Royal Marsden Hospital: Early Diagnostic Unit (Hansard, 23 November 1982)

§ Baroness Jeger
My Lords, I beg leave to ask the Question which stands in my name on the Order Paper.

§ The Parliamentary Under-Secretary of State, Department of Health and Social Security (Lord Trefgarne)
My Lords, my honourable friend the Minister for Health is studying a report from the board of governors of the Royal Marsden Hospital on its Early Diagnostic Unit. In the meantime, the service provided at this unit continues. The average cost for each attendance at this unit is £20. There are no reliable up-to-date figures available for the average cost to the National Health Service of mastectomy and hysterectomy.

§ Baroness Jeger
My Lords, will the noble Lord the Minister stress to his honourable friend the concern of thousands of people in this country, men and women, about the threat to this hospital, particularly when one bears in mind that one in 17 women in this country are likely to have breast cancer in one form or another? Can he tell us whether the Government have any policy about these screening techniques, which are preventative, which can save a lot of money, pain and distress, and which really ought to be a more important part of the National Health Service, as distinct from the sickness service?

§ Lord Trefgarne
My Lords, I am very sorry to say that the screening procedures to which the noble Baroness, Lady Jeger, refers are not preventative; they simply determine the existence or otherwise of this unfortunate disease. Furthermore, there is no evidence as yet—although we are conducting a study to look into this matter more carefully—to show that this screening helps the expectation of life of those who are found to suffer from one or other of these diseases.

§ Lord Byers
My Lords, does it not mean that if this disease is diagnosed early, there is a better chance of its not becoming a terminal one?

§ Lord Trefgarne
My Lords, I am sorry to say—and I was surprised to discover this—that the noble Lord is mistaken and that that is not correct.

§ Baroness Jeger
My Lords, will the noble Lord the Minister not take further advice on that point? I have many friends who have been to this hospital and who, having been diagnosed as early cases, have had to undergo only a small operation, and not a mastectomy. Their lives have been made bearable and have gone on for a long time.

§ Lord Trefgarne
My Lords, I must adhere to what I said earlier: that the existence of the screening techniques, welcome though they no doubt are in psychological terms, are not yet proven to have a significant effect on the longevity of the patients. 790 Having said that, I may add that there has been very little research into this matter. Surprisingly, no research is being done at the Royal Marsden Hospital, but we are having a study done at some other hospitals. A study was undertaken in New York nearly 20 years ago, but that was inconclusive.

§ Lord Byers
My Lords, may I ask the noble Lord the Minister to reconsider one aspect of this subject, which is that if the result of the diagnosis is negative it will ease the anxiety of the woman immediately?

§ Lord Trefgarne
My Lords, I have no doubt that the noble Lord, Lord Byers, is correct in that, but I was referring to the longevity or otherwise of patients who are discovered to have the disease.

§ Lord Wells-Pestell
My Lords, in view of the fact that this matter has received publicity owing to the cost of screening, may I ask whether the noble Lord's figure of £20 per person per screening is accurate? Was a statement not made recently by the authorities at the Royal Marsden Hospital that screening 10,000 patients last year cost £100,000, which amounts to £ 10 per patient?

§ Lord Trefgarne
My Lords, I did see the figures to which the noble Lord has referred, but unfortunately they were not accurate. The costs of the unit for the year 1982–83 will be around £155,000 and the unit will examine around 7,700 or so patients; that is, 7,700 or so attendances. Therefore the cost is as I have described it to be.

§ Lord Cledwyn of Penrhos
My Lords, is the noble Lord the Minister seriously saying that early screening does not increase the chances of survival and extended life? Is that the advice he has received? Is that not contrary to all the evidence that we have had hitherto?

§ Lord Trefgarne
I am afraid, my Lords, that those who examine the evidence come to the conclusion which I have conveyed to your Lordships. The fact is that early diagnosis of this unfortunate disease does not necessarily lead to longer expectation of life. As I have said, there is a shortage of concrete evidence on this fact and we are conducting further studies to clarify the position.

§ Lord Cledwyn of Penrhos
My Lords, if I may press the noble Lord the Minister on this important matter, will he then recommend to his honourable friend that the closure of this unit be postponed until those studies have been completed?

§ Lord Trefgarne
My Lords, my honourable friend will wish to consider all these matters very fully. The studies to which I have referred are not likely to bring concrete conclusions before 1986. In the meantime, some screening procedures at least are available at other places, but that is not to say that my honourable friend has reached a conclusion on this matter.

§ Baroness Bacon
My Lords, if what the noble Lord, Lord Trefgarne, says is right—that early diagnosis is really of no use—does it not lead one to the conclusion that it is useless having any operations at all?

§ Lord Trefgarne
My Lords, we are talking about a particular problem of breast cancer, and the question put to me was whether early diagnosis resulted in a longer or shorter expectation of life; and I had to report to your Lordships the conclusions which we have so far reached on this matter.

§ Baroness Bacon
My Lords, I believe that the noble Lord the Minister has misunderstood me. What I intended to ask was, does this mean that any breast cancer operation is useless?

§ Lord Trefgarne
My Lords, the noble Baroness goes too far to reach that conclusion. There are a number of different types of breast cancer and the prognosis for these different types is different in each case. It is important that we get more knowledge on this matter and that is why we are conducting the studies to which I have referred.

The Earl of Halsbury
My Lords, will the noble Lord the Minister tell the House what he means by "cost"? Does it include a lot of overheads and fixed charges which would fall for recovery elsewhere if they were not recovered from the unit which is to be shut down?

§ Lord Trefgarne
My Lords, the cost to which I referred is a proportion of the total costs of the Royal Marsden Hospital, calculated in accordance with a proportion of the capital charges and other items which exist.

§ Baroness Ewart-Biggs
My Lords, would the noble Lord the Minister not agree that there are an enormous number of women who suffer horrible anxiety that they have this dreadful disease, with all its ensuing disfiguring treatment; and would he not further agree that if it were men who were suffering from this very great anxiety, the future of this unit might not be in jeopardy?

§ Lord Trefgarne
My Lords, I recognise, of course, that this disease, or the prospect of it and anxiety concerning it, is widely felt among women, and I am not surprised. But there is a large number of other ways of determining the existence or otherwise of this disease. For example, there are screening methods other than the particular type which is carried on at this hospital and which are equally widely used.

§ Baroness Masham of Ilton
My Lords, may I ask the Minister how many women serve on the board of governors and how many men serve on the board of governors at the Royal Marsden Hospital; and is he aware that the chairman is male and perhaps there is a bias?

§ Lord Trefgarne
My Lords, if the noble Baroness is suggesting that the board of governors are any less anxious about this matter because they happen to be men rather than women, then she is mistaken.

§ Lord Nugent of Guildford
My Lords, is my noble friend aware that there is an early diagnostic unit in Guildford and that very authoritative medical opinion in Guildford is convinced that it has the greatest 792 possible value? Would the noble Lord ask his experts to look very closely at the reports they are receiving from Guildford.

§ Lord Trefgarne
My Lords, Guildford is one of the places at which the study to which I referred is being carried on, and of course the conclusions reached there will be of great value in reaching final conclusions.

§ Lord Byers
My Lords, in view of what the noble Lord has said, will he check this again, because his statement is going to cause very serious anxiety in many homes throughout the country?

§ Lord Trefgarne
My Lords, I am not sure why it should cause anxiety. There are a large number of different screening methods. One of those type methods is carried on at the Royal Marsden. There are other places where the same methods are carried on, and there are of course a large number of other clinics where less sophisticated methods are employed.

§ Lord Byers
My Lords, does the noble Lord not realise that what he has done is to cast doubt upon the value of the operation, and this is very worrying for a lot of people?

§ Lord Trefgarne
My Lords, the noble Lord reached the wrong conclusion, if I may say so, from what I said. What I was doing was casting doubt, if doubt it was, on the screening procedure, not on the operations.

§ Baroness Jeger
My Lords, I apologise for intervening again, but this is so important—

§ The Lord Privy Seal (Baroness Young)
My Lords, I think we could argue about this for some very considerable time. May I suggest that we have the question from the noble Baroness, Lady Fisher, who has been trying to get in for some time, and then I think we should move on. It is open to any noble Lord to put down another Question on this subject for another day.

§ Baroness Fisher of Rednal
My Lords, surely the Government must be fully aware by now that everything that we call success stories in medical treatment under the National Health Service is falling into jeopardy because of Government cut-backs. The breast screening at Marsden is a follow-up to what is happening at Tadworth; it is a follow-up to what is taking place in Birmingham—the curtailment of kidney treatment services in the Queen Elizabeth. It is the medical success stories that are being so severely cut back. Would the Minister consider not only the Royal Marsden but all these success stories where the medical profession have done so much for the benefit of the National Health Service?

§ Lord Trefgarne
My Lords, I yield to no one in my admiration for the technical advances which have been achieved within our medical profession in this country. There have of course been no cut-backs; the noble Baroness, if I may say so, is mistaken. The Royal Marsden itself has received a growth in its allocation this year.