House Of Commons
Friday 13 March 1987
The House met at half-past Nine o'clock
[MR. SPEAKER in the Chair]
Cancer Patients (Treatment And Care)
I beg to move,
I should like to thank the research department of the House of Commons Library. The researchers were most helpful. I thank also the Parliamentary Under-Secretary of State for Health and Social Security. The hon. Lady was kind enough to speak to me last night about the terms of the motion. I should also like to thank her staff. I am also grateful for the help given by Dr. Charles Gillis of the cancer prevention unit at Ruchill general hospital in the north end of the city of Glasgow. Seventeen years ago I was told that my mother was suffering from cancer of the womb. I know what families go through when they get that dramatic news. They have a duty to look after their loved ones, and at the same time they have to face one of the most distressing situations with which they will have to cope in their life. Even after all those years, I still say to myself that perhaps in my mother's case, and that of many other women, that could have been prevented had there been the proper screening facilities and education for women. I should like to mention research into cancer. I am told by many experts that there is serious concern about the lack of research and the fact that excellent grant applications are being turned down because of the lack of resources. Perhaps the Minister can comment on that. I have been informed that in the United States of America public and private resources are made available to the tune of 20 times the level in the United Kingdom. Not only does that inhibit research into a cure for cancer, but it leads to some of our brightest young scientists going abroad. It is not helpful in any branch of science that we are losing the cream of our scientific community. The Medical Advisory Committee working group on "Acute Services for Cancer," expressing concern about resources, stated:That this House believes that a humane and efficient health service should be guided by three main priorities in relation to cancer, namely: an effective national screening system designed to facilitate the earliest possible diagnosis of the different forms of disease, the provision of resources to enable patients to benefit promptly from the most technologically advanced treatment available, and the development of hospice and other facilities to permit the terminally ill to end their lives in decent and dignified surroundings with the minimum of pain; and calls on the Government to ensure that these priorities are fully reflected in the future funding of the National Health Service.
The Lancet and other leading medical journals have claimed that Medical Research Council funds are insufficient to maintain a healthy base of science for medical research in the United Kingdom and the confidence and morale of the gifted workers, especially those entering research. I should be obliged if the Minister would comment on such statements by journals that are highly regarded in the medical world. If we are to find a cure for cancer, we must support research. On the issue of prevention, screening must be available to everyone who is at risk in the community. Proper screening means that there must be proper recall services and easy access to the clinics and GPs who are able to carry out such screening. On 11 June 1986, the Nursing Times expressed grave concern about screening. It stated:"The NHS generally cannot be insulated from economic realities, but current resource constraints do have particularly significant implications for services to cancer patients. The gap between the level of services generally available and the level that it is now possible to achieve has increased considerably. This may be true for some other diseases but we believe it is especially true for cancer. The costs of surgery and radiotherapy are largely contained within the fixed costs of the service but the more recently developed methods of investigation and treatment of cancer patients, based on recent technical advances, are frequently very costly and have to be provided from the limited funds available for new developments. We recognise the difficulties but the overall aim must be to narrow the gap between what is technically possible and what is practicable in service terms with available resources."
"The mortality rates for cervical cancer have not improved markedly during the past 15 years and this despite increased medical and technical knowledge.
In my area, the Greater Glasgow health board is taking steps to rectify the problem. However, until recently, the board would have been unable to tell whether six, seven or eight smears had been taken from one individual over several years, or whether several women were involved, because proper records were not kept. If we are to have proper screening facilities, we should have a recall system, and proper records must be kept if we are to have effective recall. We must also have specialists to analyse the smears that are taken. Scandinavian countries are far more effective in their screening processes than we are. In those countries, cervical and breast cancers have been drastically reduced. Why can we not learn from the countries that are so successful at the moment? We need not only effective screening but to cut down the incidence of error. The clinics should be within easy reach of both city and rural dwellers. I welcome the statement made by the Secretary of State for Social Services on 25 February 1987 in which he spoke of the need for proper recall services for cervical and breast cancer. I hope that the resources that he mentioned will be new resources, not funds shifted from another part of the Health Service. There can be no doubt that education must and will play an important part in prevention. There has been a three fold increase in the incidence of female lung cancer in Glasgow—it has been established that smoking is on the increase among younger women—yet 40 per cent. of the population continue to smoke. The medical profession regards Glasgow as the lung cancer capital of the world. In 1985, 46 per cent. of male cancer deaths were due to lung cancer, and 90 per cent. of lung cancer is avoidable. People working with dangerous substances, such as asbestos and rubber, and who are non-smokers, run the risk of contracting cancer. People in the same occupation who are smokers vastly increase their chances of catching the disease. I know that the Parliamentary Under-Secretary of State, the hon. Member for Derbyshire, South (Mrs. Currie), has got into difficulties over the issue of diet. However, we should all take expert advice on our diets and lifestyles. I hope that her Department envisages expanding education on those matters. Turning to patient care, I understand that some cancer wards in my area—this could be the case throughout the country — have nursng levels below those which doctors and specialists would like. I should be grateful if the Minister could look into that. I should like to mention specially the Beaton memorial hospital in Glasgow. One of my friends, a terminal patient, was cared for in that hospital some weeks ago. Through visiting her on many occasions, at a stage when the family were allowed in at any time, I know that the care given by the nursing staff and doctors in that hospital was absolutely second to none. Such care is a great comfort to the patient's loved ones. It helps them to know that the patient has been cared for in a loving manner and with all the dignity that is deserved. I hope that all hospitals that care for terminally ill and other cancer patients, who are receiving radiotherapy treatment, look after their patients in that way. In my constituency, there is the Marie Curie hospital, known as Hunters Hill. When I visit that hospital I am always amazed, because it is one of the most cheerful environments that I have had the pleasure of visiting and it is one of the happiest communities in my area. I would certainly welcome an expansion of hospitals. Many people who are ill want to be cared for in their own home and cancer patients are no exception. Domiciliary care is most important. It takes a great deal of support to look after a patient at home, and support must be given not only to the patient, but to the family. Such care requires co-operation between general practitioners, district nurses, health centres and social services. When patients want to be cared for at home every effort should be made to make that possible. Often a husband or wife will not leave a sick spouse who is in pain unless an experienced nurse is prepared to sit with the patient through the night. The Marie Curie organisation and the Health Service are prepared to provide night services. Will the Minister tell us whether she intends to expand the domiciliary care services? I understand that there are many effective ways of relieving pain. However, those who live in rural or remote areas run the risk of sometimes being denied that help because doctors are not prepared to leave what are considered to be dangerous drugs with anyone other than a qualified nurse. People who live in the borders and the Highlands must travel long distances for radiotherapy treatment. I would like an assurance that steps will be taken to reduce such long journeys to relieve the burdens that patients already endure. Finally, I should like to read two quotes from the report of the Standing Medical Advisory Committee. The first relates to the need for an integrated service. The report stresses the need for an integrated service, and states:Cervical cancer is a largely preventable cancer. That is the good news. The had news is that an estimated 2,000 women arc still dying each year from this disease, often because they leave treatment too late. Why is the screening programme still so ineffective?"
My final quotation is on the need for co-operation between the different disciplines. The report states:"In discussing the organisation of cancer services we have emphasised the importance of easy access to services. The underlying aim of cancer services should be to ensure that cancer patients, whether potential or confirmed, have speedy access to the diagnostic and treatment services their condition demands. This must be the baseline on which the efficacy of services in any Region is judged. Given the complex nature of the various cancer conditions and the increasingly complex and expensive treatments involved, we believe this access can only be achieved where cancer services within a Region are planned and delivered in an integrated way. This should embrace not only the hospital services, with which this report is concerned, but also the community and prevention services."
I am grateful to have had this opportunity of bringing the motion before the House."Success in developing integrated cancer services depends very much on the quality of communications between the individuals and institutions concerned. A theme throughout the Report is the need for good communication between clinicians, between clinicians and nurses and between staff and patients and their families. Good communications between DGHs and the hospitals providing specialist services are essential if the close working links described above and elsewhere in the Report are to be developed successfully. This Report is intended to help clinicians, planners and others both at Region and District to meet the challenge of organising their service in a way which ensures the development of these good communications and the resulting complementary working relationship. Only in this way will those working in both DGH and specialist unit be equipped to meet the basic aim of providing all cancer patients in their care with the services they need when they need them."
I am sure that all hon. Members present are grateful to the hon. Member for Glasgow, Springburn (Mr. Martin) for giving the House the opportunity to debate this important subject this morning. We have heard, rightly, a great deal recently about the threat of AIDS, but that should not obscure the importance of the long-term fight against cancer, which continues to kill many people.First, I must declare an interest as the vice-president of the Women's National Cancer Control Campaign. It is a voluntary organisation concerned, not only with educating women about cancer, its prevention and treatment, but with practical steps to fight the disease, particularly through screening programmes. Breast cancer, because it affects women in a way which is particularly damaging to their self-perception as women, demands particular care in treatment. As with all cancers, women are frightened of the unpredictability of the disease, but women are also not helped by the unpredictability of treatment. To many women, breast cancer invokes images of radical mastectomy, yet in reality treatment may involve the removal of only small amounts of tissue. Although less obviously traumatic, much the same applies to the treatment of cervical cancer. The most important step is early screening. The Government's recent acceptance of the Forrest report's recommendations and their announcement of a national screening service for all women between the ages of 50 and 64 are essential first steps and are most welcome. I accept that any such services started from scratch will need time to establish a network of back-up services, such as training for staff and treatment and counselling for patients. Nevertheless, one must recognise that the numbers of cases of breast cancer among young women are increasing. I hope that the Government will continue to monitor that and to keep under review whether the service should be expanded to cover all women. Obviously, it will not be easy to persuade all women to be screened. Understandably, some will be frightened by the possible results of the tests. The only way to counteract that is to show that early screening means early detection of problems and swift, more effective treatment. The WNCCC is in the vanguard of that work and runs a special mobile screening unit which is already in demand. I should like to congratulate the Tesco supermarket group, the headquarters of which are in my constituency. The firm has arranged with the WNCCC for the mobile unit to tour stores in England, Scotland and Wales, providing free cervical smear tests and breast examinations for female employees. I should add that men have not been ignored — check-ups for excess weight and blood pressure are available to them. That is an excellent example to other employers. It is an initiative that could usefully he developed. Resources are spread widely throughout the many services within the National Health Service and opportunities for involving the private sector in developing screening programmes would surely he in the best interests of all. As more companies recognise the benefits of pay packages that involve more than just money, co-operation is definitely possible. Recently the WNCCC provided its mobile screening unit for use during a women's health week which was run by Waltham Forest health authority. The facility was backed up by considerable publicity in the local press and by the use of posters and leaflets. Results were encouraging and, paradoxically, worrying. The tests performed were cervical smears and breast examinations. Of the 406 tests, two were positive, 61 required recall within three to 12 months, 12 were inadequate or lost and 331 were negative. The number of women coming forward was a good response to the publicity, but the fact that 63 out of 406 would require at least further screening suggests that there is a definite problem since, without the WNCCC's mobile unit and Waltham Forest's initiative, none of those women would have been aware of any problem until much later. Other statistics reinforce my plea for constant monitoring by the Government. A total of 59 per cent. of the women were under the age of 50, which emphasises that screening may have to be widened. The computerised call and recall system for cervical cancer will go a long way towards tackling that, but the inclusion of breast examination needs to be kept under review. A total of 129 of the women gave details of previous tests. No fewer than 84 per cent. had not had a test within the last three years, 55 per cent. had not had a test within five years and 18 per cent. had never had one. That illustrates the scale of the problem. The committee on gynaecological cytology has recommended screening at three-year intervals. While I can understand that improving the numbers who come forward for tests is high priority, I think that it is important that if shortening intervals from five to three years significantly improves successful treatment, the change ought to be considered seriously. Despite a comprehensive screening programme, it is inevitable that some women will still develop both breast and cervical cancer and, unfortunately, die as a result. It is true that tremendous strides in the development of treatment have been made over recent years, not only in relation to tackling the disease at cellular level, but in providing psychological support for those undergoing therapy. Medical science has known for some time that the speed and effectiveness of recovery from surgery is improved by giving patients accurate, relevant information about their treatment and what they can expect to feel like after an operation. It is as important to post-operative care as pain-killers can be. Much of that research is now incorporated into hospital treatments, and more especially into the work on those who are terminally ill, both in hospitals and hospices. Such an approach requires co-operation between patient and doctor. The onus lies with the doctor, for it is not always easy to discover a patient's true worries in a simple, single interview. The development of the role of trained nurses as counsellors must provide a way forward. That may produce an additional burden upon resources, but some of that will be offset in the improved effectiveness of treatment. It would also help to deal with the known problems of depression and anxiety which are often found in patients undergoing courses of cytotoxic drugs. The process relies upon two-way communication: both nurse and patient need to develop a relationship which gives the patient trust and confidence in the treatment she is undergoing. In the light of this, treatment needs to take full account of the views of women as patients, not simply the results of clinical reports and observations of doctors. Across the country, there are hospitals where such attitudes prevail; but it is not universal. We all accept that the NHS exists for patients, and in the area of cancer treatment that philosophy needs stressing above all. It is not just a matter of surgery as a steady, clinical process. For all that, for some patients there will come a time when treatment cannot cure; it can act only as a palliative. In this area, I welcome the recent DHSS circular and the National Association of Health Authorities' publication on care of the dying.Publicity about AIDS has heightened awareness of this both in hospitals and hospices, and emphasised the humane, dedicated care already provided for those unfortunate enough to have cancer. I welcome in particular the stress laid by the DHSS upon collaboration between local and national voluntary groups and health authorities. No one group has a monopoly on wisdom or resources; joint planning arrangements would make sense. Although there will be training for those in the Health Service, what arrangements exist for assisting those in the voluntary sector, or local authority social services staff? It is important that there should be no weak links in the chain. Care of the terminally ill cannot rely on small numbers of centres of excellence; every hospital, hospice or home has to be a centre of excellence. So we need to strengthen links between the Health Service and the community — between individuals, rather than between the daunting face of bureaucracy and the confused member of the public, which is the image of big organisations. What provisions exist for liaison between community nurses and ward staff who have been looking after patients who choose to leave hospital? Patients must have the maximum confidence that community nurses know all about their case, and the treatment that has been offered. That is especially important in the tragic cases of child cancer patients. I believe that cancer services have been greatly improved over the past 10 years. We have in this country a record of treatment and care of which we can be proud. There is always room for improvement, but every year brings us more understanding and knowledge, and a step nearer a cure. What we can do is to help ourselves by improving prevention.
I am grateful to the hon. Member for Glasgow, Springburn (Mr. Martin) who has allowed us the opportunity to debate this subject. The hon. Member for Broxbourne (Mrs. Roe) hinted at the fact that we often have an opportunity on a Friday to deal with important subjects, which are not total cross-departmental subjects. Cancer, by its sheer statistical toll, has affected and does affect so many families. It is the second highest cause of death in this country. Most of us have had personal experience of coping with the death of close relatives from cancer. This is a good opportunity to try to put that into the perspective of public policy, so I am grateful to the hon. Member for Springburn for his choice of subject.The hon. Gentleman highlights three main priorities as being those on which to concentrate. Clearly, in a relatively short debate we cannot talk about all of them. Principally I want to consider the facilities available to deal with the terminally ill. However, I want briefly to mention the first two of the three priorities highlighted by the hon. Member for Springburn. I shall start by rehearsing one or two of the statistics which make this such a vital subject for our consideration. The Minister will confirm that, apart from circulatory diseases, cancer is still the largest cause of death in the United Kingdom. It is interesting that that is not the case in other countries. Other countries are more successful in reducing the incidence of cancer, especially preventable cancer; for example, lung cancer through the avoidance of smoking. At the moment, we suffer about 150,000 deaths a year from cancer in the United Kingdom out of a total of 650,000 deaths. Among those under the age of 70, the disease affects women more than men. We should be aware of that when we consider ways to deal with cancer. I notice that adverts on billboards claim that one person in three suffers from cancer at some time in their lives. I believe that the figure is closer to one in four. To complete the picture, I will give the other figures. Some 190,000 cancer cases are diagnosed each year and there are approximately 75,000 cures. A lot of good work is being done, but we will not be able to find cures in many cases for some time to come. Therefore, we need to concentrate on care and support systems as well as the preventive aspects of the debate. The hon. Member for Broxbourne said that one in 12 women suffer from breast cancer at some stage during their lives. The figures are horrific because 15,000 women a year die from breast cancer. That is still the most common form of cancer among women. Therefore, last week's initiative announced by the Government is more than welcome because there are still about 25,000 new cases of breast cancer a year. Those are the cruel statistics of this horrendous killer disease. The announcement made by the Government two weeks ago was, as I said at the time, unreservedly welcome. It was specifically aimed at women aged between 50 and 64. Hopefully it will provide relief and prevent deaths for up to 2,000 women a year. Before I consider other issues, I hope that the Minister will deal with the points made in Hospital Doctor magazine last week. On its front page an article states that effective screening will take up to 10 years. That is clearly of some concern. Although those people involved with the Forrest committee welcomed the announcement, there is still concern about how long full implementation will take. When the Minister replies, I hope that she will consider whether it is possible to foresee a speeding up of the timetable so that we can have effective screening for those who are intended to be covered by last week's announcement. There is proper professional concern on that point.
Was the 10 years based on the current rate of funding announced by the Government last week or was it calculated on some other basis? Clearly the rate of funding is crucial.
That was the assessment made by the Forrest committee in the light of the recent announcement. That is the figure which has been announced in the light of funding. Obviously, funding and resources will always be the major determinant of the speed with which programmes can be implemented. The hon. Member for Newham, South (Mr. Spearing) may want to develop that later.The second priority highlighted by the hon. Member for Springburn was the provision of resources to enable patients to benefit promptly from the most technologically advanced treatment available. I guess, as the hon. Gentleman must know, that that will never be entirely achievable. However highly advanced the technology available, there will none the less never be enough technology to deal with everyone at the maximum rate of efficiency. There will always be a difficulty there. That is probably one of the reasons why the third priority which the hon. Member for Springburn quite rightly highlighted — the development of hospice and other facilities — is even more important. I remember when my father was dying of cancer he lived in Hereford and had to be treated in Cheltenham in Gloucestershire. He had to go there every week for treatment. The institution in Cheltenham was a relatively new one and the special therapy treatment it provided was also new. I was aware that the competition for places for treatment was enormous. That is still the case and not everyone lives near to such high-tech treatment which can provide alleviation and a possible cure for the disease. I want to consider the treatment of the terminally ill and the collaboration between health authorities and the voluntary sector. First, I want to consider the growing and apparently effective role of self-help groups, self-help centres and facilities for the dying. I wonder whether we need to be a little wary of the sort of announcement that appeared in The Independent on 10 March which stated that it was forecast that by the year 2000 there would be a cure for two thirds of those suffering from cancer. I am not certain that that idea is generally accepted yet. I am not sure that we can look forward to as early a solution as that suggests. Because self-help is very important, I shall consider one example of an organisation and address my points specifically to the Minister about that body. The Minister will be familiar with the body as it is the British Association of Cancer United Patients—BACUP. That body is run by a cancer patient, Vicky Clement Jones, of whom the Minister will know well. Vicky Clement Jones has come to public knowledge through the publicity which BACUP has received in the past two years. She has learnt, as she came to terms with her ovarian cancer, that she had to confront the fact that she was dying. That was her challenge. When the able-bodied go about their daily lives, they do not think about dying, although we should all be confronted by the fact that we are dying. The point for cancer sufferers, AIDS victims and others is that death may be more imminent for them than for the rest of us. Vicky Clement Jones found—as we often find—that people with a fatal disease often shrink back from confronting the reality. The rest of the public silently put those people into a different category. They seem to say, "They are dying, we are not." That is a false dichotomy. Vicky Clement Jones reacted to such attitudes. She had the advantage of being a doctor and she reacted positively. She claimed that the lives of people who were dying—the terminally ill — are just as valuable, and probably more valuable for that period, than the lives of healthy people. The terminally ill can live their lives fully and often more fully than those of us who have no imminent risk of our departures. "The prospect of death concentrates the mind wonderfully" is a cliché but in reality it also concentrates the way in which people try to get the most out of their lives. Prevailing attitudes must be changed. Even those who are well-informed withdrew from Vicky Clement Jones and that included her medical colleagues. People must be encouraged not to do that. BACUP is trying to ensure that people do the opposite and above all it is trying to inform people of the alternatives if they are suffering from cancer. They inform people of the alternative ranges of action available to them to overcome the disease, minimise its effects or to maximise the opportunities during their remaining weeks, months or years of life. Without doubt, BACUP, over two years, has begun to change attitudes. I hope that the Minister will be able to give some encouragement to that body today. Since its launch on 31 October 1985—only 16 months ago — it has dealt with 20,000 inquiries, 80 per cent. of them from women. It has been almost overwhelmed by the volume of inquiries because it emphasises the need for information and to communicate to and with the cancer victim. It has become the national information service for cancer patients. It sees itself as in no way challenging the National Health Service but as a complement to the NHS. It deals with all types of cancer and goes across the range of cancer issues. Cancer patients represent 40 per cent. of its clients; relatives and friends of cancer patients represent another 40 per cent.; 6 per cent. are health professionals, who are often ignorant of the emotional implications; and 6 per cent. ask about screening and prevention. Apart from a few doctors who still believe that no one else should talk to their patients about their health, BACUP has been accepted as a valuable and useful service. It has received favourable professional comment and it has an eminent team of advisers. Its founder, Vicky Clement Jones, has been recognised by being made a fellow of the Royal College of Physicians. The organisation has tried to invoke the users of the service as much as possible. An important point is that the organisation has made it clear in its statements that there can be no psychological or psychosomatic alternative cure. We often hear the argument that health is all in the mind, but the organisation does not encourage people to believe that the main cause of cancer is psychological and that if they deal with the psychological problem the cancer will go away. All BACUP services are provided free. The organisation employs 14 staff and its budget this year is £422,000. It is supported by all the cancer charities. In November it asked the DHSS for £40,500. The request is under consideration, and I strongly urge the Minister, although she can probably do nothing today, to grant that request. I understand informally that the Minister may give £10,000. I respect her concern for organisations that predominantly help women, and I ask her to give the service the full amount because it could use it to fund two administrative staff and someone to run the cancer information service. It is the sort of partnership and public access organisation that we must support. I hope that the House recognises the value of such organisations and that the Department will grant the money for which it asks. There is no great difference across the political spectrum about terminal care. We all want proper provision for the terminally ill, including hospices specially designed to meet the needs of dying people. The theory on which they work is commonly recognised and the Government have responded to them. The circular of 27 February shows that they are committed in principle, but yet again the point at issue is resources. Doctor magazine of 29 January said — it is still true — that the hospice movement is "cash starved". That must be corrected, and the Government must play a key role. The sector is growing. Of course, there is voluntary money, but going round with a begging bowl for money for hospices is always difficult and unreliable. It will be more difficult if one of the key groups of people who need hospice treatment are AIDS sufferers, who may not be the most obvious beneficiaries of charity. I was in the House when the Minister answered a question about encouraging the partnership between the voluntary sector and the public sector. Of course, that must be done, but there is now a serious challenge given the growth of the AIDS factor in hospice care, which must not be allowed to detract from the continuing and growing need of cancer victims in hospices. I hope that the Government will move quickly to respond to the requests for financial and other support. South-East Thames regional health authority produced an excellent report on AIDS, highlighting the fact that hospice treatment and the funding of it is required. Perhaps we have reached the stage in the development of the hospice movement where we need an umbrella body to co-ordinate voluntary sector provision. London Lighthouse has made representations to the Government in relation to AIDS. It may be the right organisation or it may not, but we shall need an appropriate forum to provide a proper partnership dialogue between the Government and the voluntary sector. I hope that the general good will and support for the hospice movement will be recognised and that, in the words of the hon. Member for Springburn, terminal care will become a generally accepted priority for NHS expenditure in every region and district in England and Wales and in every health board in Scotland. That will be increasingly important if the service which the organisations have shown that they can deliver is to be available to everyone who needs it.
I, too, congratulate the hon. Member for Glasgow, Springburn (Mr. Martin) on his choice of subject. If one is lucky in the ballot, it is often tempting to choose a subject that is bound to hit the headlines or one that is of a partisan nature. But, as the hon. Member for Southwark and Bermondsey (Mr. Hughes) said, most of us have an interest in this subject because the scourge of cancer is so widespread. This is an especially valuable opportunity to discuss it.The motion refers to screening for protection against cancer, the treatment of cancer and the care of cancer patients, but it omits to mention—although I was glad to hear the hon. Gentleman mention it during his speech—the prevention of cancer. Alas, we know of no cure for some cancers and we do not know how most cancers are caused, but there is at least one well-known cause of some types of cancer. I refer, of course, to smoking. That cause of cancer is eminently avoidable. Of course, the tobacco companies argue that it has never been possible to isolate an ingredient in tobacco that causes cancer. But there is overwhelming evidence of the link between smoking and cancer. The most obvious type of cancer is lung cancer, but it is also true that a smoker is between five and 10 times more likely to develop cancer of the mouth or the throat than a non-smoker. I asked the British Medical Association what evidence there was to link smoking with other cancers or whether it could be linked only to the three that I mentioned. It provided me with evidence which is scientific, technical and somewhat beyond my grasp, but it is voluminous. I was surprised by the extent to which cancer of the pancreas, the kidney, the cervix, the urinary tract and the bladder may be associated with smoking.
Is the hon. Gentleman aware that some people still believe that the relationship between cigarette smoking and lung cancer is not proven? I ask hon. Members to push as hard as they can to show that that is not true. If we had even one hundredth of the evidence linking smoking with lung cancer showing that Westminster bridge was unsafe, it would be closed within two or three minutes.
The hon. Gentleman, who is a general practitioner, is far more knowledgeable on these matters than I am. What he says is true, and he will also know that the tobacco companies still deny it. We all know that if tobacco had only just been discovered and was suddenly introduced today, it would not be allowed on the market. He and I are realistic enough to know that it would not be practical to prohibit tomorrow morning the consumption of tobacco. However, we have to do all that we can to persuade people to cut down on smoking, because not only does it have links with the forms of cancer that he and I have talked about, but there is clear evidence that babies whose mothers smoked in pregnancy are more likely to develop cancer.There is increasing evidence linking the incidence of cancer with the inhalation of other people's smoke, so-called passive smoking. We should be thankful that smoking is becoming a minority activity and that many people are ceasing to smoke. Unhappily, smoking is increasing among young women. About one third of the adult population smokes and it is becoming less socially acceptable. That should be encouraged. We have just had National No-Smoking Day. Last year, some 50,000 people stopped smoking as a result of the National No-Smoking Day campaign and we hope that that figure will be exceeded this year. In the light of the evidence, we must hope that the new health education authority will give fresh impetus to the campaigns to discourage the young from taking up smoking, and to encourage smokers to cut down or cut out smoking altogether. There is ample scope for that authority to do more work in educating people and to develop non-smoking policies in public places and workplaces. Since it is the case, alas, that we cannot prevent all cancers, we must do all that we can to detect cancer in its earliest stages. I warmly welcome the recent announcement about Government funds for this purpose. Breast cancer is responsible for 13,500 deaths a year. Following the Forrest report, the Government agreed to set up a nationwide service for breast cancer screening and to have a centre in operation in each of the regions by this time next year. The target is for 100 centres by 1990. This is good news and will be welcome in all parts of the House. Cervical cancer causes about 2,000 deaths a year. Funds have been made available for call and recall schemes and for the speeding up of testing. This is important because I am sure that all hon. Members will have experience of constituents who had a smear test and then had to wait weeks for the result. That is not satisfactory. If the funds recently allocated assist in speeding up the testing process, it will be money well spent. The hon. Member for Southwark and Bermondsey and I were present a few weeks ago at a press conference held by an organisation called Quest for a Test for Cancer. It claims to have developed a mechanical screening process for cervical smears and says that it is faster and more reliable than conventional processes and can detect cancer at an earlier stage. I do not profess to understand the scientific basis for the test, although I tried to master the papers that the organisation provided, but it seems that the process was devised and tested by qualified people. The organisation is keen to open centres throughout the country. It has sought help from the DHSS which says, perhaps understandably, that it wants the process to be properly evaluated. The organisation says that it has already held independent tests and has had the process evaluated, but that it does not have the resources to do further testing. With the support of the Royal College of Nursing and many women's organisations, it has started a campaign to raise £2 million to set up centres. I am not medically qualified to judge the validity of this process, but it seems to hold out hope. Perhaps there is some misunderstanding between this organisation and the DHSS. My hon. Friend the Parliamentary Under-Secretary of State, the Member for Derbyshire, South (Mrs. Currie), is not one to stand on ceremony. If one wanted somebody to cut through red tape, one would go to her. Perhaps she and her officials could get round a table with people from Quest for a Test for Cancer to see whether there is some way in which the work that it is doing could be accelerated. Hon. Members will know about St. Christopher's hospice in Beckenham in the borough of Bromley, part of which borough I represent, and of the pioneering work carried out by Dame Cecily Saunders. I do not need to dilate on that, because on 19 February the hospice was the subject of a debate initiated by my hon. Friend the Member for Beckenham (Sir P. Goodhart), in whose constituency the hospice is situated. He urged more Government support for the hospice, which at present receives support of about 35 per cent. of its costs. The rest of the money for running the hospice comes from voluntary sources and an enormous number of people do a great deal of voluntary work to raise money. I know that it is not usual to report conversations that take place in the Tea Room or the Lobby, but I was stopped in the Lobby by one of the Badge Messengers who serve this House so very well. He invited me to sponsor him on a walk in support of St. Christopher's hospice and I was happy to do so. It sounds an interesting sponsored walk because I gather that the stages are between local hostelries. The cause could not be a better one, and I hope that when hon. Members are leaving the Chamber after today's business they will take the opportunity to add to my sponsorship in aid of St. Christopher's. Government support of 35 per cent. is not enough and my hon. Friend the Member for Beckenham suggested that about 50 per cent. would not be out of order. I hope that the Government will consider whether more help can be given to hospices. St. Christopher's does fine work not only in the hospice but in the community. Community care has become known as hospiscare. In that part of north Bromley, the hospice is able to help many families because it is often better for the family and the patient for the patient to spend his last days in the comfort of his home — but with the right sort of care, attention and treatment — rather than in a hospice. That service is limited to the immediate area of St. Christopher's hospice. About two and a half years ago a similar voluntary hospicecare scheme was set up in the southern part of the borough of Bromley. In that time. 422 patients and families have been helped. On any one day between 30 and 40 people are cared for by South Bromley Hospiscare. The movement has only three full-time nursing sisters, two doctors who voluntarily give their spare time to the movement, a part-time social worker and secretarial staff. Obviously, this sort of work is extremely valuable in helping the patient in the final stages of a terminal illness, in helping the family after bereavement and in educating medical and nursing staff in hospitals on how to cope with the terminally ill. It is a special technique which is not part of the usual training of medical staff. The service enables the patient to spend his or her last days in familiar surroundings as well as releasing a bed in an acute ward for other purposes. It is important, however, that there should be one or two beds available in nearby hospitals for urgent and immediate use if the home situation breaks down or the illness develops in such a way that the patient has to return quickly to hospital. The recent DHSS letter invited district health authorities to review their care provision for the terminally ill. I hope that the outcome will be the conclusion that each district health authority needs adequate hospital and/or hospice care facilities for cancer patients and adequate domiciliary hospice care services of the kind that I have described. I think that I have shown the value of those services, but to operate properly they must have generous financial support from the health authorities. I conclude by expressing die hope that some of these points will be recognised by the Government as priorities and will be fully reflected in future funding of the National Health Service.
On a point of order, Mr. Deputy Speaker. I shall be brief, as the debate is of great importance to all our constituents. As you will know, Mr. Deputy Speaker, the Government have in effect been found guilty in the Australian court of neglecting national security since 1981. We had expected a statement from the Government at 11 o'clock this morning, as this is the first occasion for many months on which they cannot argue that, although the matter is not sub judice here, it is sub judice in the Australian courts, but there is no announcement on the Annunciator and it is only 15 minutes or so until 11 o'clock. So that we may be prepared, can you, Mr. Deputy Speaker, say whether there has been any request from the Government to make a statement? If not, may we make it clear through you that the House will expect a full statement on Monday before any appeal is lodged in Australia?
I am not aware of any request for a statement. As the right hon. Gentleman knows, such requests normally have to be made before 10 am on a Friday, so it seems that there will not be any statement at 11 o'clock. However, the right hon. Gentleman's request will have been heard and will no doubt be communicated to the Leader of the House and to the Minister responsible.
I join hon. Members on both sides in congratulating my hon. Friend the Member for Glasgow, Springburn (Mr. Martin) on giving us the opportunity to debate this important matter which affects ever-increasing numbers of women. Like the hon. Member for Broxbourne (Mrs. Roe), I must declare an interest as a vice president of the Women's National Cancer Control Campaign since its inception. I am also pleased to record that a former colleague, Mrs. Joyce Butler, was the leading light in getting the campaign started.The eagerly awaited Forrest report has now been published, with proposals for a national breast cancer screening scheme. Everyone accepts that breast cancer is a killer disease, responsible for the deaths of almost 15,000 women per year, and there are about 24,000 new cases every year. Each year, there are 75,000 deaths among women from all forms of cancer—the highest mortality rate in western Europe or north America. Surgery. radiotherapy, chemotherapy and hormone therapy have produced only modest increases in survival rates after treatment, partly because patients present themselves only after a large tumour has developed. One of the messages that must go out clearly is that medical advice should be sought as soon as there is any suspicion of cancer. The Forrest report summarises tests carried out in America, Sweden and the Netherlands, and concludes that there is
The report states:"a convincing case on clinical grounds, for a change in UK policy on the provision of mammographic facilities and the screening of symptom-less women'.
The final report said that mammography was effective for mass screening, that priority should be given to the 50 to 64 age group and that screening should be carried out every three years. The report continued:"It would not be sensible to introduce mammographic screening on a UK basis without providing the necessary back-up service to assess the abnormalities that would be detected".
Forrest says that a unit with one mammography machine would need two full-time radiographers, who could carry out basic screening for about 12,000 women per year in the 50 to 64 target age group. Besides radiographers to carry out the basic screening, a high level of expertise in mammography will be needed so that false negatives and false positives which could endanger women's lives can be avoided. That is a major problem in the way in which testing is currently carried out. Radiologists are therefore essential to interpret mammograms and to work with the surgeons who would then have to carry out the surgical procedures. Forrest says:"These techniques should be carried out by a multidisciplinary specialist assessment team — an essential prerequisite of a screening service for breast cancer."
I hope that the Minister will confirm that those targets will be achieved. Clearly, there are both manpower and financial implications. There will be considerable financial implications for investment in equipment, buildings and mobile units, amounting to about £18 million, with capital costs of about £31 million at 1985–86 prices. We are thus a long way from achieving the allocation of resources recommended by Forrest. If more frequent screening is required, more staff and equipment will be needed and costs will be proportionately higher. As research and practice improve, other age groups can be screened, but again more trained staff and equipment will be needed. The Secretary of State recently announced his contribution to this urgent programme as £6 million in 1987–88, so we are a long way off the totals recommended by Forrest. Demand for cancer screening will certainly increase among younger women and better training and techniques will save many more lives. Britain's handling of science policy has been described by the American president of the Institute for Scientific Information as an "anti-science movement". He goes on to say:"An established breast cancer screening programme with 120 basic units (which is what we need) will require 930 whole time equivalent staff, including 40 radiologists and 200 radiographers plus nurses and receptionists."
It is this lack of support for our scientists and researchers in science, technology and medicine that fuels the brain drain so that, unfortunately, many of our scientists go abroad, often to America, due to the lack of resources available in this country. The new test for screening cervical cancer has been mentioned. This might be the first time that screening for cancers of the lung, bladder and stomach is a possibility. The test has been devised by doctors at the Whittington hospital. It involves measuring two chemicals in cell samples by liquid chromatography. The test avoids the present rather cumbersome system and results can be achieved at once. I should like to consider the role that should be played by others who work in this area. A conference of the Royal College of Radiologists was recently told:"I say shame on you, Mrs. Thatcher, your budget policy is short sighted, it can only lower the cultural and economic standard of living of your nation. And what an ungrateful response it is, both to Britain's noble record of achievement in science and to its current legions of world-class researchers".
The necessary medical manpower is available if we decide that breast screening is a priority. We are training 32 more radiologists than there are posts available each year. It is not that they are in short supply, but that we do not fund the posts. The role of general practitioners in persuading patients to accept screening is important. Experience shows that screening for breast cancer is much more likely to be accepted if encouraged by a GP. The response rate has been found to be highest when patients are sent a personal note with a provisional appointment bearing the GP's signature. The signature was found to be a real motivating factor. The Minister should encourage GPs to do that. A survey by the National Federation of Women's Institutes in conjunction with the Women's National Cancer Control Campaign in England and Wales revealed that 65 per cent. of women had never been told by doctors that they should have a smear test and that 68 per cent of those who had had a first smear test had never had any form of reminder that another test was due. We have a good deal to do to ensure that information is given accurately to women patients, about whom we are most concerned. Many women are worried that they are not told the results of tests. I hope that the Minister will be able to give us some assurance that she will take up these points with the medical profession."Some existing centres are so bad—they have so many false positives and false negatives—that they positively do harm. We must improve or eliminate these centres or they will threaten the whole screening programme. If word gets around that the tests are inaccurate, women will not take up screening and the cost per patient will rise."
I apologise to my hon. Friend the Minister and the House, but I have to leave shortly after I complete my speech as I have a constituency duty early in the afternoon.It would have been wrong if any hon. Member had used this debate as an opportunity to bash the Government or to make too much political capital out of what the Government have done. We do not want any of that in this constructive and helpful debate. Nevertheless, the figures for cancer deaths are a matter of concern. If by cash injection, exhortation or just plain education the Government can do anything to reduce cancer deaths, they should do it. We will all die of something. That is an incontrovertible fact. Fortunately, none of us—I hope—yet know what we will die of. Some of us will just die of old age, we hope, and drop off the perch. Others, unfortunately, will die of cancer. We know that 2,000 women die of cervical cancer each year. The tragedy is that most of those deaths are probably preventable. As the hon. Member for Wolverhampton, North-East (Mrs. Short) said, few women have the test. Most women do not know whether the test is available and, human nature being what it is, most people do not think about it until far too late. In the Trent region, people have heard that the smear test will be available for anybody who wants it. That is good news but it suggests, I think correctly, that the service is not yet available for anybody who wants it. There must be some system in which everybody in their sexually active years is called regularly for a smear test. It should not be left to the bright and prudent to make their own arrangements. The harassed mother and the sexually active, working middle-aged woman just as necessarily need that test. They need to have it drawn to their attention in writing that the service exists, where it exists and what they have to do to take advantage of it. That is not done for the majority of women today. If we are to reduce or even eliminate the 2,000 deaths annually that are due to cervical cancer, the onus must not be put on women to take their courage in both hands, trot down to the hospital, health centre or doctor and ask to have the test. Doctors are busy people, and most women who have children who they take to the doctor know that all too well. They are sometimes afraid of imposing unnecessary burdens on busy practitioners, so they hesitate to have the test. A lot of women would come in for a test if called and, for a variety of reasons, they would fail to have the test if not called. We are talking of preventive medicine. We are worried about people's eating and smoking habits. We pontificate and campaign about them. I hope that this debate leads to resources being made available to district health authorities throughout the country to ensure that all women of sexually active age are called, and recalled from time to time, for a smear test. I believe that most doctors would welcome such a scheme. I hope that none — I know of none—would make women feel that they were wasting the doctor's time, but if there are any I hope that they will be discouraged from making women feel that doctors are busy people and have far more important things to do. That is my main point, but I should like to make another which has been touched on by my hon. Friend the Member for Chislehurst (Mr. Sims)—terminal care. I join my hon. Friend in paying a tribute to the hospice movement. We have a hospice in Nottingham and others are planned. It takes a great deal of the burden of physical and mental care and anxiety from the patient and his or her friends or family. The Health Service cannot do that, but it is something that it should encourage more and more. Hospices attract—in a voluntary capacity generally—men and women of the highest social commitment. They do positive caring and therapeutic work and cannot receive enough praise for that. I hope that, if I die of cancer, the hospice movement will be ready to help when my needs are most. Hospices deserve all the praise that the House can bestow on them, and I support them.
Hon. Members have spoken constructively in the debate, and I thank the hon. Member for Glasgow, Springburn (Mr. Martin) for introducing it.We need not go over the facts and figures again, because it has been demonstrated that cancer is an illness that touches almost every family in the land and many of our constituents. I do not want to go over the ground that has already been covered by hon. Members, but I would like to illustrate some of the problems in the treatment arid care of cancer patients with regard to the experience of my constituents in Edmonton. The problem in the North-East Thames regional health authority area is that proposals have been made to reorganise the treatment of cancer patients. A report has been made and we are now in public consultation, both of which I welcome. That shows that a great deal of genuine interest and concern is being shown by the regional health authority that proper care should be taken of cancer patients. A great deal of concern has been generated through the consultation process among my constituents and those of hon. Members. They believe that the quality of the treatment will be reduced by the proposals of the regional health authority. It is suggested that there should be a reduction in the regional cancer treatment units from the present figure of nine. The objectives of that are laudable—to improve the care of cancer patients, to improve treatment, increase work on prevention, about which other hon. Members have spoken and to help implement the new Government proposals on screening, which are welcome and which go some way to meeting the genuine criticisms of the process thus far. In practice, I have grave doubts about the way in which the reorganisation would work. I have raised this subject on the Adjournment, and my hon. Friend the Minister has been helpful and constructive in replying to that. I hope that I can now illustrate one or two points that I did not bring out fully on that occasion. My main concern about the proposals is that there will be a cut in the standard of service to my constituents and others in the region. There would be a drop in the quality of life for cancer sufferers. The concept of the quality of life is increasing in value in cancer treatment, and is something to which we are increasingly turning. I wonder why my region has decided upon its plan. It is not a financial cut—spending will rise because of its plans. However, cancer treatment services will be radically disrupted in the area. We know that it is not because the region has a poor cancer treatment record; it is one of the better regions in terms of survival rates for cancer sufferers. We know that need for cancer treatment is not declining. Cancer is growing, and, with an increasingly older population, cancer may be claiming more of us than it has in the past. A report has been brought out by my region called "A Better Cancer Service", which makes it clear that one of the main reasons behind the plans of the region is an increased reliance on chemotherapy, the treatment by drugs. The reliance on drugs is not a universally accepted medical fact. There is a great deal of doubt about the value of relying increasingly on drugs for the treatment of cancer. That worry is not purely restricted to radiographers, but comes also from chemotherapists who believe that, as drugs become more powerful and effective, they may become more toxic and more deaths may result from the side effects of that treatment. The region seems to be relying on the argument that: bigger centres are better. There is some force in that, in that surgeons, radiologists and chemotherapists would be grouped together in the same teaching hospital where, in the words of the region, they have the right setting and,
That is a genuine point. However, I have reason to think that that probably is more pious hope than reality and that those who thought up the idea have not thought through the consequences. One of the ideas in the plan is that surgeons and chemotherapists should continue their surgeries and meet their patients in the 16 health districts in the region. They will not, therefore, be concentrated in the regional cancer centres, but spend much of their time going to the district general hospitals and other centres. It seems doubtful that the professional togetherness that the regional planners envisage—for the right reasons—is unlikely to happen."where progress can be made through sharing of knowledge. experience and opinion."
The argument as to whether there should be a few big centres or a larger number of small ones has been going on for a long time. In the United States, in the sector of high technology, some of the bigger firms have found that it is better to have a larger number of small, bright people—I do not mean small in size—who are given the go-ahead with a limited amount of money. Some of those big firms—3M, for example, but I do not want to mention specifically who they are—have found that they get better results in that way, rather than have a bureaucratic structure with large groups, many of which are not doing very much. It is a better idea to spread matters around with a smaller number of people, but much larger in scope.
The hon. Gentleman illustrates that point well from his own experience.The report that the regions are relying on in coming to the conclusion that there should be fewer and larger centres recognises that small centres can be good and suggests that it is not necessarily a good idea to close smaller centres. Indeed, it recognises that it can be a good idea to build on the smaller centres and not follow through the idea of bigger and larger centres. That is particularly true in the Thames region, which has some great teaching hospitals situated in the centre of London. No one is arguing that those should be reduced and that we should not have specialist centres. The consultant at the North Middlesex hospital recognises that there are cancers which it cannot treat, and it quickly passes patients to the specialist centres. We are talking of a small percentage of cancer patients who cannot be treated at the cancer centres. A centre such as North Middlesex hospital, and other centres in the region that are to be closed, are not small centres. The North Middlesex is a purpose-built centre with good equipment. It was to have had a linear accelerator which was cancelled by the region only because the report came out. The cost of the cancellation was £40,000, which is not recoverable. If the regional authority listens to the widespread opinion throughout the region it will have to reorder that equipment and re-equip the North Middlesex, which has space for expansion. The Department of Health and Social Security puts some reliance on the figure of 1 million population as the catchment area for cancer centres. In built-up areas, which I assume includes my constituency, the figure is 2 million population. The Government call in aid two documents—a 1978 circular and "Acute Services for Cancer". In my Adjournment debate, my hon. Friend the Minister refers me to those documents and I have read them again to try to discover the Government's justification for the I million population criterion. I was disappointed by the results of my reading. Both documents contained the broad statement that the 1 million figure is correct. There is no justification for that figure and no appendices showing how it was worked out or giving detailed arguments. The regional health authority should pay particular attention to the lack of argument and evidence from the Government for the centralisation of cancer treatment. I look forward to the Minister's reply today or in future if the Government have to take a decision on the matter. I suspect that the "Big is Beautiful" movement is left over from the 1960s and 1970s when it was fashionable. We could talk about back-up services and the cost of equipment, but technology changes and becomes more efficient and we can use the same technology in the present units, which are not small and are better located for cancer sufferers. There is a temptation, which I mentioned in my Adjournment debate, to reward teaching hospitals and their staff with bigger and better facilities at the expense of district general hospitals. The fact that those hospitals may be teaching nurses is often patronisingly forgotten by the planners. I have yet to see a convincing argument that resources in the North-East Thames regional health authority are not being concentrated in teaching hospitals for the sake of rewarding them. The net result of centralisation in my region and, I suspect, throughout the country may be that centres such as the North Middlesex, which are extremely accessible—we are on the major routes out of London and on the major radial routes round London—will be closed and the travelling time of patients will double. At present, patients from as far away as Hertfordshire, Hackney and Haringey can reach the North Middlesex in a short time. In future, they may be asked to come into central London in the rush hour and try to find a parking space. I have news for them. I sometimes have to take my son to Great Ormond street and I know that parking for a long while is virtually impossible. Cancer sufferers will have to rely on their families to drive them into London and to hang around waiting for them. The alternative will be for patients to come to London by ambulance—12 people at a time, being collected early in the morning and returned late at night. According to the regional health authorities, it would be better still if there were hostels in which cancer patients could stay during the week. But most of the people we are talking about will die, and we need to alleviate their symptoms while they are being treated with radiotherapy. The regional health authorities would ask them, perhaps in the last year of their lives, to spend long periods away from their families and their loved ones. That is in complete contradiction to the thoughtful speeches of hon. Members in this debate and to the thinking of those involved in cancer treatment and care. I reiterate that we should be very careful before increasing centralisation on big units where patients may be treated more as numbers than as individuals, where they will not see the same staff on each visit and where it will be much more difficult for their families to visit them. I praise the Government for their recent announcement about screening for breast and cervical cancer. That is welcomed. I am sure that there is still a long way to go and there is a lot more work to be done for cancer patients, but the Government, working hand in hand with the strong voluntary and charitable sector, can make an enormous contribution to increasing the quality of life for people — no doubt including some hon. Members in the Chamber—who will suffer from cancer.
I, too, congratulate the hon. Member for Glasgow, Springburn (Mr. Martin) on choosing an important subject for the debate. I am doubly grateful to have the chance to take part in the debate. I am grateful to you, Mr. Deputy Speaker, for calling me to speak and I am especially grateful to the dedicated doctors, nurses and staff of the Accrington Victoria hospital and Blackburn royal infirmary, without whose skill and care 12 months ago my only contribution to the debate would have been as a cancer death statistic—one of the 19,000 people who die from cancer of the colon each year.It comes as a great shock to be told that one has cancer, but the speed of my treatment, from routine X-ray through further tests and admission to hospital to the operation, was a tribute to the efficiency of the National Health Service. It may not be perfect, and we criticise it from time to time, but when emergencies occur it responds quickly and magnificently. Many of my constituents agree with that view. In cancer cases it is important that investigations and care should be provided without delay, because delays are distressing to patients and their families and, as cancer is a progressive disease, they can be detrimental to the long-term prognosis. Despite the remarkable progress made in treatment in recent years, the word "cancer" still strikes fear into the hearts of those who are told that they are suffering from it. Most people think of cancer as being synonymous with death. I was not worried about dying, though I suspect that that was not the attitude of Conservative Central Office, which would have had to defend my majority of 21. Although I was not scared of dying, I am a coward and I was very afraid of the pain that might accompany my death. Therefore, I thank God that the people of east Lancashire, under the inspiring leadership of Dr. Merton Seigleman, had, by fund raising and direct contributions involving the whole community, raised £450,000 to build the East Lancashire hospice. East Lancashire is not an area of great wealth or high wages, but it is an area of great generosity and its people wish to help those in most need. The regional health authority contributed £150,000 and, perhaps more important, agreed to fund the running costs. Thus, we had established a hospice which has been a blessing to many people. I assure the House that just to know that the hospice is there is a great comfort to many people, as it was to me. Hundreds of patients have received kindness and care at the hospice. Their pain has been brought under control and many are able to return to their homes and lead normal lives in the knowledge that Dr. Seigleman is on hand if the pain returns. When the end is near they are able to return to the hospice and die with dignity. I pay tribute to Dr. Seigleman and his devoted staff, especially the many voluntary helpers. In east Lancashire there is a wonderful tradition of self-help. We see a need and we act. We do not wait, nor do we always expect the state to do everything for us. Having established the hospice we are now involved in fund raising for a laser — an appeal sponsored by the AccringtonObserver and Times. We are also raising funds for a CAT scanner — an appeal sponsored by the Lancashire Evening Telegraph. The latter appeal has had widespread support since its launch only six weeks ago. The fund hopes to raise—I know that it will—£500,000. The appeal has such public support because there is a widening recognition that many of the common cancers, which may be difficult to treat at a later stage, are curable if detected and treated earlier. Public awareness of the importance of early diagnosis and optimal treatment on the outcome of the disease has changed the level of expectation of standard of care. There is an increasing expectation that the highest standard of treatment, including the very latest developments, should be available to all. The NHS cannot be insulated against economic realities. The development of new techniques and improved standards of treatment clearly put a strain on scarce resources—not simply in terms of competing priorities for cash, but also the availability of suitably trained manpower. I believe that the NHS must work in closer partnership with the voluntary sector if rising expectations are to be fulfilled. When people of an area have shown some initiative and are prepared to try to help themselves, the NHS should offer its support. The NHS benefits greatly in many ways from voluntary efforts — not least through voluntary fund raising. The Blackburn, Hyndburn and Ribble Valley district health authority has recently unanimously agreed that, to give the voluntary sector the encouragement it deserves, the DHSS should urge the Treasury to make additional funds available to support and supplement local fund raising efforts — preferably on a pound-for-pound basis. It has suggested that, to start with, that support should be restricted to fund raising for DHSS projects and that it should be limited to a maximum support of £2 per person per year based on the district health authority's catchment population. It also believes that it should be restricted to projects that are part of long-term strategic plans. Such DHSS support would not be at the expense of a commitment to the proper funding of the Health Service; it would be a supplement to such funding, giving a new vital boost to self-help projects. The district health authority estimated that the maximum cost to the Exchequer would be £100 million per year, but the NHS would benefit by £200 million per year. That would enable projects to be funded much sooner than otherwise would be possible with the consequent saving of lives, especially those of cancer patients. I believe that that scheme has much to commend it. I hope that when the suggestion is discussed by the regional chairman and other district chairmen the Department will give urgent and serious consideration to the proposals. The people of my area have shown by their efforts their concern for the victims of cancer and their desire that more should be done. Therefore, they welcome—as I do—the Government's recent proposals for cancer screening, which will do much to reduce death from breast cancer as early detection can lead to successful treatment. The Government are to be congratulated on the steps that they have taken to increase and monitor the effectiveness and efficiency of screening. I very much hope that more people will be persuaded to come for ward for such screening. Now that I am fully restored to health it would be remiss of me not to pay tribute to the support I received, during a difficult time, from colleagues in all parts of the House, constituents, friends and relations. Everyone was kind and helpful. However, I could have managed without the headline that appeared in my local evening newspaper a few days before my operation which said, "Tories in by-election drama". I am glad that I was able to disappoint them.
I believe that the whole House echoes the closing remarks of the hon. Member for Hyndburn (Mr. Hargreaves). We are all very pleased when there is an escape from this fearsome type of reaper. We are indebted to my hon. Friend the Member for Glasgow, Springburn (Mr. Martin) for bringing this important motion before the House today. I believe that its terms are especially significant for those who have control of the country's resources — Her Majesty's Government.The motion highlights the importance of Friday debates. Most of our citzens are not aware of the difference between a private Member's Bill and a private Member's motion. These motions allow matters of great public importance to be aired in what is, after all, the forum of the nation. Even if the clash of cymbals and the trumpets of warfare receive prime attention in the public broadcasting of this place — I believe that that broadcasting does not give anything like a proper impression of the House's activities—motions such as this one, calling Ministers to account and highlighting the concerns of our constituents, are very important. There can hardly be a family in the land who is not, has not been, or may not be affected by this scourge of our modern life. Understandably there is a degree of reticence, sensitivity and, in some cases, fear in confronting and discussing the disease. For that and many other reasons, if not the extent and degree to which whole communities can be savaged by the disease, we must, as a nation, make its confrontation a matter of public endeavour. It is a matter not just for statutory agencies—important and fundamental though they are—but for professional skill and advice combined with the skill of voluntary agencies. It is the way that all those factors work together throughout and for all the nation that is important. It is a national matter. Therefore—without using the word "nationalisation"—it is a matter of public concern that must be dealt with at a national level by national public finance. Of course, that immediately puts the spotlight on the structure, funding, and strategy of the NHS. Those factors may be judged on how they bear on this problem. The strategy on preventive medicine and the link with voluntary agencies also has a bearing on the problem. Cancer care and cure can put its own X-ray on how the NHS and the voluntary agencies are tackling the problem. Such treatment and care brings the problem into focus and, as has been said by many hon. Members this morning, it is a matter not just of quantity but of the quality of care with which the Minister should be concerned. The hon. Member for Edmonton (Dr. Twinn) spoke of his fears concerning the new centres and treating people as numbers. The hon. Member for Broxbourne (Mrs. Roe) discussed breast cancer and pointed to the fundamental psychological importance of dealing with that particular complaint. It is a matter not just of pounds and pence, but of how they are deployed and the provision of personal caring services. Anyone can see how all this affects our constituencies. I make no apology for referring to Newham, the second most deprived borough in Britain, according to the quantitative criteria. Cervical cancer smears have been a matter of controversy for some time. My hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) has raised this as a public issue. There has been some response, but things have not gone smoothly in my constituency. The district health authority wished to improve its cervical smear services, but found that funds were not available to do so. There was correspondence, and disagreement, between me and the chairman of the North-East Thames regional health authority. I do not blame him for everything, because there are only limited resources at his disposal. But the funds that we wanted to improve cervical smear services were not available this year. We hope that they will be available in the forthcoming year. There was misunderstanding and an eruption of letters and publicity in the national and local press, which would not have been necessary if the issue had been sorted out. I suggest to the Government that relatively small sums spent in this area would have prevented the problems that have arisen and will prevent the problems that may arise. The money is needed to improve the callback facilities now on computer in most cases. This is not a dead issue, but I do not believe that the priorities are being properly addressed everywhere in the country. Even if the system becomes as perfect as we can make it, it depends to some extent on people being registered with general practitioners. It is estimated that up to 30 per cent. of the population in my part of London are not registered with a general practitioner. In those cases, however perfect the system, the recall facility will not operate. Such a system is particularly important for young people who tend to move often, and especially for young women it is a growing problem. The Forrest report's proposals for breast cancer screening have been given the headlines. I understand that the Royal College of Nursing and its breast care nursing forum have had a part to play in the spotlight which has now been directed to the problem. I understand also that the incidence of breast cancer is much greater than that of cervical cancer — up to 10 times greater. We need to know the figures.
It is 20 times greater.
I understand that it is perhaps 20 times greater. The Forrest report's timeliness is highlighted by what to some is an astonishing figure. Another astonishing figure is the cost of the report—£7·40. I understand that limited copies have been made available to district health authorities. This is just an example of our problems. I do not know the extent of distribution, but I believe that the report deserves wide circulation among district health authorities. I wonder how many copies have been sold at £7·40 a throw. The report and the implications of the Government's announcement last week have to be digested.I asked the Secretary of State for Social Services
I shall read the reply by the Under-Secretary of State for Health and Social Security — the hon. Member for Derbyshire, South (Mrs. Currie)—because it applies to more than 600 constituencies and all the district health authorities. The hon. Lady said:"what additional funds he expects to be allocated to the Newham district health authority in respect of his programme for cancer screening."
That means that my district health authority, which covers three constituencies, will have to battle with 10 or 12 other districts within the North-East Thames regional health authority if we are to set up what I understand from professional advice will be one pilot centre in one district health authority."Funds will be provided for a national breast cancer screening service to be established in England over the next three years on the basis of centres each serving a population of approximately half a million. It is for regional health authorities to decide in which districts the centres should be located and how the special allocations provided to establish them should be deployed. In 1987–88 each region will receive an allocation of about one third of a million pounds to cover the capital and revenue costs of establishing its first centre. Similar provision will be made for the remaining centres in the following two years."—[Official Report, 6 March 1987; Vol. 111, c. 723.]
We are implementing the Forrest report exactly as we were recommended to do. Within the next 12 months there will be one regional centre in each region. The Forrest report recommended that the best way for the screening centres to function from that time onwards was to have one centre to every two districts, and that is what we propose to do. Therefore, it is probably not quite accurate to say that the district health authority where the hon. Gentleman's constituency is situated would compete with 10, 12 or 14 other districts. Within the three years, as we get the full system, the hon. Gentleman's constituents will share the centre with another district. The centre may well be situated in Newham, or it may be elsewhere, but that specific decision will be taken by the regional health authority.
I am grateful to the hon. Lady. That again illustrates the usefulness of these Friday morning debates when we can obtain information on a leisured and accurate basis. I understand from what the hon. Lady has said that one district will not be favoured with a centre to deal with a population of 500,000, but that the centre will be set up by the region and will serve potentially all the population of the region. The hon. Lady nods her assent. But that will cause all sorts of problems. In the North-East Thames regional health authority, the centre, for geographical reasons, will clearly be somewhere in north-east London. Will it be in Romford, in Waltham Forest or in Newham? What is to be the system of referral? The potential demand would appear to be 10 times the provision, if the figure given by the hon. Member for Southwark and Bermondsey (Mr. Hughes) is correct. We shall get one centre serving a wide area, but 10 years of funding will be required to give a comprehensive service.Although we welcome this initiative — something being better than nothing—it is clear that the demand in the first year by general practitioners is likely to be almost 10 times the supply of the service, even given the centres that the Minister will provide. If that is correct—no doubt the hon. Lady will correct me if I am wrong—the Government's initiative must be put into perspective. I foresee problems of choice and of administration. As the hon. Member for Broxbourne said—I am glad to see her in her place again — breast cancer is a particularly difficult matter for the patient. I understand that the morbidity rate of those patients who are involved in treatment is up to 40 per cent. This brings me back to the issue of cancer counselling. The problem is just as much psychological as medical.
I am glad to see that the hon. Lady agrees.In the borough of Newham there is an excellent organisation which deserves to be better known, Cancer: You Are Not Alone—CYANA. It provides a meeting place and forum. It is a co-operative group, mainly of ladies who give support to each other, and it is an excellent arrangement. It is funded by the local authority out of its well-used rate support grant. I hope that it is not affected by recent developments. It is that sort of voluntary effort, funded slightly and given the seedcorn of public money, that we all applaud wholeheartedly. It is perhaps one of the best examples of a proper partnership between statutory and voluntary authorities. I move from organisations such as CYANA to the hospice movement, which has been mentioned by many hon. Members. We should be grateful for it, but the mere fact that it is a movement that has arisen from voluntary effort illustrates the fact that there must have been a gap in our professional and more customary statutory services in the first place. As the hon. Member for Southwark and Bermondsey said, we are all dying in one sense or another anyway, and dealing with that is a high proportion of the medical profession's task. We all know from our own experience that hospitals are there to cure, but sometimes the care of those who are beyond cure needs attention. It is in that area that the hospice movement started and where it has been so valuable. In east London, St. Joseph's hospice is well known, and the Macmillan services do excellent and praiseworthy work in homes, which is important. I understand from those involved that, contrary to some public impression, hospices are not only for those who are terminally ill. The condition of many of those who suffer from cancer can be stabilised. Stabilisation can be for a long period, perhaps after two or three short return visits to the hospice. So the hospice movement is for those not just nearing the autumn of life, but for those who may be given life again. That is why that movement and the home care services that the associated nursing staff give arc so important. We all know that the alleviation of pain and the amount of tranquillity that can be achieved by those suffering from cancer are important. That has been referred to several times by hon. Members. The tranquillity and philosophy that some people display are an example to us all. However, the services of those who go out from hospices, treat the patients and counsel their families are fundamental in the hospice movement. I understand that there are some difficulties. A hospice's beds cannot always be used. In some hospices, a proportion of beds are empty. Why is that? It is partly because the necessary voluntary funds may not be available, but there is an additional constraint. If someone leaves the hospice—many do for nursing care at home—domiciliary support nursing is necessary. In some cases it is provided by the district health authority with the help of public funds. However, where those funds are not available, or where there is an imbalance between beds and nursing facilities, those beds cannot be used. Therefore, I ask the Minister to undertake to look at the problem. I do not think that she will give an undertaking immediately, but I think that she can undertake to look at the problem. I should have thought that it is right and proper for the NHS to say that where hospice beds can be funded by voluntary sources, the NHS, through the district health authority, will provide the necessary domiciliary skilled Macmillan-type back-up to enable those beds to be fully used. It would be a scandal, voluntary agencies having established hospices, for those beds not to be used because there was insufficient public backing to make them usable. I hope that if that problem exists it will be rapidly eliminated. We have heard much recently about the strategy of regional health authorities in respect of cancer treatment and detection. Nowadays funds are often devoted to spectacular medical cures. We must look at the balance between the funds established and maintained for those purposes and those of cancer detection, stabilisation and cure, because, as has been said time and again, that disease is one of the major killers. Recently a horrific disease has received an enormous amount of publicity, but we must remember that the majority of people suffer even more through the disease of cancer. What of them? We must make sure that we get things in balance, otherwise we, as public representatives or people involved in the medical profession, will be found not to be doing our duty. What about preventive medicine? It is one of those things to which people pay lip service, but they do not necessarily take a great deal of action. There is a welcome movement of well women clinics. A great deal of our discussion today has been about cancer in women. What about well men clinics or well person clinics? We in the House are privileged because at three or four-year intervals check-ups are available to us. Why are they not available to the whole population, if necessary? Surely we in the House should not rest until such comparable facilities are available easily for every person who wishes to use them. What about the role of general practitioners? Do we pay sufficient attention to the epidemiological techniques of finding out causes not just of cancer but of environmentally linked diseases? What about the role of the medical officer of health? I do not believe that he exists now. Many years ago I remember hearing anecdotes from an elderly doctor who was a medical officer of health. He said that the best tools of a medical officer of health were a sharp pair of eyes and a sniffing nose. We have community physicians. They are also concerned with the scourge of cancer. But do we give them the proper prominence in our district health authorities and community health councils? Those are relevant questions. What about the role of family practitioner committees? Are they only committees operating the contractor relationship between medical practitioners and the community? We in east London have problems of coverage, with the hours that general practitioners' surgeries are open and the number of visits that they can make. On today's Order Paper, as the Minister will know, there is a modest Bill arising from deficiencies in that respect. Do we say to our family practitioner committees, "You have a role in the detection, prevention and cure of cancer through the general practitioner services."? We have all heard of colleagues who have suddenly become ill, gone to their general practitioner and found that the disease is well advanced. What role can general practitioners play in preventing or producing preventive measures to stop that happening? It is possible that not only hon. Members but the entire nation have inverted priorities about such matters. This debate, initiated by my hon. Friend the Member for Springburn, has enabled those issues to be aired in the place where such matters should be aired. The treatment and care of cancer patients is the responsibility of the entire nation. It is the responsibility of us all to ensure that we encourage the whole person. The nation, through public, voluntary and private means as well as family sacrifice, should encourage those who are less fortunate than hon. Members in the Chamber today.
I am spurred to make a small contribution to the debate by the quality and the scope of the speeches that I have heard. My hon. Friend the Member for Newham, South (Mr. Spearing) referred to the medical surveillance scheme that applies to Members of Parliament at the moment. I am grateful to my right hon. Friend the Member for Blaenau Gwent (Mr. Foot) whose House of Commons (Services) Committee accepted the arguments that were put forward by the hon. Member for Reading, East (Sir G. Vaughan) and myself after two years work, and instituted the medical surveillance scheme, which is working extremely well. Such a scheme could be considered for every section of the community and population. Indeed, it is being implemented in some places.My hon. Friend the Member for Glasgow, Springburn (Mr. Martin) has done a service in terms of the scope and priorities that he envisages in his motion, which sets out clearly the way in which a civilised community should think about the disease of cancer. The horror and terrifying power of the disease have been triggered in my mind. In science and medicine, one can encounter horrific injuries and diseases of various kinds, where people are badly affected, but the body mechanism helps the patient. Often natural help, without invasive help from the medical profession, can bring that person to perfect health again. However, in the case of cancer, it is incredible that a little spot or blemish on one's skin—often the size of a pin head, if not smaller—can develop into a condition that kills the whole human organism. The mind boggles at the ability of the disease. When I was a medical student, progress was just beginning to be made into antibiotics against infectious diseases. When we learned about Dr. Paul Ehrlich's magic bullet, we thought that infectious disease could be controlled by vaccination, inoculation, or the giving of antibiotics or bacteriostatics. Bacteriostatic and bacteriocidal medicaments have been given different names at different times. That area of research not only showed promise, but lived up to that promise. There are few infectious diseases now that are not preventable or curable. However, cancer does not fall into that category. As a medical student, I felt that the cure or prevention of heart disease and cancer were the two problems that remained to be conquered. Unfortunately, in the last few years, we have seen another one, which bears a strong relationship to cancer. The way in which the AIDS virus, HIV, works is similar to what happens to the human cell in cancer. That is why there is considerable evidence that some cancers and leukaemias are viral in their origins. Although the state of medicine and science at the moment in relation to curing the disease is not static—it is making slow progress—at least one can say that there is a much greater understanding of what causes cancer. As it primarily affects the older members of the population and as people are enabled to live longer, we expect the incidence of cancer to increase. Indeed, with the better methods of diagnosis in the past 25 years one would also expect an increase in the number of cancers. Fortunately, advances towards cures have been made in science and nursing. It is difficult to speak of "cures" because the disease may appear to be cured, but can recur or break out anew many years later. The Forrest report is excellent in the limited but extremely important matter of mammary cancer. Incidentally, that can also affect men and, perhaps, men as well as women should be screened. I have seen one such case in my lifetime; the incidence is not great.
I can confirm that breast cancer is not confined to women. I understand that about 100 men a year die from breast cancer, but that pales into insignificance beside the 15,000 deaths a year of women. At present, our plans are directed wholly towards women which I hope the hon. Gentleman will accept.
I accept that entirely and have no objection to it. It is one of those little matters that sparks in one's mind as we are now in an era of equality of the sexes. The point is well made and I take it.My hon. Friend the Member for Springburn has done a great service bringing his motion before the House and I wish to say a few words about prevention. Cancer is common and accounts for almost a quarter of all deaths. That figure is fairly constant in most parts of the world, certainly in developed countries. There is a variation from 22 per cent. to 25 per cent. As the disease is difficult to cure, it is incumbent on us to prevent it where possible. I cannot make a big enough plea for people to forget the propaganda that cigarette smoking has not been proved to be the cause of lung cancer. It depends on what is meant by proof. Sometimes it is not easy to juxtapose cause and effect and to reach a conclusion. Evidence has been accumulating for a long time. The Doll report was published in 1956—that is 31 years ago—and I stopped smoking then. After about 10 years, many doctors had stopped smoking and the incidence of lung cancer among them fell. It falls after a period in every group which smokes less. That cannot be coincidental. Since cigarette smoking is responsible for many conditions in addition to lung cancer, that should be a strong incentive for people to stop smoking. I do not favour a complete ban on cigarette smoking, if for no other reason than that it would be impossible to effect. However, I am certainly in favour of a complete ban on smoking in all public places where others can be affected. There has undoubtedly been an increase in the incidence of cancer through passive smoking and inhaling smoke. I invite colleagues on both sides of the House to do everything in their power to ensure that all efforts are made to reduce the areas where smoking is permitted and to hammer home that message. It is, as it ought to be, the norm not to smoke. Two thirds of the population do not smoke. About 25 or 30 years ago 75 per cent. Of the population did smoke and, therefore, the message is having a great effect. We should not be lulled into any false sense of security by those who say that the relationship between smoking and cancer has not been proved. I again commend the efforts of my hon. Friend the Member for Springburn and other hon. Members who have contributed to the debate. As my hon. Friend the Member for Newham, South (Mr. Spearing) said, there is something different about Friday debates. I suppose it has been going on for years—one forgets that it happened in the past — but certainly in recent years Friday's debates have been excellent, not only in the subjects discussed but the contributions made by hon. Members and, not infrequently, the responses from the appropriate Ministers. I ask the Minister who is to reply to pay particular attention to the terms of the motion and to the points of view that have been expressed by hon. Members. I should say to the hon. Member for Hyndburn (Mr. Hargreaves) that I, too, feel a sense of elation when someone escapes the evil of cancer. I am sure, from the type of condition he had, that he will live a full life without any great problems resulting from his operation. I wish him all the best in the future.
I should like to congratulate my hon. Friend the Member for Glasgow, Springburn (Mr. Martin) on his good fortune in winning the raffle and our good fortune in him choosing topics relating to cancer as the subject for debate. There have been many interesting contributions, including those from Opposition Members, but I hope that they will not take it amiss if I say that the most touching contribution was made by the hon. Member for Hyndburn (Mr. Hargreaves) who drew on his own experience. It was moving to hear the hon. Gentleman describe and pay tribute to those who helped save his life. I felt that he showed admirable levity in the matter which I am sure I could not have displayed had I undergone the same experience.What he did and said should be taken as an example to show that there are many cancers which, if caught in time, can be treated, and that people can lead entirely full and happy lives thereafter. That is one of the most important lessons that can be drawn from the debate. Despite, at one level, many people understanding that that is the case, at another level there are large numbers of people who feel that the mention of the word cancer is a death sentence and give up. Giving up is no way to survive. I am not suggesting that one can overcome some types of cancer by sheer willpower, but without it it is difficult to benefit from the medical and surgical help available. Cancer, as we know, is a major individual cause of deaths in Britain. There are questions that must be asked. Are we doing all we can to carry out useful and productive research into finding out what causes it and what can be done to prevent it and treat it? Are we taking measures to prevent cancers? Are we taking measures to treat cancers and are we taking the necessary steps and providing sufficient resources in a proper form to help those who are trying to deal with that suffering? With regard to prevention, it is a plain fact that the major preventive action that could be taken in this country is a really substantial effort to stop people from smoking. There was publicity this week about a National No Smoking Day or whatever it was called. However, our effort in relation to the problem is quite trivial. We are just playing with the matter until we do something about the advertising and promotion of cigarettes. By doing something, I mean doing something nasty about the advertising and promotion of cigarettes. Smoking kills 100,000 of our people a year. Not all of them, by any means, die of cancer. Nevertheless, smoking kills 100,000 people a year. It follows as night follows day that the cigarette industry must recruit another 100,000 smokers to make up for those it has killed. That is a plain fact and the industry sets about its task in a skilful way. It knows, for instance, as we all know, that very few people take up smoking for the first time after the age of 20. Consequently, the bulk of advertising and promotional activity by the cigarette industry is directed at young people and, because young women, at least until recently, had smoked considerably less than young men, that activity has been directed particularly at young women. The cigarette industry is pretty successful at drumming up people to buy its deathly product. I do not believe that any amount of sincere efforts by some Ministers in the Department of Health and Social Security to get people to stop smoking is likely to have the necessary effects to bring about the required reduction. There is now a class bias in smoking in the sense that the relatively well off and well informed have tended to give up smoking while those who are less well off and less well informed have tended not to give it up. In health education, there has always been what I have previously described as the "too much of the Habitat and not enough of the Tesco" approach. We have been quite good at getting the message across to people who, roughly speaking, are pretty well informed in the first place. However, we have been pretty lousy at getting it over to those who are not well informed to begin with. The best way to get the message across is the Labour party policy. I am glad that this policy has been adopted as it involves prohibiting by statute all forms of advertising and promotion of tobacco products. That, and only that, will bring about a substantial reduction in the capacity of the cigarette industry to recruit more people to kill. We must stop that recruitment. Screening women for the signs of the early stages of cervical cancer has been called prevention, although I do not believe that it is really prevention. Perhaps I should refer briefly to attempting to prevent cervical cancer. There seems to be considerable evidence now that cervical cancer in women is caused by small genital warts in men. Therefore, if the Government's campaign to get people to wear condoms as a method of contraception is successful, that may have the side effect of reducing the incidence of cervical cancer. There is some evidence that barrier forms of contraception will reduce cervical cancer. Further studies should be carried out to verify the evidence that has been brought forward to date about the causes of cervical cancer so that we can set about preventing it rather than just having the early warning system in the screening process to treat the early signs of cervical cancer. In 1981, the Government's committee on gynaecological cytology advised them to introduce computer-based call and recall cervical cancer screening schemes in every district health authority in England and Wales and every health board in Scotland. The Government did not do very well on that, because when they allegedly passed on the committee's advice to the health authorities they missed out the vital aspect, which was that they should introduce a call system as well as a recall system. It was not until 1985 that the Government got round to advising health authorities that call was a vital aspect of the committee's recommendations. In a parliamentary answer to me on 6 November 1986 — I always attach great weight to the accuracy of parliamentary answers — the Government claimed that this time last year 33 of the 191 health authorities in England were operating cervical cancer call and recall schemes. The answer went on to say that, of the 158 health authorities that had not implemented such schemes as at 31 March 1986, 76 planned to do so by the end of this month. In pursuit of truth and justice, I asked my secretary and someone else who works for me to telephone those 76 health authorities. The parliamentary answer of 6 November was confirmed as recently as February by the Secretary of State in his statement on cervical and breast cancer screening and AIDS research. I do not accuse him or anyone else of lying, because that would be out of order and, in any case, it may not have been his fault. However, I accuse him of not checking the accuracy of what he asserted. Up to this morning, my staff had managed to contact 56 of the health authorities and discovered that no fewer than 42 do not yet operate call and recall schemes in their areas. Darlington expects to have such a scheme by April this year; East Cumbria by July; Gateshead by September; Tyneside by April; South West Durham probably later this year—whatever that may mean—and Dewbury in April. Leeds, Western might do it by 1988–89. Northallerton hoped to have a partial recall scheme, but no call scheme, in operation by the end of 1987. Scunthorpe said that it hopes to have a system by the autumn of 1987. Wakefield says June this year. Leicestershire said that such a system was imminent, which is bureaucratese for mañana. Nottingham says within the next few weeks, while Norwich and West Norfolk hope to have the system by July this year. East Surrey, Kingston and Esher, Mid-Surrey, North-West Surrey, South-West Surrey and West Surrey and North-East Hampshire say that the hardware has just been installed and that they hope to have a system in operation by March 1988. Bath says that one third of its area which is covered by one family practitioner committee has coverage, and it hopes that the other two thirds will be covered "fairly soon" and "a bit later" — whatever that may mean. Southampton says that it will have a scheme by June or July. Aylesbury Vale says that it hopes to have a scheme working by September 1987. Kettering says July or August. Milton Keynes says September. Northampton says that the first patients might be called in September. Wycombe says that its scheme will not come on stream until it has had time to evaluate the results from Aylesbury Vale. The House will recall that Aylesbury Vale says that its system will be in operation by September this year. Bromsgrove says it hopes to do it by April. The great city of Birmingham with five health districts says that it hopes to have one pilot scheme—not a proper scheme—in operation and that the other four are still at the planning stage. North Warwickshire says that it expects to start calling patients, but not before June. Herefordshire says it will be in operation there at the end of 1987. Five health authorities in Cheshire—Chester, Crewe, Halton, Macclesfield and Warrington—that had promised to have it in operation by the end of this month say that it will now be April. Tameside says that the first patients will be called in September or October, Bury says August, and so it goes on. I expect that the people on my staff will by now have just about completed getting in touch with the other 20 out of the 76, but on the strength of what they have found so far they will not find that many of the health authorities which we were promised would have schemes in operation in this financial year will have them in operation. That is most disturbing but, I am sorry to say, it is typical of the Government's treatment of this issue. Ever since 1981 when they received the advice from the committee on gynaecological cytology, their response to the report and to the proper implementation of these vital schemes has been slipshod, to say the least. That is a disgrace. We know that women will die as a result of this slipshod attitude by the Government. Perhaps in slightly less offensive tones it appears that The Lancet shares our view, because talking about the Government's proposed initiative on breast cancer screening the issue of 7 March says:
It does not amount to making mistakes, because the Government have not been making much of anything and certainly not making progress. We need further progress if women are to be saved from cervical cancer. One of the problems is that, although the Government have rather late in the day issued instructions to health authorities, they have never given them earmarked funds with which to do the job. Health authorities in London that I know have been faced with the choice of introducing a cervical cancer screening system or continuing to fund cardiac surgery for the last month of the financial year. I cannot blame those authorities if they choose to come down on the side of keeping cardiac surgery going. I blame the people who are not providing them with the funds, especially funds that are earmarked for these purposes."'standards must not be sacrificed to expediency. The UK has a poor record in the organisation and management of its cervical cancer screening programme and the same mistakes must not be made again'."
The figures that my hon. Friend has quoted are disturbing. It is important that the suggestions made by my hon. Friend should be taken up. In my native city of Glasgow when I was a councillor about 1956–57, the health committee instituted a massive radiography campaign. Glasgow had about four hospitals devoted entirely to the treatment of tuberculosis, but within 12 months we were able to close them all. We detected every case of tuberculosis and treated patients with the modern drugs available at the time, and were able to wipe the disease from the face of Glasgow.
I accept what my hon. Friend says. If the right amount of effort is put into screening and it is properly carried out, it works to great effect.One aspect that bothers me is that the Secretary of State in his February statement about breast cancer screening said that he was ensuring that a close watch was kept on progress with cervical screening because the Government wanted to increase the takeup. If the Department has not sufficient grip on the situation to know whether anything or nothing is being done, its chances of discovering the takeup rate in the minority of health authorities which have introduced screening must be very small. Staff from my office rang around to discover the takeup rates. The lowest rate given was 40 per cent. in Manchester, where the authority had at least kept tabs on how many women responded. That figure is nothing like good enough. We must put far more effort into achieving a greater response. In parts of Scandinavia the response rate is 90 per cent. or more. Until we can achieve that level in this country, the situation will remain unsatisfactory. Even more disturbing than the figure for Manchester was the fact that most authorities with schemes in operation could not even give the response rate because the system did not make it possible. Clearly, insufficient attention is being paid to the aims of the scheme. The Government promised to publish the Forrest report in December, but they did not get around to it until February. Their response, as far as it goes, has been welcomed by most people but, given the rag-bag situation in relation to cervical cancer six years after the equivalent report was published, every woman in this country and every man who cares about women's health must look with a jaundiced eye at the Government's promises about breast cancer screening. I do not usually seek to disagree with the recommendations of an expert committee, but I have doubts about some of the Forrest recommendations. For instance, it is proposed that breast cancer screening should be confined to women between the ages of 50 and 65. I understand the reason for that. It is because there is a high incidence of breast cancer among women in that age group and technically it is relatively easier to use mammography to find lumps which may be cancerous, so there is a good pay-off in relation to the effort involved. Many people, however, want the age limit brought down as soon as technically and humanly possible so that women of 35 and 40 can also be screened. There is one recommendation with which I disagree completely. It relates to the screening of women over the age of 65. Of all the 10-year age groups, women in the first decade above 65 have the second highest incidence of cancer and are extremely vulnerable to breast cancer. The explanation for the Forrest report recommendation that nothing should be done for those women is not that it is technically difficult to find the lumps and carry out the necessary diagnosis, but that women over 65 do not come forward very much for screening. I do not know how anybody knows whether they come forward very much because there is scarcely anywhere where they have had an opportunity to come forward. More and more people, especially women, are living longer, and most women of between 65 and 75 regard themselves as perfectly normal and entitled to any treatment that is going for younger age groups. I think that they are right. The other explanation put forward by the Forrest report is that women between the ages of 65 and 75 may die of something else. So they may, but the object is to so stop them dying of breast cancer. The Government should reconsider the upper limit recommended by Forrest and ask why on earth there is a cut-off point when, perhaps with a lot of effort, we could save about as many lives in that age group as among those aged between 50 and 65. Implementing the Forrest report properly will require a considerable and consistent commitment by Government during the next few years, but it is not just a matter of buying a few X-ray machines, although practically every part of the country will need new machines designed and earmarked to screen symptomless women. Moreover, practically every part of the country will need new or newly adapted buildings because, by and large, symptomless women should not be screened in the same units as women who have been referred for mammography by a doctor who thinks that there is something wrong with them. For many reasons the service should not be provided in part of the ordinary X-ray unit. Staff are even more important than machines and buildings. It is a disappointment that the Government received the interim report on Christmas eve 1986 and that nothing has yet been done to identify the staff who must be recruited, trained and put in place if we are to have a proper breast screening system. Although Forrest's final recommendations were not known then, they were fairly predictable, and the Department should have done far more, in consultation with the professions and the health authorities, to get on with the work in anticipation of the report's likely recommendations. Not much has been done on that score, even on what might be described as the technical side. There is another aspect of the Government's response to the Forrest report which does not have the emphasis right. As the hon. Member for Broxbourne (Mrs. Roe) rightly said, women's breasts are precious to them, and there are all sorts of psychological problems and fears about having anything done to them. Neither Forrest nor the Government's response give sufficient attention to the need to recruit and train nurses throughout the country to give proper psychological advice to the 50 out of 1,000 women who show some signs that they require further attention after being screened and the three to six out of those 50 who may require an operation. Those 50 women will suffer massive psychological problems until they can be assured that they do not need treatment, and even more massive psychological problems will be suffered by the limited number of women who will need treatment. The Forrest report does not give sufficient weight to deploying staff to give that psychological help and counselling, nor to giving women the necessary information and confidence to have a bit of a say in how they will be treated. Everybody agrees that that is a welcome and useful development. I said that I did not like criticising official technical reports, but the organisation that Forrest has proposed is probably the most dubious aspect of the report. The history of the cervical cancer screening system shows how immensely difficult it is even when each health authority is under an obligation. If we are now saying, roughly speaking, that there will be one local breast cancer screening unit for every two health authorities, the potential for argument, dispute, local petty jealousies and delay is immense. There will be arguments about where the unit should be located, who will provide the back-up, and such matters. It makes me cringe to think of the potential delays. We all know of the degree of rivalry between various hospitals, between people who have been to different medical schools and between consultants who have not spoken to one another for 20 years. There is a danger that local jealousies and so on will delay and foul up even the regions' decisions as to where the major regional centres will be. I ask the Minister to consider—not necessarily in reply to the debate, because considered responses are better than ones made on-the-hoof as an immediate response to something that someone has said—whether the Ministry needs to lay down from the centre who will have operational responsibility for each scheme. The only way in which it can do that is to earmark the funds for each of those schemes on the first instance, and not ask two, three or four health authorities to have a barney about who will do the job and an even bigger barney about who will find the money to do it. There is a great potential for delay in that.
I touched on this issue in relation to the North-East Thames regional health authority. Is my hon. Friend suggesting—in an army analogy—that, although a regional health authority might be attached to a district for pay and rations, it should be responsible for strategy, funding, operations and regional priorities?
Not quite. Often, the existence of the regional tier is used as an excuse for irresponsibility by Ministers and district health authorities. If my hon. Friend asks Newham health authority why they are not doing something, it will say, "The region has not given us the money." If my hon. Friend then complains to a Minister that Newham does not have the money, the Minister will say, "That is an autonomous decision of the North-East Thames region." In this case, if we attach as much importance as we should to the proper, effective and swift introduction of a breast screening system, then we should not have any confused responsibilities. Either Ministers or the local health authorities take the hammer. No intermediary should be hanging around, confusing matters.There are in England almost the same number of family practitioner committees as the number of units recommended by the Forrest report. As those committees will be the basis of the call and recall system, because they should possess age-sex registers and the necessary computers, perhaps the Minister and her officials could consider—I do not ask for an instant response—whether it would be sensible to base the local centres on family practitioner committees. That would get round the problem of arguments between districts. I emphasise that we cannot expect women to suffer the delays in breast cancer screening that they have faced in cervical cancer screening. I do not wish to be controversial, but I cannot agree with the endorsement of the hon. Member for Broxbourne of the role of the private sector. It is crucial to ensure that all women are covered, and the only organisation that covers all women is the NHS. In addition, the private sector does not appear to have the necessary capacity to follow up some of its work. BUPA's medical research outfit—if we can call it that—said:
Only 63 per cent. had been traced. If the private sector does not have the age-sex registers, the computing capacity or the localised base of family practitioner committees, it will always be in that position. I fear that a number of women will go to the private sector, in the absence of a proper NHS scheme in their locality, and will get lost to the system. We need a proper, comprehensive screening system rather than a lot of bits and pieces. The hon. Member for Edmonton (Dr. Twinn) spoke about the organisation of the treatment of cancer. The North-East Thames regional health authority, which serves one quarter of London and south-east England, carried out a review of its major cancer treatment centres. Many doubts were expressed about that review and the report produced by Coopers and Lybrand was a disgrace to the management consultancy profession. It was denounced not just by me. but by several Conservative Members, not because they disliked its conclusions, but because it was slipshod and inaccurate. A few weeks after the report was issued, the regional authority was forced to issue two and a half or three and a half pages of corrections—not of typing errors, but of facts. Some centres that were said to have linear accelerators or simulators did not have them, and centers that were reported as not having such equipment did have it. The regional health authority paid £80,000 for that load of rubbish. I am glad that it ignored almost all the recommendations and set up a little working party of its own, which produced better-founded, if not more acceptable, conclusions. The original report, referring to the incidence of cancer in the region, produced figures that differed from those of the Office of Population Censuses and Surveys, which is normally an accurate source of information. It even predicted a lower work load for the new centres than that currently carried out by the existing centres. It appeared to suggest that, in some way or other, the review would crack cancer in North-East Thames region. It also produced alternative travel times from various places to various centres. I believe that those estimates were denounced by the hon. Member for Hornchurch (Mr. Squire) as plain wrong. I will go no further. Suffice to say that people were extremely dubious about the report. I feel somewhat responsible for what happened next. As some of the centres for North-East Thames are located in London, I did not believe that it would be a sound thing for North-East Thames to review its major provision without considering what would happen in the other three Thames regions — North-West Thames, South-West Thames and South-East Thames. I asked Ministers whether they would consider urging the four health authorities to get together or whether they might hold the ring, intervene and require an overall review. Ministers refused to do so, but the regional health authorities, after a fashion, did it themselves. The only disturbing feature was that the authorities employed Coopers and Lybrand to advise them. North-West Thames region stated:"We have attempted to follow up the 86 women who were found to have abnormal smears at the BUPA Medical Centre in London in 1982 but despite letters and telephone calls have been able to trace only 54".
I believe that that is the smallest commendation that can be made for the review team. Having made one shambles, it was invited to produce possibly three other shambles for the other three Thames regions. However, we all learn from our mistakes—I make as many as anyone and I try to learn from them — and perhaps Coopers and Lybrand will attempt to learn from its mistakes. Perhaps it has. I am disturbed because South-West Thames region told me that it had commissioned Coopers and Lybrand, which for the purposes of the review for South-West Thames, is assuming that the plans already prepared in North-East and South-East Thames regions will be implemented. That is absurd. The object must be a thorough-going, proper review of provision throughout the four regions rather than to assume that the ones that have got off first will stick by their proposed plans, especially as the proposals in North-East Thames have been changed a number of times. Those proposals have gradually improved, but not enough. My other objection to such a process of review is that all such reviews have pre-supposed that no more resources are available for major cancer treatment centres in any of the regions. I do not believe that that is the proper approach. The four Thames regions should have got together to set up a small unit consisting of members from each region. That unit should have produced a review of the provisions it believed would be necessary. The regions should have then asked for the money that they believed was necessary. They should not have supposed, "We will not have enough in the first place, so let's bodge around and see what we can do to get near to a scheme which will do as good a job as possible with the money that is available". That is the wrong approach. It is certainly the wrong approach at a time when the Government are contemplating giving as much as a 4p in the pound tax cut next week. If there is enough money to contemplate taking twopence off income tax, surely to God we have enough money to allow the British health authorities to decide what they believe will be needed to treat cancer properly and find the money for them to do so. The Opposition support the call for more effort to be put into cancer research. The shortage of funds—I shall not call them "cuts" in case it causes offence—within certain health authorities where practical clinical cancer research is being carried out is having an impact on that research. To provide additional nursing to carry out the various bits of clinical experimentation to deal with cancer research at St. Bartholomew's hospital, the health authority provided additional nurses on top of the money that the Imperial Cancer Research Fund provided. The authority has said that it can no longer afford to provide the additional nurses. It will continue to fund the ordinary level of nursing, but the extra level of nursing provided in the Kenton children's ward at Bart's will have to be met by the ICRF. As well as directly funding the research, the ICRF is expected to fund part of the nursing. That is characteristic of what is happening all over the country. There must be continued research efforts. We need to do more to prevent cancer and to screen people. We clearly need to do more and to do better in terms of cancer treatment so that everyone can be properly treated by people who have the necessary resources and necessary capacity to care. I am delighted to see that that care was deployed to such good effect on the hon. Member for Hyndburn. I hope that that will be an example to everyone. A number of hon. Members, including my hon. Friend the Member for Newham, South (Mr. Spearing), have mentioned the hospice movement, which developed in the voluntary sector and has set an example. Although my hon. Friend rightly said that people who are not terminal cases sometimes stay in hospices and benefit from that stay, a curious fact emerges. People looking at the system without knowing what has happened might think that it is wrong to establish a place where one basically goes to die and feel that it is an artificial and possibly unpleasant place to go. But it is clear that if a place sets out to provide the atmosphere, care and concern that characterises the hospice movement, it succeeds better in helping people to cope with dying and in helping their relatives to cope with death than does a general hospital, where other activities are occurring all the time and which, even with the best will in the world by the staff, are not geared for the sympathy, kindness and cajoling that goes on in a hospice. We welcome the development of the hospice movement. We should like it to be extended. It is right and proper that the Health Service should take on its share of providing hospice care, particularly when a number of small hospitals here and there are no longer needed for acute treatment or for treatment that has gone out of fashion or is no longer needed. The NHS should take up the baton — but not take it out of the hands of the voluntary movement—and provide hospices. I am grateful to my hon. Friend the Member for Springburn for choosing this subject for debate. Not every debate is of particular benefit to the people of this country, but I hope that at least some will draw some benefit from the products of this one."Coopers and Lybrand are conducting the four reviews, building on the methodology developed for their review of services in North East Thames, and maintaining continuity in the membership and expertise of the Review Team they have engaged to undertake the detailed review."
I apologise to both Front Benches for my late arrival to the debate. I gave prior notice that I would be late. I launched a mobile surgery in my constituency this morning, but, as it was Friday the 13th, I was not helped when a tyre on my car burst as I was going through Whitechapel about an hour ago.I commend the hon. Member for Glasgow, Springburn (Mr. Martin) on choosing this subject for debate. I wish that it were not necessary, but there is no doubt that cancer is well known to all hon. Members. We have all known someone who has had cancer, and we all have friends and relatives who have been affected by the disease. Unfortunately, I did not hear the speech by my hon. Friend the Member for Hyndburn (Mr. Hargreaves), but I well remember the personal trauma that he experienced when he was told that he had cancer. I went to see him in hospital, and I join him in congratulating all the staff and people who looked after him at Accrington Victoria hospital. There is no doubt that he owes his life to that hospital, with the excellent care that was provided. The subject that I wish to bring to the attention of the House is on two fronts. It is all about the care and treatment of cancer patients. I wish to bring to the House's attention a document produced by the North-East Thames regional health authority, entitled "A Better Cancer Service". The hon. Member for Holborn and St. Pancras (Mr. Dobson) commented on it. I wish to bring that document to the attention of the House because it has caused grave disquiet throughout south-east Essex. In the introduction we are told:
"Cancer occurs when cells in tissues and organs of the body get out of control. They divide and multiply and form tumours. The smallest tumour detectable by the most advanced diagnostic equipment might have as many as one thousand million cells.
The introduction concludes:Surgery or radiotherapy, or the two combined, will often halt the spread of a tumour—the first by removal of the affected area, the second by the destruction of the cancer cells with high-voltage x-rays. Nevertheless, some of the cancer cells may already have invaded other parts of the body."
The document goes on to outline the authority's proposals for improving cancer care services. The Government have adopted a most serious and responsible attitude to the treatment of cancer patients. I am delighted with the amount of money that they have committed to the long-term task of trying to find a permanent cure for that horrific disease. In the interim, we must concentrate on how best to treat it. For the people of south-east Essex, the best way to treat cancer patients in our area is to leave alone the excellent facility that we already have at Southend hospital. I realise that my hon. Friend the Parliamentary Under-Secretary has already answered an Adjournment debate on that subject. The constituents of seven right hon. and hon. Members are served by that facility. I refer to my right hon. Friends the Members for Castle Point (Sir B. Braine) and for Southend, West (Mr. Channon), my hon. Friends the Members for Southend, East (Mr. Taylor) and for Billericay (Mr. Proctor), the hon. Member for Thurrock (Dr. McDonald) and, last but not least, my hon. Friend the Member for Rochford (Dr. Clark). In Basildon, more than half of the people who are diagnosed as suffering from cancer receive treatment from Southend hospital, which provides an excellent facility. Frankly, we were horrified by the proposals put forward by the North-East Thames regional health authority to take that excellent facility away from Southend and move it to Harold Wood. The report in page 11, appendix 3, states that the longer travelling times would cause grave anxiety to patients treated with radiotherapy. We all understand that the longer radiotherapy treatment continues, one often begins to feel sick. Longer travelling times cause great trauma, not only for the patients but for their friends and relatives. The travel time to Harold Wood would be far greater than that to Southend for most of the residents of south-east Essex. Southend has more travel arteries leading directly to it and also facilitates easier transit, whereas, from most places in Essex, one has to change trains in Southend to reach Harold Wood. I emphasise to my hon. Friend the Parliamentary Under-Secretary that, when the matter goes before the Secretary of State, the proposal has nothing to do with resources or cuts. In fact, it will cost an extra £4·5 million. That is why we cannot understand it. The facility that is suggested at Harold Wood will be very expensive. The ancillary services of Southend hospital are quite removed from Harold Wood and the co-ordination of those services would present personal expense as well as difficulty. My hon. Friend the Parliamentary Under-Secretary of State knows only too well that our local newspaper, the Evening Echo, has been most responsible in launching a powerful and effective campaign to mobilise the people of south-east Essex in support of that excellent hospital. Only last week, we arrived at Westminster in an open-air double decker bus. We went round Parliament square four or five times before arriving at No. 10 Downing street. A petition, signed by more than 100,000 people, was presented there by six cancer patients, all of whom are currently receiving radiotherapy treatment at Southend. We are all determined that that excellent service should be retained at Southend. I know, from what my hon. Friend said in a Adjournment debate, that she is not in a position to comment in detail until the decision goes before her right hon. Friend. However, this is a gentle signal to say that our resolve is as firm as it could possibly be. We have an excellent service that has the confidence of all the people of south-east Essex. Under no circumstances do we want it removed to Harold Wood for the extra expenditure of £4·5 million. The final point that I should like to make relates to the role of hospices upon which the hon. Member for Holborn and St. Pancras touched. I am delighted that we have a hospice movement in my constituency. About two years ago, the Cox family, together with some friends, local doctors and nurses, decided to build a hospice in Basildon. The development corporation — now the new town commission — was most co-operative in more or less giving them a converted farm house. In just two years we have raised £280,000. We have not asked and are not asking the Government for a penny. We raised that £280,000 through voluntary work. Until then, we did not have a charity in Basildon. Through the St. Luke's hospice movement in my constituency the entire town and district have rallied round in fund-raising activities to raise that huge amount of money. The large thermometer outside the hospice shows that we are only halfway there. I need help from my hon. Friend the Minister, and particularly from Treasury Ministers, with whom I have raised the matter. In last year's Budget the Government took a specific line to encourage businesses to make donations to charity. I understand and support the argument for it. We would like the Treasury to waive VAT payments on the added expenditure involved in the conversion of the farm house. That would save us £140,000, which is a considerable sum. Therefore, I ask my hon. Friend to raise that matter with a Treasury Minister. The plan is for St. Luke's hospice to have an eight-bed facility for patients. Statistics from similar institutions give the approximate stay of each patient as being about three weeks, in which case St. Luke's will be able to treat 140 inpatients a year. However, the hospice will not stop there. It has plans for a day-care facility for those who are well enough to remain at home but would like or need to spend an occasional day in a nice environment. It would also be a place of rest for patients after threatment but before the journey home. It wants to operate a home-care team who will visit the homes of patients who are well enough to remain at home, but not to travel. Patients will certainly not be well enough to travel if the facility is removed from Southend to Harold Wood. The hospice will provide services to relieve families of the full responsibility of care for patients by helping to care for the patients. The day-care facility and the home-care team will be operated by St. Luke's to relieve pressures on families, and at the same time it will relieve pressures on overcrowded facilities in hospitals and in the hospice. The hospice beds will relieve the families and facilities of extremely ill patients, so that others may be treated in hospitals and families will not have to suffer the trauma of caring for dying relatives. I am grateful for the opportunity provided by the hon. Member for Springburn to raise those two matters. I look to my hon. Friend the Minister to urge her right hon. Friend the Secretary of State not to remove the excellent facility from Southend to Harold Wood and to encourage the Treasury team to help us with our VAT payments for St. Luke's hospice."Advances in surgical techniques and radiotherapy will continue, but the best long-term hopes of beating cancer may well rest in developing drugs which can get at cancer cells that surgery and radiotherapy cannot reach—drugs which will kill the cells or change their behaviour."
I join other hon. Members on both sides of the House in congratulating the hon. Member for Glasgow, Springburn (Mr. Martin) on his wisdom in drawing this subject to our attention and giving us an opportunity for this debate. This is certainly the first debate that we have had on cancer in this Parliament. I am not sure when we last had a debate on the subject, but I suspect it was many years ago. We may have had odd debates on individual cancers in the past. Therefore, we should all feel extremely grateful to the hon. Gentleman.My hon. Friend the Member for Edinburgh, South (Mr. Ancram) would wish to be associated with those remarks and, as hon. Members will have noticed, he was present on the Front Bench at the beginning of the debate. I understand that, challenged by an Edinburgh newspaper on Tuesday night, he immediately gave up smoking. That may account for the fact that he found it a little difficult, suffering as I suspect he was from some of the cold turkey symptoms, to stay in the debate for the whole day. I am sure that we wish him well and hope that he will be successful. As his parents live in my constituency I take a particular maternal interest in his welfare and hope that he will be successful. Some 12 hon. Members have spoken in the debate and covered many different aspects. If I miss anything in my responses I hope that hon. Members will forgive me, and I shall undertake to read Hansard in detail and write to them on any individual cases.We have come a long way on cancer. Cancer is no longer the taboo word it was 40 years ago when Lord Beaverbrook forbade its appearance in his newspapers because he thought that people did not want to read about it at breakfast. Perhaps at that time he was right. The moving words offered to us today by my hon. Friend the Member for Hyndburn (Mr. Hargreaves) about his own treatment and recovery from cancer have done a great deal to move us on from Lord Beaverbrook's attitude. People should talk about cancer and say, "I have suffered from cancer, I have got rid of it and here I am, fit and well and working again." That is one of the best ways in which we can encourage people to come forward for screening and treatment programmes and it is also one of the best ways of advising people about prevention. I honour my hon. Friend for what he said. I have checked up, and the type of cancer from which he was suffering has a good survival rate. We look forward to his retiring when he chooses to do so at some point long in the distant future. We also heard from my hon. Friend the Member for Broxbourne (Mrs. Roe) and the hon. Member for Wolverhampton, North-East (Mrs. Short) about the Women's National Cancer Control Campaign. As they may know, I had lunch with people from that organisation just before Christmas at the Cafe Royal, which I enjoyed very much. I hope to meet them again in May when I plan to visit one of their mobile clinics, I hope in Soho square. I would welcome an opportunity to discuss the campaign in more detail with the organisation, perhaps in my office, to find out what it is developing at the moment. I shall ensure that the two hon. Ladies are advised of the meeting and, if they wish, perhaps they might attend. We fund the WNCCC to the tune of some £68,000 per year and the grant for next year is currently under consideration. We also fund the excellent organisation, Women's Health Concern, to the tune of £7,000 and we are involved in helping a number of other organisations such as the Mastectomy Association, which gets £6,000, Cancer Link which also receives £6,000 and the Anthony Nolan Trust which received £11,000 this year. We are closely in touch with the Imperial Cancer Research Fund and Cancer Research Campaign which have funds of their own of about £20 million each. Of course, we are in touch with the Marie Curie Memorial Foundation which I shall mention later. As I understand it, that has nearly £10 million. We are talking about good links with those voluntary organisations and quite large sums of money. The hon. Member for Southwark and Bermondsey (Mr. Hughes) mentioned the British Association of Cancer United Patients. He may not know that among the 20,000 inquiries it received since it was set up was one from myself as a Back-Bencher asking whether there was anything I could do to help and registering my personal interest. The Department has received its request for a grant and I have asked officials to give it sympathetic consideration. We hope to make announcements shortly on a number of grants for various organisations that have been mentioned for the year starting in April, along with all the other requests that we get. This is an opportunity to pay tribute to all the volunteers and fund raisers in the area of cancer whether it is cancer research, prevention, treatment, care, advice for families or whatever. The volunteers do things that we cannot do in the National Health Service and perhaps, particularly in the hospice, Macmillan and Marie Curie movements, they do things in ways that we can admire and learn from. Particular reference has been made to hospices, and I know that at St Christopher's hospice, on which there was a recent Adjournment debate, there are 200 paid staff matched almost man and woman for man by 200 volunteers. We could not run the Health Service in that way. That is an excellent recognition of the desire of ordinary people to put something back into health care and I believe we all welcome the voluntary effort and would not wish to see it wither or disappear. I should like to join my hon. Friend the Member for Broxbourne in recognising the work of the private sector, which has done so much to promote screening and understanding among those people able to take advantage of it. Of course, we work closely with it. I want to refer to individual points raised by hon. Members. My hon. Friend the Member for Edmonton (Dr. Twinn) and my hon. Friend the Member for Basildon (Mr. Amess) questioned the proposals that are soon to come to us for the re-organisation of cancer services in the south west and the inner London regions. I take issue with the comments of my hon. Friend the Member for Edmonton about the cut in the standard of services to constituents. As I understand it, the idea is to improve the service to constituents, not to cut it. Both my hon. Friends drew attention to the fact that the proposals would cost more money, not less. Therefore in no way is there a cut. The proposals are based on scientific advice from committees which date back 10 years which suggest that the larger centres have better survival rates ultimately than smaller centres. We set up the committees so that they could provide advice—in the same way as we gained advice from the Forrest committee. It behoves us to do what we can to take that advice. However, that does not absolve us from the responsibility — especially as time goes on and some of the research is now 10 years old—of carefully examining the papers to ensure that they are not out of date through changes in prices of equipment or staff rotas so that the procedures may be modified. I intend to ask my officials to gather in the information and evidence that lies behind those decisions. I shall examine that and attempt to get an up-to-date scientific view. I do not know whether we shall change anything. However, we ought to take that information into account. I shall ask my officials to advise how far stress and problems with travelling play a role in the treatment of patients. We must be aware that with cancer, as with many other diseases, stress can be an exacerbating factor. That is hard to measure, but we are not absolved of responsibility to assess that. I will consider that matter. The hon. Member for Newham, South (Mr. Spearing) raised particular questions about the way in which the breast cancer screening service might work for Newham. I shall take that point up later. I agree with the hon. Member for Holborn and St. Pancras (Mr. Dobson) that we do not get enough "Tesco". That is why we have recommended that Miss Carey Dennis, the daughter of Sir Jack Cohen the founder of Tesco, should be a member of the new Health Education Authority. Miss Dennis is in charge of product development and consumer control and the way in which products are presented to the consumer in Tesco. She has been responsible, among other things, for the much improved labelling of Tesco products and the removal from many of Tesco's products of unnecessary additives. That is remarkable. I am delighted that she has accepted our invitation to serve on the new Health Education Authority. I hope that the hon. Member for Holborn and St. Pancras will not start to accuse us of having too much "Tesco" and not enough "Habitat". In my view we need both. With regard to voluntary organisations and hospices I want to go deeper into the relationship between the National Health Service, the DHSS, local health authorities and the voluntary movement. Questions were raised at Question Time on Tuesday about terminal care and the circular that was issued last week. The hon. Member for Southwark and Bermondsey mentioned that point. Obviously at Question Time we do not have time to go into those issues in great detail. However, I want to read into the record paragraphs 4 and 5 and paraphrase paragraph 6 of the circular as that should answer some of the points that have been raised by hon. Members. The section is called:
It states:"Collaboration with the voluntary sector."
That is what we told health authorities last week. We mean that and we want them to report back to us on how they propose to do that. Paragraph 6 sets out in detail some of the ways in which authorities might want to help. For example, section 23 of the National Health Service Act 1977 gives health authorities powers to assist voluntary bodies by making available to them land, buildings, vehicles, medical supplies and special equipment. There is guidance to health authorities on the making of grants to voluntary bodies under section 64 of the Health Service and Public Health Act 1968, and joint finance is available. That is apart from any other arrangements that they may wish to make. I hope that that answers some of the points that were made."Health authorities should take particular account of the contribution that is being or can be made by local and national voluntary groups. Wherever possible these should be involved in the planning of services in order to make the most effective use of all the resources available. Where a voluntary group provides a service that represents an essential element in a health authority's overall plans for terminal care, the health authority should agree with them a contribution to the costs of that service."
There must be a partnership, and the circular sets out well the parameters, between local health authorities and the voluntary sector, and the Minister has accepted that there must also be a Government contribution. But knowing the figures in relation to the voluntary organisations in that sector that are grant-funded, I believe that there is scope for a substantial overall increase. The present amounts are so small that it would be a significant contribution, not just in cash terms but in a recognition by the Government of the importance of care and treatment, if in the decisions that are about to he made that partnership is backed with a bit more hard cash than we have seen so far.
Perhaps it is safest to say that the hon. Gentleman's views are noted. We have acquired an extra £1 billion for the year starting in April, much of which has been distributed to the regional health authorities and, eventually, to the family practitioner services. As a former district health authority chairman, I am reluctant to see more done from the centre when we should be telling local health authorities, as we have done in this circular, "You must work with the voluntary organisations in planning and development and if you ask them to do some of it, you must pay."
Although I do not expect the Minister to give a full undertaking, will she at least give an undertaking to consider the point I made about voluntary agencies providing the beds in hospices and Government assistance in the provision of the domiciliary, associated nursing services?
I shall come to some of the more detailed points a little later. I am glad to have the opportunity to do so.It is highly appropriate to discuss cancer this week, following the announcement in December last year by the Prime Minister, on behalf of the EEC Heads of Government, that 1989 will be European Information on Cancer Year, and that between now and then the EEC Commission is proposing a plan of action as part of the Europe against cancer initiative. That will cover prevention, public information, health education and research, and it will be considered in detail by EC Health Ministers in May. This has also been the week in which we have had no smoking day, with all the razzmatazz that that has involved, so it is apposite to end the week with this debate. The first question that I have asked is how much we spend overall. I am advised that it is impossible to quantify NHS resources involved in the treatment of cancer, primarily because cancer patients are distributed throughout the main medical specialties. The only service that is wholly devoted to cancer treatment is radiotherapy. However, the information that is available suggests that cancer makes a considerable demand on the Health Service and that the demand is increasing. The development of expensive diagnostic and treatment techniques, some of which we heard about today and which are mentioned in the motion, will contribute to the demand on resources. We are well aware of the points that were made by hon. Members. There are 200 or more different conditions called cancer which affect more than 1 million people in the community at any one time. In 1981, it caused 23 per cent. of all deaths in the United Kingdom. It is a strongly age-related phenomenon, with about 60 per cent. of all cancers affecting the over-65 age group, although it occurs in all age groups. But the number of cases of cancer which present for treatment is increasing, at least partly as a reflection of the ageing population. The hon. Member for Holborn and St. Pancras mentioned the number of women in older age groups who die from breast cancer. Survival rates seem to have changed little overall, although reports that we have received point to significant improvements in certain cancers. I shall mention those in detail in a minute. It is worth putting on record what we know and what the Department accepts about deaths from cancer and about potential or possible or agreed causes, because we do not have many opportunities to put such things on the record. That will make sure that at least before we go on to talk about treatment, we shall know what is happening and, perhaps will know about the forces for prevention in future. The biggest killer in Britain is heart disease—heart and arterial diseases and strokes. That is the largest single group, and in England and Wales in 1985 about 287,000 deaths were caused by diseases of the circulatory system. Therefore, that remains our major target and among other things we will have in April a look-after-your-heart campaign which, we hope, will draw people's attention to that fact. Cancer is the second biggest killer in Britain. In 1985 more than 150,000 people in the United Kingdom died from cancer. The biggest single group, more than one quarter—40,000—had lung cancer. I shall read into the record one or two of the other cancer figures from the 1985 report of the United Kingdom Office of Population, Censuses and Surveys. Total deaths from cancer were 160,000. Of these, 40,000 were from lung cancer; 20,000 from large bowel cancer; 15,000 from breast cancer; 11,000 from stomach cancer; and 10,000 from lymphomas and leukaemias. The other cancers accounted for fewer than 7,500 deaths each. Those are the main cancers to which we are paying attention. There is a difference between the figures for men and women. The major cancer that kills men is lung cancer, of which there are nearly 30,000 cases a year. After that, we are talking about large bowel cancers, prostate and so on. In women, the main killers are breast cancer, which causes 15,000 deaths a year, and lung cancer which results in more than 11,000 deaths a year. However, deaths of women from lung cancer are rising and one of the most worrying things that has arrived recently on my desk is the information that deaths from lung cancer in women have gone up by 20 per cent. since 1979. That is completely against the trend for lung cancers as a whole, where there seems to have been some slight drop since 1979. That 20 per cent. rise is extremely worrying and it troubles me when I visit universities and colleges and someone has a go at us about cervical cancer while she is smoking a cigarette. Deaths of women from lung cancer are five to six times more likely, more common, than deaths from cervical cancer. On the other hand, the major cancer killer among women is breast cancer. Both of those are killers of women before their time — premature deaths. I should also like to place on record the trends in cancer survival in Great Britain. These are details of cases registered between 1960 and 1974 and it looks as if the death rates have not changed very much in these cases. The relative survival rate at five years for all lung cancer cases in England and Wales, the average for males and females, is only 7 per cent. Worldwide there are now more than 1 million cases of lung cancer a year, and most patients die within two years. The prognosis for lung cancer victims is very poor and has barely improved. I am advised that only about 25 per cent. of all lung cancer cases are operable, and that the survival rate of those which are operable is not good. Therefore, it follows that for that cancer perhaps more than for any other, prevention is almost the only cure. To seek cures for lung cancer against figures of that sort is going about it in the wrong way. The survival rates for cancer of the oesophagus, which I shall come to in a moment, and for cancer of the stomach are about the same. The survival rates for many other cancers are much better. For example, the survival rate for cancer of the uterus, which was mentioned by the hon. Member for Springburn is generally very good and seems to be improving. I am delighted to say that I have checked on the survival rate for the illness of my hon. Friend the Member for Hyndburn and find that it is generally very good and improving dramatically all the time. My hon. Friend is here to prove that statement. What is causing those cancers? I am not a doctor, so I looked up the books and I should like to quote from "The Causes of Cancer" by Richard Doll and Richard Peto, the standard work on the subject which was published in Britain and in America in 1981. The authors say:
A material effect would also be produced on the incidence of cancers of the mouth, the pharynx, the larynx, the oesophagus and other organs."No single measure is known that would have as great an impact on the number of deaths attributable to cancer as a reduction in the use of tobacco … The principal impact would be on the incidence of cancer of the lung which by late middle age is more than 10 times greater in regular cigarette smokers than in lifelong non-smokers … By contrast, the difference in incidence between smokers and non-smokers is less marked for cancers of the bladder, pancreas and kidney than for cancers of the respiratory and upper digestive tracts, but the accumulating evidence suggests that an average consumption of cigarettes approximately doubles the incidence of cancer of the bladder and probably also of the pancreas while being associated with a more moderate increase in kidney cancer".
In other words, the carcinogens go right through the system. The same reference work compares the number of deaths observed in a sample of male cigarette smokers with the number that would have been expected if the rate of death had been the same as that for age-matched non-smokers. The figures come from the United States, but there is no evidence to suggest that the figures would be any different in north Europe. To put it colloquially, it shows how many times higher the chances of cancer are for smokers. For cancer of the lung, the risk is 11·3 times higher. For cancer of the mouth, pharynx, larynx or oesophagus it is seven times higher. For cancer of the bladder, it is 2·2 times higher, and roughly the same for cancer of the pancreas. It is also higher for cancer of the kidney. Indeed, for all other cancers there is a 30 per cent. increase in the observed risk. For causes other than cancer, deaths from respiratory disease are 4·3 times higher for smokers and there is an increase for just about all the other diseases. The authors of that work go on to consider one or two other possible causes. The second is alcohol. They say:"That smoking should affect bladder cancer and perhaps kidney cancer is not surprising since tobacco smoke contains a wide range of mutagenic and other chemicals, some of which are absorbed from the lungs into the bloodstream, circulate through distant organs and are found at particularly increased concentration in the urine of smokers."
They then go on to look at diet. I make no comment at all about this, although I am entertained and interested by what they say. They state:"It is convenient to consider alcohol next, not because it is the second most important cause but because it 'interacts' with smoking, each agent enhancing the other's effects … Both in Western Europe and in North America, the carcinogenic effect of even quite substantial consumption of alcohol is small in non-smokers … In smokers, on the other hand, consumption of the same amount of alcohol would have a large absolute effect as it seems to multiply the carcinogenic effect of tobacco smoke on the mouth, the pharynx, larynx and oesophagus, although it has no such effect on the lung…Pure alcohol is not by itself carcinogenic … but most of the cancer deaths now caused by alcohol could have been avoided by the absence of smoking even if alcohol consumption remained unchanged."
the book was published in 1981—"Diet is a chronic source of both frustration and excitement to epidemiologists. For many years, there has been strong but indirect evidence that most of the cancers that are currently common could be made less so by suitable modifications of national dietary practices. This is even more plausible now than it was 10 years ago"—
On the other hand, they go on to say:"but there is still no precise and reliable evidence as to exactly what dietary changes would be of major importance. The chief need is, therefore, for continued and more intensive research."
"The importance of gross aspects of nutrition were suggested 40 years ago by Tannenbaum's experiments on mice, which showed that restricting the intake of food without modifying the proportion of the individual constituents could halve the incidence of spontaneous tumours of the breast and lung and of a variety of cancers produced experimentally by known carcinogens. The underfed mice grew to one half the size of those fully fed but they were active and sleek, appearing perfectly healthy and they lived on average longer than the others … Tannenbaum's experiments made little impact on cancer research … (More interest might have been aroused, however, if the freely fed mice had been described as obese instead of the mice on the restricted diet being described as small!)"
We are all interested in that, but may I suggest that what the Minister has just said is very confusing? The public want to know facts, not Tannenbaum's experiments. It would be much better if we stuck to what is certain — the relationship between cigarette smoking and lung cancer and other conditions.
The hon. Gentleman is absolutely right. I am putting those findings on record simply because there may well be more than one cause. Professor Doll's Stevens lecture to the Royal Society of Medicine on 23 June 1986 says:
He says elsewhere that many of the recommendations that are being made for dietary changes are for other reasons, but make enjoyable choices and should be encouraged. The hon. Member for East Kilbride (Dr. Miller) was right. The single most important cause of cancer is smoking. I am very glad therefore that my right hon. Friend the Secretary of State for Social Services has issued today the statement by the independent scientific committee on smoking and health on passive smoking. I shall read some of it into the record. The committee was set up in 1973. It is intended to advise Ministers and the industry on what might be done and what might be needed to be done about the effects of smoking. It is chaired by Sir Peter Frogatt of the university of Belfast. The note that it has sent to us says:"Scientists should take care to distinguish the advice they give that is based on incontrovertible evidence (such as the harmful effects of tobacco, alcohol and asbestos) from that which is based on their assessment of the most likely interpretation of the evidence such as the benefit from increasing the consumption of dietary fibre, vegetables and fruit."
The remainder of the statement is available in a parliamentary answer which has been issued today. The more colloquial way in which to put that is to say that perhaps 200 to 300 additional cases of lung cancer per year are caused by people breathing in other people's cigarette smoke. That is a matter for some concern. We are issuing the statement. We expect to receive the final report at the end of this year and we will then consider, in the light of responses to the statement as much as anything else, what action may or may not be required."In its third report to the Secretaries of State in January 1983, the independent scientific committee on smoking and health noted reports of the irritant effects of tobacco smoke on eyes, nose and throat, the exacerbation of symptoms in some adults already suffering from coronary and other arterial diseases and chronic non-specific respiratory disease and the increase in the incidence of respiratory diseases in children exposed to tobacco smoke in the home. The four main studies investigating passive smoking in relation to cancer were reviewed and the committee considered that a causal association had not been unequivocally demonstrated. Since them, additional studies have confirmed the association between passive smoking and the exacerbation of respiratory and cardiovascular symptoms while other studies have examined the possible association between passive smoking and lung cancer, some reporting 'positive' and some 'negative' results. While none of the studies of passive smoking and lung cancer can on its own be accepted as unequivocal, the findings overall are consistent with there being a small increase in risk of lung cancer from exposure to environmental tobacco smoke, possibly between 10 and 30 per cent. This opinion regarding an increased risk is supported by other types of evidence."
Does the Minister accept that the DHSS, which is responsible for the nation's health, cannot have two masters — the tobacco industry and good health? Therefore, it must come down on the side of God rather Mammon—good health. Has the hon. Lady, or her departmental team, spoken strongly to her two sets of colleagues — the Treasury and the Department of the Environment — and told them that they cannot encourage tobacco from one part of the Government while discouraging it from the other? We must have a clear, new direction.
Is that not the value of this debate? The British people are moving fast on some of these issues; sometimes they are moving faster than Ministers, sometimes slower. However, a lot of research into the effects of passive smoking is still under way and the Committee is continuing to review the evidence.We have seen some progress. The percentage of people who smoke in this country has dropped sharply from more than 52 per cent. of the population in 1972 to 36 per cent. in 1984, and I am sure that it has dropped since then. The percentage of women who smoke has dropped from 42 per cent. in 1972 to 32 per cent. in 1984. People are giving up smoking at the rate of about 3 per cent. per year, which means that we are giving up smoking faster than any other country in Europe. The number of cigarettes smoked has dropped from 137,000 million in 1973–74 to 98,000 million in 1984. The average tar content of cigarettes has dropped from 20 mg to 14·4 mg. As a result, as we mentioned earlier, deaths from lung cancer are just beginning to slide; we are beginning to see the tide turn. Unfortunately, that is just among men. The numbers of deaths of females from lung cancer is rising. Smoking is increasing among the young, and more female teenagers smoke than male. That is a horrible legacy for the future. We have many successes to report. Leukaemia is an example. Not long ago, that disease was, invariably, incurable, but bone marrow transplants offer a prospect of treatment. Hon. Members will know that we have given a commitment that bone marrow transplant will be a service development priority for all English regional health authorities. In October 1986, the Secretary of State set a new target of 550 such operations by 1990. We can look forward to that improvement.
Does the hon. Lady think that one of the more bizarre aspects of the relationship between the Government and the tobacco industry was that the Scottish Development Agency gave a £1 million grant to help an American tobacco company set up the Skoal Bandit manufacturing plant to produce little tea bags of tobacco, which were so dangerous that on the day that it first started selling its product in this country the chief medical officer of the DHSS issued a warning to all doctors that these things were likely to cause cancer of the mouth? Is it not a little bizarre that one arm of the Government was giving that company £1 million, yet the other arm was telling people that this project could kill them?
Sometimes, we all must be wary of our friends. I recall that when the Southern Derbyshire health, authority, which covers my constituency and five others., recently attempted to implement a no smoking policy in its NHS premises, NUPE objected most strongly. I am sure that the hon. Gentleman will take that message back to where it came from.I hope that Scottish Members will not mind if I leave some of the Scottish issues in view of the time that we have taken, but I shall ensure that my hon. Friend the Under-Secretary of State for Scotland has an opportunity to respond. I shall now turn to screening, which has been raised in some detail. There are some misconceptions about screening, such as that we should screen all of the people all of the time. That would serve no real purpose. The principles of screening were clearly set out in 1968 by Wilson and Jungner for the World Health Organisation, They are sound and worth recognising. There are 10 principles. First, the condition should pose an important health problem; secondly, the natural history of the disease should be well understood; thirdly, there should be a recognisable early stage, which there is not for lung cancer; fourthly, treatment of the disease at an early stage should be of more benefit than treatment starting at a later stage, which applies strongly to breast cancer screening; fifthly, there should be a suitable test; sixthly, the test should be acceptable to the population—that is perhaps one of the difficulties that we have run into with certain sections of the population over cervical cancer screening; seventhly, there should be adequate facilities for diagnosis and treatment; eighthly, for diseases of insidious onset, screening should be repeated at intervals; ninthly, the chance of physical or psychological harm to those screened should be less than the chance of benefit, which is why I question screening everybody for AIDS; tenthly, the cost of a screening programme should be balanced against the benefit that it provides. There is a clear distinction between screening symptomless people, which is what our screening programmes are for, and treating people who have symptoms, who do not come into the screening programme and should be strongly encouraged to seek help and advice. If a woman has a lump in her breast she should not wait for the Newham system to be set up, but should come in and seek help now. If a woman is having trouble with infections of the cervix, she should not wait for a piece of paper carrying the signature of a doctor or anyone else, but should come in and seek advice and assistance. People with problems should not wait; they should come in at once for assessment, diagnosis and treatment. On the other hand, we have to advise and encourage people without symptoms and problems to feel that they are part of the screening service. They should not feel that simply because they are fit and well it does not apply to them. They are just the people whom we are trying to reach. Mention has been made of the ages of the women whom we want to screen as part of the breast cancer programme. Time and again we have been asked why we will not screen younger women. I am 40 and if I thought that there was any benefit in screening women of my age, by golly we would be doing it. At least, I hope that I could convince my colleagues that we ought to do it. I read the Forrest report with great care. Opposition Members have been waving the report at me and I hope that, as well as having acquired copies, they have read it, particularly chapter 5 which sets out advice based on the latest scientific evidence. It says:
The report goes on:"The most important risk factor for breast cancer is age … the incidence and mortality rates increase with age so that for women aged 50–54 incidence is over seven times and mortality is over 12 times that of women aged 30–34."
The report goes on to list various studies in Holland, Sweden and New York which show that even when women were screened at a younger age there was no apparent improvement in detection and mortality rates until the women reached their 49th or 50th birthdays. In other words, much of the earlier screening was of no benefit to younger women. Indeed, they could be told that they were all right and in the clear when they were not or they could be advised that they had some problem when they did not. The Forrest report concluded:"Screening policy should ideally be based not merely on the age groups most likely to develop breast cancer, but on those in whom early detection can improve the prognosis. All of the studies that have so far examined the effect of screening on deaths from breast cancer have clearly shown its value for women aged 50 or over but at younger ages its effectiveness is less and is uncertain."
The studies that I have seen from Sweden suggest that the acceptance rate of older women for call and recall schemes drops off sharply and can be as low as the 40 per cent. rate of which the hon. Member for Holborn and St. Pancras was so critical. I accept the points made about the treatment of women as people and the importance of counselling—that has been written into the Forrest report and the advice that we are issuing. I reject the criticisms that have been made about the timing of Forrest and how long it will take to implement that report. I reject the criticism that the rate of development depends on the rate of funding. The real constraint is how quickly we can get radiologists, radiographers and other essential technicians recruited and trained. As part of the preparations for the Government's decision on the Forrest report I went to Guildford and I spoke to Dr. Barbara Thomas and her team. Their strong advice was, "Don't rush it. Get the people trained." If we are to achieve a 90 per cent. success rate through screening it is important that that screening is carried out properly. Recently when Professor Forrest was challenged that it was all too little too late he said:"There is clear evidence that women aged 50 and over are likely to benefit from screening. Further evidence on the effectiveness of screening women under 50 is required: studies are continuing … Women up to age 65 should be positively encouraged to be regularly screened, but after this age screening should be provided only for those who request it."
I would much prefer that we do it a little bit more slowly than we would like so that we get it right. Getting a proper, effective screening service for women is not a magic wand exercise."On the contrary. They are after a high quality service."
Does the Minister agree that the broad outline of the Forrest report's likely recommendations were discernible in December 1985 when the interim report came out? I believe that things could have been done a bit quicker if the Department, the health authorities and the professions had got on with starting, at the preliminary stages, to identify the availability of staff and had done something about that rather than wait until the second Forrest report came out.
There is no point in having interim reports that help us to initiate discussions, but then to ignore the possibility that the final report may reach slightly different conclusions. It seemed wise to wait. We are now going ahead to implement the Forrest report in precisely the terms and with precisely the costings that were recommended to us. That report has been widely welcomed throughout the country and, with respect to the hon. Gentleman, he might do rather better than carp at it.
Does the Minister agree that she must also approach the Treasury about this matter because the pay and conditions of nurses must be improved? The Nursing Times and Nursing Mirror of this week carries a large coloured advertisement offering a salary of between $28,000 to $40,000 a year as well as all sorts of benefits, to nurses in California and other parts of the United States. I do not say that we should match that figure, but I believe that the Government should do better on nurses' pay.
I sometimes wonder what the reaction of other members of the Health Service would be if we paid our nurses more than our doctors—that would broadly be in line with the figures that the hon. Gentleman has given. A pay review is under way, evidence has been given to it and we expect it to report in April. We shall see what it has to say.With regard to cervical cancer I am most grateful to the hon. Member for Holborn and St. Pancras for the hard work he has done. Earlier this week he said that he did not trust letters these days, but he clearly trusts the telephone. However, as far as we have been able to check up, he is getting different information from us. I agree that some of the things that he has said are accurate, but I believe that he is carping if he criticises a health authority that, at one stage has said that it will be ready in March, but now says it will be ready in April. I find that perfectly acceptable. If it says it will be ready in June I will hold the authority to that promise. I have regular reports from the call and recall schemes to discover exactly what they are up to. With regard to the remark that Leeds Western district authority is reported to have made to one of the hon. Gentleman's staff, we shall check and if there is any truth in what he said one of my officials will be there next week to find out exactly what the authority thinks it is up to. I am aware that there have been some difficulties in Birmingham. I intend to invite the chairmen of the five district authorities and the chairman of the family practitioners committee to see me in London. In that way I can discover what they propose to do to ensure that women in Birmingham are given the same opportunities as everywhere else. I believe that some cities believe that London is a long way away. Perhaps I should just warn them that it is not far enough away. We intend to ensure that promises are kept and that the systems are implemented.
We have another debate to come, so I hope that the hon. Gentleman will forgive me if I do not give way. I suspect that some of the difficulties come from the fact that—
The Minister has just attacked my staff.
On the contrary, I have not attacked the hon. Gentleman's staff. I will offer them a job in the Department if they are that good at making telephone calls to the FPCs.
I understood from my staff when I returned from Stockport this morning that DHSS officials had telephoned around trying to find out what was happening, only after they had discovered that my staff had been doing so. I am willing to stand by the information supplied to me. Perhaps on odd occasions points have been slightly misheard, and some of my comments may turn out to be mildly unfair to an individual health authority. If so, I shall duly apologise to the authority when it proves me wrong.Of the 56 health authorities which my staff contacted, 42 have not done in this financial year what Ministers told women would be done in this financial year. I welcome the Minister's commitment to put the boot into those who are not doing their job properly, but I regret the fact that it takes an initiative from me at the end of the financial year to get attention drawn to that aspect, when a bit of effort by her officials earlier in the year would have drawn it to her attention in sufficient good time for them to have kept their promises.
On the contrary, what is clearly happening is that the questions asked by the hon. Gentleman's overworked staff and by my overworked staff are probably eliciting different replies because the questions are worded in slightly different ways. Installing the system involves a number of stages. First, the equipment has to go in. Then the register has to be put on the computer. Then the existing screening records have to be put on the computer. Then there is, I hope, the opportunity for a dry run before we practise the system on any patients. Then we go on to the call and recall of patients. Some health authorities have done one of those before the other.Recently, the hon. Member for Holborn and St Pancras went to the Calderdale district, to Halifax. He was extremely critical about the non-existence of a service for the women of Halifax. The doctor who started running that service 22 years ago took him to task in the local newspapers. When I visited the area a few days later, the authorities insisted on taking me into the magnificent laboratory where cervical screening tests were carried out, and they were able to demonstrate exactly how all that work is done. It is clearly not satisfactory that we get different answers. I checked again this morning, and I am told that we are getting good answers from some of the health authorities. They say—
Will the hon. Lady give way on Calderdale?
No, that is enough. The hon. Gentleman has already made his speech, and I want to finish mine.I am told that the Leeds Western health authority is still saying that it will be ready at the end of March and that Aylesbury Vale and Wycombe say that they will be ready in the summer. We shall check, not because the hon. Gentleman has been jumping up and down about it but because, apart from anything else, I as a woman am concerned to ensure that they do things properly. We have insisted that the family practitioner committee computer programmes include a report-back facility on take-up rates. We expect to get accurate reports back from May. We have heard about a 90 per cent. response rate, but I do not think that that is possible. I doubt whether that calculation has been done on the same basis as the others. Apart from anything else, 18 per cent. of women in their sixties have had hysterectomies and, therefore, are that much less likely to be candidates for these problems. About 20 per cent. of the register is inaccurate. We have looked repeatedly at this problem and at other possible registers, but this is the best that we have. I am satisfied that we are saving lives. The district medical officer recently reported to the Southern Derbyshire health authority—my local health authority — that in that district 22 women die each year from cervical cancer, but some 150 cases are picked up through its cervical cancer screening programme. Although the death rate is not now being improved, God willing, in future 150 women will not die of cervical cancer. Therefore, we should begin to see an improvement. We fund cancer research to the tune of very large sums of money. We have been in touch with Quest for a Test for Cancer for over four years and have told it repeatedly that the correct procedure for it or any other similar research group is to have its work independently assessed by one of the appropriate bodies. In this case, that would be either the Medical Research Council or one of the major cancer research charities. We advised the quest in March 1983 and on several subsequent occasions to make a formal application to one of those bodies. As I understand it, so far it has been unable to do so. In the absence of an independent evaluation, the DHSS cannot consider the potential application in the Health Service of that technique as a cancer screening test. That is the wise and sensible line for us all to take. Hon. Members mentioned several other issues. In view of the time and the fact that we have another debate yet to come, I hope that they will allow me to write to them. However, I should like to mention the care of cancer patients at home, because that issue comes into the terminal care circular. I have taken an interest in it for many years, going back to my time in Birmingham. I was involved in setting up the nightwatch services, funded by the local authority in Birmingham, which supplemented the work of district nurses and the health authority's "tuck-in" service. This year we have given an extra 1 per cent., through Department of Environment grants to the local authorities, to pick up the costs of community care. That means about £26 million. There is no harm in at least some of that being directed to such services. There are now some 125 home care teams, NHS-employed, with some charitable funding, and some 25 hospital support teams, which do much of the work that has been described. There are some 4,000 Marie Curie day and night nurses, most of whom are part-time. They have been recruited by the Marie Curie foundation, which sends them to the health authorities on request, and then each meets half the cost of the care. There are now 350 Macmillan nurses all full-time and highly trained. That is a specialised resource on which the ordinary NHS staff can draw. They are trained by the Macmillan fund and paid for by the district health authorities. Much of the recent hospice movement developed through the Macmillan campaign. I am a patron of the Macmillan hospice in Derby, which has been established in the old Nightingale home. Also available for the care of patients at home is financial assistance through the attendance allowance, mobility allowance, invalid care allowance and so on. Some of those allowances have a six-month qualifying period because they are intended to help those needing long-term care, but increasingly as we are able to help cancer patients—we hope that the death rates and survival rates will improve—it is likely that more will be able to qualify. From April 1988 grants to promote community care of terminal cancer patients will be available to those on income support under the new discretionary social fund. Although we expect it to start fairly modestly, the Government hope to develop that element of the fund. In recent weeks we have seen yet more steps taken to combat cancer. They range from the razzmatazz of no smoking day, which was a gimmick, but it worked, right through to the major announcement of breast cancer screening, which will save women's lives for decades to come. We have gone from improvements in the cervical cancer screening system—they will be improvements and they will make the system effective—to the setting up of the Health Education Authority, which is a major step forward in prevention and health promotion, and then on to the circular on terminal care, which will make such a difference to so many people. The debate has been yet one more step forward. I believe that it will also have been a major contribution. I should like to put on record my gratitude to the hon. Member for Springburn for raising the matter and allowing us all to debate the issues.
I should like briefly to thank all hon. Members who have taken part in the debate. It has been interesting, and I have enjoyed all their contributions. It was good of them to stay, particularly as this is a Friday and I know that Friday is often the only opportunity that they get to return to their constituencies. I thank my hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) and the Minister for their contributions. I should also like to add to the comments made by other hon. Members about the hon. Member for Hyndburn (Mr. Hargreaves), and say that his contribution was excellent. My majority being different, he at least had his party headquarters worrying about him. When I was ill some years ago, the only get-well card that I received was from my pair.
Question put and agreed to.
That this House believes that a humane and efficient health service should be guided by three main priorities in relation to cancer, namely: an effective national screening system designed to facilitate the earliest possible diagnosis of the different forms of disease, the provision of resources to enable patients to benefit promptly from the most technologically advanced treatment available, and the development of hospice and other facilities to permit the terminally ill to end their lives in decent and dignified surroundings with the minimum of pain; and calls on the Government to ensure that these priorities are fully reflected in the future funding of the National Health Service.
Gipsy Caravan Sites
I beg to move,
This is the third debate that I have had the privilege to introduce this year on environmental matters. The first was an Adjournment debate on the river Ver in my constituency, which is in danger of disappearing. The second was about the green belt, which we are determined should not disappear. The third, today, is about gipsy sites which, unfortunately, show no sign of disappearing. They will not disappear because local authorities are caught in a "Catch-22" situation under the present legislation. Without designation, local authorities do not have adequate powers to move on gipsies using illegal sites and are forced to tolerate them. To obtain the powers to move them on, local authorities must create official sites. So, one way or another. we have to have gipsy caravan sites in our area. Gipsy caravan sites and their locations are emotive because they concern three powerful considerations. The first is our concern for the environment. The second is fear of crime. The third is the importance that people attach to education. However, it is not just an emotive matter as some people claim. The concern is based on genuine hard and concrete problems, to which I recognise that there are no easy solutions. We now need a thorough review of the present legislation. I do not think that the recent and modest review, which was carried out by my right hon. Friend the Secretary of State for the Environment, is sufficient, because, in the words of the Environment Committee that recommended it, it was "merely modest". It was also quite distinctly biased towards accommodating the needs of gipsies, rather than recognising the public concern. The key legislation under which we operate is the Caravan Sites Act 1968. I am sorry that no Liberal Members are present today because that legislation was introduced by a Liberal Member, under the congenial supervision of a Labour Government—congenial to the Liberals, that is. The legislation was introduced by Lord Avebury. When I mentioned to the inhabitants of Redbourn, who are threatened with a gipsy site, that the present legislation was introduced by the present Lord Avebury, soon after he had publicly announced his desire that his body should be fed to the dogs after his death, their immediate response was, "Why wait until then?" However, I do not want to put the blame on him or the Liberal party because, on looking back, I see that the Act received near unanimous support on Second Reading. In my experience, that should have given us cause for suspicion because my experience is that when any measure has nearly unanimous support across all parties all too often it is an unmitigated disaster. We should have recognised that when we passed the legislation without proper, careful consideration and recognition of the difficulties which would arise. I wish to highlight one particular problem which is not mentioned in the Act, in Professor Wibberley's report, which was recently prepared for my right hon. Friend the Secretary of State for the Environment, or in the final review of the operation of gipsy caravan site policy. The problem is the provision of gipsy caravan sites in the green belt. The Act requires every county council to build sufficient sites in its area to accommodate all the gipsies who habitually resort to or live in its area. The only limit on that obligation for London boroughs was a maximum of 15 pitches per borough. Circular 28/77, which was issued to implement the Caravan Sites Act, specifically states that caravan sites can be built in the green belt. Indeed, it states:That this Rouse calls for a thorough reform of the legislation requiring local authorities to provide caravan sites for so-called travellers; believes that no special privileges, such as the right to build permanent sites in the green belt, should be granted to one section of the population when the rate-paying, settled majority is rightly prevented from doing so; recognises that districts which are comprised largely of green belt and residential areas should be required to provide fewer sites than other districts; and believes that official caravan sites should be available only for those pursuing a genuinely nomadic lifestyle rather than semi-permanent residents in one place.
That has been taken by county councils and planning authorities generally to mean that gipsy sites can be placed in the green belt. There is a tendency to neglect that the circular also states:"In certain counties there are areas of open land (including Green Belts, and Areas of Outstanding Natural Beauty, etc.) where the land use policies which apply are severely restrictive to development. It may be necessary, however, to accept the establishment of gipsy sites in such areas."
There will, indeed, have to be such special circumstances and I hope that the Minister and the Secretary of State, in evaluating any proposals in my area, will lay greatest weight on that final sentence. Not only does that apply, but county councils can exercise compulsory purchase powers in the green belt and elsewhere to establish such sites. In effect, one section of the community is being given an extraordinary privilege. Ordinary owners of caravans do not have the right to set up caravan sites or to have sites set up for them in the green belt. Plenty of local residents in my area would like the right to build a house or site a caravan in the green belt. We, rightly, forbid them to do so because we believe that the green belt should be sacrosanct and preserved as a green lung, separating us from London and other built-up areas. There are plenty of people without jobs in the old smoke-stack industries of our major towns, often in the north, who would love to seek work in my constituency where jobs are plentiful. They would be only too happy to reside in caravans on green belt land, but they are not permitted to do so; only gipsies are granted that privilege. Gipsies are given that privilege despite the fact that they are not conspicuously noted for paying rates or taxes or for abiding by the law, as most of my constituents do. When the privilege was granted, people may have thought of gipsy sites as a few rustic, wooden caravans nestling among the trees, like a Constable painting—the sort of feature that would enhance rather than detract from the green belt—but in practice that is not the case. They can look like dumps. Indeed, even well-regulated gipsy sites are not attractive with their modern, garish caravans and vehicles. Indeed, they look all the more unattractive as the activities in which gipsies frequently engage and on which they depend for a living, such as car breaking. the provision of aggregates and laying tarmac, are unsightly, require unsightly machinery and equipment and leave residues which destroy the environment. Nobody else would be given permission to carry out those activities on green belt land. If gipsies are not allowed to do those things on green belt land—it is not required by the Act that working provision should be provided at the same place as living accommodation — they have to be able to do them somewhere. In many areas, there is no alternative to green belt land unless working areas are to be thrust into built-up residential areas. I hope that the Minister and my right hon. Friend the Secretary of State enforce vigorously their powers to prevent the development of sites on the green belt. I hope that we will have a review of legislation to remove that special privilege from gipsies, but clearly gipsies must go somewhere. In my area, if they are not on green belt land, they have to be in residential areas because my constituency consists solely of green belt land or built-up residential areas. The 1968 Act recognises that London boroughs, being entirely built up, do not have the full obligation to accommodate all and every gipsy caravanner who can claim to have resort to their area. It seems reasonable that a similar exception should apply to other districts which are heavily urbanised or consist solely of urbanised areas and green belt land. That is simply a recognition of the fact that gipsy sites cannot be placed easily in the middle of residential areas. Gipsies themselves, by their culture, want to live apart from the rest of society. They want to be different, separate and distinct. That is their privilege and I do not want to deprive them of it. However, that desire is reciprocated by the majority of the public. They do not want to be cheek by jowl with gipsies either. That is their right and privilege and we should not force gipsies upon them. I am sure that, like everybody else, the majority of gipsies are decent, law-abiding folk, but a significant number do not abide by our laws and there is often a crime problem associated with gipsy caravan sites. That crime problem will be intensified if they are in the middle of residential areas. There is an educational problem if one has to accommodate large numbers of gipsy children in existing schools. That also gives rise to concern in residential areas. Often, a travelling school is the best solution to that problem. At best, only a small number of gipsies can be accommodated within residential and built-up areas in constituencies such as mine just as in the London boroughs. I hope that any review of the legislation that is implemented will extend that recognition to areas such as St. Albans. The presumption must be that most gipsies will be accommodated in rural areas that are not designated as green belt. Failing that, planners should at least be allowed to take into account the social and other problems associated with caravan sites when they are considering a particular application for an official caravan site in an area. At present, I am told that they are required to assume that all the problems of crime, education and other social problems are deemed to have been solved. That unrealistic assumption is required of them and they consider only the environmental and visual aspects of a gipsy site in their green belt or other planning areas. That is obviously nonsense and should be changed. I hope that all those factors will be taken into account when my hon. Friend the Minister and his right hon. Friend the Secretary of State consider the proposal to establish a gipsy site on green belt land in the village of Redbourn. That epitomises the problems I have been talking about. It is proposed to build an official gipsy site on green belt land that falls in the middle of a residential area. A more unsuitable location could barely be imagined. At the same time, all the associated problems of crime and education are to be deemed to been solved. I know that my hon. Friend the Minister cannot comment on specific cases in his response, but I hope, none the less, that he will hear what I have said and bear it in mind when a decision has to be taken. The second point which I hope will be considered when a thorough review of the legislation is carried out is the fact that under the present law designation, once granted to a district because it has established a sufficient number of official sites to accommodate all the gipsies who habitually live in or resort to the area, can subsequently be revoked. That is viewed with apprehension by people in my area. They fear that even if we establish enough sites and subsequently gain designation, that may be revoked and we would be back in the original position and prey to an influx of more gipsies from elsewhere. That is a particular problem with regard to the one official site in my constituency at Barley Mow. When that site was established more than a decade ago with 15 pitches, local inhabitants were assured that the site would be temporary although there was a possibility of it being renewed, and that 15 pitches was the maximum that they would have to face. There is now a proposal to expand that site by another five pitches. In view of the past assurances, I hope that the proposal will be withdrawn. Even if it is not withdrawn and a further five pitches are established, we must be able to give the local inhabitants an assurance that, if designation is given in return, that will not subsequently be revoked. The third problem that we have to tackle is the definition of what constitutes a gipsy. The current definition is vague. It appears to be a bureaucratic reinterpretation of Stevenson's "The Vagabond":"On the other hand, there will clearly be a special obligation to ensure that the arguments in favour of a departure from the development plan are convincing."
Gipsies are simply defined as:"All I seek, are the heavens above And the road below me."
For some reason that excludes only people engaged in travelling circuses and travelling show men. I do not know why those are the only categories of people who cannot pose as gipsies. The definition is so loose that virtually anyone could pose as a gipsy. Hippies are increasingly seeking the status of gipsies and they have a nomadic mode of life whatever their race or origin. Presumably official sites must be provided for them. Indeed, many of my constituents spend most of their time moving house from one part of the area to another. Are they of a nomadic habit of life? If they own caravans, could they claim a right to official gipsy sites? We must tighten the definition and prevent an increasing number of people claiming to come within it. At the same time we must recognise the Irish dimension to the problem. In recent years, ever since the war, there has been a growing influx of Irish tinkers and didicois. That is a consequence of our immigration laws which permit people from Southern Ireland to enter this country without requiring British nationality status. That is absurd."Persons of nomadic habit of life whatever their race or origin."
That is true of people from the rest of the EEC.
That has been so until now. No check is placed on those people, not even the checks that apply to other EEC citizens. Irish entrants should clearly be placed full square with other EEC citizens.We are dealing with a balance of rights and obligations. We must consider the obligations of each part of society. The general public has a duty to be tolerant towards gipsies and those who pursue that way of life. There can be no question of harassing them unnecessarily or of acting vindictively towards them because they are different—although that may have happened in the past. We have the same obligation towards members of the gipsy community who need help as we have to any other member of society and, by and large, my constituents overwhelmingly accept that obligation. But we have no moral obligation to subsidise a lifestyle, nor to promote it artificially. It may have become more difficult to pursue a gipsy lifestyle than it used to be with the decline of casual agricultural work, but many opportunities have become more difficult to pursue. There are fewer opportunities for those whose parents and grandparents were tenant farmers to become tenants, but we do not compulsorily acquire land, hand it over to tenant farmers and artificially subsidise them. There are fewer opportunities for people to become steel workers, but we do not build steel works in the green belt and artificially subsidise them to keep them going. We do not have obligations to provide benefits to a special category of people who are often considerably wealthy. I have visited several illegal gipsy sites in my constituency and been impressed by the quality of the cars and how new they are, the expensive caravans, the heavy lorries that they use and the immense variety of equipment that they possess to carry out their activities. We have no obligation to provide social security benefits to people who are clearly well able to look after themselves, if they are not genuinely unemployed. Gipsies, too, have obligations to pay taxes and rates, to abide by the general laws of the community and to respect the rights of the majority among whom they live. The policy makers—Members of Parliament and the officials and well-meaning people who determine the climate in which policy is made — have a duty to consider the gipsies and the general public. In almost all the work that I have read on the subject, the bias is towards the gipsy and the tendency is to sneer at the worries of the general public. Even Professor Wibberley, who, by and large, is free from this, refers to the frenetic opposition by local people to reasonable site suggestions for new gipsy sites. He says that, as a local councillor, he was aware of how strong and distasteful such local opposition can be. It is not especially distasteful for people to express their anxieties about genuine problems. There is nothing distasteful about the concerns expressed by my constituents. I am extremely worried on their behalf, and I hope that the law will be altered to accommodate their worries as well as to allow opportunities for gipsies to continue their way of life. The Act is producing intolerable pressures, which are especially strong in green belt and residential areas. The laws are weighted too heavily towards the gipsies, who are accorded privileges that are not available to any other section of the ordinary public. There is a great danger that others will learn of those privileges and seek to define themselves as gipsies under the loose definition that operates. All those matters require correction after a thorough review. I hope that my hon. Friend the Minister will begin such a review.
Time is so short that it is impossible to make more than the briefest remarks about this subject. Wherever nomads and settled people have lived alongside each other, there has been conflict. One can see that in Darwin's "Voyage of the Beagle" and in the song by Rodgers and Hammerstein, which said that farmers and cowmen should be friends, but they were not. The amount of virulence, venom and hatred directed towards gipsies is almost metaphorical. I have encountered it in my constituency, as have most people.In a civilised society, we must try to find an accommodation between people of different lifestyles. It is not easy, and there are no absolute principles that one can lay down, but we must try to find that accommodation and deal with the problem objectively, instead of giving way to prejudice. I have looked at the Minister's response to the recent inquiry and have no hesitation in agreeing with almost all of that response. I am unhappy about designation, but for reasons quite different from those put forward by the hon. Member for St. Albans (Mr. Lilley). As the Government provide the whole of the cost for gipsy sites, a further effort must be made to try to enforce local authorities to meet the need that remains by providing one site for each gipsy family for every 10,000 settled families in Britain. That should not be too difficult to do. It would be hopeless if we started to make even more exceptions and gave further dispensations to local authorities, some of which are not meeting their responsibilities. I appreciate the constituency points that were made by the hon. Members for St. Albans, but we must take art overall view. We have to try to enforce more thoroughly than before the duty that is placed on local authorities, because it is often the neglect of that duty that creates problems. I hope that the Government will renew their efforts, which follow the efforts of the previous Labour Government, to try to solve this problem by the provision of proper sites.
Time is so limited that I shall not be able to address all the problems in my constituency that I should have liked to draw to the attention of the House. In my constituency there are some horrendous problems because of an invasion of the area by so-called gipsies. Instead of describing those problems, I shall ask the Minister a few questions, because he has been to my constituency and has seen the problems that exist there. He also kindly met me to discuss these problems.Does the Minister know where the people who invaded my constituency come from? Are they covered by the provisions of the Caravan Sites Act 1968, and is any research being conducted to find out why this sudden growth has occurred? What are the exact legal obligations of Haringey borough council? It says that it has a duty to accept all these visitors. My understanding of the law is that a council has an obligation to provide a 15-caravan site properly laid out with all the necessary facilities so that it can be kept in a clean and tidy condition. Is not a 100 per cent. grant available from the Government for the provision of such a site, and is it therefore wrong for the council or its members to say that no money is being made available by the Government to regulate this problem? Once a council such as Haringey has provided a properly regulated site for 15 caravans at Government expense, is that not an end of the council's obligation and can it not claim to be a designated area and receive powers to turn away any fresh invasion? If such a council fails to apply for designation, in his review of the law, would the Minister consider the possibility of, say, up to 50 local ratepayers applying to the Secretary of State for designation when the council refuses or neglects to do so? I read with great interest the report by Professor Wibberley, and the Minister will know that that report says that the London Boroughs Association asked for automatic designation for every London borough. That would suit my constituents very well, but if that cannot be done, at least when the minimum provision has been made, can there not be a direct application to the Secretary of State from hard-pressed and distressed residents?
This is a short debate, but it is clear from the speeches that we could go on for a long time. All that I can do in the time remaining is to congratulate my hon. Friend the Member for St. Albans (Mr. Lilley) on once again bringing this topic to the Floor of the House and on securing time for the debate. He asked questions and made some comments and criticisms in order to enable us to address this problem. I pay tribute to my hon. Friend for his work on behalf of his constituents since he entered the House. Today's debate is evidence of his persistence in that work.I also pay tribute to my hon. Friend the Member for Hornsey and Wood Green (Sir H. Rossi), Chairman of the Select Committee on the Environment, who has led some interesting research and discussion on this subject, leading to a report—
It being half-past Two o'clock, the debate stood adjourned.
Orders Of The Day
Private Members' Bills
Considered in Committee; reported without amendment; read the Third time, and passed.
Medical Act 1983 (Amendment) Bill
Order for Second Reading read.
Second Reading deferred till Friday 20 March.
Animals (Scotland) Bill 'Lords
As amended (in the Standing Committee), considered.
Motion made and Question, That the Bill be now read the Third time, put forthwith pursuant to Standing Order No. 56 (Third Reading), and agreed to.
Bill accordingly read the Third time, and passed, with amendments.
London Borough Of Ealing
Motion made, and Question proposed, That this House do now adjourn.— [Mr. Malone.]
I welcome this opportunity to develop on behalf of ratepayers in the London borough of Ealing the case for the Secretary of State to rate-cap the council in 1988–89. My hon. Friend the Member for Ealing, North (Mr. Greenway) hopes to catch your eye, Mr. Deputy Speaker, for a couple of minutes at the end of my remarks. We are both delighted by the response of our hon. Friend the Minister for Local Government, who has first-hand constituency experience of the damage wreaked by Left-wing Labour councils.For eight years, until last May, Ealing council was Conservative controlled. In the last four of those years, rates increased by only 13 per cent. in cash terms due to prudent budgeting, contracting services out to the private sector where that made sense, making realistic charges for rents and other services, keeping a tight control on manpower and developing a partnership with the private sector to harness its energies to regenerate rundown parts of the borough. Those policies bore fruit and the new town centre opened by the Queen two years ago brought fresh heart to the borough. In my constituency, the Park Royal industrial estate, which had been declining for many years, began to sprout new offices and factories. Attracted by the combination of low rates and good services, businesses in Ealing expanded, others moved into the borough, and more discerning people, including the Leader of the Opposition, chose to make their homes in the borough. Last May, Labour took control and the policies that I have described were thrown into reverse. As democrats, we live by the ballot box and accept the verdict, but with one or two comments. First, it is now remarkably difficult to find anyone in Ealing who admits to having voted Labour last year. A random poll in the Red Lion in Acton earlier this week found no volunteers. Had people known last year what they know now, Labour would certainly not have got in. The Labour party now running Ealing is an entirely different animal from that which ran the borough in the 1960s and 1970s, for which a number of people mistakenly thought they were voting. The biggest cost increase is in the number of additional staff and the office space needed to house them. Sadly, many of them are political appointments. Since coming to power, the council has taken on 750 extra staff, a figure which is due to double by May next year to about 1,225. The majority provide no actual services—they are not teachers, social workers or refuse collectors. Many are political appointments. There is a large number of press and publicity officers, personal assistants and clerical support to the chairman of committees. We have large numbers of people running the animal rights sub-committee, the gay and lesbian subcommittee, the nuclear disarmament sub-committee, the anti-apartheid committee, the women's committee and the race equality committee—all the municipal apparel that the well dressed Labour council now feels obliged to wear. Those people have to be accommodated, and a new office block has been hired at a cost of £3.1 million a year, to the enormous relief of the developer who put it up. That represents a long-term commitment by the council. Where else has the money gone? Some £1.3 million a year goes to the GLC in exile. £1 million goes on the de-privatisation of street cleaning, we are to have an antiapartheid festival in Ealing in July at a cost of £12, 000 and we have a race equality commit tee with a campaigning role budget and grants of £200,000. The cost of stationery has increased by 44 per cent., and attendance allowance for councillors has gone up by 400 per cent. They, at any rate, do not propose to be worse off. Last Thursday, the bill for one year's Labour administration in Ealing was added up. The council voted an increase in the domestic rate of 65 per cent. and in the industrial rate of 57 per cent. An alternative Conservative budget involving an increase of up to 10·6 per cent. was voted down. I pay tribute to the Conservative opposition on Ealing council under the dynamic leadership of Councillor Martin Mallam. I attended part of the council meeting at which the director of finance described the path down which Ealing council has now embarked as an exceedingly high-risk strategy. A higher increase was avoided only by a dubious practice of charging to capital account a number of items conventionally charged to revenue account. By adopting that strategy, the council has ignored its own research into the acceptability of a rate rise. Independent research funded by the council and carried out last year in four Labour wards and one Liberal ward showed that 48 per cent. wanted no increase at all and that 38 per cent. were prepared for a small rise if it meant an improvement in services in their area. Only 5 per cent. were prepared to fund a big rate rise. The average rate rise for a council tenant will be more than £4 a week and for the average owner-occupier nearly £5 a week. For industry, the problem is even more acute. I should like to quote from a statement by the Industrial and Commercial Ratepayers Consultative Panel, the energy and initiative of which I applaud for bringing home to the council the consequences of what it has done. After the rate increase, it said:
There is an impact on the health authority, which has to pay rates. I have a letter from the director of finance which outlines how the more than £250,000 extra rates might be found. It involves a delay in opening 12 geriatric assessment beds, converting a children's ward to a five-day ward and a reduction in the mental health unit's budget, all of which would cost 21 jobs in the Health Service. I have just opened a letter from Landis & Gyr which says:"We would reiterate our view that the damage to the industrial and commercial sectors in the London Borough of Ealing will be considerable.
1. Some smaller traders have already advised that they will go out of business as a result of such a large increase. 2. With regard to the larger businesses employing in excess of 1,000 people, such an increase will affect their overheads and their competitiveness. It would require a substantial increase in turnover just to stand still. It would also make such companies less competitive arid could have a knock-on effect on their ability to create further employment opportunities. 3. There is no doubt that some other companies will be affected by such an increase which could result in a reduction in the number of people employed, or curtailment of investment, or both. 4. Businesses in general would be severely affected and some have already indicated the possibility of relocation to areas more conducive to industrial and commercial development."
"Further to your recent visit to Landis & Gyr we have learnt through the newspapers of the appalling rise in rates in Ealing which I believe to be 65 per cent.
As we discussed, the effect on our company is extremely unpleasant to say the least, and we calculate that it will cost us approximately £150,000 a year. Put another way, that is worth at least 15 jobs or we must sell another £2 million worth of goods to pay for it.
That is what I am doing at the moment. The point is well made by the panel to which I referred a few moments ago, which said:Will you please use your best endeavours to resist this outrageous increase or at the very minimum ensure that it does not occur next year?"
It is not just the Conservative party that is fed up with Ealing council and would like to see it restrained. The hon. Member for Bassetlaw (Mr. Ashton) was quoted in The Sunday Times as saying:"We would ask the council what is the net gain to the local economy if additional jobs in the public sector (as the council is proposing) are at the expense of jobs in the private sector."
"I was told to keep quiet after the Bermondsey by-election. I kept quiet after the miners' strike. I kept quiet during the Militant Tendency but I am not going to keep quiet any longer.
Neil has got to take on these councillors. We can't win with 65 per cent. rate rises in Ealing and stories about banning boxing in Hackney.
The right hon. Member for Birmingham, Sparkbrook, (Mr. Hattersley) wrote in The Mail on Sunday:They are not fighting an election in Ealing until 1990 so they don't care. We are fighting an election this year…"
We all know of the views of Patricia Hewitt, who said:"Nothing can be more damaging to a political party than small groups of vocal zealots who think they know best—better than the leader, better than official party policy, better even than the voters whose support they hope to win."
The equal opportunities programme in Ealing will cost the ratepayer £7·5 million. There are national implications of what is happening in Ealing. Two leading councillors are trying to get into Parliament, presumably so that the national taxpayer can benefit from the treatment which is being allocated to the Ealing ratepayer. They are not alone in London. They represent the new modern Labour party in London—dogmatic, humourless and expensive. Not only is spending out of control, with unpopular policies being pursued and senior officers leaving, we now have the first ever white-collar strike in Ealing. It is not possible to pay rates in Ealing because the town hall is on strike. Houses and businesses cannot be sold in Ealing. If a bill is sent to the local authority it will not be paid. No urgent housing repairs are being conducted, the switchboard is on strike, the homeless families unit is not working and even the incontinent laundry service is out of operation. That is the administration that my constituents are having to put up with. I ask my hon. Friend the Minister for Local Government for help. I want to put the problem in perspective. Previously, Ealing had enjoyed eight years of Conservative administration. We have had eight years of Conservative Government, and we are all looking forward to the Budget. The undoubted damage which is now being done in Ealing can be reduced if, next year, Ealing is rate-capped and if it is known, as soon as possible, that that is the course of action that will follow. For some, one year of Socialism will be one year too many, but the rest of business in Ealing might survive if we knew that help was on the way. We in Ealing are not asking for the cavalry: one horse will do, as long as it is mounted by my hon. Friend equipped with his rate-capping gear. The people of Ealing are looking to the House to protect them from the local tyranny that we now have in the London borough of Ealing."The 'loony Labour Left' is taking its toll…The gays and lesbians issue is costing us dear."
I am grateful to my hon. Friend the Member for Ealing, Acton (Sir G. Young) for allowing me two or three minutes in his debate. I congratulate him on securing it and on the excellent case that he has made out, which I second with all my heart and determination.The House should note that the alliance is opposed to rate capping, so it will not support any efforts to rate-cap this high spending and evil council. The Ealing rate is the highest in the country. As my hon. Friend has said, the borough has been brought to a standstill within 10 months of the accession of this council. In addition to the services that my hon. Friend said had been affected, schools are being closed throughout the borough and children are being sent home on account of the strike. It is a most serious situation. Can my hon. Friend the Minister answer a question that is on the lips of everyone in Brent? By how much could rates in Ealing have been raised without the council incurring penalties? My hon. Friend and I both know Whitton avenue, because it runs between our constituencies. Previously, rates on the Ealing side have always been half of those on the Brent side. From 1 April this year the Ealing rates will catch up at a stroke. Ealing council says that rates have been too low, and that is part of its justification for raising them. An elderly lady, who is well into her nineties, lives in a small house and pays rates of £210. She has been told that they will go up by no less than £136, and she will have no increase in her income, apart from a rise in her pension, to pay those rates. The rates of the Leader of the Opposition will go up by £333 a year. We need not feel sorry for him, but we should note the facts. People from all over Ealing want to take round petitions against the rate increase. Mrs. Penny Talbot of Northolt brought me a petition signed by 1,000 people. It says:
There has been a great deal of such expenditure. The rates of Lyons, which employs 2,500 people in my constituency, will go up by over £600,000 a year. That means that porridge, tea, coffee, ice cream and other basic necessities of life will cost much more or people will be made redundant or there will be a combination of the two effects. The CDS laundry tells me that its rates will rise by £8,000 in a full year, which will hit mums, dads and single parents in their laundry operations. Carhill Roller Shutter Services wants to move from its present 3,900 sq ft of premises to a new place of 5,600 sq ft, but the rate rise is likely to rule out such a move. As a result, six people who would have been employed by the firm will not now get jobs. The situation is serious and we look to my hon. Friend the Minister for Local Government for the succour of rate capping."We the undersigned bitterly reject Ealing council's planned 80 per cent. rate increase and their wasteful expenditure behind it, compared with a reduction of 4 per cent. by the previous council. We demand no further rate increases for ten years. We particularly reject the wasteful expenditure on homosexuals, lesbians and other such wrongful expenditure."
I have listened carefully to the excellent speeches of my hon. Friends the Members for Ealing, Acton (Sir G. Young) and for Ealing, North (Mr. Greenway). There is no doubt about how strongly the people of Ealing and their representatives feel about this matter.I am grateful to my hon. Friends for raising the subject. I trust that we can influence public opinion, even if we cannot do anything about rate capping this year. I shall refer later to rate capping. Ealing is just one of a number of London boroughs that have recently fallen under the control of the hard Left. Once a haven of sensible Tory administration, it has now been infected by the Brent disease spreading across the Great West road and Whitton avenue. Hilary Benn and his cohorts are, by their antics, giving new life and meaning to the noble traditions of Ealing comedy. Life in Ealing, once the heartland of fine old English comedy, has reverted to tragic farce. The situation is doubly horrifying because Ealing has a long history of responsible, moderate and Conservative administration. It has spent within 2·5 per cent. of its grant-related expenditure assessment in every year since the block grant system was introduced and in every year expenditure growth has been consistently below the rate of inflation. During that period, when there were targets and penalties for overshooting them, the council budgeted prudently and safeguarded its ratepayers from the loss of grant penalties. That is not to suggest that service levels have been low; on the contrary, Ealing has the sixth highest grant-related expenditure per head of outer London boroughs. Rates have been held closely in check, with rate poundages last year among the lowest in outer London. That increased the shock that Ealing ratepayers faced this year. The rate increase in 1985–86 was only 0·1 per cent. Now, as Ealing ratepayers dig deep into their pockets to find the extra 72 per cent. that the council is asking for, they will come to look on the time of the previous Conservative administration as a veritable golden age. This year the Government have given authorities an extremely reasonable RSG settlement. Indeed, throughout the country there has been an increase in RSG of £1·2 billion, which represents an average of 9 per cent. so nobody can say that the Government have not done their share to help hold down local rates. The majority of boroughs have taken the opportunity to budget sensibly and levy modest rates increases. So far, the average increase in the country as a whole is about 6 per cent. In outer London Conservative boroughs the restrictions on expenditure have been such that the average rate increase is only 5 per cent. What a difference from the Ealing scene! As my hon. Friend the Member for Ealing, Acton has said, the council is blaming the Government for the increase. It is arguing that grant reductions have forced the increase on the council. It would have been interesting to note what the rate levy would have been had the Conservatives been elected last year — no doubt the wisdom of the electorate will increase as a result of this year's events. It is complete nonsense to say that Government grant cuts have caused the rate increase. This year had the council increased spending in line with inflation—as the previous Conservative administration constantly achieved or bettered — the block grant entitlement would have been £73.2 million and the rate increase 3.6 per cent. On top of that, ratepayers would have had to find about 2.4 per cent. for teachers' pay, but, even so, the rate increase would have been only 6 per cent. I should add, as my hon. Friends know, that the council is also receiving extra balances from the London residuary body, and grant that it did not budget for this time last year — in total about £4.4 million. Had the council sought to use this extra for the benefit of ratepayers, the rates could have been lower still. In fact, overall, Ealing's local rate need not have risen at all if the extra balances had been used in such a way. Instead, ratepayers in Ealing are having to face a massive increase. My hon. Friends have said that that increase is driving business out and bankrupting people of all ages. I listened with great care to the effect that the increase is having upon old-age pensioners within the borough.
If my hon. Friend will allow me I will give way in a moment.
I apologise. I was not seeking to intervene, but was passing some papers to my hon. Friend the Member for Ealing, Acton (Sir G. Young).
I thought that my hon. Friend was so excited that he sought to intervene. I thought that the spirit of intensity had moved him.I am grateful to my hon. Friend the Member for Ealing, Acton for giving us full details of Ealing's final budget and rate for 1987–88 so that we can compare it with previous years. Neither I nor my officials had, until now, succeeded in obtaining this information since Ealing town hall appears to be out on strike and is incommunicado at this time. One cannot phone, write, or make personal approaches. Personnel management does not appear to be one of the strong points of Ealing's Left-wing council as, apparently, there is no contact with that council. To the Leftists presumably, these are just teething problems before their view of Utopia is achieved. I had feared that the grave problems relating to management efficiency, recently highlighted by the Audit Commission in certain Labour-controlled London councils, might spread to other authorities. However, I never dreamed that it could spread as quickly as it has to Ealing. It is a great sorrow to me that this year the Government have no power to protect ratepayers from such swingeing increases—except where an authority is rate-capped. My hon. Friend the Member for Ealing, Acton, who served as a distinguished Minister in the Department which I now have the honour to serve, knows the basis of rate capping. As hon. Members will be aware, selection for rate capping is on the basis of budgeted spending in the previous year in relation to GR E, not on the basis of rate increases in the year itself. Rate capping for 1987–88 is based on expenditure in 1986–87. This year we have selected 20 high-spending authorities for rate limitation. All of them were budgeting to spend at least 12·5 per cent. above their GRE—the Government's objective assessment of what an authority needs to spend to maintain a standard level of service—and all have increased their spending significantly in recent years. Ealing was not selected because its spending was very close to the GRE—in fact, slightly below it in 1986–87—nor had it shown any significant increase in previous years. Needless to say, it was at that time under a Tory administration. I should add that where an authority budgets below GRE, as Ealing did in 1986–87, the Rates Act 1984 specifically provides that it cannot be selected for rate limitation. That is to acknowledge that in such circumstances the authority is clearly run economically with the interests of its ratepayers in mind. Four London councils fell to Labour control in the 1986 municipal elections — three from Conservative control and one from hung Conservative control. Those boroughs were Waltham Forest, Hammersmith and Fulham, Brent and, of course, Ealing. One could consider them the unfortunate boroughs in last year's election. Their ratepayers certainly feel that they were. For 1986–87, ratepayers in those boroughs were protected by the modest rate set by the previous administration. Unfortunately, no such protection is available in 1987–88. Apart from Ealing's local rate increase of 71·8 per cent., increases of 67 per cent. and of a staggering 127 per cent. have been announced by Waltham Forest and Hammersmith and Fulham respectively. Only in Brent, thanks to rate capping, is a modest increase proposed—7 per cent.—a testimony to the value of rate capping if ever there was one. Any hon. Member who doubts the use of rate capping need only look at those three boroughs to see the necessity for it. Even in these three boroughs, however, some protection is afforded this year by the capping of the precepts levied by the Inner London education authority and the London fire and civil defence authority. This reduces the increases in actual rate bills in the high-spending Labour authorities. In Hammersmith and Fulham the increase at ratepayer level comes down from 127 per cent. to 50 per cent.; in Waltham Forest from 67 per cent. to 62 per cent; and in Ealing from 72 per cent. to 65 per cent. If it were not for the rate capping of the precepts levied by the ILEA and the London fire and civil defence authority, the ratepayers would face larger increases. If the 1987–88 selection criteria had been applied to Ealing's latest budget, it might have been a different story. It appears that the council is budgeting to spend £179 million, as against last year's budget of £144·6 million—a phenomenal increase. It would have meant Ealing would easily have met the growth criteria for selection. If £179 million is the correct figure, the council is proposing to spend 18 per cent. above GRE, and would also have met the other GRE criterion for selection—GRE plus 12·5 per cent. As regards the case for rate capping Ealing in 1988–89, I can only say that my right hon. Friend the Secretary of State for the Environment has not yet decided what criteria should apply for selective rate limitation in 1988–89. Before deciding on the appropriate criteria for excessive spending, he will, of course, need to have regard to all relevant considerations. It is intended that he will make an announcement on selection in July in the usual way for next year, in the same way as there was an announcement in July last year for the rate-capped boroughs which were selected for rate capping in 1987–88. I feel strongly on the matter, both as a Minister and as a Member of Parliament, as my constituency is adjacent to that of Ealing, North. Brent, as well as Ealing, has a hard Left authority. I should like to mention Brent, and I cannot let this opportunity pass without commenting on a leaflet about the police now circulating in the borough, which came to light this week. I believe that it is also circulating in Ealing. It was distributed by the Brent hard Left Labour council throughout the borough. The chief superintendent of police in Brent issued a statement against it this week. The leaflet is entitled "How to make a complaint against the police and take them to court". It is an outrageous and completely irresponsible document. In an area in which the police are working hard to build better relations with people of all races and creeds, the leaflet is designed to create an atmosphere of distrust and fear among all the people. The tone of the leaflet is clearly demonstrated by a cartoon on its opening page. It shows the boot of a policeman crushing the head of an individual stretched on the ground. Another cartoon and the text of the leaflet seek to undermine confidence in the independent police complaints procedure. I hope that the House will join me in condemning that leaflet, which can do nothing but harm. I am sure that there is unanimity on that on the Floor of the House this afternoon. When in control, the hard Left spends money as if there is no tomorrow, and, by attacking the police, it hopes to undermine law and order in society. Those people are the wreckers of the late 1980s. Ealing, Brent, Waltham Forest and Hammersmith and Fulham show the whole country what Britain would be like if Labour won the next general election. We did not volunteer to suffer, but at least the warning is going round the rest of the country. The lesson is being learnt every day by more people as to what happens when the hard Left takes control, as it has in Brent, Ealing and the other boroughs. We see the misery of the ratepayers. That misery cannot be revenged but it can be ended nationally by our victory at the general election—
The Question having been proposed after half-past Two o'clock and the debate having continued for half an hour, MR. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
Adjourned at two minutes past Three o'clock.