Cervical Smears Inquiry (Greenock) (Hansard, 1 November 1993)

§ Dr. Norman A. Godman (Greenock and Port Glasgow)
Madam Speaker—[Interruption.]

§ Mr. George Foulkes (Carrick, Cumnock and Doon Valley)
On a point of order, Madam Speaker.

§ Madam Speaker
Order. The hon. Member for Greenock and Port Glasgow (Dr. Godman) has a good voice, if he tries to use it. Come on!

§ Dr. Godman
I always use my voice properly, Madam Speaker, even when I am being reprimanded by your good self in that charming way.
I shall begin by asking the Minister a serious question because I could argue that I have been misled with regard to a request that I made to him. On Thursday, I asked him for a copy of the response of the Argyll and Clyde health board to the report into the cytology laboratory at the Inverclyde Royal hospital in Greenock. I have an idea that the copy that I received from his office is incomplete. My copy of this important report ends at paragraph 2.5.
I understand that section 3 of the report, which is a response to Dr. McGoogan's report, deals with such matters as discipline and the need for the hospital to be allowed to continue with its application for trust status. I do not believe that the hospital should be given trust status until certain serious concerns involving the management of the hospital are sorted out. I shall welcome the Minister's response to my comment about the incomplete copy of the report that I received from his office. It might have been a genuine mistake, but I am concerned that the report which I have ends abruptly at section 2 of that document.
The Minister and I are here to exchange views on the report of the inquiry into cervical cytopathology at the Inverclyde Royal hospital at Greenock. The four authors of the report are leading experts in their respective fields. They have produced a unanimous report, despite what some members of the health board would have us believe.
Although the Minister and I may disagree profoundly on various aspects of the report, I think that we are at one in our concern to ensure the restoration of public confidence, not only in Inverclyde Royal hospital in Greenock but in the national cervical smear test programme. I am sure he agrees that that confidence, which has taken about four decades to build up, was badly damaged by this scandalous affair at Inverclyde Royal hospital.
When the misreporting of smear test slides was first reported six or seven months ago, not only my constituents but those of my hon. Friends the Members for Dumbarton (Mr. McFall) and for Renfrew, West and Inverclyde (Mr. Graham) and those of the hon. Member for Argyll and Bute (Mrs. Michie) were deeply dismayed at the board's admission that something had gone terribly wrong. We all have a duty to restore public confidence in the hospital and to restore the morale of its staff.
However, we should not allow this scandalous affair to be swept under the carpet. Ten days ago, Mr. Robert Reid, the chairman of the Argyll and Clyde health board, urged us all to set this unfortunate incident behind us. Mr. Reid's "unfortunate incident" was described to me by an angry, 127 distressed woman constituent as "this bloody scandal." That is a graphic but accurate description, while Mr. Reid's description is in itself unfortunate.
Thousands of smear test slides were misread by hospital employees who, as the report states in page 56, paragraph 6.25 worked in a laboratory which was known to have been over-worked, under-staffed, antiquated and isolated. Senior medical staff and senior health board officials knew that, but nothing was done about it.
In our surgeries women constituents have told us about having to go back for fresh smear tests. Some of them had to undergo hospital treatment. Is that the way to run a hospital? Is no one to be disciplined over this affair?
The Minister knows that the bruising of local confidence in the hospital was exacerbated by a recently highly contentious and controversial television programme about the hospital. In the interests of patients and hospital staff, we need an independent inquiry into the management of the hospital. That view is shared by many of my constituents and others elsewhere in Inverclyde.
Last week I received a letter from a young woman employee at the hospital. The letter states: The recent incidents which have resulted in bringing Inverclyde Royal under the public spotlight have further demoralised staff and undermined patient care. At the IRH all staff regret this. Only full independent investigations into all areas of concern will restore public and staff disquiet. I am quoting accurately, but I think that the young woman means that such investigations will restore public and staff confidence in the hospital. The letter continues: One welcome first step is the decision to refer surgical procedures to the Royal College of Surgeons. That young employee is referring to a decision by the Argyll and Clyde health board to invite members of the Royal College of Surgeons in Glasgow to conduct an inquiry into surgical services at the hospital in response to the television programme. I understand that the president of the college, Professor Donald Campbell, declined the invitation on the ground that such an investigation was impossible to conduct unless it was properly constituted. I quote from the Greenock Telegraph of 27 October: In my view an independent inquiry would lead to the hospital being given a clean bill of health.

§ Mr. John McFall (Dumbarton)
Will my hon. Friend give way?

§ Dr. Godman
My hon. Friend told me prior to the debate that he wished to contribute, but in the hurly-burly at the start of my remarks I forgot to ask the Minister for his agreement to that.

§ The Parliamentary Under-Secretary of State for Scotland (Mr. Allan Stewart)
indicated assent.

§ Dr. Godman
I ask my hon. Friend to be brief.

§ Mr. McFall
My hon. Friend will be aware that, in my constituency last year, 1,000 smear tests were sent to the Inverclyde Royal hospital. Does he agree that the public will be satisfied only if some disciplinary action is taken at board level?
On Friday 5 April last year, I had an interview with the district manager of my hospital. He subsequently told me that at that time he had known of the problem with the smear tests, but had decided not to convey that information 128 to me, the Member of Parliament. Instead, he waited a month before doing so. Does my hon. Friend agree that the procedures within the board are wrong and that something has to be done—and the Minister must undertake it—so that public confidence can be restored?

§ Dr. Godman
I agree with my hon. Friend. As I said earlier, this sorry affair, which has caused so much distress and anxiety among so many women in Inverclyde and elsewhere, should not be seen merely as an unfortunate incident that is now behind us. One question that I wish to put to the Minister, which has been prompted by my reading of the report, is what procedures exist to enable senior managers and, indeed, the Scottish Office to monitor the wrongful, careless or neglectful conduct of senior consultants and, just as important in such a matter, senior hospital administrators. Are those people above discipline? They certainly appear to be above resignation.
I have the greatest respect for the doctors, nurses and ancillary employees at the hospital, the overwhelming majority of whom provide a superb service for their patients. However, there are serious problems with the management of the hospital, and that needs to be examined. I therefore repeat my first question: what procedures exist to allow for the vigorous examination of inappropriate, careless or neglectful conduct by senior consultants, medical administrators or health board officials?
I want to ask the Minister a number of questions, to some of which I have already alerted his staff. Dr. McGoogan and her colleagues say on page 9 of their report: The high false negative rate is not the responsibility of one individual alone but can be attributed to deficiencies in … the approach of the Argyll and Clyde Health Board to cervical screening and to the staffing and operation of the laboratory. In no way do I want a witch hunt of the two individual senior medical people who have direct responsibility. The ultimate responsibility rests with senior management and the board.
On the question of discipline, I accept what the Minister of State, Lord Fraser of Carmyllie, said when I demanded the resignation of the chairman of the board and other disciplinary measures. He wrote: As to disciplinary action against senior staff this is a matter solely for the Board. You will appreciate that the Secretary of State could have an appellate role where senior staff are concerned and it would be inappropriate for me to offer any further comment. However, we should not allow Ministers to make that sort of statement without conducting some sort of investigation and seeking some response from the board about disciplinary measures.
Paragraph 4.8.7 on pages 31 and 32 of the report states: As at 25th August 1993, one hundred and fifty-two women with results other than negative"— in other words, with results other than normal— and seven hundred and forty-four women with normal results remain untraced. I am deeply concerned about that former group—those whose smear tests displayed some form of abnormality but who had not been traced as late as the end of August. What is the Scottish Office doing by way of urging the health board to take every measure to locate each and every one of those 152 women? Naturally it is my hope, and I am sure of all hon. Members present, that each and every one of them will be given a clean bill of health.
129 The board, assisted by the Scottish Office, must make every effort to trace those women. If the Minister can say tonight that they have been traced and cleared, no one will be happier than me. Some of those women could be in danger and they must be traced.
Similarly, it is essential that the 744 women with normal results come forward for proper smear tests. I am sure that I have the Minister's support in that matter.
It appears that the board was less than helpful to Dr. McGoogan and her colleagues. The Minister may dispute that, but paragraph 5.2.5 on pages 34 and 35 of the report states: A request was made for smears to be rescreened and for the histology reports and slides to be reviewed at Inverclyde Royal Hospital to verify the diagnosis and stage of the disease. Despite repeated requests, the information does not link the date and stage of diagnosis of invasive cervical cancer to previous smear reports from these individual women. I hope that the Minister will address that aspect.
Despite all the criticisms levelled against Dr. Stanworth, paragraph 6.4 of the report states: Dr. Stanworth's diligence was also apparent in her willingness to work long hours often without remuneration and at the expense of her own private life. That individual was engaged in incredibly onerous and difficult work. Together with the Minister for Health, I spent half a day in Dr. McGoogan's laboratory and received some indication of the difficult nature of the work. Dr. Stanworth was working for the health board unpaid—that is how the board treated that loyal servant.
As to acceptance by the Under-Secretary of State for Scotland and by other Ministers in the Scottish Office of the report's recommendations, the Under-Secretary of State stated last Thursday, in answer to a written question of mine, that he and his colleagues accepted the seven recommendations directed at the Scottish Office.
Perhaps the Minister will say something about the need rapidly to implement the recommendation in paragraph 6.36 on page 60 of the report for a national health education programme to improve understanding of the benefits of regular screening. The Scottish Office has accepted that. At Thursday's sitting of the Scottish Grand Committee, I said how pleased my hon. Friend the Member for Renfrew, West and Inverclyde and I were with the many courtesies shown to us by the Minister. However, I am sure that my hon. Friend—who has many thousands of constituents involved in this sorry affair—will agree that we need a national health education programme.
I know that difficulties are involved in bringing the various specialists together; but it seems to me that such a programme is needed, in the light of what has happened at Inverclyde Royal hospital and, more recently, the taking of smear tests in Gateshead and elsewhere in England. It is needed to persuade women to return to the smear-test programme. Confidence has taken a battering. I hope that the Minister will spend a moment or two replying to that question.

§ Mr. Thomas Graham (Renfrew, West and Inverclyde)
As my hon. Friend knows, there has been much concern about the problem, and about the lack of confidence experienced by many women in our area. It is important for the Government to recognise that, and to provide enough money to persuade women to ensure that they do not miss tests but follow them up and have 130 confidence in them. I am also worried—as I know my hon. Friend is—that clinicians seem to be getting out of some of the accusations scot free.

§ Dr. Godman
I thank my hon. Friend for his intervention.
I am sure that the Minister will support what I am going to say now. The cervical smear test programme is very important in its own right. Cervical cancer is easily detectable in its precursor stage and it is essential that women's confidence in the programme is restored. I hope that every hon. Member supports me in that view.

§ The Parliamentary Under-Secretary of State for Scotland (Mr. Allan Stewart)
I congratulate the hon. Member for Greenock and Port Glasgow (Dr. Godman) on obtaining an Adjournment debate on a subject that is of great importance to his constituents, but whose wider importance is shown clearly by the attendance of my hon. Friends the Members for Dudley, West (Dr. Blackburn), for Ayr (Mr. Gallie) and for Edinburgh, West (Lord James Douglas-Hamilton), and the hon. Members for Glasgow, Maryhill (Mrs. Fyfe), for Dumbarton (Mr. McFall), for Glasgow, Provan (Mr. Wray), for Renfrew, West and Inverclyde (Mr. Graham), for Argyll and Bute (Mrs. Michie) and for Moray (Mrs. Ewing).
I entirely agree with what the hon. Member for Greenock and Port Glasgow said about the importance of reassuring women—not just in the Inverclyde area, but nationally—about the smear test programme. Because time is limited, I will not go into the details of the background to the action taken by my right hon. Friend the Secretary of State and my right hon. and noble Friend the Minister of State. As the hon. Member knows, the inquiry was announced under the independent chairmanship of Dr. McGoogan on 28 April. Its findings were made public, and—as I will explain to the House—are being implemented.
I hope that the House will agree that, by announcing that independent inquiry, the Government demonstrated that they wished to move quickly to explain the position to the general public and to offer the reassurances whose importance hon. Members have rightly emphasised.
I am happy to reassure the House that, as at this date, none of the women concerned were found to have invasive cancer. I agree with the hon. Member for Greenock and Port Glasgow about the stress of the exercise, but I hope that the House will be reassured by that outcome.
I am sure that the House will accept that the inquiry team completed its task despite a demanding time scale, beginning work in early May and publishing its report on 9 September. The report has been widely distributed throughout Scotland, the United Kingdom and worldwide. As hon. Members know, a copy was placed in the Library.
The report should reassure women in Scotland of, first, the health benefits of regular smear testing and, secondly, that implementation of the recommendations will reinforce the already high standard of the screening programme in Scotland.

§ Mrs. Maria Fyfe (Glasgow, Maryhill)
Will the Minister give way?

§ Mr. Stewart
I shall give way, but I am sure that the hon. Lady will appreciate the pressure on time.

§ Mrs. Fyfe
Will the Minister give the time scale within which the recommendations will be implemented?

§ Mr. Stewart
I give the hon. Lady the general assurance that the Government are determined to ensure that progress on implementation proceeds as quickly as circumstances will allow, with continual monitoring of progress. May I spell out what that means in detail?
The report's recommendations fall into three main categories—those directed at the Scottish Office Home and Health Department, those directed at the health board and those directed at its laboratories. The aim is to implement these as quickly as practicable. The process involves consultations and discussions with professional bodies, health bodies and trusts on the details.
Of the seven recommendations directed to the Scottish Office Home and Health Department, we have already announced that we shall set up a central co-ordinating unit for cervical screening on similar lines to that in place for the Scottish breast cancer screening programme. That will be funded centrally, at an estimated cost of£100,000 per annum. There is a guarantee on the future of the proficiency testing scheme, which costs an estimated£20,000 per annum and is an important element in maintaining standards of smear testing in all NHS laboratories.
We are preparing and will issue guidance to health boards, trusts and their laboratories on proposals in respect of training, staffing—including grading and staffing levels—health education and the rationalisation of laboratories.
The hon. Member for Greenock and Port Glasgow asked in particular about health education. I confirm that discussions have already taken place with the Health Education Board for Scotland on promoting a national health education programme to improve awareness of the benefits of regular cervical screening. The results of the discussions will be reported to the House in due course.
We are now working to finalise the membership of the working groups, which will address quality control and guidelines for training techniques in smear taking, staffing and the rationalisation of laboratories. The handling of perceived reporting discrepancies, as I told the Scottish 132 Grand Committee, will be looked at in the light of the report of the Calman committee, which was set up following the problem in Birmingham.
On the recommendations directed to the board and its laboratories, the hon. Member for Greenock and Port Glasgow will know that the health boards set up a task force headed by a senior health board member. It has produced an interim report, and a formal report was submitted on 27 October to the chief executive of the management executive. He is studying its contents and will closely monitor implementation.
I confirm that the board has already implemented the recommendations which ensure that monitoring and evaluation include the comparison of statistical returns and an audit of the screening history of all new cases of squamous carcinoma of the cervix and that all aspects of quality assurance are exercised in the laboratory and funded accordingly. The board has confirmed that it will make provision for continuing education for technical and medical staff of non-training grades and that a person in each hospital should ascertain that all staff make use of it.
The board accepts all but two of the remaining recommendations directed at it and proposes to implement them once a further investigation of possible options and alternatives has been fully carried out by a health board working group. The board considers that the two recommendations will require a longer period of implementation but they have been accepted by the board.
I am aware that, in the time available, I have not answered every detailed question asked by the hon. Member for Greenock and Port Glasgow, but I assure him that I shall write to him with those detailed answers. I shall, however, respond to the very important question about the number of women still to be traced. There are 69 women still to be traced, 53 of whom are thought to be in the United States. The board is liaising closely with the United States' authorities and following up addresses of women and their relatives elsewhere in the United Kingdom.
The motion having been made after Ten o'clock and the debate having continued for half an hour, MADAM SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
Adjourned at nine minutes to Eleven o'clock.