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Breast Cancer (Devon)

Motion made, and Question proposed, That this House do now adjourn.--[Jane Kennedy.]

10.45 pm

Mrs. Angela Browning (Tiverton and Honiton): An independent review commissioned by the Royal Devon and Exeter healthcare NHS trust identified micro-calcification in nine mammograms that needed further assessment rather than the advice that the patients had been given--that they should return home and wait for the normal recall period of three years for another mammogram. The issue has been raised on the Floor of the House before, but I welcome the opportunity to engage in a fuller discussion tonight, because the matter is of great concern to women and their families living in the Exeter area, including those in my constituency.

I am aware of the sensitivity of the subject. Cancer in any form can cause fear, and breast cancer causes fear to many women, especially those currently undergoing treatment. I do not intend to spread alarm by raising the matter tonight, but, in view of its seriousness, I would welcome the Minister's recognition of the fact that much wider implications in matters of policy and procedure will emerge from the very necessary investigation that is now to be held at Wonford House hospital in Exeter.

Now that the Chamber has cleared somewhat, let me express my gratitude for the presence of members of all parties. I note that the hon. Member for Exeter (Mr. Bradshaw) is here, as are Cornwall Members. They are here because they are aware of the wide-reaching implications of what has been revealed following the Exeter hospital announcement.

Let me put on record that it was the trust's own quality control that identified the problem. I pay tribute to it for having such measures in place and for being extremely frank and open in wanting the matter to be fully investigated and to be brought into the pubic domain. I also fully endorse the recommendation of the hospital's management that women should continue to keep their appointments at the hospital while the matter is being investigated.

The number of undetected breast cancers among women screened by the east Devon service is within the national average range--30 cancers for every 10,000 in the population. I shall refer later to the implications, the figures and the position as it compares with that in the rest of the country.

On 9 June in answer to a private notice question tabled by my right hon. Friend the Member for East Devon (Sir P. Emery), it was stated that two consultants who were advising those patients were to be retrained. However, it was with concern that I read an article in The Independent on Saturday 7 June this year which identified the case of Miss Simone Renvoize who was treated by one of those consultants in his former hospital, the Treliske, in Cornwall.

I have received a copy of a letter, which I understand has been sent to the Secretary of State for Health by the cousin of Miss Renvoize, who has now died. I should like to read from a small portion of that letter. Miss Renvoize's cousin, Mrs. Barnes, states that in 1990 her cousin, Simone Renvoize, was sent to one of the consultant radiologists currently suspended for a

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mammogram at Treliske hospital in Truro. It revealed tumours in both breasts. However, she was told that her lumps were purely hormonal, leading to a delay of six and eleven and a half months respectively for mastectomies which she later had. Fellow radiologists who subsequently reviewed those X-rays could see clearly both the tumours. Mrs. Barnes's concern was that the error was known about while this doctor was employed at the Treliske hospital and he was even to move to the Exeter hospital with no suggestion of retraining at that time. She states that her cousin also began a legal case seeking redress for the inadequacies of her diagnosis and that treatment and medico-legal reports were prepared but still no one alerted the Exeter hospital.

We all recognise and, having worked for a short time in the Wonford House hospital, I certainly recognise, that doctors are not infallible and make mistakes. In cancer diagnosis especially, a doctor may often see grey areas on a mammogram that are not easy immediately to recognise. However, it seems that here the people concerned did not err on the side of caution, which is a reasonable expectation by patients. It is clear that the same procedures were carried out by the same person over a long period.

I have asked the management of Wonford House hospital what references were taken up and whether anything was drawn to their attention that made it clear that retraining was needed much earlier. I understand that inquiries have been made and that nothing in the references of this person gave any reason for further investigation.

I have also received a letter from a constituent who is a state registered nurse and who worked at the Wonford House hospital. She expressed concerns about staff in the unit who have been aware of the diagnosis controversy but who, in many cases, felt it difficult to share their concerns with senior management at the hospital. I should like to ask the Minister to consider two matters in relation to the wider implications of this issue.

First, will the hon. Lady look at the way in which medical references are taken up? That matter bears further investigation, not just in this case but in the case of boards which interview clinicians. Does the way that those interviews are carried out mean that boards can be absolutely sure that they are receiving an accurate account of a person's aptitude and ability to carry out specific tasks? Secondly, as a result of what has been said and written to me by hospital staff, I am aware that the issue of whistleblowers can be controversial and can have adverse effects both ways.

There must be a structure in hospitals to allow staff to make concerns known to senior management without feeling in any way intimidated or that their positions are put at risk. Obviously, here we have a situation where I am being told by a nurse in that hospital that it was common knowledge that there was concern among other staff that there were problems in this area.

There is always the question of the clinician, the surgeon, having the final say and using his or her medical judgment about an individual case, and we all recognise their need to be able to do that. If Wonford House hospital in Exeter is, like other hospitals throughout the country, to be designated a specialist centre for cancer treatment, those of us who live in the region and who use the hospital

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must have confidence that we are receiving in that hospital the best possible practice that has been garnered from the best hospitals throughout the country.

My understanding was that the chief medical officer's recommendations--the Calman response to considering the way in which we take forward specialist cancer centres in the region--envisaged that, instead of those of us who live out in the sticks having to go to the big cities or even to London for specialist treatment for serious diseases, the best that was available would come to us, and that, if it came to us, the hospitals that offered that level of treatment would be able to say that they were specialist cancer treatment centres. I am sure that I speak for many of my constituents--I am certainly speaking personally now--when I say that, if I needed specialist treatment, particularly cancer treatment, I would rather have it at the Royal Marsden hospital and know that I was going to get the best treatment than have someone stick a label on my local hospital, which did not live up to its name.

In fairness to the people who work in Wonford House hospital, particularly those working in other disciplines and specialising in other areas of cancer treatment, it is vital that an analysis is made not just of the procedures that are carried out there, but of what it is able to offer us in terms of outcomes, if it is to become a specialist centre.

Sir Peter Emery (East Devon): In pressing what my hon. Friend is saying, and I have followed it clearly, will she urge the Minister to examine the facts so that the hospital can reassure what must be about 5,000 to 6,000 women who have been tested that they are no longer at risk or, if there is any risk, that they are going to be called back in at the earliest possible and proper time to be re-examined? It is essential that those people should not be left still wondering what is going to happen to them.

Mrs. Browning: I concur with my right hon. Friend's concern on behalf of his constituents. We want not only quick action and a full investigation of what has gone on, but lessons to be learnt from this. Clearly, there are lessons to be learnt that may have even national implications over a wide area. I hope that this debate will trigger that. It is my intention that we learn from what has been an unhappy experience.

Women need reassurance that the way in which they are screened, diagnosed and treated for breast cancer should not be a geographical lottery. Where people live should not matter in terms of the sort of service that they receive. We should be considering why different parts of the country produce different outcomes. The Cancer Relief Macmillan Fund charity endorses my view that this country's mortality rate does not compare well with that of other countries.

We have one of the worst records in the world for breast cancer. It is difficult to identify why that is so. There is research into the matter and various theories are suggested, but the fact is that our rate is 29.3 per 100,000 of population, whereas it is 19.4 in France and 17.3 in Germany. When our rate compares so badly with those of other countries, surely within the whole spectrum of the medical profession dealing with the disease there must be a concentrated interest in the reason for the figures and what can be done to reduce them through screening, diagnosis and treatment.

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Anyone working in the medical profession, whether at consultant or any other level, should be hungry to identify what is happening elsewhere in the country and what new procedures are being adopted. We must garner the best practice that is available and take that out into the regions.

When I looked in the Library, I found figures produced by Macmillan showing that mortality rates from breast cancer in the south-west between 1993 and 1995--the latest figures available--were higher per 100,000 of population than was the case in any other part of the country. That, too, is a cause of concern. If the disease is being treated better in other parts of the country, please can we find out what it is that they do better and please can the people who practise is this area of medicine and surgery in my part of the country not be too proud to find out why the rates are better elsewhere? We want the matter to be taken seriously. I know that the Department's guidelines to purchasing authorities say that they should look at outcomes. Right across the spectrum, outcomes involve what happens in screening, what happens when cancer is detected and what happens thereafter.

I hope that tonight the Minister will reassure us that what has happened in Exeter will be fully investigated and that any lessons to be learned, which may have national implications, will be speedily adopted by the Department. We look to the Minister and the Secretary of State to ensure that no stone is left unturned. Until the matter is investigated and the lessons learned, and until there are changes to put things right, I and other women will not be fully confident about what is being offered to us locally.

It is devastating for women who have or think they may have breast cancer. We know that doctors cannot always perform miracles, but let us get as near to a miracle as we can.

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