Cervical Cancer Screening

Debate between Alison McGovern and John Baron

Thursday 1st May 2014 Commons Chamber

[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.

--- Later in debate ---

[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.