That this House has considered ovarian cancer diagnosis and treatment.
It is a pleasure to serve under your chairmanship, Mr Bone. I thank the Backbench Business Committee for allowing the debate, as well as everyone who is here to support this important and timely event—both my colleagues in the Chamber, and everyone in the Public Gallery. The issue is extremely important, and I am privileged to open the debate. This will be the first time since 2014 that ovarian cancer has been debated in either Chamber.
Ovarian cancer is a quiet, invasive cancer, which robs wives, daughters, sisters, mothers and grandmothers of years of their lives, often unexpectedly and quickly, with devastating impacts on their families. Today about 25,000 women are living with the cancer and every day 20 will be diagnosed with it. Despite some progress in recent years the disease still takes away the lives of 4,000 women a year, and hundreds of thousands around the world. Because of its devastating effects its survival rate is, tragically, not as high as everyone would like, and 46% of sufferers do not survive for five years or more.
I warmly congratulate the hon. Gentleman on securing the debate. To improve survival rates, we need earlier diagnosis. For many years ovarian cancer was known as the silent killer, but there are a number of signs and symptoms. Will the hon. Gentleman join me in encouraging anyone with those signs and symptoms to see their GP urgently?
I absolutely will. It is a timely and important point. I was on Radio Sheffield only this morning talking about the debate with someone from Target Ovarian Cancer. We spent an awfully long time talking about the symptoms, because it is important that people understand them, and are aware of them, so they can get the treatment they need if they are, unfortunately, affected.
All cancers are important. Extremely sadly—sometimes tragically—ovarian cancer tends not to receive the bulk of the attention or funding. That is partly because that it does not affect as many people as other cancers, but it is also because of survival rates. The 46% rate of survival beyond five years compares unfavourably with the rate for breast cancer, which is 87%, and prostate cancer, which is 85%. There are simply fewer survivors of ovarian cancer in the UK who could highlight the importance of fighting the disease and succeeding than there are survivors of other cancers. There is a need for people to speak up about ovarian cancer. Thanks to the work of those who are doing so, it has started to receive the attention that it needs. Charities such as Target Ovarian Cancer work tirelessly every day to raise the profile of the disease, support those who have been affected, improve diagnosis and treatment and work for a cure. I pay tribute to the work of the all-party parliamentary group on ovarian cancer, and in particular the hon. Member for Washington and Sunderland West (Mrs Hodgson), who chairs it. It has been a privilege to be involved in the work and I am grateful to be able to help in a small way.
What is it about ovarian cancer that requires a particular focus? From the work I have seen, there are four things: improving awareness of the disease, as the hon. Member for Torfaen (Nick Thomas-Symonds) mentioned, so that it can be caught earlier; speeding up the diagnosis when it is suspected that someone has the disease; improving the data available for tracking the disease and our progress in the fight against it; and improving the treatment, allowing people to recover and be disease-free more quickly.
On the point about early diagnosis, my constituent and good friend Jane Sagar had a cyst of 6.5 cm, which a specialist identified. However, its removal was not recommended, although she was later told that any cyst greater than 5 cm on her ovary should automatically have been removed, because it was likely to be cancerous. As a result she is entering her fourth year of treatment for advanced ovarian cancer.
My hon. Friend makes an important point. Treatment around the country needs to be made more consistent and clearer, to put a stop to the issues that many of us have heard in stories from constituents.
I apologise that I shall not be able to stay for the whole of this important debate. Does my hon. Friend agree that the additional resources that the Government are devoting to the NHS are welcome, and that it is important for it to use them wisely, which includes improving early diagnosis and treatment of cancer? Early diagnosis is crucial to successful outcomes and the raising of survival rates for ovarian and other cancers.
My right hon. Friend is right and I hope that the Minister will recognise that. It is a matter of getting a diagnosis, and encouraging people who feel that something may not be quite right to go to the doctor, so that the pathway starts. Then, if there is an issue—most of the time there is not—there can be progress, and people can get the treatment they need earlier.
The first step in improving outcomes on ovarian cancer is improving awareness among the general public, and among GPs and in doctors’ surgeries in general. As has been mentioned, the symptoms of ovarian cancer are often easy to mistake for something else. Too often it is easy to dismiss them as inconsequential or not worth further attention. Symptoms include bloating, a need to go to the toilet more frequently, pain in the tummy or always feeling full. Recognising that those symptoms are potentially problematic is a key to survival. Those diagnosed at the earliest stage, stage 1, are almost certain to be alive a year after the diagnosis; 98% of them will be. Only half of those diagnosed at stage 4 are alive a year later.
Awareness of the symptoms among the general public remains low. For example, only 20% of women can name bloating as a symptom, and only 3% can name feeling full and loss of appetite as an issue. A regional Be Clear on Cancer pilot on ovarian cancer symptoms in 2014 was promising. There was an increase in both spontaneous and prompted awareness of the issues. There were also promising findings from a further regional pilot last year, which focused on abdominal symptoms, including bloating. Initial findings showed that the campaign led to an increase in the number of GP referrals for suspected cancer. We ask that if the Government propose to run any future public health campaigns, they should include work to make people aware of those symptoms.
The second area where there is work to be done is diagnosis, not least because 45% of women reported that it took three months or longer from first presenting to their GP with concerns to recognition that they might have an issue. Diagnosis relies on two forms of assessment—an ultrasound and a blood test called CA125. In too many areas the assessments are done sequentially rather than simultaneously, which often means vital weeks are lost. We have urged the National Institute for Health and Care Excellence and the NHS to review that process and extend the coverage of multidisciplinary diagnostic centres. Those centres prove very useful for the sort of cancers that hide behind vague, less common symptoms, which it is important to get to the bottom of as quickly as possible.
The third area is data. There are many calls on the Government from many sources to ensure that the cancer dashboard demonstrates the progress already being made on a variety of cancers. I understand the challenge, but we also hope that in time the Government may look favourably on the idea of including ovarian cancer data in the dashboard. We hope that that would be relatively simple, as much of the data is already collected and published elsewhere. Good data is vital in driving forward and improving early diagnosis. Huge strides have been made in its collection, and making it available would help with the continuing work to drive up standards.
Finally, treatment also requires further attention. As with many health issues, ovarian cancer treatment is invasive and often difficult. It centres primarily on surgery and chemotherapy. There has been much progress in recent years on drugs to treat the cancer, with the development of a number of PARP inhibitors, providing new tools and opportunities to improve the outcome. However, spending and research on ovarian cancer remains lower than for other cancers, and there is much work to focus on. Where surgery is required there is a strong case for specialist centres around the country, supported by a detailed service specification from NHS England.
To further drive up the quality of treatment, charities such as Target Ovarian Cancer and Ovarian Cancer Action, together with the British Gynaecological Cancer Society, are funding an ovarian cancer feasibility audit. Over the next two years, it will map and analyse existing data on ovarian cancer, and look at the treatment provided and the outcomes for women.
Will the hon. Gentleman join me in congratulating Target Ovarian Cancer and other cancer charities on highlighting this issue and putting forward some very sensible recommendations for improving treatment? Does he agree that it is shocking that our survival rates in the UK are among the lowest in Europe?
I absolutely do. All these things are a work in progress, but I hope that through debates such as this, through talking about it and through all the fantastic work the charities and the APPG do we can move things forward, make progress and, in time, have fewer women suffering from this and more women getting treatment more quickly than today.
The question of ovarian cancer is, however, more than a technical discussion about diagnosis, awareness, data and treatment, as important as those are. Behind each statistic is a real person who has been unexpectedly struck down by the disease and, in far too many cases, might not be around today to tell the story of their fight. As part of the preparation for this debate, the Parliamentary digital team and Target Ovarian Cancer asked people to share stories of their fight and those of their family members.
I am hugely grateful to both organisations for helping with that, and to everyone who got in touch. The stories we received were heartbreaking and heartwarming in equal measure, tragic and terrific, and whatever the outcome, they were inspiring to us all. I cannot possibly do justice to everybody who got in touch or to all the stories and experiences out there, but I will share a few today to remind us of the importance of making progress on this disease.
Danielle got in touch to tell us about her mum, who was diagnosed with stage 3 ovarian cancer in September of last year. Like many other people’s, her symptoms were fuzzy: irritable bowel syndrome, feeling full, swelling and weight loss, which could have been a hundred other things. By chance, the doctor who saw Danielle’s mum also sent her for a blood test, which quickly confirmed that there was an issue. A month or so later, Danielle’s mum started chemotherapy, and in January this year she had a full hysterectomy. After a 10-hour operation, it was hoped that everything had been caught and the focus was on recovery. By June, however, the cancer had returned; sadly, a few months later in August, Danielle’s mum lost her battle, just 10 months after diagnosis.
Forty-year-old Sarah also had symptoms such as weight loss, feeling full and ovary pain. Before the cancer was diagnosed, she tried many times to find out what the issue was, including once being told, “Well done,” for having lost weight. In Sarah’s case the blood test that often highlights an issue came back normal, which emphasises the imperfect nature of the diagnosis. A nine-hour operation and six rounds of chemotherapy later, Sarah continues to battle her cancer while looking after her two young children.
We also heard the story of the daughter of Jean, who was diagnosed in 2011 with stage 4 ovarian cancer as a result of severe bloating and loss of appetite. After major surgery and four rounds of chemotherapy, the news came through that the cancer had spread. Her battle ended early in 2013.
Emma told us about her mum, who was told she was suffering from irritable bowel syndrome; the actual issue was found too late and she lost her battle, aged 64, just six weeks after diagnosis.
Seren started feeling unwell while at university, aged just 19. Unable to get a doctor’s appointment, she came back home and was diagnosed with cancer. Her tumour was the size of a rugby ball and her operation was pushed forward as it was stopping her eating and affecting her breathing. Chemotherapy followed and today Seren is recovered and working for a cancer charity.
Christine is also one of the good news stories. She was diagnosed with stage 2 ovarian cancer aged 35, having had to visit three different GPs to resolve the problems she was suffering from, which had initially been put down to colitis and anxiety. After her diagnosis, an emergency operation and 10 chemotherapy sessions followed. That was in 1985 and Christine is still here; she has been able to share her story in the last few days.
Finally, Linda was diagnosed with ovarian cancer in September 2017, having initially felt unwell at the beginning of summer while she was on holiday. The classic symptoms were there: bloating, feeling full and knowing that something “wasn’t right”. Multiple trips to the GP followed until, finally, a blood test was taken, confirming the cancer. Linda had a full hysterectomy that same month and spent much of the next few months recovering.
I know that many hon. Members may be wondering the obvious: why am I standing here making the case about a disease that cannot and will not ever affect my body? As with so many others, although it may not have touched me personally, it has touched my family. Linda is my mum. Up until last year, she had had relatively good health and there is no history of ovarian cancer in my family. I generally try to keep my family out of politics—I was the fool who ran for Parliament, not them—but last year was a nightmare that none of us want to experience again, and we have no wish to see anyone else experience the same. My dad, my brother and I watched my mum live through an extremely scary diagnosis, hugely invasive treatment and one of the hidden aspects of all cancers, the brush with mortality that takes time for sufferers to get to grips with.
Happily for me and my family, my mum is one of the lucky ones. She is sitting at home in north Derbyshire right now, possibly watching this debate on the internet. She has had a hard year and we are extremely proud of her. Yet I know that for every family like mine who have had good news, there are more people who face a tragic outcome. My mum and Danielle’s mum were diagnosed about the same time and I know that my mum’s journey, like that of Danielle’s mum, could have been so different. I do not want anyone else to face what those of us who know and understand what this disease forces on sufferers have faced. Better treatment, diagnosis and a cure cannot wait. I am grateful for the opportunity to discuss these hugely important issues; I look forward to the debate and the Government’s response. Together, I hope we can beat ovarian cancer.
I congratulate the hon. Member for North East Derbyshire (Lee Rowley) on securing this debate. He is right that ovarian cancer does not affect us men, but it affects people we know, and that is why we are here. I thank him for his introduction and for the extensive work he has done on the issue in his role as vice chair of the all-party parliamentary group on ovarian cancer. I was particularly impressed by the group’s report, “Diagnosing ovarian cancer sooner: what more can be done?”. If hon. Members have not had a chance to read it, I suggest that they do so, because it is very helpful. It was published earlier this year and contains a number of key recommendations and findings, which I will pick up on today.
Every single year, more than 7,000 women across the United Kingdom receive the devastating news that they have ovarian cancer. The hon. Gentleman, in his examples at the end of his speech, referred to those who have survived and those who have not; it is important to realise that sometimes people do survive it. Unfortunately, in my time as an elected representative, most of the people I have known who have had it have caught it at a late stage and have not lived as long as perhaps they could have. UK survival rates are among the lowest in Europe and less than half of all women diagnosed with ovarian cancer survive five years or longer.
The fact that we are at the lower end of that league table is an indication that perhaps we need to do more. I look to the Minister, as we always do, for a positive response. We also know that the earlier a person is diagnosed, the better chance they have of beating the disease. More than a quarter of women with ovarian cancer are diagnosed through an emergency presentation, for example via accident and emergency. The hon. Gentleman referred to those who thought they had irritable bowel syndrome, had a bad stomach or were bloated, or whatever it might be, and suddenly found it was something much greater. Over 80% of women diagnosed following a GP referral will survive for a year or more. I think if an early diagnosis can be made, the figures speak for themselves. We must do more to raise awareness about the disease, something I will come on to later.
Before I continue, I would like to share a bit of welcome news for ovarian cancer patients in Northern Ireland. As colleagues may be aware, drugs approved by the National Institute for Health Care and Excellence for use through the cancer drugs fund in England are now being considered in line with the country’s existing endorsement of NICE recommendations and will be equally accessible in Northern Ireland. That has just been announced recently. In cases where a drug is yet to be fully approved by NICE, it can be made available for use under the CDF. I will mention one lady who is no longer with us, Una Crudden, who I got to know when she met us here, as someone who had had ovarian cancer. I think it was six years after her diagnosis. She was a remarkable lady and her story was a very real one: I remember it probably every day of my life.
CDF-approved drugs were previously unavailable in Northern Ireland, meaning that patients had to wait for their full approval by NICE, which can take up to two years. This change in Northern Ireland will help more people to survive, and for longer.
Whenever ladies go through this treatment, their aftercare and companionship with other people is important. Will my hon. Friend join me in congratulating a lady in my constituency, Mrs Maureen Clarke, who set up the Angels of Hope charity some years ago? It has been a tremendous help, psychologically and in every other way, for people who suffer from ovarian cancer.
I wholeheartedly support the tremendous work of the great many people in charities and elsewhere. Una Crudden was one of those who inspired everyone around her. We think of her often.
Without CDF approval, cancer patients in Northern Ireland have been unable to access life-extending drugs that have been approved for use in England, Wales and Scotland, such as niraparib. It is a PARP inhibitor, meaning that it blocks the action of the enzymes PARP1 and PARP2 that help to repair any damaged DNA in cancer cells while they divide to make new cells. Niraparib blocks PARP enzymes, which is incredibly important, and it is good news that we will have direct access to it in Northern Ireland. When researchers trialled niraparib on women with ovarian cancer, they discovered that the women lived for longer without the disease worsening and could go significantly increased times between treatments, meaning that they had more time between chemotherapy sessions.
Almost 200 women in Northern Ireland are diagnosed with ovarian cancer every year, and more than 50% lose their battle with it. It is particularly frustrating and upsetting for patients, and their families, who did not have access to the same potentially life-changing drugs as their English, Scottish and Welsh counterparts. However, that has changed in the last month; patients in Northern Ireland are finally set to have the same access to drugs as the rest of the United Kingdom. According to reports, the implementation of this policy will take place at some point in this financial year. We look forward to that. I am sure that colleagues will join me and my hon. Friend the Member for Upper Bann (David Simpson) in welcoming this fantastic news.
Access to drugs is one thing, but it is reactionary, rather than preventive. Evidence, including in the APPG’s report, suggest that much more needs to be done to raise awareness about ovarian cancer, which could affect the number of people diagnosed with the disease. Early diagnoses give longer life and prevent death. Although not limited to these, the four main symptoms are abdominal pain, bloating, feeling full quickly and needing to pass water. Most concerning is that only 20% of women could correctly identify those as being symptomatic of ovarian cancer, which goes back to a point made by the hon. Member for North East Derbyshire.
Ovarian cancer has low survival rates and, sometimes, delays in diagnosis, so we need a reinvigorated effort to ensure that the general public know what to look out for and when to see a doctor. The Be Clear on Cancer campaign was first introduced in 2011, and I take this opportunity to put on the record my thanks to Public Health England for launching it. It is an excellent campaign that has undoubtedly played a vital role in improving cancer awareness more generally among the general population, which is part of the strategy’s focus.
National campaigns have been successfully run for bowel, lung, breast, bladder and kidney cancers, but only regional and local pilot campaigns have been launched for ovarian cancer. Does the Minister intend to launch a pilot campaign for ovarian cancer? A regional campaign launched in 2014 included the use of television, radio, online and face-to-face events and led to a significant improvement in women’s awareness of the symptoms of ovarian cancer and a greater inclination to visit their GP to discuss and concerns that they might have.
Raising awareness—especially about potential symptoms —is obviously important and can only be a good thing, so I will be grateful if the Minister will indicate what discussions he has had with Public Health England about the possibility of running a national campaign for ovarian cancer that covers the four nations. We could work together to raise awareness at every level. I always think it is better to do things together. As you know, Mr Bone, we are better together in everything that we do, and I would like that to continue to be the case, especially for this.
Another way to improve awareness about ovarian cancer would be the introduction of a national screening programme. Screening programmes currently exist for breast and cervical cancer, but there is no equivalent for ovarian cancer. I understand that the UK collaborative trial of ovarian cancer screening looked at the possibility of an ovarian cancer screening programme, with a blood test to identify changes in the levels of the CA 125 protein, which is a tell-tale sign. If levels had risen, the patient would be sent for an ultrasound, so a system would be in place to offer early diagnosis, and it would be preventive as well. It is estimated that, if a national screening programme were rolled out, 12.5 million women over the age of 50 would be eligible to attend, with around 2% required to have a further ultrasound. Such a programme could take preventive help to the next stage.
I understand that, when women are contacted about making an appointment for a cervical or breast cancer screening, they are provided with informative leaflets that detail possible symptoms. Of course, although the screenings are vital, it is entirely up to the patient if they follow up and make an appointment. However, just having access to the leaflets is helpful in raising awareness. Does the Minister intend to produce a leaflet to raise awareness of ovarian cancer? Recognition of the symptoms of ovarian cancer remains low, so it would be helpful if women could be provided with a similar leaflet that might help to improve awareness of this specific disease.
I understand that the cost of national screening programmes is high, but it needs to be measured against the long-term benefits. If people can be screened and ovarian cancer caught early, people have a greater chance of survival, and their long-term reliance on the NHS could well be reduced. It is ultimately cost-effective, because it reduces the amount of care that they later need.
I understand that one concern with rolling out a screening programme of that nature is the lack of sonographers, who are of course required to provide ultrasounds. Are the staff with those skills in place? I am interested to hear what consideration has been given to the use of artificial intelligence to fill the gap of highly skilled diagnosticians. Would it be possible to provide some sort of incentive for those considering postgraduate UK ultrasound qualifications? We often say this, and I know that the Minister is responsive to it, but if we can set out the graduate positions that will be available in the future and encourage graduates to study towards those jobs, that would be helpful.
Prevention is vital. Approximately 15% of women with ovarian cancer develop it as a result of a mutation in the BRCA1 or BRCA2 gene. Identifying women with ovarian cancer with a BRCA mutation not only helps in designing their treatment plans, it also enables family members to be tested. We sometimes look at the individual, which is important, but we should also look at the family circle—sisters and daughters and so on—and test them as well, which would allow them to make decisions about reducing their risk of developing ovarian cancer.
“Achieving world-class cancer outcomes: a strategy for England 2015-2020” calls for all women with ovarian cancer to be offered access to genetic testing at the point of diagnosis. That follows 2013 NICE guidelines that require all women with a 10% or higher risk of carrying a BRCA mutation to be offered genetic testing. However, in reality, testing varies between regions and between hospitals, because the guidelines are often interpreted differently. This clearly needs to be addressed, as the same testing should be available for all, without variation depending on postcode or because of the funding—or lack thereof—available in different genetic testing centres across the country. Obviously if eligible family members were tested to identify potential mutations, they might be able to take steps, including surgery, to ensure that ovarian cancer cannot occur.
Concerns have been raised about what genetic testing could mean for individuals with private health or life insurance. Members may not have thought of this, and the hon. Member for North East Derbyshire did not mention it, but he and others will be aware of it. For example, does a person with private health or life insurance need to declare if a genetic test has been carried out, and its results? I am interested to hear from the Minister what work the Department is doing alongside the insurance industry to address any disparity for cancer patients and their families who undergo genetic testing, which may have an impact on their private health or life insurance.
We can all agree that, while improvements have been made in the last couple of decades, survival rates for ovarian cancer continue to lag behind other cancers. We need to do more to raise awareness of ovarian cancer, to ensure that women know what to look out for and when to see their doctor—particularly those in higher risk categories, either because of family history or because of their age.
I am very pleased about the recent news for cancer patients in Northern Ireland: as is currently the case with genetic testing, it is unfair for patients to access different treatments, tests or drugs simply because of their postcodes. I hope that the Minister will work with Public Health England and NICE to consider national campaigns, which take in all the regions, and screening programmes for ovarian cancer, as well as to ensure that guidelines are implemented and funding made available for testing.
I again thank the hon. Member for North East Derbyshire for the opportunity to speak on this subject. It is close to my heart; indeed, that can be said of all of us who are here and many who are not here because they are doing other things. Ovarian cancer is one of those diseases on which we need to give hope and support to the people affected. We all know people who are affected and we are here today to speak on their behalf.
I, too, congratulate my hon. Friend the Member for North East Derbyshire (Lee Rowley) on securing this important debate and on speaking so compassionately and movingly about his constituents and, indeed, his family.
Like other hon. Members present, I am sure, I was inundated with emails and correspondence from constituents urging me to take part in the debate, so I want to make a few remarks on their behalf. Of course, those emails come from the lucky ones—the women who, like Amanda Gilham from Makerstoun in my constituency, benefited from timely diagnosis and treatment. Amanda was totally unaware that she had ovarian cancer and was diagnosed only because she was fortunate enough to be given a blood test, as her GP suspected that something else entirely was wrong.
When talking about statistics, it is important to remember that the numbers on spreadsheets represent people—our constituents—and, in the case of ovarian cancer, grandmothers, mothers and sometimes daughters. Clearly, early diagnosis and treatment are crucial to tackling ovarian cancer, as they are to tackling all types of cancer. If ovarian cancer is found early, the five-year survival rate is 90%, compared with 4% if it is found late. Although survival rates have doubled in the past 40 years, survival rates in the United Kingdom are lower than the European average, and still not enough people are diagnosed early.
The NHS in Scotland is of course entirely devolved and therefore the responsibility of the Scottish National party Government. I want to spend a little time talking about the situation in Scotland and the circumstances that my constituents have to experience. Patients in Scotland are being let down. Much more needs to be done to improve diagnosis and treatment. This summer, for example, the Scottish Medicines Consortium approved the use of niraparib, but only for women without a gene mutation that affects about one fifth of women living with ovarian cancer. That restriction does not apply in England, meaning that women with a BRCA gene mutation in England and Wales have more treatment options than their counterparts north of the border, in Scotland. A postcode lottery for accessing life-enhancing drugs is unacceptable. I agree with Ovarian Cancer Action that women in Scotland deserve better.
Women in Scotland also deserve better in terms of the time that it takes to receive a diagnosis and treatment. Scotland’s cancer treatment waiting times are at their worst levels in six years. Only 87% of patients with ovarian cancer started treatment within 62 days of referral. In response, the Scottish Government have admitted that that is “simply not good enough”. Just last week, the Scottish Government announced that they were not planning on meeting their own diagnosis target until at least 2021. That was spun as a new “three-year plan” to meet waiting time targets—something that was supposed to be good news. Given that the SNP has been in charge of the NHS in Scotland for the past 10 years, the Scottish Government’s record, particularly on cancer treatment, deserves further scrutiny. I hope that some of the extra £2 billion a year that the Scottish Government will be receiving to spend on the NHS, thanks to yesterday’s Budget, can be put to good use to reduce those waiting times.
Ovarian cancer is not the most common type of cancer in the United Kingdom and is not easily diagnosed at the moment, but the impact of early diagnosis is significant. I again congratulate my hon. Friend the Member for North East Derbyshire on securing this important debate. I support the efforts across the United Kingdom to improve diagnosis and treatment of this terrible disease.
It is a pleasure to serve under your chairmanship, Mr Bone. I congratulate the hon. Member for North East Derbyshire (Lee Rowley) on securing the debate and on bravely speaking of his own experience and that of his mum, Linda. I am sorry to hear about the experience that his family have had in the past year and I wish Linda well.
I thank hon. Members on both sides of the Chamber for highlighting the issues faced by their constituents. They have talked about both the successes of the health service and the lessons that need to be learned for the future. Healthcare in Scotland is of course devolved to the Scottish Government, so I can only speak to that experience, but ovarian cancer is one of the most common types of cancer in women. It typically affects those who have been through the menopause, and more than 7,000 diagnoses are made each year across the UK. In Scotland, 350 women die of the disease each year. However, the survival rate for ovarian cancer is high compared with that for other types of cancer and, like other cancer survival rates, it increases with early detection.
One key issue with this disease is that awareness of the symptoms is still low among both GPs and the general population. As we have heard on both sides of the Chamber, more needs to be done to raise awareness of the early signs and to secure an early diagnosis. Most women with ovarian cancer are diagnosed when the disease has, unfortunately, reached an advanced stage.
In many regards, Scotland still leads the way on UK ovarian cancer diagnosis, but there is no denying that there is always more to do in this area. Scotland has improved its diagnostic pathway and the access to much-needed treatments. The SNP Government developed the Detect Cancer Early programme to improve survival rates through diagnosis and treatment at an earlier stage. Scotland has been able to tackle cancer through world-class scientific research. The Scottish Molecular Genetics Consortium uses DNA to detect a range of genetic disorders, including cancer. The Scottish Genomes Partnership is pioneering Scottish research in human genome discovery in four key research areas, of which cancer is one. That partnership involves the Universities of Edinburgh, Glasgow, Aberdeen and Dundee. However, although that research is saving lives, its funding is being slashed. The proportion of EU funds allocated to universities in the UK has already dropped and will continue to fall because of Brexit and the uncertainty about the future. Programmes such as those will collapse unless a post-Brexit Government are prepared to plug the funding gap.
In Scotland, the SNP wants to improve cancer care and treatment, which is one reason why the Scottish Government are investing £100 million in their new cancer strategy. In addition to the SNP Government’s work on prevention and early detection, the strategy includes enhanced radiotherapy services through new technology, and recruitment drives to reduce waiting times and improve patient outcomes. The Scottish Government have outlined actions for end-of-life care needs through the “Strategic Framework for Action on Palliative and End of Life Care”, which encourages a culture of openness and dignity around dying and death.
In June, I was contacted by a constituent from Hamilton, Mr Gerard Murphy, who sadly lost his wife, Elizabeth, last year after a battle against late-diagnosed ovarian cancer. Mr Murphy expressed a lot of the sentiments articulated during this debate, calling for publicly funded awareness campaigns so that women and GPs know the symptoms to look out for, faster diagnosis so that women can start treatment earlier and have a greater chance of survival, and treatment in specialist centres such as the Beatson West of Scotland cancer centre, where Elizabeth was treated, in his words, “wonderfully well”. I am sure that Mr Murphy would welcome any advances for other families experiencing this disease.
We have heard calls from both sides of the Chamber for greater knowledge and awareness of the signs and greater investment in early diagnosis. This is something that we would like to tackle across the House. I hope that the Minister will pay heed to the comments that have been made.
As we know, the four key symptoms of ovarian cancer are a bloated tummy, needing to urinate more often or urgently, experiencing tummy pain and always feeling full. Anyone newly experiencing those symptoms 12 times a month or more is advised to see their GP. However, awareness of these symptoms is worryingly low. According to Target Ovarian Cancer, just 20% of women can name bloating as a symptom and only 3% can name feeling full or loss of appetite. Awareness campaigns run by Public Health England have been shown to be highly effective. The one currently running focuses on blood in urine. Considering that we know how important it is that those with ovarian cancer are diagnosed quickly, it would be helpful to know whether Public Health England has any plans to run a Be Clear on Cancer campaign that focuses on either ovarian cancer or a cluster of symptoms for a range of cancers, including ovarian.
It is a pleasure to see you in the Chair, Mr Bone. I, too, congratulate my hon. Friend the Member for North East Derbyshire (Lee Rowley) on securing the debate. As vice chair of the all-party parliamentary group on ovarian cancer, the subject means a great deal to him. We also heard more about why it means a lot to him. I place on record my thanks to the all-party group and to the excellent ovarian charities. Target Ovarian Cancer is the biggest, but others work tirelessly in that space, such as Ovacome.
Watching my hon. Friend the Member for North East Derbyshire brought back memories of sitting in that exact chair as one of the vice chairs of the all-party parliamentary group on ovarian cancer almost exactly seven years ago, in October 2011. I was talking about ovarian cancer, which has also had an impact on my family, although sadly not with the outcome that my hon. Friend currently has. I described it as a “silent national scandal”, which was then trending—quite something in 2011. I was also present for the 2014 debate that he remembers, which was the last time the subject was specifically debated in the House. It was a pleasure to hear him today; he reminded me of me—but I put on record the warning that this is where I have ended up.
I was pleased to meet with the hon. Member for Washington and Sunderland West (Mrs Hodgson) and Target Ovarian Cancer a couple of weeks ago to discuss the all-party group’s report, as the hon. Lady said. As she knows, I take the all-party groups very seriously. I have the report here—this is my coffee table copy in the Department of Health and Social Care, and anybody who knows my office knows that what is on the coffee table is what counts. It is an excellent report with many important recommendations and I will return to it a lot in my remarks. I have already committed to responding fully to it and the hon. Lady knows that I will do that.
I am responding to my third cancer debate in the House in less than two weeks, which demonstrates that improving cancer diagnosis and treatment is a priority for right hon. and hon. Members, as it is for me as the Minister with responsibility for cancer, the Government, the Prime Minister and the Opposition. In this job, I am fortunate to see first hand the superb work being done by our NHS staff and by our many partners and charities across the cancer community in implementing the 96 recommendations in the cancer strategy for England.
We are three years into that work and cancer survival rates have never been higher, as has been said. About 7,000 people are alive today who would not have been had mortality rates stayed the same as before Cancer Research UK and Harpal, who led the work, published the strategy. As I make clear every time I respond to a cancer debate, however, I know that we must do more and that people want us to do more, because we still lose 12,000 women a year to breast cancer and far too many women to ovarian cancer. We must do better. Despite the huge strides that I have mentioned, and the best-ever survival rates, ovarian cancer survival rates in the UK are among the lowest in Europe with fewer than half of all women diagnosed surviving five years or more, so there is much that we need to do.
The Minister has mentioned the success rates in dealing with cases of ovarian cancer in our country compared with some of our European partners. Can he set out what we can learn from them in terms of improving outcomes for women in this country?
I will certainly cover that. Put bluntly, as I will come on to in a second, and as almost all hon. Members have mentioned, it is about early detection. That has an impact because, as the former chair of the all-party parliamentary group on cancer, my hon. Friend the Member for Basildon and Billericay (Mr Baron), has said many times, early diagnosis is cancer’s “magic key”. We have that magic key in some cancers in this country. We do very well in breast cancer, where the early-stage survival rates are well over the 75% target that the Prime Minister set out at the party conference earlier this month, but it is true that we do not yet have the magic key in enough cancers. I will come on to what we need to do.
I was pleased when the Prime Minister announced the ambitious package of measures for cancer care and treatment earlier this month, which will be at the heart of our long-term plan for the NHS. It will be backed up by the new funding that was announced in the summer and confirmed in yesterday’s Budget. We will overhaul screening programmes, provide new investment in state-of-the-art technology to boost our research and innovation capability and, critically, transform how we diagnose cancers earlier. As I have said, our ambition is to diagnose 75% of all cancers at an early stage, which will result in an estimated 55,000 more people surviving cancer for five years in England each year from 2028.
All hon. Members have mentioned early diagnosis, and many have mentioned some stats—or the same stats. The important one for me is that a quarter of women with ovarian cancer are diagnosed through an emergency presentation. When I first became an MP, I remember going to meetings with the all-party parliamentary group on ovarian cancer and the all-party parliamentary group on cancer, where I was shown the stats for my constituency of the number of people who presented in the emergency department with cancer. It really frightened and shocked me—it still does—and along with my personal history, it was one of the reasons why I wanted to get involved in health and cancer when I joined the House.
Of that quarter of women with ovarian cancer who are diagnosed through an emergency presentation, just 45% survive for a year or more. That is no surprise—if someone is diagnosed in an emergency department, they have exhibited more outward symptoms, so they are at a later stage and their survival rate is lower. The survival rate is more than 80% when women are diagnosed following a GP referral, so it is crystal clear where improvements are urgently required. That is why early diagnosis is a key strategic priority in the cancer strategy. As has been said, it allows for more options for treatment and, crucially, the earlier a cancer is diagnosed, the more likely it is that doctors will be able to provide successful treatment or operate on the “bunch of grapes”—that is a good analogy, which I have heard before.
My hon. Friend the Member for North East Derbyshire talked about the multidisciplinary diagnostic centres. NHS England and the Department are testing new innovative ways of diagnosing cancer earlier. As regular attendees of cancer debates will know, I never tire of praising the accelerate, co-ordinate, evaluate—ACE—centres, which are the multidisciplinary diagnostic centres for patients with vague or non-specific symptoms. As the hon. Member for Washington and Sunderland West said, they are being piloted across 10 sites in the country. They offer patients a range of tests on the same day—a point that has been made by several hon. Members—with rapid access to results.
The centres are magnificent. I visited the ACE centre at the Churchill Hospital in Oxford earlier this year. I met the practitioners who work there, the commissioning group and the GPs who are involved in it. GPs are tremendously, and rightly, excited about the centres. They will make a huge step-change improvement in early diagnosis, particularly for cancers such as ovarian cancer, where symptoms can be vague and can appear less serious at first. The plan is for that innovation to address the delay that the hon. Member for Washington and Sunderland West and other hon. Members spoke about, so instead of a GP having to refer for one test and wait for the results, then refer for the next test and wait for an appointment, the ACE centres will allow for a snappy, quicker turnaround. They could be a game-changer and could unearth the magic key when it comes to ovarian cancer.
The APPG’s report says that we should roll out ACE centres nationwide, so I am delighted, as I know the hon. Member for Washington and Sunderland West is, that the Prime Minister recently committed to doing just that, as part of our long-term plan. I do not get excited easily, Mr Bone, as you well know, but I am excited about the ACE centres and they are potentially transformative.
I turn now to early diagnosis in primary care. Other support measures are necessary to ensure that more cancers are caught in primary care. The NICE guidelines for suspected cancer referral recommend safety netting for those people who are at higher risk of cancer but who do not meet the referral criteria. Both Cancer Research UK and Macmillan have produced additional advice and support for GPs to implement those guidelines, including the safety netting that I have just mentioned, over the last few years.
I was blown away to meet Macmillan GPs at Britain Against Cancer earlier this year. They are an excellent innovation and have an awful lot to give, but they are small in number. I am very interested in them and I talk to Macmillan about the potential use of Macmillan GPs in helping to transfer specialist knowledge of cancer to wider general practitioners. I always say of GPs that they are not dissimilar to MPs when we hold our surgeries, in that almost everyone who comes to our surgeries is more of an expert on the subject that they have come about than we are, because we are general practitioners. So GPs get a hard rap, but they are general practitioners and that is the area of the profession that they have chosen to go into.
That is why we need to support GPs better through diagnosing cancer, from our targeted lung cancer screening in the lorries in car parks in the north-west—we trialled that approach in Manchester and it has been very successful—to the ACE centres that I have mentioned. That is all aimed at supporting the NHS, especially GPs, to identify cancer earlier.
The shadow Minister asked about the review of the referral pathway. As she knows, the implementation of the faster diagnosis standard requires trusts to review and speed up diagnosis pathways for suspected cancers. NHS England and NHS Improvement are working closely together to emphasise the key principles for improvement that we need in this area, which include ensuring that the most value is derived from each appointment. The standard is being measured for a year from April 2019 to April 2020, when it comes into place. It will ensure that patients are told that they have a cancer diagnosis or an all-clear within a maximum of 28 days of being urgently referred by their GP for suspected cancer. As I always say, 28 days is not a target; it is a maximum. When someone has a cancer worry, 28 minutes can seem like a lifetime, and such things always seem to come on a Friday night, when the weekend lies ahead. Twenty-eight days is our new target, but it is certainly not what we aim for; we aim to do better than that.
We heard from several Members—including the hon. Member for Strangford (Jim Shannon) and the shadow Minister—about Be Clear on Cancer. That campaign is one of the great successes of public policy in recent years. The APPG’s report also recommends, as the hon. Lady said, running a Be Clear on Cancer campaign to raise awareness of ovarian cancer symptoms. However, she is experienced and smart enough in this area to know that Be Clear on Cancer cannot focus specifically on a cancer type, such as breast cancer; it is about clusters. That is where we have found it to be most successful.
Public Health England, for which I have ministerial responsibility, takes a number of factors into account when deciding which campaigns to develop; of course, there is healthy competition in this space and unfortunately there is always more demand than supply. One of the main criteria in deciding which campaigns to run with is the scope to save lives through early diagnosis; that measure is what I will judge that work against.
PHE is currently undertaking new data analysis and research to determine Be Clear on Cancer campaigns for next year, which is 2019-20. At this time, no decisions have been made, and I will take the bid from today’s debate very strongly. The outcomes from the regional pilot—and a pilot that focused on a range of abdominal symptoms such as diarrhoea, bloating and discomfort, which can be indicative of a number of cancers, including ovarian cancer—will of course be taken strongly into consideration, and that is where I think we will head with this work.
However, let me clear that PHE and NHS England have had a very clear steer from me that I want to run the campaign on lower abdominal symptoms as soon as practicably possible. We have to make sure that the operational capability is in place across the NHS, because the worst thing that we could do would be to create a demand without being able to meet it. That is a rather boring, practical reality, but it is a reality. I reiterated this point to the APPG recently when we met and I will of course keep Members updated; I know they follow these matters very closely.
The hon. Member for Strangford also asked about genetic testing and its role in identifying the increased risk of ovarian cancer. One area where England is very much at the cutting edge of cancer diagnosis is in the creation of the new national genomic testing network, which will be delivered through seven new genomic laboratory hubs, as we call them. They will give patients access to state-of-the-art tests that can diagnose their disease or help to inform their treatment. So the genomic lab hubs will do three things: provide consistent and equitable access to genomic tests, which is very important, as it will ensure there is a level playing field; operate to common national standards, specifications and protocols; and deliver the single national genomic testing directory, which will cover the use of all the genomic technology, from the single gene to the whole-genome sequencing for cancer and for rare and inherited disease.
The labs are currently in a period of transition, to embed fully the new infrastructure and the new national genomic test directory. I hope that this transition will ensure the safe roll-out of the service without disrupting current clinical care. Patients will continue to receive the testing they need to inform their clinical care, and the new national test directory will also include the BRCA testing for women with ovarian cancer in line with NICE guidance, which the hon. Gentleman rightly mentioned.
While I am talking about the hon. Member for Strangford, or “the hon. Member for Westminster Hall” as I like to call him, I note that he also touched on screening programmes, as did the Opposition spokesperson and my hon. Friend the Member for North East Derbyshire. The UK National Screening Committee is awaiting the updated results of the UK trial of ovarian screening, which is the UK collaborative trial of ovarian cancer screening, as it is known. The secretariat is in contact with the researchers and the committee will review the findings as soon as they are published.
The hon. Member for Strangford was absolutely right to talk about the workforce. On page eight of its report, the APPG outlines the importance of sonographers. There will be increased emphasis on diagnosing cancers earlier, but we will not be able to find the magic key without those people who do the searching, who are our NHS workforce. So we must ensure that we have the right workforce in the right place to deliver that frontline care and meet the Prime Minister’s ambition.
Last December, Health Education England published its first ever cancer workforce plan, committing to the expansion of capacity and skills. HEE will follow that plan up with a longer term strategy that will be aligned with the NHS long-term plan, which seems sensible to me, and that will look at workforce needs beyond 2021. We have to look at a very long landscape when it comes to the NHS workforce. I will not pre-empt that plan, but I can assure hon. Members that it will set out how we will ensure that a sustainable cancer workforce is in place to deliver on the ambitions that we have set out.
My hon. Friend the Member for North East Derbyshire talked about the cancer dashboard. The APPG report, which of course he was involved in drafting, also recommends including ovarian cancer data within the dashboard. The dashboard was first published in May 2016 as a tool to help the cancer alliances, the commissioners and the providers in the acute trusts to quickly and easily identify the priority areas for improvement, and to enable easy tracking of progress towards our national ambitions.
PHE is working with NHS England’s cancer programme team on the next phase of the dashboard development, and that will be informed by the needs of the key stakeholders and the cancer charities, with whom I hold a regular roundtable; some of those charities’ staff are here in the Gallery today. It is no secret that hon. Members know that I am frustrated about the cancer dashboard. I am impatient about most things, as my private officer will sadly attest, and I am incredibly impatient about the dashboard being limited to the top four cancers. I want to see it expanded and I intend to see it expanded: NHSE and PHE have a very clear direction from me that I will be watching their work and I expect to see it producing what I and other Members in this House want.
The hon. Member for Washington and Sunderland West spoke about surgery and the mixed picture around the country. I do not want to short-change her by not giving her the detailed answer I want to provide to her good point, so I will look into it and write to her and the other Members who have been in the debate today. We obviously must diagnose early, as that gives us better and less radical treatment options, but for some surgery is a sad reality. We must ensure that the NHS is good at not only sharing best practice but implementing it, and that is as true in surgery as anywhere else.
I pay tribute to the hard work and professionalism of our dedicated cancer workforce, and to the Members who care so passionately about the subject and have brought it to the House today. Ultimately, it is our workforce that will determine the success of the cancer strategy and the long-term plan for the NHS. We can only set the direction and the ambition and ensure that the resources are in place, and I believe that I am doing that, as Minister for cancer.
I am excited by the huge potential for the next 10 years of cancer diagnosis, treatment and support. We have fully established the 19 cancer alliances. We have backed them with the funding they need to transform services, and will go on doing that, to ensure that the NHS long-term plan can be delivered on the ground through the alliances, with cancer at its heart. The plan can turbo-charge all that we have achieved through the cancer strategy. I have said before, and I will say again, that I want the alliances to be much more open and accountable and much more approachable, especially by Members of Parliament in England, who should be able to call them to account much more than they do. I suspect that many Members here have the chief executive of their local trust on speed dial; I hazard a guess that they do not have the leader of their cancer alliance there also, and that should change.
It was interesting to get the Scottish perspective from my hon. Friend the Member for Berwickshire, Roxburgh and Selkirk (John Lamont). We would like to see the ambition in England matched across the whole United Kingdom and we absolutely stand ready, as always, to work with Scottish Members and the Scottish Government. If there is anything we can do to help share that ambition, we will do it.
NHS England, Public Health England and I, with the tireless support of our cancer community—team cancer as I always call it—are committed to making a reality the ambitions that the Prime Minister has set out. That will ensure, as I said in this place not two weeks ago, that we continue to make huge leaps forward over the next 10 years to a future where cancer has no future.
I thank all right hon. and hon. Members who have contributed to this exemplary debate. It has been one of those debates that we all aspire to have, in which we talk about the detail and leave out a lot of the politics, and in which there is unity regarding wanting the same outcome: we all want to be able to treat the disease more quickly, with better outcomes and fewer people experiencing it. I am grateful to everyone for entering into the discussion in that spirit.
I thank the hon. Member for Strangford (Jim Shannon) for attending this morning, for highlighting the importance of the issue to him, and for mentioning all the work being done in Northern Ireland—particularly for raising the point about genome testing. I thank my hon. Friend the Member for Berwickshire, Roxburgh and Selkirk (John Lamont) for sharing his experience north of the border. He, like so many others, provided some of the most important elements of the debate—examples of constituents’ own experiences. I also thank the Front-Bench spokespeople: the hon. Member for Lanark and Hamilton East (Angela Crawley) for also sharing her experience north of the border; and my colleague on the all-party parliamentary group, the hon. Member for Washington and Sunderland West (Mrs Hodgson), who spent so much time highlighting the group’s great work. It has been a privilege to be part of that work over the past few months; the report is a great piece of work and I hope to see improvements coming out of it.
I also thank the Minister. I am a relatively new Member, but I can often tell in debates when Ministers are going through the motions and when they actually care, and today I have heard a speech that demonstrates a genuine interest. It was great to hear about the Minister’s personal connection and about how he cares about the issue, and it was interesting to hear some of the things he highlighted. “Lots to come” is the summary I think it is fair to say we can take from the speech, with regards to the ACE centres, the potential for more public health campaigns, the genome point and the screening. I was particularly glad to hear about the dashboard, which I hope, in time, will give us an opportunity to push forward and demonstrate greater transparency.
Although they are not all still in their place, I thank my hon. Friends the Members for Grantham and Stamford (Nick Boles) and for Nuneaton (Mr Jones), my right hon. Friend the Member for Chipping Barnet (Theresa Villiers), and the hon. Members for Blaydon (Liz Twist), for Torfaen (Nick Thomas-Symonds) and for Upper Bann (David Simpson). I am incredibly grateful for their contributions. I also thank everyone in the Public Gallery, who has listened and provided support. I am aware that there are Members in the room to whom the matter means much but who, by convention, are not able to speak: my hon. Friend the Members for Erewash (Maggie Throup) and you, Mr Bone. You are undertaking a different role today, as Chair, but you were so kind in supporting me when we applied to the Backbench Business Committee for the debate. I am grateful to you and my hon. Friend for your silent but heartfelt support.
This is an important area. It has affected me personally, but it is not about the personal effects; it is about ensuring that we make progress as a country in sorting out the disease and resolving the issues, reducing the number of people out there who get a diagnosis. The debate has shown that a lot has been achieved, that a lot can be done, and that there is a lot of progress we can make, and I look forward to seeing that progress in the coming years.
I thank all Members for the excellent debate.