§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Lightbown.]
12.50 am§ Mr. Terry Fields (Liverpool, Broadgreen)Cervical cancer is cancer of the neck of the womb, or the uterine cervix. It is one of the most common causes of the premature death of women. Over 2,000 women die unnecessarily of cervical cancer every year. Those deaths are preventable, provided that adequate screening techniques are used and women receive appropriate treatment. It is important to note that it is incorrect to assume that only older women are at risk. A woman beomes at risk when she begins sexual intercourse, which varies widely from person to person. Therefore, there should he no minimum age limit for women requesting a first smear, and publicity should he given to the need for screening from at least the age of 20.
In 1972, 15 per cent. of all women with cervical cancer were under 34. By 1982 that figure had risen to over 25 per cent.—it is on the increase. In 1987 the Liverpool area health authority revealed that, during the 21 months between March 1983 and December 1985, nearly 800 cervical smear test slides had been passed as "normal", when in fact abnormalities were present which required further investigation. The health authority decided that 487 should be recalled. One hundred of those people have since received, or are receiving, treatment and some have had hysterectomies. One can imagine the distress and worry if one's wife, daughter or grandchildren, or if my wife, had that problem. Tragically, there have been reports of at least one death—in the constituency of my hon. Friend the Member for Liverpool, West Derby (Mr. Wareing)—if not more, within the Liverpool area.
Once the error was discovered, the Liverpool health aurthority acted swiftly to trace most of the women. However, about 50 women have yet to be traced. Some have left the area. Others, for whatever reason, have refused to come forward. This incident illustrates how the value of a screening programme can be undermined by behind-the-scenes processes that most people take for granted. The validity of analysis techniques and skills are crucial to the effectiveness of screening for cervical cancer.
The error, which puts hundreds of Liverpool women at risk, must be thoroughly investigated and the findings acted upon by providing screening services throughout the country. The internal review conducted by the Liverpool health authority is totally inadequate for that purpose. For instance, representatives of the community health council have not been allowed to attend the inquiry, even as observers. Health workers called to provide information cannot be compelled to attend. More important, only the inquiry's key findings will be made public. This is done by administrators—place men and women put in by this Tory Government to cut funding to the Health Service, while they are on fat salaries for carrying out the Government's diktats. In those circumstances, there will he no self-criticism from those people or condemnation of their so-called professional performance. Clearly, any irregularities or criminality found will lead to compensation, but the Liverpool people fear that there will be no condemnation from those people.
The evidence presented by workers to the inquiry has shown that members of trade unions did as much as they 488 could within the constrictions of their professional code of ethics to alert their seniors to the problem. They expressed disquiet. A few union members are not in favour of the public inquiry for which I call because they are aggrieved by the fact that following their previous ordeal, they would have to reappear before the same committee. The reason why they are reluctant to get involved in another inquiry is the way in which the inquiry has been conducted to date. It is my opinion that it has been most unsatisfactory, unjust and unequal. The medical staff — that is, the higher echelons in the pecking order — have each engaged legal representatives, who are allowed to intervene and to cross-examine witnesses, but the same facility has been denied to the union representative, who has been allowed to be present, but only as an observer.
The inquiry has currently been adjourned but will reconvene on 30 July. Perhaps the ground rules will be amended to allow trade union representation and legal representation. However, that is by no means certain at this stage. In any event, it may be too late to make any difference to the outcome of the inquiry, given the evidence that has been presented to date and the results that will ensue.
My view is that the union should have withdrawn from the inquiry when the unequal treatment became obvious. However, the representative concerned at the time felt that he had been asked to observe by his Members and to offer them moral support and he was faced with a difficult choice. I offer no criticism of his performance. However, by participating, the union has given credibility to a behind-closed-doors inquiry, which is what this health authority inquiry is.
The two most vital things that are required from tonight's debate are a public inquiry and a national quality control scheme to report on the smears. That will ensure that monitoring, of the results is carried out, perhaps externally from the Liverpool health authority in this case. At present, the results and the analyses are often left to the clinical judgment of a single pathologist. We demand that stringent controls be placed on the commercial laboratories that carry out such work. Many authorities send the work abroad, making democratic control even more difficult, if not impossible.
The public should be aware that there are widely differing opinions, even in the medical profession, about the usefulness of cervical cytology screening and the type of reporting systems that should be used. That deserves to be debated publicly, because at present many women assume that a single, unified system is in operation. They would not have questioned that in this case nor in the cases of other incidents that have been reported nationally.
Other abnormalities have been taking place in cancer screening in the Liverpool area. As a background to this case we can discuss the unevenhandedness of what is happening. One young women applied for legal aid to take her case forward, to be allowed to make representation and, if necessary, to have legal redress in the event of maladministration in the Liverpool area health authority. However, that has been denied to her because on the analysis of legal people in the Law Society, damage in excess of £500 has not been done to her because of the laser treatments that she has received. On that argument, she could have received the same laser treatment two years ago and has not, therefore, necessarily suffered to the amount of £500. If that is the value placed on the dignity of human life, and especially on women, as dictated by today's caring 489 society, it is time that we put a stop to it, and this inquiry should expose what has taken place and the treatment of those women.
On the financial side of the appeal that this women will make, in consultation with the community health council and the Liverpool Labour Women's Council, if all else fails, we shall set up a fund and challenge the rulings of the Law Society in this case. We shall take this matter right through the courts on behalf of the women of Liverpool who have been so affected by this maladministration in the Liverpool area health authority.
One of my constituents was diagnosed as suffering from cervical cancer in January. In February it was confirmed, but this woman must wait until December before she can start to receive initial treatment to combat that potential killer disease. A young woman, whom I know personally, went to a Liverpool hospital because of lumps on her breasts and was examined in a linen or broom cupboard in the hospital. Incidentally, this is happening when we have the first woman Prime Minister in the history of this parliamentary system. That is a scandal and a condemnation of her and her Government. This Government's attitude to women has set the women's movement back many years.
In a written reply on 3 July 1987, the Minister reported that 75 health authorities were now computerised. We are talking about 75 out of 191, which is equal to 39 per cent. of all area health authorities. That means that the other 61 per cent. are not computerised. The Minister also reported that 19 of those 75 health authorities had call and recall systems. That means that 9 per cent. of the 191 authorities are attempting to deal with the problem of cervical cancer. I have to say to the Minister, in all honesty, that the people whom I represent and who have been in contact with me believe that this is an exposition of scandalous complacency by a woman Minister dealing with a problem that affects the nation's women.
In the case of the 500 Liverpool women, more concern was shown for older women. As I said, women have shown signs of being at risk at the age of 20, but older women were given preferential treatment in Liverpool because the consultant involved did not consider that the mild abnormalities in young women merited a repeat test to find out what they meant.
I am making 10 demands on behalf of the women's council, the community health authorities in the Liverpool area and Liverpool women. First, we want a national, integrated, National Health Service-based call and recall cervical cancer screening service, because there are many regional variations and we want this to apply to all women. Secondly, we want mobile screening units to visit estates and shopping centres to provide easy access for women. Thirdly, the system should not depend upon women volunteering for smears. It is important that health authorities actively seek out women, especially those known to be in high-risk groups.
Fourthly, screening facilities should be made available at the workplace, or time off allowed to allow women to visit a clinic who could not do so in normal circumstances. Fifthly, we want a full system of Well Woman clinics opearating round the country to provide resources and back-up for women in need. Sixthly, we want women doctors available wherever possible to carry out these tests. We are not being sexist about this, but the experience 490 of the Liverpool women has distressed and upset them, and they thought that they would have been better served if they had had women doctors to attend to them at such a trying time.
Seventhly, we want follow-ups to be done with sensitivity. A call for a repeat smear test may be due to a breakage or technical problem. and giving that information could reduce anxiety in many women waiting for a repeat visit. Eighthly, we want to ensure that the most up-to-date equipment is available. For example, it has recently come to light that the type of spatula used to take the smear is critical, and in many instances it is not used correctly. Ninthly, we want counselling for the women involved, because of the trauma and worry through which they must go. Those who have been told that they have cervical cancer should not be left to their own devices, feeling some social stigma. We want back-up counselling.
Tenthly, we are actively opposed to the privatisation of any NHS services and support the public ownership of supplies to the NHS. Labour Members, and especially I and my colleagues here tonight, will campaign in our party for democratic control over the Health Service; but, more important, when we are looking for finance, we will go to the drugs and chemical industry and the vast profits that it makes out of the misery of people—in this instance, of women — and put those resources back into the Health Service to ensure that women are taken care of at the point of need.
In the past 24 hours I have consulted some of the women involved in these cases. I asked them, "If you had the facility of addressing Parliament and demanding the inquiry, which you have asked me to do, what points would you make?" they said that the mistakes should have been discovered earlier. Why did it take so long to call them back when the proper procedures should have been carried out? They want to know the truth, but they cannot be sure that they will be given the truth if the inquiry is not held in public. They need to be sure that the mistakes will not happen again. They say that they are not after anyone's blood—they just want to know what went wrong.
The women of Lverpool are really scared about going for a smear. They do not feel sure that they can believe that a negative result really means that they are OK. They need to be sure that the mistakes will never happen again.
I believe that a petition was delivered to the Minister yesterday.
§ The Parliamentary Under-Secretary of State for Health and Social Security (Mrs. Edwina Currie)indicated dissent.
§ Mr. FieldsWell, a petition came down from Liverpool. Perhaps the Prime Minister has it tucked away with some of the other petitions that we have brought down from Liverpool. The petition delivered yesterday is symptomatic of the depth of feeling among Liverpool's women and it represents the views of the women of the Liverpool central, southern and eastern community health councils. It also represents the feelings of the Liverpool women's Labour council. The campaign has just started and although we may be talking about some 3,000 names on that petition, the organisation is well in place to take this matter forward, perhaps into a national campaign.
We ask the Minister to respond in a positive way. We are asking for an open inquiry so that women can feel that 491 the information about the causes of the incident and the remedies to prevent its recurrence will be undertaken, as it has national implications. It is only in that way that confidence in the national cervical cancer screening programme will be restored. That is essential if women's lives are to be saved by the early detection and treatment of pre-cancerous conditions.
My comrades and I believe that the nation's women deserve better treatment than they get from this Government. As I have said before to the Minister, she should not chide and harangue us. She knows what is wrong in these circumstances. If the Minister wants to make a name for herself and wants to do something on behalf of the nation's women she should take hold of this issue. The Minister should go along with us to ensure that there is a public inquiry. Women would be grateful that a woman in Parliament has done something positive to alleviate the sufferings, the worry and the hardship that they presently face under the existing system operated by the Government.
In conclusion — I hope that the Minister does not take too much offence — there are too many people posing as professional Scouses. She comes from up there and she should do something for that place instead of sitting here criticising us all the time.
§ 1.7 am
§ The Parliamentary Under-Secretary of State for Health and Social Services (Mrs. Edwina Currie)I congratulate the hon. Member for Liverpool, Broadgreen (Mr. Fields) on his success in the ballot. He has raised some important questions on behalf of his constituents and, indeed, many women. I shall attempt to answer them.
The main events of this case took place in Liverpool between 1983 and 1985. I hope that the hon. Gentleman will accept that those events are not and should not be subject to party politics. I share with him and with colleagues on both sides of the House their concern about these events and their determination that we should put things right and learn from events to ensure that the same thing does not happen again. I am sure that that concern is also shared by the trade unions that he quoted at some length.
The hon. Gentleman mentioned that he thought that there had been cuts in the Health Service in Liverpool. However, I must put on record that the gross revenue of the Liverpool health authority for 1982–83 was £114 million——
§ Mr. FieldsDo not play the same old record.
§ Mrs. CurrieIn 1987–88 the initial cash allocation was £144 million. The number of in-patients treated in 1982 was 80,000 and that figure increased to 88,000 in 1985. I am especially pleased to note that there have been considerable improvements in gynaecology. It is worth giving that information as part of the background to this case.
The hon. Gentleman may know that, yesterday, at the request of his hon. Friends the Members for Birkenhead (Mr. Field) and Liverpool, West Derby (Mr. Wareing), I met Mrs. Lily Hopkins of Fazakerley, who is one of the women tested in 1983 and subsequently shown to be in need of treatment. I admire her common sense and courage. She is now undergoing treatment and is in good 492 hands. She has been contacted by various other women and has helped make their feelings known. I am glad I had the opportunity of meeting her, and I have asked the Liverpool health authority to take their views into account.
May I say to the hon. Gentleman that he has made one or two errors of fact in his description of cervical cancer. First, we give publicity to the fact that women from the age of 20 onwards—indeed any woman who is in the at-risk group, which the hon. Gentleman accurately described—may come in for a smear test. Indeed, if there is any clinical suggestion that a woman needs a smear test more regularly than the recommended period, it is for her practitioner to advise her and that test is available to her.
According to the hon. Gentleman's own figures, about 75 per cent. of cases are older women. Therefore, we continue to regard the reaching out to older women as a top priority. He said that this was on the increase. It is not. Thank goodness, it is going into slow decline. There is a steady but small decrease in the number of women now dying from cervical cancer, but I share the hon. Gentleman's feeling that it is nowhere near enough and I look forward to seeing a substantial reduction, hopefully along the lines achieved in the Scandinavian countries.
Let me now respond to the 10 points that the hon. Gentleman mentioned as being the requirements of the ladies in Liverpool. I agree with him absolutely on items 3, 6, 7, 8 and 9. We already have the requirement in item 1 or are working closely towards it. I would actively encourage item 4. Items 2 and 5 are matters for the local health authorities. If they wish to organise their services in that way, I would welcome it. I note item 10.
Let me comment further on the events in Liverpool. As the hon. Gentleman knows, on 15 January 1987 the Department was informed by Mersey regional health authority of the concern within Liverpool health authority about the results of tests on cervical smears carried out at the Women's hospital in Liverpool between March 1983 and December 1985.
During this period it appears that 911 tests were misinterpreted, reporting them as negative when, in the light of a recent preliminary re-examination of the slides, many showed evidence of abnormal pathology. During this period some 45,000 cervical cancer smears were examined at the Women's hospital.
The slides of 911 women had to be re-examined. Or these, 300 were eliminated because their slides were found to be normal after the second review; a further 103 women were eliminated by hospital records which showed them as having had further tests or treatment; another 21 women had been married since 1983 and had had a second smear under their married name; and 487 were identified as requiring further investigation or treatment. Of these 487. 437 have already been seen and every effort is being made by the health authority to continue to trace the remaining 50 women who have moved house at least once since having their smear between March 1983 and December 1985.
I became involved in the early weeks of 1987, when I indicated my full support for the plan of action by the health authority. This has included a complex programme of contacting all the women affected and making available whatever facilities and staff were required. The matter was given top priority and received the ready co-operation of consultant gynaecologists, GPs, nurses, laboratory and support staff.
493 The women have been contacted through their original referral agents — either the GP or clinic they were attending. They have been invited to attend a clinic for advice and, if necessary, examination, repeat smear test, colposcopy or other form of clinical investigation as appropriate, except where this has already taken place. As many as 50 per cent. of the women affected were, or had been, under the care of a gynaecologist already and were therefore already receiving whatever care or treatment was required.
§ Mr. Robert N. Wareing (Liverpool, West Derby)The figures the hon. Lady has given are all very well. Nevertheless, the wife of one of my constituents died as a result of cervical cancer which was diagnosed in September 1984, even though that lady's last smear had been as recent as May 1984. What procedures exist to discover that sort of mistake? Surely the mistakes to which my hon. Friend the Member for Liverpool, Broadgreen (Mr. Fields) has referred should have been discovered as early as September 1984 when that lady's diagnosis was made.
§ Mrs. CurrieI am doing my best to set out exactly what the health authority has been doing. It is as well to put on record exactly what has been going on.
A special community tracing task force was set up in February this year by the Liverpool health authority involving community physicians, nurses and health visitors to make contact with any woman who was sent advice but who failed to respond. A knock-on-the-door approach was also carried out when no response had been registered. This follow-up part of the contact programme has located women in various parts of the United Kingdom and in countries abroad, including Australia, Bahrain, West Germany and Spain.
Some of the women unable to be traced so far have had their cervical smears referred to the Women's hospital from the Bedford clinic — the abortion clinic within Liverpool health authority—and it is possible that they have tried to conceal their identities, perhap by giving false names and addresses.
Nevertheless, the health authorities are continuing to pursue the matter of the women whom we have not found so far. I must say at this point that I have been very impressed with the efforts of Liverpool health authority since this problem came to light. It has put the patients' interests first and have acted with commendable speed and thoroughness. I know that it will continue to make strenuous efforts to trace the remaining women. In the meantime an independent and rigorous review of the 911 slides is being carried out under the direction of a distinguished professor of histopathology, in order to assist the health authority in its inquiries.
§ Mr. Fieldsrose——
§ Mrs. CurrieI met last night the chairman of the Liverpool district health authority, Mr. James Fitzpatrick and his district general manager Mr. Mike Collier, and am most grateful for the time they gave me. They have set up a review, whose terms of reference would, I believe, answer the points made by the hon. Gentleman's constituents. The first term of reference is to inquire how cervical cytology tests were processed from receipt at the laboratory between March 1983 and December 1985, to the point at 494 which advice was submitted to a gynaecologist, a general practitioner or a clinical medical officer. The second is to assess the methods used to ensure a consistently high standard of reporting. The third is to inquire into the reasons for the delay in the doubts surrounding the suspect test results coming to light. The fourth is to assess whether improved management arrangements should be implemented, and the fifth is to make recommendations in the light of these terms of reference. The review is chaired by Mr. Fitzpatrick and has two other members of the health authority, neither of whom, as far as I know, have the fat salaries that have been mentioned. It includes a consultant pathologist from outside the Mersey region, nominated by the Royal College of pathologists, Dr. John Burston.
§ Mr. Fieldsrose——
§ Mrs. CurrieI heard what the hon. Gentleman said—and I know that it was also requested yesterday by Mrs. Hopkins—about a public inquiry, publication, holding discussions on the matter in public and so on. Such calls are, as yet, premature. Until the review team has finished conducting its work and has reported to the Liverpool health authority I suggest that the hon. Gentleman holds fire. He alleges that there will be no self-criticism, but that is to prejudge the conclusions of the review. It is wise, as the review is expected to report shortly, first to see what it comes up with. I shall ensure that all those views are passed on.
As for court cases, I am sure that Opposition hon. Members are aware that, to date, two women have taken out High Court writs against the Liverpool health authority, and another 48 women have registered claims against the authority through their solicitors.
In all the cases and events that we have been discussing, we should put on record the fact the hon. Gentleman's constituents, working for the Liverpool health authority, have been making a big effort to improve their services to women, both because of pressure from the Government and because they believe it to be right. Liverpool health authority has developed its smear testing system and the treatment and laboratory facilities to back it up. There are no backlogs in Liverpool; it keeps within the one-month target, even with a huge throughput. It was the first district in the Mersey region to operate the computerised call and recall system, which has been in operation since 1 April. Last year, almost 17,500 smears were dealt with in that laboratory, of which some 1,500 were picked up as requiring further investigation. In other words, these efforts have ended, not in failure, but in a substantial detection of early cancer and pre-cancerous conditions, and thus in the saving of many lives of Liverpool women.
I am asked whether women should have confidence in the system, and the answer is yes. Opposition Members could join us in helping to restore confidence. Many of those who die of cervical cancer have never had a smear. Many are in the older age groups. If they do not have a test, and they allow themselves to be sufficiently put off by the events of several years ago, or by some of the remarks made tonight, the death rate from this preventable cancer will remain high on Merseyside, instead of coming down as it should. Whatever the faults of the Liverpool system may or may not have been, one thing would have been worse—no system at all. I urge any of the missing 495 women to come forward, and I urge those who have never been for a smear to come and ask for the test. That is the message I want to put on record tonight.
§ Question put and agreed to.
§ Adjourned accordingly at nineteen minutes past One o'clock.