Cancer Screening: Working Women (Hansard, 20 October 1986)

§ Lord Graham of Edmonton
My Lords, I beg leave to ask the Question standing in my name on the Order Paper.

§ The Parliamentary Under-Secretary of State, Department of Health and Social Security (Baroness Trumpington)
My Lords, we shall not be satisfied until we have covered the whole field. Under existing arrangements, women, whether they work outside the home or not, may have a cervical smear taken by their general medical practitioner, or in a community health clinic; for example, a family planning clinic. Appointments are generally outside working hours. The computerised call and recall systems now being introduced should help to ensure that women who have not been screened within the recommended period receive personal invitations to be tested.

§ Lord Graham of Edmonton
My Lords, I am grateful to the noble Baroness for that reply. Is the Minister aware, however, that the incidence of cervical cancer among women in the 20 to 34 age range is on the increase, and that 2,000 women die from cervical cancer and 11,000 from breast cancer every year? Is she aware that many of these cases are preventable? I know that the Minister appreciates that early detection is crucial. Will she, therefore, lend support to those trade unions. among them the Union of Shop, Distributive and Allied Workers, who are increasingly negotiating with employers a facility whereby women at work are enabled to leave work to attend NHS facilities, or the firm encourages visits to its factories, shops or offices by mobile screening facilities?

§ Baroness Trumpington
My Lords, with regard to the early part of the noble Lord's question, the department's guidance to health authorities is that all women who are, or have been, sexually active should be screened every five years, irrespective of age. However, 94 per cent. of deaths occur in women aged 35 or over, and screening for this age group remains a priority.
With regard to the last part of the question, workplace cancer screening facilities are provided by some employers. These are additional to those available within the National Health Service. I should like to pay tribute to the Women's National Cancer Control Campaign which, if invited, with its mobile units, is certainly welcome in this field.

§ Lord Ennals
My Lords, in view of the many occasions on which the need for a call and recall system for cervical cancer screening has been raised in the House, and in view of the strong pressure from the British Medical Association and the National Association of Health Authorities, what real progress 6 has been made? How much money has been put into the development of the sort of scheme that the noble Baroness talked about? And how many district health authorities still have no effective system?

§ Baroness Trumpington
My Lords, with regard to computerised call and recall systems, we are closely monitoring health authorities' progress towards achieving implementation no later than March 1988. As at 31st March 1986, 33 health authorities had implemented such systems; 76 plan to do so during 1986–87 and 82 in 1987–88.

§ Baroness Macleod of Borve
My Lords, may I ask my noble friend the Minister whether she will encourage this aspect? Will the Minister issue an instruction that women under the age of 35 should also be screened? The medical profession is aware that younger women also need to be screened. If the noble Baroness accepts this, will she also ensure that the medical profession will be paid for the screening of women under the age of 35, which does not happen at the moment?

§ Baroness Trumpington
My Lords, I think that I answered the first part of the question by my noble friend Lady Macleod in answer to a previous supplementary question. I said that we were certainly keen that all women should be screened. With regard to paying extra to doctors who screen women, surely as a GP the doctor is responsible for the whole of each patient's health.

§ Lord Wigoder
My Lords, will the Government consider positively encouraging employers to consider on-site screening facilities?

§ Baroness Trumpington
My Lords, we are most anxious that this screening should be available to all women for whom it is considered necessary that the screening should take place. We would do everything we could to encourage employers. But in the end it is up to each employer.

§ Lord Rea:
My Lords, the noble Baroness, Lady Macleod, asked whether GPs should not be paid for women who are screened between the ages of 20 and 35. This age group is now showing an increase of a particularly nasty form of cervical cancer. If it is thought that doctors should be paid for screening women over 35, why should they not be paid for screening women under 35? I wonder whether the noble Baroness could clarify that situation.

§ Baroness Trumpington
My Lords, I cannot clarify the question of payment. However, I am aware of research work in which it has been suggested that there could be an increase in deaths. This underlines the importance of improving the effectiveness of the screening programme.

§ Lord Chalfont
My Lords, can the Minister confirm the findings of a report I read recently? One of the conclusions stated that the problem was not only the provision of facilities but persuading women to attend for screening, especially on recall.

§ Baroness Trumpington
My Lords, yes. It is difficult to persuade women. We believe that younger women can do a lot by asking their relatives to be screened. We believe that doctors can do the most by encouraging their patients to be screened. We believe that knowledge on a local basis, and local advocacy of screening, is the most effective.

§ Baroness Seear
My Lords, in reply to my noble friend Lord Wigoder, the noble Baroness said that the Government would give every encouragement to employers to have screening carried out at the place of work. This undoubtedly makes it easier for women to attend to be screened than if they have to take time off to go to their practitioner. Can this encouragement not take a financial form? There are costs involved for companies who are laying on private screening through their health departments. These include tax liable expense, and women lose time. A lot of costs are involved in putting on a service of this kind. Can the Government not be more practical in their assistance?

§ Baroness Trumpington
My Lords, if the noble Baroness, Lady Seear, looks at my original reply she will see that I said that whether or not women are working outside the home—in other words, women who are working in the home are still working women so far as I am concerned—appointments are generally available outside working hours. There are a great many different options as to where they can have the smears taken.

§ Baroness Seear
My Lords, that does not answer my question. That is a completely different point. My question suggested that employers who are laying on the service through their medical department should have some financial encouragement for so doing. Apart from anything else, it is much easier for women to attend.

§ Baroness Trumpington
My Lords, I quite agree that that is another question entirely. But I do not see why the women involved should not take advantage of the options outside working hours. If they have their smears taken during working hours, it is surely better for the employer to lose a little time—and it does not take very long to have a smear test—than to have one of his workers away very ill.

Lord Wallace of Coslany
My Lords, does the noble Baroness appreciate the urgency of a speedy follow-up of any positive case? What steps are being taken to ensure that there is no unnecessary delay in follow-up after a case has been proved to be positive?

§ Baroness Trumpington
My Lords, all women should be told how to get the result of their tests. We are currently consulting the medical profession on draft guidelines on the follow-up of abnormal smears.

§ Lord Graham of Edmonton
My Lords, I am grateful to the Minister for using, more than once, the word "encourage". Can the noble Baroness tell us in regard to the 41 health authorities who in June 1985 had no system whatsoever, how far the number has been reduced? Has the Minister taken careful note of the 8 report this month from the BMA which is calling for every family practitioner council to have the call and recall facilities available in their areas?

§ Baroness Trumpington
My Lords, we are closely monitoring health authorities' performance to ensure that laboratories can meet demand and avoid backlog. Health authorities' annual outturn reports show that at 31st March—I have already indicated this to the noble Lord, Lord Ennals—out of a total of 191 district health authorities, 40 health authorities, served by 33 laboratories, had backlogs that exceeded one month's work. Problems in individual laboratories are a matter for local management. Regional health authorities will ensure that remedial action is taken before they report to us again.