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Secondary Metastatic Breast Cancer

Volume 829: debated on Tuesday 9 May 2023


Asked by

To ask His Majesty’s Government what assessment they have made of the incidence of secondary metastatic breast cancer in England.

My Lords, the latest cancer registration data shows that secondary breast cancer accounted for 14% of the 39,871 recorded diagnoses of female breast cancers. NHS England is funding a new clinical audit on breast cancer, including metastatic breast cancer, to provide evidence for cancer service providers of where patterns of care may vary, in order to increase the consistency of access to treatments and help stimulate improvements in outcomes for patients. The first outputs are expected next year.

My Lords, I thank the Minister for his Answer. Given the anticipated rise in cancer incidence, what steps are the Government taking to increase the NHS’s capacity to deliver innovative radiotherapy treatments for cancer—including molecular radiotherapies, which have additional infrastructure requirements? Also, what access to clinical trials and medicines are the Government providing for those diagnosed with metastatic secondary breast cancer? While I welcome the audit, will it be made permanent?

My Lords, the Healthcare Quality Improvement Partnership commissions, develops and manages the National Clinical Audit and Patient Outcomes Programme on behalf of NHS England, NHS Wales and the other devolved nations. This includes five national clinical audits focused on priority cancers, such as prostate, lung, breast, oesophageal, gastric and bowel cancers. These audits have been introduced to reduce variation in treatment by demonstrating where care is being provided in line with standards, and where a service is doing well or could be improved. Five additional new clinical audits were announced in May 2021, one of which will focus on metastatic breast cancer. I would be very happy to update the House on the metastatic breast cancer audit once it is in a form that I can share.

My Lords, the audits are very welcome, but nevertheless there is great variation in the way in which innovative drugs are being given to some patients. With the prognosis being much better with new, innovative drugs and treatments, what access is particularly given to those patients?

My Lords, the Government are committed to supporting timely access for NHS patients to clinically effective and cost-effective new drugs, including for breast cancer. NICE is able to recommend the vast majority of cancer medicines that it appraises. It has also made positive recommendations in all 19 of its appraisals of breast cancer treatments since 2016. This track record has been made possible by the cancer drugs fund, which has benefited more than 88,000 patients as of March 2023, with 102 medicines treating 241 different cancers having received funding. The CDF has enabled breast cancer patients to access promising new medicines such as Enhertu and Ibrance, while allowing for the collection of further data on their clinical and cost effectiveness.

My Lords, while it is good to hear about the audit, five months ago respected oncologist Professor Carlo Palmieri from Liverpool University estimated that the number of cases of metastatic breast cancer in England increased from more than 48,000 in 2019 to more than 57,000 in 2020-21, resulting in an increased need for clinical activity and work. What planning, design and recommissioning of appropriate cancer services have been undertaken by the NHS? Have the Government provided the extra resources needed to deliver clinical services to these patients this year?

The department has committed an additional £8 billion from 2022-23 to 2024-25, on top of the £2 billion elective recovery fund and the £700 million targeted investment fund already made available to the NHS. The Autumn Statement 2022 provided additional funding of £3.3 billion, and £3.3 billion for 2024-25, to support the NHS in managing the pressures that it faces.

My Lords, modelling from Cancer Research UK shows that the number of cancer cases in the UK is projected to rise by as much as a third in the next 15 years. As it takes 15 years to train an oncologist, a pathologist, a radiologist or a surgeon, can the Minister assure the House that the Government’s very long-awaited workforce plan will give transparent and ambitious projections for 10, 15 and 20 years into the future, to reflect the time it takes to train the cancer specialists that patients need?

The target within the cancer workforce plan of more than 4,000 staff members for 2016 and 2021 was exceeded by 226, with an annual growth rate of the cancer workforce of 3% to 4%. The Government have committed to publishing an NHS long-term workforce plan for the next 15 years, covering doctors, nurses and other key professionals. This should be published in spring 2023. In 2023-24, NHS England will continue to make investments in education and training to increase capacity in the cancer and diagnostics workforce, building on the £81 million invested in 2022-23.

My Lords, earlier questions have indicated the importance of accurate data. What steps are the Government taking to ensure that data is collected to find out the number of patients living with metastatic breast cancer today?

My Lords, up-to-date and accurate data is critical to finding a cure for this terrible disease. The National Cancer Registration and Analysis Service works closely with hospital trusts to determine sources of data that can be used to complete the cancer outcomes and services dataset, and works with the software suppliers of cancer management systems to ensure that data items can be recorded. Compliance and data standards are monitored by local integrated care boards, otherwise known as ICBs.

My Lords, time is critical in all cancer cases. What impact is the ongoing industrial action in the NHS having on the average delays to cancer diagnoses and the commencement of treatment for such cancers?

I thank the noble and gallant Lord for that question. I do not have specific data regarding strike action, but while strike action is unhelpful, the faster diagnosis standard, which ensures that 75% of patients receive a definitive diagnosis regarding cancer within 28 days of referral from a GP or screening services, was met for the first time in February 2023, at 73.5%.

My Lords, the Minister said that the workforce plan would be published this spring. In his department, when does spring end?

I can reassure the noble Lord that I asked that exact question before I came to this Dispatch Box. Unfortunately, I cannot give a definition of spring; my personal view is that spring ends sort of at the end of June, but I hope to bring a work- force plan to noble Lords sooner rather than later.

My Lords, perhaps I could assist the Minister. This morning he may have been listening to one of his colleagues, who told the “Today” programme that, in his view, the workforce plan would be published within the next couple of months. I think that is a slightly less precise answer than the one he has just given, for which no doubt the House is grateful. Of the very large numbers that the Minister has mentioned in the course of giving various answers on this Question, can he tell the House how much of the money he has mentioned is new money, and how much of it is simply being repurposed from the current NHS budget?

In an answer I gave just a moment ago, I referred to the Autumn Statement—from 2022, just last autumn—providing additional funds of £3.3 billion. But on the precise question that the noble Baroness asked, I am afraid I will have to write to her.

Can the Minister guarantee to the House that the long-awaited workforce plan will contain specific numbers and targets for each clinical group—numbers to be trained over the next 10 or 15 years, accompanied by a commitment from the Treasury to fund those places? Otherwise, it will be a waste of time.

My Lords, can the Minister assure us that older women, both those who have experienced breast cancer and those who have not, can continue to have access to breast cancer screening into their 70s and older?

Absolutely. We have provided an extra £10 million for the breast screening programme, which will provide 28 new breast screening units, targeted at areas with the greatest challenges of uptake and coverage, which includes more senior members of the community.