HL Deb 25 February 1987 vol 485 cc241-50

5.27 p.m.

Baroness Trumpington

My Lords, with the leave of the House I shall repeat a Statement made in another place by my right honourable friend.

"With permission, Mr. Speaker, I should like to make a Statement concerning cancer screening and AIDS research.

"The Government attach particular importance to reducing deaths from breast cancer and cervical cancer. In both cases early detection can lead to successful treatment. Breast cancer is the commonest form of cancer among women in this country. Each year there are something like 24,000 new cases, and 15,000 deaths, from the disease. In July 1985, the Government appointed a working group under the chairmanship of Sir Patrick Forrest to consider the position. I am today publishing its final report and I would like to express the Government's thanks to the group for its work.

"The report has concluded that screening by mammography—X-ray of the breasts—will enable us to reduce deaths from breast cancer. The Government accept the proposals made in the report and accordingly have decided to implement a national breast cancer screening service. This will provide for screening every three years for all women between 50 and 64 throughout the United Kingdom. My colleagues, the Secretaries of State for Scotland, Wales and Northern Ireland, will be putting into effect proposals broadly similar to those I am announcing. We are determined that breast cancer screening should be implemented as efficiently, as effectively and as quickly as possible. This will need careful planning to ensure that all the necessary back-up facilities, as well as the screening centres, are available. It will mean assessment and diagnostic facilities, treatment facilities, counselling and after-care, and training for key groups of staff.

"We have, therefore, decided to provide additional funds for each regional health authority to have at least one centre in operation within the next 12 months. The funds will also enable four of these centres to provide a training facility for the whole country. We shall expect the locations of the first centres to be announced by May of this year. An extra £6 million will be provided in 1987–88 for the first centres.

"In addition, I shall shortly be sending to the professions and to health authorities a draft circular containing my detailed proposals for implementing breast cancer screening in England. I shall be calling for plans before the end of this year from each region to extend the service over the next three years to cover all women in the age groups concerned. The report envisages that up to 100 centres are likely to be needed in England. I shall also be setting up an advisory committee to advise on the development of screening and to monitor its effectiveness and efficiency. Breast cancer is a major scourge. We believe that these measures will achieve a substantial reduction in mortality from this disease among women of this age group.

"Cervical cancer kills 2,000 women each year and we are no less committed to reducing that figure. The great majority of these 2,000 deaths are among women who have never had a cervical smear under the existing screening programme. We have already taken urgent steps to increase the effectiveness of that programme and, in particular, to increase the proportion of the population at risk who are being screened. Computerised call and recall systems should be operating in 109 health authorities in England by next month and in the remaining 82 over the next 12 months. These will enable women to be sent personal screening invitations, usually from their own general practitioners.

"Our first priority is to persuade more women to come forward for screening. We shall closely

monitor the success of the system and we shall keep under review ways of making further improvements. In addition, I shall be asking health authorities to make two specific changes.

"First, since the number of cases among younger women has been increasing, health authorities should rationalise existing arrangements for screening women under 35 by ensuring that the call and recall system begins at the age of 20. Secondly, I shall be asking each health authority to make a specific, named individual responsible and accountable for the organisation and effectiveness of screening.

"Our proposals for both breast and cervical cancer screening take account of the wide range of evidence available from other countries. I am convinced that these proposals will make a substantial contribution to the cause of women's health, which is a key priority for the Government.

"Turning to AIDS research, as the House is aware, there is at present no vaccine against the virus or cure for AIDS itself. It is for that reason that the Government have mounted their major public education campaign. It is also important, in addition, that we in this country should make an effective contribution to the international effort to develop a vaccine and a cure.

"In recognition of this need, the Medical Research Council has recommended a new directed research programme aimed both at developing a vaccine which will prevent infection and also at new anti-viral drugs to treat people who are already infected. The research would be directed from the centre by two scientific steering committees which will consist of some of the country's leading scientists. There will be two specially appointed full-time directors and the programme will be built up by letting specific contracts to the most appropriate laboratory, public or private. This proposal goes beyond the usual approach of research initiated by the investigator.

"The Government are extremely grateful to the MRC for taking a lead in formulating these proposals, which are based on wide consultations among outstanding British scientists, by Sir James Gowans, the Secretary of the MRC, with Sir David Phillips, the Chairman of the Advisory Board of Research Councils. This country has scientific strengths which should enable it to make a distinctive contribution to these important lines of research. The Government commend the readiness of the scientific community to collaborate in tackling this major problem.

"Accordingly, the Government welcome the proposal and accept it in full. We will therefore launch in 1987–88, through the Medical Research Council, a new directed research programme on the lines the council has proposed. For this purpose my right honourable friend the Secretary of State for Education and Science will increase the grant-in-aid to the MRC by £14½ million over the next three years. The grant in aid will go up by £2.5 million in 1987–88, by £5 million in 1988–89 and by £7 million in 1989–90. The programme will be closely monitored by the council, with my department and the Department of Education and Science. This will enable us to review progress against results. I should make it clear that the directed research programme will not affect or hinder any research initiatives by pharmaceutical companies.

"This new programme should not be seen as an isolated venture. It is not. It will be part of an international research effort. We will build on the work already done, especially in the United States, and in turn contribute to the international body of research information that is being built up. In the United States all the medical scientists I met in my recent visit were unanimous in their view that the United Kingdom could indeed make a distinctive contribution to AIDS research.

"The House will appreciate that it is impossible to predict the progress of this research. I have made it clear in earlier statements that we cannot expect a vaccine or cure to be generally available within five years. But this programme will help us to make progress in three ways. It will enable this country to make a full contribution to AIDS research. It will mean that we are better placed to collaborate with, and benefit from, work that is being done in other countries; it will increase the chances of developing a vaccine and finding a cure. I hope that the House will welcome the new proposals."

My Lords, that concludes the Statement.

Lord Ennals

My Lords, may I first thank the noble Baroness for repeating the Statement made by her right honourable friend in another place. At the same time I should like to thank Professor Sir Patrick Forrest and his colleagues for their report, which I have not read in full but which is obviously an outstanding document. Thanks should also go to the Medical Research Council for the advice on which the Government are acting.

The three subjects in question have aroused a great deal of interest in this House from which a great deal of pressure for more action and resources has come. The pressure has been to provide additional resources for vital research into AIDS and HIV infection, to proceed with the organisation of an effective call and recall system for cervical cancer, particularly for women aged between 20 and 35, and to tackle the very high death toll from breast cancer in older women.

We naturally welcome the progress that has been made in each of these fields. It indicates the value of repeated and persistent pressure from your Lordships' House and from another place. The announcement has been a long time coming. It has come the night before a by-election, which is natural. Good news is welcome at any time. In a grey world, good news will always he welcomed by your Lordships' House even if that good news seems in some cases to be a little late and its content perhaps rather small.

May I put some questions to the noble Baroness? My first question is about cervical screening and breast cancer. We know that about 2,000 women in Britain die of cervical cancer each year and that 60 per cent. of them have not been screened. In almost all cases the deaths could have been prevented by an effective call and recall system. The last time that I asked the noble Baroness from this Bench about a call and recall system, she said that by 31st March 1986 only 33 health authorities had put such a scheme into operation.

In view of that rather slow progress, is the noble Baroness confident that 100 per cent. of the health authorities will have come into line within the next 12 months? I hope they will. The department promises screening every year for breast cancer. If effective, that could save the lives of more than 3,000 of the 15,000 women presently dying each year from breast cancer. I am pleased that there is to be an extra £6 million. Will the money simply be for the four centres that will be established in different parts of the country? Or will part of that £6 million go to finance the work and responsibilities of health authorities in setting up a call and recall system?

Can the call and recall system for cervical screening be used for older women affected by breast cancer? Within an effective computer system, the two call and recall systems may well work to good effect for women of both age groups.

Your Lordships will remember that in October last year my noble friend Lord Rea asked the noble Baroness about payments to GPs, seeking to know why, if they were to be paid for screening women over 35 they were not to be paid for screening women under 35. The noble Baroness may be able to answer that question. My noble friend Lady Ewart-Biggs asked about a screening service in the Palace of Westminster. I wonder whether there is news from the Administration Committee about that.

I turn to the second half of the Statement which deals with AIDS. We naturally welcome the additional funds. Deep concern is felt in the country about cuts in research funds. It is good to see that in one field we are moving forwards rather than backwards. Even now, the sums referred to by the Secretary of State and repeated by the noble Baroness are, in many respects, small for research on a subject as vital as AIDS. It is a minute proportion compared with that available in the United States. It is less than one-twentieth of 1 per cent. of the general cost of the health service.

Can the noble Baroness indicate the Government's thinking on three areas of research? Can she say where she thinks the priorities lie? The discovery of an effective vaccine is clearly the highest. No one doubts that it will be some years before that is available. It is a high prize if it can ever be won.

There is a second stage. What priority will be given to those people who have already contracted the infection, have the strain within them but have not developed the disease? That is an important group of people, first, to identify and, secondly, to help. Bearing in mind that there is a five-year incubation period front contracting the infection to the onset of the disease, that would seem to be acutely important. I wonder whether the noble Baroness has any information as to whether the MRC will be looking at matters such as diet. Some pilot research projects have dealt with the effects of diet on this group of people. That seems a possible field for research, but there may be others. It is an important area of research because there is no way in which we can stop the many hundreds of thousands who already have the infection from contracting the disease. Vital research is needed to ensure that they do not contract the disease.

It would be helpful to know whether the Government envisage research in other fields such as the sexual behaviour of, and HIV transmission among, prostitutes, and the various types of homosexual behaviour. That would be studying preventive measures.

We welcome the Statement. It is a positive one. I have my questions and doubts as to whether the resources are adequate for the task but, for what we have and are about to receive, may the Lord make us truly thankful!

5.45 p.m.

Lord Winstanley

My Lords, on behalf of my noble friends on these Benches, I should like to join with the noble Lord, Lord Ennals, in thanking the noble Baroness for repeating this important and welcome Statement. Like all Gaul, the Statement comes in three parts. The first relates to screening for breast cancer; the second, cervical cytology and screening for cervical cancer; and the third is the need for reources for research into AIDS.

On these Benches we warmly welcome all the steps that the Government have announced with regard to screening for breast cancer. We shall support them in every possible way with, perhaps, one proviso. It is one that is referred to in the Statement and in the report of Sir Patrick Forrest's working party. We too should like to add our thanks and congratulations to Sir Patrick Forrest and his colleagues on the working party for producing this admirable report on breast cancer screening. The proviso is that we should like to underline the need for monitoring so as to validate, or otherwise as the case may be, what is being done.

It is unfortunate that medical progress is such that once one introduces a new procedure, it is liable to enter medical practice and become like some form of ritualistic religious observance, and stay there for all time. Once there, it is difficult to remove if we later find that it has not proven to be cost-effective. I hope that there will be proper monitoring.

That leads me to the second part of the Statement with regard to cervical cytology and screening for cervical cancer. We warmly welcome the steps that are being taken. We welcome what is said about computerised call and recall systems, the recognition that the number of cases among younger women has been increasing and that the call and recall systems should begin at the age of 20.

I note that the Statement says that each health authority will be asked to make a specific named individual responsible and accountable for the organisation and effectiveness of the screening. I hope that the names will be made known to all those to whom they may be useful. That includes many noble Lords and many patients. I again underline the importance of monitoring and validation. Hitherto, there is no doubt that we have wasted resources because of the way in which the screening programme has been conducted. As the Statement emphasises, those women who are most at risk have never had any smears while those women least at risk have been having smears with almost clockwork-like regularity. That has been wasteful. The proposals in the Statement I believe promise to bring that to an end.

I come now to the important part of the Statement on the funding of research into AIDS. That is very welcome. As your Lordships' Select Committee on Science and Technology has shown, the funding of scientific research in Britain has been deficient for all sciences, and medical science in particular. There is no doubt that it is desperately needed for research into AIDS. I am glad that it is now being provided in the way that it is, and not with kind of strings that some doctors would have regarded as unacceptable.

Referring to priorities, as did the noble Lord, Lord Ennals, I personally believe that it may be 20 years before we have an effective vaccine in force and in use. It takes a long time to prepare a vaccine. However, I believe that there is hope of establishing and developing an effective therapeutic agent that might render patients non-infected as soon as it is taken, as in the case of tuberculosis years ago. When that happens we will indeed have made progress.

So far it seems that progress has been made by the Americans who, I venture to suggest, have proceeded with some of these substances on a scientific basis that would not have been regarded as wholly acceptable by our own scientists. In that connection, what is needed here is not merely the funds but the skilled manpower. In my experience, since most of the cases of AIDS occur in London, most of the clinical work in caring for those cases has been undertaken by academic clinical staff. They are the very people who should be doing the research but who, up to now, have not had time to do it.

I believe that Britain leads the world with its virologists and microbiologists. I hope that we shall see British scientists in those fields taking as full a part as possible into the research of this very worrying condition. We regard the Statement as very welcome and should like to make that absolutely clear.

Baroness Trumpington

My Lords, I am most grateful to the noble Lord, Lord Ennals, and to the noble Lord. Lord Winstanley, for their welcome to our initiative.

I wish first to answer the point concerning the money spent on breast cancer and whether it would cover the call-recall system. The money is for all facilities for 14 centres, one in each region, including the four training centres, as I said in the Statement. The call and recall systems require only a small modification to the system, and the costs should be covered by the £6 million for these 14 centres in the first year. The GPs are remunerated for general medical services, including cervical cancer screening, out of the generality of their fees and allowances.

Women aged 35 and over, among whom 94 per cent. of deaths from cervical cancer occur and who are generally less likely than younger women to come forward for screening of their own accord, remain a priority. General practitioners will continue to receive an item of service payment as an additional incentive to them to persuade these women to be screened.

The noble Lord, Lord Ennals, surprised me when he spoke of little money for AIDS research. It is very important that your Lordships take on board that we have agreed every penny that the Medical Research Council has asked for—approval of its proposals for direct research into vaccines to prevent AIDS, and the drug therapies for those who are already infected. The money additional to the MRC existing grant-in-aid to permit this was £2.5 million in 1987–88, as I have said then £5 million, and then £7 million, totalling £14.5 million. The MRC, the DES and the DHSS will monitor and review progress, a point that the noble Lord, Lord Ennals, and possibly the noble Lord, Lord Winstanley, asked me.

There is at the end of the day no guarantee of success. One has only to think of the money that has been spent on the common cold, yet that remains a baffling situation.

The plans that we have made will put Britain in the forefront of international action to tackle breast cancer. We take our commitment to prevent this disease, as well as looking after the health of our women, as of paramount importance.

The new returns completed by health authorities should provide a range of additional information on cervical screening programmes, including numbers invited for screening, numbers who accept and the proportions of each five year age group that have been screened within the recommended period. These returns will be introduced in 1988 as part of a broader improvement in NHS information. Following completion of implementation of computerised call and recall systems, similar arrangements will be introduced for breast cancer screening. The Medical Research Council has consulted eminent United Kingdom scientists working in fields of research relevant to drug development for AIDS patients. They are very enthusiastic about such a programme of research. and see no difficulty in pursuing it or in gathering together teams of scientists who will work in a collaborative fashion.

As to the 1988 deadline for the call and recall remit, we are confident that the whole country will be covered by call and recall systems by March of next year. They have already been implemented in 49 out of 90 family practitioner services, as I said. By March this year 109 of 191 districts will be covered, the remainder by March 1988.

As to whether monitoring of the breast cancer screening programme will be undertaken, it is proposed to appoint an advisory committee on breast cancer. The terms of reference will include monitoring the programme. The final point concerns the Palace of Westminster screening facilities. I suggest that the noble Lord and the noble Baroness may like to consult my noble friend the Chairman of Committees about this point.

Lord Hunter of Newington

My Lords, I do not wish to appear ungrateful in speaking, but I wish to draw your Lordships' attention to something that I think is vitally important.

This morning Sir James Gowans came and addressed Sub-Committee II of the Select Committee on Science and Technology. He was talking about these various matters. One thing that he said with certain pride was that in this country we have young people who have been able to serve and rise to this emergency because they exist in the MRC and in the universities. Thus they can be brought together to work on the problem of AIDS. That is the programme the Government have decided to support.

The point that I wish to make—I hope that it does not seem uncharitable—is this. Unless the Government pay attention to the advice that the research councils have given, that the ABRC has given and that the Royal Society has given as well as the Select Committee of your Lordships' House—that we must keep the research base of British science in the universities and in the research councils—when something like this happens again, the young people will not be here. I therefore draw attention to this point.

Baroness Trumpington

My Lords, I am grateful to the noble Lord, Lord Hunter of Newington. I will make sure that my right honourable friend is informed of this aspect. I have a feeling that the noble Lord's worries are needless.

Lord Hatch of Lusby

My Lords, I can welcome without hesitation the first and third parts of the Statement on breast cancer and AIDS, although I share the doubts about the Government's willingness to maintain the funding and standard of medical research.

It is three years since I raised in this House the question of cervical screening. It has been pointed out this afternoon that 2,000 women a year die unnecessarily from cervical cancer. I asked at that time whether the Government would take a lead in reducing the recall period from five years to three years, at least for women between the ages of 20 and 35, and to increase the facilities for women over 35. It seemed to me that the Statement was much vaguer on its proposals for cervical cancer than for breast cancer or AIDs research.

Will the Government now pledge themselves to take a lead in this matter? Will they use all their influence throughout the country to reduce both the recall period from five years to three and to increase substantially. radically and quickly the whole policy of encouraging women to take advantage of the smear facilities? Will they increase those facilities in order to bring down this tragic annual loss of life?

Baroness Trumpington

My Lords, we have considered reducing the period for screening. At the moment we are not convinced that this is necessary. The most important factor is that GPs invite their patients to be screened. The best way that this can be done is on a local basis. It is extremely important that women take up the offers and facilities which are already available for them for screening.

The major number of deaths are among older women, but we have reduced the age at which cervical cancer screening will be done. We accept the Forrest conclusion on research. We accept that determining the optimum interval between screening is a high priority.

On breast screening, we also recognise the importance of the other Forrest suggestions for further research. I am picking up the former point of the noble Lord. Lord Hunter. The DHSS, the MRC and the UK co-ordinating committee on cancer research will be considering how these research proposals may be included in future research programmes.

Lord Kilmarnock

My Lords, I have two brief questions. Taking up the cervical cancer point, it is very welcome that the Government have recognised the spread of the disease in the earlier age range, towards 20. But whereas the figure of £6 million is attached to the breast screening proposals, there is no figure in the Statement attached to the action which is recommended for cervical cancer screening. Perhaps the noble Baroness will say a word about that.

On the research funding, are the tranches given here—£2.5 million, £5 million and £7 million—Treasury dictated or will the Government respond to the MRC's assessment of the lumps in which they will need the money? In other words, is it demand led?

Baroness Trumpington

My Lords, on the last point, extra money comes from the allocation from the Department of Education and Science. As I said in the Statement, both the DHSS and the DES will be monitoring what goes on in the MRC research. However, the funding has been provided on the basis that the MRC asked for it. It has obtained what it wants and there is no question of any Treasury input into the "ifs" and "buts" of the sum of money which I have announced.

Lord Graham of Edmonton

My Lords, will the noble Baroness accept from me that millions of women will find great relief from the announcements that have been made this afternoon? However. does she recall that some time ago I urged upon her support for the initiatives that are increasingly being taken by trade unions—in particular by the Union of Shop, Distributive, and Allied Workers—to try to ensure that screening facilities are made available in workplaces, offices, shops and commercial premises? Will the Minister again consider whether it is possible to encourage more women to take advantage of the facilities? They may for some reason or another be inhibited, but might be encouraged to do so in a workplace. Certainly the union to which I have referred, and many others, have good arrangements with large employers and these should be encouraged.

Baroness Trumpington

My Lords, I well remember the exchange between the noble Lord, Lord Graham, and myself on the matter. There is no reason, if it suits local authorities—for instance in rural areas—why screening could not be done by mobile vans. There is no reason why the mobile vans should not call at places of work if it was so wished. It is up to the local health authorities to work out the best plan for the people who live in the area. All areas vary.

Lord Kilmarnock

My Lords, the noble Baroness did not answer the question about additional funding for the cervical cancer programme.

Baroness Trumpington

My Lords, it was about extra money. The changes needed in cervical cancer screening are mainly organisational: a matter of making the best use of health authority resources.