NHS smear tests `fail' thousands
Saturday 05 December 1998
Health service leaders have "lacked grip" on the service and must take some responsibility for Britain's worst smear test scandal in which eight women died, MPs will say. It concludes that the NHS "is failing many of the most vulnerable".
The report from the Public Accounts Committee, which is due to be published tomorrow, will provoke a furious row with the beleaguered service, which has tried to recover from a series of high-profile problems.
But sources close to the service yesterday accused the MPs of grabbing "five minutes' worth of headlines" and said the report could actually deter women from coming forward to be screened.
"If they want to attack the NHS Executive let them find another battlefield," said one insider. "If women are frightened away from the service lives could be endangered."
Cancer of the cervix is the fifth most common cancer among women. The NHS screening programme was set up in 1988, and women aged between 20 and 64 are called for a cervical smear every three to five years. Since it was set up, deaths have fallen by a third.
But the committee says that six years after its previous report "there are still significant quality failings at every stage of the cervical screening programme" and it is "sceptical" that the new improvements introduced could prevent another scandal.
It notes that more than 10 per cent of health authorities are still failing to reach the target of screening 80 per cent of women aged 25-64 in the previous five years and "their failure to achieve ... the target is putting lives at risk".
The committee also blames the NHS cervical screening programme for taking until March 1996 - after the scandal at Kent and Canterbury hospital - to issue comprehensive guidance for laboratory practice and performance. Eight women died in Britain's worst smear scandal and 30 were forced to have hysterectomies because their cancers were not diagnosed in time.
"In our view the late development of this guidance is one reason why many laboratories are a long way from achieving key targets and from providing an effective service to women," the report says.
One woman in 12 is still going through the stress of having a repeat smear taken because of poor smear taking, and one third of health authorities failed to contact general practices with persistently high rates of inadequate smears, failures the committee said were "regrettable".
Despite efforts, the service had still not overcome particular problems in reaching the worst off women and those from ethnic minorities. "The fact remains that the NHS is failing many of the most vulnerable people in our society," said David Davis, chairman of the committee. A spokeswoman for the NHS Cervical Screening Programme said yesterday that she could not comment until the report was published. Insiders, however, said that the committee had to realise that the programme could not prevent all deaths. "Screening is a seatbelt, not a vaccine - there can never be a 100 per cent guarantee, however diligently the service is run, because of the nature of the test."
The committee's strongest criticism however is reserved for the NHS Executive itself and its failure to hold the service accountable at local level. It censured the local management at Kent and Canterbury, for presiding "over a state of affairs where repeated warnings of understaffing, poor training and low morale...went unheeded over many years".
The committee calls for the NHS Executive to set firm national and local timetables to achieve targets in smear taking, laboratory and colposcopy performance as well as taking "robust action" when standards slip.
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