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Baroness Fookes: Is there no age limit? I thought there was an age limit for screening above 65 or 70. If that is not so, I should be delighted to hear it. Does the Minister accept that there is a greater risk of breast cancer in older women?

Lord Hunt of Kings Heath: My Lords, there are two points to make. First, we have announced our intention to extend screening to women aged 65 to 69. That is on the basis of some pilot programmes. Secondly, I should stress that women over 70, and women now between the ages of 65 and 69, have always been able to obtain a screening test if they wish. The point is that the younger age group have received positive information to come for those tests.

I listened with great interest this morning to the debate on the Age Concern survey, to which I think the noble Baroness alludes. Little hard research is available to show that population screening in the over 70s is effective in reducing mortality. We shall look at the survey and I will arrange for the Advisory Committee on Breast Cancer Screening to look at the results of that survey.

Baroness Northover: My Lords, does the Minister agree that it was a huge mistake to exclude older women from breast cancer screening? Does he also agree with the statement that Professor Ian Fentiman made today that 2,000 older women will die unnecessarily each year from breast cancer if routine screening is not extended beyond the age of 70? Given that 85 per cent of older women are unaware that they are at risk from breast cancer, is the Minister satisfied that adequate measures are being taken to turn this situation around?

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Lord Hunt of Kings Heath: My Lords, I thought I answered the substance of that question. Perhaps I may just raise the issue of health promotion because clearly one of the helpful issues raised by the Age Concern survey is whether people aged 70 or over are in receipt of relevant information. We are working with Age Concern to produce appropriate leaflets. But we will look at that matter again.

Lord Dubs: My Lords, does my noble friend agree that one important aspect of treatment is the way in which women suffering from breast cancer are counselled and advised on the nature of their illness and the forms of treatment that are open to them? Does he further agree that some hospitals like the Royal Marsden are excellent in this respect? Can he say what can be done to ensure that standards in other hospitals are as good as those achieved by the Marsden?

Lord Hunt of Kings Heath: My Lords, I am very happy to endorse the points made by my noble friend and to acknowledge the fine work that has been undertaken at the Royal Marsden. The way that we will tackle the issues in relation to cancer, ranging from prevention to screening and treatment and to ensure that there is a continuum of care, is a very important challenge for us. We have already introduced protocol guidelines for GPs. The National Institute for Clinical Excellence will be providing further guidance. Information for women is vitally important and we shall be redoubling our efforts to ensure that the relevant information is available to them.

Earl Howe: My Lords, does the Minister agree that the recent adverse criticism of breast screening has been unfortunate? Does he also agree that a combination of screening and better treatment has brought about a significant reduction in mortality from breast cancer? Therefore, it is very important that the positive value of screening women is emphasised whenever possible.

Lord Hunt of Kings Heath: My Lords, I could not agree more with the noble Earl. The figure I have is that nearly 8,000 women in England had breast cancer detected and treated through screening in the year 1998 to 1999. That shows the effectiveness of the screening arrangements we have. That is why we want to extend them. In relation to other age groups, it is very important that we extend the automatic invitation recall system only on the basis of the best clinical evidence available.

Baroness Darcy de Knayth: My Lords, I went for breast screening at the age of 62 this summer. It was made very clear to me that I would be able to self-refer after that until the law that one will be called regularly comes into force. Does the noble Lord agree that it is a very good idea when one is screened for it to be made very clear that one can, and perhaps should, self-refer?

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Lord Hunt of Kings Heath: My Lords, that is a very helpful suggestion. I shall certainly make sure that it is passed on to the appropriate officials.

Baroness Barker: My Lords, in view of the Minister's earlier replies and the fact that the extension of the age limit from 65 to 70 will not fully kick in until 2004, will his department ensure that health workers overcome their acknowledged ageist discrimination? Will his department also focus its energies on campaigning to get women over the age of 70 to make those self-referrals?

Lord Hunt of Kings Heath: My Lords, I want to take up the overall issue of the allegations of discrimination in the health service against older people. I have made it clear to the House on a number of occasions that such discrimination is totally unacceptable. Noble Lords will know that we have made that clear in relation to the "do not resuscitate" issue. We have given firm guidance to the NHS on that matter. That has arisen very much from the debates in your Lordships' House. We are developing a national service framework for older people which will be published at the end of this year. It will focus on ensuring that we give high-quality services to older people. But, as I have said, in relation to automatic recall and invitations to people over 70, that has to be based on evidence that that will be effective.


3.17 p.m.

Viscount Waverley asked Her Majesty's Government:

    What action they are taking to underpin the democratic process in Serbia.

The Parliamentary Under-Secretary of State, Foreign and Commonwealth Office (Baroness Scotland of Asthal): My Lords, the United Kingdom has spent over £2 million in Serbia in the past year in support of independent media, civil society groups, elections monitoring and other activities in support of democratic development. The UK will continue to respond positively to requests for help with democratic reform, including an expansion of the UK's assistance to democratic municipalities. The Department for International Development will consider implementing a programme of support for economic reform.

The Government firmly support the EU's decision of 9th October to support the new democratic authorities by lifting sanctions, including the FRY in EU Balkans initiatives, and examining urgently ways of working towards a close EU-FRY relationship.

Viscount Waverley: My Lords, the people of Serbia should be thanked for their relentless action. What could now delay early ambassadorial exchange? Is the importance of wholesale reform of key institutions in

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Serbia as part of a pan-Balkan reconstruction programme fully recognised? Does sufficient evidence exist to extradite Milosevic to The Hague?

Baroness Scotland of Asthal: My Lords, perhaps I may take those questions in order. I can tell the House that Her Majesty's Government have, through the British interest section of the Embassy of Brazil, proposed to the FRY Ministry of Foreign Affairs that diplomatic relations be restored. We expect a positive reply from the ministry very soon. Ambassadors will then be exchanged as soon as practicable. I should like to express our immense gratitude to the Brazilian Ministry of Foreign Affairs for all its help as protecting power since March 1999.

I come to the noble Viscount's second point. The House will know that the EU stability pact for south-east Europe is already taking a regional approach in its work to promote economic and political reform. Inclusion of the FRY in the new CARDS EU aid programme is also part of the EU's pan-European approach. Every opportunity will be taken, both bilaterally and multilaterally, to build capacity within the institutions. The United Kingdom's Department for International Development is already in the process of implementing a successful programme of public sector reform in Montenegro.

On the noble Viscount's third point, it is a matter for the International Criminal Tribunal for the former Yugoslavia. The ICTY is satisfied that there is sufficient evidence for Milosevic to stand trial for crimes against humanity. The UK has complete confidence in the competence of the ICTY.

Baroness Williams of Crosby: My Lords, perhaps I may ask the Minister two questions on the democratic process. First, can she comment on the present decision by the Serbian Parliament to resist the acceptance of the legal status of the new president? Secondly, in view of the possibility of early elections for the federal parliament, can she say whether DfID and the other bodies can engage the Yugoslav Government in the discussion of the possibility of election monitors for what could be a quite difficult election in terms of its acceptability as a legitimate expression of the opinion of the Serbian and Yugoslav people?

Baroness Scotland of Asthal: My Lords, I know that a number of comments have been made in relation to the attitude taken by the president of the Serbian Parliament. It appears that there is acceptance of the election success of the new president, President Kostunica. We are grateful for that. But it is right to say, too, that at the moment there is active negotiation between the president and the president of the Serbian Parliament as to the ministries that will be utilised by them. It is early days. It is right that we are carrying out comprehensive needs assessment work in relation to Serbia. Obviously, the noble Baroness's comment in relation to monitors will be borne in mind.

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