That this House has considered early diagnosis and the cancer workforce in the NHS long-term plan.
It is a pleasure to see you presiding over our business this morning, Mr Howarth. I wish everyone a happy new year. I thank the Backbench Business Committee for supporting the bid of a number of colleagues for this debate, and the Chairman of Ways and Means for allowing it. I was lucky enough to be chosen as the chief sponsor, but I recognise the support of other Members in this Chamber. I will try to keep my remarks to 10 minutes or thereabouts.
I am grateful for the many briefings we have had—we have had briefings from the House of Commons Library, Barts Health NHS Trust, Cancer Research UK, Breast Cancer Care, the Fire Brigades Union, Macmillan Cancer Support, Breast Cancer Now, the Royal College of Pathologists, Maggie’s, the British Lung Foundation, the Royal College of Physicians, CLIC Sargent and the Royal College of Nurses. I have had more briefings from interested parties on this debate than on any other in my 21 years here. Interestingly, they virtually all agreed on two basic points. First, they welcomed the fact that the Government have addressed their issues in the 10-year review and, secondly, they welcomed the new investment but asked for more detail about staff training, recruitment and retention.
Running through most of the briefings I received were questions about the publication of the NHS long-term plan, which was promised by the end of 2018. In very timely fashion, the Government published it yesterday. It has focused the debate but not eliminated the need for it.
I want to highlight some of the issues raised in the briefings. The Royal College of Pathologists cited disturbing statistics. Notably, just 3% of services reported that they have enough staff to meet clinical needs, and more than three quarters of departments reported vacancies for consultants. The royal college emphasised the need for early diagnosis and called for increased investment in pathology services, particularly in the recruitment and training of pathologists and scientists. It said that histopathologists should be listed on the shortage occupation list as there is a shortfall in that speciality. The Migration Advisory Committee currently includes no pathology specialities on the shortage occupation list. Placing histopathology on that list would help overseas qualified pathologists to obtain a visa to work in the UK.
I lost my mother to bowel cancer last year, and I have been campaigning to reduce the bowel cancer screening age to 50. I understand from my campaign and the debates I have had that it is important that we get the pathology capacity right. Otherwise the reduction in the screening age will not work. Does my hon. Friend agree?
I certainly do. I am sorry to hear about the fatality in my hon. Friend’s family. I am sure the Minister will talk about staff and I will come to it later in my speech. Without staff in diagnosis and pathology services, the reduction in the screening age will be pointless.
The Royal College of Pathologists identified a growing demand for pathology services and predicted a 28% shortfall in staff by 2010. Cancer Research UK said, as we all know, that the earlier a cancer is diagnosed, the more likely it is that it will be treated successfully. The Labour Government’s initiative to reduce the time between an urgent GP referral to seeing a cancer consultant to two weeks was a success in ensuring swifter treatment, but 2018 was the first year in which that target was not met. I would be grateful if the Minister told us how the Government expect to address that slippage.
Cancer Research UK added that it expects new cancer cases to reach 500,000 a year by 2035—right now, it is 350,000. With more cases and more thorough screening measures, our NHS will need more diagnostic and treatment staff. Cancer Research UK highlighted that the promise to produce a workforce implementation plan after the 2019 spending review leaves the status of Health Education England’s upcoming cancer workforce plan unclear. Will the Minister give us more information about how the two initiatives relate to each other?
Macmillan said that it recognises and welcomes the focus on cancer in the NHS long-term plan, including the Prime Minister’s commitment radically to improve early diagnosis. However, it has concerns that the long-term plan will not adequately address the immediate and long-term pressures facing the NHS cancer workforce. It also asked when the workforce implementation plan can be expected this year. I note that the Health Secretary said yesterday that he expects Baroness Dido Harding to report to him by the end of March. I would be grateful therefore if the Minister can confirm that we can expect the publication of the workforce implementation plan by summer this year.
Order. This is an important subject and many Members have signified that they wish to speak in the debate. I will not impose a time limit straight away. I will see how it goes. If hon. Members co-operate, I am sure that everybody will be able to speak.
Thank you, Mr Howarth. It is a pleasure to serve under your chairmanship. I wish everyone a happy new year and congratulate the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) on securing this incredibly important debate, which is timely in the light of yesterday’s announcement of the NHS long-term plan.
I will restrict my remarks on the cancer workforce to the radiotherapy workforce and other issues relating to radiotherapy. Sadly, at some point in our lives, one in two of us will have cancer of some form or other, and one in two of those with cancer will receive radiotherapy treatment, so one in four of us will need radiotherapy. Roughly speaking, 1,500 people—clinicians, medical physicists and therapeutic radiographers—make up the entire radiotherapy workforce of the United Kingdom. In the plan that we have been digesting since yesterday, there are many things worthy of remark and which are to be welcomed, but many questions remain unanswered.
On radiotherapy, the focus on survival and early detection is clearly crucial. The United Kingdom is very low down in the league table of European countries when it comes to early detection of cancer, which is the chief reason why survival is so poor compared with other nations of similar prosperity. That is tragic on a personal level and deeply humiliating on a national level. If the Government, the National Health Service and we all are successful in our bid to detect cancer earlier at stage one and stage two, treat it effectively and cure patients—radiotherapy is eight times more likely to be curative than chemotherapy and 50% of those with cancer are already having radiotherapy—it stands to reason that the need for capacity for radiotherapy will increase manifold.
There are 52 radiotherapy centres in England with a number of other satellites. There is nothing in the plan that scopes forward how the national health service will cope with the additional work required if early diagnosis becomes more successful. It is worth bearing in mind that, as things stand, there are significant pressures with a workforce of 1,500. There are two ways of looking at it: one is that the workforce is a very small and precious resource that we need to protect, and the other is to remind ourselves that those are relatively small figures, and that with a relatively small amount of investment, we could make a significant difference to increase that workforce. Relatively small numbers equals a huge percentage, which equals the ability to tackle many more cancers and, indeed, to cure many of them.
Thank you very much for calling me to speak in this important debate, Mr Howarth. I congratulate my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick), and I thank my friend the hon. Member for Westmorland and Lonsdale (Tim Farron), who chairs the all-party parliamentary group on radiography, of which I am also a member.
I do not want to repeat the arguments that have just been made, but some key threads run through the whole of the debate. Although the motion refers to “early diagnosis and the cancer workforce in the NHS long-term plan”, we have to marry some concepts. Yes, early diagnosis is important, but it has to be married with a skilled and effective workforce, as well as the most effective treatment available, by which I do not mean the treatment available in our capital city only, but across the whole country. I will touch on that issue as well.
I declare an interest: I am a cancer survivor. I was successfully treated with both chemotherapy and radiotherapy, thanks to a relatively early diagnosis. I am vice-chair of the all-party parliamentary group on radiotherapy. I am not alone in having benefited from radiotherapy. As was mentioned earlier, during the course of our lifetimes, almost half of us will suffer from cancer at least once, and about half of those people will receive radiotherapy.
Although I was fortunate and count my lucky stars, I am acutely concerned about particular cancers, notably prostate cancer, pancreatic cancer—yesterday, we heard a terrible story from the hon. Member for Crawley (Henry Smith) about his caseworker who passed away as a consequence of pancreatic cancer—and lung cancers and breast cancer. For a modern industrial nation, our cancer outcomes are poor. They should be far better. I hope that the 10-year forward plan that was published yesterday is an opportunity to address some of those fundamental problems. It is important for us to invest in modern accessible cancer diagnosis and treatments.
It is a pleasure to serve with you in the Chair, Mr Howarth. I thank my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick) and other hon. Members for their contributions.
I will focus on cancer affecting children, teenagers and young adults. As hon. Members know, I have personal experience of breast cancer, but more expert people in the Chamber will talk about that, so I will discuss the form of cancer for which I recently set up the all-party parliamentary group on children, teenagers and young adults with cancer.
I set up the group because each year in the UK, 4,450 children and young people under 25 are diagnosed with cancer—that is 12 children and young people every day somewhere in the UK. Four out of five of them will survive for five years or more, but for the parent of a child such a survival rate seems minuscule. Most of us expect our children to survive far longer than that, so the survival rate can seem quite hard. Those of us who have had adult cancer might think, “Oh good—five years! I’ll still be around in five years’ time.” For adults, that feels like a success; for children, not so much.
Cancer remains the biggest killer by disease of children and young people under 25 in the UK. That is important, because one of the reasons why cancer is the biggest killer is that other diseases have declined. That is a good thing, but cancers still affect many children. We want the incidence to decrease, and the number of children surviving and being diagnosed earlier to increase. The all-party parliamentary group wants things to be better. The Minister knows that, because he has been good to the group and worked closely with us. We understand that the small number of children affected can make it difficult to identify real specifics that could make a big difference, but because the number is small, some of the things that we want might be relatively straightforward to do.
Craig Tracey (North Warwickshire) (Con)
The hon. Lady makes an excellent case for education. As co-chair of the all-party parliamentary group on breast cancer, I want to raise the fact that about 3,500 breast cancers go undetected each year due to women not understanding the risk due to breast density. Education would seem critical as part of the long-term plan to get world-class outcomes, so that people understand their personal risk.
The hon. Gentleman is absolutely right; education is critical across all cancers, particularly breast cancer. Many young women need more under- standing of how their risk can be reduced by certain lifestyle choices. I say that carefully, without wishing to blame cancer survivors, because there is a difficult balance. Education is important, because the health service we want for the 21st century is about health rather than sickness. I wanted to see more emphasis in the NHS long-term plan on prevention.
Will the Minister respond to some of our recommendations in his reply to the debate? The all-party group thinks that an emphasis on prevention is critical to young people’s long-term survival and long-term health—not long-term sickness. We are concerned about the shortage of radiographers and radiologists, but other Members will discuss that. If more children and young people with cancer are to survive longer than five years, early diagnosis is critical. Health professionals may see only one childhood cancer in their entire professional life, so they will need help. I ask the Minister to talk to us and to his officials about how to help the professionals to do better. We would like more education for young people on a range of cancer indicators and on ways to change their lifestyle, such as exercising more, reducing alcohol consumption and so on. We all know about those actions, but quite often it is too late; we could do with knowing them from an early age and building them into our way of life, starting when we are young.
I want to conclude, without getting too emotional, by paying tribute to CLIC Sargent and to the Teenage Cancer Trust in particular. They do so much, not just for children and young people but for parents and families. Members of my family received help from CLIC Sargent. My dear sister-in-law works for CLIC Sargent and she has been an inspiration to me on childhood cancer. I want the work they have done to be embraced by Ministers other than this Minister, who already has embraced it, to take that forward in the NHS long-term plan.
10:04 am
Stephen Lloyd (Eastbourne) (Ind)
It is a privilege to serve under your chairmanship, Mr Howarth. I thank the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) for securing this important debate.
I will keep my remarks brief because quite a lot of people want to speak, so I will focus on one area of early diagnosis—that of bowel cancer. There are two reasons for that: bowel cancer is the fourth most common cancer, and it is the second biggest cancer killer, yet bowel cancer is not only treatable but curable, especially if diagnosed early. The Minister will know that since my re-election I have pressed him and the Department hard to reduce the bowel cancer screening age in England from 60 to 50. I was delighted when, a few months ago, the Minister agreed to that and announced that the reduction would take place.
I pay tribute to my constituent Lauren Backler, who started the campaign to reduce the screening age three years or so ago. Sadly, her mother died in her mid-fifties; it is very likely she would not have died had she lived in Scotland and had an early diagnosis. That prompted Lauren to launch a campaign, and it has been an unbelievable success in numbers alone: more than half a million people across the country have signed her petition. Colleagues in the Chamber and I have campaigned avidly for it for the last couple of years, and the Minister and the Department of Health announced the change a few months ago.
David Simpson (Upper Bann) (DUP)
The hon. Gentleman will be pleased to know that in Northern Ireland, following the introduction of bowel cancer screening kits, participation is 60%. It is a fantastic result for Northern Ireland and we need to do more of it.
Stephen Lloyd
The hon. Gentleman is right. The introduction of the new faecal immunochemical test kits will make a huge difference.
I am speaking in this debate because, as the Minister will know and one or two people have alluded to, in yesterday’s announcement there was no clear announcement about additional staff and capacity to ensure that the bowel screening age is brought down from 60 to 50. I commend the Government for listening to Lauren, hundreds of thousands of people across the country, my colleagues here and me, and reducing the age—it is quite clear statistically that many thousands of lives will be saved—but I am anxious that there was no announcement yesterday about the additional budget that will be required for new staff, and a plan for it to happen. I am keen to hear from the Minister not just that the Department of Health is behind it, but detail of when the announcement will be made about additional staff capacity. I urge that particularly because, as the Minister knows, the budget decisions will be announced in March. I want some flesh to be put on the bones.
This is an issue where we know we have a solution. We in this Chamber understand that there are capacity and finance issues. We applaud the Government and the Department of Health for publicly stating that they will bring down the screening age limit. What we all need now is flesh on the bone and detail, so that Lauren Backler, following her remarkable campaign in tribute to her mother, can see in the next few months the first roll-out of the age reduction in screening for bowel cancer.
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Breast Cancer Now made the point that only 18% of breast cancer screening units are adequately resourced with radiography staff, in line with breast screening uptake in its area. My area of north-east London is covered by Barts Health NHS Trust, the NHS North East London Commissioning Alliance and the East London Health and Care Partnership. Many of the points made by the national charities are apparent locally. Those bodies have made their concerns clear. They have raised the basic issue that cancer outcomes in north-east London are among the poorest in London and the country, and that presentation via the emergency route remains high and is clearly associated with advanced cancer and low one-year survival rates.
In my borough of Tower Hamlets, the one-year survival index of people diagnosed with cancer is 4% lower than the England average, and diagnosis through the emergency route remains high. The local NHS trust has plans to attack that problem with a new early diagnosis centre, which is due to open in December; the introduction of multi-diagnostic clinics, which were first introduced in Denmark and were supported here in the pilot phase by Cancer Research UK; and new faecal immunochemical testing for colorectal cancer in primary care from April this year. It plans a health and wellbeing school spread across the whole of north-east London, based on the principle of making every contact count. It is raising population awareness and screening initiatives, including placing staff to promote screening in GP practices, promoting text reminders for cervical cancer screening, video competitions for schools to promote vaccinations, prostate cancer targets, breast and bowel cancer target ads on Muslim TV channels, and the reintroduction of bowel screening reminder calling and other initiatives.
The North East London NHS Foundation Trust conclusions are relatively simple. The workforce is a key factor in delivering a faster diagnosis standard, expected by 2020 and beyond; earlier diagnosis of cancer needs a resilient and sustainable radiology, endoscopy and pathology workforce; the high cost of living, the lack of affordable housing and the disparity in salaries across London are barriers to recruitment; and there is a need to look at technology such as artificial intelligence and digital pathology, and innovations in careers.
CLIC Sargent raised the problem of diagnosing child cancer and said, worryingly, that more than half of young people diagnosed visited their GP with their parents at least three times before their cancer was diagnosed. That is of particular concern.
Breast Cancer Care also raised the workforce plan, and asked how the commitments of the current cancer strategy and the ambitions of the long-term plan will be met. The Royal College of Physicians told me that, in London in 2018, 27% of physician consultant posts advertised were not filled, and that across the UK a total 45% of advertised consultant posts went unfilled due to a lack of suitable applicants.
The British Lung Foundation made two key points: that early diagnosis is essential because almost half of lung cancers are diagnosed at stage 4 when survival rates are very poor; and that there is an urgent need to train and employ more NHS staff to diagnose lung cancer earlier. The Royal College of Nursing stated that in England there are nearly 41,000 vacant registered nursing posts in the NHS. It predicts that the number will increase to almost 48,000 by 2023 if the Government do not take action.
The Commons Library briefings said that the cancer workforce plan devised in 2017 recommended that action be taken to ensure that enough staff with the right skills are trained to deliver the cancer strategy by 2021. In November last year, the highly respected Professor Sir Mike Richards—NHS England’s cancer director—announced that cancer screening would be overhauled as part of the long-term plan. He also announced a review team to assess current screening programmes and a report is due this summer. I ask the Minister whether that timetable might coincide with the publication of the Government’s workforce plan. The Library stated that there is no measure of the total NHS cancer workforce. Will the Minister comment on that anomaly?
I would be grateful if the Minister addresses the fundamental issue raised in all the briefings: how the workforce implementation plan fits in with the strategy, and when it can be expected. I look forward to his response. He is highly regarded in his post. I look forward to the responses from the hon. Member for Central Ayrshire (Dr Whitford), the Scottish National party spokesperson, and from my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson), the shadow Health Minister, and to other colleagues’ contributions.
I will focus briefly on one profession within the radiotherapy workforce—therapeutic radiographers. I do not know whether hon. Members are aware, but in the current academic year, there has been a 50% drop in applications to therapeutic radiography courses at UK universities. One of the leading universities had to cancel its entire intake altogether due to under-recruitment. The cause is almost certainly—99% certainly—the removal of the bursary from that programme. The standard applicant is a mature student who chooses to do something different with their life, having done something else first, and the withdrawal of the bursary has had a huge impact on those people. If the Minister wanted to do something quickly to tackle that workforce issue, I will throw out there the suggestion that he could reinstate the bursary for radiographers.
I am chair of the all-party parliamentary group on radiotherapy, and one of our vice-chairs is here—the hon. Member for Easington (Grahame Morris). We and many other hon. Members had a really good meeting with the Minister at the end of November last year. I am very grateful to him and to his staff for their time and attention. They have yet to respond to the manifesto that we presented to them that day, although I did not expect them to have done so by now. That manifesto calls for a number of things: new investment and more money—it would be surprising if we did not ask for that, but I will put it in context.
As I have said, half of those who have cancer in the United Kingdom will require radiotherapy, yet only 5% of the cancer budget goes on radiotherapy. That compares poorly with other countries. In Australia, the figure is about 5% but the European average is something like 7% or 8%. Our cross-party proposition is that the Government invest £100 million every year into machine upgrades for high-quality, targeted, stereotactic, and other advanced forms of radiotherapy. That fund would cover all trusts, which would not have to delve into their own reserves. We also propose a £250 million up-front, one-off investment so that people who live in communities like mine an awful long way from the nearest treatment can have a satellite unit developed close to them.
Many of my constituents in South Lakeland have to make three or four-hour round trips to get good treatment at Preston, but a large percentage—up to 50%—of those who could have radiotherapy in my constituency and in other parts of south Cumbria do not get it because they are considered to be too far away for it to be a reasonable journey time. Radiotherapy is so often more curative than chemotherapy, ergo people do not live as long because they live too far from treatment. That is why the radiotherapy satellite centre at Westmorland General Hospital in Kendal is a key example. Access and travel times are a problem in other parts of the country, which is why investment in satellite units is important. They do not necessarily involve that much more staffing because, with proper IT networking, we would be able to do many of those things remotely.
In conclusion, the NHS plan announced yesterday contains much that is interesting, but when it comes to radiotherapy, it is entirely a rehash of things that we already know. Some things are welcome, but there is nothing new. I look forward to the Government’s response to its consultation on radiotherapy, which closed 12 months ago, and I ask for an update on that. I also ask that the National Cancer Advisory Group’s 2018 report is released as soon as possible. Finally, I very much look forward to the Government’s response to the manifesto by the all-party parliamentary group on radiotherapy, which was presented to them in November.
I want to talk about the long-term plan that the Prime Minister announced yesterday, on which we had a statement in the House. I will refer in particular to chapter 3, especially section 3.62, on treatment and radiotherapy. I must admit that I was optimistic after meeting the Minister, who I have known for some years. I think he is a decent and honourable individual, and he and his staff were very positive in our meetings. I therefore hoped that, based on the evidence presented, we would have a much more positive outcome from the 10-year plan.
The Government have promised to complete the £130 million investment in radiotherapy machines and to commission the proton machines—the two proton-beam machines, at the Christie in Manchester and at University College Hospital, London—but, in all honesty, that is not a new commitment. Those machines are already or almost completed, so the commitment is a recycling of an existing announcement.
If we are to have a step change and to achieve a world-class set of outcomes and a world-class cancer treatment service, we need a modest increase—modest in relative terms—for advanced radiotherapy. As set out in the “Manifesto for Radiotherapy”—which I recommend that all Members read, because if they are not affected themselves, many of their constituents certainly will be—we ask for an initial one-off investment of £250 million, with an additional £100 million in each successive year for workforce, running costs and so on.
Radiotherapy is required in 50% of cases, but access is patchy. Access varies from 25% to 49%. For example, the hon. Member for Westmorland and Lonsdale represents a rural area, where the figures are low. The average is about 38%. Ideally, according to Cancer Research UK, patients should not have to travel more than 45 minutes to access such treatment and, if we are to achieve that, considerable investment is required. The Minister might be able to elaborate on this, but I do not think that anything concrete in the plan addresses that serious issue.
I welcome the Government commitment on early diagnosis to increase the number of patients diagnosed with stage 1 and 2 cancer by 25% and, for lung cancer, to increase the diagnosis of stage 1 patients by 47%. In practical terms, however, the Government will need more advanced radiotherapy machines to ensure that many of those stage 1 tumours can be cured, as well as additional radiotherapy machines to treat the stage 2 patients. The Government will need to rapidly expand the number of advanced radiotherapy facilities around the country, and how to do that is set out in the manifesto, which would achieve not only early diagnosis but improved survival and outcomes.
I want to give the Minister credit—he is looking a bit quizzical, but I had not intended to beat him up, because we are trying to be helpful. The aspiration and wish to improve cancer outcomes and to see a first-class service is shared in all parts of the House. I am therefore very pleased that he has recognised the representations made on hypofractionated treatment and the perverse incentive in relation to the tariff. The Government have said that they will address that issue, but I would like an assurance that it will be addressed quickly and not in 10 years’ time. The evidence is clear about that disincentive to the most appropriate form of treatment.
Many people want to speak in the debate, so I will wind up. I am pleased that the Government have admitted and accept that advanced radiotherapy is more effective and has fewer side effects. I would like to see a specification come out and to ensure that, when it comes out, we do not see what we have in effect at the moment, which is the rationing of effective treatment. Specialists in the field have told me that the specification under discussion now is in essence no different from that available a year ago. I therefore press the Minister to respond to our submissions.
I want to see an increase in the budget for advanced radiotherapy—fairly modest as part of the NHS budget, or even the cancer budget—from 5% to 6.5% of the cancer budget. That would enable large numbers of cancer patients to live longer and more fulfilling lives and would achieve better NHS outcomes and positive economic benefits. I commend that proposal to the Minister, and I urge him to look at it as part of the ongoing cancer strategy and the NHS 10-year plan.
Last year, we held an inquiry into young people’s experience of childhood and young adult cancer. We now call on the Government and the NHS long-term plan to look at the impact of a young person’s route to diagnosis. Recent research by CLIC Sargent found that more than half of young people had to visit their GP at least three times before their cancer diagnosis. Katie, the young woman who was a panel member in our inquiry, said that because childhood and young people’s cancer is so rare, GPs did not expect to see it, so frequently signs and symptoms were misunderstood. I have the greatest sympathy for GPs and clinicians, and because those cancers are so rare, we would like a training and e-learning module for healthcare professionals.
CLIC Sargent and the Teenage Cancer Trust have teamed up to create such a module on the signs of cancer in children and young people, developed in partnership with the Royal College of GPs. We would like more support in the NHS workforce to improve recognition of the signs, whether that is the e-learning module or something different. I hope the Minister will say something about that when he sums up. In the NHS long-term plan published yesterday I was really pleased to see a specific mention of childhood cancer, but I was disappointed that there was not more emphasis on skilling up the healthcare workforce to recognise the signs and symptoms. We all know that often the consequence of failing to make an early diagnosis is a very poor survival rate.
In our inquiry we recommended many measures, which the Minister has very kindly agreed to go through with his officials and respond to in some detail. Perhaps after the debate, will he liaise with my office about a time to meet? I am grateful to him for his willingness to do that, but we would like to make some progress in the first half of this year. Some of our recommendations are relevant to this debate. We say that the Secretary of State for Education should ensure that every young person receives health education that includes cancer signs and symptoms, done in an appropriate way. The Teenage Cancer Trust has developed an education module, which many of us will have seen recently when it was demonstrated in Parliament. I would like to see something such as that being used.