Cervical Smear Tests (Hansard, 5 July 1990)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Hooper)
My Lords, the number of cervical smear tests examined in Great Britain has increased by two-thirds to approximately 5 million over the past 10 years. We expect a similar rate of increase to continue in the short term. We also expect the GPs' new contract which came into force at the beginning of April to provide a powerful incentive to GPs to increase the number of women screened.

§ Baroness Fisher of Rednal
My Lords, I thank the Minister for that reply. Is she aware that many women's groups are concerned about the undue delay in receiving the results of the tests? The waiting period in some cases can be as long as two to three months. Obviously that causes great concern and anxiety to many women who are awaiting the results. Is the Minister further aware that there is a grave shortage of laboratory technicians which is therefore causing delay in receiving the results?

§ Baroness Hooper
My Lords, I fully realise that anxieties have been expressed in that regard. We have asked laboratories to report the results of routine cervical smears within a month. Some laboratories have reported increased difficulties due to GPs making extra efforts to boost coverage, but our information from health authorities shows that around 75 per cent. to 80 per cent. of laboratories achieve that one month target. However, we shall, of course, keep the situation under review, as will the health authorities.
I should add that for cases diagnosed as urgent, as opposed to routine tests, the reporting time is normally much less than one month.

§ Lord Ennals
My Lords, is it possible to tell whether a case is urgent or not until the result of the screening is known? Is the noble Baroness aware that there is a good deal of concern when delays in receiving results from laboratories can be as much as several months?
Does the noble Baroness accept that in many areas where there is a high proportion of people from ethnic minorities it is unlikely that any doctor will 2260 carry out smear tests because it is unlikely that he will reach even the minimum target and therefore under the new contract he will receive no pay? Is that not a very strange way of encouraging doctors to increase smear tests?

§ Baroness Hooper
My Lords, to answer the noble Lord's first question, I believe that there are certain at-risk categories which can be identified as urgent. Obviously in the routine call and recall system one would not know whether a case was urgent until the results were received. However, in those cases presumably the women concerned would not be suffering the same anxiety as somebody for whom a test has been recommended for specific reasons.
A great deal of work is being done to encourage women from ethnic minorities to accept their screening invitations. Money has been identified from the breast screening budget to fund four cancer screening development workers. Those workers will examine primarily the problems faced by districts with multi-ethnic populations and the acceptability of breast screening. There are other funded arrangements: for example, the Department of Health has funded the full cost of a video on screening produced by the London Chinese Health Resource Centre. A number of health authorities have developed or are developing screening literature in ethnic minority languages, including invitations to screening and explanatory leaflets. We hope that there will be considerable progress in that particular area.

§ Lord Molloy
My Lords, the noble Baroness said earlier that, quite rightly, this matter is under review. I am sure that that will be warmly welcomed in all parts of the House. Will that review take into account the possibility that there may be insufficient laboratory scientists coming from the universities to meet what will be required for this and other matters?

§ Baroness Hooper
My Lords, the Question on the Order Paper refers specifically to the GP contract. It is very difficult to predict the impact of that contract because the returns for the first quarter since the contract has been in operation are not all in yet. However, we are keeping the situation under review.

§ Baroness Fisher of Rednal
My Lords, can the noble Baroness say what happens in the case of women patients in practices with only male doctors? Are any provisions made for them to go to another GP or to a hospital for the service? As the noble Baroness will be aware, there are certain groups of women who do not wish to be dealt with by a male doctor.

§ Baroness Hooper
My Lords, there are many possible responses to meet that particular problem. They include the possibility of tests being taken in hospital or arrangements being made with women doctors in other practices.

§ The Lord Bishop of Chester
My Lords, does the Minister accept that considerable sensitivity is being expressed by women who are single—not least nuns and sisters, and also women in their early sixties and those caring for those who are mentally ill —about the pressure that is inevitably being brought to bear in certain practices in order to bring the figure for screening up to 80 per cent? Does the Minister therefore agree that the review of the arrangements might include consideration of a graded system of reward instead of that sudden jump from nil at 50 per cent., £760 at 79 per cent. and £2,260 at 80 per cent? Would not a grading be a fairer way of encouraging screening and lessening the pressure on some practices?

§ Baroness Hooper
My Lords, we have recognised that women have the right to choose not to accept what [...]s after all only an invitation to be screened. Also, a doctor may exercise his clinical judgment in deciding whether or not to invite a particular woman for screening. That was recognised in not requiring the 100 per cent. target. That is why the target was set at 80 per cent. We believe that the grading that is provided, that is to say the lower target payment between 50 per cent. and 80 per cent. to which the right [...]everend Prelate referred, is helpful in that respect.