§ Motion made, and Question proposed, That this House do now adjourn.—[Jane Kennedy.]10.45 pm
§ Mrs. Angela Browning (Tiverton and Honiton)
An independent review commissioned by the Royal Devon and Exeter healthcare NHS trust identified micro-calcification in nine mammograms that needed further assessment rather than the advice that the patients had been given—that they should return home and wait for the normal recall period of three years for another mammogram. The issue has been raised on the Floor of the House before, but I welcome the opportunity to engage in a fuller discussion tonight, because the matter is of great concern to women and their families living in the Exeter area, including those in my constituency.
I am aware of the sensitivity of the subject. Cancer in any form can cause fear, and breast cancer causes fear to many women, especially those currently undergoing treatment. I do not intend to spread alarm by raising the matter tonight, but, in view of its seriousness, I would welcome the Minister's recognition of the fact that much wider implications in matters of policy and procedure will emerge from the very necessary investigation that is now to be held at Wonford House hospital in Exeter.
Now that the Chamber has cleared somewhat, let me express my gratitude for the presence of members of all parties. I note that the hon. Member for Exeter (Mr. Bradshaw) is here, as are Cornwall Members. They are here because they are aware of the wide-reaching implications of what has been revealed following the Exeter hospital announcement.
Let me put on record that it was the trust's own quality control that identified the problem. I pay tribute to it for having such measures in place and for being extremely frank and open in wanting the matter to be fully investigated and to be brought into the pubic domain. I also fully endorse the recommendation of the hospital's management that women should continue to keep their appointments at the hospital while the matter is being investigated.
The number of undetected breast cancers among women screened by the east Devon service is within the national average range—30 cancers for every 10,000 in the population. I shall refer later to the implications, the figures and the position as it compares with that in the rest of the country.
On 9 June in answer to a private notice question tabled by my right hon. Friend the Member for East Devon (Sir P. Emery), it was stated that two consultants who were advising those patients were to be retrained. However, it was with concern that I read an article in The Independent on Saturday 7 June this year which identified the case of Miss Simone Renvoize who was treated by one of those consultants in his former hospital, the Treliske, in Cornwall.
I have received a copy of a letter, which I understand has been sent to the Secretary of State for Health by the cousin of Miss Renvoize, who has now died. I should like to read from a small portion of that letter. Miss Renvoize's cousin, Mrs. Barnes, states that in 1990 her cousin, Simone Renvoize, was sent to one of the consultant radiologists currently suspended for a 432 mammogram at Treliske hospital in Truro. It revealed tumours in both breasts. However, she was told that her lumps were purely hormonal, leading to a delay of six and eleven and a half months respectively for mastectomies which she later had. Fellow radiologists who subsequently reviewed those X-rays could see clearly both the tumours. Mrs. Barnes's concern was that the error was known about while this doctor was employed at the Treliske hospital and he was even to move to the Exeter hospital with no suggestion of retraining at that time. She states that her cousin also began a legal case seeking redress for the inadequacies of her diagnosis and that treatment and medico-legal reports were prepared but still no one alerted the Exeter hospital.
We all recognise and, having worked for a short time in the Wonford House hospital, I certainly recognise, that doctors are not infallible and make mistakes. In cancer diagnosis especially, a doctor may often see grey areas on a mammogram that are not easy immediately to recognise. However, it seems that here the people concerned did not err on the side of caution, which is a reasonable expectation by patients. It is clear that the same procedures were carried out by the same person over a long period.
I have asked the management of Wonford House hospital what references were taken up and whether anything was drawn to their attention that made it clear that retraining was needed much earlier. I understand that inquiries have been made and that nothing in the references of this person gave any reason for further investigation.
I have also received a letter from a constituent who is a state registered nurse and who worked at the Wonford House hospital. She expressed concerns about staff in the unit who have been aware of the diagnosis controversy but who, in many cases, felt it difficult to share their concerns with senior management at the hospital. I should like to ask the Minister to consider two matters in relation to the wider implications of this issue.
First, will the hon. Lady look at the way in which medical references are taken up? That matter bears further investigation, not just in this case but in the case of boards which interview clinicians. Does the way that those interviews are carried out mean that boards can be absolutely sure that they are receiving an accurate account of a person's aptitude and ability to carry out specific tasks? Secondly, as a result of what has been said and written to me by hospital staff, I am aware that the issue of whistleblowers can be controversial and can have adverse effects both ways.
There must be a structure in hospitals to allow staff to make concerns known to senior management without feeling in any way intimidated or that their positions are put at risk. Obviously, here we have a situation where I am being told by a nurse in that hospital that it was common knowledge that there was concern among other staff that there were problems in this area.
There is always the question of the clinician, the surgeon, having the final say and using his or her medical judgment about an individual case, and we all recognise their need to be able to do that. If Wonford House hospital in Exeter is, like other hospitals throughout the country, to be designated a specialist centre for cancer treatment, those of us who live in the region and who use the hospital 433 must have confidence that we are receiving in that hospital the best possible practice that has been garnered from the best hospitals throughout the country.
My understanding was that the chief medical officer's recommendations—the Calman response to considering the way in which we take forward specialist cancer centres in the region—envisaged that, instead of those of us who live out in the sticks having to go to the big cities or even to London for specialist treatment for serious diseases, the best that was available would come to us, and that, if it came to us, the hospitals that offered that level of treatment would be able to say that they were specialist cancer treatment centres. I am sure that I speak for many of my constituents—I am certainly speaking personally now—when I say that, if I needed specialist treatment, particularly cancer treatment, I would rather have it at the Royal Marsden hospital and know that I was going to get the best treatment than have someone stick a label on my local hospital, which did not live up to its name.
In fairness to the people who work in Wonford House hospital, particularly those working in other disciplines and specialising in other areas of cancer treatment, it is vital that an analysis is made not just of the procedures that are carried out there, but of what it is able to offer us in terms of outcomes, if it is to become a specialist centre.
§ Sir Peter Emery (East Devon)
In pressing what my hon. Friend is saying, and I have followed it clearly, will she urge the Minister to examine the facts so that the hospital can reassure what must be about 5,000 to 6,000 women who have been tested that they are no longer at risk or, if there is any risk, that they are going to be called back in at the earliest possible and proper time to be re-examined? It is essential that those people should not be left still wondering what is going to happen to them.
§ Mrs. Browning
I concur with my right hon. Friend's concern on behalf of his constituents. We want not only quick action and a full investigation of what has gone on, but lessons to be learnt from this. Clearly, there are lessons to be learnt that may have even national implications over a wide area. I hope that this debate will trigger that. It is my intention that we learn from what has been an unhappy experience.
Women need reassurance that the way in which they are screened, diagnosed and treated for breast cancer should not be a geographical lottery. Where people live should not matter in terms of the sort of service that they receive. We should be considering why different parts of the country produce different outcomes. The Cancer Relief Macmillan Fund charity endorses my view that this country's mortality rate does not compare well with that of other countries.
We have one of the worst records in the world for breast cancer. It is difficult to identify why that is so. There is research into the matter and various theories are suggested, but the fact is that our rate is 29.3 per 100,000 of population, whereas it is 19.4 in France and 17.3 in Germany. When our rate compares so badly with those of other countries, surely within the whole spectrum of the medical profession dealing with the disease there must be a concentrated interest in the reason for the figures and what can be done to reduce them through screening, diagnosis and treatment.
434 Anyone working in the medical profession, whether at consultant or any other level, should be hungry to identify what is happening elsewhere in the country and what new procedures are being adopted. We must gamer the best practice that is available and take that out into the regions.
When I looked in the Library, I found figures produced by Macmillan showing that mortality rates from breast cancer in the south-west between 1993 and 1995—the latest figures available—were higher per 100,000 of population than was the case in any other part of the country. That, too, is a cause of concern. If the disease is being treated better in other parts of the country, please can we find out what it is that they do better and please can the people who practise is this area of medicine and surgery in my part of the country not be too proud to find out why the rates are better elsewhere? We want the matter to be taken seriously. I know that the Department's guidelines to purchasing authorities say that they should look at outcomes. Right across the spectrum, outcomes involve what happens in screening, what happens when cancer is detected and what happens thereafter.
I hope that tonight the Minister will reassure us that what has happened in Exeter will be fully investigated and that any lessons to be learned, which may have national implications, will be speedily adopted by the Department. We look to the Minister and the Secretary of State to ensure that no stone is left unturned. Until the matter is investigated and the lessons learned, and until there are changes to put things right, I and other women will not be fully confident about what is being offered to us locally.
It is devastating for women who have or think they may have breast cancer. We know that doctors cannot always perform miracles, but let us get as near to a miracle as we can.
§ 11.3 pm
§ The Minister of State, Department of Health (Ms Tessa Jowell)
I am grateful to the hon. Member for Tiverton and Honiton (Mrs. Browning) for raising this subject this evening. I am glad to echo both her feelings of outrage and the regret expressed by my right hon. Friend the Secretary of State last week about what happened in Devon. This debate gives us the opportunity to say once again how sorry we are for the women and their families and friends who have been affected in a variety of ways—and in particular, those close to the two women who died because of the events that gave rise to the inquiry.
§ Mr. Paul Tyler (North Cornwall)
As the hon. Member for Tiverton and Honiton (Mrs. Browning) said, one of those concerned was a constituent of mine. It was a tragic case of misdiagnosis at the Treliske hospital in Cornwall. As the hon. Lady said, it is not just people in Devon who are affected by what happened at the Wonford House hospital—there is anxiety throughout the west country.
The failure of information between one hospital trust and another raises important questions about the relationship between trusts in different parts of the country. I hope that the Minister will deal with that point.
§ Ms Jowell
I entirely accept the hon. Gentleman's point and, of course, we regret the distress, further illness, and in two cases the deaths, of patients who had the right to expect better. That is why we have taken rapid action to 435 establish precisely what happened in that dreadful business and to learn, as quickly as we can, any lessons that that horrifying story has to teach us.
I wish briefly to set out the facts as we currently understand them. In February this year, concern was expressed by medical staff about the work of two consultant radiologists, one employed by the Royal Devon and Exeter Healthcare NHS trust and the other by the South Devon Healthcare NHS trust at Torbay.
Contrary to the impression given by some reports in the media, the consultants undertook diagnostic mammography for women with symptoms of cancer, as well as more routine breast cancer screening. Twelve sets of mammograms, including both symptomatic and screening cases, were sent for an external review to an independent consultant who worked in Nottingham. Nine of those mammograms were found to be faulty.
The review concluded that further assessment should have been undertaken in nine of the cases. It recommended that the doctors concerned should undergo formal retraining and that further audits should be undertaken of the mammograms of all women identified as requiring early recall for screening, and of all cancers that have occurred between screenings in the past five years.
The doctors concerned are not currently working in the NHS and management action is under way locally to review the management of the breast screening service and the provision of symptomatic services. An audit will be undertaken of the films of women who have been scheduled for recall earlier than the normal three-year screening interval, the films of women recalled for assessment after screening during the previous two years and the films of women with cancer that has occurred between screening invitations.
There will be a meeting shortly between the trust and representatives from other screening centres to make the necessary arrangements for the audit. I should add that both screening and services for breast cancer are continuing to be provided in Exeter, as locum arrangements have been made.
I assure the hon. Member for Tiverton and Honiton that the Government are determined to get to the bottom of what happened at the Royal Devon and Exeter trust. We would welcome any information to help the inquiry from hon. Members who may be able, through constituency cases or other representations, to shed further light on the events that led to the tragedies.
As my right hon. Friend the Secretary of State announced yesterday, the Government's chief medical officer is undertaking an urgent review of breast services in Exeter, to establish the facts and to report his findings to the Secretary of State, and, in the light of those findings, to consider the implications for breast cancer services as a whole, again reporting his conclusions to the Secretary of State. We hope that his report will be available by mid-July. An interim and immediate report on the inquiry so far will be available by the end of this week and my right hon. Friend will happy to brief the hon. Lady about the interim findings.
The chief medical officer has assembled a distinguished independent team to assist him, including the president of the Royal College of Radiologists, a consultant surgeon from Huddersfield, a cancer nursing specialist, who is also a member of the expert advisory group on cancer, 436 the chief executive of the Royal Marsden hospital, and Miss Polly Toynbee, who will represent lay interests. The team has already started work—it visited Exeter yesterday and began by interviewing a wide range of staff to collect detailed information.
The hon. Member for Tiverton and Honiton mentioned the need to take representations from staff who may be reluctant to come forward. It is important that the views and information that staff gain in clinical practice are made available. We realise that some trusts make that task more difficult for staff than others, but we will provide every assistance to staff members, so that their representations aid the inquiry.
§ Mr. Ben Bradshaw (Exeter)
I should like to express my gratitude to my hon. Friend the Minister and to the hon. Member for Tiverton and Honiton for the constructive and tripartisan approach that hon. Members have adopted in dealing with the crisis. I am grateful also for the swift and open way in which the Government and the Royal Devon and Exeter hospital have responded.
Will my hon. Friend the Minister please continue to encourage women in my constituency to come forward for testing, which is incredibly important? Today, can she tell those women that they can have full faith in the results of current hospital tests? Will she also confirm that the Government's commitment to women's health and the £10 million that Ministers have earmarked to speed up the breast screening process will help to resolve some of the problems that the hon. Member for Tiverton and Honiton mentioned and our poor record nationally in dealing with breast cancer?
§ Ms Jowell
I thank my hon. Friend and I entirely endorse his call to women, not only in his constituency but in all constituencies, to continue to attend for breast cancer screening, because screening remains the single most effective way in which to identify breast cancer at a very early stage.
The Government will not rest until we have applied in practice every lesson that the inquiry shows must be learned and applied. Women should realise not only the importance of regular screening but the fact that screening services will be subject to regular review and quality checks. Those services will be supported and developed further in the light of the best possible information on developments in treatment and screening technology.
It is therefore important that we identify specifically what happened in a dreadful set of circumstances and ensure that those lessons are applied locally, to restore and rebuild women's confidence. We must also ensure that the lessons learned are applied across the screening service and on a national basis.
§ Sir Peter Emery
I cannot do other than praise the Minister for the action that the Government are taking for the future; but how shall I respond to women who write to me saying, "Sir Peter, I have been there; what do I do? I had a test two years ago or 18 months ago—am I at risk? What action should I take? How should I react to this great problem?" Reassurance of those people is of very considerable importance to all constituents, whether they are in Exeter, Totnes or any other local constituency. 437 I had hoped that we would find a way in which to give such reassurance to those women as soon as humanly possible.
§ Ms Jowell
It is obviously a matter of concern. I advise the right hon. Gentleman to refer his constituents who may have those concerns to the helpline that was established immediately after the events were disclosed. I also assure him that a further audit of mammograms and diagnostic investigation is being conducted to establish that no further mistakes were made. I would in the first instance suggest that the right hon. Gentleman refers his constituents to the helpline, so that they get the reassurance and information that they might want.
We shall certainly continue supporting the implementation of the Calman/Hine model of cancer service, which we believe provides the best and safest basis for the delivery of cancer services in Devon and Exeter, as well as across the country. We also intend to produce a series of evidence-based guideline documents responding to some of the points raised by the hon. 438 Member for Tiverton and Honiton in relation to the importance of lessons learned in practice being applied to future clinical development. We are determined to ensure that those lessons are applied for the benefit not only of her constituents but of people across the country.
The hon. Lady asked about local cancer centres. The Plymouth Hospitals NHS trust and the Royal Devon and Exeter Healthcare NHS trust have both been designated as cancer centres, but it was agreed that the Plymouth Hospitals trust would take responsibility for clinical leadership.
The hon. Lady will also be aware that we are moving to the implementation of clear treatment protocols, which will be a very important step in ending the geographical lottery and ensuring that there is a national breast cancer service for all women—
§ The motion having been made after Ten o'clock, and the debate having continued for half an hour, MR. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
§ Adjourned accordingly at fifteen minutes past Eleven o'clock.