Non-Invasive Precision Cancer Therapies

– in the House of Commons at 4:06 pm on 18th July 2019.

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Photo of Grahame Morris Grahame Morris Labour, Easington 4:06 pm, 18th July 2019

I beg to move,

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

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

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

Photo of Jeff Smith Jeff Smith Opposition Whip (Commons)

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

Photo of Grahame Morris Grahame Morris Labour, Easington

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

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

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

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

The current system of commissioning for radiotherapy often incentivises trusts not to use their most modern precision radiotherapy machines to their full capability. That means that some patients are treated more often and less effectively, even though there are modern stereotactic ablative radiotherapy machines that could treat them more effectively. Precision radiotherapy is needed to cure 40% of cancers, and all that we want is to ensure that all patients can get to a radiotherapy machine and that the professionals are allowed to switch on the machines and provide the appropriate treatment. However, chronic underfunding and the complications of radiotherapy commissioning and delivery are preventing that from happening.

Radiotherapy receives only 5% of the cancer treatment budget. At £383 million a year, that represents 0.025% of the total NHS budget, and I want to compare that with the cost of just two cancer drugs. The NHS budget for Herceptin—an effective drug that is used to treat about 15% to 20% of breast cancer patients—is £160 million. A recent UK trial showed that only six months, not 12 months, of adjuvant Herceptin may be needed for adjacent therapy, which is when the drug is used in combination with radiotherapy. In financial terms, the NHS could therefore save up to £80 million a year, offsetting much of the additional radiotherapy costs.

It is time to put radiotherapy back at the top of the NHS agenda, and we need someone to advocate for that. We are urging the Department to appoint a radiotherapy tsar who will ensure that the NHS has a world-class radiotherapy service. Many other MPs want to speak in the debate, so I will keep my remarks short. I am pleased that the Government have accepted that advanced precision radiotherapy is more effective and has fewer side-effects.

In summary, I want to see a modest increase in the budget for advanced radiotherapy, rising from 5% to 6.5% of the cancer budget. That would enable large numbers of cancer patients to live longer and more fulfilling lives and would achieve better outcomes and more positive economic benefits. I am keen to ensure that Members have an opportunity to participate in the debate. There are many issues that we need to highlight, including in relation to commissioning, workforce planning and IT networks, so I will leave it at that to allow others to participate.

Several hon. Members:

rose—

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

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

Photo of Gillian Keegan Gillian Keegan Conservative, Chichester 4:15 pm, 18th July 2019

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

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

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

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

During evidence sessions for the all-party group on radiotherapy, the current tariff system came up again and again, including the fact that the tariff is paid per fraction. Clearly, if we have new technology that will reduce the number of fractions, there may be a perverse incentive that would discourage the use of it. Earlier this year, the all-party group visited Elekta in West Sussex, which is pioneering the future of advanced radiotherapy technology, including the MRI LINAC—linear accelerator—machines. Ironically, West Sussex does not have a single LINAC machine—neither the MRI version nor even the standard version—so many of my constituents are travelling as far as London and Brighton for their treatment. Time and again, I have heard from them, and from charities including CancerWise, which is based in Chichester, just how gruelling these daily journeys are. Many adjacent counties have this capability, and I started this journey to make the case for having that capability for my constituents.

It is worth highlighting that £130 million was invested in 2016-17, and that upgraded and replaced machines right across England’s cancer centres. It was the largest investment for 15 years, so we thank the Department of Health and Social Care for it; it was very welcome. However, we are concerned that in the long term, the equipment may not be maintained unless there is a rolling fund. The way we budget for this seems stochastic. We know that the equipment has a life span. As it is all new, perhaps we can now plan for when it is old, and ensure that there is a rolling budget in place. We have mentioned IT. It is vital that we have the latest network, to ensure that all the constituent parts are interconnected.

Radiotherapy is the most incredible resource, and is involved in 40% of cancer cures. It is a cost-effective treatment, taking up just 5% of the cancer budget while treating 50% of cancer patients, but it needs a bigger voice, and I am grateful to my colleagues on the APPG for securing this debate and allowing us to give it that voice.

I would like to take this opportunity to thank the NHS staff across our country who deliver this phenomenal service. The changes that we are discussing could save many more lives. Britain has always embraced innovative technology, so I have no doubt that advanced radiotherapy and integrated IT networks will be the standard in the future; the question for all those suffering from cancer is merely when.

Photo of Tim Farron Tim Farron Liberal Democrat Lords Spokesperson (Communities and Local Government), Liberal Democrat Spokesperson (Communities and Local Government) 4:21 pm, 18th July 2019

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

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

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

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

The major issue in my patch is access. Those needing radiotherapy across our communities in south Cumbria have to travel to the Rosemere unit in Preston. That unit is excellent. The staff are wonderful and the kit is brilliant. There is only one thing wrong with Rosemere: it is far too far away. The National Radiotherapy Advisory Group has said that it is bad practice for people normally to have to travel more than 45 minutes to receive radiotherapy treatment. I drove Kate from Kendal to her treatment in Preston the other week; it was a three-hour round trip. She had been doing that every day for six weeks. For those living in Garsdale, Langdale or Coniston, those trips could be five or six hours, or far longer on public transport, every day for weeks. Those are ludicrous distances to travel to receive vital treatment, and that is why we want a satellite of the Rosemere unit to be based at Westmorland General Hospital.

I spoke to one lady over 80 years of age who was recommended a course of radiotherapy. She decided to forgo that treatment because of the distance she would have to travel. She did not have the option of a shorter journey, so she has instead taken the option of a shorter life. And she is not alone.

A group of leading UK professionals at the British Institute of Radiology met to discuss their experience of setting up satellite centres. They calculated an average 20% uplift on top of the projected figures for those using the service, while the centres of which they were satellites saw no decline in numbers. That means that in areas such as mine, where access to radiotherapy is poor, 20% of people who should be getting radiotherapy are not getting it, but if a satellite centre was built, they would get that treatment. This is not about convenience; it is about saving lives.

My hon. Friend the Member for Easington has already raised the problems with commissioning. I will simply say that 100% of radiotherapy centres in the UK are equipped with SABR—stereotactic ablative body radiotherapy—technology. That is the best technology, giving the most focused and concentrated treatment that is most effective at killing cancerous tissue and causing the least damage to surrounding healthy tissue. That means fewer treatments, fewer side-effects and better results. The scandal, however, is that only 25 of those 52 centres are commissioned to use it.

Is it any wonder that cancer survival rates in this country are among the worst in Europe? We have the second lowest survival rate for lung cancers and below average survival rates for nine of the 10 main cancers. Don’t hear me wrong—I know that radiotherapy is not the only solution. Surgery is vital, as are drugs and chemotherapy. We are very proud of the battle we won to deliver chemotherapy to Kendal—countless people have benefited from that—but when chemo improves survival by 2% whereas radiotherapy improves survival by 16%, we need to think carefully about the disparity in investment.

The simple fact is that radiotherapy lacks the financial backing to be heard. Drugs companies lobby passionately and legitimately for the treatments they provide. Radiotherapy has no such lobby. The all-party group has been struck by the realisation that we are the entire UK radiotherapy lobby, along with those people who work in the industry. Radiotherapy has become a Cinderella service because it lacks a champion. We invite the Minister to become that champion.

Finally, enthusiastically we welcome the Government’s focus on earlier cancer diagnosis, but earlier diagnosis will increase demand for radiotherapy. When tumours are spotted earlier and are smaller, they will need more precise and focused treatment—they will need radiotherapy. Twenty thousand people a year are missing out on radiotherapy already, but if we do not invest now, as more and more cancers are diagnosed earlier, that figure will rocket and this secret scandal will become painfully public.

Our cancer survival rates are distressingly low. Radiotherapy is, after surgery, the most effective cure for cancer—far more so than drugs. It has been left behind in terms of investment for many years under many Governments. This is the moment when that shameful state of affairs must end. People should have the best treatment for their cancer, and where at all possible they should have it close to home—because shorter journeys equals longer lives.

Several hon. Members:

rose—

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

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

Photo of Kate Hollern Kate Hollern Shadow Minister (Housing, Communities and Local Government) 4:28 pm, 18th July 2019

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

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

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

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

Preston is our nearest radiotherapy centre. It is a very short journey from Blackpool to Preston, but Preston is really struggling with workforce, funding and a shortage of oncologists. At least four of the seven machines there are in the second part of their life. There needs to be funding to provide, sustain and maintain the machines. In October 2016, NHS England announced a £130 million investment to spend on upgrading radiotherapy machines. It was welcome, but that money was merely the underspend from the drugs budget. Of the 260 machines in use, approximately 90 needed replacing by the end of 2017. We must ensure that the machines have a sustainable future.

Finally, I want to echo the asks in the “Manifesto for Radiotherapy” for a one-off £250 million investment and an estimated sustained additional £100 million a year to catch up and provide the advanced, modern radiotherapy and IT networks currently needed in the UK. Experts, charities, clinicians and patients are calling for urgent investment in radiotherapy services. Please, Minister, listen, and support the motion before the House.

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

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

Photo of Chris Bryant Chris Bryant Chair, Finance Committee (Commons) 4:33 pm, 18th July 2019

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

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

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

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

UK-wide, only 3% of path labs believe that they are adequately staffed at the moment. This is not to attack the Government in any way, but simply to say that we have to recruit more people. In relation to radiotherapy, the Velindre Cancer Centre in South Wales, a wonderful centre, has a target of seeing and treating 98% with radical radiotherapy within 28 days, but that has not been met in any month in the past year. In January, the figure was just 63%. Why does all this matter? It is because time is of the essence when it comes to cancer. Long waits for biopsy results are absolutely terrifying for the individual, but they may also mean that the treatment is delayed, which makes it less effective than it might be. We could save more lives if we had more people working in these services.

Photo of Liz McInnes Liz McInnes Shadow Minister (Foreign and Commonwealth Affairs) 4:37 pm, 18th July 2019

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

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

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

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

In summary, plans to transform radiotherapy provision and the NHS 10-year plan more broadly must be backed with a long-term cancer workforce plan and associated investment. Without this, the NHS and the Government will simply not be able to fulfil their commitment to patients.

Photo of Paula Sherriff Paula Sherriff Shadow Minister (Mental Health and Social Care), Shadow Minister (Mental Health) 4:41 pm, 18th July 2019

I thank Tim Farron and my hon. Friend Grahame Morris for securing this debate, and the Backbench Business Committee for allowing the time for it.

As my hon. Friend Kate Hollern said so poignantly this afternoon, cancer is a disease that touches all of us. In my case, it was my lovely dad who was diagnosed with bowel cancer in his 50s. Thankfully, due to early diagnosis and amazing NHS expertise, he survived. I am truly blessed that he is still with us. However, not everyone is that lucky.

I also pay tribute to my hon. Friend Chris Bryant, who, with his typical fortitude, eloquence and courage, spoke about how important it is that people seek all-important help upon noticing symptoms.

Of those of us born in the UK after 1960, almost half of us will be diagnosed with cancer at some point in our lifetime, and around a quarter of us will receive some form of radiotherapy. These are scary statistics. Radiotherapy is not some obscure treatment that is easy to ignore because it only happens to someone else. Statistically, every fourth person in this room will have had or will at some point need radiotherapy. If nothing else, from a purely self-preservation perspective it is in all our interests to ensure that the provision of radiotherapy is exemplary.

Although the UK has a long history of being active in radiotherapy research due to having a much higher radiotherapy machine capacity and a larger workforce than elsewhere, access to radiotherapy in many parts of northern Europe is now superior to that in the UK. Radiotherapy need in the UK is expected to rise by a further 25% by 2025, but as things stand and as has been demonstrated today, the provision of radiotherapy across the country is patchy at best. Indeed, it is widely held by the experts that up to 24,000 people may be missing out on the radiotherapy they need, resulting in thousands of unnecessary or premature deaths each year. This is simply not good enough.

The advanced radiotherapy techniques of today are the standard techniques of tomorrow, and we need to invest in ensuring that these treatments are easily accessible for all patients across the country as soon as possible. There have been major breakthroughs in radiotherapy in the last 10 years. Technological advances have made radiotherapy treatments safer and more effective, improving cure rates with fewer short and long-term side effects—often to the point where patients can even continue working during the course of their treatments.

Advanced radiotherapy is now an extremely effective treatment in curing cancer when the disease is detected early enough, and for palliating symptoms when a cancer has spread. However, this advanced radiotherapy is not currently available across all of the UK, with many advanced radiotherapy techniques available at only a small number of centres, as the hon. Member for Westmorland and Lonsdale pointed out.

Radiotherapy centres across the UK are unevenly distributed, and although it is estimated that radiotherapy is needed to treat more than half of all diagnoses of cancer, access to it in England varies between 25% and 49% of cases, depending on the region. The charity Action Radiotherapy reports that patients understandably want to be able to access the best quality radiotherapy as close to home as possible. Only 57% of the people surveyed said that they would be willing to travel as far as was necessary to get the best radiotherapy treatment available, with many opting for shorter travel times and convenience over quality. It is vital, therefore, that we ensure that the best possible treatment is available consistently across the UK, so that every patient is able to access the best high-quality radiotherapy for their individual cancer, without needing to worry about the added stress and inconvenience of lengthy travel times and distances and the associated costs.

However, tackling barriers to access is not only about travel and distance. Having radiotherapy can be very tiring, so greater consideration needs to be given to the quality of support that people receive throughout their treatment—for example, the provision of free parking and accommodation where needed or allowing people to book all their appointments in advance. Different types of radiotherapy techniques are not always available in the UK centres that are willing and able to deliver those treatments, and evidence suggests that some patients are missing out due to a failure of appropriate commissioning of the specific therapies they require.

One story I have heard about is Robert’s. When examining the surgery versus radiotherapy option, Robert was offered the opportunity to take part in a trial that explored whether, by using stereotactic ablative radiotherapy, or SABR—a type of non-invasive therapy—the number of radiotherapy treatments he would receive could be condensed to just five sessions, as opposed to the 20 currently recommended. For obvious and understandable reasons, the chance to have a short course of radiotherapy treatment appealed to Robert, and he underwent five sessions in just one week. It is disappointing, then, that such advanced techniques are available at only a small number of centres, reducing patient access.

As the cross-party manifesto for radiotherapy outlined, £100 million a year is needed to catch up and provide the advanced modern radiotherapy currently needed in the UK. A one-off £250 million would be required to secure equal access for all radiotherapy patients over the next 10 years, with cutting-edge technology. Unfortunately, the commitment that we have from the Government thus far falls far short. As we have heard this afternoon, current spending levels on radiotherapy fall well short of our comparable international partners, and UK cancer survival rates lag behind the European average for nine out of 10 cancers.

As we have heard from my hon. Friends the Members for Heywood and Middleton (Liz McInnes) and for Rhondda and Gillian Keegan, a further clear and pressing concern is that our current oncology workforce is simply not large enough to meet current demand. There are inadequate plans to increase the workforce to ensure that it will have the capacity for our future needs.

Without drastic and immediate action to remedy the chronic, NHS-wide staffing crisis, we are in no position to deliver the improved radiotherapy treatments that we both deserve and have been promised. Per head of population, the NHS now ranks among the lowest in the western world when it comes to the number of doctors, nurses and hospital beds, according to King’s Fund analysis of OECD health data. Analysis from the Health Foundation showed that the number of personnel leaving the NHS because of a poor work-life balance has trebled in the last seven years.

The NHS workforce remains overstretched, overworked and undervalued. Much like the rest of our NHS, our radiotherapy services and staff need transformative actions, not words, to provide the world-class care that patients deserve. To address that, we would like a national plan for the funding of radiotherapy equipment, to enable every patient to have access to the appropriate treatment. Funding models should act to support innovation and research, and should incentivise new and novel ways of working, but the current tariff funding of radiotherapy per fraction is clearly not fit for purpose. It can disincentivise novel ways of working, such as delivering a smaller number of fractions with a more complex technique.

As I said at the start of my speech, as many as 24,000 people are not receiving the radiotherapy they need. That cannot be allowed to continue. We must do more, today, to ensure that all those who need it are able to access not only radiotherapy but the best, high-quality radiotherapy available for their specific cancer. With sufficient investment and development, the UK can develop a world-class, patient-first radiotherapy service. I will do all I can to ensure that we achieve that goal.

Photo of Seema Kennedy Seema Kennedy The Parliamentary Under-Secretary for Health and Social Care 4:49 pm, 18th July 2019

I want to begin by thanking Grahame Morris for introducing the debate and all Members who have spoken today, particularly Kate Hollern, who spoke movingly about her late partner, John. His example lives on through his two beautiful daughters—my beautiful cousins—who, too, have dedicated their lives to public service. I am happy to reassure all Members that I am very happy to meet the all-party group—fingers crossed—and if I fail to address any of the points made today, I will try to address them at that meeting.

Cancer is a priority for this Government, and we have got survival rates up over the last 10 years, but there is a lot more to do. In the long-term plan, we state our aim to have 55,000 more people surviving cancer for five years by 2028. Four in 10 NHS cancer patients are treated with radiotherapy, so clearly radiotherapy is a really important part of the mix. I did not know about that until I met members of the APPG. I want to thank them for the manifesto that they presented to me, which I have read with interest and am happy to respond to.

NHS England announced a £130 million fund, which the hon. Member for Easington mentioned, to start a programme of modernising LINACs and giving patients access to leading-edge technology, regardless of geography. I will come on to the specific point raised by Tim Farron, because we share Rosemere as a cancer centre.

Since 2016, we have seen more than 80 machines either upgraded or replaced, with the aim of giving cancer patients access to the latest technology, regardless of where they live. The long-term plan specifically promises

“Faster, smarter and effective radiotherapy”, with an aim of providing curative treatment, with fewer side effects and shorter waiting times.

Members mentioned the facilities at the Christie Hospital. Some of my constituents go there as well. The good thing is that previously some people had to leave the country, but at least now people are able to be treated in this country. The first treatment was last December. Work continues on the University College London Hospitals proton beam therapy centre, which we hope will be opened next year.

Photo of Chris Bryant Chris Bryant Chair, Finance Committee (Commons)

I commend the Minister for everything she has said, but it is slightly easier to put new kit in and build new buildings than it is to develop new staff. The biggest difficulty is with the number of radiologists and the whole staffing element. I wonder whether she could co-operate with colleagues in Wales, because this is a UK-wide issue.

Photo of Seema Kennedy Seema Kennedy The Parliamentary Under-Secretary for Health and Social Care

I will come on to talk about workforce, and I will also talk to my officials about meeting my counterparts in the devolved Assemblies, because that keeps coming up. I cannot say anything from the Dispatch Box because I do not know the protocol on that.

Fifteen million pounds has been committed to evaluate treating patients with SABR. There are 25 providers, and it is to treat early non-small cell lung cancer. I know that there are problems with lung cancer treatment. There are only 25 centres at the moment while there is assessment of emerging clinical evidence. NHS England is investing a further £6 million to support the great work that Cancer Research UK is doing on SABR clinical trials. This is regularly reviewed by NHS England’s national specialised commissioning team and was last reviewed during 2016-17. It is expected that access will be reviewed again over the course of 2019-20 to 2020-21.

Several Members talked about the tariff. Radiotherapy services are funded through national prices, linked in the main to the number of radiotherapy fractions delivered. Any change to the income that trusts receive for radiotherapy would therefore require a change to the national tariff. We must continue to ensure that NHS payment mechanisms support the delivery of the most effective treatments. That is why the long-term plan set out NHS England’s commitment to review the national tariff, in particular to ensure that appropriate incentives are in place to encourage providers to deliver the modern techniques that we all need—the ones of today and tomorrow—and that work commenced this year.

The long-term plan also sets out NHS England’s intention to use its capital settlement, which will be negotiated in the upcoming spending review, in part to continue to replace radiotherapy equipment. I will not pre-empt those negotiations, but I think that shows a clear and ongoing financial commitment to modernising NHS radiotherapy.

We have published specifications for operational delivery networks for adult external beam radiotherapy services. That is about the 11 radiotherapy networks, and I have spoken to the hon. Member for Easington specifically about satellite services. The point is that decisions on cancer services need to be taken locally. The networks have been established—the cancer alliances—so I urge all hon. Members to encourage their local services to engage in those, because that is really what we need.

With regard to the workforce, which is mentioned in every debate on cancer, the interim people plan was published recently. The noble Baroness Harding has met the all-parliamentary party group on cancer and is fully apprised of what it is saying. The final people plan will be published later this year.

I will draw my remarks to a conclusion, because I want to leave the hon. Member for Easington enough time to sum up the debate. This has been an excellent debate. I thank the hon. Gentleman for all the work he does with Members across the House. There has been progress, but I know that there is more to do. I am happy to meet the APPG to discuss this further. We need to do more to increase cancer survival rates. We have a very ambitious target. I am happy to work with him and with all hon. Members to ensure that radiotherapy is a vital part of the battle against cancer.

Photo of Grahame Morris Grahame Morris Labour, Easington 4:56 pm, 18th July 2019

I thank the Minister for that considered and helpful response. I can assure her that the spirit of our contributions, and of the all-party parliamentary group, is intended to help, not to hinder progress. We certainly give her credit for the aspiration to improve cancer outcomes and to see a first-class service. We want to see that in all parts of the United Kingdom.

I thank all Members who participated in the debate. Gillian Keegan highlighted the perverse incentives, which have been identified in the all-party parliamentary group’s inquiries. Tim Farron mentioned the satellite centres and the number of people being denied life-saving therapy. My hon. Friend—my dear friend—Kate Hollern, in a deeply moving contribution, talked of her personal experience. My hon. Friend Chris Bryant talked about the importance of workforce planning and early diagnosis. My hon. Friend Liz McInnes also mentioned workforce issues. My hon. Friend Jeff Smith talked about the exciting developments in proton beam therapy at the Christie Hospital. My hon. Friend Paula Sherriff gave an excellent response on behalf of the Opposition.

I also want to thank all the staff involved in delivering cancer services. We value the contribution they make—each and every one of them—and we are absolutely dedicated to ensuring that the issues we have raised here are followed through.

I have one point to make on tariffs and perverse incentives. As part of our efforts we have met extensively with NHS England. Addressing that is potentially a quick win for the Government, because it would not involve evaluating new techniques and could be done quickly. My suspicion is that NHS England does not intend to implement that for some time—in years rather than months—so I hope that the Minister will take that up immediately.

Question put and agreed to.

Resolved,

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