§ Mr. Frank Dobson (Holborn and St. Pancras)
(by private notice) asked the Secretary of State for Social Services if he will make a statement on the current state of the cervical cancer screening programme.
§ The Minister for Health (Mr. Barney Hayhoe)
The Government's plans for further improvements to health authority arrangements for cervical cancer screening were announced by my right hon. and learned Friend the then Minister of Health on 29 April 1985. As I told the hon. Member for Holborn and St. Pancras (Mr. Dobson), health authorities are being asked to give priority to improving their cervical cancer screening programme. I expect arrangements to be made with family practitioner committees to implement computerised call and recall systems with the necessary laboratory service to meet the related demand and to avoid backlog. We are consulting the medical profession on better follow-up arrangements. Those measures should help to increase the number of women at risk who are screened, to provide for the processing of cervical smears taken from them and the necessary follow up.
The number of deaths from cervical cancer has fallen by about 13 per cent. during the past decade. Provisional 1984 figures suggest a further 3 per cent. fall. More can be achieved and to do that we need more women, especially those who have never been screened, to join the programme. The most effective way to achieve that is by personal invitations from women's general practitioners. Computerised systems will aid the identification of the women who are due for screening. That is the right way forward.
§ Mr. Dobson
Does the Minister expect anyone to be satisfied with that statement? Does he recall that on 18 March the right hon. and learned Member for Rushcliffe (Mr. Clarke), the former Minister for Health, told the House that the Government were soon to issue a questionnaire asking all health authorities for full details of local screening services. Yesterday, nine months and 1,500 deaths later, the Minister could not tell me when the survey was sent out, when the replies were received or whether it would be published. I ask him those questions again today.
Perhaps I should ask whether the questionnaire has been sent out at all. In the statement on 29 April to which the Minister has referred, the right hon. and learned Member for Rushcliffe told the House that the Government intended to improve the effectiveness of laboratory facilities for processing cervical smears and would be discussing with health authorities how best to achieve that.
On 9 December, the Minister said that he could not list the authorities which had asked clinics or doctors to suspend taking smears because of backlogs in laboratories. On 11 December he said that he did not know the average time taken to process a smear through a laboratory. Also on 11 December, rather astonishingly, the Minister told me that he would not expect health authorities to express concern to him about delays in processing cervical smears. I wondered what had happened to the discussions announced with much publicity in April. Yesterday, the Minister told me that no specific discussions on that issue are now proposed.
570 The statements made in March and April were intended to convince people, in particular women, that something was being done to improve on the earlier shambles. Last night's "Newsnight Special" and the recent parliamentary answers show that nothing much is happening. So in addition to the specific questions that I have already asked I now demand the answer to the fundamental question: when will the Government commit themselves to finding the resources to introduce and operate computerised call and recall schemes to cover every woman at risk in Britain as recommended to them by their expert advisers in 1981? Nothing less than that will satisfy the women of Britain.
§ Mr. Hayhoe
As I have explained, district health authorities are being asked to give priority to those programmes. More computerised call and recall systems are coming on stream the whole time. At the moment, 50 per cent. of the family practitioner committees have the computer capability to operate the call and recall system. As I have said, district health authorities are under instruction from the centre to give priority to that work.
I made it clear yesterday that the questionnaire to which the hon. Gentleman referred was a checklist which was intended to enable health authorities to review their cervical screening programmes and that was issued on 29 April. We asked to have results back by 14 June. As I explained to the hon. Gentleman, the results and answers have come back and the information that was received was not designed for summary and publication but to help the centre in its work in that area.
The health authorities are being asked to give, and are giving, priority to providing the appropriate back-up so as to remove the backlog that regrettably exists in some areas and also to improve facilities for the future.
§ Mr. Robert McCrindle (Brentwood and Ongar)
Is it not a fact that the only effective method of tracing women in high risk categories is through the computerised systems operated by district health authorities? If that is so, does my right hon. Friend not share with me some concern that the rate of progress between one district health authority and another shows a considerable variation? Does he have any plans to intervene to try to expedite the progress among those health authorities who seem to have slipped far behind in their programme? Is he satisfied that the financing of the computerised systems and the financial division between his Department and district health authorities is satisfactory and leads most efficiently to the operation of the system to which I suspect most hon. Members would wish to subscribe?
§ Mr. Hayhoe
On the matter of finance, my hon. Friend will know that the health authorities have, on average, 6.7 per cent. more cash plus the resources made available by cost improvement programmes. That is £650 million extra cash, plus a considerable sum, certainly exceeding £150 million a year, of cost improvement. Out of those extra resources cervical cancer screening is one of the priority claims.
I share the concern expressed by my hon. Friend about the difference in the provision of service for one part of the country and another. I assure him that is one of the matters dealt with in the reviews that my colleagues and I carry out. On the matter of health authorities, I believe that we shall be making considerable progress in implementing the call and recall system which, I agree with my hon. Friend, is the best way to deal with the 571 problem. Regular screening every five years is highly desirable. Personal invitation from the women's general practitioner is much more likely to be effective than a national advertising campaign, which I know is advocated in other areas.
§ Mrs. Renée Short (Wolverhampton, North-East)
I am sure that the Minister will appreciate that, if the necessary cervical cancer screening programme is intensified, it will inevitably produce more patients who need treatment by radiology, radiotherapy or surgery. How does the Minister expect those additional patients to be treated when hospital resources are being reduced all over the country and most of the London teaching hospitals, which are in the front line of research in this area, are having to close their beds? Will he look at that issue and find out what resources the London teaching hospitals need?
§ Mr. Hayhoe
I accept the hon. Lady's comment about the increase of patients coming forward for treatment if the coverage of the screening programme becomes more widespread and effective. I hope that it will lead to more patients coming forward for early treatment which requires fewer resources than if the condition is not found early enough by the screening programme that we are now trying to encourage women to use more extensively.
I repudiate the hon. Lady's suggestion that resources are being cut. Under this Government, the resources made available for the Health Service have increased in real terms by 20 per cent. There is no way in which that can be described as a cut.
§ Mr. Peter Viggers (Gosport)
Does my right hon. Friend agree that, contrary to the statement made by the hon. Lady, the pressure on the National Health Service is not caused by cuts in Government programmes but by the advances in medical science that make so much more possible for the population? Within that growing demand, does he recognise the need in the allied field of screening for breast cancer in women where there is an increasing awareness of the risk that women run and a need for the availability of screening that can save so many lives?
§ Mr. Hayhoe
I agree with my hon. Friend's remark about the pressures on the Health Service. As we all know, the demand for health care is practically unlimited, yet the resources that can be made available to it must, of their nature, be limited. We are seeking to have an increase in 572 real terms in resources going to the Health Service and an increasing cost improvement programme so that more resources are available for patient care. The statistics show that that is being fulfilled as we compare one year with another. I agree with my hon. Friend about the need for screening and preventive action across the whole spectrum of medicine.
§ Mr. David Alton (Liverpool, Mossley Hill)
In view of what the Minister has said about resources, will he tell the House how much it costs per person to carry out a cervical screening test? Will he also tell the House whether he has read the recent criticisms of the accuracy of the test so that he can give an assurance about how accurate it really is?
§ Mr. Hayhoe
I do not know the precise cost of the test, but I shall write to the hon. Gentleman. I know that it is relatively small. It is not the cost of the test that is at issue. We are seeking to persuade the women concerned, particularly the priority group, the over-35s, to come forward to have the test. As I said, by far the best way to do that is for the invitation to come from the GP. That is why the computerised system of call and recall operated by the family practitioner committees is the best and most effective way of achieving that result.
§ Mrs. Ann Clwyd (Cynon Valley)
The Minister plainly has greater faith in the efficiency of GPs' surgeries than the rest of us have. Can he say in which Welsh area health authority areas backlogs exist?
I note that the Secretary of State for Wales is not here this afternoon. As the Minister will be aware, the Health Service in Wales is less democratic than it is in England or Scotland because there are no regional health authorities to plan overall health services. Can he give us detailed answers of where in Wales the backlog exists? Will he support the well woman clinics and give the necessary resources so that we can have more of them. That would help if he genuinely wants to track down cervical cancer in women.
§ Mr. Hayhoe
I agree with the hon. Lady that GPs play a crucial role in the call and recall programme for those tests. GPs' co-operation and involvement in those programmes is of the highest importance. I am not competent to reply about the position in Wales, but I shall draw the attention of my right hon. Friend the Secretary of State for Wales to the point made by the hon. Lady.