SIXTY-NINTH REPORT
The Committee of Public Accounts has agreed to
the following Report:—
THE PERFORMANCE OF THE NHS CERVICAL SCREENING
PROGRAMME IN ENGLAND
INTRODUCTION AND SUMMARY OF CONCLUSIONS AND RECOMMENDATIONS
1. Cervical screening is a method of preventing cancer
by detecting and treating pre-cancerous changes in a woman's cervix
(the neck of the womb). The NHS Cervical Screening Programme was
first established as a national programme in 1988. It aims to
reduce the number of women in England who develop invasive cervical
cancer (around 3,500 a year) and the number of women who die from
it (around 1,300 a year). The financial costs of the Programme
are around £132 million a year (£34 per woman screened).[1]
2. The Programme comprises four stages: inviting
women for screening; taking smears; laboratory analysis of smears;
and, when necessary, further diagnosis and/or treatment in colposcopy
clinics.[2]
The Programme is based on inviting women in the eligible range
20-64 for screening at least once every five years. Around 3.5
million women are invited for screening each year and around 4.4
million smears are taken, mostly in general practices. A minority
of women, around 208,000 each year, receive a result indicating
an abnormality.[3]
In each of the last six years, the Programme has screened at least
80 per cent of eligible women over the preceding five years.[4]
3. Overall, the Programme has had valuable outcomes.
Cervical screening is estimated to prevent between 1,100 and 3,900
cases of invasive cancer each year.[5]
Early diagnosis of the disease has contributed to a reduction
in the number of deaths from it.[6]
And mortality rates are currently falling by seven per cent a
year.[7]
However, there have also been some significant and well publicised
cases where the programme has failed; notably at the Kent and
Canterbury Hospital where problems may have contributed to eight
deaths, 30 hysterectomy operations and unacceptable anxiety to
many women.[8]
4. On the basis of a report by the Comptroller and
Auditor General,[9]
the Committee examined the coverage of the Programme, the achievement
of quality standards, and accountability to Parliament for the
management of the Programme.
5. Overall, we recognise the progress the NHS Executive
have made since we last examined this subject in 1992,[10]
but are particularly concerned about three issues:
- Six years after the Committee's previous report,
there are still significant quality failings at every stage of
the cervical screening programme. These affect scores of thousands
of women. The NHS Executive need to set firm national and local
timetables for fully achieving quality standards and take robust
action where standards slip, and they must recognise the concerns
and anxiety which will be felt by each woman about the results
of her smear test;
- We have long been concerned about accountability
arrangements across the NHS, and whether there is a lack of grip
between the centre and the NHS Executive on the one hand and the
parts that deliver services on the other. It is clear that the
absence of clear and robust lines of accountability was a major
factor in the failings at Kent and Canterbury. We note the changes
that have since been made, and that further changes are proposed.
But until we see those accountabilities work in practice, we shall
remain sceptical about their effectiveness;
- There are considerable variations in deaths from
cervical screening across regions, and research indicates that
women in the lower socio-economic groups and ethnic minorities
are under-screened. While the NHS Executive are taking action
to address these inequalities, the fact remains that the NHS is
failing many of the most vulnerable in our society. We are therefore
looking for new initiatives and renewed vigour in tackling these
issues.
6. The Chief Medical Officer set up a review of the
cervical screening programme and the report was published on 24
August 1998. We expect the NHS Executive to let us have their
action plan to implement its findings.
7. Our more specific conclusions and recommendations,
which underpin the general views above are as follows:-
1 C&AG's Report (HC 678 of 1997-98), paras 1 and
2 Back
2
ibid, para 3 Back
3
ibid, para 2 Back
4
ibid, paras 2.1 and 2.7 Back
5
ibid, para 1.6 Back
6
ibid, Appendix 3, para 4 Back
7
ibid, para 1.6 Back
8
ibid, paras 4.18 and 4.19 Back
9
HC 678 of 1997-98: The Performance of the NHS Cervical Screening
Programme in England Back
10 HC
236 of 1991-92: Cervical and Breast Screening in England and Second
Report from the Committee of Public Accounts, 1992-93: Cervical
and Breast Screening in England (HC(92-93)58) Back
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