Covid-19: NHS Support for Prostate Cancer Patients

Sadly, the statistics and anecdotes that many of us will have heard point to the fact that men are far less willing to get themselves checked. Whether that is out of embarrassment or fear, getting diagnosed early can make an enormous difference to survival rates; five-year survival rates for men who are diagnosed with prostate cancer between stages 1 and 3 are over 95%. There are fantastic NHS campaigns, such as the “Help Us Help You” campaign, which has urged people with potential cancer symptoms to come forward for life-saving checks. The second stage of that campaign addresses the fear that often comes with booking the first appointment. Despite the fantastic work that is already being carried out, I hope that the Minister will be able to enlighten us about what more the Government are doing to destigmatise men coming forward to check their symptoms.

While being checked for prostate cancer is important for all men, it is especially important for men of black African or black Caribbean origin. I was taken aback to learn that, while one in eight of all men will get the disease, one in four black men will be diagnosed with prostate cancer in their lifetime; black men are also far more likely to be diagnosed with a more aggressive type. People from black and ethnic minority groups are also 4% less likely to receive radical treatment than people from white ethnic groups.

Through covid-19, we have seen what we can achieve when we work together. Last year, I was proud to host a roundtable in Carshalton and Wallington in collaboration with the NHS, the third sector and community groups to encourage ethnic minority communities to come forward and get the jab. The roundtable was well attended and demonstrated what we could achieve in prostate cancer diagnostics if the Government worked closely with the third sector and community groups to spread awareness.

However, improving awareness requires a corresponding increase in imaging capacity. Imaging services such as multiparametric MRI are critical to achieving earlier diagnoses, which, as I stated earlier, is key to survival. MpMRI scans can confirm or rule out prostate cancer in an accurate and timely manner, reducing the stressful wait for patients and their families. From speaking with cancer charities, I know that the significant variation in access to mpMRI provision is concerning. If we are to bring prostate cancer diagnoses back to pre-pandemic levels—and, indeed, increase them—we must address that postcode lottery. MpMRI provision must, as a minimum, be expanded in line with growth rates prior to the pandemic if we are to get diagnoses back to pre-pandemic levels. The 10-year cancer plan provides a golden opportunity to address this issue.

I have already mentioned the negative impact the pandemic has had on the prostate cancer community, but I am keen to highlight some positives that could be considered in a post-pandemic setting. Prostate Cancer UK has noted that the policy change during the pandemic to grant special access to certain covid-friendly novel hormone therapies for patients was very warmly welcomed by the community. This policy change has been wanted for some time, and it not only kept patients safe at home during the pandemic but improved their care experience, as they spent less time in hospital. Along with the increased interaction between patients and clinicians using technology, the change has made for higher levels of patient satisfaction and experience.

I look forward to seeing greater access to diagnosis and treatment and increased use of technology in my constituency at the London cancer hub, an exceptionally exciting project in the London Borough of Sutton. As a former employee, the Minister will know the Royal Marsden Hospital very well. I will not go over ground that she already knows, as cancer nurse who, I believe, is still practising.

I appreciate that there is strong interest in the debate, so I am keen to conclude my remarks. If the Minister takes anything away, I hope it is the need to find those 14,000 men missing from the prostate cancer treatment pathway, and to ensure that workforce issues are looked at by the Government. The pandemic has provided the NHS with a unique opportunity to rethink how we provide care not just to prostate cancer patients but to all cancer patients, with greater use of technology and the benefits of covid-friendly treatments that patients have had access to throughout the pandemic.

Finally, the one message that I hope those watching the debate—especially those in high-risk categories—will take away from it is: “Please get yourself checked”. The support available for patients and their families is fantastic, and it is out there. I say to people watching: “You are never alone”. I urge them to book that vital first appointment. I look forward to hearing the contributions from other hon. Members on this incredibly important issue.

That illustrates the issue raised by the hon. Member for Carshalton and Wallington said. We have to put in place a prostate cancer strategy or plan for, as the hon. Gentleman said, men of a certain age—and I am one of them, by the way. It is not for me to comment on people’s age, but a few others present may also qualify.

Prostate cancer is the most common cancer for men, with over 47,000 new cases every year. Even prior to the pandemic, challenges in delivering the highest quality of care for patients had increased. It was exacerbated by staff shortages, inadequate care pathways and limited access to effective diagnosis. That is what we have to address. I know the Minister recognises the need for early diagnosis on any condition, but today’s debate is about prostate cancer. One in six men in the UK will be diagnosed with prostate cancer. It accounts for 27% of all new male cancer patients in the UK. That gives Members an idea of the size of the subject matter and why it is so important to debate it.

I always want to give a Northern Ireland perspective in debates, because we are part of this great United Kingdom of Great Britain and Northern Ireland, and what happens in Northern Ireland is replicated here. Our population is only 1.8 million, but we can none the less illustrate the issue. In Northern Ireland, 1,100 men are diagnosed with prostate cancer every year, with sadly 276 of those on average losing their lives to the disease. That is a large number—26% or 27% of those with prostate cancer unfortunately do not make it. Whether this is due to late diagnosis owing to the pandemic or to men downplaying their symptoms as they feel that there are more important things to deal with, we must encourage and raise awareness of the importance of checking for prostate cancer.

Speaking as a man, I know that those watching and present in the Chamber will know that there is no cold as bad as a man’s cold. But when somebody tells us to go to the doctor, we say, “No, I won’t.” If we are asked to go to the doctor, we put it off because we do not want to bother them. We say, “It’s not that bad really. I was exaggerating a wee bit. I think I’ll be alright.” That is our attitude. How do we change that attitude? We cannot do it by raising awareness alone. Perhaps one way of addressing it is by highlighting the brutal facts of how prostate cancer is taking people out of society. Perhaps we need to shock men into responding.

I have been in contact with Prostate Cancer UK, which has highlighted the troubles faced during the pandemic. First, reduced access to MRIs as a result of covid impacted on the ability of the NHS to diagnose prostate cancer, and there has been significant variation in the provision of services. How are the Government addressing the issue of early diagnosis and of access to MRI scans and biopsies to check it out? Crucially, what impact did the “Stay at Home” message have on people in need of diagnosis?

The pandemic has had many detrimental effects on society, one of which is people getting used to not seeing others. They are not going out in the way that they did in the past. We have to address that. In particular, older men, who are in a higher risk group for covid, were less likely to visit their GP and more likely to downplay their symptoms. Could the Minister give an indication of how we can address that?

Workforce issues and staff shortages were already significant before covid, with a growing shortage of oncologists and workforce burnout exacerbating the challenges faced by healthcare professionals in providing high-quality care. NHS England has been working with cancer alliances to ensure that improvements made during the pandemic are retained and improved further. I urge the Minister to have conversations—I know that he already does this—with our counterparts in the devolved nations to ensure that no man, nobody, is left behind by health provisions across the United Kingdom.

Education also plays a crucial role in health improvement. It should provide clear and simple messaging to educate men who are at risk of prostate cancer about the potential impact of diagnosis. Do we advertise that on TV, or are there more adverts in the press? It is advertised in my surgery in Kircubbin; I suspect that the same is true of everybody’s surgery. I do not go to the doctor very often, except for my diabetes check-ups. Perhaps the messaging is not getting to the people it needs to get to. How do we do that better?

Prostate Cancer UK has shared an online 30-second risk checker, which is very helpful for men across the United Kingdom. They can enter basic details and assess the risk that they face. That involves men taking a minute out of their day, and the online tool will direct them in the right way.

I will draw to a finish, as I am conscious that others wish to speak. The pandemic has had a significant impact on all aspects of life and disrupted the provision of routine care, forcing providers and patients to postpone many services and to adopt virtual consultations. I can almost feel my blood drain when I hear the term “virtual consultations”, because people need to see their doctor face to face. This has highlighted the need for face-to-face appointments in order to embrace and enhance the services that our NHS provides.

For too long, cancer patients have felt let down by the prioritisation of covid. Today’s debate gives us a chance to address the issue. I thank the hon. Member for Carshalton and Wallington for securing the debate, and I look forward to the Minister’s response. I am never disappointed with her responses. I know that she understands the issues and we look forward to her answers.

The data shows that the age of 50 onwards is the danger zone for men. Only four cases of prostate cancer per 100,000 happen in men aged 40 to 44, but the figure rises to 6,285 for men aged 60 to 64. Men between 50 and 80 are most at risk. The data shows beyond doubt that a man of African heritage is twice as likely as a Caucasian male to contract prostate cancer. Research from 1995 showed a drop of 44% in mortality over 14 years when screening takes place, and another trial showed a reduction of 21%. Whichever figure we take, it is a staggering number of lives that could have been saved—2,000 lives or more every year.

The issue has been the effectiveness of screening and the cost, but medical science has moved on. A simple prostate-specific antigen blood test is inexpensive, costing literally pennies, and it will help to identify high antigen counts so that we know who is most at risk. These men can then be monitored and retested after a further three months. The relatively few men who still have a high number of antigens can then be given an MRI scan to confirm beyond doubt whether they have prostate cancer or not. Those who are diagnosed can then be treated, thousands of lives will be saved, and thousands of lives will be longer and will be quality lives.

Does screening work? The current breast cancer screening programme is believed to save 1,300 lives a year. Around 2,600 women are diagnosed with cervical cancer each year and 690 women die of it each year. It is estimated that 83% of cervical cancer cases would be avoided if all women used the cervical cancer screening programme. Screening works well for breast cancer and cervical cancer. It is proven to work. So why do we not have a screening programme for prostate cancer?

Implementation of a prostate cancer screening programme would obviously be beneficial for the men involved, but it would also be beneficial for their family, their friends and the country at large. Early diagnosis will save the economy money, as it will enable those affected to continue working rather than being dependent on the welfare state. It saves the NHS money in avoiding the expensive treatments that would be needed for advanced cancer. Wives will not lose their husbands, children will not lose their fathers, and friends and other loved ones will not be emotionally scarred by grief.

What can be said against introducing a national screening programme for all men between the ages of 50 and 80? The criteria for a screening programme have been met: it would extend many thousands of lives; it would save the NHS money; prevention is better than cure; and it causes no harm, instead providing a real benefit at a reasonable cost.

I have two asks today: can we seriously consider putting in place both a national prostate screening programme and a men’s health strategy? These initiatives will save money, but much more importantly they will save lives.

Throughout the ongoing health crisis, the First Minister of Scotland has persistently stressed that the NHS remains available for those who need it. Advice has been sent to all cancer services in Scotland, including the key message that boards are expected to maintain full urgent cancer services. Indeed, most cancer treatment continued throughout lockdown; even at the height of the pandemic, patients in Scotland waited on average just two days before starting treatment. Regrettably, I understand that that was not the case in England or Wales.

The impact of this decision in Scotland undoubtedly saved the life of one of my constituents in Coatbridge, Chryston and Bellshill. After feeling unwell and explaining their symptoms to the NHS 24 helpline, they were quickly admitted to hospital, with specialist cancer treatment and support to hand. However, the only available treatment option that could be offered was invasive surgery, bringing with it, of course, a longer recovery time and more risk compared with a keyhole surgery procedure. None the less, that early diagnosis proved to be critical.

In order to ensure that this does not spiral into a secondary health crisis, a large amount of investment will be needed to clear the backlog of screening and treatments, to get cancer services back operating at the level that they were before the pandemic. We should actually be aiming to make them even better. The Scottish Government continue to engage with the cancer community to ensure that all key partners involved in the delivery of the national cancer recovery plan, which will support cancer patients to have equitable access to care regardless of where they live, improve patients’ experience of care and roll out innovative treatments to improve cancer services.

To improve cancer performance over the next five years, the Scottish Government are taking a range of actions, including ensuring that everyone across Scotland who meets referral criteria has access to an early cancer diagnostic centre, and investing £40 million to support cancer services and improve cancer waiting times, with a focus on the most challenged cancer pathways, including neurology, colorectal and breast cancer. Of that, £20 million will support the Detect Cancer Early programme, providing greater public awareness of signs and symptoms of cancer and supporting the development of optimal cancer pathways to improve earlier diagnosis routes. We are also supporting a rehabilitation programme for cancer patients, to ensure the best possible preparation for treatment and improve both the experience of treatment and its clinical outcomes. That is what a Government with their priorities in the right place look like.

The UK Government must begin to invest properly in the NHS in England. That, of course, will ensure that adequate consequentials are delivered to Scotland to enable us to recover from the pandemic. Those improvements should be funded through efficient decision-making, strategy and budgeting, not by raising national insurance, which threatens to hit those on the lowest incomes in the midst of the cost of living crisis. They are the very people who are most likely to rely on the services of our NHS, so they are facing quite the double-edged sword. I urge the Minister and the Government to take a leaf out of our book in Scotland and take the necessary steps to safeguard the prospects of prostate cancer patients in the light of the pandemic, and for generations to come.

I reiterate the comments of the hon. Member for Carshalton and Wallington, and I urge all men to go and get that check. That moment of discomfort and embarrassment may just be the moment that saves your life.

As other Members have done throughout the debate, I pay tribute to the brilliant work of Prostate Cancer UK. I am proud to support its campaign to identify 14,000 men who are absent from the prostate cancer treatment pathway because of the pandemic. Such campaigns are vital in raising awareness, and the 400,000 men who subsequently checked their risk of prostate cancer is testament to that. I welcome the investment that the Government made in the campaign, and I am keen to hear from the Minister what plans they have to continue that.

Those campaigns make a real difference, so it is important that the Government recognise the need for further development in the relationship between the NHS and the relevant charities. Awareness is just one part of the action that we need to take on prostate cancer, and much more needs to be done to improve the patient journey beyond the initial stage.

A clear and accessible diagnosis process is vital to ensure that patients can access the treatment they need in a timely manner. Diagnosis rates have continued to fluctuate for a number of years and, despite peaking in 2018, they made a noticeable drop in 2019, before the start of the pandemic. Given the problems that the pandemic has caused in accessing primary care services, I am keen to hear from the Minister what understanding the Government have of where we are now on diagnosis rates.

I have spoken to several stakeholders across the cancer sector, and they are concerned that many post-pandemic diagnoses will, sadly, be of later stage cancers. I therefore look forward to the Minister outlining the steps that the Government will take to ensure that awareness campaigns are not stunted by inaccessible diagnosis pathways, putting patients’ outcomes at risk.

As other Members and I have mentioned, referrals are one area in which prostate cancer lags behind other cancers. The Secretary of State acknowledged that himself when launching his elective recovery plan, reaffirming his commitment to get back on track with referral targets, and yet there is absolutely nothing of merit in that plan to reassure prostate cancer patients.

The Secretary of State masks his complete lack of action with grand and frankly unhelpful language when he talks about launching a “war on cancer”. Such words, far from making the Secretary of State look strong, show a gross disrespect for patients and set a dangerous precedent. I urge him and all Ministers to think about the implications of their language for people living with prostate cancer—with all cancers—and the impact that such language can have on them.

One element underpinning all the issues outlined in the debate is workforce, which other Members have mentioned. The existing prostate cancer workforce is overstretched, with prostate cancer specialist nurses having a caseload more than three times higher than that of nurses covering breast cancer. Without a robust workforce strategy, our NHS will simply not be in a place to provide the support that prostate cancer patients need as we emerge from the pandemic, and beyond, but Ministers continue to bury their heads in the sand. They have failed to bring forward a long-term workforce strategy, and with weeks to go until the end of the financial year, there is still no clarity on Health Education England’s budget. In fact, all the Secretary of State can say is that the NHS has to find money from existing budgets to address the workforce shortage. That is really unhelpful. Does the Minister really think that is good enough?

I want to take this opportunity to praise the work of colleagues in the other place in championing workforce issues in their consideration of the Health and Care Bill. I welcome Baroness Cumberlege’s amendment to the Bill to require the regular publication of health and care workforce projections. Will the Minister take this opportunity to reassure us that the amendment will not be overturned when the Bill comes to the Floor of the House? I look forward to working with Members across the House to keep the workforce issue at the forefront, ensuring that prostate cancer patients and others have the support that they need.

I am keen to hear from the Minister what plans the Government have to ensure that staff are trained and retained in a sustainable way so that prostate cancer patients can always access care. People living with prostate cancer need an NHS that has the time and resources to support them as we emerge from the pandemic. It is about time the Government delivered on that.

Although people stayed away during the pandemic, they are coming back in their droves now, and the ambition is to try to get as many of those diagnosed as quickly as possible and into treatment. We are trying to get prostate cancer in particular diagnosed as quickly as possible by implementing best practice timed pathways for prostate cancer, including the use of mpMRI, which my hon. Friend the Member for Carshalton and Wallington mentioned. It captures images of the prostate in a much better way than the standard MRI does, so that is a focus and we have seen a major uptake in that. Back in 2016, only 335 people were going through that system, but by 2020 that had gone up to 11,000 people. We are seeing a real shift in the use of that technology, which better diagnoses men with prostate cancer.

Partnering with Prostate Cancer UK, we are delivering a cancer risk-awareness campaign, which started in February and will continue to run until the end of this month. As a number of colleagues have said, we must raise awareness about the symptoms of prostate cancer and encourage men to come forward.

Although I do not wish to generalise, I take the points made by my hon. Friend the Member for Don Valley (Nick Fletcher) and by the hon. Member for Strangford (Jim Shannon) about the differences in how men and women face health issues. When women have an issue, they will come forward, although they often feel as if they are not being heard and that there is a delay in accessing healthcare. Men are slightly different in that often they will not come forward in the first place, so the campaigns let them know about the symptoms, encourage them come forward and reassure them that diagnosis and treatment will happen relatively quickly.

The outcome is good for many men with prostate cancer, but we encourage people to come forward quickly because the prognosis is improved the earlier they can get involved in treatment, and the treatment is often less invasive. There are good reasons to encourage men to come forward.

The purpose of our campaign is to educate people about their risk of prostate cancer. As we have heard, some people are more at risk than others. As a cancer that does not present with many symptoms, particularly at an early stage, it is vital to encourage those at risk to discuss that with their GP and have a prostate-specific antigen test. To address the point made by my hon. Friend the Member for Don Valley, gentlemen over the age of 50 can request a PSA from their GP.

There is no national screening programme at the moment because the PSA test on its own is not foolproof. It is a simple blood test that measures the PSA level in the blood which, if raised, can be indication that prostate cancer could be present. However, many men with prostate cancer do not have a raised PSA, and many men who have a raised PSA that does not change over time do not have prostate cancer. We do not have a national screening programme because it is not a foolproof test in the way that a mammogram is for breast cancer.

A huge amount of research is going on about that right now. The team at University College London is working on PSA and integrating it with another test, to combine them to see if accuracy can be improved. If there were a more accurate screening test, there would be a strong case to bring that forward, but at the moment the accuracy of the test is holding us back.

Prostate Cancer UK has reported that over 310,000 people have completed their risk checker, so obviously a lot of good work is happening that is getting the voice out there. This debate today also helps raise awareness. As many hon. Members have said, we are encouraging men to come forward if they have concerns.

We also have the “Help Us Help You” NHS campaign, which is looking at a number of cancers, including prostate cancer. It has raised awareness of non-specific symptoms, which are often experienced by the patients who we have the hardest time diagnosing. This month, we are launching a campaign specifically about prostate cancer and the barriers to seeking treatment. The phases of the campaign that have run to date have contributed to the high levels of urgent cancer referrals the NHS has seen—around 11,000 referrals per day—as I mentioned earlier. The campaigns are working and people are coming forward, but there is a huge amount more that we can do.

In addition to these national initiatives, we also fund more local awareness raising through cancer alliances, where we specifically target communities who may be more at risk or less likely to come forward if they have symptoms. As part of that plan, every system will need to take ongoing action to support general practice capacity, so that if people come forward they are able to be seen as soon as possible.

We are also working on long-term prostate cancer improvements. Clearly, the covid pandemic had an impact on referrals, but there were long-term issues before the pandemic, as outlined by the shadow Minister, that we are now trying to address. Research is one of those issues. There is a wide range of treatments for prostate cancer. My hon. Friend the Member for Don Valley talked about the watch and wait policy, and it has been quite successful. There are many older men with prostate cancer that may have a less aggressive form, and this is where techniques such as watch and wait and seeing whether PSA is showing in their blood are very helpful. Many of those men will die of things other than prostate cancer. Watch and wait is a useful and robust treatment.

Treatments for prostate cancer are not without their side effects, despite our best efforts. We are working hard to improve treatments, both in terms of their success rate and the impact they have on a man’s quality of life. The use of stereotactic radiotherapy, for example, to target prostate cancer and reduce side effects is making a huge difference to outcomes for men. Better surgical techniques, and state-of-the-art surgery, are also improving outcomes and the side effects from surgery. Hormone treatments are also available; research is pushing the barriers there. However, hormone treatments are not without their side effects. I reassure men that there is a wide range of treatments, depending on the type of prostate cancer that they have, that will not only treat their cancer but reduce the side effects.

In the spending review we announced an extra £5.9 billion of capital to support our recovery programme, particularly in diagnostics. That includes £2.3 billion to increase the volume of diagnostic activity in our community diagnostic centres. What we are trying to create in local communities is a situation where if someone presents with non-specific symptoms to their GP, we can use the community diagnostic centres to refer people so that they can have the tests—whether it is an ultrasound, an MRI, or blood tests—and can get a more rapid diagnosis than has historically been the case. We are rolling out 44 community diagnostic centres to increase our capacity, which could deliver up to 2.8 million scans in the first full year of operation. By 2024-25, the aim is to deliver at least another 56 of those centres. That will allow the NHS to carry out 4.5 million additional scans. The diagnostic centres will make a big difference, diagnosing people as quickly as possible and at as early a stage of their cancer as possible.

There are some pilot works going on that look at self-referral; that is particularly the case with breast and skin cancers. I do not want to speak for cancer alliances, but there could be an argument for prostate cancer to be included too, if people have specific symptoms. Watch this space with regards to self-referral and its ability to get people into the system as quickly as possible.

We also talked about workforce. As someone who has worked as a nurse specialist, I take it on board that a urology nurse specialist will often cover all urology cancers. There is a difference between treating someone for testicular cancer; they often tend to be younger men who need very different treatment. Prostate cancer is a very different type of cancer, but it is often lumped in under urology. I recognise that nurses there have a greater volume of patients to see than nurses treating other types of cancer. There is huge progress being made on that. There is investment going into workforce planning, and we are supporting the training and development of nurses, in particular, to become specialists and practitioners in both screening and diagnostics. It is not just about increasing numbers in our workforce; it is about giving them the skills and training to expand the roles and services that they can go into. That is at the forefront of our mind.

My hon. Friend the Member for Don Valley talked about a men’s health strategy. I will say to him that just by having a women’s health strategy does not mean we are ignoring men at all. We are producing our health disparities White Paper very soon. Some of the issues that he talks about around life expectancy and differences in suicide rates will feature quite heavily in that. However, if he does not feel that that goes far enough, I am very happy to have a further conversation. There are differences, in some areas, for men and, on prostate cancer particularly, we can do more to support them with their diagnoses and treatment.

For many men, prostate cancer will be a chronic illness. We will be able to treat and cure many, but some will need to learn to live with their disease—people can live with quite advanced prostate cancer for many years—and it is about providing them with support. Living with prostate cancer often causes psychological challenges, where people are just getting on and dealing with it but are not getting the support that they need with many of the issues that they face. We fully recognise that that is something that we need to focus on.

I reassure colleagues that prostate cancer is very much top of our agenda in the cancer sphere. We are improving the facility to try to diagnose it much more easily. Treatments for prostate cancer are changing and improving all the time. We must focus on supporting men with prostate cancer through their cancer journey. We must encourage men to come forward and reassure them that they will be diagnosed quickly and receive the treatment that they need for their prostate cancer.