House of Lords
Contaminated Blood (Support for Infected and Bereaved Persons) Bill [HL]
(14 years ago)
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Lord Morris of Manchester
My Lords, I beg to move that this Bill be read a second time, and in doing so I wish to pay warm tribute to the officers and staff of this House who together have made it possible for me to be here notwithstanding the severely incapacitating effect of a recent injury. I have interests to declare, not pecuniary, as president of the Haemophilia Society and as the architect of the independent public inquiry into contaminated NHS blood and blood products presided over by my noble and learned friend Lord Archer of Sandwell.
I am grateful to all noble Lords who are here to take part in debating a profoundly important legislative proposal, conceived and drafted to give solace and support to arguably the most needful minority in Britain today.
A small and stricken community of barely 5,000 people, already disabled by a rare, lifelong blood disorder requiring continuous medical treatment—haemophilia patients—have twice been infected en masse by contaminated blood and blood products used in their NHS treatment. Over 95 per cent were infected with hepatitis C, and one in four with HIV. Of the 1,243 haemophilia patients infected with HIV, only 361—29 per cent—are still alive; and the much higher number of deaths from hepatitis C infection is still increasing. As of now, an estimated 1,994 haemophilia patients have died from being infected by contaminated NHS blood and blood products in this worst ever treatment disaster in the history of the National Health Service. If anyone disputes that assessment, they should look at the findings of distinguished statisticians that the disaster has involved the haemophilia community in a loss of life more savage in proportion to the numbers of people at risk than the Black Death in the mid 14th century. While stigma is less explicit today than the warning cross then scrawled on a plague victim’s door, it is no less cruelly oppressive in terms of social exclusion at a time of direst need.
Yet even the grievous and still ascending death toll does not tell the whole story of the suffering inflicted on the haemophilia community. As my dear and brave and inspirational friend, the noble Baroness, Lady Campbell of Surbiton, whose husband was among the haemophilia patients fatally infected, so movingly said in this House on 23 April, the history of the contaminated blood disaster is one of unspeakable suffering also for,
“mothers, fathers, sisters, brothers, wives, husbands and friends … seeing their loved ones die”.—[Official Report, 23/4/10; col. 1614.]
I want again today warmly to congratulate my noble and learned friend Lord Archer of Sandwell on parliamentary service of the highest distinction in conducting his independent inquiry into the disaster so skilfully and with such excelling integrity. I honour more than words can say both him and those who worked side by side with him in producing his landmark report: Dr Norman Jones, former emeritus senior consultant physician at St Thomas’s Hospital, and Judith Willetts, chief executive of the British Society for Immunology. No inquiry team could have possibly shown more commitment or have been more eminently qualified for the arduous task they so readily and ably undertook, entirely without remuneration.
For parliamentarians there can be no higher duty than to ensure just treatment and due care for people afflicted and bereaved by life-threatening medication supplied by the state; but as every participant in the debate knows, infected haemophilia patients, many of them now terminally ill, also suffer privation at a depth most other people can barely imagine. They speak to me day by day of no longer being able to work full time, if at all; of having been made uninsurable by the prohibitively expensive premiums demanded of them by insurers; and, among numerous other burdens, of costs generally being too high for them to cope with.
I am especially indebted to my noble friend Lord Corbett of Castle Vale for his help in enabling me to cope with the incapacitating effects of my injury in preparing for this debate. I am also indebted to the noble Lord, Lord Owen, from whom I received a movingly supportive letter this morning. Had he not been meeting commitments in Greece when the debate was announced he most certainly would have been here.
I shall comment on the clauses of the Bill as we proceed but, taken together, they transform the Archer report into the language of legislation. My purpose in working for most of last year’s Summer Recess to draft this measure—with unstinting help from Sarah Jones of the Public Bill Office—was to guarantee parliamentary time for this House to debate both the Archer report and the Government’s response to its findings.
Like other noble Lords who took part with me on 28 April 2009 in a debate to amend the Health Bill then before the House, I thought that we had an assurance very close to that guarantee from my noble friend Lord Darzi, then a junior Health Minister, speaking for the Government and having just announced that their response to the Archer report would be published at an early date. He went on to say:
“Furthermore, we will of course assist as far as possible in securing a debate on the Government’s response”.—[Official Report, 28/4/09; col. 143.]
Yet in the three months that then elapsed before the Summer Recess, there was no sign anywhere on the parliamentary horizon of a debate being arranged. Thus there was nothing precipitate in my decision to spend much of that Recess addressing the tasks involved in having this Bill ready for a First Reading in your Lordships’ House by 19 November. Indeed, it was then already nine months after the publication of a report the recommendations of which were vitally important to afflicted patients and the bereaved families on the day they were published in February last year.
The privation I have described among those afflicted is addressed in Clause 4, which deals specifically also with the crudely discriminatory treatment now of widows of infected patients in deciding whether they are eligible for financial help solely on the basis of when their husbands died, even where they died within two days of each other from exactly the same cause. The ending of that discrimination was one of the issues of longstanding concern to the Haemophilia Society and was strongly and repetitively emphasised in its evidence to the Archer inquiry. I mention it first today, in referring to Clause 4, because several of the widows excluded from help, who wanted very much to be here for the debate today, have contacted me to say that they simply could not afford the fares—and this at a time when just five NHS officials are seen to have been paid a total of £6 million over the past year.
Clause 4 addresses the whole range of compensation issues and has been welcomed as fair and balanced by commentators on social policy of wide experience, as was the Archer report itself all across the media. Everyone knows that there will be costs in giving full effect to the report, but there will also be priceless benefits in enabling haemophilia patients to live fuller and more fulfilling lives.
Moreover, the cost will be nothing even remotely approaching the £3 billion price tag put on the Archer recommendations by people, including commentators in the media, who had never even spoken to my noble and learned friend Lord Archer; but happily he is here this morning to speak for himself. Of course, costings should also include the high cost to the taxpayer of legal action by the Department of Health with such unsuccess.
Clause 1 creates a widely empowered statutory committee, with patient and family representation, to advise government on the management of haemophilia; Clauses 2 and 3 deal with blood donations and improving medical care; while Clauses 5 and 6 are about monitoring progress and the effects of regulations made under the legislation.
Turning to issues not dealt with in the Government’s response to the Archer report but worthy of close attention in the House, there is the spectre now of a third deadly scourge facing haemophilia patients. In response to Parliamentary Questions about the growing number of haemophilia patients known by the Department of Health to have been infected with blood from donors who have since died from variant CJD, I was told on the authority of the Chief Medical Officer that the risk of infection in such circumstances was purely “hypothetical”. That is demonstrably not the case today, a post mortem on a hepatitis C-infected patient having found variant CJD in his spleen. Ministerial statements on this further scourge urgently need updating. We also need to know how the Government now assess the variant CJD threat to the haemophilia community.
As the House knows, the Archer report was about more than the unmet needs of infected patients and bereaved families; it addressed also highly disturbing administrative shortcomings, serious omissions and a failure to inform Parliament why provision made in other countries is so much better than here in Britain. For example, there was no mention in the Government’s response to the Archer report’s findings of the behaviour of the Blood Products Laboratory in failing to comply with requirements of the Medicines Act 1968. This is a hugely important issue, as is that of the effect of using Crown immunity to avoid any question of legal redress.
The Archer report stated that the,
“BPL was rescued by Crown Immunity”,
adding that the BPL’s,
“existing plant continued production, relying on Crown Immunity to dispense with all the requirements of the Medicines Act, but was able to meet only about 40% of the national requirements”.
That can mean only that, by the use of Crown immunity, a relic of feudal England, the lives of countless haemophilia patients were put blatantly and gravely at risk.
The seriousness of this had already been underlined by my noble friend Lord Darzi. When responding to exchanges about thalidomide on 10 March 2009, he referred to,
“the tremendous amount of work that has gone into the marketing, testing and regulation of drugs, as encapsulated in the Medicines Act 1968, from which society has benefited greatly”.—[Official Report, 10/3/09; col. 1059.]
Could there be any clearer text than that for condemning the BPL's use of Crown immunity to dispense with all the requirements of that renowned and vital statute?
From whom was the BPL rescued by its use of Crown immunity? First, of course, it was rescued from those afflicted and bereaved by the disaster. At a stroke, they were denied any right to legal redress, a denial made all the more cruelly unjust by refusals of successive Governments to hold a public inquiry. They were left with no hope of any independent assessment of where responsibility for their plight lay until the Archer inquiry was announced. Of course, the BPL was rescued from any danger of censure by the courts. Crown immunity was abolished by John Major in 1991, and the afflicted and bereaved ask why, since it is clear that the present Government had no intention of reinstating Crown immunity, they could not now review the claims of those from whom the BPL was rescued by that immunity.
The noble Lord, Lord Thomas of Gresford, who is much respected here and outside the House for his role in this policy area, said on 23 April that it would be possible for actions to be brought now, dating back as necessary, if the Government chose to waive Crown immunity. Thus the question today is whether the Government, opposed as they must surely be to restoring Crown immunity, have considered this possibility or will now do so. At the very least, Ministers could review the claims, where it is still feasible to do so, of the victims of contaminated NHS blood from whom the BPL was rescued by Crown immunity. If anyone thinks there is no way now of our being able to do any more to help the afflicted and bereaved, they should look at how the Irish Government found ways of compensating victims there by more than anything even contemplated by Ministers for NHS-infected patients.
In this regard, it must be made absolutely clear that the Government of the Republic did not, as stated in this House by my noble friend Lord Warner, briefed by and speaking for the Department of Health on 25 March 2004,
“set up their hepatitis C compensation scheme following evidence of negligence by the Irish blood transfusion service”.—[Official Report, 25/3/04; col. 796.]
That is untrue. It was again wrong for the Department of Health to have briefed Gillian Merron, then a junior Health Minister, to tell the House of Commons that,
“a judicial inquiry in Ireland found failures of responsibility by the Irish blood transfusion service and concluded that wrongful acts had been committed. As a result, the Government of the Republic of Ireland decided to make significant payments to those affected”.—[Official Report, Commons, 1/7/09; col. 130WH.]
Brian O'Mahony, chief executive of the Irish Haemophilia Society, who was personally involved in the negotiations with the Department of Health and Children in Ireland in 1994 and 1995 that led to the establishment on a statutory basis of a hepatitis C compensation tribunal on 16 December 1995, has written to me to say that my honourable friend's statement to the House of Commons was “misleading and erroneous”. He goes on to say that the compensation tribunal heard its first cases in early 1996 and that the first award for persons with haemophilia was made in March 1996. He concludes:
“Therefore the establishment of the Hepatitis C Compensation Tribunal, and significant payments by the Tribunal, pre-dated the setting up of both the Finlay Tribunal established in October 1996 and the Lindsay Tribunal of Inquiry set up in September 1999”.
I also have a letter from Kay Maher of the Republic's Department of Health and Children confirming Brian O'Mahony's statement, which concludes:
“I hope this will serve to clarify the sequence of events in Ireland for Ms Merron and I trust that her department will now correct the record”.
I look forward to hearing the department's response to that extremely important request.
Before concluding, I must inform noble Lords that sadly, as well as anguish and despair, there is evidence now also of anger in the haemophilia community about the Department of Health's treatment of the Archer inquiry and its report. It is five weeks ago that a terminally ill haemophilia patient, now deceased, who had given evidence to the inquiry, said to me with bitterness: “While we crossed the whole of Britain to meet the Archer inquiry, Health Ministers refused even to cross the road”.
The same intensity of feeling is seen also in the Haemophilia Society’s reaction to a recent letter sent to Chris James, its chief executive, by Anne Milton MP, a junior Health Minister, saying how appreciative she was of his involvement to date. It said:
“I do hope you will feel able to continue to work with me and my officials as your input is invaluable”.
In a letter I received from Chris James yesterday, he expressed deep annoyance at her suggestion that he had been working in close consultation with her and said that the truth was that he had met briefly with her only once since the election and had made it emphatically clear to her that the Haemophilia Society wanted full implementation of the recommendations from the noble and learned Lord, Lord Archer. Only that, he said, could ease the suffering of the afflicted and bereaved. He said also that it was utterly disgraceful for the Government to have chosen to ignore Mr Justice Holman’s findings in the High Court in the case of the Department of Health v Andrew March.
Chris James also tells me that one of his members, David Leadbetter, who is severely afflicted as a result of contaminated NHS blood, met the Prime Minister for 15 minutes as his constituent on 2 July. He writes:
“David was very touched by the Prime Minister’s empathy for his plight and was told by him that the issue would be dealt with urgently and in a positive way”.
At that meeting, David Leadbetter asked David Cameron whether he would also meet me, as president of the Haemophilia Society, to discuss the Government’s approach. His response was that he would “readily do so”.
I have not so far been asked to see David Cameron, but I am, of course, well aware of his warmly supportive attitude to the Haemophilia Society’s desire for urgent closure on just terms in a letter to Chris James on 18 June last year. In the society’s view, all that he has said contrasts sharply with the language now used by Anne Milton and explains the growing anger across the haemophilia community.
In the interest of creating hope in place of anger, let me assure the haemophilia community as a whole that it has in this House both a ready understanding of its despair and an unbreakable resolve that if this struggle has to go on, then go on it will until right is done. I beg to move.
Lord Archer of Sandwell
My Lords, we are debating a Bill presented by my noble friend Lord Morris of Manchester, who is very much to be congratulated on having secured this debate so early in the Session. I say at the outset that we all wish him a speedy recovery from his present affliction. For my noble friend, this is one chapter in an unrelenting campaign on behalf of a group of people who, through no fault of their own, suffered a devastating misfortune. In some cases, it ruined their lives; in others, it deprived them of close family members and for many of them it is already, sadly, too late.
Perhaps unusually among our exchanges, there is no question in this debate of seeking to pass the blame like a parcel from hand to hand. The events which led to the tragic outcome happened many years ago and extended over more than one Government. No Government who have held office during this millennium can be held responsible for what transpired, except that the years have passed and the victims understandably feel, as my noble friend said, that Government after Government have responded with little warmth or sympathy. It would not be true to say that there has been no response, but usually it has been wrung from a reluctant Government.
We are now making a little progress. It seems to be a matter of consensus across all parties that the victims have suffered too long, and that in a community that claims to care for its citizens there should be some alleviation of their afflictions and some willing recognition that those who suffer misfortune should not feel that they are on their own. When the inquiry made its recommendations—and I am sure that I can speak for my colleagues on the inquiry—it was not our intention that they should be set in stone on a take-it-or-leave-it basis. They were proposals intended to move the discussion forward. We gave reasons for them, but it was never our intention that if they were not accepted in their entirety we would walk away from all further discussion. Sadly, there was little discussion. The last Government made their response, but it would be a sad reflection on the democratic process if that were considered to be the last word.
My noble friend Lord Morris has incorporated some of our proposals in his Bill but I believe that that, too, is an attempt to move the discussion forward. A human tragedy should not become a political football. Perhaps the clearest example lies in the proposals for financial relief for the victims and their families, as my noble friend said. One obvious consequence of the condition from which they suffer is a loss of earning capacity, often followed by a forfeiture of pension rights. To that, we can add the costs of additional heating, a special diet and additional transport costs. Successive Governments have, to their credit, provided some relief, as I hope we set out fairly in our report, but some of those we are discussing were previously capable of earning and enjoying high living standards.
That raises a number of questions. Should the Government provide relief to compensate the victims for the quality of life which they have lost and for the financial loss which has exacerbated their condition? Those questions have become intertwined with yet further issues. Was there a legal liability on Governments to pay compensation? The problem about relying on legal redress—I say this from long professional experience—is that it becomes entangled with issues that are further and further remote from the suffering and need. Has the limitation period expired? Are the victims precluded from claiming by the releases they were compelled to sign as a condition of receiving government assistance? After the long delays, can people’s memory of what transpired be relied on? Were proper records kept? In all this, the important issue—the human need—is lost.
There have been long and sometimes expensive debates on whether the disaster happened because successive Governments were in some way at fault. We declined to address that question, because we do not agree with the proposition that unless a Government were at fault they have no obligation to relieve the distress. We believe that where there is undeserved suffering among an identifiable category of citizens, they are entitled to look to the Government for relief. If the Government address their duty and offer relief, that should not be construed as an admission that they or their predecessors were at fault. We summed it up by saying:
“The very purpose of Government is to protect its citizens, so far as possible, from life’s vicissitudes, and to afford them the best achievable quality of life”.
With hindsight, and this was discussed by my noble friend, we may have clouded rather than clarified the debate by suggesting a comparison with Ireland. We did so because it seemed to us that that should offer some guidance as to the standard of relief that we had in mind. The history of the catastrophe in Ireland bore strong similarities to that in England. Sadly, it gave rise to the very kind of arguments that we had been concerned to avoid. The Government said, “But there was a distinction between the two situations. In Ireland the Government were said by an inquiry to have been at fault. There has been no such finding in England by statutory inquiry”. Of course there has not; there has been no statutory inquiry. Successive Governments have refused to appoint one.
We declined to address the issue for the reasons that I have suggested, and in any event we were not a statutory inquiry. We were enabled to pursue our inquiry by the efforts of my noble friend Lord Morris, who sought to repair the omissions of successive Governments. We did not say that Governments had not been at fault; we said that the question was irrelevant to what mattered.
I want to correct a further misconception. It was suggested that the criticism of the Irish Government came from the Finlay tribunal and the Lindsay inquiry, as my noble friend said. The compensation tribunal and the compensation scheme for haemophilia sufferers were established in early 1996. The Finlay tribunal was not established until October 1996, and the Lindsay inquiry not until 1999. The provision made by the Irish Government was not a response to anything in those reports—it was a recognition of need. We believe that Ireland provides a relevant model, although we never suggested that the United Kingdom Parliament should be bound by legislation from Dublin or that it should slavishly follow the Irish mathematics.
One further consideration remains. We are conscious that this is not the most propitious time to propose government expenditure. There have been times in the past when the Government have had fewer constraints on their generosity. It is ironic that the delays by successive Governments in addressing the problem should have provided an excuse for being less generous. Surely the test of any community, though, is whether, when times are hard and resources are limited, the burden is allowed to fall on those who are least fortunate and most in need. Those who suffer misfortune do not forfeit their place in the community. The city gates are there to protect all the citizens, not to exclude those most in need. If my noble friend’s Bill initiates a conversation before yet more of the victims are no longer here to take part in it, his efforts will be justified.
Baroness Hussein-Ece
My Lords, I am grateful to be able to contribute to this debate on this important Bill. Unfortunately, I see from recent debates in Hansard that this is a long-running and much debated issue that has not yet been concluded. More importantly, the victims and families affected have not had the justice that they deserve.
As a new Member of your Lordships’ House, I come to this matter with a fresh outlook, and have been surprised and disappointed at the apparent lack of urgency and what seems like prevarication over successive Governments and over the intervening decades in coming to a fair and just settlement. I pay tribute to the noble Lord, Lord Morris, and the noble and learned Lord, Lord Archer, for their tireless and exemplary work on this.
It is even more unfortunate, in my view, that a resolution was not arrived at in previous years, as the noble and learned Lord has just mentioned, when we did not face the economic pressures that we face today. The treatment of patients with contaminated blood has been described as one of the most tragic episodes in the history of the NHS; it has also been described as the “contaminated blood scandal”. It is hard to argue with either of these descriptions; through no fault of their own, patients were treated with contaminated blood products and many have subsequently suffered poor health, needing specialist help, treatment and support. Many more have sadly died. We also know that many have suffered, and are still suffering, exceptional hardship.
I was, however, a little heartened to read the public health Minister’s statement in the other place last week that, while ruling out a suggestion to match the compensation to those in the Irish Republic, as was mentioned earlier, she would look again at some aspects of the report of the noble and learned Lord, Lord Archer, and would report by Christmas this year. Although we know that this will disappoint many families and campaigners, at least it provides some movement and hope, and I welcome the review.
I feel that we have arrived at the last chance saloon, and that a resolution needs to be negotiated with the assistance of sufferers of hepatitis C, their families and carers and other interested parties. It cannot be right that we have such a disparity between sufferers who contracted HIV and those who contracted hepatitis C. We know that HIV has become a much more manageable disease than it once was, while hepatitis C is treated by a gruelling six to 12 months of antiviral therapy, which can have severe side effects comparable to chemotherapy and successfully clears the virus in only around 50 per cent of cases. We know that sufferers can develop cancer and other serious medical conditions.
As we heard earlier, many sufferers face continuing hardship and rely on handouts from charities. This is not sustainable or acceptable in the long term. For many, it means a lack of access to insurance, crippling prescription charges and a reliance on social care services, which have to be paid for, depending on their circumstances. Any form of compensation should be awarded on the basis of a needs assessment.
To pluck out one example, it seems very unfair that the dependants of those who died after 5 July 2004 can apply for support from the Skipton Fund only if the victim had applied to the fund before dying. This does not seem to take into account all the merits of each case. I hope that this can be looked at. I also welcome the intention to establish a proper appeal mechanism for those whose claims may be or have been rejected; that is very welcome.
Like others, I believe that it is the responsibility of the Government to address the needs of their citizens. It is a question not of blame but of doing the right thing—of ameliorating the ongoing suffering and distress. The added challenge in today’s climate is to achieve this within the economic constraints that we find ourselves in. Sufferers and families must be treated with decency and fairness. The many expressions of sympathy that we have heard over many years, and which I have read, have probably been welcome but will no longer pay the bills, offer support or address the exceptional hardship.
I welcome the review and support efforts to establish, within a limited period, a timetable to reach a conclusion to this matter. I hope that we are not going to wait another period of years until the matter resolves itself. The dwindling numbers of sufferers deserve our support; they deserve closure and justice.
Baroness Finlay of Llandaff
My Lords, I rise in support of the noble Lord, Lord Morris of Manchester, who must be admired for his perseverance and loyalty to a group of people who have felt severely wronged. It has been said that the civilisation of a society is reflected in the way in which it looks after its most vulnerable members. I think that the noble Lord has done a great deal to raise the level of civilisation in our society and the way in which we approach people who are vulnerable.
I declare an interest: I work for Velindre NHS Trust, which now incorporates the Welsh Blood Service. I am grateful to Geoff Poole, the director of that service, for having discussed this matter with me prior to this debate.
I take this opportunity to pay tribute to the deceased husband of my noble friend Lady Campbell of Surbiton. Graham was a delightful, charming and intelligent man, who unfortunately had contaminated factor 8. He was responsible for supporting my noble friend at the beginning of her career, which I sincerely believe has been as stellar as it has been because of the love and support that he gave her. When he died, she was completely devastated, as were many of us. In his dying, he was extremely dignified and never bitter.
The tragedy that has happened is one from which lessons must be learnt. Indeed, the noble and learned Lord, Lord Archer, says in the closing paragraph of his report:
“We must now look to the future. We cannot undo the damage done, nor turn back the clock to take a closer view of those past events and decisions”.
I take this opportunity to take a forward look. The Bill is important, but I just wonder whether it might need to take more of a prospective view, particularly where it includes lists of conditions to be considered in blood donations.
This tragedy has highlighted the problem of risk assessment. We do not live in a risk-free society and it is important that we do not fail to recognise risk when it emerges and stares us in the face. The Advisory Committee on the Safety of Blood, Tissues and Organs—SaBTO—was set up three years ago, replacing its predecessor. I ask the Minister to provide assurance that the committee will continue and remain supported, as it has important work to do. It is currently looking at the risk of new variant CJD in relation to blood, tissues and organs. The services out there are waiting to hear its conclusions as new evidence emerges.
I also take this opportunity to say that, in my view, we face an unintended consequence of previous legislation—the Human Tissue Act—which prevented our looking at routine samples from tonsillectomies and splenectomies in an ongoing way to try to find out the true incidence in the population of variant CJD. Without that information, it is harder to know the size of the risk that blood transfusion services face in taking blood from donors, as we do not have a reliable and simple clinical test to look for the presence of variant CJD. It is likely that variant CJD is transmitted in blood transfusion, but we are not sure whether the removal of white cells from blood has decreased the risk as much as the services hope. The removal of white cells should have decreased the risk hugely, but the risk is always there in the clinical scenario, where a patient faces life-threatening haemorrhages—the risk of dying from exsanguination versus the risk of transfusion. Obviously, the risk of using blood and the readiness to do so in the service varies with the clinical condition of the patient, but that balance is considered every day across Britain. We do not know whether blood should now be filtered more vigorously than has been the case because of variant CJD. SaBTO’s ongoing work will, we hope, inform that decision.
Blood services are aware of the theoretical risk, but they just do not know the best way of allocating resources to keep that risk to a minimum. We no longer use imported plasma, we do not accept paid donors and HIV is quickly identified in screening. However, the true safety of blood depends on the way in which the service screens and refers its donors. Men who have had sex with men are excluded for life from being blood donors. The decision has just been made that people with ME are deferred. There is a possibility—it is unproven—that the XMRV virus is associated with ME. The fact that these people are being excluded from being donors does not make the statement that there is a definite association, but it is part of the risk assessment process and I am glad that the risk has been taken seriously and that proportionality was applied when the question emerged. Similarly, when people have travelled abroad, donation is deferred, as things such as dengue fever are not easily detected. Much of our safety depends not on testing the blood that is donated but on the early screening out of donors who may be at risk and on being careful about the blood products that are used.
The use of blood is remarkably safe, but it would not be fair to say that it has zero risk. The major problem now comes from misidentification—either a blood sample wrongly labelled at cross-match or misidentification of the recipient, so that they are given the blood that was cross-matched with somebody else. Another problem is infection in relation to platelets, although the use of single donors for platelets has decreased that risk hugely. Platelets cannot be stored at 4 degrees centigrade; they are stored at 20 to 22 degrees centigrade, so that they still function, but that is an environment in which bacteria can multiply. Indeed, there have been recent deaths of people who, unfortunately, have had bacterial septicaemia. I hope that the Government will support new developments, such as the clotting factors that have been developed for our troops in the battlefield. They are contained in teabags and, when they are put over a bleeding wound, rapidly cause clotting. They may revolutionise our management of trauma. They are expensive and new, but they may turn out to be cost-effective in the long term.
In the balancing act, we also have to consider the costs related to self-salvage of blood. I pay credit to Dr Dafydd Thomas from Morriston Hospital, who has pioneered a lot of this work to significantly decrease exposure to pathogens. As far as factor 8 concentrates go, we hope that they are now virus free, but it should be stated that that relates to all known viruses. When I qualified, HIV did not exist; it was not known. I remember clearly the index cases that started to emerge in the USA, when people did not know what the condition was. We do not know what we will face tomorrow. Looking towards tomorrow, I think that, whatever happens, we need to be vigilant about emerging new diseases, as well as the discovery of viruses of all types which we do not currently know exist but which I am sure we will find are responsible for diseases that we are treating but do not know are infection related.
In these last moments, I turn to compensation. Whenever something has gone wrong, the longer it goes on, the worse it is for those who are bereaved and feel aggrieved. The anger and distress turn to deep, corroding bitterness as time goes on and people feel that they have not been listened to. The sad reality is that no money can replace the life of the person who has died prematurely from a cause that was not expected. In many ways, the only measure that we have in our culture is money, so we look to financial compensation. However, I hope that one of the lessons that will be taken from this whole tragic saga is that things must be dealt with quickly. To become overfocused on money is to lose sight of the deep personal distress of people before they die from the time that they know that something has gone wrong. We must address that with a change in attitude
I support the comment of the noble and learned Lord, Lord Archer, that we must get away from looking to the courts and the legal system to provide us with answers. They are the point of last resort; I would say that they are beyond the point of last resort. Things have probably gone irretrievably wrong by the time they get there.
There are many lessons to be learnt. I wish the noble Lord, Lord Morris, well with his Bill. Some tiny amendments could make it more future proof.
Lord Corbett of Castle Vale
My Lords, if there was a Nobel Prize for persistence, my noble friend Lord Morris of Manchester would walk away with it by a mile. I also pay tribute to noble Lords who have taken a consistent interest in this matter, as well as colleagues in the other place along the Corridor.
We are not picking on this Government, but on the Government of the day. There is a widely supported view in both Houses of this Parliament that the debt of honour owed to the victims of contaminated blood, their carers and their families must now be redeemed. Of the 4,670 patients given infected blood by the NHS in the 1970s and 1980s—my noble friend Lord Winston called this the worst treatment disaster in the history of the NHS—only 2,700 survive. We also owe special thanks to my noble and learned friend Lord Archer of Sandwell and his colleagues for conducting the independent inquiry into this issue against the background, as he said, of the refusal of successive Governments to have an official inquiry.
As my noble friend Lord Morris has explained, the Bill sets out a comprehensive system of compensation to alleviate the intense hardship and suffering of victims, their carers and families. I, too, hope that the Government accept that it has now been acknowledged that the statements made about the timing of the introduction of the Irish scheme were mis-statements to both Houses. I hope that, in responding to this debate, the Minister will be able to assure us that those corrections have been made to the official records in the Department of Health. They are of great importance—although, as my noble friend said, no one involved in this campaign wants to go down the road of trying to apportion blame. The matter of negligence simply does not arise. A great wrong, an injustice, has been done. It must now be put right.
I will not go through the detail of the Irish case, but I underline its importance. Successive Governments have relied upon the finding of negligence in the Irish republic in saying that they did not want to know about what happened in Ireland as no negligence was established in the United Kingdom. As my noble and learned friend Lord Archer said as early as page 9 of his report, which bears repetition,
“The past cannot be undone. Nothing can rescue the victims and their families from what they have already suffered. But a review of the events and decisions that led to the tragedy may assist in coming to terms with the consequences, and might suggest ways in which Government may address those aspects which it is not too late to rectify. While hindsight, by definition, operates after damage is done, it may reveal important lessons for the future. We consider that to be more important than apportioning blame”.
It seems that the Government have now abandoned arguments around the issue of negligence. In the other place, Ms Anne Milton, the Parliamentary Under-Secretary of State at the Department of Health, announced on 14 October a review of the recommendations made by my noble friend for ex gratia payments, free NHS prescriptions in England and access to insurance. It will be conducted by officials with the support of clinical experts and external groups. She aims for this review to be completed by Christmas. This is progress and I welcome it, although I would have been a little happier if it had had a more independent flavour about it. I hope that the estimated cost of the scheme proposed in my noble friend’s Bill will not be exaggerated. My noble friend mentioned an estimate of £3 billion being snatched out of the air by lazy journalists—it is no such thing; it is about a third of that.
However, the cash involved should not be a factor influencing the review. It is the principle that matters. Damage was done to people, through no fault of their own, when, like the rest of us, they felt that our National Health Service could be relied upon. I believe that there is strong moral duty on government to recognise that and put it right. That is the first principle to be established.
Then we come to the matter of cash. I accept absolutely that this is perhaps not the best day of the week to be asking for cash, but I remind the House of my former constituent, Mrs Sue Threakall. She would have a robust response if the result of that review were to be, “We acknowledge that something should be done about this. Terrible tragedies have happened. Unhappily,”—to borrow a remark from an honourable friend in another place—“there is no money left”. Her husband Bob had hepatitis B and C after being given contaminated blood. What price can we put on the loss of that life and the severe financial strain put upon Mrs Threakall and her family? I have no idea what monetary sum could get anywhere near compensating for that.
When Bob died, which she knew was going to happen, Mrs Threakall said very starkly, “It just ripped the family apart”. However, because her husband died before 2003, she was ineligible for any compassionate payment, and so she and her then young family were left bereft. Now her means-tested benefits are under threat from this Government’s comprehensive spending review. Mrs Threakall lives with severe financial problems, as do so many others who the Government should now decide deserve the compensation outlined in the Bill.
The issue can be put quite simply. It is now time that the great wrong done to Bob Threakall, to his wife—his carer, his spouse—and his family is put right. That is what the Bill seeks to achieve.
Lord Low of Dalston
My Lords, I am glad to follow the noble Lord, Lord Corbett of Castle Vale, because I identify so strongly with the points of principle that he has made. However, I fear that I will be unable to articulate them with anything like his eloquence.
I add my voice in support of the Bill. I shall be brief. It is unnecessary to go over the whole sorry history of this tragedy—indeed, this scandal—which, as several other speakers have mentioned, has been described by the noble Lord, Lord Winston, as the worst treatment disaster in the history of the National Health Service. It is a textbook illustration of the truth of the great Richard Titmuss’s warnings about the dangers of allowing commercial factors to operate in something like the supply of blood products. Nor shall I go in any detail into the recommendations of the Archer inquiry or the Bill based on them, which is before us today. The noble Lord has done that for us already. I join other speakers in paying tribute to the noble Lord, Lord Morris, and the noble and learned Lord, Lord Archer of Sandwell. It is only the tireless persistence of the one and the dedicated and the meticulous investigation, analysis and documentation of the issues by the other, together with a clear-sighted prescription as to what a civilised society ought to do, that have brought us to this point.
What I find particularly deplorable is the complacency displayed by the authorities when what had happened came to light. The journey from the promise of self-sufficiency to its attainment took five years in Ireland but 13 years in England and Wales. This reflects discreditably on the administration of our health services and is something that makes us all feel ashamed. Equally shaming is the heartlessness, obfuscation and prevarication shown by successive Governments, and the cheese-paring and obstructive nature of their response. This is an indictment of the whole of our official culture in this country. Successive Governments had recourse to the device of Crown immunity, requiring sufferers to sign a waiver in respect of hepatitis C in circumstances where they did not know they might have it but the department knew they were at risk. There was resistance to the disclosure of documents to the multi-party group. There was the refusal to hold an inquiry or co-operate fully with the inquiry of the noble and learned Lord, Lord Archer, and then disingenuous reliance on the fact that there have been no findings of fault against the British Government. There was a reliance on discretionary trust funds, rather than a system of benefits as of right, to provide a measure of compensation. There was a failure to recognise the claims of widows. There was a suggestion that, unless a Government are in some way responsible for a misfortune that befalls a group of their citizens, they are under no obligation to relieve it. All these things and more can bring only shame on the reputation of this country and its handling of this tragedy, which has been so much less open and generous than that of numerous other countries.
Two things stand out particularly. One is the reliance on a system of ex gratia and discretionary payments to provide a measure of compensation, rather than a system of direct financial provision as recommended by the Archer inquiry. This smacks of the mentality of the Poor Law. Secondly, most shocking of all is the way that the state has sought to shuffle off responsibility for making amends to those who, through no fault of their own, have suffered as a result of state action or the actions of organs of the state.
The past cannot be undone. Nothing can rescue the victims and their families from what they have suffered. All we can do is make amends as best we can, and as far as measures of compensation can, at the earliest opportunity we have. The previous Government’s response fell significantly short of full implementation of the Archer report. The least this Government can do is take the first opportunity they have to right the wrong that has been done to the victims of this tragedy. The Coalition Government have already shown that they have an honourable record of doing the right thing where other Governments have done their best to obfuscate, prevaricate and shuffle off responsibility in the way that Governments do. The Government’s response to the Saville inquiry into Bloody Sunday, and the way they have grasped the nettle in relation to those who lost out as a result of the collapse of Equitable Life, gives one confidence that their instincts are sound; that they know what is the right thing to do; and that they are able to face up to their responsibility and act on it when they know it.
As we have heard, the Parliamentary Under-Secretary of State for Health, Anne Milton, has said that she hopes the matter will be sorted by Christmas. The best way for the Government to achieve this would be to give the Bill a fair wind. I very much hope that they will.
Baroness Rendell of Babergh
My Lords, I will be brief. It is Friday morning and—however serious and important the question under discussion, and this one is very serious indeed—no one wants to be too long detained. The position of those of us who support the Bill has been made very clear by my noble friend Lord Morris of Manchester and, in his report, by my noble and learned friend Lord Archer of Sandwell. We have already heard eloquent and informative speeches from four other noble Lords. I shall not, therefore, speak of statistics or the large sums of money, which have been mentioned in discussion of what levels of compensation would cost the taxpayer, or do more than touch on the clinical and medical aspects of haemophilia and its amelioration.
I am only speaking at all because I believe I am in a unique position to talk about haemophilia and those afflicted by it. Some 10 years ago I wrote a book—a work of fiction—that centred on what I called the two strands of inheritance: the inheritance of a peerage and the inheritance of a disease. This was at the time of the House of Lords Bill, and inheritance of a peerage was very much to the fore in debates in your Lordships’ House. As to haemophiliacs, their sufferings were by then being alleviated, if not cured, by modern medicine.
My book was in part a historical novel. It dealt with haemophilia in the late 18th and early 19th centuries, as well as later manifestations of the disease. I went into the peculiar nature of its genetic inheritance carefully, since many previous writers had made mistakes in this area. For this very reason I researched the whole subject with great care, investigating the discoveries made and the progress achieved at various American universities. I also used your Lordships’ Library and travelled to south-east Switzerland to see what I could discover in a village which had once been, but was fortunately no longer, the home of many sufferers from this tragic blood disease as a result of contiguity and in-breeding.
What I carried away from all this research, apart from what I needed for my novel, was an abiding indignation that, just as effective treatment was successfully allowing haemophiliacs to lead almost normal lives, these sufferers were being afflicted from an unsuspected, indeed bizarre, source. The blood that they needed—a life-giving elixir—was contaminated with some of the worst diseases known to man: HIV, hepatitis C and, perhaps worst of all, human-variant CJD. It was, in fact, death dealing. My novel ends with the descendants of those 18th century haemophiliacs leading full and active lives—the men knowing that their daughters will be carriers, the women aware that all or some of their sons will be haemophiliacs—but wise enough to become parents through adopting children. None of them could have dreamt, in fiction or in fact, that a triple plague could be visited on them through medication. None of them, in fiction or in fact, would have believed that they would have such huge premiums demanded of them by insurance companies as to be made virtually uninsurable.
When I wrote to the Guardian and the Times on this subject at the time of my noble friend Lord Morris’s earlier Bill in December 2009, outlining the tragic results of contaminated blood transfusions, I received many letters from readers. Most were from the widows and other dependants of infected people, describing how they had suffered as a result of losing the family breadwinner, which often meant also losing their homes. One told me that I was wrong to write of HIV/AIDS as being a serious disease, since so much effective medication was now provided for its victims. I hope such a view is not generally held and is not an opinion shared by opponents of the new Bill, who might then extend that principle to hepatitis C and CJD. These are terrible sufferings—even the stress and fear occasioned by HIV, as mentioned by the noble Baroness, Lady Finlay—and they are made all the worse for those afflicted, and the widows, children and families whom their deaths have left behind, by the knowledge that these diseases were received through being given the blood of drug addicts and of inmates of US prisons.
My researches taught me a great deal about haemophilia. I would not have the temerity to say that they showed me what it is like to have the disease. They did, however, teach me exactly what those sufferings may be and how to a great extent sufferers may be exempted from them by transfusions of suitable and uncontaminated blood. The transfusions received by those whom my noble friend Lord Morris has called “a small and stricken community”, which were supplied by the NHS, have unknowingly killed nearly 2,000 of them. These people were ill already. They already had a depleted lifespan. Haemophilia itself is bad enough, a daily disablement, but the treatment they were given was a case of adding insult to injury.
This is not a political issue—it makes no difference whether one belongs to the right, the left or in-between—but a moral issue. Those who took part in the previous Bill introduced by my noble friend Lord Morris—I was not among them—and those who have spoken today, have explained the situation and gone into detail, presenting various aspects of the disease and what can be done to ease it. They did so from a sense of moral indignation and resentment on victims’ part, and from a powerful sense of justice, for no explanation for the sake of clarity has been necessary. The issue is so clear that a small child could have understood it, as children can always understand what is right and what is wrong, what is fair and what is deeply unjust.
Lord Addington
My Lords, for those who speak this far down the list, not much remains to be said and most of it will be repetitious. However, we should congratulate the noble Lord, Lord Morris, on consistently coming back to this issue. He has worked on disability issues for a long time. If there is a bulldog spirit in this House—a tenacious person—he embodies it totally. It is probably worth putting on the record again the fact that he has not thought twice about hitting his own party’s Ministers hard and often. He has shown no fear about that. Party loyalty has not got in the way of his raising the issue.
I hope that the Government do not defend their position with a series of Treasury Bench-type responses, such as, “We don’t have to pay this out so we won’t”. I am afraid that previous Ministers have given such responses. I hope that we get some answers. If we cannot accept the Bill in its entirety, what can be done? That is a very important question. Moreover, what will be done in a certain phase of time? If we can find out when something will happen—Christmas has been mentioned—and what exactly that is, the degree of certainty and knowledge will help those involved. We can argue about exact details later, but that certainty would be something.
What initially got me involved in this issue, a good few years ago, was the difference in the way that we treated two groups of people—I refer to those affected by hepatitis C and HIV—who had contracted very similar conditions through a very similar process. However, because of a legal defence position, one group did not receive help. Surely we can address that at the first opportunity. If we carry on like this, we will carry on having similar debates and wasting time, leaving the people affected scrabbling in the air, waiting for something to happen and grabbing on to hope and despair. That affects their lives as well and piles not insult on insult but injury on injury. I hope that the noble Earl will be able to give us a positive response as the whole House and the entire political system deserve to be given a clear answer. If this is not the final measure that we seek, at least I hope that it will not leave us demanding a sequel.
Baroness Kennedy of The Shaws
I hope that I may make a brief contribution in the gap. The present Government have said that they want closure on the contaminated blood issue but, to achieve this, they must offer financial compensation, not charity hand-outs through the two charities that were set up, the Macfarlane Trust and the Eileen Trust.
Following the report of my noble and learned friend Lord Archer, the previous Government had agreed to make some payment to those infected with HIV by contaminated blood products and some sort of payment to their infected partners. However, they made it very clear that this was not compensation, so it falls far short of the recommendations in Lord Archer’s report and does not apply to those infected with hepatitis C by contaminated blood products. I want to reinforce what has been said by others—that we now know that those infected with hepatitis C are more likely to die early than those who have HIV.
As the noble Lord, Lord Corbett, and my noble friend Lady Rendell have said, this is a moral issue. Closure for those affected will come only with an apology from government and some sort of capital payment. That is why this Bill is so important. Clause 4(2) seeks such a payment and paragraphs (b) and (c) are particularly relevant, so that any capital payment is paid directly to the person infected, and not by way of charity hand-out. It is clear in the report and in the Bill that such a payment should not be means-tested.
That leads me to another important issue in the context of our times. I understand that many victims are literally worried sick that the spending review and subsequent welfare cuts will, if applied to any of them, have a serious effect on their presently very limited standard of living. The multi-drug regimes that many undergo on a daily basis can make them feel well enough one day but very ill the next. There is no normal day, so that any medical for, say, disability living allowance, may not accurately reflect their condition or their ability to work. It is, therefore, essential that those infected with HIV/hepatitis C be passported through any such medicals. I hope that the Minister will give us an assurance that this is what will happen.
Baroness O'Cathain
My Lords, I rise to speak briefly in the gap. I apologise to the noble Lord, Lord Morris, as I have spoken in support of him in this Chamber from the very start of his campaign but, due to my lack of attention to detail, I did not realise that this debate was taking place today. However, everything that I wanted to say has been said in the most moving and compassionate way.
Promises have been broken, victims have been betrayed and trust has been compromised—all of this, I am afraid, is accepted. I have three hopes. The first is that the response from my noble friend will be positive and compassionate. Secondly, I hope that this debt, which is much easier to settle than the debts that this Government have inherited, will be settled. Thirdly, I hope—this is probably the vainest hope of the lot—that the media will find it in their hearts to support the Bill, cover the speeches made today and realise that this debate is something on which this House scores. It is a good news story, and we have a role to play in the Parliament of this country.
Baroness Wheeler
My Lords, I, too, begin by paying tribute to my noble friend Lord Morris of Manchester, for his tenacious and tireless work in campaigning on the issue before the House today. Indeed, no one reading back through the reports of the debates on the Bill in its previous passage to Third Reading in the House, as I have done in preparing for today’s debate, can fail to admire and be very humbled by his continued determination to ensure that the plight of those whom he has described as,
“arguably the most needful minority in Britain today”,—[Official Report, 23/4/09; col. 1607.]
is fully recognised and properly financially compensated.
We recognise the important and continued role played by him and other noble Lords who have spoken in today’s and previous debates. I refer particularly to the independent inquiry report of my noble and learned friend Lord Archer into NHS-supplied contaminated blood and blood products, which received widespread all-party acclaim, and whose report recommendations form the core framework of the Bill. Like him, we welcome the consensus in the House that victims have suffered for too long. We also value his insights into his report from the perspective of events that have followed its publication. Finally, I endorse the admiration expressed across the House for the work of the Haemophilia Society and the close support that it has provided to the people infected, their carers, widows and dependants.
The debates in this House and in the other place last week recount the very personal and tragic experiences of patients, their families and those who have died. Haemophilia sufferers were plunged into a nightmare of failing health, pain, suffering, financial hardship and social deprivation. The support and campaigning work of the society over the past three decades have helped to provide solace and constant, practical everyday support, and have led to real improvements in care and financial support.
However, we readily accept that there is much more to be done. This is unfinished business from the previous Government and we regret that we were not able to respond formally to the High Court judgment and to the related recommendations in the report of the noble and learned Lord, Lord Archer, before we left office. Despite the sense of frustration at this and the belief that much more should have been done by successive Governments, the House will recognise the work undertaken by my noble friend Lady Thornton to progress through the Department of Health vital improvements such as in the administering, handling and safety of blood products and in developing further best practice and improvement in service provision for the ongoing treatment of haemophilia sufferers.
On behalf of these Benches we welcome the review announced last week by the noble Earl, Lord Howe, following the announcement and debate in the other place. It is a very positive step that will, I hope, take this matter forward towards achieving the closure that is desired in the House.
We welcome the inclusion in the review of the commitment to look at ex gratia payments made to those infected with hepatitis C, including financial support for dependants, issues surrounding the arbitrariness and injustice of cut-off dates for eligibility of the current scheme, and comparison with ex gratia payments made in the UK to those infected with HIV and their dependants. We also welcome consideration of the provision of life, mortgage protection and travel insurance for those infected in light of similar access available to other groups. As we have continually found, there is often a real difference between what insurance companies promise will be their actions on such issues, and what they actually do when considering individual cases.
In respect of prescription charging for those infected, noble Lords on both sides of the House will be aware of the previous Government’s commitment to introduce free prescriptions for people with long-term conditions, which would have included people infected by contaminated blood. I therefore ask the Minister what impact the announcement under the Government’s CSR that the free prescriptions programmes will not now be taken forward will have on the review’s consideration of this matter. Will the Government no longer honour this commitment to people infected by contaminated blood?
We also endorse the inclusion in the review of the provision of, and access to, nursing and other care services in the community for those infected. We hope this will lead to improved NHS and local authority service provision, coproduction and co-operation.
We welcome the Government’s commitment for the review to make recommendations to Ministers for their consideration by the end of the year. As noble Lords have stressed during this debate, it is crucial for this review to be conducted with the utmost expedition. I look forward to hearing further details from the Minister on who is to lead it, how it is to be undertaken, the relevant expert groups and external groups that were referred to in the other place by the Under-Secretary of State for Public Health, Anne Milton, and how the views of those infected, their relatives and carers, and other representatives will be sought and taken into consideration.
The Minister emphasised her desire for the review to be dealt with,
“openly and honestly, with clarity, without party politics, with humility and with empathy”.—[Official Report, Commons, 14/10/10; col. 568.]
We wholeheartedly agree and look forward to it proceeding without delay. Will it include an overview of all the different compensation funds established to administer payments to people infected by contaminated blood to ensure consistency of approach and decisions?
Finally, on the question of continued government funding to the Haemophilia Society, can the noble Earl confirm that the current level of funding will not be affected by the changed basis for voluntary sector funding?
In closing, I again congratulate my noble friend Lord Morris on bringing back the Bill to this House and his dedication, determination and persistence—once again so much in evidence today. We look forward to working on the Bill in its future stages in the House.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, I congratulate the noble Lord, Lord Morris of Manchester, on the reintroduction of the Bill and echo the noble Baroness, Lady Wheeler, in paying tribute to the noble Lord. On a personal level, I am sorry that I was unable to be present at the Second Reading of his Bill in the previous Session, but I am pleased to be able to rectify that situation today, albeit on a different side of the House.
Since this debate was scheduled, an important development occurred in another place, which is of direct relevance to the debate today. My honourable friend the Under-Secretary of State for Public Health laid a Written Ministerial Statement on 18 October which stated that the Government are reviewing a number of aspects of the support available to those affected by contaminated blood. This includes ex gratia payments for hepatitis C, access to insurance, access to nursing and care services, and prescription charges.
I can confirm to my noble friend Lady Hussein-Ece that the review will look at a number of aspects of the hepatitis C payments scheme, including the size of payments, whether annual payments should be made, payments to spouses or dependants of those who died before the scheme was set up, and additional payments in respect of spouses or dependants of those who are still alive. The terms of reference of the review have been placed in the House Library, and I can confirm to the noble Baroness, Lady Wheeler, that the issue of free prescriptions for this group will indeed form part of the Government’s review. I believe that my honourable friend sent copies of the Statement to the noble Lord Morris of Manchester, and the noble and learned Lord, Lord Archer of Sandwell.
It is important that the House understands that this review is under way and that Ministers of this Government are not impervious to representations made to them to reconsider these matters. The noble Lord, Lord Morris, is I hope already aware of my sympathy for the group of people affected by this tragedy and the fact that I recognise and respect what he is trying to achieve with this Bill. Nevertheless, I have to be candid in expressing some reservations as to the need for legislation on this issue. We all acknowledge the plight of those affected, but in debating the Bill we should consider whether it delivers tangible benefits for those affected by this tragedy. In this respect, there are three main themes in the Bill that we need to consider: first, improving treatment and services for those affected by this tragedy; secondly, preventing a similar tragedy occurring in future; and thirdly, financial support for those affected.
I will start with the issue of improving treatment and services for those affected. This Government are firmly committed to the principle of ensuring that NHS services for all patients are of the highest possible standard, and that standards continue to improve. That principle is at the centre of our approach to the NHS. It applies as much to those infected by contaminated blood as to any other patient group. Where services are failing or inadequate, there are established procedures in place to address this. Clause 1, the main clause in the Bill, aims to establish a statutory committee,
“to advise on the treatment of haemophilia”.
The purpose of the committee would be to provide advice on the selection, procurement and delivery of therapies, as well as access to those therapies, for haemophilia patients. But what additional benefit would be gained by placing the proposed committee on a statutory footing? The only clinicians that the Bill stipulates should be members of the proposed committee are the haemophilia centre doctors themselves. I take this to be implicit acknowledgement of the effectiveness of haemophilia doctors in using their clinical expertise to secure the best treatments for their patients. We have to ask: what more is to be gained from their forming a committee?
I recognise that there is a wider issue here of patients being involved in decisions about their care and that, historically, haemophilia patients feel that they were subjected to treatment without sufficient knowledge of the risks. However, it is exactly for those reasons that the Government’s White Paper, Equity and Excellence: Liberating the NHS, published in the summer, sets out a vision to place patients at the heart of the NHS, giving them greater choice and control over their treatment, with the objective of making shared decision-making the norm. Progress is already being made in achieving this objective for this patient group through the Haemophilia Alliance, a network of patients, doctors and others involved in caring, which was established in 1999. The Department of Health now formally meets the alliance twice a year. Two such meetings have already been held and the group has unanimously agreed that it would be helpful for all parties to better understand how specialised services for haemophilia patients are commissioned, and to identify how the Haemophilia Alliance can influence service provision countrywide. The alliance is working well, and I have not yet heard a convincing rationale for replicating its role in a statutory committee.
Lord Archer of Sandwell
I am most grateful to the Minister. Does he appreciate that one matter that concerned us was the establishment of a permanent secretariat to the committee, so that one would not have to wait for a meeting of the committee before responding to something that had happened? It would monitor events as they arrived and respond to them quickly.
Earl Howe
I am grateful to the noble and learned Lord. My understanding is that there are established routes of communication to enable the alliance to contact officials in the department if such a contingency were to arise. I am not sure that the fact that the meetings are at intervals makes any appreciable difference in this context.
Clause 3 also focuses on treatment. It provides for a scheme of NHS cards for those infected through treatment with contaminated blood and blood products. These would enable access to NHS services, including prescriptions, free of charge. In fact, the majority of services specified in the Bill, such as counselling and physiotherapy, are already available in England under the NHS, where needed, free of charge. Perhaps I may venture that the real issue for this patient group is not that of cost, but whether they receive high-quality, adequate levels of treatment and care. I recognise, however, that prescription charges are a particular grievance for this patient group, and that some have experienced difficulties in accessing nursing and care services, including specialised counselling. That is why these issues are included in the current Department of Health review.
I was concerned to see that the clause also provides cardholders with priority access to NHS treatment. This could have significant implications. At one level, it would give priority access for everyday treatments such as chiropody services. At another, it could provide for jumping the organ donation queue, which, when organs are at a premium for everyone, cannot be justified. Those decisions must be based on clinical need and nothing else.
Lord Morris of Manchester
My Lords, perhaps I should explain why I made that provision. Other people know all the statistics about the disaster, but I personally knew hundreds of its victims—and now, day by day, I hear of the deaths of valued friends. That is why I approached this in the way that I did. As honorary parliamentary adviser to the Royal British Legion for many years, since 1985, I know that the priority that their members are given under the National Health Service is never abused. No one has ever said that disabled ex-servicemen abuse that privilege. I am certain that the Haemophilia Society will act just as honourably as those who so readily give their lives in the service of this country.
Earl Howe
My Lords, I respect greatly the points that the noble Lord, Lord Morris, has made. Nevertheless, it is difficult to enshrine in legislation priority access to NHS services for an individual group of patients. That is the real issue, but of course I shall reflect the point that he has made.
As I have indicated, the issue is whether patients infected with contaminated blood receive prompt access to the necessary treatment, based on clinical need. I have heard no reports that anyone in this patient group faces difficulties in this regard. I therefore argue that nothing in the Bill would improve treatment or services for those affected by contaminated blood beyond what is already on offer from the NHS or the Department of Health, or is being considered by Ministers.
I turn now to the critical issue of making sure that no similar tragedies occur in future. The Government are firmly committed to ensuring that the blood supply is as safe as possible, and we continue to work to provide ever safer blood and blood products. Clause 2 provides for haemophilia patients to be offered testing for a number of specified infectious agents, and for blood donations to be screened for those agents; yet testing for all but one of the agents is already available to haemophilia patients, and all blood donations are screened for those same agents. The sole exception is variant CJD, for which there is currently no validated test available. We cannot legislate on something that it is currently not possible to implement. The Bill rightly acknowledges that the list of agents for which the blood supply is screened needs to be kept under constant review. There are effective systems in place to ensure that this is done, both within the UK blood services and also through the Advisory Committee on the Safety of Blood, Tissues and Organs, SaBTO—which I can assure the noble Baroness, Lady Finlay, will continue to exist. Therefore, there is no need to replicate this function on a statutory basis.
The Bill also provides for the introduction of prion filtration. The Government are currently undertaking an evaluation of the costs, benefits and implications of prion filtration to inform our decision on whether to implement this recommendation. We do not need primary legislation to do this.
Finally, blood safety is regulated by European directives that set standards of quality and safety for the collection, testing, processing, storage and distribution of human blood and blood components. Blood products such as clotting factors are regulated in accordance with the Community code for medicinal products. Therefore, there is nothing in the Bill that would improve the safety of the blood supply. I fully support the principle of making the blood supply as safe as practically possible, but it is not appropriate to use legislation to require the blood services to adopt a specific technology such as prion filtration. Such legislation cannot properly take account of emerging scientific advances, and it is important for the blood services to retain the flexibility to introduce the most appropriate measures on the basis of expert advice.
I now turn to the subject of Clause 4, the issue of compensation. In recognition of the plight of those affected, the Department of Health has already set up ex gratia payment schemes for those infected with HIV and hepatitis C. It is worth pausing to lay out the level of financial support currently available to people in this group. Those infected with HIV receive a flat-rate payment of £12,800 a year. They may also be eligible for additional discretionary payments. In the year ending April 2010, the average total payment to an individual infected with HIV was £17,400. Those infected with hepatitis C are eligible to receive an initial one-off lump sum of £20,000 when they develop chronic infection. Despite contracting the virus, some people will make a full recovery. However, others may go on to develop serious liver disease. For this group, there is a second one-off lump sum payment of £25,000. All these payments are tax-free and are not counted when calculating individuals’ eligibility for state benefits. Therefore, if they are unable to work for health reasons, they will receive state benefits in addition to these payments.
One of the key elements of this clause is subsection (4), which states that,
“the Secretary of State shall have regard to any comparable compensation schemes offered in other countries”.
I should like to inform the House that previous Governments did indeed have regard to comparable schemes when the Macfarlane and Eileen Trusts for HIV were first set up, and we are taking account now of schemes elsewhere. The current payments for those with HIV generally compare very favourably with payments in other countries, and I direct that remark particularly to the noble Lord, Lord Low of Dalston.
I acknowledge that there are anomalies between the current payments for HIV and those for hepatitis C, whose payments are less favourable. That is why the Department of Health’s current review includes payments for hepatitis C, as well as looking into whether there are any alternative payment mechanisms. In the light of that, the House needs to consider what purpose there is in trying to legislate on this issue.
Finally, Clause 5 requires the review of a number of issues which were covered in the previous Government’s response to the report of the noble and learned Lord, Lord Archer. Again, the question is whether any benefit is to be gained from putting this work on a statutory footing.
The one issue in Clause 5 on which I should like to comment specifically concerns medical insurance. I am aware that patients infected with HIV and/or hepatitis C by contaminated blood either cannot obtain health insurance or are subject to a significant premium loading. However, one of the underlying rationales of the welfare system here in the UK is to provide services for those who cannot obtain insurance, for whatever reason. The whole point of the NHS is that people should not need private medical insurance. For the state to assist a particular uninsurable patient group to obtain private medical insurance would, I believe, set a dangerous precedent that could undermine the core principles of our welfare system.
In conclusion, I should like to address a few of the questions raised in this debate, dealing first with some of those raised by the noble Lord, Lord Morris. He asked what the Government have done in relation to the recent case of variant CJD having been found in a haemophilia patient. My advice is that, although these concerns are of course very understandable, no haemophilia patient has ever developed clinical variant CJD.
The noble Lord, Lord Morris, asked about the calculation of the £3.5 billion—a point mentioned by a number of other noble Lords. A note of how much the department estimated it would cost to replicate the compensation scheme of the Republic of Ireland in the UK has been placed in the Library, and I refer noble Lords to that document.
The question of comparability with Ireland was raised not only by the noble Lord, Lord Morris, but by the noble and learned Lord and the noble Lord, Lord Corbett of Castle Vale, among others. I have taken the opportunity of looking carefully at this comparison. From what I have seen, I am satisfied that the Irish scheme was set up in response to a very specific set of circumstances which are unique to the Republic of Ireland, and I say that not least for the following reason. In an article in the Irish Times dated 5 August 1997, Brian Cowen, then Minister for Health and Children in the Republic of Ireland, and currently Taoiseach, confirmed that the Irish Government knew in 1995 that the Blood Transfusion Service Board had been negligent and had attempted to conceal this fact. I do not believe that I have ever heard the noble Lord, Lord Morris, or others acknowledge the contents of this article.
The noble Lord, Lord Morris, raised the question of Crown immunity in respect of Bio Products Laboratory. I understand that the activities of BPL were covered by Crown immunity and therefore fell outside the requirements of the Medicines Act until 1991. Therefore, it could not be prosecuted under the Act. This immunity did not protect from civil suit but only from prosecution under the Medicines Act. Indeed, some affected persons brought an action in 1988, which was settled out of court. Affected persons did and do therefore have rights of redress in civil law. Our legal advice is that permitting prosecutions under the Medicines Act after all this time would be seen as unfair and oppressive by the courts for various reasons, not least the breach of the European Convention on Human Rights.
The noble Lord, Lord Low, called into question the use of commercial blood products. Most countries experienced similar tragedies as a result of contaminated blood and blood products—even countries that were totally self-sufficient. The fact that the UK domestic blood supply was also contaminated with these viruses does not therefore mean that the tragedy could have been avoided if the UK had been self-sufficient in blood and blood products.
The noble Baroness, Lady Kennedy, asked about the future of benefits in this context. My honourable friend the Parliamentary Under-Secretary of State for Public Health said during the Back-Bench debate in the other place last week that she would be raising the issue of benefit payments with the Minister responsible, and at this point I have nothing to add to that assurance.
I urge the House to consider the Bill very carefully. The contaminated blood issue is enormously emotive, but we should not be passing legislation simply because we have compassion for those affected. All legislation passed by your Lordships’ House must deliver meaningful benefits. I have argued that any changes that this Bill would introduce are limited. Some are impossible to deliver, some are inappropriate, and the tangible benefits that might arise from others are unclear at best. The Bill will not of itself improve patient safety; it will not of itself improve treatment or services; and it will not of itself influence Ministers to agree to more generous ex gratia payments for this patient group. I refer again to the review currently under way. For these reasons, I respectfully suggest to the noble Lord that there is no need for recourse to legislation on the issues that he has brought before us.
Lord Morris of Manchester
My Lords, the speech of the noble Earl, Lord Howe, will cause further despair in the haemophilia community. He will see tomorrow morning in the Official Report the references that I made again and again about the situation in Ireland. The quotation that the noble Earl came out with is somewhat dated. He will find that the timing, the reasons and the case for action taken in the Irish Republic was already on the parliamentary record. He quoted a former Minister. I have been in touch with present Ministers and with Brian O’Mahony, the chief executive of the Irish Haemophilia Society. The Minister can be certain, as I said, that notwithstanding everything that he has said this morning, if the struggle has to go on, then go on it will until right is done to the victims of this worst ever treatment disaster in the history of the National Health Service. I beg to move that the Bill be referred to a Committee of the whole House.
Building Regulations (Review) Bill [HL]
(14 years ago)
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Lord McKenzie of Luton
My Lords, it is with great pleasure that I rise briefly to support my noble friend Lord Harrison. He makes a powerful case for his Bill, which I support. I also pay tribute to his commitment to the cause of fire safety, which he demonstrated again towards the end of the previous Parliament in a Bill truncated because of the general election. Like my noble friend, I take this opportunity of placing on record a tribute to the fire and rescue services, their dedication, their bravery and all they do in keeping so many of us from harm’s way.
If I may say so, I think the approach of this Bill is better than that of the previous Bill. It is seeking a review of the building regulations and an impact assessment of the possibility of automatic fire suppression systems being included for new residential premises. It sets out the matters which should be included in this assessment, but allows for factors outside the list. I have no doubt that the Minister, in giving a government view, will be able to refer to the evidence base which is anyway being assembled in connection with a review of Part B of the building regulations, but there is no reason why this could not be encompassed within the assessment that my noble friend is seeking in the Bill. While Part M of the building regulations is not due to be formally reviewed until 2013, the long lead time needed for changes would not seem to be inconsistent with the 12-month timeframe called for by this Bill.
The BRE research that underpinned the previous update of the building regulations was a bone of contention, and there was no meeting of minds about whether its analysis took account of all the evidence. The Bill presents an opportunity to move on from that, and it is encouraging that the Chief Fire Officers Association is now working on a project with the BRE to update the research. Perhaps the Minister would also take the opportunity to update us on progress on a couple of the research projects that were in train when we left office, particularly the trialling of low-cost sprinkler systems in Lancashire, Kent, Suffolk and Northumberland and the commissioned research looking at the cost-effectiveness of sprinkler systems in high-risk buildings.
My noble friend’s Bill rightly calls for an impact assessment looking at costs and benefits. I have no doubt that we will hear other contributions today which remind us of the fragility of the current housing market and the challenges facing the housebuilding sector, which were not made any easier by the draconian cuts to capital for affordable housing of which we were informed just this week. It is also right that we consider these in the longer-term context. My noble friend’s earlier Bill focused on sprinkler systems for new residential property, not the retrofitting of existing homes. Whatever the conclusions of the review and the impact assessment, we need to continue with a robust, proactive fire safety strategy. That involves efforts to reduce the incidence of fire through education, information and publicity, and in particular reminding people of the importance of having working smoke alarms installed in their homes and regularly testing them. We have seen a dramatic increase in smoke alarm ownership, helped in part by a pump-priming funding stream, which was then mainstreamed for fire and rescue authorities in the revenue support grant of those authorities.
My noble friend Lady Smith of Basildon will say more about this, but any assessment of the costs and benefits of sprinkler systems will doubtless give some regard to the capacity of the fire and rescue authorities to carry out their preventive activities at current levels. The cuts of 25 per cent in support grant will not make this easy. Making up the difference with council tax increases is hardly an option, especially with a squeeze on council tax benefit.
What my noble friend’s Bill seeks is entirely reasonable. It seeks facts and analysis about the impact of installing sprinkler systems in new residential properties and asks that this work be reported to Parliament when completed. It would seem consistent with, and could be accomplished together with or alongside, work streams that might already be under way in connection with an update of the building regulations. It presents the chance to try to resolve a difference of view that is not just about some theoretical or technical debate but about improving fire safety, saving lives and reducing the devastating consequences that a fire can inflict on individuals and families. My noble friend deserves our support and praise for his unswerving commitment to this cause.
Lord Tope
My Lords, I, too, give my thanks to the noble Lord, Lord Harrison, for introducing this Bill and for the full and careful way in which he did so and explaining how it differs from the Bill that he introduced before the last election. I am very grateful to the noble Lord, as I am sure we all are, for meeting those who moved amendments to the previous Bill and for meeting so many of those concerns in the Bill that he has presented. We must all be grateful for that. I am pleased, too, to hear that the Chief Fire Officers Association has formed an interest group to carry forward this research and to update the research that was carried out in 2004 by the Building Research Establishment, implemented in 2006. As both previous speakers said, that research was in part controversial and certainly needs to be looked at again, and I am very pleased that the Chief Fire Officers Association has taken the initiative in doing that. I am even more pleased that it is being done at no cost to the taxpayer, particularly in view of the announcements this week. I should be interested to know when the results of that research will be available, because I am sure that we will all look at it with very great interest.
I hope that the Minister will confirm not only that his department will take part in this research, but that it will play a positive role and, in so doing, dispel the belief that exists in some quarters—wrongly, I am sure—that CLG is somehow anti-sprinkler. It would be a reassurance to all of us to know that CLG welcomes the initiative of the Chief Fire Officers Association and will play a positive role in it—not necessarily an uncritical role, but a positively critical role.
All of us recognise the important part that sprinklers play in the control of fire. Noble Lords will know that my background is in London; I am a former Member of the London Assembly and before that was a member of the London Fire and Civil Defence Authority, so I have some limited interest and knowledge in all this, and I have consulted the London Fire and Emergency Planning Authority for its view. LFEPA tells me that sprinklers control 99 per cent of fires in buildings fully protected by sprinklers, and that losses from fires in buildings protected by sprinklers are estimated to be one-10th of those in unprotected buildings. LFEPA—and I remember former Mayor Livingstone saying that it sounded more like a tapas bar than a fire authority—advocates that sprinklers should be fitted in domestic properties where the most vulnerable live, in addition to smoke alarms. The noble Lord, Lord Harrison, in introducing the Bill, made the case very well. LFEPA says that the impact of fire is grossly disproportionate, in that 30 per cent of fire victims have limited mobility, whether through age, physical disability or loss of mobility occasioned by drink or drug abuse, which may be more the case in London than in many places. In all those cases, smoke alarms alone are not likely to be sufficient. Again, as the noble Lord pointed out, the demography of our nation means that this problem is, sadly, more likely to increase than decrease.
Few of us would disagree that the greater and more effective use of sprinkler systems is desirable. The real question is how best to bring that about. I know that neither this Bill nor the Chief Fire Officers Association necessarily seeks further legislation or regulation, but perhaps better regulation. Whether that needs another expensive government review—or, indeed, whether such a review needs to be expensive—I do not know. Whether it is necessary so soon after the implementation of the 2004 review, I am less sure. Certainly, we should have the outcome of the CFOA review first.
I now digress a little, as this is a Second Reading debate. We will all agree that fire prevention is even better than fire control. I have been approached by NICEIC, which has regulated the UK electrical industry on a voluntary basis since 1956. It tells me that in 2007 there were over 43,000 fires of electrical origin in the UK, nearly 8,000 of which were due to electrical fault. NICEIC believes that it is imperative that standards of electrical installation work are not impacted on adversely by potential future changes to the building regulations. It believes that building regulations can be improved to reduce the burden on local and central government, as well as to the tradesmen belonging to a competent persons scheme. Those schemes are working well, but better regulation enforcement and promotion are needed. There is a need to ensure compliance and consistency in the building regulations so that practitioners, as well as consumers, can have confidence in the standards of the electrical work carried out. NICEIC contends that if industry were to take responsibility for the future development of the technical requirements contained in approved documents, such as approved document P, there would be greater clarity and industry support, thereby ensuring consistency and compliance. This would reduce the burden, in terms of staff time and costs, on central government.
I am sorry that I was not able to give the Minister notice of this concern and, of course, I do not expect him to respond today. However, I know that these concerns are known to his department and I should be grateful if he would arrange for me to get a response in due course.
I also know that my honourable friend Andrew Stunell in another place is undertaking a review of building regulations on behalf of the department. I happen to know, because I have known him for a long time, that it is a subject in which he has taken a personal interest for many years and on which he is very knowledgeable—something that I certainly do not claim for myself. I am sure therefore that the results of his review will lead to very much better regulation. Better regulation certainly does not mean more regulation, nor, necessarily, less regulation. It is what it says it is—better regulation. It is regulation that is clear in its objective and capable of effective enforcement, which of itself must therefore mean greater compliance.
I end as I began by thanking the noble Lord, Lord Harrison, for introducing this Bill and thus stimulating further debate on this very important subject.
Lord Best
My Lords, I congratulate the noble Lord, Lord Harrison, on bringing forward this revised version of his earlier Bill. During Committee on the noble Lord’s previous Bill, I moved an amendment to his proposal for a mandatory requirement for the installation of domestic sprinkler systems, changing this to introducing a review in consultation with representatives of house purchasers, tenants, housebuilders, housing associations and other interested parties to ascertain the feasibility of amending the building regulations. I am therefore very pleased with the noble Lord’s mark 2 Bill, which follows this line.
I declare an interest as chairman of the Hanover housing association, a charity which provides 19,000 homes for older people. My remarks relate particularly to the building of new homes for this age group, which, as the noble Lord has pointed out, is the main target for the changes in the building regulations which eventually may emerge from this initiative.
The housing associations, including Hanover, are keen to find ways to keep our residents safer and to lower the costs of damage if there are fires in our buildings. Sprinklers would achieve that. I would add a further point in favour of installation of sprinklers in new homes; that is, the advantage in terms of design. With sprinklers in place, it is possible to have open-plan apartments without the ventilated lobbies and cumbersome internal walls that are necessary because of current fire regulations. I have witnessed many excellent and well designed open-plan apartments for older people in Switzerland, Germany, Sweden, Denmark and the Netherlands, where architects and residents have been liberated from the requirements for boxed-in lobbies that use up space and restrict design options. I recommend that any reviews look at European experience and that from the US. Indeed, some American providers of care homes are now operating in this country and bringing with them a knowledge of sprinkler systems from which all of us can learn.
Perhaps I may list some of the questions which the review of the building regulations envisaged by this Bill would need to address. On capital cost, we need to know how much a new system will cost to install, but we also will need to know how much is likely to be saved on an average basis as a result of the installation. If each fire costs less because there is less damage, quite apart from the saving of lives, that advantage means we need to know what savings will result. If there is a net additional cost to the provision of the new homes, we have to ask whether this is affordable at a time when we are trying to invest more in other ways in new housing—namely, in the sustainability of new homes and moving up to the levels of the code for sustainable homes—and in investment in accessibility of new housing to achieve full lifetime home standards, meaning that all homes are spacious enough and well planned enough to accommodate all mobility problems that any of us may encounter in our lifetimes. Will something else have to give if we add expenditure on sprinkler systems to the capital costs of each new home?
The Hanover housing association and all housing associations, not least because we are very worried by the cuts announced earlier this week, are having to look at the capital costs of everything that we do with the utmost care. We are trying to trim any possible frills in anything that we build and we would need to be convinced that the cost benefits are really there before adding any extra burden to the total expenditure.
Leading on from that, there will be ongoing costs. What will these be in terms of maintaining the system? For example, there may be repairs if pipes burst, perhaps because they always have to be kept filled during the winter months, and regular checking and servicing of the system to see that it works. There also may be offsetting costs. For example, will insurance companies reduce premiums because fire claims are likely to be fewer and smaller? But if there are net costs—I gather that the estimate for servicing the systems will work out at around £150 per annum or £3 per week—will this be welcomed by the occupiers who have to pay? Does research with consumers and residents suggest that they would see this as a priority for extra spending?
At Hanover housing association we are having to increase service charges in many of our schemes because help from the Supporting People grants has become tighter. Residents never like to pay more. While £3 per week could well be worth paying, before adding it to the rising costs facing tenants we would need to get buy-in from those residents since they will be paying the bills. This is not the place to express my anxieties about the future for housing benefit, but it is possible that the support for tenants’ rents will be reduced in the future. If so, adding any additional burden might be impossible.
The noble Earl, Lord Cathcart, in the earlier debates pointed out that expenditure here would not reach any existing homes. Some 85 per cent of existing stock will still be with us in 2050. One has to ask whether the same amount of investment going into a relatively small number of new homes might not do more good if it were to be spread among the most hazardous buildings and existing accommodation where fire hazards may be greater. There will be opportunity costs involved here.
In talking to colleagues, questions have been raised about behavioural aspects of this issue and how people may react to the introduction of sprinkler systems. For example, at present, if a smoke alarm is triggered in a development of apartments for older people, the advice for all those adjacent to the fire is to stay put. The doors of the flats will hold back the spread of fire until help arrives. It is not a good idea for older people to pour out of their flats and try to get out of the building. Will the presence of sprinklers, whether they go off or whether residents believe that they will go off, lead to more people trying to get out of their flats when a fire alarm sounds? Could that lead to more accidents and harm than the current system? Could our own forgetfulness and occasional ineptitude mean that sprinklers could cause as much damage as they prevent—for example, when the toast is badly burnt and smoke fills the kitchen? Will residents worry about false alarms and systems soaking their flats for no good reason? These are some of the points that I hope a major review could investigate.
I support the noble Lord, Lord Harrison, in pressing the case for this review. I certainly pledge the expertise of my organisation, Hanover, with its excellent architectural advisers such as Sidell Gibson and PRP—as well as, I am sure, the input of the very articulate and well informed residents in our retirement housing—to assist in any way we can. I wish the Bill well.
Lord Hoyle
My Lords, as I am the last to speak before the Front-Benchers, your Lordships will be pleased to know that I am not going to make a very long speech. If I did, I would be as popular as the fourth official at the Reebok Stadium if Bolton Wanderers were beating Manchester United one nil and he allowed four minutes’ extra time.
However, I could not not be here this morning to support my noble friend, having supported him in his previous Bill, because it is very important that we examine this proposal. His proposal now does not go as far as his previous one, which called for it to be mandatory policy to fit sprinklers, but goes along with building regulations. The noble Lord who just spoke raised some interesting questions. He asked: would it be better, instead of putting sprinklers in every new house, to look at the most hazardous buildings and fit them there, where more people might be at risk? That is certainly something that we need to look at. I hope that the Minister's speech does not concentrate solely on the cost. There is a cost—that has been illustrated—but what is the cost of losing a life? That is what we have to pose everything against.
I am very pleased that my noble friend has the support of the chief officers in the fire services, because none of us here can pay enough tribute to them for their work, and we must take note of their going along with proposals under which they feel that we could make people safer against fires. It is quite right that my noble friend concentrated on the changing circumstances of society. Elderly people will remain in their homes for longer. They will be more vulnerable because of that, especially to fires—or they may cause fires.
I raise another instance that can arise with fires, which involves young couples with children who are in different rooms. It is difficult to get them out in time. As my noble friend said, it can take up to 10 minutes for the fire service to arrive, but a sprinkler can prevent that fire in three minutes. Imagine the anguish that people face if they have children in other rooms. Sometimes they have to decide which room they can get into and which child they can save. If sprinklers begin to help to save their lives, that will be very well worth while.
My noble friend was also right when he said that the examinations that have been made under building regulations are not up to date in looking at the appropriate facts. We must look at the fitting of sprinklers not only in this country but where it has been mandatory, in Vancouver and certain parts of Arizona. There, we see quite a different efficiency applied to sprinklers. They say that fire deaths have all but been eliminated, that injuries have been reduced by 85 per cent, that there has been an improvement in fire fighters' safety and that property damage has been reduced by 90 per cent. Those are figures that we must take into account when reaching a decision on this matter.
My noble friend is not calling for something that is mandatory at this stage, but for a new look at sprinklers. He is not asking for a complete review—I know that the Minister may say in reply that they have had a review and that it is complete. All my noble friend is asking for is for us to look again at the question of fire safety in relation to sprinklers. Finally, if the facts that we have available from other countries that have tried it out have shown that lives can be saved and property damage reduced, that would be worth while and certainly ought to be looked at in depth, because if we can save one life as a result of this debate, this Bill will have been very worth while. I welcome it.
Baroness Smith of Basildon
My Lords, the Bill before us today is the result of discussions on amendments made to the Bill introduced by my noble friend Lord Harrison in the previous Session of Parliament. I add my appreciation of the work that he has done and endorse the comments made by other noble Lords. His tenacity and commitment on this issue is to be congratulated.
His Bill, the Building Regulations (Amendment) Bill, sought to amend the building regulations to make the installation of domestic sprinkler systems in all new domestic buildings a mandatory requirement. The Bill before us today, the Building Regulations (Review) Bill, would ensure that building regulations are being reviewed and that the latest and most up-to-date research available is used to assess whether it is effective—including cost-effective—for sprinkler systems to be used in new homes.
Reading through your Lordships’ debates at that time, it is clear that there was considerable support in your Lordships' House for fire reduction measures and sprinklers, and with good cause. As my noble friend Lord McKenzie stated in the previous Session, we have common cause on this issue. That has been clear today as well. There were some concerns about the precise focus of the Bill. I congratulate my noble friend Lord Harrison on bringing forward this measure today, to which I hope that the Government will give speedy passage and effect.
There are very good reasons to ensure that the Bill becomes law. The statistics for the number of fires show a huge fall—it is quite remarkable. A number of factors are responsible for that. Fire safety legislation has been brought in, including legislation on smoke-retardant furniture, which has meant fewer incidents of furniture catching fire quickly. The fire service has done incredible work promoting awareness of fire safety. Of course, the promotion and installation of smoke alarms has also had a major impact. As a result of all those measures, the number of fires in England has been steadily falling. Last year, in 2009-10, it was down by 3 per cent on the previous year, and there were 32 per cent fewer fires than 10 years ago, although there were some annual fluctuations. Even more welcome is the ongoing downward trend in deaths and casualties from fire incidents. Last year there were 55 per cent fewer deaths than 25 years ago.
I have been a patron of the Burned Children’s Club, an amazing charity based in Essex with a national reputation, which started in Basildon. The charity works closely with the fire service and provides support for children and young people who have been badly injured by fire. It was founded and is run by a remarkable woman, a former burns unit nurse, called Pat Wade. Many of us have seen the devastating effects of fire, but unless you have experienced it, it is hard to understand the impact it can have on a young life. A child who has been horrifically burned may be unable to use one or more limbs, or may have scars and injuries that create a host of medical and social issues for many years to come.
We also have to consider the impact on fire fighters themselves. When a fire fighter goes to work, they never know what they may face that day, but they have to be prepared to face any situation. They may spend the day advising on and installing smoke alarms, or maybe talking to schools and groups, but equally they may be required to enter a burning building. I have served as a Fire Minister both in England and in Northern Ireland, and previously on a fire authority for eight years. When a fire fighter dies or is seriously injured in the course of his or her duty, it is something that affects not just their family but their colleagues and the wider fire service family in a way that is profoundly and deeply upsetting. One of the reasons I feel so strongly about the need fully and properly to consider the issue of sprinklers in domestic properties is having met those whose lives have been forever changed by fire. If there is anything we can do to reduce the likelihood of such deaths and injuries, and make people safer in their own homes, we have a duty to do so.
The great hope has been that fire deaths have reached a plateau and that the efforts made will ensure that the numbers remain low, protecting both the public and the fire service, but the fear is that without greater efforts now, we could see an increase. My concern is that the risks are increasing, and there are a number of factors for why this is so. As we heard from my noble friend Lord Harrison, we have an ageing population and a greater proportion of older people who are more likely to be living at home. We also have a greater number of people with disabilities or with mobility problems who are living at home. Changes in social care reflect this pattern. We also now have more timber-framed homes, more people work from home, and we have to take on board cuts in fire service budgets.
The Chancellor, George Osborne, said in the CSR Statement, which was repeated in your Lordships’ House this week:
“In recognition of the important service provided by the fire and rescue service, we have decided to limit its budget reductions in return for substantial operational reform”.—[Official Report, Commons, 20/10/10; col. 953.]
At the same time, the Department for Communities and Local Government was sending out a notification of the cuts to be made to local fire authority budgets that amount to a staggering 25 per cent of the formula grant. Different fire authorities receive a different proportion of their funding through the grant, so the impact will not be uniform across the authorities. For my own authority in Essex, it amounts to about 13 per cent of the budget, at probably over £8 million. In Staffordshire, the cut will be around £4.5 million, and it will increase in each year of the spending review period. I understand that the Fire Minister has committed to working with the fire authorities on this, but I find it difficult to understand how such a level of cuts can ever be achieved through operational reform without impacting directly on the level of service that fire authorities will be able to provide.
We do not yet know what the cuts in the fire service will mean. Chief fire officers, along with the fire authorities, will look at how they can manage this in the best interests of the service, and the Fire Brigades Union will no doubt have to undertake an analysis of what this means for its members. Your Lordships will appreciate that this is very recent news and there has not really been time to digest and understand the full implications, but it is impossible to divorce the implications of such high and unjustified budget cuts from the need to take an urgent look at all ways to improve fire safety, taking into account the other pressures I have referred to.
No one wants to see unnecessary legislation or legislation that is overly bureaucratic or disproportionate to the issue. So, when looking at this issue, we need to examine the factors already referred to, as well as the cost to the economy, as we have heard, of fires and fire damage, which is substantial and runs into billions. Many buildings in this country already have sprinkler systems in place, and our building regulations recognise their contribution to fire safety. Where sprinkler systems have been installed, fire deaths have been almost eliminated, fire injuries reduced by 85 per cent, and there have been significant improvements in fire fighter safety. There is also a significant reduction in property damage, both by tackling the fire earlier and by using less water through sprinkler systems and the fire service. The evidence about sprinklers that is available already is encouraging, and the Bill before us today will enable us to use evidence from other parts of the world where fire sprinkler systems are already a statutory requirement.
My noble friend Lord Harrison’s Bill seeks to address these issues by examining, in a building regulations review, costs, benefits, the environmental impact, the impact on fire fighters and sustainability—in short, all the relevant factors. The noble Lord, Lord Best, expanded on these and raised further concerns that can be addressed in the review. I share his concern about fire sprinklers going off unnecessarily. Every time I cook in the kitchen, the fire alarm goes off. However, I am told that sprinklers are much more sophisticated than smoke alarms.
My noble friend Lord Harrison also referred to the cost issues and the support of the Chief Fire Officers Association. The work it is already undertaking with the BRE can be expanded to take into account the provisions of this Bill.
My noble friend Lord McKenzie referred to work that has recently been undertaken. I refer the Minister to the recent research, A Cost Benefit Analysis of Options to Reduce the Risk of Fire and Rescue in Areas of New Build Homes, with specific reference to the Thames Gateway. The research did not recommend that all new homes should have sprinklers. One of its reasons was that in the Thames Gateway the fire and rescue service level is relatively good, with adequate resources for relatively low levels of utilisation. However, if resources are cut, it will make it more essential that we look at other means of fire prevention and of protecting the public. When Part B has been reviewed—we know it is being reviewed now—will he promise the House that he will ensure that building regulations are reviewed and that the provisions in this Bill will be taken forward as part and parcel of that review?
My noble friend Lord Harrison has done this House and the interests of fire safety a great service in bringing this Bill forward. It provides the most relevant and up-to-date information and evidence that can be assessed and tested. I hope the House and the Government will give the Bill all the support it deserves.
Earl Attlee
My Lords, I congratulate the noble Lord, Lord Harrison, on introducing this Private Member’s Bill. Fire safety is clearly a matter of great concern to us all and I know that the noble Lord has taken a considerable personal interest in the subject. I am grateful for the way in which he has carefully explained the background to his Bill. He spoke movingly of the victims and the increasing vulnerability of the population, a point also strongly made by the noble Baroness, Lady Smith.
I shall not get drawn into a dog fight about the Budget because the noble Lord’s point is a technical one about how we can best reduce casualties. Fire safety strategies are starting to succeed: fire deaths in the home in England have halved since the 1980s and the long-term trend is downwards. However, there are still too many. In 2008, 213 people perished in accidental fires in the home—and, of course, one fire death is one too many. We all remember the events of 3 July last year and the devastating fire in Lakanal House, Camberwell, in which six residents tragically lost their lives; and then, on 6 April this year, firefighters James Shears and Alan Bannon died in the line of duty at Shirley Towers in Southampton. I join many noble Lords in their fulsome tributes to those in our fire service who have to take great risks indeed. As a noble Lord pointed out, they go to work and do not know what is going to happen that day; it is a complete mystery.
Recent statistics suggest that the long-term downward trend is beginning to plateau. We are anxious to see how deaths can be reduced still further and we will not allow the status quo to obtain; we will constantly look to see how we can reduce casualties. I am sure that that is exactly what the noble Lord, Lord Harrison, seeks to do with his Bill.
Since 1997, the key strategy to reducing preventable fire deaths has been through community fire safety activities. This involves efforts to reduce the incidence of fire through education, information and publicity. The noble Lord, Lord McKenzie, made important observations in this area, a key one of which was the need to regularly test smoke alarms. The installation of properly maintained smoke alarms in every household is at the centre of these efforts as they provide vital early warning of fire, enabling people to escape.
The Fire Kills campaign has, for some time now, conducted high profile campaigns promoting smoke alarms which have proved very successful. While building regulations have an important role to play, this kind of campaign benefits the whole population, not only the occupants of newly built properties. Ownership of smoke alarms in England now stands at 85 per cent of households and they can be purchased relatively cheaply. We are seeking to raise awareness of their value as evidence suggests that those who do not have them are often in the groups that are most at risk from fire. The noble Baroness, Lady Smith, spoke about how devastating fires can be to individuals and important charitable activities in Essex.
Initially a freeze was imposed on all government awareness campaigns while their effectiveness was assessed. However, I am pleased to say that the Cabinet Office’s Efficiency and Reform Group has recognised that the Fire Kills media campaign delivers measurable public safety benefits and we are, therefore, continuing to support this important and effective programme. The national campaign developed by DCLG will work with the fire and rescue services and the commercial and voluntary sectors to seek out new opportunities, creating hooks that can be utilised at the local level.
In these difficult economic times, an important part of the Government’s strategy for financial growth is to support business by adopting a deregulatory policy. The Government will regulate to achieve a policy objective only if it can be shown that regulation is the last resort. In addition, the one-in, one-out rule for regulation means that when the Government introduce a new regulation, they must first identify an existing one to remove so that the number of regulations does not increase. This groundbreaking approach makes it clear that all non-regulatory routes must be exhausted before any new regulation is brought in.
The Government are determined to make it easier to build the homes that this country needs. Appropriate building standards, applied sensibly, help both builders and communities, but they can be effective only if they are easier to understand. That is why we are committed to simplifying the process for housebuilders to meet the standards that communities rightly demand. This work to cut red tape will complement the review of building regulations launched by my colleague Andrew Stunell earlier this year.
We have called for views on how building regulations can be improved, added to or slimmed down. We have also asked for suggestions as to how we can deliver even better levels of compliance in the future. We will listen to these ideas and those from the Cabinet Office’s Your Freedom and my own department’s Cut Red Tape exercises. We plan to announce the results around the end of the year. It has been suggested that there should be greater requirement for sprinkler protection in building regulations for residential and domestic buildings and for public and commercial buildings. These comments will be given due consideration, but there is little new evidence to suggest a need for change.
I am well aware of calls for the building regulations to be amended to require sprinklers to be provided in new dwellings and other new domestic buildings. We recognise the significant role that they can play in life and property protection and in public safety. We do not consider that it is necessarily for the Government to dictate to the business sector how to manage its business risks. If the fire industry or fire and rescue service consider that greater fire protection would be good for UK businesses, they should take the case directly to building owners rather than to Government.
There are already provisions in the building regulations for the use of sprinkler protection. Part B deals with fire safety and Requirement B3 covers internal fire spread within a building. This already sets out that, subject to the size and intended use of the building, suitable fire suppression systems such as sprinklers and sub-division by fire-resisting construction should be provided. The Department for Communities and Local Government also issues guidance in the form of Approved Document B, which sets out what is considered to be a reasonable provision to satisfy the requirements of Part B. Sprinkler protection for certain non-residential buildings has been included within this guidance for some time to cover those premises where such a provision is considered proportionate to the risk to people in and around the building from fire.
Provisions for sprinkler protection in domestic and residential buildings are also given in the latest edition of Approved Document B which was published in 2006. This included provision for sprinklers to be installed in tall blocks of flats over 30 metres in height and included their use as an option in residential care homes. This option offers an alternative to an otherwise more onerous set of standards for care homes introduced at the same time.
This is just one of a range of measures that can be varied where sprinkler systems are installed. The benefits that such installations can offer are explained in the approved document and the guidance is structured so that those benefits are realised in reduced construction costs.
The changes made in 2006 drew on an extensive four-year research project looking at residential and domestic sprinklers from both an effectiveness and cost-benefit perspective. Since then, the previous Government also commissioned a project looking at the installation of sprinklers as an active protection measure where large numbers of houses were being built at one time. It had been suggested at the time that sprinklers might provide an option to address the fire and community safety needs of areas such as the Thames Gateway and perhaps avoid the need for increased fire and rescue services. The study concluded that this was not a cost-effective solution. The noble Baroness, Lady Smith, also referred to that and I will read what she said carefully in Hansard.
Noble Lords will appreciate that, given the work that has already been done in this area and the absence of compelling new evidence, the Government are reluctant to commit more time and energy revisiting the same question. However, we note the news that the Chief Fire Officers Association has commissioned a further review, funded by industry, to update and expand the available evidence base. In answer to my noble friend Lord Tope, officials from the Department for Communities and Local Government are fully engaged with the project team working on this new review and have offered their assistance in developing as robust an analysis as possible. We await the results of that work with interest.
We will continue to monitor the situation and the effectiveness of the various strands of fire safety policy. I accept that we are likely to return to this issue and we recognise that the issues listed in the noble Lord’s Bill are among those matters that are likely to be addressed. However, I question whether it is either wise or prudent for any Government to commit themselves to a specific timeframe to commence a review, given the inevitable need to respond to changing priorities. I also question whether it is not more appropriate for the fire protection industry and the insurance sector to consider some of these matters for themselves.
The noble Lord, Lord Harrison, mentioned the £7 billion cost of fire. In 2004, the total cost of fire in England and Wales was estimated at £7 billion, but it is important to understand that this figure incorporates all costs associated with fire. The consequences of fire are just one component of that figure; they were estimated at £2.25 billion. The £7.03 billion figure includes the costs of providing fire protection and fire and rescue service interventions. Introducing the requirement for more fire protection in buildings could only increase that overall bill.
In his interesting intervention the noble Lord, Lord Best, properly identified some difficulties involved with installing and, most important, maintaining sprinkler systems. I hope that his organisation will contribute to the study. In response to my noble friend Lord Tope—I think that I have touched on this—Andrew Stunell will make a statement around the end of this year to set out his intentions for the building regulations. It will include plans relating to electrical safety.
In one of the points made by the noble Lord, Lord McKenzie of Luton, he asked about the projects on low-cost sprinklers and on the cost-effectiveness for high-risk premises. I understand that both of those projects were essentially complete when the noble Lord was still in post and that there is now an expectation that further work in that respect is being taken forward by the Chief Fire Officers Association and the fire protection industry.
Many noble Lords touched on the issue of costs. There appears to be some doubt about how much domestic sprinkler systems cost. Estimates vary greatly, from less than £1,000 to well over £3,000. Of course, I accept that costs are likely to fall with volume. However, if we were to build 150,000 homes in a year and assume a typical unit cost of £2,000, that would cost the country £300 million every year. In answer to the noble Lord, Lord Hoyle, on the costs that we consider for human life, we have to look for the most cost-effective technical solution and for where the greatest risk lies, which is not necessarily in new buildings.
The cost of carrying out the work set out in the Bill should not be ignored. I refer to the earlier work that was commissioned by the previous Government to look at sprinkler protection in areas of rapid growth such as the Thames Gateway. I understand that this comparatively simple project cost in the order of £100,000 of taxpayers’ money. In my opinion, to commit many more times this sum to go over old ground so soon would be an irresponsible use of public resources.
The noble Lord, Lord Harrison, mentioned the experience in Vancouver. While experience from other countries is obviously valuable information, we must consider the level of uncertainty of the statistics derived from the comparatively small sample size.
Many noble Lords, including the noble Lord, Lord Harrison, and the noble Baroness, Lady Smith, talked about timber-framed buildings. This is an obvious problem. The new Government are aware of the concerns about this type of building and will tackle them head-on. We intend to work with industry to establish whether there is evidence of specific risks associated with timber-framed buildings and how best to address them. We are also actively awaiting a London Assembly report on this issue, and we will look at its conclusions carefully.
The Government take fire safety issues very seriously. We all understand the injury, the heartache and the damage that fire causes, and we are keen to explore new and innovative ways to reduce the toll. At present, however, we must focus on our priorities. While we agree with the desire to answer the questions set out in the Bill, we must express strong reservations about the provisions in it of a statutory commitment for the Government.
Lord Harrison
My Lords, this has been an excellent and wide-ranging debate, and I am grateful to the noble Lord, Lord Tope, for bringing his experience of local authorities and London to the table. I am pleased to have heard once again the noble Lord, Lord Best, who asked pertinent questions and who was prepared to avail us of the information from the housing association that he is associated with, as well as the consumers who are affected by any changes that might be made.
I am grateful to my noble friend Lord McKenzie of Luton, who brings with him his own expertise, having wrestled with this in the past. Clearly the mantle has been passed well to the noble Baroness, Lady Smith of Basildon, as her contribution shows.
I noted that the noble Lord, Lord Hoyle, went five minutes over time in making his contribution, which would have given Manchester United ample opportunity to score more goals. However, it is relevant to point out that in the past, as many of us will remember, incidents such as the dreadful fire in the Bradford football stadium led to legislation and work with the industry to ensure that spectators were not incinerated in future. That is why it is important that again we wrestle with these issues.
I will not give a deep analysis of the Minister’s reply. I will say, though, that he talked about an absence of new evidence, and we are happy to bring that new evidence forward. I congratulate him on, and I am grateful for, the proper sense of inquiry that he has shown today. He is cautious, but we will attempt to persuade him, to ensure that we can achieve the aims of the Bill and to put a time limit on action, because we think that these things are urgent.