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Cancer Treatment: Patient Travel Times

Volume 634: debated on Wednesday 10 January 2018

[Sir Christopher Chope in the Chair]

I beg to move,

That this House has considered patient travel times for cancer treatment.

It is a great pleasure to serve under your chairmanship, Sir Christopher. I should also like to consider satellite radiotherapies at Westmorland General Hospital.

Almost every story that I have heard or read in recent times about the national health service has been negative. I understand why, given the debate in the main Chamber at this moment, but I sometimes wonder how much this further damages the morale of the thousands of professionals who work in the national health service. So I want to start by paying tribute and saying a massive thank you to those NHS professionals who work tirelessly up and down the country, day in and day out, to look after us and our loved ones when we need it most. I especially want to put on record my appreciation for those who work in cancer care. We have some of the best cancer care in the world. We should all take a moment to recognise the fantastically high standard of treatment that we have in this country, delivered by professionals whose competence and compassion are the hallmark of our NHS.

But here is the problem: yes, we have world-leading treatment, but it is not truly available equally. The availability of care depends hugely on people’s ability to access it. I welcome, and have done so on the record, the £130 million announced by NHS England that is to be invested in improving radiotherapy treatment, and the new service specification, which aims to improve standards across the country. Working in clinical networks and developing specialised services has a strong evidence base, but what is not addressed is the inequality in access to services that already exist. That inequality will only get worse if it is not addressed now by NHS England. I am grateful to the Government that the consultation on allocating that investment has been extended to 24 January, not least because it gives the Minister the chance to amend the criteria and the priorities for allocating services.

I passionately believe that one of the criteria in allocating improved radiotherapy services must be the shortening of the distances that people have to travel, especially for those with more common cancers. My position is backed up by evidence, including a publication in The BMJ in 2016 indicating that outcomes are worse for people who need to travel further. Let me be clear what “worse outcomes” actually means. Worse outcomes can mean patients actively deciding to forgo potentially life-saving or life-lengthening treatment because getting to hospital is just too much of a trauma for them owing to the length and difficulty of the journey that is required. Worse outcomes means choosing forms of treatment that may be less effective than radiotherapy because the nearest unit is too far away. Worse outcomes includes patients failing to complete a vital course of radiotherapy treatment because they simply cannot cope with the gruelling, wearying travelling every single day.

Action Radiotherapy estimates that one in six of us will need radiotherapy to treat cancer at some point in our lives, but easy access to this treatment can depend entirely on a postcode lottery. It is the sad reality that in rural areas of England travel times to cancer treatments can be unbearably long for too many people, and patients are often forced to cover these long distances on public transport. Not everyone has the option of travelling in the relative comfort of a personal car, and even if a person does, driving themselves or being driven, day in and day out for four to six weeks, is a massive challenge. I believe that it is frankly cruel, if we could do otherwise, to force people who are already very poorly to make a two or three-hour round trip every day, for weeks, in order to receive life-saving care.

I congratulate the hon. Gentleman on securing this debate. I am a cancer survivor. I survived stage 4 cancer and I had a month of radiotherapy; I had to get the bus most days to get there, and caught a nasty infection because of the travel time, so I fully appreciate where he is coming from. I would like to highlight the cases of families with children with cancer. According to CLIC Sargent there are fewer than 20 treatment centres nationally, and that makes life extremely difficult for families who are having to travel for treatment. Will he pay tribute to CLIC Sargent for the respite care, finance and accommodation that it provides to families going through this terrible process and journey?

I am grateful to the hon. Gentleman for raising those issues and his own personal experiences. As I will come to in a moment, the issues affecting children and young people are even greater. I am very happy to pay tribute to the work and provision of CLIC Sargent and, in particular, to recognise the impact on people with cancer who have young children themselves. Maintaining an income and maintaining family life is an immense challenge, and the distances involved can make it yet harder, so I thank him for that intervention.

In its 2007 report, the national radiotherapy advisory group recommended that cancer patients should have to travel no more than 45 minutes one way—an hour and a half both ways—to receive radiotherapy treatment. This was adopted in the service specification by NHS England, but has since disappeared. Experts in the field maintain that travelling any longer could have a hugely negative impact on treatment outcomes and patient wellbeing. If preventing unacceptable travelling times became a part of NHS England’s criteria for delivering radiotherapy, it would hugely increase our chances of bringing a radiotherapy satellite unit to Westmorland General Hospital in Kendal.

I thank the hon. Gentleman for giving way during his important and passionate contribution to this debate. I know that he is focused on England, but may I share with him that in Scotland the issue is the same, if not worse, because of the rurality of Scotland and the distances travelled? I find some of his points very interesting when we have the Ayrshire and Arran health board not closing, but reviewing, a chemotherapy unit, Station 15, at University Hospital Ayr. The closure of that unit would impose a 32-mile round trip on patients who, to exacerbate that, may have travelled a 40 or 50-mile round trip. The issue is UK-wide, so I thank him for securing this debate.

I very much acknowledge the hon. Gentleman’s powerful point. In general, it is important that none of us are misunderstood here: centres of excellence are incredibly important; nevertheless access to treatment is also important. Where we are at the moment means that we are looking at the former to the exclusion of the latter, when both could be considered.

If I may, I would like to declare that my wife is a therapeutic radiographer in an NHS cancer trust, and put that on record. I agree with my hon. Friend the Member for Ayr, Carrick and Cumnock (Bill Grant). From a Welsh perspective, we are seeing some people travelling 60, 70 or more miles to get radiotherapy treatment. Does the hon. Gentleman agree that satellite centres from specialist centres are the way forward? My wife works in the Hereford cancer unit, a satellite centre from the specialist centre in Cheltenham, which knocks 40 miles off people’s journeys.

I would like to thank the hon. Gentleman’s wife for her work, but also to say that he is absolutely right. There are great models, including from the Christie in Manchester, where they already operate satellite services. Arguing for rural or any form of standalone cancer services is foolish and is not what I am asking for. I am asking for satellites of existing, established, high-quality cancer units such as the Rosemere in Preston, the Christie or others of that nature. Making sure that we meet those needs by having a satellite unit at the Westmorland General Hospital in Kendal would have a positive impact on the lives of thousands of people in south Cumbria who are living with cancer. That is what I ask the Minister to do.

Radiotherapy treatment at Westmorland General Hospital is long overdue and would mean the world to local people, who now have to make the long journey to Preston for treatment. Let us be clear: the Rosemere unit in Preston is excellent—my own mother received wonderful treatment there, and the quality of the service and care provided by NHS professionals still moves me when I look back today—but for most people in south Cumbria, it is ludicrously distant.

I congratulate the hon. Gentleman on securing the debate. Will he also note the importance of local charities? In my constituency, we have a charity called York Against Cancer, which has raised £15 million over the past three years. That money goes towards running a local minibus from York to Leeds for patients who have to be treated at Leeds in the radiology department.

I am very happy to acknowledge the work of local charities in my area. The Rosemere Cancer Foundation and South Lakes CancerCare do immensely good work, just like the charities in the hon. Gentleman’s constituency.

For some people living in the remotest areas of my part of the world—in south Cumbria—who are eligible for hospital-provided pick-ups, a round trip to access treatment in Preston, including waiting times, could easily surpass six hours. That is on a good day, when all standards are being met.

I congratulate the hon. Gentleman on securing a debate on this very important matter. The area of Cornwall that I represent has similar issues to those in Cumbria, and NHS England is consulting on closing our only treatment centre for radiography in Truro. That would mean people from the far west of Cornwall having to travel all the way to Plymouth for treatment. At the height of summer, when the roads are busy, that could easily be a five or six-hour round trip. Does he agree that that is far too long to expect patients to have to travel to receive this essential treatment?

Yes, I fully agree. That is why the NHS England consultation is the right time to set criteria. If we all say, “We’d rather like it if these issues are addressed,” nothing will happen, but if they are set as firm criteria and priorities as a consequence of the consultation, something should happen. The hon. Gentleman was right to raise that point.

Requiring NHS trusts to make it a priority for investment to ensure that radiotherapy is available more locally—such as by bringing a satellite unit to our local hospital in Kendal—would significantly improve outcomes for patients. That has been the focus of our long-running community campaign. I want to say a massive thank you to the many thousands of people who have been involved in that campaign so far. Just before Christmas, on behalf of our community, I presented a private Member’s Bill that would specify 45 minutes as the maximum time that patients have to travel to access radiotherapy treatment. I urge the Minister to support that Bill and ensure that the Government accept it.

I was asked on the radio this morning why, after nine years of fighting this campaign, I had not just accepted defeat and walked away. The answer is that every week in Westmorland, more families learn that they must fight cancer, and we have no right to turn our backs on them. Sadly, the challenge of cancer renews itself week after week, and so our zeal in fighting for those families must also be renewed week after week.

Some 840,000 people live in West Sussex and yet we are the only county in the whole of England that has no radiotherapy facilities within its boundary. I can also confirm the point made by my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti). I recently visited the Sussex Snowdrop Trust, which looks after desperately ill children. The stories of them traveling up to London or Southampton and having to stop several times along the way were heartbreaking; it is the worst thing to happen when they are facing that kind of trauma. I agree with the hon. Member for Westmorland and Lonsdale (Tim Farron) completely that patient travel times need to be taken into account during the consultation. I hope that they are, and that St Richard’s Hospital in Chichester is considered as a worthwhile investment for LINAC—linear accelerator—machines to help local people in West Sussex.

All the points that the hon. Lady makes are absolutely right and relevant to those of us who are here today—especially so, given the nature of her county.

Our community in south Cumbria remains proud that we won part one of our fight for a cancer centre. When we launched our campaign in 2009, it was for chemotherapy and radiotherapy. In 2011, we cut the ribbon on the Grizedale ward—the chemotherapy unit—and we are determined to win our fight for radiotherapy too. We have had an overwhelming response to the petition we launched again last September, adding to the 10,000 people who signed the original petition. Thousands more have written in and shared their stories with me locally and nationally. They include stories of the pain they went through in travelling hours every day to get the treatment that they desperately needed; stories of families who suffered watching relatives deteriorate as the long days of arduous travel visibly took their toll; and stories of choosing not to proceed with treatment because of the unbearable rigours of travelling huge distances. All those people have told me how a centre at Kendal could have helped them and their loved ones.

Most of us know, and all can imagine, the shock of being diagnosed with cancer. It is a life-shattering blow. Imagine then being faced with weeks of daily, grindingly long and tiring journeys to receive care. The travel can become the biggest part of the problem. One of my constituents, Philip from Grange-over-Sands, gave me this story, and his words speak more powerfully than any I could use. He said:

“At the age of 81 I had to attend 37 visits for treatment between the May and July 2013. The round trip from Grange to Preston Hospital was in excess of 100 miles per day whether by road or by train and then bus to the hospital. The times of my treatment varied day by day from 8am to 6pm. The treatment machine was not always available at the specified time which meant further time added on to the days travelling. All the above resulted in a very stressful time for myself and my wife on top of suffering from prostate cancer.”

Thankfully, Philip has now been discharged following three years of follow-up visits. He added:

“I trust that future patients may get their treatment at Kendal so good luck with your efforts.”

I was also contacted by the parents of Josie from Oxenholme. They told me:

“After a truly horrific chemo-therapy regime, which nearly killed her, Josie was left shattered and we faced the prospect of having to make daily trips for 4 weeks to Preston for Radiotherapy. The round trip typically takes 4-5 hours. She is left tired and with little time in the day to do much else. A unit in Kendal would have transformed this experience and left her with more energy and time to take more care of herself.”

Lastly, the words of Magda from Windermere sum up the problem perfectly:

“The whole idea of ever having to do any of this again would make me think twice about undergoing the treatments I was offered”.

Thousands of residents joined me back in 2009 when we launched a similar campaign to bring chemotherapy treatment to the south Lakes. Back then, patients had to travel many miles for any kind of cancer treatment. Thanks to local support, the chemotherapy ward at Westmorland General Hospital opened in 2011, and since then hundreds of local people have benefited from treatment there. We showed that when a community gets behind a campaign and the Government recognises that there is a real issue, changes can be made, funding can be allocated and problems can be solved.

It is true that the problem of outrageous travel times thankfully affects a relatively small proportion of the population throughout the UK—evidenced by the fact that although this is a massively important issue, only a few of us are here today—but in the places where access is a problem, it is a dreadful problem. NHS England must address it directly and explicitly in its current consultation on radiotherapy. I ask the Minister to ensure that NHS England does just that.

Solving the problem for south Cumbria would not create an expensive precedent—there are relatively few sizeable communities in this position—but for the people who are affected, living in rural areas makes accessing treatment unbearably difficult and arduous. That was highlighted recently by Age UK’s Painful Journeys campaign. It would cost the Government a relatively small amount to fund a satellite radiotherapy unit in Kendal: a capital cost of about £12 million—a sum that had been earmarked during the coalition Government in early 2015. That investment would lead to important changes. Above all, it would stop local people opting not to take up lifesaving treatment because of the need to travel those distances. In south Lakeland, the number of people aged over 60 is 10% above the national average, so older people and people with disabilities in our area are disproportionately negatively affected by distant access to radiotherapy treatment. That makes it all the more important for us to take advantage of this consultation to tackle the problem.

The Equality Act 2010 was passed by the House to ensure that services are offered to people in such a way as not to discriminate against older and disabled people, among other characteristics. Through those unbearably long travel times, those groups are disproportionately disadvantaged and indirectly discriminated against in breach of that Act.

My request is simple. I want travel times and equality of access, particularly for people who are older or who have disabilities, to be key criteria when allocating cancer services. This NHS England consultation on radiotherapy is the opportunity to ensure that those criteria are set so that access is prioritised. I want the Minister to agree to do that today. An expectation should then be placed on hospital trusts to ensure that satellite units of existing established centres are provided in rural communities such as the south Lakes to meet those criteria. Only then will our community be able to access cancer treatment fairly, equally and safely.

It is a pleasure to serve under your chairmanship, Sir Christopher. It is also a pleasure to respond to the hon. Member for Westmorland and Lonsdale (Tim Farron). I wish to associate myself with his opening comments in praise of the NHS. Demand for NHS services is constantly increasing. We always want the best we can possible get, but by making that case, we often sound as if we are talking the NHS down. Nothing could be further from the truth—we have the best national health service in the world. I am glad to see that the hon. Gentleman is nodding his head, and I am grateful for the persuasive way in which he made his case. He can consider that a very good representation in response to the consultation to which he referred. The points he has made will be reflected on keenly.

Improving cancer outcomes remains a priority for the Government. The work under way is making a difference: cancer survival rates in England have never been higher and have increased year-on-year since 2010. The decrease in cancer deaths means that around 7,000 people are alive today who would not have been had things stayed the same.

We are committed to implementing every one of the 96 recommendations in the cancer strategy for England and to making a difference to the millions of people living with the disease and the thousands more diagnosed each year. We are providing the funding to match our commitment. NHS England has confirmed £607 million in funding to support the delivery of the strategy between 2017-18 and 2020-21.

We want our cancer services to be the best in the world, and we want patients to have access to the treatment and services that will give them the best chance of a successful clinical outcome. That includes the time they spend travelling for treatment. We know that cancer treatments can be arduous. Patients often undergo treatment daily and treatments can last several weeks at a time. Ideally, we want patients to have treatments at their local hospital.

However, specialised cancer treatments are not always best delivered locally. We want patients to have the best possible care available, but for certain cancers that sometimes means seeing a specialist multidisciplinary team with a full range of clinical expertise and capability. Although local is good, we clearly cannot always have specialist care provided as locally as we would like.

A perfect example of that is proton beam therapy treatment. Patients with high-priority cancer types requiring that treatment are sent to Florida and Switzerland at great cost to the NHS, because we have been unable to provide it here. In April 2012, the Government announced a £250 million investment to build proton beam therapy treatment facilities at the Christie in Manchester and University College London Hospitals. The Christie’s facilities will become operational later this year and will offer patients access to world-class treatment on the NHS.

Over the last few years, we have seen astounding technological advances. The UK is leading from the front in using cutting-edge technology in the form of whole genome sequencing to transform healthcare and health research. Wherever possible, it is right that patients have easy access to those life-saving treatments.

The same principle applies to radiotherapy. Around four in 10 of all NHS cancer patients are treated using radiotherapy. Recent advances have helped to target radiation doses at cancer cells more precisely, which means far fewer doses, better outcomes and improved quality of life for patients. That is a crucial part of why survival rates have continuously risen in England.

One of the cancer strategy’s key objectives is to deliver a modern, high-quality cancer service. In October 2016, NHS England announced a £130 million fund to modernise radiotherapy across England that will upgrade or replace older treatment devices over two years.

The hon. Lady mentioned proton beam therapy, which is a wonderful treatment. We are grateful for the investment of more than one Government, which has ensured that it is coming to Manchester and London. She also talked about upgrading existing equipment, which is a reminder that 80% of commonly occurring cancers will still be treated by linear accelerators, albeit regularly upgraded. Therefore the delivery of proton beam therapy and other specialist and precise treatments, and the investment in more locally delivered treatment from linear accelerators in places such as Westmorland, are not mutually exclusive. We need to do both.

I absolutely agree—the two are complementary and need to be key ingredients in a successful strategy to combat cancer.

NHS England is not only modernising existing radiotherapy services; it is currently consulting on a new model for them, as the hon. Gentleman said. The aim is to encourage radiotherapy providers to work together in networks to concentrate expertise and improve pathways for patients requiring radical radiotherapy for less common cancers. That will help to improve access to more innovative radiotherapy treatments, increase clinical trial recruitment and ensure that radiotherapy equipment is fully utilised. There is no intention to reduce the number of radiotherapy providers, nor is that considered to be a likely outcome of the proposals being consulted on.

We will continue to ensure that travel times are taken into consideration when looking at cancer treatment in this country. The National Cancer Registration and Analysis Service is evaluating the impact on cancer outcomes of patients living different distances from a cancer centre. Public Health England is also testing travel times from several available datasets, so a programme of work can be established that incorporates data on travel times.

One of the first outputs of that work will be a report on whether there is any demonstrable difference in radiotherapy treatments associated with the time taken to travel to a specialist cancer centre. We expect the first results of that work to be published in the spring. I am sure the hon. Gentleman will have a considerable interest in the outcome.

In the current NHS England consultation, there are proposals that would allow local commissioners and providers to plan, review and redesign services through a joint radiotherapy board. Any case for change would determine the optimum location to achieve the best impact for patients, so it would be possible for patients requiring radiotherapy for common cancers to be treated at a satellite centre. Specialised commissioners will always want to balance patient travel with issues such as the sustainability of the service, whether the service is accessible enough to patients to be financially viable, and ensuring that patients who have to travel are supported in other ways, including through transport and accommodation.

I hope that meets with a positive reaction from the hon. Gentleman. We are consulting on making services more accessible and looking at travel times. I dare say that we will continue to have this debate over the coming months, not least because of his private Member’s Bill.

I understand that the hon. Gentleman recently met his local clinical commissioning group at Morecambe Bay to discuss the accessibility of services. I am encouraged that that dialogue is taking place at a local level.

I hope that what I have set out gives the hon. Gentleman some reassurance. I emphasise that cancer remains a priority for the Government. We remain committed to ensuring the best possible treatment and to achieving easy access in terms of travelling time for all cancer patients, regardless of where they live. I am grateful to the hon. Gentleman for securing this debate.

Question put and agreed to.