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Health: Endoscopy and Bowel Cancer

Volume 792: debated on Monday 2 July 2018


Asked by

To ask Her Majesty’s Government what plans they have to respond to the increase in demand for endoscopy services to prevent bowel cancer through early diagnosis.

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and declare an interest as patron of Beating Bowel Cancer.

My Lords, the Health Education England Cancer Workforce Plan includes a commitment to invest in a further 200 clinical endoscopists by 2021 to support an increase in capacity for earlier diagnosis. This builds on the existing commitment to train 200 clinical endoscopists by the end of 2018. The Health Education England training programme has already recruited 130 trainee endoscopists against this target, with two further cohorts planned this year.

I thank the noble Lord for that Answer. Around 16,000 people die from bowel cancer each year—my mother was one of them—so early diagnosis is vital. I congratulate the Government on introducing FIT, a test which will save lives, but endoscopy units are already struggling to cope with the increase in referrals because of inadequate funding and a lack of highly trained NHS staff to carry out the procedures. What plans do the Government have to provide training for the staff needed, and when will details of the planned phased rollout of the FIT be published?

I thank the noble Baroness for raising that question and am sorry to hear about her mother. As she will know, bowel cancer is unfortunately the third-most prevalent cancer and the second-biggest killer, and we need to go a long way to improve treatment. I have already mentioned the increase in the number of endoscopists, and that will help. There are also plans to make sure that existing staff within the cancer workforce have the necessary specialist skills. The size of the cancer workforce has increased over the last few years but there is a goal to dramatically increase it further. We know that the test that the noble Baroness mentioned is much more effective and can be administered much more easily. The rollout will take place from December this year.

My Lords, there is an increasing interest in capsule endoscopy, which of course is less invasive as it does not require an instrument to be put down into the abdomen. However, it requires training, which the medical literature clearly shows is insufficient. Can the Minister indicate whether the NHS is planning to provide more training for the provision of capsule endoscopies? Also, what is the risk of a large number of false positive results with all these endoscopies?

I will have to write to the noble Lord with an answer to his question about the type of endoscopy he mentions, as I do not have the details of it. The risk of false positives is one reason that we have to be extremely careful with screening programmes of all kinds, whether it is the faecal immunochemical test or an endoscopy. As he knows, whatever screening programmes are implemented, the National Screening Committee tries to reduce the number of false positives wherever possible.

My Lords, given that we have one of the poorest outcomes compared with other health services in the developed world and that the demographic changes that will occur in the population may well mean that one in two people will develop cancer, are the Government aware of what determinants there are for poor outcomes? What plans do they have to improve them for cancer patients?

The noble Lord is quite right to point that out. While outcomes have improved, they lag behind those of other countries, which we need to correct. The independent cancer taskforce set the goal of saving 30,000 extra lives a year by a number of different routes. The one that I pick out in particular is early diagnosis. We know that too many cancers are diagnosed at a late stage, so this year the NHS has committed to increasing the proportion of cancers diagnosed at stage 1 or stage 2, and we are spending £200 million in cancer alliances to support early diagnosis in the community.

My noble friend has done much to bring the benefits of the digital revolution to the NHS. Are there digital solutions that might help to prevent bowel cancer and other cancers in the fight against this dreadful disease in the coming months and years?

My noble friend is quite right to point out the potential of digital, particularly the analytical capability of artificial intelligence to look at samples. That was one reason why the Prime Minister recently pledged to have 50,000 more early cancer diagnoses by 2033—a long-term goal—precisely because the NHS is such a good place to use artificial intelligence to improve care.

My Lords, after a cancer diagnosis, English patients have poorer outcomes than all but one of our European comparators. We welcome the announcement that the Minister has just made about new clinicians, but in some areas there are delays in referral, testing diagnosis and then treatment. The longest wait for treatment reported this year was 541 days. That is not good enough. How long does the Minister think we will have to wait for there to be sufficient clinicians and facilities to deliver a service that moves us significantly up the table?

The noble Baroness is right to highlight the importance of waiting times. The 62-day standard is unfortunately not being hit at the moment. The NHS has pledged to get back on that standard this year. We are also piloting a faster, 28-day diagnosis standard in five areas at the moment with the idea of rolling that out so that there is a higher standard of care and fewer people have to wait longer.

We should probably be grateful that the Minister did not choose to bring a FIT as a visual aid, as his honourable friend did on the “Andrew Marr Show” yesterday. I welcome the Government’s announcement that that test will be in introduced in England in the autumn, but will the Minister confirm that all eligible people will receive the FIT kit in the autumn rather than through a phased introduction across England? How long will that take?

I will not be rummaging around in my pocket to reveal something; nobody wants to see that. My understanding is that FIT will be introduced from the autumn and the intention is to get national coverage. I do not believe that it will be achieved immediately, but I will write to the noble Baroness with the specific timeframe.

My Lords, will the Minister look at access to mental health services, so that referrals can be made early on for patients who are identified with bowel cancer where that is helpful? Does he not agree that patients will make better recoveries if assessments are made of their mental health and emotional well-being, along with support groups and other services to help them with these aspects of their recovery?

The noble Earl makes a good point. A cancer diagnosis can be a devastating piece of news. One way of ameliorating that is through the support of charities like Macmillan Cancer Support, as well as through clinical nurse specialists who can provide such support. Some 90% of people are seeing those nurses when they are diagnosed and our ambition is to see that percentage rise to 100% next year.