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Baroness Cumberlege: Yes, my Lords. As I said, we are extending, through pilot schemes, screening for older women. Indeed, we have a research project for younger women—those from 40 to 50 years old. We have also taken on board the recent research on two-view mammography which detects more cancers. It reduces recall rates and we know that it is very cost effective. That is the Government's policy now and every mammography unit of the NHS will have introduced the new scheme by 1st August this year.

Baroness Jay of Paddington: My Lords, I am sure that we are all pleased by the Minister's response to the new research, which is very encouraging. As it is so encouraging, does she agree that it would be advantageous if the double-mammography approach was extended to include women of all age groups and

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was available at every appointment? It would therefore be offered not only at first appointments but would be available at follow-up visits.

Baroness Cumberlege: My Lords, implementation for all age-groups will depend on research studies that we are conducting. At the moment the facility is offered only on the first appointment. The researchers are looking at the efficacy of offering it for every appointment. However, at the moment our advice is that it would not be effective.

Baroness Gardner of Parkes: My Lords, can my noble friend say whether there is a problem in terms of the additional radiographic exposure required for the double view, and whether the radiation dosage now required is being reduced by improved techniques or films to offset the need for the double imaging?

Baroness Cumberlege: Yes, my Lords, my noble friend is right. There is a marginal increase in the amount of radiation that women get through this process. However, it is very minimal and it is well below the limits that have been set.

Lord Ashley of Stoke: My Lords, can the noble Baroness tell the House why pilot schemes are necessary for a measure which is so obviously desirable and necessary?

Baroness Cumberlege: My Lords, it is a very expensive process to introduce nationwide. We do not know at the moment how many women would take up this opportunity. We do not know what the costs would be in terms of the detection of cancers. It is traditional in the health service, before introducing very costly schemes, to run pilot studies so that we can learn from them.

Baroness Rawlings: My Lords, what are the Government doing to improve the treatment of cancer for women?

Baroness Cumberlege: My Lords, an enormous amount is going on in terms of improving the treatment of cancer. In April we published a new policy called A Policy Framework for Commissioning Cancer Services. Its key recommendation is that all patients should have access to the best possible cancer service regardless of where they live. We are also introducing guidelines through our clinical outcomes group. We are increasing the number of consultants and the number of breast care nurses. Over the past three years we have provided £15 million to health authorities and trusts for equipment for diagnostic and treatment services.

Lord Shepherd: My Lords, it is clearly early days but the noble Baroness referred to high costs or added costs. Can she give an indication of what would be the added cost for carrying out the scheme that is now being proposed?

Baroness Cumberlege: My Lords, we do not have the details of that. To set up the two pilot schemes will cost in the region of £80,000. What we do not know is how many cancers will be detected and what implications that will have for the whole of the service. One of our greatest constraints is not so much the

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funding of the services but ensuring that we have trained staff to carry out the procedures once the cancers have been detected.

Lord Shepherd: My Lords, the cost is therefore not necessarily a prohibition on introducing the scheme.

Baroness Cumberlege: My Lords, your Lordships will be aware that year on year we spend more money on the National Health Service. Spending has never been higher. On the question of cancer services—I am aware that this is a very sensitive time to be talking about the funding of any service—the greatest constraint is manpower rather than cost.

Baroness Robson of Kiddington: My Lords, I thank the noble Baroness for introducing the pilot studies. In the sums of money that are going into improved breast cancer care, has adequate thought been given to increasing the number of specialist breast cancer nurses? I understand that in this country we need 250 specialist breast cancer units whereas we have only 170 specialist care nurses. There is a great gap and I hope that some of the money will go towards increasing that number.

Baroness Cumberlege: My Lords, the introduction of breast care nurses is a new development. The increase in their number over the past three years has been considerable. We share the noble Baroness's view that they are most effective, especially in terms of communicating bad news and, indeed, sometimes good news. But again the question is one of training, and it is up to local health authorities to decide whether to purchase services that include breast care nurses. We believe that many of them are doing that.

Lord Ironside: My Lords, I apologise to the House for not being present when the Minister gave her Answer. Does she not think that the time has come for a 10-year overview of the screening programme, as happens in Sweden? Does she not agree that one should be looking at all the problems, such as two-dimensional imaging, the ageing bracket and the interval for screening; and, above all, at what the EU now calls in its third action plan "the women of suspect image"? Those are the EU's words. I think that those issues are important and I hope that my noble friend will pay particular attention to them.

Baroness Cumberlege: My Lords, I think that I covered all the points that my noble friend has made. He will be able to read them in Hansard. If there is anything outstanding, I shall write to him.

Lord Strabolgi: My Lords, will the noble Baroness confirm that the Royal Marsden Hospital is now absolutely safe in terms of its future, as the hospital was under threat at one time by the Government?

Baroness Cumberlege: My Lords, we have discussed the Royal Marsden on many occasions in your Lordships' House. The noble Lord will be aware that the Royal Marsden is now part of the general scheme of things. It is a trust; and like every trust, its services are purchased through the health authority.

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Tributes to the Late Yitzhak Rabin

3.9 p.m.

The Lord Privy Seal (Viscount Cranborne): My Lords, with the leave of the House, I should like to make a Statement.

I am sure the House would not wish to let the day pass without honouring the memory of Yitzhak Rabin, who was cruelly murdered last weekend.

The late Prime Minister of Israel was a soldier. Like all true soldiers, he pursued his profession in order to achieve the ultimate security of his country. Your Lordships, perhaps better than any other assembly, know that peace alone can provide any nation with that security. There was therefore no paradox in the fact that the general became the peacemaker.

I believe that the whole House will acknowledge that the most appropriate memorial that the nations can erect to Mr. Rabin is a lasting peace settlement in his homeland. If his untimely death is to serve any purpose at all, let it accelerate the conclusion of that settlement rather than delay it.

Our deepest sympathy goes to his family, to the Jewish community in this country which contributes so much to our national life, and, of course, to his countrymen.

Lord Richard: My Lords, may I start by thanking the Leader of the House for giving us the opportunity of expressing our sentiments at these dreadful events. May I echo what he has just said about our sympathy going to Mr. Rabin's family, the Jewish community and the whole state of Israel. The killing of Yitzhak Rabin last Saturday evening is one of those, thankfully, rare events which really make us wonder for the future. It is almost a truism to say that Israel and the Middle East will never be quite the same again; but it is so. One gathers that inside Israel itself there is a feeling of shock and revulsion; a sense of bewilderment and perhaps, too, a feeling of self-questioning in the light of the fact that the assassin was himself a young Israeli. As one Minister put it:


    "I always stubbornly thought that perhaps we are better than others, but we are not".

It is this threatened loss of national self-confidence and sense of identity and unity in Israel which could now prove to be one of its greatest dangers. Israel is a young country and a young democracy. Its institutions are going to come under severe strain in the coming months. It is important that we should all do what we can to help to nurture that democracy and help preserve those institutions. They will need all the help that we can give them in the aftermath of this terrible blow.

There is almost a classical sense of tragedy about these events—a soldier turned peacemaker killed as the peace process he did so much to promote gradually gathered momentum. The awful fact is that he was shot by one of his own countrymen and not by one of his former enemies. Finally, there is the extraordinary contrast between his last words and the act that almost immediately followed them.

At that final rally last Saturday, Mr. Rabin said:

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    "I have always believed that the majority of the people want peace and are ready to take a chance for peace. And you"—

addressing the audience—


    "by coming to this rally prove that the people truly want peace and oppose violence".

He then said this:


    "Violence erodes the basis of Israeli democracy. It should be condemned, expunged and isolated. It is not the way of the State of Israel. There is democracy. There can be disputes, but the outcome will be settled in democratic elections".

I believe that Yitzhak Rabin was one of the great figures of our time. He was one of those very rare people who genuinely shaped and changed events. I found the sight of so many Arab leaders at his funeral this morning profoundly moving, as it was to see the King of Jordan expressing himself to an Israeli crowd in the way that he did and with the emotion that he so clearly felt. It would have been inconceivable a few years ago. As the Leader of the House said, his most fitting memorial would be to take forward the process towards peace and reconciliation in the Middle East. That is a process which in his lifetime he did so much to promote and for which in the end he gave his life.


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