Breast Cancer Screening

Baroness Maddock Excerpts

Thursday 3rd May 2018 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the noble Lord for repeating that Statement and say to him that, along with millions of other people in this country, I am looking at my older relatives and wondering if any of them were caught by this. I do not think I am alone in that. As a woman of my age, it is important to say that we absolutely depend on the screening process to take care of us, to be invited for the smears and breast cancer screening and to be warned and told. So this is a massive public health failure—I think that we would all agree about that.

The noble Lord is quite right: there are a great many questions that he has mentioned that need to be answered. I appreciate his candour in questioning why this problem was not picked up, because eight years is a long time for an error of this magnitude to go undetected. Did the department receive any warnings in that time? Is there any record of how many women raised concerns that they had not received the appropriate screening? Were there any opportunities to change this mistake that were missed? We on these Benches indeed welcome the establishment of a national inquiry. Will the inquiry be hosted and staffed by the Department of Health or by another department? In the interests of transparency, I hope that Public Health England’s analysis from this year will be put in the Library, so that we can see what was identified as the problem with the algorithm. The noble Lord says that NHS England will take steps to expand capacity of screening services. Can he say a little more about that? Where are those extra resources going to be found and how will they provide extra screening?

The reason that this is so terrible in many ways is that we all know that the screening rates were falling; we have known that for years. The proportion of women aged between 50 and 70 taking up routine breast screening invitations fell to 71% in 2016-17; in London, I understand it is about 64%, so this is very serious indeed. In a way, I hope that the inquiry will address how we can make sure that those warnings are heeded and will allow questioning to take place of the whole process, which should be escalated to the right level in the Department of Health. There is an enormously wide range of variation in screening rates, which I hope the inquiry will also address. It seems that the fact that there is such a wide variation is also connected with things such as kit and staff—yesterday we were discussing the understaffing at various levels in the National Health Service. So beyond the problems identified by the Minister today, what more are the Government doing to make sure that screening rates rise again so that cancer care for patients is the best it can possibly be?

We are all concerned—this has cast a shadow that will bring fear and anxiety to millions of people. I know that all Members on all sides of the House who want to see cancer prevented will see this as an issue which we will all join in helping to resolve.

[Baroness Maddock (LD)]

My Lords, I am sure that all of us in this House are considerably concerned about those older women who at the moment are suffering acute anxiety because of what happened, and not only them but their families. It would appear that this was a software error. As I understand it, the same situation has not occurred in Wales, although the health service there appears to be on the same system. Can the Minister tell us a little more about that?

The Minister said that past notes will be looked at. How long does it take to get notes from the archive? Not all notes are held with GPs, and hospitals sometimes archive historic records. Are there enough current NHS staff to look at this, or will we need to take on new staff? That leads me on to another point about speed being of the essence. Depending on the uptake, as has already been alluded to, there may be a need to get women in this cohort X-rayed quickly and at scale. I know that we have had a shortage of radiologists; do we have enough to meet this need?

There is a wider issue, already referred to by the noble Baroness, Lady Thornton, of the lowering of the take-up rate. One thing that has come to my notice because of where I live and from talking to other people, is that if you happen to be unable to take up the appointment in the travelling van that comes round, you are often referred to a hospital. Sometimes that works and sometimes it does not—it can be a long way to go. However, when one of my colleagues asked whether she could have it done when she was here in London and have the X-ray emailed to her, she was told that that was not possible. Can the Minister look at that? While on technology, perhaps the problem of not detecting this is connected with the fact that we have become so reliant on technology that we think it is looking after things and so people do not personally ask the questions they need to.

I hope that the Minister will give us a bit more information about other steps that the Government are taking to try to help improve the take-up rate of screening. Unfortunately, this episode will cause some people to lose faith in the system, and we need to do something about that. Can he also say what his department will do to raise awareness, particularly among women over 70, so that they can continue to be checked?

I hope that the House will indulge me if I take this opportunity to thank those in the health service who have served me with my breast cancer. I may or may not have been one of these people; I self-referred when I was 70 because I had been through the screening process and had been looking out for signs that I had been warned of, so that is one very good thing. I had excellent service at the Royal Victoria Infirmary in Newcastle, which has been rated as outstanding after an inspection, and I was fortunate enough to be able to have chemotherapy down the road in my local hospital in Berwick. The two nurses who run that are absolutely fantastic. So I am very fortunate, and I know that that is what happens in my part of the country. I therefore thank the National Health Service for helping me, and I look forward to hearing from the Minister.

[Lord O'Shaughnessy]

First, if I may, I express my thanks to the noble Baronesses, Lady Thornton and Lady Maddock, for their constructive questions and the offer of working together to make sure that we get to the bottom of the situation and put it right. I also thank the noble Baroness, Lady Maddock, for sharing her own experiences with us. I am glad that she got good care, as, of course, the vast majority of people do, and we are indebted to the NHS staff who provide it. She made an incredibly important point about self-referral. One thing we must emphasise throughout this is that screening is one part of a much broader programme for spotting cancer early, and women’s awareness of their own body is absolutely at the front line of those efforts.

I want to add my own apology to those of my right honourable friend and the Government to the women affected, and to express my personal sympathies to them and to their families.

The noble Baronesses asked excellent questions and I will attempt to answer all of them. Key questions included early warnings, whether public concerns were expressed but not picked up on, and whether technology could have looked for trends in uptake in this age group—an example of technology coming to our help rather than being a problem. These are all very good questions that must be and will be the focus of the review. The review will, I am sure, also look at issues around variation. There are attempts to address falling screening rates, including national information campaigns, but whether or not those are adequate is a reasonable question given what we know about uptake.

The noble Baroness, Lady Thornton, asked specific questions about the analysis from Public Health England on the flaw in the algorithm. Indeed, my right honourable friend the Secretary of State committed to sharing that yesterday, which we will do. Since finding out about this problem, we have been in close conversation with NHS England to make sure that there will be additional resources, such that all women can be seen within six months for an extra screening if they want one. The vast majority would be seen much sooner than that and in a way that does not interrupt the normal screening programme, which is critical. The department and NHS England will provide additional resource to make that happen, including using temporary independent sector resource as necessary.

The noble Baroness, Lady Maddock, asked about case notes taking a long time to be assembled. That can happen, and it is critical for any woman or her family who think that they may have been affected negatively by this, with her cancer not being spotted. We will go through case note reviews for each of the women who may have been affected in that way—and if the NHS is shown to have been at fault, they will be eligible for compensation.

The noble Baroness asked a very good question about the location of screening. Choice is embedded in the system. I believe it was the noble Baroness, Lady Jolly, whom she was talking about and who had that experience. I looked into this: the 2016-17 guidance from NHS England provides flexibility and choice for women to say where they want their screening, which is one of the ways of driving uptake. If that has not happened in this case, and it does not sound like it has, I will be happy to raise that directly with NHS England at the highest levels.

I hope that I have been able to answer the questions from the noble Baronesses. I agree with them that this is a dreadful outcome of administrative incompetence and that we need to make sure, as we are reassured at the moment, that it is not affecting either other screening processes or other countries. One reason for that is that the particular clinical trial—the AgeX trial—applied only in England in its interaction with the screening database. The trial is not taking place in Wales or Northern Ireland, which share the same system—which is why the Welsh case seems to be different.

We will at all times in the process of the review and as we find out more be at great pains to make sure that we are as transparent as possible and to share information with the House.