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Health: Cancer

Volume 794: debated on Thursday 29 November 2018


Asked by

To ask Her Majesty’s Government what steps they are taking to improve (1) early diagnosis of, and (2) survival rates for, cancer.

My Lords, we know that early cancer diagnosis improves survival. Last month, the Prime Minister announced a package of measures to be rolled out nationally with the aim of seeing three-quarters of all cancers detected at an early stage by 2028. Since 2010, cancer survival rates have improved annually and are currently at a record high. Around 7,000 people who are alive today would not have been had mortality rates remained at the 2010 levels.

My Lords, the targets set by the Prime Minister and the progress made are obviously welcome, but the Minister will be aware that data from the national cancer registration service has shown that the early diagnosis rate for cancers has been static for the past two years, with 16 CCGs showing a decline in the rate. Patients are reluctant to go their GPs, GPs refer less than in other countries and hospitals are overwhelmed by referrals. How are we going to see a step change in the approach so that our success rates are more closely aligned to those of comparable countries, and does the Minister agree that we need to see the spread of rapid diagnostic centres?

I do agree with that point, and indeed it was one of the policies announced by the Prime Minister in October. Of course we need to make more progress on early diagnosis. One-year survival rates have improved in the past 10 years but we still lag behind our continental neighbours, as we have done for decades. The noble Lord mentioned GP referrals, which have been in the news this week. The threshold for referrals from GPs to specialist cancer doctors has been reduced in line with the NICE guideline. The consequence has been that in the past seven years, the number of people referred to a specialist cancer doctor has increased by 1 million—that is, an increase of 115%. Therefore, we are seeing more referrals at an early stage. We are seeing many more appointments and of course those will feed through over time into our survival figures.

My Lords, what is the Government’s estimate of the funding needed for better radiological equipment; to train radiographers to be able to report, given the shortage of radiologists; to develop AI, given that the diagnosis of malignant melanoma using AI has been shown to be as accurate as diagnosis by a dermatologist; and to invest in pathology services? Without quantifying the amount and making sure that NHS England and CCGs sign up to these things, I worry that our diagnostic facilities will never catch up with those of other countries.

The noble Baroness pinpoints some really important issues that we need to deal with. The good news is that the number of radiographers has increased by 3,500 in the last eight years, but of course we need to do more and the cancer workforce plan includes plans to recruit more specialists. Greater investment in equipment is taking place, the Prime Minister has announced investment in specialist cancer centres, and the first proton beam therapy centres in this country have now opened. Finally, AI has extraordinary benefits. It is now able to diagnose some tumours better than most expert specialists. We have made some commitments in this area through the expansion of digital pathology and radiology, and we will be doing more.

My Lords, there is a complete postcode lottery for breast cancer care. It starts with appointment delays—first with the GP and then with the consultant— and then very often, as the noble Lord has said, the equipment is old and is very expensive to replace. Are there any grants that NHS England can make available to hospitals to help them purchase this equipment sooner?

One reason that our cancer survival rates are not where they should be is that there is huge variation. The truth is that in some communities cancers are detected far too late as a matter of course. One way in which we are trying to address this problem is through the cancer strategy, which has provided about £600 million, £200 million of which has been to support cancer alliances in every corner of the country to make sure that we eliminate some of that variation and ensure that there is much more care for anybody suffering from cancer.

My Lords, does my noble friend agree that the best cancer strategy is prevention? In that regard, I congratulate the Government on their recent decision to extend the HPV vaccination to all young boys as well as girls. I know that my noble friend has had great influence in that area. Does he also agree that this decision has the potential to save thousands of lives that would otherwise be lost to cancer in the future?

I am grateful to my noble friend, not just for her recognition of that fact but for her campaigning on this issue. It is a really important step forward. The rollout of HPV vaccinations to boys will make a big difference to cancer rates, as it is doing for girls and women. It is part of a world-class screening programme in this country. A few issues need to be dealt with, and Mike Richards will be looking at those, but we are determined to make sure that our screening programmes get better and better.

My Lords, the Minister’s statements about the targets for 2028 are not consistent with the terrible and chronic staff shortages that NHS pathology departments are suffering. This will definitely be exacerbated by Brexit. Only three of 100 departments report to the Royal College of Pathologists that they have enough staff. Given that these are vital to the diagnosis and treatment of cancer, what are the Government’s plans to rectify this very serious problem?

I absolutely recognise that it is a problem. As I said, we have increased the numbers of doctors in a range of specialties. Pathology has been a challenge, it must be said. There are two answers: the first is to continue to recruit more people, either domestically or internationally. The second refers to the point that the noble Baroness, Lady Finlay, made: we are determined to utterly transform this service through technology while also delivering better results.

My Lords, pancreatic cancer is one of the deadliest cancers. One in four sufferers survives for less than a month after diagnosis, and only 7% survive for five years. What is more, the outcomes have hardly improved in the last 40 years. Will the Minister join me in welcoming the Demand Faster Treatment campaign led by Pancreatic Cancer UK, whose ambition is that by 2024 people with pancreatic cancer will be treated within 20 days of diagnosis? Will he assure the House that the Government will play a leading part in helping to achieve that goal? I declare my interest as an officer of the Pancreatic Cancer All-Party Group.

The noble Lord is quite right. We have seen incredible improvements in outcomes for some cancers, whereas others, pancreatic cancer among them just, have not seen improved survival rates. We need to do a lot more, and part of that is early diagnosis. I understand that while pancreatic cancer becomes symptomatic in the last six months of a person’s life, it can be in the body for up to 14 years, so making that early diagnosis and using new technology such as liquid biopsies will help us achieve that noble goal.