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Paediatric Cancers of the Central Nervous System

Volume 648: debated on Monday 22 October 2018

Motion made, and Question proposed, That this House do now adjourn.—(Rebecca Harris.)

I am extremely grateful to have been granted this important Adjournment debate. In all honesty, I wish I was not having to take part in it, but on 29 January, Cian Case, a six-year-old little boy from Llanharan in my constituency, tragically died after suffering a relapse of an aggressive cancer of his central nervous system. Cian was a young, gentle and happy young boy whose life was lost too early—far too early. It was a privilege to meet Cian at a fundraising rugby match in March 2016. I will never forget his warmth and acute sense of humour about his condition, or indeed the look of joy on his face at the fact that the community had come out in their hundreds to support him.

Cancer is a foe that every single Member will have experience of. Whether it be a sibling, a parent, an aunt, an uncle, a friend or even somebody we have just got to know in passing, Members across this House, as well as the people we serve, will have had cancer touch their lives and will know of its life-shattering effects. There is no good time for anybody to get cancer, but as I am sure you would agree, Madam Deputy Speaker, it is particularly harrowing and particularly life-changing to live through your child’s suffering with, and eventually dying from, this terrible disease.

It may come as a surprise to many Members across the House that, on this occasion, I do not stand here to point the finger of blame at the Government or to take a swipe at the NHS in England, or indeed in Wales. Instead, I seek to tell Cian’s story in the hope that we can work together, on a cross-party and cross-Government basis, to help to ensure that no family has to go through what Cian Case’s family underwent.

I congratulate my hon. Friend on securing this debate, and on speaking so movingly about his young constituent. Having experienced having a seriously ill child, I know that one vital thing in such a situation is the care that hospitals provide not just for the child, but for the parents and the carers who spend a great deal of time there. Does he agree that there should also be a focus on that as we move forward on this crucial issue?

I entirely agree with my hon. Friend. I pay tribute to him for the bravery that he and his wife, Rebecca, have shown over William. I am so pleased to see pictures of him now looking so well and on the road to recovery.

I thank the hon. Gentleman for bringing forward such an important issue as an Adjournment debate. We have some three hours to complete the debate, so he has tons of time. About 400 children are diagnosed with a central nervous system tumour in the UK each year, accounting for a quarter of all childhood cancer cases. Like the hon. Gentleman, I salute the doctors, nurses and carers for all the work that they do in looking after these children. Survival rates for other cancers have significantly increased in the past 50 years, but the same cannot be said for brain tumours. Many charities and research groups are working in collaboration to find a cure. Does the hon. Gentleman agree that more needs to be done to raise awareness, find a cure and ensure that parents are fully aware of the key signs and symptoms in babies and young children?

I agree entirely with the hon. Gentleman. I hope my speech will go some way to highlighting that more work is needed, and to paying tribute to parents and families who have lost children through this horrendous condition.

Cian was first diagnosed with an atypical teratoid/rhabdoid tumour in 2015, when he was four years old. This type of tumour, often called an AT/RT, is a very rare and rapidly growing tumour of the central nervous system. Cian’s primary tumour was found on his spine, with seeds of the cancer also found in his brain. In the majority of cases, AT/RT is associated with a specific genetic mutation, INI1, which can occur spontaneously or be inherited. However, genetic testing in Cian’s instance did not indicate that he had this specific mutation. Cian’s tumour was located on his spine. AT/RTs are generally located anywhere in the brain, but are most commonly found in the cerebellum—the base of the brain—and in the brain stem, which is the part of the brain that controls basic body functions. The fact that Cian’s tumour bucked this trend made a difficult medical situation even more complex. AT/RT was previously thought to have been a type of medulloblastoma. However, it is now known that this is a totally different type of cancer and cannot therefore be treated via the same methods.

Mercifully, childhood cancer is rare in itself. The majority of children who are sadly subjected to this disease are diagnosed with a form of leukaemia. Brain tumours are much more rare, and AT/RTs make up only between 1% and 2% of these cases. I hope this illustrates just how tragic it was that Cian contracted not just cancer, but a cancer of the rarest of forms. This, however, is exactly why we have to do something. We have to do something to remember Cian and ensure that his legacy is that other families may be prevented from suffering a similar fate.

I congratulate my hon. Friend on his wonderful speech and pay tribute to Cian’s family for all they have done on this issue. Will he join me in paying tribute also to Cancer Research UK, which in the past 12 months has tripled its funding for brain cancer research, understanding that it has been under-researched up to now? Should we not be encouraging the Government and working with them to do all they can to ensure that research into these key cancers continues?

I agree entirely. I am sure the Minister will set out the extra work the Government here and the Administrations in Scotland, Cardiff and Belfast are doing.

The very fact that these cancers are rare often makes it difficult to get a research cohort together, but we cannot allow that to be a barrier to finding new treatments and even cures for such illnesses. The treatments currently available for childhood cancers in the brain or spine tumours range from neurosurgery to radiotherapy, chemotherapy and steroids, and finally proton beam therapy. The course of treatment is tailored to the individual case, with patients typically undergoing multiple treatments. Sadly, AT/RT patients do not typically have good survival rates, and outcomes are poorer if a child has signs of tumour spread at diagnosis. We cannot accurately predict the outcome for any individual child who has developed such a tumour, but children diagnosed who are less than 12 months old are less likely to be able to fight the disease.

It will come as no surprise to hon. Members when I say that the key to fighting this disease in the long term lies in medical research. There are many competing priorities in medical research, with many historic frontiers yet to be conquered, but we must ensure that all forms of illness that cause pain and suffering receive the attention and the willingness to tackle them they deserve. I welcome the announcement from the Department of Health and Social Care earlier this year that the UK will invest £20 million in brain tumour research over the next five years. In addition, Cancer Research UK is investing £25 million to support that work. Will the Minister say what percentage of that funding will be used specifically for research into paediatric cancers?

I am grateful to my hon. Friend for securing this debate. This year, I have attended the funerals of two very special and inspirational people. One was well known to us in this place: Dame Tessa Jowell, who led a valiant campaign against brain cancer. I welcome the Government’s response to her efforts. The other was my eight-year-old constituent Kaleigh Lau, who waged an equally valiant fight against diffuse intrinsic pontine glioma—a particularly rare form of brain tumour. May I endorse what my hon. Friend says about the importance of specific funding for childhood brain tumours, including rare conditions such as DIPG? May I also through him urge the Minister to look again at support, especially financial support, for families who travel long distances—in Kaleigh’s case, to Mexico—to access experimental, often successful and life-extending, treatment? That needs to be looked at, so that in future the life expectancy of a child depends not on how much money their parents have or can raise, but on whether our Government are prepared to ensure that all children have access to potentially life-extending treatment.

I agree, and I will touch on the impact on families later in my speech. People talk of the late Baroness Jowell—Tessa—and her legacy. There can be no greater legacy than securing the additional research funding through her campaign on tackling the causes of brain tumours. Of her many great achievements, that has to be the one that will live with all of us the longest.

My hon. Friend will be aware of CLIC Sargent’s campaign. In an event today, the charity highlighted the cost of travel for families with children who are in treatment. The average is about £200 per month. We need to do a lot more to support families and to cover some of those costs.

I agree. Often with children’s cancer, one member of the family—usually the mother—has to give up their job to be a carer. That has a massive impact on the family. I completely agree with my hon. Friend that that has to be addressed.

My hon. Friend is being generous with his time, debating an important subject that has been raised several times in this House. I rise to pay tribute to two constituents—Alex Logan and Luke Stewart—who lost their lives recently. I have spoken to the Minister and others about treatment abroad, and I urge the Minister and the NHS to look more widely for possible cures and to be—I phrase this carefully—more open-minded about where the answers may lie.

I agree with my hon. Friend and endorse his tribute to his two constituents. I will speak later about some of my asks regarding international research, to which I hope the Minister will respond positively.

It is of course vital that we continue to undertake the best research possible into brain tumours in adults, but I must impress upon the Minister that it is essential that we give equal priority to childhood cancers. It is extremely positive to see groundbreaking work being undertaken in Wales, including through the Wales Cancer Research Centre, which is funded by the Welsh Government and led by Cardiff University. In recent years, it has been very positive to see the new drug/radiation combination trials coming to Wales, which could lead to new world-leading treatments being made available in the Welsh NHS. Clinicians and politicians of all political colours agree that this is an uphill struggle, but I know that it is a fight that colleagues in the Welsh Government will face head-on.

I pay tribute to the charities doing such vital work to advance research. I am pleased that the charity Brain Tumour Research is working closely with Cardiff University to fund research into some of the most aggressive forms of brain tumours. I know that Brain Tumour Research and CLIC Sargent have raised concerns about the hidden costs of treatments for the families of patients being treated for such cancers. CLIC Sargent finds that parents of children suffering from cancer spend as much as £600 a month on top of their normal travel expenses. We must work together, across health boundaries, to decrease that cost and provide financial support where possible.

Will my hon. Friend join me in paying tribute to Cian’s parents? As a parent in a similar position, I know how difficult it is for them to talk about their personal loss and to campaign for their son. They should be applauded for their courage in allowing us to discuss this important issue.

I thank my hon. Friend for her, as ever, courteous and heartfelt intervention. I know of the trauma she is facing in her family life. Richard and Lorraine are extraordinary people, as are their wider family. I have been impressed by their courage throughout Cian’s illness and, now, his passing.

We must not forget those who are lucky enough to survive such aggressive forms of cancer. Survivors often face a lifetime of other health complications, including mobility issues, cognitive challenges, infertility, growth complications and other conditions that require a high level of medical support. We must ensure that aftercare for those children is world class, and that they are able to lead as full, happy and long a life as possible.

I congratulate the hon. Gentleman on securing this Adjournment debate to raise awareness of an important health condition. He described how the tumour affecting his constituent was in the cerebellum and is now discussing the long-term effects for survivors of childhood brain tumours. Both treatment and recovery are determined to some degree by the location of the tumour, which can vary widely. I remember clearly a young patient who had a tumour so close to her brainstem—the part of the brain that controls breathing, which we do not think consciously about—that she had to live in intensive care for many months during her treatment, because at any point she could stop breathing. I remember sitting with her when she was making a cotton wool collage of a winter scene and she simply stopped breathing. When she was awake, one could say, “Breathe,” and she would make a conscious effort to breathe; if she was asleep or distracted, or no one was paying attention, she would have passed away. She needed that constant reminder. That is why it is important to ensure not only that we have research and medical treatment during illness, but that for recovery there is a multi-disciplinary team—physios, speech therapists, occupational therapists and so on—so that children who survive these awful tumours make the fullest possible recovery and can live the fullest possible lives afterward.

I agree with the hon. Lady entirely. There is clearly a need to look not just at treatment but at what comes next. If we are to improve survival rates, which we must—research is a key part of that—then we need to look at what comes next for these families and for the children who, touch wood, will survive.

We must not forgot mental health either. It is very important that we provide support and counselling afterwards. After what these young people have gone through, it is important they receive mental health support.

I agree entirely with my hon. Friend. It is such an important part of the recovery that families go through. That a child has cancer is in itself a huge trauma. What comes next is so important, and mental health for both the child and the family cannot be forgotten. This again underlines the life-changing effects of cancers such as AT/RT on a child. It will in all likelihood impact on every aspect of their life.

There is a great deal of positive work happening in this House. I would like to pay tribute to my hon. Friend the Member for Bristol West (Thangam Debbonaire) and her colleagues on the all-party group on children, teenagers and young adults with cancer, who recently held an inquiry into patient experiences of childhood cancers, the findings of which were published this year. After discussing the inquiry with my hon. Friend, I would like to thank the Minister for the positive contribution he made to it. I ask him and the Secretary of State to look at the report’s recommendations. Many are comparatively inexpensive and would make a huge difference to the children and their families who find themselves in this situation. I appeal to the Minister to update the House on his response to the all-party group’s findings.

I thank my hon. Friend for giving way and for the very kind tribute he paid to the all-party group for its inquiry. Many of the panel members are in the House today. I would just like to add my support to what he has just asked of the Minister. Does my hon. Friend agree that it would be good if the Government could commit to greater education and awareness? Although it is rare, the signs and symptoms of cancer in children need to be picked up early. The earlier they are picked up, the more likely it is that treatment is successful.

I entirely agree with my hon. Friend. I again pay tribute to her and her leadership not just on childhood cancer but on cancer generally. She is a true heroine of the cause and we are extremely grateful to have her in this House. It is clear that there is positive work being undertaken on this issue, but it has to be said that we can do more, much more, to help to tackle this disease.

Members across the House will remember when our dearly missed friend, the late Baroness Jowell, spoke so movingly, just days before Cian passed away last January, about the need to work much harder to make brain tumour research more effective. Tessa stressed the need to support the Eliminate Cancer Initiative to improve the chances of tackling this rare illness internationally. The creation of a clinical trial network around the world, an increase in the use of active trials, and the use of a global database would help to improve research and patient care. As Tessa so rightly said, through sharing knowledge across borders, and thereby at a local level across medical governance structures, we will be best placed to advance our knowledge of the most difficult and rare forms of cancers, including cancers of the central nervous system.

Making that happen will involve further investment in research into specific tumours such as AT/RT, and international collaboration to ensure that we have the best minds and the most innovative technology working on the most difficult of challenges. I believe the UK Government can be doing more to facilitate that. When Ministers visit other countries abroad, more often than not the two principal reasons for the trip are to further international trade or promote international security, both of which are of course vital. However, it is my view that in discussions with our foreign counterparts the issue of international research must rise up the agenda if we are to have any hope of accelerating our efforts in this area.

My hon. Friend is being very generous with his time. I am reluctant to introduce Brexit to this debate as we spend so much time discussing it, but on that specific point we have to ensure that we maintain research co-operation with other EU member states, not least so that we get the scale of rare cancers. In the week in which my local NHS trust announced it is closing the chemotherapy unit at King George hospital because of a shortage of chemotherapy nurses, may I gently ask the Minister to ensure that we recruit and retain, from both here and across EU member states, the staff we need to provide the high quality of care and treatment our constituents so desperately rely on?

I entirely agree with my hon. Friend. I will move on to the big B and the big C shortly.

Many of the children Cian was in hospital with had previously been sent abroad to participate in medical trials, including proton therapy. Will the Minister please look at what more we can do to collaborate with international drug trials and trials of new therapies to ensure that we have the most up-to-date treatments available here in the UK? Just as cancer affects so many people, so our efforts to counter it must include as many people as possible. This is simply not something that we can tackle alone.

Sadly, while the majority of my remarks have been about the big C, I must, as ever, touch on the big B. As we leave the European Union, it cannot be stressed enough how important it is for us to continue to work with our European partners to fund research, and indeed to undertake research ourselves into rare cancers. It is vital that we continue to play our part in EU research and development projects of genuine international importance. We must also continue to work with the European Association for Cancer Research, because we simply cannot sacrifice the potential new cancer treatments we will uncover in the name of, in my view, a misguided sense of regaining sovereignty. Indeed, the current treatment is agreed at EU level. Having first been established in 2002, the treatment was last fully reviewed in 2009. The drugs being used to treat this type of cancer are old in relative terms, showing what a vital role international governance can and will play in helping to improve outcomes in the future. Overall, the message I want to get across today is clear. So many cancers rightly receive a great deal of attention and research funding. I would argue that, just because rarer cancers, such as the one Cian suffered from, affect fewer people, that does not mean that we should not be as targeted or as innovative in our efforts to fight them.

If you will allow me, Madam Deputy Speaker, I would like to mention briefly the brilliant and selfless work Cian’s family have been doing to raise awareness of this particular type of cancer, and their work in fighting for new research and treatments for such paediatric cancers. Cian’s father, Richard, is in the Gallery today. I pay tribute to him and Cian’s mum, Lorraine, and his siblings Dillan aged 11 and Bethan aged 9, for their bravery. [Hon. Members: “Hear, hear.”] From when Cian was first diagnosed in November 2015, to when he was told in June 2016 that the tumours had gone, through to when he sadly relapsed in November 2017, his family have tirelessly raised awareness. His community have fundraised and, since his passing, they have continued their efforts.

I pay tribute to Cian’s family for all their efforts in the most difficult of circumstances. I would like to thank the whole community of Llanharan, the surrounding villages and far beyond, whose support for Cian has been unwavering. The online funding page set up following Cian’s death raised in excess of £6,000, which is going to help the charities who supported Cian and his family throughout his treatment. I am sure you will agree, Madam Deputy Speaker, that this shows what a mark this little boy has made on his local community. Likewise, I am so proud of all the staff, pupils and parents at Llanharan primary school, the school Cian attended, who were so supportive to Cian throughout his journey and who have been there for his parents and friends since. I was privileged to attend the memorial event they held shortly after Cian died. I am always proud to serve my constituents from the many communities across Ogmore, but I have to say that being part of this outpouring of love in the most tragic of circumstances was truly a privilege. I would like to put on record my thanks to Cian’s headteacher, Mrs Price, his class teacher, Mr Arthur, and all his school friends and the wider school community for the support and generosity they have shown Cian and his family. They planted bulbs which will bloom every year in his memory, so that Cian can never be forgotten.

I admit that there is no easy answer to the issues I have raised today. It will not be solved overnight simply by throwing money at it. The sad reality is that while we seek to meet some of the challenges, other families like Cian’s will sadly suffer the same anguish in the future. It is therefore essential that we raise awareness of the symptoms to look out for to ensure that this disease can be caught early, giving those unlucky few the best chance of survival. The National Cancer Institute finds that children who have developed AT/RT may experience the following: headaches, particularly in the morning; nausea or vomiting; fatigue or lethargy; difficulty with balance and co-ordination; and an increase in the size of their head. Because AT/RT develops so quickly, these symptoms can onset incredibly quickly over a matter of days or weeks. The symptoms can also vary depending on their age and the precise location of the tumour.

It is only right that I highlight the fact that many of these symptoms represent common medical conditions in both children and adults and, in the majority of instances, will not mean that a child has developed a brain tumour. If a parent ever has any doubt in their mind, however, I would always encourage them to seek medical advice. In Cian’s instance, he began experiencing stomach pains that were originally thought to have been abdominal migraines. In reality, it was the pressure of the tumour restricting the spinal cord that transmitted the nerve pain on to his torso.

Cian touched the hearts of all those around him. He was a warm, fun-loving and generous boy. While tragedies like this thankfully do not happen every day, when they do happen, it is only right that we reflect, pay tribute and act to help to ensure that we prevent such instances happening again. Cian was delighted to have met the Speaker during his visit to Parliament and No. 10 Downing Street back in 2016. While I would have liked him to have had the opportunity to return to this House, sadly this will now not be possible. Instead, we must ensure that the House comes together to support those affected by cancer and send a message that our determination to beat it—across all parties—is utterly unwavering.

I thank Members from across the House who have remained in the Chamber to hear Cian’s story and I thank the Minister for taking the time to consider what more we can do about this important issue. The key point I have stressed today is not party political; it is that we must continue to advance our knowledge base across the UK and, most importantly, internationally. By steadfastly supporting the Eliminate Cancer Initiative and redoubling our efforts to find new treatments, and, hopefully one day, a cure for cancers of the central nervous system, we can ensure that Cian’s legacy lives on.

Cian was a young boy with his whole life ahead of him. I appeal to the Minister and every Member: let us help to ensure that more children survive such cancers in his memory.

I, too, wish we were not here, but let me congratulate my friend the hon. Member for Ogmore (Chris Elmore) on securing this evening’s debate. I commend him on his support and the incredible tribute he gave to Cian and Cian’s family this evening, and on the way he has handled the debate. For those who know him, in both the Government and the Opposition, it is rather typical of the man.

From what we have heard this evening, it is clear that Cian was a very special little boy who touched many people in his short life. I have seen his “Cian’s Kicking Cancer” campaign online, including the picture of him with his hands out in front of the No. 10 Downing Street door—it is a lovely photo—and I pay tribute to the determination of Cian’s parents to raise awareness of paediatric cancers. The way that they have been supported by their local MP is brilliant.

As the cancer Minister, I all too often hear of the devastation that this terrible disease can bring to people and their families, but nothing is as heartbreaking as when a child is affected. I said last week in the breast cancer debate that a life lived long or a life lived short is still a life lived, and I passionately believe that a life lived, short or long, still leaves an indelible mark on this world and still changes this world forever, even in a small way. From what the hon. Gentleman has told the House this evening, there is no question but that Cian has left his mark and changed the world a little bit. We will do our best to honour that and see whether we can change it a bit more.

Every day, at least 12 children and young people are told that they have cancer. When they are born—I have children myself—we all imagine bright futures for our children and the things that we want them to do, but cancer robs many children of that future and the opportunity to fulfil their potential. As the hon. Gentleman said, it is relatively rare in young children, but that is absolutely no consolation to the parents of a child with cancer. It can even be worse to know that and inevitably leads to questions such as, “Why me? Why my child? They haven’t made any lifestyle choices.” Cancer is indiscriminately cruel, and that is one of those awful truths that we face in life.

It is great that we have so much time for this debate. I know that there has been a bit of knockabout that the business finished early again this evening, but I genuinely believe that there is a reason why that happened, and we are going to make the most of it. I start by reassuring the House and those watching that cancer absolutely is a priority for me—I think most people know that—and for this Government.

I happened to be in the Tea Room before coming into this debate and the Prime Minister popped in after her marathon stint on her statement this afternoon. She asked me what I was working on and I said that I was doing this debate tonight. We spoke about how remarkable the way in which the House comes together in these debates is and how there is a concentrated audience for such debates. I know that the hon. Gentleman has put out on social media networks, as I am sure many others have, the fact that this debate is happening tonight, and I know, many people will be watching, so let us be clear: fighting cancer is absolutely central, as the Prime Minister said in her conference speech, to our long-term plan for the national health service in England—I have to say “in England”, because I am an English Health Minister, and the English cancer Minister. It will build on the progress already achieved in the cancer strategy and will set out how we will achieve our ambition that some 55,000 more people in England will survive cancer for five years each year from 2028.

I am absolutely committed to ensuring that our plan transforms outcomes for children with cancer over the next 10 years. The fantastic work being done by NHS cancer doctors and nurses, as well as the invaluable support that we get from our incredible cancer community, is helping us to achieve our vision of transforming cancer services for children and young people.

As I have said, childhood cancers are mercifully rare, but 1,600 children under 15 are still diagnosed each year in the UK. Central nervous system cancers are estimated to account for 25%, with 400 children diagnosed each year. Brain cancers alone account for more than 100 CNS cancers, making each cancer extremely rare.

It is true that survival for children’s cancer has gone up over the past decade, with five-year survival for children’s CNS cancers at 75%—that is how we measure it, but, of course, if people develop a cancer in their 70s, a five-year survival rate is a more significant achievement than for those who develop a cancer when they are under five. The survival rates have gone up, but there is not an ounce of complacency in me; we will and must keep working hard to go further and faster.

Treatment of CNS cancers varies depending on several factors—age, the tumour growth rate and the location and size of the tumour—but, as the hon. Gentleman said, it will usually involve a combination of surgery, chemotherapy and radiotherapy, depending on the clinical need. To ensure that patients have access to the latest, most cutting-edge technology wherever they live, we have invested heavily—some £130 million—to modernise NHS radiotherapy equipment. Over the past two years, 73 trusts have had their older linear accelerators, as they are known, upgraded or replaced, and that is an important thing that we have done—[Interruption.] Cheltenham is one of them, says my Parliamentary Private Secretary, my hon. Friend the Member for Cheltenham (Alex Chalk)—who says that PPSs do not speak in the House? He sits there diligently day in, day out, so why not?

The hon. Member for Ogmore mentioned proton beam therapy and I want to touch on that. In the past few years, there has been an increase in the use of PBT—for those who do not know, it is an advanced form of radiotherapy—for treating children with CNS tumours. It uses high-energy proton beams to treat the cancer much more precisely. These targeted doses of treatment have less impact on surrounding healthy tissue and fewer side-effects. In childhood cancers, that is critically important—the hon. Gentleman mentioned side-effects of treatment with regard to fertility, for instance.

Until now, PBT for children has been commissioned from overseas. We have sent children to America and to Germany. That is why we have invested £250 million to provide PBT services in England. I am delighted that the first NHS centre, at the Christie in Manchester, is scheduled to begin treating patients this autumn. A second facility is due to open at University College London Hospitals in London in 2020. I had the pleasure of visiting the Christie shortly after delivery of the giant ProBeam proton system, which is a significant engineering feat. The scale and complexity of the technology is truly breath-taking, and I am tremendously excited that we will shortly be providing PBT on the NHS in England, sparing patients the upheaval, discomfort and cost—I will come on to that—of travelling abroad for treatment.

Although survival rates for CNS cancers have been improving, some children will unfortunately suffer relapse, as we heard in Cian’s case, and treatment options can sadly be limited, even for palliative care. That is why NHS England is reviewing whether additional radiotherapy treatments, such as stereotactic radiosurgery and stereotactic radiotherapy—there is a difference—would be suitable for these patients. I am following that work closely, as I am interested in and excited by its potential.

This month, NHS England published the draft national genomic test directory for cancer, setting out how whole-genome sequencing for paediatric brain tumours and other genetic tests are now being considered for CNS cancers. I hope that introducing those tests will support better tumour identification and more targeted treatments for CNS cancers in children, and give hope to many others.

Perhaps the most exciting development in our efforts to treat childhood cancers successfully is the increasing availability of personalised treatments such as CAR-T therapy, about which there is understandably a lot of excitement in the medical community. With the introduction of more personalised and targeted treatments and different treatment options for children with CNS cancers, NHS England is reviewing how best to ensure that children receive the available treatment and from the relevant clinical team, now and in the future. We expect the availability of more personalised treatments to be a real game-changer for childhood cancers. The work is still in its early stages, and it will involve clinicians, service providers and charities as it progresses, but I will of course update the all-party group, which I will come to in a moment, as it develops.

Research, which the hon. Gentleman mentioned, is a crucial part of the fight against brain tumours. In May, we announced £40 million over five years for brain tumour research through the National Institute for Health Research, as part of the late Tessa Jowell’s brain cancer mission, which includes research for children with brain cancer. I only met Baroness Jowell once, unfortunately, but I was left in no doubt about what she wanted me to do—her legendary determination was very much in evidence. I very much enjoyed meeting her and Jess, her daughter, who is carrying on much of the work.

The hon. Gentleman talked about research projects. Baroness Jowell’s mission is about stimulating quality research projects—a point that the late baroness was able to nail as soon as she started to look into it. Although the NIHR spent £137 million on cancer research in 2016-17—the largest ever investment in a disease area—it does not allocate funding for specific disease areas. It does not have a basket for each disease area. Spending has to be driven, therefore, by scientific potential and the number and scale of quality funding applications.

The baroness was very pithy and understood immediately that we needed to stimulate the market in brain tumour research to enable quality research proposals to come forward. After that, the clinical research network, which is recruiting for or setting up more than 700 cancer trials and studies, including studies into childhood cancers and brain tumours, can press forward and do its work. Funding for paediatric cancer research is critical.

The hon. Gentleman also talked about international research. I absolutely agree that international collaboration is key for successful research on rare diseases such as CNS and childhood cancers. The Prime Minister has made it very clear that we want to work closely with Europe in science and research and that the UK is committed to establishing a far-reaching science and innovation pact with the EU, facilitating the exchange of ideas and researchers and enabling the UK to continue to participate in key programmes alongside our EU partners. Whatever “take back control” meant—one day I will be told—it did not mean that we are not to work with our EU partners in such areas. I am determined that it will not mean that, as are the Government. The Chancellor has also made it clear that he will guarantee EU structural and investment funding and underwrite payments for competitive EU research awards through the Horizon 2020 underwrite guarantee, which is a very important project.

The hon. Gentleman mentioned the Eliminate Cancer Initiative, which the late Baroness Jowell made sure I was acutely aware of. Its tagline “Making cancer non-lethal for the next generation” is really neat, and we certainly support it. It has huge global potential and reach. As he mentioned, given my international health brief, I travel to talk to Ministers from around the world. I was at the G20 earlier this month. The G20 and G7 have Health Minister meetings, as they should do; I certainly hope they will when we have the chair. I would like to see international research collaboration, specifically on cancer, on one of the G20 or G7 agendas. The hon. Gentleman’s point was well made. I will take it up with my officials so that, as we lobby for the chair of the next meetings, we talk about that. It would be an interesting piece of work that we as fellow Ministers could do. I know that people think that sometimes these international meetings are talking shops, and of course there is an element of that, but actually an awful lot of good stuff goes on and an awful lot of other agencies—the OECD, the World Bank, the EU—are part of those meetings. If Ministers decide that this is part of our agenda, that will make a difference and move the dial.

Several Members have talked about awareness of childhood cancers and I thank the hon. Gentleman for what he said about the all-party group on children, teenagers, and young adults with cancer. I am pleased to see my friend the hon. Member for Bristol West (Thangam Debbonaire) in her place. I welcome the establishment of that all-party group on the specific needs of children and young people with cancer. It is an excellent all-party group—several of its members are or were here. I was delighted to give evidence to its patient experience inquiry earlier this year. She had some of her patient advocates there, who asked great questions as well, and I commend it for an excellent report. I do not have to do this for all-party groups—I do for Select Committees—but I have undertaken that the Department will respond line by line to its report. I will definitely do that. It is not ready yet, but it will happen.

One of the all-party group’s recommendations was on signs and symptoms, which I will come on to, and another was on the cost of travel. The hon. Member for Alyn and Deeside (Mark Tami) mentioned the CLIC Sargent report that highlighted the financial impact of travel on the families of young cancer patients. It is a really good piece of work. I assure hon. Members that the Government are working to review the service specifications for children and young people with cancer. This will help us to consider how some aspects of the patients pathway might be provided more locally to reduce the travel burden for patients and their families. There is the other element: sometimes that cannot be done and people have to travel for treatment. The NHS cannot do everything brilliantly everywhere—clearly, specialisms are sometimes needed. That is why we have the healthcare travel costs scheme, which is part of the NHS low income scheme. It allows for patients’ travel costs to be reimbursed if they are in receipt of a qualifying benefit or are on a low income. The scheme helped some 337,000 applicants to receive financial help with their NHS treatment. I am very interested in the recommendations of the all-party group on that and I assure its members that I am taking great note of them.

I am pleased to learn that my hon. Friend takes such an interest in reports from all-party parliamentary groups. Will he undertake to look equally carefully at the report that will be produced tomorrow by the all-party parliamentary group for children who need palliative care, known as Together for Short Lives, which I co-chair with the hon. Member for Newcastle upon Tyne North (Catherine McKinnell)? It looks at how we provide palliative care for children with cancer and other life-limiting and life-threatening conditions.

I am grateful to the Minister for his thoughtful response to the debate. Will he and the Department look carefully at the issue of access to experimental treatment and financial support, and also the issue of control? One of the conversations that I had with Tessa was about how she had to wrest back control over her own choice in relation to risk and access to experimental treatment.

It would be hard enough for adults to make such choices for themselves, but parents are having to make those difficult choices, too. Some parents feel that they are making the best decisions for their children in turning down the opportunity of access to experimental treatment on the basis of an assessment of the risk and the impact on the life that they have left, while others choose to access such treatment in the interests of their children. While there are challenges in respect of the governance and, perhaps, some of the ethics of those arrangements, we must put a bit more trust and faith in parents. When they choose to access experimental treatment, even if the Department will not fund access to the treatment itself, it might be able, reasonably and ethically, to provide more support than it currently provides in respect of the associated costs of, for instance, travel, accommodation and subsistence.

I will look into that. The late Baroness and I talked about exactly that subject. I do not think it is so much about ethics; I think that this must be clinically led. There is a great deal of debate in the clinical cancer community about the toxicity of concurrent treatments. However, I take the hon. Gentleman’s point about the costs, and the importance of supporting parents who must make decisions which are hard enough when people are making them for themselves.

My hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) mentioned an all-party parliamentary group of which I was a member before I was a Minister. I take all-party parliamentary groups so seriously because I used to lead loads of them. I spent hours writing reports, and, dare I say, I wish that they were sometimes taken as seriously as I take such reports.

It is in all-party parliamentary groups that a lot of good work goes on in the House. Opposition Members, who are not in government at this time, have a huge role to play in moving the dial. The smart Ministers are the ones who say that they do not know everything. The lines that the civil service gives them are often great, but they are not the be-all and end-all. I see APPGs as a brilliant and rich vein of knowledge for me, and I learn a lot from them. So yes, I will look out for my hon. Friend’s work in Together for Short Lives.

My constituency contains one of the best children’s hospice trusts, Naomi House and Jacksplace. My heart goes out to the child hospice movement and my respect for it is ample, and what Together for Short Lives does to represent that movement is incredible.

There is also a fabulous children’s hospice in Stoke-on-Trent, the Donna Louise Trust, which goes above and beyond its remit to support not just children with life-limiting conditions, but their families. Most children’s hospices depend almost 100% on charitable giving and fundraising to undertake such work. Should not we, as a society, be considering that, and should not the state have a role in helping to provide the service when it is needed?

There is a role for the state, but the hospice trust in my constituency told me many times that the last thing it wanted was to be 100% reliant on the state. It does not want to be an arm of the state; it enjoys its charitable status. I remember taking delegations from Naomi House, and from the sector, to meet David Cameron when he was Prime Minister, and I think that we could do a lot better in relation to the specialised commissioning of these services. It is still too confusing and too confused, and still too patchy from clinical commissioning group to clinical commissioning group. We are determined to do better in that regard.

Before I went off on a tangent, I was talking about awareness of childhood cancers, which a number of Members mentioned. We must improve awareness of cancer, full stop. I am very proud of Be Clear on Cancer’s “blood in pee” campaign, which is part of my brief. However, as someone who has young children, I know that the challenge is striking the balance between educating children about the warning signs of cancer and frightening them about a risk that is relatively low at their age. My motto would be that the best must not be the enemy of the good.

A number of Members will know about the work of the Teenage Cancer Trust and CoppaFeel! The hon. Member for Bristol West certainly does, because of the work that she has done in relation to breast cancer. Coppafeel!—I still think that that is the best name for a charity that I have heard since I have been doing this job—is run by Kris Hallenga, a brilliantly brave young lady who has terminal breast cancer. It ran a superb cancer awareness campaign in schools, about which I have talked to secondary schools in my constituency. It is sensitive and evidence-based, and pitched very appropriately.

I recently took both those charities to discuss their campaigns with the Minister for School Standards, my right hon. Friend the Member for Bognor Regis and Littlehampton (Nick Gibb). As the House will know from a statement made by the Secretary of State before the summer recess, the Department for Education will be consulting on its health education guidance until 7 November. I encourage charities, all-party parliamentary groups and parents to put forward their views on how we might go further to educate children about cancer. That is critical if we are serious about prevention, which we are.

Let me end by putting on record my tribute to the NHS doctors, nurses, support staff and charities, and our colleagues in the wider cancer community—Team Cancer, as I call it—who work so tirelessly every day to ensure that our constituents, and thousands of children like Cian, benefit from the support and the expertise that give them a chance of recovery and a full life. They are true heroes. They are the ones who will oversee the potential for huge progress in the next 10 years on the cancer diagnosis, treatment and support that we hope to see.

I am extremely grateful to the Minister for giving way again—we are in the unusual position of having lots of time, as he has pointed out. I am not sure whether this is in order, but I want to thank him most sincerely for the open way in which he has spoken and responded to Cian’s story, and for the commitments he has given this evening, which will be welcomed across the House and by Cian’s family, particularly the commitment to respond to the all-party parliamentary group and the international commitment on the G7 and the G20. I am enormously grateful, as I know every cancer sufferer and every family member of a cancer sufferer will be. I pay tribute to him, in a rare moment of affection and thanks in this House, which often resembles a bear pit more than anything else, because he clearly has an enormous commitment to the cause that is cancer.

That is a very nice thing to say. I thank the hon. Gentleman.

In closing, we think that the NHS long-term plan, with cancer right at its heart and with the new north star ambition on early diagnosis and 75% early stage detection, will turbo-charge all that we have already achieved. We are on track to achieve that through the cancer strategy. Last Thursday, in the Westminster Hall debate on breast cancer, I said that I want to see a future where cancer has no future. Maybe I am naive and ambitious, but I want to reiterate that today, because I think that we could achieve that. If we are ever to achieve that goal, I sincerely hope that we can begin by first eradicating all childhood cancers, because many people are relying on us.

I commend the Minister, the hon. Member for Ogmore (Chris Elmore) and everyone who has taken part in the debate for showing what this House of Commons can do when it treats a sad but important subject in a serious, hopeful and positive way. Too many people see us as just arguing for the sake of it, so I hope that some will notice that progress can be made in this Chamber.

Question put and agreed to.

House adjourned.