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Cervical Cancer Test Centre, Swansea

Volume 708: debated on Wednesday 10 March 1965

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Motion made, and Question proposed, That this House do now adjourn.— [Mr. O'Malley.]

12.1 a.m.

May I say, in opening this debate, how pleased I am to welcome my hon. Friend the Member for Gloucestershire, West (Mr. Loughlin)—the Parliamentary Secretary to the Ministry of Health—on his first appearance to answer a debate from the Dispatch Box?

I open this debate because of the importance of establishing a cancer test centre in the Swansea area, and because of the increasingly persistent demand from women's organisations that the exfoliative cytology service should be made available to those women who wish to use it. In Britain every year, 3,500 women die from cervical cancer. There is a high mortality rate in Wales and Swansea from this disease. That is, in itself, sufficient reason for the establishment of a cancer-test clinic for women in order that the mortality rate should be diminished as speedily as possible.

At the meeting of the Glantawe Hospital Board on 6th January, 1965, the Medical Officer of Health for Swansea protested at the decision of the Minister of Health not to establish a clinic of this nature for the detection of cervical cancer in women in the Swansea area. The Medical Officer of Health, Dr. E. B. Meyrick, was quoted in the South Wales Evening Post of 7th January as saying:
"This would save many lives and suffering. In many fields we are short of beds in hospitals. This service would reduce the demand."
At the same meeting of the hospital board, Councillor Mrs. Eunice Jones said that evidence of cancer could be found by this means up to 20 years before it became apparent otherwise.

I would refer to the report of the Central Health Services Council for the year ending 31st December, 1963, the last available report of this council. The Standing Medical Advisory Committee of this body reported, on page 15, paragraph 72:
"The Standing Medical Advisory Committee recommended that provision of cytological facilities in hospital pathology should be accelerated and recruitment of pathologists and technicians with special training should be encouraged. Regional Hospital Boards should decide the degree of priority they could give to hospital developments but they might be encouraged to treat this service as one of recognised importance for the future, justifying special consideration."
In September, 1964, the Ministry issued a circular announcing the introduction of a series of training courses in exfoliative cytology, open to pathologists and medical laboratory technicians. As a result, the Glantawe Hospital Management Committee had a circular from the hospital board, and arrangements were made for the attendance at a training course of one pathologist and one technician from Swansea Hospital. The training course is completed, but it is impossible to set up a centre without an increase in technical staff.

Singleton Park Hospital should be the location of a cervical test centre clinic, and this view is supported by all the women's organisations in Swansea. If centralisation of the hospitals in Swansea should occur, as was hinted in a recent Press report, this would be a natural site for such a clinic. In addition, there is a view in the medical profession that a diagnostic laboratory should serve a total population of half a million. Swansea would be the sensible place to locate this cervical cancer test centre, because this clinic would serve not only Swansea, but the areas surrounding. It is the natural centre in West Wales for the siting of a clinic for this service to be made available to women. If centralisation of hospital services occurs at Singleton Park Hospital—as I hope it will—the centre should be made available at that hospital.

The present policy of allowing the cervical cancer test service to develop within the existing cytology service does not meet the wishes of the local women's organisations, which support the idea of the establishment of clinics. There are three difficulties in the way of expanding the cytology service: first, finding enough trained technicians and pathologists for the work; secondly, obtaining adequate laboratory equipment; and, lastly, obtaining adequate accommodation for more technicians to be employed to meet the demands.

The Swansea Medical Officer of Health, Dr. G. B. Meyrick, reported the South Wales Evening Post on 7th January, deplored the laisser-faire attitude of approach of the Ministry. He said that the Glantawe Hospital Management Committee had been informed that the regional hospital board had refused permission for the clinic. The firm attitude of this responsible doctor contrasts with the action of the Ministry.

There have been other efforts to secure this service for Swansea and the whole West Wales area. My hon. Friend the Member for Neath (Mr. Coleman) on 5th March questioned the Ministry about the feasibility of providing a regional service for the Principality. He was told that expansion of the cytology service would occur as a part of the existing pathological service. A regional diagnostic laboratory is a feasible possibility. I would refer to a brilliant article in the Guardian on 3rd November last year by Dr. N. E. O'Neil. The establishment of a Swansea cervical cancer test centre clinic is feasible, and, in the opinion of the women's organisations in Swansea and the surrounding areas, necessary and long overdue.

The Report of the Health Services Council for the year ended 31st December, 1963, says in paragraph 14 that fewer beds would be needed in the long run for patients with cervical cancer, and that the use of exfoliative cytology would make it unnecessary for some women to be admitted as in-patients for diagnostic examination. In paragraph 70 it says that close liaison is required between the general practitioner and hospital services so as to ensure that the taking of cervical smears by general practitioners in an area was not begun until the hospital pathological services were able to arrange for prompt examination of material sent in. In my view, that is what my hon. Friend the Member for Neath was referring to. It is a sensible approach.

There have been many approaches from other organisations. The Trades Union Congress at its conference last year supported the establishment of a cervical cancer test centre service. A nation-wide preventive service should be established, as in certain parts of the Continent, even behind the Iron Curtain. In China there is a more than rudimentary service in cytology available to women. Russia has an excellent cytology service available to women. The question arises whether Swansea and Wales have a right to such a service. I say that they have. The view has been expressed that Swansea is denied a cytology service because of those who are sheltering behind a curtain of wilful obstinacy.

I have a letter from the Secretary of the National Council of Women, Mrs. Mary Stewart, who is also Chairman of the Standing Conference of Women's Organisations, and she says:
"All the women's organisations feel keenly on this subject and hope you will be successful."
It is believed that a five-year screening service would reduce the risk of this disease of about 75 per cent. Positive—that is, malignant—smears are rare under the age of 25 years and equally so after 60. About 1 per cent. are positive in the pre-40s. I read with interest the statement of my hon. Friend the Under-Secretary of State for Scotland that facilities for tests are being made available in 27 family planning centres.

At the T.U.C. meeting in 1964 it was stated that cervical cancer causes one in 100 female deaths. It is estimated that we need 750 technicians trained in cytology to allow every woman at risk to be screened once every five years and that we require 1,000 technicians for a triennial screening. My hon. Friend the Member for Swansea, West (Mr. Alan Williams), who feels keenly on this subject, will, if he has an opportunity to speak, comment on the establishment of a test centre clinic. My hon. Friend has, I know, made a statistical study of this matter and has gathered much important information. His statistics emphasise the necessity for detecting the disease in the pre-invasive stage.

If the Ministry of Health has agreed that routine screening should be available to every woman at risk, then the service should he made available to every woman in the Swansea area who wishes to make use of it. As Dr. M. E. O'Neill, writing in the Guardian, stated on 3rd March last year:
"There is a sense of urgency in the diagnosis of cancer and intelligent women fret at the interminable delay in introducing a scheme. It is men who commonly advance and administer these services. One wonders what these people might do if cancer of the prostate gland could be detected by a reliable screening test and occurred on a scale similar to cervical cancer."
The sting was in the last sentence, which went:
"Be assured that there would be a diagnostic clinic in every village and a special unit at the Ministry".
The Ministry should recognise the necessity of establishing a cancer test centre clinic for women in the Swansea area. This service should be made available to the women who are demanding that such a clinic should be set up.

12.12 a.m.

I, too, congratulate my hon. Friend the Parliamentary Secretary on what will be his first appearance at the Dispatch Box. In the few minutes available to me I will try to show the statistical validity of our case for the establishment of a test centre, such as my hon. Friend the Member for Swansea, East (Mr. McBride) described, in Swansea.

The Parliamentary Secretary will no doubt be aware that there is a higher incidence of cancer in Wales than in the United Kingdom as a whole. A higher proportion of cases in Wales is attributable to cervical cancer and in only two of the last 10 years has the Welsh figure been less serious than the figure for Britain as a whole. While the Welsh situation is worse than that in England, the Swansea situation is even worse than either. Indeed, in the last 10 years the proportion of deaths of women from cancer which can be attributed to cervical cancer has been one-third higher in Swansea than in the country as a whole, and in four of the last 10 years the figure has been twice, or nearly twice, as high as the national figure. In only one of the last 10 years was it significantly lower than the United Kingdom figure. Although I would not expect my hon. Friend to answer this question tonight, in the long run we are entitled to find out why this should be the case in Swansea.

It might be said that my figures represent a small sample. That would be a legitimate criticism were I using one year's figures. In fact, I am giving 10 samples; the figures for each of the last 10 years. The trend is clear. I suggest that, on these valid figures, we can legitimately ask that a test centre for Swansea be established so that all women over the age of 35 who wish to may be examined. A new hospital gives us an opportunity and site for the establishment of this centre.

I was told in an Answer from the Ministry of Health that to provide this service Swansea would need one or two technicians. We already have one in the town, so we should need only one more technician to make this service available. Swansea would make an ideal regional or area centre and I hope that the idea of creating a service of this kind for Wales will be sympathetically considered by the Ministry of Health. If this service is necessary for Scotland, then it is necessary for Wales. If it is possible for Scotland, it is also possible for Wales.

12.15 a.m.

I would first thank my hon. Friends the Members for Swansea, East (Mr. McBride) and Swansea, West (Mr. Alan Williams) for the kind things they said about my first appearance at the Dispatch Box. They will realise, having been in the House while I have been here, how inhibiting it may be for me to be in this position. I also have to congratulate them on having this evening raised a very important subject. They have performed a service, not merely to their constituents, but to all the women of the nation in spotlighting problems faced by women after the age of about 30.

That is not the only thing they have done. They have pursued this matter in a very good Parliamentary way. Along with the hon. Member for Neath (Mr. Coleman), whom I see in his place, they have subjected my Department to Questions. They have also assisted the Department, because I can assure them that my right hon. Friend and I attach very great importance to this service, and want to see it extended, not only in Swansea and in Wales but throughout the British Isles. This Adjournment debate enables me to underline our concern that regional boards should do everything they possibly can to extend the cytological service.

I would first reassure my hon. Friends that the Welsh Hospital Board is fully alive to the need to provide a laboratory service that will allow screening for cervical cancer to be offered to all women at risk. We therefore have, in the first instance, the Ministry, which is fully alive to this need, and we also have, in this case, the Welsh Hospital Board which is also fully alive to the need. Where we may differ in some respects is in the way in which we can do this job so as to give the best possible service to the greatest number of people without causing too great a strain on certain sections within the Health Service.

The Welsh Hospital Board is going forward with the development of a cytology service within the framework of its existing pathology service. We believe that that is the right thing to do. I know that two centres have been set up, in Newport and in Cardiff, but these are centres in which we hope to get some experience of the best way in which we can tackle the job. The Welsh Hospital Board is sending staff to be trained, and is making available the necessary laboratory staffs and equipment. This is in line with the policy we have urged on all boards for the provision of a cytology service.

We fully accept the value of exfoliative cytology as a means of detecting cervical cancer and the pre-cancerous state which often exists for several years before invasive cancer develops, but this laboratory service must be carried out by fully trained and experienced staff. The taking of the cervical smear itself is relatively easy, but the examination in the laboratory for abnormal cells is pretty exacting work for which special training and experience are required—

I appreciate that, and I am grateful to my hon. Friend, but is he aware that the concentrated effort of the technician cannot be extended for a period of more than four hours, which underlines the necessity for the speedy training of more technicians?

I am grateful to my hon. Friend for that remark, but I hope in a moment or two to show him that we want to train more people, and that the Welsh Hospital Board intends to train more. Our view is that this work should be undertaken in hospital pathology laboratories by specially trained technicians working under the supervision of pathologists who have also been trained in cytology. We have accordingly asked boards to expand their cytology services in hospital pathology laboratories as quickly as possible so that screening for cervical cancer may be offered to all women at risk, and I hope that in the event of there being even one member of one board in any doubt as to our intentions, he will take my word as meaning precisely what we have asked them to do.

I think hon. Members know that the main reason why these facilities cannot be provided all at once is the shortage of pathologists and medical laboratory technicians trained in cytology. Arrangements to overcome the shortage were put in train last year when five hospital authorities agreed to arrange full-time courses in cytology for pathologists and technicians at special centres in Newcastle, Manchester, Birmingham and London. Obviously, if we are going to give a service that is efficient and worthwhile, we have got first of all to spend some time in training the right kind of personnel to do the job. It would not matter what our intentions were; we could set up clinics of a specific kind as distinct from clinics for other purposes, such as family planning clinics, and we could satisfy Members of Parliament that we had set up clinics, but unless we could find the trained personnel to man the clinics we should be serving no useful purpose at all. We are trying to ensure that there are special allocations to meet the cost of running these courses, both as regards capital and current expenditure. That, of course, includes extra staff.

The intention was that on completion of their courses the candidates would be able to play their part in establishing or expanding hospital cytology services in their regions and help in furthering local training arrangements. I can assure hon. Members that the Welsh Hospital Board is taking full advantage of these courses to train the staff it needs to extend the present service.

For the purpose of this debate I have taken the Swansea area to be coterminous with that of the Glantawe Hospital Management Committee area. Let me say to my hon. Friend how grateful I am to him that he mentioned Glantawe, because if he had not I would not have known how to pronounce it. In this area there are laboratories undertaking the work of exfoliative cytology at the Swansea General Hospital and at the Llanelly Hospital. The Swansea General Hospital receives smears from the gynaecological out-patient department at Singleton Park, the family planning clinic, Swansea, and the Eaton House Gynaecological Clinic at Swansea. They are also starting to examine smears from Family Planning Association clinics in Brecon and West Glamorgan. The Llanelly Hospital receives cervical smears for cytology from the gynaecological department there and the Amman Valley Hospital.

At the Swansea Hospital there are one trained pathologist and one technician, and at the Llanelly Hospital, where there is no trained technician, a number of smears are examined by a pathologist. At the present time staff at Swansea are undertaking the screening of some 240 to 250 cases a month, which is a substantial increase over the numbers previously tested, while at Llanelly they are dealing with some 100 cases a month. Both departments, of course, also undertake other pathology work.

At the present time the laboratories at both hospitals are receiving smears from patients seen at clinics for other reasons. It is hoped as soon as trained staff are available and other resources permit to extend screening to well women. This is what we want to aim at. We want to aim not merely at maintaining a situation where we get smears incidental to other treatment a woman is having but we want to aim at the provision of a service for all well women so that we avoid the dangers in the first period where it is so important to get to know what is happening. It is considered that an additional three or four trained technicians would be required to set in train a full screening service, that is to examine all women of 35 years of age and over once every five years. Apart from the additional trained technicians we should require extra laboratory space at the Swansea Hospital. This would be desirable, but we feel that the additional work could be carried out at a pinch in the existing laboratory.

Additional space should be available on completion of the phase of the building of Singleton Park Hospital now under construction. The final phase of the hospital is now being planned and when finished a completely adequate laboratory service for the area, including the needs of a cytology service, will be available. It is necessary in setting up a screening service to consider what is to be done with women who are shown to require treatment of one kind or another. This may place an extra burden on gynaecological and radiotherapy departments.

The position in Swansea is that the gynaecological department is working under heavy pressure even at present but we hope that another consultant gynaecologist will be appointed shortly. His appointment to this department will be in part to deal with the work arising from an extension of the screening arrangements. The radiotherapy department, which is due to be replaced by a new department at the Singleton Park Hospital towards the end of June, 1966, is at present able to supply such treatment as is shown to be necessary as a result of cytology screening. Since the new department should be very much more effective, an extension of screening is not thought to present a problem for radiotherapy.

Hon. Members will appreciate that we can spend only a limited amount of time in this debate and I therefore want to try and clear up a misstatement which my hon. Friend the Member for Swansea, East inadvertently made. I can assure him that the Ministry of Health did not refuse to allow the Medical Officer of Health at Swansea to set up a specific clinic. It may be that the regional board did, but my hon. Friend said that the Ministry had done it and I wanted to make sure that that did not go on the record without correction. I am sorry that my hon. Friend criticised unnamed persons for wilful obstinacy. It is true to say that the regional boards, in Wales and throughout the country, do a first-class job of work and we should give them the greatest measure of encouragement in whatever work they are doing.

I accept the figures quoted by my hon. Friend the Member for Swansea, West because he was quoting from an Answer which I sent to him recently. I cannot at this stage start analysing and making comparisons with other similar areas but the figures are disturbing. I assure both my hon. Friends that we at the Ministry want to see an extension of the service, but that extension must be done in such a way as to ensure that there is no displacement of other services. This can be done only when we have trained the staff necessary to do the job required of them. I hope that my hon. Friends will accept my thanks for initiating this debate. I believe that there is a lot of work to be done in this field. We are determined as far as humanly possible to see that it is done in the quickest possible time.

Question put and agreed to.

Adjourned accordingly at half-past Twelve o'clock.