National Cancer Plan

Statement

“With permission, I will make a statement on the Government’s national cancer plan for England.

A cancer diagnosis changes you for ever. When I was diagnosed with metastatic breast cancer 18 months ago, I did not know whether I would be alive today, never mind standing at this Dispatch Box announcing a national cancer plan, but one year ago almost to the day, the Prime Minister asked me to do just that. Since the Government took office, over 212,000 more people are getting a cancer diagnosis on time, over 36,000 more are starting treatment on time, and rates of early diagnosis are hitting record highs. Despite those vital signs of recovery, though, the NHS is still failing far too many cancer patients and their families. That is why, first and foremost, this plan is a break with the failure of the past 15 years.

In 2011, the coalition Government published Improving Outcomes: A Strategy for Cancer. That strategy was followed in 2016 by Achieving World-Class Cancer Outcomes: a Strategy for England 2015-2020. In 2019, the long-term health plan for England made cancer a priority and included a headline ambition to diagnose 75% of cancers at stages 1 and 2. However well-intentioned those strategies were, not one of them has lived up to its promises. Cancer mortality rates in the UK are much higher than in other comparable countries, while survival rates are much lower. Cancer incidence is around 15% higher than when the 62-day standard was last met, and working-class communities are being failed most of all. The most deprived areas, including rural and coastal communities, often have fewer cancer consultants, leaving patients waiting longer. This all adds up to the chilling fact that someone living in Blackpool is almost twice as likely to die young from cancer than someone living in Harrow. Wherever in our country a person lives, they deserve the same shot at survival and quality of life as everyone else. Wealth should not dictate their health, and neither should their postcode.

Behind these statistics are real people. I have heard from those whose care lacked empathy and dignity, from those whose cancer was missed or whose test results were lost, from those who were passed from pillar to post and kept in the dark about their condition, and from those whose loved ones died before their turn came for surgery because the wait was too long. Those experiences are unacceptable—they are devastating. From day one, I was determined to put their voices front and centre of our plan. Over the past year, we have listened to and learned from cancer charities, clinicians and, most importantly, patients and their families. Every action is a response to someone’s lived experience. Every commitment is a promise to transform someone else’s life. Their stories have become the blueprint to make the biggest improvement in cancer outcomes in a generation.

Three major themes stood out from the 11,000 responses to our call for evidence, some 9,000 of which came from patients and their carers: core performance standards, improved survival, and quality of life after diagnosis. Those are not radical ideas but, unlike previous strategies, this plan is not limited to incremental improvement. Instead, it is an ambitious, bold plan to save 320,000 more lives by 2035, which will be the fastest rate of improvement this century. We will do that by modernising the NHS, harnessing the power of science and technology, putting our patients at the front of the queue for the latest medicines, and helping them to live well after diagnosis, not least for people diagnosed with stage 4, metastatic and incurable cancers—people like me.

How do we get there? We are placing big bets on genomics, data and artificial intelligence, as set out in our 10-year plan for health. We will hardwire the three shifts of our 10-year plan into cancer pathways. First, on moving from analogue to digital, we heard from patients about the importance of clinical trials, so we will make the UK one of the best places in the world to run a trial, with a new cancer trials accelerator. We will start people’s care earlier using liquid biopsy tests, which can return results up to two weeks sooner than conventional testing. We will harness AI to read scans, plan radiotherapy and identify the right path for each patient. We will harness genomics so that every eligible patient has access to precision medicines. We will harness data to make sure that all metastatic disease is counted properly—starting with breast cancer—so that people with incurable cancer are properly recognised and supported. When people are not counted, they feel like they do not count, but we will end that.

Innovation will also help us fight inequalities and make the shift from sickness to prevention. We will turn the NHS app into a gateway for cancer care. By 2028, it will host a dashboard for cancer prevention, with access to tests and self-referral. By 2035, it will bring together genomic and lifestyle data with the single patient record to advise every patient according to their risk. That will benefit people in rural and coastal communities who can find it difficult to access specialist care simply due to geography.

Finally, we will use the neighbourhood health service to make the shift from hospital to community. That will mean more care, from prehabilitation to recovery support, delivered closer to home. We will help people live well with cancer through tailored support closer to home. People will be given personal cancer plans, named neighbourhood care leads and clear end-of-treatment summaries so that no one feels abandoned after their treatment.

For too long, those with rarer cancers have seen little to no progress for many of their conditions. They told us we need a special focus on these cancers, and our plan sets out how they will benefit from the deployment of genomics, early detection and the development of new treatments. That was asked for by patients and will be delivered by this Government. I pay tribute to my honourable friend the Member for Mitcham and Morden, Dame Siobhain McDonagh, for her campaigning in memory of her late sister Margaret. We should also remember that the late Tessa Jowell raised this issue in 2018, and her family have campaigned ever since.

Our plan also gives pride of place to children and young people. We will improve their experience of care at every level, from hospital food to youth worker support and play support. I pay tribute to my honourable friend the Member for Leyton and Wanstead (Mr Bailey) for his campaigning on that point. Our children and young people cancer taskforce asked for support with travel costs, because when someone’s child has cancer, the last thing they should worry about is how they will pay for their train ticket. Today, I can announce that we will fund those travel costs.

Alongside rare and less common cancers, we will make research for children and young people a national priority. I take this moment to thank the children, young people and families who made up our Children and Young People Cancer Taskforce. It was a pleasure and a privilege to meet them earlier this week. I thank the many families and loved ones of people lost too soon who continue to fight to make change for others. I am so grateful to them, and I want people to hear their voices as they read the plan, because it is rooted in the voices of patients, families, clinicians and charities. It will turn cancer from one of this country’s biggest killers into a chronic condition that is treatable and manageable for three in four patients. It delivers the ambition of the 10-year health plan, embodies this Government’s three shifts and sets a clear path towards earlier diagnosis, faster treatment and world-leading survival rates by 2035.

This plan does not belong to the NHS, and it does not belong to the Government; it belongs to us all. We all must play a part in making it work. Over the past year, I have met the patients, families, carers, clinicians, researchers, cancer charities and voluntary groups who all contributed to our plan. This Government is on their side. We wrote this with them, and we cannot deliver it without them. Let us do it together. I commend this Statement to the House”.

My Lords, I begin by welcoming the publication of the national cancer plan and make it clear we fully share the Government’s desire to tackle cancer and to succeed in the fight against a condition that has affected almost every family in the country in one way or another. The Government have set out a clear ambition in this area, and we support them in that endeavour. It is appropriate for me also to pay tribute to all those who have contributed to the development of the plan, particularly those with lived experience with cancer and those close to them. Their willingness to share their experiences with such openness—and in many cases, courage—has, I am sure, been invaluable in shaping the finished result, and they deserve our thanks and recognition.

The national cancer plan sets out a number of significant commitments, including improving early diagnosis, restoring performance against cancer waiting time standards, accelerating the set-up of clinical trials and rolling out targeted lung screening nationally. It also places a strong emphasis on modernising services through technology and innovation.

These are all laudable aims and, indeed, Cancer Research UK has said that there is “much to welcome” in the plan. However, it has also rightly noted that delivery, funding and accountability will ultimately determine whether patients see real change. It is easy to put ambitious plans down on paper, but what matter in the end are clear delivery milestones and accountability. In that respect, this plan echoes many of the ambitions of the 10-year NHS plan, which was strong on aspiration but lighter on detail about how improvements would be delivered on the ground. My first question is, therefore, straightforward. When will the Government publish clear, fully funded milestones setting out how and when patients can expect to see tangible improvements over the next year or two?

It is also clear that the success of the plan will depend on having a sufficient workforce of cancer nurses, radiographers, pathologists and oncologists to deliver its aims. Can the Minister say whether we will shortly see a fully funded long-term workforce plan to support the staffing required to expand diagnostic and treatment capacity, not just in NHS trust settings but within neighbourhood health centres? In particular, can the Government explain clearly who will staff these services and how they will be funded? Blood Cancer UK has highlighted the importance of ensuring that blood cancers are properly recognised in workforce and service planning, and that patients receive consistent support from the point of diagnosis, including access to a named healthcare professional. Staff also need to know that they will be supported in delivering this plan, given current strains on capacity. In that context, we hear anecdotally of the difficulties involved in ensuring that staffing by doctors is adequate in all parts of the country. Some doctors, especially doctors in training, make up their minds that they will not be sent to work in an area that is not to their liking, perhaps because it would locate them far from friends and family. Will the welcome announcement of more training places in rural areas be enough to get sufficient doctors working in those areas?

My Lords, from these Benches, we very much welcome the national cancer plan and support its ambitions—and it is very ambitious. Many organisations and committees have called for an integrated, long-term plan, so it is very good that the Government have listened and, in particular, have taken note of the views of patients and their families—the people with lived experience of all these problems. However, may I reiterate Cancer Research UK’s response to the plan? It said:

“The key question that patients and their loved ones will ask, however, is how quickly will they see progress in cancer survival and outcomes? The improvements they are waiting for will depend on how this plan translates into delivery. Funding must match the ambition of what has been promised, or the NHS will struggle to expand its diagnostic capacity or introduce innovation at scale. And clear leadership and accountability are also crucial”.

Many of those points have also been mentioned by the noble Earl, Lord Howe, just now.

We know that outcomes in England have lagged behind comparable countries for decades, so it is positive to see improving cancer survival at the centre of the plan. However, it is going to be tough to achieve and will require much faster progress than what we have heard so far indicates. The key, of course, is improved diagnosis at an early stage, so I welcome the renewed commitment to earlier diagnosis and to meeting all cancer waiting time targets by 2029. It is outrageous that 92% of trusts do not reach the target for starting treatment. I welcome the full rollout of lung screening by 2030 and increasing the sensitivity of the tests used in bowel screening by 2028. However, what about breast screening? There have been problems in some parts of the country in getting that done. Can the Minister say whether these plans will be fully resourced? There is no point in doing the screening and tests unless an expert is there to interpret them. There are bold promises, but will they be matched with the resources and training required?

My Lords, I am grateful for the warm welcome from both Front Benches for the national cancer plan. This is a moment when we transform our cancer care and we make it personalised—we wrap it around the person instead of expecting it to be the other way around. The 62-day treatment standard has not been met since 2015, and outcomes, as we have talked about a lot in this Chamber, continue to lag behind those of comparable countries. That is what has driven us to this point to ensure that, by 2035, three in four people diagnosed with cancer will be alive five years later, whereas at present, the figure is three in five. That represents 320,000 more lives saved, with all the effects on their friends, families and communities, as well as themselves. That will be the fastest improvement in cancer survival this country has ever seen.

I will try to deal with some of the Front-Bench questions. I agree with much of what has been raised, including the recognition of all those, including those with lived experience, who contributed to what is, in my view and experience, a very bold 10-year strategy that actually sets out how we will do this. Both the noble Earl, Lord Howe, and the noble Baroness, Lady Walmsley, asked about clear milestones. I am glad to say that those are set out at the end of each chapter, with dates and the responsible organisations for all key actions and commitments.

The noble Earl raised the workforce plan. It will be published in the spring and will set out guidance—this goes to the point raised by the noble Baroness—not just on expanding numbers but on ensuring that staff are properly trained and supported. This will require a multidisciplinary team approach. We will use training directly as a lever to prioritise training places in trusts, often in the rural and coastal areas that the noble Earl asked about, as it is indeed the case that vacancy rates are higher and performance is lower. Training doctors of course takes time, but this is about long-term sustainable change and about turning around the whole of the cancer pathway. It is the exact opposite of us tinkering here and there. We are working with the royal colleges to boost the numbers of doctors specialising in clinical and medical oncology.