5. Debate on petition P-06-1243 Reinstate cervical screening to every three years

– in the Senedd at 3:21 pm on 19 January 2022.

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Photo of Elin Jones Elin Jones Plaid Cymru 3:21, 19 January 2022

(Translated)

The next item, therefore, is the debate on a petition on reinstating cervical screening to every three years, and I call on the Chair of the Petitions Committee to move the motion—Jack Sargeant.

(Translated)

Motion NDM7887 Jack Sargeant

To propose that the Senedd:

Notes the petition P-06-1243 'Reinstate cervical screening to every 3 years' which received 30,133 signatures.

(Translated)

Motion moved.

Photo of Jack Sargeant Jack Sargeant Labour 3:21, 19 January 2022

(Translated)

Thank you very much, Llywydd. On behalf of the committee, thank you very much for the opportunity to present this debate on this important petition.

Photo of Jack Sargeant Jack Sargeant Labour

As Members will know, the recent change in the cervical screening arrangements in Wales has been of significant public interest. This petition to the Senedd, titled 'Reinstate cervical screening to every 3 years' gathered 30,133 signatures in just three days, and a similar petition on the change.org platform has so far received over 1.2 million signatures. Llywydd, to put this into perspective, that is over 100,000 more people than who voted in the Senedd elections last May. This is utterly remarkable and it demonstrates the strength of feeling and concern about women's health in Wales.

I don't pretend to be a medical expert, but what is clear to me is that women right across Wales want and deserve answers. The petitioner, Joanne Stroud, is passionate about the importance of regular screening and is pleased that the Senedd's petitions process has ensured that her voice will be heard on the floor of this Chamber today. Her petition represents thousands of women's fears, disappointment and dismay about how and why this change happened. Therefore, Llywydd, we asked the petitioner to close the petition after just three days, so that it could come forward to the Petitions Committee last week, and they agreed to request it be considered for debate immediately. I'm grateful to the Llywydd and members of the Business Committee for enabling this debate to take place today, and I'm also grateful of the Welsh Conservatives for offering some of their time in today's proceedings. I'd also like to extend my thanks, on behalf of the committee, to Gareth and Mared and the wider clerking team for all their work on this important petition.

At the start of January, Cervical Screening Wales extended the routine screening for 25 to 49-year-olds from three to five years. The change was recommended by the UK National Screening Committee in 2019 due to the success of the human papillomavirus vaccine roll-out and the use of, and I quote, 'more accurate' cervical screening. This was announced on 4 January and a social media storm erupted—challenging, questioning and seeking clarification about why there would be a longer interval between life-saving cervical screenings. Such an important decision and change should have been carefully and fully explained and effectively communicated to all women in Wales. Social media is excellent for many things, but it should not have been used as the way to announce such an important issue.

I do hope that this debate today will provide an opportunity to listen to the concerns women in Wales have, and to hear facts about why the changes to the screening framework have been made. Many women will not have been offered the highly effective HPV vaccine, which was introduced in 2008. For them, the key question is whether it is possible to come into contact with HPV and for problems to develop in the five-year gap between screenings. I know many of you will have read similar concerned e-mails to the ones I have received from women in my constituency who feel they are bearing the brunt of cost-cutting and time-saving measures during a period of extreme pressure on our NHS.

Llywydd, in her petition Joanne states her concerns that these important changes have been made without public consultation, stating that the response to the announcement on 4 January was, and I quote, 

'met with anger, sadness and serious concern for the cervical health of Welsh women.'

She shares the concerns and questions of thousands of people in Wales about whether this change would result in later detection of cancers resulting in, and, again, I quote,

'more aggressive, lengthy and costly treatments', and is it ultimately a risk to life.

These concerns have been widely reported in the media and on social media platforms following the announcement at the beginning of the month. And as I mentioned at the start of my contribution, over a million people have signed a similar petition on change.org, emphasising the genuine concerns, the genuine anxiety and the genuine distress resulting from the announcement, made without sufficient clarity or explanation regarding why the change was made.

I'm glad to see that Public Health Wales apologised on social media, acknowledging that they didn't do enough to explain the changes, which created so much confusion and so much anxiety. They have since provided more information to explain the decision and tried to reassure women. Their communication strategy was clearly flawed to say the least, and I would call on them to carefully reflect and review their policy for the future. Clear, high-quality information is vital when sharing such important information and messages. When communicating with residents, you should do so. Isn't it in everyone's next appointment? Wouldn't that have been much easier, and wouldn't that have been the time to raise this important message?

I must say I was also disappointed that such a significant change in our public health approach was not announced by the Minister for Health and Social Services on the floor of our Parliament in advance of the changes.

All their adult life, women have been told about the dangers of delaying their smear tests, that a quick trip to the doctor every three years could make all the difference. It should come as no surprise that the announcement of a two-year delay via Twitter caused such extreme outrage. We, as Members of the Senedd, as their representatives, should have been given the chance to raise their fears and concerns openly, and for the Minister to explain the reasons behind the change in full.

Gweinidog, I did read with interest the reports this morning from medical professionals, pointing to the vaccine as a crucial development, and I accept this. I would welcome you using your response to update the Chamber on the percentage of women in Wales who have been vaccinated. I would also urge you to use your response to address the information vacuum that was left by the way this was announced, and in that vacuum, I'm aware of young women throughout Wales who have been targeted by Facebook ads encouraging them to pay £500 for the vaccine. This has really troubled me. 

Llywydd, before I conclude, I would like to thank Joanne for petitioning the Senedd so that these important concerns about women's health are discussed here in our Parliament today. There are around 166 new cervical cancer cases in Wales every year according to Cancer Research UK. Screening to identify those at risk or who have cancer is essential. It can save lives, ensuring women or people with a cervix receive the treatment they need.

Coincidentally, this debate is taking place during Cervical Cancer Prevention Week, and I hope it will contribute to raise awareness of the importance and benefits of cervical screening. There are many who don't take up screening opportunities for various reasons. We all need to support that campaign to raise awareness and aim to increase the take-up to protect lives.

Llywydd, I look forward to hearing the Members' contributions this afternoon, and I look forward to the Minister's response, and I trust she will answer the questions of the many women who signed this petition, and those similar petitions out there. Diolch yn fawr.

(Translated)

The Deputy Presiding Officer (David Rees) took the Chair.

Photo of Laura Anne Jones Laura Anne Jones Conservative 3:29, 19 January 2022

I welcome the chance to debate this in the Senedd today, particularly during cancer awareness week, as Jack Sargeant has just pointed out, and given the strength of feeling on this from women, and in support of women, on these significant changes that have taken place. And I thank Jack Sargeant and the Petitions Committee, the Government and the Llywydd, for allowing this to come forward at such speed. The strength of feeling has been exceptionally high, as demonstrated by the sheer amount of signatures the petition has gained, as outlined by Jack earlier, with the shocking statistic, as he said, of 100,000 more people signing that than voted in our Senedd elections.

Photo of Laura Anne Jones Laura Anne Jones Conservative 3:30, 19 January 2022

I find it very concerning that the decision to extend the time between cervical cancer screenings from three to five years wasn't given the right, careful promotion that was needed to ensure that half of the population of Wales were educated properly on these hugely significant changes. The way that the news was broken to women the length and breadth of our country was shameful, with a snappy headline on social media that ensued panic. That's not a bad use of the word; there was panic amongst women and families across Wales because, as Mr Sargeant pointed out earlier, we have been educated for years on the timing and how significant it is at catching cervical cancer as early as possible.

The lack of information following from that snappy headline just assumed everyone knew why this was happening, that everyone would know the move was due to a positive development in science, rather than an alarming extension of two years where women would be unable to be screened as they previously were and any cancerous cells would not be picked up. People know full well that when you're diagnosed can mean the difference between life and death—that's how we've been educated. The lack of information from this Government and Public Health Wales on such an important development and change caused anxiety and distress across our nation, worried about developing cervical cancer and not catching it in time. And for families as well there was panic, particularly those who have lost people to cervical cancer.

It brings me some comfort that both Jo's Cervical Cancer Trust and Cancer Research UK are in support of this change, as outlined today. But this and the reasons for it need to be brought to women's attention. Due to the communication being so appalling on this, I must admit my own panic initially when hearing the news. And I can recall the awful situation that Jade Goody endured whilst suffering from cervical cancer, who was a former Big Brother celebrity, for those who don't know. She had a horrendous time from not catching it early enough; she didn't go to her screenings. And as result she lost—oh, it makes me sad—her life, and left behind her two young boys. It was quite emotive. Sorry, I don't mean to cry, but it was quite an emotive campaign and period of time, and what happened from that, the result, was that many, many women, who hadn't even thought about it—it hadn't even been on their radar—came forward and were tested. It was very traumatising at the time, and, obviously, it still rings true. But she was very brave, and used her celebrity status for good, taking everyone on that journey with her until her sad death. It shook a lot of women into action, and the take-up for cervical smears increased substantially. The publicity campaign that followed was a huge success, and I ask that this Welsh Government look at doing something similar.

It is clear that a substantial public awareness campaign is needed now, particularly given the clear message from over a million people signing a petition opposing this change. This tells me there are countless more women out there needing to know about the reasons for this change from three to five years still. An apology from Public Health Wales was great, but there will be many women out there who won't have seen that one social media post and will still not understand why these significant changes have happened and what they mean.

When the reasons for change were relayed to me, it brought me some comfort initially—not totally, because there are examples, as has been posted on social media, as I'm sure others have seen. There are people who still will slip through the net because, with the change, some people will develop those cancerous cells in that time frame that will be missed. But, for the majority, this technological advance will mean that HPV cells will be detected sooner, and that is very welcome. And it will mean for the majority of people that they will have now longer gaps between screenings, which is absolutely fine. We must make absolutely sure that this is not a cost-cutting exercise though, as Jack said, and that it will be 100 per cent safe to do this.

Minister, there are still a lot of concerns, as the virus can, as I said earlier, lay dormant for many years and present no sign or symptom of infection. And although I've seen many e-mails regarding cervical cancer screening from constituents over the last fortnight, one in particular caught my attention. It was from a woman aged 30 who had developed stage 1 cervical cancer, which had thankfully been picked up on her third smear test. If that test would have been delayed another two years further, the cancer would have likely developed and it could have been either infertility for her or death. 

There is a lot of work still to be done—

Photo of Laura Anne Jones Laura Anne Jones Conservative

—to improve life chances for women who develop cervical cancer, and I fear that this extension of two years will not contribute towards saving more lives. There's still so much more to be done. 

I will reiterate now, Deputy Presiding Officer, the calls I made last week to the First Minister and this Government, and I strongly urge them, and Public Health Wales, to launch a public awareness campaign to help inform our Welsh citizens of the significant developments that have occurred. We need to actively encourage more people to come forward for a cervical screening than have done recently. These new changes will not work and not be effective unless everyone now comes forward for a new screening with this new screening technology. Thank you very much.

Photo of Rhun ap Iorwerth Rhun ap Iorwerth Plaid Cymru 3:36, 19 January 2022

Thank you for the opportunity to make a brief contribution to this debate. And, firstly, let me say how much I sympathise with all those people, the many, many thousands, who have spoken about their deep concerns about the change in the cervical cancer screening regime. Screening has, of course, become a valuable part of the preventative armoury when it comes to women's health, and many, many lives have been saved through early diagnosis stemming from the screening programme. And the sudden announcement that three-year tests would become five left so many people distressed and worried. And my own reaction, I must say, was one of incredulity: could this really be the result of the current pressures on the NHS, another effect of systems under strain?

But, in trying to learn more then about the change, what became apparent is that we are talking not about a downgrading of this invaluable protective health measure, but, in fact, a serious failure to communicate change that is in fact the right change, and one we should celebrate, in fact, as a step forward in preventative healthcare. I'm immensely grateful to those organisations, Cancer Research UK and Jo's Cervical Cancer Trust in particular, for stepping in with explanations of why this is a positive change, why advancements in technology means testing for the HPV virus, which causes the vast majority of cervical cancers, allows for earlier identification of what could ultimately lead to increased risk, early enough in fact to allow five years between testing episodes if no evidence of HPV is found. In the past, screening tested for changes in cells, the beginning of cancer; now we can find earlier signs of what might eventually lead to that and so allow for more timely intervention.

Now, can I draw the attention of Members to the statement of opinion I've tabled this week, following discussion with Jo's Cervical Cancer Trust, noting that this week is Cervical Cancer Prevention Week, and expressing again how vital screening is? The statement expresses regret that recent changes to the cervical screening programme—the way they were communicated—have caused anxiety and confusion, and urges Ministers and Public Health Wales to prioritise restoring confidence in the programme through clear and direct communication to answer the concerns that so many have. Now, I've written to the health Minister the week before last, I think, to ask for that direct communication to happen. It has to happen. The handling of this change by Welsh Government and its agencies has caused a great amount of anxiety, and it's up to Government and its agencies to put that right. 

Now, may this be a real lesson in the importance of getting communication right, and, at the same time, a reminder of the importance of screening. We must encourage more to come forward, so that we can be confident that as many women as possible can be giving themselves the chance of an early diagnosis. 

Photo of Jenny Rathbone Jenny Rathbone Labour 3:39, 19 January 2022

On 4 January, Public Health Wales announced this important enhancement to the cervical screening service. Whilst it was disappointing that they failed to provide some context as to why this was an improvement, rather than a reduction in service, hindsight is a wonderful thing. And I can see why a change that was introduced nearly two years ago in England and Scotland was not deemed to be controversial in any way. This was following what the experts had told us was the best way of approaching this particular service. Clearly, it's entirely to be regretted that over 30,000 people were sufficiently exercised by what they were persuaded was a cut in service, rather than an enhancement, to sign this petition. But, really, I don't think that persisting with this inaccuracy is at all helpful. 

Photo of Jenny Rathbone Jenny Rathbone Labour 3:40, 19 January 2022

This debate takes place on the afternoon when we've all had the opportunity to ask questions of our health Minister. So, we have fresh in our minds the areas of health provision where we can all agree we need to do better, whether that's eating disorders, ADHD, hearing loss, social prescribing, or, earlier, I attended a meeting about ovarian cancer, which was hosted by Mark Isherwood. On all these things we need to do better, and nobody in the Senedd would disagree with that. So, I have to just repeat that no change is not an option for us. It is our duty to ensure that we are constantly reshaping services to better meet the needs of our population, and that we are constantly delivering best value with limited resources. I was born in the era where people routinely had their tonsils and adenoids removed when they were aged seven, and how traumatic was that for a child to be removed from their parents for something that was proved to be a completely pointless intervention, unless there were very particular issues.

So, as with COVID, we need to follow the latest scientific evidence, and the experts tell us really clearly that HPV is what causes 99.7 per cent of cervical cancers. That's why we offer all teenagers the HPV vaccine, so that the HPV virus is going to be put out of business and no longer able to cause cervical cancers in the future, once the people who've benefited from the vaccine have grown up. So, we have to recognise that the cervical screen has changed substantially. It's much more sensitive, much more accurate and it's now checking first for the presence of HPV. And by reducing the period of time when women are screened, it makes it possible to free up time to concentrate on that small minority of the female population who are causes for concern, where they have HPV present in their cells and can be benefiting from even better screens to ensure that, were they to develop cervical cancer, that will be picked up earlier. 

I spent many, many years of my life, before I became a Senedd Member, trying to help drive up cervical cancer screening rates. So, I find it extremely disappointing that, despite all the evidence presented by Cancer Research UK and Jo's Cervical Cancer Trust, still Laura Jones decided she was going to put out a statement of opinion about the inaccurate information that people had been given. This simply won't do. Yes, this week is Cervical Screening Awareness Week, and a very important week it is too, because the people we need to focus on are the people who never turn up to have a cancer screen. The sort of people that we're talking about are people who have caring responsibilities and have nobody to leave their child with in order to go for a screen, who are in zero-hours work and therefore are unable to take time out from their work in order to go for their screening appointment.

So, one of the ways in which we can benefit from this blast of publicity on a pretty unnecessary story is to focus on how we improve the rates of young women who attend for screening, or who get the cancer screen. And I particularly want to focus on the pilot of home screening that has been going on at King's College London, in an area where there are predictable low levels of presentation for the regular screening because—

Photo of Jenny Rathbone Jenny Rathbone Labour

Okay. I'd like to hear from the Minister how that compares with the bowel screening that takes place in the over-60s, because obviously once again this is something that takes place in people's homes, they don't need to go for an appointment, they don't need to travel to see the nurse who's going to do the screen. This is a very important way of ensuring that cervical cancer is something that is so rare as to be almost non-existent.

Photo of Delyth Jewell Delyth Jewell Plaid Cymru

As we mark Cervical Cancer Prevention Week, I'd like to make a general point at the outset, and that is that girls don't always get taught enough about their bodies—neither do boys, of course. A mix of embarrassment, a lack of understanding, even body shaming, can coalesce from when girls are really quite young, and those factors surely contribute to the fact that one in three women fail to attend their cervical screening appointment when they're invited. We've heard already in the debate about the thousands of women who'll be told every year that they have cervical cell changes, so surely we have to find better ways of talking about these issues and normalising the process of smear tests.

Specifically on this petition, the changes to routine smear tests, it's already been said that they were communicated very poorly, and that did cause avoidable anxiety. The explanation that we have been given by Public Health Wales has set many minds at rest, but since that change was announced I've been contacted by women who are still nervous. I wanted to raise those concerns here so that I could get some constructive answers for them from the Minister. Some constituents have raised the fact—it's already been rehearsed—that a HPV infection can clear within one or two years, meaning that an infection could have cleared by the time a test is taken. Those constituents have queried how someone looking at the results could then know whether the infection has caused cellular changes if they're not looking for those changes. Another constituent was diagnosed with stage 1 cancer at age 30 in 2021 and the cancer was caught during her three-year smear test. She's worried that, had she waited an additional two years, the cancer could have progressed far more and potentially affected her fertility or something far graver.

Now, as I've said, the new test should work very well for most of those who've had the HPV vaccine, which is obviously something to be very much welcomed, because that will have reduced the incidence of abnormal cell changes. Not everyone will have been offered that vaccine, and I know that women, particularly in their 30s, will have missed out on that opportunity because that's true for me as well. So, I'd equally like to hear more about what could be done to put women's minds at rest about that. A further worry felt by some of my constituents concerns women who could develop cervical cancer that isn't linked to HPV. They would presumably be left without screening, so what provision, please, could be made for them? I've raised these concerns in order to get clarity for those constituents who are still feeling uneasy about this change.

Minister, all of this could, of course, have been avoided had a communication gone out before that graphic was shared on social media. I understand of course that lessons will have been learnt about this, but alongside those specific queries I would ask how Public Health Wales will be seeking to combat any sense that could develop of the wrong message being sent to women—that is, that it isn't as important to keep on top of smear tests. I know that that is in no way what's meant by this change, but again a vacuum could develop for the wrong assumptions to be made, unless that vacuum is filled. One constituent said to me that, like visiting the dentist, even if you don't think you need to go, it's important to go, and it's really important that public health messaging doesn't inadvertently discourage women from attending. So, I'd be grateful for any information the Minister could provide in summing up the debate that could alleviate those concerns of my constituents that I've relayed to you. 

But the overwhelming point I would make, just in concluding, Dirprwy Lywydd, is that again we need to make sure that women of all ages get the sense that smear tests are normal, that they're not something to be worried about. When I was in school, they were talked about in this hushed, quite horrified way—not by teachers, I should say, but by other pupils—and I got this impression it was going to be this very painful thing. Actually, for most women, it's totally painless; bit awkward—it needn't be awkward. But I think we need to find ways of countering this narrative, and it comes about because too many of these topics are considered taboo and they're not talked about.

Photo of Buffy Williams Buffy Williams Labour 3:49, 19 January 2022

Diolch to Jack as Chair of the Petitions Committee for making sure this debate could take place at such short notice.

Cervical screening isn't a pleasant experience to say the least, and I'm sure I'm not the only woman in Wales to have put off or dreaded attending a screening appointment, but we also understand that cervical screening is one of the most important appointments for us to attend as women and, without a doubt, saves lives. The scientific strides that have been made to make sure that the test for HPV is more accurate is fantastic news and should be celebrated. But, the way in which the announcement was made was appalling and left many women feeling anxious, frustrated and confused. For this petition to reach over 30,000 signatures over the space of a couple of days is testament to the strength of feeling out there. Although the announcement was followed by the apology, which was far more informative, many women still feel aggrieved, and I'm one of them.

It has taken generations and generations of women to fight to have control over their own bodies. Women should have the right to decide when they'd like to attend their screening appointment, be it every three years or five years, or anywhere in between, regardless of the improved test. For many women, life just gets in the way, be it due to work or childcare. And I think, if we're being honest with ourselves, more often than not, we let life get in the way. We know that three years between screening appointments then becomes more like four or five. If we are to see a change from three to five years, then for some women this could easily become up to 10 years.

Cervical screening appointments are, first and foremost, to detect HPV, but we all know that when you attend the all-important smear test, the test itself isn't the only thing that we discuss, it's the whole well-being package. Being at our most vulnerable during the smear test, we sometimes feel more able to have the more uncomfortable discussions that are usually left on the back burner. For some women, such as those experiencing domestic abuse, their cervical screening appointment could be the only time they're able to see a healthcare professional alone. These appointments aren't just about screening for HPV, they're about the wider package of checks and care available to them. To increase the duration between these appointments would be detrimental to women and their well-being. Let's acknowledge the huge scientific strides that we have made, but not take a step back on women's right to decide, especially when it comes to their well-being. 

Photo of David Rees David Rees Labour 3:52, 19 January 2022

(Translated)

I call on the Minister for Health and Social Services, Eluned Morgan. 

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour

Diolch yn fawr. Thank you for the opportunity to respond to the debate today. I know that it has really produced some very strong responses from across our communities, and the tone and the passion that we've seen in the debate this afternoon demonstrates that this has touched many, many people. So, I would like to thank people for engaging in the conversation, but clearly there is a need to learn some lessons here.

As you've all pointed out, this follows a petition calling on the Welsh Government to reinstate cervical screening to every three years. This was announced by Public Health Wales on 4 January and the idea was to extend the routine screening interval for people aged 25 to 49 from three to five years if high-risk HPV is not found in their cervical screening test. And that will bring the screening interval into line with those aged 50 to 64.

Many this afternoon have pointed out the calamitous way in which this was communicated. Public Health Wales has apologised and I met with them earlier this week, where they were at pains to tell me that they have learned the lessons, that they understand the anger and the concern that people felt because of their failure to communicate in an adequate way. And it is important, I think, that Public Health Wales is reviewing its approach now to communicating public health messages following that feedback.

It's important to note that the interval change will not apply to those who are found to have high-risk HPV, with or without cell changes, as they will be offered annual screening and further tests as necessary. And that's the point, that's what we're doing here is really focusing on those people who are more at risk. This change is fully supported, as many have pointed out today, by the main cancer charities, and I've got to emphasise that this has not been made to save resources. Investing in preventative services, such as screening, and detecting cancers at earlier stages makes them easier and more cost-effective to treat.

The change has also not been made due to the success of the HPV vaccination programme in schools, although that has been successful, and I was asked by Jack what the rates are. The rates last week in terms of the uptake of vaccine in year 8, which is 12 to 13-year-olds, was around 71 per cent. So, far fewer than we'd hoped, but there will be a catch-up immunisation programme that we'll be looking to roll out—obviously it's a very disruptive year in our schools. And those people who've had the vaccination, they're only now entering the age cohort for the screening programme, although it's expected that in future the combination of vaccination and screening should see cervical cancers decline significantly in the near future.

The Welsh Government follows the advice of the UK National Screening Committee, which recommended that all nations implement the new cervical screening test and interval change because the new testing method is more accurate. The UK National Screening Committee is an independent scientific advisory committee that reports to all four UK chief medical officers, and is recognised globally for its expertise and its academic rigour. It requires a very high level of evidence, and its recommendations are based on years of research and public consultation. And that's, I guess, the frustration with this, that this should have been a good news story and, somehow or other, it's created a real sense of anxiety within our communities.

The aim of the cervical screening programme is to reduce the incidence of and mortality from cervical cancer. This is by detecting and treating changes at the cervix before they develop into cancer. But the new test, which was introduced in Wales in 2018, before any other part of the United Kingdom, I think it's important to state, is not a test for cancer itself. It helps to protect against cervical cancer by identifying the virus that causes it. Current screening looks for the presence of high-risk human papillomavirus, which causes nearly all cervical cancers. The data that Jenny Rathbone pointed out, I think, are accurate and should be considered. The new improved test involves the same procedure as the previous screening, whereby a sample is taken from the cervix, but instead of looking at abnormal cells, the sample is tested for HPV first.

As having a high-risk HPV infection comes before abnormal cells develop, HPV primary testing detects people at risk of developing cervical cancer at a much earlier point. If HPV is found, the sample is then also checked for cell changes and followed up with further tests if changes are present. If abnormal cells are not present, the person will be invited for screening again in one year's time. So, it's important to remember that if you don't have HPV, then there is a different system for those who are found to be higher risk. If no high-risk HPV is found in the sample, the person will be invited for screening in five years' time. And that interval change will apply to people whose next routine screening result shows that they don't have high-risk HPV, and this is because their risk of developing cervical cancer within the five years following their screening is very low.

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour 3:59, 19 January 2022

(Translated)

Now, I understand that many people are concerned that extending the interval between screenings will lead to missing cases of cervical cancer. But I'd like to assure people that HPV causes changes to the cells very slowly over several years, and that means that if there were to be cellular changes, they could be identified early on still in the next screening process. Screening more often than five years after a negative HPV result would be too early usually for any changes to the cells to come to the fore. So, the screening would not be beneficial and it could also give an incorrect reassurance to people. I'm pleased that Wales has led the way, and that we were the first nation in the UK to introduce those screens for high-risk HPV back in 2018. Scotland and England have now introduced those same tests for HPV, and in Scotland, the interval between screenings was extended some time ago, in March 2020.

Undoing that change to the interval for those at low risk would be a retrograde step. I acknowledge fully that more regular screening feels as though it would provide that additional reassurance, but, for those low-risk individuals, it doesn't provide the benefits that they would want to see. Extending the interval for those at low risk means that the screening programme can then focus on those high-risk individuals, who will be monitored more closely than in the past. We have to ensure that health services follow the science, and that they are provided only when they provide genuine benefit, and when there is a clinical need for them. So, that is the response to Buffy's comment about using this to talk about other health issues. It's very important that you are careful about how you use clinical interventions. We have to decrease possible harm in terms of providing those unnecessary interventions. Screening programmes need to evolve in response to cancer and developments in science. Just to respond to Jenny Rathbone—.

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour 4:01, 19 January 2022

She was asking about the pilot in England. We are watching the pilot in England with interest. We know that we've seen a better response in terms of bowel screening since people have been sent out a FIT test. We've sen an increase in people using that from 60 per cent to 65 per cent. We want to know whether that will be the response in relation to cervical screening for those particular areas where people are not coming forward. So, we want to see that the evidence is safe and effective before we think about introducing that into Wales. 

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour 4:02, 19 January 2022

(Translated)

Introducing those tests for HPV will enable us to make more—

Photo of David Rees David Rees Labour

(Translated)

Minister, you will have to come to an end now.

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour

(Translated)

Okay. Thank you very much. This should be a good news story for Wales. We can prevent more cases of cancer and detect those that are developing earlier on in the process. It's important to note, as many have done, that a quarter of those who are invited for a screening don't attend their appointments. So, if we can use this issue that we have seen, and the concerns that people have expressed, we do need to take this opportunity as a chance to tell people to come forward for their screening care appointments, and to encourage more people to take that opportunity. Thank you very much.

Photo of David Rees David Rees Labour 4:03, 19 January 2022

(Translated)

I call on Jack Sargeant to reply to this debate.

Photo of Jack Sargeant Jack Sargeant Labour

Diolch yn fawr, Deputy Presiding Officer. Diolch, Weinidog, for your response to today's debate, in particular for setting out some of the science behind the decision by Public Health Wales and answering some of the questions from Members. And, of course, thanks to Members.

I do think that it's right to say that, unfortunately, the outcome of today will not always be satisfactory to some. There will still be thousands of women out there across Wales who have been left feeling let down. They have been left feeling confused, and of course, they will still be frustrated by the events of the last few weeks. So, I do feel that it's right, and that it's time, for Government, for officials, and for the health service, to not only reflect and learn lessons from the process that has happened, but also to think about how we can rebuild the trust lost to ensure that failure of this magnitude does not happen again.

Deputy Presiding Officer, I have been reflecting on how the petitions process is a vehicle to bring forward issues that are important to people across Wales. It does provide opportunities to raise awareness, highlight challenges and strive for positive change. It brings these matters to the heart of our democracy and ensures that citizens' voices are heard.

I think that we heard from all Members right across the Senedd Chamber today on the importance of screening, the importance of education, the importance of early diagnosis. We heard Laura Anne Jones specifically call once again for a public awareness campaign. I feel she is absolutely right to call for that, and will join her in those calls. We heard Members refer to the cancer charities, Jo's Cervical Cancer Trust and Cancer Research UK, who welcomed the news, but of course we have to do everything we possibly can to spread this message to women across Wales.

As Buffy Williams rightly reminded us, it has taken generations and generations of women to fight to have control of their bodies, and they should not, and we should not, then allow a step to be taken back. Buffy Williams is absolutely right when she says that, and I do commend her for that. And the very real story that life sometimes gets in the way—we do have to remember this when we make decisions on public health. So, I do feel, although there has been a debate today and I'm pleased that the Senedd Petitions Committee could facilitate this, that there is clear work that needs to go on to convince people and the women of Wales that this is the decision that needs to be taken forward. I look forward to seeing that happen in the future.

Photo of Jack Sargeant Jack Sargeant Labour 4:06, 19 January 2022

(Translated)

On behalf of the committee, I'd like to thank Joanne Stroud and all of those who have supported this petition, and I thank the Minister and all Members for their contributions today. Thank you very much.

Photo of David Rees David Rees Labour

(Translated)

The proposal is to note the petition. Does any Member object? There is no objection, and therefore the motion is agreed in accordance with Standing Order 12.36.

(Translated)

Motion agreed in accordance with Standing Order 12.36.