Non-Invasive Precision Cancer Therapies

Part of the debate – in the House of Commons at 4:21 pm on 18th July 2019.

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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.