On the need for improved coverage of the screening
programme to minimise the incidence of cervical cancer and to
ensure equity
(i) If health authorities screen
women every five years, they will prevent 84 per cent of cervical
cancers, and screening every three years will prevent 91 per cent.
Although some authorities face particular problems with ethnic
minorities and transient populations, we are very concerned that
13 health authorities have not yet achieved the target of screening
even 80 per cent of women aged 25 to 64 within the previous five
years (paragraph 25).
(ii) We recognise that the Executive, the
NHS Cervical Screening Programme and health authorities are taking
a wide range of national and local actions to improve coverage,
and in 1996-97 10 of the 13 authorities improved their coverage
over the previous year. But their failure to achieve the 80 per
cent coverage target is putting lives at risk, and we urge the
Executive to look again at the scope for targeted action, and
to set each authority a firm deadline by when they should have
achieved 80 per cent coverage (paragraph 26).
(iii) There are considerable variations
in the incidence of and deaths from cervical cancer across regions,
and research indicates that women in the lower socio-economic
groups and ethnic minorities are under-screened. We note the wide
range of actions the NHS Executive and others have taken to address
these inequalities, but the fact remains that the NHS is failing
many of the most vulnerable people in our society (paragraph 27).
(iv) A pre-requisite to tackling inequality
amongst ethnic minorities is quality data at local, regional and
national levels. Such data do not yet exist although some steps
are in hand to obtain this information through other research-based
methods. Without such baselines, the Executive cannot set meaningful
targets which would lead to action to achieve equitable levels
of coverage of women in those groups. We look to the Executive
to give priority to improving the data available (paragraph 28).
(v) One way of improving coverage in the
13 health authorities currently missing the 80 per cent target,
and of those women who are currently under-screened, might be
to refocus the target payment system for general practitioners.
The Executive are studying the question of equality of access
to general practitioners, and we look to them to explore ways
of refining the incentives scheme to help (paragraph 29).
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