend for bringing this Adjournment debate on an important issue for Hertfordshire residents. Does she agree that early diagnosis of cancer would mean that stories such as that of Jess, which she has eloquently put forward, will not necessarily happen again?

My hon. Friend is right: early diagnosis is key. From Jess’s experience, I want to dig into some of the ways that we can get early diagnosis and a diagnosis that speeds up the process to help to stop unnecessary suffering and death from cancer.

Jessica had her whole life in front of her, but because of the restrictions on face-to-face GP appointments and misdiagnoses, she finally received the correct diagnosis just three and a half weeks before she died. I was immeasurably moved by her story and immediately contacted the then Secretary of State for Health and Social Care, my right hon. Friend the Member for West Suffolk (Matt Hancock). I take this opportunity to thank him, because he immediately met me, and Andrea and Simon, and we agreed numerous follow-up points. I thank the current Health Secretary for carrying on that work. Andrea and Simon also shared Jess’s story at the Health and Social Care Committee.

There are four key elements to Jessica’s story: the fragmented nature of the GP care and provision that she received; the misdiagnosis that caused so much pain to her and her family; how her age helped to shape the process; and how we need to use her story to make sure that the same mistakes are not repeated. I will take those elements in turn.

Jessica’s experience of the GP care she received was, at best, fragmented and, at worst, insufficient to deal with the specific needs that she faced. The problem here was not the individuals involved; the problems for Jessica often came from the organisation of the system itself. The GP provision that Jessica experienced was definitely exacerbated by covid. At the Select Committee session, Andrea described how, at Jessica’s lowest ebb, she struggled to navigate receptionists and switchboards while trying to receive any kind of contact from a doctor. In Andrea’s own words, “Nobody listened” and “Nobody took it seriously.” I cannot imagine your child suffering such pain and yet saying, “What's the point? Nobody will do anything.”

We talk so much about how crucial an early cancer diagnosis is, but all parts of the system need to be working for the process to be efficient and, above all, effective. Andrea Brady summed this up perfectly at the Health and Social Care Committee session. She explained:

“No one looked at the big picture and assembled the jigsaw puzzle pieces.”

Jessica really needed one person on her case, looking at all the evidence and looking at things holistically. Whether we see it as an umbrella model, a wheel and spoke model or whatever, they all need a focal point that holds the rest of the process together. Without this, we know just how awful the results can be. In the end, Jessica saw four different doctors, with not one of them taking ultimate responsibility for her care.

I thank and pay tribute to my hon. Friend the Member for Hertford and Stortford (Julie Marson) for bringing this debate before us, and for raising this difficult issue in a typically dignified and sensitive way. She has done justice to Jessica and her family.

I join my right hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald) and my hon. Friend the Member for South West Hertfordshire (Mr Mohindra), who intervened, in sending my condolences to Andrea and Simon, and to Jessica’s family and friends, following her death. We know that the passage of time can help, but it can never totally remove that sense of loss. I pay tribute to them for the work that they are doing to highlight the issue. It must be very difficult for them and it is humbling that they—through their excellent Member of Parliament, but also in person—have been willing to share this deeply upsetting experience to seek to build a better future for others. I put on record my tribute and gratitude to them.

As my hon. Friend the Member for Hertford and Stortford has set out, Jessica sadly had a very rare form of cancer. I am advised that the timescale and complexity of diagnosis in this case was due to the rarity of the cancer, especially in younger people, but we are always willing to look more broadly and holistically at other factors that we may have some control over that could help to improve diagnosis in the future. It is absolutely right that we do so because, as my hon. Friend said, sadly no one is too young to fall victim to cancer, so it behoves all of us in this House and beyond to do all we can to improve diagnosis.

As my hon. Friend alluded to, we are working nationally on achieving the long-term plan commitment towards early diagnosis of cancer, including rarer cancers or those that are harder to diagnose, in order hopefully to avoid situations such as Jessica’s being repeated in the future. Hertfordshire’s hospital trusts are working extremely hard to that aim. In delivering the long-term plan for cancer, we have the aim of diagnosing three quarters of cancers at stage 1 or 2, and increasing cancer survival rates so that an additional 55,000 people survive their cancer for five years or more. Delivering those ambitions through earlier and faster diagnosis, rapid adoption of innovation and, crucially, the roll-out of personalised care—looking at someone as an individual—will benefit children and young adults across the country.

I want to follow up on the point that I made when intervening on my hon. Friend the Member for Hertford and Stortford (Julie Marson). The project that the Minister is talking about is very good, but I just wonder about disseminating best practice more widely in GP surgeries. Does he think that the idea of having one GP in a practice who takes a lead on cancer—ensuring that the practice is up to date with the latest diagnostics, treatment and so on—is worth pursuing?

My right hon. and learned Friend is also an old friend, so I suspect that he has a slight insight into where I was to be going in a few minutes. I hope to be able to answer that point specifically.

On education in cancer diagnosis within Hertfordshire and on GPs having the necessary skills and keeping them up to date, GPs in the region are encouraged to maintain their knowledge and skills in the field and are supported by Macmillan GPs, who are specialists in cancer care. Cancer education programmes such as Gateway C are available online, and face-to-face education sessions have now resumed, including monthly seminars offered by providers and by Cancer Research UK. A primary care network cancer clinical leads group has also been established to share the latest local issues and best practice.

I turn to specific points highlighted by my hon. Friend the Member for Hertford and Stortford. On face-to-face appointments and the ability to diagnose in that context, £20 million of elective recovery funding has been distributed to cancer alliances in this financial year to help accelerate the implementation of service models that streamline the front end of the pathway and support the management of high referral volumes. Throughout the pandemic, NHS England and Improvement has provided guidance to general practice and continually updated standard operating procedures to ensure that changing services could operate safely. NHS England and Improvement set out clear expectations that general practices offer face-to-face appointments alongside remote appointments—telephone or online—and that clinical necessity and patient preference should be taken into account to determine the most appropriate method.

My hon. Friend raised research and how it could help save lives in the future. NHS England and Improvement is supporting GRAIL’s Galleri trial, where studies have shown the ability to detect more than 50 types of cancers through a single blood test. The Galleri test can, as she said, detect chemical changes in blood as cancer can release small particles of DNA into the blood—known as circulating tumour DNA—which leak from tumours into the bloodstream, to give a vital early warning. The Cancer Research UK and King’s College London cancer prevention trials unit is conducting a randomised control trial along with the NHS and GRAIL. The blood samples from the first subjects in the trial are being obtained at mobile testing clinics in retail parks as well as at various convenient community locations. The trial’s participants must not have had a cancer diagnosis in the last three years. The main trial has now started. As hon. Members will know, I am always cautious about such things, but I am cautiously optimistic and genuinely hope that the trial will yield innovation that will make a huge difference in the ways mentioned by my hon. Friend.