Breast Cancer Diagnosis and Services: Covid-19 — [Esther McVey in the Chair]

– in Westminster Hall at 1:30 pm on 12th November 2020.

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Photo of Esther McVey Esther McVey Conservative, Tatton 1:30 pm, 12th November 2020

I remind hon. Members that there have been some changes to normal practice in order to support the new call list system and ensure that social distancing can be respected. Members should sanitise their microphones using the cleaning materials provided before they use them and then dispose of those materials and respect the one-way system around the room.

Members should only speak from the horseshoe and Members can only speak if they are on the call lists. That applies even if debates are undersubscribed. Members cannot join the debate if they are not on the call list. Members are not expected to remain for wind-ups. I remind hon. Members that there is less of an expectation that Members stay for the next two speeches once they have spoken. This is to help manage attendance in the room. Members may wish to stay beyond their speech, but they should be aware that doing so may prevent Members in the seats in the Public Gallery from moving forward to the seats on the horseshoe.

Photo of Craig Tracey Craig Tracey Conservative, North Warwickshire 1:31 pm, 12th November 2020

I beg to move,

That this House
has considered the effect of the covid-19 outbreak on breast cancer diagnosis and the future of breast cancer services.

It is a pleasure to serve under your chairmanship, Ms McVey. As co-chair of the all-party parliamentary group on breast cancer, I am delighted to raise these hugely important issues. It is great to see the Minister in her place; she brings great expertise and knowledge to this topic. This has all the hallmarks of an excellent debate.

To set the scene, as hon. Members will know, the pandemic has had a major impact on breast cancer services, with Breast Cancer Now estimating that almost 1 million women in the UK missed out on their screening appointment as a result of a pause in the programme. There was a worrying drop at the peak of the pandemic in referrals of suspected breast cancer and breast-related symptoms.

We also know that some breast cancer patients had their treatments changed or temporarily paused to protect their immune system, or had their surgery delayed. That caused, understandably, huge anxiety, particularly for patients with incurable cancers, such as secondary breast cancer, and that was passed on to their families. Recruitment to many clinical trials was paused. The sustained pressure on staff as a result of dealing with the covid-19 pandemic alongside the existing challenges for the breast cancer workforce, has the potential to overwhelm the system for the foreseeable future.

There is some good news. Despite a dip in August, referrals have been steadily recovering. Although there is some way to go before they reach pre-pandemic levels, breast screenings are restarting and the number of people beginning treatment is rising. I am sure hon. Members across the House will join me in thanking the NHS for its effort in treating people and finding ways to deal with cancer patients during the pandemic. I would particularly like to thank my local hospital, the George Eliot Hospital, and Kristy and her team in palliative care. They do such amazing work, in difficult circumstances.

The recovery plan set out how we will restore breast cancer services to pre-pandemic levels, but we also need to look to the future, to ensure that the progress we made in treating cancer is not allowed to stall or be forgotten. As I mentioned, the pandemic has raised several urgent issues in relation to cancer. It is fair to say that many of those needed tackling prior to the pandemic, and they still need addressing.

In 2018, a report by the APPG on breast cancer showed that while breast cancer outcomes were good and outperforming those of other cancers, inequalities in diagnosis, treatment and care across the country were being masked, impacting the experience and outcomes of patients. Our inquiry also found significant variations across England in the support that women with secondary breast cancer received, particularly in access to a clinical nurse specialist, patchy provision of information, psychosocial needs not being met, and a lack of prompt and timely access to specialist palliative care services.

I know that hon. Members will all have their own angles that they want to address in today’s debate, and I take the opportunity to thank the many organisations that have been in touch with their views on what we could discuss. However, I want to focus my remaining remarks on secondary breast cancer, which is an issue that the APPG has had a particular focus on. For hon. Members who are not aware, secondary breast cancer occurs when breast cancer has spread to other parts of the body. Critically, it cannot be cured, but it can still be treated. To put that in context, about 1,000 women still die every month from breast cancer in this country, and pretty much all those deaths are from secondary breast cancer, so it is a considerable issue that we need to address.

Five years ago, in October 2015, I hosted my first ever Westminster Hall debate, which was on the subject of secondary breast cancer. I spoke about the inequalities in the system, and the fact that secondary breast cancer patients were often overlooked. It was in that debate that the present Minister, my hon. Friend Jo Churchill—then a Back Bencher—spoke so powerfully about her experiences and battles with cancer. I know this is an issue that she is really passionate about getting right, but sadly, for various different reasons, since my 2015 speech nothing much has changed. I know that that frustrates the Minister as much as it does me.

The research continues to show that although many secondary breast cancer patients receive inadequate care, it is all too often even worse than that which they received when they had their primary diagnosis. That cannot be right in this day and age. The 2015 debate noted how much of the current discussion and debate on cancer focuses on promoting early diagnosis of primary breast cancer and improving survival outcomes, which is absolutely right; we should be dealing with that, but a crucial part of any strategy has to be that we do not forget about people who are living with incurable cancers. They should be given parity of care in our system.

There are many things that we could do, including focusing on earlier diagnosis of secondary breast cancer and increasing knowledge and understanding of the signs and symptoms of it. However, I want to focus on two areas; if we addressed them, it would make such a difference to patients who have secondary breast cancer. The first is around data, which is one of the key issues. One of our problems that is that we have a real lack of understanding of the data on secondary breast cancer. At the moment, we do not know how many people are diagnosed with it each year, how long they are living for, how the disease spreads or what kind of treatment and support they are receiving.

Where data on secondary breast cancer is collected, there is variation in what is recorded and how that is done. That is despite its being mandatory since 2013 for hospitals to collect data on their new diagnoses of metastatic cancer. Research by Breast Cancer Now in 2016, repeated in 2018, showed that that is still routinely not happening. In the 2018 study, a staggering 40% of hospital trusts and health boards across the UK were still unable to tell Breast Cancer Now how many secondary breast cancer patients were under their care.

I brought up that issue in the 2015 debate on secondary breast cancer. I highlighted some of the practical barriers to data collection, which often include IT constraints, constraints of time within hospitals, their structures, a lack of awareness about what data is required, and confusion in the trusts and hospitals about who was responsible for inputting the various data items.

Photo of Grahame Morris Grahame Morris Labour, Easington

The hon. Gentleman is making an important and powerful point, and I hope the Minister is taking note. As he rightly says, many older people—particularly older women—with breast cancer were not prioritised to receive breast radiotherapy over the past six months. Data is available in the radiotherapy datasets that are held by Public Health England, but they have not been published so far. Does he agree that the Minister should seek to persuade NHS England to publish that data?

Photo of Craig Tracey Craig Tracey Conservative, North Warwickshire

The hon. Gentleman raises an interesting point, which I am sure the Minister will address. It makes perfect sense that we are seeing the lack of cohesion in data. We know that data is power in everything—without the data, how can we plan a strategy? Wherever we get it from, it should be imported into the system. In the 2015 debate, I asked the Minister to lead the way on ensuring that the data was collected uniformly in every hospital, and not just collected, but collected in a format that enables us to interpret it. We need that now more than ever.

I felt that we were making some headway at the start of the year. I had a productive meeting with my right hon. Friend the Secretary of State for Health and Social Care, where we brought in some secondary breast cancer patients and had a really good discussion on a number of topics. Data was one of the key things that we addressed. The Secretary of State made very positive noises about the potential for a national secondary breast cancer audit. Unfortunately, shortly after that, we ended up in the grip of the pandemic and I appreciate that the Department’s focus has been pulled into different areas.

To return to the point that I have made, without accurate figures for the number of people living with secondary breast cancer, it is nigh-on impossible for the NHS to plan and commission services effectively to meet patients’ needs. Equally, without understanding the level of service and care that patients were accessing before the pandemic, it will be challenging to know how to improve outcomes when we get back to pre-pandemic levels. How can we hope to do that without knowing where we started?

Inadequate collection and sharing of data acts as a barrier to service improvement. We are missing out on an incredibly powerful tool that we should be using to spot variation and hold services to account, and to better understand the secondary breast cancer population and the service it requires. At a time when long-term local and national plans are being drawn up, we want to ensure that the NHS can fully deliver on its commitments, and that we have a clear understanding of the experiences of people with secondary breast cancer.

I ask the Minister to follow up on the delivery of a national secondary breast cancer audit, which would cover things such as diagnosis, treatment and access to support. That could transform our insight into this key area and provide the missing information that is desperately needed to ensure that the NHS can meet the needs of those living with secondary breast cancer.

The second point that I will touch on is the importance of increasing access to clinical nurse specialists. In the 2015 debate, I said that the cancer patient experience survey showed that when a clinical nurse specialist contributes to a patient’s care, it is the biggest driver in improving their experience. That measure could save money in the long term, by keeping patients out of hospital and highlighting problems before they become crises in A&E. That is particularly true for secondary breast cancer patients, because they are on a lifelong treatment pathway and often have complex emotional and supportive care needs. A recent survey found that less than a third of secondary breast cancer patients had seen a CNS regularly. With the number of men and women developing breast cancer increasing, and people with secondary breast cancer living longer with the disease, there was already a high demand for CNSs. With covid-19 resulting in changes to people’s treatment and care, however, while also having an impact on their emotional wellbeing, access to CNSs for secondary breast cancer patients has never been more urgent.

Yet Breast Cancer Now’s most recent report said that 41% of breast cancer patients felt they had had less contact with their CNS during the lockdown period. That was partly down to the fact that, in common with other parts of the workforce, many CNSs were moved elsewhere in the NHS during the peak of the pandemic. As an example, 400 Macmillan NHS professionals, including Macmillan-funded CNSs, were among those redeployed.

I am sure all hon. Members agree that it is encouraging that the NHS long-term plan commits that everyone, including those with secondary cancers, should have access to a CNS. There was also an additional commitment in the recent people plan 2020-21 to offer grants for 250 nurses to become cancer nurse specialists. That is another step in the right direction, which we really applaud, but the commitments made by the Government require investment in training and expanding of the CNS workforce to meet both the current and future challenges. I am sure we all want that to be addressed when the full NHS people plan is published, and I am sure we all want it to be matched in its intent by receiving the necessary funding in the upcoming spending review.

I realise many people want to speak. There is much more that I could talk about, but I will conclude and recap the asks, which are pretty straightforward. We need a secondary breast cancer audit and a fully funded long-term workforce plan to ensure that the Department of Health has the appropriate tools and structures to honour its commitments to deliver the best possible outcomes for all cancer patients, and to build back breast cancer services better following the pandemic.

Photo of Esther McVey Esther McVey Conservative, Tatton

It might be helpful for colleagues to know that I intend to get to the Front-Bench speakers no later than 2.30 pm, so, to enable everybody to get in and speak, speeches will be limited to four minutes. Also, will the Front-Bench speakers be mindful of the time, because we want to hear Craig Tracey again?

Photo of Stephanie Peacock Stephanie Peacock Shadow Minister (Environment, Food and Rural Affairs) 1:46 pm, 12th November 2020

It is a pleasure to serve under your chairmanship, Ms McVey. I pay tribute to Craig Tracey for securing this important debate. He has spoken incredibly passionately and covered a wide range of issues relating to breast cancer. I want to focus my remarks on two issues. First, I want to speak about the need for a cancer recovery plan to deal with the backlog in breast cancer screening tests and get cancer treatments up and running again. Secondly, I want to speak about the need for urgent action to prevent the widening health inequality gap in this country.

Over the past few months, we have seen spiralling wait lists, the longest since records began. That has had a direct and devastating impact on people’s health. I have heard stories of frontline workers who have had their cancer screen test delayed, only to find out months later that their cancer has spread. It is a simple fact that the sooner someone has a cancer diagnosis, the more likely they are to survive. In March, breast cancer screening programmes were put on hold. One week into the second national lockdown, people are worried that that might happen again, and they fear for loved ones who might not get the care that they need.

In response to a parliamentary question that I asked, the Government revealed that nearly 10,000 women are waiting for a breast cancer screening in Barnsley alone, and more than 30,000 women in South Yorkshire. We have a postcode lottery in this country when it comes to breast cancer screening and mortality rates. Depending on where someone lives, they can be up to a third less likely to have attended a breast cancer screening in the last three years. Staffing pressures have directly impacted the capacity of the NHS to screen patients for suspected cancer, affecting the speed at which patients are diagnosed.

A Public Health England report found that the number of empty consultant breast radiologist posts in the country doubled between 2010 and 2016. The same report revealed that all breast radiologists in Yorkshire and the Humber are due to retire by 2025. Has the Minister’s Department assessed the impact of the pandemic on recruitment, and will she outline the Department’s plans to deal with the staffing crisis?

Health inequality in this country is not new. Life expectancy in Barnsley is five years lower than in Kensington and Chelsea. The pandemic threatens to widen existing health inequalities as areas such as mine face the double impact of more covid-19 cases and severe financial hardship because of the restrictions. As has already been mentioned in the debate, we need comprehensive, accurate data on patients and populations to map health inequalities across the country. This includes improving the cancer outcomes and services dataset so that patients and local providers can quickly and easily compare information on all cancers, including breast cancer. More needs to be done to support local providers to ensure they submit information to the dataset. It is the first step towards recognising the scale of health inequalities faced by this country and taking action to increase service improvement.

Covid-19 has not been a great leveller. Inequalities in care, treatment and diagnosis have come to light during the pandemic. At the same time, it is now widely recognised that societal inequalities have increased certain populations’ likelihood of suffering complications from the virus. It is clear that unless the Government act now to reduce the unequal impact of covid-19, those inequalities will become further entrenched, directly impacting the health and wellbeing of people across the UK.

Photo of Elliot Colburn Elliot Colburn Conservative, Carshalton and Wallington 1:50 pm, 12th November 2020

It is a pleasure to serve under your chairmanship, Ms McVey. I add to the tributes to my hon. Friend Craig Tracey for calling this important debate and speaking so powerfully at the outset about this issue.

This subject is especially pertinent because cancer, sadly, will touch each of our lives in some form. If we are not personally diagnosed, we will know someone close to us who is. It is one of the biggest long-term health challenges we face as a country, notwithstanding the current pandemic. Coronavirus has impacted on breast cancer services, as it has impacted on every part of our lives. Breast Cancer Now has described coronavirus as “the biggest crisis” that breast cancer has faced in decades.

As Stephanie Peacock outlined, the earlier breast cancer is diagnosed, the more likely treatment is to be successful. Earlier this year, the screening programme was officially paused in Scotland, Wales and Northern Ireland, and it was effectively paused in England from March. Screening has now restarted, but it is patchy across the country, with some having quicker access than others. With each month that passes, more women with breast cancer could be missing the chance of an early diagnosis, which is key to preventing deaths from the disease.

As my hon. Friend the Member for North Warwickshire pointed out, Breast Cancer Now estimates that nearly a million women who require screening are currently waiting across the United Kingdom, and around 8,600 of them could be living with undetected breast cancer. This has been exemplified in my Carshalton and Wallington constituency. As part of the London borough of Sutton, we are lucky to be home to the world-leading Royal Marsden Hospital. I want to put on record my thanks to Dame Cally Palmer and the amazing staff at the Royal Marsden whom I had the pleasure of visiting recently.

Sutton is also home to the Institute of Cancer Research, which is expanding in conjunction with the Royal Marsden to become the first cancer hub in London and, indeed, the UK—right on our doorstep. That will provide thousands of highly skilled jobs for the area, and it is massively exciting for the future of cancer research. Sutton could well be the site of a major breakthrough in cancer research. The ICR and the Royal Marsden do a fantastic job. The latter stepped up and played its role in tackling the pandemic, adapting to deal with coronavirus patients, but that meant, sadly, that cancer patients had their diagnosis delayed, as did so many others.

In the second national lockdown, it is most important to ensure that those services are not paused again. I am pleased that that has not happened in my part of London, but we must have a plan to deal with the backlog as soon as possible. The NHS long-term plan is ambitious when it comes to cancer. I worked on that when I was in the national health service. However, there were challenges in dealing with the cancer strategy even before covid-19.

We have already heard about the existing problems in the workforce, and we need a plan for the implementation of Professor Sir Mike Richards’s review of the adult screening programme. I can see the Minister is nodding, so I hope she will add a few words on that. I hope she will tell us how we intend to deal with that backlog and return to the implementation of the ambitions in the long-term plan.

Photo of Grahame Morris Grahame Morris Labour, Easington 1:53 pm, 12th November 2020

Thank you for calling me in this important debate, Ms McVey. I thank Craig Tracey for securing it. We are from the same part of the country, but from different tribes; I am red and white.

This is an important subject, and it is important that we address it. We are living through an unprecedented pandemic. I was saddened and alarmed to read yesterday that the UK had become one of only five countries to exceed 50,000 deaths from covid-19. In the fullness of time, no doubt, we will have a public inquiry into covid-19 that will examine the flaws in the Government’s covid-19 response. I certainly believe that the Government will acknowledge that they were not properly prepared for a pandemic and did not have a proper and effective plan to manage infectious disease and routine day-to-day healthcare.

The impact on breast and other cancers has already cost lives and will continue to do so, but I want to focus on the cancer recovery plan. The Government can take steps to avoid unnecessary cancer deaths arising from the backlog of delayed diagnosis and treatment. I have met the Minister on several occasions in my capacity as vice-chair of the all-party group for radiotherapy and the all-party group on cancer, and we have had constructive dialogue, so I am afraid she will not be able to argue that solutions were not put forward to address this issue and mitigate potential deaths arising from delayed treatment.

The Catch Up With Cancer campaign, which Radiotherapy4Life is supporting, has identified that the cancer backlog stands at more than 100,000 patients. I recently had a meeting via Zoom with Macmillan cancer support—I am one for badges; I am wearing Radiotherapy4Life’s and Macmillan’s—to discuss what needs to be done to address the cancer backlog. It estimates that there are 50,000 missing diagnoses for cancer across the UK—it calls them the forgotten C. An estimated 100 fewer women started treatment for breast cancer each working day in May and June, compared with last year. Breast cancer two-week wait referrals are down 25% in March to August this year, compared with 2019.

I was joined on the call by a representative from Macmillan’s Joining the Dots campaign—a lady called Chloe Shaw, who is doing excellent work. That brilliant local service, which may be available in other parts of the country, offers practical help and support to people affected by cancer—in my case, those living in County Durham and my constituency of Easington. Joining the Dots has supported people in my constituency living with cancer throughout the pandemic. At the moment, it is having to work primarily through telephone and video calls.

Macmillan estimates that there are currently almost 18,000 people in County Durham living with and beyond cancer—people who have already been diagnosed may be fearful that there will be a recurrence. It is estimated that that figure could rise to almost 29,000 by 2030.

As vice-chair of the all-party parliamentary group on radiotherapy, I am particularly interested in this issue. In the Chamber today we have a number of former Ministers who have been banging this drum for some time. The issue now is the impact of the pandemic on the availability of radiotherapy treatment. We really must do something for the many older women with breast cancer who have not been prioritised to receive radiotherapy over the past six months. The data is available and should be acted upon. Will the Minister publish those datasets? We certainly need smart solutions and investment, but they must be reflected in a comprehensive spending review, so I hope the Minister will make the necessary representations to the Treasury.

Photo of Robert Largan Robert Largan Conservative, High Peak 1:58 pm, 12th November 2020

It is a pleasure to serve under your chairmanship, Ms McVey. I congratulate my hon. Friend Craig Tracey on securing this timely and important debate. I pay tribute to the work that he and the all-party parliamentary group have done on this issue over a number of years. It has been really important.

We have come a long way in this country on breast cancer survival rates over the past few years, but about 11,500 women still die every year from the disease. We know that early diagnosis is absolutely vital when it comes to survival rates, so I am very concerned about the impact that the pandemic has had and continues to have.

In my constituency in the High Peak, a commissioning decision was recently taken by NHS Midlands to withdraw the breast cancer mobile screening units from three towns—Buxton, Chapel-en-le-Frith and New Mills—and to move that service outside the High Peak to Bakewell. This is no slight at all on Newholme Hospital in Bakewell and the fantastic staff there—I pay tribute to them and to all the NHS staff working in breast cancer screening services—but there is a question of accessibility. The Peak district does not have the best roads; we are heading into winter, when those roads become even more inaccessible. Public transport is patchy at best, and I am incredibly concerned about how many women will feel unable to make appointments if they have to go all the way to Bakewell. I am alarmed about this decision, and it is one that I disagree with. I really hope that we can reinstate the mobile screening units in the High Peak as soon as possible. My message to the Minister is clear: we desperately need to get those units reinstated, and I hope that I can meet her to talk about this in the near future.

Photo of Helen Hayes Helen Hayes Shadow Minister (Cabinet Office) 2:01 pm, 12th November 2020

It is a pleasure to serve under your chairship, Ms McVey. I, too, congratulate Craig Tracey on securing this important debate.

This year has been incredibly difficult and challenging for everyone working in our national health service, for the patients they serve and for the staff and volunteers at the many charities and community organisations that help to support patients and carry out critical research, including Breast Cancer Now, Breast Cancer UK, Macmillan Cancer Support and Cancer Research UK. I pay tribute to them, and to every one of the staff who work in King’s College Hospital in my constituency for their incredibly hard work since the start of the coronavirus pandemic. Our nurses, doctors, care assistants, allied health professionals, porters, cleaners and admin staff have all worked with extraordinary commitment in exceptionally challenging times.

Breast cancer is a devastating condition, and every year across the UK more than 50,000 women, as well as approximately 400 men, receive their first diagnosis of it. I pay tribute to Tracey Crouch and to my friend Paula Sherriff, the former Member for Dewsbury, for speaking publicly about their recent experience of diagnosis and treatment during coronavirus—an experience that is made all the more difficult by the restrictions on contact with friends and family, who are often so vital in providing comfort during a difficult time.

Although our NHS staff have worked so incredibly hard this year, as always, the coronavirus pandemic has exposed the impact of 10 years of austerity on our healthcare system. In many parts of the country, including my constituency, our NHS was not able simultaneously to care for patients impacted by coronavirus and to maintain the array of other critical services, including cancer screening. Our local hospital worked extraordinarily hard to maintain cancer treatment, but across the NHS the need to cope with the huge influx of coronavirus patients and prevent further infection spread, particularly among clinically vulnerable people, caused significant disruption to surgery pathways.

Many people also became concerned that GP surgeries and accident and emergency departments were not safe environments, and therefore they put off reporting concerning symptoms that might have been the first sign of cancer, including breast cancer. The breast screening programme was officially paused in Scotland, Wales and Northern Ireland, and effectively paused in England, in March. At the peak of the pandemic, there was a drop of approximately 70% in the number of cases of cancer being reported across the UK, with Breast Cancer Now estimating a drop of more than 100,000 referrals for breast cancer.

As we know, early diagnosis is key to obtaining the best possible outcomes for patients who are eventually diagnosed with cancer. As MPs, unfortunately I am sure that we are all aware of constituents whose diagnosis came much later than it should have done, because the impact of the coronavirus pandemic. However, even for those constituents who managed to receive a diagnosis, there have often been unacceptable waiting times for treatment that was urgently needed. The stress of knowing that urgent surgery is needed to remove breast cancer, but not having a firm appointment or timescale for such surgery, has been unbearable for a number of my constituents.

Exercise Cygnus clearly showed that the UK was hugely underprepared for a pandemic such as covid-19, but instead of learning the lessons from 2016, this Government buried them. That has resulted in unbearable strain on many parts of our NHS. Just a few days before the second national lockdown, I visited King’s College Hospital to thank the staff for their tremendous hard work and to discuss the preparations for the second wave of coronavirus. It was reassuring to hear about the detailed planning that has been carried out for the second wave, and about the focus on keeping non-coronavirus treatments and care going at this time, but we know that there is a backlog.

I want to end by highlighting the inequalities that already exist in gaining access to breast cancer treatment and screening, with black, Asian and minority ethnic residents far less likely to access screening and far more likely to end up with a late diagnosis. We urgently need a proactive programme to ensure that there is equal access to screening services, that this pandemic does not result in a further deepening of unequal access and that all breast cancer patients get access as soon as possible to the treatment and care they need.

Photo of Steve Brine Steve Brine Conservative, Winchester 2:05 pm, 12th November 2020

Another debate about breast cancer. There have been many—too many. For my first five years in this place, I was proud to lead the all-party parliamentary group on breast cancer, and it is in good hands now with my hon. Friend Craig Tracey. For more than two years, it was the privilege of my life to serve as the cancer Minister and to be part of what I call team cancer. Heaven knows, I spent my fair share of time sitting in the Minister’s seat in Westminster Hall, as she—the current Public Health Minister—now knows.

For each of the 10 years that I have been an MP, we have lost around 11,500 women a year in the UK to this menace, as has been said. That number has come down thanks to advances that we have made and investments that all Governments have put in, but we have to do so much better. That is 115,000 mums, sisters, grans, aunties and friends over the decade that I have served in this place. I have never spoken before about which one of them it was for me, and I do not think I will go there today, but I will say this: I have fought and lost to breast cancer more than I have won.

And let us not forget the guys. I was glad that the previous speaker, Helen Hayes, mentioned them. Yes, breast cancer is rare in men, but around 370 men a year are diagnosed in the UK. It still kills, so I welcome the Male Breast Cancer Study that was established to pinpoint some genetic and environmental lifetime causes in men.

Going back to the title of today’s debate, it is true that covid has not helped, but the breast cancer toll goes on regardless. That is as true today as it was pre-pandemic. Breast cancer remains a largely beatable and treatable cancer if it is detected early. Primary breast cancer can be fatal, but we know that almost all deaths are attributable to the development of metastatic, or secondary, breast cancer. As Breast Cancer Now puts it so well—this has been quoted before, but it is worth saying it again—coronavirus is the biggest crisis secondary breast cancer has faced in decades.

We know that some patients with breast cancer had their treatments changed or paused to protect their immune systems. We wait with nothing but fear for the impact of those periods on keeping the disease stable. Let us stop for a moment to consider the reality of those pauses. There is that sinking feeling in a person’s stomach every morning when they wake up and remember that they have breast cancer but they cannot take any action to beat back the disease, because of the pandemic. When they are busy doing something else—maybe enjoying a child or a grandchild being super-cute—it rushes back in, like a punch to the stomach, and they realise they cannot take any action to beat the disease, because of the pandemic. For the children of breast cancer patients who call up on Zoom because they cannot meet, things look and sound the same, but mum cannot take any action to beat back the disease.

Many of these covid delays have had a negative impact on the emotional wellbeing of patients and their families. Never before has the clinical nurse specialist role been more important. We have heard from research undertaken by Breast Cancer Now, an excellent charity, that patients feel they have had less contact with their CNS during the pandemic. When the Minister sums up, could she update us on that? I know she will.

The flip side to that emotional support is the third sector. Many charities, including Wessex Cancer Trust and the Winchester and Eastleigh Cancer Support Group in my area, have switched from physical to virtual, and I thank them for their work. However, there are other charities that have had to pull back just when we need them most, including Breast Cancer Haven, Wessex, which opened only a few years ago, and Breast Cancer Haven, West Midlands, in Solihull. They have closed permanently, and the charity is now operating only online services out of its London base.

Breast cancer incidence in my area, Wessex, is significantly higher than the England average. The rate is 184 per 10,000, compared with 168 across the country. Our mortality rate is spot on the average, but that still has us losing 118 people every year, almost all from secondary cancer.

I was alarmed that my trust had to cease the local breast screening programme in March, because of “did not attends” and cancelled appointments in the first lockdown. Three weeks later, the trust got formal guidance, and the service was suspended for 17 weeks. I fear that this is going to be one of the terrible legacies of lockdown.

The good news is that the restoration of the screening service is well under way, and I thank the team at Hampshire Hospitals for that. The tragedy for us is that, pre-covid, Winchester had a very high uptake of screening in the local population. We have to get back to that.

We have a battle royal on our hands with breast cancer; that was the case before the pandemic, and it is after. When I sat in the Minister’s seat, many hated me describing cancer and breast cancer as a fight, but they are just that. They always were. We needed to up our game pre-covid, and we certainly need to up our game post-covid, if we are not to be here in another 10 years having exactly the same conversations.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health) 2:11 pm, 12th November 2020

I welcome you to your new role in Westminster Hall, Ms McVey. It is a pleasure to follow Steve Brine. He and I have sparred many times—never sparred; we have worked together, which is a better way of putting it—in many debates in Westminster Hall and the Chamber. I very much value those times, and I thank him. It is also nice to see the Minister and shadow Ministers in their places.

Every person in this place, including myself, is probably intimately acquainted with someone who has suffered from breast cancer. The statistics stick in your mind. I will focus on my own area; I know it is not the Minister’s responsibility, but I will give a few stats from Northern Ireland and my own constituency.

Some 129.4 people per 10,000 develop breast cancer in Strangford, compared with 165.2 right across Northern Ireland—a significantly better incidence rate in Strangford. But when we compare the stats with England, we are worse off. The incidence rates for Northern Ireland and Strangford are 62 per year, and 38 people per 10,000 die from breast cancer in Strangford, compared with a rate of 36.1 across England. We in Northern Ireland, and in my constituency in particular, have some rates that are very scary. People are also dying from secondary breast cancer. Northern Ireland has the highest mortality rate from breast cancer in the UK, compared with 33.97 in England, 34.2 in Scotland and 33.9 in Wales.

A freedom of information request by Breast Cancer Now found that 40% of hospital trusts and health boards across the UK were unable to tell how many secondary breast cancer patients were under their care, including my local South Eastern Health and Social Care Trust.

As Craig Tracey did, I want to focus on secondary breast cancer. I congratulate him on bringing the issue forward for debate. He set the scene well. Clinical trials provide a vital opportunity for patients to access potential new treatments at an early stage of their development. That is particularly important for women with secondary breast cancer, who often have limited treatment options available to them and for whom clinical trials provide precious hope to have more time with loved ones. Recruitment to the many clinical trials was paused during the pandemic. While there was relatively little disruption for breast cancer patients already on clinical trials, the pause in recruitment to many trials will have made it difficult for other patients to access them.

In March, the National Institute of Health Research suggested that many NIHR-funded or supported studies might have to be paused as healthcare professionals were asked to prioritise frontline care and make research facilities available if asked to do so by their employer. Of 92 breast cancer trials that the NIHR clinical research network was supporting in March 2020, 50% were paused for recruitment, 45% continue and 5% were closed.

Research clinical trials are so important. Of the 118 respondents to the Breast Cancer Now survey who were receiving or expecting to receive treatment as part of a clinical trial during this time, just under a quarter said they had experienced disruption. The pause in recruitment will have made it more difficult to access trials, and 59% of all respondents were concerned about it.

I know that the Minister always answers with knowledge and understanding. I ask her what lessons can be learned from the speed with which trials for coronavirus have been set up. How can we apply that to setting up clinical trials for other health conditions such as secondary breast cancer? Perhaps coronavirus gives us an opportunity to look at trials—breast cancer trials in particular—in a different way. What good can we take from all of this?

Members of the Association for Medical Research Charities account for 66% of research on cancer. Shop closures and the suspension of many fundraising activities because of covid-19 have had an immediate and severe effect on those charities’ incomes, and their investment in research will drop by £310 million. Breast Cancer Now will see a 34% drop in its income as a result of the pandemic. I support the AMRC’s call for a life sciences charity partnership fund to mitigate the impact of the pandemic and ensure the continuity of charity-funded research.

I welcome the Government’s commitment to the £750 million charity support package, but the medical research charities have not had any help. I thank the hon. Member for North Warwickshire for leading the debate and all those who contributed. I spoke at about 100 mph there.

Photo of Imran Ahmad Khan Imran Ahmad Khan Conservative, Wakefield 2:15 pm, 12th November 2020

It is not just a pleasure but a delight to serve under your chairmanship for the very first time, Ms McVey. I thank my hon. Friend Craig Tracey for securing this important debate at a critical time. It is a great pleasure to follow my indefatigable friend, Jim Shannon—I believe this is the first time, as he usually follows me.

The lockdown order and the ensuing restrictions that we presently endure have had a seismic impact on the services that the NHS can provide, including, crucially, cancer services. NHS figures show a 60% drop in urgent cancer referrals from the initial days of the March lockdown, compared with the same time last year.

Breast Cancer Now, which has been mentioned by a number of colleagues, has raised concerns that almost 1 million women in the UK have missed NHS breast cancer screenings as a direct consequence of the pandemic, because they were paused during the first lockdown before being gradually resumed. Mammograms have the potential to detect cancer in its early stages and, ultimately, to save lives.

Treatment for those with other cancers has been significantly disrupted. The national guidelines may well have stated that urgent and essential cancer treatment must continue, but that has not been the case in every hospital. Not everyone who has required urgent surgery has been able to access it, whether because of a lack of intensive care units or because it is too great a risk to patient or staff.

Similarly, those who have required major surgery have not always been fortunate enough to receive it. That, again, has been a consequence of a lack of recovery beds with ventilation or of there being no ICU beds, if the surgery encountered complications, or because the surgery was simply too risky. Aftercare—whether palliative care or chemotherapy—has also been disrupted by the lockdown.

The reality of those delays not only puts women under a great deal of stress and anxiety, but risks making the cancers diagnosed harder to treat if they are caught at later stages. I truly understand that pain: an inordinate number of my family members have suffered from cancer.

Those who suffer from breast cancer should not be collateral damage in the battle against covid. Worryingly, that has been the case for virtually all forms of cancer treatment. The Health Data Research hub for cancer has warned that, as a result of the pandemic, there could be an additional 18,000 deaths of people with cancer.

In Wakefield, the Mid Yorkshire Hospitals NHS Trust has been proactive in its attempts to ensure that cancer diagnoses occur and cancer patients are treated. Prior to the pandemic, cancer was sadly already the biggest single cause of early death in the district. Breast cancer was the second most prevalent form, with about 250 new cases diagnosed each year.

In May, Pontefract Hospital was temporarily developed into a dedicated cancer centre to care for the people of Wakefield and North Kirklees who need diagnosis for surgery and suspected cancer during the covid-19 outbreak. Here, I have similar concerns to my hon. Friend Robert Largan, because the move from Pinderfields Hospital to neighbouring Pontefract was undertaken on the basis that exposure to covid-19 in Pontefract was significantly lower than in Pinderfields, which is the regional hub for covid-19 patients.

However, while I concur with the chief executive of the NHS trust, Martin Barkley, that we are

“fortunate that we have excellent modern facilities at Pontefract Hospital”,

which is relatively close to Wakefield, having to travel significantly further afield will likely be a behavioural impediment on attendance for constituents scheduled for diagnosis and treatment. That adds to the existing fear about patients entering hospitals, evidenced by Abdul Mustafa, GP lead for cancer care at NHS Wakefield CCG, who said:

“Clinicians working in cancer services know that patients are choosing not to have time-critical cancer treatment because of fear of exposure”.

In closing, I simply say that we must ensure that, however well meaning the policies, the antidote does not become worse than the disease we seek to cure.

Photo of Kieran Mullan Kieran Mullan Conservative, Crewe and Nantwich 2:21 pm, 12th November 2020

It is a pleasure to serve under the chairmanship of a fellow Cheshire Member, Ms McVey. I congratulate my hon. Friend Craig Tracey on securing the debate.

I think we all agree that the NHS is facing probably the most challenging period in its history. During the previous lockdown, the Government and the NHS leadership were dealing with enormous levels of uncertainty and, like all of us, had in their minds the images of what happened in Italy, with parts of its health service totally overwhelmed by covid cases. Enormous effort was put into preparing the NHS for that possibility: wards were reorganised, whole new systems for moving patients through hospitals were instigated and staff were redeployed. I pay tribute to the hard work, commitment and flexibility shown by so many NHS staff as part of all this. The changes made and the approach taken can only be described as a success, in terms of the NHS managing the wave of covid cases as it did. Our NHS was not overwhelmed, and no patient with covid who needed more intensive treatment was prevented from getting it.

However, we are here to talk about the wider picture of healthcare for our constituents during the pandemic. Colleagues of mine noticed almost immediately enormous drop-offs in patient attendance that simply could not be explained away by the lockdown. The first time I went to help in A&E, the department was quite simply the quietest I had ever seen it. It seems clear that there were people at home experiencing things such as heart attacks and strokes, which do not always present in a calamitous way that would cause one to definitely seek help.

[Steve McCabe in the Chair]

Of course, the debate is specifically on cancer diagnosis, and even in the best and most proactive health systems in the world, the journey often consists of experiencing a wide range of minor symptoms that only over time become apparent as something more serious. That is why it matters that, over the last few months, there has been an inevitable downturn in people seeing doctors and nurses, because people think they can put off seeing them about these symptoms.

In discussing breast cancer, we can at least take some comfort from our relative success in educating people about the symptoms to watch out for, which by comparison with other cancers are a little bit more specific. We have a proactive screening programme, because we know that we can spot cancers earlier and save more lives if people are screened, rather than waiting for symptoms. Most breast screening services were suspended due to the coronavirus, and Breast Cancer Now estimates that, while screening was paused, almost 1 million women missed out on their mammogram, and that around 8,600 women caught up in the screening appointment backlog could be living with undetected breast cancer. Thankfully, screening has now restarted across the UK, and I understand that more than 400,000 women were invited for breast cancer screening between June and August, with thousands more invitations being sent every month.

I will finish by focusing on two points. First, backlogs—I just described them for breast cancer; we have all described them today—affect a wide range of treatments. We must ensure that the NHS gets the additional resources that will be vital for it to catch up on the backlog of care and treatment built up during the lockdown, and which I am afraid is still building up in some areas. The record numbers of nurses and doctors now working for the NHS will be needed, and we will have to deliver on our manifesto commitments to keep building that workforce in primary and secondary care.

Secondly, we must make it clear to the public that the choice is not between tackling coronavirus or tackling the other healthcare needs of our constituents. Tackling coronavirus will allow us to carry on meeting the wider healthcare needs of our constituents. Any hospital faced with a choice between providing critical care for patients very sick with covid, who are at risk of dying there and then, and providing screening and non-urgent treatments will have to prioritise that immediate and critical healthcare need. That is why keeping the coronavirus suppressed is absolutely vital.

The NHS has moved on from where it was at the start of lockdown and every week is getting better and better at doing both things at the same time. We must all carry on giving it the room to manoeuvre that it needs to build on that further, enabling it to look after patients with and without covid, patients with urgent healthcare needs and planned healthcare needs, and patients requiring things such as screening.We will only stand a chance of being able to do that if we can continue to keep coronavirus suppressed, following the guidance that we have all been given—hands, face and space. Let us ensure that it is clear to constituents: this is not a choice between one or the other, but about supporting both groups of patients.

Photo of Sir David Amess Sir David Amess Conservative, Southend West 2:25 pm, 12th November 2020

It is a great honour for me to make my maiden speech from the Opposition side of the Chamber, although it seems a little strange.

I congratulate my hon. Friend Craig Tracey on securing the debate. I agreed with everything he said. Yes, I am reminded of my hon. Friends the Members for Norwich North (Chloe Smith) and for Chatham and Aylesford (Tracey Crouch), and of the redoubtable Paula Sherriff. We are all thinking of them at the moment, as they battle cancer. As far as my hon. Friend Steve Brine was concerned, I empathise with his remarks, because I was once on the Health Committee for 10 years. We had inquiries into many of the issues raised today.

Breast cancer is the most common cancer of all. At any time, about 600,000 people in the UK are living with or recovering from breast cancer. My wife had breast cancer. She was stage 2 and her treatment was absolutely wonderful. She, dare I say, got away with radiotherapy, but a number of her friends were stage 3 and had to have chemotherapy. Through early detection, however, more and more women are surviving as a result.

Perhaps my hon. Friend the Minister will write to me about this: Southend breast cancer service has been way up there at the top, but I was slightly concerned to be told that, in my constituency, 42 per 10,000, or 152 people, develop breast cancer every year; and I am really concerned that the uptake of breast cancer screening is below the national average, at only 65.3% of women invited to attend. Only 76.7% of women are diagnosed at stage 1 or 2, compared with nearly 80% across England. I am concerned by that, and I feel a responsibility as a local Member of Parliament to do something about the issue.

As we have heard from other colleagues, covid-19 has caused many regular services to be cancelled or delayed. In order to clear the backlog and ensure attendance at screening centres, women are sent—again, I say this to my hon. Friend the Minister—open invitations, rather than timed appointments. That may lead to fewer women making appointments and so reduce the uptake of breast screening, which has been happening consistently in recent years. If open invitations are issued, measures such as appointment reminders and letters from GPs must be put in place, urging women to attend.

Colleagues have mentioned Professor Michael Richards and his recommendations last autumn. The review found that screening capacity in the NHS needs urgent investment to increase the workforce and provide adequate equipment and facilities. Following the plan to extend the upper age for testing from 65 to 70, additional pressure was placed on existing staff, many of whom are near retirement age. About half of all mammographers are aged 50 and are likely to retire in the next 10 to 15 years.

I also hope that, now the Chancellor has discovered a money tree—which I am certainly going to get hold of—additional funding will be found for investment in clinical nurse specialists, to support those with incurable secondary breast cancer. Yes, the Macmillan nurses do an absolutely fantastic job—but more needs to be done.

In conclusion, the coronavirus pandemic has changed the way in which the NHS offers its services beyond recognition—we all salute that—with new technology, such as virtual appointments, being offered to patients. However, we must not lose sight of the importance of physical screening and consultations, in particular for breast cancer diagnosis. With the sobering statistic that one in seven women in the UK—my wife and three of our colleagues, whom we know about—will develop breast cancer at some point in their lives, it is more important than ever that this service is funded and resourced to allow the best chance of survival and recovery for those women.

Photo of Steve McCabe Steve McCabe Labour, Birmingham, Selly Oak

We have 30 minutes now for the Front Benchers to respond and to allow a little time for Mr Tracey at the end.

Photo of Neale Hanvey Neale Hanvey Shadow SNP Spokesperson (Health Team Member) 2:30 pm, 12th November 2020

I thank Craig Tracey for securing this very important debate, and I congratulate him on his compassion and lucidity in presenting his case. I start by paying tribute to all the NHS, research and charity staff who have been working on the frontline in their respective disciplines to ensure that we move through this challenging time and continue to meet the challenges of breast cancer.

Breast cancer is the most common cancer, with one in seven women affected, and the impact of covid-19 is most keenly felt by those women and has the greatest potential to affect the lives of so many because of its prevalence. Covid has had an impact on almost every aspect of our lives. We have heard that 1 million women have missed their breast cancer screenings, but the covid pandemic has affected all aspects of the cancer pathway, from screening and diagnosis to treatment and follow-up care.

The reasons are varied, and include concern and fear over attending, cancellations due to re-deployment and the impact on the wider NHS services, radiology, surgical, medical and clinical oncology. All of those aspects of the treatment pathway have felt the impact, including, as I mentioned earlier, the capacity for clinical trials and research. In that spirit, I led a cross-party letter to the Chancellor asking for the Government to consider the establishment of the life sciences charity partnership fund to support the charities that have been significantly affected by the covid pandemic.

The design and success of cancer treatment is absolutely reliant on early diagnosis, as it allows rapid progress to treatment, prompt surgical intervention in the case of breast cancer, and onward to radiotherapy or chemotherapy, or indeed both. As such, it maximises the efficacy of those interventions, whilst allowing tissue and immune systems to recover. However, there are challenges.

The Royal College of Radiologists has highlighted that there has been a reduction in referrals for symptomatic breast cancer within the two-week wait standard and a reduction of clinical capacity. There have been some innovative moves, where appropriate, for a hyperfractionation of radiotherapy treatment schedules. The royal college also noted that radiologists are having to deal with attendance anxiety. It has, however, also noted innovative changes to the configuration of services, which have enabled some of the softer aspects of cancer care to continue where possible.

The impact on the challenges that were already present prior to covid also needs to be considered. I remember—more years ago than I would like to mention—when I was involved in peer reviews with a London cancer network there was already a shortage of radiologists within the cancer pathway. That problem has, sadly, not gone away. It is not a problem unique to the English system at all. There is at least one consultant vacancy in clinical oncology. Another important issue to consider is that the attrition rate for consultant posts is greater than the ability to recruit. Thus, there is a pressing need to move these challenges forward.

The new ways of working—telemedicine, Hospital at Home, and other innovations—need investment. There is also a need to reassess the skill base of the workforce and acknowledge chronic excessive workload, which has been highlighted by The King’s Fund. According to Macmillan, there is a need more generally to recruit around 2,500 cancer nurses alone—of course, other disciplines, from GPs to radiographers, also need consideration for recruitment.

The post-covid recovery plan must include significant investment in diagnostics and treatment, radiology, recruitment and training in specialist allied disciplines. Effectively, the covid pandemic has landed a narrow aperture at the point of diagnosis for many cancers and, because of its prevalence, breast cancer is a significant cohort. To widen that aperture, there is a real and pressing need for funding to come forward in the comprehensive spending review; it must deliver an expansion of service to support innovation, fund the NHS plan and support social care.

It is important to acknowledge that staff in hospitals have been working incredibly hard throughout the pandemic, but there is only so much that we can squeeze out of them, and we cannot rely on a never-ending supply of goodwill and extraordinary resilience. My suggestion echoes a plea from my hon. Friend Dr Whitford, who is a breast cancer specialist herself: clinical audit and quality improvement standards need to be at the heart of the drive forward. That work has been commended by the Nuffield Trust in its “Learning from Scotland’s NHS” paper.

We need to support getting it right first time, while making great strides to enable clinical outcome data to be captured and the impact to be fully understood. In short, substantial investment is no longer optional, and I hope that in the spending review the Government make the necessary investments, as called for by the hon. Member for North Warwickshire, to ensure that that is brought forward.

Photo of Justin Madders Justin Madders Shadow Minister (Health and Social Care) 2:37 pm, 12th November 2020

It is a pleasure to serve under your chairmanship, Mr McCabe. I start by thanking Craig Tracey for securing this important and timely debate and for his excellent introductory speech. He made a number of important points, some of which I hope to return to, and I hope he gets a positive response to his very helpful suggestion on the gathering of data. I also thank all the other hon. Members for their contributions today, and I will go through some of the highlights of those.

My hon. Friend Stephanie Peacock spoke about the need for a cancer recovery plan, which I think we all agree on, and addressed the important point about widening health inequalities and the startling differences in the availability of screening depending on where people live. I agree with her that improvements to the cancer outcomes datasets are an important part of beginning to understand how those disparities work out.

We heard from my hon. Friend Grahame Morris; I pay tribute to the work he does on the all-party parliamentary groups in this area. He mentioned the Catch Up With Cancer campaign and drew attention to the backlog, which, of course, many hon. Members have raised today. He also raised the availability of radiotherapy, which, in his own words, he bangs the drum on consistently in this place, and we pay tribute to his persistence.

Robert Largan made an important point about the availability of mobile screening units and Jim Shannon , who always speaks with such knowledge on this subject, made some important points about clinical trials and charities, which I hope to be able to return to if time allows.

It was a pleasure to see Sir David Amess find his spiritual home at last; it is the equivalent of Gary Neville turning out to play for Liverpool, but he is welcome all the same. We have a vacancy in the shadow health team for a Parliamentary Private Secretary at the moment and, if he shows the promise that he demonstrated in his speech today, I think we may be able to find a role for him on this side of the House.

The hon. Gentleman made, as my hon. Friend Helen Hayes did, an important point about some of the people who are not here today, including Tracey Crouch, who we heard this morning in business questions speaking about her frustration at not being able to participate in this debate. I am sure it would have been enhanced by her presence, given her current battle, alongside the former Member—still our friend—for Dewsbury, Paula Sherriff. I am sure the whole House sends both of them our very best wishes.

I want to speak about the impact the pandemic has had on the early diagnosis of cancer in general, as many Members have referred to already. We know how important early diagnosis is to improving chances of survival and in successful treatment. As we heard, Cancer Research UK estimates around 3 million people are waiting for breast, bowel or cervical screening, and there were over 1.2 million patients waiting for a key diagnostic test by the end of August this year. As my hon. Friend the Member for Easington mentioned, we know from Macmillan’s latest report that there are currently around 50,000 missing diagnoses; that compares to a similar timeframe for this time last year, and means 50,000 fewer people have potentially not been diagnosed with cancer.

We know significant amounts of capacity had to be created during this pandemic, and that meant the cancelling of planned operations, large numbers of patients being discharged back into the community, and staff and patients having to be protected from the transmission of covid-19. What those changes also meant is that, thankfully, intensive care did not have to be rationed so that only covid-19 patients were treated. However, it also caused the shutdown or reduction in many other non-covid services, which, combined with drastic changes in patient behaviour, has led to us facing this huge backlog today. We know that stricter infection control measures—which are absolutely necessary—mean that the backlog of care will probably take much longer to clear than we would like.

My hon. Friend the Member for Dulwich and West Norwood and other hon. Members referred to the Breast Cancer Now report, and how the number of people referred to see a specialist declined dramatically from April. There is an estimate that across the UK, there have been 107,000 fewer breast cancer referrals, and a backlog of almost 1 million women requiring screening has built up during this time. Some of those women may well have been living with undetected breast cancer, and some may still be. Every month that that situation continues, more women could be missing out on the best chance of getting an early diagnosis and the best chance of beating the disease. It is vital—and something that we have been pushing for for a long time—that we get a clear sense of how we are going to tackle that backlog, because it is so important.

The hon. Members for Wakefield (Imran Ahmad Khan) and for Crewe and Nantwich (Dr Mullan) mentioned the importance of mammograms. As we know, they are a key tool in early detection. There is a plan to send open invitations for screening from September to March of next year. That has caused some concern among cancer charities, because some of the research shows that the number of women who make appointments is significantly lower than those who actually attend timed appointments. There is a fear, sadly, that this could actually worsen the persistent decline we have seen in recent years of the uptake of breast cancer screening. We are particularly concerned about the impact that will have on some groups where uptake is already low, such as those living in deprived communities and some BAME groups. We heard a little bit about the impact on BAME groups from my hon. Friend the Member for Dulwich and West Norwood, and both she and Steve Brine very powerfully put into words the additional mental toll that this disease has during this time, on top of everything else that people ordinarily face when they have received such a diagnosis.

Several hon. Members mentioned the impact of covid-19 on secondary breast cancer patients. It is still, sadly, the case that around 11,500 people—women, mainly—die from breast cancer each year. Most of those are to do with secondary breast cancer, and as we have heard, it is not something that there is a cure for at the moment. It is estimated that around 35,000 people in the UK are living with secondary breast cancer. As the general population ages and people live longer, numbers will continue to increase, so it is really important that we get a better understanding and response to secondary breast cancer. We also need to look at this issue from the patient’s perspective.

I want to mention my hon. Friend Debbie Abrahams, who wanted to speak in today’s debate but could not. She wanted to pay tribute to one of her constituents, Jo Taylor, and to METUP UK, which focuses on making positive changes for everyone with metastatic breast cancer. Its “busy living with mets” campaign calls for increased awareness of secondary breast cancer, because catching it earlier leads to better outcomes. It is also campaigning for better access to drugs, clinical trials, radiotherapies and surgical pathways.

As the hon. Member for North Warwickshire mentioned in his opening comments, the national cancer patient experience survey tells us that the experiences of patients with secondary cancer differ greatly. It has identified gaps through the taskforce in the support and services offered to people, including variation in access to clinical nurse specialists, patchy provision of information, patients’ psycho-social needs not being met, and a lack of prompt and timely access to palliative care services.

As we have heard from several hon. Members, clinical nurse specialists play a critical role in co-ordinating care, providing information and helping people to manage their diagnosis and treatment better. In fact, Breast Cancer Now reports that the support of a clinical nurse specialist is the single most important contributing factor to people’s positive experience of care. That is particularly important for secondary cancer patients, who are often on lifelong treatments and have complex needs as a result. Its importance was acknowledged in the long-term plan, with a commitment that by 2021—it is only six weeks away now—all patients, including those with secondary cancers, will have access to a clinical nurse specialist or support worker.

It is very important that we get to a point where everyone is able to take advantage of the expertise that a clinical nurse specialist provides. Prior to the pandemic, the workforce was already overstretched and under pressure due to increased demand and persistent shortages across the workforce. A report by the Public Accounts Committee was highly critical of the Government’s approach to the workforce, finding that the long-term plan was not supported by a detailed workforce plan. Of course, the removal of the NHS bursary in 2017

“signally failed to achieve its ambition to increase student nursing numbers.”

Before I conclude, I want to echo what the hon. Member for Strangford said about the importance of charities in this sector. We know there is a great deal of concern in the sector. I know that some support was announced by the Government back in April, but it falls well short of what was suggested by the associations involved, and only a few have been able to benefit from it. I hope the Government will listen to the sector and look again at what additional financial support can be provided, because we know that clinical trials provide a vital opportunity for patients to access new treatments, which are always in development. We know it is particularly important for patients with secondary breast cancer. We hope that is something the Minister can take on board today, and I look forward to hearing her response.

Photo of Jo Churchill Jo Churchill The Parliamentary Under-Secretary for Health and Social Care 2:48 pm, 12th November 2020

It is a pleasure to serve under your chairmanship, Mr McCabe. I have an awful lot to cover and less than 10 minutes to respond, if I am going to give my hon. Friend Craig Tracey time to sum up. I congratulate him on securing the debate and on the important work he does running the APPG on breast cancer with his co-chair. I know that he has been a fundraiser for breast cancer and that, like me, he came to this place with tackling this issue as one of his key ambitions. We will get there.

As my hon. Friend Steve Brine said, everyone with breast cancer is a mum, a sister, a daughter or a friend. Some 3% of them are now fathers, sons and brothers. I am grateful for the contributions to the debate. A debate such as this allows us to park much of the politics but talk about what is really important here: the patients, and the outcomes for them.

Early diagnosis is key, and hon. Members have outlined the challenge that covid has brought. I thank my hon. Friend Dr Mullan, and indeed Justin Madders, for outlining just how challenging covid-19 has been for the NHS and how it has responded to an unprecedented event in an unprecedented way. I reassure all hon. Members that in the second wave, we have made sure, as we have heard from many hon. Members, that cancer services are prioritised and remain.

I pay my own tribute to my hon. Friend Tracey Crouch, who has written to me because she would have liked to be here today and who is currently in treatment, as well as to my hon. Friend Chloe Smith, who is currently having treatment, the former Member for Dewsbury, who has been mentioned, and the former Member for Eddisbury, who is having her own challenge living with cancer. It is around us all. I well remember the emotional tsunami that diagnosis brings. As my hon. Friend the Member for Chatham and Aylesford said in her letter, because she is always the same with language, “Cancer sucks”. I could not agree more. I wish them all the best on their journey, as I do every patient through their treatment.

I am really aware of how covid-19 has upended our lives, but clinical decisions had to be made in March. We were dealing with the unknown and we had to protect people and highlight priorities. For those who have had their cancer treatment or surgery changed or delayed, I understand the uncertainty and anxiety they have had on top of that diagnosis of cancer. For patients and their families, this is a really tough time. We must have a laser focus on early diagnosis, as was laid out in the manifesto, and we must not veer from that. I do not want covid-19 to be the derailer; I want us to seize some opportunities that have come about.

Although it makes it no less bearable for those affected, the decision to pause some patients’ treatment in the first wave was taken on clinical advice that factored in the risk to the most vulnerable. As soon as it was possible, however, the NHS was charged with restoring cancer services as quickly as possible, and it has risen to that challenge. I meet with Cally Palmer, who was mentioned earlier, and Professor Peter Johnson often—at points weekly—to make sure that we are doing everything we can.

Across the country, there are 21 cancer alliances and their cancer hubs. My hon. Friend Elliot Colburn outlined the amazing work done at the Royal Marsden to bring hospitals across the capital together to optimise safe theatre space to deliver treatments and so on. We have asked for that approach to happen across the country to ensure that we optimise treatment. I hear my hon. Friends the Members for Wakefield (Imran Ahmad Khan) and for High Peak (Robert Largan), but it cannot always be on the doorstep at this time; we have to have a bit of flex. I will happily meet my hon. Friend the Member for High Peak to talk about his particular concerns.

I join my hon. Friend the Member for North Warwickshire and other hon. Members in recognising the tremendous efforts of the cancer workforce. In forming those cancer hubs and the rapid diagnostic centres, people have moved mountains to care for the patients they look after every day. Ultimately, they are the ones on the frontline to ensure that breast cancer services are there when we need them, and our thanks go to them.

The latest official data for September, which was published only this morning, shows that urgent two-week GP referrals across the entire spectrum of cancers are 2% higher than last year and they continue to rise for all cancers. In breast cancer, we have seen a month-on-month rise of more than 15% from August to September, but we still have work to do; I am not going to stand here and say that we do not. There is still a way to go to meet current demand and improve on that rise for those who are waiting for treatment.

More than 86% of people saw a cancer specialist in September within two weeks of their referral from a GP, and nearly 95% of patients received treatment within 31 days of a decision to treat. I know precisely how long every day feels when people have had a diagnosis. I have had tumours in both breasts and other primary sites. The wait is anxious. It is terrifying. Your mind asks, “Who will pick the children up?”, and, as my hon. Friend the Member for Winchester said, a million other unanswerable questions every single day.

There have been some bright spots and some innovative treatments that have moved the profile of the disease further forward. I personally—this is an ambition of Breast Cancer Now—want to see the eradication of breast cancer by 2050. We must work to that, because it is possible. As we have a 98% ability to treat testicular cancer, we can do better. Breast cancer should not claim the lives of over 11,000 women a year. I want to see it put back in its box.

Breast cancer treatments are advancing. This year has been no exception, with advances in radiotherapy and chemotherapy. We have seen oral chemotherapies that are easier to deliver and better for the patient. We have seen the publication of the FAST trial, which looks at five-fraction radiotherapy to treat early breast cancer. I thank Grahame Morris, who is no longer in his place, and the other members of the APPG on breast cancer who came to see me. That treatment enables individuals to be treated quicker with fewer hospital visits. When we are fighting covid-19 and we are trying to keep people out of hospitals, it is better to minimise visits. All radiotherapy providers in England are adopting this approach. Yes, we have challenges with the workforce, but radiotherapy did remarkably well at keeping itself going through the pandemic.

I will try to cover as many of the different issues as I can, but I barely have any time left. They will drag me out of here with my nails pulling on the carpet. Clinical nurse specialists are important, valued and flipping marvellous—we all need one. Some 350 extra clinical cancer nurse specialists were allocated in the long-term plan, but we need to work together. I am working with Andrew Strauss and my right hon. Friend James Brokenshire.

Cancer nurse specialists need to come from the existing workforce. They must be encouraged to do further training. We need to ensure that it is seen as a career path that really does have that purpose. Boy, oh boy, when one needs a cancer nurse specialist— they save the oncologist and one can phone them to ask about one’s niggles—they do amazing things. I want to see everyone come together, including the charities, to encourage nurses to come forward and help the community.

I met with the secondary breast cancer women before the pandemic. The situation is variable, and that is not good enough. The journey of a woman who has a cancer nurse specialist by her side is not an easier journey, but it is one where they feel supported. They have someone there. My cancer nurse specialist helped me to get some of the psychological counselling that colleagues have spoken of. I was angry and ticked off that I had that disease again. We need to encourage people to sign up to do that additional training. The money is there.

Data needs to be better. I could go on about data, screening and clinical trials, but I am aware that I have such little time. The majority of clinical trials are open for registration. I am urging local decisions to be made to get people reinstated and on to clinical trials. We have opened up screening with open invitations to try to get more women through. We know we have an issue with women not attending their appointments. We need to make people feel safe when they go to have their screening test in a hospital. Unless they feel safe, they will not go. We must work together to say, “It is open, but you have to go. Our NHS is a really precious resource. If you have an invitation, take it up and go to see the professionals who are there to help you.”

I wish I could say more, but I want to give my hon. Friend the Member for North Warwickshire a second or two to sum up. I thank everyone working on the frontline. Advances are happening; there is more to do. I am happy to work with my hon. Friend on an audit. We need to get better data. It is collected, but not in a good enough format. I want to see us do better in all those areas.

Photo of Craig Tracey Craig Tracey Conservative, North Warwickshire 2:59 pm, 12th November 2020

I thank the Minister. It is far better that we heard from her than from me. She has tackled this issue in the forthright way we have come to expect. Coming into this debate, I knew that we were in the right hands and I am even more sure of that now. I also thank other colleagues who participated in the debate, not just for their contributions but for the way the debate has been conducted. That is the message—

Photo of Steve McCabe Steve McCabe Labour, Birmingham, Selly Oak

Order.

Motion lapsed (Standing Order No. 10(6)).

Sitting suspended.