On the need to achieve quality standards throughout
the cervical screening programme
(viii) It is regrettable that one in 12
women must go through the stress of having a repeat smear taken,
because of poor smear taking. In 1996-97 the proportion of smears
which were inadequate was greater than the target set by the Programme.
Had the target been met, 57,000 women would have been spared that
experience (paragraph 63).
(ix) We are surprised that as many as a
third of all health authorities failed to contact general practices
with persistently high rates of inadequate smears. We note the
Executive's view that the key relationship is that between the
laboratory and the smear taker, and that they were acting to improve
the effectiveness of that relationship. But we look to them to
take all available measures, including health authorities contacting
smear takers, to reduce the unacceptably high number of inadequate
smears (paragraph 64).
(x) It is a vital part of the cervical screening
programme that laboratories accurately screen smears, and identify
any abnormalities. The significant failings at Kent and Canterbury
Hospital demonstrate the appalling consequences if laboratories
fail to provide a quality service. And there have been other significant
failures elsewhere (paragraph 65).
(xi) The NHS Cervical Screening Programme
has taken a number of initiatives since this Committee's report
in 1992, and in the light of Kent and Canterbury. But we are disappointed
that it was not until March 1996 that they launched comprehensive
guidance that aimed to set achievable standards and targets for
laboratory practice and performance (paragraph 66).
(xii) In our view, the late development
of this guidance and standards is one reason why many laboratories
are a long way from achieving key targets, and from providing
an effective service to women. This is continuing to put women
at risk (paragraph 67).
(xiii) We note the Executive's confidence
that there will be consistent progress on quality issues. But
we are disappointed that they are not prepared to set a target
date by when all laboratories should meet the standards expected.
We look to the Executive to set firm national and local timetables
for achieving the improvements necessary (paragraph 68).
(xiv) It is essential that the colposcopy
service provides a quality, accurate and timely diagnosis and
treatment. We note that continuing progress is being made, but
we are concerned that improvements are still needed particularly
in waiting times, staffing, and quality. We therefore welcome
the programme of national and local action now taken by the NHS
Executive and colposcopy clinics (paragraph 69).
(xv) Providing women with clear, timely
information at every stage of the screening process is essential
if the Programme is to allay women's fears and anxieties. The
Executive are committed to ensuring that everyone receives proper
written information at every stage of the process. We note their
initiatives to improve recruitment and retention of cytoscreeners,
and thus to provide women with their results promptly; their insistence
that women receive their results in writing; their treatment of
information for women as a priority area; and the Chief Medical
Officer's examination of the whole question of public information
about cervical screening. We look to the Executive to ensure that
these initiatives lead to women receiving clear and timely information
at every stage of the screening process (paragraph 70).
(xvi) 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 (paragraph
71).
