| Previous Section | Index | Home Page |
Mr. Breed: On that basis, there will be no change. If the EFA pronounces on a matter, the member state can simply ignore it and carry on regardless.
Ms Blears: Yes, but I hope that, in a system whereby everybody is engaged and has a stake in the process, people will share information and expertise and reach a consensus. If not, the EFA could not prevent people from taking unilateral action.
Cost and compliance were mentioned. There are high level proposals for traceability; people will have to record where they buy a product and to whom they sell it. The majority of businesses make some record, for example, of an invoice or a VAT return. Consequently, there are no new specific requirements to fill in forms; there is no increased bureaucracy, as the hon. Member for Rochford and Southend, East will be delighted to know. It is simply a matter of recording in the way that businesses already operate. We have held extensive consultations with small and medium-sized enterprises and were assured that compliance costs for business can be met.
Let us consider the EFA's involvement in nutrition. It will play a role in functional foods, babyfoods and so on, but its purpose is not to run campaigns on healthy eating. Those are matters for member states, which must decide what they wish to promote. Its purpose is not to harmonise so that all member states have homogenous food and diets. All of us who enjoy consuming different European food must strive to maintain its diversity.
The debate has been interesting because genuine tensions have been expressed. Some hon. Members said that the EFA should be independent and robust if it is to have integrity and credibility, while the hon. Member for Rochford and Southend, East wants to control it and ensure that politicians determine its actions. In our negotiations, we have striven to push forward the boundaries of openness and transparency to try to ensure an element of public scrutiny. That does not accord with traditions in some other countries, and it is fair to say that the Food Safety Agency and our approach take a lead on involving the public and consumers. That is the right way forward. If this body, whose aim will be to bring together the sources of the very best science, is to have credibility and re-establish consumers' confidence in their food, it is crucial for it to be seen as being able to say things without fear or favour on the basis of the scientific evidence before it.
The cost will be 24.9 million euros initially, rising to 44 million after three years. No extra funding will be needed: I understand that provision has already been made. As for location, there are currently bids for Barcelona, Helsinki, Parma and Lille. The Government have not taken a view of the appropriate location; each will be considered on its merits.
Media provision is important. Obviously the public will want to know that information is being disseminated widely, and that they know what is emerging from the scientific committees.
My hon. Friend the Member for Stroud—indeed, I think all hon. Members—mentioned the division between risk assessment and risk management, which will clearly be a fundamental issue for the authority. The authority's purpose is to provide advice in order to inform the development of policy, and there is a clear difference between those two roles. If a new authority had a complete remit, without leaving member states or the Commission any role, we would risk creating a monolithic approach without the necessary flexibility and sensitivity to the needs of individual states.
The whole debate has concerned getting the balance right between independence and credibility—balancing control and advice, and achieving balance between the parts of the authority that will need to act and the basis on which such action should be informed. Such considerations are important, but I believe that the balance is right.
Third-country imports have been mentioned. That, too, is an important issue: consumers want to know that they can rely on the information that is available. I believe that the Food and Veterinary Office makes regular enforcement visits and gives regular guidance on the matter.
I entirely understand the commitment of the hon. Member for Rochford and Southend, East to these issues. Let me encourage him to be a little more optimistic, and not to assume that this institution will not make a difference. It will make a difference: it will bring together the best scientific knowledge that we have.
It being one and a half hours after the commencement of proceedings on the motion, Mr. Deputy Speaker put the Question, pursuant to Standing Order No. 16 (Proceedings under an Act or on European Community documents).
- That this House takes note of European Union document no. 14174/00, a draft Council regulation laying down the general principles and requirements of food law, establishing the European Food Authority and laying down procedures in matters of food; and supports the Government's objective of the introduction of effective arrangements to re-establish and maintain consumer confidence in the regulation of food safety at European Union level.
Cervical Cancer
Motion made, and Question proposed, That this House do now adjourn.—[Mrs. McGuire.]
7.23 pm
Dr. Vincent Cable (Twickenham): I am grateful for the opportunity to speak on this subject. Let me begin by summarising what I want to say before developing my arguments.
The cervical cancer screening programme has performed an enormously valuable service in this country over the years. Tens of thousands of women's lives have been saved by it. However, it is now running up against technical limitations. Advances are being made in the science and the application of testing—especially human papilloma virus testing—that are not yet operating in the United Kingdom. I know that the Government are conducting pilot studies, but my purpose is to bring a sense of urgency to the process, and to ask whether it can be accelerated.
I have a personal and a broader reason for doing this. Earlier in the summer I lost my wife, whom I loved very much, to cancer. As it happens it was breast cancer rather than cervical cancer, but obviously, having been through that experience, I want to ensure that all that can possibly be done will be done to stop women's lives being cut short prematurely. My wife received superb NHS treatment in the Royal Marsden hospital, as many women do. The fact is, however, that lives are being lost, and we must do anything that we can to stop that.
There is a growing campaign to focus attention on the possibilities of human papilloma virus testing. It is now a Europe-wide campaign, and some Ministers, parliamentary colleagues and European colleagues are involved in it. It is sufficiently well developed that, earlier this year, I had 5,000 separate letters from women in my constituency alone, pressing for action on this matter. There is a growing consciousness of the issue, and a growing sense of frustration at the slow progress that is being made.
I shall explain why the issue is important. Cervical cancer is a major cancer in women—the second most important for younger women. The incidence of the disease in the United Kingdom is above average in European terms. Morbidity from the disease has been falling, which clearly reflects the success of the screening programme, but it has, until recently, been rising among younger women, which reflects some growing difficulties.
The key point about this disease, as opposed to many other cancers, is that it is exceptionally amenable to early treatment. I believe that 80 per cent. of women whose cervical cancer is detected early survive, which is a very high rate. That is why the issue of screening is so important.
Smear testing in the United Kingdom has a long history—I think that it was first introduced in the 1940s. It has been well developed in this country, and I think that we are still the only European country with a full national screening programme. It is to the credit of the NHS and the Government that they introduced it and made it work. There have been considerable success stories along the way. As I mentioned, probably tens of thousands of women are alive who would not be if they had not been screened using smear tests.
However, it became apparent a few years ago that there have been limitations. This was all brought to a head in the 1998 report by the Public Accounts Committee, which revealed the many limitations of the screening programme that were beginning to pile up. These included human fallibility, lack of staffing, failures in the cytology process, numerous cases of litigation against the NHS—in particular, scandals associated with hospitals such as the Kent and Canterbury hospital—and so on.
The Government have addressed these issues, and I do not want to dwell on them. This is part of the history of the smear test as it has developed, and the limitations are now reasonably well understood, in terms of the lack of training, the lack of staff numbers among cytologists, and the fact that a significant number of women are still being missed by the test, many of whom are on low incomes or in ethnic minority groups.
I do not want to dwell on those issues, however. I want to focus on the particular problems associated with the testing itself. The problem is that the smear test is highly imperfect. Even the most optimistic assessments judge that 20 per cent. of the tests are wrong. There is some argument about whether it is 20 per cent., 30 per cent., or 40 per cent., but substantial numbers of women who are tested and found to be clear none the less develop the disease. That is due to the limitations of the technology.
I believe that about 1,200 women a year die from cervical cancer, despite the screening process. About half those women have been fully tested—in other words, they participated fully in the screening process and there were no failures by the people carrying out the tests. What has happened has been due simply to a deficiency in the technology. That is the issue on which we need to focus.
In recent years, there has been a growing understanding of what causes the disease. Uniquely among cancers, it is caused by a virus, known as the human papilloma virus or HPV. There is also a growing understanding that the virus can be detected. When I started researching this debate, I was surprised at the extent to which that was well known years ago. Professor Jack Cusick, one of the leading practitioners from the Imperial Cancer Research Fund, was publishing on this subject in the British cancer journals in about 1994 and 1995. We are not dealing with entirely new science. We are dealing with science that is well known and well understood.
There has been a lot of research and testing, particularly in the United States. I do not claim to be a medical scientist, but I have tried to understand as best I can some of the recent literature. In February, a major study was published in "Journal of the National Cancer Institute" in the United States—the ASCUS/LSIL triage study, a summary of a great deal of testing in pilot studies in the United States, which advanced not only the science, but the understanding of how testing can operate and be made to work.
Knowledge is spreading widely in Europe. The European Journal for Infectious and Immunological Diseases in Obstetrics and Gynaecology published a study earlier this year by a group of German scientists, which again advanced knowledge and understanding of the subject. What can now be said categorically is that the cause of the disease is understood: it comes from the virus. That virus can be detected with 100 per cent. certainty, as opposed to the 80 per cent. or less certainty that comes from the smear test.
I understand that merely achieving a scientific breakthrough is not a sufficient condition for adoption by the NHS. The NHS rightly has to go through a process of evaluation. The economics are always important. I have on occasions pressed for early introduction, for example, of drugs to deal with Alzheimer's, and the answer comes back from Ministers, "We understand that it will clearly help a lot of people, but it is very costly and we have to look at the costs and benefits."
What is unique about the HPV screening controversy is that it is an example of a new advance that would save, as opposed to cost, large amounts of money. That is not merely my assertion. A lot of technical literature supports that view, with which I am sure the Minister's Department is familiar. Articles were published as early as 1997 by Professor Cusick and his collaborator Sasieni. The British Journal of Cancer published an article in the same year by a Dutch researcher, Van Ballgooijan. Jeremy Holmes of the Economists Advisory Group was also involved. They have all done the sums and come to some careful conclusions about the benefits that the NHS would derive from adopting the HPV testing system. It would be possible to increase the length of time that women need to spend before the screening from three to five years, and there would be fewer inadequate tests: the figure could be cut from 8 per cent. to 1 per cent. That means fewer women being recalled and less need for testing, quite apart from the anxiety that that causes the women concerned.
There would be a considerable reduction in the NHS time and resources involved. Moreover—and perhaps most important—fewer women would attract the disease, and there would be less need for extensive and indeed painful therapies. The research suggests that the NHS would probably save £30 million a year by adopting HPV testing—a quarter of the whole cost of the screening programme. There are probably very few examples in modern medicine where the benefit-cost ratio of a new programme is so clear cut.
That brings us to why testing is not happening. A controversy has run over the years as to why things have not moved more quickly under the Government of the day—primarily this Government, because people became aware of the problem after 1997. One of my colleagues in the House of Lords, Lord Clement-Jones, secured a debate on the issue in the early part of 1999 and raised many of the questions that I raise now, which makes me even more impatient to understand why there has been a hiatus.
I understand that the Government have brought in a series of pilot tests in three regions and that they are due to be finished at the end of 2002. Presumably, there will then be a period of evaluation until early 2003, and a decision will be made roughly two years from now. Perhaps the Minister can clarify whether that would be the timing and what the roll-out time would be to make the programme universal, were it established that it was sound.
First, I have to ask why this is necessary. As someone with scientific training, I understand the importance of pilot studies, but many pilot studies have been carried out in the United States involving not only an enormous amount of laboratory work, but extensive field testing. Beyond that, health practitioners in the United States have already been given guidance on how to administer the
test, so they are several years ahead of us. I appreciate that that applies not only to the UK, but to the whole of western Europe.I am perplexed about why we cannot adopt American best practice. I appreciate that we have a universal programme and that, in that sense, ours is a better system, but given that the technology and the economics have been proved, I cannot understand why we cannot move on more quickly.
My second question relates to the British pilot testing system. I understand that it deals only with borderline cases. As the HPV test has potential for universal screening to be run alongside the smear test, why is it not being undertaken on all women in a particular region of the country? Why is it being carried out in this rather narrow, circumscribed way?
My third question also relates to the British pilot. I understand that the Scottish Executive have recently curtailed funding for various pilot studies in Scotland. I appreciate that it is not the Minister's responsibility; indeed the Scottish Executive are the joint responsibility of our two parties, so this is not a party political point. However, for whatever reason, the Scottish Executive have chosen to curtail research. That merely adds to the feeling of many campaigners and specialists in this field that the United Kingdom is not as committed as it could be to bringing this new testing system on stream.
In conclusion, I should like to quote an extract from what my colleague in the House of Lords said about this two and a half years ago. Almost exactly the same points were being made then, so it is not a novel problem. He said:
- "The FDA in the United States has already undertaken extensive trials. The test is in use for the US for borderline cases. There are trials in a number of other EU countries. Here in the UK the ICRF has a trial involving 12,000 women due to be completed next year."
- "It is already in use in Marie Stopes clinics, yet the official trials seem to be destined to take for ever . . . Yet this is a diagnostic tool to supplement an existing test, not a major new treatment. Why cannot we rely on the ICRF trials when they are complete? That does not seem to be displaying the same sense of urgency as the Dutch Government, for instance, who are pressing for interim results."—[Official Report, House of Lords, 3 March 1999; Vol.597, c.1781-2.]
At first sight, there seems to be little reason for holding back. There are good humane reasons in terms of the health of women as well as economic reasons for progressing fast. Will the Minister explain why it is necessary to go through this rather protracted process? When is the earliest end point to the process of testing that she can envisage? Can she give us an assurance that if—as seems to be the case—knowledge and understanding are advancing rapidly, this process of testing can be short-circuited in order to save hundreds of unnecessary deaths?
| Next Section
| Index | Home Page |