Cancer Strategy

Disabled People and Economic Growth – in the House of Commons at 2:41 pm on 22nd February 2018.

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Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Mental Health) 2:41 pm, 22nd February 2018

I beg to move,

That this House
has considered the Cancer Strategy.

Thank you, Madam Deputy Speaker, for your guidance. I will try to behave much better timewise in this debate, which it is an honour and a privilege to introduce. I pay tribute to the Backbench Business Committee for enabling the debate, to the all-party parliamentary group on cancer for its timely and extremely important report and, in particular, to Mr Baron, who could not be with us today but deserves our thanks for the extraordinary amount of work he has done on this issue.

We in the House are all on the same side against cancer and in our ambition to achieve world-class cancer outcomes. My speech will address—briefly, according to your instructions, Madam Deputy Speaker—the recommendations of the all-party group’s recent report, “Progress of the England Cancer Strategy”. The report received more than 80 contributions from charities and bodies and truly reflects the passion in the sector, but it is also a cry for help, progress and a positive way forward. My speech will address the report’s four main areas of concern: workforce strategy, data, transparency and funding. It is open to colleagues to raise all aspects of cancer care and treatment, but, on behalf of the all-party group and the hon. Gentleman, I will stick to the recommendations in the report.

The report considers progress as we reach the halfway point of the NHS cancer strategy 2015-20 and is the result of an inquiry that the all-party group held last summer and autumn. The inquiry was formally launched at a summer reception last July and the number of written submissions was far larger than anticipated, showing the dedication of those working in the field. Many submissions came from cancer alliances and others on the frontline of the services being provided and identified many pressures and challenges. The evidence from frontline services in particular seemed to amount to a call for help. In its report, the all-party group concluded that although progress had been made since the launch of the strategy, the NHS

“will struggle to achieve the objectives set out in the Cancer Strategy unless corrective action is immediately taken.”

To this end, the all-party group has listed recommendations, a copy of which will shortly be sent to all MPs. The lack of workforce planning emerged as a key concern. The cancer workforce is constantly recognised as the biggest barrier to implementing our strategy. We are all pleased that Health Education England published its report into the cancer workforce in December 2017, but it was originally promised for December 2016. According to written evidence from Breast Cancer Now, the workforce is the greatest challenge in delivering the cancer strategy. The all-party group also heard that transformation funding is being withheld from cancer alliances because of their performance against the 62-day waiting-time target—a new conditionality of funding that emerged only after the bidding process had closed.

Photo of Jim Cunningham Jim Cunningham Labour, Coventry South

I appreciate the hon. Lady acknowledging the cancer organisations, such as Macmillan, which often rely on subscriptions. Does she agree—I am sure she does—that the public should be encouraged to give more subscriptions where possible?

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Mental Health)

Absolutely. The hon. Gentleman makes an excellent point. These agencies are working on the frontline with people and families at their most vulnerable and deserve all our encouragement, praise and, of course, funding.

In addition to setting out how cancer alliances are to be funded and supported for the duration of the strategy and into the future, the all-party group strongly recommends that the 62-day waiting-time target be immediately decoupled from any release of funding to the alliances. The previously mentioned issues prevent progress in improving cancer care and treatment, which is not our collective vision. The all-party group also heard that improving transparency in priorities and accountability would help to support the delivery of the strategy. At the moment, a lack of clarity and lines of communication are delaying its implementation. Publishing a detailed progress update on each of the strategy’s 96 recommendations would be a positive step forward.

It is generally accepted that the 62-day waiting-time target has been treated as a higher priority among clinical commissioning groups and cancer alliance leaders than survival or stage at diagnosis, as shown by the linkage between funding and performance against the measure. Decoupling funding from process and target performance in favour of a greater focus on outcomes would strongly be in the interests of patients, not least because, if outcomes are good and survival rates increasing, processes will also be functioning efficiently and correctly.

Photo of Bambos Charalambous Bambos Charalambous Labour, Enfield, Southgate

The 62-day target has not been met since 2014, so the issue has been around for a while. Does the hon. Lady agree that more funding is needed if the target is to be met as soon as possible?

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Mental Health)

I absolutely agree with the hon. Gentleman. It is essential that the target be met and that resources be put in to ensure that it is.

The all-party group also found that access to detailed and timely data is critical for the strategy’s success, particularly in relation to data for rare and less common cancers. Strong concerns were also raised about how future data protection regulations might affect surveys, such as the cancer patient experience survey. The value of the cancer patient experience survey should be emphasised, along with outcomes from patients. We must hear from those who are experiencing services; they know how to improve things. In addition, the ageing UK population cannot be left out of the conversation. The cancer patient experience survey suggests that older people are less likely to have access to a clinical nurse specialist. Additionally, older patients are less likely to know the full extent of their illness. Age discrimination must come to an end, especially in cancer care.

The all-party group recommends that the NHS and Public Health England’s data team work to produce more timely cancer data and make them publicly available. It advocates that the Government ensure that the cancer patient experience survey and other such surveys can continue in a way that allows patient experience to be considered on a par with clinical effectiveness, rather than leaving patients without sufficient information regarding their cancer and care.

Furthermore, for specific cancers such as breast cancer, there are key priorities for delivery in the cancer strategy. It must ensure that data are collected for people living with incurable secondary cancer; that everyone with secondary breast cancer has a specialist nurse with the right skills and expertise; and that everyone has access to the right support after finishing treatment for primary cancer so that they are able to live well after breast cancer. We should not ignore the fact that the strategy has had positive effects. In the last year, 16 cancer alliances and three vanguards have been established, and £200 million has been made available to them for earlier diagnosis and post-diagnosis support. In addition, 23 NHS trusts have now received new and upgraded radiotherapy machines. However, as the report makes clear, much more work still needs to be done.

In the few minutes that I have left, I want to speak a bit more about less survivable cancers. The Less Survivable Cancers Taskforce was in touch with me prior to today’s debate. It is made up of Pancreatic Cancer UK, the British Liver Trust, the Brain Tumour Charity and Action Against Heartburn, covering oesophageal cancer, and Core, covering all digestive diseases. The staggering 55% gap in morbidity is absolutely unacceptable. Much, much more must be done. Recently, I lost a very dear uncle to pancreatic cancer. As a family going through that experience, we know that we need much more research and much more specialist understanding. We need investment in those areas—it is absolutely crucial. I want to ensure that other families have a better chance of an improved survival rate, and I pay tribute to my own uncle for his courage in coping with that condition right to the end.

Hospice care is also absolutely essential. We must ensure that families and patients have dignity at the end of life. That is imperative. I have watched far too many family members die in hospital beds, surrounded by other patients with the curtain screens drawn, to know that that is not dignified and that where possible, we must improve services and access to hospice care.

I pay tribute to the Teenage Cancer Trust—we often think of cancer as an illness that affects older people, but young people are also diagnosed with cancer—which does fantastic work. Vanessa Todd in my constituency is an absolute advocate for the Teenage Cancer Trust. Although GPs may not expect a young person to come with such symptoms, which are perhaps not easily identifiable, it is something that we can increase awareness of to make sure that diagnosis is very quick and timely for young people to improve their prognosis.

I thank everybody and, again, I thank the all-party group. It has been a privilege to open the debate for the hon. Member for Basildon and Billericay, who leads the group on these issues so well.

Photo of Eleanor Laing Eleanor Laing Deputy Speaker (First Deputy Chairman of Ways and Means)

Before I call the next speaker, I say to hon. Members that I am going to try to continue my experiment of seeing whether people will self-regulate and behave in a decent, honourable fashion. That means taking eight to nine minutes, and not 13, 14 or 15 minutes. I trust the well experienced Mr David Tredinnick to do so first.

Photo of David Tredinnick David Tredinnick Conservative, Bosworth 2:54 pm, 22nd February 2018

It is an honour to be called to speak first from the Government Benches, Madam Deputy Speaker. I heard what you said about time and intend to respect it.

On 25 January, in the other place—the House of Lords as we tend to call it now—a very distinguished former Secretary of State for Culture, Media and Sport and former Minister for the Olympics, someone who did much to bring the Olympics to London, Tessa Jowell, now Baroness Jowell, made an impassioned speech about the brain tumour from which she is suffering. That is something with which I can identify. I do not usually talk about family matters, but I will share with the House that my sister died of a brain tumour.

What Baroness Jowell said in her speech should be marked well by the Under-Secretary of State for Health, my hon. Friend Steve Brine, who has, I know, a strong interest in cancer. She said:

“For what would every cancer patient want? First, to know that the best, the latest science was being used and available for them…What else would they want? They need to know that they have a community around them, supporting and caring, being practical and kind. While doctors look at the big picture, we can all be a part of the human-sized picture.”—[Official Report, House of Lords, 25 January 2018;
Vol. 788, c. 1170.]

Yesterday at the all-party group on cancer, of which I have the honour of being a vice-chair, one of the things we looked at was recovery packages, which are very dear to my heart as the Member who has chaired the all-party group for integrated healthcare for much of the 30 years for which I have been in this House. My researcher, who has worked with me for 20 years, told me today that I have chaired more than 120 meetings of that group. Over the years, among other things, we have tried to look at how to support cancer patients in a broader way.

Let me share a figure with the House straight away. In the United Kingdom, according to Cancer Research UK, 33% of those who have cancer use some sort of additional support therapy, often complimentary therapy. For some types of cancer, such as breast cancer, this number is even higher, at almost 50%. People use these treatments because when used alongside conventional cancer treatments such as radiotherapy or chemotherapy, they make it easier for them to cope with the cancer and to feel that they play a part in how they cope. Such treatments help them relax, reduce stress, enable them to take a more active role in their treatment and recovery in partnership with their therapist, and enable them to feel more in control of their feelings and emotion. There is very strong evidence that these therapies work effectively, although more research is always welcome. The use of acupuncture to relieve sickness caused by some chemotherapy drugs is now well established, as well as to relieve a sore mouth after having treatment for head and neck cancer.

Not far from here there are three good examples of how these additional therapies have helped. At Guy’s and St ThomasNHS Foundation Trust the outpatient clinic offers aromatherapy, massage, reflexology and reiki. Quantitative data analysis show a statistically significant improvement. At the Royal Marsden, a world-renowned hospital not far from here, aromatherapy massage has been used on 1,000 patients to date. At the Full Circle Fund Therapies clinic at St George’s University Hospitals NHS Foundation Trust, they are using reflexology, massage therapy and relaxation training. Professor Ted Gordon-Smith, professor of haematology there, said that the

“Full Circle Fund therapy team has made a fantastic difference to the wellbeing of our patients.”

There are other citations.

Photo of George Freeman George Freeman Conservative, Mid Norfolk

I know, having been a Health Minister, of my hon. Friend’s assiduous commitment to this cause. He mentioned the noble Baroness Jowell. Does he agree that, with the sight of her and the Prime Minister together embracing, the Prime Minister’s announcement of £40 million for brain cancer is good news and that that is being done in the spirit of cross-party commitment to tackling disease? It will give a lot of hope to that community.

On the point about alternative therapies, does my hon. Friend agree that it is very important that the medical community and, through Government, the National Institute for Health Research do the research to examine those therapies? Although they might not be rooted in a tradition of empirical science, if there is data that shows that they help patients’ recovery time, that is worthy of consideration.

Photo of David Tredinnick David Tredinnick Conservative, Bosworth

My hon. Friend has helped me on my path. Various trials have taken place: randomised control trials, observational studies and quality-of-life studies. The person who came up with the notion of evidence-based medicine, Professor Sackett, said:

“The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence”.

In plain language, that means, “You have to look at the patient and see what the patient thinks and what the patient’s experience is.” We are often told by Ministers and others that we need more evidence—that there must be evidence. The trouble is that when evidence is produced on the basis of proper trials, it is often ignored.

The subject on which I have chosen to focus this afternoon is healing—therapeutic touch; call it what you like. There is very good evidence that people are able to use their hands to transfer some kind of energy. I have studied Reiki myself—I have done it twice—as well as another Japanese tradition. I once ended up speaking to 5,000 therapists at a conference in Japan, believe it or not, many years ago.

According to Cancer Research UK, a study conducted in 2007 found that up to 40% of people in America used some kind of what they termed spiritual healing. In this country, there is good evidence to suggest that seeing a healer helps people. In the UK, long-term hormone therapy for women with breast cancer can be enhanced and patients can be helped if they are given healing therapy for the side-effects of their treatment. A study showed that a number of women who were given the therapy for 10 weeks experienced fewer side-effects.

In the national health service, there was a two-year trial involving 200 hospital patients with long-standing illnesses. It was the largest clinical trial of its kind, and was funded by the national lottery and supervised by the University of Birmingham, a Russell Group university known for its first-rate research. The methodology was used to assess the effectiveness of healing in dealing with irritable bowel system and inflammatory bowel disease in 200 patients. After the assessment, the Measure Yourself Medical Outcome Profile showed a significant improvement after six, 12 and 24 weeks.

That trial was scientific and properly carried out, and I think that if healing worked for those problems, it would almost certainly work for cancer. I suggest to my hon. Friend the Minister that if a drug showed the same results, especially at such minimal costs, it would be recommended by the National Institute for Health and Care Excellence. More research and trials are needed.

Some of the Government’s efforts to bring about more rigorous assessments of therapies have involved the Professional Standards Authority, which was set up to oversee the UK’s nine health and care professional regulatory bodies. It was previously known as the Council for Healthcare Regulatory Excellence. In February 2013, it launched a Government-backed accredited register scheme. There are now 24 accredited registers covering 31 occupations and 80,000 practitioners. They include the Association of Child Psychotherapists, the British Acupuncture Council, the British Association of Sport Rehabilitators and Trainers, the Federation of Holistic Therapists, the National Hypnotherapy Society, and many others. In its summary, Harry Clayton, chief executive of the Professional Standards Authority, said that

“a key recommendation is for practitioners” whom the PSA is regulating

“to have the authority to make direct NHS referrals—in appropriate cases—thereby reducing the administrative burden on GP surgeries.”

I ask the Minister to take note of that: it is saying that practitioners on that PSA register should have the authority to make direct NHS referrals. If that were possible, we would bring into the service 30,000 practitioners.

Madam Deputy Speaker, I am trying to figure out how long I have been speaking for; perhaps you can guide me.

Photo of Eleanor Laing Eleanor Laing Deputy Speaker (First Deputy Chairman of Ways and Means)

I can guide the hon. Gentleman: about 11 minutes to date, but he has taken a few interventions. Therefore, I am not compelling him to sit down, but I am sure he will conclude quite soon.

Photo of David Tredinnick David Tredinnick Conservative, Bosworth

I conclude by saying that I am encouraged that Leicester’s hospitals have entered into a memorandum of understanding with the Affiliated Hospital of Nantong University in China. The agreement intends to promote co-operation on medical research, training and education between the institutions.

I have used Chinese medicine for 20 years, and I believe—from that and from the testimonials I have received—that the use of acupuncture to increase the flow of energy in the body and the use of herbal medicine dramatically increase the sense of wellbeing of those who suffer from cancer and frequently extend their lifespan. I commend the hospitals of Leicestershire for discussing this with the authorities in China, to look at the possibility of training therapists in Chinese therapy. I rest my case.

Photo of Colleen Fletcher Colleen Fletcher Opposition Whip (Commons) 3:06 pm, 22nd February 2018

It is a pleasure to follow David Tredinnick, who made an interesting speech. I also thank Dr Cameron for securing this important debate.

We all know someone who has had, or has been affected by, cancer. My family is no exception: both my parents had cancer and my husband lives with cancer every day of his life, and I could talk about cancer forever—but, Madam Deputy Speaker, I will try to limit myself to the recommended time.

The cancer strategy sets out strategic priorities and recommendations which aim to improve radically the outcomes that the NHS delivers for people affected by cancer, yet we also know that the specific needs of blood cancer patients are not being fully met by the cancer strategy. That is primarily because the experience of blood cancer patients is different from that of solid tumour cancer patients, so general cancer services are not always effective in meeting their needs.

These unmet needs occur in a number of priority areas identified in the cancer strategy, including awareness and early diagnosis, patient experience, living with and beyond cancer, access to new treatments and research, and NHS commissioning. Today, I want to focus on one particular issue: the need to improve post stem cell transplant care for blood cancer patients. This issue overlaps with a number of the aforementioned priority areas: patient experience, living with and beyond cancer, and NHS commissioning.

It is estimated that by 2020 there will be more than 16,000 people in the UK living post transplant, many of whom will be experiencing both physical and psychological side-effects from their treatment which can last for months or even years. The side-effects can include graft versus host disease, second cancers, infertility, depression, isolation and post-traumatic stress disorder.

Unfortunately, we know that there are worrying gaps in the care and support available to stem cell transplant patients after treatment. It is particularly concerning that only half of those who need psychological support actually receive it. The same is true for practical support: one in five are not offered any specialist care to help with elements of their physical recovery. These statistics are reflected in the experiences of many blood cancer patients, who feel that the level of support available to them falls away when they are sent home after their transplant. They feel that they have no one to talk to about the effects of the transplant, the challenges of late complications, the psychological burden of living with and beyond cancer and its treatment, their dietary needs, their infertility problems or practical issues such as when they can start to resume the everyday activities that they enjoyed before their treatment started.

This is happening because the commissioning of post transplant services is simply not working for every patient. After 100 days, responsibility transfers from NHS England to the clinical commissioning groups, but evidence suggests that this arbitrary cut-off can lead to fragmentation and gaps in the care and support offered to patients. To remedy this situation, there must be a review of the 100-day cut-off, as well as of the care currently provided to patients after a stem cell transplant, to ensure that all patients can access the support they need. This includes ensuring that all patients have access to appropriate emotional and psychological support services, and to a clinical nurse specialist or the equivalent model of support, both of which are pledges in the cancer strategy.

This issue very much ties into what the cancer strategy says about the commissioning of cancer services being “highly fragmented”. The strategy recommended

“setting clearer expectations, by the end of 2015, for how cancer services should be commissioned”, and as we head rapidly towards 2020, it is important that we continue to work hard to resolve the confusion that still exists. I hope that the Minister will be able to update us on how work in that area is progressing. I have outlined just a few of the priority areas where much more needs to be done to ensure that blood cancers and the needs of blood cancer patients are appropriately addressed by the cancer strategy. I believe that thorough and robust action in these and a number of other key areas will have a significant impact on outcomes for blood cancer patients, improving care on their journey from diagnosis to treatment and through to recovery.

Photo of Craig Tracey Craig Tracey Conservative, North Warwickshire 3:12 pm, 22nd February 2018

I am delighted to be taking part in today’s debate. I know that this is an important area for the Government. I congratulate the members of the all-party parliamentary group on cancer on securing time for the debate today. Since 2010, the Government have recognised the need to improve cancer services offered by the NHS and to make the UK a world leader in cancer research, diagnosis, treatment and care. Many innovations have been introduced, including the cancer drugs fund and the implementation of the independent cancer taskforce’s strategy. Cancer survival rates are at a record high, and access to the world’s leading cancer drugs continues to improve. It is clear that a lot of great work is already being done.

I would like to focus specifically on breast cancer. It has been a real honour for me to be co-chair of the all-party parliamentary group on breast cancer for the past three years. This has given me the chance to meet and work with a range of really inspirational people, from patients through to clinicians. It is great to see two former chairs of the group representing both Front Benches here today. During his time as chair, the Minister in particular did some really good work on age-related risk, and it is good to see that he is carrying that on. I hope that we will be able to tempt him to talk about some of the work he is doing when he speaks later.

As we know, breast cancer is the UK’s most common cancer, with 11,500 women and 80 men dying from the disease every year. That said, great strides are being made in diagnosis and treatment, leading to survival rates doubling in the past 40 years. One of the key recommendations in the cancer strategy is on early diagnosis, with a target that, by 2020, 95% of patients will be diagnosed and receive results within four weeks. I want to concentrate my remarks on an area that is critical to achieving that ambition, and that is often referred to as the biggest breast cancer risk that women are not aware of—namely, breast density.

During my work with the APPG, issues surrounding breast density have become clear, particularly the increased risk and the masking of cancers in mammography. Mammograms are obviously the main method of national screening and, while considered the gold standard, evidence shows that they are not as effective for women with dense breasts. Before I move on, it is important to understand the implications of breast density. It is not uncommon, with 40% of women aged over 40 having dense breast tissue. Although it is completely normal to have, it is also a well-established predictor of developing breast cancer. Women with the highest density are between four and six times more likely to develop the disease than those with less dense breasts.

The challenge is that tumours show up as white on a mammogram, but so does the dense tissue, meaning that the cancer is missed in more than 50% of cases. To illustrate the significance of that, it is useful to recount a couple of examples given to me by patients that highlight the importance of the issue and the differences in approach by country. One lady living in the UK underwent mammogram screening from 2004 to 2012, receiving a clean bill of health each time. Shortly after her fourth mammogram, she found a lump, which was later found to be 7 cm in size and had been missed for over 10 years due to her breast tissue being 75% dense. She underwent a mastectomy and, as a result of her illness, was forced to give up her business. Six years later, she continues to undergo breast construction surgery. Compare that experience with that of another patient I met who lives in France. In 2016, her first ever mammogram was clear. However, as she was also diagnosed as having dense tissue, she was immediately referred for an ultrasound scan, which revealed an 8 mm invasive tumour. As a result of the early detection, she received minimal treatment and an extremely positive outcome. Sadly, the first experience is not unusual, with 3,500 breast cancers going undetected each year in the UK alone.

I am aware that there is a global movement to educate not only women, but also health professionals about the implications of density, with a view to ultimately saving lives by promoting earlier diagnosis so that tumours can be found when they are small. In the USA, 30 states have passed legislation to provide women with some level of information on breast density, detailing the increased risk they face and how effective mammograms are likely to be for them. Having raised it with the Minister previously, I know that he has a great deal of interest in this area, and it is pleasing that some action is already being taken in the UK, with the Government commissioning research from the University of Warwick. However, clear evidence shows that high breast density eclipses family history as a risk factor for actually developing breast cancer.

What are the solutions? In an ideal world, the answer would be to change screening guidelines and offer further screening to those women at risk. For changes on this scale, I appreciate that we need to await the outcome of the research so that long-term decisions can be reached, but a relatively straightforward solution can be achieved right now. We should not ignore the breast cancer experts in the UK, who are already educating about breast density, as there is a definite need to promote awareness not only to women, but health professionals, including GPs, who are the usual first port of call for women concerned about their health. The simple task of educating about breast density can potentially promote more positive health outcomes, lead to less harsh treatments, reduce mastectomies, avoid secondary cancers and, ultimately, save lives.

In conclusion, I have learned an awful lot about breast density over the past two years, and I would like to think that more people will be informed about its potential impact as a result of today’s debate. However, the following questions remain: Do the women in your family or among your friends know the risk from breast density? Does your mother, wife, sister or daughter know that a clear mammogram may not actually be clear? Those potentially life-saving pieces of information should be available to every single woman to ensure that the Government’s excellent ambition to deliver world class cancer outcomes and even better cancer survival rates can be achieved.

Photo of Nicholas Dakin Nicholas Dakin Opposition Whip (Commons) 3:19 pm, 22nd February 2018

It is a pleasure to follow Craig Tracey, who reminds us of the importance of using the expertise and knowledge we have in the system to accelerate improvements in outcomes.

I thank Mr Baron, who I know is disappointed not to be here, for securing the debate and for his time and dedication in chairing the all-party parliamentary group on cancer so well and so impressively over the past nine years.

This debate focuses on the cancer strategy and the current challenges it faces. It is important to reflect on the positives, too. In the space of my lifetime, the progress on understanding, diagnosing and treating cancer has been remarkable. In the 1950s there was limited knowledge of cancer and of the associated risk factors, the NHS had only recently emerged and there was no co-ordinated plan to treat cancer. We have come a very long way since those early days.

Cancer survival rates have doubled in the UK since the 1970s, which is a real credit to the countless health professionals, researchers, volunteers, charities and, of course, patients who have pioneered progress and who continue to do so every day. It is because of them that we are where we are today, where a person in the UK is more likely to survive cancer than to die from it.

However, massive challenges remain. My constituent Maggie Watts came to see me after losing her husband, Kevin, to pancreatic cancer in 2009. It is her fault that I have ended up as chair of the all-party parliamentary group on pancreatic cancer—thank you, Maggie. Kevin’s mother died of pancreatic cancer 40 years earlier, and the shocking thing is that Kevin’s chances of survival were no better than his mother’s. In most parts of life the world has moved on rapidly in 40 years, but it has not done so in that part. In fact, at less than 7% in the UK, pancreatic cancer has the worst five-year survival rate of the 20 most common cancers, with the UK ranked 26th out of the 27 EU countries, according to the Association of the British Pharmaceutical Industry. Sadly, pancreatic cancer is on course to become the fourth biggest cancer killer by 2026, so action is needed now.

Photo of George Freeman George Freeman Conservative, Mid Norfolk

Does the hon. Gentleman agree that, if we are to tackle such cancer outliers, it is vital that, as well as the great research we do in the UK, we make sure that the NHS is better at adopting and taking up innovative medicines? A large part of the accelerated access review, the genomics programme and the informatics programme is about making sure that the NHS is capable not just of doing the research but of enlightened procurement to take up more quickly the drugs that work.

Photo of Nicholas Dakin Nicholas Dakin Opposition Whip (Commons)

Absolutely, and I will come on to that later.

As Dr Cameron, who introduced the debate so well, pointed out, we are now almost halfway into the five-year implementation plan of the Government’s cancer strategy for England. At this mid-point there are concerns about the rate of progress being made, and the workforce plan is not yet as effective as we would wish.

For example, as the Royal College of Pathologists has said, it can take up to 15 years to train a pathologist. Pathology services are unable to recruit to vacant posts today, and it is anticipated that a third of consultant histopathologists will retire in the next five years, which is just one example of the challenges we face.

The lack of workforce capacity must be addressed to change survival outcomes for pancreatic cancer patients. It would be good if the Minister were able to update us on what his Department is doing to prioritise workforce planning and to provide the funding needed, based on England’s cancer workforce plan.

Fast access to quick and accurate diagnostic tests is also crucial. Many pancreatic cancer patients are diagnosed too late, when surgery—the only curative option—is no longer available. The early diagnosis inquiry by the all-party parliamentary group on pancreatic cancer, “Time to Change the Story,” heard anecdotal evidence from a healthcare professional that a CT scan can be done quite quickly but that the report can sometimes take 10 weeks. It would be helpful if the Department were able to respond to the recommendations of the all-party group’s report and to update us on the progress being made in that area.

The diagnosis of not only pancreatic cancer but other cancers, such as blood cancer, can be complex because symptoms such as back pain or tiredness are often misunderstood or misdiagnosed. Delays in blood cancer diagnosis can have a major impact on a patient’s quality of life and overall outcome, and earlier diagnosis would make a difference for many, but not all, blood cancers. To change this, recommendations for early diagnosis in the cancer strategy should be reviewed to ensure that all people with blood cancer are benefiting from early, accurate diagnosis. GPs could be encouraged to ask for a simple blood test for people displaying one or more blood cancer symptoms.

Diagnostic techniques also have the potential to guide what treatment options are likely to be effective. Last month, NICE provisionally rejected the use of five tumour profiling tests to guide treatment decisions on whether patients with a particular type of early breast cancer should also receive chemotherapy following surgery, reversing its previous guidance recommending Oncotype DX as an option. This goes to the heart of the point made by George Freeman about using genomics effectively and precisely. Breast Cancer Now is concerned that this could be a backwards step for some breast cancer patients, especially in the context of the current cancer strategy’s welcome ambition to enable more personalised treatment.

Photo of George Freeman George Freeman Conservative, Mid Norfolk

Does the hon. Gentleman agree that on this subject of accelerated, earlier diagnosis and treatment, the work of the Institute of Translational Medicine in Birmingham, led by Professor Charlie Craddock, and the Cure Leukaemia team, working on blood cancers, has written the playbook on how we do early diagnosis? They have pulled in £200 million of free drugs for NHS patients by doing accelerated access.

Photo of Nicholas Dakin Nicholas Dakin Opposition Whip (Commons)

There is some wonderful work going on, and this goes back to what Craig Tracey said about the need to grab this wonderful work and move it forward, and not be held back by frameworks that are not quick enough to move with the times.

The ability to personalise treatment based on tumour profiling, which would allow many women to avoid the gruelling side effects of chemotherapy, is an essential part of improving patient care and has the potential to reduce costs associated with chemotherapy—that is a win-win. It can also give both clinicians and patients invaluable reassurance that they may safely not have chemotherapy, thus reducing overtreatment. NICE has not communicated clearly enough the reasons behind provisionally rejecting the future use of the Oncotype DX tumour profiling test, as it is unclear whether this is a result of additional clinical evidence, the cost or a combination of both. Will the Minister ask NICE to clarify the clinical and economic drivers behind the recent provisional rejection of tumour profiling tests to guide treatment decisions in a specific group of breast cancer patients?

The cancer strategy calls on Public Health England to continue to invest in “Be Clear on Cancer” campaigns to raise awareness of possible symptoms of cancer. Symptom awareness is a big challenge in terms of pancreatic cancer, as well as other cancers. A ComRes poll carried out by Pancreatic Cancer UK in 2017 found that 35% of adults in the UK would not be worried if they had a few of the potential symptoms of pancreatic cancer. Last year, Public Health England launched an exciting regional pilot on vague abdominal symptoms, including persistent diarrhoea, bloating and discomfort. Although the results for the campaign were positive, it has not yet been rolled out nationally. I would be keen to know when the Minister plans a national roll-out of the vague abdominal symptoms “Be Clear on Cancer” campaign.

In conclusion, much has been done and much is happening, but there is much more to do. Cancer alliances have a significant role to play in delivering effective change, and many are clearly making a difference. Workforce planning, early diagnosis and greater symptom awareness are key areas where we need to up our game as we move into the second half of this five-year cancer strategy.

Photo of Alister Jack Alister Jack Conservative, Dumfries and Galloway 3:28 pm, 22nd February 2018

I, too, thank Dr Cameron for securing this debate. I would like to take this opportunity to discuss blood cancer in particular.

As many will know, there are different types of blood cancer, ranging from leukaemia, lymphoma and myeloma to the rarest blood cancers, which affect just a few people. Blood cancer is a complex and much misunderstood disease. According to Cancer Research UK, blood cancer is the third biggest cancer killer in the UK and the fifth most common cancer overall, with more than 230,000 people living with blood cancer. Compared with patients suffering from other cancers, those blood cancer patients had to see their GP significantly more times before being referred to hospital. More than 35% had to see their GP three or more times before referral, which compares with only 6% for breast cancer and 23% for other solid tumour types. According to the Office for National Statistics, blood cancer is by far the most common cancer among people aged under 30. Despite that, a number of issues with blood cancer still need to be addressed.

As Nic Dakin said, diagnosing can be very complex at times. Symptoms such as back pain or tiredness are often misunderstood and diagnosed as other conditions. Delays can lead to major problems for patients in terms of not only their quality of life but the overall outcome. Recommendations in the cancer strategy for early diagnosis should be reviewed to ensure that all people with blood cancer benefit from early and accurate diagnosis. GPs should be encouraged to ask for simple blood tests for people displaying one or more blood cancer symptoms.

The cancer strategy says that all cancer patients will have had access to the recovery package by 2020. The package helps people, once their treatment has ended, to return to their normal lives. It includes a health needs assessment, care planning, health and wellbeing events, and a review of cancer care. However, the package is based around the needs of people with solid tumour cancers. In recent survey responses, people with chronic leukaemia, relapsing myeloma or lymphoma have said that terms such as “beyond cancer” and “post treatment” are not applicable to them. To ensure that people with blood cancer receive sufficient ongoing support, will my hon. Friend the Minister consider how all blood cancer patients can benefit from aftercare support, including by ensuring that the recovery package takes account of the unique characteristics of blood cancer?

Five thousand people a year with some slow-growing blood cancers are put on a regime of watch and wait instead of starting treatment straightaway. Their cancer is monitored for potentially many years before it has progressed to a point where treatment needs to start. Being monitored in this way can be difficult for many patients, and it can lead to psychological distress. Tailored psychological support must be made available to those patients on watch and wait.

Unlike with the treatment of solid tumour cancers, blood cancers are often not treatable through the use of surgery or radiotherapy. This means that blood cancer is more dependent on the development of new drugs and the ability to access them, and those things are very important if we are to continue improving patient outcomes. Continued Government investment in blood cancer research, including in clinical trials infrastructure, is required to capitalise on the UK’s position as a leader in blood cancer research. That will deliver benefits for patients, but it will also help the Government to reach the ambitions outlined in the UK life sciences industrial strategy.

The cancer strategy sets out how clinical leaders should work together in cancer alliances with those affected by cancer to decide how local care and services should be delivered. Despite this ambition, patients often find that services are fragmented, which adds stress to their experience. That can be a particular problem with blood cancer, because patients are often treated in haematology rather than oncology units. Cancer alliances should reduce fragmentation between the different stages of care for blood cancer patients by acknowledging and bridging the recognised gaps between oncology and haematology departments and between primary and secondary care.

To conclude, the cancer dashboard has been developed following a recommendation in the cancer strategy. It allows clinicians and others to compare performance of clinical commissioning groups and to identify areas for improvement. However, it covers only the four most common solid tumour types: lung, breast, prostate and colorectal. That equates to less than half of all cancer cases. Will the Minister provide an assurance that the health service will actively work to include blood cancer in the cancer dashboard, as the fifth most common cancer, and to ensure that decisions about future services do not disregard these patients?

Photo of Thangam Debbonaire Thangam Debbonaire Opposition Whip (Commons) 3:33 pm, 22nd February 2018

It is a great honour to follow Mr Jack, who spoke so passionately and knowledgeably for better understanding, treatment and diagnosis of blood cancer.

Like everyone in the House, I could speak about many aspects of cancer, including my own experience. I could speak about the very moving speech made by Baroness Jowell in the other place—a very special moment in Parliament’s history, and one I will always be glad to have been there for, although I am very sad that she had to be there. I could speak about how horrible chemotherapy is and about how deeply a girl can feel the loss of her eyelashes, for example. I could speak about my support for health labelling for alcohol, as so few people are aware of the connections between alcohol and breast, bowel and other cancers.

Photo of Thangam Debbonaire Thangam Debbonaire Opposition Whip (Commons)

The Minister is nodding vigorously from a sedentary position, and I hope that means he will support better labelling.

I could speak about how important healthy habits are generally for reducing cancer, and again I ask the Minister to do more to urge people to take up those healthy habits from an early age. I could speak about how all women should learn how to check their breasts properly, because so many have told me that they do not how to do that. I could talk about what I learned last week in CERN, of all places, where the Large Hadron Collider is, about the contribution that that scientific institute has made to improving diagnoses of cancer. I could mention, for instance, the development of the MRI—the magnetic resonance imaging—machine. I spoke to scientists there who, I am glad to say, are doing what they can to reduce the very frightening knocking that happens when a person is inside the machine. However, today, I am going to speak about the patient experience of a very specific group—children and young people with cancer and their families.

I say to those children and young people, their parents, their brothers and sisters, their clinicians and the charities supporting them, who may be listening, that this speech is for you. I pay tribute in particular to CLIC Sargent and the Teenage Cancer Trust and thank them and all the other charities, too numerous to mention, that help children and young people with cancer every day. I want to give a very personal thanks to my sister-in-law Emilie, whose volunteering, fundraising and work for CLIC Sargent is an inspiration to so many and whose personal knowledge has taught me so much.

Photo of Mark Tami Mark Tami Opposition Pairing Whip (Commons)

I am a parent of a child who has had the support of CLIC Sargent. It is not only that the charity supports you from a medical point of view—the people you talk to actually understand what your child and you are going through.

Photo of Thangam Debbonaire Thangam Debbonaire Opposition Whip (Commons)

I thank my hon. Friend for that intervention. He is absolutely right: these specialist organisations understand not just what the patient is going through, but what the families are going through and how devastating a diagnosis can be. They also know what can be done to help people through it.

I set up the all-party parliamentary group on childhood and teenage cancer last year with the help of CLIC Sargent and the Teenage Cancer Trust, which provide the secretariat, because children and young people living with cancer and their parents told me that they want to have their voices heard in Parliament. I thank the officers, almost all of whom are here, for their work. I thank my hon. Friends the Members for Alyn and Deeside (Mark Tami), for High Peak (Ruth George), the hon. Members for Filton and Bradley Stoke (Jack Lopresti) and for Strangford (Jim Shannon) for their support.

Childhood cancers are, thankfully, rare. Just 4,000 children and young people under 25 are diagnosed with cancer each year in the UK, but this rarity means that they are very often difficult to diagnose and, therefore, much more likely than older patients to be diagnosed at emergency at a later stage. That also means that the treatment can be difficult and that children, young people and their parents have to travel a long way for specialist treatment. It can mean that treatment can be particularly and unpleasantly aggressive. There are consequences for children’s education and their future employment. The treatment may also affect their fertility—something that they may not even be thinking about at the time of diagnosis. It may cause a disability. It may set them apart from their friends at exactly the moment when they are just finding out who they are.

In Bristol, the Teenage Cancer Trust provides a specialist ward for teenage cancer patients—I thank everyone who works there. It is able to help teenagers and their parents to get through this difficult time with services that are tailored to their specific needs. CLIC Sargent provides specialist support, which, in Bristol, includes a home—not a house—for children and their families to live in and have care from while they are having treatment for cancer. Indeed, a parent I met when visiting the CLIC Sargent house told me of arriving in Bristol in the morning with nothing—apart from them and their child—expecting just a check-up, and by the evening discovering that their child had cancer and that the treatment was due to start immediately. The CLIC Sargent social worker in that case can explain what the house does and what the facilities are and help to guide people who are suddenly dealing with not only a really traumatising experience, but having no food, no clothes and no supplies for the next few days.

Two years ago, the “Cancer costs” report, the parliamentary launch of which I had the honour of hosting in autumn 2016, identified specific costs for families affected by childhood cancer. I urge the Minister to relook at that—I am sure that he has already seen it. Young people and parents at that launch told me that they wanted a voice, hence the formation of the all-party group. We are launching our first inquiry on Monday, looking at patient experience, and I know that the Minister will want to engage with that process as we go forward.

We want Parliament to better understand the really specific experience of children and young people with cancer and their families, and to identify whether their needs are being met and where improvements can be made. For example, there might be suggestions for improvements to cancer diagnosis, post-treatment support, or help with the specific issue of the impact of the diagnosis that my hon. Friend the Member for Alyn and Deeside mentioned, as well as all the other areas that I have listed.

Many of us here may have had contact with children with cancer or their parents in our constituency work. I say to those people: this inquiry is for you, but it is also about you and with you. Young people, parents and professionals can get involved from Monday by filling in the short online survey on the all-party group’s Twitter feed and website. They can find out more about the inquiry on the webpage if they just google “APPG young cancer”. Our lines of inquiry are also informed by what children, young people and parents have already told us, and we have young people involved in hearing and analysing evidence as well as giving it.

The Government have committed to collecting patient experience data for the under-16s, and research into how that can be undertaken is progressing. We are pleased to hear about that data collection, but I would like the Minister to consider how it might be improved and tell us a bit more about that.

Photo of Mark Tami Mark Tami Opposition Pairing Whip (Commons)

A few years ago, CLIC Sargent produced a report about children with cancer returning to school. That really highlighted some of the major problems and the lack of guidelines to give teachers a proper understanding. Particularly for children who are very young, it is difficult not only for the child with cancer but for the other children at the school, particularly girls who have seen their friend, who looked perfectly normal, without hair, or something like that. It is a very difficult situation. We need a proper system in place so that those children can be properly included rather than excluded.

Photo of Thangam Debbonaire Thangam Debbonaire Opposition Whip (Commons)

My hon. Friend is absolutely right. I know from my experience in my own circle exactly how that can affect not only the young person but their educators. Young people have spoken to me of really different experiences. Some have said that they had good support from their school, while others have been told, rather sadly, that they were upsetting their peers with their hairlessness. I find that really challenging, because a child or a young person with cancer is actually an opportunity for schoolteachers to work with young people on how they can not only support their friends but reduce their own risk through making healthy choices at that point.

I reiterate to all hon. Members in the House and beyond that, if they would like to get involved with the all-party group or this inquiry, they should please get in touch with me. If children, young people, parents or other family members also want their voice heard in the inquiry or in Parliament, they can contact the group or me, or their own MPs. I hope that the Government, and Parliament generally, will be willing to hear the voices, needs and experiences of children and young people with cancer, and their families. I am sure that everyone here is committed to that, but we really must actually do it.

Photo of Michelle Donelan Michelle Donelan Conservative, Chippenham 3:42 pm, 22nd February 2018

I thank Dr Cameron for securing this debate. It is an honour to follow Thangam Debbonaire in her passionate and very well-informed speech.

We all have loved ones who have been affected by cancer. I lost my maternal grandparents to breast cancer and oesophageal cancer. Many in my family have suffered from melanoma, including my mother, and one of my friends is currently battling cancer. We have all heard harrowing stories from constituents. Cancer is indiscriminate: it does not care whether you are young or old, or someone’s mother or brother. Yes, we can make dietary and lifestyle changes to try to avoid it, and be aware of the symptoms, but advances in medicine mean that we can fight it more effectively and detect it earlier to increase the odds of survival, although there are still no guarantees.

Cancer survival rates are at a record high, with about 7,000 people alive today who would have not have been had mortality rates been the same as in 2010. This is a fantastic step in the right direction, but we are not at our destination. That is the point that I want to labour. For all those who lose their mother or child or friend today and hear of this debate, I want them to know that the Government, and all MPs, do “get it”. We get that we are on the right track, but equally that there is a long way to go, because cancer is still the most dangerous serial killer that remains at large in our communities. That is why we must continue to prioritise this area.

The formation of the £1.2 billion cancer drugs fund in 2010 was a massive step forward and has helped more than 95,000 people to access the life-extending drugs that they need, as was the implementation of the independent cancer taskforce’s strategy, seeking to save a further 30,000 lives by 2020. As I said, we are on the right track. In 2010, we had some of the worst survival rates in Europe, but we are now closing that gap. Last year, there were 7 million more diagnostic tests than in 2010, and 57,000 more patients started cancer treatment.

When it comes to cancer, prevention is key. I welcome the increased investment in cancer research by the National Institute for Health Research since 2010 and the work that the Government have done with Cancer Research UK, including a jointly funded network of 18 experimental cancer medicine centres aimed at driving the development and testing of new anti-cancer treatments.

I would like to draw attention to the high uptake of the HPV vaccination among teenage girls, which can prevent around 600 cancers per year and 99% of cervical cancer cases. I have spoken before in the Chamber on Public Health England’s tobacco control plan, which aims to usher in the first smoke-free generation by 2022.

Improving diagnosis is equally essential. Public health campaigns such as “Be Clear on Cancer” are vital to raise awareness of early symptoms, especially of less common cancers. Crucially, the £200 million that has been invested to ensure that patients receive a diagnosis or the all-clear within 28 days by 2020 will make a huge difference.

That would have benefited my constituent, whose symptoms were initially dismissed as irritable bowel syndrome. She then waited a long time for testing. She is now terminally ill with bowel cancer, but inspiringly, she is trying to work hard every day to raise awareness and help others to get diagnosed quickly. Nearly everyone will survive bowel cancer if diagnosed early—in fact, nine in 10 people—yet shockingly and sadly, only 15% of people are diagnosed at that stage.

Photo of George Freeman George Freeman Conservative, Mid Norfolk

I thank my hon. Friend for giving way; she is making a powerful point. On early diagnosis, prevention and screening, the 100,000 Genomes Project that we launched here in the UK, focused on cancer and rare diseases, is seeking volunteers for genome sequencing to combine with patient data, to identify people at risk. That is a brilliant way for people to get involved, and if anyone is concerned, they should contact the NHS and enrol. We still need another 50,000 patients, and that is a marvellous way of getting access to early diagnosis. Does she agree?

Photo of Michelle Donelan Michelle Donelan Conservative, Chippenham

I thank my hon. Friend for making that point. Unfortunately, time does not permit me to cover that, so I am delighted that he has.

I welcome the new bowel cancer test, the faecal immunochemical test, known as FIT, which will be rolled out in April. It is more sensitive and accurate and can detect twice as many cancers as the current test. Currently only half of those invited to take part in bowel cancer testing do, but FIT is proven scientifically to increase the number participating in the programme, especially as it is easier and more hygienic to post than the current test.

However, new awareness of symptoms, coupled with the new test and the ageing population, is leading charities within the sector to voice concerns of a looming endoscopy workforce crisis. Bowel Cancer UK and Beating Bowel Cancer question the realism of getting 400 non-medical clinical staff by 2020 to carry out the 450,000 procedures, especially as only 48 have been trained so far. I would like to hear more from the Minister in response to that, so that my constituent can be assured that others may be diagnosed earlier than she was.

A key issue when it comes to beating cancer and preventing cancer is getting screened regularly when applicable. That is especially the case with cervical cancer. The NHS cervical screening programme in England offers screening to women aged 25 to 49 every three years and women aged 50 to 64 every five years. Every year in the UK, around 3,000 women are diagnosed with cervical cancer, but research shows that the number of women using the service has dropped to a 20-year low, with more than 1.2 million not attending their screening in the last year. A recent report by Jo’s Cervical Cancer Trust showed that embarrassment is a key barrier to attendance for between a third and a half of all women, as is the desire not to miss work. There is also a severe lack of understanding about the importance of screening. Shockingly, one in three women aged between 25 and 29 miss their smear, yet cervical cancer is the most common cancer for women under 35. We must address this.

I note that Imperial College has conducted a trial to assess the effectiveness of texting non-responders to improve coverage, but I think that we should just do this—it can only help. I also welcome the fact that the Department of Health and Social Care’s behavioural insight team has undertaken a trial to investigate the use of behavioural insights to optimise the content of the invitation letter for cervical screenings.

I must admit that I was one of these women: I put off my screening for years. I left it at the bottom of my to-do list until I could fit it in around my job, and it just kept slipping year on year. I must admit, if I am honest, that I really did not realise that cervical cancer is most common in women under the age of 35. When I did have my screening, I had to go through the processes necessary after abnormal cells show up. As my results showed high grade abnormalities, I am extremely thankful that I went when I did. I want to take this opportunity to praise the work of Jo’s Cervical Cancer Trust, which provides women with information and support, which I found extremely helpful.

We seem to be very British about cervical smear tests. We do not really like to talk much about them, and that does not promote women going for them. Yes, it is not nice—it hurts a little, it is awkward and a bit embarrassing —but it could save your life. That is the message we need to get out. We need to promote cervical screening from school age, so that women recognise all the risks and the importance of going from age 25.

In September and October 2017, Jo’s Cervical Cancer Trust sent freedom of information requests to all upper-tier and unitary local authorities and clinical commissioning groups in England to ask what activities they had undertaken to increase cervical screening coverage from August 2016 to August 2017, along with the outcomes of those activities. Of the 149 local authorities that responded, 32% had not undertaken any activities at all. I ask the Minister to commission a review—and to adopt a strategy to increase the falling rate of cervical screenings—looking at availability and the challenges of reaching all women, and at the need for awareness of cervical cancer.

To conclude, Macmillan claims that, by 2020, 47% of people will get cancer at some point in their life, which is almost one in two. That is the scale of the problem we face. While we have come so far since 2010 in terms of diagnosis and treatment, there is still so far to go.

Photo of Karen Lee Karen Lee Shadow Minister (Home Office) (Fire) 3:52 pm, 22nd February 2018

I thank Dr Cameron for bringing about this debate, which matters hugely to a lot of people.

Most of the speakers today will talk about the facts, figures and statistics, but I will talk about the impact of cancer on people behind the statistics. A lot of us in the Chamber have been affected by cancer. My daughter died at just 35 of breast cancer, and I will talk about cancer from a patient’s perspective. One in eight women develop breast cancer in their lifetime, and 80% survive for five years or more. About 95% of women will survive for one year, and my daughter survived for 13 months. Recent data show that 11,500 women and 80 men in the UK still die from breast cancer every year.

My Lynsey was diagnosed with triple negative breast cancer in April 2010, and she died just 13 months later. She was a very bright girl, with a degree in politics and a degree in social work, and she worked with underprivileged children. She had a husband and three small children, who were two, four and seven when she died. She was treated at Nottingham City Hospital under Dr Steve Chan—she had chemotherapy, radiotherapy and a mastectomy—and her treatment was just amazing. The staff just could not have been better. She came home for the final three weeks of her life to die, and the unqualified team that came in to support me and her husband, Mike, were just amazing as well. I can never thank them enough.

I want to talk a little about the information that Breast Cancer Now, a charity, has made available to me. I am an ambassador for it, because I decided that one of the things I wanted to do when I got elected was to be an ambassador for a breast cancer charity. It has said that

“it will be challenging to meet the objectives set out in the Cancer Strategy unless corrective action is immediately taken”.

My Lynsey’s cancer was advanced—it was stage 3 when diagnosed, so screening probably would not have helped her. The Breast Cancer Now report states:

“Breast screening is a key initiative to ensure the early detection and diagnosis of breast cancer. Although controversy still exists around over-diagnosis, its benefits are recognised to outweigh its risks in the Cancer Strategy, in detecting 30% of breast cancers and saving 1,300 lives a year from breast cancer.”

The report also talks about a shortage of staff—32% of radiologists are expected to retire between 2015 and 2025.

My daughter developed a brain tumour—a common secondary effect of breast cancer—and she had to go for radiotherapy. It is truly traumatic. She used to see flashing blue and white lights; she had to wear a mask. The really upsetting thing was that because of staff shortages, she often had to lie around on a trolley waiting for things. Imagine what it is like laying on a hospital trolley with cancer in your bone and metastasis—it is just so distressing. That is the effect on patients of short staffing. It is just a phrase in a report, but that is what it really means.

Breast Cancer Now’s report states:

“We are also concerned about the lack of access to Clinical Nurse Specialists for secondary breast cancer patients: only 21% of organisations in England, Scotland and Wales report having one or more CNS dedicated to secondary breast cancer. We know that access to a CNS can make a big difference to the way people with cancer experience their care, providing patients with support and helping them manage their symptoms. This is especially important for patients— those like my Lynsey—

“with incurable secondary breast cancer who have particularly complex needs.”

Finally, Breast Cancer Now also said:

“We have serious concerns about the future of the National Cancer Patient Experience Survey as a result of the introduction of a new opt-out model scheduled in May 2018. The CPES has been a key driver of the improvements in cancer patient outcomes and experience since 2010.”

It is the aspiration of Breast Cancer Now that by 2050, everybody who develops breast cancer will live. I used to say to my daughter, “I’ve had so much of my life, more than you. I wish it could be me.” She used to say, “Mum, I wish it could be no one.” As parliamentarians we have power to influence things and change them, so perhaps we can join together across the House and make Breast Cancer Now’s vision a reality, so that by 2050, nobody need die of breast cancer.

Photo of Grahame Morris Grahame Morris Labour, Easington 3:57 pm, 22nd February 2018

I thank Dr Cameron for opening this debate on behalf of Mr Baron, and I pay tribute to his excellent work over many years as chair of the all-party group on cancer. I am delighted to support this debate, and as someone who has always taken a key interest in cancer strategy, I wish to highlight three issues. Pancreatic cancer has been well covered by my hon. Friend Nic Dakin, so I will refer to it only briefly. I also want to mention transformation funding and make a plea to the Minister, and I will say something about advance radiotherapy—a hobbyhorse of mine.

As hon. Members may be aware, I have recently recovered from a reoccurrence of lymphatic cancer, so I have first-hand knowledge of the importance of getting the cancer strategy right, not least in terms of early diagnosis and appropriate treatment. Delivering the recommendations set out in the cancer strategy is crucial to improving care and support for thousands of people affected by cancer. I do not seek to make a party political point about the nature of that policy, but essentially it requires resources, a plan, a strategy and commitment.

Sadly, pancreatic cancer has taken friends of mine, and it is particularly nasty. It has the worst five-year survival rate of the 20 most common cancers at less than 7% across the UK—a figure that has hardly changed over the past 40 years. In most other types of cancer, survivability has gone up. For pancreatic cancer, however, it has remained fairly flat. We urgently need investment and action, because pancreatic cancer is set, on current trajectory, to become the fourth biggest cancer killer by 2026. Currently, 80% of pancreatic cancer patients are diagnosed at the stage where the disease is advanced. Surgery is the only potential curative treatment, but sadly it is not an option when the disease is at an advanced stage. As far as I am aware, pancreas transplants are not an option. Early diagnosis is therefore absolutely key to improving the appalling survival rates and ensuring that patients are able to live longer following diagnosis.

I looked up the figures for my own area. Between 2010 and 2014, pancreatic cancer took the lives of 188 people in the Easington, Durham dales and Sedgefield clinical commissioning group area. It is clear that much more work is needed to deliver the kind of change we must see for the people affected, and their families, so we can achieve the improvements in survival rates that are so desperately needed.

Not long ago, I had the pleasure of visiting a local National Citizen Service group of young volunteers in my constituency—I think many Members have taken similar opportunities. The House might be interested to note that one group of young people were raising money for a chemotherapy ward because of their personal and family experiences. They thought that the facilities available were inadequate. This was because the ward, although filled with excellent and committed staff, was grappling with an increase in demand and a lack of funds. These young people raised enough money to buy an assortment of things, including floor fans to keep the patients cool. It is an indictment that, when we are putting additional money into the recovery fund and encouraging people to get through the treatment and to go on, we are relying on charitable donations.

At the Britain against Cancer conference 2016, the chief executive of NHS England announced £200 million of funding for treating cancer, along with improving early diagnosis and funding stratified pathways. The money was intended to support the roll-out of the recovery package. However, since this transformation funding was announced, there have been significant delays in its reaching cancer alliances, with only nine of 16 alliances having received funding. At the Britain against Cancer conference in December 2017, the Secretary of State for Health said that the release of funding to cancer alliances would be delayed in areas that were unable to demonstrate an improvement in their 62-day waiting time standard. That was an additional requirement that had not been included as part of the original criteria set during the bidding process.

Every person diagnosed with cancer—it does not matter where they live—should be able to rely on timely diagnosis and treatment when they are told they have cancer. However, as the final report from the all-party group on cancer’s inquiry concluded, the delayed release of funding to the cancer alliances has had a significant impact on their ability to make progress. I hope the Minister is paying attention, because I want to ask him a question.

Photo of Grahame Morris Grahame Morris Labour, Easington

I am very glad to hear it, because this is a serious point. The Department of Health and Social Care must decouple the release of transformation funding to cancer alliances from progress against the 62-day waiting time standard. I hope the Minister will address that point in his remarks. [Interruption.] I look forward with anticipation to his remarks.

It would not be a contribution on health from me if I did not mention advanced radiotherapy. I have raised regularly its benefits and advocated further investment in its research. Investment and research, given the cost, should be evidence-based, but there are some really quite exciting areas: in particular, proton beam therapy—I visited University College Hospital in London for part of my treatment and saw the installation of the proton beam therapy bunker and equipment there; stereotactic ablative body radiotherapy; adaptive radiotherapy based on advanced imaging—a kind of magnetic resonance linear accelerator; combinations of radiotherapy and novel drugs; biomarkers with selections for altered radiotherapy strategies so that radiotherapy can precisely target the cancer cells; and molecular radiotherapy. It is necessary that we evaluate the use of these new radiotherapy techniques and compare them with conventional radiotherapy and some surgical techniques, as radiotherapy is sometimes more effective than surgery and pharmaceutical products. I am advocating that they be used not instead of, but alongside other treatments and following considerable evaluation. This could result in better outcomes and reduced treatment costs.

Finally, I would like to thank all my colleagues on the all-party group on cancer, the cancer charities that continue to do excellent work and all those in our national health service working in cancer prevention and treatment.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health) 4:06 pm, 22nd February 2018

I congratulate Dr Cameron on securing this debate, and I am grateful to hon. Members for their extremely touching, wonderful and very personal contributions. As everyone here can testify, cancer has touched everyone—no family will not be aware of it. In fact, it is said that by 2020 one in every two people will be diagnosed with cancer in their lifetime. My father had cancer three times and each time survived, owing to the skill of the surgeon, the care of the nurses and the prayers he clearly believed in.

We have many problems in Northern Ireland—we all know about the political process—and I am conscious that health is a devolved matter, but I wonder if the Minister could have discussions and co-ordinate with the permanent secretary in the Department of Health, Richard Pengelly, to see if he can help and encourage his Department with the problems facing it. The incidence of cancer in Northern Ireland has increased by 25% in the past 10 years, such that the number of cancer cases each year has reached 9,000 for the first time. That is an indication of the problems.

I thank the many organisations, particularly Macmillan Cancer Support, for the information they have provided to us. There are 2.5 million people living with or beyond cancer in the UK today. The issue is that not all of them are living well: many experience physical, emotional and financial consequences as a result of their treatment. One in four face disability or poor health following their treatment that can persist for many years after treatment has ended, despite the NHS being set up to meet the changing needs of cancer patients and to enable access to the best treatment that is right for patients.

Macmillan is even more conscious of, and concerned about, the financial implications. According to projections in the “Five Year Forward View”, expenditure on cancer services is set to grow by 9% each year, which gives us an idea of some of the issues and takes us back to some of what was said earlier about prevention—I think that Thangam Debbonaire and others referred to prevention. We have had cancer patient experience surveys in Northern Ireland for a while now, and it is important that we are able to see what the trusts and CCGs are doing, what the cancer types are and the different aspects of the cancer journey. In England, the cancer patient experience survey has been happening since 2010 and has been proven to encourage hospitals to implement changes in order to improve results. That is very important.

I would be very pleased if the Minister could come back to us on the following point. Macmillan is concerned that the NCPES will not continue to deliver the same high-quality data, as the current survey model is not likely to be viable under the terms of the national data opt-out model that is scheduled to be introduced in May 2018. It is clear that Macmillan care has concerns. We have collected all the data and all this information through the clinical commissioning groups. The continuation of the cancer patient experience survey in its current format with high-quality, robust data is vital across the whole United Kingdom of Great Britain and Northern Ireland. Again, will the Minister provide the clarity that is needed on the issues that have been outlined on the NCPES to ensure the continued delivery of this essential and robust patient survey? The benefits are there in the data. I thank him for that.

About one in eight people diagnosed with cancer face mental health problems, such as anxiety, depression and post-traumatic stress disorder. Planning is needed to ensure that everyone living with cancer across the whole United Kingdom of Great Britain and Northern Ireland can access the right care and support, whether that means information, financial assistance, vocational rehabilitation or emotional support. Families can give so much of that emotional support, and they do so gladly, but at the same time we need to reach outside that.

Just 68% of people with cancer in Northern Ireland started treatment within 62 days of referral. Again, I am very much in the early diagnosis category and we need that in place. Cancer deaths in Northern Ireland are at the highest level that they have ever been. My party is totally committed to improving the five-year-survival rates and believes in targeting resources to tackle deprivation, which is another issue. There is a higher level of cancer incidents where there is deprivation.

More needs to be done to provide good continuity of care and to ensure that all patients have supported access to key information about their condition, treatment options and the types of support that are available. Macmillan is funding a second Northern Ireland survey that will be launched in spring 2018. It has invested £7 million in the Northern Ireland specialist cancer nursing plan, because this vital segment of the cancer workforce is not keeping pace with demand. Macmillan recognises that there are shortcomings and it has tried to introduce finance where it can to ensure that things go the right way.

Cancer is the most common cause of death in Northern Ireland. The end-of-life choice is very important. The Northern Ireland cancer registry found that 75% of patients would prefer to die at home. That subject matter is not easy to speak about, but the fact is that this needs to be looked at. Macmillan’s research found that people are more likely to die in the place of their choice when their wishes are recorded and known by their healthcare. We believe that a new cancer strategy should include commitments to improving end-of-life care and giving everyone who is diagnosed with cancer the opportunity to have advance care planning discussions.

Macmillan has made a number of recommendations, which I will conclude with—it is referred to as the “Delivering Together” strategy. I totally support Macmillan’s reforms, such as producing a detailed implementation plan, including specific actions to improve care and support for people living with cancer and to enhance the patient experience in all trusts and CCGs. It recommends making the recovery package available to everyone living with and beyond cancer, the timely adoption and implementation of NICE guidelines to improve cancer detection, treatment and support, and close working with GP federations to ensure that care is provided closer to home.

The recommendations include long-term cancer workforce planning, integrating health and social care with higher education to attain a more knowledgeable and skilled workforce—it is important to have that—and with effective recruitment and succession across disciplines and settings. They include the better integration and co-ordination of all those things as well, including signposting to the non-clinical support that patients need at each stage of their cancer journey, and providing high-quality palliative end-of-life care in all settings on a 24/7 basis. That should begin with cancer patients having the option of advance care planning conversations at the earliest possible stage. The recommendations also include increasing the involvement of people affected by cancer in the development, redesign and delivery of services and a commitment to ongoing routine use of data collection tools, including the cancer patient experience survey and the peer review programme, to identify any gaps or inequalities in cancer care and pinpoint areas for improvement locally and benchmarking across the UK.

I ask the Minister to take on board all the issues we have all referred to and to do what can be done to help the massive amount of cancer sufferers across the whole United Kingdom of Great Britain and Northern Ireland so that they have a better journey, a better outcome and better support.

Photo of Ronnie Cowan Ronnie Cowan Scottish National Party, Inverclyde 4:14 pm, 22nd February 2018

I thank Mr Baron, who cannot be with us today, for being proactive in securing the debate this afternoon. I also thank my hon. Friend Dr Cameron who stepped in to open the debate in his absence. She raised concerns about targets not being met and the resources available to meet those targets, and reminded us all that those in receipt of treatment must be involved in the ongoing conversations. Their experience is vital in improving the process as we go forward. It is imperative that we improve end-of-life care to offer the dignity that is appropriate at that time.

David Tredinnick spoke eloquently about alternative therapies and the role they can play. I would include in that category—although I am not putting words into his mouth—the investigation into the use of medicinal cannabis. Colleen Fletcher focused on post-stem cell transplant care and the practical support that is required, and also asked whether we could review the 100 day cut-off date.

Craig Tracey spoke about breast cancer, the UK’s most common cancer, with a survival rate that has doubled in the past 20 years. He went on to highlight the question of dense tissue, something that was new to me, and the need for early diagnosis, and he called for better education in this area.

Nic Dakin put out challenges about pancreatic cancer. Although progress has been made, this seems to be an area in which minimal progress has been made over the years. He drew attention to the workforce programme and asked whether NICE could possibly clarify some of its decisions.

Mr Jack focused on blood cancer and the complexities around diagnosis, and called for continued clinical research. Thangam Debbonaire spoke about young people and cancer, and the role played by CLIC Sargent. Today I am proudly wearing my Glow Gold ribbon, given to me by a young man in my constituency this time last year.

Michelle Donelan highlighted the desire that the Government prioritise cancer research. We have come a long way, but we still have a long way to go. She also highlighted the need for early diagnosis, a recurring theme this afternoon. Karen Lee spoke movingly about the people behind the statistics, including her own daughter. She also highlighted the reality of staff shortages and what they mean for patients.

Grahame Morris spoke of his first-hand knowledge of overcoming cancer and, as many speakers have said, survivors’ experiences should be hugely influential when developing better treatments. Who could possibly have a better understanding?

Jim Shannon mentioned that every family is struck in some way by cancer. He also mentioned the financial implications, and I shall take up that topic later.

Despite our progress cancer remains a lingering, stubborn foe and as policy makers we have to support our respective health services as they seek to improve the treatment that patients receive. We have undoubtedly taken great strides and our progress from a historical perspective is one of steady improvement, but for individuals, months, weeks and even days become precious as they grapple with the uncertainties that this illness brings to their life.

While patients come to terms with the emotional and physical impact of their diagnosis they must also continue to manage the everyday practicalities of life. Chief amongst these is finances, and research commissioned by Macmillan Cancer Support shows that four out of five people with cancer are, on average, £570 a month worse off as a result of their diagnosis. I believe we can improve that situation by introducing a duty of care for financial services as that would allow cancer patients to have increased flexibility when dealing with organisations such as their bank.

It is clear that more needs to be done to give cancer sufferers greater security. The introduction of flexibility of mortgage payments, interest freezes on credit cards or signposted financial advice to avoid problem debts are just some of the ways in which banks may be able to assist. I would therefore encourage the UK Government to strongly consider the introduction of a legal duty of care as a matter of urgency so that those recovering from cancer are afforded greater support.

I hope that, where possible, the different health services across the United Kingdom have satisfactory measures in place for the sharing of best practice. The Nuffield Trust, for example, concluded in a 2017 report that Scotland had a unique system for improving the quality and safety of patient care, and that other health authorities in the UK could benefit from the approaches used in Scotland. Mark Dayan, the lead author of the report, stated that Scotland had

“worked on getting its healthcare services to co-operate for longer than the other nations of the UK. So we’re urging healthcare leaders from England, Wales and Northern Ireland to think about what elements they might want to import from Scotland.”

I am sure that those in the Scottish NHS will be watching with interest as the NHS in England continues to implement the Cancer Taskforce’s five-year strategy for cancer care. Shared knowledge is a vital tool for future progress.

Earlier this year, I hosted the world cancer day drop-in event, along with Daniel Zeichner. It was heartening to listen to Cancer Research UK’s ambassadors, and to reflect on the many unsung heroes who assist cancer sufferers or have experienced cancer themselves. I hope that the Government are listening to those in the third sector, because through their effort and commitment they have gathered a huge amount of valuable knowledge.

The hon. Member for Dumfries and Galloway talked about blood cancer, and the hon. Member for Bristol West talked about cancer in children. I want to combine the two by telling a story about a young man from my constituency—a very brave young man called Nathan Mowat. Nathan is now at the ripe old age of seven. With the love and support of his mum Gillian, dad Paul and sister Annabel, he has completed three years of treatment for lymphoblastic leukaemia, which he can pronounce a lot better than I can. He has experienced 10 different cocktails of chemotherapy, six bone marrow procedures, three surgeries, 22 lumber punctures, and 16 blood and platelet transfusions. Nathan earns a “bead of courage” for every procedure that he goes through. He has earned 1,500 “beads of courage”. Where Nathan and other brave children have led, others will follow.

I hope that all Members will join me in reaffirming our commitment to three actions: considering legislation that will help to support cancer patients in different aspects of their life, including their personal finances, giving our health services the financial support that they require, and ensuring that the expertise and knowledge of academia around the globe are fully utilised to formulate Government policy.

Photo of Sharon Hodgson Sharon Hodgson Shadow Minister (Public Health) 4:22 pm, 22nd February 2018

I thank Dr Cameron for leading the debate and for her excellent speech, and I thank Mr Baron for securing the debate. He is not in the Chamber, but I also want to thank him for the excellent contribution that he has made to the work of the all-party parliamentary group on cancer for many years. His expertise and passion about this matter are what has made the APPG so successful.

I also thank the other Members who have made excellent speeches about this important issue. I thank the hon. Members for Bosworth (David Tredinnick), Craig Tracey, with whom I co-chaired the all-party parliamentary group on breast cancer—he raised the important issue of breast density, which, as he said, is an issue on which we really do need to make progress—the hon. Members for Dumfries and Galloway (Mr Jack) for Chippenham (Michelle Donelan), for Strangford (Jim Shannon), and for Inverclyde (Ronnie Cowan), the Scottish National party spokesman. I thank my hon. Friends the Members for Coventry North East (Colleen Fletcher), for Scunthorpe (Nic Dakin), and for Bristol West (Thangam Debbonaire), and my hon. Friend Karen Lee. She is no longer in the Chamber, but she made a powerful and emotional speech about her daughter, who would be so proud of her bravery today—as, I am sure, her grandchildren will be. I hope that the whole family were watching the debate today. I also pay tribute to my hon. Friend Grahame Morris, who, I think, has fought cancer twice.

Photo of Sharon Hodgson Sharon Hodgson Shadow Minister (Public Health)

It is an absolute pleasure to see my hon. Friend in his place. Long may he stay there.

Cancer is, understandably, a very emotional topic. One in two people in the UK will be affected by cancer in their lifetimes, and, as we have heard from almost everyone who has spoken today, we have all been affected in some way ourselves. When my children were very small, I lost my mother-in-law to breast cancer. That is one of the reasons why I joined the all-party parliamentary group on breast cancer, and I am vice-chair of the group to this day. It is this emotion that encourages us and gets us all to come together to tackle cancer.

Over the years there has been a steady improvement in cancer survival rates in England. However, we still lag behind the improvements of our European counterparts, and the number of new cancer cases continues to rise year on year. If these trends continue it is estimated that by 2020 some 2.4 million people in England will have had a cancer diagnosis at some point in their life. That is why the Government must take urgent steps so that cancer diagnosis care and outcomes in England can be improved.

The cancer strategy was a welcome step forward to achieving the best cancer care and outcomes in the world, and Labour is fully committed to delivering, and helping to deliver, that strategy in full. However, as has been mentioned, there are some concerns across the House about the progress of the strategy. I am pleased that some of the targets have already been met, but I am under no illusions—many are no closer to being reached than they were almost three years ago. Will the Minister today commit to publishing a detailed progress update on each of the 97 cancer strategy recommendations by the end of this financial year, so we are all able to celebrate success but also focus our attention on more pressing challenges where needed? There are many challenges that the Government must face before achieving world-class cancer outcomes, but I will touch on only a few today: early diagnosis; waiting times; the workforce; and prevention.

On early diagnosis, we know that if a cancer is diagnosed early, treatment is more likely to be successful, but for cancers such as ovarian cancer and lung cancer it is often too late. The National Cancer Registration and Analysis Service found that over a quarter of women with ovarian cancer are diagnosed through an emergency presentation. Of those women, just 45% survive a year or more, compared with over 80% of women diagnosed following a referral by their GP. I should state at this point that I am chair of the all-party group on ovarian cancer. Similarly, research by the British Lung Foundation found that more than a third of lung cancer cases in England are diagnosed after presenting as an emergency. As a result, the Roy Castle Lung Cancer Foundation found that, if caught early, a person has up to a 73% chance of surviving five years or more. However, the current five-year survival rate for lung cancer is just 10% and, sadly, one in 20 lung cancer sufferers was not diagnosed until they had died. Cancer survival rates have doubled over the last 40 years, but those are shocking statistics. I therefore ask the Minister what his Department will be doing to ensure that cancers are detected even earlier, so that patients are no longer pushed from pillar to post trying to find a diagnosis.

Unfortunately, we know that once a patient has been diagnosed, they then have an agonising wait for treatment. Even if it was a wait of just a week it would be agonising, but the 62-day target between urgent GP referral and treatment has not been met now for two years, meaning that patients are having to wait much longer than they should for treatment. Since the target was first breached in January 2014, over 95,000 people have waited for more than two months for treatment to start. Cancer patients should not be expected to wait so long. I therefore ask the Minister, what his Department is doing to address this issue.

It is no secret that the NHS and the NHS workforce are under extreme pressure due to underfunding and understaffing by this Government. I want to place on record the fact that Labour Members do not take the NHS workforce for granted. We are incredibly grateful to them for their hard work, support and kindness to patients and their families. They are doing an incredible job despite the circumstances we currently find ourselves in, and we should never stop thanking them for the work they do to diagnose, treat and care for patients. The cancer workforce really are the backbone of the cancer strategy.

The improvement of early diagnosis and waiting times relies on an efficient cancer workforce, so the Minister must make these concerns a top priority if the targets in the cancer strategy are to be fulfilled. A report by Macmillan Cancer Support found that more than half the GPs and nurses surveyed in the UK say that, given current pressures on the NHS workforce, they are not confident that the workforce are able to provide adequate care to cancer patients. That is deeply worrying. The NHS workforce should be suitably equipped to diagnose, support and care for cancer patients, during and beyond cancer.

Through my work with the all-party parliamentary group on breast cancer, I have heard—as I am sure the Minister did during his time as the group’s co-chair—of the overwhelming support that a cancer nurse specialist can bring to breast cancer patients and their families. As we have heard, however, patients with secondary breast cancer are unlikely to have access to a cancer nurse specialist. Research from Breast Cancer Care shows that 42% of hospital trusts and health boards in England, Scotland and Wales do not provide dedicated, specialist nursing care for people with secondary breast cancer, even though they often have complex emotional and supportive care needs. Patients with secondary breast cancer are subject to a postcode lottery when it comes to having a cancer nurse specialist. What steps is the Minister taking to ensure that every cancer patient has access to a clinical nurse specialist?

There is no doubt that, if the cancer workforce had the time, resources and support they so desperately need, the recommendations in the cancer strategy would be achieved. I know that that is something the cancer workforce plan, published in December last year, aimed to address. Will the Minister update the House on the progress of the plan, and outline how much funding the Government will be granting to ensure that the proposals in the plan soon become a reality? The NHS cancer workforce care for and support their patients every day, and we really need the Government to support the workforce, too.

Finally, I move on to the first issue raised in the cancer strategy: prevention. The World Health Organisation estimates that a third of deaths due to a cancer are the result of the five leading behavioural and dietary risks: high body mass index; low fruit and vegetable intake; lack of physical activity; tobacco; and alcohol. The subject of alcohol was raised by my amazing hon. Friend the Member for Bristol West. Tobacco was identified as the most important risk factor, responsible for approximately 22% of cancer deaths. Taking all five risk factors into account, it is estimated that between 30% and 50% of cancers could be prevented.

The Government’s tobacco control plan—which the Minister thankfully pushed to be published in his first weeks in the job—and the childhood obesity plan are welcome steps towards reducing the high rate of preventable cancers, but they will not go far enough if the Government continue to slash public health budgets. Will the Minister therefore commit to strengthening public health budgets so that fit and healthy lifestyles can be encouraged across all our communities and help to contribute to cancer prevention? I know that, like me, he is passionate about making sure that England is one of the world leaders when it comes to cancer outcomes, but we are currently lagging behind. However, with the right funding and support from the Government, the cancer strategy has the potential to achieve that. I hope that he will take on board all that we have heard today and go back to his Department with an action plan of how best to move forward so that we can really achieve world-class cancer outcomes in 2020.

Photo of Steve Brine Steve Brine The Parliamentary Under-Secretary for Health and Social Care 4:33 pm, 22nd February 2018

I should like to thank my friend the shadow Minister, Mrs Hodgson, for her remarks. I congratulate the members of the all-party parliamentary group on cancer on securing the debate, in particular the hon. Members for Scunthorpe (Nic Dakin) and for East Kilbride (Dr Cameron)—I shall leave it at that in describing the hon. Lady’s constituency, lest I make a total fool of myself. As the cancer Minister—Members will know that that is the job I always wanted to do—I thank them for the constant work they do on the all-party group and on the Britain Against Cancer conference. Linked to that, I want to extend my appreciation to the Members on both sides of the House who chair the all-party parliamentary groups on different kinds of cancer for the work they do. Some of them are here today. As has been mentioned, I was a co-chair alongside the shadow Minister and the previous Member for Mid Dorset and North Poole and we were quite a team. We were often referred to as Steve and the girls—I found my inner girl. We chaired the group together for five years and I was so proud to do that. We met some amazing people and I think we did some good.

With the shadow Minister, I was also vice-chair of the all-party parliamentary group on ovarian cancer—she still chairs that group—so I know how important it is that Parliament allocates time for this subject, both upstairs in the APPGs and here in the Chamber. Looking at how many people are in the Public Gallery and around the Chamber, this is about quality more than quantity. I say to those watching today who may say, “This is a debate on the cancer strategy. This is so important. Why isn’t the House as full as it is for PMQs?”—this is not all about what goes on in here. This is about what goes on in Government, what goes on upstairs in the APPGs and Select Committees and, for so many Members, what goes on within ourselves. I did not know the shadow Minister’s motivation for chairing the APPG. I have never said my motivation—I will one day—but I realise now why she was so passionate.

The hon. Member for East Kilbride pretty much summed things up in the first line of the first speech of this debate when she said that we are all “on the same side” when it comes to cancer—what a brilliant way of putting it. Colleen Fletcher talked about her husband, who lives with cancer. Macmillan has been brilliant with some of its communications, and we have all seen the television adverts saying that a mum with cancer is still a mum. There are so many people who are living with and beyond cancer—they call it “survivorship” in America—and we should always remember that.

Let me start by reassuring the House, if I need to, that cancer is a huge priority for me, for the Secretary of State and for this Government. As several Members have said, cancer survival rates have never been higher, and the latest survival figures show an estimated 7,000 more people surviving cancer after successful NHS cancer treatment compared with three years prior. Our aim is to save 30,000 more lives by 2020 through the cancer strategy that we are debating.

However, I know more than anybody that there is still so much more to do and so much potential, which is why we accepted all 96 recommendations in the cancer strategy. We have backed that commitment with over £600 million of additional funding up to 2021. We are now just two years into the implementation of the strategy and the fantastic NHS cancer doctors and nurses supporting us to achieve our vision have made tremendous progress in many areas. I echo what many Members have said in their support.

The shadow Minister and others asked whether I will report back on how we are doing on all of this. In October, NHS England published its “two years on” report on the day that I gave evidence to the all-party parliamentary group on cancer’s inquiry, which led to its report and to this debate. That was our latest progress report, and I hope that we will be doing something again later this year. NHS England’s national cancer director, Cally Palmer, who is based at the Royal Marsden Hospital and is an incredible lady with whom I enjoy working, is leading the implementation of the strategy. She agrees with me that there are many areas where we agree with the APPG’s report. We do not shy away from scrutiny, which is exactly why we are here. However, progress in many areas was not given sufficient prominence in the APPG’s analysis of progress. We said that at the inquiry. It is important that I put that on the record.

The measure of the strategy’s success will of course be about significant improvements in early diagnosis, which I will come on to, and obviously treatment and research. However, I am increasingly aware in this job that we need to make cancer services even better beyond 2020 and that there needs to be a greater focus on a fourth pillar— the “fourth Beatle”, if you like—which is prevention. Of course, we want to be the best in the world at delivering positive outcomes for patients after a diagnosis, but we have to understand the position. Earlier this week, I responded to a Westminster Hall debate attended by Members from Oxfordshire. There has been a 120% increase in the number of people presenting with cancer in Oxfordshire alone in recent years.

The number of people presenting with cancer continues to rise. We can do very well on the first three pillars, and we are, but prevention is where we will really move the dial. That is why my whole mission as the Minister for primary care and public health, a role created by this Health Secretary, has been to put in place a comprehensive system of measures to reduce the risk of cancer, as well as to treat cancer when it occurs.

As my hon. Friend Michelle Donelan and the shadow Minister mentioned, one of my first acts as Minister was to launch the tobacco control plan. Why was I so keen to get it out there? Because we promised we would, but also because tobacco is the biggest preventable killer in our country today. The previous Labour Government and this Government have done well with the legislative framework. It is now about supporting local areas to continue bringing down the number of people who smoke from what are already record lows and to ensure that people do not start smoking in the first place.

Last year we also launched a cross-Government air quality plan, which has been in the news and in the House this week. That plan is important, too, because it will significantly reduce the carcinogens in the air we breathe, which we know has a big impact on the development of disease. Furthermore, in 2016 we published our child obesity strategy, which was just the start of a conversation about how we will reduce child obesity over the next decade. Our overarching focus in all that work is to ensure that our children are supported to live healthy, active and happy lives so that they grow into healthy, active adults who are less likely to develop cancer. We have always said that the child obesity strategy is constantly under review—it is part one—and we will go further, if needed, to build on that.

As has been mentioned a few times in this debate, perhaps the biggest game changer in preventing cancer is the world-leading work on genomics happening in our country. The chief medical officer’s 2016 annual report, “Generation Genome,” which was published the year before I was appointed, set out the huge potential for genomics in helping us to understand the inherited and acquired genomic causes of cancer and in shaping future research and future personalised cancer treatment, which is so important—it is something we should talk more about, as we should the whole prevention agenda.

Many subjects have been raised today and I am grateful to you, Madame Deputy Speaker, and to Members for giving me time to respond to them. As I suspect she would like me to do, I will give a couple of minutes to the hon. Member who opened the debate.

As I have already said, the workforce is key to our strategy. We have already committed to investing in and expanding our diagnostic workforce to improve survival rates by diagnosing cancer earlier. The first ever cancer workforce plan, which Health Education England published in December, set out how we will expand our workforce, how we will continue to invest in the skills of the staff we have, and how we will use their time and expertise where it is most needed.

HEE has already committed to training 746 more cancer consultants and 1,890 more diagnostic and therapeutic radiographers, which we know are in short supply, by 2021. The plan further commits to the expansion of capacity and skills, including 200 additional clinical endoscopists and 300 reporting radiographers by 2021. HEE will also expand the number of clinical nurse specialists, as the shadow Minister rightly mentioned, and develop common and consistent CNS competences, with a clear route into training, to ensure that every cancer patient has access to a CNS or other support worker by 2021—that subject was constantly raised when I chaired the all-party group. HEE will follow the plan later this year with a longer-term strategy looking at the workforce needs beyond 2021.

The hon. Member for East Kilbride and others, including Grahame Morris, talked about the link between the 62-day standard and the performance and phasing in of transformation funding. Cancer alliances, as the House knows, are an important mechanism for improving performance on the 62-day standard from urgent referral through to treatment. They bring together clinicians from primary and secondary care, as is right—one NHS. They ensure collective responsibility for the cancer services they provide, and they provide the necessary leadership for the transformation of services. So £76 million of funding has already been allocated to the cancer alliances.

It is imperative that the alliances have the operational rigour and readiness to achieve the transformation that we need. After all, our constituents’ money is being allocated. So it is only right and proper, as the Secretary of State made clear in the question and answer session at Britain against Cancer, that the alliances demonstrate their preparedness for this funding. That is not to say that the 62-day standard is a requirement, but it does give a basis on which NHS England and NHS Improvement, along with other senior clinical advisers, can assess an alliance’s readiness to transform services. Transforming services is what we want to do.

Photo of Grahame Morris Grahame Morris Labour, Easington

What happens when cancer alliances do not achieve the 62-day target? It seems completely perverse that individuals suffering from cancer in those areas are penalised by lack of funds from the transformation fund. Is the Minister saying that those cancer alliances can still apply for that funding and measures will be put in place to ensure that they do reach that target?

Photo of Steve Brine Steve Brine The Parliamentary Under-Secretary for Health and Social Care

Yes, this is not hard and fast. I noted that NHS England has written to me as a constituency MP and to all other MPs today with details of the cancer alliances that they have in their individual areas. I bang on about this every time, as the shadow Minister knows, but I implore Members to engage with their local cancer alliances. I suspect that the people in this debate do that, but I would hazard a guess that many other Members do not. Members should know who the cancer alliances are in their areas and should have a relationship with them.

Let me now discuss CPES, which Jim Shannon mentioned, as did Karen Lee. On her speech, let me just say, wow. I said to my officials before this debate that there is always one speech in these debates—the shadow Minister was that person a few weeks ago—who leaves not a dry eye in the House, and today it was the hon. Member for Lincoln. I know she is not in her place now and I do not blame her for that. I think the whole House wanted to run over to give her a hug—many Labour Members did, and bless them for doing that. I think that the House, in its own way, gave her a collective hug, and I say well done to her for an amazing speech.

We totally recognise how important CPES is in our continued drive to improve cancer treatment and care, and to monitor that progress. I have always been clear that I want any future survey to continue to deliver the high-quality data that CPES does. I can tell the House that CPES will continue in its current form in 2018-19. We will engage with the cancer community to ensure that any decisions about future delivery and the model to be adopted, should the commissioning arrangements be revised, are informed by all parties and ultimately protect the integrity of the survey and quality of the data. I saw Dame Fiona Caldicott last week in Oxford and discussed the subject with her. Obviously, her work as the patient data guardian led to the challenge we now have—it was necessary work, but it certainly left us with a challenge. Cally Palmer, the national cancer director, and I will meet all the major cancer charities next week at my second roundtable, and this is on the agenda and we will be discussing it with them. I hope Members know that CPES remains very much at the top of my agenda.

Let me touch on early diagnosis, because everybody else has and because it is one of the most important shows in town. In every conversation I have ever had about how we can beat cancer, I have been told, “Early diagnosis”. Historically, our cancer survival rates have lagged behind the best-performing countries in Europe and around the world. The primary reason for that is, without question, late diagnosis. Sir Harpal Kumar will stand down as chief executive officer at Cancer Research UK shortly, but I had the privilege of having lunch with him a few weeks ago, when I asked him what we should think about in terms of the next cancer strategy. He said, “The rock upon which you build your church is early diagnosis.” I will not forget that, which is why one of the key priorities of the strategy is to diagnose cancer earlier, when the disease is more treatable.

How are we doing that? As part of our drive to ensure early diagnosis, we are also introducing the new 28-day faster diagnostic standard from GP referral to diagnosis or the all-clear. I have often said, and I repeat now, that 28 days is not a target; it is a maximum. I well know that when people have a cancer worry, 28 minutes seems like a lifetime, let alone 28 days. However, the 28-day standard is really important. It will be introduced from April 2020. Five pilot sites have started testing the new clinical pathways to ensure that patients find out within 28 days whether they have cancer or the all-clear.

Today, Public Health England, for which I have ministerial responsibility, has launched its 14th “Be Clear on Cancer” campaign, which focuses on breast cancer in women aged over 70, something that my hon. Friend Craig Tracey—my excellent successor chair of the all-party group on breast cancer—mentioned. That campaign will run until the end of March. It focuses on age-related risk, encouraging older women to be breast aware, and particularly to be aware of non-lump symptoms, which, understandably, have lower levels of awareness.

The other point I want to make on early diagnosis is that we know that the hardest cancers to detect are those where early symptoms can be vague and often symptomatic of less serious illnesses. Patients often see their GP multiple times before that all-important referral. That is why we are piloting 10 multidisciplinary diagnostic centres as part of wave 2 of what we call the ACE— accelerate, co-ordinate and evaluate—programme. Patients presenting to their GP with vague symptoms can be referred to an ACE centre for multiple tests, one after the other, and receive a diagnosis or the all-clear on the same day. The initial findings are incredibly exciting; I do not get easily excited, but I am excited about this. I had the pleasure of visiting one of the ACE pilots at the Churchill Hospital in Oxford last Tuesday, during recess, and I have to say that the enthusiasm and feedback I got from clinicians and patients about the potential of the ACE centres were really quite incredible. I look forward to seeing the analysis on that work in the coming months.

The shadow Minister talked about emergency room presentations, which are something I was quite shocked by as a Back Bencher when I went to all-party group meetings. It is true that emergency room presentations for cancer are horrible, but that is why the 28-day standard and the ACE centres are so important. When I talk to GPs, they tell me that they will refer and that there will then be a wait. Patients who are, understandably, worried and terrified may then present themselves at an A&E, at which point they may be diagnosed with a primary cancer. That then hits the stats around emergency room presentations for cancer. It does not mean that those people have been carried in; they have often walked in. That all explains why we need to grip early diagnosis better than ever.

My hon. Friend David Tredinnick talked about Baroness Jowell’s speech in the other place last month. The Secretary of State was there to listen to the speech, and it was incredibly powerful. Baroness Jowell met the Secretary of State and the Prime Minister this morning. Investment in brain cancer research has been limited by a pretty low volume of research proposals focused on the topic in recent years, and we have been working with charities, academics and the pharmaceutical industry to address that over the last 12 months.

To accelerate our efforts in brain tumour research, the Secretary of State has today announced, alongside Cancer Research UK and Brain Tumour Research, a package to boost research and investment into this most harrowing form of cancer. We have announced £20 million through the National Institute for Health Research over the next five years, with the aim of doubling this amount once new high-quality research proposals become available. CRUK has confirmed it will provide £25 million of its money over five years in major research centres and programmes dedicated to brain tumours. Today’s announcement is incredibly positive.

Photo of Rachael Maskell Rachael Maskell Shadow Minister (Transport)

I have listened patiently and, unfortunately, I was not here at the beginning. However, my constituent has a very rare form of cancer. He has had to self-fund his treatment in Germany and Southampton, but he has run out of money. The treatment meant he did not die within the weeks he was given and is now living. However, he needs top-up therapy, and his individual funding request has been refused. Without his treatment, he will not live. Could the Minister look into this case?

Photo of Steve Brine Steve Brine The Parliamentary Under-Secretary for Health and Social Care

Obviously, I will not comment on the case. I was going to suggest that the hon. Lady gets the clinicians to make an IFR, but she can by all means bring the case to me.

My hon. Friend the Member for North Warwickshire talked about breast density. The UK National Screening Committee commissioned a Warwick University study to investigate the link between breast density and breast cancer. Once complete, if the review suggests that there should be changes to the national breast screening programme, the UK National Screening Committee, which we work with, will consider that under its modification programme. I am in touch with Breast Density Matters, which is a small charity—small but perfectly formed.

The hon. Member for Coventry North East and others talked about blood cancer. We had a very good Westminster Hall debate last month led by my hon. Friend Henry Smith. As has been said, many patients with blood cancer diagnosis will sadly never be cured; they will be on the regime of watch and wait, often over many years, to see whether the cancer has progressed to a point where treatment needs to begin. That can take a huge psychological toll, which Members have mentioned, on the patient and their families.

By 2020, every patient will receive a holistic needs assessment as part of the recovery package, which is excellent. For the blood cancer patient, their recovery plan will be personalised to take account of the unique characteristics of blood cancer, and will include their mental health needs. That is why the Secretary of State announced the additional £1.3 billion last July to expand the mental health workforce. My hon. Friend Mr Jack made that point very well in his speech—I say this as I am passed a note. I love the notes from the Whips.

Photo of Steve Brine Steve Brine The Parliamentary Under-Secretary for Health and Social Care

No, I will not, because I want to finish.

My hon. Friend the Member for Dumfries and Galloway touched on the cancer dashboard, including, yes, rarer cancers. NHS England and Public Health England are currently considering next steps on how we can expand the dashboard. They know that I am frustrated about its being limited to the top four, and I want to see us expand it and do better, and they have had a very clear direction from me on that.

Thangam Debbonaire, as always, spoke brilliantly. What a brilliant advertisement for her all-party group and its inquiry. If there is anything that I can do to help—I do not know about the cost of cancer report, but if she sends it to me, I would love to see it—she knows that she only needs to ask.

The hon. Members for Scunthorpe and for Easington talked about pancreatic cancer. NHS services for pancreatic cancer have significantly improved in recent years, with clearer diagnostic pathways, decision making by specialist multi-disciplinary teams and the centralisation of pancreatic surgery with specialised teams. On 7 February, the National Institute for Health and Care Excellence published the final guidance on the diagnosis and management of pancreatic cancer in adults. This will ensure quicker, I think, and more accurate diagnosis referred to specialist MDTs, and better access to psychological support. The hon. Member for Scunthorpe mentioned tumour profiling tests. NICE has made a decision on that. I will get it to write to me with an explanation of that decision, as he has asked, and I will share that with him.

Let me conclude by paying tribute to the staff who do so much, the patient groups and the charities that are working so hard as part of team cancer—we are all on the same team when it comes to cancer—to implement the cancer strategy and to save lives. We are on track to deliver, we think, but we need to make more progress, especially on early diagnosis and looking further forward on the subject of prevention, as I have said. I thank all Members for speaking today. The fight goes on.

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Mental Health) 4:57 pm, 22nd February 2018

Today’s debate has been so profound and amazing, with so many personal contributions. I have been absolutely astounded by the breadth and depth of knowledge across the House and the absolute dedication to the cancer strategy right across these Benches. I am assured that we will work together, taking things forward very positively and making a difference.

It is important that we have discussed the fact that cancer cuts across the lifespan and recognise the serious issues for young people and their experience of cancer. We also looked at not just the physical aspects, but the mental health aspects and the support that is required. We talked about the fact that treatment has to be holistic and evidence based.

I wish to commend the valuable contributions from charities and our NHS staff. To be honest, their support is invaluable because they are on the frontline. I also wish to mention the very personal contribution of Karen Lee. She made such an amazing speech today. I am sure that, given her experience, she will go on to support and assist so many people, and I am delighted that she is a cancer ambassador. I am sure that many people will benefit from that in the future. Once again, I thank her and everybody here today, and I look forward to working with them on this issue.

Question put and agreed to.


That this House
has considered the cancer strategy.