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Mr Nigel Dodds (Belfast North) (DUP): In the light of the arrest and detention of a certain Gerry Adams in connection with the murder of Jean McConville, a mother of 10 who was abducted and murdered by the IRA, of which Gerry Adams was commander in Belfast in the ’70s, simply for going to the aid of a dying soldier, does the Leader of the House agree that this is an appropriate time for a debate on victims, so that they can be reassured that evidence will be followed up and that people will be brought to book no matter what their status or standing in society?

Mr Lansley: The right hon. Gentleman will, I am sure, understand that I am not in a position to comment on any ongoing police investigation. His point about victims is important and, as my right hon. Friend the Secretary of State for Northern Ireland made clear at the Dispatch Box recently in relation to the wider circumstances and questions about the on-the-run terrorists review, we should always make sure that the needs of justice are served and that victims can see that we are continuing to pursue the issues that relate to that.

Dr Matthew Offord (Hendon) (Con): On Monday, I sought to ask the Home Secretary about the cost of the MPs’ asylum and immigration hotline, but was unable to do so. Will a Minister come to the Dispatch Box and give us that figure, and can we also talk about the proposal for a dedicated asylum hotline so that MPs and their staff are not tied up with comments and questions from people seeking explanations about their asylum applications and can focus on our constituents’ needs?

Mr Lansley: My hon. Friend will know, not least from the many occasions on which I have quite properly received representations from hon. Members, that it is important to Members of this House that they can advise and support their constituents on many issues arising from asylum and immigration and that they can do so effectively through their contact with the Home Office and its associated agencies. I will, if I may, ask my hon. Friend the Minister for Security and Immigration to respond directly to my hon. Friend on the subject of the cost of the asylum immigration hotline. If he is happy to do so, he might like to have a direct conversation about how we can best represent our constituents in a way that serves their interests.

Kevin Barron (Rother Valley) (Lab): Will the Leader of the House find adequate time for discussion of the outstanding reports from the Standards Committee that await debate and of the report from its predecessor, the Committee on Standards and Privileges, on the proposed revision to the guide to the rules relating to the conduct of Members? That report was published in December 2012, yet we are still waiting for time for a debate in the House.

Mr Lansley: I am grateful to the right hon. Gentleman for his question, which allows me to say that I had hoped that we might have resolved those issues before now. We have not and I hope that we will soon. We and other stakeholders across the House need to establish consensus not only on that important issue but on how we might take forward the issues that the right hon. Gentleman and his Committee are considering as regards

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a more general revision of the code of conduct. I hope that in our conversations and my representations to his Committee we might be able to strengthen the work of the Standards Committee and give greater reassurance to the public and our constituents about the independence and robustness of the processes we have in place.

Mr Richard Bacon (South Norfolk) (Con): As chair of the all-party group on self-build, custom-build and independent house building, may I remind the Leader of the House that next week’s business includes a debate on this important subject, to which the Government committed £150 million in the recent Budget? Hon. Members who wish to intervene in that debate should attend at the end of the day next Wednesday.

Mr Lansley: My hon. Friend is quite right and, in self-build week, he has managed to obtain an opportunity for an Adjournment debate that will highlight the support we are giving and the potential there is for people to increase our housing supply in this country through self-build. We do not do very well in comparison with many other countries and he is an advocate of our doing much more. I encourage Members who have the opportunity to do so to support my hon. Friend in his debate on this important subject.

Mr Barry Sheerman (Huddersfield) (Lab/Co-op): As we have been talking about petitions today, will the Leader of the House take account of the growing number of people from Huddersfield and Halifax who are signing a petition because they are deeply concerned about the possible closure of accident and emergency departments in those two towns? That is very important to them. May we have an urgent debate on what the hell is going on in A and E departments up and down our country?

Mr Lansley: I know the hon. Gentleman will be aware that what is going on is that we are continuing to deliver high standards of care in A and E departments in circumstances where there is a consistently rising number of people attending. We need to do two things. We need to make sure that people are cared for effectively in the community to minimise their requirement to use A and E, and we need to focus A and E on the task that it needs to do. But when people go to A and E, we need to make sure that they go to an emergency department that has the skills and the capability to deal with their case, and what is available at present varies dramatically between locations. We need to ensure that people with the most serious conditions get to the emergency departments with a full range of capabilities to deal with them.

Tessa Munt (Wells) (LD): Each year more than 324,000 tenants are evicted in response to complaints they must make about the condition of their homes, so it is no surprise that 12% of private tenants do not report any problem for fear of retaliatory eviction. May we have a debate about stopping bad landlords dodging repairs when evicted tenants complain to their local councils, and giving tenants the right to appeal a notice to quit if it is a response to a problem, particularly as more than 1.3 million private rented homes do not meet the Government’s decent homes standard?

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Mr Lansley: My hon. Friend will be aware that our colleagues in the Department for Communities and Local Government, through their review of property, have identified the extent to which there is a deficiency in the quality of the housing stock in part of the private rented sector. We want to make sure that people have good access to housing and that the housing is of good quality. I will, if I may, talk to my colleagues at the Department for Communities and Local Government about when we might have an early opportunity for them to respond further in relation to that.

Stephen Doughty (Cardiff South and Penarth) (Lab/Co-op): Tomorrow I will be meeting veterans and beneficiaries of the Royal British Legion at the very well named 617 Squadron room at the new Penarth Pier pavilion in my constituency. Will the Leader of the House join me in welcoming their work and find time for a debate on the importance of community covenants and strengthening community partnerships, such as this excellent work?

Mr Lansley: I would like to take the opportunity to join the hon. Gentleman in our support for the community covenant and support for the communities who are backing up the military covenant in this way. It is important to recognise the sacrifice and the tremendous contribution that many people have made through their service in the armed services. I do not see an opportunity for a debate immediately, but there may be ere long further opportunities for us to highlight that in our own constituencies.

Andrew Bridgen (North West Leicestershire) (Con): Two years ago, alongside my hon. Friend the Member for Loughborough (Nicky Morgan), now the Financial Secretary to the Treasury, I addressed the UK Trade & Industry Leicestershire chamber of commerce conference. In my speech I highlighted the need for business to look beyond the eurozone to emerging markets and our Commonwealth partners for export growth. Given that exports to India were up 20% last year and exports to China are now averaging £1 billion a year, may we have a debate on what steps the Government can take to help further UK business to export to new markets?

Mr Lansley: My hon. Friend is right. I applaud what he has done in Leicestershire to enable businesses to access the support and help of UKTI. Many Members will be aware that UKTI has significantly improved its offer to businesses, as was reflected recently in export week, but we know we have much more to do. If we can increase the proportion of businesses in this country, particularly small and medium-sized businesses, that are exporters, we can ensure that the recovery that we are seeing in the economy can be sustained for many years to come.

Angela Smith (Penistone and Stocksbridge) (Lab): I thank the Leader of the House for his kind words earlier, but I was disappointed by his response to the comments that my hon. Friend the Member for Wrexham (Ian Lucas) made about Royal Mail. Can I take it from his response that he does not think that the Government have any lessons to learn at all from the way that they handled the sale of Royal Mail?

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Mr Lansley: In relation to the business of the House, the hon. Lady will be well aware that both the Select Committee on Business, Innovation and Skills and the Public Accounts Committee are looking at the issue, and no doubt they will bring forward reports, which I know that the Government will want to consider carefully and respond to. The reason why I was perhaps more dismissive of the hon. Member for Wrexham (Ian Lucas) than of the hon. Lady’s perfectly proper question is that the hon. Gentleman’s question was based on a false assertion. The Royal Mail privatisation was achieved successfully. I know from my involvement in past privatisations, as a civil servant way back in the 1980s, that it is very difficult to get the price right at the initial public offering. It is normal for the privatised company subsequently to sell at a higher price than the one at which it was offered. It is very important to establish the price at which it can be underwritten, and to engage substantial investors to ensure that the bulk of the sale can be made.

Paul Uppal (Wolverhampton South West) (Con): I am sure that the Leader of the House will welcome, as I did over the Easter recess, the news that Wolverhampton Wanderers have been promoted to the championship. I am a stoic Wolves fan, but I am not asking for a debate on that, as it might be guillotined. Perhaps more pertinently, the Black Country local enterprise partnership has outlined a vision for regeneration in the area, and I warmly endorse two aspects of that vision. One is around the Wolverhampton interchange, and the second is around cultural capital investment in the city centre. May we have a debate on how LEPs, and this one in particular, facilitate regeneration in areas such as Wolverhampton?

Mr Lansley: I am grateful to my hon. Friend, and I wish Wolverhampton Wanderers well; Wolves have a great history, and it may be that their future is getting better all the time. I am sure that he and many supporters of the club will be very encouraged by that.

On my hon. Friend’s question about the Black Country LEP and many other LEPs, it is important to note that we are agreeing a whole range of city deals that are enabling locations across the country to identify what they believe will best assist in economic regeneration for the future. The same is true of applications to the regional growth fund. The LEP and the local authority are coming together, as my hon. Friend says, to define projects such as the interchange. That is very important, and it is important for them to make bids to the regional growth fund. There is £3 billion already committed to 430 schemes under that fund, and there is dramatic leveraging—something like a fivefold or sixfold leverage—of private sector investment as a consequence.

Several hon. Members rose

Mr Speaker: Order. I recognise that there is intense interest, as always, in business questions. I simply remind the House that we have two important debates, under the auspices of the Backbench Business Committee, to follow. The first is on cervical cancer screening tests and the case of Sophie Jones, and the second is on freedom of thought, conscience and religion. We must progress to those before too long, so I appeal for short questions and answers.

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Lilian Greenwood (Nottingham South) (Lab): Two weeks ago, Imperial Tobacco announced its intention to close the Horizon factory in Lenton, with the loss of more than 500 jobs, leaving many of my constituents and their families reeling. Can the Leader of the House confirm which Department or Minister is co-ordinating the Government’s response and the resourcing of joint work by the city council, Nottingham and Nottinghamshire Futures, the LEP and other partners? When will a Minister report to Parliament on the practical support to be offered to those affected by the shock decision?

Mr Lansley: I can understand how the hon. Lady feels about the impact on her constituents. On those who will lose their jobs, ensuring that they can access new employment and, if necessary, retraining and the like is a responsibility for the Department for Work and Pensions. As for wider interests, and supporting the local enterprise partnership and local authorities in ensuring a broader economic development response, that is the responsibility of the Department for Business, Innovation and Skills, but I will ask both Departments to contact the hon. Lady about the steps that they are taking.

Mr Mark Harper (Forest of Dean) (Con): I listened carefully when the Leader of the House announced the business for next Thursday. Perhaps he could add some time to the debate on the procedures of the House for discussing the Backbench Business Committee. He, I and the Chairman of the Committee could then explain to the shadow Minister for Europe, the hon. Member for Harrow West (Mr Thomas), that it was not the Prime Minister who scrapped debates ahead of European Councils; this House unanimously decided, as a result of the Wright Committee recommendations, to give that time to the Backbench Business Committee. We could also suggest that having a debate before every European Council would not be welcome.

Mr Lansley: Yes, the House took an important and positive decision to give Back-Bench Members, through the Backbench Business Committee, the opportunity to assess the relative priority of debates. I am not sure of the view of shadow Leader of the House on the matter, but I hope that she might have a word with the shadow Minister for Europe, the hon. Member for Harrow West (Mr Thomas), to make it clear that trying to revert to the past will actually undermine the independence of the Backbench Business Committee and of Members of this House.

Luciana Berger (Liverpool, Wavertree) (Lab/Co-op): There are 48,000 homes in the private rented sector in Liverpool. All those tenants had been heartened by the Secretary of State for Communities and Local Government when he said that he wants

“longer fixed-term, family-friendly tenancies that meet their needs.”

May we have an urgent statement about when the Government will honour that aspiration and support the proposals announced today by my right hon. Friend the Leader of the Opposition to scrap letting fees, end excessive rent rises and introduce long-term tenancies?

Mr Lansley: If the hon. Lady is saying that she supports what my right hon. Friend the Secretary of State for Communities and Local Government is doing to promote flexibility, quality and supply in the housing

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market, I am pleased. I suspect, however, that what she is saying is that we do not want to go beyond that to a rent control policy of the kind advocated by her leader. In that respect, she probably takes the same view as the shadow Housing Minister, the hon. Member for Wolverhampton North East (Emma Reynolds), who said on “Channel 4 News” in January that

“rent controls are not going to work in practice”.

What the hon. Lady said was right then and it is right today.

Stuart Andrew (Pudsey) (Con): This morning, the Royal College of Paediatrics and Child Health and the National Children’s Bureau published a report analysing the UK’s poor record on child mortality compared with the rest of Europe. Yesterday, the Department of Health’s children and young people’s health outcomes forum also acknowledged that the UK has a historically poor child mortality record. May we have an urgent debate to consider how we can ensure that the UK is the best place not only to end life, but to begin life?

Mr Lansley: I am grateful to my hon. Friend, who will recall that, some two and a half or three years ago, I initiated work on how to improve health outcomes for children and young people, which led directly to the work of the children and young people’s health outcomes forum. It forms part of the NHS England mandate that my right hon. Friend the Secretary of State for Health has put in place and is a key part of Public Health England’s work. However, outcomes for children and young people depend on things far wider than what the health service does, such as being ready for school and avoiding periods when young people are not in education, employment or training. Such measures are critical, which is why the Government are focused on them.

Keith Vaz (Leicester East) (Lab): I do not know whether the Leader of the House likes mangoes, but today marks the first day of the EU ban on the importation of Indian Alphonso mangos, a decision taken by Brussels without consultation with the House that will cost businesses in Leicester and beyond millions of pounds. May we have an urgent debate on the matter, with an action plan to get the ban reversed?

Mr Speaker: I have sampled the mango in question and can testify that it is extremely tasty.

Mr Lansley: Yes, indeed, Mr Speaker. Temporary restrictions are in place, as the right hon. Gentleman says, and are important to protecting home-grown salad crops—an important industry worth £320 million a year—from potential pests and diseases. India is a key trading partner, but we know that these temporary restrictions will impact only on a very small percentage of the successful business that we conduct with it. However, we are working with our Indian and European counterparts to resolve the issue.

As for the business of the House, I am delighted that the right hon. Gentleman has secured a debate on the Adjournment at the close of business next Thursday that will allow him to raise his concerns with the House.

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Sir Tony Baldry (Banbury) (Con): Now that we have five-year, fixed-term Parliaments, we are obviously in the longest general election campaign ever, and perhaps the business of the House should be changed to reflect that. Clearly the Leader of the Opposition is not going to ask the Prime Minister any questions on jobs, growth or the reduction in the deficit, so can we change Prime Minister’s questions so that the Leader of the Opposition can ask the Prime Minister three questions and then the Prime Minister can ask the Leader of the Opposition three questions? That way, we might have a proper examination of the fact that we have created 1.5 million new jobs, growth was up by 3% last year and the deficit has been halved.

Mr Lansley: My right hon. Friend makes an interesting suggestion, but I fear that it is not one we will take up. When the Leader of the Opposition asks his six questions, often what he leaves out speaks volumes, and I think that will inform the public as he continues to be bereft of anything to say on Labour’s plans for the economy.

Valerie Vaz (Walsall South) (Lab): We all rightly condemn the abduction of more than 200 girls from their school in Nigeria, so may we have an urgent debate on how Britain can help to ensure that they are returned to their rightful place, which is with their families and, more particularly, are in education?

Mr Lansley: The hon. Lady is absolutely right. We will all have been horrified by what we have seen and by the continuing trauma that those girls and their families and friends must be experiencing. We will do everything we can to help. I will of course speak with my right hon. and hon. Friends in the Foreign and Commonwealth Office to see whether they can advise Members on what more can be done.

Pauline Latham (Mid Derbyshire) (Con): May we have a debate on what the Government are doing to recognise, assist and support businesses that focus on energy efficiency, such as the Vaillant Group—Glow-worm, as it is better known locally—which has a base and factory in my constituency?

Mr Lansley: The Vaillant Group is very well known. We are doing a great deal to promote the important energy efficiency sector, which is already worth more than £18 billion and employs over 130,000 people in this country. It is economically important to my hon. Friend’s constituents and many others. Indeed, the installation of more efficient gas boilers, the green deal, the energy obligations and the product policy in building regulations are all promoting renewable heating technologies through the world-first renewable heat incentive.

Jonathan Ashworth (Leicester South) (Lab): I was delighted to learn a few minutes ago that my right hon. Friend the Member for Leicester East (Keith Vaz) has secured an Adjournment debate on the mango ban, which is causing considerable concern for businesses in my part of Leicester as well. Will the Leader of the House use his good offices to ensure that we can bring a delegation of businesses affected to the relevant Minister in the Department for Environment, Food and Rural Affairs ahead of that debate?

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Mr Lansley: As the hon. Gentleman knows, I always try to assist Members of the House in whatever way I can. I will certainly see whether Ministers would be willing to have such a meeting in that time frame.

Mark Pawsey (Rugby) (Con): This coming week I will join a party led by the mayor of Rugby on a visit to the Menin Gate memorial to remember local people who lost their lives in the great war, reciprocating the visit made by Field Marshal John French, the Earl of Ypres, who unveiled Rugby’s memorial in 1922. Can our commemorations here in Parliament include a debate on the links between our constituencies and where our brave soldiers lost their lives?

Mr Lansley: As I told the House at the last business questions, I hope to be in a position to announce a further debate in which Members can talk about how their constituents are commemorating the events of 100 years ago, as I am sure my hon. Friend’s constituents are doing. I was very proud to have an opportunity to visit a village in my constituency only last Friday where they are planning a publication that details each person who died in service during the first world war and tells their story, including where they fell and where they are commemorated.

Julie Hilling (Bolton West) (Lab): The Minister for Civil Society recently said that it was “okay” to lose some of the youth services that have been slashed due to Government cuts because—excuse me, Mr Speaker—they were “crap” in the first place. May we have a debate in Government time on the devastating cuts to services for young people, which will also give the Minister an opportunity to explain his disgraceful and derogatory remarks?

Mr Lansley: I do not remember reading those remarks and I do not know precisely the context in which my hon. Friend spoke. However, because I know him very well, I know that he is a devoted advocate of supporting civil society, charitable organisations and community groups in providing high-quality services, including to children and young people. I will alert him to what the hon. Lady has said and give him an opportunity to respond.

Mr Philip Hollobone (Kettering) (Con): According to the Department for Business, Innovation and Skills, Northamptonshire is officially the most enterprising county in the country. May I share with the Leader of the House the good news from the latest economic review by Northamptonshire chamber of commerce for the first quarter of this year? It says that 78% of manufacturers in the county report increased export sales and that over 90% of manufacturing and service sector firms expect turnover and profitability to stay the same or to improve over the coming year. May we have a debate on the Floor of the House about why counties such as Northamptonshire are leading this country out of the great recession?

Mr Lansley: I am grateful to my hon. Friend. I know from personal experience of meeting business people in his constituency that those in Northamptonshire are indeed very enterprising—although I imagine that the title he claims will be hotly contested in this House. His

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question is apt, because this week we have seen evidence from the latest first-quarter GDP growth data that manufacturing is the fastest-growing sector of the economy. That is in marked contrast with what happened under the previous Labour Government, when manufacturing employment was cut by 1 million and there was a focus on financial services to the detriment of manufacturing.

Barry Gardiner (Brent North) (Lab): Last month the Government were absolutely right to give the go-ahead to the new power station at Hinkley Point, at a cost to the consumer of £92.50 per megawatt. May we have a debate on consistency in Government subsidy, given that last week they announced that it would be unfair and insupportable to give a subsidy to onshore wind, which costs between £70 and £80 per megawatt?

Mr Lansley: As the hon. Gentleman will recall from a response from the Prime Minister at yesterday’s Prime Minister’s questions, the point about the build-out of onshore wind farms is that the Government set a target to increase onshore wind farms and renewables generation, and it is not necessary, in our view, to keep providing a subsidy to go beyond that. The point about nuclear is that it is a different form of generation. It is, as it were, the bedrock of security of supply, and it is important to ensure that it is there.

Mr David Heath (Somerton and Frome) (LD): The tourism industry is absolutely essential to the south-west, yet operators in my constituency say that even now they are getting phone calls from people who are convinced we are still under water. May we have a statement before the bank holiday—I appreciate that that probably means the tourism Minister coming back here this afternoon—to tell the world that the floods have gone; that the railways are mended; that the food, drink, countryside and welcome are as great as ever; and that Somerset and the west country are very much open for business?

Mr Lansley: My hon. Friend makes the point very well, and I hope that people will listen to it. He is absolutely right. The railway line has reopened and the waters have receded. People have gone to enormous trouble to rebuild and recover, and Somerset and the west country are open for business. I was very pleased over the Easter holiday to see evidence of people who were really enjoying themselves in the west country. I hope that people will have sunshine this weekend so as to have an opportunity to enjoy themselves again.

Diana Johnson (Kingston upon Hull North) (Lab): For the benefit of the UK Independence party donor who said this week that women should be banned from wearing trousers, may we please have a debate on the historic contribution that women in trousers have made to this country, including Amy Johnson from Hull, who wore trousers as an aviator, the women’s Land Army in the second world war, and Princess Elizabeth, who wore trousers as a mechanic serving in the second world war?

Mr Lansley: Well, good for her. I cannot promise a debate, but I entirely endorse the hon. Lady’s sentiments.

Glyn Davies (Montgomeryshire) (Con): Bowel cancer is often a completely curable disease, but a key to successful treatment is early diagnosis. May we have an

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urgent statement about the effectiveness of bowel cancer screening programmes, particularly in relation to access to colonoscopies, and a comparison between the effectiveness of bowel cancer screening services in Wales and in England so that we can gain best practice?

Mr Lansley: I will ask my hon. Friends at the Department of Health to respond in detail, particularly on the point about comparisons. We should be very pleased that during this Parliament we have seen the roll-out of the bowel cancer screening programme across England. We look forward very positively to being able to roll out flexible sigmoidoscopy, as we plan over the next three years, which will enable not only early diagnosis of bowel cancer but early interventions. That will make a further big, positive step forward.

Heidi Alexander (Lewisham East) (Lab): May I ask the Leader of the House for a statement or a debate in Government time on the operation of the Access to Work scheme? I recently met a constituent who faces losing her job because she cannot pay through the scheme for a qualified British sign language interpreter. This is a very important and urgent matter on which Members need to be able to question Ministers.

Mr Lansley: As the hon. Lady will know, through the Work programme and the new Help to Work scheme, further details of which were announced this week, we are focusing on ensuring that we give everybody, including those whom it has clearly been most difficult to help, the support that is necessary to enable them to get back into work. However, she has raised a particular, and interesting, issue. I hope that she might give my office further details, and I will ask a Minister at the Department for Work and Pensions to respond.

Rehman Chishti (Gillingham and Rainham) (Con): The Leader of the House will know that I previously presented a Bill to the House that considers increasing the sentence for those who cause death while driving when they have been disqualified from driving from the current two years to 14 years, in line with the sentence for causing death by dangerous driving. I know that the Government were sympathetic to what I said then. Will the Leader of the House clarify whether they have taken a decision on the Bill prior to next week’s debate on the Criminal Justice and Courts Bill?

Mr Lansley: My hon. Friend is right that the Government do indeed share his concern about those who drive while disqualified and cause death or serious injury on our roads. He will know from my statement that the first day on Report of the Criminal Justice and Courts Bill will be on Monday 12 May. I direct him to that debate, where I know he will be in his place to hear the response from my right hon. Friend the Secretary of State for Justice.

Debbie Abrahams (Oldham East and Saddleworth) (Lab): One and a half million pounds worth of donations to the Tory party from private health care providers resulted in £1.5 billion—

Mr Lansley indicated dissent.

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Debbie Abrahams: There is evidence. The Leader of the House is shaking his head, but I have cast-iron evidence. Those donations resulted in £1.5 billion-worth of NHS contracts going to those same providers. Will arrange a statement to explain why the Government are refusing to exempt the NHS from the EU-US trade negotiations, thereby threatening the future of the NHS as we know it—or is that also linked to those donations?

Mr Lansley: I scarcely know where to begin in refuting that nonsense. First, donations to the Conservative party do not result in contracts—they simply do not. It is a complete travesty and a disgrace to suggest that the people who take procurement decisions within the NHS would be influenced in any way—or, frankly, know whether the individuals associated with any particular company happened to have political affiliations or otherwise.

On the transatlantic trade and investment partnership negotiations, I wish that Labour Members—this was evidenced during our debate on the subject—would focus on the dramatic potential for increasing trade, jobs and growth in Europe and America rather than trying to focus on something that will not have the effect that the hon. Lady describes, because within the NHS there is already, as there was under her party’s Government before the last election, scope for private companies in America to access contracts if they are able to provide the best services inside the United Kingdom.

Robert Halfon (Harlow) (Con): Has my right hon. Friend seen my early-day motion 1306?

[That this House notes that Essex County Council is turning off street lights across Essex between the hours of midnight and 5am to make savings; further notes that turning off street lights in Harlow affects many Harlow residents, many of whom work late shifts; acknowledges that some Harlow residents have expressed concerns that they feel unsafe; and therefore calls on Essex County Council to review its decision and shorten the amount of time that street lights are turned off each night in Harlow.]

My right hon. Friend will be aware that Essex county council is turning off the street lights in Harlow between the hours of midnight and 5 am. This is affecting many residents, particularly females and shift workers late at night. Will he look at this issue and contact the Department for Communities and Local Government to see what can be done to extend the hours that the lights are on, and may we have a debate on it?

Mr Lansley: I understand the point my hon. Friend is making and he will know that my right hon. Friend the Prime Minister is also aware of it, as shown in a reply he gave during Question Time yesterday. Street lighting is the responsibility of the local highways authorities, including Essex county council in my hon. Friend’s constituency. The Government advise that, when considering its street-lighting needs—including when considering turning them off—an authority should work closely with the emergency services and other key partners on community safety.

Dan Jarvis (Barnsley Central) (Lab): Further to the question asked by the hon. Member for Rugby (Mark Pawsey), the Leader of the House will know that the country will be looking to Parliament to play our part

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in the world war one commemorations, and I know that Members on both sides of the House will wish to do so. We had a very good debate in this place last year, but this year many of the key anniversaries fall during the summer recess, so may I ask the Leader of the House whether we can have a debate before the summer recess, so that Parliament can be given the opportunity to pay its own tribute to those who served us 100 years ago?

Mr Lansley: The hon. Gentleman is right and I hope to be able to announce such a debate before the summer recess. Since our last debate on the subject I, like many Members throughout the House, have seen great evidence of how constituents are proposing to commemorate the events of 100 years ago.

Several hon. Members rose

Mr Speaker: Order. May I appeal to the remaining Members to ask succinct, single-sentence questions so that we might proceed to the next debate ere long?

Jim Shannon (Strangford) (DUP): The Keep Sunday Special campaign has insisted there should be no change to Sunday shop opening hours and it is supported by the Home Retail Group and the workers. Will the Leader of the House agree to a statement or a debate to put this matter to rest for retailers and workers?

Mr Lansley: I am not aware of the plans to which the hon. Gentleman refers. I cannot promise a debate, but I will check to see whether there is any way in which we can provide him with the reassurance he seeks.

Michael Connarty (Linlithgow and East Falkirk) (Lab): Will the Leader of the House ask the Home Secretary to report to the House when she will be taking the next step in delivering a modern slavery Bill? She asked my right hon. Friend the Member for Birkenhead (Mr Field) to set up a cross-party Joint Committee and it has just reported after 10 weeks of work. We need to build a consensus for a modern slavery Bill, which we promised on the 200th anniversary of Wilberforce’s Bill.

Mr Lansley: We are very grateful to the Joint Committee on the draft Modern Slavery Bill. As the hon. Gentleman will know, I am not in a position at this stage to anticipate the contents of the Queen’s Speech.

Steve McCabe (Birmingham, Selly Oak) (Lab): The Leader of the House must have been dismayed with the compensation award made to convicted triple killer Kevan Thakrar. Given that the Government have a bit of time on their hands, why do they not introduce a short, simple Bill that says that any future awards of that kind must be paid directly to a special fund for victims?

Mr Lansley: Other Members will have been just as dismayed about that. I am not sure whether what the hon. Gentleman suggests is the right solution. I will ask my right hon. Friend the Secretary of State for Justice to respond to the hon. Gentleman with his views.

Graham Jones (Hyndburn) (Lab): Yesterday the Government issued a ministerial statement on fixed odds betting terminals, which resulted in a sharp rise in bookmakers’ share value. When will Members get an opportunity to debate the proposals in full? I hope it will be before the Whitsun recess.

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Mr Lansley: I cannot at this stage say that there will be a debate on those issues, but it is important that the written ministerial statement said positive things about providing safeguards in relation to fixed odds, high-stakes betting terminals. It also said what I think communities will regard as very encouraging things about how local planning authorities can make their own judgments about the extent of change of use with regard to betting shops on local high streets.

Mrs Sharon Hodgson (Washington and Sunderland West) (Lab): May we have a debate on long-term unemployment? In my constituency, the number of over-25s on jobseeker’s allowance for more than two years has risen by 41% in the past year alone. The rate is now the eighth highest in England and Wales. Instead of recognising that their Work programme is failing, Ministers now want to punish my constituents even further with yet another of their silly schemes, which has been shown not to work. Instead, they should implement Labour’s compulsory jobs guarantee, which I guarantee would work.

Mr Lansley: As I have said, I hope there might be an opportunity for a debate on employment, if not before then during the debate on the Queen’s Speech, which might include a proper focus on it. That would enable us to celebrate the fact that there is a record level of employment; that employment is up by more than 1.5 million since the general election; that youth unemployment is down 38,000 on the previous quarter and lower than at the time of the election; and that the proportion of 16 to 24-year-olds not in education, employment or training is at its lowest in five years.

Nick Smith (Blaenau Gwent) (Lab): May we have an oral statement on the inspectorate of constabulary report, which says that police are failing to record up to 20% of crime? The situation is intolerable.

Mr Lansley: The Home Secretary rightly commissioned Her Majesty’s inspectorate of constabulary to undertake that inquiry and is very clear that we want to ensure that police-recorded crime figures are robust. Those figures and the independent crime survey point strongly to the same conclusion, which is that levels of crime are falling and policing is working. On debating the HMIC report, the hon. Gentleman will know that it is an interim report, so the Home Secretary will no doubt report to the House in due course.

Mrs Madeleine Moon (Bridgend) (Lab): May we have a debate on the excellent review of diagnosis and treatment carried out by the Pernicious Anaemia Society, which is based in Bridgend? Pernicious anaemia involves memory loss, poor concentration, debilitating tiredness, personality and balance problems and mood swings. Two thirds of those who responded to the review were unhappy with their current treatment. That is diabolical. May we have an urgent debate on the issue?

Mr Lansley: I can well understand how strongly the hon. Lady feels about pernicious anaemia, which she rightly describes as a very debilitating condition. I will ask my colleagues at the Department of Health to respond to her about the position generally. She and other Members might like to seek an Adjournment debate in order to raise the issues.

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Backbench Business

Cervical Cancer Screening

12.26 pm

Steve Rotheram (Liverpool, Walton) (Lab): I beg to move,

That this House notes the e-petition relating to the tragic death of Sophie Jones from cervical cancer; believes that the Government should urgently issue guidance stipulating that all women should have the choice of taking a smear test regardless of their age and in consultation with their doctor; and further notes that the best way to combat cervical cancer is by increasing awareness of its symptoms so as to ensure that early diagnosis rates are driven up, doctors and nurses understand that although it is very rare, younger women can develop cervical cancer, and high levels of coverage among young girls of the HPV vaccination programme introduced in 2008 are achieved.

I am grateful for the opportunity to bring this important debate to the Floor of the House, although I wish it was not under such tragic circumstances. The number of MPs present does not necessarily reflect the wider public interest in the issue. Perhaps that shows that many MPs have lots of competing interests and that many who would have liked to have been here today are, unfortunately, unable to attend.

I want to place on record my thanks to members of the Backbench Business Committee, skilfully chaired by my hon. Friend the Member for North East Derbyshire (Natascha Engel), for listening to the voices of the tens of thousands of people who wanted this issue debated, and to the Leader of the House for recognising the considerable national interest in it. I also thank the Liverpool Echo, the Daily Mirror and the Daily Mail for their continued coverage of Sophie’s case and the steps they have taken to raise awareness of this debate and, more importantly, the issue of screening and the early identification of symptoms, which I will go into in more detail during my contribution.

I want to place on record my gratitude to Sophie’s mum, Peri, and to each and every one of the 321,925 people who signed the online petition following the heartbreaking death of her daughter earlier this year. They made history in the process by accumulating the largest ever number of signatories to a Government e-petition.

There has been a lot of speculation and conjecture about what is actually being requested today, but my motion, seconded by my hon. Friend the Member for Wirral West—

Alison McGovern (Wirral South) (Lab): South!

Steve Rotheram: Sorry—she will kill me for that!

The motion is clear in its intent. I am not calling for the introduction of routine cervical screening for all women and young girls under 25, but I am calling on the Government to issue guidance that stipulates that all women should be able to request a cervical smear regardless of their age. Put simply, young women and teenage girls who present to their GP with possible symptoms of cervical cancer should have the choice, if they so desire, to have a smear test, but that must of course go hand in hand with extensive consultation with their GP to ensure that they are informed of all the potential consequences of the procedure. Given the

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limited number of cervical cancer cases in women under the age of 25—just 47 in England in 2011, according to Department of Health figures—such an option would not open the floodgates to thousands of unnecessary, costly or possibly damaging tests for young girls.

The motion is an attempt to promote the issue, and to encourage the medical profession to take up the provision that is already available to doctors of granting screening tests to females of any age in exceptional circumstances. It must be said that some of the medical profession are clearly not exercising that power, and that has proven fatal in cases such as Sophie’s. Indeed, at the heart of the motion is one simple premise—that a woman of any age over 16 should, through written departmental guidance, have the right to make an informed choice for themselves.

I will highlight areas in which I believe the Government could take immediate action to educate and inform both patients and medical professionals better about the symptoms and diagnosis of cervical cancer in young women and teenage girls, but I want to make it clear that I am very much of the opinion that any changes to age restrictions must be evidence-based.

Sophie Jones was a much-loved and popular 19-year-old girl from the Wirral who had her whole life ahead of her. She had fashioned a successful career in modelling, and was described by her twin sister Ashleigh as

“the life and soul of everything”.

In 2013, after experiencing constant stomach cramps for more than a year, Sophie visited her GP. She advised her doctor of her symptoms and asked for a smear test. Sophie knew that something was seriously wrong, but she was continually refused a test solely on the basis of her age. Instead, Sophie’s GP incorrectly diagnosed her with Crohn’s disease. Last November, Sophie was forced to enter hospital permanently, due to the deterioration in her health and the escalation of her condition. Despite that, numerous doctors still failed to recognise her symptoms or to diagnose her illness accurately.

Eventually, Sophie and her family’s worst nightmares were confirmed when she was diagnosed with cancer of the cervix. Tragically, by the time doctors were able to make an affirmative diagnosis, it was too late. The cancer had spread to other parts of her body, and by then she was terminally ill. For four months, Sophie fought against her devastating disease and, with her family and friends alongside her at her hospital bed, fought bravely to the end. On 15 March, after four long and excruciating months, Sophie’s defences were overwhelmed by her condition and she lost her struggle for life.

There was a time in Britain when a cancer diagnosis struck the fear of God into people, but thanks to advances in medical treatments and preventive measures, early diagnosis ensures that cancer patients survive in more than half of cases. Cancer is no longer a death sentence if caught early enough. Sophie’s diagnosis came too late for treatment to be successful, but it should never have been that way. That is what makes her case so painful for her family and friends.

I know that I speak on behalf of my hon. Friends the Members for Wirral South and for Liverpool, Wavertree (Luciana Berger) when I pay tribute to Sophie’s family and friends for the dignity that they have shown, and for their determination to highlight Sophie’s story to prevent anyone else from ever having to go through

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what they have been through. Sophie was failed by the current system, and that should not be allowed to happen to anyone again.

Moreover, I am confident that Sophie’s case is not an isolated incident. I am aware of other cases, and other Members will speak about cases that have been brought to their attention. Those cases include that of Maryanne Makepeace, who was told that she had a water infection, before she was finally diagnosed with terminal cancer.

Just last week, the BBC in Wales reported the case of 20-year-old Jessica Bradford, who was also told by her GP that she was too young for cancer. Initially, she was diagnosed with thrush, with the doctor believing that she had a sexually transmitted disease, but Jessica was eventually diagnosed with cancer of the cervix. She has been told that she is now infertile, having undergone radiotherapy and chemotherapy. That is one example of how a woman exercising her right to a test resulted in her being given treatment, which I hope will lead to a full and complete recovery.

Cervical cancer is the second most common cancer worldwide. It is the 11th most common cause of cancer-related deaths in the UK, amounting to about three in every 100,000 women, according to the crude mortality rate of Cancer Research UK. There are, on average, just short of 1,000 deaths from cervical cancer each year in the UK. Three women are diagnosed with the disease every day.

As Jo’s Cervical Cancer Trust points out, almost all cases of cervical cancer are caused by the persistent high-risk human papilloma virus. The NHS guidance on the HPV vaccine indicates that 99% of cervical cancers are caused by an HPV infection, and that four out of five sexually active adults will come into contact with it during their lives. The condition is not one that solely women can get; men also carry the HPV virus. The thing is that many people do not necessarily present with any particular symptoms.

It is worth highlighting the other risk factors that can affect a woman’s propensity to develop cervical cancer. They include smoking, as carcinogens weaken the immune system and leave the individual more likely to attract an infection of the cervix, as well as unprotected sexual activity at an early age, teenage pregnancy, multiple births, decreased immunity in women receiving immunosuppressant drugs and, in some cases, mothers given the DES—diethylstilbestrol—infertility drug when pregnant. Some medical opinion suggests that long-term use of the contraceptive pill, for instance for more than 10 years, can slightly increase the risk of developing cervical cancer, although I am sure there is consensus that the benefits of the pill far outweigh the risks for most women.

The previous Labour Government’s decision to introduce the HPV vaccination programme was extremely apposite. It has saved and will continue to save many thousands of lives across the country. However, we must be relentless in rolling out the vaccination programme in our schools and colleges. Typically, year 8 girls—those aged 12 and 13—are offered the vaccination, and the take-up rate is about 80%. The vaccination offers protection against their developing the condition in later life. A catch-up programme was also introduced by the previous Government in 2009-10, in which almost 1 million girls aged between 12 and 18 were vaccinated. The continued roll-out of vaccination in girls before they become sexually

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active will greatly decrease the chances of their contracting the infection, and it will increase the chances of cervical cancer survival.

As many as 2,800 women a year are diagnosed with cervical cancer, and more than a third of sufferers die each year because of the failure to catch the cancer through early diagnosis. It is impossible for women on their own to detect abnormalities in cervical cells, but symptoms that seem inconsequential when taken in isolation can amount to a clear indication of cancer of the cervix when assessed cumulatively. Those include abnormal bleeding during or after sexual intercourse or between periods, post-menopausal bleeding if a woman is not on hormone replacement therapy or has stopped it for six weeks, unusual and/or unpleasant vaginal discharge, discomfort or pain during sex, and lower back pain. As the cancer develops, it can cause additional symptoms such as frequent urination, blood in the urine, rectal bleeding, diarrhoea, incontinence and lower-limb lymphoedema.

Alison McGovern: My hon. Friend is giving an excellent description of the symptoms that everyone should be aware of. It is refreshing to hear a man talking about the symptoms of women’s cancers. Does he agree that one thing that we can definitely do today is raise the awareness of those symptoms and encourage men and women to understand more about women’s cancers?

Steve Rotheram: My hon. Friend makes a powerful point. In all honesty, I did not know an awful lot of this information before I was asked to head up the campaign in the Backbench Business Committee to get this matter debated in the House. I suspect that the same is true of many male colleagues on both sides of the House and many men in the wider public. We must destigmatise the use of words like “period” or “vaginal discharge” by men, because it is important that such things can be spoken about openly. As the father of two daughters, I certainly want them to be aware of the symptoms of this condition, so that they can bring them to my attention and I can help and guide them should they need a consultation with the GP. This is an important matter for us to debate in the Chamber. I am sure that other colleagues will go into the symptoms of this horrible disease.

The danger of highlighting the symptoms is that some women might misdiagnose themselves, causing them unnecessary worry. Conversely, if doing so means that one person with the symptoms is diagnosed with cervical cancer and has her life saved, it is well worth it.

According to the NHS figures, the vast majority of women’s test results come back normal. For about one in 20 women, the test will show some abnormalities in the cells of the cervix. Most of those changes will not lead to cervical cancer and the cells often return to normal on their own. Indeed, that is particularly true of young patients. In some cases, the abnormal cells need to be removed so that they cannot become cancerous.

About 3,000 cases of cervical cancer are diagnosed each year in the UK, which amounts to 2% of all cancers diagnosed in women. As I have stated, cases of cervical cancer in women under 25 years of age are extremely rare. They amount to about 1% of all cervical cancer sufferers in England. However, the relatively small

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number of occurrences should not be dismissed as statistically negligible. The mission of the NHS cervical screening programme is

“to reduce the number of women who develop cervical cancer and the number of women who die from it.”

The screening programme is credited with saving the lives of about 5,000 cancer patients a year across the board.

In 2004, the last Labour Government increased the age at which young females could have a test from 20 to 25, in accordance with international recommendations from the World Health Organisation. America has adopted the position that a test should happen at 20 years of age or within three years of first sexual activity, whichever comes earlier. To me, that seems an appropriately flexible policy to have. It is estimated that early detection and treatment prevents up to 75% of cervical cancers. The contention centres on the appropriate age at which screening should become routine and on the health consequences for somebody who chooses to have a test before the recommended age of 25.

So that I am not accused of presenting an imbalanced view of the medical thinking on this issue, I should say that there is an opinion among some professionals that smear tests on young women and teenage girls can lead to false positives, unnecessary treatment, anxiety for the patient, infertility or pre-term delivery later in life. There can also be discomfort, embarrassment or, less commonly, pain during the screening test. There is a very small chance of getting incorrect results, which could lead to abnormalities being missed or to unnecessary distress and treatment. There is also a chance of unnecessary treatment occurring if the abnormalities would have corrected themselves naturally. Some of the treatments that are used to remove abnormal cells may increase the risk of premature delivery in pregnancy.

Undoubtedly, there is still extensive debate in the medical profession about whether tests on young women would have the desired impact. In 2009, the British Medical Journal released a paper on the effectiveness of cervical screening with age, which concluded:

“Cervical screening in women aged 20-24 has little or no impact on rates of invasive cervical cancer up to age 30. Some uncertainly still exists regarding its impact on advanced stage tumours in women under age 30. By contrast, screening older women leads to a substantial reduction in incidence of and mortality from cervical cancer.”

For that reason, it is important to reiterate that the motion does not call for routine screening for under-25s.

I believe that it is the duty of any Health Minister to adhere to the medical advice that is presented to the Department. To my knowledge, no new evidence has emerged that is substantial enough to change the Government’s position on screening ages. I believe that, at this juncture, it would be prudent to follow the decision of the Advisory Committee on Cervical Screening in 2009 to reaffirm the policy that the age for routine screening should remain at 25. However, although it is right that politicians should not ride roughshod over medical experts, it is the job of Health Ministers to examine the orthodoxy of the day, to keep matters such as age restrictions under constant review if new evidence emerges and to scrutinise international patterns and comparisons.

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I must mention that I am not a medical expert. My opinions are predicated on what I have read and learned about the subject. The debates on either side of the screening argument need to be qualified by further research. I believe that there are steps that the Minister can take right now to address those concerns and the concerns that have been highlighted by Sophie’s death. For me, the Minister should get to work on five things immediately.

First, the Government should address the online advice and guidance that is available to young women and girls who suspect that they have the symptoms of cervical cancer. At present, it is far from adequate. In the course of my research for this debate, I was amazed at the total non-existence of good online advice for young women who suspect that they are displaying the symptoms of cervical cancer. Despite young people having a higher propensity to use the internet to access information than most adults over the age of 30, there is an absence of advice on what steps should be taken by young people who are concerned that they are exhibiting the symptoms and on the support that is available. On the NHS “Your health, your choices” website, there is no mention of what young girls or teenagers should do. Instead, there is a vague information section on smear tests for over-25s. Users of the Public Health England website are forced to wade through pages and pages of material and to follow hyperlink after hyperlink before they finally find the information that they need in the frequently asked questions section. It appears that some of the information online—

Madam Deputy Speaker (Dawn Primarolo): Order. I was very reluctant to interrupt the hon. Gentleman, but he has been going on for over 23 minutes. Other Members wish to speak and there are other debates today. The guidance is that Members should speak for 10 to 15 minutes, so I have given him a lot of latitude. I would be grateful if he thought about speeding through his points so that we can move on to another speaker.

Steve Rotheram: That is not as I was informed, Madam Deputy Speaker, so apologies if I have overrun my time limit. I was told absolutely the opposite. I will try to conclude, and I will contact the Minister in writing with any points that I miss out.

Whatever is said and decided today, this debate needs to be the beginning of the process, not the end. I said when I made my application to the Backbench Business Committee on 8 April that I was there as a spokesperson for the 320,000 signatories to the “Sophie’s choice” petition. Today, I have presented their case, which is a case for women’s right to choose, for clearer medical guidance for patients and professionals, for improvements to the sex and relationships education system—I will inform the Minister about that in writing—and for immediate action to tackle the blind spot that exists in the vaccination programme for 19 to 24-year-olds.

We must not forget that it was the people who put this debate on the Floor of the House today, and now it is time for the Government to listen to the British public and act. In their name, let us ensure that Sophie’s legacy is a life-saving one, so that her family and friends can take comfort from the fact that despite failings of the highest order in her case, Sophie did not die in vain.

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12.51 pm

Mr John Baron (Basildon and Billericay) (Con): First, I congratulate the hon. Member for Liverpool, Walton (Steve Rotheram) on securing the debate. Needless to say, all our thoughts go out to Sophie’s family and friends at this time of loss.

The hon. Gentleman rightly focused on the importance of early diagnosis, which is crucial with not just cervical cancer but cancer in general. I hope, in a relatively brief speech, to remind the House of the importance of the figures that the Government are due to publish soon—one-year cancer survival rates broken down by clinical commissioning group. I and fellow Members of the all-party group on cancer believe that those figures could have a transformative effect in encouraging earlier diagnosis, thereby saving literally thousands of lives.

The recent period has been interesting, because we have had both good news and bad news on cancer. The good news is that, as Cancer Research UK announced only a few days ago, 50% of those diagnosed with cancer now are likely to make it to 10 years following diagnosis, which is twice the survival rate that existed back in the 1970s. That is extremely positive. The bad news is that in this country, shamefully, one in four cancers are still first diagnosed as late as when somebody goes to A and E. It is of further shame that figures suggest that if we were to match European averages for cancer survival rates—just the averages—we could save an additional 5,000 lives a year. If we believe the OECD’s figures, if we were to match international averages—again, just the averages—we could save up to 10,000 lives a year. That shows clearly that we have a long way to go and that early diagnosis is crucial. The all-party group describes it as cancer’s magic key. There are very few magic keys in life, with which we can open the door and find that there is suddenly a plethora of riches in front of us, but a magic key does exist for cancer, and it is early diagnosis.

Katy Clark (North Ayrshire and Arran) (Lab): Does the hon. Gentleman agree that there is huge regional variation in cancer survival rates? In areas such as the one that I represent, where we have high levels of poverty and deprivation, survival rates are a lot worse than elsewhere, so we have massive challenges before us.

Mr Baron: The hon. Lady makes an excellent point, which leads me neatly on to the report that the all-party group produced back in 2009 on reducing cancer inequalities—I should perhaps declare an interest as the chairman of the group. The report, which was extensive and took in much written and oral evidence, found that this country’s health care system stood as much chance as any other of getting patients from the one-year point to the five-year point after diagnosis. However, where we fell down was on getting them to the one-year point in the first place. That suggests that the NHS is as good as any other health care system at treating cancer once it is detected, but very poor at detecting it. That underperformance in diagnosing cancer means that we trail other health care systems. We never catch up from that original loss.

Comparisons are always dangerous. When we compare our system with that in France, for example, we are comparing it with centres of excellence, so we have to be careful in our comparisons. However, the figures of

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5,000 lives a year that could be saved if we matched European averages and 10,000 that could be saved if we met international averages are generally accepted. They can largely be accounted for by the early phase, when we fail to pick up cancer early enough and so do not get enough people to the one-year point after diagnosis.

The all-party group therefore decided to ask how we could focus the NHS on earlier diagnosis. We have been laser-like and dogged in our campaign on that front.

The Parliamentary Under-Secretary of State for Health (Jane Ellison) indicated assent.

Mr Baron: The Minister is nodding—kindly, I think. I thank her for that in one respect.

The solution that the all-party group came up with was to focus on outcomes. We could bombard the NHS with a lot of targets to try to encourage earlier diagnosis, but instead we decided to focus on one outcome measure—the one-year survival rate, broken down by CCG—as a driver towards earlier diagnosis.

Alison McGovern: Given some of the specific details that we have heard, does the hon. Gentleman agree that the all-party group’s approach of not setting a lot of targets but instead focusing on outcomes might enable groups of GPs to make themselves more aware of symptoms that have been missed in the case that we have discussed and in similar cases?

Mr Baron: That is absolutely right. When it comes to cervical cancer, all the figures suggest that if it is caught early, 95% to 98% of patients can reach the one-year point. That figure falls away significantly if it is not caught early enough. The hon. Lady is right that the idea behind one-year survival rates, broken down by CCG, is to encourage earlier diagnosis. It is intended to encourage CCGs to introduce local initiatives to address the points that the hon. Member for Liverpool, Walton made about late diagnosis. We all know that late diagnosis makes for poor one-year figures, so putting the one-year figures up in lights, broken down by CCG, means that we can see clearly which CCGs are underperforming. The cancer community and politicians can therefore come together and put pressure on those CCGs to raise their game.

As the hon. Member for Wirral South suggests, there could be a range of initiatives, such as better awareness campaigns, whether on cervical or other cancers, better diagnostics in primary care or better GP training—the hon. Member for Liverpool, Walton made the point that the GP in the case in question missed the diagnosis. There could be a range of local measures, and to answer the point that the hon. Member for Wirral South made, it would be up to the CCG to tailor-make those initiatives to address the needs of its individual area. That is what those figures are about and, for the first time, we will have the opportunity to hold underperforming CCGs to account when it comes to late diagnosis. Late diagnosis makes for poor one-year figures, and when those figures are broken down by CCG, we will know which ones are failing to do more to raise their game on early diagnosis.

In conclusion, I have one or two questions for the Minister. First, I managed to secure from the Prime Minister at Prime Minister’s Questions an assurance that the one-year figures will be published in June. I

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asked that question because those figures were due out in January but then postponed to the spring, I think, and then postponed again. Will the Minister assure the House that we are still on course for their publication in June this year?

Secondly—the Minister knows what is coming— can we throw any more light on how we can hold underperforming CCGs to account? There is no point in having one-year cancer survival figures broken down by CCG if there are no systems in place to ensure that CCGs that underperform are held accountable and encouraged to raise their game. There is no point having the tools in the toolbox if we do nothing with them. Will the Minister enlighten the House about whether there has been any further thought on that issue since we last raised it in this place back in February?

I know that the all-party group’s report, “Cancer Across the Domains”, is on the Minister’s desk at the moment, and I hope she will say a few words about how quickly we will get a response—we look forward to that. In direct relevance to the point made by the hon. Member for Liverpool, Walton about GPs and the challenges of improving earlier diagnosis, will the Minister say whether there are any other initiatives by the Department of Health or NHS England to look at earlier diagnosis, apart from the one-year figures? For example, GPs are recompensed through the quality and outcomes framework system, and I think I am right in suggesting that the QOF system deals with everything when it comes to cancer post-diagnosis, but there is nothing to encourage earlier diagnosis.

Finally, I mention briefly the all-party group’s reception on 8 July, which will highlight the importance of those one-year figures. In summary, for the first time we will have the tools in the toolbox to hold underperforming CCGs accountable when it comes to earlier diagnosis. We must make use of those tools, and the cancer community, politicians, and everyone else must be aware of their importance—I am confident that they will be. If we embrace the concept fully and focus on outcomes and the one-year figures, we have the potential to save, quite literally, thousands of lives a year in this country.

1.3 pm

Alison McGovern (Wirral South) (Lab): It is an honour to contribute to this important debate, and I welcome to the House of Commons today Sophie’s mum, Peri, her sisters Chelsea and Ashleigh, and other members of her family. I have been very proud to be involved in this campaign to highlight what happened to Sophie, who was my constituent. I think I am right in saying that this has been the biggest ever e-petition, which I think represents a real change in the way we do our politics in this country. Long gone are the days when only certain people in this place could call on us to hold debates here and only the Government said what we would talk about. In Sophie’s name, her very many friends and family have brought us here to talk about these issues today. That is a massively important change in our politics, alongside the important issue we are discussing.

I congratulate my hon. Friend the Member for Liverpool, Walton (Steve Rotheram)—even though he keeps saying that I am the hon. Member for Wirral West, which I am

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not; I’ll have a row with him about that later—on having initiated this extremely important debate. As I have said before, it is very important for men in Britain, as well as women, to care about women’s cancers, and I will say more about that and about awareness. I make a plea, however, for all my male colleagues, as dads, brothers and friends of women as much as anything else, to ensure that they know the symptoms of cervical cancer and other women’s cancers, and to support their sisters, friends and mums if they have any concerns. That is important.

I begin my contribution by borrowing the words of Peri, Sophie’s mum, which she has allowed me to do. She characterised what Sophie was like in a really brilliant way:

“She was an amazing daughter, sister, girlfriend and friend, a live wire with a huge heart, the glue that held our family together. Her attitude to life was to live it to the best and her positivity shone through to everyone so as you couldn’t help but smile”.

I think those are lovely words about Sophie, and it is in her name that we all come here today. I know I represent all my constituents when I offer their condolences to Sophie’s friends and family, and I feel sure that the many thousands of people who signed the e-petition did so because they wanted to show that they cared about what happened to her. Members might be interested to know that friends and family have also organised fundraising events—they did so before Sophie died—and are taking care of all her family. That is a truly great thing.

Sophie had high aspirations for her life, and she had hopes and plans. She was clearly a vibrant, clever, beautiful young woman with her whole life ahead of her. She attended her GP surgery as she had been suffering for months with symptoms such as stomach pains and various things, and it seems that her request for a smear test was refused on the basis of her age. My hon. Friend the Member for Liverpool, Walton has gone through those issues in some detail. It seems that Sophie was diagnosed with Crohn’s disease, but her health continued to deteriorate until she was eventually diagnosed with cervical cancer and very tragically died in March, just 19 years old.

The disease is rare in younger women, but in this case a smear test would have been important. Sadly, this is not the first case to come to light in which a young woman has died of cervical cancer following such events. Mercedes Curnow died aged 23 in 2011, and reports suggest that she too had requested a smear test. Another young woman, Becky Ryder, was 26. Thankfully, such cases are few and far between, and we are grateful for that; none the less we will all understand the tragic scenario that friends and family face when a young woman faces such a serious disease. Even though the numbers are relatively small, it is important that we take the issue seriously.

Approximately 3,000 cases of cervical cancer are diagnosed in the United Kingdom every year. While there are groups of people such as women under 25 among whom cervical cancer is rare, it does occur. I understand that there are approximately 2.5 cases of cervical cancer for every 100,000 women under 25 years old. It is thankfully rare, but very serious for those people who face it. How can we help GPs to pick up the symptoms of something so rare? A balance has to be struck, but it is important to raise GPs’ awareness of such conditions—rare though they are, they do happen.

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There are potential risks in screening women under 25, which have been mentioned. The consequences of unnecessary screening can cause problems in later life, which is why the medical community has had such a discussion about the point at which screening should be done. As politicians, our first regard must be for the medical evidence, and we would never ride roughshod over that, but one thing that we have perhaps not always got right is making information available to people and accepting that people should be trusted with that information. The NHS is very good at giving advice and telling people what they should be doing, but much less good at giving information to help people to make their own informed decisions. The e-petition is about choice and how we ensure that people have the information they need to make the choice for themselves. I understand that Dr Moss of the Advisory Committee on Cervical screening has argued that volunteering to have the test should be an option. If someone does make that request and is turned away, it could cause a very negative response when they are invited for the test later. I know that Sophie was one of the youngest victims of this devastating disease, and such requests would be rare, but people should have the choice.

The debate is an opportunity to talk about the importance of smear tests. We have all had the invitation and thought, “Oh goodness, I’m not really sure I want to go for that.” But it is vitally important that people have the test if invited, and I hope this debate will make people think about the importance of having a smear test. Cervical cancer is a real problem, and the hon. Member for Basildon and Billericay (Mr Baron) rightly talked about early diagnosis and said that that was a problem across various types of cancer. The biggest challenge we face in fighting cancer is getting people to come forward early, and my view is that that is more of a problem in areas of social deprivation. I know from Merseyside, my home patch, that in such areas people are likely to have busy lives, perhaps less awareness, and a bit less confidence and are perhaps working shifts. They may be concerned about symptoms but put their concerns aside, for whatever reason, and the possibility of diagnosis gets later and later.

We need to recognise the differential prevalence of late diagnosis in different areas, and we should ask what we can do to recognise and address the various social and economic factors that can cause late diagnosis.

Lyn Brown (West Ham) (Lab): I am listening to my hon. Friend’s speech with interest and she anticipates many of the points that I want to make. Does she agree that women often put themselves last, behind their family, and there are always other pressing issues to be dealt with rather than a routine cervical smear? Somehow we have to get it across that the smear test is as important as anything else they have to do.

Alison McGovern: In my slightly cack-handed way, that is what I was trying to say. Women are incredibly good at putting off things that concern our own health, which is why it is important that our brothers, fathers, husbands and friends encourage us to be concerned about our health and to look after ourselves. It is also important that we make the point today about the importance of smear tests. People should have a choice

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and be able to talk to their GP about having a test if they need one, and if invited to be screened, they should take up the invitation.

Mr Baron: The hon. Lady correctly makes the point that we can do more about the disparity in late diagnosis. By focusing on the one-year cancer survival figures by CCG, we can also come together—whether as cancer charities, the cancer community or as politicians—to focus on the under-performing CCGs and ask why that is happening, in the hope that they will themselves introduce initiatives at the local level to drive forward earlier diagnosis. I hope she recognises that that will be an important element of our battle against late diagnosis.

Alison McGovern: I agree with the hon. Gentleman. As I said, Merseyside has a particular issue with cancer, and I feel sure that some of that is to do with late diagnosis that arises from aspects of people’s daily lives. We need to think how we can engage with people in a way that does not depend on their having already some amazing knowledge about the possible symptoms. Many people in my family have had cancer, so we would know, but many people do not know. It can be incredibly stressful to take the first step of going to the GP and saying, “I am really worried. What tests can I have?” We need to encourage CCGs to look at the local conditions and figure out how to get through to the public in their area. The all-party group on cancer has led on that, and I fully support that work.

Another important aspect is broader cultural change. We need a culture change in the NHS in two respects, and Sophie’s case has caused me to reflect on how the NHS works. First, it is important that we talk about women’s health. Women are very good at putting themselves last and putting off the visit to the GP or the smear test that they need. We have seen the great success of breast cancer and other awareness campaigns, and we need to do the same with some of the less well-known cancers, whose symptoms are less well-known. We need a real focus on women’s cancers to try to improve everybody’s knowledge of them. I realise that it is not always easy to talk about periods and so on. Women are very good at hiding such issues and just coping with them, but we need to talk about symptoms. It is also crucial that GPs are aware of possible symptoms. I have learnt from Sophie’s family and friends, and others in Wirral, that the big barrier is ensuring that GPs understand better what they should be looking for and what advice they should be giving to people who come to them with worries or concerns. I know that some excellent GPs are wrestling with that question. People should not be made overly concerned, but if we had more of a culture of giving people information and helping them to make their own decisions, it would help them to feel more empowered.

The second culture change that I would like to see in the NHS is the NHS listening to young women, who are often dismissed in our society. Colleagues have done great work on women’s representation in the media, and I think we have a cultural issue with the place and value of young women that sometimes presents itself in our health service. Too often in the NHS—this is, I am afraid, something I know from my own experience—young women are given advice and told, or at worst instructed,

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what to do about their health, which is totally disempowering. There are lots of forces in society that are set up to undermine young women, so please let us not have the NHS be one of them. Let us rethink how we identify symptoms early and get people the tests they need. Rather than trying to instruct people, we need to listen to them, respect them, provide them with information and help them to find their own way to the right treatment. In serious cases such as Sophie’s, there are clear worries. More broadly, there is no future for a health service that thinks it can tell people; it has to empower people to make their own decisions.

In conclusion, Sophie’s family and friends started the petition and all signed it, which has brought us to this debate. They have shown tremendous courage at what must be a difficult time. They want to see the change outlined by my hon. Friend the Member for Liverpool, Walton. The public across the country have signed the e-petition—this has been a national campaign—and have brought the issue to the top of the agenda. That shows how important it is and how much cancer affects family life. We are asking for women to be given more choice over their own health, no matter what their age, and for them to feel more empowered. This was a tragic event. We feel the loss of Sophie in our community. It sparked an outpouring of grief and we must do better to make sure it is less likely to happen again.

This is Sophie’s debate and we remember and honour her. In her name, I ask that we resolve to make whatever changes are necessary to make this less likely to happen to anyone else. Cancer is a terrible disease, but we are now more able to diagnose, control and contain it than we have ever been. We can win this fight against cancer, so let us all recommit ourselves to do more, to help others and to make sure that we take care of everybody in our society.

Several hon. Members rose—

Madam Deputy Speaker (Dawn Primarolo): Order. I think it will be helpful if I make sure that all Members who wish speak understand the time constraints. There is another debate this afternoon and some Members in the Chamber wish to speak in that debate too. This debate will end for Back Benchers at 2 o’clock. We will then move on to the Front Bench winding-up speeches so that this debate will end by 2.30 pm. I am therefore asking each Member to speak for about seven minutes, including interventions. There are a lot more speakers in the second debate and I need to be fair to them on time allocation too. I am not going to set the clock, but I hope that even when taking interventions each Member will consider the time and their colleagues who are waiting to speak. I hope that is clear in terms of the problems I have, as the Chair, to get us through the debates today.

1.23 pm

Paul Burstow (Sutton and Cheam) (LD): I will stick to your injunction, Madam Deputy Speaker.

I welcome this debate and recognise the tragic circumstances that have made it necessary. I watched Sophie’s mum on “Good Morning Britain” this morning. I saw the courage the hon. Member for Wirral South

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(Alison McGovern) described and the dignity with which she advanced the case for what needs to happen. The story Sophie’s mum tells of her fantastic daughter strikes a chord with Members across the House. Indeed, I am speaking in this debate because of my constituents, John and Barbara Welch. They came to my surgery because they were moved by this case and by the experience of their niece in a previous situation.

I agree entirely with the hon. Member for Liverpool, Walton (Steve Rotheram) that we have to base decisions on cervical screening, and on all screening programmes, on the evidence. It is the evidence that will provide at least some pause for thought, not for Members but for the committee that advises Ministers on screening. I want to touch on that issue; hon. Friends may elaborate on it.

The original decision to change the age restrictions on the general call-up for cervical screening was taken in 2003. The 20-to-24 age group was excluded at that point. That decision was reaffirmed in 2009 by the Advisory Committee on Cervical Screening when it reviewed the matter. The argument at the time was that it would have led to unacceptable numbers of premature births compared to lives saved, and that it would cause women anxiety. Those are very important considerations and one can understand why the committee made its original decision on the basis of evidence from research. My point to the Minister is this: since 2009 the evidence has changed, or appears to have changed, so I hope that the advisory committee will look at it again.

In 2012, a study published in the British Medical Journal, which I understand was the largest of its kind conducted in the UK, appears—I stress the word appears—to contradict the earlier findings of smaller studies. It concluded that treatment for cervical disease does not appear to increase the risk of premature birth. The hon. Member for Liverpool, Walton touched on this point. Furthermore, the same research found that, since the change in the age at which people begin to be called for screening, the number of women diagnosed with advanced-stage cervical cancer at the age of 25 has tripled. The early-stage numbers have quadrupled. I stress that we are still talking about a rare set of circumstances and small numbers, but small numbers do not, in the end, absolve us from looking at the individuals who then find themselves with this terrible disease.

Will the Minister ask the Advisory Committee on Cervical Screening to review the 2012 evidence? The evidence was produced from a study by one of the leading professionals in the area, who was also responsible for the earlier studies that led to the opposite decision. Will the Minister look at why the 2010 guidance referred to by the hon. Member for Liverpool, Walton, which should have ensured that GPs made the right decisions on symptoms to allow smear tests to take place, does not appear to have had its full intended effect? The number of women diagnosed under the age of 25 apparently continues to fall, while the number of women over 25 continues to rise. There is, therefore, something going on. I hope we can ask the experts to advise us and look at what the research is telling us, so that we can make adjustments and ensure that the trend is reversed.

The hon. Gentleman talked about the goal which must be shared across the House and in the wider community of cancer rightly no longer being seen as a

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death sentence. If we get early detection right and raise awareness of the early signs and symptoms of any cancer, but particularly cervical cancer, we can make a difference to the lives of thousands of our fellow citizens. As a former Minister with responsibility for cancer, I know it is important to be guided by the evidence. I took the decision to commission a further review on breast cancer to ensure that we were satisfied that screening was not doing inadvertent harm. I hope that we can ensure that we are acting on the basis of the best evidence.

The Government’s work, which began at the beginning of this Administration, in introducing the Be Clear on Cancer campaign, is critical. Awareness is critical not just to raising public awareness, but to raising GP awareness. I hope the Minister will say more on the plans in relation to cervical cancer. I look forward to hearing what she has to say.

I would like to end by offering my condolences and sympathies to Sophie’s family. I hope that some good can come out of something so tragic.

1.29 pm

Lyn Brown (West Ham) (Lab): Let me begin by offering my condolences to Sophie’s family, and thanking the Backbench Business Committee for scheduling the debate.

As we have heard, cervical cancer, although rare in women under 25, can be far more aggressive than cancers developed by older women. As we saw in the tragic case of Sophie’s death, her cancer had a devastating effect although she was only 19. The smear test that Sophie requested would have shown abnormal tissue growth in her cervix, and, although it might have been too late to save her life, the fact that she was refused that test is tragic. We must all learn the lessons of her death, and seek new and better ways of dealing with such cases.

Newham has a lower incidence of cancer than many other areas, but, sadly, our mortality rate is higher, owing mainly to late presentation. In 2012 the London-wide mortality rate was about 112 deaths per 100,000 cases, while in Newham it was 123 deaths per 100,000 cases. There have been instances in which stage 4 cancer has presented itself for the first time in A and E departments, and we know that there is no stage 5.

As we heard from my hon. Friend the Member for Wirral South (Alison McGovern), there is a relationship between deprivation and death from cancer. Social and economic deprivation have a severe impact on health, as has been shown by countless reports and studies. The figures for London and England clearly demonstrate that deprivation contributes to the incidence and types of cervical cancer, and to the survival rates of sufferers. The mortality rate among those in the 30 most deprived areas is nearly double that among those in the 30 most affluent.

Although the deprivation in Newham means that poor health is more prevalent there than it is in other areas, excellent work has been done in the borough, especially in our schools. Newham is also building on its current 90% coverage of the human papillomavirus vaccination programme. It is one of only two areas to have achieved that target, thus helping to prevent cancer despite the barriers to screening uptake. However, as we

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know, HPV immunisation does not entirely eliminate the risk of cervical cancer. That should be explained clearly to young women who take part in the programme, which is what is being done in Newham.

Regular smear testing is the only way in which individuals can be sure that their health needs are being met. In the case of cervical cancer, the take-up of screening services in Newham was just 22% in 2012-13. That is nearly 2% less than the figure for the previous year, and below the average figures for London and England, which, sadly, are only marginally better. Poor survival rates in deprived areas are arguably due to low take-up of screening, which results in the cancer presenting itself at a later and more advanced stage.

I am pleased that the Government have said that they aim to match European survival rates and, in doing so, save approximately 5,000 more lives, but it worries me that no indication has yet been given of how that will be measured, or, indeed, whether the targets are being met. Cancer networks, which were established in 2000, are currently being replaced by strategic clinical networks, which will deal not only with cancer but with maternity, mental health and dementia. Many professionals have suggested to me that, given that the new networks will cover a wider clinical range and a larger geographic area and will retain fewer dedicated cancer network staff, the overall decrease in funding may well lead to an inconsistent and unreliable service. I think that the Government should heed those fears and examine the allocation of resources to ensure that the areas with the greatest need receive appropriate funding, thus reducing the disparities in life expectancy and survival between the least deprived and the best off.

There is ample evidence of the need for awareness of conditions such as cervical cancer to be kept at a high level, and that requires continual effort. Following the death of Jade Goody in March 2009, 70% more women than the normal average were given smear tests, and I must admit to being one of them. I am sure that I am not the only woman in the Chamber today who has found other things to do rather than nipping down to the doctor for that very quick, clear test. Most of those who were tested were aged between 25 and 39, which is the age group with the lowest rates of attendance for screening. That is understandable, given that smear tests can be very uncomfortable and even painful in some instances, but we still need to have them.

Owing to the nature of the populations of Newham and, I assume, similar areas, national awareness campaigns struggle to have a fully effective impact in our communities. We need to understand why that is, and take action to deal with it. I am grateful to Newham’s fantastic Community Links charity, whose awareness campaigns have been very proactive. It has been instrumental in driving up screening rates, and its work in schools has ensured that its message reaches not only children throughout the borough, but their families at home. Children are a great way of getting to parents, and nagging them to pieces.

I know that the aim of this debate is to ensure that other girls, unlike Sophie Jones, can have their concerns heard. Much more needs to be done to educate young women about the detectable symptoms of cervical cancer, and it is imperative for the NHS to remove as many of the barriers to screening as possible. I urge the Minister to look at the excellent work of Community Links, and

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to consider whether the action that it has taken on behalf of my community can be learnt from and prove relevant in other parts of the country.

1.36 pm

Martin Horwood (Cheltenham) (LD): It is an honour and a pleasure to follow the hon. Member for West Ham (Lyn Brown), as well as other Members, particularly my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) and, indeed, the hon. Member for Wirral South (Alison McGovern), whose speech was a moving tribute to Sophie Jones—her constituent—and her family. I also congratulate the hon. Member for Liverpool, Walton (Steve Rotheram) on securing this timely debate.

I welcome the Government’s work on cancer in general. Their Be Clear on Cancer campaigns, which began in 2011, have been producing good work, which is now being done in conjunction with Public Health England. I should probably declare a non-pecuniary interest here: my wife is the director of one of Public Health England’s regional centres.

I feel some sympathy with the Minister. I am sure that her instinct was to trust her brief from the Department, and its representation of the risks and statistics attached to cervical cancer and screening. I suspect that, being a member of the coalition, I have a similar brief before me now. I have to say, however, that deeper examination of those risks and statistics casts grave doubt on the Department’s current interpretation of them.

I have benefited from some forensic research carried out by my constituent and friend Mel Gladwin. Mel works for an organisation in Cheltenham that is well known for its forensic examination of data, but she contacted me in connection with today’s debate because in 2003, at the age of 22, she was diagnosed with a very aggressive form of cervical cancer. I am delighted to say that she is now perfectly healthy, and has a bouncy seven-year-old son. Her life was saved by effective treatment. The treatment was effective because Mel’s condition was diagnosed early, and it was diagnosed early because she was part of a routine screening programme for those aged under 25. Mel, her family and I are all pretty well convinced that she would not be with us today if that routine screening programme had not existed.

Mel tells me that in 2009, the Advisory Committee on Cervical Screening cited two specific reasons for not restoring screening for those aged under 25. One was that it caused significant anxiety. That view appears to have been based not on any recent evidence, but on evidence dating back to the 1970s and 1980s, when survival rates generally were much lower, a much greater stigma was attached to cancer, and, I suspect, anxiety levels were higher. I believe that cancer now constitutes a largely curable disease in the public imagination, and that anxiety levels may not be quite the same. In any event, I think that when anxiety is balanced against the risk of death, most people would rather be sure that they were safe, even if the cost of that was some anxiety.

The principal reason given by the ACCS for its decision was the potential risk of premature birth if the women concerned had children later in life. That evidence was presented to the committee by Professor Peter Sasieni of Queen Mary, University of London—the self-same Peter Sasieni who conducted the much more robust

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2012 study referred to by hon. Members today. It was a study of 44,000 women, including 2,000 to 3,000 under the age of 25, and was much larger than the earlier studies and based in England, whereas the others were done in Scandinavian countries where the incidence was different and the treatment appears to have been somewhat different. Therefore, this research is much more robust and relevant.

Although my right hon. Friend the Member for Sutton and Cheam presented the results in quite a qualified way, actually, the British Medical Journal was pretty robust in its conclusions when it published them:

“After adjusting the results to account for the type of treatment and whether it had occurred before or after the birth, the researchers found that there was no increased risk associated with treatment. The researchers concluded that the increased risk of preterm birth in women who have been treated for cervical disease was due to common factors that increased the risk of both cervical disease and preterm delivery, and not to the treatment itself.”

The BMJ could not really have been clearer, yet that evidence has never been formally reviewed by the ACCS.

That suggests that there is no strong reason not to screen women under 25, but perhaps we should balance that against whether there is a strong reason actually to screen women under 25, because the Department must also take that into consideration. Mel comes from a talented family. Her father, as luck would have it, is a mathematician and computer scientist at the university of Kent’s school of computing. He has looked at research produced by Cancer Research UK on the incidence of diagnosis of cervical cancer in various age cohorts. The statistics are very strange. The incidence of diagnosis at 25 has tripled in just the last few years—a huge spike in the statistics—and is many times the incidence at 24 and lower ages, which appears, strangely, to have reduced. It is also higher than the incidence at 26, so something very odd is happening. What was previously a gradual increase in incidence of diagnosis by age cohort now contains a massive spike.

Peter Welch, Mel’s father, is not medically qualified but he is a statistician and knows his statistics. His conclusion was pretty clear:

“The figure shows a dwindling of diagnosed cervical cancers in the 20-24 year group since they stopped being screened and a massive spike in those aged 25 (discovered on their first screen). That dwindling is very unlikely to be because the prevalence of cervical cancer has dwindled. The huge spike—approximately 10 times the counts for the individual year groups 20 through 24 and 3 times the counts for the year groups 26 through 29—is most likely because of cancers that would have been prevented by screening now developing and cancers that would have been found earlier now being found late.”

In other words, withdrawing routine screening has suppressed the numbers at 25 and younger, and massively increased them at age 25. That is a very serious conclusion. If it is true and the conclusions of the second batch of Sasieni research are true, the inescapable conclusion is that we have denied screening to young women whose lives would have been saved, and increased the risk at the age of 25 and above of people having had undiagnosed cancer before then.

I am very glad that Mel is happy and healthy, but she clearly attributes her survival to the routine screening programme. This issue is now in urgent need of review. We are not talking about vast numbers of young women —there were about 45 in 2010, according to the most recent available statistics—but their lives might be being

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put at risk each year, and the Government must reflect urgently on the issue and reconvene the ACCS to look again at the most recent and robust research.

1.44 pm

Katy Clark (North Ayrshire and Arran) (Lab): It is a pleasure to follow the knowledgeable contribution from the hon. Member for Cheltenham (Martin Horwood). I want to thank my hon. Friends the Members for Liverpool, Walton (Steve Rotheram) and for Wirral South (Alison McGovern) for bringing this matter to the House today on behalf of the family of Sophie Jones, who did so much work to collect the many signatures that ensured that we had this debate. I pay tribute to them for reacting in that way, because it is incredibly important that people such as them do this work to raise awareness of the condition, and to ensure that we have the health services required for this form of cancer.

I am speaking in today’s debate because of my constituent, Suzanne Fernando, who lives in Ardrossan. She was diagnosed with cervical cancer when she was pregnant, and describes herself as a survivor of cancer. She has campaigned tirelessly on the issue throughout my time as a Member of Parliament, and I have campaigned with her on many different aspects of the disease: ensuring that people use cervical cancer screening services and get smears; attending local schools with her and encouraging girls to get the HPV vaccination; and supporting her in her fundraising work. She was Scotland’s first campaigns ambassador for Cancer Research UK. She set up a cervical cancer support group in Ayrshire, which provides people with advice on the disease at any stage. We should pay tribute to all the women throughout the country who have experience of cervical cancer and who do everything they can to ensure that others do not go through what they have been through, that the condition is identified early and prevented and that people get the treatment to which they are entitled.

I listened carefully to the comments of my hon. Friend the Member for Wirral South about young women. Often, young women have the greatest contact with the health service when they have children. Many of us have been aware for generations how disempowering many women find that experience. It is incredibly important that the motion before us states clearly that when a woman asks to have a smear test, she should be entitled to have it. The case of Sophie Jones shows powerfully why that is important.

There are far wider issues, such as having a patient-centred service and actually listening to what people are saying—whether they are young or old, a woman or a man, and whatever ethnic or other background they come from—and ensuring that they are given access to the treatment they deserve.

Suzanne Fernando is taking part in cervical cancer awareness week, participating in a 5 km walk for fun at Eglinton Park in Kilwinning, Ayrshire, on 15 June. Of course, she is just one of the many women who are trying to raise awareness of this condition. I hope the message goes out clearly from this House today that we want the Government to do what is necessary to ensure that young women in particular are given access to the NHS facilities that they deserve, that we listen to what young women say, that we listen to what Sophie Jones’s family is saying and that we learn the lessons to ensure that such a tragedy does not happen again.

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1.49 pm

Jim Shannon (Strangford) (DUP): It is a pleasure to follow the hon. Member for North Ayrshire and Arran (Katy Clark) and I thank her for her contribution. Today’s debate is an emotive one as it directly concerns the loss of a 19-year-old lady. May I pass my sincere condolences to the family of Sophie Jones, some of whom, as the hon. Member for Wirral South (Alison McGovern) has said, are in the Gallery today? As a father of children around that age, my heart breaks a little to think of what the family are going through, and I congratulate those family and friends who worked so hard to see this issue brought before the House. We are debating this issue because of their enterprise and commitment, and the response from hon. Members. May I especially commend the hon. Members for Liverpool, Walton (Steve Rotheram) and for Wirral South for their massive contributions here today, and the other Members who clearly, excellently and passionately made detailed contributions?

I am a major supporter of the HPV vaccine being brought into schools so that we can take a hold of this cancer. I was delighted when the vaccine became standard in schools. The statistics for cancer are beyond frightening, and if anything can be done to prevent cancer or ensure its early diagnosis, we need to implement it as a matter of urgency. It is estimated that by 2020 one in two people will either suffer or have family who suffer from a form of cancer. That statistic makes me go cold, but it is a reality that warrants action, and today we have an opportunity to discuss and highlight cervical cancer and how it affects people.

In 2010, 2,851 women in the UK were diagnosed with cervical cancer, which is the 12th most common cancer in women and the most common cancer in women under 35 in the UK. Again, that shows the magnitude of the issue. In 2011, there were 972 deaths from cervical cancer in the UK. Between 2005 and 2009, 66.6% of adult cervical cancer patients in England survived their cancer for five years or more. A number of hon. Members have made the point about early diagnosis, and I know that the Minister will indicate the steps that the NHS has taken to address early diagnosis. The statistics I have given warrant this debate, and we must examine the case of Sophie Jones to see whether the age limit should be changed. What is clear to me is that if a young lady requests a smear test, there should be a mechanism through which she receives it as a matter of urgency. Clearly that did not happen in Sophie’s case when it should have done, which is why we are discussing this matter today. That is a terrible lesson that must be learned from this case, and I ask the Minister to confirm that tests will always be given in those circumstances from now on. That is the issue we are asking the question and seeking the answer on; everyone who has spoken on this matter has asked that question.

Among women in their 30s, cervical screening can prevent about 45% of cervical cancer cases. That figure rises with age to 75% among women in their 50s and 60s who attend screening regularly. Clearly, screening works, and there is a case to be answered. I ask that the Minister, in providing an in-depth response to the debate, also indicates what discussions have taken place with the devolved health bodies to ascertain their opinion and to ensure that the strategy we are discussing can be allocated to and introduced in all regions of the UK.

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She often hears me ask about the following issue in our debates, but I am always conscious that we have good practice in many parts of the United Kingdom and that when we exchange our viewpoints and agree strategies all can gain across the United Kingdom of Great Britain and Northern Ireland. I know that our Health Minister in Northern Ireland is well aware of this issue and has a well-informed opinion on the matter, and I am anxious to ensure that there is a UK-wide informed strategy in place.

This is one of those occasions when the House excels, coming together, across party lines, to grasp an issue that we can all support and try to push forward. It is good to have that unanimous support today from across the Chamber, with all parties giving their contribution. Cancer is a dreadful disease and if something is in our grasp that will prevent any of our constituents from going through it, we need to act. I am no medical expert—far from it—and I cannot give an answer, but I can demand, as the Member of Parliament for Strangford and on behalf of my constituents, that the medical experts give reasons why they have reached the decisions they have. I would like to understand the implications of dropping the age limit back down to 19, as is the case in Scotland and as was the case in Northern Ireland until 2004, when it was changed.

As I have said, there is a case to answer. The terrible loss of Sophie Jones has prompted this debate. To honour her memory, I support the calls for a review of the age limit for cervical screening UK-wide.

1.55 pm

Luciana Berger (Liverpool, Wavertree) (Lab/Co-op): I thank my hon. Friend the Member for Liverpool, Walton (Steve Rotheram) and the other hon. Members who supported the application for this debate to ensure that the House can discuss such an important issue. I also thank hon. Members for their thoughtful contributions throughout the debate, which are a testament to how much the case of Sophie Jones has moved Members on both sides of the House. Not only across this House, but across the country people have reacted with shock and sadness at the death of a young woman that might have been prevented. We need only consider the number of people who signed the petition calling for the Government to look again at cervical cancer screening to appreciate the depth of feeling surrounding this issue. As we heard, 321,956 people signed it, which is more than three times the number required for it to be considered for a debate in this House. As my hon. Friend the Member for Liverpool, Walton said, that is the largest number for any of these petitions.

I would like to take this opportunity to pay tribute to Sophie Jones’s family and friends for their courage, spirit and strength in driving forward this campaign and for their determination to ensure that what happened to Sophie does not happen to another young woman. I am speaking in this debate not just as shadow public health Minister, but as a constituency MP representing Liverpool, Wavertree. My constituency is close to that of my hon. Friend the Member for Wirral South (Alison McGovern), where Sophie Jones lived, and this tragic case has affected people right across Merseyside. I have

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heard from a number of constituents who have read about Sophie’s story and were very keen for me to participate in this debate.

I was very privileged to meet Sophie’s family with my hon. Friend the Member for Wirral South and hear from them about what a remarkable young woman Sophie was. She was active, well-liked and so positive, and I was so moved hearing about her bravery and positive outlook, even as her cancer took hold—it really is a true inspiration to us all. I am glad that the House has had the opportunity to hear about Sophie’s case, to examine policy on cervical cancer screening and to debate ways in which we can do so much more to ensure that such a tragedy does not happen again.

Cervical cancer is the most common cancer in women under 35 in the UK and although deaths from cervical cancer have plummeted over the past 30 years, about 970 women died from it in 2011 in the UK—that is more than two women every day. Cervical cancer is not normally associated with younger women—as we have heard from a number of hon. Members, it is extremely rare in under-25s. There were 47 cases in women aged under 25 in England in 2011, which was less than 2% of all cases. The House has heard today many good reasons why routine cancer screening is offered when women turn 25. I will not go through them in detail but I will touch on them briefly.

We have heard today, including from my hon. Friend the Member for Liverpool, Walton, about evidence showing that screening all women under the age of 25 can lead to some harmful investigations and treatments. I listened to what the hon. Member for Cheltenham (Martin Horwood) said and I will be interested to hear the Minister’s response and whether she believes that that evidence needs to be reviewed. I am grateful for the opportunity I have had to speak to experts in this field, including at the Liverpool women’s hospital, in preparation for today’s debate. I have heard that there are problems involved in screening under-25s and that young women often undergo natural and harmless changes in the cervix that a smear test would identify as abnormalities. Screening young women would involve putting these women through further tests and investigations they would not otherwise have gone through when, in most cases, the abnormalities would have sorted themselves out without any need for treatment. I understand that the decision for routine cervical screening to begin at 25 was taken after a thorough review of the evidence by expert clinicians and scientists. That decision was reviewed in 2009 by the Advisory Committee on Cervical Screening, which at the time voted unanimously to keep the age at which screening starts at 25, reaffirming the earlier conclusion that the harms of screening women under 25 outweighed the benefits.

The point in the cases of Sophie Jones and of all the other people we have heard about today is that there is heartbreaking proof that, though rare, cervical cancer in the under-25s can happen. We must get better at spotting the signs of the disease and diagnosing it earlier.

I wish to cover three main areas for improvement to which I hope the Minister will respond. First, we must increase awareness of the symptoms not just among women so that they can spot the signs and go to their doctor at an early stage, but among doctors and nurses so that they understand that young women can develop

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cervical cancer. Secondly, we must ensure that once cancer is diagnosed, women are swiftly referred for treatment. Finally, we must do more to prevent cervical cancer from happening in the first place. We can do that by ensuring high levels of coverage among girls of the human papillomavirus vaccination programme and that eligible women attend their cervical screening appointment.

The cervical screening programme is highly effective at detecting early stages of cancer or pre-cancer, but it is not the best tool for diagnosing cervical cancer once symptoms are apparent, as they were in the case of Sophie. We know that detecting cancer early can make a real difference. The earlier that cervical cancer is diagnosed, the better the outcomes are likely to be. As we heard from the chair of the all-party group on cancer, the hon. Member for Basildon and Billericay (Mr Baron), it is so important that women are made aware of the signs and symptoms of the disease.

I echo the point made by my hon. Friend the Member for Wirral South; it was refreshing to hear a man—my hon. Friend the Member for Liverpool, Walton—listing the different symptoms experienced by women. I will not read them out again, but encouraging women to visit their GP if they have any concern or are showing any of the symptoms is such a simple message that could make a really big difference. Men, as fathers, partners and siblings, can also play a part, by being aware of the symptoms.

The tragedy in Sophie’s case was that she did visit the doctor on a number of occasions, but tragically was not diagnosed accurately. The Government must do more to ensure that GPs are getting the support and the training they need to help them identify cancer signs and symptoms, and that needs to be done during initial training and ongoing professional development. Clinical commissioning groups have a role to play, too. Crucially, we must make doctors aware that, although rare, young women can suffer from cervical cancer.

As much as these improvements at the first point of contact are needed, they are not enough if, once cancer is suspected, people are not seen quickly enough by specialists. We have heard from Members about how important early diagnosis and treatment are. NHS England’s figures on cancer targets for the last three months of 2013 reveal that 4,500 people waited more than two months for treatment after an urgent GP referral, which was in breach of the Government’s own target. That is not good enough, and the Government must urgently get to grips with the failing.

If we are to win the battle against cervical cancer, we must do everything possible to prevent it from occurring in the first place. I am proud of the fact that it was the previous Government who, in 2008, introduced the HPV vaccine, which immunises teenage girls against the majority of the high-risk strains of HPV that are associated with cervical cancer. My hon. Friend the Member for Liverpool, Walton highlighted the very high risks connected with the HPV virus and cervical cancer. All 12 and 13-year-old girls are now being offered the vaccine through their secondary schools. From September 2012 to September 2013, 86.1% of 12 to 13-year-old girls in England went on to receive all three doses of the vaccine. There is room for improvement here, and the Government must do more to encourage girls aged 12 and 13 to participate in the HPV vaccination programme.

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As my hon. Friend the Member for West Ham (Lyn Brown) outlined in her contribution, the HPV vaccination alone will not prevent every case of cervical cancer. Alongside the HPV vaccine, the best preventative measure is for eligible women to attend their routine cervical screening appointment. We know that cervical screening saves around 5,000 lives every year in the UK, but, despite that, around 3.7 million women are currently overdue for a smear test. Shockingly, that has increased to 11% since 2009-10.

One challenge is around access to GPs. A YouGov survey for Jo’s Cervical Cancer Trust found that of the women of screening age who have missed or delayed appointments, almost a third of them said that it was hard to book a screening at a convenient time, and 35% said that if GP surgery opening times had been more flexible it would have encouraged them to attend their appointments. As my hon. Friend the Member for Wirral South said, we should do all that we can to encourage and provide the opportunity for women to take up their invitation for a smear test.

I wish to finish by coming back to Sophie and her family. As Sophie's mother, Peri Cawley, said:

“If we can do something to make sure this doesn’t happen to someone else, then Sophie's death will not have been in vain.”

The petition under discussion had hundreds of thousands of signatures, which shows that people across the country support that goal. As today’s debate has shown, Members of this House are clear about what needs to be done. We must increase awareness of the symptoms among not just women, but men and all GPs to ensure that they understand that younger women can develop cervical cancer and are able to spot the signs. We must also ensure that we do more to prevent cervical cancer from occurring in the first place by encouraging girls to have the HPV vaccine and women to attend their cervical screening appointments. We now look to the Government to take the action that is needed to make progress on those counts and to ensure that there is no repeat of the tragedy that happened to Sophie Jones. I look forward to the Minister’s response.

2.6 pm

The Parliamentary Under-Secretary of State for Health (Jane Ellison): I congratulate the hon. Members for Wirral South (Alison McGovern) and for Liverpool, Walton (Steve Rotheram) on securing and leading this debate. We all wish that we were not debating this issue, important though it is, against such a tragic backdrop. I share the view of the hon. Member for Wirral South that it is a great innovation that, through e-petitions and the Backbench Business Committee—she knows that I used to serve on that Committee—we can now bring issues of such huge public concern swiftly to the House for debate.

This has been an excellent debate, and I thank all Members for their contributions. Depending on how tolerant Mr Deputy Speaker is feeling, I may not get the chance to address all the points that have been raised, but I hope Members know that I will, as I always commit to, respond to them after the debate.

Mr Deputy Speaker (Mr Lindsay Hoyle): Order. The Deputy Speaker is always generous in the time that he gives but, recognising that there are constraints, I welcome those comments.

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Jane Ellison: Indeed, and I will be guided by you, Mr Deputy Speaker.

Like others, I start by paying tribute to Sophie Jones and her brave battle against cervical cancer. I also offer my sincere condolences to her family who have conducted themselves with such dignity in recent weeks and months. I assure all Members that I will try to address the important issues that they have raised. There is a lot to say, so if I do not get through it all, I will respond to them afterwards.

Although I am not able to comment in detail on individual clinical cases, we understand that Sophie’s case was one of misdiagnosis rather than of screening, to which the hon. Member for Liverpool, Walton alluded. Thankfully, cases of cervical cancer in her age group are extremely rare. I understand that the medical director for the Cheshire, Warrington and Wirral area team has requested that the GP practice undertake a significant event analysis to review the case, and ensure that all appropriate procedures are followed and that any lessons learned are put into practice. Once that is completed, it will be agreed with the practice how that will be shared. I can assure the House that I fully expect NHS England to keep the family and local MP fully informed as the investigation progresses.

Despite the tragic circumstances in this case, I reassure the House that the NHS cervical screening programme is one of the most well regarded in the world. More than 3 million women are screened every year. Experts estimate that the programme saves up to 4,500 lives in England alone. However, it has to be based on the best available evidence. The best independent evidence shows that routine screening of women under 25, on balance, does more harm than good. The UK national screening committee reviewed the age of cervical screening in 2012—although some Members have said that the last review was earlier or later than that—and confirmed the English policy of not screening those aged under 25 as it has no impact that can be seen on the detection rates of cervical cancer in young women and gives rise to a high number of false positives, which cause anxiety and, more importantly, lead to unnecessary investigations and treatments that can have side effects.

The UK NSC review in 2012 followed a review of the age at which cervical screening starts by the Advisory Committee on Cervical Screening, or ACCS, which is made up of experts in a range of disciplines, third sector representatives from Jo’s Cervical Cancer Trust and patients. The ACCS review took place in May 2009 to consider the raising of the screening age from 20 to 25, and it confirmed that decision. The 2012 review was partly a response to the Jade Goody effect mentioned by some hon. Members today and was intended to reconsider that decision. The ACCS was unanimous in deciding that there was no reason to lower the age from 25, which is in line with World Health Organisation guidelines.

Some of the reasons behind that decision have been mentioned. The research presented showed that there was little or no impact on detection rates in those aged up to 30, no clear evidence of an increase in the incidence of cervical cancer following the change to the screening age in 2004, no new scientific evidence was available to support the reintroduction of screening and one in three young women aged under 25 would have an abnormal result when screened, as opposed to one in 14

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from all women who are screened. That shows a lot of false positives in young women.

Martin Horwood: Will the Minister give way?

Jane Ellison: If the hon. Gentleman is going to draw my attention to the statistics he presented, I am happy to look at them in detail and, indeed, I have a partial answer to some of his questions.

Martin Horwood indicated dissent.

Jane Ellison: I will give way very quickly, but I need to get through my speech.

Martin Horwood: I was interested to know when in 2012 the UK NSC met. The second Sasieni research was only published in August 2012 and the Cancer Research UK statistics were published in the BMJ in 2013, so they have not been reviewed as far as I know.

Jane Ellison: As I said, the hon. Gentleman presented quite a detailed statistical submission and I shall respond to him after the debate rather than off the cuff. His statistics deserve better than that.

Cervical cancer is thankfully very rare in women aged under 25. As has been said, there were 47 cases in England in 2011, the last year for which we have figures. That is less than 2% of all cases and there were two deaths. Obviously, we will consider the statistics presented by the hon. Member for Cheltenham (Martin Horwood), but we are aware that in 2009-10—this also relates to the points made by other hon. Members, and most strongly by the hon. Member for West Ham (Lyn Brown), about health inequalities—an extra 600,000 women came forward for screening, many as a result of the publicity surrounding the death of Jade Goody. Many of those women were from lower socio-economic and hard-to-reach groups, and they are more often at risk. That is an important statistic and we need to consider that again.

It may help the House if I briefly run through the science behind the abnormal screening results in younger women. Primarily, they are caused by the fact that they have a high rate of HPV infection, as the cervix in young women is more prone to infection with transient HPV, both because it has not yet matured and because younger women might be exposed more often to different types of HPV. Furthermore, some of the few cancers found in young women are unusual and rare tumours that differ from the type we screen for, such as small cell tumours that can develop rapidly and are very dangerous. However, some are HPV-associated tumours that develop at a young age and sometimes simply as a rapidly developing cancer. The key thing in such cases is rapid referral and an appropriate medical response.

In its 2009 report, the ACCS was concerned that young women presenting to primary care with symptoms of cervical cancer were not always given the best advice. I know that that will be a concern not only to Sophie’s family but to all of us in this House and to the NHS. We know that for many GPs, seeing a patient with cervical cancer is rare, and potentially only one GP in 16 will see a new case each year. That is quite a statistic. To help GPs make the right clinical decisions, new guidance for primary care on the management of young women with gynaecological symptoms was developed and sent to all

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GPs in England in March 2010. The guidance was developed by a multi-disciplinary group, and supported by all the relevant royal colleges. I undertake to raise the issue again with the Royal College of Obstetricians and Gynaecologists and the Royal College of General Practitioners to explore the best way to remind GPs of the guidance.

I reiterate that whatever her age, if a woman is concerned about abnormal symptoms she should contact her GP, who will be able to examine and refer her urgently to a gynaecologist if clinically appropriate. The House might not be aware that the guidance is explicit that in any case where a woman is showing symptoms, best practice is that she should not be referred for screening. That is because a cervical screening test is aimed at women without symptoms. It is a screening, not a diagnostic test, and waiting two weeks for the result could delay examination by a gynaecologist. That is a really important point to bring out in the debate. If someone has symptoms, we want to get them urgently from symptom to diagnosis via a referral, and a screening test could further delay that.

I want to talk a little, as others have, about the human papilloma virus, or HPV. Many Members have mentioned the fact that we have identified high-risk types of the virus and that the vaccination programme sprang from that identification of risk. The programme was introduced in 2008 for girls aged 12 to 13. Its aim was to prevent cervical cancer related to the HPV types covered by the vaccine, which covers about 70% of all cervical cancers. The programme has been a big success. More than 7.8 million doses have been given so far in the UK since 2008, and we have among the highest rates of HPV vaccine coverage in the world, with 86% of girls eligible for routine vaccination in England in the 2012-13 academic year completing the three-dose course, and 90% receiving at least two doses.

It may be of interest to Members to hear that the Merseyside area team reports a higher than national average take-up of the HPV vaccine, with 87.8% of girls vaccinated with all three doses in 2012-13. In Wirral and Sefton, that figure was 90%. However, we cannot be complacent and we want to get the fullest possible coverage. That is something about which MPs, as well as Ministers, can do a lot to spread the word. When we go into schools, a good question to ask might concern the coverage and whether there are particular groups of parents or people from particular backgrounds who do not take up the vaccine.

It is expected that the programme will eventually save more than 400 lives a year from cervical cancer. The first indication that the programme is successfully preventing infection with HPV types 16 and 18 in sexually active young women in England was published in the scientific journal Vaccine, and showed that the proportion of infected rates in 16 to 18-year-olds fell from 17.6% in 2008 to 6.6% between 2010 and 2012. That is major progress, so the take-up of the vaccine is really important.

We encourage all girls, irrespective of religion or ethnic background, to receive the HPV vaccination. NHS England is responsible for making arrangements to implement the programme for eligible girls and young women in the local area, taking into account local circumstances, such as the number of independent or special schools and the number of girls who are not in school. Interestingly, I was informed that Surrey has a

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much lower take-up, so perhaps we need to consider how to deal with girls in independent schools, or other local circumstances. NHS England is also responsible for ensuring that local programmes meet the national specifications.

We are using our growing knowledge of HPV to modernise the NHS’s cervical screening programme by considering HPV infection alongside the screening programme and looking for abnormalities and seeing how they can interact. Public Health England is also promoting the use of the HPV test as a primary screen, which is very interesting. A lot of work is going on, and the first evaluation report of the pilot is due in spring 2015. Cancer Research UK has estimated that, when fully implemented, HPV primary screening could prevent hundreds of cancers a year.

There are some particular matters to which I would like to draw the attention of the House, as I have a little time. The Prime Minister’s £50 million GP access fund will support more than 1,400 practices covering every region to offer extra services for those who struggle to find appointments that fit in with family and work. That is important and responds to one of the points made by the shadow Minister.

I hope we can show that despite tragic cases such as Sophie’s, the age at which screening starts in England is based on sound evidence. It has been carefully considered by members of expert committees pretty recently. However, I am very aware that we need to keep all evidence under review. I have already had a brief conversation with the chief medical officer about this. Members may be aware that one of my fellow Ministers is a specialist in this area of medicine, so we will make sure that we look again at the points that have been made in the debate.

There is much we can do as a House and as a country to reduce the number of women who suffer from this devastating disease. I urge every woman invited to screening to take up the opportunity, as we know that 25% of women in the 25-to-30 age group do not. On screening, I do not have time to describe the work in detail, but I can assure Members that Public Health England has work under way specifically to look at low coverage in certain areas and to work on local action plans to improve that coverage.

I want to do more to urge employers to support their staff. Again, evidence from Jo’s Cervical Cancer Trust, representatives of which I met on Monday evening and discussed some of these issues with, suggests that many younger women do not want to ask an employer for time off for a smear test. I will look at what we can do through work that is already going on with employers to see how we can encourage them to make it clear to young women that they do not have to go through an embarrassing conversation to get time off for that. I will be looking at that further with Jo’s Cervical Cancer Trust.