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Cervical Smear Tests
3.30 pm
Dr. Norman A. Godman (Greenock and Port Glasgow) (by private notice) : To ask the Secretary of State for Scotland if he will maka statement on the disclosure yesterday of serious errors in the cervical smear testing of more than 2,000 women at the Inverclyde Royal hospital in Greenock.
The Secretary of State for Scotland (Mr. Ian Lang) : The Argyll and Clyde health board-- [Interruption.]
Madam Speaker : Order. It is time that the House came to order so that we can hear this important exchange.
Mr. Lang : The Argyll and Clyde health board announced yesterday that there had been some inaccurate reporting of results of smear tests by the laboratory staff at Inverclyde Royal hospital, Greenock, carried out between 1987 and February 1992. This problem was confirmed last week following the analysis of 1,000 slides, and the health board has moved quickly to take appropriate action. Some 20,000 slides are being reviewed and it is expected that 90 per cent. of these will be confirmed as normal, requiring no further action. The board considers that up to 2,000 women may require a repeat smear test and that a high proportion of these will also be found to be normal. Arrangements have been made for counselling through the provision of helplines and to follow up quickly any women whose re-test shows an abnormal result. General practitioners have been fully briefed. It is anticipated that the whole process will be completed in eight to nine weeks, but that the large majority of the women involved should receive reassurance well before that. My noble Friend, Lord Fraser of Carmyllie, has already indicated that priority will be given to this problem and the other Scottish health boards will assist as necessary to ensure a speedy conclusion of the review and follow-up action. He has also announced that he has commissioned a full inquiry into the circumstances of the problem at Inverclyde in order to put beyond doubt that the situation was unique and will be non-recurring. Dr. Euphemia McGoogan of Edinburgh University will head the inquiry team, and my noble Friend hopes to be able to announce the names of the other members shortly, together with the full terms of reference. The findings of the inquiry will be made public.
I regard this as a serious incident that deserves the closest and most careful attention. That it will have. I would, however, also like to reassure the House that all national health service laboratories in Scotland are now working to the highest professional standards and subject to external audit. Women in Scotland should be reassured that the results of tests are as accurate and reliable as they can be, throughout Scotland as elsewhere in the United Kingdom.
Dr. Godman : I thank the Secretary of State for his statement on this critical and sensitive issue. He will surely agree that our main concern must be for the retesting of the women, and that re-testing should be carried out as accurately and as speedily as possible, with accuracy being the key word. Should he not be considering the use of laboratory resources from elsewhere in Scotland and south of the border in order to reduce this over-long period of
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eight to nine weeks? For my constituents, caught up in this distressing affair, I can tell the Secretary of State that eight to nine weeks is much too long to wait for peace of mind.With regard to the inquiry to be chaired by the excellent Dr. McGoogan, may I implore the right hon. Gentleman to invite a woman of commensurate stature from outwith the medical profession to join Dr. McGoogan so that we can dispel once and for all the idea that this is a case of a doctor examining other doctors?
While the monitoring of these so-called quality control programmes is adequate, it surely now requires statutory regulation. Will the right hon. Gentleman set up a supervisory body that can examine in as accurate a way as possible the monitoring procedures adopted by these clinics throughout Scotland's health boards?
The Secretary of State will surely agree with me that we must tell women of all ages, from teenagers to grandmothers, not to allow this dreadful incident to put them off obtaining cervical smear tests, because of the importance of such tests in preventing the dreadful scourge of cervical cancer.
Mr. Lang : I absolutely agree with the hon. Gentleman in emphasising the importance both of speed and of accuracy in the handling of the re- tests, such re-tests as may be necessary. As regards the time scale for completing the exercise, I indicated eight to nine weeks as the outside limit within which we expect all aspects of the matter to be concluded, but I confidently predict that the very large majority of cases will be dealt with quickly and well within that time scale.
We are considering the membership of the inquiry team along with Dr. McGoogan. I take note of the point that the hon. Gentleman has made about involving somebody from outside the medical profession. The hon. Gentleman raised the question of a supervisory body to monitor auditing procedures in the future. This is certainly a topic that I expect the inquiry to want to examine.
Finally, the hon. Gentleman spoke of the importance of women not being put off having the tests, and I absolutely endorse what he said. These tests are important and of great value to the women concerned. They are now carried out on a three-year cycle, whereas before it was a five-year cycle, and I have considerable confidence in their efficiency and accuracy.
Mr. Phil Gallie (Ayr) : I agree with my right hon. Friend that this is a most regrettable situation. I sympathise with the hon. Member for Greenock and Port Glasgow (Dr. Godman), but I must point out that the problem extends into Ayrshire, albeit not to such a degree. Does my right hon. Friend agree that application for trust status for hospitals demands very stringent quality processes to be built into business plans? Does that help in this situation for the future?
Mr. Lang : My hon. Friend is right to the extent that a number of cases, particularly in north Ayrshire, will also be involved in this rescreening exercise since some of the smears taken in that part of Scotland were processed at the Inverclyde laboratory. On the latter part of his question, I agree with him on the importance of the highest possible quality both of performance and of auditing of measures of this kind.
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Mrs. Ray Michie (Argyll and Bute) : The Secretary of State will be aware of my concern and that of my constituents in Cowal and Bute whose tests were also sent to the Inverclyde Royal hospital. I too welcome the swift action by the Argyll and Clyde health board in making this very serious matter public and in setting up the valuable helpline. I endorse what the hon. Member for Greenock and Port Glasgow (Dr. Godman) said about the membership of the inquiry team. I hope that a suitable lay person will be included in the team. Has any thought been given to tracing women who have left the area, including the Scottish wives of Americans who have returned to the United States following the closure of the Holy Loch base? Finally, will the Secretary of State consult his right hon. Friend the Secretary of State for Health about the possibility of introducing the Quest cancer test? I believe that it is 95 per cent. accurate, and much less subjective than the method currently used. Only £480,000 is required to conclude the final trial.
Mr. Lang : I note what the hon. Lady has said about the membership of the inquiry team, and I shall bear her suggestion in mind. Every effort will be made to track down all the women involved in the tests over the period in question, including, where possible, those who have gone abroad. The community health index will be helpful, and all Scotland's health boards have offered whatever help may be needed to improve both the speed and the accuracy of the exercise.
The hon. Lady also asked about new procedures for cervical smear tests. I am confident that the processes being used throughout the health service in Scotland--and elsewhere in the United Kingdom--are the most appropriate at present, but research continues, in this country and abroad, to find ways of improving them. If any improved method is established, we shall of course want to consider it.
Mr. Bill Walker (Tayside, North) : My right hon. Friend will be aware of the concern that was felt throughout Scotland when the problem was announced. Surely the important task now is to reassure everyone that the Government are acting to remedy this difficult and serious situation. We all realise that human errors will always occur when humans are involved ; the important thing is to deal quickly and effectively with such errors when they are revealed.
Mr. Lang : My hon. Friend is absolutely right. Since February 1992, the auditing process that has already been in use elsewhere throughout Scotland has been used in the hospital concerned. I am confident--as is the chairman of the health board--that the problems will not recur.
Mr. Tony Worthington (Clydebank and Milngavie) : The problem clearly occurred because of procedural errors. Will the Secretary of State give an assurance that the same procedural errors could not have occurred in other health boards between 1987 and 1993?
Mr. Lang : As far as I am aware, there is no question of their having occurred in other health boards. All the general managers met yesterday to discuss matters ; this matter was also discussed, and I am confident that they will all re-examine the processes that are used. I believe,
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however, that the situation that existed in the Argyll and Clyde board until February 1992 does not exist anywhere else.Mrs. Margaret Ewing (Moray) : Does the Secretary of State accept that all hon. Members wish to ensure that women are guaranteed a service that will secure the correct results of tests that they undergo--for instance, cervical smears or mammography? That is very important.
Any woman whose test produces a slightly worrying result will experience weeks of agony in her attempt to come to terms with the situation. The Secretary of State has said that he estimates that women in the Inverclyde area will have to wait no longer than eight or nine weeks at the outside for the final result. Will he give us his estimate of the shortest time that they will have to wait, to reassure the 20,000 women involved--and, no doubt, all the other women throughout Scotland who are deeply concerned about the possibility that their tests have produced an inaccurate result? That is an important consideration for women.
Mr. Lang : I agree : it is urgent that as many people as possible are reassured as quickly as possible. Mrs. Mary Robertson, the unit general manager, has been appointed head of a task force set up to take appropriate steps as quickly and efficiently as possible, and the assistance of two external laboratories has been called in to speed up the process. In addition, further resources will be made available as necessary.
I emphasise that the eight-to-nine-week time scale is the outside limit within which I hope the entire exercise will have been completed, including the follow-up on those who have to be tested again.
Mr. Tom Clarke (Monklands, West) : Does the Secretary of State accept that it would be churlish not to agree that the Government have acted speedily on this matter but that my hon. Friend the Member for Greenock and Port Glasgow (Dr. Godman) has done a great service to the House and to women in tabling the question? Although the Secretary of State apparently takes the view that this is an isolated incident, does he accept that 20,000 women are deeply worried and that the incident has implications beyond Inverclyde?
Will the Secretary of State accept that we require assurances about standards of quality elsewhere in Scotland and that it is a matter not only of human frailty but of the type of systems that we operate? Is he satisfied that the available resources are sufficient to ensure that no such incidents occur elsewhere?
Will the Secretary of State consider whether the inquiry that he has outlined should be broadened in its remit not to deal only with the specific problem in Inverclyde but to allay the worries of women throughout Scotland and Great Britain who have rightly placed so much faith in smear tests?
Will the right hon. Gentleman give an assurance on resources? Will he assure us that the local health authority will not be asked to pay the bill arising from this unfortunate incident?
Does he accept that the Opposition and the whole House wish to encourage the great majority of hospital laboratory personnel engaged in such demanding work to maintain their very high standards, and that we acknowledge that the obligations placed on them are horrendous in the extreme?
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It is essential that this incident should not act as a deterrent to anyone anywhere in the United Kingdom, and certainly not in Scotland, who is considering whether to be screened or tested by the NHS. Apart from the re-examination of slides, which the Secretary of State has announced, and the inquiry, what further steps will he take to ensure that there is no such deterrent effect from the sad experience of Inverclyde?Mr. Lang : I am grateful to the hon. Gentleman for his comments about the speedy reaction of the health board and the Government to this extremely unfortunate and serious incident. I must emphasise the fact that, of the 20,000 cases involved, some 90 per cent. will not need to be recalled--that is our expectation--and, of the remainder who are recalled, a substantial proportion will be recalled simply because the quality of the original smear does not enable an adequate reading to be taken.
I anticipate that any difficulty or problem arising over the identification or diagnosis of a cancerous or pre-cancerous condition will be confined to a very small number of people within the overall numbers with which we are dealing.
As for resources, I stress that the important thing is to get the exercise completed quickly, accurately and sensitively, and I shall not allow resources to be a problem. Whether it is a matter for the health board or for the health service as a whole in Scotland, I shall ensure that resources are adequate.
The question of the possible broadening of the inquiry's remit is essentially a matter for the inquiry itself whose terms of reference have not yet been set, but I shall consider what the hon. Gentleman said.
I certainly pay tribute to the staff of the health board for the speed and commitment which they have shown in bringing all their efforts to bear on this problem and ensuring that the counselling services and other ways of helping the anxious women involved are put into operation as speedily and effectively as possible.
I underline the wish stressed by the hon. Gentleman and by the hon. Member for Greenock and Port Glasgow (Dr. Godman). This incident should not deter women from undertaking these tests. Tests that identify a problem early are immensely valuable for the prospects of the woman affected. As for further steps that might be appropriate to ensure that that result is achieved, I shall watch the situation closely as it develops and take full account of the inquiry's findings.
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Business of the House
3.38 pm
Mrs. Margaret Beckett (Derby, South) : Will the Leader of the House state the business for next week?
The Lord President of the Council and Leader of the House of Commons (Mr. Tony Newton) : Yes, Madam. The business for next week will be as follows :
Tuesday-- 4 May----European Communities (Amendment) Bill, Report state, first day.
Wednesday-- 5 May----European Communities (Amendment) Bill, Report stage, second day.
Thursday-- 6 May----Debate on the Royal Navy, on a motion for the Adjournment of the House.
Friday-- 7 May----Private Members' Bills.
Monday-- 10 May----Progress in Committee on the Finance (No. 2) Bill.
The House will also wish to know that European Standing Committees will meet on Wednesday 5 May at 10.30 am to consider European Community documents as follows :
Committee A'
Document No. 11235/92 on European agricultural guidance and guarantee fund anti-fraud measures.
Committee B'
Document 7021/92 on company taxation.
[Wednesday 5 May :
European Standing Committee A
Relevant European Community Document
11235/92 Anti-fraud measures
Relevant European Legislation Committee Document
HC 79-xviii (1992-93).
European Standing Committee B
Relevant European Community Document
7021/92 Company Taxation
Relevant European Legislation Committee Report
HC 79-vi (1992-93)]
Mrs. Beckett : I thank the Leader of the House for that statement, and especially for the debate on the Navy for which he will recall hon. Members on both sides have been pressing for some time. I remind him that we are still anxiously awaiting an announcement of the assignment of the new European constituencies in terms of where they will go and of who will deal with the issue of boundaries. Labour Members have repeatedly said that it would be outrageous if such decisions did not go to the Boundary Commission, which has expressed its willingness and ability to deal with them. We are anxious to have an early statement in the House on the matter.
May I press the Leader of the House for a statement and some information on the Asylum and Immigration Appeals Bill, which I understand may be returning from another place shortly? I hope that he can tell us that it will be possible to have the new draft immigration rules before the House before we come to that part of our proceedings so that people can assess how the Government have been able to meet assurances given in Committee which will clearly inform the debate that we have here.
I ask the Leader of the House to bear in mind that we will need at least three full days in Committee on the Finance Bill so that we can explore, for example, the recent judgment of the IMF that we are seeing the emergence of a structural budget deficit alongside a structural trade
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deficit in the United Kingdom. The emergence of such twin deficits will be of great concern to hon. Members on both sides of the House. To address the issue of the victims of the Government's economic policy, I ask the right hon. Gentleman to ask the Secretary of State for Employment to come to the House and make a statement on the observation of the hon. Member for Welwyn Hatfield (Mr. Evans) : "of the 1 million long-term unemployed, probably half can be termed layabouts". --[ Official Report, 27 April 1993 ; Vol. 223, c. 838.]The Secretary of State conspicuously failed to rebut that statement at the time--it has caused outrage certainly among Labour Members. I hope that she will take the opportunity to make a statement to rebut it.
Finally, I remind the Leader of the House that we are anxiously awaiting a further Opposition day.
Mr. Newton : On the last but one point, I will certainly bring the the right hon. Lady's request to the attention of my right hon. Friend the Secretary of State for Employment. I must admit that I did not read into those remarks of my hon. Friend quite the import that the right hon. Lady has suggested.
As for days on the Finance Bill, the right hon. Lady will find that she will have ample opportunity to make the points that she evidently wishes to make, although I am not sure whether they truly arise in relation to the Finance Bill. It sounded more like the sort of point that she wanted to make anyway, and I acknowledge and, within limits, respect that.
On the Asylum and Immigration Appeals Bill, I cannot give immediately to the right hon. Lady the precise undertaking that she sought. I know that my hon. and right hon. Friends will seek to ensure that the House has what information it feels it properly should have in undertaking the further debates that will be required on that measure.
On the question of the boundaries of the extra European seats, I cannot add to what I have said on the past two or three occasions--that once proposals on the matter have been formulated, the Government plan to consult the Opposition parties. I am sure that the right hon. Lady will come well within that parameter.
I note the further request for another Opposition Supply day. I couple it with the right hon. Lady's kind thanks for the debate on the Navy. I repeat the point that I think I have been meeting the right hon. Lady's requests at the rate of one a week, so at least she can harbour some continuing hope.
Sir Terence Higgins (Worthing) : As it appears to be the policy of the Chairman of the Accommodation and Works Committee not to reply to letters from right hon. and hon. Members regarding the future of Old Palace yard, will my right hon. Friend allow us to have a debate next week? Is he aware that it is a serious matter? It is wrong that hon. Members and their secretaries should be evicted to accommodate the House of Lords secretarial agency. Their Lordships have said that the building is not suitable. The proposal is to apply for planning permission to make structural alterations to a building that is clearly of great historical importance.
Mr. Newton : I am, of course, aware of the concern expressed in various quarters, not least by my right hon. Friend, about the matter. As he suggested from the way in
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which he put his question to me, the issues are primarily for the Accommodation and Works Select Committee, the Chairman of which I note is present in the Chamber. I am sure that he will have noted and will seek to respond in an appropriate way to my right hon. Friend's remarks.Mr. Matthew Taylor (Truro) : The Leader of the House may not be aware that in the past two weeks confusion seems to have developed between Ministers at the Department of the Environment about whether they have any responsibility for water charges in those parts of the country which face large increases in water charges. In view of the differences of opinion within the Department and with the Prime Minister, perhaps it would be appropriate to allow some time for a debate in the Chamber so that the matter can be urgently resolved. It seems extraordinary that Ministers have not decided among themselves.
Mr. Newton : I am sure that my right hon. and hon. Friends in all Departments are united in their view about such matters, but I will certainly bring the hon. Gentleman's perception of disagreement to their attention.
Mr. Andrew Hunter (Basingstoke) : Last week my right hon. Friend agreed to consider my request that statutory instruments Nos. 526 and 542 should be referred to a Standing Committee for debate. In those statutory instruments the Government seek to treat timeshare dwellings as commercial properties subject to business rates. Now that the weakness of the Government's position has been exposed and the cost to individual timeshare owners has become clear, will my right hon. Friend grant my request?
Mr. Newton : I am afraid that I have not yet had an opportunity to complete my examination of the matter in the light of my hon. Friend's request last week. However, I note his further request, and I shall seek to complete my consideration as soon as possible.
Ms Diane Abbott (Hackney, North and Stoke Newington) : May I draw the attention of the Leader of the House to early-day motions 1858 and 1859 and the recent murder of the black schoolboy Stephen Lawrence?
[That this House shares the sense of outrage in the community in South East London following the brutal racist killing of Stephen Lawrence on 22nd April 1993 ; sends condolences to his parents, Neville and Doreen Lawrence ; recognises the state of shock in the area in view of the previous murders of Rolan Adams and Rohit Duggal ; believes that the presence and activity of the British National Party in the area incites racial hatred and contributes to the level of racial violence ; calls on the Attorney General to bring proceedings against the British National Party for incitement to racial hatred ; and calls on Bexley London Borough to use its enforcement powers to close the British National Party headquarters which are operating in breach of planning regulations.]
Stephen Lawrence, a church-going schoolboy, was standing by a bus stop when he was set upon by a gang of white youths carrying knives. It is the third murder of a young black person in recent months in that area. All those murders have taken place within a four-mile radius of the headquarters of the British National party. I visited the family last weekend. In the light of the family's grief and the fear of the black community that the murders represent the start of a wave of racist attacks, I
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ask the Leader of the House to make time for a debate on racial attacks. We want to tell the House that the black community wants to see such murders receive the front-page attention that other attacks receive. They are fearful that the type of racial violence that we have seen in Europe is coming to the British Isles.Mr. Newton : I cannot promise the hon. Lady a debate, but I can say- -and I am sure that I say it on behalf of not only members of the Government but of all Members of Parliament--that I unreservedly condemn all attacks on members of ethnic minority communities. We all extend our sympathy to the family of Stephen Lawrence and express our hope that the culprits will be caught and brought to book.
Mr. James Couchman (Gillingham) : My right hon. Friend will have seen early-day motion 1670 on the selected list proposals for family planning.
[That this House notes the Government's proposal to include the contraceptive pill in the Selected List of drugs for prescription under the National Health Service ; notes that the United Kingdom uses the cheapest oral contraceptives of any country in the EC and that the contraceptive pill gives the lowest failure rate of any form of contraception ; recognises that following medical advances, the newer and more expensive pills containing safer progestagens are most vulnerable to the Selected List proposals because they are more expensive but are the first choice when prescribing ; is concerned about the possible side effects, such as weight gain, headaches, bleeding and even unplanned pregnancies in women forced to transfer to a cheaper contraceptive pill ; notes that the saving per woman is of the order of £16.90 per annum and contrasts this with £200 as the average cost of a termination of pregnancy and £1,217 for a delivery ; therefore concludes that there will be no net saving if between two and four unplanned pregnancies occur in 100 women per year ; understands the concerns expressed by health care professionals and organisations including the Royal College of Obstetricians and Gynaecologists and the Family Planning Association ; and therefore calls on the Secretary of State for Health to delete the contraceptive pill from the Selected List.]
The matter is causing increasing anxiety among both doctors and the pharmaceutical industry. I draw the attention of the House to my declared interest in the matter. Will my right hon. Friend give time for a full debate in the House in Government time on the proposals, which will affect many patients throughout the country? I am aware that my hon. Friend the Member for Basingstoke (Mr. Hunter) recently had an Adjournment debate on the matter, but I feel that it should have Government time for full debate.
Mr. Newton : My right hon. Friend the Secretary of State for Health will be present to answer questions on the first day of the business programme that I have announced. Meanwhile, I understand that the independent advisory committee on NHS drugs will ensure that oral contraceptives to meet real clinical need remain available on NHS prescription.
Mr. Ray Powell (Ogmore) : As to the question by the right hon. Member for Worthing (Sir T. Higgins) about the Accommodation and Works Committee, I can assure
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the Leader of the House that any letters he or any hon. Member sends to it are replied to. Indeed, if anyone has a complaint, most of them--like the right hon. Member for Worthing--are invited to raise it with the Committee.I was not going to ask that particular question. My main question was to ask whether the Leader of the House had read early-day motion 1892.
[That this House shares the concern reported in the House Magazine of 19th April over the way the televising of Select and Standing Committees can be something of a lottery because of a haphazard pricing structure which can result in broadcasting organisations being asked to pay up to £2,000 for the television feed of a two-and-a-half-hour Committee hearings ; believes that Committee hearing which are of interest on editorial grounds should not go unrecorded soley because of cost ; and calls on the Lord President of the Council and the Broadcasting Select Committee to have discussions with the independeks.]
I pay tribute to the Table Office for ensuring that it appeared on the Order Paper because it was tabled only at 2.30 this morning. I do not expect the Leader of the House to have read it, but it is of direct relevance to him. It has a direct effect on the House of Commons Committees and, in particular, on those dealing with private Member's Bills. The televising of my Committee was stopped because it could not be funded on the particular day that I wanted it to be televised.
Mr. Newton : If I might advert briefly to the first part of the hon. Gentleman's question--which he conceded was not really his intended question at all--I realise that I am standing here as a sort of postbox in an exchange between my right hon. Friend the Member for Worthing (Sir T. Higgins) and the hon. Member for Ogmore (Mr. Powell).
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