Organ Donations

Lord Markham Excerpts

Tuesday 12th December 2023 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

I add my thanks, particularly for all the work that the noble Lord, Lord Hunt, has done, not just in bringing this debate today but, obviously, in putting the Act through in the first place. On a personal note, one of the pleasures of this job is looking into an area that is fascinating and something we are all involved in and have experiences of in our everyday lives. There are lots of hard things about the job, but sometimes these are the fun bits.

Coincidentally, I am visiting the NHS blood transfusion service’s Bristol operation on Thursday—so this is very timely. I will put a lot of these challenges directly to them. Obviously, I am speaking personally here, but what we have seen is a mixture of the disruptions of Covid and quite a change in the leadership of the blood transfusion service. The service has been undergoing quite some changes, and it would be good to test the temperature to see just how much it is on this.

One of the things I would probably like to do is set a challenge—“Where are you on this?” Maybe they will give us some fantastic answers; it is always best to hear things from the horse’s mouth. As I say, there is a relatively new CEO and maybe they will give us some fantastic answers and I can just report back to the House—that would be fantastic. I suspect what we really need to do is to say, “You have a couple of months”—or whatever—“to take this away. These are all the issues that were raised. Come back and make a presentation to us”. We could do that as a round table, because I think that is something we would all find illuminating—putting them through their paces.

The noble Baroness, Lady Merron, reminded us of the Churchill quote—it is not the end, or even the beginning of the end; it is the end of the beginning. My gut feeling is that the Act was almost a case of “Right, we’ve done this now and it will all look after itself”. Of course, there is a lot of underlying issues from there. We had Covid, and suddenly everyone was focusing on other things. This is why this debate is very timely: we need to turn our attention back on this and say, “Actually, now, thankfully, we are getting back to normal. How do we need to look at this?”

As many noble Lords have picked up, the real disparity seems to be in the involvement of the family. If the person has consented anyway through other processes, they are much more likely to follow those wishes and rates go up to 90%. If they have not given their consent, and so the family do not know, it is much more like 60% or 61%.

That real disparity, I have been told, means that we need to do comms campaigns all around increasing the level of people proactively going out to do that. It could be when they apply for driving licences or passports, or in other interactions. By doing that, it is much easier for the family; they know that that person made their wishes perfectly clear. As I say, 90% of the time the family then go with it, because they understand those wishes. That is really the thinking on the major facts in the comms campaign.

Within that, it is also about trying to make it as easy as possible. A new lens needs to be used for looking at the whole customer journey, for want of a better term, to make it as user-friendly as possible. The noble Lord, Lord Allan, mentioned some of his Facebook experiences about how you do this. There is a complicated process for which organs you can opt in and out on. Is that needed? Again, there is an argument for giving people choice. I am told that people have an aversion to giving corneas. They will approve a lot of things but are more disturbed by the thought of giving their eyes. I think people like having that choice, but this is almost about having a “yes to all” tick box as the automatic default option here.

Before I reply formally to some of the questions, another observation I make is that, although I am not saying that this should be driven by economics, the economics are clear: transplants save a lot of money as well, particularly in the case of kidney transplants. That is because you have people who are having a lot of dialysis and other treatments. In my research for this debate, I was told that the economics are very clear. It is worth investing in the resource behind this, because the transplant is not only much better for ongoing life; it actually saves the NHS money, because patients are not having to go for those future treatments.

I mentioned my meeting with the staff. The noble Lord, Lord Weir, made points about the recommendations of the Organ Utilisation Group. I am told that DHSC, the blood transfusion service and NHSE have accepted those recommendations and are working towards ensuring that they are implemented. A lot of the time, this is about trying to make sure that we are maximising it. As the noble Baroness, Lady Merron, said, it is not just the number of people who consent but the utilisation. They have managed to increase the number of organs used to about two and a half per person right now. It is about not just converting those people who have consented but how you utilise it, so they are working on that.

On the resource for this, at the moment there are 330 specialist nurses—it is accepted that you need a specialist nurse to do this—and 55 clinical leads. Clearly, that should be one of the things we challenge when we meet on this, given that the economics are clear. On the marketing, again, attention is being turned more towards that. After Organ Donation Week, the impact of that campaign was a 22% increase in registrations. As I said before, it was very much focused on trying to persuade people to proactively go out and consent, because it is much more likely that the families will go along with that when they do so.

There are a lot of small things in this; there is no silver bullet. It is about trying to get across them all. As was mentioned by the noble Lords, Lord Weir and Lord Allan, there is quite a disparity for black and ethnic-minority people, which we need to understand further. I was wondering about the point made by the noble Baroness, Lady Merron, on the disparities between regions. My hunch when looking at that sort of data is that there are younger populations in London and the Midlands and an older population in the south-west, so is there something going on with the age profiles? Perhaps those are driving a difference in behaviour, so maybe the comms campaign needs to try to target certain people some more.

Some international comparisons were mentioned. For me, the biggest lesson is in another point made by the noble Lord, Lord Allan: these things are so cultural as well. From my understanding, it took Spain a good 10 years or so to really do this. We need to think about all those cultural aspects in our campaigns. Just saying, “Now that we’ve changed the Act, it will go ahead and happen” is not a silver bullet. What we have really learned from all this is, as the noble Baroness, Lady Merron, said, that it is just the start. It is not the end of the journey. As the noble Lord, Lord Allan, said, it all comes down to trust in people—and trusting that the process is all there.

I hope I have managed to pick up most of the questions as I have gone through this. To me, the biggest thing is about putting the challenge down to the NHS blood transfusion service and giving it the time to do it properly. We can then invite its people back, and at that point we could invite all the noble Lords who are here today. I really appreciate this being brought up today, as we could do a lot more on it.

House adjourned at 7.37 pm.