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Mr. Dobson: There are possible shortages of radiologists and radiographers, which will take a long time to address. We cannot just snatch radiographers out of the air. We will, however, do what we can to make available any resources that are necessary.
The small group of extremely expert people who were under the guidance of Dame Deirdre Hine considered whether local, regional or national quality assurance would be the best option, and came down firmly in favour of the regional option as being the most practical, and bringing the surveillance and monitoring as near as sensibly possible to the people actually doing the work. I am sure that everyone will want to consider that, but,
given the circumstances and the need to get on with things, I have told the national health service that it must adopt that option.
Mrs. Alice Mahon (Halifax):
I congratulate my right hon. Friend on the speedy way in which he has reacted to a tragic and serious situation. The women who suffer from this killer disease--the real foot soldiers--realise that the situation exposes the stupidity of introducing an internal market in the national health service.
Can my right hon. Friend update the House on the progress of the pilot studies being conducted on bringing older women into the recall system? As my right hon. Friend knows, Age Concern and many other agencies representing older people are pressing for that and think that it would be worth while.
Mr. Dobson:
I am sorry to disappoint my hon. Friend, who has done a great deal of sterling work in this sphere. The studies into the practicability and health gain from screening women over 65 are continuing, as are parallel studies about the merits or otherwise of screening younger women. I am not in a position to report on the state of progress on either of them.
Mrs. Virginia Bottomley (South-West Surrey):
I thank the Secretary of State for his statement. As I was the Secretary of State who commissioned and began the implementation of the Calman report, I obviously take a special interest. The right hon. Gentleman is right to say that, increasingly, the general public will be more demanding and discerning about quality assurance, and one of his challenges will be how he can deliver and meet that growing expectation. I urge him to visit the Jarvis centre in Guildford, a breast screening service of great excellence, and one of the early centres.
I detect an encouraging sign. With the delay in the publication of the right hon. Gentleman's White Paper, I note a softening of his approach towards NHS managers, whom he initially appeared to be regarding only with contempt. It seems that he is beginning to see that they have some merit.
Mr. Dobson:
In answer to the right hon. Lady's final point, I have always been in favour of good managers in the national health service, who manage to the level that one might expect from the salaries that they receive. I applaud the good managers, but I do not applaud the mismanagement that went on or the Ministers who introduced a system that made it more and more difficult to manage quality assurance in breast cancer screening, as has been made obvious not by me but by Dame Deirdre Hine, the former chief medical officer for Wales.
The right hon. Lady asked about expectations, but we are not speaking about rising expectations. Women have been entitled to expect top-quality services in every part of the country and a system that spotted things that were going wrong and did something about them. We are talking about the failure of management, clinicians and politicians to deliver the standards that people could reasonably have expected in the past, let alone higher expectations in future. I have visited a number of breast screening centres, including the one in Cardiff which has been so brilliantly successful under the encouragement of Dame Deirdre Hine.
Mr. Gerry Sutcliffe (Bradford, South):
I congratulate my right hon. Friend not only on the speedy and
Mr. Dobson:
We are progressing as quickly as we can with removing the internal market. In view of the failures of the lead purchaser system in relation to both cervical and breast cancer, we are reviewing the whole concept of lead purchasers in any part of the country, because, on the evidence that is available to us so far, it is not working.
Mr. Gary Streeter (South-West Devon):
Given the level of anxiety about this matter in Devon, I thank the Secretary of State for the speed and, dare I say, decisiveness with which he has acted in this case. I hope that the suffering of women in the west country will not be used as an opportunity to score political points. Can the Secretary of State reassure me that should extra resources be needed to make the breast cancer unit at the Royal Devon and Exeter hospital a viable, efficient and successful unit, he will treat it as a priority and make sure that that excellent hospital receives extra resources?
Mr. Dobson:
I am sure that any extra resources that are needed to make the hospital work properly can and will be found, but the general point is that to do things clinically badly and to manage things badly is frequently more expensive and more demanding on resources than doing them properly. If it can be done properly in other areas, it should be done properly in Exeter. I pay tribute to the relatively new chief executive in Exeter, who, as soon as this was drawn to her attention, started sorting it out, in marked contrast to her predecessors, some of whom have gone on to promotion in other parts of the NHS.
Caroline Flint (Don Valley):
I thank my right hon. Friend for presenting the report, especially just after the end of a month in which breast cancer awareness has been at the top of the agenda--last week, I was happy to publicise that with women Members on both sides of the House. Does he agree that, in their lifetime, one in 12 women may be affected by breast cancer? Only recently, he opened the Jasmine centre at Doncaster royal infirmary, which shows the way ahead in dealing with the problem. It offers one-day, one-stop testing and diagnosis. That is how we should treat and deal with the problem for the 21st century. The centre has got off the ground only with money from this Government after the general election.
Mr. Dobson:
I was very pleased to open the Jasmine centre, whose combined characteristics women would expect in these circumstances. It has state-of-the-art equipment, but it is also furnished, upholstered and generally laid out in a comfortable and homely way; much waiting and hanging about are involved in screening. It is, therefore, a place where people get the best of high-tech combined with tender loving care. That is what people want from the health service, not just for screening, but for everything else.
Mr. John Burnett (Torridge and West Devon):
We are grateful for the speed with which the report has been
Mr. Dobson:
The report does not deal with that, so I cannot comment. All I can say is that what went on when the consultants were there was the problem, not what did not go on when they were not there.
Mr. Paul Flynn (Newport, West):
Does my right hon. Friend agree that the previous Government had three measures of success in the health service--the novelty of management techniques, the total amount of money that was spent and the total number of procedures that were carried out--to the almost complete neglect of the quality of service? We often find that, when more money is spent and more procedures are carried out, there is a proportional decrease in the quality of the service.
We are all grateful for what my right hon. Friend has said and for what he has done throughout his period as Secretary of State: he is putting the emphasis on quality and on the outcome of procedures. He must root out from the health service all the incompetence that is around. Of course, it is not universal--he rightly paid tribute to what is happening in Cardiff and elsewhere--but where there is poor-quality work and incompetence at the top and lower level in the health service, it becomes literally a matter of life or death.
Mr. Dobson:
I agree with most of what my hon. Friend has said. Our White Paper aims to have an NHS that is geared to having quality standards and a system that delivers those standards. I am confident that we will be able to carry the clinical professions with us because they are showing much enthusiasm for the proposals that we are discussing with them before they go in the White Paper. It would appear that the only people who are not up to speed on what NHS patients and staff want are the official Opposition, whoever they may be.
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