Breast Cancer Screening — [Sir Edward Leigh in the Chair]

– in Westminster Hall at 11:30 am on 16th December 2020.

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[Sir Edward Leigh in the Chair]

[Relevant document: e-petition 332828, Lower the age that breast screening services are offered.]

Photo of Robert Largan Robert Largan Conservative, High Peak 2:30 pm, 16th December 2020

I beg to move,

That this House
has considered breast cancer screening.

It is a pleasure to serve under your chairmanship, Sir Edward.

I am pleased to have secured this debate on a really important issue that affects so many people in the High Peak and across the country. I am glad to see the Minister in her place today and very grateful to her for meeting me to discuss this issue. I look forward to hearing her response to the debate, as well as the thoughts of colleagues who are in Westminster Hall today. I pay tribute to those colleagues who have worked so hard on this issue over many years, especially through the all-party parliamentary group on breast cancer. I pay particular tribute to my hon. Friend Craig Tracey, who led a debate on this issue just last month.

In my lifetime, we have come a long, long way on breast cancer research, treatment and survival rates. Despite that huge progress, breast cancer remains one of the biggest health challenges facing this country. Every year, one in seven women will develop breast cancer, which is 55,000 women. Also, 370 men will develop breast cancer every year; it is important that we do not forget them. Almost 1,000 women die from breast cancer every month and around 600,000 people are living with or after breast cancer, including 35,000 women living with secondary breast cancer. I will repeat those figures—almost 1,000 women die of breast cancer every month, which is around 11,500 women every year. Just in my small local area, an estimated 223 people develop breast cancer every year and 41 people die from it, almost all of them from secondary breast cancer. Those numbers cannot begin to convey the heartbreak caused to too many families, who grieve the loss of a mother, a sister, a daughter, a wife or a partner.

We know that early diagnosis is the best way of preventing these deaths and increasing the chances of survival. Around 186,000 women a month are screened in England, which prevents an estimated 1,300 deaths every year. However, although it is true that there has been increased uptake of screening nationally, that uptake has not been evenly spread across the country. Of the women aged between 50 and 70 invited for screening in my local area, 69.7% attended within six months. That is lower than the 72.4% average across England.

I fear that the situation in my area has been made worse by the recent commissioning decision by NHS Midlands to withdraw the breast cancer mobile screening unit from Buxton, Chapel-en-le-Frith and New Mills in the High Peak, citing covid as the reason. Instead, my constituents are being asked to travel to appointments at Bakewell in the Derbyshire dales.

I am very worried about the impact that decision is having. To be clear, this is no slight at all on Newholme Hospital in Bakewell and the fantastic staff there; I pay tribute to them and to all NHS staff working in breast cancer screening services. It is a question of accessibility. The Peak district is beautiful, but our transport links are poor, especially in the winter months, when road closures are common because of extreme weather. For example, driving from the village of Rowarth to Bakewell typically takes just under an hour and involves having to drive a good part of the way on single-track country lanes, which are often closed when there is snow or heavy rainfall. Public transport links between the High Peak and Bakewell are even more limited. The railway between Buxton and Bakewell closed in 1968, cutting off the High Peak from the rest of Derbyshire.

I am very worried about how many women in my area will be unable to make screening appointments, which is why I have been campaigning to get the mobile screening unit reinstated in the High Peak as a matter of urgency. In just a few weeks, over 2,000 local people have signed my petition calling for its reinstatement. I hope that the Government will listen and that the Minister can give my constituents good news today. I was very grateful to her for meeting me last week to discuss this issue, when she gave me positive news by assuring me that the current arrangement is temporary. However, it has often been said that there is nothing more permanent than a temporary Government measure, so I hope that she can be more specific today and that we can get a date for when we can expect these services to be reinstated to the High Peak.

More broadly, to help more people get a diagnosis early on, we need the capacity ready in our local health services. Breast Cancer Now found that 40% of hospital trusts and health boards—including Stockport NHS Foundation Trust, which runs Stepping Hill Hospital and so serves a large part of my constituency—could not say how many secondary breast cancer patients were under their care.

Coronavirus has placed immense pressure on our NHS workforce and infrastructure. It is essential that we keep the virus under control, but there is a heavy cost. In March, the breast cancer screening programme was officially paused in Scotland, Wales and Northern Ireland and was paused in all but name in England. Screening has restarted, but access is not rising fast enough nationally, and it is falling in places such as High Peak. Breast cancer screening services in England are running at around 60% of normal capacity, according to Cancer Research UK. As a result, there was a 70% drop in all cancers being reported in some parts of the country, leading to nearly 107,000 fewer breast cancer referrals. Despite the fall in referrals, cancer waiting times have increased. In August, the rate of achieving the two-week wait target fell to 87.8% from 90% the previous month.

I am grateful to the digital engagement team and Breast Cancer Now for reaching out to people affected by breast cancer screening delays caused by covid. I thank everyone who responded ahead of the debate to share their experiences. For example, Gill said:

“My routine screening was rescheduled (twice) from April 2020 to Sep 2020. I was then diagnosed with stage 3 breast cancer spread to a lot of lymph nodes. I can’t help but wonder how much better it would have been to have picked this up 6 months earlier.”

This has been happening to people across the country, with serious consequences that must be addressed. Breast Cancer Now estimates a backlog of nearly 1 million women requiring screening across the UK because of the pause in March. We do not know how long it will take to catch up. Around 8,600 of these women could have been living with undetected breast cancer.

As the general population ages and lives longer, the number of women and men developing breast cancer has increased. Of course, people younger than 50 can also develop breast cancer, and it is important that they also have access to screening. I take this chance to note that more than 13,000 people have signed an e-petition in support of lowering the age at which screening services are offered, including many in High Peak. We clearly need to ramp up capacity to meet the rising demand for screenings. Not doing so will put the NHS workforce infrastructure under incredible strain. I ask the Minister: what action are the Government taking to ensure that women respond to open invitations and make appointments for screening, and how many women have been screened this year compared with last year?

Managing demand for screenings as a result of increased uptake and the backlog created by covid requires a long-term strategy to raise capacity, with a strong focus on the NHS workforce. There is a serious worry of burnout among NHS workers due to the sustained physical, psychological and emotional pressure of this difficult year. A British Medical Association survey revealed that 28% of doctors have found non-covid demand to be higher than before the pandemic, with 58% saying that they are concerned about their ability to care for patients, 44% worried about plans to manage the huge backlog of patients and 65% saying that staffing shortages are the most pressing concern.

That is compounded by the fact that a considerable proportion of the breast cancer screening workforce is approaching retirement. Around half of all mammographers are aged 50 and likely to retire in five to 10 years. This has led to a rise in vacancies for crucial roles. Public Health England has reported a 15% vacancy rate for mammography; that only 18% of screening units are adequately resourced with radiotherapy staff; and that one in four trusts and health boards has at least one vacant consultant breast radiologist post. Ensuring that the breast imaging and diagnostic workforce is fully staffed and trained is critical to the delivery of the commitment in the NHS England long-term plan to ensure that the proportion of cancers diagnosed at stages 1 and 2 rises from around half to three quarters by 2028. I understand that the pandemic delayed the publication of the full implementation plan, but further detailed is needed.

NHS workforce development was not mentioned in the recent spending review, and there has not been a national NHS workforce strategy since 2003. We need to prioritise that work to be sure that the new NHS funding is being used in the best way possible. Long-term solutions cannot be sacrificed because of short-term pressures.

I am therefore glad that the Government asked Professor Sir Mike Richards to review screening programmes as part of the NHS long-term plan. The review concluded that the main obstacle to achieving the commitment on cancer diagnosis is the size of the workforce, and the equipment and facilities available to them. Professor Sir Mike Richards recommended that we recruit 2,000 additional radiologists and 4,000 radiographers, as well as other support staff, and replace outdated testing machines. Those recommendations ought to be a critical part of the next NHS people plan, setting out a long-term strategy for the NHS workforce. I hope that the Minister is able to update us on when she expects to publish a plan to implement the review. It will also be interesting to learn how the new National Institute for Health Protection will affect the breast cancer screening programme.

It is crucial that people are not discouraged from seeking help with a health problem. The NHS’s “Help Us Help You” campaign is a promising initiative that urges people to speak to their GP if they are worried about possible cancer symptoms. I understand that people feel reluctant to come forward, worried that they might catch the virus or be a burden on the health service, but it is more important than ever that women are able to have a regular screening check-up. If the campaign is successful, I hope that the Minister will explain how the Government expect the NHS workforce to cope with increased demand during the winter months.

The Government need to set out how capacity in the diagnostic workforce will be managed; provide funding to grow the workforce and ensure they are properly resourced; and increase the number of facilities where people can be diagnosed. That includes reinstating important services across the country, such as the mobile screening unit in High Peak. Failure to do so will reduce our chances of delivering the early diagnosis, treatment and care that could help thousands of people beat breast cancer.

Photo of Nicola Richards Nicola Richards Conservative, West Bromwich East 2:42 pm, 16th December 2020

It is a pleasure to serve under your chairmanship, Sir Edward. I thank my hon. Friend Robert Largan for securing this important debate.

Finding breast cancer early will save lives—that is the bottom line and has always been the case. The earlier breast cancer is diagnosed, the more likely it is that treatment will be successful. That is the messaging that needs to be harnessed moving forward. Fifty-five thousand women and 370 men are diagnosed with breast cancer in the UK per year. We are doing much better, but those figures are a stark reminder of the prevalence of this type of cancer in our communities.

In my local patch, West Bromwich East has about 141 per 10,000 people developing breast cancer, compared with 168 per 10,000 across England. That means 284 people in my constituency are diagnosed with breast cancer every year. In West Bromwich, 67.5% of women aged 50 to 70 are invited to attend a screening within six months—a figure that is significantly worse than the 72.4% across England. The uptake of screening appointment invitations is also significantly worse than the England average.

Aside from screening appointment uptake, we have a wider issue that affects the entire NHS. As an increased percentage of the population becomes eligible for breast cancer screening, the existing infrastructure needs to evolve to meet that demand, in terms of both a trained workforce and diagnosis machines. Indeed, Professor Sir Mike Richards’ independent review of adult screening programmes in England, which was committed to in the NHS long-term plan, made some incredibly interesting findings when it was published last year. Most strikingly, according to the review, screening programmes are constrained by the size and nature of their workforce and by the equipment and facilities available to them. That will act as a barrier to implementing the review’s recommendations.

The breast cancer screening workforce are being put under increasing strain as the populations eligible for breast screening increase. Creating the capacity for that change is key to ensuring that screening programmes are fit for the future. The Chancellor’s spending review announcement committing £325 million for the NHS to invest in new diagnostics machines such as MRI and CT scanners was clearly welcome, but that is only a short-term fix to address the current backlog. Ultimately, it comes down to education about the importance of the issue and of the process of getting women to be screened. We also need to move away from the idea that only the over-50s are diagnosed with breast cancer; young people are affected too.

Various online petitions to lower the age at which breast cancer screening services are offered outline a crucial point. Research shows that the X-ray mammogram test used in the breast cancer screening procedures, which can spot cancer when it is too small to see or feel, is much less effective in younger women due to their tissue density. Therefore, educating young women to check for anything abnormal in their body has never been more important, mainly because we know that they have a much higher chance of survival if it is caught early.

I ask the Minister to update us on the Government’s plans to lower the age at which breast screening services are offered and on what the Government plan to do to help younger people identify breast cancer sooner. The NHS has a serious job on its hands to break down these barriers, where people simply think it will be okay and do not get screened. We need to be proactive in encouraging people to take this seriously.

We have made amazing progress so far, but more can be done and early diagnosis is key. I can relate to that directly. Six months after my aunt passed away from secondary breast cancer, my mum—her sister—was also diagnosed. I advised her to be on the lookout for early signs, namely dimples. She is in full health now, but if I had not told her of the signs back then, things could have been different. My mum would not have gone to see her GP and she would not have known some of the lesser-known early warning signs of breast cancer.

The coronavirus pandemic has caused a backlog in screening and treatment. Breast Cancer Now estimates that a significant backlog of nearly 1 million women requiring screening built up across the UK in the course of this year. It is unclear how long it will take to catch up. Some measures have been taken to try to ensure attendance at the reduced number of appointments available. In England, from the end of September to the end of March 2021, women will be sent open invitations to call and make an appointment for screening, rather than a timed appointment.

Research shows that the number of women making appointments is significantly lower than those who attend timed appointments. That could worsen the persistent decline that we have seen in the take-up of breast cancer screening in recent years. The impact this will have on groups among which the uptake is already low is particularly concerning—for example, women living in deprived areas and some black and minority ethnic groups. How can we reach these people, reassure them and encourage them to be screened? I would be grateful if the Minister has any ideas on this. Will she also confirm what action the Government are taking to ensure that women are sent open invitations to make an appointment for screening, and what success there has been in the take-up of open invitations?

Our NHS staff have worked tirelessly over the course of this dreadful pandemic and made sacrifices on an unimaginable scale. We need to back them in this place on breast cancer screening too. I passionately believe that it is everyone’s role to promote the importance of breast cancer screening and early diagnosis, and to ensure that we have the right number of women screened as early as possible. After covid-19 is over, this should be one of our new “saving lives” messages.

Photo of Tim Farron Tim Farron Liberal Democrat Spokesperson (Environment, Food and Rural Affairs), Liberal Democrat Lords Spokesperson (Communities and Local Government), Liberal Democrat Spokesperson (Housing, Communities and Local Government) 2:47 pm, 16th December 2020

It is a pleasure to serve under your chairmanship, Sir Edward. I thank Robert Largan for securing this debate. Nicola Richards made a remarkably good speech, citing her own family’s experience.

Both hon. Members have spoken about Breast Cancer Now’s assessment that almost 1 million women have missed a screening during this period. Its assessment is that that would mean 8,650 women may be out there with undetected breast cancer. Cancer Research UK assesses that screening services are running at 60% capacity. That means the situation is getting worse week by week. A hundred fewer women started treatment for breast cancer each day in May and June than during those months in 2019.

If we look beyond breast cancer, in my county of Cumbria there is a 17% reduction in the number of people starting cancer treatment this year compared to 2019. It is fair to assume, therefore, that roughly one in six people who would have been diagnosed with cancers of all kinds is out there undiagnosed. We know that for every four weeks treatment is delayed, for whatever reason, the chances one has of survival fall by 10%. That delay in treatment can be due to a delay in people coming forward, a delay in diagnosis and a delay in treatment.

Any Government of any combination of colours would have been thrown by the coronavirus. In those early months the messaging was really good and powerful: “Stay at home. Protect the NHS. Save lives.” It often occurs to me that the position of the NHS in British society, the affection in which it is held, was a key driver. I suspect that in another country, where the message might have been, “Protect the expensive private healthcare that you use, through exorbitant insurance models,” would probably have been less compelling. The NHS was a key driver and the Government deployed it well.

Why were we protecting the NHS? We were doing so not only so that we could tackle covid, but so that the NHS could carry on its lifesaving work in every other area. People not coming forward for treatment, for reasons that have been mentioned, such as being scared of being infected or nervousness about being a burden and troubling staff, is a huge part of the reason why the backlog exists.

There were treatment cancellations for perfectly good clinical reasons, as well as those for not good clinical reasons. I am chair of the all-party parliamentary group on radiotherapy, and Members would be staggered if I did not talk about radiotherapy as a treatment for breast cancer and other forms. Radiotherapy is the clean form of cancer treatment. It does not affect immunity and is not likely to open up someone to infection. The amount of radiotherapy being delivered during that period should not have been changed, because people are at no more risk of covid from taking it and, because it is a clean form of treatment, it should be substitutionary. It could be used, and in some cases has been, as a substitute for more risky forms of cancer treatment, such as chemotherapy and surgery, where that was necessary. In some cases, that has happened, which should be noted.

For example, bladder radiotherapy treatment is now at 160% of normal levels and capacity. In that area at least, we are using that clean technology to catch up with cancer in that area. The problem is that it is not the case across the board. We do not have figures since summer, but Public Health England has just released figures from April to the summer, which showed a 15% drop in radiotherapy treatments started during that time. That includes starting in April, so that cannot have been a response to fewer people coming through.

The National Institute for Health and Care Excellence recommendations and guidance at the beginning of coronavirus were to stop, postpone or delay radiotherapy treatment—for no clinical reason whatsoever. Some cancer centres followed that advice and people did not get treatment. We know what that means for people’s likelihood of surviving. That 15% drop in radiotherapy treatment will have cost lives. It was unnecessary and it means that the backlog is even greater than it would have been.

Cancer Research UK has estimated that we will unnecessarily lose 35,000 lives to cancer because of the crisis. The British Medical Journal published research a few weeks ago that showed we would lose, as a country, 60,000 additional years of life to cancer, because of the coronavirus crisis.

When breast cancer screening services are running at just 60% of capacity and we are witnessing a 50% reduction in the number of people starting radiotherapy treatment, we see a backlog that can only be getting worse as we speak. I want to endorse what has been said by the Chair of the Health and Social Care Committee, Jeremy Hunt—that it will take NHS cancer screening, diagnostics and treatment services, as a piece, operating at 120%usb capacity for two solid years to catch up fully with the backlog, to catch up with cancer.

Members will have been as deeply moved as I was by the recent sad death of Sherwin Hall, a 27-year-old father of two, as a result of delayed treatment. His family have been supported by the Catch Up With Cancer campaign, launched by the family of Kelly Smith, who also died far too young as a result of delays to her treatment during this process. Catch Up With Cancer estimates that the backlog might be up to 100,000 people. This is a national crisis on the scale of covid—different, but on the same scale—and it needs a response as ambitious and as urgent as the NHS’s correct response to covid. However, in the comprehensive spending review there was just a single mention of cancer in the entire document.

There are three issues at play here, the first of which is people having the confidence and awareness to come forward, as has been mentioned. The second is the diagnostic process and the third is the treatment. Issue one, the issue of people being brought forward or encouraged to come forward for treatment, is about strong public health and public information messages, and all of us getting behind them and being open about the necessity—as was mentioned, rightly, by the hon. Member for West Bromwich East—for a person to come forward if they have the slightest hint of a doubt that something might be wrong or unusual with any part of their body.

Issues two and three, diagnostics and treatment, need more than an ad campaign. They need more than good public relations and public information: they need money. It has been mentioned that within the CSR, £325 million was set aside for diagnostic machines, but the CSR says that that is

“enough funding to replace over two thirds of imaging equipment that is over 10 years old.”

In other words, it is money to replace some of the stuff that ought to have already been replaced. It is not new—it is not expanded capacity—and yet, when it comes to treatment, we have not got even that.

This was the Government’s opportunity. As chair of the all-party parliamentary group on radiotherapy, along with the Catch Up With Cancer campaign and the all-party parliamentary group on cancer—which I am proud to also be a member of—we made a submission to the Department of Health and Social Care and to the Treasury, calling for an immediate fund to catch up with cancer. That did not arrive, and I am going to shock the Minister by reminding her of a promise that she made me in this place a couple of weeks ago—to meet me and the Catch Up With Cancer team before Christmas, to look at how we can get that urgently needed ring-fenced investment through the spending review and into additional cancer diagnosis and treatments. I would like to hold her to that promise, and I hope she will refer to it in her closing remarks.

Alongside covid, the early diagnosis of women with breast cancer, so that we can treat them and cure them, is an ongoing problem. The United Kingdom is towards the bottom of the league tables for most of the major cancers when it comes to survival. To the Government’s credit, they acknowledged that in the NHS long-term plan released two years ago. Its fundamental aim—the headline part of that NHS long-term plan—was to diagnose more people early with all cancers, including breast cancer, so that we could treat them and cure them, and so that survival rates would be far better than the terrible situation that we have for most cancers in this country now.

I say to the Minister that if we are successful in diagnosing more people sooner, earlier—and we must be successful—we will then need the capacity to treat those people, and we do not have that. Radiotherapy is part of the solution, so it is absolutely essential to invest now in the kit, the technology and—as has been mentioned—the workforce, in order to be able to deliver treatments to those people who have been diagnosed early. How tragic would it be to diagnose maybe tens of thousands more people earlier than we do at the moment, and then not have the kit, the capacity, the staff or the technology to treat them? That is a challenge that the Government can meet, and I hope the Minister will take that on board and do just that.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health) 2:58 pm, 16th December 2020

Thank you for calling me, Sir Edward. First of all, I congratulate Robert Largan on the way that he set the scene. I thank Nicola Richards for her contributions, as well as Tim Farron, and I also thank him for the leadership that he gives to the all-party parliamentary group on radiotherapy. I am a member of that APPG, but I know that the person who moves it and makes it happen is the hon. Gentleman, along with other colleagues who are trying to make this subject a focus for every one of us.

The statistics for breast cancer are horrifying. The hon. Member for High Peak set them out in his introduction, but I want to repeat them. It is salient and important to focus on the stats, because they are not just stats: they are a person’s life and they affect everybody around them. That is what I want to refer to. The breast cancer stats are clear: 55,000 women and 370 men are diagnosed every year in the UK. We sometimes overlook the fact that men can get breast cancer—not in the same numbers or percentages as ladies, but none the less it can develop in them.

One in seven women in the UK will develop breast cancer, and 35,000 women are living with incurable secondary breast cancer. Almost 1,000 die from breast cancer in the UK every month. Perhaps if they had screening, that would not have happened. That is 1,000 mothers, daughters, sisters—1,000 homes that will never recover from the loss. We must never underestimate the loss and hurt that people feel when someone they love is no longer there. We sometimes focus on the “if only”—we do not know what that “if only” would have done, but it does come into our minds and our questions.

About 600,000 people in the UK are living with or beyond breast cancer. Let us be honest: if it is caught in time and if the surgery and treatment go correctly, people can live for longer. We should perhaps not always focus on the negatives, although this debate is about breast cancer and is an opportunity to highlight the issues that we feel are important. Health is a devolved matter in Northern Ireland, and I understand that the Minister cannot answer for it—I am not asking her to—but I want to make a contribution to this debate because what happens here on the mainland will be replicated in Scotland, Wales and Northern Ireland.

I said that it is not only the person who has breast cancer who suffers. We have to look at the families around them who also suffer—those who feel the pain of their partner or loved one who unfortunately has breast cancer and, in some cases, is still waiting for the treatment or screening that they need.

I am my party’s spokesman, and I have a deep interest in health matters. That is why I attend all health debates whenever I have the opportunity. I cannot get to them all, but I do my best to get to most of them. Back in Northern Ireland, I have had the opportunity over the years to get to know some of my constituents personally. The hon. Member for Westmorland and Lonsdale referred to two names. I never refer to names—they probably would not know who they are when they are referred to in this Chamber, but I do not do that because this is a very personal thing. It is a very physical problem that they have gone through. Some of those people have survived and some have not. As an elected representative and a person with compassion, as we all are in this House, my heart goes out to those who are in need of treatment and need it now.

We cannot neglect—I do not think there is an intention to do so—those with cancer, because time is of the essence and early diagnosis is needed. This is where we are. What I and other Members want is a different set of statistics for next year. We do not want to be referring to the 100,000 and some of the other stats that I will give in a few minutes. We want statistics that show more early diagnosis, more successful outcomes and—please, God—nowhere near 1,000 grieving loved ones. How do we achieve that? That is the key issue of this debate, and why we are here. I believe we all agree on this. It is simple: screening. Early screening, frequent screening, structured screening, simple screening—screening, screening, screening. We need to get that into our minds for how we deal with this. We are here today because we all have the same idea. That is how we get better outcomes.

In the media and the newspapers yesterday and every other day I can recall, we have had stats for cancer treatment. We cannot fail to be annoyed when we see the stats for the people who are waiting for treatment, diagnosis or screening. It has all been put on hold, and we need to look at that urgently. The hon. Member for Westmorland and Lonsdale referred to the Government response to covid-19. The Government responded in an excellent way. They made all the necessary resources available and they gave us hope, up to the stage where we are now, with the vaccine in place. That hope will lead us into next year. Perhaps by this time next year everyone in the United Kingdom of Great Britain and Northern Ireland will have had that vaccine; that would be our hope.

The coronavirus is the biggest crisis that breast cancer care has faced in decades. With every month that passes, more women with breast cancer could be missing the best possible chance of early diagnosis, which is key to preventing death from the disease. The breast screening programme was officially paused in Scotland, Wales and Northern Ireland, and effectively paused in England, in March. Screening has now restarted, although that has happened more quickly in some parts of the country than others.

Breast Cancer Now has estimated that a significant backlog of nearly a million women requiring screening built up across the UK during the first pause, which is a massive number. If a million ladies are waiting to have the screening, that underlines the importance of putting resources into that, to try and give people peace of mind. It is unclear how long it will take to catch up. Around 8,600 of those women could have been living with undetected breast cancer, which is a worry.

When my wife went to get the test, we got the results back quickly, but imagine what it would be like for someone waiting for the screening if they suspected something was wrong but were not sure. Sometimes the screening can diagnose at an early stage something that the individual was not aware of or might not see themselves. Can the Minister be so kind, during her closing remarks, to clarify what the Government mean when they say they have cleared the backlog on breast cancer screening? Does that mean that open invitations to breast screening have been sent, but not that the actual screening has happened? I have every confidence that the Minister’s response will answer those questions and give us the hope and reassurance that we need.

The expected increase in referrals and backlog of women waiting for breast screening will lead naturally to an increase in demand for diagnostic and imaging services in the coming months, threatening to overwhelm a workforce that was already stretched before the pandemic. Combined with a reduction in the number of people that services will be able to see, as a result of infection prevention and control measures, there is grave concern that that may lead to people waiting longer to be diagnosed and receive treatment. Again, we need reassurance.

A recent survey by the British Medical Association revealed that 28% of doctors—the people on the frontline, doing the work—have found non-covid demand higher than before the pandemic. They recognise a serious gap that needs to be filled. Moreover, 58% are concerned about their ability to care for non-covid patients, 44% are worried about the plans to manage the huge backlog of patients and 65% say staffing shortages are their most pressing concern. I understand those concerns, and I look genuinely and respectfully to the Minister for her answers.

The unprecedented pressures put on the NHS by the first wave of the pandemic, which have already had damaging impacts on diagnosis and treatment for breast cancer patients, are now being exacerbated by the second wave and the winter pressures, which we all know are coming to every region in the United Kingdom. Winter pressures come every year, but this year they will be greater because of the waiting lists and the ways we are dealing with that.

While it is great to see Health Education England receive an additional £260 million to train more staff in 2021-22, Cancer Research UK estimates that £140 million to £260 million is needed over the next 35 years to grow the cancer workforce alone. It is not only about responding to the current waiting lists, but how we deal with the growing number of those with cancer over the next few years. An additional £260 million for HEE’s total budget in 2021-22 should go some way to address that, but will not fill the gap.

I conclude by reflecting on the comment by the hon. Member for Westmorland and Lonsdale, because to me it is the key to the issue. The Government responded in an exceptional way to covid-19. They made the resources available. A strategy for something we had never dealt with before was difficult to get together, but they did it in a way we all welcomed—we give credit where it is due—until now we have the vaccine.

However, when it comes to cancer we need a similar policy and strategy, so that we can give peace of mind to all those people who have breast cancer, and have a worrying process to go through. The Government have shown they can do it, and I believe they, and the Minister, can again respond in a way that will show us we can deal with breast cancer. We need a dedicated strategy and long-term investment. I look to the Minister to hear how that can and will be provided, in the light of the additional covid-19 demands. Covid-19 is not over yet. I wish it was, but at least we are going the right way. We can see the light at the end of the tunnel and there is hope for the future, but we need the same hope for those with cancer.

Photo of Owen Thompson Owen Thompson SNP Whip 3:11 pm, 16th December 2020

It is always a pleasure to serve under your chairmanship, Sir Edward. I thank Robert Largan for securing this important debate. It is also important to thank all the NHS staff who are working so hard to keep services running during this difficult time, and the cancer charities working to keep funds coming in and awareness high, and to support those living with a cancer diagnosis. High-profile breast cancer awareness events such as the “wear it pink” photocalls that we are all so used to were lost to the virus this year, so there is a lot of ground to make up to keep the UK’s fourth biggest killer high on the political agenda.

Thanks to a combination of advances in the medical sciences, treatments, early diagnosis and screening, breast cancer survival has doubled in the last 40 years, but the necessity of disrupting routine screenings has created a danger of progress taking a significant step backwards. There are immense challenges, now, for the NHS, in meeting an influx of demand, when we are clearly still in the teeth of the pandemic. As members of the Royal College of Radiologists report, challenges are made all the tougher by the extra infection control methods needed at screening centres, limited availability of space because of distancing, and, at times, staff and equipment shortages because of redeployment.

As other hon. Members have said, Breast Cancer Now estimates that nearly 1 million women in the UK missed potentially life-saving mammograms because of covid-19. There was also a marked fall in the number of urgent breast cancer referrals from GPs during the pandemic. That was due to a range of factors, including reluctance to take up the scheduled appointments, worry about catching the virus, or a lack of awareness that while routine screenings were paused the majority of cancer treatment services continued throughout. According to Macmillan Cancer Support, 100 fewer women started treatment for breast cancer each working day in May and June 2020, compared with a year ago. It estimates that there are 50,000 missing cancer diagnoses across the UK because of covid-19 disruption.

Those are serious causes for concern. Cancer patients cannot be allowed to be collateral damage as we struggle to fight the pandemic. All of us have a role to play in encouraging take-up of opportunities for screening, self-checks and getting out the message that the NHS is there for people if they are worried about cancer. Covid continues to dominate the headlines, but the NHS has never stopped prioritising cancer cases.

Governments also have a role in communicating about cancer services, and making sure that there is investment in facilities and staff in the NHS cancer workforce. As the RCR reports, the clinical radiology workforce was already under strain before the pandemic. One in four English trusts has at least one vacant consultant breast radiologist post, and the UK has fewer CT and MRI scanners than the majority of comparable OECD countries. Decisions about the NHS are made by the devolved Government in Scotland. Thankfully, the Scottish Government are working to minimise disruption in the face of the covid-19 challenges. They have invested an additional £10 million to support cancer treatment throughout the pandemic and beyond, in addition to purchasing six additional MRI scanners and three additional CT scanners to aid cancer diagnosis, at a cost of £5.6 million.

There is much to be done, but I welcome the fact that there has been an 89.6% increase in consultant oncologists in Scotland under the current SNP Administration and a 54.4% increase in consultant radiologists. Early detection will also be improved by more GPs. Scotland has 76 GPs per 100,000 population, compared with the UK average of just 60. There are also two new early cancer diagnostic centres, which will be opened in the spring of next year.

I have a great deal of sympathy for the request to extend screening to younger men and women in the petition that we are debating today. It is always heartbreaking to hear of cases that are not diagnosed early enough, leading to long battles to fight the disease and a greater chance of lives being lost too early. We know the risk is related to age and is highest in women over 50—they account for 80% of cases—but that is cold comfort to the 10,000 women under 50 and the 370 men in the UK who receive the dreaded diagnosis each year. Catching this disease early is essential to saving more lives. I would back screening for all in a heartbeat if it was justified clinically, but it is just one tool in the toolbox and it is not always the best one to use.

There are harms as well as benefits to getting mammograms, and decisions on routine screening programmes are all about getting the balance right. The four nations of the UK all take advice on screening from medical experts at the UK National Screening Committee and the Scottish Government concur with the points made in the UK Government’s response to the petition.

If there is one thing that the pandemic should have taught politicians—perhaps even the Chancellor of the Duchy of Lancaster—it is that we should be listening to experts. Their views are so important. It is the scientists and clinicians who are guiding us through the pandemic and providing hope for a solution through their incredible efforts to find treatments and vaccines. So, too, should we trust evidence on screening. The Marmot review of the benefits and harms of breast cancer screening identified overdiagnosis as one of the dangers, stating:

“The consequences of overdiagnosis matter, women are turned into patients unnecessarily, surgery and other forms of cancer treatment are undertaken, and quality of life and psychological well being are adversely affected.”

Only 1% of cases involve men. There is a need for us to focus on messaging and spread the awareness that breast cancer is possible for both sexes, although at a far lower risk for men. Perhaps we all need to do that bit more to highlight that point, to make sure that men self-check and seek treatment where necessary.

Although there is largely consensus on the science, there is perhaps more divergence on these isles about the resources needed. Warm words about tackling cancer are easy, but they need to be backed up by sustained and substantial further investment. Ahead of November’s comprehensive spending review, the SNP called on the Government to increase funding for NHS England to match per capita spending in Scotland. That would have amounted to a £35 billion increase by 2023-24. The £3 billion offered for the next year is only a third of what we have been calling for on a yearly basis. After a decade of austerity, the sum is not even enough to cover the cost of outstanding hospital repairs in England, let alone recover from the coronavirus and deliver decent cancer care moving forwards.

I urge the UK Government to do all they can—to “build back better”, to borrow their phrase—and to properly and genuinely invest in the NHS to save lives.

Photo of Justin Madders Justin Madders Shadow Minister (Health and Social Care) 3:18 pm, 16th December 2020

It is a pleasure to see you in the Chair this afternoon, Sir Edward. I thank Robert Largan for securing this important debate and for his introductory speech. It is clear that he feels very passionately about improving access to breast cancer screening for his constituents. He was right that tremendous progress has been made in tackling this awful disease in recent years, but there is still an awful long way to go, as we have heard today.

The hon. Gentleman mentioned the importance of screening, as most Members did. I was very sorry to hear that the mobile screening service in his constituency has been temporarily halted. I hope it is a temporary halt and the Minister is able to give us some good news when she responds. It is particularly disappointing because the hon. Member spoke very highly of that service in the last debate we had on this matter, only last month. He certainly set out very clearly why moving to the system that we have at the moment is presenting a particular challenge to his constituents. He also gave some very personal testimony about the consequences of a delay in screening, showing why, of course, access is important.

We have heard some other excellent contributions this afternoon. Nicola Richards cited her local area’s statistics to point out that the figure for screening appointments in her constituency was lower than the national average; clearly, such a situation is something that all Members can play a role in remedying. She was right to say that the key to all this is being proactive and encouraging people to seek screening and early diagnosis. She gave a very personal example of how that approach had made a real difference to someone very close to her.

Tim Farron extrapolated from his local statistics to state that about one in six people who would ordinarily have received treatment this year are not receiving it. He mentioned his work as the chair of the all-party parliamentary group on radiotherapy and I commend him for his consistent work in that particular forum. He referred, quite rightly, to the 15% drop in the use of radiotherapy treatment, which is of particular concern. He said that he does not believe that there were good medical reasons for that reduction, so there is a challenge for the Minister to go back to trusts to see whether there are reasons beyond medical reasons why these treatments are not taking place. He described the situation as a crisis on the scale of covid and said that it needs a Government response on that scale to tackle the issues that we have discussed today.

Those sentiments were also expressed by Jim Shannon, who gave a typically passionate and well-informed speech. I am sure that we all agreed with him when he said that he would like to read out a different set of statistics in a debate on this issue next year. Like all the hon. Members who have spoken today, he very clearly set out the importance of screening. He also raised a number of other issues, which I will touch on in my remarks.

This is the second Westminster Hall debate on breast cancer in as many months, which reflects the importance of this subject. On both occasions, it has been evident from the testimonies of Members how many people have had their own lives touched by breast cancer. Debates such as this one are important because, as many Members have mentioned, the various statistics out there show that there are very few people whose lives are not touched by this issue in some way. As we have heard from many Members, one in seven women in the UK will develop breast cancer during their lifetime—on average, that is 55,000 women, as well as 370 men, every year. Around 600,000 people in the UK are living with or beyond breast cancer, and, sadly, around 35,000 people have incurable secondary breast cancer.

As the hon. Members for High Peak and for Strangford both said, almost 1,000 women die from breast cancer in the UK every month, almost all of them from secondary breast cancer. The hon. Member for Strangford put things very well when he reminded us that these statistics are about real people and real homes, which may never recover from such a tragic loss. We must never forget the human tragedy behind these figures when we read them out in debates such as this one.

This very important issue affects so many people, but there are also many people who are united in their desire to do all they can to beat this disease. I pay tribute to all the dedicated campaigners, ambassadors and charities, who all do their bit to make life a little bit easier for those suffering with cancer. We must, of course, pay tribute to the NHS staff for everything that they do, not just this year—the most difficult of years—but every year, in the fight against cancer. I also thank Breast Cancer Now for its continuing support for all politicians from all parties in the House and, most importantly, the support it gives to those living with or affected by breast cancer, because, as we have heard, more women, thankfully, are now surviving breast cancer than ever before.

As many Members have already said, the key to that is screening, because we know that the earlier a cancer is diagnosed, the more likely it is that treatment will be successful. We also know that currently around 95% of women diagnosed will survive for more than one year and more than 80% for more than five years.

In the debate on this issue last month, I touched on the impact of coronavirus on early diagnosis, as most Members have today. Cancer Research UK estimates that around 3 million people are waiting for breast, bowel or cervical screening, and Macmillan estimates that there are currently around 50,000 missing diagnoses from this year compared to last year. This is the biggest crisis that cancer has faced in decades.

Breast Cancer Now estimates a significant backlog of nearly 1 million women requiring screening has built up during this year. Among the women still waiting for their screening, we know from the statistics that there will be around 8,600 who do have breast cancer, but it remains undetected. As Members have set out, the reasons for that backlog are numerous. Social distancing and infection control means that many cancer services can operate only at about 60% of their capacity. As the hon. Member for Westmorland and Lonsdale pointed out, that means the situation might get worse rather than better. Services were already under severe strain during the first few months of this year, and we know about the unprecedented steps that the NHS has had to take to deal with the large influx of covid-19 patients, which has led to an effective pausing of breast screening in England.

Of course, not only the screening programme was affected. Breast Cancer Now has also reported that the number of people referred to see a specialist with suspected cancer declined dramatically during the peak of the coronavirus outbreak in April. It estimates that across the UK there are likely to be nearly 107,000 fewer breast cancer referrals. Some of those women could be living with undetected breast cancer, and with every month that passes more women will be missing that early diagnosis that we have all heard today is the key to preventing death.

Although screening programmes have now restarted, we have heard that that has happened more quickly in some parts of the country. Breast cancer charities have raised concerns about the current strategy that has been adopted to clear the backlog, with the plan to send women open invitations to call and make an appointment from September this year to the end of March. As the hon. Member for West Bromwich East said, research has shown that the number of women who make appointments is sometimes lower than the number of women who actually attend for a timed appointment.

Breast Cancer Now fears the strategy could worsen the persistent decline that we have seen in the uptake of screening in recent years. It has also raised concerns, as did the hon. Member for West Bromwich East, about the impact on groups, among which uptake is already low, such as those who live in deprived areas and those from black and minority ethnic groups. This is particularly important at a time when surveys have shown that people are reluctant to come forward with symptoms due to concerns about catching coronavirus and giving it to the family, and putting pressure on an already very busy NHS. When the Minister responds, will she tell us a little more about what steps the Government can take to ensure that the women who have received open invitations for screening are able to take those up in the coming months?

It is very welcome that October’s NHS breast cancer waiting times showed an increase in referrals for people with potential symptoms of breast cancer to see a specialist. However, the crucial targets for women to be seen within two weeks was missed. There are immense pressures on our health service at the moment, but before the pandemic the breast imaging and diagnostic work was already overstretched and under severe pressure because of increased demand on their services—and that of course has been compounded, as many Members have referred to, by the shortages and vacancies in the workforce.

As the hon. Member for High Peak mentioned, Public Health England has previously reported a vacancy rate of 15% for mammography staff. About half of all mammographers are aged 50 or over and therefore likely to retire in the next 10 to 15 years. That is very concerning, given the importance of mammograms in detecting breast cancer.

Of equal concern is what Breast Cancer Now tells us: only 18% of breast screening units are adequately resourced with radiography staff in line with breast screening uptake demand in their area, and one in four trusts and health boards across the UK has at least one vacant consultant breast radiologist post. Sadly, that situation is unlikely to improve any time soon as vacancies are set to increase with about a quarter of breast radiologists forecast to retire over the next five years.

A recent analysis of NHS trust risk registers showed that 83% of trusts surveyed reported a workforce risk, including not having enough staff to manage cancer care, showing the NHS entering the pandemic with huge holes in the workforce.

The Government commissioned reviews that have highlighted some concerns. We heard from the hon. Member for High Peak and various other Members about the independent review of adult screening programmes in England, which found that such programmes are constrained by the size and nature of their workforce and by the equipment and facilities available to them. As we heard, Professor Sir Mike Richards’s review, which was commissioned by Sir Simon Stevens, found that significant investment in facilities, equipment and workforce was needed. That means replacing outdated testing machines and expanding the imaging workforce by about 2,000 additional radiologists and 4,000 radiographers, as well as support staff.

In September, a Public Accounts Committee report called on the Government urgently to prioritise publication of the long-term workforce plan. Unfortunately, that exposed the lack of long-term thinking in the current approach to the NHS workforce. Such thinking is vital if we are to see the NHS perform at the level we all want it to. We need to see a full five-year people plan, with costed actions within it.

The pandemic has shown, as other Members said, just how valuable and appreciated NHS staff are, but it has also highlighted the unaddressed long-term issues of excessive workload, burn-out and the inequalities experienced by staff. The rhetoric on support for our NHS staff needs to be matched by action. As we have heard today, that commitment is vital to ensuring that breast cancer services can safely continue to give all those affected by breast cancer the very best chances of survival. I hope that we will hear from the Minister about how that ambition, which we all share, will be delivered.

Photo of Jo Churchill Jo Churchill The Parliamentary Under-Secretary for Health and Social Care 3:31 pm, 16th December 2020

It is a pleasure to serve under your chairmanship, Sir Edward.

I thank my hon. Friend Robert Largan for securing this important debate. As he and many Members know, breast health—diagnosis, treatment and research, as well as screening—is a matter that is close to my heart. I am honoured to respond on this important issue on behalf of the Government, and on behalf of women and the 3% of men who are diagnosed with breast cancer every year.

I want to state clearly that screening services are back up and that the availability of breast screening to everyone who needs it is there. However, the recovery of those services from the disruption this year is not only a priority for me, but an enormous challenge, for exactly the reasons that have been laid out so eloquently by all contributors to the debate. We know that our cancer workforce had challenges before we went into the pandemic.

Let me remind Members of something that only Jim Shannon briefly referred to: yesterday, 506 families lost a loved one to covid. It is still with us. We are in a covid-tinged world, and that affects how quickly we can drive other services. However, the resumption of cancer services across the piece—be they treatment, diagnosis or screening—has been the No. 1 priority for me from the time we understood and were able to drive those things in.

I am glad that hon. Members who have taken part in the debate recognise the importance of breast screening in the early detection of breast cancer. As with any diagnosis of cancer, early detection gives people a better chance. The simple fact is that screening saves lives.

I very gently take Tim Farron to task on the statistic that every four weeks represents a 10% lower chance of survival. Cancers, as he well knows, vary enormously in type, grade and everything else. I do not want people not to come forward for screening, diagnosis or treatment because they feel that any loss of time will have had a negative impact. It has to be that as soon as you have a symptom, you come forward. Campaigns such as “Be Clear on Cancer” and “Help Us Help You” are driving at giving people confidence.

We have ensured that services are safe, and our aim is for people to be able to access them as quickly as possible, secure in the knowledge that they are safe. I will cover this later, but while I understand what my hon. Friend Nicola Richards and Justin Madders were saying, the whole point of open appointments is to maximise the use of available capacity versus fixed-time appointments. A health inequality impact assessment has been done to try to make sure that nobody is disproportionately impacted, and I have asked for a specific eye to be kept on that. Now, if you like—

Photo of Edward Leigh Edward Leigh Conservative, Gainsborough

Order. As a matter of courtesy, it is normal for Ministers to address the Chair.

Photo of Jo Churchill Jo Churchill The Parliamentary Under-Secretary for Health and Social Care

I am so sorry, Sir Edward. As I was saying, the challenge is that there is variation in the system. That variation occurs for a plethora of reasons, not only those that are covered by an impact assessment on accessibility via open appointments. It is important to keep an eye on all the data.

I am proud that we have a national breast screening programme that offers every woman between the ages of 50 and 70 an appointment every three years. We will strain every sinew to ensure that nobody waits longer than 36 months. We will not step back from that, even with the challenge of driving the backlog down. The programme reaches millions of women and detects approximately 20,000 cancers each year. I recognise the challenge, but every single individual provider has been asked to produce a recovery plan, which should help us to understand the variation. I recognise that about half a million women are waiting, but there are also 500,000 women who have not replied. They will need to be re-approached and encouraged into the system. It is incumbent on everyone to give women the confidence to come forward.

We have also had to look at making sure that women are asked to come forward in accordance with priority by targeting the women who are most likely to have an occurrence of breast cancer. High-risk women will not have open appointments; they will be called immediately. We will then screen positive women in the pathway, followed by screening results that have not been processed, routine open episodes, those who have previously been invited but not screened, and the delays. It is important that we prioritise, so that we target the women we are most worried about.

I am aware that this year, the national breast screening programme could not maintain the service that it normally provides. In March, as the NHS responded to one of the biggest challenges that has faced our healthcare system in a generation, many local providers made the decision to pause appointments so that arrangements could be put in place to protect staff and patients from covid-19. We were unaware at that point what we were dealing with. Staff and facilities were redeployed to tackle the outbreak of the pandemic, but as soon as it was possible to do so, it was made an absolute priority that they were brought back in to do the job that we need them to do.

I am sure that there is not a single Member in this Chamber, or indeed the House, who does not pay tribute to the hard work of all NHS staff. Cancer staff and their teams have done a particularly incredible job of making sure that people across the cancer family have received treatment. Earlier today, I talked to a young man about the treatment he has had, and I talked to a young woman who experienced chimeric antigen receptor T-cell treatment earlier this year. The redeployment of staff left a shortfall in the breast screening programme, and screening appointments for many women have been delayed. I know that that wait, and the anxiety it drives, is incredibly difficult. For those who are looking for reassurance from their routine screen, or who are waiting to receive an all-clear or an early warning that something is wrong, this is undoubtedly a challenging time. However, I want to be absolutely clear that no woman has been left behind, and no woman ever will be. It is a priority to ensure that services are there. Improvements are being driven by the heroic efforts of staff, who have been working longer days and over weekends. They have gone above and beyond to schedule as many appointments as possible to help to drive down the backlog that was created earlier this year.

The first priority is to screen women aged 53 who have not yet had their first screening appointment; those who have passed their 71st birthday and have not yet received their final breast screen; those at very high risk of breast cancer, as I said; and those who have been identified for further treatment. I am pleased to say that the tremendous efforts of screening staff—the nurses, the radiographers and the whole team—are succeeding and the backlog is steadily reducing. The number of women waiting for screening, having received an invitation prior to the first wave, decreased by 98% between 1 June and 4 November.

Screening has been made a clear priority this winter and NHS commissioners have been instructed, where humanly possible, not to redeploy their staff or their facilities away from screening services. It is a priority, and that is absolutely the right approach. My message to everyone is that breast screening services are running, they are safe, they will continue to run through the winter and they are standing up to the increased capacity that is coming towards them.

When people receive an appointment to attend, I urge them to go. “Do not attends” are so frustrating. Those appointments could be taken by a woman who—although she would not want a diagnosis—might get into the stream quicker.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

I suspect that on some occasions, ladies are not attending because of the fear of catching covid-19 at the hospital. I have spoken to some ladies back home and that was one of their concerns. How can we address that?

Photo of Jo Churchill Jo Churchill The Parliamentary Under-Secretary for Health and Social Care

Essentially, by constantly reassuring them that the reason why we can do elective operations, have out-patient clinics open and carry on doing some of the business as usual is because heroic efforts have been made to make sure that there are safe places. I pay tribute to Dame Cally Palmer, who has made sure that rapid diagnostic centres have been stood up to ensure that patients can access care safely. We had 17 at the start of the pandemic, and we now have 45. The cancer alliances have worked extremely hard in all our regions. There is no one silver bullet, but it is important that we do what we can for patients.

If people have any concerns or notice any abnormal changes in their breasts, they should contact their GP. I pay tribute to my hon. Friend the Member for West Bromwich East, and I am pleased that her mum is now in good health. CoppaFeel! is a great charity and its website shows how to do a good check. Breast Cancer Awareness Month still went on—I did wear it pink—although it did not quite have the same profile as usual. It is every woman’s responsibility to make sure that they check their breasts monthly. If they see anything unusual that they are concerned about, such as puckering or discharge from the nipple, GPs are open and there to help women.

One thing that can help is to make sure that people go, but we are here to talk predominantly about screening services. Cancer diagnostics and treatments are back on track. The latest official data for October 2020 suggests that GP referrals are back to almost 85% of pre-pandemic levels, compared with August 2019. I appreciate that that leaves a lag, but we are heading in the right direction.

Urgent referrals were 156% higher in October than in April, which is when they were most affected. That shows that we are not only getting there, but beginning to go beyond. Nearly 88% of cancer patients saw a specialist within two weeks following their referral, and nearly 96% of patients received their treatment within 31 days of a decision to treat. In October, 83.5% of breast cancer patients received their first treatment within 62 days, and breast cancer treatment activity was at 101% of last year’s levels. However, these figures do not hide the fact that there is a backlog and we have to work as hard as we can to address that. The “Help Us Help You” campaign, launched in October, is a key part of this and reinforces that message of seeking help. We will closely monitor the effect of covid restrictions on referral rates to ensure that the number of people coming forward with symptoms remains high, because it is about confidence. Some pathways are more problematic than others, but the important thing is to make sure that we get as many people as possible through the pathway.

I turn to the theme of breast screening for younger women. As Owen Thompson has said, this has been found not to be evidenced-based. There is a risk in referring women for unnecessary tests, in over-treatment, and in operating on women who have diseases that mean that that is likely to cause harm. Women with a very high risk of breast cancer, such as those with a family history, may well be offered screening earlier and more frequently. Sometimes, in life, we just have to ask a question, and I recently asked a breast cancer specialist about this. My hon. Friends the Members for Chatham and Aylesford (Tracey Crouch) and for Norwich North (Chloe Smith), and the former Members for Dewsbury and for Eddisbury, all of whom are in the younger age group, are going through treatment—I think one of them is post treatment—and I was their age when I was diagnosed. Just because something looks right, it does not necessarily mean that it is, and we have to act on the evidence. That is where we are at the moment for young women.

We published the people plan in July, and I recognise, as Sir Mike Richards did, that the screening workforce is a challenge and it is important that we drive more individuals into the areas of radiography, mammography, pathology, nursing and cancer specialist nursing. The spending review provided another £260 million to continue to grow the workforce and support those commitments, which were so important in the NHS long-term plan.

Health Education England has also provided £5 million to support training and development programmes through the National Breast Imaging Academy, which aims to improve breast screening recruitment targets and early diagnosis. It has already made significant progress, launching the mammography level 4 apprenticeship; recruiting the first of the NBIA radiology fellows, who will benefit from specialist training in breast radiology; and developing e-learning for health programmes on the breast.

To improve screening uptake, we need to work with cancer alliances, primary care networks and the regional teams to promote the uptake of breast screening and to get to as many people as possible. As I said, the open appointments systems is something that we are looking at, and we hope that the result will be that we get more women through. The national cancer recovery plan was released this week. It is a joint effort from cancer charities, royal colleges, national teams and patient voices, and it was led by the national clinical director for cancer, Professor Peter Johnson. Its whole ethos is to outline the actions that need to be taken to restore demand to at least pre-pandemic levels by raising national public awareness through campaigns; ensuring that there are efficient routes into the NHS for people who are at risk of cancer; improving referral management practice in primary and secondary care; and setting out immediate steps to reduce the number of people who wait more than 62 days from urgent referral, so that patients are seen as quickly and safely as possible. Finally, it ensures sufficient capacity to meet demand through maximising the use of available capacity in both symptomatic and screening pathways, which both feed into the same funnel, optimising the use of the available independent sector capacity, enabling the restoration of other services, and protecting service recovery during winter.

This is an excellent plan, which will work towards the long-term plan ambitions for cancer services to continue during the pandemic. I am fully committed to seeing it through and working with Dame Cally Palmer and all the others to ensure that we can get to a better place. I recognise that, as the hon. Member for Westmorland and Lonsdale said, there have been some remarkable changes to treatments with radiography and other treatments in cancer. We must take those silver linings where we can.

I pay tribute to my hon. Friend the Member for High Peak for coming to me to say that High Peak was special due to its geography, and he did not want the women he serves in his constituency to be disadvantaged in any way by a loss of service. I understand that the decision to put breast screening services into static positions was taken to maximise capacity. I was quite amazed that, pre pandemic, 70% to 80% of screening happened in mobile units. They are particularly helpful in dispersed rural areas, but with some of the challenges of providing covid-secure spaces—some of those units did not even have running water—a decision was made to bring them back to a static site. The static units can stay open longer and at the weekend, making about 1,000 more appointments possible in a three-month period, so a lot more women can be seen.

Although I take on board the point about travel, I am asking women to bear with us—to work with us. These are temporary changes, but they are a vital measure in the recovery of breast cancer screening services, allowing more women to be seen, particularly those who may have missed an appointment this year. I know that longer travel times are difficult. I know that those beautiful hills that my hon. Friend’s constituency is blessed with do not have particularly good bus services either. This is not always an easy proposition, but it was decided that, for now at least, optimising the service to see as many people as possible should take priority over optimising a mobile service.

When my hon. Friend came and met me, I could not give him any assurance, and he has pressed me again today. I assure him that this is a short-term measure. The increase of appointment availability will assist us in in being able to resume mobile screening for High Peak, safety permitting, by July 2021. I have been reassured by the Chesterfield Royal Hospital NHS trust that it is monitoring attendance, that this compromise is temporary, while services recover, and that the usual screening locations will be reinstated in the longer term to ease access. I take this opportunity to stress that the screening services are safe to attend and a range of measures have been put in place to ensure that people go.

I thank my hon. Friend and all other hon. Members who have participated today. I pay tribute to all the incredible staff across the country who are working so hard on the backlog and to make sure that cancer services stand up and catch up over the winter period. Hon. Members have my absolute commitment that we are focused not only on the short-term recovery of screening services, but on their long-term improvement too. Prevention, public health and early diagnosis continue to be a huge priority for me. We will continue to bear down on screening services, making sure we have the right kit in the right place and that we are delivering the different parts of the cancer pathway for men and women to have the best treatment.

Photo of Robert Largan Robert Largan Conservative, High Peak 3:54 pm, 16th December 2020

It is a pleasure to sum up this debate. It has been very constructive, with a lot of agreement. I appreciate the speeches from both the Opposition speakers, who made a lot of important points in a constructive manner, striking the right tone. I would like to highlight the contribution from my hon. Friend Nicola Richards, who talked of her family’s personal experience. She is a fantastic champion for her constituency.

I would also mention Tim Farron. We represent similar constituencies; he represents the Lake district and I represent the Peak district. I am sure we could argue all day about which is better, but they face similar challenges. I am a big admirer of his knowledge of the subject and the work he has done over the years. I must, of course, mention Jim Shannon who is always an assiduous attendee in this place. He made an important speech, with lots of very good points.

I am grateful to the Minister for her comments. I have listened to her speak before about her personal experience. I know there is no one more committed to this issue. I am reassured that we have such a diligent and committed Minister working for us on this subject. I am pleased with the news that the breast cancer screening service mobile unit will be reinstated to High Peak. I hope the Minister understands that I will be holding her feet to the fire, and making certain that the date is brought forward to be as soon as possible, so that we can get the mobile unit back to New Mills, Chapel-en-le-Frith, Buxton and the rest of the High Peak.

Question put and agreed to.

Resolved,

That this House
has considered breast cancer screening.

Sitting suspended.