Steve Brine: “Would I like to see more money come to the NHS? Yes, you’re not going to find a health minister that argues for less”
Steve Brine is ‘obsessed’ with ensuring cancers are diagnosed earlier to help improve survival rates in England. But with recent figures highlighting the scale of the task, can the minister turn things around? He talks to Sebastian Whale
Steve Brine’s voice is hoarse after watching his son’s team storm to an emphatic 12-2 victory in the final of an under 7s football competition. He denies being rowdy on the touchline, but even if he was he was unlikely to face punishment. Brine was the appointed ‘respect’ steward responsible for keeping overzealous parents in check. “I’m not going to tell myself off, am I?” he jokes.
Fortunately for Brine, being a minister in the Department of Health means there’s no shortage of good advice on how to get his voice back up to scratch. Another perk is the panoramic view of London’s skyline from his seventh-floor office. The modern décor is interrupted by a stick figure drawing of his family given to him by one of his two children for his 44th birthday. He insists it was not drawn by one of his fellow ministers.
Brine is a relatively new fixture in the department, after being appointed Parliamentary Under Secretary of State for Public Health and Primary Care in June 2017, but he’s no outsider. Brine, who entered Parliament as MP for Winchester in 2010, served as Jeremy Hunt’s PPS in 2015.
“I knew the department, I knew the people here, I’m passionate about the cancer stuff… and so to get to come and do the job that you’ve wanted to do on the subject that you care most about, it’s perfect,” he says.
Brine, a former BBC radio journalist, cuts a relaxed figure in the interview format. After his broadcast career, which saw a year spent in Chicago with WGN Radio, he worked as a consultant before joining Conservative Central Office in the early 2000s. His wife, Susie, is a speech therapist, while members of his family are doctors.
Often referred to as the minister for cancer, Brine speaks with compelling enthusiasm in his pursuit to improve survival rates in the UK. He also refers intermittently to his own experiences of losing loved ones to cancer, though in such a manner that it doesn’t seem appropriate to pry for more information.
Top of Brine’s priority list for improving survival rates is the new target to diagnose cancer within 28 days, which will be rolled out across the NHS in April. In 2016, NHS England made £200m available to cancer alliances to invest in speeding up diagnosis.
“Early diagnosis is not critical in brain cancer because you can be diagnosed and sadly lose your battle in a space of weeks. But with breast cancer, it is critical, because primary breast cancer is treatable and curable. Secondary breast cancer – as I know to my cost – is not,” he says, pausing briefly.
“Let’s just say that 28-days is not a target. It’s an upper end. If we can do it quicker we jolly well should, because if you’ve got a suspect lump you need to know and you want to know very, very quickly and then you want to start treatment. Diagnosis is the big show in town, that’s why we’re investing so heavily in that.”
He hurries over to his desk to collect a Christmas card from breast cancer charity, Coppafeel!, founded in 2009 by Kristin Hallenga, who was diagnosed with incurable breast cancer at the age of 23. “Merry Titmas” screams from the front of the card. Hallenga visits schools across the country to encourage kids to check their breasts and testicles. Brine recently went along for one of these talks.
“It’s really powerful, because the kids are all too cool for school and then she tells them that she’s dying and she tells them why it matters. So, Coppafeel is a brilliant charity, working in that education space around touch, look, feel, check your breasts, get yourself checked out. Early diagnosis is the thing I obsess about,” he says.
“The 28-day standard, the new cancer diagnosis standard, is the thing that I’m absolutely focussed we’re going to meet. Until we move that we won’t move the dial a bit further.”
Hallenga’s story reminds me of Theresa May’s call at a recent Prime Minister’s Questions for young women to get a smear test. Does Brine agree that public figures speaking openly in this way can help raise awareness? “Definitely. People seem to love it when politicians talk about what’s impacted them personally. I don’t know why. Maybe they believe that we don’t have normal lives outside of here, but we do,” he says.
Brine’s fervour will be needed as the scale of the task was thrown into sharp relief not long after we meet. A study published in The Lancet medical journal showed how despite improvements over the past 15 years Britain still lags behind on cancer survival rates. The UK sits 17th in Europe for bowel cancer survival, and 30th in the world.
Once the early diagnosis target is reached, Brine would like the focus to shift to research and genomics, and treatment and radiotherapy. “We want the NHS to be world leading in genomics medicines so that we can have personalised cancer medicines that are more effective than ever,” he says. “Once we’ve done early diagnosis, research and genomics and treatment and radiotherapy, then I hope we can then really start to move the dial. The ambition in the cancer strategy is to save a further 30,000 lives by 2020.”
Our chat comes days after Tessa Jowell was given a standing ovation in the House of Lords for a moving speech on her battle with a high-grade brain tumour. The former Cabinet minister urged peers to back an international project called the Eliminate Cancer Initiative to share resources, research and new treatments for cancer. Brine has discussed her speech with the Health Secretary, who watched her address in the Upper Chamber, and says ministers are exploring the points raised by the Labour peer.
One takeaway Brine took from Jowell’s address was the importance of cancer alliances, which bring together local senior clinical and managerial leaders representing the whole cancer patient pathway across a specific geography.
“If you have breast cancer and you go to the Royal Marsden in London, you are going to get some of the best treatment in the world from some of the best consultants and surgeons anywhere in the world. But, can I with my hand on my heart say you’re going to get exactly that same treatment in every cancer alliance in every part of the country? I don’t think I can at the moment and I want to know why,” he says.
“It’s not about the NHS sharing best practice – it’s very good at sharing best practice – it’s about the NHS implementing best practice.”
Brexit throws in an added complication, however, with campaigners expressing concern about the transfer of radioactive isotopes to treat cancers after the UK leaves the European Union. How can Brine assuage those who are concerned about access to cancer treatments? “I would say the UK has already got a world class UK life sciences sector. This is all part of the negotiation in part two. We’ve offered reciprocity with our partners in Europe. It is very much in their interest to continue to work with the world class scientists and medics that we have in this country and it’s very much in our interests to work with them. As you know, I was not a Brexiteer but we voted for it and we will make it work and there is absolutely no reason why we can’t,” he says.
There is an obvious link to cancer with other aspects of Brine’s brief. As the minister responsible for public health, he has overseen the publication of the Tobacco Control Plan, which pledges to reduce smoking among adults in England from 15.5% to 12% or less by 2022. In January Brine announced an investigation into prescription drug addiction in the UK. The review will cover sedatives and anti-anxiety drugs, painkillers and antidepressants amid concerns patients experience difficulties when they try to stop talking them.
Brine is also responsible for overseeing the rollout of the government’s Childhood Obesity plan, which in recent days has faced renewed criticism. The Royal College of Paediatricians and Child Health branded measures in the plan “piecemeal” and called for the government to rethink its decision not to ban pre-watershed junk food advertising.
Isn’t more action needed? Brine insists that the obesity strategy does include a combination of intervention and education, but suggests the government has not ruled out looking again at stronger measures.
“The child obesity problem we’ve got in our country is a super tanker. And turning super tankers round takes a long time. I think there is a very ambitious plan with some ambitious targets in it. In terms of stuff around the future of advertising, you bet, we keep it under constant review… We absolutely reserve the right to go further if we want to and if we need to,” Brine says.
“Being overweight is one of the risk factors to developing cancer,” he adds. “It used to be that it would be the poor children who would be skinny and scrawny and the rich children who would be big. That’s completely changed around. And it tends to be children from the poorest backgrounds and the most deprived backgrounds who are having the most challenging start in life, who tend to be most impacted by poor diet, poor exercise and then as a result have a challenge with their weight and that impact on their health outcomes long term.
“That’s something that we’ve got to do. When the Prime Minister talked about her burning injustices on the steps of Number 10, that’s one of the burning injustices that I think she meant; how we challenge child obesity.”
Is part of the problem that such interventionism is anathema to Conservative ideology?
“If you were talking to the Conservative public health minister 20 years ago, yes. The Conservative party has changed. I think there will be more of a challenge within the parliamentary Conservative party if we don’t get on top of this issue,” he says.
“This is a publicly funded health service. Not only do we have a right, I think we have a responsibility to take seriously these public health challenges. And there are many, but there are few greater than childhood obesity and its impact on people’s live chances and health outcomes.”
“However much more we put into the health service, if we don’t deal with some of these long term recurring public health challenges, all that’s doing is creating the clients and creating the patients of the future. So, I think it’s about both, it’s about investing year on year increases in the health service, which we’ve done since we came into office, but it’s also about dealing with the public health challenges that are creating more and more workload on the health service.”
As Brine notes, it’s difficult to avoid discussing the health service without touching on both Brexit and funding. Would Brine, who voted in favour of Remain, like to see an injection of money after the UK leaves the EU?
“I don’t think anybody should be surprised that a Conservative MP let alone a Conservative Cabinet minister in Jeremy Hunt or Boris Johnson or a minister like me would be arguing for more money for the NHS. Because bluntly, it’s what we’ve done every year, year-on-year since we came to office.
“So, would I like to see more money come to the NHS? Yes, you’re not going to find a health minister that argues for less money to come to the NHS.”
Would he like to see the £350m a week floated by the Vote Leave campaign? Brine rallies himself.
“The NHS has got a five-year forward view, which we’re coming towards the end of. Jeremy [Hunt’s] been very clear that we need a much longer plan going forward once we renew that. I’m totally with him on that. We probably need a 10-plus-year plan. And we probably need a new 10-year plus cancer plan,” he explains.
“Now, once we’ve done that, then we know what our ambitions are, then we know what we’re asking for. As the Chancellor has made rightly clear, he gave the NHS an extra £6bn in the Budget just before Christmas, and at the next spending round he’ll work out how much he’s going to give us. I would be very surprised and disappointed if it was less.”