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Cervical Screening

3. Laura Moffatt (Crawley): What plans he has to increase public confidence in cervical screening for women. [84998]

The Secretary of State for Health (Mr. Frank Dobson): It is vital that women have confidence in the cervical cancer screening system to identify early signs of abnormalities or to provide reassurance that none are present. The only way to increase such confidence is to provide services that justify it. That is why I announced

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in December 1997 stringent new quality assurance arrangements to apply to all cancer screening services. This involves setting high standards, outside monitoring of those standards and external accreditation of the laboratories involved.

Laura Moffatt: I thank my right hon. Friend for that answer. I welcome the new targets and innovative methods for getting women to accept that screening is the best way to ensure that they maintain their good health. Is he aware that some commentators seek to undermine screening and suggest that it is somehow an invasive and nasty procedure that the medical profession do to women? Does he agree that screening is a partnership between women and health workers and that better methods of increasing take-up of screening will increase the numbers of women who survive--some 1,300 a year currently--and who would not do so without screening?

Mr. Dobson: Certainly I accept the points that my hon. Friend makes. The new arrangements will raise standards, although no screening system can be 100 per cent. accurate. Our present system saves the lives of more than 1,300 women every year, and mortality rates from cervical cancer have fallen year on year. We are drawing up plans for a national publicity campaign to increase public understanding and confidence in the NHS cervical screening programme.

Miss Julie Kirkbride (Bromsgrove): I was interested in the Secretary of State's response to the last question, but many women still die every year from cervical cancer despite the undoubted success of the national screening programme. What interest is his Department showing in the potential of a new technology to assist in the treatment of the disease? A company called Digene has a new product that could screen with an almost 100 per cent. success record according to the trials that have taken place so far. Will the right hon. Gentleman set up a pilot scheme to discover whether the product is as effective as it appears and, therefore, potentially save the lives of the many women who still die from that entirely treatable disease?

Mr. Dobson: My interest in cervical cancer screening did not commence when I became Secretary of State for Health. When I was the shadow health Minister more than a decade ago, I put together the first comprehensive report on screening call and recall schemes, which the then Government could not be bothered to do.

Since then, the system has been put in place. I have been pressing the various organisations involved and talking to the Cancer Research Campaign about new ways in which to carry out screening. It has always seemed to me that a change discernible to the human eye through a microscope must be the result of a chemical change. I understand that that approach is being pursued, although the necessary tests are being carried out largely in the United States.

I hope that that approach is successful. If so, it will improve the accuracy of screening, but it will not make it 100 per cent. accurate.

Mr. Simon Hughes (Southwark, North and Bermondsey): I am sure that the Secretary of State wants this country to have the best cancer screening processes

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and to succeed in bringing down our cancer death rate, which is far worse than in many parts of Europe. Does he agree that that will require the best processes, technology and education system, and that we have all the necessary staff--nurses, doctors, consultants, and other professionals?

When will the Government announce that their policy for the health service will mirror their general election policy for the education service? Such an announcement would mean that, over this Parliament, the amount of our national wealth, as a proportion of national income, that is spent on our national health would increase. When will we begin to spend on our health service the same amount as most of our European neighbours spend on theirs?

Mr. Dobson: Rather than joining in the vague theorising that Liberal Democrat Members go in for because they will never be within a sniff of being in power, I shall address the point that the hon. Gentleman raises in relation to the amount that is paid to people working in the cervical cancer screening system. We have offered pay increases of between 6 and 26 per cent. to those who train cytoscreeners. To qualified cytoscreeners, we have offered an increase of 11 per cent. That reflects the difficulty of recruitment, the poor levels of pay that they have received in recent years, and the importance of their work, which is very demanding and which, up to now, has been badly paid.

Teenage Pregnancies

4. Dr. Jenny Tonge (Richmond Park): When he expects to publish the report of the social exclusion unit on teenage pregnancies. [84999]

The Parliamentary Under-Secretary of State for Health (Mr. John Hutton): The social exclusion unit will be publishing its report very shortly.

Dr. Tonge: I thank the Minister for that welcome reply, although I wonder what the word "shortly" means. Does he share my shame that this country has the highest rate of teenage pregnancy in Europe? Does he connect that in any way with the reduction in the number of family planning clinics and the very poor quality of sex education over the past 18 years?

Does the hon. Gentleman also recall that there was no mention of teenagers' sexual health or of teenage pregnancies in the Green Paper "Our Healthier Nation"? We have waited longer than two years for the social exclusion unit report, and it will be at least another year before the report on teenagers' sexual health is ready. When will we see some action?

Mr. Hutton: In my earlier response to my hon. Friend the Member for Stretford and Urmston (Ms Hughes), I described those areas in which the Government are already taking action to deal with some of the problems arising from sexual health and pregnancies among teenagers. The hon. Lady is usually right, but she was wrong to say that we have waited two years for the social exclusion unit report. My right hon. Friend the Prime Minister commissioned that report last July, and we expect it to be published very soon.

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However, I agree that action needs to be taken to reduce teenage pregnancies, which are four times more common here than in France, and six times more common than in the Netherlands. That is not acceptable, as a consequence of teenage pregnancies is social exclusion at a crucial time in young women's lives. The Government are taking action. We have announced the formation of a national comprehensive strategy, led by an expert task group, whose composition will be announced shortly. The Government are committed to taking action, and are doing so.

Mr. John Healey (Wentworth): Before finalising his plans for reducing teenage pregnancies, would my hon. Friend encourage health authorities to consider the lessons learned in pioneering baby-doll projects run in Rawmarsh and Wath-upon-Dearne? Fourteen-year-olds are given life-like dolls to look after, and the dolls wake at night, scream, feed and much more. Half those who took part in the projects said that the age at which they would wish to have children was a lot higher than it had been beforehand. Will my hon. Friend congratulate the Rotherham youth workers, Karen Kirby, Ann Brown, Pat Hickling and Sue White, on pioneering the projects?

Mr. Hutton: I am happy to endorse what my hon. Friend has said about that work. The experience of young children to which he has referred was certainly my own experience when I first became a father. My hon. Friend confirms that action is already being taken up and down the country. Many health action zones are doing pioneering work to develop new approaches to tackling teenage pregnancy. We support that work, and we want to spread best practice around the country.


5. Dr. Vincent Cable (Twickenham): If he will make a statement on (a) the level of take-up and (b) regional disparities in the take-up of Aricept in the NHS. [85000]

The Minister of State, Department of Health (Mr. John Denham): Donepezil hydrochloride--Aricept--was prescribed by general practitioners in the national health service in all health authorities in England over the 12-month period ending March 1999. At a regional level, the number of prescriptions per 100,000 population aged 60 years and over varied from 58 in west midlands to 339 in Trent, with an average of 170 for each region.

Dr. Cable: I thank the Minister, but does he agree that those figures demonstrate the enormous regional disparity that is already clear to many patients and their carers? In some areas, prescriptions are freely available, but in others, patients can obtain them only at the considerable cost of around £150 a month. In view of the growing clinical evidence of the benefits of the drug and of the enormous help it gives victims and carers, does the Minister accept that the drug should be included in the first round of drugs appraised by the National Institute for Clinical Excellence?

Mr. Denham: Two important points must be made. First, Aricept, which is licensed for treatment of mild to moderate Alzheimer's disease, is a symptomatic

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treatment, and there is no evidence that it affects the progression of the underlying disease. Secondly, I am advised that it has not been widely prescribed to date because of concern that the moderate improvements it brings in cognitive function tests may not necessarily translate into worthwhile clinical and social benefits. The variation in the figures that I have given probably reflects differing attitudes among specialists to use of the drug. Research projects are under way, and a large trial organised by the NHS in the west midlands is covering 3,000 patients. In addition, it is likely that NICE will at some point be asked to consider drugs for the treatment of Alzheimer's disease.

Mr. Alan Duncan (Rutland and Melton): NICE may attempt to iron out regional disparities in the availability of drugs such as Aricept, but has not its chairman, Professor Rawlins, already admitted that he will rule out advocating the use of drugs that NICE considers to be too expensive, even if they are highly clinically effective? Can the Minister name just one respectable organisation prepared to support his absurd claim that there is no rationing in our national health service?

Mr. Denham: Clinicians in the NHS want NICE to offer consistent guidance on the clinical effectiveness and cost effectiveness of treatments. There has been wide support from a variety of professional bodies for the establishment of the National Institute for Clinical Excellence precisely because people know that such guidance will be made available.

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