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17 July 2007 : Column 45WH—continued
My final point on breast cancer screening is that, as with all cancers, screening is only as good as the subsequent cures and treatments. There is no point screening people if they are not promptly dealt with and there is a long-standing issue about the speed of treatment for breast cancer patients. Are the Minister and her officials aware of an article that appeared in the British Medical Journal in recent months, which was based on a case study in Bristol and pointed to the difficulties with the so-called two-week rule? Apparently, GPs are putting a lot of women in the non-urgent category, where cancer diagnosis is growing rapidly, so
something is not working with the two-week rule and the other principles designed to get people quickly into treatment.
The third and final category about which I wish to ask the Minister is bowel cancer screening. It is a big step forward and very welcome that the Government have accepted that there is value in screening for bowel cancer, which is of course different from cervical cancer and breast cancer in that it affects men at least as much as—indeed, probably more than—women. There is a large number of fatalities—about 16,000 a year, or about half of those who are diagnosed—and the number is growing rapidly. An estimated 2,500 people a year could be saved if screening were effective, so it is very welcome that the Government have taken a step forward.
I speak on the issue with some local interest because one of the leading charities—Beating Bowel Cancer—is located in St. Margaret’s in my constituency. It is a strong advocate of the screening process, and some of us participate annually in its loud tie day, which is one of its gimmicks to make the subject more attractive. For obvious physical reasons, bowel cancer is not something that people particularly want to talk about, and the charity has done a brilliant job in overcoming some of that psychological resistance.
The screening programme is now being rolled out, which is very welcome, and the primary care trust in my area was one of the first in London to adopt it. However, I have some questions about how the process is working. First, the roll-out has been going on for a year, so do the Government have any preliminary conclusions? If so, when will they publish them? Secondly, some of the feedback from the work that has been done suggests that uptake is quite low and that only half of those who are tested return the kits, as they are required to do. Is anything being done to raise that problem and deal with it? Thirdly, do the Government have the funding to complete the envisaged three-year roll-out? Finally, are interesting conclusions being drawn as a result of different age ranges being applied in Scotland, Wales and England?
My final point about bowel cancer is that, as with other forms of cancer, the success of the Government’s programme depends entirely on whether those who are screened can get treatment. As the Minister will know, difficult and emotive issues have been raised as regards the drugs that are made available to bowel cancer patients once they have been screened and diagnosed. A constituent called Adam Griffin, who is only 30, has run up against the barrier that was created by the National Institute for Health and Clinical Excellence when it ruled that Erbitux and another bowel cancer drug, Avastin, could be made available only in exceptional circumstances, and several young people in their 20s and 30s in London are being denied those drugs because of that new ruling. I know the difficulties involved, and these drugs are expensive, but I wonder whether the Government take account of age in interpreting the phrase “in exceptional circumstances”. Common sense suggests that if people can be saved from premature death in their 20s and 30s, they would, quite apart from any humanitarian consideration, have a much longer life to live, so the value of the treatment would be much greater. How much flexibility is there in that respect? A lot of emotion has, rightly, been generated
around Herceptin, but there are some equally dramatic and difficult issues around bowel cancer drugs.
That rather broader question takes us a bit away from screening, but I wonder whether the Government are responding to the rather critical study by the Swedish Karolinska institute. The study suggested that despite Britain’s screening record, which is second to none in the developed world, we rank among the worst in terms of the availability of cancer drugs. The study partly attributed the relatively low cancer survival rate in the UK to that limited availability.
My final point—I have just exceeded my 15 minutes, so it is my final point—is that some cancer conditions cannot be dealt with through screening because the science is insufficiently precise, and we are always told that prostate cancer is one of those conditions. It is increasing rapidly among men, which is not necessarily as insidious as it seems, because it is a condition of very elderly men, who have many other problems. I was recently invited to an MPs’ health check and I was very struck by the fact that I was offered a prostate cancer test, thereby becoming one of the 6 per cent. of men who are tested. I therefore have one simple question: if such tests are good enough for MPs and for 6 per cent. of the population, why can the other 94 per cent. not enjoy them?
12.38 pm
The Parliamentary Under-Secretary of State for Health (Ann Keen): I congratulate the hon. Member for Twickenham (Dr. Cable) on securing the debate. As he recognised, we have neighbouring constituencies and share the same acute trust—the West Middlesex University Hospital NHS Trust. He also mentioned the personal side of the debate, and I acknowledge that.
The earlier detection of cancer is vital to long-term efforts to reduce cancer mortality. Where screening for cancer is possible, it is an essential tool in detecting abnormalities at an early stage. That is why the NHS cancer plan proposed a major expansion of our cancer screening programmes, where it is clear that that can reduce mortality. The efforts of the service to deliver that expansion are now coming to fruition.
The hon. Gentleman mentioned breast cancer screening, and the NHS breast screening programme was the first such programme in the EU. It is regarded as one of the best screening programmes in the world and is estimated to save l,400 lives a year. I wish that our media would portray such things, rather than the negative issues that are usually associated with cancer and cancer screening.
In March 2005 we completed two of the objectives set by the NHS cancer plan. The screening age was extended to include women aged 65 to 70, and the service was fully upgraded so that two X-ray views of each breast are taken at all screening rounds. As a result of those changes, the breast screening programme screened more women and detected more cancers than ever before in 2005-06; 1.63 million women were screened and more than 13,500 cancers were detected, which implies a 62 per cent. increase since 2001; 40 per cent. of the cancers detected were small cancers that could not have been detected by a hand examination.
We cannot, however, be complacent, and we are always looking at ways of improving the service, as long as there is a clear evidence base. For example, the evidence to support inviting women aged over 70, on a population basis, is not clear. That is why research has been commissioned on behalf of the advisory committee on breast cancer screening. Women over 70 can still self-refer for breast screening every three years, and we have collaborated with Age Concern on a leaflet to remind women of that. I am sure that all hon. Members will welcome that, and actively encourage Age Concern’s involvement. In the areas that the hon. Gentleman and I represent it is important to look for ways to approach education in such matters for the ethnic minority communities.
The hon. Gentleman raised the matter of cervical cancer, which is the subject of the NHS’s other longest running screening programme; again, it was the first such programme in the EU. The introduction of cervical screening has prevented an epidemic of cervical cancer and is estimated to be preventing up to 5,000 deaths a year. In 2005-06, 79.5 per cent. of eligible women in England had had a test result in the previous five years, 3.6 million women were screened and laboratories reported 4 million tests. However, again, we are not complacent. Following the National Institute for Health and Clinical Excellence technological appraisal in 2003, we are rolling out the use of liquid-based cytology across the service. That will reduce the number of inadequate tests and speed up the reading of slides. It will mean that 300,000 women a year will not have go through the anxiety of being called back and retested because their slides could not be read.
For women under 25 screening is not a good idea and can do more harm than good, because the cervix is not properly developed. More research on that is taking place. The 2005 Labour party general election manifesto contained a commitment to speeding up cervical screening results. The LBC is a key aspect of that, and the commitment is being taken forward through the cancer reform strategy, which will be published at the end of the year. A more recent development in our battle against cervical cancer has been the advent of human papilloma virus vaccines. HPV is implicated in nearly all cervical cancers. The Joint Committee on Vaccination and Immunisation has recommended that an HPV vaccine should be routinely offered to girls aged around 12 years.
The hon. Gentleman raised a very new area of screening—that for bowel cancer. The NHS bowel cancer screening programme began in April 2006, and full national roll-out is expected by December 2009. It is one of the first national bowel screening programmes in the world, and it is the first cancer screening programme in England to invite men as well as women. Once it is fully operational, each year, around 3 million men and women in their 60s will be sent a self-sampling kit to use in the privacy of their homes. It is an ambitious project and, when fully implemented, will detect around 3,000 bowel cancers every year. I am pleased to say that those of the hon. Gentleman’s constituents who are in their 60s began to be invited to participate in the programme on 8 January.
We are committed to introducing a screening programme for prostate cancer if and when screening and treatment techniques become sufficiently well
developed. I note the point that the hon. Gentleman made about what he was offered in the House. The Department of Health is supporting the development of screening technology for prostate cancer by way of a comprehensive research strategy. Prostate cancer is the only cancer with a departmental research funding target, and we continue to fund at least £4.2 million of prostate cancer research each year.
The hon. Gentleman and I both attended an Ovarian Cancer Action charity reception yesterday. The NHS cancer plan committed the Government to introducing ovarian cancer screening as and when research demonstrates that screening is appropriate and cost-effective. The research is well under way, and the UK collaborative trial of ovarian cancer screening began in 2000; results are expected in 2012. The cancer used to be called the silent killer, but we now have evidence to suggest that we can do more. I welcome the research, having taken an active interest in ovarian cancer for some time.
We need, of course, to screen for and monitor other cancers. However, participation is very important, and the hon. Gentleman raised the important issue of increasing participation in our screening programmes. We agree with him, but we must encourage people to attend for screening in a responsible way. People who are invited to participate in our cancer screening programmes need to understand the potential benefits and harms in doing so and to be able to make an informed choice about whether they want to proceed. That is why all people who are eligible to participate in the programmes receive a national information leaflet when they are invited for screening. Those leaflets have been translated into 19 languages; posters and CDs are also available in seven languages.
Cancer screening will form a major part of the cancer reform strategy. As part of the strategy we will be looking at new ways of encouraging people to make the decision to attend screening; that applies particularly to those from more deprived groups, whose uptake of screening has historically been poor. I hope that the leaflets in different languages and the way we approach education in communities where English is not the first language will help to improve constituents’ quality of life.
I pay tribute to all organisations and MPs who keep the issue of breast cancer in the public and Government eye. I hope that the hon. Gentleman will join me in thanking all the staff who have worked so hard in making our cancer screening programmes some of the best in the world, and particularly those in screening programmes in the areas that we represent. I congratulate the hon. Gentleman on bringing the debate to the House.
12.47 pm
Cycling Deaths (Abergele)
1 pm
Chris Ruane (Vale of Clwyd) (Lab): On 8 January 2006, Thomas Harland, aged 14, Maurice Broadbent, aged 61, Dave Horrocks, aged 55, and Wayne Wilkes, aged 42—all members of the Rhyl cycling club—were killed when a car ploughed into their group after skidding on ice on the A547 near Abergele. Although the tragedy occurred just outside my constituency, three of the four cyclists were my constituents, and the father of Thomas Harland was a close personal friend. It was and remains Britain’s worst traffic accident involving cyclists.
Following the accident, I asked the Secretary of State for Wales, my right hon. Friend the Member for Neath (Mr. Hain), to visit the scene of the crash and to meet the victims’ families and the North Wales police. I raised the matter at Prime Minister’s questions, arranged for two members of the Rhyl cycling club to meet a transport Minister here in the House and have tabled a number of parliamentary written questions. I have also tabled Question 3 for Prime Minister’s questions tomorrow, when I shall raise the issue of the coroner’s report with the Prime Minister.
I pay tribute to the relatives of those killed in the accident. They have conducted themselves with dignity. I also pay tribute to the Daily Post, and to its reporter Roland Hughes for his excellent, sensitive and detailed coverage of the accident and the coroner’s inquest. I have brought some of the Daily Post reports with me and I will be drawing on them heavily—I acknowledge that at the outset. Finally, I pay tribute to coroner John Hughes, whose inquiry has raised a number of issues that must be addressed not just in Denbighshire, Conwy and Wales but throughout the nation.
The first issue is police protocol on two matters. When ice is spotted on the road, what is the protocol for reporting accidents to the control room? The other matter is the protocol governing the control room’s reporting of such incidents to the relevant local authority. There are 43 police forces and 430 local authorities in England and Wales. An absence of protocols, or a protocol that is not strictly adhered to, is a recipe for disaster. Will the Minister seek clarification from his advisers on whether such a protocol exists? I have given them at least 20 minutes to find the answer.
I shall describe the police response to the reporting and actioning of numerous accidents involving ice on or near the A547 on the day of the tragic accident in order to illustrate some shortcomings that have not been addressed. On the day of the accident, police did not tell local councils about four crashes and near misses on icy roads near the site of the Rhyl cycling tragedy. Four drivers—including three on and off-duty police officers—skidded on or near the A547 in the hours leading up to the tragedy, but police did not think it necessary to tell Conwy county council’s highways department that the roads should be gritted, despite the fact that one accident occurred within Conwy’s boundary, just two metres from the county boundary and one mile away from the boundary in Denbighshire. The only time that police rang Conwy’s highways staff was when a car skidded on ice more than two miles away.
At the inquest into the cyclists’ death, police admitted that they had no fixed policy on alerting highways chiefs to icy roads, but said that it was expected of them. That is what I want to flush out. What is expected and what is not? I want a better definition.
A police officer who skidded twice on the Denbighshire side of the Borth crossroads, half a mile away, called the control room at about 3.30 am to say:
“The road is like glass here...I’m not sure if it’s policy to call out the council”.
“In our opinion, the road needed gritting immediately and the council needed informing at the least. We had expected those messages to have been acted upon.”
He was unsure of the policy. I am sure that if we were to ask other police officers around the country what the policy is, their responses would be similar. Neither Denbighshire county council nor Conwy, whose boundary is only metres away, were alerted by police to the icy conditions.
At 5.30 am, another accident occurred. An off-duty police officer, a friend of mine, was involved. He lost control on the Borth crossroads, only metres inside the Denbighshire boundary. Neither the Denbighshire nor the Conwy highways department was alerted to the conditions. At about 6.45, another off-duty police officer came off the A525 a mile from the tragedy. Again, the highway authorities were not informed. The only time that highway officials were contacted was at about 8.50 am, after two cars skidded on ice at a bridge in Towyn. A police control room worker mistakenly called Denbighshire—some Members might be unaware of the local geography, as indeed were some of the control staff—saying that the accidents had occurred on the Foryd bridge, which straddles the border between Conwy and Denbighshire. The control room informed Denbighshire that the accident was in its jurisdiction, but it was in fact a mile and a half away on the Towyn bridge in Conwy.
The highways department rectified the mistake shortly afterward, but the incident illustrates the need for local knowledge in order to pinpoint locations. It also illustrates the confusion that can occur if control room staff do not have such information at hand. If they do not know the co-ordinates and cannot report exactly where an accident occurred, they could quite easily end up alerting the wrong authority, as they did in the incident that I described, leading to delay or causing the wrong area to be gritted, with deadly consequences.
I have described a catalogue of errors that contributed to the death of the four cyclists. Is the Minister satisfied that robust procedures are in place for the reporting and actioning of accidents involving ice for every police force in England and Wales? Are they sufficiently understood by police and civilian staff? Confusion can arise if control room staff do not have the exact co-ordinates of an accident, but it can also arise without robust procedures for staff shift changes.
The latter had a bearing on the tragic accident that we are debating. As well as those that I have described, one final accident occurred on exactly the same spot as
the fatal crash, just one hour before. The control operator mistakenly told her replacement colleague that both Denbighshire and Conwy gritters were operating, so when the accident was reported, no action was taken. Does the Minister feel that the rules governing shift changes in control rooms need to be reviewed? I spent 25 days with the North Wales police under the police parliamentary scheme, and I am aware that when ordinary bobbies on the beat change shifts, a debriefing session is held. Does that take place in control rooms? Should staff sit down together to debrief each other?
The coroner suggested that a hard copy of all reported incidents involving inclement weather should be left on the desk when staff change over, so that operatives do not have to go back into the computer. They would have no excuse—the information would be before them on the table in black and white. They could not ignore it. That simple suggestion could improve safety dramatically.
In summing up after the inquest, Mr. Hughes said that the way in which information was passed on by the police patrol room left a lot to be desired. I share his concerns and urge the Minister to do all that he can to prevent a repetition of such failings in all police forces in England and Wales. I say “England and Wales” because I know that the Minister has jurisdiction for England and Wales, but I also urge him to contact the Scottish Parliament and the Northern Ireland Assembly, so that they can learn from these mistakes.
Mr. Harland is a personal friend, and I took the family, including young Tom, on a tour of Parliament two or three years ago. They are a lovely, lovely family. When I contacted him to tell him about this debate and to ask whether he wanted me to relay anything to the Minister, he said that
“the main lesson I would like to see learnt is that a single incident suspected of ice should be treated as a road closure situation in every case until it is clarified/dealt with/made safe.
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