Full text of the Adjournment debate put forward by Henry Smith MP in the House of Commons on 23rd November 2018, and the response from the Minister of State for Health, Stephen Hammond MP.
Henry Smith (Crawley) (Con)
I am grateful for the opportunity to raise the important issue of the NHS long-term plan and blood cancer. In doing so, I congratulate my hon. Friend the Member for Wimbledon (Stephen Hammond) on his appointment to his ministerial position.
We are already nearing December. It is often said that the months seem to fly by, and this is very much the case in terms of the work of the all-party group on blood cancer throughout 2018. As chair of the all-party group, it certainly does not seem like almost a year ago that we launched our first report, which coincided with a Westminster Hall debate on blood cancer care and the NHS. As we come towards the end of the year, we are also approaching the publication of the Government’s long-term plan for the NHS. It is vital that the needs of blood cancer patients are considered and implemented if we are to build on the progress undertaken in recent times for people with blood cancer.
Our all-party group has continued to take evidence from a host of experts and to raise further awareness with health officials and policy makers. Our pursuit of this cause in Parliament is ongoing. September saw Blood Cancer Awareness Month. To mark that occasion it was my pleasure to host Bloodwise, as it invited MPs to meet members of their successful and ever growing patient ambassador programme. Speaking with people such as patient ambassadors really helps to put cancer into a human context. It is important to highlight the fact that some 40,000 people are diagnosed with blood cancer in the UK each year, but listening to just one or perhaps a handful of people who are either living with or have been treated successfully for blood cancer is a powerful reminder that behind every statistic are individual patients, with their own story to tell.
Mark Tami (Alyn and Deeside) (Lab)
I add my praise for the work that the hon. Gentleman has been doing with the all-party group. When it comes to patients who need a transplant, around 60% of patients who are white will get the best possible match, but if someone comes from a black, Asian and minority ethnic background, that drops to 20%. Does he agree that we need to do much more work to improve this dreadful situation?
I am grateful for the hon. Gentleman’s intervention, and I pay tribute to him for his contribution to this debate and for raising this matter in this place just yesterday. I absolutely endorse what he says about the importance of transplantation.
Last week, the APPG held its latest meeting on the timely topic of ensuring that patients have access to the best drugs and treatments, ahead of the publication of the NHS plan. In recent months, there have been some significant decisions regarding treatments for blood cancer on the NHS. In September, CAR—chimeric antigen receptor—T-cell therapy was approved for entry into the cancer drugs fund by the National Institute for Health and Care Excellence and NHS England to treat children and young people with relapsed acute lymphoblastic leukaemia. CAR-T therapy is a new type of therapy that modifies a person’s infection-fighting T cells to better spot and kill cancer cells. It could offer people with certain hard-to-treat blood cancers the chance for long-term survival, or even a cure.
I was pleased to question my right hon. Friend the Prime Minister at Prime Minister’s questions about CAR-T therapy following the NHS England announcement. I continue the call I made that day for the Government to ensure that a focus on blood cancer awareness, diagnosis and prevention will continue into the future. With that in mind, will the Minister update the House on when people with blood cancer are likely to benefit from CAR-T treatment and on whether the health system is ready for this type of personalised medicine?
Additionally, NHS England changed its mind recently and allowed ibrutinib to be used for patients with chronic lymphocytic leukaemia after three years’ remission. The development of new drugs is ongoing. Bloodwise estimates that over one third of all indications for which drugs are funded on the cancer drugs fund are for blood cancer, which highlights not only the challenges we face, but the potential to help.
In January, the APPG launched its inaugural report, “The ‘Hidden’ Cancer—The need to improve blood cancer care.” Key to this is the word “hidden”. Blood cancer is known as the hidden cancer because although patients may indeed be receiving or waiting to start treatment, they may not be displaying any obvious or visible signs of ill health.
I am careful to try to refer to patients and their support networks, especially in this context, as the impact of diagnosis on a patient’s family must also be considered, especially when children are involved. This is particularly the case for patients on so-called watch and wait. That is typically an option only for people with few or no worrying symptoms, whose quality of life and prognosis will not be affected by delaying treatment, and it is recommended for those with blood cancers or related conditions that are stable or slow-growing. However, if someone has been told that they have cancer and, at the same time, they know that they will literally watch and wait to see when they are in a position to begin treatment, it is understandably disconcerting, to say the least. Patients on watch and wait told the APPG inquiry that specific emotional support was required to help them to come to terms with what was happening. Approximately 27,000 people with blood cancer are currently on watch and wait in the UK. To put this in context, that is 13% of those living with blood cancer.
Turning to mental health, anyone with experience of living with cancer or supporting a friend or family member who has done so will know of the dedication of NHS staff and health workers in seeking to do all that they can to provide support. However, it is vital that these staff are given the tools to ensure that patients are fully equipped mentally through the psychological support that they receive. Our APPG report recommended:
“Patients should have access to the full range of emotional and psychological support services throughout their treatment, for themselves and their families”.
The Government have put mental health on a par with physical health. As such, I would be grateful for the Minister’s assurances that blood cancer patients will receive the psychological support that they need after diagnosis, during treatment and after it has been completed.
I congratulate the hon. Member for Alyn and Deeside (Mark Tami) again on his Adjournment debate yesterday on psychological support after cancer treatment. By working together on a cross-party basis, it has become powerfully apparent to me that we can make a significant difference. Indeed, I have mentioned that only last week, the blood cancer APPG held its latest meeting on access to drugs and treatments for patients. We were fortunate to be joined by MPs, charity representatives and, of course, patients, one of whom said something that has remained in my mind. She said that patients
“don’t know if they’re living or dying”.
That highlights succinctly and powerfully the importance of this work and the importance of patients, politicians, cancer charities, the Department of Health and Social Care and the wider national health service in ensuring that patients are supported as well as treated.
One of the most striking passages of our APPG report referred to the long-term nature of blood cancer, and how it is different to solid tumour cancers. Respondents to our inquiry found that the term “living beyond” blood cancer was irrelevant. They will probably never live without blood cancer—it will remain part of their life—and very few of those patients have access to the recovery package. Indeed, one respondent even said that they did not know what the recovery package was, which is a point of concern. The recovery package assists patients after their cancer treatment has ended so that they can seek to return to their normal life.
I welcome the fact that the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Winchester (Steve Brine) recently reiterated that
“the recovery package is being commissioned and delivered in full or in part by many Clinical Commissioning Groups and providers across England”.
“NHS England’s aim is to accelerate the process to ensure full implementation by 2020 so the package will be available to all cancer patients across the country regardless of location.”
He also stated that NHS England was
“building up a picture of current provision to help target future work to support rollout.”
I should be grateful for clarification from the Minister for Health on how support for blood cancer patients is included in this analysis.
Turning to data collection, the inclusion of blood cancer in a range of data collection initiatives will help policy makers to gain a greater understanding of the condition and how patients can be supported. For example, clinical commissioning groups and cancer alliances do not group blood cancer into a single disease area, unlike the national cancer patient experience survey, which means that blood cancer currently receives less attention and therefore fewer resources. The inclusion of blood cancer in the cancer dashboard, which only covers breast, colorectal, lung and prostate cancers, would be a step forward for patients.
Earlier this year, the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Winchester, said in a written answer:
“A second iteration of the dashboard is being considered by the National Cancer Transformation Board with a wider ambition to include rarer cancers and cancers with a lower incidence, such as blood cancers, as the dashboard develops.”
May I ask when we may expect such a development to come into effect?
GP surgeries are a vital part of the NHS. Like all MPs, I receive correspondence from my constituents on the subject of access to GPs. Indeed, in the NHS plan, we need enhanced support for doctors and their capacity to see patients every day, both in Crawley and up and down the country. While the A&E in Crawley Hospital was closed under the previous Government, Crawley Hospital urgent care centre is now open 24 hours a day, seven days a week. I urge the Minister to ensure that hospital services continue to come back to sites such as Crawley Hospital, while at the same time ensuring that the resources are in place to enable our constituents to access their GP, not on the other side of the town or county, but in their own local area.
GPs need more assistance to detect and flag up blood cancer. A GP will see, on average, eight cases of cancer per year, only one of which will be blood cancer. The number of GP visits needed before a cancer diagnosis is significantly higher for blood cancer patients than for people with other forms of cancer. Someone with cancer will of course want to be diagnosed the first time they see their GP with symptoms, but one in six blood cancer patients needed to visit their GP three, four or even more times before diagnosis. Only one in 42 breast cancer patients required such regular visits to be diagnosed with their condition.
In the wider debate, the numbers and the statistics are important. Not far shy of a quarter of a million people are living with blood cancer in the UK, and one in 19 people will develop blood cancer at some point in their lives. In Crawley there were fewer incidents of blood cancer than either breast or prostate cancer, but there were more blood cancer deaths than from either of those other forms of cancer. The challenges are immense. Blood cancer is the UK’s fifth most common cancer, and the third biggest cancer killer. However, there are reasons to be positive. Over a period of almost four decades, from 1971-72 to 2010-11, 10-year survival rates for leukaemia, one of the most common groups of blood cancer, increased from 7% to 46%. Among children, the figure has trebled to 81%.
In all those figures are the individuals who live with blood cancer, who care for family members who are patients, or who are advocates on behalf of those affected by the condition. My constituent Bill Bedford was diagnosed with myeloma in September 2016. He has undergone a stem cell transplant operation and is now fortunately in remission. Bill is one of many patients who are seeking to give something back. He has undertaken a 310-mile cycle ride, from London to Paris, to raise funds for Myeloma UK. Seven-year-old Ebonie Musselwhite, also from Crawley, was diagnosed with acute lymphoblastic leukaemia two years ago. About 650 people are diagnosed with ALL each year in this country, half of them children. Crawley Fire Station and Crawley Lawn Tennis Club are just two of the local organisations that have held fundraising events to help contribute to the cost of support for Ebonie. Angus Rowland, a young man living just outside Crawley, was diagnosed with acute myeloid leukaemia in 2010. Sadly, he died in May 2011, just 14 and a half years old. The Angus Rowland Forget-Me-Not Walk and Run took place in October, just outside Crawley, to raise funds for Bloodwise in Angus’s name.
I said at the APPG report launch that we could not just stand there and be pleased with what we had published in our first report. Rather, it must form the basis of a continued programme of work to effect lasting change. To people living with blood cancer right now, who may be on watch and wait, who may be undergoing treatment, or who may have only just been diagnosed, 1 say this: there are people in Parliament who are on your side, and we will stand up for you. We want to help, and we will keep the pressure on the Government and the NHS. To those who may have undergone treatment, who may be having treatment now, or who simply want to ensure greater support for blood cancer patients, my message is simple: contact your local MP and ask him or her to contact the Department for Health and Social Care, NHS England and local clinical commissioning groups. Let us continue to raise awareness, so that blood cancer is no longer the hidden cancer.
Madam Deputy Speaker (Dame Eleanor Laing)
I am delighted to welcome back to the Dispatch Box the Minister, Mr Stephen Hammond.
The Minister for Health (Stephen Hammond)
It is a great pleasure to be here.
Blood cancer is the third biggest cancer killer in the UK and nearly 250,000 people are living with it today. Although cancer is relatively rare in younger people, blood cancers are the most common cancer in under-30s, so this is an important debate, despite the fact that the Chamber is not packed.
I congratulate my hon. Friend the Member for Crawley (Henry Smith) on securing the debate and thank him for his contribution as chair of the all-party parliamentary group. As he rightly said, this is cross-party, so I also congratulate the hon. Member for Alyn and Deeside (Mark Tami), who I understand is the deputy chairman and had an Adjournment debate yesterday.
Cancer is a Government priority. Survival rates have improved since 2010. About 7,000 people are today alive who would not be if mortality rates had remained at those levels. This must continue. We are transforming cancer services across England and taking an “all cancer” approach to improvements. We want our cancer services to be the best in the world. We want all cancer patients to have access to the treatment and the care that will allow for the best possible chance of a successful clinical outcome.
This is really important. That is why the Prime Minister last month announced a package of measures that would see 75% of all cancers detected at an early stage by 2028. Currently, just half of all cases are detected at an early stage. The new 75% target applies to all cancers, not just the 10 currently in the public health outcomes framework early diagnosis metric. We are keen to work with charities representing sufferers of cancers not currently included in that metric on how best to measure progress towards the 75% target.
We are reforming screening, and investing in technology and research to improve diagnosis and care. That will form part of the long-term plan for the NHS and forms part of how we will achieve our ambition of seeing 55,000 more people surviving cancer for five years in England after 2028.
In December 2016, the Government invested £200 million to encourage earlier diagnosis, improve the care for those living with cancer and ensure that cancer patients get the right care for them. Early diagnosis of blood cancers can sometimes be difficult, as my hon. Friend said. Symptoms can be vague and often misdiagnosed, delaying treatment.
That is a particular problem with children. Sometimes these things are dismissed as growing pains or bruising—just kids being kids.
The hon. Gentleman makes an important point. That is essentially why the Government put that money in—to ensure that earlier diagnosis could be enabled. He makes a valid point. It is clear that sometimes patients see GPs multiple times before getting that referral. The money put in to ensure that earlier diagnosis will hopefully ensure that that referral happens more quickly.
In addition to helpful earlier National Institute for Health and Care Excellence guidelines, NHS England has been testing innovative ways of diagnosing cancer earlier, with sites piloting multidisciplinary diagnostic centres for patients with vague or non-specific symptoms, such as those common in blood cancers. In her announcement, the Prime Minister pledged to roll out these rapid diagnosis centres nationally to offer all patients a range of tests on the same day with rapid access to results.
My hon. Friend the Member for Crawley mentioned CAR-T cell therapy. He will know that earlier diagnosis must mean earlier treatment and there have been some exciting developments in that area for people under 25 with leukaemia. Last week, NICE recommended the pioneering cancer treatment CAR-T cell therapy for young people with relapsed or refractory B-cell acute lymphoblastic leukaemia.
My hon. Friend asked about what is happening and timescales. Through the Cancer Drugs Fund, Kymriah will now be offered to people under the age of 25 who have not responded to current treatment or who have relapsed from stem cell transplants. That marks a new generation of personalised medicine with the potential to transform cancer patient care worldwide. As he knows, the work is in its early stages. We know that more personalised treatments will be game changers in cancer treatment.
My hon. Friend also talked about people who have to live with and beyond cancer. More than 300,000 people are diagnosed every year. Innovations in treatment mean that more people look forward to a life after cancer and, as survival improves, we must ensure that patients enjoy as good a quality of life as possible after treatment. We are rolling out the recovery package to every cancer patient by 2020, including of course those with blood cancer. This is a set of interventions designed to help patients and clinicians to assess a patient’s physical and emotional needs at appropriate points on the journey of recovery. It goes from diagnosis at the beginning to recovery at the end. For blood cancer patients, the recovery plan will be personalised to take account of the unique characteristics of blood cancer, which can be very different from those caused by a solid tumour, as my hon. Friend, the chair of the all-party parliamentary group, rightly recognised.
My hon. Friend asked for some comments on psychological support, which was the basis of the Adjournment debate yesterday. Many patients with a chronic blood cancer diagnosis will sadly never be cured. They will be on a regime of watch and wait, often over many years, to see if the cancer has progressed to a point where treatment needs to take place. This takes a huge psychological toll on the patient and their family. The recovery package therefore takes a holistic approach and also considers mental health needs. When patients require additional psychological support, they must have access to appropriate mental health services. Mental health is a priority for the Government, and last year we announced an additional £1.3 billion to expand the NHS mental health workforce, which will allow an extra 1 million patients to be treated by 2020-21. That will help to ensure that cancer patients can be referred promptly to any psychological support they need as part of their recovery package.
My hon. Friend mentioned including blood cancer in the cancer dashboard. Public Health England is working with NHS England on the next phase of the dashboard development, and this will be informed by the needs of key stakeholders and cancer charities. I know that the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Winchester (Steve Brine), has expressed his frustration that the dashboard is limited to the top four cancers and wants to see it expanded. NHS England and Public Health England have had clear direction from him on this, and he and the Department will be watching this with interest. I know that he will want to speak to my hon. Friend and to the all-party parliamentary group on that matter.
I hope that my hon. Friend the Member for Crawley will be reassured to hear that the Government are absolutely committed to transforming services for all cancer patients, including blood cancer patients. More people are being referred and diagnosed than ever before, and thanks to innovative treatments, more of them will survive their cancers. The cancer strategy and the progress that the Government have made in implementing its 96 recommendations provide the ideal launch pad for the long-term plan. With cancer as one of its key components over the next decade, it will enable the NHS to ensure that every cancer patient gets the emotional, psychological and physical support that they need to live well with, and beyond, cancer.
Question put and agreed to.