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National Screening Programmes
10. Liz Blackman: To ask the Secretary of State for Health what proposals he has for improving the reliability of national screening programmes. [3475]
16. Laura Moffatt: To ask the Secretary of State for Health if he will make a statement about the breast cancer screening programme. [3482]
Mr. Dobson: Breast and cervical cancer screening remain the best method of detecting breast and cervical cancers early so that women can get treatment as quickly as possible. It is vital therefore that women can be confident about the quality of that screening. That is why everyone is so disturbed by the record of failure in breast cancer screening in East Devon NHS trust and in cervical cancer screening in Kent and Canterbury NHS trust.
Arrangements have already been set in train for the chief medical officer to conduct an inquiry into what has been happening in east Devon. At my request, Sir William Wells, the chair of South Thames regional office, has set up an independent inquiry into the lamentable failure of the cervical cancer screening services in Kent and Canterbury, and the equally lamentable failure of the management to deal with the situation. He has accepted the resignation of the chair and chief executive.
Liz Blackman:
I thank my right hon. Friend for his answer, which will give great reassurance to many women. A significant number of women in the target groups do not take up invitations to go for screening. The figure varies between 16 and 34 per cent. in different health authorities. Those women do not come forward for a variety of reasons: they lead busy lives, work anti-social hours or do not regard themselves as a high priority. Does he have proposals to encourage such women to come forward to take advantage of the screening programme?
Mr. Dobson:
As I think my hon. Friend knows, the target take-up rate for breast cancer screening nationally is 70 per cent. of women in target age groups. That is exceeded in every region except North Thames, but that figure does not apply to quite a lot of women in badly deprived areas or to substantial numbers of women among various ethnic groups. I have asked that special measures be taken both in North Thames and in other areas to lift the take-up rate in such groups. I have also asked officials to consider whether the 70 per cent. target is reasonable.
Laura Moffatt:
In Crawley, ethnic groups form about 10 per cent. of the population. For all sorts of reasons, women in those groups do not come forward. They may have problems understanding what the test is about and be worried about the people who will deal with them if they do come forward. I am thrilled that my right hon. Friend is keen to examine the issue of getting people to
Mr. Dobson:
I support the propositions that my hon. Friend puts forward, both from her political knowledge and from her professional knowledge as a nurse. Speaking as one privileged to represent the Elizabeth Garrett Anderson hospital, I can say she might have added that, for some ethnic minority women, a guarantee that they would be dealt with by women would undoubtedly help to raise the take-up rate.
Mr. Baldry:
The right hon. Gentleman has talked about shifting resources from elsewhere in the NHS to breast cancer. There has been much rhetoric about red tape, bureaucracy and reviews. Can he make clear what reviews are taking place in the NHS? What are their timetables? When will work be completed? Will he give an undertaking that their results will be transparent, so that we shall be able to compare what the Government say about NHS bureaucracy with what is there now to manage a system that spends £42 billion a year?
Mr. Dobson:
For a start, £10 million has been shifted into breast cancer treatment. That is half the sum saved by not proceeding with the eighth wave of fundholding: £20 million of the NHS budget had been earmarked for the paperwork of the additional wave. It has been shifted not from anything useful but into something useful. I would have hoped that everyone would welcome that. I have made it clear that the chief medical officer's review of screening provision in the south-west, and the review being carried out by Sir William Wells of cervical cancer screening services in Kent and Canterbury, will be reported to me and published.
Rev. Martin Smyth:
When we think of a 70 per cent. target for take-up, is the other 30 per cent. made up mainly of people in deprived or rural areas? Is there an opportunity to use mobile screening units, as promoted by Action Cancer in my constituency, which go out to where people are so that they do not have to wait to go to specialist centres?
Mr. Dobson:
Generally speaking, women who are better off and better informed get more screening than women who are worse off and worse informed. Therefore, we have to do everything that we can to target any effort to improve the take-up rate on the worst off and worst informed. Techniques such as the one that the hon. Gentleman has just mentioned and those mentioned by my hon. Friend the Member for Crawley (Laura Moffatt) are all being applied in various parts of the country. I want to see them stepped up because I am not satisfied with the present level of take-up.
11. Ms Perham:
To ask the Secretary of State for Health if he will make a statement about his plans for improving primary health care. [3476]
Madam Speaker:
I have called Question 11.
Mr. Dobson:
I thought that I could have a bit of a rest, Madam Speaker. Primary care services are the first contact that most patients have with the national health service. Up and down the country, there are innumerable examples of very high quality services being provided by dedicated primary care professionals. The Government are determined to build on the achievements of those professionals, encouraging excellence and innovation and helping all practices to attain the standards of the best.
We have begun to release primary care from the bureaucratic excesses of the internal market and we are working to ensure that non-fundholding practices and their patients are no longer at a disadvantage.
Ms Perham:
Is my right hon. Friend aware that the waste of money on bureaucracy and the state of the health service were the issues that most concerned people in Ilford, North during the election campaign? My right hon. Friend touched on prescription fraud in his answer to my hon. Friend the Member for Bolsover (Mr. Skinner). I understand that it costs about £100 million a year, which means that each health authority could spend an extra £1 million on 145 heart by-pass operations or even 222 hip replacements. That scale of deception was allowed to go on by the Conservative party. How does my right hon. Friend intend to tackle the scandal?
Mr. Dobson:
The first point to make is that the vast majority of patients, doctors and pharmacists are decent and honest and have had nothing to do with the scandalous level of prescription fraud. However, there are a limited number of villains among all three categories and we are determined that they will be stopped. One of the problems--this is another matter for our general review of the NHS--is that the system as operated at present is scandalously open to fraud. We have to make it less open to fraud, while not imposing additional bureaucratic burdens or making life difficult for patients who have to deal with their doctor and pharmacist.
Mr. Maples:
As the right hon. Gentleman knows, one of the things that are useful in planning the future of primary health care is to know the future of funding levels. In the past 18 years, spending in the NHS has risen in real terms by an average of 3.1 per cent. a year. Can the right hon. Gentleman commit himself to matching that performance over the lifetime of this Parliament?
Mr. Dobson:
We are committed in our manifesto to a real increase--
Mr. Dobson:
The hon. Gentleman apparently wants to give the answers as well as ask the questions. That would be more understandable if he had shifted straight from one side of the House to the other, but he has had a five-year interval before doing so. I repeat that, in our election manifesto, we said that there would be an increase in real terms every year under the Labour Government.
12. Mr. St. Aubyn:
To ask the Secretary of State for Health how many NHS in-patients were waiting over one year for treatment (a) in March 1979 and (b) in the latest month for which figures are available. [3477]
Ms Jowell:
On 31 March 1979, there were 185,195 patients waiting more than 12 months for treatment at national health service hospitals--an increase of 24 per cent. over the previous year. The provisional figure for 31 March 1997, the latest available, is 31,318, which represents a 580 per cent. increase in those numbers over the past year. The highest-ever recorded March figure for patients waiting more than one year was the 223,311 who were waiting in March 1989. We now have the highest-ever number of patients waiting--more than 1.1 million.
Mr. St. Aubyn:
In view of the reply that the numbers waiting more than one year fell during the period of the previous Government from 185,000 to just 31,000, do the Minister and her colleagues continue to denigrate the previous Government's record on health because they think that waiting lists do not matter; or, if they think that they do matter, what commitment is the Minister prepared to make today to exceed the previous Government's outstanding record of cutting waiting lists to such an extent?
Ms Jowell:
We would not set our sights so low as to try to exceed the record of the previous Government. There are 1.1 million patients waiting for treatment--the highest-ever recorded figure. That was the last Government's legacy to the people using the national health service. It is a shameful legacy. We have made promises to patients and we shall keep the promises we made.
Mr. Corbett:
Is not the main reason for those appalling figures the indifference to the number of acute surgical and medical beds available to provide such treatment in our hospitals? Will my hon. Friend give an instruction to Mr. Bryan Stoten, who chairs the Birmingham health authority, that, when considering the reorganisation of hospitals in Birmingham, it is bed numbers in those categories that matter, and not his attempt to fulfil his ambition of getting rid of all but one or two of the city's hospitals?
Ms Jowell:
My hon. Friend makes an important point in underlining the increase in the number of emergency admissions, which has been a steady trend in recent years for a number of different reasons. The increase in emergency admissions certainly has an impact on the rate at which elective surgery is performed. As for the situation in Birmingham, I am sure that my hon. Friend, who is a Birmingham Member of Parliament, and my hon. Friend the Minister of State will discuss with other Birmingham Members of Parliament the need to maintain a proper balance in patient capacity in line with the development of community and primary care.
Mrs. Ann Winterton:
Does the hon. Lady agree that it is not only the numbers of people on waiting lists that are important, but the length of time that those people are
Ms Jowell:
Patients on waiting lists want to be sure of the rate at which they will be treated and that they will be admitted to hospital and treated according to the severity of their condition. In recent years, there has been a collapse of public confidence that patients will be treated on the basis of clinical need and the severity of their illness. Our commitment on breast cancer and eliminating waits for breast cancer surgery is an important step in reassuring women, thousands of whom waited unacceptable lengths of time as a result of previous Government policy.
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