House of Commons Hansard Debates for 16 Apr 1999 (pt 22)

2.48 pm

The Minister for Public Health (Ms Tessa Jowell): I congratulate the hon. Member for South-West Hertfordshire (Mr. Page) on securing this debate. I listened carefully to his speech and I think that nothing divides us. I hope that he will take from everything that I say our shared sense of urgency about moving ahead to underpin the screening programme with the quality assurance that is essential and seizing the opportunities of new technology when it is established to the tests of proof that we require: that it is effective and can be disseminated as standard practice.

Having said that, let me recap on the scale of the programme. As the hon. Gentleman said, some 4 million women are screened every year in England. Our experts estimate that the programme prevents about 3,900 cases of cervical cancer each year.

The death rate from cervical cancer has fallen steadily since the programme began in 1988, and mercifully it continues to fall. The number of deaths from cervical cancer in England and Wales has dropped from 1,369 in 1994 to 1,222 in 1997. I think that we should be proud of what has been achieved so far. However, we should be under no illusion--despite the overall success there have been some failures. I shall set out some examples of the price of failure, especially in terms of the confidence of women, to which the hon. Gentleman rightly referred.

Following the failures in Kent and Canterbury Hospitals NHS trust and elsewhere, we believe that as a Government we have taken swift and wide-ranging action to address shortcomings in the cervical screening programme. Since December 1997, the programme has undergone the biggest shake-up in its 10-year history.

I shall run through the steps that we have taken to address the weaknesses that were identified. First, regional directors of public health were required to carry out detailed regional reviews of the cervical screening programmes and draw up action plans to deal with areas of weakness. From this year they will be making formal annual reports to the NHS executive of the performance of the programme in their region, thereby underpinning accountability.

Secondly, improvements have been made in the way in which the programme is managed. Responsibility, particularly for commissioning quality assurance for the cervical screening programme, has been transferred to the regional office and all regions have now appointed a quality assurance director. Let me not for one moment underestimate the extent to which we inherited fragmentation, confused lines of accountability and an absence of any systematic quality assurance, which clearly had a bearing on the poor performance of the screening programme in some areas.

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The third improvement that we have made is that laboratories that read smear tests are required to apply for accreditation. They were required to apply by June 1998, and all have now done so. This is important because laboratories that read fewer than 15,000 smear tests have been reviewed, and the majority have now stopped reading smears or have merged with other laboratories. That is important because of all the evidence that suggests that it is necessary to have a critical mass of experience to ensure maximum reliability in reading smears.

The fourth improvement is that where refresher training has been provided for staff in laboratories, a resource pack for the training of smear takers has also been published. We hope that that will also help to reduce the number of inadequate smears. The NHS cervical screening programme has also provided pump-priming money and expertise for a training course to support the implementation of the training pack. Training and retraining must be a continual aspect of the service.

Finally, work is under way to build better relationships between laboratories and smear takers to ensure that adequate feedback and training systems are in place. Under the new stringent quality assurance arrangements, regional quality assurance teams will be able to identify both those laboratories that report high rates of inadequate smears and individual GP practices which take a high number of such smears, and will work with them to improve their performance in smear taking.

In December 1997, a cervical screening action team was set up to oversee the review process on implementation of the identified action plan. In its report, which was published in August 1998, the team noted the progress made but expressed particular concern about the lack of public confidence in the screening programme. I am extremely concerned about that.

The failure of public confidence is the price that we pay for publicised failures. Whatever the number of women involved, that leads to widespread failure in confidence in the programme. We must always be vigilant about that, but the major task ahead of us is to rebuild confidence among women about the effectiveness of the screening programme. In order to do that, we must be more open and explicit with women about both the benefits and the limitations of cervical screening. We completely understand that when women get a result they want a guarantee that it is correct. However, even with perfect management and 100 per cent. coverage, no screening programme can ever be 100 per cent. accurate. Screening is like wearing a seatbelt; it reduces risk, but does not remove it. We must ensure women throughout the country understand that that is the basis for the terms on which they use the service.

A common, but understandable, misconception is that cervical screening is a test for cancer. It is not. It is a test for abnormalities which, if left undetected and untreated, might lead to cancer. Cervical cancer is a very slow-developing disease. By having smear tests every three to five years, women can reduce their risk of developing cancer by between 80 per cent. and 90 per cent.--a major gain. That is why it is so important for women to have regular smear tests. However, women should always report any abnormal bleeding to their doctors.