Cervical Cancer Screening
Debate between Lyn Brown and Jane Ellison(10 years, 6 months ago)
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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.
Social Housing in London
Debate between Lyn Brown and Jane Ellison
Jane Ellison (Battersea) (Con)
Before I make my few remarks, I draw Members’ attention to my entry in the Register of Members’ Financial Interests. In case anyone is curious about it, I rent out the flat I lived in previously. I am in every sense a small landlord. It is slightly unhelpful that whenever people talk about landlords, they constantly refer to Rachman and the like; it has peppered this debate. There are lots of good small landlords, just as there are some good big landlords. It is important that we acknowledge that and do not descend into cliché.
We have had a good debate. There are clearly some ideological differences across the Chamber and within parties, but we all know that there is an issue. Although the debate has been forced on us by circumstances, inasmuch as we appear to be almost the only MPs left in the building, it has been really useful to have a London-focused debate, because we all acknowledge that London is different. Indeed, it is unique.
As the Member for Battersea, I welcome and enormously enjoy representing a genuinely mixed community. I want to continue to represent a mixed community. One of the great joys of London is the amazing mix of people. This morning, I was out at an unearthly hour delivering leaflets in my constituency and I noticed the extraordinary conjunction of posh flats, tower blocks and rows of terraced houses. It is one of the things that makes London amazing and it is an honour to represent a London constituency.
I have a few remarks about a practical solution that my council, Wandsworth, has been putting into practice for some years. When I talk about the number of new homes created under the scheme, Members may think it is relatively small given the scale of need identified during the debate; nevertheless, it has brought real homes to real people in need over the last 10 years, and I take this opportunity to highlight it.
The project is called the hidden homes programme. In 2002, Wandsworth undertook an enormous survey of all its properties and started the first hidden homes initiative. It is an odd title, because obviously the homes are not hidden; they were previously hidden, but they should now be called uncovered homes. Wandsworth undertook a survey of its entire estate and looked at the potential to bring back into use as homes all the rooms and spaces that were designed into the 1950s and 1960s blocks but are no longer needed—storerooms, laundry rooms, the big old boiler rooms, some unused garage spaces and so on. Many of those spaces are abandoned and, as we all know, places where antisocial behaviour lurks. The opportunity was there not only to create some new homes, but to design out crime from some of the estates.
To date, Wandsworth council has built 183 affordable homes, latterly with a housing association partner. There is a potential programme to bring many more new dwellings on stream. Wandsworth estimates that around 10,000 such new homes could be created across London, and 70,000 nationally, if all councils replicated the programme. It means creating valuable additional housing units at relatively low cost because the land is already owned. The acquisition of land, which, as we all know, is one of the great hurdles in London because it is very expensive, is therefore not a problem, and the council can crack on with building.
Planning permission is also relatively easy to secure. If a scheme is offered that could design out crime in areas where antisocial behaviour takes place, residents will greatly welcome that. Again, a box is ticked on that front. Another particularly positive aspect of the building programme is that it often involves valuable ground-floor and basement properties. Many of those who come to our surgeries have particular needs, which means that ground-floor accommodation is greatly in demand. Some properties have been designed and built from the start with adaptations for families who have a disabled member. The scheme therefore has many positives, and the accommodation has been provided quickly.
Another nice aspect is that many properties are unique in character. As I was slotting a few leaflets through letterboxes this morning, I was thinking that, as many of us recognise, people in social housing have the same desire as anybody else to live in a unique home, which has character and perhaps some quirkiness, rather than something standardised and mass produced. Again, the scheme has much to offer.
In 2006, Wandsworth council built almost half the new council homes in London through the scheme. It is important, and I understand that three other boroughs are considering it. Some are already some way down the line of looking to do the same on their estates. Wandsworth council has always said that it is happy to share ideas and expertise. Obviously, people learn along the way—it is not always plain sailing. Some of the adaptations— I have come across one or two in basements—have been challenging. However, expertise is available in identifying potential sites and putting together suitable packages.
I encourage other Members to consider that approach in their authorities. As I said, some authorities are looking at the scheme, and it is well worth bringing it up and considering the potential. I do not pretend that it represents anything other than a small contribution towards solving London’s housing, but if it can be brought on stream quickly and relatively cheaply, what’s not to like?
I want briefly to consider under-occupation. I thank the hon. Member for Islington North (Jeremy Corbyn) for securing the debate, not least because, as a member of the Backbench Business Committee, I must say that it was not an easy day to offer to supplicant Members, either in Westminster Hall or the Chamber. There was not a huge queue for the day, so it was excellent that we could have the debate and that the hon. Gentleman secured it. However, I want to pick up on one of his points about people’s need for a civilised family life in the context of solving under-occupation. The right hon. Member for Lewisham, Deptford (Joan Ruddock) also mentioned that. More imaginative thinking is being applied to the matter. The problem cannot be solved by saying, “Here’s the number of people, here’s the number of rooms. That’s it.” Clearly, that will not work.
We have talked about the needs of older people. We need to recognise that it might not be possible to persuade someone to move from a three-bedroom flat to a one-bedroom flat, but it might be possible to move someone from a three-bedroom flat to a two-bedroom flat with room for the grandchildren to stay or for someone who comes regularly to keep them company. Those things are really important. Many housing associations and the National Housing Federation are considering them and trying to encourage people to take that approach. They are not taking the one-size-fits-all approach.
Jane Ellison
I am not sure I entirely agree with that, if we are talking about older people and pensioners, in particular. Nevertheless, the housing associations are considering the matter, and it is something that we could all look to encourage as well.
I want to deal with another matter that I feel strongly about and that has been alluded to already. I think that the hon. Member for Eltham (Clive Efford) asked why people are not angry or marching on Parliament and so on, given that so many people sign petitions about other things. There is a genuine problem in how we democratically represent the housing problem. One of the biggest challenges we face is that we often do not speak on behalf of the people who are not yet living in an area. The voices to which MPs and councillors listen—rightly—are those of the people already living in their areas. However, there remains a democrat deficit when it comes to speaking up for the people who want to live in an area but are not yet there. Naturally representatives will tend to voice the concerns of local residents.
MPs and councillors have to set themselves a challenge. It was slightly naughty of the hon. Member for Lewisham East (Heidi Alexander) to suggest that nimbys are limited to any one party. I do not think that is true; there are nimbys across all parties, and probably, if we look to our own consciences, everyone at some point in their political lives has thought in their heart of hearts, “Hang on, actually there is a real need for this housing, but there is a huge local campaign against it.” Sometimes we have to take courage and say to someone, “No, I’m sorry, but there is a real housing need.” I did it recently at an exhibition on my patch. A lady was saying, “Oh, there are going to be too many houses and so on”, and I said, “I’m sorry, but there is a terrific housing need in London, and this is an urban area with brilliant transport links. This is a really great place to build some new homes. So I do support this building.” We have all got to be prepared to do that from time to time.
On a tangential point in relation to what is happening today around the country, I voted no in the AV referendum this morning, mainly because I worry about encouraging blandness and people’s desire to try to please everybody. Sometimes we have to show leadership and be prepared occasionally to be unpopular, perhaps in the short term or with a particular group of residents. Giving political leadership means that occasionally we have to be prepared to go against the grain, and housing is a good example of an issue in which we should be prepared to do that. There are things we can do. We have to encourage great design and sensitive interaction with local residents. I have seen the amazing difference that it can make if the people who want to build have in place a good programme of communication, but I have also seen terrible programmes with really bad models and representations and in which people have been treated with arrogance. I have seen good and bad examples.
We have to do much to convince people about designing out antisocial behaviour and crime. We all know that when we talk about building new blocks of social housing, some people worry that it will bring a disproportionate amount of antisocial behaviour.