§ Sir Peter Emery (East Devon)
(by private notice): To ask the Secretary of State for Health if he will make a statement on the errors in the results of breast screening scans carried out in Exeter and east Devon and give whatever assurances are possible to the many women who are extremely worried about the situation.
§ The Secretary of State for Health (Mr. Frank Dobson)
I thank the right hon. Gentleman for bringing this very serious matter to the attention of the House.
I am determined that the truth should out, and the awful truth is that 12 women who were not referred for treatment after being screened for breast cancer subsequently developed breast cancer, and two of them have died.
More than 12,000 women are screened for breast cancer each year by the Royal Devon and Exeter Healthcare NHS trust and the South Devon Healthcare NHS trust. As a result of that screening, some women are identified as having breast cancer and referred for further tests and treatment; others are told that they need not return for further screening until three years have elapsed; and others are told that they do not need treatment, but should return for earlier screening. The trusts cannot tell me how many women fell into each category, but all 12 of the women to whom I referred were screened, but not referred for treatment.
In February, medical staff at the Royal Devon and Exeter trust expressed concern about women who had been screened and not treated and who subsequently developed cancer. The trust sent details of all 12 cases to the national breast screening centre in Nottingham on 1 April and asked for its advice.
The centre did not reply until 28 May, when it concluded that the 12 women concerned should have been referred for treatment, and recommended an audit of mammograms of all women scheduled for recall earlier than three years; of all women recalled in the past two years; and of all breast cancers that have occurred between screenings in the past five years. None of those audits is yet under way.
The review also recommended that the two doctors concerned should stop screening for the time being, pending further training. A special helpline was established on 5 June for women in Exeter and Devon who want advice, help or reassurance. I understand that the doctors concerned have also been carrying out screening at private hospitals in the area and that a similar helpline has been established.
Breast cancer screening, like other forms of medical screening, has two purposes to identify patients who need treatment and to reassure patients who do not. The breast cancer arrangements in Exeter and Devon have failed on both counts. They have failed to ensure the most prompt treatment for breast cancer and they have given false reassurance. I am not satisfied with the performance of East Devon breast screening service. I have asked the chief medical officer to conduct a preliminary inquiry. If I remain as dissatisfied after that as I am now, I shall exercise my statutory powers to establish an independent inquiry.
794 At the same time, I have asked the chief medical officer to review the breast screening programme nationwide. Women in England deserve a breast screening service on which they can rely to identify cancer when it is present and to give accurate reassurance when it is not. On behalf of the Government, I offer my sympathy to all the women affected by the failure and to their families. Finally, I urge women to continue to attend centres for breast cancer screening, because, whatever went wrong in the south-west, screening remains the best method of identifying breast cancer and ensuring early treatment.
§ Sir Peter Emery
I thank the right hon. Gentleman for his statement, which is most serious and causes me perhaps even greater concern than I had had before I tabled the question. He said that he could not give the exact numbers. Can he either now or in the immediate future publish in the Official Report the number of people who have been recalled for tests; the number of people who have had reassessment carried out; the number of ladies who have had to be recalled for biopsy, which I gather is one of the likely factors; and, equally important, how many of the 36,000 ladies who would have been tested over the three years can be assured that they are not affected? How many mammogram films must be rechecked?
The second part of my question involves staffing. I gather that two doctors have been told to stay away and will be retrained, but how many staff are employed? I gather that there are very few. Inadequate staffing may mean that work will come to a standstill and that it may not be possible to carry out reassessment fully or quickly. What action will the Secretary of State take to overcome that problem?
§ Mr. Dobson
The right hon. Gentleman raises two points. He asked about the extent of screening, the incidence of cancer and the number of women who were recalled. Those are the very questions which I have been asking, on which the trust cannot currently give me an answer—a fact which in itself I find disturbing. On the second point, arrangements are being made for the necessary experts in assessing mammograms to be drafted in to help out in east Devon, to ensure that the service is provided and, in particular, that the reassurance that women in the area will naturally be seeking can be given.
§ Mrs. Linda Gilroy (Plymouth, Sutton)
Does my right hon. Friend agree that his recent welcome announcement of £10 million of additional funding to improve breast screening services, which was obtained by cutting red tape in the health service, will go a long way to ensure that such incidents, which cause such grave anxiety to women in Devon, do not recur?
§ Mr. Dobson
I am pleased that we were able to provide additional resources as we had promised. It remains the case that if proper standards are not being maintained by those responsible for the service, things will go wrong and women will suffer. We must ensure, both through the professions and through the national health service, that the necessary standards are reached.
§ Mr. Stephen Dorrell (Charnwood)
I should like to begin by associating the Opposition with the sympathy that the right hon. Gentleman expressed to the women of the area in relation to this obvious failure of service.
795 The right hon. Gentleman said that he does not know how many cases are being recalled for further audit. Can he therefore confirm that the figure that appeared in last week's press, that 1,900 cases were being recalled for audit, is wrong? Can he further confirm that as soon as he knows how many cases are being recalled for audit, the women concerned will be the first to be told? Is it not the case that one of the most disturbing aspects of the story is that both those women and the doctors concerned first heard about the story through the newspapers? Must it not be the principle of this kind of service that first the patients and, secondly, the clinicians hear about such evidence directly from the hospital and not through the newspapers?
Can the right hon. Gentleman further confirm that it is the second time in three years that East Devon breast screening service has been subject of a review? A review was conducted in 1994 because of concern about the low rate of detection of cancer that was reported from east Devon. Can the Secretary of State tell the House whether the latest report will analyse whether the recommendations of the earlier report were implemented, or whether there are still outstanding recommendations that should have been implemented?
§ Mr. Dorrell
This is a matter not of party politics, but of the health of women in east Devon.
Is it not the case that what has happened in east Devon appears to be a failure of the process of clinical audit? Will the right hon. Gentleman ensure that the said procedures governing the east Devon service are reviewed? Furthermore, will he ensure that the evidence that emerges from that review is used to improve the clinical audit of other breast screening services? We welcome the right hon. Gentleman's announcement that the chief medical officer will analyse the background to what has happened in east Devon. Will he undertake to publish that report when it is available?
§ Mr. Dobson
I shall start with the last question. It is my intention that, once I can verify the facts rather than rely on newspaper reports, all that information is made available to the public, and in particular to people in the south-west.
As for the numbers involved, as I have already explained, the trust is not capable this afternoon of verifying that fact. As I have already said, that in itself is a matter for concern.
I must tell the right hon. Gentleman that the clinicians did know about the matter, because it was they who expressed concern in February about the incidence of cancer among women who had been screened and who had been told that they did not need immediate treatment. The clinicians have been in the picture since February.
As for the record of treatment in east Devon, it is partly because of that background that I am so determined to have a thorough inquiry into what has gone on down there in the years leading up to May this year.
§ Mr. Simon Hughes (Southwark, North and Bermondsey)
First, I associate my colleagues from the south-west and elsewhere with the strong expression of concern from the Secretary of State. I thank him for his clear statement.
May I ask that the review should consider three things that are not concerned with Devon specifically, but which relate to breast screening practice in general? First, will there be resources to provide competent staff who are adequate to the task—radiographers and radiologists—as well as the equipment in all places where screening is carried out? Secondly, will the Calman recommendation be implemented so that the work of widespread screening is matched by that of a breast unit, which will carry out further diagnosis? Thirdly, an obvious point for lay people relates to those who, as in this case, present with clear symptomatic evidence of potential concern, for example, lumps. Will the Secretary of State ensure that the screening process is not the end of the exercise, and that in every case women who contact the health service who are concerned about possible breast cancer are treated and not put behind the queue of women waiting for routine screening? There should always be a second opportunity to look at anyone who presents with any sign of potential breast cancer. It would offer great reassurance if those factors could be considered.
§ Mr. Dobson
On resources, as a result of our decision not to go forward with the eighth wave of fundholders and the saving of £20 million in bureaucratic costs, by the end of this month, the first £10 million of that will be available to breast specialist centres throughout the country. Under the Calman/Hine proposals, which are gradually being implemented, a full range of services is available for those who suffer from cancer. It was not just a question of mammograms. Some women who were diagnosed as not needing treatment had had physical examinations, which failed to pick up evidence that should have been picked up.
§ Madam Speaker
Order. I remind hon. Members that the private notice question deals specifically with one region and one national health service trust. Therefore, it is limited and I shall call first those hon. Members whose constituents are involved.
§ Mrs. Angela Browning (Tiverton and Honiton)
You will be aware, Madam Speaker, that I have asked for an Adjournment debate on this subject. Notwithstanding the Minister's statement, I should still like that request to be considered, because many issues that we wish to discuss cannot be dealt with in the short time that is available today.
The Secretary of State may wish to write to me on the following matter. As Wonford hospital was not long ago identified under the Calman recommendations as a specialist cancer centre, and in view of what we have heard about the way in which women patients have been treated there, could the right hon. Gentleman make some inquiries about the analysis that was made when Wonford was put forward as a specialist cancer centre, in the context of the treatment at that time in the breast care unit there? It would be a matter of great concern if that hospital were following different practices from other hospitals, 797 because the purpose of Calman was to take best practice throughout the country and regionalise it. I share with the House the fact that I have been a patient of that unit for some years and therefore share the concern of my constituents about what has happened there in recent years.
§ Mr. Dobson
I appreciate that the hon. Lady's points arise from her direct experience, and that is probably as good a reason for having locally elected Members of Parliament as any that I have ever heard in the House. It is certainly the intention to try to spread best practice. However, one of the criteria for deciding where a cancer centre should be located is a good geographical spread. I do not think that we would wish to say that some hospitals should not be used as specialist cancer centres because they have had shortcomings. The object must be to make sure that there are no future shortcomings.
§ Mr. Gary Streeter (South-West Devon)
I congratulate my right hon. Friend the Member for East Devon (Sir P. Emery) on raising this matter, and I thank the Secretary of State for Health for the way in which he is dealing with it. In view of the anxiety in Devon on this important matter, perhaps the right hon. Gentleman can answer two questions. First, can he reassure me and my constituents that the problem does not relate to women who have had breast screening at Derriford hospital in Plymouth, but relates specifically to the one in east Devon and to other private hospitals in the east of the county? Secondly, in view of that concern and in the context of the track record of this unit, will he think again about his action on the matter and consider going straight to a full, independent inquiry, so that the truth can be exposed and public confidence can be restored?
§ Mr. Dobson
I shall have to be careful that I do not raise concerns that do not need to be raised. To the best of my knowledge, the shortcomings have been, in the 798 national health service, in the Royal Devon and Exeter Healthcare NHS trust and the South Devon Healthcare NHS trust, and in some private hospitals across Devon. As far as I know, I am glad to say that the problem does not affect Derriford hospital.
The hon. Gentleman asks about an inquiry. As I said at the beginning of my statement, I am determined to get to the bottom of the matter, and I shall not hesitate to use my statutory powers to set up and carry through an independent inquiry if I judge that to be necessary after I have received a preliminary report from the chief medical officer. As I have said, if I am as dissatisfied after I receive that preliminary report as I am now, I shall certainly set up an independent inquiry.
§ Mrs. Alice Mahon (Halifax)
I thank my right hon. Friend for his swift action in this matter and assure him that the women covered by that trust will be very grateful indeed, as will women all over the country. However, I point out to him that there is another group of women—older women who are not on the recall cancer screen—who would be grateful if the current pilot scheme were speeded up in some way.
§ Mr. Dobson
I take my hon. Friend's point—she has been very active in this field, to her great credit. I hope that the chief medical officer's general review of breast cancer screening provision will take her concerns into account.
§ Mr. John Gunnell (Morley and Rothwell)
My right hon. Friend spoke of the matter being referred to the centre in Nottingham on 1 April and a report coming from that centre on 28 May. Is not that an undue length of time, given the urgency of action when someone's false diagnosis is revealed?
§ Mr. Dobson
I do not know whether it is a customary length of time, but, as far as I am concerned, it is a wholly undue length of time and cannot possibly be tolerated any further.