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Mr. John Maples (Stratford-on-Avon): I thank the Secretary of State for his statement. I know that this is a subject in which he has taken a very serious interest for a long time. In particular, he has campaigned for better cervical smear testing and breast cancer screening. I join him in expressing my sympathy for the women concerned. This is a simply dreadful disease, and the uncertainty must have been really terrible.
The breast cancer arrangements in Exeter and East Devon failed to ensure proper treatment for breast cancer, and they gave false reassurance. I very much hope--I join the Secretary of State in this--that the inquiry will finally put matters right. I remind the House that it was the last Conservative Government--the first EU country and one of the first in the world--who introduced a nationwide breast screening programme based on computerised call and recall and who introduced the Calman-Hine recommendations, which were praised by the Macmillan Fund cancer relief briefing, which said that the Government had an excellent record on them.
This matter was first raised by my right hon. Friend the Member for East Devon (Sir P. Emery) in a private notice question in June, and by my hon. Friend the Member for Tiverton and Honiton (Mrs. Browning) in an Adjournment debate in the same month. They are not here today, unfortunately, as my right hon. Friend is in hospital and my hon. Friend, I am afraid, is stuck in a traffic jam.
The Secretary of State sought in part to blame what happened on the internal market, but was it not a failure of two individual consultants? The report blames them quite clearly. If the Secretary of State is saying that there is a far more widespread failure across the country, perhaps he will tell us. Is everything being done for the approximately 1,900 women who are directly affected?
The right hon. Gentleman told us about the women who have been recalled, but have those who have not been recalled been given a reassurance that they do not need to be? He told us what is being done at the Royal Devon and Exeter hospital, but are there wider lessons that he feels have been learnt across the country which are not just the failure of individual consultants? Does he have reason to believe that similar errors are being made elsewhere? In particular, can he confirm that absolutely nothing that has arisen out of the inquiry is being withheld or not being published?
Should there be a revised national protocol on screening to promote best practice? Is the Secretary of State satisfied that the existing protocol contained in the NHS executive letter of 23 January 1995 is working satisfactorily? That executive letter expires on 28 January next year. Do the results of the inquiry require any change to those protocols? Referrals in the Royal Devon and Exeter hospital seemed to be solely to radiologists. Even doubtful cases were not referred to surgeons for a second opinion. Is that right, or should such practices change?
I apologise to the Secretary of State if those questions are answered in the report, but I received a copy of his statement only at a quarter past 3, and, although I managed to read that, I did not manage to read the whole report.
Will the Secretary of State confirm that the commitments on cancer treatment made by his party before the election still stand, and will he tell us the time scale for their implementation? I shall remind him what they were. In April this year, the Minister for Public Health said:
In September 1996, the Labour party announced that the first £30 million of the first £100 million saved by cutting down on red tape would be used to reduce waiting times for cancer surgery. What progress has been made with that money, and when does the Secretary of State expect it to be fully committed?
In a statement in June this year, the Secretary of State said that, as a result of the decision to postpone the eighth wave of fundholding, £20 million would be saved, of which the first £10 million would be available to breast cancer specialist centres throughout the country. Will he tell the House whether that has happened?
Is the Secretary of State aware that the Health Service Journal reported that many health authorities had already spent hundreds of thousands of pounds equipping potential GPs? Quite a lot of GPs are becoming fundholders next year, so it would appear that the eighth wave has not been totally postponed.
I notice that the Secretary is not taking a single note of any of these questions, which perhaps shows the regard he has for the importance of reporting to the House on his duties. These are serious questions, and people outside the House have an interest in having them answered. He apparently does not share that view.
Has the postponement of the eighth wave of fundholding saved £20 million? That seems unlikely. If £10 million has been spent on breast cancer services, from where has that money come? What other national health service budget has been reduced to fund the service? Is an extra £30 million actually being spent on cancer services? Since June, when the Secretary of State made the promise, has £10 million been spent on improving breast cancer services?
The Secretary of State mentioned his forthcoming White Paper. We were led to expect it in September, and then in October, so he is obviously having some difficulty with it. Will he tell us when it will be published?
Mr. Dobson:
I shall deal briefly with the points raised by the shadow Secretary of State that are irrelevant to breast cancer screening. To the best of my knowledge, we never said that we would produce a White Paper in September: we expect that it will be produced this month.
The hon. Gentleman asked about extra spending on breast cancer services. We announced the postponement of the eighth wave of fundholding, which released £20 million, £10 million of which has already been spent in cancer centres all over the country to improve the service provided for women with cancer, although it is not to do with screening. I emphasise that that money has not merely been released: it is being spent now in various parts of the country.
An NHS executive letter is going out today spelling out the changes that we require. No doubt further executive letters will go out when we have had time to consider the more detailed recommendations in the report, which was completed only on Friday. It is foolish for the hon. Gentleman to suggest that this matter springs only from the shortcomings of two radiologists in Exeter. Headlines in the report say:
Mr. Ben Bradshaw (Exeter):
I thank my right hon. Friend for his statement, and thank Sir Kenneth Calman and his team for their excellent report. I also congratulate my right hon. Friend on the swift and firm action that he has taken today, which is in contrast to the activities of Conservative Governments over the past 18 years. Will he confirm, however, that the report has not been watered down or toned down in any way as a result of the threat of legal action by one of the consultants concerned?
Mr. Dobson:
I am not sure whether I am supposed to say this, but I will, because I think that the House is entitled to know.
We were challenged in the High Court by Dr. John Brennan on Friday, and both the chief medical officer and I agreed to three minor changes in the text of the report. As far as I could see, those changes did not really change the meaning of even the sentences in which they were included, let alone the general drift of the report; but that apparently satisfied Dr. Brennan, his lawyers and the judges, and I thought it better to agree to those three minor changes than not to present the report to the House.
Mr. Simon Hughes (Southwark, North and Bermondsey):
I thank the Secretary of State for his statement. I approve of both his concern for action to be taken, and the action that has been announced. It is important that we have in the national health service a standard of care that is enforced so that it is applicable across the country, and does not become a lottery that depends on where people live.
"The waiting time to see a specialist and receive a diagnosis should end. If a woman has discovered a breast problem and is concerned, she should be able to see her GP, and be seen without delay by a specialist team at a breast cancer clinic, who can carry out the essential tests on one day."
What progress has been made, and when does the Secretary of State expect to be able to fulfil that pledge?
"Lead purchasing has failed the breast screening programme"
and:
"Lack of expertise and resource in lead purchaser Health Authorities"
and:
"The result: a quality assurance service that is unable to take effective action".
The basis of my statement is that there is no point in trying just to blame two radiologists: there will always be things that go wrong with the reading of mammographs and the reading of cervical cancer slides. The object is to have a system that identifies things when they go wrong, and puts people in positions of authority to do something about it. The system that we inherited from the last
Government, which probably was not too strong in the first place, was seriously weakened by the changes that occurred when regional health authorities were abolished, and that has meant that the quality assurance system throughout the country is weak. It needs to be strengthened, and we will strengthen it.
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