HC Deb 14 July 1988 vol 137 cc557-61 3.31 pm
Mr. Keith Bradley (Manchester, Withington)

(by private notice): To ask the Secretary of State for Social Services if he will make a statement on the errors found in the cervical screening tests performed at the laboratories at Christie hospital in Withington, Manchester.

The Parliamentary Under-Secretary of State for Health and Social Security (Mrs. Edwina Currie)

The Christie hospital in Manchester processes some 250,000 cervical smears per year. I understand that it undertakes work for several health authorities, including North Staffordshire.

As a result of a routine check, some doubts were expressed about 60 slides that are now being checked by independent advisers from other regions. I understand that part of the problem relates to the process by which the slides were made, which has made them somewhat difficult to interpret.

I am satisfied that appropriate action has been taken promptly. All the slides were taken quite recently and all the clinicians concerned were notified at once. Where appropriate, repeat smears have been, or are being, taken.

We have complete confidence in the Christie, which has an international reputation in this area.

Mr. Bradley

I am grateful for the answer that the Minister—the junior Minister —has given.

I should like to praise the Christie hospital, which is based in my constituency of Withington, as it is a centre of excellence and I believe that it is one of the best-run laboratories in this country undertaking cervical screening. I have particular praise for Dr. Yule and his staff who have worked under tremendous pressure during the past few years when the financial resources to the South Manchester health authority have been extremely limited.

When the errors—as they have been called—which were identified came to light in north Staffordshire, why were Dr. Yule and his staff not informed of that fact? No discussion has taken place between the Christie laboratories and north Staffordshire about the differences that have been found.

The Labour party welcomes the extension of cervical screening—we have been pressing for that for a number of years—and the regular call and recall of women. It is absolutely essential that resources are made available to ensure that there is reliability and a high standard of staff within the laboratories such as the Christie laboratories. Such reliability should continue, not only in public laboratories such as Christie's, but in the private laboratories to ensure that proper procedures and reliability are maintained. Finally—[Interruption.]

Mr. Speaker

Order. This is a question, not a statement. I appeal to the hon. Member to be brief.

Mr. Bradley

Briefly, when will the Government recognise the pay and conditions of the laboratory staff and ensure that they are adequately funded, trained and maintained in the public sector of public health?

Mrs. Currie

As the hon. Gentleman may well know, since January this year, when a circular was sent out from my Department, all laboratories taking part in the cervical cancer screening system are required to have external policy assessment systems. The standard practice is to do a quality check on one in 10 smears. At the Christie the staff routinely read one in seven. Therefore, their checking procedures, which are of the utmost vigour, set higher standards than are routinely required. The normal practice where there is a dispute between clinicians, as there is in this case, is to call in a third party, and that is precisely what we have done. We wait to see exactly what they will recommend to us, if anything.

The hon. Gentleman may well know that the MLSO training scheme has not until now included specific training for cervical cytology, but it is under consideration. We are keen to standardise both training and qualifications in this area. I am satisfied that it has not been a question of resources but of how the slides were prepared and whether there is any genuine dispute about the results that they might or might not show.

Mr. Churchill (Davyhulme)

Is my hon. Friend aware that her tribute to the excellence of the Christie hospital will be much appreciated by my constituents and people throughout the north-west of England? Will she confirm that the Christie hospital conducts more cervical screening than any other hospital or centre in the country? Is not the suggestion that the specific smears, which have been alluded to as being faulty, were apparently sub-standard, of concern? Was that due to human failure or the failure to provide the correct, most modern equipment for the smears to be taken? As the Christie hospital draws 95 per cent. or more of its patients from outside the South Manchester health authority area, will she seriously consider putting it on the same basis as the Royal Marsden in London, which is its own health district?

Mrs. Currie

It would probably be premature of me to comment on what went on, if anything, in the terms my hon. Friend suggests. The Christie does 250,000 smears a year out of a national total of 4 million. Therefore, it is a major part of our screening programme, as my hon. Friend said, although many of those smears come, not through the screening programme, but through work done on patients who have other conditions. I am sure that my hon. Friend would agree that the woman in danger is the woman who has never had a smear. It continues to be true in Manchester, as in the rest of the country, that the majority of deaths occur in woman who have never been tested.

Several Hon. Members


Mr. Speaker

Order. I appeal for brief questions.

Mr. Tony Favell (Stockport)

My hon. Friend announced that cross-checks have been taken in respect of women who have had smears in north Staffordshire. Can she confirm that cross-checks will be made on samples taken elsewhere, particularly in the north-west, including my constituency of Stockport?

Mrs. Currie

Yes, this is standard practice and we expect first-class internal and external quality control systems to be implemented. I have no information that that is not the case.

Mr. Tony Lloyd (Stretford)

Does the Minister accept that she is wrong when she tells the House that the woman in danger is the woman sho has not had a test? The woman who has had a wrongly diagnosed test is in considerable danger. Can she satisfy the House that this cluster of samples which showed problems is a one-off and has no implications for any other district? As the Minister said, many district health authorities use the good facilities at Christie, but we want to ensure that if mistakes have been made in north Staffordshire, they have not been made anywhere else.

Mrs. Currie

Yes, I am satisfied that this is an unusual incident that deserves the full investigation that it is receiving. I repeat what I said earlier: the women who are in danger are those who have never been tested. Most deaths in this country from cervical cancer among our women are those of women who have never had a smear test. I notice that the lady Members in the House are nodding as I say that.

Mr. John Evans (St. Helens, North)

In view of this morning's press report that the Christie has taken work from large numbers of other authorities, including St. Helens, will the Minister undertake to return to the House with a full statement once she has concluded her investigations? Obviously, a number of women up and down the counry must be worried.

Mrs. Currie

I am satisfied that it is entirely right that the outstanding work at the Christie, which is one of the world's greatest cancer hospitals, with first-class laboratories, should be available to a large number of health authorities. The hospital also acts as assessor for other authorities, which is entirely right and proper. I am satisfied that this batch of 60 slides, which comes from one part of the country and whose problems may be due to the way in which the slides were prepared and not so much to the way in which they were read, is being properly investigated and any cause for concern is being alleviated.

Mr. Eddie Loyden (Liverpool, Garston)

The situation on Merseyside should again exercise the mind of the Minister. If such things happen they will obviously undermine women's confidence in the service, and the women the Minister mentioned who have not had a smear may not trust the system. Should she not be seriously concerned to ensure that there is no recurrence of this sort of thing?

Mrs. Currie

The hon. Gentleman will know of the efforts that my Department made to ensure that the problems in Liverpool were dealt with as promptly as possible once we had been alerted to them. We have learnt the lesson from Liverpool. In part, it was that there was no clear internal or external quality control system. In this case, quality control systems have picked up problems extremely quickly. All the smears that are the subject of dispute were taken within the past few weeks and all the clinicians concerned have been contacted.

Mr. Jerry Hayes (Harlow)

Sadly, cases of this sort will continue as long as we have cytological methods that are slow and up to 40 per cent. inaccurate, and which examine only normal looking cells. Will my hon. Friend do all that she possibly can to divert more resources into research relating to automation and accuracy?

Mrs. Currie

Yes, we are as interested as my hon. Friend in eventually getting some form of automation, especially as we are dealing with 4 million smears a year. I was pleased to note at a recent scientific meeting in the Department that about 13 different proposals were presented to us, some of which looked promising. Getting it right is a slow business; for the time being we shall continue to rely on the excellent people who work in our laboratories.

Mr. Ken Eastham (Manchester, Blackley)

I want to take up the point the Minister made about the women who have not had the test being at greatest risk. Is she satisfied that there is enough expenditure on promotions to encourage women to have the test? Will she assure the House that if there are greater financial needs at Christie hospital and similar hospitals she will ensure that the funding is available to expand the service?

Mrs. Currie

The work in Manchester in particular suggests that one of the key problems in getting people to respond is that the FPC registers are not always accurate. Sometimes that is because the names and addresses of the women concerned have changed and they have not notified their GPs. I met the Manchester family practitioners committee recently. It is taking vigorous steps to update its FPC registers, so we hope that some of the problems will diminish in future.

Ms. Harriet Harman (Peckham)

Will the Minister ensure that when there is a difference between two health districts about the accuracy of smears her Department is called in at an early stage to provide independent assessment? Does she accept the proposal of the Institute of Medical Laboratory Sciences that there should be annual proficiency checks for all cervical cancer screeners as part of a national quality control programme in our laboratories?

Although the Government have numerous procedures for measuring the cost of laboratory services, is it not true that they have no national procedures for monitoring their quality? Will she use national television advertising to give women the confidence to go for a smear test, and will she set up quality control to justify that confidence? Does she accept that there are more likely to be further doubts about the quality of the screening programme in view of the cuts and closures of family planning clinics and the collapsing morale of underpaid laboratory staff? [Interruption.]

Mr. Speaker

Order. This is a private notice question.

Mrs. Currie

In answer to the hon. Lady's first question —and I am sure that she would like to hear the answer —[Interruption.]

Mr. Speaker

Order. These are indeed very serious matters. Let us listen to the answers.

Mrs. Currie

In answer to the hon. Lady's first question, my Department does not itself provide independent assessment. What happens is that the departments that are in dispute are required to call in third party assessment, and that is what they have done from two different regions.

In answer to the second question, we are interested in annual checks on staff proficiency, and we are working together with the profession to see whether it can be introduced. In answer to the third point, that there are no national procedures, let me gently recommend the hon. Lady to go to the Library and read the circular that I issued in January this year. The reference number is HC(88)1. She will find that the procedures are contained in it. [Interruption.] If the hon. Lady has not read it, I am not surprised that she does not know about it.

In answer to the question about television advertising, as 4 million smears are being taken every year it is probably now unnecessary to organise a campaign of that kind. In answer to the last two questions, I do not think there is any reason for doubts of the kind that the hon. Lady has expressed. Opposition Members have called for 20 years for the cervical cancer screening programme to be brought in. We have now done that, and I am satisfied that it will save many lives in future.