Non-invasive Precision Cancer Therapies

I beg to move,

That this House recognises the vital role that radiotherapy plays in cancer treatment across the UK with an estimated one in four people needing that treatment at some stage of their life; notes that there is a significant body of expert opinion that up to 24,000 people may be missing out on the radiotherapy they need, resulting in many hundreds of unnecessary or premature deaths; further notes that the UK spend on radiotherapy as a percentage of the overall cancer budget is approximately five per cent which compares badly with most other advanced economies where the percentage varies from nine per cent to 11 per cent; notes that the current commissioning system for radiotherapy is sub-optimal as exemplified by a tariff regime which discourages NHS Trusts from implementing advanced modern effective radiotherapy; calls on the Government to provide an immediate up-front £250 million investment in the service, an ongoing extra £100 million per annum investment in personnel and skills and IT, and to introduce a sustainably, centrally and fully funded rolling programme for Linac machine replacements; and further calls on the Government to appoint a single person to oversee the commissioning and implementation of radiotherapy services.

I thank the Backbench Business Committee and its Chair, my hon. Friend the Member for Gateshead (Ian Mearns), for granting this debate, and all the Members on both sides of the House who supported the application. I must declare an interest as one of the vice-chairs of the all-party group on radiotherapy, and also as a cancer survivor—[Hon. Members: “Hear, hear.”] Thank you. Thanks to early diagnosis, I was successfully treated with both chemotherapy and, crucially, precision radiotherapy.

I want to point out to the Minister that there is currently a crisis—there is no other word for it—in the management and funding of radiotherapy in the United Kingdom. Indeed, the charity Action Radiotherapy estimates that as many as 20,000 people across the UK may be missing out on the radiotherapy they need. Many of these patients will die prematurely or unnecessarily as a result of this shortfall. Given that one in four people receives some form of radiotherapy during their lives, and that almost half of us in the United Kingdom will be diagnosed with cancer at some point in our lifetimes, I hope the Government will realise just how important it is that we invest in modern and, importantly, accessible cancer diagnosis—and not just in diagnosis, but in cancer treatments.

I am very proud to have the Christie Hospital in my constituency of Manchester, Withington. It has a fantastic proton beam therapy unit, which is going to be the future of cancer treatment. However, when I speak to the staff at the Christie, their biggest worry is the workforce. Does my hon. Friend agree with me that the challenge is not just funding for treatment, but actually investing in our cancer workforce as well?

Absolutely, and I am grateful to my hon. Friend for pointing that out. Indeed, that is one of the four basic requirements, as the all-party group, the charity Radiotherapy4Life and Action Radiotherapy have pointed out. That is clearly demonstrated in the “Manifesto for Radiotherapy”, which I commend to the Minister and to all hon. Members.

I appreciate that the Minister will want to refer to chapter 3 of “The NHS Long Term Plan”, particularly paragraph 3.62 on more precise treatments using advanced radiotherapy techniques. In anticipation of that, I would like to say, on investment, that the Government have promised to complete the £130 million investment in radiotherapy machines and, as my hon. Friend has just mentioned, to commission the proton beam machines at University College Hospital in London and the Christie Hospital in Manchester. However, I respectfully point out to the Minister that that is not a new announcement of additional resources, but the recycling of previous announcements. The money has already been spent or committed, so it is not part of the comprehensive 10-year plan for radiotherapy that we advocated for in the “Manifesto for Radiotherapy”.

The £250 million for proton beam facilities, while welcome, will only treat 1,500 patients a year. I accept that many of them will be children with brain cancers, but the number represents only 1% of patients needing radiotherapy. As indicated in the manifesto, we recommend that the same sum that was spent on proton beam facilities—a relatively modest sum given the size of the budget as a whole—is all that is needed to renew radiotherapy centres and to ensure that all patients, not just those who live in London or near to major conurbations, can receive treatment within the recommended 45-minute travel time. I know that other hon. Members will say a little more about that.

We are also asking for an additional £100 million a year, increasing the cancer funding for radiotherapy from the current 5% a year to 6.5% a year, to ensure sufficient funding for workforce planning, including ensuring that there is suitable training, and ensuring that there is an effective IT network, equipment upgrades and a rolling programme to ensure that all radiotherapy machines across the UK are up to date. According to analysis of freedom of information requests made by Action Radiotherapy, more than 40% of NHS trusts in England—all bar six responded to the requests—that provide radiotherapy have machines that are past their recommended lifespan, leading to less efficient and effective care.

I will try to manage without a formal time limit. If everybody takes around five minutes, everybody will have the opportunity to speak.

It is a pleasure to follow the hon. Member for Easington (Grahame Morris). Half of everyone in the UK will develop cancer at some stage in their lives and a quarter of us will receive radiotherapy treatment. Radiotherapy is highly effective, especially when compared with other therapies, given that survival rates improve by 16% compared with just 2% with other therapies such as chemotherapy. That is important because the UK has the second worst survival rates for lung cancer in Europe and we lag behind the European average in nine out of 10 cancers. We know that our population is ageing and that, more and more, our lifestyle choices are detrimental to our health. This means that over the next six years, cancer rates are expected to increase by a quarter, so ensuring that we get cancer treatment right is of fundamental importance.

The Government are making progress in this area. Since 2010, rates of cancer survival have increased year on year. It is thought that 7,000 people are alive today who would otherwise not have been. The NHS long-term plan has set out a way to ensure that future radiotherapy treatment will be faster, smarter and more effective. Although it is a welcome strategy, we in the all-party group on radiotherapy have been looking into the detail and have highlighted some pressing issues, which we look forward to publishing in due course.

As has been mentioned, there are serious workforce shortages; for example, radiotherapy clinical scientists have a current vacancy rate of 8%. We need to take swift action to address that, and specifically, to support the education and training programmes that feed the pipeline of talent. There are only 10 therapeutic radiography degree programmes in England and that will soon reduce to nine, as one very close to me in Portsmouth is due to close soon.

Since 2016, entry-level training for this industry has fallen by 23% since the loss of the bursary; last year, only 240 students undertook this training. I therefore hope that the Department for Health and Social Care and the Department for Education will review the impact of terminating the bursary programme and consider how to attract students to this profession. The Society of Radiographers recently developed an apprenticeship standard at degree level to provide another entry point to the profession. I believe that that is exactly the right approach, whereby the next generation of industry professionals can learn and earn on the job. Sadly, however, the Institute for Apprenticeships and Technical Education offered a funding band of around £19,000 for the programme’s delivery, but given the high-tech and expensive infrastructure needed to support it, the level of funding was insufficient. I urge the institute to carry out a review of the scheme and ensure that we have the right funding requirements.

It is a great pleasure to follow my hon. Friends the Members for Easington (Grahame Morris) and for Chichester (Gillian Keegan), who are vice-chairs of the all-party parliamentary group on radiotherapy, of which I am honoured to be the chair.

Many of us know too well the pain, hardship and heartbreak that cancer causes. As my hon. Friend the Member for Easington said, it is widely accepted that half of us will get cancer in our lifetime. While I am on my feet, there will be people getting their diagnosis and families coming to terms with it, and lives turned upside down. Most of us have been affected by cancer in some way; cancer took my mum, far too young. But increasingly cancer is a condition to be overcome, not a death sentence. Advances in medical science mean that there are often a host of possible treatments when the diagnosis comes.

Perhaps the form of treatment of which we hear the least is radiotherapy. It is widely accepted that 50% of those who suffer from cancer will require radiotherapy at some point in their treatment. However, in its recent radiotherapy specification, NHS England reduced the figure for cancer patients needing radiotherapy to 40%. It reached that figure on an interpretation of the Malthus model; if only 40% of cancer patients need radiotherapy, then the current level of investment will be just about adequate, as everyone who could benefit from radiotherapy would receive it, so we might as well conclude this debate and go home—only that figure is wrong, as NHS England has had to admit.

The APPG on radiotherapy recently held a number of evidence sessions, in part to get to the bottom of this inconsistency. We heard from a wide range of experts, including one of the authors of the Malthus model, who explicitly stated that NHS England’s interpretation of the model underestimates the number of patients requiring treatment, because it takes into account only those patients whose initial treatment is radiotherapy, not those who need it after the initial point. When pressed, NHS England accepted that, acknowledging that the 40% estimate was not accurate and fell shy of the true figure. This matters, because the real figure is roughly 50%, which means that NHS England is not commissioning sufficient radiotherapy treatment to meet the needs of cancer patients. The Government must plan on the basis of true demand, not of a figure discredited by the experts and now disowned by NHS England. The Royal College of Radiologists has confirmed that this combination of factors means that, as my hon. Friend the Member for Easington said, 20,000 people in Britain are not receiving the radiotherapy that they need.

Order. Hon. Members have done well on six minutes, but can we please now aim for five minutes? I am sure that people want to hear what the Minister has to say in response. There is no point in asking questions if there is no time for the Minister to answer.

I echo the comments of my hon. Friend the Member for Easington (Grahame Morris). There is not one Member in this House whose life has not been touched by cancer. My late partner, John, suffered from it and, sadly, lost his battle two years ago, despite excellent treatment from the Royal Blackburn Hospital. I know and sympathise with many constituents struggling through treatment. Major breakthroughs have been made in radiotherapy in the past 10 years, with modern advanced radiotherapy being more precise, curing more patients and producing fewer side effects to the point where patients can continue to work normally; but when comparing cancer services on a global scale, we see that only one quarter of people in the north-west believe that the NHS offers the best cancer care.

Like John, 47,000 men a year in Britain are found to have prostate cancer, and more than 11,500 a year die from the disease. Last October, the University of Birmingham published an article about a breakthrough in treatment. Previously, it was unclear whether there was any benefit to treating the prostate directly with radiotherapy if the cancer had already spread. The research helps to answer the question and has implications beyond prostate cancer. Clinical trials for the disease found that advanced radiotherapy boosted survival rates by 11% for men whose cancer had spread to nearby lymph nodes or bones. The result is likely to change the care given to around 3,000 men every year in England alone, and could benefit many more around the world.

I am conscious of the time, so I am going to shorten some of my points, but I still feel that they are important. Until now, it was thought that there was no point in treating the prostate itself if the cancer had already spread because it would be—I have heard those words—like shutting the stable door after the horse had bolted. However, the study proved the benefit of prostate radiotherapy for those men. Unlike many new drugs for cancer, radiotherapy is a simple and relatively cheap treatment that is readily available in most of the world. However, there are two main issues with access—the tariffs and the availability of modern radiotherapy machines.

As other Members have said, the current tariff disincentivises trusts from saving money because their income depends on the number of treatments. NHS research has shown that treating prostate cancer patients with 20 treatments, rather than 37, was better for patients and would save the NHS in excess of £20 million a year. I hope the Minister will let me and others know when the current situation will stop. When will NHS England allow trusts to use the radiotherapy equipment that they already have to move to even shorter periods of treatment? A period of five treatments has gradually been adopted around the world for large numbers of prostate cancer patients.

That was a very courageous speech by the hon. Lady, and I am only sorry that she had such a short time in which to make it.

I completely concur with what you just said, Madam Deputy Speaker. My hon. Friend the Member for Blackburn (Kate Hollern) made a very warm and touching speech, which only reinforces the point made by my hon. Friend the Member for Easington (Grahame Morris) that so many people have been touched, in many cases very painfully, by cancer.

My anxiety is that a growing crisis in cancer care is coming in this country. The worst of it is that we may not spot it, because our cancer survival rates are, of course, improving, which is brilliant. Doctors and scientists—pathologists and so on—have done an amazing job in recent years in managing to keep many more people alive, and in this country in particular we have done well, but frankly we started from a very low base compared with other countries in Europe and around the world. I am painfully conscious of that in relation to Wales.

I make no partisan point here, but I will criticise what we are doing in the Welsh NHS at the moment. I do so not out of partisan anger, but simply because we need to get this right. The truth is that cancer survival rates will improve, but not as well as they could do if we managed to get several things right. We have to persuade more people, particularly from poorer backgrounds, to go to the doctor when they have suspicions about their condition. We must also persuade more doctors, particularly those in poorer backgrounds, to refer people on when they think there might be a suspicion of cancer. It is still worrying that, in my patch in south Wales, we still do not refer on enough people, so that they end up being referred much later, when they are in the later stages of cancer. The most galling thing of all for anybody is when they hear, “Well, it’s just a little bit late. If only you had come six months, three months or even four weeks ago, you would have been at stage 2 or stage 1.”

The truth is that we are failing at the moment in the UK, and particularly in Wales. The diagnostic teams in Wales are in far worse nick than they are in Australia, Poland, Scotland, the best area in England, which is the north-east of England—ironically—and the worst area in England. Nine out of 10 consultant radiologist vacancies in Wales have been unfilled for more than a year. We need 105 more radiologists by 2023 if we are to meet the growing demand for CT and MRI scans, which has risen by a third in the past three years. Thirty six per cent. of Welsh consultant histopathologists are over 55 —that is much higher than in the rest of the UK—17% of whom are locums, which means that we are paying agency staff over the odds and therefore wasting NHS money.

It is a pleasure to follow my hon. Friend the Member for Rhondda (Chris Bryant) and all the speakers in the debate, especially my brave hon. Friend the Member for Blackburn (Kate Hollern). I also thank my hon. Friend the Member for Easington (Grahame Morris) and the hon. Member for Westmorland and Lonsdale (Tim Farron) for securing this debate on this very important subject.

Last week, I visited Cancer Research UK’s event in Parliament to raise awareness of issues around cancer. The one message that I came away with is that cancer treatment is being seriously affected by a lack of diagnostic and radiotherapy staff and equipment. In June this year, the Public Accounts Committee said that the ongoing failure of many hospitals to meet targets for cancer and elective care is unacceptable and called on officials to be more accountable for improving standards.

The Royal College of Radiologists welcomed the main thrust of that report on waiting times in England, which clearly urged increased involvement and oversight from healthcare leaders in NHS England, NHS Improvement and the Department of Health and Social Care to improve waiting times and safeguard the future care of patients. The Society of Radiographers also supports the call for a workforce increase and for investment in equipment and infrastructure to improve connectivity across radiotherapy networks. Although acknowledging that fantastic care is delivered by all professionals across the patient pathway, it highlighted a comprehensive survey on clinical staff across the country, which identified current staff shortages as a barrier to providing effective and efficient cancer treatments and excellent patient experience. It identified many problems, including missed opportunities for service improvement; insufficient capacity to undertake clinical research; the downgrading of patient experience; competition for scarce staff numbers in the local labour market; and decreased staff wellbeing and morale. There is also a great deal of concern about the impact of the loss of the bursary on staff recruitment and retention.

A recent report by the department of allied health professions at Sheffield Hallam University said that recruitment to therapeutic radiography programmes in the UK has been problematic for several years, but that this appears to have been exacerbated since the 2017 changes in healthcare education funding from bursaries to the standard student loan system for both fees and maintenance. In 2018, several programmes confirmed that they had not recruited to target, and most had needed to go into clearing to recruit students close to the start date of the course. The general trend appears to be a decline in applications, with the added problem of places being awarded at the clearing stage, which poses a risk that students may embark on courses to which they later find they are unsuited, increasing the risk of students dropping out of their courses. If I have just one ask of the Minister, it is that she commission a full assessment of the impact on allied health professionals of the replacement of bursaries with loans. These skilled, dedicated and highly qualified staff are the unseen backbone of our NHS, and it is vital that patient care does not suffer because of these changes.