Women (Cancer Screening)

HC Deb 05 February 1986 vol 91 cc355-86

8 pm

Mr. Frank Dobson (Holborn and St. Pancras)

I beg to move, That this House deplores the lamentable failure of the Government to make sure that every woman at risk of cervical cancer is covered by a computerised call and recall screening system with adequate laboratory back-up, as recommended in 1981 by the Committee on Gynaecological Cytology, because this failure has led to thousands of deaths which would have been avoided had successive Ministers shown a real commitment and provided the necessary resources in good time; and calls upon the Government to commit itself now to implement fully and swiftly any recommendations on breast cancer screening it receives from the expert working group established in July last year.

Mr. Speaker

I have selected the amendment in the name of the Prime Minister. Since this debate is starting very late, may I again appeal for short speeches, from both the Front Benches and the Back Benches?

Mr. Dobson

The Government's failure has led to the deaths of thousands of women which could have been avoided if successive Tory Health Ministers had shown a real commitment and provided the necessary resources in good time. Much of our general criticism of the Government's health record springs from the fact that we have different health policies. The Opposition are committed to the National Health Service. The Government are committed to promoting commercial medicine. But in the case of cervical cancer there is no political difference. Everybody is agreed that we need a comprehensive screening system in this country that covers all women at risk. We have not got such a system, and it is the Government's fault that we have not got it. They stand condemned on every ground. They have been shifty, complacent and negligent. They have failed to heed their expert advisers.

In 1981 the committee on gynaecological cytology recommended the abandonment of the outdated national recall scheme and the establishment of computerised systems in every part of the country, not just to recall those women who had previously had smear tests but to call for the first time those who had never had a smear. This recommendation got off to a bad start because when the committee's proposals were reported to the House on 20 November 1981 by the then junior Health Minister, the hon. Member for Hampstead and Highgate (Sir G. Finsberg); he did not even mention the introduction of a call system, even to reject it.

The Department of Health and Social Security consultative documents and circulars then went to absolutely ludicrous lengths to avoid mentioning the crucial recommendation about the initial call. In the event, the Government advised health authorities to set up local recall schemes. However, the Government took so little interest in the subject after 1981 that they do not have the faintest idea of how many authorities have introduced even the limited recall schemes that they recommended.

In May 1984 the right hon. and learned Member for Rushcliffe (Mr. Clarke) asserted that the outdated national scheme was replaced last year with local recall schemes. This was not true. A survey carried out on my behalf and published less than a year ago showed that of the 201 health authorities in England and Wales, only seven had call and recall schemes, while 77 had no scheme at all. The rest were somewhere in between. The Government never disputed that survey. They could not do so because it was accurate. And in any case they could not challenge the figures because they had none of their own.

On 18 March 1985 the right hon. and learned Member for Rushcliffe said that it was not true that the Government had not got the information. He said that they had got it through direct contact with health authorities and that the Government were preparing a systematic questionnaire which would soon be issued so that they could compare the standards achieved by every health authority. By 19 December 1985, this was revealed by the new Minister to be not so systematic, after all. It was not designed, he said, for summary and publication. The only alternative explanations are that it was so sloppily drafted as to be useless or that the results were so embarrassing that he dared not disclose them.

On Monday of this week the Minister finally admitted that according to the last check by the DHSS only 13 health authorities were operating computerised call and recall schemes and that he did not intend to make a further check on progress until June of this year.

Dr. M. S. Miller (East Kilbride)

I accept entirely my hon. Friend's proposition, but will he take it from me that the Government do not need to wait until there is a countrywide system in place? There are group practices —for example, the group practice in my constituency of which I am a patient — which have computerised services for exactly this purpose. That ought to be encouraged.

Mr. Dobson

But the Government, as my hon. and medically learned Friend knows, are not giving any such encouragement. It is not just that the Government have not set up call and recall schemes. After the smears have been taken they need to be processed in the pathology laboratories to establish whether there are signs of pre-cancer. There are massive delays in the laboratories of all three countries.

Mrs. Elaine Kellett-Bowman (Lancaster)

That is not true.

Mr. Dobson

On 29 April 1985 the right hon. and learned Member for Rushcliffe said that the Government intended to improve the effectiveness of laboratory facilities for processing smears and that he would be discussing with the professions and the health authorities how best to achieve that aim. He made that promise on behalf of the right hon. and hon. Members who are now sitting on the Treasury Bench, so it would be a good idea if they listened to this.

Mrs. Kellett-Bowman

May I assure the hon. Gentleman that in our pathology laboratories the smears are processed within four days. People are notified about whether they are negative or positive within four days.

Mr. Donald Coleman (Neath)

Will my hon. Friend give way?

Mr. Deputy Speaker (Mr. Harold Walker)

Order. We cannot have intervention upon intervention. Perhaps the hon. Member will allow the hon. Member for Holborn and St. Pancras (Mr. Dobson) to reply to one intervention at a time.

Mr. Dobson

All I can say to the hon. Lady, who represents a constituency in Lancashire—

Mrs. Kellett-Bowman

It is the county town.

Mr. Dobson

I thought Preston was the county town of Lancashire.

Mrs. Kellett-Bowman

That is another error that the hon. Gentleman has made.

Mr. Dobson

Then all I can say is that the hon. Lady and the women in her constituency are unusually fortunate.

Mr. Coleman

Does my hon. Friend recollect that earlier today he appeared on a television news programme during which we were shown a pathology laboratory in this country that contained stacks and stacks of unexamined slides? Were we not told in that programme by the pathologist that this was the experience in all parts of the country?

Mr. Dobson

I cannot confirm what was shown on that programme, because my only contribution to it was my interview. I did not see the rest of the programme. However, if the programme was accurate, it would have been able to show film that indicated that there are enormous delays all over the country.

Mr. Robert Litherland (Manchester, Central)

I spoke today to Dr. Yule of the cytology department at the Christie hospital. He told me that there is a seven weeks' delay, that 35,000 women are waiting for smear results, that this is causing grave anxiety and that over 100 of the tests could be positive. I was also told that the hospital's funding is the same now as it was in 1976.

Mr. Dobson

My hon. Friend has stolen a bit of my thunder. I shall deal later with some of the Manchester details. The right hon. and learned Member for Rushcliffe said that the Government intended to improve the effectiveness of laboratory facilities and that they would be discussing with the professions and the health authorities how best to achieve it. However, on 18 December 1985 the present Minister for Health told me that specific discussions with health authorities on that issue were not proposed. He had previously told me that he did not know what was the average time taken to process a smear and that he could not list those authorities that had asked clinics or doctors to suspend taking smears because of backlogs in laboratories. He even told me that he did not expect health authorities to express concern to him about delays in processing cervical smears. Clearly he shares the Prime Minister's Orwellian view that ignorance is strength.

What is the position? In the absence of a detailed and comprehensive survey by his officials, I shall give the Minister a few examples. I confirm the information given by my hon. Friend the Member for Manchester, Central (Mr. Litherland) that at the Christie hospital, which supplies a service for most of the north west, there is a backlog of 35,000 smears, about seven weeks' work; the backlog used to be two weeks. At Sutton Coldfield, which the Secretary of State for Health and Social Services purports to represent, there is a three-month backlog. In Plymouth there is a two-month backlog. In Nottingham the backlog is two to three months. In Kent a person has to wait four months for the result. There is a three-month backlog in Norfolk and Norwich where I understand that slides have had to be stored in an empty garage. When a smear shows signs of pre-cancer a delay of even a few months can be vital. Unnecessary delays are occurring. In many districts doctors have been asked from time to time to reduce the number of smears taken because the laboratories cannot cope.

As in England and Wales, the position in Scotland shows enormous variations. Lothian health board has delays of 10 to 12 weeks. It can no longer do laboratory work that it used to carry out for the Fife health board. Greater Glasgow health board returns its results to doctors within seven days. It almost goes without saying that Tory Ministers constantly chide Greater Glasgow for what they call overspending and inefficiency while praising what they refer to as the efficiency and frugality of the Lothian board. Only fools and accountants see it in that way.

Mr. Willie W. Hamilton (Fife, Central)

My hon. Friend is not giving all the facts. Not only is there not a Scottish Minister present, but there is not even one Conservative Member from Scotland here for the debate although the figures for Scotland are probably worse than those for the rest of the United Kingdom.

Mr. Dobson

In view of the relative lack of Tory Members from Scotland, anyway, if one was present they would probably be over-represented when we see the throng on the Tory Benches.

The Government should have anticipated the problem in the laboratories and should have got to work in 1981 to make sure that enough laboratory staff were being trained to meet the demand. It takes from one to three years to train a laboratory scientist. The Government did not act in time. So all of us are faced with a crisis. The position is now so bad that the Institute of Medical Laboratory Sciences has organised a meeting for this weekend to discuss the subject "Cytology—From Crisis to Crisis".

To meet the crisis, some health authorities have been forced to farm the work out to commercial laboratories. I advise them to take care. Quality control tests on one commercial laboratory showed that it picked up one positive smear in five, while another commercial laboratory actually lost some of the slides that it was supposed to be looking after. If even the best placed authorities can scarcely cope with the current demand for laboratory facilities, what will happen as call and recall schemes come into operation? The chairman of the British Society for Clinical Cytology recently wrote to me to say that that would be the last straw unless adequate staff were appointed and trained.

In the face of all that, the Minister appeared on a "Newsnight" programme on 18 December, offering great sympathy to those who had developed cancer because his predecessors had failed to act. Sympathy is not enough. Action to put things right in future is wanted. The Government should use their powers to oblige health authorities to set up comprehensive schemes covering all women at risk. They should take immediate steps to ensure that enough laboratory staff are recruited and trained. They should provide the necessary extra funding and earmark those funds for the purpose. Nothing less will do.

Much more needs to be done in the long term. The present screening system is often described as preventive. It is not; it is a surveillance system intended to pick up signs of cervical cancer before it does its damage.

Mrs. Gwyneth Dunwoody (Crewe and Nantwich)

Will my hon. Friend comment on the fact that if administrative staff are cut by as much as 30 per cent. throughout the hospital service there will be no one to operate a recall system of any kind?

Mr. Dobson

My hon. Friend makes a valid point, because Ministers have confessed in answer to questions that administrative staff play an important part in providing direct services for patients. This is one of the services they provide.

In the longer term there should be an effort to do more research into the causes of cancer so that it can be prevented rather than diagnosed at an early stage. More work needs to be done to find out whether there is more than a statistical link between smoking and cervical cancer. More needs to be done to verify or disprove the suggestion that barrier types of contraception seem to reduce the chances of cervical cancer. More effort needs to be put into the development of machines which can read smear slides quicker and more accurately than the laboratory scientist with a binocular microscope.

Dedicated doctors, laboratory scientists, nurses, computing and administrative staff and researchers are eager to take on all those tasks. The only people not showing any commitment are Ministers and officials of the Department of Health and Social Security. The British Medical Association told me yesterday that the DHSS had not consulted the medical profession until a couple of weeks ago, despite the fact that the BMA had been calling for a meeting for almost a year. Ironically, the meeting was arranged for today and had to be cancelled because of the debate. That shows the effort that has been put into the discussions which the right hon. and learned Member for Rushcliffe promised in April.

Almost everybody concerned wants to do things properly. We should ensure that older women who have not had a smear test get them because most older women who die of cervical cancer have never had tests. Clearly effort needs to be concentrated there. That must not mean that younger women get less attention, particularly as there is evidence that some of them are affected by a more virulent, swift-acting cancer.

Considerable doubts are developing about the interval between tests being as long as five years. Many people think that it would be safer to shorten the interval to three years. No one supports the preposterous suggestion made by the Minister on "Newsnight" that a 10-year interval might be all right for younger women.

The Minister might be forgiven for feeling that it is unfair to visit on him the sins of his predecessors, but he cannot shirk responsibility when he is about to ask the House to accept the grotesque complacency of the Government's amendment which invites us to commend the Government for its positive action to ensure that by 1988 all health districts will have computerised call and recall systems and adequate laboratory back up". Even if all the schemes were in operation by 1988—a dodgy suggestion anyway—if the Government were to stick to the five-year interval between smears that would mean that the last woman called for screening would get her computer card in 1993, 12 years after the committee for gynaecological cytology first made its recommendations. Even the skills of Saatchi and Saatchi would be stretched to the limit to turn into a triumph a promise to deliver something 12 years late.

Mr. Dafydd Wigley (Caernarfon)

The hon. Gentleman has rightly referred in depth to cervical cancer. Will he be dealing with screening for breast cancer which is so important given the progress that has been made in Sweden? The Committee that is investigating the Swedish experience must produce its report rapidly so that it can be implemented since 12,000 women a year are dying from that form of cancer.

Mr. Dobson

The logical structure of my speech must have prompted the hon. Gentleman to raise the point that I am about to make in my next sentence. My hon. Friend the Member for Barking (Ms. Richardson) will concentrate particularly on breast cancer.

That takes us to the Government's welcome, if somewhat belated, decision in July last year to set up an expert working group to advise them on breast cancer screening. Its members and every woman in the United Kingdom will be hoping that when the group comes up with workable recommendations they will be implemented quickly and in full, not half-heartedly, slowly and patchily like the experts' recommendations on cervical cancer. We want the Government to commit themselves tonight to implement quickly and fully whatever the breast cancer experts recommend.

The Government's record on cervical cancer is a disgrace—a lot of words, little action and less money. What the women of this country demand is the same protection that is available to women in many parts of Scandinavia and North America. That would not just save the lives of at least 1,000 women a year; it would save tens of thousands more from worry and concern. Many more lives and worries would be saved by a comprehensive breast cancer screening programme. Neither will cost much money. We all know what needs to be done. What we want now is for the Government to do it.

8.21 pm

The Minister for Health (Mr. Barney Hayhoe)

I beg to move, to leave out from "House" to the end of the Question and to add instead thereof: 'commends the Government for its positive action to ensure that by 1988 all health districts will have computerised call and recall systems and adequate laboratory back up for cervical cancer screening; and welcomes the establishment of an expert working group to examine urgently the available evidence on breast cancer screening and to propose a range of policy options for implementation within the National Health Service.'.

I regret the absurdly exaggerated and emotive language of the motion moved by the hon. Member for Holborn and St. Pancras (Mr. Dobson) and his speech, but I am glad to have the opportunity to discuss these issues today.

There is no need to underline the vital importance of the matters which will be covered in this debate, so I want to start by reminding the House of the facts as regards both of these forms of cancer. I then want to say something about the position we have reached in improving the effectiveness of cervical screening, and the plans that we have for advancing it further. I shall also deal with the role of screening in the detection of breast cancer, and what the Government have done to get the best scientific advice on the need and how it should be met.

Unlike the hon. Gentleman, my world does not begin in 1979. I do remember and have researched much further back. When one looks at the record, only he can explain how he could have had the bare-faced impudence to stand up today and make the criticisms that he did, speaking from the Front Bench for a party with its record in this affair. The issue is of great importance. Cervical cancer claims the lives of 2,000 women each year. I am advised that breast cancer claims the lives of 13,000—not 12,000, as referred to by the hon. Member for Caernarfon (Mr. Wigley). Together they represent about 5 per cent. of women's deaths in Britain. In neither case does the knowledge exist to prevent those diseases.

The effectiveness of early detection of cervical cancer by screening is not at issue. Since 1966, when the Labour Goverment introduced a screening programme, that has continued in one form or another. In recent years doubts about its effectiveness have grown. Whereas the previous Labour Government did little, if anything to improve matters, this Government have not only been concerned that the programme has not made the impact on mortality which might have been expected from experience abroad, but have taken action to improve matters. I stress, because of the very party political nature of what the hon. Member for Holborn and St. Pancras was saying, that the previous Labour Government did nothing.

The national manual recall system operated by the NHS central register at Southport, established well over a decade ago early in the 1970s, has proved ineffective. Very low rates of recall were being achieved. Following advice from the committee on gynaecological cytology and after consultation with health authorities in 1981, the central scheme was wound up and health authorities asked to introduce local recall systems.

The health service circular—HC(81)14—issued in December 1981 made it clear that local recall systems were to be introduced by 1 April 1983. Advice was given to health authorities on the elements of a simple recall system which could be operated manually. It was not essential for health authorities to have a computer in order to introduce an effective system.

In 1984, after looking at the programme again, the Government issued further advice aimed at improving its effectiveness. They were concerned that although the screening programme had been in operation for nearly 20 years, it had had very little demonstrable impact on the number of deaths from cervical cancer. They were also concerned that there had been an observed increase in the number of cases of cervical cancer in women under 35.

The expert committee on gynaecological cytology had been asked to consider all the available evidence on the desirable age and frequency of screening. The CGC concluded that the women most at risk were still those over age 35, with 94 per cent. of deaths occurring in this age group.

Mrs. Dunwoody

Does the Minister accept that there has been a dramatic rise in the number of young women who are suffering from carcinoma in situ and it is noticeable that the 60 per cent. rise hides a 117 per cent. rise in that particular age group who are much more at risk? There is now a real epidemic in that age group.

Mr. Hayhoe

I was reporting the advice of the expert committee, the CGC, in 1984. At that time it observed that the majority of women who developed invasive cervical cancer had never been screened. It concluded that population screening had failed to reduce mortality not because the policy was wrong, but because it had not been properly implemented. Those important conclusions were set out clearly for the guidance of the NHS in the Health Service circular, HC(84)17, issued in July 1984.

That circular gave clear guidance on the priorities for screening, and I think it covers the point made by the hon. Lady. Those were women over 35 and those who had been pregnant on three or more occasions. They were to be screened at age 35 and every five years thereafter until age 65. Those under 35 who were or had been sexually active were also to be screened at regular five-yearly intervals.

The circular also gave clear advice to authorities to determine how local resources could be used most effectively. They were invited to consider the use of health education campaigns and the way the service might be provided so as to encourage the women at greatest risk to use it.

Further emphasis was given to the need to have recall systems. Such recall systems were clearly the best way of ensuring that all the women in the priority group who had come forward for screening were recalled at the appropriate time. The response of health authorities to this advice remained a matter of departmental concern. In 1985, therefore, my predecessor as Minister for Health announced yet a further set of initiatives. The catalyst, as the House will recall, for this announcement was the unfortunate and tragic events at Oxford where deaths occurred.

My right hon. and learned Friend, the Minister for Health, issued further advice to health authorities in April 1985. That had two main aims. First, it gave health authorities a check list against which to review urgently the organisation and effectiveness of their screening programmes.

Secondly, it asked them to introduce call systems in addition to the recall systems already required. They were asked to make immediate plans to introduce those computerised systems under arrangements made with family practitioner committees. That had become a practical and viable approach. Standard computer software had, with DHSS support, been developed by the Exeter family practioner services computer unit. It was stressed that the use of those systems had to be co-ordinated with the availability of laboratory services. My right hon. and learned Friend also announced that discussions with the professions and health authorities would be held on other measures for improving the effectiveness of the existing policy.

The particular points that my right hon. and learned Friend had in mind were to see in what other ways women most at risk could be reached; how the effectiveness of laboratory services for processing smears could be improved; and to explore ways of ensuring that there is always effective follow-up of abnormal results. The latter point arose directly from the problems experienced at Oxford.

Since April 1985 we have had feedback from authorities following the review that we asked them to conduct. This is the point that the hon. Member for Holborn and St. Pancras mentioned about questionaires. It became clear that many authorities were not proposing to proceed fast enough with the introduction of computerised call and recall systems.

As regards the effectiveness of laboratories, it also became apparent from discussions my right hon. and learned Friend had with British Society for Clinical Cytology that in many parts of the country there were unacceptable backlogs in laboratory treatment of smears. Health authorities had not attached and were not attaching sufficient priority to the cervical screening programme and its needs.

As the House knows, each year Ministers review service priorities and then notify health authorities of any changes. The same circular gives regional authorities their resource assumptions. The 1986 circular has recently been issued. Item 6 is headed "Service priorities",. Item 6a, headed "Cervical cancer screening" states: Ministers require Authorities to give priority to improving cervical cancer screening programmes (HC(84)17 and DA(85)8 refer). This should include ensuring that laboratories can meet demand and avoid backlogs (which should not regularly exceed one month's work) and arrangements are made with FPCs to implement computerised call and recall systems, no later than 1987–88. Details of action to be taken to complete achievement of these goals should be included in regional short term programmes due in the Department on 31 December 1986; and short term programme outturn reports due with the Department on 30 June 1986 and subsequently should record progress towards full implementation. Thus, not only is cervical screening a national priority, but the whole apparatus for monitoring NHS performance is to be called upon to ensure that that priority is reflected in plans and action on the ground.

Comments have been made about resources. The full implementation of computerised call and recall systems will not require major new resources. I am advised that the health authorities will require about £4 million to install the necessary systems.

Similarly, if every health authority needed to employ another person in their laboratories it would cost about the same amount. This must be set in the context of the resources already being devoted to the cervical cancer screening programme, which are estimated at between £20 million and £30 million. The steps now taken will target this expenditure much more effectively.

The overall cost must be put in the context of the extra £650 million which will be spent next year on the hospital and community health services, and the further increases of £470 million and £450 million outlined in the public expenditure White Paper, planned for the following two years.

Mr. Litherland

Is the Minister aware that smears have been sent to private laboratories and even to other countries, such as Sweden and Holland? Where is the money coming from? If moneys can be afforded for that, why can they not be afforded for facilities in this country?

Mr. Hayhoe

Getting the appropriate tests carried out in the most cost-effective and efficient way must be a matter for local decision. I am not sure whether the hon. Gentleman seeks to ensure the most cost-effective use of resources or whether he has some other consideration in mind. The most cost-effective use of resources, directed towards the needs of potential patients, must be the guide.

In addition to the extra £650 million that I have mentioned for the next financial year, 1986–87, that will go to the hospital and community health services, authorities also have the benefit of their growing cost improvement programmes, which achieved £100 million worth of resources for extra deployment in 1984–85 and £150 million planned in 1985–86, and I expect them to achieve significantly better results in 1986–87.

The hon. Member for Holborn and St. Pancras referred to the "Newsnight" programme on 18 December. It shows the paucity of the material available to him that he has sought to quote and exploit the highly selective extracts that were used from a 20-minute interview that I gave to the BBC. About three minutes were carefully sliced out — out of sequence — and portrayed in conditions that sometimes, I fear, one comes to expect from our television programmes. They tend not always to present matters in a wholly fair and impartial fashion. It was interesting, because the hon. Gentleman referred to the fact that he gave an interview and he commented on the programme, even though he had not seen it. I said that I was available to be in the studio.

Mr. Dobson

The programme in which I took part was today.

Mr. Hayhoe

The hon. Gentleman saw that programme, but the point I am making still stands. I was available to be interviewed live, but that offer was refused because they preferred to take a long film interview and slice it up. The hon. Gentleman sought to make his point. I have put it into context to show its worth.

Much has been made by the hon. Gentleman about the fact that DHSS headquarters does not know the details of where and when laboratory backlogs occur. Such details are not collected centrally. We do not believe it right to use resources to seek information of that type.

Ministers set health authorities clear priorities. I have pointed out the clear priority that has been given to cervical cancer screening in the coming year. Those priorities are reflected in the short-term programmes of district health authorities and, through the regional health authorities, they are monitored through a system of outturn reports every year. The introduction of general management and its development within the service will make better use of those resources and avoid some problems that have been referred to in the past, which flow from bad management and inadequate planning. I am as worried as others about the backlogs that are occurring in too many places. Health authorities have been told that they are expected to provide a service which regularly achieves an outturn of results within a month. The existing systematic accountability arrangements will give us the tools to ensure that those results are achieved.

The hon. Gentleman dredged up the fact that I had postponed a meeting with the British Medical Association as clear evidence of my culpability and that of the Government. I must tell him that I meet the general medical services committee of the BMA from time to time. I understand from a letter, and I confirmed with the committee today, that it wished to tell me that the cervical cytology screening programme should be extended to include women aged over 20 at three-yearly intervals. That is not a new point. The expert committee on gynaecological cytology recommended five-yearly screening, but that advice will be reviewed at its meeting in April. It has been advised of the BMA's representations, and I am sure that they will be taken into account. Therefore, the points that the committee wished to put are already being considered.

It is absurd and ludicrous to suggest that that committee was unwilling to put its views in written representation and advice that would be considered by officials and experts at the DHSS and that the meeting with me was crucial. Its views are being taken into account by the expert committees, and their reports will come to me.

Reference has also been made to breast cancer. To date. cervical cancer is the only form of female cancer for which mass screening is of proven value, but the prospects for the early detection of breast cancer are promising. Extensive trials on the effectiveness of different methods of breast cancer screening, funded by the Government, are in hand. The trials, which began in 1979 and are expected to report in 1988, cost about £750,000 a year and involve 250,000 women. They are part of a Government-funded research programme that also covers the economic, social and psychological aspects of mass screening.

My officials and advisers keep in touch with the findings of overseas studies. Last year's report of the study conducted in Sweden appeared to remove many of the doubts previously attached to breast cancer screening by mammography.

The fairest and most sensible comment made by the hon. Member for Holborn and St. Pancras was his tribute to the speedy action taken by my predecessor who, on behalf of other United Kingdom Health Ministers, established an expert working party under the chairmanship of Professor, now Sir, Patrick Forrest. We have received an interim report from Sir Patrick, copies of which I shall soon place in the Library. The interim report concluded that there is a convincing case on clinical grounds for a change in United Kingdom policy on the provison of mammographic facilities and the screening of symptomless women aged 50 and over. The report also concluded that it would not be sensible to introduce such screening on a United Kingdom basis without ensuring that the necessary back-up services were available.

That is a preliminary view only of the group, and it will be considered in detail for its final report. In that report, the group is expected to set out policy options, their costs and benefits and overall implications for the NHS throughout the United Kingdom. The final report is expected later this year and, as with the interim report, copies will be placed in the Library and the Government will respond as quickly as possible.

The Opposition motion and the speech of the hon. Member for Holborn and St. Pancras show that this is nothing more or less than opportunistic politicking. However much criticisms of Government action since May 1979 may be justified—with the benefit of hindsight, it is easy to make such points — it does not lie in the mouths of Labour party spokesmen to make those charges. They have nothing to boast about. Their fury shows the measure of their guilt. Apart from initiating cervical screening for women aged over 35 at five-yearly intervals in 1966 — 20 years ago—the Labour Governments of 1966–70 and 1974–79 have a record of complacency and inaction. In contrast, this Government's record is better. We have increased the number of cervical smears taken by 30 per cent. a year. Of course, I shall not be satisfied until the call and recall system that I have described is fully operational.

Perhaps the debate will persuade more women —especially those who do not come forward in sufficient numbers, but who have been identified by the experts as a target group that one must persuade—to ask for tests. Indeed, we must persuade all women who meet the conditions to which I referred to do so. If the debate helps to persuade those women to come forward for testing, it will have been worth while. I hope that the House will reject the Opposition motion and support the action that the Government are taking to deal with this important matter.

Several Hon. Members

rose—

Mr. Deputy Speaker

Order. I must echo Mr. Speaker's plea for brief speeches.

8.47 pm

Mrs. Renée Short (Wolverhampton, North-East)

The Minister has the nerve to attack the Labour party for the shortcomings in this area of medicine. The Conservative Government have had six years in office to do something about it, but the amendment tabled by the Government shows that they do not even propose to introduce a recall system until 1988. It is scandalous. In the meantime, every surgeon to whom one talks and every leader in medical journals attacks the shortage of provision for dealing with cancer of the breast and cervical cancer. The Minister is trying to hide his inefficiency and the Government's refusal to provide the resources that are needed.

In America, Sweden, Holland and many other countries, trials have been carried out on many thousands of women which have demonstrated conclusively the value of screening for breast cancer, on which I wish to concentrate. There has been a 30 to 40 per cent. reduction in the risk of dying from breast cancer within 10 years of detection, and there is no doubt that women who are involved in screening programmes have a lower mortailty rate from breast cancer than those who do not have that opportunity. It is accepted that the early detection of small tumours makes it possible to avoid removing the breast and may even reduce the need for radiotherapy. Early detection is the key to success.

The Government so far have not been willing to introduce a proper screening programme for all women at risk in that age group. They claimed that the cost was prohibitive. In America, the cost of screening has been put at $12 for each patient and $2,000 for each cancer detected. The Canadian trial cost $25 for both mammography screening and clinical examinations. Here in Britain, the current estimate for mammography is £10 a patient. The Minister might want to comment on that figure later. To that figure must be added the cost of nurse and medical counselling to assist those women found to be positive. When one takes into account the savings in treatment of advanced cancer which would be avoided by early cure, clearly it is good value for money to introduce a screening programme.

Screening requires very competent technical and clinical techniques. It therefore ought to be provided on the National Health Service where we can be confident that doctors, nurses and technicians will provide a high standard of service. I hope that the Minister will not be tempted to say that screening could also be provided in the private sector. Screening is not an area for private profit. There are skilled breast cancer teams here which are desperately frustrated at being unable to offer that service to women and they are very angry at the lack of resources to treat patients.

The Minister told the House that he intends to set up, in conjunction with breast cancer treatment teams, mammographic screening units with their own computerised call and recall systems. A start ought to be made in NHS areas that have a good computerised family practitioner committee report system and a breast cancer register. A start should be made immediately where the preparation has already been done.

Our services are utterly inadequate. They will first have to be improved before a national breast cancer screening programme can be introduced. There should be a considerable increase in the number of consultant radiologists and radiographers. The Minister did not say anything about that. If we extend a screening programme, who will read the X-rays and who will operate on the patients who are found to be positive?

At present, consultant radiologists are being appointed who have no experience in mammography. What are they supposed to do? Training facilities will be needed, particularly in high quality techniques, and mobile units could in due course provide screening for more women. Why is the Minister not proposing to have more mobile units where women can be screened quickly? Why is not the Minister proposing to set up such units in shopping centres, as many other counries do, where screening can be rapidly carried out?

There is no doubt that screening for breast cancer can save lives. We need a screening service of high standards and more information to encourage informed public debate. Above all, we need to provide facilities that can treat and call women rapidly into the hospital service if they are found to be positive. Perhaps the Minister who is to reply will say what the Government intend to do to provide that resource. It is not enough just to screen; there must be follow-up and action.

8.55 pm

Mrs. Elaine Kellett-Bowman (Lancaster)

I am certain that every woman in the land was shocked and horrified by the case to which my right hon. Friend the Minister referred in his opening remarks of the unfortunate Oxford woman who died after having her tests duly taken and who was not told of the outcome.

To have a system of smears without a proper follow-up and notification is, in many ways, worse than having no smear programme at all. Women who have had the test and who then hear nothing are lulled into a false sense of security. I therefore welcome the great effort made by my right hon. and learned Friend the former Minister of Health to extend full facilities to the whole of the country. The programme outlined tonight reveals the positive actions which have been taken by the Government in picking up the broken and even non-existent pieces left by the Labour Government. The programme announced in April 1985 was intended to improve the standard of care in all districts to that of the best.

I am fortunate, as I mentioned earlier, in coming from a district health authority which has always taken its responsibilities very seriously indeed. For the past 15 years, long before it became fashionable we have had a very tight recall system and we shall soon have a completely computerised family practitioner committee service. We are also fortunate in the speed with which tests are undertaken and results obtained. We have at Lancaster Moor hospital not only a top cytologist, Dr. Morris, but also an internationally known microbiologist, Dr. Telford.

We hold cytology clinics whenever they are required. As soon as 20 people want a test—approximately every four days—a clinic is held. No one need wait more than four or five days. The clinics are held at a wide variety of places— baby clinics, gynaecology clinics and family planning clinics. Local GPs pounce on the women who come into their surgeries for other reasons and whom they then persuade to have a smear test immediately. Nobody slips through the net. Results from our clinics are known within four days. All women seen at the clinics are informed of the results within four days.

For historical reasons, some tests from my area are still sent to Christies where it is true that the waiting time is longer. I very much hope, as I have family connections with that hospital, that that problem will be overcome in the not too distant future. The coverage of women in our district is rising every year. It is essential that these high standards should be available to women wherever they live.

A recent study was carried out in Manchester to discover why women who had developed invasive cancer of the cervix had not been detected at a pre-invasive stage by screening. By far the most common reason was that they had simply never been screened. That applied to two thirds of the total sample and four fifths of the women over 40 who were particularly at risk. Failure to follow up abnormal cytology results accounted for a horrifying 15 per cent. of deaths. That latter figure makes my blood boil. Actually to have the test and not be properly followed up is totally inexcusable.

Health authorities have a responsibility to the whole of the population they serve. A five-yearly programme which reaches a high proportion of women, including older women, and which ensures action on those found positive, is clearly preferable in my view to repeated smears on a small number of women. I know that some younger women are developing very fast growing cancers. Even annual screening would not pick up all those as they are so fast growing. However, to get massive cover of the whole country is the first essential. That is why I welcome the initiative by my right hon. and learned Friend the former Minister of Health which is backed by the current Minister. I welcome the urgency with which the Government are following the initiative and monitoring progress by the various local health authorities.

9 pm

Mr. Michael Meadowcroft (Leeds, West)

It is easy always to castigate the Government for not responding to every health need. Sometimes, but not often, I have a little sympathy for Ministers because the health sphere is one in which it is easiest to point out failings, as it is impossible for resources to match expectations.

With cervical cancer, the results are conclusive. The Government purport to give priority to prevention but it is astonishing that they do not follow their words with better action. The evidence is conclusive. We have varying standards within the United Kingdom. Some health areas and districts perform better than others, screen more women and go beyond the guidelines to obtain better results.

The evidence from abroad on screening is far more conclusive. In Scandinavia. where there is a more homogeneous population, the conclusions can be demonstrated. A national scheme was started in Iceland in 1960. Within 10 years it had reached 90 per cent. of women aged between 25 and 70. The aim was to screen them at two to three-yearly intervals. In 1978, the incidence of cervical cancer had decreased to 30 per cent. of the 1965 figure. Similarly, in Finland, screening reaches 90 per cent. of women aged between 30 and 59, with a five-year recall interval. The incidence has been halved. Sweden offers four-yearly screening to women aged between 30 and 49. The incidence is down to 60 per cent. of its previous level. The crucial point is that in Norway where there is no national screening organisation incidence has increased. It is now 15 per cent. above the 1965 level.

With such conclusive evidence, it is astonishing that the Government do not respond by extending screening. Evidence from this country suggests that where the payment to general practitioners operates according to the guide lines, and where the screening is within the intervals and age groups set out, the incidence of cervical cancer in those age groups is declining slowly. Presumably, there are some benefits from screening.

As has been mentioned, the incidence of cervical cancer in younger women is increasing. Why do the Government not respond to the statistics by improving and increasing the screening of younger women?

The hon. Member for Wolverhampton, North-East (Mrs. Short) mentioned breast cancer and the encouraging results in Sweden. If the results of the trials are as conclusive as they are for cervical cancer, and if there is clear evidence that there would be benefits from screening for breast cancer, will the Government undertake to introduce a scheme similar to that recommended for cervical cancer?

Cost has been mentioned. I know that we did not have much notice of the debate, but within the time constraint I endeavoured to find whether there was any comparison of the cost of screening compared to the expensive intervention required later. I do not suggest that the cost is the most important factor. The human factor is far the most important. I could not find any evidence to suggest that there was no cost benefit from screening and prevention compared with the massive cost of chemotherapy, radiotherapy and surgery. It is strange that the Government do not save money by increasing and improving screening.

The importance placed on cost is shown by the fact that on 20 January the Leeds west district health authority minuted that it was looking for economies and that cervical cytology must be kept within budget". If health authorities are so strapped for cash that they have to pass a minute which is looking for economies, it shows the desperate position in which they are. That is despite the fact that the number of deaths of cervical cancer in Leeds is above the national average.

Recall is crucial. In Leeds, it is still done manually. Despite the fact that it has been agreed to base computerisation on the family practitioner committee records, we still have no date when that will be achieved. The position in Leeds seems to be a shambles, but not the same shambles as there is in Liverpool, where the records of 100,000 women were wiped off the computer in one fell swoop. Efforts are now being made to reconstitute the records.

Pressure for the changes and improvements needed will come from the women's movements. I hope that the pressure to introduce well-woman clinics will gain momentum. I hope that the bid for a well-woman clinic in Leeds which is to be put into the 1986–87 urban programme application will succeed.

I wonder whether the position of cervical cancer screening would be different if it were a male problem. I wonder whether any Government would be able to respond in the way this Government have—slowly and partially — if 20,000 men were diagnosed as suffering from a male cancer and 2,000 were dying from it each year.

The prevention of cervical cancer is crucial. The evidence and the facts are available. It is reprehensible that the Government do not progress faster and more comprehensively with what is needed.

9.4 pm

Mrs. Edwina Currie (Derbyshire, South)

My qualification, such as it is, for speaking in this debate—apart from the fact that I am one of the few Members who have been able to have a cervical cancer test—is that several years ago I had some experience in this matter when I was involved with the Central Birmingham health authority.

The West Midlands regional health authority had a cervical smear campaign and came to us and said that it wished to do a lot more smears and wished to expand its campaign. It was not entirely clear why it wished to do so, but we co-operated with the campaign. We co-operated with great enthusiasm with many adverts, leaflets and posters. Twenty thousand more tests were done over a few weeks and we were all pleased with ourselves because it was all concerned with preventive medicine.

When I attended the next meeting of the district management team of my authority I had a rude awakening. The chairman of the medical executive committee, a clinical chemist, who was the consultant member of the team was apoplectic with rage. He asked me if I had realised what our smear campaign had done. I was rather nonplussed by that and asked what he meant. He told me that we had jammed up every laboratory in the entire west midlands with the smear slides, which were stacked up everywhere. The laboratory girls were bleary-eyed having to look down microscopes and were having to work overtime every night. There was a backlog of enormous proportions and every other type of laboratory work which they had been trying to do had ground to a halt. He said that we had not saved a single life and asked us to put a stop to the campaign.

I turned to the specialist in community medicine, who usually backed the schemes that I got up to, Dr. Rod Griffiths — I spoke to him this afternoon and he confirmed my recollections of this meeting—and asked if it was true. He confirmed that it was and that the same women were coming forward in the campaign, mainly low risk women, the vast majority of whom had already been tested but who were now coming forward yet again. The high risk women in whom we should have had more interest were not reached by the campaign. I venture to suggest that many of the resources that we were tying up in those laboratory tests were costing lives elsewhere in other campaigns which we all hold dear, such as perinatal mortality.

This is the experience all over the country and it is a classic case of what happens all the time in the National Health Service when we chuck resources at problems—in fact we pride ourselves on how we chuck resources at problems. Opposition Members demand that we chuck more resources at problems, but it does not solve the problems. We are spending over £30 million a year on cervical screening and over 3 million tests a year are done. However, the death rate in England and Wales is dropping by only 1 per cent. a year, but it was dropping at the same rate before 1965 when there was no screening system. We still have over 2,000 deaths a year.

We have a test which is efficient and which will identify the illness. It has a high rate of success in predicting the cancer. It is an illness that will kill and which, if not treated, is not likely to get better of its own accord. There are excellent chances of recovery if the cancer is treated and especially if it is treated early. In other words, we have all the tools of success and we have plenty of resources. There is no lack of resources; the Government have been immensely generous and they are to be congratulated. The programme, however, cannot be regarded by any means as a raving success.

Two recent matters have been mentioned. The first was the scandal at Oxford when a positive test was not communicated to the patient, who subsequently died. That is not a matter of resources. The bulk of resources are needed in the laboratory and that work was done. The piece of paper was sent back and was put into the lady's file, but nobody got round to telling her. That was due to sheer bloody incompetence. Chucking more resources at that health authority will not help the authority.

I share the view of many hon. Members that it is scandalous for women to wait for those answers. The pattern in the country is highly erratic. In my health authority, South Derbyshire health authority, women wait about four to six weeks, which is acceptable. Next door in Nottingham there is a waiting time of six months and that is not acceptable by anybody's standards. A recent survey showed that 59 per cent. of the women in Nottingham with positive tests were never followed up. Somebody in Nottingham needs shooting, and I would happily volunteer to do it. That record is an absolute disgrace, and there are other health authorities where the same is true.

A more virulent strain affecting especially young people has emerged recently. Getting at those young people might require a different type of campaign. If it means doing tests in schools and colleges, let us do it. It is simple. It does not take long or much in the way of equipment. Only a wooden spatula is needed. There is no need for people to go to clinics. If it means that we have to run a campaign in the New Musical Express rather than in Woman's Own, let us do that.

Although it is true that the death rate for the under-35s has doubled in 10 years—

Mrs. Dunwoody

Trebled.

Mrs. Currie

Has doubled in 10 years.

Mrs. Dunwoody

Trebled.

Mrs. Currie

I can quote the hon. Lady the figures if she wants.

Mrs. Dunwoody

If they came from the Minister's Department I should have doubts about them.

Mrs. Currie

They came from the British Medical Journal, if the hon. Lady wants to know. The death rate among the under-35s has doubled in 10 years. However, the death rate among young women is still one-twentieth of that among older women such as the hon. Lady, with respect to her, and 94 per cent of all deaths as a result of cervical cancer are among the over-35s. The advice being given to my right hon. and hon. Friends is quite right.

The fact is that 80 per cent. of those aged over 40 who die have never had a test, so bumping up the number of smears merely wastes resources. All we do is re-test those who have already been tested. The same is true for the recall programme. All it does is enable us to re-test people and therefore add to the number of negative tests. The task is to get at the older women who do not know how to ask, who do not know what we are talking about, especially those who think that the campaign does not mean them. Older women feel that the publicity aimed at younger women, especially sexually active women, seems not to apply to them, especially if they have ceased to be sexually active. The problem is—how?

I am sure that my right hon. and hon. Friends are aware of the British Medical Journal issue of 6 October 1984, which went into this matter in great detail. One of the articles considered a general practitioner system and showed that they can be highly effective — a 96 per cent. uptake was reported in that study. In all honesty, we do not need vast complex computer systems. If I am considered a heretic, I can only say that that is what the research shows. Pushing buttons is not the answer; knocking on doors is.

Mortality has fallen sharply in Sweden, Finland, Denmark and Iceland. However, exactly the same has happened in Norway as in England. Norway put a lot more resources into the screening programme, but the mortality rate has not dropped more than it would have done if the screening programme had not been in place. Why? I asked Professor George Knox, the professor of social medicine at Birmingham university, who used to advise me in days gone by. He said that the countries that had succeeded had "put somebody in charge." They put a named person in charge of the programme. They did not in Norway and we have not. He said that we can choose to provide a laboratory service for clinicians—that is what the BMA will ask for—or we can choose to provide orders for the computer industry. That is a good thing if it is what we want. We could, however, choose to start reducing mortality, which is an entirely different objective. The way to do that is to designate one person, perhaps in each health authority, monitor his—or her—performance, not for input or for resources, but for results and to get him —or her—to cut across all the muddle.

Right hon. and hon. Members know that I share their concern. I think that it is possible to spend only half of what we now allocate to the service and to save nearly all the 2,000 lives that are being lost, by allocating the money to a named person in each health authority, telling it to get on with it and perhaps asking it to stop testing and retesting an infinite number of times fit 25-year-olds, but to get moving on their mothers.

The hon. Member for Holborn, and St. Pancras (Mr. Dobson) clearly thinks that he is God's gift to women. He is up the creek on this issue. My experience warns me that we should not make this issue a bandwagon. It is preventive medicine, but that does not automatically make it worth while. Universal screening is neither desirable nor necessary. Large-scale screening by traditional means will miss most of the potential victims. Meanwhile, I fear that the tie-up of large funds and scarce resources may cost lives and diminish welfare elsewhere, and may make progress on other forms of health care more difficult. I therefore counsel caution, and I look forward to cheaper and more effective real progress.

9.15 pm

Mr. Lewis Carter-Jones (Eccles)

The hon. Member for Derbyshire, South (Mrs. Currie) will forgive me if I do not follow her. I usually speak on rehabilitation, but my wife has asked me to speak on this issue tonight as she had a masectomy 14 years ago. It is a dreadful time for any family to live through. My wife was diagnosed as having cancer, but she has lived for 14 years. I can assure the hon. Lady that my wife is at risk, and she goes for tests at regular intervals. That is absolutely as it should be. In no way is any part of that effort wasted.

The effect of such a health problem on the family is quite devastating. I certainly could not cope well with it, and I do not know how my wife managed. We relied on the support and help of medical practitioners at the Maelor hospital in Wrexham. I am pleased to say that my wife enjoys good health, and handles the garden more effectively than I can. I am sure that her good health is due to the care, attention and continuous screening from which she benefits. When my wife returns from her screening and says, "It is OK today," my first response is, "Thank God," and a great sense of relief goes through the whole family. It is an incredible and unbelievable feeling. The next thing that she says is, "Why don't other people have this screening as well?"

The Minister said that more women should go for screening, and that is true. But they need to be invited for screening. The figures show that 90 per cent. of those invited for screening for either cancer of the breast or a cervical smear attend.

One group of people that I call in support of my point are the paramedical professionals and the nurses. I do so because the radiographers, physiotherapists and nurses are mainly women — and, sometimes, women know a lot more about the needs of women than do men. I speak only as a client in a position that is unique for me. I assure the House that the professional organisations that I represent in Parliament, both collectively and as individuals—and many of them are my close friends—urge that greater resources should be made available.

I intend to be brief so that as many hon. Members as possible may have an opportunity to speak. Certain costs are immeasurable. I refer to the cost to the family of the loss of loved ones. The numbers are substantial. It is not easy for a man to bring up a child without a mother. Those are the real social costs. As an economist, I believe that if we did our sums properly, if we did a real cost-benefit analysis taking both sides of the balance sheet, we would quickly recognise that the costs of treating and healing often more than outweigh the costs of screening and monitoring.

There must be a sense of urgency. Human beings are strange in that they are the only animals who laugh or cry and who realise the difference between things as they are and things as they should be. We know how things should be. We know that there should be continuous screening for breast and cervical cancer so that we can reduce the suffering for the family and the patients, and reduce the total costs.

When I speak about rehabilitation in the House I use an expression that people have heard repeatedly. The things about which we are talking are technically possible. They are certainly economically viable and morally right. The Government must show a sense of priority and, with the support of the Opposition, introduce a massive campaign to eradicate this disease from our country.

9.21 pm

Mrs. Gwyneth Dunwoody (Crewe and Nantwich)

I get very angry when I hear the sort of speeches that we have heard tonight from the Government Back Benches. We are facing an epidemic of cervical cancer, and the complacency shown today makes it difficult to defend the attitude of any Member of Parliament who could seriously make the comments that we have heard tonight.

There has been a dramatic increase in the number of women with cervical pre-cancer in the United Kingdom in the past 15 years — an increase that has gone much faster in the past two years. The general 60 per cent. increase over the time covers a staggering 117 per cent. rise in the 25 to 34-year-old age group. The death rate from cancers that could have been avoided if the pre-cancers were treated has trebled in the past 10 years. In comparison, the Canadians and the Finns have halved their death rate, and, by two-year testing, increasing numbers in the 20 to 45-year-old group have been saved. The figure of 2,000 deaths could be halved if we were to follow sensible precautionary measures.

There has been talk about the amount of money involved. I must remind the Government of the simple fact that it costs £500,000 per life saved to build a motorway crash barrier. We know how keen the Government are on improving motorways. It would cost £25,000 per life saved if we were to provide proper screening services for all those at risk. Let us not be in any doubt. The NHS has had its money cut to such an extent that an increase of cervical screening of the kind being demanded would put an unacceptable burden on all the clinics concerned.

Less than a year ago, the Minister made a speech in which he said that the important thing was to screen those over 35, as they were most at risk and had to be considered first. There was a media campaign, and many more women went to clinics of their own volition to get the screening done. In many instances, district health authorities were unable to deal with the influx of numbers. Not only do they not have the staff, but the cuts in clerical and administrative staff, quite apart from medical facilities, have made it virtually impossible for them to set on foot even the basic follow-up provisions that are essential to the efficient running of such a system.

It is clear that all this should have been computerised a long time ago, but the investment in hardware and input is considerable. It cannot be found from within existing budgets. I know of one particular clinic which has had a 108 per cent. increase in the past year in the number of people that it is seeing, and a 124 per cent. increase in the numbers of new patients in that time. No hospital service can expand at that rate without a specific campaign by the Government to earmark more new money for it. The existing equations, by which the Government say that such clinics can have the money, provided that it is found from within the existing budget, is not what is needed. We need more new money for a campaign. If it is not forthcoming, we shall know that the Government's weasel words tonight can be simply explained.

If there were more women Members of Parliament, including Conservative Members, who were prepared not to waffle about how sufficient people are already being tested — in reality it is only that more patients are returning to be re-tested—the subject would be debated seriously.

In reality, Ministers have not been prepared to consider this as a matter of great urgency, and women are dying every day because of that incompetence and intolerance of true priorities. I am ashamed to be a Member of a House of Commons which is prepared to allow Ministers to speak as the Minister did this evening.

9.25 pm

Mr. Willie W. Hamilton (Fife, Central)

I am the first Scottish Member to take part in this United Kingdom debate. It is worthy of comment that throughout the debate no Scottish Back-Bench Tory Member or Scottish Minister responsible for the National Health Service in Scotland has attended for a minute. That is absolutely disgraceful behaviour, and irresponsible contempt of the House.

The Minister made great play of the cost effectiveness of the expenditure on the service. In an article in The Times during July 1985, Dr. Robert Yule, the director of Britain's biggest screening laboratory at the Christie hospital in Manchester, said about the cost: It is a tremendous bargain. It guarantees a cure if cancer of the cervix is detected early enough. There is nothing to compare with it. We have repeatedly made that point to the House. When we consider the programme's cost effectiveness, the Government should say, "The sky is the limit," because the ultimate saving far outweighs the financial cost. The article continues: Yet the screening programme was described only last March as 'a shambles' and is seen by the medical profession as a relative failure. The Minister, reeking with complacency, talked about the vast amount of additional cash that the Government were investing in the service, but declined to say that it was less than the rate of inflation. Hospital authorities are saying that that will mean reductions in the standards of service, not least in this area. The Minister spoke of an additional £3 million or £4 million, but on what pay assumptions is that made? There must be pay assumptions, unless the Government are saying that people performing such valuable work in the Health Service will not receive pay increases.

In 1980 a Royal Commission report on inequality in health was published, and then buried by the Government because its recommendations were too radical and expensive ever to be seriously considered by a Conservative Government. The Government were to preoccupied in undermining the basic concept of the Health Service, and encouraging the growth of private profiteering. That report was invaluable in underlining what was commonly believed but never before so thoroughly researched, which was that the poorer classes who desperately needed the Health Service were, generally speaking, the least well provided for. That is described as the "inverse care law": the availability of good medical care tends to vary in inverse proportion to the need of the population served. The report pointed out that women in classes 4 and 5—the poorer sections of the community—did not get that service. The mortality rate among those women was the highest.

My hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) rightly cited the Scottish figures because the position is much worse there than in the United Kingdom generally. In July 1985, a group practice in Fife referred in its letter to me to the cytology service in Fife which was normally provided by the Lothian health board. The board wrote to the doctors saying: You are probably aware that the Cervical Cytology Laboratory has an accumulation of 10,000 smears waiting to be read. This is an increase of almost 6,000 since January 1985. The delay in reporting which this represents is now unacceptable and the Board has also had to take into consideration the sheer practical difficulty of attempting to manage a service which is overstretched to such a degree. An expert Committee has been consulted and has advised the Board on developments which are needed to meet the present level of demand. This will entail taking on new staff who will require several months' training. In the meantime, to deal with the backlog of work and to avoid dislocation of the service, it is necessary to impose a severe restriction in its use, for at least three to four months".

That means that services in Fife were set back because of inadequate provision in the Lothian area. Fife does not have a service of that kind, although I understand that progress is being made.

On all counts — health, social, economic and cost effectiveness grounds—it behoves the Government to take a long and hard look at this problem and to give women, who are dying in epidemic proportions, the great priority that we think they deserve.

9.32 pm

Ms. Jo Richardson (Barking)

I am extremely sorry that the Minister for Health did not give more of his attention to this debate but spent so much time outside the Chamber. A number of interesting speeches to which he should have listened were made. We listened to his speech with disgust—that is all I can say for it.

The speech of the hon. Member for Derbyshire, South (Mrs. Currie) was unbelievable. I thought that we were talking about the encouragement we should be giving women to return regularly for testing. The hon. Lady was saying that we should not be re-testing them.

Mrs. Currie

The hon. Lady knows that I share her interest in all the issues that affect women. I am interested in saving lives, not just in providing more and more resources to do exactly what we are doing now and seeing the death rate barely affected.

Ms. Richardson

We can save lives by constant screening. I point out to the hon. Lady a remark in The Lancet of 30 March 1985. Dr. Gillian Gau, consultant cytopathologist at Queen Charlotte's hospital, said: At the moment the middle class get the smears and the working class get the cancer. That is true. I agree with the hon. Member for Derbyshire, South on one point: we need to campaign in different ways. However, that costs money and involves thought and planning. We are not doing what is needed. The Government's record on cervical screening offers practically no encouragement and hope to women that there will be a significant reduction in the number of women who can expect to die from breast cancer—one in 30 women—even though everyone knows that about 3,000 lives could be saved from breast cancer each year and a further 1,000 saved from cervical cancer if a properly resourced national screening programme were established now.

The Minister talked about the Government spending £650 million on the National Health Service over the next year. I wish that he had talked about billions rather than millions—[Interruption.] I say that in all seriousness. There is a need to spend much more and I hope that it will be recognised and acted upon. The Minister is virtually saying that we must choose our own priorities within the expenditure of £650 million. Instead, he should be setting the direction of priorities for the district health authorities.

Throughout their term of office the Tory Government have cynically exploited the complexities of Health Service finance with a view to misleading the public. They have hidden behind a barrage of distorted statistics and half-truths and have launched an unprecedented attack on every sector of the NHS. Anyone outside this place will say the same. Their attack on the Health Service has had far-reaching implications for women. There has been a reduction in services, and I read the other day of the threatened sale of the Elizabeth Garrett Anderson hospital, the closure of the South London hospital for women and children — the Minister's predecessor refused to intervene to do anything about that—and the threat to the Soho hospital for women. These examples are indicative of the Government's refusal to respond to women's special circumstances and preferences in health care.

We are talking of increasing resources for the provision of high-technology equipment, which is crucial, and we must concern ourselves also with the type of services which women require and the way in which they are made available. That is an equally important factor.

Women are still expected to take the major responsibility of caring for the health of their families. With the emphasis that is now being placed on caring for the elderly, the infirm and the disabled within the community, women are shouldering increasingly heavy responsibilities, possibly with serious implications for their own health. They combine their domestic and caring commitments with paid employment, and many more families would be in dire poverty if they did not do so. However, very few people take sufficient account of the lack of time that is available to women to stop and think about their own health and to put their own needs first for a change. Far too few general practice surgeries or hospitals take women's multiple commitments into account when, as in most instances, men are planning the management of the services.

About 2.5 million women are screened each year for cervical cancer. That accounts for only 15 per cent. of the 16 million women between the ages of 20 and 65 years who should be using cancer screening services regularly. If the Government would for once listen to women, significant improvements could be made.

I am surprised that the Minister did not refer to the survey which was carried out by the Women's National Commission, the results of which were published in November 1985. The members of the commission are appointed principally by the Government and the commission is situated in the Cabinet Office. Its report confirmed yet again the consistent demands made by women, women's organisations, women's health groups and women in the trade union and Labour movement which they have been making for years. Of the 6,000 women who were surveyed, 70 per cent. expressed that they saw a need for doctors to hold at least one surgery a week in the evening. That need was expressed by nearly 85 per cent. of women who were working full time. More than half the women surveyed expressed the need for surgeries other than for emergencies only to be held on a Saturday morning, with more consultation time made available for each individual patient session, which means time to talk and to be heard.

The women surveyed expressed a preference—one which has been expressed for many years and of which no one has taken any notice—for the choice of treatment to be provided by women doctors and women staff. That preference was confirmed by the commission's survey. Of the 6,000, 72 per cent. supported the view that women should be offered the choice of consulting a woman doctor. When conditions specific to women only were involved, such as breast and cervical screening, the figure rose to 95 per cent. Only three health authorities of those which replied to the survey said that they could offer such a choice.

Those are avenues which the Government should be exploring to try to solve the problem. It is therefore perhaps not surprising that more than 85 per cent. of the women said that they would use a well-woman clinic if one were provided in their area. That figure rose to more than 90 per cent. in the 25 to 44-year age group.

I should like to ask the Minister a specific question. The Women's National Commission is a Government-appointed body which is situated in the Cabinet Office and presumably the Department of Health and Social Security looks at its reports. Therefore, when it recommended that the Government should draw up a code of practice for workplace health care", including cervical and breast screening facilities as a guide for employers, why have the Government done nothing about it? The report goes on to say that the Government should set an example by extending the occupational health care of its own employees along these lines … building upon the Health Education Council discussion paper 'Health Education in the Workplace' and the Trades Union Congress paper 'Women's Health at Risk'. It is extremely important that the Government should adopt those and other proposals and set an example for other employers.

It is true that in response to trade union pressure many workplaces have already established on-site screening programmes. About 10 trade unions are involved in that, but to save time I will not list them. However, one in particular, SOGAT '82, which has recently been in the news, bought its own caravan two years ago to help with mobile screening. That has been extremely useful in its negotiations with employers.

Dr. M. S. Miller

Will my hon. Friend also include family planning clinics in the list of organisations where a cervical test is done on everyone who goes to them?

Ms. Richardson

I am grateful to my hon. and, as has been said, medically learned Friend for reminding me of that.

Perhaps not many people will know it, but women from two of the trade unions in the Palace of Westminster have been trying for well over a year, to my knowledge, and with the support of my hon. Friend the Member for Wolverhampton, North-East (Mrs. Short) and of the hon. Member for Birmingham, Edgbaston (Dame J. Knight), to establish on-site screening in the Palace of Westminster. About 1,800 women work here at any one time. They work unsocial hours and they could have their cancer screening done here. Why do not the Government encourage the authorities to provide such a service? I believe that it is a disgrace that the Government are not picking up all the initiatives which have been suggested. In fact, they are leaving it largely to a charity organisation, the Women's National Cancer Control Campaign, which carries out fundamental work by taking mobile screening facilities into shopping centres and housing estates as well as into the workplace. My hon. Friend the Member for Wolverhampton, North-East mentioned taking mobile cancer screening units into shopping centres. That is what we should be doing. That would answer the points which the hon. Member for Derbyshire, South made. The campaign has an all-women staff and it examines and screens between 20 to 25 women in each two-and-a-half-hour session at a cost of about £100 each session.

Those are precisely the services which the Government should be fully funding. I do not mean just giving them a little money to put out a few leaflets; I mean actually funding, encouraging, helping and buying the equipment to enable them to do the job.

Every trade union that is involved with workplace screening has reported a very high take-up rate. I hope that these examples will give the Government some ideas. However, as we have stressed in the motion, the success of these initiatives is dependent upon laboratory facilities and the technical and back-up staff who deal with the results. We have heard that the situation is scandalous, but the Government have not said that they will do anything that will result in a marked improvement. No comprehensive provision is made for a breast screening service, with a call and recall back-up. The cervical screening service has been allowed to descend into chaos and confusion.

Women are confronted with confusing and conflicting information and advice about when to start using the service and at what age and about the safe length of time between each examination and smear test. They are faced with an insufficient choice of places and available times and with a lack of women staff and doctors. Last, though by no means least, they face increasing insecurity and lack of confidence because the system is incapable of producing a fail-safe follow-up should their examination or smear indicate that action needs to be taken.

I invite right hon. and hon. Members on the Conservative Benches to remember that half of their constituents are women, some of whom will probably die if the Government do not get on with the job and use the information and evidence already available to them. They should campaign effectively to prevent the death of women who otherwise would be able to live a happy life.

9.46 pm

The Parliamentary Under-Secretary of State for Health and Social Security (Mr. Ray Whitney)

First, I wish yet again to make it clear, as my right hon. Friend the Minister for Health said, that the Government are far from satisfied about the provision for cervical cancer screening. The district health authorities know about our concern. Let me explain why we have concentrated upon using the health authority system to provide this service. The country tried to adopt a national approach but it did not work. The hon. Member for Holborn and St. Pancras (Mr. Dobson) said that the national recall system was outdated, outmoded and unsuccessful. We can at least agree about that. [Interruption.]

Mr. Speaker

Order. I have returned to the Chamber especially to hear the hon. Member.

Mr. Whitney

I am more than usually honoured, Mr. Speaker.

The Government decided therefore to use the health authority system. We are very concerned that the response so far has not been satisfactory in all areas. The recall system needs to be improved. Greater efforts must be made to clear the backlog in laboratories. The delays are unacceptable. Our target is an average delay of four weeks.

Let me outline what the Government have done, what they are doing and what we intend to do. As for resources, when the hon. Member for Barking (Ms. Richardson) wound up the debate for the Opposition she seemed to be blithely indifferent about whether she was referring to an increase in National Health Service spending next year of £650 million—although is is actually £670 million—or £650 billion. The amount is £670 million. The hon. Lady was happy to say that it should be £650 million. The hon. Lady was not making a joke, so that is a measure of her economic illiteracy. Hon. Members should recognise that increased resources have been made available through the National Health Service.

The hon. Member for Fife, Central (Mr. Hamilton), among others, suggested that the amount devoted to cervical cancer screening did not reflect the rate of inflation. The answer is precisely the opposite. In the next financial year the resources will increase by no less than £670 million, which represents a significant increase above the projected rate of inflation. The same is true for the following two years. So there can be no doubt that resources are available for the services that we have been discussing. As my right hon. Friend said, we are talking of £4 million for the computerised system and a similar sum for the technicians who will be required.

Mr. Litherland

The Minister is talking about resources. Would he like to visit the cytology department at Christie hospital in Manchester where he would see the prefabricated huts that the staff have to work in? Perhaps he could convince Dr. Yule that he has enough resouces to cope with the backlog of 35,000 smears. It is a disgrace for the Minister to talk as he is doing.

Mr. Whitney

I shall be happy to discuss with health authority chairmen, as we discuss with all regional chairmen who in turn have discussions with district chairmen, the high priority which should be given to screening and to laboratory provision.

In January we published guidelines for health authorities. No authority should be in doubt about the priority we have given to cervical cancer screening. March 1988 is the target for computerised systems to be introduced but I shall be very disappointed if the programme is not complete before then. It is important and obviously must be carried out carefully. Studies have been set in train in Exeter to ensure that the best methods are used. The results of the studies are being implemented by other health authorities.

Mr. Dobson

Does the Minister think that Bolton health authority is making wise spending by employing outside consultants to second-guess the proposals of the Exeter unit?

Mr. Whitney

The hon. Gentleman must direct that question to Bolton health authority. The resources given to that authority are adequate to fulfil the demands made upon it in this sphere.

Dr. M. S. Miller

The Minister has said that he hopes the computerised system will be operative by March 1988. Surely in the meantime he will not delay having smears done even with the inadequate facilities that are available.

Mr. Whitney

Indeed not. The programme is increasing all the time and we have been assured that progress is being made. Of course, as has been said several times already from the Dispatch Box, we must have faster progress. That is precisely the message that we are communicating to health authorities.

A point of great interest to many hon. Members is what should be done about breast cancer. Cervical cancer accounts only for the minority of deaths of women from cancer. We are, as my right hon. Friend pointed out, funding a series of extensive trials on the effectiveness of different methods of breast cancer screening and those trials, which began in 1979, are expected to report in, perhaps, two years' time. They are costing £750,000 a year and involve about 250,000 women. Those are part of a Government-funded research programme and also cover the economic and psychological aspects of mass screening.

But, as has been pointed out, and as we all recognise, progress has now been made in Sweden in particular and some of the doubts about breast screening by mammography appear to have been removed. There again, the Government acted quickly, and as my right hon. Friend pointed out, established the committee under Professor Sir Patrick Forrest. We have now received its interim report. My right hon. Friend advised the House of the details of that interim report and, as he said, we shall seek to respond quickly to that.

The right hon. Member for Wolverhampton, North-East (Mrs. Short) referred to a number of possible ways in which we may respond to the possibilities of breast screening. One of the major elements in the terms of reference of the study group was to suggest a range of policy options and assess the benefits and costs associated with them, and set out the service planning, manpower, financial and other implications of implementing such options.

The record of the Government and the Conservative party compared with that of the Labour party makes it difficult for the House to understand why the Opposition should call a debate of this nature and produce the sort of speeches that we have heard from the Labour Benches tonight. We recognise that the problem is serious and that what has been done so far is not sufficient. Much more has to be done. Let me remind the House what we have done and what the Labour party in eight or nine years of Government failed to do.

It is true that in October 1966—[interruption.] Hon. Gentlemen may laugh, but we have to go back 20 years to the last and only action that the Labour party took in this important area. In October 1966 the Labour party asked health authorities to introduce cervical screening for women over 35 years. After that, all the running has been left to Conservative Governments. We have a record in that regard which compares favourably with that of Labour Members.

For example, in 1971 the then Government announced that a reform would be undertaken of the Health Service register at Southport and that started in 1972. In 1973 the Government asked the health authorities to extend the priority group to include women under 35 with three or more pregnancies.

When the Government came to power in 1980 we reviewed the scheme with the expert committee and it was found that the national recall system was not working satisfactorily. Only 20 per cent. of women recalled responded, whereas it was shown that the response achieved to local schemes was about 60 per cent. That is why we moved to the local authority basis. We consulted in 1981 and thereafter instituted a system of local recall. That system was approved in 1981 and launched in April 1983. However, we have been dissatisfied with the results and there was the sad case of the affair in Oxford. My right hon. and learned Friend the present Paymaster General announced further improvements in April 1985, which my right hon. Friend the Minister for Health has outlined. The further reviews that we have announced today, the challenge of the computerised health service, and the resources we are devoting to it, show yet again that, instead of words, we offer results.

Mr. James Hamilton (Motherwell, North)

rose in his place and claimed to move, That the Question be now put.

Question, That the Question be now put, put and agreed to.

Question put accordingly, That the original words stand part of the Question:—

The House divided: Ayes 209, Noes 281.

Division No. 63]	[10 pm
AYES
Adams, Allen (Paisley N)	Cohen, Harry
Alton, David	Coleman, Donald
Anderson, Donald	Conlan, Bernard
Archer, Rt Hon Peter	Cook, Frank (Stockton North)
Ashdown, Paddy	Cook, Robin F. (Livingston)
Ashley, Rt Hon Jack	Corbett, Robin
Ashton, Joe	Corbyn, Jeremy
Atkinson, N. (Tottenham)	Cox, Thomas (Tooting)
Banks, Tony (Newham NW)	Craigen, J. M.
Barnett, Guy	Crowther, Stan
Barron, Kevin	Cunliffe, Lawrence
Beckett, Mrs Margaret	Cunningham, Dr John
Beith, A. J.	Dalyell, Tam
Bell, Stuart	Davies, Rt Hon Denzil (L'lli)
Benn, Rt Hon Tony	Davies, Ronald (Caerphilly)
Bermingham, Gerald	Davis, Terry (B'ham, H'ge H'l)
Blair, Anthony	Deakins, Eric
Boothroyd, Miss Betty	Dewar, Donald
Boyes, Roland	Dobson, Frank
Bray, Dr Jeremy	Dormand, Jack
Brown, Gordon (D'f'mline E)	Douglas, Dick
Brown, Hugh D. (Provan)	Dubs, Alfred
Brown, N. (N'c'tle-u-Tyne E)	Duffy, A. E. P.
Brown, R. (N'c'tle-u-Tyne N)	Dunwoody, Hon Mrs G.
Brown, Ron (E'burgh, Leith)	Eadie, Alex
Bruce, Malcolm	Eastham, Ken
Buchan, Norman	Edwards, Bob (W'h'mpt'n SE)
Caborn, Richard	Evans, John (St. Helens N)
Callaghan, Rt Hon J.	Ewing, Harry
Callaghan, Jim (Heyw'd & M)	Fatchett, Derek
Campbell, Ian	Faulds, Andrew
Campbell-Savours, Dale	Field, Frank (Birkenhead)
Canavan, Dennis	Fields, T. (L'pool Broad Gn)
Carlile, Alexander (Montg'y)	Fisher, Mark
Carter-Jones, Lewis	Flannery, Martin
Clark, Dr David (S Shields)	Foot, Rt Hon Michael
Clarke, Thomas	Forrester, John
Clay, Robert	Foster, Derek
Clelland, David Gordon	Foulkes, George
Clwyd, Mrs Ann	Fraser, J. (Norwood)
Cocks, Rt Hon M. (Bristol S)	Freeson, Rt Hon Reginald

Freud, Clement	Oakes, Rt Hon Gordon
Garrett, W. E.	O'Brien, William
George, Bruce	O'Neill, Martin
Godman, Dr Norman	Park, George
Gould, Bryan	Parry, Robert
Gourlay, Harry	Patchett, Terry
Hamilton, James (M'well N)	Pavitt, Laurie
Hamilton, W. W. (Fife Central)	Pendry, Tom
Hancock, Michael	Penhaligon, David
Hardy, Peter	Pike, Peter
Harman, Ms Harriet	Powell, Raymond (Ogmore)
Harrison, Rt Hon Walter	Prescott, John
Hart, Rt Hon Dame Judith	Radice, Giles
Healey, Rt Hon Denis	Randall, Stuart
Heffer, Eric S.	Redmond, Martin
Hogg, N. (C'nauld & Kilsyth)	Rees, Rt Hon M. (Leeds S)
Holland, Stuart (Vauxhall)	Richardson, Ms Jo
Home Robertson, John	Roberts, Allan (Bootle)
Howell, Rt Hon D. (S'heath)	Roberts, Ernest (Hackney N)
Howells, Geraint	Robertson, George
Hoyle, Douglas	Robinson, G. (Coventry NW)
Hughes, Dr Mark (Durham)	Rogers, Allan
Hughes, Robert (Aberdeen N)	Rooker, J. W.
Hughes, Roy (Newport East)	Ross, Ernest (Dundee W)
Hughes, Sean (Knowsley S)	Ross, Stephen (Isle of Wight)
Hughes, Simon (Southwark)	Ryman, John
Janner, Hon Greville	Sedgemore, Brian
John, Brynmor	Sheerman, Barry
Kaufman, Rt Hon Gerald	Sheldon, Rt Hon R.
Kennedy, Charles	Shore, Rt Hon Peter
Kilroy-Silk, Robert	Short, Ms Clare (Ladywood)
Kinnock, Rt Hon Neil	Short, Mrs R. (W'hampt'n NE)
Kirkwood, Archy	Silkin, Rt Hon J.
Lambie, David	Skinner, Dennis
Lamond, James	Smith, C. (Isl'ton S & F'bury)
Leighton, Ronald	Snape, Peter
Lewis, Ron (Carlisle)	Soley, Clive
Lewis, Terence (Worsley)	Spearing, Nigel
Litherland, Robert	Steel, Rt Hon David
Livsey, Richard	Stewart, Rt Hon D. (W Isles)
Lloyd, Tony (Stretford)	Stott, Roger
Loyden, Edward	Strang, Gavin
McCartney, Hugh	Thomas, Dafydd (Merioneth)
McDonald, Dr Oonagh	Thomas, Dr R. (Carmarthen)
McKay, Allen (Penistone)	Thompson, J. (Wansbeck)
McKelvey, William	Thorne, Stan (Preston)
MacKenzie, Rt Hon Gregor	Tinn, James
Maclennan, Robert	Torney, Tom
McNamara, Kevin	Wallace, James
McTaggart, Robert	Wardell, Gareth (Gower)
McWilliam, John	Wareing, Robert
Madden, Max	Weetch, Ken
Marek, Dr John	Welsh, Michael
Martin, Michael	White, James
Mason, Rt Hon Roy	Wigley, Dafydd
Maxton, John	Williams, Rt Hon A.
Maynard, Miss Joan	Wilson, Gordon
Meacher, Michael	Winnick, David
Meadowcroft, Michael	Woodall, Alec
Michie, William	Wrigglesworth, Ian
Millan, Rt Hon Bruce	Young, David (Bolton SE)
Miller, Dr M. S. (E Kilbride)
Mitchell, Austin (G't Grimsby)	Tellers for the Ayes:
Morris, Rt Hon A. (W'shawe)	Mr. Frank Haynes and
Morris, Rt Hon J. (Aberavon)	Mr. Don Dixon.
Nellist, David

NOES
Adley, Robert	Bellingham, Henry
Aitken, Jonathan	Bendall, Vivian
Alexander, Richard	Benyon, William
Amess, David	Best, Keith
Ancram, Michael	Biffen, Rt Hon John
Ashby, David	Biggs-Davison, Sir John
Aspinwall, Jack	Blackburn, John
Atkins, Robert (South Ribble)	Body, Sir Richard
Atkinson, David (B'm'th E)	Bonsor, Sir Nicholas
Baker, Nicholas (Dorset N)	Boscawen, Hon Robert
Batiste, Spencer	Bottomley, Peter
Beaumont-Dark, Anthony	Bottomley, Mrs Virginia

Bowden, A. (Brighton K'to'n)	Hawkins, C. (High Peak)
Bowden, Gerald (Dulwich)	Hayhoe, Rt Hon Barney
Boyson, Dr Rhodes	Heathcoat-Amory, David
Braine, Rt Hon Sir Bernard	Heseltine, Rt Hon Michael
Brandon-Bravo, Martin	Hicks, Robert
Brinton, Tim	Higgins, Rt Hon Terence L.
Brooke, Hon Peter	Hill, James
Brown, M. (Brigg & Cl'thpes)	Hind, Kenneth
Bruinvels, Peter	Hirst, Michael
Bryan, Sir Paul	Hogg, Hon Douglas (Gr'th'm)
Buchanan-Smith, Rt Hon A.	Holland, Sir Philip (Gedling)
Buck, Sir Antony	Holt, Richard
Budgen, Nick	Hordern, Sir Peter
Bulmer, Esmond	Howard, Michael
Burt, Alistair	Howarth, Alan (Stratf'd-on-A)
Butcher, John	Howell, Rt Hon D. (G'ldford)
Butler, Rt Hon Sir Adam	Hunt, David (Wirral W)
Butterfill, John	Jenkin, Rt Hon Patrick
Carlisle, John (Luton N)	Jessel, Toby
Carlisle, Kenneth (Lincoln)	Johnson Smith, Sir Geoffrey
Carlisle, Rt Hon M. (W'ton S)	Jones, Gwilym (Cardiff N)
Cash, William	Jones, Robert (Herts W)
Channon, Rt Hon Paul	Jopling, Rt Hon Michael
Chapman, Sydney	Kellett-Bowman, Mrs Elaine
Chope, Christopher	Key, Robert
Clark, Sir W. (Croydon S)	Knowles, Michael
Clarke, Rt Hon K. (Rushcliffe)	Lamont, Norman
Clegg, Sir Walter	Latham, Michael
Cockeram, Eric	Lawler, Geoffrey
Conway, Derek	Lawrence, Ivan
Coombs, Simon	Leigh, Edward (Gainsbor'gh)
Cope, John	Lennox-Boyd, Hon Mark
Cormack, Patrick	Lewis, Sir Kenneth (Stamf'd)
Corrie, John	Lightbown, David
Couchman, James	Lilley, Peter
Cranborne, Viscount	Lloyd, Peter (Fareham)
Currie, Mrs Edwina	Lord, Michael
Dickens, Geoffrey	Luce, Rt Hon Richard
Dorrell, Stephen	Lyell, Nicholas
du Cann, Rt Hon Sir Edward	McCrindle, Robert
Dunn, Robert	Macfarlane, Neil
Durant, Tony	MacKay, Andrew (Berkshire)
Dykes, Hugh	MacKay, John (Argyll & Bute)
Edwards, Rt Hon N. (P'broke)	Maclean, David John
Eggar, Tim	McNair-Wilson, M. (N'bury)
Evennett, David	McNair-Wilson, P. (New F'st)
Eyre, Sir Reginald	McQuarrie, Albert
Fallon, Michael	Madel, David
Farr, Sir John	Major, John
Fletcher, Alexander	Malins, Humfrey
Fookes, Miss Janet	Malone, Gerald
Forman, Nigel	Maples, John
Forsyth, Michael (Stirling)	Marland, Paul
Fowler, Rt Hon Norman	Marlow, Antony
Fox, Marcus	Marshall, Michael (Arundel)
Franks, Cecil	Mates, Michael
Fraser, Peter (Angus East)	Mather, Carol
Freeman, Roger	Maude, Hon Francis
Gale, Roger	Mawhinney, Dr Brian
Galley, Roy	Maxwell-Hyslop, Robin
Gardner, Sir Edward (Fylde)	Mayhew, Sir Patrick
Garel-Jones, Tristan	Mellor, David
Gilmour, Rt Hon Sir Ian	Merchant, Piers
Glyn, Dr Alan	Meyer, Sir Anthony
Goodhart, Sir Philip	Miller, Hal (B'grove)
Gower, Sir Raymond	Mills, Iain (Meriden)
Grant, Sir Anthony	Mills, Sir Peter (West Devon)
Gregory, Conal	Mitchell, David (Hants NW)
Griffiths, Sir Eldon	Moate, Roger
Griffiths, Peter (Portsm'th N)	Monro, Sir Hector
Grist, Ian	Montgomery, Sir Fergus
Grylls, Michael	Moore, Rt Hon John
Hamilton, Hon A. (Epsom)	Morrison, Hon C. (Devizes)
Hamilton, Neil (Tatton)	Morrison, Hon P. (Chester)
Hampson, Dr Keith	Murphy, Christopher
Hanley, Jeremy	Neale, Gerrard
Hannam, John	Nelson, Anthony
Hargreaves, Kenneth	Newton, Tony
Harris, David	Nicholls, Patrick
Harvey, Robert	Norris, Steven

Oppenheim, Phillip	Shaw, Sir Michael (Scarb')
Oppenheim, Rt Hon Mrs S.	Shelton, William (Streatham)
Ottaway, Richard	Shepherd, Colin (Hereford)
Page, Sir John (Harrow W)	Shepherd, Richard (Aldridge)
Page, Richard (Herts SW)	Silvester, Fred
Parkinson, Rt Hon Cecil	Skeet, Sir Trevor
Parris, Matthew	Smith, Sir Dudley (Warwick)
Percival, Rt Hon Sir Ian	Smith, Tim (Beaconsfield)
Pollock, Alexander	Soames, Hon Nicholas
Porter, Barry	Speed, Keith
Powell, William (Corby)	Speller, Tony
Powley, John	Spence, John
Prentice, Rt Hon Reg	Spencer, Derek
Price, Sir David	Spicer, Michael (S Worcs)
Proctor, K. Harvey	Squire, Robin
Raffan, Keith	Stanley, Rt Hon John
Rathbone, Tim	Steen, Anthony
Renton, Tim	Stern, Michael
Rhodes James, Robert	Stevens, Lewis (Nuneaton)
Rhys Williams, Sir Brandon	Stewart, Allan (Eastwood)
Ridley, Rt Hon Nicholas	Stewart, Andrew (Sherwood)
Ridsdale, Sir Julian	Stokes, John
Rippon, Rt Hon Geoffrey	Stradling Thomas, Sir John
Roberts, Wyn (Conwy)	Taylor, John (Solihull)
Robinson, Mark (N'port W)	Taylor, Teddy (S'end E)
Roe, Mrs Marion	Temple-Morris, Peter
Rossi, Sir Hugh	Terlezki, Stefan
Rowe, Andrew	Thomas, Rt Hon Peter
Rumbold, Mrs Angela	Thompson, Patrick (N'ich N)
Ryder, Richard	Thorne, Neil (Ilford S)
Sackville, Hon Thomas	Thornton, Malcolm
Sainsbury, Hon Timothy	Thurnham, Peter
Sayeed, Jonathan	Townend, John (Bridlington)
Scott, Nicholas	Tracey, Richard
Shaw, Giles (Pudsey)	Trippier, David

van Straubenzee, Sir W.	Whitfield, John
Vaughan, Sir Gerard	Whitney, Raymond
Viggers, Peter	Wilkinson, John
Waddington, David	Winterton, Mrs Ann
Wakeham, Rt Hon John	Winterton, Nicholas
Waldegrave, Hon William	Wolfson, Mark
Walden, George	Wood, Timothy
Walker, Bill (T'side N)	Woodcock, Michael
Waller, Gary	Yeo, Tim
Ward, John	Young, Sir George (Acton)
Wardle, C. (Bexhill)	Younger, Rt Hon George
Warren, Kenneth
Watts, John	Tellers for the Noes:
Wells, Bowen (Hertford)	Mr. Donald Thompson and
Wells, Sir John (Maidstone)	Mr. Michael Neubert.
Wheeler, John

Question accordingly negatived.

Question, That the proposed words be there added, put forthwith pursuant to Standing Order No. 33 (Questions on amendments), and agreed to. Mr. Speaker forthwith declared the main Question, as amended, to be agreed to.

Resolved, That this House commends the Government for its positive action to ensure that by 1988 all health districts will have computerised call and recall systems and adequate laboratory back up for cervical cancer screening; and welcomes the establishment of an expert working group to examine urgently the available evidence on breast cancer screening and to propose a range of policy options for implementation within the National Health Service.