Madam Deputy Speaker ( )
Before we come to the statement, I am required to put on record
Mr Speaker’s disappointment that an important policy has not been
announced first to the House. Not only have Ministers been on the
airwaves trailing the policy on lung cancer, but a detailed press
notice appeared on the Department’s website well before the start
of this statement. Mr Speaker has repeatedly made it clear that
such announcements should be made first to the House, that to do
otherwise is discourteous to the House, and that this practice
must not continue.
17:18:00
The Secretary of State for Health and Social Care ()
Thank you, Madam Deputy Speaker. May I first address the remarks
you made on behalf of Mr Speaker? Of course, any disappointment
expressed by Mr Speaker is a matter of concern. No discourtesy
was wished on the part of the Government. It may be helpful to
clarify that no change of policy is being announced in the
statement; it is an expansion of an existing policy, which I hope
the House will regard as good news. However, we very much take on
board any concerns that Mr Speaker has expressed.
With permission, Madam Deputy Speaker, I would like to make a
statement on our national lung cancer screening programme for
England. About a quarter of patients who develop lung cancer are
non-smokers. We all remember our much-missed friend and
colleague, the former Member for Old Bexley and Sidcup, . He campaigned tirelessly
to promote lung cancer screening and was the first MP to raise a
debate on that in Parliament. His wife Cathy is continuing the
brilliant work that he started in partnership with the Roy Castle
Lung Cancer Foundation.
In 2018, after returning to work following his initial diagnosis
and treatment, James told this House that the Government should
commit to a national screening programme and use the pilot to
support its implementation. I am sure many colleagues in the
Chamber will recall him saying:
“If we want to see a step change in survival rates—to see people
living through rather than dying from lung cancer—now is the time
to be bold.”—[Official Report, 26 April 2018; Vol. 639, c.
1136.]
Despite being a non-smoker, James knew that the biggest cause of
lung cancer was smoking and that the most deprived communities
had the highest number of smokers. That is why I am delighted
that today the Prime Minister and I have announced a national
lung cancer screening programme, building on our pilot programme,
which will target those who smoke or have smoked in the past.
Lung cancer takes almost 35,000 lives across the UK every
year—more than any other cancer. Often, patients do not have any
discernible symptoms of lung cancer until it is well advanced; in
fact, 40% of cases present at A&E. Since its launch in 2019,
and even with the pandemic making screening more difficult, our
pilot programme has already given 2,000 lung cancer patients in
deprived English areas an earlier diagnosis. That matters because
NHS England states that when cancer is caught at an early stage,
patients are nearly 20 times more likely to get at least five
years to spend with their families.
We all know that smoking is the leading cause of lung cancer. It
is responsible for almost three quarters of cases, and in
deprived areas people are four times more likely to have smoked.
We have deployed mobile lung trucks equipped with scanners to
busy car parks in 43 deprived areas across England. Before the
pandemic, patients from those areas had poor early diagnosis
rates, with only a third of cases caught at stage one or two. To
put that in context, while a majority of patients diagnosed at
stage one and two get to spend at least five more years with
their children and grandchildren, less than one in 20 of those
diagnosed at stage four are as fortunate. Thanks to our targeted
programme, three quarters of lung cancer cases in those
communities are now caught at stage one and two.
Targeted lung cancer checks work. They provide a lifeline for
thousands of families.
We need to build on that progress, which is why we will expand
the programme so that anyone in England between the ages of 55
and 74 who is at high risk of developing lung cancer will be
eligible for free screening, following the UK National Screening
Committee’s recommendation that it will save lives. It will be
the UK’s first and Europe’s second national lung cancer screening
programme. If results match our existing screening—there is no
reason to think that they will not—when fully implemented the
programme will catch 8,000 to 9,000 people’s lung cancer at an
earlier stage each year. That means that each and every
year around 16 people in every English constituency will be
alive five years after their diagnosis who would not have been
without the steps we are taking today. That means more
Christmases or religious festivals with the whole family sitting
around the table.
Alongside screening to detect conditions earlier, we are
investing in technology to speed up diagnosis. We are investing
£123 million in artificial intelligence tools such as Veye Chest,
which allows radiologists to review lung X-rays 40% faster. That
means that suspicious X-rays are followed up sooner and patients
begin treatment more quickly.
How will our lung cancer screening programme work? It will use GP
records to identify current or ex-smokers between the ages of 55
and 74 at a high risk of developing lung cancer, assessed through
telephone interviews. Anyone deemed high risk will be referred
for a scan, and will be invited for further scans every two years
until they are 75.
Even if they are not deemed at high risk of lung cancer, every
smoker who is assessed will be directed towards support for
quitting because, despite smoking in England being at its lowest
rate on record, tobacco remains the single largest cause of
preventable death. By 2030, we want fewer than 5% of the
population to smoke. That is why in April we announced a robust
set of measures to help people ditch smoking for good, with 1
million smokers being encouraged to swap cigarettes for vapes in
a world-first national scheme. All pregnant women will be offered
financial incentives to stop smoking, and HMRC is cracking down
on criminals who profit from selling counterfeit cigarettes on
the black market.
The lung cancer screening programme has been a game changer for
many patients: delivering earlier diagnoses, tackling health
inequalities and saving lives. We are taking a similar approach
to tackle obesity, the second biggest cause of cancer across the
UK. The pilot we announced earlier this month will ensure that
patients in England are at the front of the queue for innovative
treatments by delivering them away from hospital in community
settings. Together, this shows our direction of travel on
prevention, which is focused on early detection of conditions
through screening and better use of technology to speed up
diagnosis and then treatment, because identifying and treating
conditions early is best for patient outcomes and for ensuring a
more sustainable NHS for the future, for the next 75 years. I
commend this statement to the House.
Madam Deputy Speaker ( )
I call the shadow Secretary of State.
17:25:00
(Ilford North) (Lab)
Before I begin, I would like to take this opportunity to pay
tribute to the life of Margaret McDonagh, of Mitcham and Morden.
Margaret was the first women general secretary of the Labour
party and the best: a political organiser second to none; kind,
compassionate and made of steel. I am one of so many people
throughout the Labour party and the Labour movement who benefited
from Margaret’s kindness, generosity and wisdom. She was a
friend, a mentor and a political hero. It breaks my heart that so
many glioblastoma victims like Margaret have no hope of treatment
and that a diagnosis means a death sentence. So, in sending, I am
sure, condolences from across the House to Margaret’s sister, my
hon. Friend the Member for Mitcham and Morden (), the best tribute we
could make to Margaret and the best condolences we could offer
her sister and family, is to unite across the House and resolve
to do everything we can to make the breakthrough discoveries we
need so that other people like Margaret do not receive this
devastating death sentence.
I also join the Secretary of State in paying tribute to the late
, who was unbelievably
kind to me when I went through my own cancer diagnosis—even more
generous given what he was going through, which was so much
worse.
I thank the Secretary of State for advance sight of the
statement.
Lung cancer patients in this country are less likely to survive
than patients in most European countries. Why? Because patients
today find it impossible to get a GP appointment. On receiving an
urgent referral, they wait too long for a scan. On receiving a
cancer diagnosis, they wait months for treatment. And before the
Government blame covid, the target for patients to start
treatment within 62 days of referral has not been hit
since 2015.
The Secretary of State was not joking when he said that he is not
announcing anything new today. The programme announced today will
not be fully rolled out until 2030. So, after 13 years in
Government, they are not announcing action today and not even for
the next Parliament, but for the one after that. I thank the
Health Secretary for making commitments for a second-term Starmer
Government to deliver.
On the workforce, the problem with the plan is that the NHS
simply does not have the staff to deliver it. The Prime Minister
and the Health Secretary have been all over the media setting out
the upcoming workforce plan, although they have not yet said a
word to the House. Is this why it will take seven years to roll
out the screening programme, because they have no plan to bring
down NHS waiting lists today? We have been waiting almost as long
as we have been waiting for the right hon. Member for Mid
Bedfordshire (Ms Dorries) to hand in her resignation and call a
by-election.
While the Health Secretary writes the Labour party’s 2028
manifesto, junior doctors who treat lung cancer patients are due
to walk out on strike for five days. More than 650,000 operations
and appointments have already been cancelled due to NHS strike
action. Is it not time for the Health Secretary to accept he has
failed, step aside and call in the Prime Minister to finally meet
junior doctors? If the Prime Minister has time to negotiate gongs
for Conservative cronies with , he has time to meet junior
doctors.
Today we learnt that the National Cancer Research Institute
announced it will be closing after 22 years, due to
“uncertainty in the wider economic and research environment.”
There is still so much we do not know about cancers and so many
treatments still to be discovered and developed, yet clinical
trials have fallen off a cliff in recent years.
What impact does the Health Secretary expect the closure to have
on cancer clinical trials?
After 13 years of Conservative rule, the verdict is in. A report
published today by the King’s Fund reveals that the NHS has fewer
CT and MRI scanners than other advanced countries, and
“strikingly low numbers of…clinical staff”.
That explains why the King’s Fund also found that the NHS was hit
harder during the pandemic than other healthcare systems. It is
not just that the Government did not fix the roof when the sun
was shining; they dismantled the roof and ripped up the
floorboards. It also helps to explain why patients in this
country are less likely to survive treatable conditions, such as
breast cancer and stroke, than those in comparable nations, and
why we have one of the lowest levels of life expectancy. The
King’s Fund summed it up with something of an understatement,
saying that the NHS had “seen better days.” Is it not the case
that the longer the Conservatives are in office, the longer
patients will wait?
Madam Deputy Speaker ( )
Order. Before I call the Secretary of State, let me say to the
hon. Member for Ilford North () that I think the whole House will join him, and
me, in sending condolences to the hon. Member for Mitcham and
Morden ().
On behalf of His Majesty’s Government, Madam Deputy Speaker, I
echo your sentiments and those of the shadow Health Secretary in
sending the House’s condolences to the hon. Member for Mitcham
and Morden (), and also our fond
remembrances of Margaret McDonagh. She played a pivotal role in
the 1997 landmark election for the Labour party, and her loss
will be keenly felt on the Labour Benches, but also much more
widely across the political spectrum.
The hon. Gentleman raised a number of issues relating to
screening, on which there is much consensus in the House, but one
issue that he did not particularly note is the importance of this
programme in closing the health inequality gap. The detection of
stage 1 and stage 2 cancers, which has had such a remarkable
impact on survival rates, has been targeted at the areas with the
highest smoking rates and, therefore, the most deprived
communities. I hope there will be a fairly wide consensus across
the House that that is a real benefit of the programme. We aim to
take the proportion of lung cancer survivors from 15% to 40% over
the next 18 months, and to 100% in the years ahead, and we are
talking today about a series of measures that have proved to be
effective: there is remarkable evidence of the survival rates
that they generate.
The hon. Gentleman raised a number of wider issues related to the
Government’s record on cancer. The NHS has seen and treated
record numbers of cancer patients over the last two years, with
cancer being diagnosed at an earlier stage more often and
survival rates improving across almost all types of cancer.
Indeed, the expansion of the screening programme is a good
illustration of the clear progress that the Government are
making.
The hon. Gentleman raised the issue of junior doctors—an issue
that we have debated a number of times across the House. He says
that he does not support the junior doctors in their demand for a
35% pay rise. They have, of course, offered to spread it over an
extra year to take 2024-25 into account, but for that they want a
49% pay rise. This is slightly esoteric: the hon. Gentleman says
he does not support their demands, but he also criticises the
Government for not meeting those demands.
The hon. Gentleman raised the subject of research funding, and I
was grateful to him for doing so, because the Government are
spending more than £1 billion on research through the National
Institute for Health and Care Research. I have met the president
of Moderna, with which the Government have signed up to one of
our landmark partnerships with the life sciences sector. There is
huge potential for us to work with life science partners as part
of our health commitment. It is clear that those within the
industry see the Government’s commitment and are responding to
it, even if Labour Members fail to do so.
We are expanding our programme because it demonstrably works. It
is tackling health inequalities and significantly increasing
survival rates. It is part of our wider commitment, through our
work with Genomics England and our work on the national screening
programmes to screen 100,000 babies. The programmes cover not
just lung cancer but, for instance, breast cancer. My hon. Friend
the Member for Winchester (), the Chair of the Health and
Social Care Committee, raised the issue of HIV screening with me
last week. That is one of the areas in which early detection is
having clear results. We are diagnosing more cases, which is why
survival rates are improving in almost all types of cancer.
Madam Deputy Speaker ( )
I call the Chairman of the Health and Social Care Committee.
(Winchester) (Con)
I remember dear saying the words that the
Secretary of State repeated today in the House. James made this
happen—this is a fantastic prevention announcement. Although this
nationally expanded programme cannot prevent lung cancer, will
the Secretary of State confirm that we will stick by the
principle of making every contact count? When people come forward
for a lung risk assessment, we can offer emotional support where
a problem has been detected, provide smoking cessation services
to those who are still smoking, or just put our arms around
people where there are comorbidities. When people come into
contact with the health service, will we make every contact count
for them?
I know that my hon. Friend was a Health Minister at the time that
James was raising these points, and that he takes a close
personal interest in the issue. He is right about the importance
of the point at which people come forward. I was having a
discussion this morning about the fact that when most patients
come forward for screening, they will not be diagnosed with
cancer, but it is still an opportunity for smoking cessation
services, for example, to work with them on reducing the risk
that continued smoking poses. My hon. Friend is right about using
the opportunity of screening to pick up other conditions and to
work constructively to better empower patients on the prevention
agenda.
(York Central)
(Lab/Co-op)
Of course those most at risk must be fast-tracked into diagnostic
services, but when we are 2,000 radiologists short, 4,000
radiographers short and 5,000 other health staff short in those
diagnostic services, how can people get the diagnostic services
they need? When will we have the workforce in place to service
this policy?
Clearly, the earlier we detect cancer, the less pressure it puts
on the workforce. There is much more work involved in the
treatment of a later cancer than of an earlier cancer. That is
why we are investing in our community diagnostic programme, with
108 community diagnostic centres already open and delivering 4
million additional tests and scans. As part of the wider £8
billion investment in our electives recovery, over £5 billion is
going into that capital programme. Yes, the workforce plan is a
key part of that, but so is getting the CT scanners and the other
equipment in place. That is exactly what our community diagnostic
programme is doing, and it is being furthered by our screening
programme through announcements such as this.
(Erewash) (Con)
Alongside the new lung screening programme, which I welcome, will
my right hon. Friend now commit to implementing in full the
recommendations made by Dr Javed Khan in his review, so that we
can finally stub out the No. 1 cause of preventable cancer and
end the suffering for smokers who develop cancer and for their
loved ones? Our late colleague requested that we be bold. In
taking forward the Khan review in full, I am sure we would be
fulfilling his wishes.
My hon. Friend is quite right to highlight the significance of
smoking as a cause of cancer. We have a number of measures,
including the programme to move 1 million smokers on to vaping,
the financial incentives to encourage pregnant women not to
smoke, the tougher enforcement and the consideration of inserts
for packaging. The Government are taking a range of measures to
address the very important issue that my hon. Friend rightly
raises.
(Barnsley Central) (Lab)
The Secretary of State may be aware that, following work that I
have been doing with Cancer Research UK, I have written to him
and to the Minister for Social Care to outline my specific
concerns about the lack of a cancer strategy. I would be very
grateful if he or the Minister came back to me.
As the Secretary of State will know, cancer does not affect
everyone equally. When it comes to health outcomes—the Secretary
of State made this point—it is often more economically deprived
areas, such as coalfield communities like Barnsley, that continue
to lag behind. I completely agree and accept his important point
about smoking, but studies have also shown that those who worked
in the coal industry have a higher risk of lung cancer. I ask the
Secretary of State to ensure that ex-miners are considered in the
roll-out of the new targeted programme.
The hon. Gentleman raises a valid and important point on the
targeting of mining communities. Of course, the roll-out will be
shaped by clinical advice, but I will flag that point as we
consider the targeting of the programme as it expands.
On the hon. Gentleman’s first point, the major conditions paper
will look at these issues in the round. That matters because one
in four adults has two or more conditions, so it is important
that we look at conditions. A moment ago, I touched on the fact
that obesity is the second biggest cause of cancer after smoking,
so it is right that we look at multiple conditions in the round.
His point about targeting is well made, and I will make sure the
clinical advisers respond.
(Chatham and Aylesford)
(Con)
In Medway, which is an area with high levels of deprivation,
mortality rates for lung cancer and chronic obstructive pulmonary
disease are significantly higher than the average in England, as
is smoking-attributed mortality. Due to the towns’ shipbuilding
and heavy industry heritage, to follow on from the point made by
the hon. Member for Barnsley Central (), we also have one of the highest rates of
mesothelioma, which is a type of lung cancer.
Although today’s announcement of the national roll-out is
welcome, what plans do the Government have to bring vital
lifesaving early detection to the doorstep of the Medway towns,
as those most affected by lung disease are probably the least
able to afford the 47-mile journey to Dover, where Kent’s
screening pilot will be based?
My hon. Friend speaks with great authority on this issue, and she
is right to highlight the importance of mesothelioma. A key theme
of the pilots is the importance of convenience of access to
screening, and a key part of the programme’s expansion is
enabling it to be targeted at those communities that are at
highest risk, as we heard a moment ago. I take on board her
concerns about some of Medway’s challenges, and I know that she
has called for this direction of travel more widely in the
past—for the targeting of early detection in the community,
because early detection brings far better patient outcomes.
Sir (Rhondda) (Lab)
Screening is obviously important, and early detection is a good
thing, but I wish the Secretary of State had not made this
announcement today, because it is only a tenth of what we need to
do to change things. There is a danger that we will make things
worse.
My melanoma was diagnosed late, at stage 3, but my treatment
started very quickly, within five days. My anxiety is that if we
do not have enough radiographers and radiologists, as my hon.
Friend the Member for York Central () said, we will be shifting
people from doing one set of tests—those for people who may have
a later-stage cancer—to other sets of tests, unless we
significantly increase the workforce.
Secondly, as the Secretary of State knows well, the statistics
for people starting their treatment when we know they have
cancer, because they have been diagnosed, are going in the wrong
direction. I wish he had been able to stand at the Dispatch Box
today and say, “We are going to have more radiographers and
radiologists—I can guarantee that—and we are going to make sure
that every single person who gets a diagnosis starts their
treatment earlier and on time, otherwise we are failing
them.”
Such is the nature of cancer that it has touched many Members,
and I know the hon. Gentleman has taken a long, close interest in
this issue. Of course, more than nine in 10 cancer patients get
treatment within a month. He is right that it is also about
diagnosis, which is why, through the community diagnostic
centres, we are rolling out 4 million additional tests and scans,
about which I spoke a moment ago. It is also why we have invested
over £5 billion through our elective recovery programme,
including over £1 billion for the 43 new and expanded surgical
hubs. There is additional capacity going in, both on the
diagnostic side and on the surgical hub side. We need to do both,
and we are making significant progress.
(Penistone and Stocksbridge)
(Con)
My constituents in Penistone and Stocksbridge will warmly welcome
this initiative to diagnose cancer earlier but, as many hon.
Members have said, we also need to reduce the waiting times for
cancer treatment after diagnosis. Will my right hon. Friend
consider using some of the new community diagnostic centres, such
as our amazing flagship centre in the constituency of the hon.
Member for Barnsley Central (), as radiotherapy treatment centres too, to reduce
treatment waiting times?
As part of expanding our capacity, we are doing both: we are
expanding the diagnostic capacity—my hon. Friend is right to
highlight that investment in Barnsley, as elsewhere—and boosting
the surgical capacity through the expansion of our surgical hubs.
In addition, we are looking at the patient pathway and
identifying bottlenecks and how we design them out, given the
additional capacity that is going into the system. So she is
right to highlight the investment that is going in, alongside
which we need to look at the patient journey and how we expedite
that. The bottom line is that we are treating far more patients,
the vast majority of whom—more than nine in 10—are getting
treatment within a month.
(Tiverton and Honiton)
(LD)
We know that 28% of victims of lung cancer have not smoked and do
not smoke. My mum was one such victim. She died having contracted
lung cancer and having not smoked before. But we were lucky in my
family that she was diagnosed early. So, on behalf of the Liberal
Democrats, I really welcome today’s announcement. However, on
behalf of people in Devon whom I represent, I ask why only 40% of
the people who are diagnosed will be subject to screening by
2025? Why do we have to wait until 2030 for the screening to be
widespread and available to all?
First, may I express regret about the hon. Gentleman’s own family
experience of this condition? On the roll-out programme, we need
to build that capacity and to do so in a sustainable way—that
point has been raised by Members across the House. We are
following the science in targeting those communities that are
most deprived; they have the highest prevalence of smoking. Of
course we will look at evidence of other risk factors, which
colleagues across the House have highlighted, but it is important
that we roll this programme out in a sustainable way. What is
clear, however, is that it is making progress and it is welcome
that so many communities want the programme to be rolled out to
their area as soon as possible.
(Kettering) (Con)
I welcome the Health Secretary’s announcement. If I heard him
correctly, it means that up to 9,000 cases will be caught early,
which is equivalent to about a quarter of the 35,000 who sadly
die every year from lung cancer. How much will the national lung
cancer screening programme cost? Why can it not be paid for in
its entirety from the profits of the cigarette companies?
My hon. Friend, an experienced parliamentarian, opens two
different issues there. As he well knows, one is a question of
tax, which, rightly, I say as a former Treasury Minister, is a
matter for the Treasury. As for the roll-out of the programme,
the additional cost of the programme will be £1 billion over the
seven years. That is the additional cost of that expansion, but
how it is funded will be an issue for the Treasury.
(Halton) (Lab)
Anybody who has lost a loved one through lung cancer will know
what a horrible and cruel disease it is. Obviously, we welcome
any move to improve screening and get more people screened. But I
would be interested to know two things from the Secretary of
State. First, in one of my local hospitals—recently, I asked a
parliamentary question about this—only 77.8% of patients got an
urgent referral within 62 days, so quite a lot of people did not.
Secondly, how much of the £1 billion will be used to bring in the
extra clinicians and staff who will be needed to do the
screening?
I am sorry, but I missed the second part of the question. On the
speed of treatment, that is why significant work is going into
the faster diagnosis standard, which was hit for the first time
in February. Part of the additional capacity going in—the extra
108 diagnostic centres—is to boost that capacity and speed up
that treatment. There has been a surge in demand; a significant
uptick in the nature of demand. That is the backlog we have been
working through as a consequence of the pandemic, but the
additional capacity is to address that exact point.
(Eddisbury) (Con)
I welcome today’s announcement and acknowledge the important
contribution made by many charities and organisations that work
in the world of cancer, including Cancer Research UK and the Roy
Castle Lung Cancer Foundation. The pilot has proved that a
national screening programme will make a huge and significant
difference to many lives, particularly in places that were not in
the pilot areas, such as Eddisbury in Cheshire. One aspect of the
pilot programme that enabled a diagnosis to be made more quickly
was the screening trucks that went out into the community. Will
that continue in the national programme, particularly in rural
areas such as the one I represent, where there are health
inequalities that need to be addressed?
My hon. and learned Friend is absolutely right. A key feature of
the programme is the use of screening trucks to offer checks
within the community. When I was talking to patients this
morning, a theme that came through was that the prospect of going
to hospital for such a check would have been seen as a more
daunting experience. The fact that the check was available, using
high-quality equipment, in a vehicle in a supermarket car park
made it more accessible to people and, as a result, the uptake
was higher than it might have been. He is absolutely right to
highlight the proven importance of that in the pilot and that
delivering checks through community schemes increases
participation; that is a key feature of the programme.
(Blaenau Gwent) (Lab)
Will the Secretary of State ask the Treasury if the tobacco
companies can stump up for the delivery of the programme?
All Health Secretaries have regular conversations with the
Treasury in terms of wider financing. The departmental budget for
Health and Social Care is over £180 billion, which is already a
significant investment. Through the long-term plan, we have
significantly increased our budget and there are many calls on
that, including, as we heard from the Opposition Front Bench, in
terms of junior doctors’ pay and other issues. Of course these
things need to be looked at in the round, but I am always keen to
discuss with Treasury colleagues what more can be done.
(Stourbridge) (Con)
I thank the Secretary of State for the excellent news about the
national targeted lung cancer screening programme. As an
ex-smoker, I welcome any intervention and the focus on
prevention. When I gave up smoking, it was chewing gum and fizzy
drinks that got me through. Today, it is vapes. My concern is
that young children are using vapes in the first instance,
without having smoked, which can lead them to go on to smoke.
Will my right hon. Friend join me in welcoming the recent
crackdown on marketing vapes to children and the new illicit
vapes enforcement squad, which will clamp down on online shops
selling illicit vapes to under-18s?
My hon. Friend raises an important and topical point. The chief
medical officer estimates 50,000 to 60,000 smokers a year may
potentially give up through vaping, which is something the
Under-Secretary of State for Health and Social Care, my hon.
Friend the Member for Harborough (Neil O'Brien), is particularly
focused on. However, there is a marked distinction between vaping
as a smoking cessation tool and vaping products that are targeted
at children, which is why we have both toughened the approach and
closed some loopholes. A call for evidence closed a couple of
weeks ago and we are looking at what further measures we can
take.
Sir (Middlesbrough South and East
Cleveland) (Con)
I warmly welcome today’s announcement, and know people across
Middlesbrough South and East Cleveland will do likewise. Across
Teesside, a targeted lung health check programme has been running
for over a year, led by the extraordinary Jonathan Ferguson, who
is the clinical lead at the outstanding James Cook University
Hospital in my constituency. The programme identified a curable
cancer every two days, through scanners operating 12 hours a day,
7 days a week, from mobile units in supermarket car parks. As the
new programme is established and proves its value to millions of
people across the country, will my right hon. Friend commit to
speaking to Mr Ferguson, who has valuable practical lessons about
how the pilot has worked on Teesside, which could benefit many
other communities?
I welcome the work that Mr Ferguson and those at James Cook
University Hospital have been doing on the programme. We would be
very keen to learn from any experience that they have to share.
My right hon. Friend also draws attention to the innovative ways
of working that are being piloted, including using scanners for
12 hours a day and looking at how they can operate in different
ways. That is what this programme is about: delivering far better
patient outcomes, much earlier detection and, as a result, far
longer survival for those who otherwise may not have realised
they have lung cancer and would have been diagnosed at too late a
stage.
The Parliamentary Under-Secretary of State, Department of Health
and Social Care () (Con)
My Lords, with the leave of the House I shall now repeat a
Statement made earlier in the other place by my right honourable
friend , the Secretary of
State.
“With permission, I would like to make a Statement on our
national lung cancer screening programme for England. Around a
quarter of patients who develop lung cancer are non-smokers. We
all remember our much-missed friend and colleague, the former
Member for Old Bexley and Sidcup, . He campaigned tirelessly
to promote lung cancer screening and was the first MP to raise a
debate on this in Parliament. His wife Cathy is continuing the
brilliant work that he started in partnership with the Roy Castle
Lung Cancer Foundation.
In 2018, after returning to work following his initial diagnosis
and treatment, James told this House that the Government should
commit to a national screening programme and use the pilot to
support its implementation. As I am sure many colleagues in the
Chamber will recall, he said:
‘If we want to see a step change in survival rates—to see people
living through rather than dying from lung cancer—now is the time
to be bold.’—[Official Report, Commons, 26/4/18; col. 1136.]
Despite being a non-smoker, James knew that the biggest cause of
lung cancer was smoking and that the most deprived communities
had the highest number of smokers. That is why I am delighted
that today the Prime Minister and I have announced targeted lung
cancer screening programmes at a national level, building on our
pilot, which will be targeted at those who smoke or have smoked
in the past.
Lung cancer takes almost 35,000 lives across the UK every
year—more than any other cancer. Often, patients do not have any
discernible symptoms of lung cancer until it is well advanced; in
fact, 40% of cases present at A&E. Since its launch in 2019,
and even with the pandemic making screening more difficult, our
pilot programme has already given 2,000 lung cancer patients in
deprived English areas an earlier diagnosis. That matters because
when cancer is caught at an early stage, NHS England states that
patients are nearly 20 times more likely to get at least five
years more of life to spend with their families.
We all know that smoking is the leading cause of lung cancer. It
is responsible for almost three quarters of cases, and in
deprived areas people are four times more likely to have smoked.
We have deployed mobile lung trucks equipped with scanners to
busy car parks in 43 deprived areas across England. Before the
pandemic, patients from those areas had poor early diagnosis
rates, with only a third of cases caught at stage one or two. To
put that in context, while a majority of patients diagnosed at
stage one and two get to spend at least five more years with
their children and grandchildren, less than one in 20 of those
diagnosed at stage four are as fortunate. Thanks to our targeted
programme, three quarters of lung cancer cases in those
communities are now caught at stage one and two.
Targeted lung cancer checks work. They provide a lifeline for
thousands of families. We need to build on that progress, which
is why we will expand the programme so that anyone in England
between the ages of 55 and 74 who is at high risk of developing
lung cancer will be eligible for free screening, following the UK
National Screening Committee’s recommendation that it will save
lives. It will be the UK’s first and Europe’s second national
lung cancer screening programme. If results match our existing
screening—there is no reason to think that they will not—when
fully implemented the programme will catch 8,000 to 9,000
people’s lung cancer at an earlier stage each year. That means
that each and every year around 16 people in every English
constituency will be alive five years after their diagnosis who
would not have been without the steps we are taking today. That
means more Christmases or religious festivals with the whole
family sitting around the table.
Alongside screening to detect conditions earlier, we are
investing in technology to speed up diagnosis. We are investing
£123 million in AI tools such as Veye Chest, which allows
radiologists to review lung X-rays 40% faster. That means that
suspicious X-rays are followed up sooner and patients begin
treatment more quickly.
How will our lung cancer screening programme work? It will use GP
records to identify current or ex-smokers between the ages of 55
and 74 who are at a high risk of developing lung cancer, assessed
through telephone interviews. Anyone deemed high risk will be
referred for a scan and will be invited for further scans every
two years until they are 75.
Even if they are not deemed at high risk of lung cancer, every
smoker who is assessed will be directed towards support for
quitting because, despite smoking in England being at its lowest
rate on record, tobacco remains the single largest cause of
preventable death. By 2030, we want fewer than 5% of the
population to smoke. That is why in April we announced a robust
set of measures to help people ditch smoking for good, with one
million smokers being encouraged to swap cigarettes for vapes in
a world-first national scheme. All pregnant women will be offered
financial incentives to stop smoking, and HMRC is cracking down
on criminals who profit from selling counterfeit cigarettes on
the black market.
The lung cancer screening programme has been a game changer for
many patients: delivering earlier diagnoses, tackling health
inequalities and saving lives. We are taking a similar approach
to tackle obesity, the second biggest cause of cancer across the
UK. The pilot we announced earlier this month will ensure that
patients in England are at the front of the queue for innovative
treatments by delivering them away from hospital in community
settings. Together, this shows our direction of travel on
prevention, which is focused on early detection of conditions
through screening and better use of technology to speed up
diagnosis and then treatment, because identifying and treating
conditions early is best for patient outcomes and for ensuring a
more sustainable NHS for the next 75 years. I commend this
Statement to the House.”
19:57:00
(Lab)
My Lords, I thank the National Screening Committee for its work
and welcome this Statement, which outlines the only response that
makes any sense: the establishment of a national targeted lung
cancer screening programme. I also pay tribute to the many
individuals and organisations that have worked over many years
for this, in particular the Roy Castle Lung Cancer Foundation,
which, in addition to campaigning, has been delivering its own
scans since 2016.
I very much wish to associate these Benches with the thoughts of
the late and much-missed MP for Old Bexley and Sidcup, . I acknowledge the work
he did in bringing this cancer screening programme about, which
was continued by his wife Cathy. This is a very fitting Statement
with which to honour his memory.
There is no doubt that diagnosing more people earlier is
absolutely crucial. This programme will certainly improve that,
but it does have to go hand in hand with treatment that is
available rather quicker than is currently the case. The UK
currently lags behind the European average for five-year survival
rates for lung cancer. More broadly, since 2010, ever more cancer
patients have waited longer than is safe to see a specialist. The
target of 85% of patients to start treatment from initial GP
referral within 62 days has not been met since 2015.
Can the Minister tell your Lordships’ House whether this
extension of screening will be matched by the necessary
improvements in access to treatment? If the treatment programme
is to be improved—as surely it must be—how will this be done, and
when? Will it be new money or a diversion from existing resources
that funds the programme and any associated improvements in
treatment?
Turning to the areas where lung disease is most prevalent,
notably those with the greatest deprivation and health
inequality, can the Minister give an assurance that resources for
the screening programme will continue to be targeted at the areas
that need it most? With existing health structures already worse
in these areas, how will they be improved to support the delivery
of the lung cancer screening programme?
Despite the Government’s support today, it has taken nearly nine
months to act on the recommendation of the National Screening
Committee, and there is now a timeline to reach 40% of the
eligible population by March 2025, with full coverage by March
2030. Can the Minister say whether work is going on to hasten the
timeline of this rollout?
The Health and Social Care Select Committee’s report last year
into cancer services concluded that a lack of serious effort on
cancer workforce shortages risks a reversal in cancer survival
rates. While we have been promised the NHS workforce plan this
week, after many years of waiting, I note that the Government’s
press release had just one line on the workforce necessary to
make the screening programme a reality, saying that additional
radiographers are due to be appointed. Can the Minister assure
the House that when we do get the workforce plan, it will address
the major shortages that were outlined by the British Thoracic
Society, whose report identifies workforce shortages as the main
challenge in the provision of healthcare to those with lung
conditions?
As the Minister rightly pointed out in the Statement, smoking is
indeed the leading cause of cancer, causing 150 cancer cases
every day and one person’s death every five minutes due to
smoking-related ill health. It is therefore important that
alongside diagnosis, we work to stop people smoking in the first
place and support those who do smoke to quit. Yet the number of
people quitting has slumped since 2010 and smoking cessation
services have been cut. Can the Minister confirm when we will get
the awaited Government response to the review of tobacco control
policies, led by Dr Javed Khan?
It is not only smokers who have lung cancer and other lung
conditions. The context in which all of this takes place is a
range of other factors in addition to smoke and smoking, and that
includes air quality. It would be helpful if the Minister
indicated what is being done to tackle these broader challenges.
Furthermore, it is not the diagnosis of lung cancer only that
will improve through the screening programme, but also that of
conditions such as cystic fibrosis. What expectation does the
Minister have in this regard?
My Lords, I am sure we all want to see this national, targeted
lung cancer screening programme save lives, and I hope the
Minister can give the reassurances I seek today.
(LD)
My Lords, I would like to follow the noble Baroness, Lady Merron,
in welcoming the Government’s acceptance of the National
Screening Committee’s recommendation to introduce a targeted lung
cancer screening programme, and echo her tribute to the late
, whom I dealt with in a
previous capacity when he was a Minister advocating for child
safety online. I found him to be very effective; a firm Minister
who was also very pleasant to deal with—the most effective model
for all of us.
The new programme is especially welcome as a step towards
addressing the glaring health inequalities we face in the United
Kingdom. I hope the Minister will reassure us that sufficient
data will be collected in order to understand whether it is
having the kind of impact the Government intend, as he outlined
in the Statement.
I hope the Minister can also provide more information about how
it can be delivered, given that we already have dire shortages in
capacity to deliver diagnostic tests. This shortfall is reflected
in today’s report from the King’s Fund, which shows a serious gap
in CT and MRI scanner capacity between the UK and comparable
countries. When can we expect to see investment from the
Government in additional scanners, to bring us up to something
more like the international mean? As well as the lack of
machines, we do not have sufficient people to operate them or to
assess the test results. I invite the Minister to refresh his
formula for when we may see the long-awaited NHS workforce plan,
including the element that relates to radiologists, perhaps
updating it from “shortly” to “in the next week”, as it surely
has to come before the 75thanniversary of the NHS on 5
July.
The concern we continually have with announcements of new
services by the NHS in the current context is that they will come
at the expense of existing services; the noble Baroness, Lady
Merron, also referred to this. I believe this is a rational and
reasonable concern to have, given the evidence of missed targets
and unacceptable wait times that is all around us. I hope the
Minister can give us further assurances that, as the Government
will the end of catching more cancers earlier, they will also be
willing to will the means to deliver on this promise.
Anyone with eyes in their head can see that vaping is being
cynically promoted to young teenagers; it is all around us in
high street shops and in the evidence from the litter around
schools. The Statement refers to the role of vaping as a tool to
help existing smokers give up their harmful habit, but there is
increasing evidence that vaping is creating new nicotine addicts,
with associated risks. The Australian Government have found that
young people who vape are three times as likely to take up
smoking, and they have plans to bring in a range of measures to
suppress vaping among young non-smokers. Can the Minister explain
what assessment the UK Government have made of the Australian
evidence of vaping leading to higher smoking prevalence among
young people, and are the UK Government considering similar
measures to reduce vaping use here? It took us five years to
follow Australia in introducing plain packaging for cigarettes. I
hope we can follow faster here, on vaping.
The new screening programme is welcome, but it must be properly
resourced with both machines and people. I hope the Minister can
give us some insights into how that will happen, and at the same
time explain what action the Government intend to take to reduce
vaping among non-smokers, so that we do not end up creating a new
wave of people who are at risk of lung cancer.
(Con)
I will start with a small correction to the Statement. It should
have said:
“We are investing £123 million in AI tools such as Veye Chest,
which allows radiologists to review lung”
scans, not X-rays. I do not whether the etiquette is that I
should have said that during the Statement. I repeated the
Statement verbatim because I was told I should, but the correct
word is “scans”.
I thank both the noble Baroness and the noble Lord for their
comments and support. I too had the pleasure of working with
, and I realise what an
effective and kind person he was. Like others, I am delighted
that we are making these positive steps today and welcome the
constructive and supportive comments.
Regarding trying to show that we are matching the will with the
means on MRI scanners, that is exactly what the 100-plus CDCs are
all about. It is a recognition that we do not have the same
diagnostic capability, as highlighted by the King’s Fund report.
That is what the investment in those centres is all about. My
understanding is that about four million tests have already been
done, so we are looking to match that. We will need 184
radiographers and 75 radiologists to do this work, but the other
big support will be the use of AI. We are seeing some promising
technology, which will help to a large degree. I am glad to say
that a lot of this will be set out in the long-term workforce
plan in the coming days—a new formulation. In other words, pretty
soon.
In terms of the comments about screening being targeted at those
most in need, that is where I have been most pleased by the
pilots. Use of the mobile trucks really made a difference in
those areas most in need. It really made a difference in the most
deprived areas, which, as the noble Baroness, Lady Merron,
mentioned, have higher levels of smoking. I am glad that it is
targeting those areas.
Can we work to hasten the timetable? I think we would all like to
but what we are trying to do here is to put down plans that we
are confident we can hit. To answer the money question, it is £1
billion of extra investment during that time and that increases
over time so that by the end it is about £270 million extra per
annum.
What does that mean in terms of the Dr Khan responses? As I
mentioned, we are committed to the smoking cessation results. As
part of that we are considering all the points in the Khan
review. I think we all accept that vaping is much better than
smoking. We are very much trying to encourage vaping over
smoking. But you have to be careful of the side-effects of that.
As we have seen, vaping can be used in a somewhat cynical way—to
borrow the phrase—with young people. More work undoubtedly needs
to be done in that space but it is recognised that there needs to
be a balance. I think I will need to come back in writing on air
quality and cystic fibrosis.
I have tried to cover the points at this stage and look forward
to further questions.
20:13:00
(GP)
My Lords, I have two questions. My first question is about the
timeframe and the role of GPs. The Statement says that, using GP
records, current and ex-smokers aged 55 to 74 will be assessed by
telephone interviews. Will that require resources from GPs? We
all know that there are many different computer systems so where
are the resources going to come from? Specifically on GPs, I can
well imagine at many GP surgeries tomorrow morning at that
terrible time of 8.30 am as everyone frantically tries to hit the
dial button that a lot of people will be asking for a scan. Have
GPs been equipped to handle that? Do they know what to say and
how to manage that kind of scenario?
My other question follows on from the questions about the Khan
review. That said that we are grossly underfunding things. Mass
media campaigns in particular are funded at 90% under what is
needed, while other services are about 50% underfunded. Surely we
have to stop these cases happening. Can we see a commitment from
the Government within some sort of timeframe to say that we are
going to put more money into this?
(Con)
I thank the noble Baroness. In terms of identifying the smokers,
the telephone is just one way of doing it. The hope is that using
the digital data and the app means that more of these things will
be on people’s records and identified with them. As ever with
these things, electronic means will be the best way to do that,
albeit those telephone resources in terms of supporting the GPs
are very much part of the plan. It is understood that GPs have a
large burden at the moment.
There is not a lot more to add about the Khan review. The
ambition is still there to be smoke-free by 2035 and investment
has gone behind that. The best example of that, as has been
mentioned, is people swapping cigarettes for vapes as one means
to do it. Undoubtedly, a lot more needs to be done in that
direction as well.
(Lab Co-op)
My Lords, I join noble Lords in paying tribute to . I met him a few times,
and it was a tragedy when he lost his life after a brave fight. I
also pay tribute to the work his wife continues to do in his
name.
This progress is to be welcomed, but can I say—if nobody else is
going to come in—that cancer takes many forms? One area of cancer
where we need to make much more progress is that of brain tumours
and glioblastomas. We all remember our dear friend , who died on 12 May 2018 of a
brain tumour. My brother John was a cab driver. Many people would
not know my brother; he was just a cheeky, funny London cab
driver who had a view on everything and who was loved by his
family. He died on 26 March this year at 57, having fought a
brain tumour for nearly three years. Our dear friend was mentioned in the
other place today. She died on 24 June at 61. She was my friend
for 42 years; I met her when I was 18.
It is devastating. There has been no progress in this area of
cancer treatment. There are quite clear inequalities, partly
because only about 3,500 people a year get glioblastomas, so
there are not huge numbers. There is no research, no trials and
no hope—it is a death sentence. That cannot continue. We are no
further than we were 30 years ago in this area. What happened
today is brilliant, and I think there is now an 85% survival rate
for breast cancer and that the rate for bowel cancer is 55%.
However, brain tumours are virtually a death sentence. We have to
improve that. It is an outrage that people can die so young from
them and that there is no hope.
I do not expect an answer from the Minister today; I just want to
put down a marker that I and other colleagues here and in the
other place will keep mentioning this. I refer all colleagues
here to the wonderful speech made by my honourable friend MP—my friend Margaret’s
sister—when she talked about her sister and the treatment she had
to undergo. I saw Margaret about three or four days before she
died; it is a real tragedy, as is my brother’s case. I hope we
can all work together and with the cancer charities, and that we
can get some research done, put some money in and improve the
situation. It cannot carry on.
(Con)
I thank the noble Lord, Lord Kennedy, and I am sorry for the loss
of his brother. I agree with his sentiment that while this is
good news today and is welcomed by all, it shows that this is a
journey and that we need to do more in lots more areas. I take on
that point and say, from our point of view, that we agree that we
must work together to make further progress.
(Lab)
Could I give the Minister another opportunity to pick up on the
key point I raised? We very much welcome the improved diagnosis
rates—and my noble friend Lord Kennedy makes a very pertinent
point that, of course, we are talking not just about one cancer.
I thank him for sharing his views and feelings with your
Lordships’ House. That takes me to my reminder to the Minister: I
asked about matching improvements in diagnosis with improved
access to treatment; otherwise, we are leaving people diagnosed
but not matching it by giving them the treatment they need in a
timely manner. Could the Minister assist with that point?
(Con)
I am sorry; I was answering in a generic format in terms of the
new CDCs. The noble Baroness is quite right that diagnosis is one
thing—and we all know that the early stages are key—but you then
have to follow that up with treatment. Of course, the good news
is that if you can detect cancer in people at the earlier stages,
they need less treatment. The resources I mentioned, in terms of
what is being spent on the programme, take into account the
treatment required as well.
Of the people being identified at this stage, only 1.4% from the
pilot were then positive and needed treatment, thankfully.
Obviously, those resources are in place. There is a second
interesting category of people—about 17% or so—who are fine but
we want to make sure that what has been noticed is in an okay
state.
I am going to grab my notes to make sure I am referring exactly
to the right term at this stage. I apologise; about 1.7% have
nodules, which is not a problem per se, but it is a problem if
those are growing. The idea is that we will be getting those
people back in for frequent scans on a three- to six-monthly
basis and using AI technology to see whether or not the nodules
are growing. If they are not growing, it is not a problem, but we
then keep up the frequency of scans. Obviously, if they are
growing, that would be a concern at the early stages, and that
would then move them into the treatment category.
The other 80% or so of people fortunately will not have any
concerns from the scan at all. At that stage, they will be put
into this continual programme, where they will be reviewed every
couple of years to make sure that we keep on top of it. I hope
that this shows that this is a well thought-out, entwined
service, with the idea being that for the 1.4% who are identified
as needing cancer treatment, the treatment is there to back them
up.
