(10 years, 6 months ago)
Commons ChamberRead Hansard Text Read Debate Ministerial Extracts
Steve Rotheram (Liverpool, Walton) (Lab)
I beg to move,
That this House notes the e-petition relating to the tragic death of Sophie Jones from cervical cancer; believes that the Government should urgently issue guidance stipulating that all women should have the choice of taking a smear test regardless of their age and in consultation with their doctor; and further notes that the best way to combat cervical cancer is by increasing awareness of its symptoms so as to ensure that early diagnosis rates are driven up, doctors and nurses understand that although it is very rare, younger women can develop cervical cancer, and high levels of coverage among young girls of the HPV vaccination programme introduced in 2008 are achieved.
I am grateful for the opportunity to bring this important debate to the Floor of the House, although I wish it was not under such tragic circumstances. The number of MPs present does not necessarily reflect the wider public interest in the issue. Perhaps that shows that many MPs have lots of competing interests and that many who would have liked to have been here today are, unfortunately, unable to attend.
I want to place on record my thanks to members of the Backbench Business Committee, skilfully chaired by my hon. Friend the Member for North East Derbyshire (Natascha Engel), for listening to the voices of the tens of thousands of people who wanted this issue debated, and to the Leader of the House for recognising the considerable national interest in it. I also thank the Liverpool Echo, the Daily Mirror and the Daily Mail for their continued coverage of Sophie’s case and the steps they have taken to raise awareness of this debate and, more importantly, the issue of screening and the early identification of symptoms, which I will go into in more detail during my contribution.
I want to place on record my gratitude to Sophie’s mum, Peri, and to each and every one of the 321,925 people who signed the online petition following the heartbreaking death of her daughter earlier this year. They made history in the process by accumulating the largest ever number of signatories to a Government e-petition.
There has been a lot of speculation and conjecture about what is actually being requested today, but my motion, seconded by my hon. Friend the Member for Wirral West—
Steve Rotheram
Sorry—she will kill me for that!
The motion is clear in its intent. I am not calling for the introduction of routine cervical screening for all women and young girls under 25, but I am calling on the Government to issue guidance that stipulates that all women should be able to request a cervical smear regardless of their age. Put simply, young women and teenage girls who present to their GP with possible symptoms of cervical cancer should have the choice, if they so desire, to have a smear test, but that must of course go hand in hand with extensive consultation with their GP to ensure that they are informed of all the potential consequences of the procedure. Given the limited number of cervical cancer cases in women under the age of 25—just 47 in England in 2011, according to Department of Health figures—such an option would not open the floodgates to thousands of unnecessary, costly or possibly damaging tests for young girls.
The motion is an attempt to promote the issue, and to encourage the medical profession to take up the provision that is already available to doctors of granting screening tests to females of any age in exceptional circumstances. It must be said that some of the medical profession are clearly not exercising that power, and that has proven fatal in cases such as Sophie’s. Indeed, at the heart of the motion is one simple premise—that a woman of any age over 16 should, through written departmental guidance, have the right to make an informed choice for themselves.
I will highlight areas in which I believe the Government could take immediate action to educate and inform both patients and medical professionals better about the symptoms and diagnosis of cervical cancer in young women and teenage girls, but I want to make it clear that I am very much of the opinion that any changes to age restrictions must be evidence-based.
Sophie Jones was a much-loved and popular 19-year-old girl from the Wirral who had her whole life ahead of her. She had fashioned a successful career in modelling, and was described by her twin sister Ashleigh as
“the life and soul of everything”.
In 2013, after experiencing constant stomach cramps for more than a year, Sophie visited her GP. She advised her doctor of her symptoms and asked for a smear test. Sophie knew that something was seriously wrong, but she was continually refused a test solely on the basis of her age. Instead, Sophie’s GP incorrectly diagnosed her with Crohn’s disease. Last November, Sophie was forced to enter hospital permanently, due to the deterioration in her health and the escalation of her condition. Despite that, numerous doctors still failed to recognise her symptoms or to diagnose her illness accurately.
Eventually, Sophie and her family’s worst nightmares were confirmed when she was diagnosed with cancer of the cervix. Tragically, by the time doctors were able to make an affirmative diagnosis, it was too late. The cancer had spread to other parts of her body, and by then she was terminally ill. For four months, Sophie fought against her devastating disease and, with her family and friends alongside her at her hospital bed, fought bravely to the end. On 15 March, after four long and excruciating months, Sophie’s defences were overwhelmed by her condition and she lost her struggle for life.
There was a time in Britain when a cancer diagnosis struck the fear of God into people, but thanks to advances in medical treatments and preventive measures, early diagnosis ensures that cancer patients survive in more than half of cases. Cancer is no longer a death sentence if caught early enough. Sophie’s diagnosis came too late for treatment to be successful, but it should never have been that way. That is what makes her case so painful for her family and friends.
I know that I speak on behalf of my hon. Friends the Members for Wirral South and for Liverpool, Wavertree (Luciana Berger) when I pay tribute to Sophie’s family and friends for the dignity that they have shown, and for their determination to highlight Sophie’s story to prevent anyone else from ever having to go through what they have been through. Sophie was failed by the current system, and that should not be allowed to happen to anyone again.
Moreover, I am confident that Sophie’s case is not an isolated incident. I am aware of other cases, and other Members will speak about cases that have been brought to their attention. Those cases include that of Maryanne Makepeace, who was told that she had a water infection, before she was finally diagnosed with terminal cancer.
Just last week, the BBC in Wales reported the case of 20-year-old Jessica Bradford, who was also told by her GP that she was too young for cancer. Initially, she was diagnosed with thrush, with the doctor believing that she had a sexually transmitted disease, but Jessica was eventually diagnosed with cancer of the cervix. She has been told that she is now infertile, having undergone radiotherapy and chemotherapy. That is one example of how a woman exercising her right to a test resulted in her being given treatment, which I hope will lead to a full and complete recovery.
Cervical cancer is the second most common cancer worldwide. It is the 11th most common cause of cancer-related deaths in the UK, amounting to about three in every 100,000 women, according to the crude mortality rate of Cancer Research UK. There are, on average, just short of 1,000 deaths from cervical cancer each year in the UK. Three women are diagnosed with the disease every day.
As Jo’s Cervical Cancer Trust points out, almost all cases of cervical cancer are caused by the persistent high-risk human papilloma virus. The NHS guidance on the HPV vaccine indicates that 99% of cervical cancers are caused by an HPV infection, and that four out of five sexually active adults will come into contact with it during their lives. The condition is not one that solely women can get; men also carry the HPV virus. The thing is that many people do not necessarily present with any particular symptoms.
It is worth highlighting the other risk factors that can affect a woman’s propensity to develop cervical cancer. They include smoking, as carcinogens weaken the immune system and leave the individual more likely to attract an infection of the cervix, as well as unprotected sexual activity at an early age, teenage pregnancy, multiple births, decreased immunity in women receiving immunosuppressant drugs and, in some cases, mothers given the DES—diethylstilbestrol—infertility drug when pregnant. Some medical opinion suggests that long-term use of the contraceptive pill, for instance for more than 10 years, can slightly increase the risk of developing cervical cancer, although I am sure there is consensus that the benefits of the pill far outweigh the risks for most women.
The previous Labour Government’s decision to introduce the HPV vaccination programme was extremely apposite. It has saved and will continue to save many thousands of lives across the country. However, we must be relentless in rolling out the vaccination programme in our schools and colleges. Typically, year 8 girls—those aged 12 and 13—are offered the vaccination, and the take-up rate is about 80%. The vaccination offers protection against their developing the condition in later life. A catch-up programme was also introduced by the previous Government in 2009-10, in which almost 1 million girls aged between 12 and 18 were vaccinated. The continued roll-out of vaccination in girls before they become sexually active will greatly decrease the chances of their contracting the infection, and it will increase the chances of cervical cancer survival.
As many as 2,800 women a year are diagnosed with cervical cancer, and more than a third of sufferers die each year because of the failure to catch the cancer through early diagnosis. It is impossible for women on their own to detect abnormalities in cervical cells, but symptoms that seem inconsequential when taken in isolation can amount to a clear indication of cancer of the cervix when assessed cumulatively. Those include abnormal bleeding during or after sexual intercourse or between periods, post-menopausal bleeding if a woman is not on hormone replacement therapy or has stopped it for six weeks, unusual and/or unpleasant vaginal discharge, discomfort or pain during sex, and lower back pain. As the cancer develops, it can cause additional symptoms such as frequent urination, blood in the urine, rectal bleeding, diarrhoea, incontinence and lower-limb lymphoedema.
Alison McGovern
My hon. Friend is giving an excellent description of the symptoms that everyone should be aware of. It is refreshing to hear a man talking about the symptoms of women’s cancers. Does he agree that one thing that we can definitely do today is raise the awareness of those symptoms and encourage men and women to understand more about women’s cancers?
Steve Rotheram
My hon. Friend makes a powerful point. In all honesty, I did not know an awful lot of this information before I was asked to head up the campaign in the Backbench Business Committee to get this matter debated in the House. I suspect that the same is true of many male colleagues on both sides of the House and many men in the wider public. We must destigmatise the use of words like “period” or “vaginal discharge” by men, because it is important that such things can be spoken about openly. As the father of two daughters, I certainly want them to be aware of the symptoms of this condition, so that they can bring them to my attention and I can help and guide them should they need a consultation with the GP. This is an important matter for us to debate in the Chamber. I am sure that other colleagues will go into the symptoms of this horrible disease.
The danger of highlighting the symptoms is that some women might misdiagnose themselves, causing them unnecessary worry. Conversely, if doing so means that one person with the symptoms is diagnosed with cervical cancer and has her life saved, it is well worth it.
According to the NHS figures, the vast majority of women’s test results come back normal. For about one in 20 women, the test will show some abnormalities in the cells of the cervix. Most of those changes will not lead to cervical cancer and the cells often return to normal on their own. Indeed, that is particularly true of young patients. In some cases, the abnormal cells need to be removed so that they cannot become cancerous.
About 3,000 cases of cervical cancer are diagnosed each year in the UK, which amounts to 2% of all cancers diagnosed in women. As I have stated, cases of cervical cancer in women under 25 years of age are extremely rare. They amount to about 1% of all cervical cancer sufferers in England. However, the relatively small number of occurrences should not be dismissed as statistically negligible. The mission of the NHS cervical screening programme is
“to reduce the number of women who develop cervical cancer and the number of women who die from it.”
The screening programme is credited with saving the lives of about 5,000 cancer patients a year across the board.
In 2004, the last Labour Government increased the age at which young females could have a test from 20 to 25, in accordance with international recommendations from the World Health Organisation. America has adopted the position that a test should happen at 20 years of age or within three years of first sexual activity, whichever comes earlier. To me, that seems an appropriately flexible policy to have. It is estimated that early detection and treatment prevents up to 75% of cervical cancers. The contention centres on the appropriate age at which screening should become routine and on the health consequences for somebody who chooses to have a test before the recommended age of 25.
So that I am not accused of presenting an imbalanced view of the medical thinking on this issue, I should say that there is an opinion among some professionals that smear tests on young women and teenage girls can lead to false positives, unnecessary treatment, anxiety for the patient, infertility or pre-term delivery later in life. There can also be discomfort, embarrassment or, less commonly, pain during the screening test. There is a very small chance of getting incorrect results, which could lead to abnormalities being missed or to unnecessary distress and treatment. There is also a chance of unnecessary treatment occurring if the abnormalities would have corrected themselves naturally. Some of the treatments that are used to remove abnormal cells may increase the risk of premature delivery in pregnancy.
Undoubtedly, there is still extensive debate in the medical profession about whether tests on young women would have the desired impact. In 2009, the British Medical Journal released a paper on the effectiveness of cervical screening with age, which concluded:
“Cervical screening in women aged 20-24 has little or no impact on rates of invasive cervical cancer up to age 30. Some uncertainly still exists regarding its impact on advanced stage tumours in women under age 30. By contrast, screening older women leads to a substantial reduction in incidence of and mortality from cervical cancer.”
For that reason, it is important to reiterate that the motion does not call for routine screening for under-25s.
I believe that it is the duty of any Health Minister to adhere to the medical advice that is presented to the Department. To my knowledge, no new evidence has emerged that is substantial enough to change the Government’s position on screening ages. I believe that, at this juncture, it would be prudent to follow the decision of the Advisory Committee on Cervical Screening in 2009 to reaffirm the policy that the age for routine screening should remain at 25. However, although it is right that politicians should not ride roughshod over medical experts, it is the job of Health Ministers to examine the orthodoxy of the day, to keep matters such as age restrictions under constant review if new evidence emerges and to scrutinise international patterns and comparisons.
I must mention that I am not a medical expert. My opinions are predicated on what I have read and learned about the subject. The debates on either side of the screening argument need to be qualified by further research. I believe that there are steps that the Minister can take right now to address those concerns and the concerns that have been highlighted by Sophie’s death. For me, the Minister should get to work on five things immediately.
First, the Government should address the online advice and guidance that is available to young women and girls who suspect that they have the symptoms of cervical cancer. At present, it is far from adequate. In the course of my research for this debate, I was amazed at the total non-existence of good online advice for young women who suspect that they are displaying the symptoms of cervical cancer. Despite young people having a higher propensity to use the internet to access information than most adults over the age of 30, there is an absence of advice on what steps should be taken by young people who are concerned that they are exhibiting the symptoms and on the support that is available. On the NHS “Your health, your choices” website, there is no mention of what young girls or teenagers should do. Instead, there is a vague information section on smear tests for over-25s. Users of the Public Health England website are forced to wade through pages and pages of material and to follow hyperlink after hyperlink before they finally find the information that they need in the frequently asked questions section. It appears that some of the information online—
Madam Deputy Speaker (Dawn Primarolo)
Order. I was very reluctant to interrupt the hon. Gentleman, but he has been going on for over 23 minutes. Other Members wish to speak and there are other debates today. The guidance is that Members should speak for 10 to 15 minutes, so I have given him a lot of latitude. I would be grateful if he thought about speeding through his points so that we can move on to another speaker.
Steve Rotheram
That is not as I was informed, Madam Deputy Speaker, so apologies if I have overrun my time limit. I was told absolutely the opposite. I will try to conclude, and I will contact the Minister in writing with any points that I miss out.
Whatever is said and decided today, this debate needs to be the beginning of the process, not the end. I said when I made my application to the Backbench Business Committee on 8 April that I was there as a spokesperson for the 320,000 signatories to the “Sophie’s choice” petition. Today, I have presented their case, which is a case for women’s right to choose, for clearer medical guidance for patients and professionals, for improvements to the sex and relationships education system—I will inform the Minister about that in writing—and for immediate action to tackle the blind spot that exists in the vaccination programme for 19 to 24-year-olds.
We must not forget that it was the people who put this debate on the Floor of the House today, and now it is time for the Government to listen to the British public and act. In their name, let us ensure that Sophie’s legacy is a life-saving one, so that her family and friends can take comfort from the fact that despite failings of the highest order in her case, Sophie did not die in vain.
Mr John Baron (Basildon and Billericay) (Con)
First, I congratulate the hon. Member for Liverpool, Walton (Steve Rotheram) on securing the debate. Needless to say, all our thoughts go out to Sophie’s family and friends at this time of loss.
The hon. Gentleman rightly focused on the importance of early diagnosis, which is crucial with not just cervical cancer but cancer in general. I hope, in a relatively brief speech, to remind the House of the importance of the figures that the Government are due to publish soon—one-year cancer survival rates broken down by clinical commissioning group. I and fellow Members of the all-party group on cancer believe that those figures could have a transformative effect in encouraging earlier diagnosis, thereby saving literally thousands of lives.
The recent period has been interesting, because we have had both good news and bad news on cancer. The good news is that, as Cancer Research UK announced only a few days ago, 50% of those diagnosed with cancer now are likely to make it to 10 years following diagnosis, which is twice the survival rate that existed back in the 1970s. That is extremely positive. The bad news is that in this country, shamefully, one in four cancers are still first diagnosed as late as when somebody goes to A and E. It is of further shame that figures suggest that if we were to match European averages for cancer survival rates—just the averages—we could save an additional 5,000 lives a year. If we believe the OECD’s figures, if we were to match international averages—again, just the averages—we could save up to 10,000 lives a year. That shows clearly that we have a long way to go and that early diagnosis is crucial. The all-party group describes it as cancer’s magic key. There are very few magic keys in life, with which we can open the door and find that there is suddenly a plethora of riches in front of us, but a magic key does exist for cancer, and it is early diagnosis.
Katy Clark (North Ayrshire and Arran) (Lab)
Does the hon. Gentleman agree that there is huge regional variation in cancer survival rates? In areas such as the one that I represent, where we have high levels of poverty and deprivation, survival rates are a lot worse than elsewhere, so we have massive challenges before us.
Mr Baron
The hon. Lady makes an excellent point, which leads me neatly on to the report that the all-party group produced back in 2009 on reducing cancer inequalities—I should perhaps declare an interest as the chairman of the group. The report, which was extensive and took in much written and oral evidence, found that this country’s health care system stood as much chance as any other of getting patients from the one-year point to the five-year point after diagnosis. However, where we fell down was on getting them to the one-year point in the first place. That suggests that the NHS is as good as any other health care system at treating cancer once it is detected, but very poor at detecting it. That underperformance in diagnosing cancer means that we trail other health care systems. We never catch up from that original loss.
Comparisons are always dangerous. When we compare our system with that in France, for example, we are comparing it with centres of excellence, so we have to be careful in our comparisons. However, the figures of 5,000 lives a year that could be saved if we matched European averages and 10,000 that could be saved if we met international averages are generally accepted. They can largely be accounted for by the early phase, when we fail to pick up cancer early enough and so do not get enough people to the one-year point after diagnosis.
The all-party group therefore decided to ask how we could focus the NHS on earlier diagnosis. We have been laser-like and dogged in our campaign on that front.
The Parliamentary Under-Secretary of State for Health (Jane Ellison)
indicated assent.
Mr Baron
The Minister is nodding—kindly, I think. I thank her for that in one respect.
The solution that the all-party group came up with was to focus on outcomes. We could bombard the NHS with a lot of targets to try to encourage earlier diagnosis, but instead we decided to focus on one outcome measure—the one-year survival rate, broken down by CCG—as a driver towards earlier diagnosis.
Alison McGovern
Given some of the specific details that we have heard, does the hon. Gentleman agree that the all-party group’s approach of not setting a lot of targets but instead focusing on outcomes might enable groups of GPs to make themselves more aware of symptoms that have been missed in the case that we have discussed and in similar cases?
Mr Baron
That is absolutely right. When it comes to cervical cancer, all the figures suggest that if it is caught early, 95% to 98% of patients can reach the one-year point. That figure falls away significantly if it is not caught early enough. The hon. Lady is right that the idea behind one-year survival rates, broken down by CCG, is to encourage earlier diagnosis. It is intended to encourage CCGs to introduce local initiatives to address the points that the hon. Member for Liverpool, Walton made about late diagnosis. We all know that late diagnosis makes for poor one-year figures, so putting the one-year figures up in lights, broken down by CCG, means that we can see clearly which CCGs are underperforming. The cancer community and politicians can therefore come together and put pressure on those CCGs to raise their game.
As the hon. Member for Wirral South suggests, there could be a range of initiatives, such as better awareness campaigns, whether on cervical or other cancers, better diagnostics in primary care or better GP training—the hon. Member for Liverpool, Walton made the point that the GP in the case in question missed the diagnosis. There could be a range of local measures, and to answer the point that the hon. Member for Wirral South made, it would be up to the CCG to tailor-make those initiatives to address the needs of its individual area. That is what those figures are about and, for the first time, we will have the opportunity to hold underperforming CCGs to account when it comes to late diagnosis. Late diagnosis makes for poor one-year figures, and when those figures are broken down by CCG, we will know which ones are failing to do more to raise their game on early diagnosis.
In conclusion, I have one or two questions for the Minister. First, I managed to secure from the Prime Minister at Prime Minister’s Questions an assurance that the one-year figures will be published in June. I asked that question because those figures were due out in January but then postponed to the spring, I think, and then postponed again. Will the Minister assure the House that we are still on course for their publication in June this year?
Secondly—the Minister knows what is coming— can we throw any more light on how we can hold underperforming CCGs to account? There is no point in having one-year cancer survival figures broken down by CCG if there are no systems in place to ensure that CCGs that underperform are held accountable and encouraged to raise their game. There is no point having the tools in the toolbox if we do nothing with them. Will the Minister enlighten the House about whether there has been any further thought on that issue since we last raised it in this place back in February?
I know that the all-party group’s report, “Cancer Across the Domains”, is on the Minister’s desk at the moment, and I hope she will say a few words about how quickly we will get a response—we look forward to that. In direct relevance to the point made by the hon. Member for Liverpool, Walton about GPs and the challenges of improving earlier diagnosis, will the Minister say whether there are any other initiatives by the Department of Health or NHS England to look at earlier diagnosis, apart from the one-year figures? For example, GPs are recompensed through the quality and outcomes framework system, and I think I am right in suggesting that the QOF system deals with everything when it comes to cancer post-diagnosis, but there is nothing to encourage earlier diagnosis.
Finally, I mention briefly the all-party group’s reception on 8 July, which will highlight the importance of those one-year figures. In summary, for the first time we will have the tools in the toolbox to hold underperforming CCGs accountable when it comes to earlier diagnosis. We must make use of those tools, and the cancer community, politicians, and everyone else must be aware of their importance—I am confident that they will be. If we embrace the concept fully and focus on outcomes and the one-year figures, we have the potential to save, quite literally, thousands of lives a year in this country.
Alison McGovern (Wirral South) (Lab)
It is an honour to contribute to this important debate, and I welcome to the House of Commons today Sophie’s mum, Peri, her sisters Chelsea and Ashleigh, and other members of her family. I have been very proud to be involved in this campaign to highlight what happened to Sophie, who was my constituent. I think I am right in saying that this has been the biggest ever e-petition, which I think represents a real change in the way we do our politics in this country. Long gone are the days when only certain people in this place could call on us to hold debates here and only the Government said what we would talk about. In Sophie’s name, her very many friends and family have brought us here to talk about these issues today. That is a massively important change in our politics, alongside the important issue we are discussing.
I congratulate my hon. Friend the Member for Liverpool, Walton (Steve Rotheram)—even though he keeps saying that I am the hon. Member for Wirral West, which I am not; I’ll have a row with him about that later—on having initiated this extremely important debate. As I have said before, it is very important for men in Britain, as well as women, to care about women’s cancers, and I will say more about that and about awareness. I make a plea, however, for all my male colleagues, as dads, brothers and friends of women as much as anything else, to ensure that they know the symptoms of cervical cancer and other women’s cancers, and to support their sisters, friends and mums if they have any concerns. That is important.
I begin my contribution by borrowing the words of Peri, Sophie’s mum, which she has allowed me to do. She characterised what Sophie was like in a really brilliant way:
“She was an amazing daughter, sister, girlfriend and friend, a live wire with a huge heart, the glue that held our family together. Her attitude to life was to live it to the best and her positivity shone through to everyone so as you couldn’t help but smile”.
I think those are lovely words about Sophie, and it is in her name that we all come here today. I know I represent all my constituents when I offer their condolences to Sophie’s friends and family, and I feel sure that the many thousands of people who signed the e-petition did so because they wanted to show that they cared about what happened to her. Members might be interested to know that friends and family have also organised fundraising events—they did so before Sophie died—and are taking care of all her family. That is a truly great thing.
Sophie had high aspirations for her life, and she had hopes and plans. She was clearly a vibrant, clever, beautiful young woman with her whole life ahead of her. She attended her GP surgery as she had been suffering for months with symptoms such as stomach pains and various things, and it seems that her request for a smear test was refused on the basis of her age. My hon. Friend the Member for Liverpool, Walton has gone through those issues in some detail. It seems that Sophie was diagnosed with Crohn’s disease, but her health continued to deteriorate until she was eventually diagnosed with cervical cancer and very tragically died in March, just 19 years old.
The disease is rare in younger women, but in this case a smear test would have been important. Sadly, this is not the first case to come to light in which a young woman has died of cervical cancer following such events. Mercedes Curnow died aged 23 in 2011, and reports suggest that she too had requested a smear test. Another young woman, Becky Ryder, was 26. Thankfully, such cases are few and far between, and we are grateful for that; none the less we will all understand the tragic scenario that friends and family face when a young woman faces such a serious disease. Even though the numbers are relatively small, it is important that we take the issue seriously.
Approximately 3,000 cases of cervical cancer are diagnosed in the United Kingdom every year. While there are groups of people such as women under 25 among whom cervical cancer is rare, it does occur. I understand that there are approximately 2.5 cases of cervical cancer for every 100,000 women under 25 years old. It is thankfully rare, but very serious for those people who face it. How can we help GPs to pick up the symptoms of something so rare? A balance has to be struck, but it is important to raise GPs’ awareness of such conditions—rare though they are, they do happen.
There are potential risks in screening women under 25, which have been mentioned. The consequences of unnecessary screening can cause problems in later life, which is why the medical community has had such a discussion about the point at which screening should be done. As politicians, our first regard must be for the medical evidence, and we would never ride roughshod over that, but one thing that we have perhaps not always got right is making information available to people and accepting that people should be trusted with that information. The NHS is very good at giving advice and telling people what they should be doing, but much less good at giving information to help people to make their own informed decisions. The e-petition is about choice and how we ensure that people have the information they need to make the choice for themselves. I understand that Dr Moss of the Advisory Committee on Cervical screening has argued that volunteering to have the test should be an option. If someone does make that request and is turned away, it could cause a very negative response when they are invited for the test later. I know that Sophie was one of the youngest victims of this devastating disease, and such requests would be rare, but people should have the choice.
The debate is an opportunity to talk about the importance of smear tests. We have all had the invitation and thought, “Oh goodness, I’m not really sure I want to go for that.” But it is vitally important that people have the test if invited, and I hope this debate will make people think about the importance of having a smear test. Cervical cancer is a real problem, and the hon. Member for Basildon and Billericay (Mr Baron) rightly talked about early diagnosis and said that that was a problem across various types of cancer. The biggest challenge we face in fighting cancer is getting people to come forward early, and my view is that that is more of a problem in areas of social deprivation. I know from Merseyside, my home patch, that in such areas people are likely to have busy lives, perhaps less awareness, and a bit less confidence and are perhaps working shifts. They may be concerned about symptoms but put their concerns aside, for whatever reason, and the possibility of diagnosis gets later and later.
We need to recognise the differential prevalence of late diagnosis in different areas, and we should ask what we can do to recognise and address the various social and economic factors that can cause late diagnosis.
Lyn Brown (West Ham) (Lab)
I am listening to my hon. Friend’s speech with interest and she anticipates many of the points that I want to make. Does she agree that women often put themselves last, behind their family, and there are always other pressing issues to be dealt with rather than a routine cervical smear? Somehow we have to get it across that the smear test is as important as anything else they have to do.
Alison McGovern
In my slightly cack-handed way, that is what I was trying to say. Women are incredibly good at putting off things that concern our own health, which is why it is important that our brothers, fathers, husbands and friends encourage us to be concerned about our health and to look after ourselves. It is also important that we make the point today about the importance of smear tests. People should have a choice and be able to talk to their GP about having a test if they need one, and if invited to be screened, they should take up the invitation.
Mr Baron
The hon. Lady correctly makes the point that we can do more about the disparity in late diagnosis. By focusing on the one-year cancer survival figures by CCG, we can also come together—whether as cancer charities, the cancer community or as politicians—to focus on the under-performing CCGs and ask why that is happening, in the hope that they will themselves introduce initiatives at the local level to drive forward earlier diagnosis. I hope she recognises that that will be an important element of our battle against late diagnosis.
Alison McGovern
I agree with the hon. Gentleman. As I said, Merseyside has a particular issue with cancer, and I feel sure that some of that is to do with late diagnosis that arises from aspects of people’s daily lives. We need to think how we can engage with people in a way that does not depend on their having already some amazing knowledge about the possible symptoms. Many people in my family have had cancer, so we would know, but many people do not know. It can be incredibly stressful to take the first step of going to the GP and saying, “I am really worried. What tests can I have?” We need to encourage CCGs to look at the local conditions and figure out how to get through to the public in their area. The all-party group on cancer has led on that, and I fully support that work.
Another important aspect is broader cultural change. We need a culture change in the NHS in two respects, and Sophie’s case has caused me to reflect on how the NHS works. First, it is important that we talk about women’s health. Women are very good at putting themselves last and putting off the visit to the GP or the smear test that they need. We have seen the great success of breast cancer and other awareness campaigns, and we need to do the same with some of the less well-known cancers, whose symptoms are less well-known. We need a real focus on women’s cancers to try to improve everybody’s knowledge of them. I realise that it is not always easy to talk about periods and so on. Women are very good at hiding such issues and just coping with them, but we need to talk about symptoms. It is also crucial that GPs are aware of possible symptoms. I have learnt from Sophie’s family and friends, and others in Wirral, that the big barrier is ensuring that GPs understand better what they should be looking for and what advice they should be giving to people who come to them with worries or concerns. I know that some excellent GPs are wrestling with that question. People should not be made overly concerned, but if we had more of a culture of giving people information and helping them to make their own decisions, it would help them to feel more empowered.
The second culture change that I would like to see in the NHS is the NHS listening to young women, who are often dismissed in our society. Colleagues have done great work on women’s representation in the media, and I think we have a cultural issue with the place and value of young women that sometimes presents itself in our health service. Too often in the NHS—this is, I am afraid, something I know from my own experience—young women are given advice and told, or at worst instructed, what to do about their health, which is totally disempowering. There are lots of forces in society that are set up to undermine young women, so please let us not have the NHS be one of them. Let us rethink how we identify symptoms early and get people the tests they need. Rather than trying to instruct people, we need to listen to them, respect them, provide them with information and help them to find their own way to the right treatment. In serious cases such as Sophie’s, there are clear worries. More broadly, there is no future for a health service that thinks it can tell people; it has to empower people to make their own decisions.
In conclusion, Sophie’s family and friends started the petition and all signed it, which has brought us to this debate. They have shown tremendous courage at what must be a difficult time. They want to see the change outlined by my hon. Friend the Member for Liverpool, Walton. The public across the country have signed the e-petition—this has been a national campaign—and have brought the issue to the top of the agenda. That shows how important it is and how much cancer affects family life. We are asking for women to be given more choice over their own health, no matter what their age, and for them to feel more empowered. This was a tragic event. We feel the loss of Sophie in our community. It sparked an outpouring of grief and we must do better to make sure it is less likely to happen again.
This is Sophie’s debate and we remember and honour her. In her name, I ask that we resolve to make whatever changes are necessary to make this less likely to happen to anyone else. Cancer is a terrible disease, but we are now more able to diagnose, control and contain it than we have ever been. We can win this fight against cancer, so let us all recommit ourselves to do more, to help others and to make sure that we take care of everybody in our society.
Madam Deputy Speaker (Dawn Primarolo)
Order. I think it will be helpful if I make sure that all Members who wish speak understand the time constraints. There is another debate this afternoon and some Members in the Chamber wish to speak in that debate too. This debate will end for Back Benchers at 2 o’clock. We will then move on to the Front Bench winding-up speeches so that this debate will end by 2.30 pm. I am therefore asking each Member to speak for about seven minutes, including interventions. There are a lot more speakers in the second debate and I need to be fair to them on time allocation too. I am not going to set the clock, but I hope that even when taking interventions each Member will consider the time and their colleagues who are waiting to speak. I hope that is clear in terms of the problems I have, as the Chair, to get us through the debates today.
Paul Burstow (Sutton and Cheam) (LD)
I will stick to your injunction, Madam Deputy Speaker.
I welcome this debate and recognise the tragic circumstances that have made it necessary. I watched Sophie’s mum on “Good Morning Britain” this morning. I saw the courage the hon. Member for Wirral South (Alison McGovern) described and the dignity with which she advanced the case for what needs to happen. The story Sophie’s mum tells of her fantastic daughter strikes a chord with Members across the House. Indeed, I am speaking in this debate because of my constituents, John and Barbara Welch. They came to my surgery because they were moved by this case and by the experience of their niece in a previous situation.
I agree entirely with the hon. Member for Liverpool, Walton (Steve Rotheram) that we have to base decisions on cervical screening, and on all screening programmes, on the evidence. It is the evidence that will provide at least some pause for thought, not for Members but for the committee that advises Ministers on screening. I want to touch on that issue; hon. Friends may elaborate on it.
The original decision to change the age restrictions on the general call-up for cervical screening was taken in 2003. The 20-to-24 age group was excluded at that point. That decision was reaffirmed in 2009 by the Advisory Committee on Cervical Screening when it reviewed the matter. The argument at the time was that it would have led to unacceptable numbers of premature births compared to lives saved, and that it would cause women anxiety. Those are very important considerations and one can understand why the committee made its original decision on the basis of evidence from research. My point to the Minister is this: since 2009 the evidence has changed, or appears to have changed, so I hope that the advisory committee will look at it again.
In 2012, a study published in the British Medical Journal, which I understand was the largest of its kind conducted in the UK, appears—I stress the word appears—to contradict the earlier findings of smaller studies. It concluded that treatment for cervical disease does not appear to increase the risk of premature birth. The hon. Member for Liverpool, Walton touched on this point. Furthermore, the same research found that, since the change in the age at which people begin to be called for screening, the number of women diagnosed with advanced-stage cervical cancer at the age of 25 has tripled. The early-stage numbers have quadrupled. I stress that we are still talking about a rare set of circumstances and small numbers, but small numbers do not, in the end, absolve us from looking at the individuals who then find themselves with this terrible disease.
Will the Minister ask the Advisory Committee on Cervical Screening to review the 2012 evidence? The evidence was produced from a study by one of the leading professionals in the area, who was also responsible for the earlier studies that led to the opposite decision. Will the Minister look at why the 2010 guidance referred to by the hon. Member for Liverpool, Walton, which should have ensured that GPs made the right decisions on symptoms to allow smear tests to take place, does not appear to have had its full intended effect? The number of women diagnosed under the age of 25 apparently continues to fall, while the number of women over 25 continues to rise. There is, therefore, something going on. I hope we can ask the experts to advise us and look at what the research is telling us, so that we can make adjustments and ensure that the trend is reversed.
The hon. Gentleman talked about the goal which must be shared across the House and in the wider community of cancer rightly no longer being seen as a death sentence. If we get early detection right and raise awareness of the early signs and symptoms of any cancer, but particularly cervical cancer, we can make a difference to the lives of thousands of our fellow citizens. As a former Minister with responsibility for cancer, I know it is important to be guided by the evidence. I took the decision to commission a further review on breast cancer to ensure that we were satisfied that screening was not doing inadvertent harm. I hope that we can ensure that we are acting on the basis of the best evidence.
The Government’s work, which began at the beginning of this Administration, in introducing the Be Clear on Cancer campaign, is critical. Awareness is critical not just to raising public awareness, but to raising GP awareness. I hope the Minister will say more on the plans in relation to cervical cancer. I look forward to hearing what she has to say.
I would like to end by offering my condolences and sympathies to Sophie’s family. I hope that some good can come out of something so tragic.
Lyn Brown (West Ham) (Lab)
Let me begin by offering my condolences to Sophie’s family, and thanking the Backbench Business Committee for scheduling the debate.
As we have heard, cervical cancer, although rare in women under 25, can be far more aggressive than cancers developed by older women. As we saw in the tragic case of Sophie’s death, her cancer had a devastating effect although she was only 19. The smear test that Sophie requested would have shown abnormal tissue growth in her cervix, and, although it might have been too late to save her life, the fact that she was refused that test is tragic. We must all learn the lessons of her death, and seek new and better ways of dealing with such cases.
Newham has a lower incidence of cancer than many other areas, but, sadly, our mortality rate is higher, owing mainly to late presentation. In 2012 the London-wide mortality rate was about 112 deaths per 100,000 cases, while in Newham it was 123 deaths per 100,000 cases. There have been instances in which stage 4 cancer has presented itself for the first time in A and E departments, and we know that there is no stage 5.
As we heard from my hon. Friend the Member for Wirral South (Alison McGovern), there is a relationship between deprivation and death from cancer. Social and economic deprivation have a severe impact on health, as has been shown by countless reports and studies. The figures for London and England clearly demonstrate that deprivation contributes to the incidence and types of cervical cancer, and to the survival rates of sufferers. The mortality rate among those in the 30 most deprived areas is nearly double that among those in the 30 most affluent.
Although the deprivation in Newham means that poor health is more prevalent there than it is in other areas, excellent work has been done in the borough, especially in our schools. Newham is also building on its current 90% coverage of the human papillomavirus vaccination programme. It is one of only two areas to have achieved that target, thus helping to prevent cancer despite the barriers to screening uptake. However, as we know, HPV immunisation does not entirely eliminate the risk of cervical cancer. That should be explained clearly to young women who take part in the programme, which is what is being done in Newham.
Regular smear testing is the only way in which individuals can be sure that their health needs are being met. In the case of cervical cancer, the take-up of screening services in Newham was just 22% in 2012-13. That is nearly 2% less than the figure for the previous year, and below the average figures for London and England, which, sadly, are only marginally better. Poor survival rates in deprived areas are arguably due to low take-up of screening, which results in the cancer presenting itself at a later and more advanced stage.
I am pleased that the Government have said that they aim to match European survival rates and, in doing so, save approximately 5,000 more lives, but it worries me that no indication has yet been given of how that will be measured, or, indeed, whether the targets are being met. Cancer networks, which were established in 2000, are currently being replaced by strategic clinical networks, which will deal not only with cancer but with maternity, mental health and dementia. Many professionals have suggested to me that, given that the new networks will cover a wider clinical range and a larger geographic area and will retain fewer dedicated cancer network staff, the overall decrease in funding may well lead to an inconsistent and unreliable service. I think that the Government should heed those fears and examine the allocation of resources to ensure that the areas with the greatest need receive appropriate funding, thus reducing the disparities in life expectancy and survival between the least deprived and the best off.
There is ample evidence of the need for awareness of conditions such as cervical cancer to be kept at a high level, and that requires continual effort. Following the death of Jade Goody in March 2009, 70% more women than the normal average were given smear tests, and I must admit to being one of them. I am sure that I am not the only woman in the Chamber today who has found other things to do rather than nipping down to the doctor for that very quick, clear test. Most of those who were tested were aged between 25 and 39, which is the age group with the lowest rates of attendance for screening. That is understandable, given that smear tests can be very uncomfortable and even painful in some instances, but we still need to have them.
Owing to the nature of the populations of Newham and, I assume, similar areas, national awareness campaigns struggle to have a fully effective impact in our communities. We need to understand why that is, and take action to deal with it. I am grateful to Newham’s fantastic Community Links charity, whose awareness campaigns have been very proactive. It has been instrumental in driving up screening rates, and its work in schools has ensured that its message reaches not only children throughout the borough, but their families at home. Children are a great way of getting to parents, and nagging them to pieces.
I know that the aim of this debate is to ensure that other girls, unlike Sophie Jones, can have their concerns heard. Much more needs to be done to educate young women about the detectable symptoms of cervical cancer, and it is imperative for the NHS to remove as many of the barriers to screening as possible. I urge the Minister to look at the excellent work of Community Links, and to consider whether the action that it has taken on behalf of my community can be learnt from and prove relevant in other parts of the country.
Martin Horwood (Cheltenham) (LD)
It is an honour and a pleasure to follow the hon. Member for West Ham (Lyn Brown), as well as other Members, particularly my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) and, indeed, the hon. Member for Wirral South (Alison McGovern), whose speech was a moving tribute to Sophie Jones—her constituent—and her family. I also congratulate the hon. Member for Liverpool, Walton (Steve Rotheram) on securing this timely debate.
I welcome the Government’s work on cancer in general. Their Be Clear on Cancer campaigns, which began in 2011, have been producing good work, which is now being done in conjunction with Public Health England. I should probably declare a non-pecuniary interest here: my wife is the director of one of Public Health England’s regional centres.
I feel some sympathy with the Minister. I am sure that her instinct was to trust her brief from the Department, and its representation of the risks and statistics attached to cervical cancer and screening. I suspect that, being a member of the coalition, I have a similar brief before me now. I have to say, however, that deeper examination of those risks and statistics casts grave doubt on the Department’s current interpretation of them.
I have benefited from some forensic research carried out by my constituent and friend Mel Gladwin. Mel works for an organisation in Cheltenham that is well known for its forensic examination of data, but she contacted me in connection with today’s debate because in 2003, at the age of 22, she was diagnosed with a very aggressive form of cervical cancer. I am delighted to say that she is now perfectly healthy, and has a bouncy seven-year-old son. Her life was saved by effective treatment. The treatment was effective because Mel’s condition was diagnosed early, and it was diagnosed early because she was part of a routine screening programme for those aged under 25. Mel, her family and I are all pretty well convinced that she would not be with us today if that routine screening programme had not existed.
Mel tells me that in 2009, the Advisory Committee on Cervical Screening cited two specific reasons for not restoring screening for those aged under 25. One was that it caused significant anxiety. That view appears to have been based not on any recent evidence, but on evidence dating back to the 1970s and 1980s, when survival rates generally were much lower, a much greater stigma was attached to cancer, and, I suspect, anxiety levels were higher. I believe that cancer now constitutes a largely curable disease in the public imagination, and that anxiety levels may not be quite the same. In any event, I think that when anxiety is balanced against the risk of death, most people would rather be sure that they were safe, even if the cost of that was some anxiety.
The principal reason given by the ACCS for its decision was the potential risk of premature birth if the women concerned had children later in life. That evidence was presented to the committee by Professor Peter Sasieni of Queen Mary, University of London—the self-same Peter Sasieni who conducted the much more robust 2012 study referred to by hon. Members today. It was a study of 44,000 women, including 2,000 to 3,000 under the age of 25, and was much larger than the earlier studies and based in England, whereas the others were done in Scandinavian countries where the incidence was different and the treatment appears to have been somewhat different. Therefore, this research is much more robust and relevant.
Although my right hon. Friend the Member for Sutton and Cheam presented the results in quite a qualified way, actually, the British Medical Journal was pretty robust in its conclusions when it published them:
“After adjusting the results to account for the type of treatment and whether it had occurred before or after the birth, the researchers found that there was no increased risk associated with treatment. The researchers concluded that the increased risk of preterm birth in women who have been treated for cervical disease was due to common factors that increased the risk of both cervical disease and preterm delivery, and not to the treatment itself.”
The BMJ could not really have been clearer, yet that evidence has never been formally reviewed by the ACCS.
That suggests that there is no strong reason not to screen women under 25, but perhaps we should balance that against whether there is a strong reason actually to screen women under 25, because the Department must also take that into consideration. Mel comes from a talented family. Her father, as luck would have it, is a mathematician and computer scientist at the university of Kent’s school of computing. He has looked at research produced by Cancer Research UK on the incidence of diagnosis of cervical cancer in various age cohorts. The statistics are very strange. The incidence of diagnosis at 25 has tripled in just the last few years—a huge spike in the statistics—and is many times the incidence at 24 and lower ages, which appears, strangely, to have reduced. It is also higher than the incidence at 26, so something very odd is happening. What was previously a gradual increase in incidence of diagnosis by age cohort now contains a massive spike.
Peter Welch, Mel’s father, is not medically qualified but he is a statistician and knows his statistics. His conclusion was pretty clear:
“The figure shows a dwindling of diagnosed cervical cancers in the 20-24 year group since they stopped being screened and a massive spike in those aged 25 (discovered on their first screen). That dwindling is very unlikely to be because the prevalence of cervical cancer has dwindled. The huge spike—approximately 10 times the counts for the individual year groups 20 through 24 and 3 times the counts for the year groups 26 through 29—is most likely because of cancers that would have been prevented by screening now developing and cancers that would have been found earlier now being found late.”
In other words, withdrawing routine screening has suppressed the numbers at 25 and younger, and massively increased them at age 25. That is a very serious conclusion. If it is true and the conclusions of the second batch of Sasieni research are true, the inescapable conclusion is that we have denied screening to young women whose lives would have been saved, and increased the risk at the age of 25 and above of people having had undiagnosed cancer before then.
I am very glad that Mel is happy and healthy, but she clearly attributes her survival to the routine screening programme. This issue is now in urgent need of review. We are not talking about vast numbers of young women —there were about 45 in 2010, according to the most recent available statistics—but their lives might be being put at risk each year, and the Government must reflect urgently on the issue and reconvene the ACCS to look again at the most recent and robust research.
Katy Clark (North Ayrshire and Arran) (Lab)
It is a pleasure to follow the knowledgeable contribution from the hon. Member for Cheltenham (Martin Horwood). I want to thank my hon. Friends the Members for Liverpool, Walton (Steve Rotheram) and for Wirral South (Alison McGovern) for bringing this matter to the House today on behalf of the family of Sophie Jones, who did so much work to collect the many signatures that ensured that we had this debate. I pay tribute to them for reacting in that way, because it is incredibly important that people such as them do this work to raise awareness of the condition, and to ensure that we have the health services required for this form of cancer.
I am speaking in today’s debate because of my constituent, Suzanne Fernando, who lives in Ardrossan. She was diagnosed with cervical cancer when she was pregnant, and describes herself as a survivor of cancer. She has campaigned tirelessly on the issue throughout my time as a Member of Parliament, and I have campaigned with her on many different aspects of the disease: ensuring that people use cervical cancer screening services and get smears; attending local schools with her and encouraging girls to get the HPV vaccination; and supporting her in her fundraising work. She was Scotland’s first campaigns ambassador for Cancer Research UK. She set up a cervical cancer support group in Ayrshire, which provides people with advice on the disease at any stage. We should pay tribute to all the women throughout the country who have experience of cervical cancer and who do everything they can to ensure that others do not go through what they have been through, that the condition is identified early and prevented and that people get the treatment to which they are entitled.
I listened carefully to the comments of my hon. Friend the Member for Wirral South about young women. Often, young women have the greatest contact with the health service when they have children. Many of us have been aware for generations how disempowering many women find that experience. It is incredibly important that the motion before us states clearly that when a woman asks to have a smear test, she should be entitled to have it. The case of Sophie Jones shows powerfully why that is important.
There are far wider issues, such as having a patient-centred service and actually listening to what people are saying—whether they are young or old, a woman or a man, and whatever ethnic or other background they come from—and ensuring that they are given access to the treatment they deserve.
Suzanne Fernando is taking part in cervical cancer awareness week, participating in a 5 km walk for fun at Eglinton Park in Kilwinning, Ayrshire, on 15 June. Of course, she is just one of the many women who are trying to raise awareness of this condition. I hope the message goes out clearly from this House today that we want the Government to do what is necessary to ensure that young women in particular are given access to the NHS facilities that they deserve, that we listen to what young women say, that we listen to what Sophie Jones’s family is saying and that we learn the lessons to ensure that such a tragedy does not happen again.
Jim Shannon (Strangford) (DUP)
It is a pleasure to follow the hon. Member for North Ayrshire and Arran (Katy Clark) and I thank her for her contribution. Today’s debate is an emotive one as it directly concerns the loss of a 19-year-old lady. May I pass my sincere condolences to the family of Sophie Jones, some of whom, as the hon. Member for Wirral South (Alison McGovern) has said, are in the Gallery today? As a father of children around that age, my heart breaks a little to think of what the family are going through, and I congratulate those family and friends who worked so hard to see this issue brought before the House. We are debating this issue because of their enterprise and commitment, and the response from hon. Members. May I especially commend the hon. Members for Liverpool, Walton (Steve Rotheram) and for Wirral South for their massive contributions here today, and the other Members who clearly, excellently and passionately made detailed contributions?
I am a major supporter of the HPV vaccine being brought into schools so that we can take a hold of this cancer. I was delighted when the vaccine became standard in schools. The statistics for cancer are beyond frightening, and if anything can be done to prevent cancer or ensure its early diagnosis, we need to implement it as a matter of urgency. It is estimated that by 2020 one in two people will either suffer or have family who suffer from a form of cancer. That statistic makes me go cold, but it is a reality that warrants action, and today we have an opportunity to discuss and highlight cervical cancer and how it affects people.
In 2010, 2,851 women in the UK were diagnosed with cervical cancer, which is the 12th most common cancer in women and the most common cancer in women under 35 in the UK. Again, that shows the magnitude of the issue. In 2011, there were 972 deaths from cervical cancer in the UK. Between 2005 and 2009, 66.6% of adult cervical cancer patients in England survived their cancer for five years or more. A number of hon. Members have made the point about early diagnosis, and I know that the Minister will indicate the steps that the NHS has taken to address early diagnosis. The statistics I have given warrant this debate, and we must examine the case of Sophie Jones to see whether the age limit should be changed. What is clear to me is that if a young lady requests a smear test, there should be a mechanism through which she receives it as a matter of urgency. Clearly that did not happen in Sophie’s case when it should have done, which is why we are discussing this matter today. That is a terrible lesson that must be learned from this case, and I ask the Minister to confirm that tests will always be given in those circumstances from now on. That is the issue we are asking the question and seeking the answer on; everyone who has spoken on this matter has asked that question.
Among women in their 30s, cervical screening can prevent about 45% of cervical cancer cases. That figure rises with age to 75% among women in their 50s and 60s who attend screening regularly. Clearly, screening works, and there is a case to be answered. I ask that the Minister, in providing an in-depth response to the debate, also indicates what discussions have taken place with the devolved health bodies to ascertain their opinion and to ensure that the strategy we are discussing can be allocated to and introduced in all regions of the UK. She often hears me ask about the following issue in our debates, but I am always conscious that we have good practice in many parts of the United Kingdom and that when we exchange our viewpoints and agree strategies all can gain across the United Kingdom of Great Britain and Northern Ireland. I know that our Health Minister in Northern Ireland is well aware of this issue and has a well-informed opinion on the matter, and I am anxious to ensure that there is a UK-wide informed strategy in place.
This is one of those occasions when the House excels, coming together, across party lines, to grasp an issue that we can all support and try to push forward. It is good to have that unanimous support today from across the Chamber, with all parties giving their contribution. Cancer is a dreadful disease and if something is in our grasp that will prevent any of our constituents from going through it, we need to act. I am no medical expert—far from it—and I cannot give an answer, but I can demand, as the Member of Parliament for Strangford and on behalf of my constituents, that the medical experts give reasons why they have reached the decisions they have. I would like to understand the implications of dropping the age limit back down to 19, as is the case in Scotland and as was the case in Northern Ireland until 2004, when it was changed.
As I have said, there is a case to answer. The terrible loss of Sophie Jones has prompted this debate. To honour her memory, I support the calls for a review of the age limit for cervical screening UK-wide.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
I thank my hon. Friend the Member for Liverpool, Walton (Steve Rotheram) and the other hon. Members who supported the application for this debate to ensure that the House can discuss such an important issue. I also thank hon. Members for their thoughtful contributions throughout the debate, which are a testament to how much the case of Sophie Jones has moved Members on both sides of the House. Not only across this House, but across the country people have reacted with shock and sadness at the death of a young woman that might have been prevented. We need only consider the number of people who signed the petition calling for the Government to look again at cervical cancer screening to appreciate the depth of feeling surrounding this issue. As we heard, 321,956 people signed it, which is more than three times the number required for it to be considered for a debate in this House. As my hon. Friend the Member for Liverpool, Walton said, that is the largest number for any of these petitions.
I would like to take this opportunity to pay tribute to Sophie Jones’s family and friends for their courage, spirit and strength in driving forward this campaign and for their determination to ensure that what happened to Sophie does not happen to another young woman. I am speaking in this debate not just as shadow public health Minister, but as a constituency MP representing Liverpool, Wavertree. My constituency is close to that of my hon. Friend the Member for Wirral South (Alison McGovern), where Sophie Jones lived, and this tragic case has affected people right across Merseyside. I have heard from a number of constituents who have read about Sophie’s story and were very keen for me to participate in this debate.
I was very privileged to meet Sophie’s family with my hon. Friend the Member for Wirral South and hear from them about what a remarkable young woman Sophie was. She was active, well-liked and so positive, and I was so moved hearing about her bravery and positive outlook, even as her cancer took hold—it really is a true inspiration to us all. I am glad that the House has had the opportunity to hear about Sophie’s case, to examine policy on cervical cancer screening and to debate ways in which we can do so much more to ensure that such a tragedy does not happen again.
Cervical cancer is the most common cancer in women under 35 in the UK and although deaths from cervical cancer have plummeted over the past 30 years, about 970 women died from it in 2011 in the UK—that is more than two women every day. Cervical cancer is not normally associated with younger women—as we have heard from a number of hon. Members, it is extremely rare in under-25s. There were 47 cases in women aged under 25 in England in 2011, which was less than 2% of all cases. The House has heard today many good reasons why routine cancer screening is offered when women turn 25. I will not go through them in detail but I will touch on them briefly.
We have heard today, including from my hon. Friend the Member for Liverpool, Walton, about evidence showing that screening all women under the age of 25 can lead to some harmful investigations and treatments. I listened to what the hon. Member for Cheltenham (Martin Horwood) said and I will be interested to hear the Minister’s response and whether she believes that that evidence needs to be reviewed. I am grateful for the opportunity I have had to speak to experts in this field, including at the Liverpool women’s hospital, in preparation for today’s debate. I have heard that there are problems involved in screening under-25s and that young women often undergo natural and harmless changes in the cervix that a smear test would identify as abnormalities. Screening young women would involve putting these women through further tests and investigations they would not otherwise have gone through when, in most cases, the abnormalities would have sorted themselves out without any need for treatment. I understand that the decision for routine cervical screening to begin at 25 was taken after a thorough review of the evidence by expert clinicians and scientists. That decision was reviewed in 2009 by the Advisory Committee on Cervical Screening, which at the time voted unanimously to keep the age at which screening starts at 25, reaffirming the earlier conclusion that the harms of screening women under 25 outweighed the benefits.
The point in the cases of Sophie Jones and of all the other people we have heard about today is that there is heartbreaking proof that, though rare, cervical cancer in the under-25s can happen. We must get better at spotting the signs of the disease and diagnosing it earlier.
I wish to cover three main areas for improvement to which I hope the Minister will respond. First, we must increase awareness of the symptoms not just among women so that they can spot the signs and go to their doctor at an early stage, but among doctors and nurses so that they understand that young women can develop cervical cancer. Secondly, we must ensure that once cancer is diagnosed, women are swiftly referred for treatment. Finally, we must do more to prevent cervical cancer from happening in the first place. We can do that by ensuring high levels of coverage among girls of the human papillomavirus vaccination programme and that eligible women attend their cervical screening appointment.
The cervical screening programme is highly effective at detecting early stages of cancer or pre-cancer, but it is not the best tool for diagnosing cervical cancer once symptoms are apparent, as they were in the case of Sophie. We know that detecting cancer early can make a real difference. The earlier that cervical cancer is diagnosed, the better the outcomes are likely to be. As we heard from the chair of the all-party group on cancer, the hon. Member for Basildon and Billericay (Mr Baron), it is so important that women are made aware of the signs and symptoms of the disease.
I echo the point made by my hon. Friend the Member for Wirral South; it was refreshing to hear a man—my hon. Friend the Member for Liverpool, Walton—listing the different symptoms experienced by women. I will not read them out again, but encouraging women to visit their GP if they have any concern or are showing any of the symptoms is such a simple message that could make a really big difference. Men, as fathers, partners and siblings, can also play a part, by being aware of the symptoms.
The tragedy in Sophie’s case was that she did visit the doctor on a number of occasions, but tragically was not diagnosed accurately. The Government must do more to ensure that GPs are getting the support and the training they need to help them identify cancer signs and symptoms, and that needs to be done during initial training and ongoing professional development. Clinical commissioning groups have a role to play, too. Crucially, we must make doctors aware that, although rare, young women can suffer from cervical cancer.
As much as these improvements at the first point of contact are needed, they are not enough if, once cancer is suspected, people are not seen quickly enough by specialists. We have heard from Members about how important early diagnosis and treatment are. NHS England’s figures on cancer targets for the last three months of 2013 reveal that 4,500 people waited more than two months for treatment after an urgent GP referral, which was in breach of the Government’s own target. That is not good enough, and the Government must urgently get to grips with the failing.
If we are to win the battle against cervical cancer, we must do everything possible to prevent it from occurring in the first place. I am proud of the fact that it was the previous Government who, in 2008, introduced the HPV vaccine, which immunises teenage girls against the majority of the high-risk strains of HPV that are associated with cervical cancer. My hon. Friend the Member for Liverpool, Walton highlighted the very high risks connected with the HPV virus and cervical cancer. All 12 and 13-year-old girls are now being offered the vaccine through their secondary schools. From September 2012 to September 2013, 86.1% of 12 to 13-year-old girls in England went on to receive all three doses of the vaccine. There is room for improvement here, and the Government must do more to encourage girls aged 12 and 13 to participate in the HPV vaccination programme.
As my hon. Friend the Member for West Ham (Lyn Brown) outlined in her contribution, the HPV vaccination alone will not prevent every case of cervical cancer. Alongside the HPV vaccine, the best preventative measure is for eligible women to attend their routine cervical screening appointment. We know that cervical screening saves around 5,000 lives every year in the UK, but, despite that, around 3.7 million women are currently overdue for a smear test. Shockingly, that has increased to 11% since 2009-10.
One challenge is around access to GPs. A YouGov survey for Jo’s Cervical Cancer Trust found that of the women of screening age who have missed or delayed appointments, almost a third of them said that it was hard to book a screening at a convenient time, and 35% said that if GP surgery opening times had been more flexible it would have encouraged them to attend their appointments. As my hon. Friend the Member for Wirral South said, we should do all that we can to encourage and provide the opportunity for women to take up their invitation for a smear test.
I wish to finish by coming back to Sophie and her family. As Sophie's mother, Peri Cawley, said:
“If we can do something to make sure this doesn’t happen to someone else, then Sophie's death will not have been in vain.”
The petition under discussion had hundreds of thousands of signatures, which shows that people across the country support that goal. As today’s debate has shown, Members of this House are clear about what needs to be done. We must increase awareness of the symptoms among not just women, but men and all GPs to ensure that they understand that younger women can develop cervical cancer and are able to spot the signs. We must also ensure that we do more to prevent cervical cancer from occurring in the first place by encouraging girls to have the HPV vaccine and women to attend their cervical screening appointments. We now look to the Government to take the action that is needed to make progress on those counts and to ensure that there is no repeat of the tragedy that happened to Sophie Jones. I look forward to the Minister’s response.
The Parliamentary Under-Secretary of State for Health (Jane Ellison)
I congratulate the hon. Members for Wirral South (Alison McGovern) and for Liverpool, Walton (Steve Rotheram) on securing and leading this debate. We all wish that we were not debating this issue, important though it is, against such a tragic backdrop. I share the view of the hon. Member for Wirral South that it is a great innovation that, through e-petitions and the Backbench Business Committee—she knows that I used to serve on that Committee—we can now bring issues of such huge public concern swiftly to the House for debate.
This has been an excellent debate, and I thank all Members for their contributions. Depending on how tolerant Mr Deputy Speaker is feeling, I may not get the chance to address all the points that have been raised, but I hope Members know that I will, as I always commit to, respond to them after the debate.
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. The Deputy Speaker is always generous in the time that he gives but, recognising that there are constraints, I welcome those comments.
Jane Ellison
Indeed, and I will be guided by you, Mr Deputy Speaker.
Like others, I start by paying tribute to Sophie Jones and her brave battle against cervical cancer. I also offer my sincere condolences to her family who have conducted themselves with such dignity in recent weeks and months. I assure all Members that I will try to address the important issues that they have raised. There is a lot to say, so if I do not get through it all, I will respond to them afterwards.
Although I am not able to comment in detail on individual clinical cases, we understand that Sophie’s case was one of misdiagnosis rather than of screening, to which the hon. Member for Liverpool, Walton alluded. Thankfully, cases of cervical cancer in her age group are extremely rare. I understand that the medical director for the Cheshire, Warrington and Wirral area team has requested that the GP practice undertake a significant event analysis to review the case, and ensure that all appropriate procedures are followed and that any lessons learned are put into practice. Once that is completed, it will be agreed with the practice how that will be shared. I can assure the House that I fully expect NHS England to keep the family and local MP fully informed as the investigation progresses.
Despite the tragic circumstances in this case, I reassure the House that the NHS cervical screening programme is one of the most well regarded in the world. More than 3 million women are screened every year. Experts estimate that the programme saves up to 4,500 lives in England alone. However, it has to be based on the best available evidence. The best independent evidence shows that routine screening of women under 25, on balance, does more harm than good. The UK national screening committee reviewed the age of cervical screening in 2012—although some Members have said that the last review was earlier or later than that—and confirmed the English policy of not screening those aged under 25 as it has no impact that can be seen on the detection rates of cervical cancer in young women and gives rise to a high number of false positives, which cause anxiety and, more importantly, lead to unnecessary investigations and treatments that can have side effects.
The UK NSC review in 2012 followed a review of the age at which cervical screening starts by the Advisory Committee on Cervical Screening, or ACCS, which is made up of experts in a range of disciplines, third sector representatives from Jo’s Cervical Cancer Trust and patients. The ACCS review took place in May 2009 to consider the raising of the screening age from 20 to 25, and it confirmed that decision. The 2012 review was partly a response to the Jade Goody effect mentioned by some hon. Members today and was intended to reconsider that decision. The ACCS was unanimous in deciding that there was no reason to lower the age from 25, which is in line with World Health Organisation guidelines.
Some of the reasons behind that decision have been mentioned. The research presented showed that there was little or no impact on detection rates in those aged up to 30, no clear evidence of an increase in the incidence of cervical cancer following the change to the screening age in 2004, no new scientific evidence was available to support the reintroduction of screening and one in three young women aged under 25 would have an abnormal result when screened, as opposed to one in 14 from all women who are screened. That shows a lot of false positives in young women.
Jane Ellison
If the hon. Gentleman is going to draw my attention to the statistics he presented, I am happy to look at them in detail and, indeed, I have a partial answer to some of his questions.
Jane Ellison
I will give way very quickly, but I need to get through my speech.
Martin Horwood
I was interested to know when in 2012 the UK NSC met. The second Sasieni research was only published in August 2012 and the Cancer Research UK statistics were published in the BMJ in 2013, so they have not been reviewed as far as I know.
Jane Ellison
As I said, the hon. Gentleman presented quite a detailed statistical submission and I shall respond to him after the debate rather than off the cuff. His statistics deserve better than that.
Cervical cancer is thankfully very rare in women aged under 25. As has been said, there were 47 cases in England in 2011, the last year for which we have figures. That is less than 2% of all cases and there were two deaths. Obviously, we will consider the statistics presented by the hon. Member for Cheltenham (Martin Horwood), but we are aware that in 2009-10—this also relates to the points made by other hon. Members, and most strongly by the hon. Member for West Ham (Lyn Brown), about health inequalities—an extra 600,000 women came forward for screening, many as a result of the publicity surrounding the death of Jade Goody. Many of those women were from lower socio-economic and hard-to-reach groups, and they are more often at risk. That is an important statistic and we need to consider that again.
It may help the House if I briefly run through the science behind the abnormal screening results in younger women. Primarily, they are caused by the fact that they have a high rate of HPV infection, as the cervix in young women is more prone to infection with transient HPV, both because it has not yet matured and because younger women might be exposed more often to different types of HPV. Furthermore, some of the few cancers found in young women are unusual and rare tumours that differ from the type we screen for, such as small cell tumours that can develop rapidly and are very dangerous. However, some are HPV-associated tumours that develop at a young age and sometimes simply as a rapidly developing cancer. The key thing in such cases is rapid referral and an appropriate medical response.
In its 2009 report, the ACCS was concerned that young women presenting to primary care with symptoms of cervical cancer were not always given the best advice. I know that that will be a concern not only to Sophie’s family but to all of us in this House and to the NHS. We know that for many GPs, seeing a patient with cervical cancer is rare, and potentially only one GP in 16 will see a new case each year. That is quite a statistic. To help GPs make the right clinical decisions, new guidance for primary care on the management of young women with gynaecological symptoms was developed and sent to all GPs in England in March 2010. The guidance was developed by a multi-disciplinary group, and supported by all the relevant royal colleges. I undertake to raise the issue again with the Royal College of Obstetricians and Gynaecologists and the Royal College of General Practitioners to explore the best way to remind GPs of the guidance.
I reiterate that whatever her age, if a woman is concerned about abnormal symptoms she should contact her GP, who will be able to examine and refer her urgently to a gynaecologist if clinically appropriate. The House might not be aware that the guidance is explicit that in any case where a woman is showing symptoms, best practice is that she should not be referred for screening. That is because a cervical screening test is aimed at women without symptoms. It is a screening, not a diagnostic test, and waiting two weeks for the result could delay examination by a gynaecologist. That is a really important point to bring out in the debate. If someone has symptoms, we want to get them urgently from symptom to diagnosis via a referral, and a screening test could further delay that.
I want to talk a little, as others have, about the human papilloma virus, or HPV. Many Members have mentioned the fact that we have identified high-risk types of the virus and that the vaccination programme sprang from that identification of risk. The programme was introduced in 2008 for girls aged 12 to 13. Its aim was to prevent cervical cancer related to the HPV types covered by the vaccine, which covers about 70% of all cervical cancers. The programme has been a big success. More than 7.8 million doses have been given so far in the UK since 2008, and we have among the highest rates of HPV vaccine coverage in the world, with 86% of girls eligible for routine vaccination in England in the 2012-13 academic year completing the three-dose course, and 90% receiving at least two doses.
It may be of interest to Members to hear that the Merseyside area team reports a higher than national average take-up of the HPV vaccine, with 87.8% of girls vaccinated with all three doses in 2012-13. In Wirral and Sefton, that figure was 90%. However, we cannot be complacent and we want to get the fullest possible coverage. That is something about which MPs, as well as Ministers, can do a lot to spread the word. When we go into schools, a good question to ask might concern the coverage and whether there are particular groups of parents or people from particular backgrounds who do not take up the vaccine.
It is expected that the programme will eventually save more than 400 lives a year from cervical cancer. The first indication that the programme is successfully preventing infection with HPV types 16 and 18 in sexually active young women in England was published in the scientific journal Vaccine, and showed that the proportion of infected rates in 16 to 18-year-olds fell from 17.6% in 2008 to 6.6% between 2010 and 2012. That is major progress, so the take-up of the vaccine is really important.
We encourage all girls, irrespective of religion or ethnic background, to receive the HPV vaccination. NHS England is responsible for making arrangements to implement the programme for eligible girls and young women in the local area, taking into account local circumstances, such as the number of independent or special schools and the number of girls who are not in school. Interestingly, I was informed that Surrey has a much lower take-up, so perhaps we need to consider how to deal with girls in independent schools, or other local circumstances. NHS England is also responsible for ensuring that local programmes meet the national specifications.
We are using our growing knowledge of HPV to modernise the NHS’s cervical screening programme by considering HPV infection alongside the screening programme and looking for abnormalities and seeing how they can interact. Public Health England is also promoting the use of the HPV test as a primary screen, which is very interesting. A lot of work is going on, and the first evaluation report of the pilot is due in spring 2015. Cancer Research UK has estimated that, when fully implemented, HPV primary screening could prevent hundreds of cancers a year.
There are some particular matters to which I would like to draw the attention of the House, as I have a little time. The Prime Minister’s £50 million GP access fund will support more than 1,400 practices covering every region to offer extra services for those who struggle to find appointments that fit in with family and work. That is important and responds to one of the points made by the shadow Minister.
I hope we can show that despite tragic cases such as Sophie’s, the age at which screening starts in England is based on sound evidence. It has been carefully considered by members of expert committees pretty recently. However, I am very aware that we need to keep all evidence under review. I have already had a brief conversation with the chief medical officer about this. Members may be aware that one of my fellow Ministers is a specialist in this area of medicine, so we will make sure that we look again at the points that have been made in the debate.
There is much we can do as a House and as a country to reduce the number of women who suffer from this devastating disease. I urge every woman invited to screening to take up the opportunity, as we know that 25% of women in the 25-to-30 age group do not. On screening, I do not have time to describe the work in detail, but I can assure Members that Public Health England has work under way specifically to look at low coverage in certain areas and to work on local action plans to improve that coverage.
I want to do more to urge employers to support their staff. Again, evidence from Jo’s Cervical Cancer Trust, representatives of which I met on Monday evening and discussed some of these issues with, suggests that many younger women do not want to ask an employer for time off for a smear test. I will look at what we can do through work that is already going on with employers to see how we can encourage them to make it clear to young women that they do not have to go through an embarrassing conversation to get time off for that. I will be looking at that further with Jo’s Cervical Cancer Trust.
If Members who called the debate and spoke in it have the appetite for it, I am happy to devote a special day in Parliament to what we can do on take-up of screening and of HPV vaccination. I would love to do that piece of work with hon. Members if they want to work with me on that, because much of this is down to local and specific community factors. A one-size-fits-all national programme is not adequate. As part of Be Clear on Cancer, we have a pilot programme on ovarian cancer which will be running this spring, so we are moving into those gynaecological issues. We will look at the review of that to see whether there is more we can do in this area. Work is under way, but there is so much more we can do working together.
Jane Ellison
Of course. I remember that I responded to the hon. Lady on the detail of that.
I have started to write routinely to the chairmen of health and wellbeing boards to make them aware of issues that are of interest to parliamentarians and changes in law or guidance. I undertake to mention this subject, particularly in the context of Sophie Jones’s case, in my next letter to health and wellbeing board chairmen, to draw it to their attention. There is a 1 million study under way by the National Institute for Health Research under its health technology assessment programme to look at the issues of effective interventions for younger women on the take-up of screening, so work is in progress.
Jane Ellison
I applaud my hon. Friend for taking a further opportunity to draw that to my attention—we met on Monday evening and discussed it. That will be part of the Department’s response to the all-party group’s report, and I undertake to update him further. I note, as he does, that he raised the matter with the Prime Minister recently and I will keenly pursue the points that he has made.
Finally, I thank all the staff involved in the national screening programme and those who deliver the important HPV vaccination programme for all their hard work. More power to the elbow of those who are looking for ways at local or national level to reach more young women, for all the reasons outlined by so many Members in so many excellent speeches. We can do so much more to achieve greater awareness and greater take-up, to get greater numbers of people screened and taking up the HPV vaccine. All that is work that we as Members of Parliament, I as a Minister and many people involved in our health services around the country can take part in. I recognise that for Sophie’s family, nothing we do can make up for her loss, but it can be part of her legacy. I thank Members for bringing this debate to the House.
Steve Rotheram
I thank all Members who have taken part in today’s debate, especially the Minister and the shadow Minister. As I said to the Backbench Business Committee, Parliament is often accused of debating only issues that stimulate interest in the Westminster bubble and that do not resonate with the wider public. That accusation cannot be levelled at us today. My hon. Friends the Members for Wirral South (Alison McGovern) and for Liverpool, Wavertree (Luciana Berger) have met Sophie’s family, and their contributions today were examples of how moved they have been by this case and reaffirmed my belief that we should do everything we can as parliamentarians to use Parliament as a mechanism to put this issue on the national media agenda.
I thank the hon. Member for Basildon and Billericay (Mr Baron) for his insightful speech, much of which I agreed with, in particular his excellently made point about the need to focus on outcomes rather than targets. The right hon. Member for Sutton and Cheam (Paul Burstow) and the hon. Member for Cheltenham (Martin Horwood) rightly highlighted the conflicting advice by some in the medical profession about the dangers of smear tests for young women, and the recent Sasieni research, which calls into question the guidance from 2009.
My hon. Friend the Member for West Ham (Lyn Brown) spoke about the work of Sir Robin Wales and Newham council, and I pay tribute to both. I thank my hon. Friend the Member for North Ayrshire and Arran (Katy Clark) for raising the case of her constituent Suzanne Fernando, and for the work that she is doing to support Suzanne’s work. It is a first-class example of how MPs can play their part in raising awareness. I also thank the hon. Member for Strangford (Jim Shannon), who spoke of his support for the HPV vaccination programme.
The purpose of this debate was to put cervical cancer, its symptoms and the anomalies that exist in its detection on the agenda, and I believe that with the support of more than 320,000 signatories, we have achieved that. I am positive that through the dedication of her family and friends that she left behind, this debate will go some way to ensuring that Sophie’s legacy is a life-saving one for many young women in the future, and I hope her family can at least draw some comfort from that.
Question put and agreed to.
Resolved,
That this House notes the e-petition relating to the tragic death of Sophie Jones from cervical cancer; believes that the Government should urgently issue guidance stipulating that all women should have the choice of taking a smear test regardless of their age and in consultation with their doctor; and further notes that the best way to combat cervical cancer is by increasing awareness of its symptoms so as to ensure that early diagnosis rates are driven up, doctors and nurses understand that although it is very rare, younger women can develop cervical cancer, and high levels of coverage among young girls of the HPV vaccination programme introduced in 2008 are achieved.
Sadiq Khan (Tooting) (Lab)
On a point of order, Mr Deputy Speaker. You will be aware that we on the Labour Benches have on a number of occasions expressed concern about the Government’s policy on legal aid and its consequences. This morning His Honour Judge Leonard QC sitting at Southwark Crown Court stayed proceedings in the Crown v. Crawley and others, a £4.5 million fraud trial, after he heard representations from one of the country’s leading and most respected QCs that the case should not proceed, as a fair trial was not possible because of the consequences of the legal aid changes introduced by the Lord Chancellor.
This case alone has cost the taxpayer tens of thousand of pounds and justice has not been done, but it is extremely serious for the criminal justice system in this country, which has not just been brought into disrepute, but is now rendered ineffective by a Lord Chancellor who is out of his depth. [Interruption.] I understand that there are at least eight other complex criminal cases, including—
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. Mr Swire, I will make the decision. We do not need any help from the Front Bench.
Sadiq Khan
That demonstrates the respect that the Government have for the justice system.
I understand that there are at least eight other complex cases, including those relating to the LIBOR fixing scandal, where barristers of sufficient expertise have not been found. Mr Deputy Speaker, have you received any indication from the Lord Chancellor that he intends to make a statement today to the House about the consequences of the judgment for the criminal courts, and his proposals to remedy the crisis he has caused in the court system?
Mr Deputy Speaker
I can assure the right hon. Gentleman that I have had no indication that anybody from the Ministry of Justice team is coming to make a statement. It is not a matter for the Chair, but it is certainly on the record and people are now aware of it.