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Breast Cancer Screening

Volume 640: debated on Wednesday 2 May 2018

I wish to inform the House of a serious failure that has come to light in the national breast screening programme in England.

The NHS breast screening programme is overseen by Public Health England and is one of the most comprehensive in the world. It screens 2 million people every year, with women between the ages of 50 and 70 receiving a screen every three years up to their 71st birthday. However, earlier this year PHE analysis of trial data from the service found that there was a computer algorithm failure dating back to 2009. The latest estimates I have received from PHE is that, as a result, between 2009 and the start of 2018, an estimated 450,000 women aged between 68 and 71 were not invited to their final breast screening.

At this stage, it is unclear whether any delay in diagnosis will have resulted in any avoidable harm or death, and that is one of the reasons I am ordering an independent review to establish the clinical impact. Our current best estimate—which comes with caveats, as it is based on statistical modelling rather than on patient reviews, and because there is currently no clinical consensus about the benefits of screening for this age group—is that there may be between 135 and 270 women who have had their lives shortened as a result. I am advised that it is unlikely to be more than this range and may be considerably less. However, tragically, there are likely to be some people in this group who would have been alive today if the failure had not happened.

The issue came to light because an upgrade to the breast screening invitation IT system provided improved data to local services on the actual ages of the women receiving screening invitations. This highlighted that some women on the AgeX trial, set up to examine whether women up to the age of 73 could benefit from screening, were not receiving an invitation to their final screen as a 70-year-old. Further analysis of the data quantified the problem and has found a number of linked causes, including issues with the system’s IT and how age parameters are programmed into it. The investigation also found variations in how local services send out invitations to women in different parts of the country.

The existence of a potential issue was brought to the attention of the Department of Health and Social Care by Public Health England in January, although at that stage, its advice was that the risk to patients was limited. Following that, an urgent clinical evaluation took place to determine the extent of harm and the remedial measures necessary. Public Health England escalated the matter to Ministers in March, with clear clinical advice that the matter should not be made public. This was to ensure that a plan could be put in place that ensured any remedies did not overwhelm the existing screening programme and was able to offer proper support for affected patients.

I am now taking the earliest opportunity to update the House on all the remedial measures that have been put in place, which are as follows. First, urgent remedial work to stop the failure continuing has now been completed according to the chief executive of Public Health England. This was finished by 1 April and PHE is clear that the issue is not now affecting any women going forward.

Of the estimated 450,000 women who missed invitations to a scan, 309,000 are estimated to still be alive. Our intention is to contact all those living within the United Kingdom who are registered with a GP before the end of May, with the first 65,000 letters going out this week. Following independent expert clinical advice, the letters will inform all those under 72 that they will automatically be sent an invitation to a catch-up screening. Those aged 72 and over will be given access to a helpline through which they can get clinical advice to help them decide whether a screening is appropriate for their particular situation. This is because for older women, there is a significant risk that screening will pick up non-threatening cancers that may lead to unnecessary and harmful tests and treatment. However, this is an individual choice and in all cases, the wishes of the patients affected will be followed. By sending all the letters to UK residents registered with a GP by the end of May, we hope to reassure anyone who does not receive a letter this month that they are not likely to have been affected.

It is a major priority to do our very best to make sure that the additional scans do not cause any delays in the regular breast screening programme for those under 71, so NHS England has taken major steps to expand the capacity of screening services, and has today confirmed that all women affected who wish to be screened will receive an appointment within the next six months. Of course, we intend the vast majority to be much sooner than that.

We have held helpful discussions with the devolved Administrations to alert them to the issue. Scotland uses a different IT system, and while the systems in Wales and Northern Ireland are similar, neither believe they are affected. However, we are discussing with each of them the best way to reach women who have moved to another part of the UK during this period. This is obviously more complicated, but we are confident that those affected will still be contacted by the end of May.

In addition, and as soon as possible, we will make our best endeavours to contact the appropriate next of kin of those we believe missed a scan and have subsequently died of breast cancer. As well as apologising to the families affected, we would wish to offer any further advice they might find helpful, including the process by which we can establish whether the missed scan is a likely cause of death and compensation is therefore payable. We recognise that this will be incredibly distressing for some families, and we will approach the issue as sensitively as possible.

Irrespective of when the incident started, the fact is that for many years, oversight of our screening programme has not been good enough. Many families will be deeply disturbed by these revelations, not least because there will be some people who receive a letter having had a recent diagnosis of breast cancer. We must also recognise that there may be some who receive a letter having had a recent terminal diagnosis. For them and others, it is incredibly upsetting to know that you did not receive an invitation for screening at the correct time, and totally devastating to hear you may have lost or be about to lose a loved one because of administrative incompetence. So on behalf of the Government, Public Health England and the NHS, I apologise wholeheartedly and unreservedly for the suffering caused. But words alone are not enough. We also need to get to the bottom of precisely how many people were affected, why it actually happened and most importantly, how we can prevent it ever happening again.

Many in this House will also have legitimate questions that need answering: why did the algorithm failure occur in the first place, and how can we guarantee it does not happen again? Why did quality assurance processes not pick up the problem over a decade or more? Were there any warnings, written or otherwise, which should have been heeded earlier? Was the issue escalated to Ministers at the appropriate time? What are the broader patient safety lessons for screening IT systems?

I am therefore commissioning an independent review of the NHS breast screening programme to look at these and other issues, including its processes, IT systems and further changes and improvements that can be made to the system to minimise the risk of any repetition. The review will be chaired by Lynda Thomas, chief executive of Macmillan Cancer Support, and Professor Martin Gore, consultant medical oncologist and professor of cancer medicine at the Royal Mardsen, and is expected to report in six months.

The NHS has made huge progress under Governments of both sides of this House on improving cancer survival rates, which are now at their highest ever. Seven thousand people are alive today who would not have been if mortality rates had remained unchanged from 2010, but this progress makes system failures even more heartbreaking when they happen. Today, everyone in this House will be thinking of families up and down the country who are worried that they may have been affected by this failure. We cannot give all the answers today, but we can commit to take all the necessary steps to give people the information that they need as quickly as possible. Most of all, we want to be able to promise that this will not happen again, so today, the whole House will be united in our resolve to be transparent about what went wrong and to take the necessary actions to learn from the mistakes made. I commend this statement to the House.

I thank the Secretary of State for advance sight of his statement and for his personal courtesy in directly briefing me as well. The thoughts of the whole House are with those whose screening was missed and who sadly lost their lives from breast cancer, or who have subsequently developed cancer. Anyone who has had a loved one taken by breast cancer, or indeed any cancer, will know of the great pain and anguish of that loss. I understand that the Secretary of State has referred to estimates, but when the facts are established, will he assure us that each and every case will be looked into sensitively and in a timely manner? Our thoughts also turn to the 450,000 women who were not offered the screening that they should have had, so I welcome the Secretary of State’s commitment to contact the 309,000 women who are estimated to be still alive.

Early detection and treatment are vital to reducing breast cancer mortality rates, which was why the AgeX pilots were established in 2009 and rolled out nationally from late 2010, when the Government expanded the screening programme. Given the problems that Public Health England has identified with its randomisation algorithm for those trials, will the Secretary of State tell us whether any evaluations and assessments of those pilots had been done by the Department before the national roll-out of the programme?

I welcome the Secretary of State’s candour in questioning why this problem was not picked up—eight years is a long time for an error of this magnitude to go undetected. Did the Department receive any warnings in that time? Is there any record of how many women raised concerns that they had not received the appropriate screening? Were there any missed opportunities to correct this mistake? He said graciously that oversight of the screening programme was not good enough. How does he intend to improve that oversight? What other trials are in place across the NHS and is he satisfied with their oversight?

We welcome the establishment of the national inquiry. Will it be hosted and staffed by the Department of Health or another Department? In the interests of transparency, will the Secretary of State place in the Library the Public Health England analysis from this year that identified the problem with the algorithm? Although the parallels are not exact, where the NHS offers bowel cancer screenings for women between the ages of 60 and 74 and cervical cancer screenings for women up to 64, what assurances can he give that the systems supporting those services are running properly, and what checks are being carried out to make sure that nobody misses out on screenings for other cancers?

The Secretary of State says that NHS England will take steps to expand the capacity of screening services. Will he say a little more about that? What extra resources will be made available to help the NHS provide the extra screening now needed? He will know that the NHS faces huge workforce pressures—according to Macmillan, there are more than 400 vacancies in cancer nursing, the Royal College of Radiologists has found that 25% of NHS breast screening programme units are understaffed, and there are vacancies for radiographers too. Will he assure us that the NHS will have the staff to carry out this extra work, and may I gently suggest that, if it needs extra international cancer staff, he ensures that the Home Office does not block their visas?

More broadly, does the Secretary of State share my concerns that screening rates are falling generally? The proportion of women aged 50 to 70 taking up routine breast screening invitations fell to 71.1% last year—the lowest rate in the last decade. There is also a wide regional variation in screening rates. The number of women attending breast screening in England is as low as 55.4% in some areas, and, as the all-party group on breast cancer found, there are stark inequalities in NHS services in England, with women in the worst-affected areas more than twice as likely to die from breast cancer under the age of 75. Beyond the problems identified today, what more are the Government doing to make sure that screening rates rise again so that cancer care for patients is the best it can be?

Finally, many of our constituents over whom breast cancer has cast a shadow will feel anxious and worried tonight. Members on both sides of the House want to see cancer prevented and those who have it fully supported. Transparency and clarity are vital. Will the Secretary of State undertake to keep the House fully informed of developments to offer our constituents the peace of mind they deserve?

I thank the hon. Gentleman for his constructive tone, and I want to reassure him that each and every case will be looked at in detail. The sad truth is that we cannot establish whether not being invited to a screen might have been critical for someone without looking at their individual case notes, and in some cases, sadly, establishing a link will mean looking at the medical case notes of someone who has died.

It is important to explain that the reason for these estimates, which are much broader than we would like, is that there is no clinical consensus about the efficacy of breast screening for older women. As I understand it, that is because the incidences of cancers among older women are higher, but a higher proportion of them are not malignant or life-threatening, which makes it particularly difficult. It is also the case that breast cancer treatment has improved dramatically in recent years and so it is less important than it was to pick up breast cancer early. None the less, we believe it will have made a difference to some women, which is why it is such a serious issue.

The evaluations of the AgeX trial, which brought this to light at the start of the year, have been continued by Oxford University throughout the trial period. I am not aware of any evaluations shared with the Department that could have brought this problem to light, but obviously the inquiry will look into that. We need to find ways to improve oversight, and modern IT systems can greatly improve safety and reliability—in fact it was during the upgrading of the IT system that this problem was brought to light.

I will share with the hon. Gentleman the advice the Department received from Public Health England in January, which was the first time we were alerted to the issue, and we will certainly provide any extra resources the NHS needs to undertake additional cancer screening. One of our biggest priorities is that women between the ages of 50 and 70, when the screens are of their highest clinical value, do not find their regular screens delayed by the extra screening we do to put this problem right. He is right that one thing that has come to light is the regional variation in how the programme is operated. It was previously operated by the old primary care trusts, under the supervision of strategic health authorities, and then brought under the remit of Public Health England, but the regional variations have continued for a long time, so this problem will be worse in some parts of the country than in others. I undertake to keep the House fully informed.

I thank the Secretary of State for the commitments and actions he has set out. Colleagues across the House will be thinking of the hundreds of thousands of women not called for their final screening test. They now need consistent, high-quality, evidence-based guidance so that they can make an informed choice about whether to take up the offer of screening. There is much material available setting out pictorially and clearly how they can weigh up the risks and benefits. Will he assure the House not only that a helpline will be in place but that it will be backed up with high-quality material available directly to patients and their GPs, many of whom will be directly counselling women following this news?

Yes, and I can reassure my hon. Friend that GPs will be briefed and that people will be referred for additional support to clinically trained staff at Macmillan Cancer Support and Breast Cancer Care. We have to be transparent with patients, however, about the absence of a clear clinical consensus on the efficacy of scanning for women in their 70s. The fairest thing is to explain that different people have different views and allow them to come to an individual choice, and that is what we are doing. It will of course cause considerable distress to those given that dilemma, but if anyone wants a scan, we will do that scan.

I thank the Secretary of State for my advance briefing, but, as a breast surgeon and co-chair of the all-party group on breast cancer, I gently take issue with his comment that we do not need to diagnose breast cancer early because of the changes in treatment. I would not like that message to stand: diagnosing early is still crucial.

Obviously this is horrendous for the women involved, but it will also create anxiety for women who are not aware whether they are involved and who might not have been part of the trial. Reassuring them will be a challenge. I welcome the independent review into how it happened and how it went so long without being picked up, and I am interested to know what will happen with the trial now—the loss of almost 500,000 women from it might have a major impact.

Given the normal pick-up rate of breast screening, approximately 2,500 cancers would have been picked up across England in the last round. As the Secretary of State says, this issue did not apply in Scotland, but some of the women affected might have moved and settled in Scotland, so when did he inform the Scottish Government?

The Secretary of State said that the Department knew in January. As far as I can establish, officers in Scotland were informed of a minor issue in March, were told only last week that it was actually more major, and were not told that it might affect women who now live in Scotland. There has clearly been preparation and talk about funding in England, but how many women who live in Scotland have been identified, and what efforts have been made to track them down? What preparations for funding or the expansion of services have been made for Scotland and, indeed, for the other devolved nations?

As was mentioned by the hon. Member for Leicester South (Jonathan Ashworth), radiology, and particularly breast radiology, is a huge shortage specialty. What funds will be provided to ensure that it can be delivered without messing up the normal system?

Will women who do not receive a letter in the next few weeks be able to telephone, or can the Secretary of State really guarantee that if they have not heard by the end of the month, they are clear? As a doctor, I find that a bit scary.

The hon. Lady has asked some important questions. I am sorry if what I said was not clear, but I do not think I said that there was no need to diagnose early. It is obviously incredibly important for cancer to be diagnosed as early as possible. What I said was that I had been advised that in many cases, because of advances in breast cancer treatment, it would not make a difference to the particular women affected in this case. I fully accept that in some cases it will, and of course it is very important to diagnose all cancers as early as possible.

I will find out from Oxford University the dates on which it expects to report the full outcome of the AgeX trial. Obviously we all want to hear the results as soon as possible. I will also inform the hon. Lady of the exact date on which Scottish Government officials were informed. Let me reassure her that if there are any additional costs to the Scottish health system, it will of course be recompensed.

We do not think that major pressures will be created in the Scottish screening programme, and we are confident that we will be able to contact everyone in the UK who is registered with a GP—whether in Scotland, Wales, Northern Ireland or England—by the end of May. We have had very productive discussions with Scottish officials about the IT exchange that will be necessary to ensure that women living in Scotland also receive their letters by the end of May. We cannot guarantee that every single one of them will have been contacted by then—some will have moved abroad, and some will not be registered with a GP for whatever reason—but we think that we can contact the vast majority, and the helpline will be open for anyone to call if they think they may have been affected.

I think that Members on both sides of the House have appreciated the measured way in which my right hon. Friend has come to the House and revealed detailed commitments to helping the women who have suffered as a result of this terrible, unfortunate IT event. I also think that the measured response from the hon. Member for Leicester South (Jonathan Ashworth) properly reflected the concern that everyone shares.

My right hon. Friend referred to additional screening capacity to ensure that there is no impact on other, younger women. What undertakings can he give to any women who have been affected, and who find that they are suffering from a malignant growth in their breast, that they will be able to receive the appropriate treatment as rapidly as possible?

I thank my hon. Friend for the work that he did on cancer when he was working at the Department of Health, and for his broader work in supporting the hospital sector. He is absolutely right: additional people will come forward for treatment, so one of the other matters that we have been looking into is our treatment capacity. We certainly intend to ensure that people are treated within the normal short period if a cancer is detected, and the first step in that process is to ensure that everyone has a scan in the next six months. During that period, we will make certain that they are able to look forward to the same rapid treatment that all other people whose cancers are detected can be confident of receiving.

We have an ethical duty to get screening right, because we are inviting well people into our health service and offering them an intervention. May I ask the Secretary of State whether the uptake of screening by 68 to 71-year-olds during the period concerned was any lower than expected? If it was less than expected, why was that not properly analysed?

I do not know the answer to that question, but I will look into it. If we find that the uptake was lower than expected in that age group, it will be a very important clue about something that may have gone wrong, and I am sure that the review panel will want to examine it. The overall uptake rate is about 80%, but I agree with the hon. Gentleman that we should look into what the rates were in specific age cohorts.

I thank the Secretary of State for his measured statement, and for all he is doing to ensure that the women affected are given the treatment and support that they need. I particularly welcome his independent review of the NHS screening programme. Will he also be looking at quality assurance programmes more widely within the NHS in relation to screening programmes? It is deeply worrying that the NHS did not identify this error for more than a decade, and there may be a need to review those programmes.

I am afraid that my right hon. Friend is absolutely right. The truth is that we do have a quality assurance programme, and it failed to pick up this problem for far too long. We need to understand why that happened. We think that a single IT mistake was made at the very start of the programme, and we understand that sometimes such mistakes are devilishly difficult to identify. None the less, as was suggested by the hon. Member for Stockton South (Dr Williams), there must have been clues that could have been picked up—or so one would think—and we need to get to the bottom of that.

I think that anyone who listened to the statement will be devastated and appalled to learn about this fatal failure, especially given that the UK’s breast cancer survival rate is below the EU average. The Secretary of State talked about the advice line that might be available to people who had been affected, but has he given any consideration to any emotional or mental health support that should be extended to those people and their families?

We are indeed talking to the charities operating in this sector about how we can best provide all kinds of support, including mental health support, as well as clinical guidance. We often talk in the House about the challenges facing the NHS, but it is important to note that breast cancer is an area in which survival rates have been improving, and have actually been catching up with those in other European countries. The NHS deserves great credit for that, despite today’s very serious failing.

I commend my right hon. Friend for the way in which he brought this very bad news to the House, and the hon. Member for Leicester South (Jonathan Ashworth) for the way in which he responded to it.

As my right hon. Friend will know, breast cancer is not just about survival nowadays; it is also about quality of life after treatment. Will his contact with those who have been affected extend to those who have been treated, but who may have had to be treated in a more radical way than might have been the case had their cancers been picked up earlier?

Absolutely. As my hon. Friend will know from his own medical background, it is impossible to know that until there is a detailed case note review, but we will certainly undertake that review for anyone who thinks they may have been affected.

I thank my right hon. Friend for his statement and for the work he is doing to ensure that women who are affected are supported and treated promptly, but what is he doing to ensure that people who are due for cervical and other NHS screening programmes are being properly called, and can he tell women who are affected—and, no doubt, very worried today—what they should do now? Whom should they call, should they be waiting for a letter, and how soon can they expect a scan if they wish to have one?

According to the advice that I have received so far, there is no read-across to other screening programmes, but obviously the independent review panel will look into that as it seeks to examine all aspects of the issue. We have made the commitment today that we will invite for scans all those who either should be scanned or should consider whether they wish to have a scan, and will offer them a date before the end of October, although we hope that in the vast majority of cases it will be much sooner than that.

What conversations has the Secretary of State had with the Welsh Secretary? Having long since passed the ages he mentioned, I certainly was never invited for a screening; I had to ask for one, and I eventually got the screening in England.

We have not had conversations at ministerial level, but we have had conversations at official level. The Welsh Administration do not believe this problem has affected them, even though Wales was using the same IT system we were using in England. Our concern is about people living in England who are registered with a Welsh GP or people living in Wales registered with an English GP. That is why we are having constructive discussions to share IT information and make sure everyone in England or Wales registered with a GP will get that letter.

To respond to the earlier question about what people should do now, anyone is free to call the helpline number, which will be made public today, but we are hoping to get the letters out as quickly as possible over the next four weeks, during the month of May, so that everyone can be pretty confident that they are okay if they have not received one of those letters.

I welcome the Secretary of State’s announcement today that there will be an independent review; it is important that women have confidence in the screening programme. As someone who worked in breast cancer for over 10 years before being elected, I gently say to women that the screening mammogram is just one tool in the early detection of breast cancer and that if they notice a change in the interval of three years between mammograms they must seek medical advice. Also, not all mammograms pick up breast cancers, so they must not just rely on screening mammograms.

I thank my hon. Friend for her excellent advice, which gives me the opportunity to repeat that the advice for women about looking after their breasts and making sure they are alert to potential breast cancer remains unchanged. All women should take great care over this and should always come forward to see their GP or local cancer service if they have any concerns or doubts.

I thank the Secretary of State for his statement. There is no other way to describe what has happened than utterly, utterly heart-breaking, and it is hard to imagine what some of the worst affected families will be going through over the next few weeks.

I am grateful to the Secretary of State for his assurance that capacity will be expanded to ensure that women can now access screening, but unless he puts further resources into the system, other people will go to the back of the queue as a consequence. In my region of the north-west, one in five posts are currently vacant, and for far too many women in this country where they live currently determines whether they live or die. So will the Secretary of State put in the additional resources needed to make sure all women can get the screening they need when they need it?

I thank the hon. Lady for her comments. We have many other occasions to have a broader discussion about resourcing of the NHS, but I recognise what she says: in the specific situation we are in now, with the people who will need additional scans and additional treatments over and above what the NHS would have otherwise done, we will need to find additional resources to make sure others are not disadvantaged.

May I add my words of support to the Secretary of State for the way he has approached this issue, and to Opposition Members for their approach too?

On the scope of the independent review, will it look at other screening programmes? It might be the case that this particular issue is not replicated, but I think people will want assurances about other screening programmes. Also, as the NHS looks to use IT as a powerful way to combat illness and disease, will the Secretary of State make sure that appropriate checks are in place so that there are proper assurances in the system and these kinds of problems do not arise in the future?

My right hon. Friend is absolutely right, and I assure him that the review being done by Lynda Thomas, one of the most senior cancer campaigners in the country, and Professor Gore, one of the most senior oncologists in the country, will look at what lessons can be learned for the entire cancer programme, and not just at the specific issue of why this particular IT problem occurred.

The statement the Secretary of State has made today is truly shocking, and many women and their families will be very worried this afternoon. The Secretary of State said that it is estimated that 309,000 women in this group are still alive and that the first 65,000 letters are going out this week. Why are the letters not going out this afternoon to all 309,000 women? Why are we having to wait until the end of May to put at rest the minds of these women and their families?

That is a reasonable question, and I assure the hon. Lady that we are sending these letters out as quickly as we possibly can, but we felt that, even though we are not able to send them all out this afternoon—for example, because we have to reconcile with the clinical databases in Scotland, Wales and Northern Ireland for women who have moved to those areas and that is going to take place later this month—it was important to come to the House as soon as possible, without delay, to inform Members that this was happening. There will be a period of a few weeks during which people will have to wait to see if they get one of the letters, and we fully appreciate that that will cause a lot of worry to the women involved.

This is a good time to pay tribute to all the excellent cancer support charities, counselling services, Maggie’s centres and so forth up and down the country. I am reassured that the Secretary of State has said he will be working with them, but will he commit this afternoon to contacting all these charities proactively and providing them with the resources they need to meet what will obviously be an increased demand over the coming weeks and months?

That is a good point, and we will get in touch with all the cancer charities that we think are going to be affected by what has happened and make sure they have the support they need.

When did the Secretary of State or the Minister with direct responsibility for screening last ask their officials about the accuracy of the screening programme and the robustness of the checks and assurances in place to ensure it was working properly and efficiently? When, before January this year, did he last ask his officials that?

I will have to get back to the hon. Gentleman with a detailed answer to that question. Ministers were informed of this issue in March, and we are responsible, as Ministers, for the effective functioning of that system—in the way all Ministers have responsibility for their various areas—so one of the questions we need to ask is whether the right escalation procedures and checks and balances were in place so that Ministers could be informed if there was likely to be a problem.

My constituency has many breast cancer sufferers who were victims of the rogue surgeon Mr Paterson, so I thank my right hon. Friend for setting up an inquiry chaired by the Bishop of Norwich, in which victims feel properly listened to, and, most importantly, are being compensated. Will any of the women caught up in this current situation who might have been harmed be eligible for compensation?

I thank my right hon. Friend for suggesting the Bishop of Norwich as a good person to help in the Paterson review, and the answer to her question is yes: if, because of a failing by the NHS, harm has happened, people will be eligible for compensation, and we will do all the necessary work to establish whether that is the case.

Breast cancer screening makes a real difference to outcomes for breast cancer patients by diagnosing early, so I applaud the Secretary of State for saying he will look at ways of improving performance in this area across the country, but what is he going to do to try to make women who have moved out of the UK who might be affected aware of what has happened?

We will look at whether we are able to get in contact with people and will get in contact whenever we can, but there is of course a helpline through which anyone can contact us. It is also important to say that, according to the advice I have received, missing the final screening will in many cases not make a difference to a patient’s cancer or the treatment they receive, but we will do everything we can to support everyone who thinks they might have been affected.

While it will be for the review to investigate and report on why the fault with the algorithm was not discovered earlier, can the Secretary of State throw any more light on the circumstances in which it eventually came to be discovered? He said, for example, that it was in the course of a computer upgrade. Obviously, the circumstances that led to its discovery could be a pointer towards greater safeguards for the future.

That is a very good point. The original issue—or the original potential issue—was identified by people working on the AgeX trial for Oxford University, who then brought it to the attention of Public Health England in early January. One of the issues seems to have been the confusion about whether the scans stopped when someone turned 70 or whether they should carry on until their 71st birthday. That is why we think the original coding error happened, but obviously this is a matter for the review, and we need to learn everything from it.

This is a hugely upsetting and serious issue, and I commend the Secretary of State for the great compassion and sensitivity with which he has delivered this very bad news for women throughout the United Kingdom. He mentioned the fact that the Northern Ireland breast screening scheme was slightly different, but he will appreciate that he absolutely must say more to reassure women in Northern Ireland at this time because we have no Health Minister. May we please have more reassurance for women in Northern Ireland?

I thank the hon. Lady for making that fair and important point. I will make a special effort in the case of Northern Ireland to understand what the situation is and to ensure that it is publicised to the people of Northern Ireland. Absent politicians are able to do that.

I also thank the Secretary of State for his measured and sensitive tone in delivering this afternoon’s statement. He mentioned that the figures of 450,000 and 309,000 were estimates. What is not an estimate, however, is that 65,000 letters will be going out at the end of this month. Will he assure us that his team in the Department will write to Members of Parliament to indicate the number of women affected in each constituency, so that we can prepare for the inevitable contacts that constituents will make with us?

I hope that the independent review will investigate this, but is the Secretary of State aware of any instances of GPs inquiring why patients who should have had a final breast screen were not invited to have one?

That is a very good question. I am not aware of any such instances, but that is exactly what we want to look at in the review. It does seem strange that people who were expecting to be invited did not come forward, and that their not receiving an invitation did not set any hares running. That is one of the things that we need to look at.

How many cancers are detected for every 10,000 screenings, and what is the clinical consensus on the effectiveness of that?

My right hon. Friend is testing my clinical knowledge here; there will be other people in the Chamber who are better able to answer that question. I am ready to be corrected by eminent experts on this, but my understanding is that, in relation to women in their 70s, for every 1,000 women there are around 12 cancers, and of those 12 cancers, around three are potentially life-threatening.

Let us be clear that this is an utterly desperate situation. We know that some women may well have died who might not have done had they been identified. However, I would like to pay tribute to the Secretary of State’s statement. It was transparent, it ’fessed up and it made clear what the Department of Health and Social Care will be doing to remedy the situation. I appreciate that. What will the Department do to raise awareness of breast cancer screening among women who are not currently registered with a GP?

That is an important question. We have the Be Clear on Cancer campaign, which is a national advertising campaign but, as my hon. Friend the Member for Lewes (Maria Caulfield) said, it is important for people to recognise that, if we are going to protect them from cancer, they will have to take an active and proactive role in detecting any cancers they might have. Important though the screening service might be, they cannot rely on the screening service, because their own experience of how their own body is functioning is the most important detection method of all.

I thank my right hon. Friend for his statement, and for the urgency and sensitivity with which he is treating this issue. Women all over the country will be very anxious at hearing this news. Will he guarantee that all women who did not get invited for their scan will now be guaranteed their screening?

We are absolutely guaranteeing that all women affected who are still alive will be invited to have a screening if they want it. Only those under 72 will automatically be sent a date and time for their screening. Those over 72 will be invited to talk to the helpline so that they can form a judgment as to whether a screening is appropriate, but anyone who wants one will get one.

I should like to thank the Secretary of State for his comprehensive response. Can he advise me how many women who have moved to Scotland might be affected? If not, will he work double time to ensure that those who have been affected and who have moved to Scotland will get their letters timeously within the correct period?

I believe that the IT work, which is a collaboration between the Scottish NHS and the English NHS, will be completed in the week of 15 May. That is why we are confident that we will be able to get the letters out to people registered with Scottish GPs who have moved from England by the end of May, which is the same timescale as for getting the letters out to people living in England. We will then know that number, and I will of course let the hon. Lady know.

My grandmother died of breast cancer a few years ago, and my heart goes out to all women affected by this fatal IT malfunction. I welcome my right hon. Friend’s assurance that he is going to do everything he possibly can to ensure that this does not happen again. Has any consideration been given to the impact of this on GP surgeries? I expect that, during the next few days while women wait for their letters, they might make appointments with their GPs in anticipation, and in fear.

Yes, we are briefing all GP surgeries and all GPs about what the appropriate response is, because we recognise that that might happen. Of course, GPs are there for people to talk to at any time if they have concerns, and some people may choose to do that. We have also set up a specialist helpline that will be open seven days a week from 8 am to 8 pm, where people will be able to get advice straightaway by picking up the phone. We think that that will be the most practical option for most people.

Order. As colleagues know, I like to call everyone on statements, and I do not wish to make an exception today, but I remind the House that we also have a ten-minute rule motion and a very heavily subscribed Opposition day debate. In pledging to try to get all remaining colleagues in, I ask them to do us all the great favour of being extremely brief. I am sure that Mr Shannon has in mind just a short sentence without any preamble or subordinate clauses.

I thank the Secretary of State for his statement and for his compassion and care. Is he aware of any discussions on the continued alignment with the European Medicines Agency’s drug licensing process to ensure that our breast cancer patients, and indeed all cancer patients, have access to the benefits of the European trials and UK citizens are able to participate in clinical trials? This is very important.

That is a slightly different topic, but we have no greater priority than to ensure that Brexit does not interrupt the cancer care of UK patients.

The hon. Member for Bexhill and Battle (Huw Merriman) will be a master of the pithy question because he was educated magnificently in my own constituency.

And I am very proud to have been.

The Secretary of State knows well and cares deeply about safety matters. As he also knows, I have spent too much of my time with the clinicians in the cancer centres of Maidstone and Tunbridge Wells. Will the review perhaps look at administrative and back-office resources and at whether they play any part in improving survival rates?

The whole House is thinking of my hon. Friend who, like many people in this country, is going through a huge amount of personal pressure as cancer strikes close to home. He is right that back-office systems are often poor when it comes to contacting patients, which is in contrast to the superb clinical care that we are usually able to offer, so we will absolutely consider that as part of the review.

I wish the hon. Gentleman well in the period ahead. I was not aware of those personal circumstances, but the whole House will wish his nearest and dearest all the best.

As I understand it, Public Health England, which is of course operationally independent of Ministers, runs the screening programme, so what assurances have the chair and chief executive of that important organisation given my right hon. Friend that the actions that he has usefully set out today will be completed within the required deadlines to meet the obvious and legitimate demands of patients?

PHE has given clear assurances that the problem has been fixed, but it is open to any suggestions that the review makes as to how things could have been handled better.

I thank the Secretary of State for his statement. As co-chair of the all-party parliamentary group on breast cancer, I know that his Department takes breast cancer seriously, so the Secretary of State and the ministerial team will no doubt be as disappointed as I am that the statement was necessary today. However, will he set out what the women affected need to do and, importantly, what additional steps can be taken to reassure and support those women?

Anyone who has concerns as of today is welcome to call the helpline, but the women whom we know have been affected will be contacted by the end of the month. The first thing that many people will do is take action on receipt of a letter. If they are under 72, the letter will tell them that they will shortly be sent a date for a catch-up scan. If they are over 72, it will tell them how they can get advice as to whether that is appropriate for them.

I welcome the tone of the Secretary of State’s statement, even though its contents will be devastating for many people and families across my constituency. Will he confirm what engagement there will be with groups such as local health watches and support networks to ensure that the information that he has given is relayed to them and their users?

That is a good point. I can assure my hon. Friend that the Department will be leading a big consultation exercise so that everyone is informed about how their individual organisations will be affected.

As chair of the all-party parliamentary group on blood cancer, I am pleased that the Secretary of State talked about the lessons that will be learned from this breast screening error. Will he assure me that what is picked up will inform future diagnostic programmes?

Tragically, it seems that the flaws were of long standing—I think the Secretary of State referred to a decade or more. Notwithstanding the length of time that has passed, will he assure the House that lessons will be learned that relate back to the procurement and design decisions that were made at the outset?

Absolutely. There are basically two parts to this process. One is what the problem was with the original procurement, and the other is the problem with the assurance of the project over the time period.

I welcome the compassionate tone of the Opposition spokesman and the Secretary of State, and I particularly welcome the fact that he personally said sorry. Will he do all that he can to ensure that faith is restored in such technologies, because they do an awful lot of good when they work?

My hon. Friend is absolutely right. One of the most important ways of getting that change in mindset is by giving patients more control. Later this year, we will be offering all NHS patients an app through which they can access their medical record, and that should start to become a way in which people take control of their healthcare destiny, including such things as invitations to screenings for all cancers and many other public health measures.

While Stockport is one of the best areas for cancer identification, there will be concern that some people may have missed a routine call for screening. Last year, my constituents in Heald Green were particularly affected when their local breast cancer screening provision was relocated to Macclesfield District Hospital, which is over an hour away. As we address the screening issue, does my right hon. Friend agree that we must ensure that breast cancer screening is local and accessible?

We need to ensure that screening is accessible. I fully understand the concerns of my hon. Friend’s constituents, and I am happy to ask the Public Health Minister to look into that issue.

My friend Emma Agnew, a woman in her own right but also known as “Mrs Aggers” because she is married to the cricket commentator Jonathan Agnew, is one of a remarkable group of women who have faced breast cancer and beaten it, but it must be said that she had huge support from her husband, and our thoughts are also with my hon. Friend the Member for Bexhill and Battle (Huw Merriman). Emma had mammography last February and thought all was good, but she kept on checking her breasts. Screening is wonderful, but she checked her breasts, which was why she knew something was wrong in July. She was immediately diagnosed, she received fantastic treatment on the NHS and she is a survivor. Will the Secretary of State reiterate that we must all keep an eye out for cancer, whatever age we are?

My right hon. Friend speaks extremely wisely. We have the Touch, Look, Check campaign, and it is important that we see screening as just one important part of the battle against breast cancer, but it is no substitute for many of the other things that really matter.

I thank my right hon. Friend for his statement and for his tone. This was clearly a failure not only of IT, but of quality assurance, so will he commission a review of quality assurance right across the health service to ensure that it is as effective as it should be?

My hon. Friend may well be right that we need to do that, but what I would like to do first is to see the outcome of this review, what the lessons are and what precisely it says about the quality assurance that applied in this case, and then make a judgment about the implications for the rest of the NHS.

I thank the Secretary of State for the genuine personal concern that he has shown today and for his determination to get to the bottom of the matter. Will he continue to keep the House and, more importantly, the public and any women affected informed as further information comes to light?

Yes, I am happy to give that assurance. The number of people affected is only an estimate at the moment, but there will obviously be great interest in the House and in the country in what the actual number ends up being.

An additional 200,000 to 300,000 women could be seeking breast cancer screening within the next six months, which works out roughly at an additional 2,000 women a day. What reassurances can the Secretary of State give to the women who were due a screening anyway that their treatment will not be delayed as a result of the additional need?

That is an important question. One of our top priorities has been to construct a resolution to the problem that will not have an impact on the regular screening programme for women between the ages of 50 and 70, which is so important. All I can say is that a huge amount of trouble has been taken to try to ensure that we are putting additional capacity into the system to deal with the extra work.

I also welcome the compassionate tone used by hon. Members on both sides of the House today, and my thoughts are with all those affected. Will the Secretary of State reassure those in west Oxfordshire and beyond who will be concerned that this IT failure may be present in other critical systems that he will do everything possible to ensure that that is not the case?

Yes, absolutely. We are doing this review because we want to understand precisely why this happened and what the proper counter-measures are.