Asked by
To ask His Majesty’s Government what steps they are taking to
ensure that NHS trusts in England meet their target for cancer
patients to be treated within two months of an urgent GP
referral.
The Parliamentary Under-Secretary of State, Department of Health
and Social Care () (Con)
My Lords, NHS England continues to actively support those trusts
requiring the greatest help to cut cancer waiting lists. This
work is backed by funding of more than £8 billion from 2022-23 to
2024-25 to help drive up and protect elective activity, including
for cancer. To increase capacity, we are investing in up to 160
community diagnostic centres—CDCs. Within CDCs, we are
prioritising cancer pathways to help reduce the time from patient
presentation to diagnosis and treatment.
(Lab)
My Lords, nearly 90% of cancer patients in 2010 received their
first treatment within two months of urgent referral, which
exceeded the operational standard, something the Government have
not achieved since 2014, while last year fewer than 65% of cancer
patients were treated within this standard. With earlier
intervention being key to saving lives, what is the Government’s
estimate of how many lives are lost each year due to failure to
meet this agreed standard? What is the impact on survival rates
of continued delays to a workforce plan promised long before the
pandemic and still being reported as not having been signed off
by the Treasury?
(Con)
The noble Baroness is correct about early diagnosis. That is why
we have invested in 160 CDCs, which will be primarily focused on
cancer, and why there are 11,000 more staff than in 2010, a 50%
increase, as well as 3,000 more consultants, a 63% increase. We
are seeing more supply than ever but at the same time, given
Covid and the pent-up demand caused by that, we are also seeing
more than demand than ever. The major expansion of supply is
focused on making sure that we quickly detect those people.
(Con)
My noble friend the Minister mentioned Covid. One thing we
learned from Covid was the importance of testing at home and
rolling out home testing. A few weeks ago, I received a letter
from the NHS asking me to provide a sample to test for a certain
cancer—a test given to people my age. I thought that that was
very interesting. How much more rollout of home testing are the
Government intending to do, so that we can catch these cancers
early—not just colon cancer but a whole range of cancers?
(Con)
I am not exactly familiar with the test that my noble friend
might have taken but many of us will have heard about the early
promise shown by the GRAIL programme. It is a simple blood test
and, right now, has a two-thirds success rate for early
detection. Those are early indicators, but early diagnosis and
innovative approaches such as the GRAIL blood test are
important.
(LD)
My Lords—
(CB)
My Lords, I interrupt to say that, while the new test shows
promise, it is nowhere near perfection. The sensitivity of the
test is extremely low and false positive rates are high. This is
cell-free DNA testing, including machine learning. It may be the
promise of five years to come that we detect cancers at an early
stage, which would be the holy grail, but we must not hype the
test at this point and raise false hope.
(Con)
The noble Lord is absolutely correct that we always need to keep
these things in balance. What I was trying to express was that we
have an opportunity to innovate in this space. We have another
innovation in our targeted lung cancer programme, which has now
been rolled out to 43 sites. In 2019, 50% of such cancers were
not detected until stage 4. Now, through mobile delivery of
services to these sites, we are detecting 60% of such cancers at
stage 1. Those are the sort of innovations for which we have very
solid data, and they do show promise for the future.
(LD)
My Lords, national waiting times for cancer treatment have fallen
way off target, as the noble Baroness, Lady Merron, set out in
her Question, but these national numbers mask significant
regional variations. In March, they ranged from 45% of referrals
within the target time in Birmingham and Solihull to 80% within
target in Kent and Medway. How does the Minister account for such
significant variations and what are the Government doing to level
up those integrated care board areas that are falling furthest
below the targets?
(Con)
That is exactly the example I was giving when I mentioned lung
cancer targets, where mobile devices are being used.
Interestingly, the most deprived areas have been targeted because
they are often areas of high smoking, and these are the areas
where they have managed to get screening times down the most. We
have the opportunity to put CDCs in the areas of most need. We
all agree that there is unprecedented demand and that we have to
expand supply; there is no other way to meet that demand but to
expand supply.
(Lab)
Having gone through treatment myself in the last few
years—successfully so far—I want to ask the Minister whether
anybody is measuring the growth of mental illness among people
who know that they need treatment but where it is constantly
delayed. The pressure on those people and their families is
enormous. Is there any measure of extra mental illness caused by
this delay?
(Con)
The noble Lord is correct. I have a friend who is in that
situation. We all understand the stress of waiting and what it
can cause. I will come back to the noble Lord on the research
into the impact on mental health. I absolutely accept that a lot
more needs to be done, but one of the main things is the target
of diagnosis within 28 days, which we are now hitting 75% of the
time. That gives people peace of mind quickly, particularly as
94% of those people end up being negative—only 6% are positive.
Peace of mind is crucial here.
(CB)
My Lords, is the Minister aware that in 2017 this House, under
the distinguished leadership of the noble Lord, , produced a report which said
that the sustainability of the NHS was in doubt unless there was
a workforce plan? Would he like to remind his friend the
Chancellor, who was the Health Secretary at the time, of that
report?
(Con)
I know that the Chancellor is very aware of it, and of course it
was the Chancellor who in the autumn kicked off that this
workforce plan should be done. The Chancellor is quite rightly
very involved in making sure we get the right answer now.
(Con)
My Lords, during the first lockdown we had some 40,000 fewer
cancer diagnoses than we would have expected during a normal
period. Cancer develops slowly and we cannot yet calculate the
lethality, but will my noble friend the Minister consider, before
we ever contemplate another policy of mass house arrest, the
long-term consequences for health of people being confined to
home? It may be, as we see the excess mortality figures coming in
from around the world, that lockdowns ended up killing more
people than they saved.
(Con)
My noble friend is correct that there were knock-on implications
of lockdown, cancer detection rates being one of them. Noble
Lords have heard me speak of Chris Whitty’s concern about heart
disease because those check-ups were missed, and mental health is
another area. Clearly, these are some of the things we are hoping
to learn from the Covid inquiry, so that we know the impact of
lockdowns, not just on restricting Covid but more widely, on the
population as a whole.
(Lab)
My Lords, have the Government made an assessment of the cost of
false positive tests in this kind of screening and the cost to
patients?
(Con)
When the noble Lord says this kind of screening, I am not quite
sure which type of screening he is referring to.
(Lab)
For cancer.
(Con)
I did not know whether the noble Lord was referring to GRAIL and
the comment from the noble Lord, , about false positives. This
question probably deserves a detailed reply but, as with any
test, it is not about just specificity but sensitivity, which is
key, so that the number of false positives is minimised. I will
provide a detailed reply.
of Hudnall (Lab)
My Lords, the noble Lord has referred at several points in this
discussion to early diagnosis. He will be aware that cancer very
often develops later in life and that the older you are the
greater the risk is. Yet older people are excluded from routine
screening tests past a certain age. Can he explain the thinking
behind that?
(Con)
It is about trying to make sure that we are screening those of
highest risk, given the impact on quality of life, and catching
it early. I know that is very specifically the thinking around
it. Beyond this, while we know the challenge around waiting
lists, we have increased the supply through a 15% increase in
activity. We are supplying more than ever, but we know that a lot
more needs to be done to meet the demand.
