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Remaining Private Members' Bills
MILITARY ACTIONS AGAINST IRAQ (PARLIAMENTARY APPROVAL) BILL
Mr. Deputy Speaker (Mr. Michael Lord): Queen's consent has not been signified. Second Reading what day?
Mr. Tam Dalyell (Linlithgow): Friday 23 July.
On a point of order, Mr. Deputy Speaker, concerning Queen's consent. Is there not an issue for Parliament here? When a matter involves the House of Commons and its debates, and whether there should be parliamentary approval for military action--in this case in Iraq, but the same would apply to Kosovo--is it right that there should have to be Queen's consent? My objection is not against the Palace; it is a point of principle as to whether it should be for the House of Commons alone to make up its mind on what can and cannot be debated.
Mr. Deputy Speaker:
The reason why Queen's consent has not been obtained is not a matter for the Chair. As the House knows, and as "Erskine May" on page 605 makes plain, without Queen's consent, I cannot propose the question on the Second Reading.
Order for Second Reading read.
Second Reading deferred till Friday 30 April.
Order read for resuming adjourned debate on Question [12 March], That the Bill be now read a Second time.
Debate to be resumed on Friday 23 April.
Order for Second Reading read.
Second Reading deferred till Friday 7 May.
Order for Second Reading read.
Second Reading deferred till Friday 14 May.
Order for Second Reading read.
Second Reading deferred till Friday 23 July.
Order for Second Reading read.
Second Reading deferred till Friday 23 April.
Order for Second Reading read.
Second Reading deferred till Friday 23 July.
Ordered,
Mr. Richard Page (South-West Hertfordshire):
First, I wish to thank the Minister for being here to respond to this Adjournment debate. We all know how precious Fridays are to Members of Parliament for visits to their constituencies. They are all the more so to a busy Minister, to whom I say a double thank you.
My interest in this issue initially came from my membership of the Public Accounts Committee, on which I have served for some 10 years. It reported on the effectiveness, or perhaps lack of effectiveness, of the cervical cancer screening programme. The report criticised the programme, which has been the subject of widespread comment. My parallel concern is that, unless there is improvement in the poor levels of accuracy being achieved, confidence among women will inevitably be eroded. That, to my mind, would be a great shame, because the screening programme has been well organised and its coverage of 85 per cent. of eligible women is unprecedented. As it stands, it saves lives. Let us make no bones about that. However, I hope that what I am proposing might save even more.
Each year, the programme costs £130 million, and an average 4.4 million smear tests are taken. The programme is a jewel in the Department of Health's public health policy crown. However, it could be much better. Over the past two years, the Government have attempted to solve many screening problems produced by the laboratory results and to achieve screening coverage targets. To reinforce that attempt, they created the cervical screening action team.
The National Audit Office report highlights the fact that cervical cancer is the most common cancer among women under 35. The United Kingdom continues to suffer some of the highest incidence rates in the developed world. Around 3,500 women are developing invasive cervical cancer, and about 1,300 dying every year.
I shall not go into the detail of the current test, which was developed 40 years ago. The pap test screens for abnormal cell changes. A sample is taken, scraped on to a slide and examined through a microscope. It seems hardly surprising that screening large numbers of tests each year by the human eye alone leads to missed detection of abnormal cells. The results achieved are, under the circumstances, magnificent, but they are not good enough for today.
A recent study by the United States agency, Health Care Policy and Research, reported that the pap test was only 51 per cent. accurate in detecting abnormalities. Other reports suggest greater accuracy levels, but it is an inescapable fact that detection rates vary between 50 and 70 per cent. For every 10 women undergoing a test, between three and five will have abnormalities that may be missed. Some 50 per cent. of women who develop invasive cervical cancer have clear test histories.
I shall not labour my point about the sensitivity of the current test. The Department of Health is only too well aware of its shortcomings. On 25 March, the chief executive of the national health service litigation authority was quoted as saying that a judgment against the Kent
and Canterbury Hospitals NHS Trust had put the whole screening programme at risk, demanding a level of accuracy that the present techniques cannot deliver.
I was disappointed to read in the press at the weekend that plans to introduce computerisation of the smear test programme had been abandoned by the NHS. That is not the health service's fault, but, under the proposed PAPNET system, accuracy levels could have risen to90 per cent. or more. It was hoped that the system could be introduced nationwide, but those hopes have been dashed by the collapse of the American company making the computerised system.
That system would have enhanced 40-year-old technology, and I hope today to persuade the Minister that all is not lost. We have an opportunity to use an alternative test in conjunction with the existing screening programme, which would increase detection rates for cervical abnormalities to around 97 per cent., a considerable jump from 50 per cent. I am referring to the hybrid capture 11 DNA/HPV test that has recently been approved by the United States Food and Drug Administration as having a99 per cent. negative predictive value. Despite the clumsy title, the test effectively eliminates false negative results. I rely on expert advice when I say that that is highly significant. If a woman is HPV--human papilloma virus--negative, the chances of her being predisposed to the cancer are negligible. Using a combination of the pap test and the HPV test would raise the detection rate to about97 per cent., as I said.
The Minister will be only too well aware that about 200,000 of the women who are screened every year show borderline abnormalities and 1,000 women are referred to colposcopy--I hope that the Minister will be able to tell me how to pronounce that word accurately--clinics for examination at a cost to the public of about £35 million. Out of the 200,000, only 4,000 were diagnosed as having invasive cervical cancer in 1996-97. We should not underestimate the worry, concern and stress that every one of those 200,000 women felt, especially as 196,000 of them, on current figures, went through unnecessary worry, and the time and cost implications of the health chain involved: the general practitioners, clinicians, screeners, pathologists and all the other staff who take part in the process.
My submission is simple: the HPV test should, at the very least, be urgently piloted in a number of United Kingdom regions. I would not be doing my job as a Member of Parliament if I did not tell the Minister that I hope that she will agree to that and that if she started such a pilot study in hospitals near my constituency I would be more than delighted--I can give her the names of the hospitals afterwards so that she can immediately get the programme under way.
The Government's position on HPV testing has remained static. The Minister will be aware of a parliamentary question that I tabled a few weeks ago on the trials taking place in the NHS. In her answer, she referred to the TOMBOLA study being conducted by the Medical Research Council. I am not in a position to judge the progress of that study, but I have been given to understand that it was commissioned quite a few years ago, but has never really got under way. If that is the case, progress in examining the causes of and surveying the disease have probably rendered the study past its sell-by date.
A paper by Professor Jack Cuzick, head of epidemiology at the Imperial Cancer Research Fund, has demonstrated that a screening programme using HPV testing could save about £30 million per year, as medical studies show that such testing could safely extend the screening interval from three to five years. The longer interval would also be a tremendous bonus for women and would mean an enormous saving in time and pressure on the medical services.
A little bird has told me--I am not at liberty to go into greater detail--that a further endorsement of the testing process will be forthcoming from the United States in the next few weeks. The Minister is aware that the NHS health technology assessment programme is conducting several studies on primary and secondary research and the roles of HPV testing. I am told that the results will be published shortly. In turn, I sincerely hope and, in fact, expect the programme to endorse the use of HPV testing in borderline cases. It will be interesting to find out its recommendations on the use of such testing on so-called borderline smears.
I am reluctant to discuss finance and cost because I am not qualified to do so with accuracy. I do not have the resources to cite the benefits with authority, but this month a conference of the British Society of Colposcopy and Cervical Pathology held in Sunderland estimated that a policy change to age-restricted cervical screening with a HPV test at 50 would substantially reduce costs. If so, that must generate some enthusiasm for change among the hard-hearted Treasury people who hold some of the purse strings. Various financial models have been run to try to show that the screening would help. They have shown results ranging from savings to maintaining the financial status quo. As the Minister and I know, the only real test of whether it would save money would be a monitored pilot scheme.
I express my appreciation to all the people who have come together to give me the facts and figures to enable me to raise this important issue. They include a professor, a manufacturer, a medical researcher, a woman's health care worker, a specialist journalist and, most importantly, the women taking part in the screening programme. I can safely say that no one has told me, "No, you are on the wrong track. I would not go ahead if I were you." Everyone has said that the test must be introduced by our national health service as soon as possible.
That Mr. Gordon Marsden and Mr. Ivan Lewis be discharged from the Deregulation Committee and Mr. Brian White andDr Ashok Kumar be added to the Committee.--[Mr. Hill.]
Ordered,
That Dr Phyllis Starkey be discharged from the Select Committee on Modernisation of the House of Commons and Lorna Fitzsimons be added to the Committee.--[Mr. Hill.]
Ordered,
That Mr. Paul Stinchcombe be discharged from the Procedure Committee and Mr. Nigel Griffiths be added to the Committee.--[Mr. Hill.]
16 Apr 1999 : Column 543
Motion made, and Question proposed, That this House do now adjourn.--[Mr. Hill.]
2.33 pm
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