Cervical Screening

HC Deb 18 March 1985 vol 75 cc633-8

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 shortcomings in the cervical screening system revealed by the recent death of a woman in Oxfordshire and evidence of a survey carried out in Nottingham last year.

The Minister for Health (Mr. Kenneth Clarke)

Last year we gave all health authorities updated, comprehensive guidelines on an effective cervical screening programme based on the advice of an independent expert advisory group. This followed the circular which we issued in December 1981 telling authorities to establish local recall arrangements for cervical screening by April 1983. All authorities should therefore now be offering a full screening service to all women with a recall service to those at highest risk.

Responsibility for operating the cervical screening programme rests with individual health authorities. It is obviously important for each authority to have effective arrangements for following up positive tests, which should always be notified to the clinician who initiated the test, who should then ensure that follow-up action is taken.

We are looking into the circumstances of the Oxfordshire cases to see whether there are any general lessons to be learnt. We were already preparing a questionnaire to all authorities to update our information on local screening services and we will be issuing that shortly.

Mr. Dobson

Does the Minister agree that although the Government received expert advice in 1981 from the Committee on Gynaecological Cytology that they should set up a computer-based, local call and recall scheme in every part of the country, on strict national guidelines, they implemented only one of those recommendations and, consequently, are directly responsible for the present shambles whereby only seven districts in this country have a decent system?

Secondly, why did Ministers ignore the findings of the Nottingham survey, published in the British Medical Journal and publicised by me in December 1984, which showed that some doctors were failing to follow up positive smears?

Finally, will the Minister accept that, as he has never asked health authorities what cervical cancer screening arrangements they have made, he can neither dismiss the Oxford tragedy as an isolated incident nor confirm that such failures are not widespread? Does he not recognise that people will notice the contrast between the efforts that the Government have constantly made to harass health authorities into introducing privatisation and the fact that the Minister, and his Department, officials and ministerial colleagues have not raised one finger to try to find out what was happening in the health districts or to urge them to do the proper job that people expect them to do?

Mr. Clarke

The hon. Gentleman's last question rather spoiled the remainder of his remarks. We are all concerned about the tragic cases in Oxfordshire and to protect women against the risk of cervical cancer, which is avoidable in many cases. We have been chasing up the authorities and it is wrong to make a political point in trying to draw a contrast between that and the tendering process.

It is right to say that in 1981 there was a recommendation that there should be a call system as well as a recall system. However, because of doubts about its cost-effectiveness, only seven authorities opted for a call system. We are financing research into a particular system at Manchester. When we have the results of that, we shall consider whether it is justified and whether a national call system would save lives, as it is claimed. Meanwhile, recall systems, including computerised recall systems, are rapidly being spread. The Government have made money directly available through information technology money. Ten family planning clinics set up computerised systems, more than 20 have computerised systems, and others are operating effective manual systems.

As I said in my original reply, we have been stressing to authorities the importance of getting on with screening and protecting women in their localities. We have not ignored the article in the British Medical Journal in October 1984; indeed, because of my constituency interest, I was involved in its appearance. The fact that it appeared publicised to all health authorities the problems that had arisen in Nottingham and that they had been put right. Obviously it is necessary—it is so obvious that it does not need to be stressed constantly by the Government —that authorities should have screening programmes, that clinicians should be told the results of all tests, and that all clinicians should ensure that women at risk are notified.

I share the anxiety of the hon. Member for Holborn and St. Pancras (Mr. Dobson). I am sure that women would like all avoidable deaths in this area to be eliminated. I assure the hon. Gentleman that the matter is being given high priority. For most of the country the present arrangements are working well, and women should not be unnecessarily alarmed.

Mrs. Jill Knight (Birmingham, Edgbaston)

I urge my right hon. and learned Friend in no circumstances to stop his programme of privatisation, as the money saved by it is badly needed elsewhere. Is there any reason why general practitioners who have been notified of the positive result of a cervical smear should fail to inform the patient about it?

Mr. Clarke

I agree with the first sentiment. Regarding my hon. Friend's question, I agree that there can be no reason for that. I should have thought that all clinicians appreciate when they are notified that one of their patients has had a positive test that they should then notify the patient and take further steps as quickly as possible. One cannot prejudge individual cases because human error can be made and information mislaid. I certainly agree with my hon. Friend that the obvious step for a clinician is immediately to take a further test as soon as he or she is notified of a positive result.

Mr. Merlyn Rees (Morley and Leeds, South)

The Minister refers to the general lessons to be learnt from the inquiry, on which he will no doubt report to the House. What will happen if the inquiry finds either human error or administrative error in an individual case?

Mr. Clarke

There are procedures for dealing with individual cases of error and subsequent complaints, and they should be adequate to deal with what is sometimes a human tragedy which follows from a patient not being notified of a positive result of a screening test and that she is at risk. The Government's duty is to ensure that all authorities make themselves aware of this sort of survey, and that the standards of the screening service in all localities are brought up to the level of the best. As I said in my original reply, we were already preparing to update our information. It is not true that we had never got information before, as the hon. Member for Holborn and St. Pancras implied. We normally get it through direct contact with health authorities. We are now preparing a systematic questionnaire, which was already in preparation, and it will soon be issued so that we can compare the standards achieved by every health authority.

Mr. Tony Baldry (Banbury)

Does my right hon. and learned Friend agree that, in so far as any conclusions can be drawn from the Oxfordshire case, they are that within the considerable resources already given to the National Health Service it is always possible to be more efficient and to make more effective use of the resources? Does he further agree that when the Opposition seek to denigrate the NHS by such instances it is of no benefit or help to anyone?

Mr. Clarke

I hope, as my hon. Friend plainly hopes, that the controversy does not deter women from seeking screening. All sexually active women should be screened for cervical cancer once every five years. The guidance that we publish makes that clear. Where abnormality is detected, the second test often shows that it is a mistake and that there is none. If there are early signs of cancer, it can be treated with a high probability of success, and lives can he saved. There is no serious resource problem here, and it is not one of the most expensive services being developed in the NHS. We must improve administrative efficiency and ensure that no errors are made at any stage of the process so that people do not forget or omit to act when a positive test has been notified.

Mr. Michael Meadowcroft (Leeds, West)

Is it not worth emphasising the fact that, in the words of the British Medical Journal, 80 per cent. of those who develop cervical cancer have slipped through the screening process"? Is it not also true that in some areas there is a far better response to those tests, because they have gone beyond the Government's guidelines? One example is Cornwall. If the Government are committed to preventive medicine, they should emphasise such matters and make the guidelines much more appropriate to the need rather than being over-concerned about administrative details, which will not necessarily cover all the cases that could occur.

Mr. Clarke

I agree that plenty of individual practices and health authorities have developed effective systems, which have the important result of saving the lives of women who might otherwise die from cervical cancer. The Government's efforts are designed to ensure that those standards are achieved everywhere. All health authorities and all members of the medical profession should back our efforts to do so. What should come from tragic cases such as the one in Oxfordshire is that health authorities will now check to ensure that such errors do not occur in their localities.

Mr. Roger Sims (Chislehurst)

Is it not clear from what my right hon. and learned Friend said that his Department, in issuing guidance, has discharged its duty in the matter and that the responsibility must lie with the general practitioner?

Mr. Clarke

We shall continue to discharge our responsibility by following up our guidance and ensuring that health authorities do what they have been clearly told to do. I agree with my hon. Friend. I am sure that most general practitioners will agree that a doctor does not need to be told that, if he is notified that a patient's test is positive, he should immediately contact that patient and submit her for another test. We know that errors can be made, but I do not believe that we are talking about a failure of policy or systems.

Mrs. Ann Clwyd (Cynon Valley)

Does the Minister agree that it is equally important for women to be screened for breast cancer? He may be interested to hear about an example of a similar mistake, when a woman who had already lost one breast—

Mr. Speaker

Order. The question is not about breast cancer. The hon. Lady should confine her question to cervical cancer.

Mrs. Clwyd

I am sure that the Minister would agree that women should be screened regularly for other forms of cancer. Does he believe that such screening is satisfactory for the other parts of the body where cancer can occur?

Mr. Clarke

We are already financing much research into screening for breast cancer, but people are not as certain of the cost-effectiveness of screening for breast cancer as they are of the screening for cervical cancer. However, we all hope that effective screening methods will be developed for all sorts of feminine and other cancers, and that when adequate methods are devised health authorities will press on to implement them effectively in their areas.

Mr. Anthony Beaumont-Dark (Birmingham, Selly Oak)

Does my right hon. and learned Friend agree that the confidence of many women will, rightly or wrongly, have been somewhat damaged by what happened in Oxford? I received three telephone calls at the weekend from people asking whether the process was effective in the west midlands. Would it not be possible at least to provide self-addressed postcards so that even negative tests can be notified? I should have thought that the cost involved was so small, compared with the confidence that could be re-established in women, as to be well worthwhile.

Mr. Clarke

Any woman who is worried should straightforwardly approach her general practitioner, who will inform her of the result of her smear test. Any woman who is sexually active and who has not had a smear test during the past five years should in any event contact her doctor to have a smear test carried out. I agree with my hon. Friend that what the Government and the health authorities must do is to reassure women that they can be protected, and then devise adequate systems. His suggestion that each woman should be notified personally of the results of a test will be considered. We shall certainly ask our expert advisory committee whether it believes that to be necessary. But the systems that are being devised and that work well in some areas already notify the doctor adequately and are saving many lives.

Mr. Nigel Spearing (Newham, South)

But is the Minister aware that in Newham, if a positive test has been notified and, within a given period, there is no voluntary recourse to the clinic, the district health authority sends a reminder of that notification directly to the individual? Is not that a sensible long-stop system? Why was it not incorporated in the original guidelines that were circulated by the Minister? Is not the failure to require the use of such a long-stop administrative procedure prime facie maladimistration on the part of his Department?

Mr. Clarke

The East Ham arrangement seems to be very sensible. It is my belief that that arrangement is to be put in hand in Nottingham as well so that when no response is received after somebody has been notified of a positive test the authority can follow it up and ask the doctor concerned why there has been no response. It would therefore act as a reminder.

We can of course reinforce all the guidance, but I believe that the hon. Gentleman will agree with me that it is a matter of common sense. The health authorities do not need all these obvious steps to be spelt out to them in circulars. They are responsible public bodies which should be capable of taking the necessary elementary steps for a screening procedure under which the doctor is given the results and then tells the patient. Fortunately, as my hon. Friend the Member for Birmingham, Selly Oak (Mr. Beaumont-Dark) said a moment ago, that happens in the vast majority of cases, but we have to guard against exceptional errors and make sure that no such errors occur again.

Mr. Jonathan Aitken (Thanet, South)

Is not one of the keys to avoiding the kind of tragedy that occurred in Oxfordshire the greater use of computerised call and recall systems? Although the greater use of such systems is primarily a question for the management of the National Health Service which my right hon. and learned Friend is doing so much to improve, does he agree that private and charitable fund raising could join the NHS in providing the necessary computer hardware.

Mr. Clarke

We are steadily advancing with the computerisation of the records of all the family planning committees. The software that has been developed, which is based upon a model developed by the Exeter FPC, enables an FPC, if it wishes, to have a fully computerised call and recall system. I believe that about one quarter of all FPCs already have such computerised systems. Some of them are financed directly by the Government. I agree that computerisation needs to be more widely spread. However, I stress that many authorities provide perfectly good manual call and recall systems. There is no reason why a proper system should have to wait for the computer.

Mr. Donald Coleman (Neath)

May I remind the Minister that it is now over 20 years since this subject was ventilated in the House and pressed upon the then Labour Government? The Minister appears to get extremely cross when hon. Members refer to the system, but is he not aware that in previous years there was a recall system to deal with tuberculosis by means of mass radiography which worked perfectly satisfactorily without computers?

Mr. Clarke

I agree with the hon. Gentleman that good recall systems can operate without computers, but it is easier to operate such systems with computers. Computers are spreading throughout the NHS. We have ended the national recall system for the simple reason that it did not work. We took steps three years ago to instruct authorities to replace the national system with better local systems, and that is what they are doing. The number of deaths in this country from cervical cancer is dropping very slightly. I agree that it is not dropping enough. That is why we shall continue with our efforts to make sure that all authorities properly protect those women who are at risk in their areas.

Mr. Derek Foster (Bishop Auckland)

I well understand why the Minister is throwing up a smokescreen to disguise his Department's ineffectiveness in this area, but it comes ill from a Secretary of State who has continually interfered in the affairs of health authorities to ride roughshod over their decision making when he wants action to be taken. Will he now show the same energy in this direction as he has in the direction of privatisation?

Mr. Clarke

I referred in my original answer to a circular that was issued in 1981. I have also referred to the guidelines that were issued last year. We keep in contact with the authorities by telephoning to find out what progress has been made. We have part financed the computerisation of the system. We have been helping with the development of the software at Exeter which will lead to the development of call and recall systems. I believe that the system is steadily improving and saving lives.

I very much regret the tragic cases in Oxford where there appears to have been human error, as a result of which two women have died. However, I do not believe it is right to build upon the grandiose claim that we are not interfering enough or that there is a lack of policy. We simply have to make sure that no tragic and avoidable deaths of women occur elsewhere.

Several Hon. Members

rose—

Mr. Speaker

Order. I have to protect the subsequent business on the Order Paper. We have had 19 minutes on this important matter.