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CHURCH COMMISSIONERS
The hon. Member for Middlesbrough, representing the Church Commissioners was asked--
Millennium
35. Sir Sydney Chapman: What plans the Church Commissioners have to mark the millennium. [11770]
Mr. Stuart Bell (Second Church Estates Commissioner): The Church Commissioners are conscious that the millennium is both an inclusive national celebration and a significant Christian anniversary, and the Church is seeking to ensure that the religious and spiritual nature of the year can be appropriately reflected within the context of the new millennium experience.
The Church is planning to give special millennium candles to every household and to encourage people to take them with them wherever they go on millennium eve--just as individuals took candles to Wembley stadium in honour of Diana, Princess of Wales, following her tragic death. There could then be a major moment of national reflection in silence as people stand together and light their candles, one from another. This is intended as the churches' gift to their local communities and something that everyone can take part in if they wish.
Sir Sydney Chapman:
While welcoming that statement, may I urge the hon. Gentleman to ensure that
Mr. Bell:
I am glad to see the right hon. Lady in her place and I am happy to endorse the right hon. Gentleman's statement. I should add that every church bell in the land will be rung at noon on Saturday 1 January 2000 for five minutes, followed by 10 minutes of prayer which will be open to all. In relation to the architecture to which he referred, these buildings are a testament to the Church, and as commissioners we shall work with Ministers to ensure that that remains the case.
Mr. Skinner:
Has my hon. Friend thought through the proposition that everyone could carry a candle? Is he aware that, if the so-called hundreds of thousands turn up at the dome with lighted candles, they might set fire to it?
Mr. Bell:
My hon. Friend and I share a common heritage--we both come from mining families and our fathers went to work with candles. The dome is in the hands of the Minister without Portfolio, my hon. Friend the Member for Hartlepool (Mr. Mandelson)--capable hands, but not those of the Church Commissioners.
Mr. Simon Hughes:
Will the hon. Gentleman ask the commissioners to throw their weight about with regard to what the state and the Church will do at the time of the millennium? First, will he make sure that we do not spend unnecessary money on a temporary construction at Greenwich when we could invest in more beneficial activities for the longer term--perhaps for people at the bottom of the social scale?
Secondly, will he try to persuade the state to encourage the international community to write off international debt--a real jubilee for poorer countries, who would be liberated for the next millennium? Finally, is he aware
that--as at Canterbury cathedral and, increasingly, Westminster abbey--the great churches of the land are either closed or too expensive to get in?
Mr. Bell:
I am always grateful to the hon. Gentleman for his suggestions. The Church Commissioners are in touch with the Minister without Portfolio about the dome. We are seeking to have a chapel in the dome to celebrate the millennium with an appropriate exhibition. With the Secretary of State for Culture, Media and Sport, we are also seeking to ensure that while it is a Christian anniversary it is also shared on a multi-faith basis so that there is a proper spread throughout our land of celebrations on the millennium. The other points are for other Ministers and I will ensure that they reach them.
36. Mr. Pike:
What representations he has received regarding changes in funding for clergy pensions. [11771]
Mr. Stuart Bell:
The commissioners have been engaged in extensive correspondence with the parishes protection group on a wide range of issues relating to its work--in particular, the proposals for the future financing of clergy pensions. The group has made a number of assertions that the commissioners do not accept, and they have made their position clear to the group. I have invited my hon. Friend to see me about those matters and I look forward to his taking me up on that offer.
Mr. Pike:
I thank my hon. Friend for that answer. Is he satisfied that the pensions scheme as it is structured is actuarially sound for present and future members and that the parishes are not being asked to bear an onerous burden that they cannot meet?
Mr. Bell:
The commissioners' actuaries have confirmed that sufficient funds are available to meet the past service liability for pensions. Future service is a matter for the pensions board and its actuaries, but dioceses are aware of the extent of their liability and are confident that the necessary funds can be raised.
Mr. Wilkinson:
Would it not be beneficial for the fund and ease the burdens on it if clergy could be encouraged to continue serving as parish priests or in other capacities beyond the normal retirement age? In many spheres of activity, clergymen even in their early 70s could perform useful functions, perhaps on more modest stipends. As few people are coming into the ministry, is that not the sort of thing that the Church Commissioners should support?
Mr. Bell:
I am grateful to the hon. Gentleman for his suggestion, which I should like to pass on to others.
3.31 pm
The Secretary of State for Health (Mr. Frank Dobson): With permission, Madam Speaker, I wish to make a statement on cancer screening.
In June this year, it was revealed that 12 women in Devon who had not been referred for treatment after being screened for breast cancer had subsequently developed cancer, and two of them had died.
On 9 June, in response to a private notice question from the right hon. Member for East Devon (Sir P. Emery), who is not here because he is in hospital, I reported what I had then been able to find out about this awful situation. I announced that I had asked the chief medical officer, Sir Kenneth Calman, to establish the facts about the breast cancer service in Exeter and to review the breast cancer screening programme nationwide in the light of what was revealed in Exeter.
The chief medical officer was assisted by a small team of people with specialised knowledge of various aspects of breast cancer. Their initial inquiries revealed wide-ranging shortcomings in Exeter and in regional and national aspects of the breast cancer screening programme. With my agreement, Sir Kenneth Calman asked the retiring chief medical officer for Wales, Dame Deirdre Hine, to lead a small team to review the national and regional arrangements for delivering quality assurance for breast screening.
Professor A. R. M. Wilson, the director of the national breast screening training centre in Nottingham, was asked to conduct an independent expert audit of 1,920 mammograms of all women who had been called back for further investigation after screening in Exeter and of all women who had developed cancers in the period between screenings in the past two years.
Completion of the chief medical officer's report was held up by the need to complete the audit of mammograms and, most recently, by a legal challenge from one of the doctors concerned. The report was completed last Friday afternoon. I am publishing it today.
The report covers three aspects: the independent assessment of the technical competence of breast screening in Exeter, based on the audit of mammograms; the examination of the organisational, managerial and quality control arrangements in the Exeter breast cancer unit; the review of national and regional arrangements for quality assurance of the breast cancer screening service. The report concludes that there were serious faults in all three.
The audit of mammograms concluded that there was evidence of failure on the part of the two radiologists involved to provide care to the standard expected of consultants involved in mammographic screening. That had not been picked up or tackled by the management of the Royal Devon and Exeter NHS trust over a number of years. It had been aware of questions of professional behaviour and other concerns about the operation of the breast unit, but no action had been taken. Management structures were confused. Lines of accountability were unclear. There was concern among staff and a lack of multi-disciplinary working. Some patients had complained about the attitude shown to them. Staff felt that their views had been ignored by management. They were right.
Responsibility for making sure that all breast screening units operated to a high national standard and that any shortcomings were spotted and dealt with promptly and effectively used to rest with national health service regions, but when regional health authorities were abolished, responsibilities for quality assurance for breast cancer screening were split. In the south-west, the Cornwall and the Isles of Scilly health authority took on the role of lead purchaser for breast screening quality assurance. The changes left the regional staff with some quality assurance duties, but neither the resources nor the authority to do the job. That situation applies throughout the country. Lead purchasing has failed the breast cancer screening service. The quality assurance system does not work.
As a result of all this, disciplinary proceedings have been instituted by the Royal Devon and Exeter trust against Dr. Brennan, the doctor in charge of the breast unit, who has been suspended. The other radiologist, Dr. Graham Urquhart, is employed by the South Devon trust, which has commissioned an audit of all his radiological work. Neither doctor is now involved in breast imaging.
Of the 1,920 women whose mammograms were reviewed in the audit, 229 were judged to need further assessment. All the women affected have been contacted, and the last one is due to be seen by clinicians on 10 November.
I know that all women in the Exeter area will be worried about whether they can rely on their screening result. The professional advice that I have received is that no other women in the area need be recalled or rescreened. The main problem was not in spotting possible cancers but in dealing with them appropriately, once identified. I am advised that all the women who needed to be recalled have been recalled. All women should, of course, continue to attend for routine screening appointments.
The report contains many detailed recommendations that will need to be carefully considered. I can announce today, however, the following action that is already being taken to implement the main recommendations: the Royal Devon and Exeter trust is taking action to make sure that the breast unit is properly managed in future and that arrangements are in place for staff to be able to report when things are going wrong; I am placing an explicit requirement on health authorities and trusts to commission and deliver breast cancer screening to national standards; all NHS trusts with breast cancer screening units are being told to review their arrangements to make sure that they deliver a high-quality service, and they must report the outcome of their reviews by the end of January 1998; all health authorities, trusts and regional offices will be expected to agree action plans by the end of February 1998 to ensure that all screening programmes meet national standards.
By 1 April 1998, responsibility and resources for breast screening quality assurance will be removed from lead purchasers and restored to NHS regional officers, who will be given all the necessary authority to secure quality assurance. In the last resort, they will be able to close down screening units that fail to meet national standards.
The shortcomings that the inquiry has revealed and the recommendations that it makes very much parallel the recent report and recommendations made by Sir William
Wells following his inquiry into the failures of the cervical cancer screening service provided by the Kent and Canterbury NHS trust. He singled out the failure of lead purchasing, the ineffectiveness of local management, the failure of arrangements for staff to report what was going on, and the absence of effective quality assurance.
Many of the problems at Exeter and Canterbury sprang from the shortcomings of the internal market, which included the absence of arrangements to secure high and uniform standards, even for cancer screening systems that were supposed to be national; legal obstacles to intervening in the affairs of trusts that are falling down on the job; staff not being able to speak their minds. All that must be changed, and the new Government will make the necessary changes. Our forthcoming White Paper on the future of the national health service will spell out proposals to improve the quality of treatment and care by setting high standards and putting in place machinery to ensure that the agreed standards are met. We have already announced the end of gagging clauses in staff contracts.
Cancer screening has two purposes: to identify patients who need treatment and to reassure patients who do not. The breast cancer screening service in Exeter and the cervical cancer screening service in Canterbury failed on both counts. They failed to ensure prompt treatment for women with cancer. For other women with cancer they gave false reassurance. They left thousands of other women not knowing one way or the other. They were a disgrace.
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