Health: Diabetes

Debate between Lord Morris of Manchester and Earl Howe

Thursday 14th July 2011 Lords Chamber

[Lord Morris of Manchester]

To ask Her Majesty’s Government what further action they are taking to help patients with diabetes.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

To support the NHS in improving outcomes, NICE has published a quality standard for diabetes, providing an authoritative definition of good-quality care and building on the existing national service framework. This year, the NHS operating framework specifically highlights the need to do more to improve in-patient care for people with diabetes, the availability of structured education and retinopathy screening for everyone with diabetes, and access to therapies, including insulin pumps.

[Lord Morris of Manchester]

My Lords, I am grateful to the noble Earl for that Answer. Is he aware that 1.4 million people with diabetes are now at risk of preventable blindness, over a million of kidney disease, and up to 8,600 a year of having a foot amputated due to delayed diagnosis and treatment; and that doctors of distinction in this specialty insist that, with adequate resources, they could do much more to maximise prevention and treatment? Knowing as I do the depth of the Minister’s own concern for this policy area, when does he expect to be able to announce specific new measures to help the rapidly increasing number of children afflicted?

[Earl Howe]

My Lords, Ministers often express thanks to those noble Lords who table Questions but I owe a particular debt to the noble Lord, Lord Morris, for highlighting one of the greatest public health challenges of our time. He is absolutely right in all that he has said. I alight particularly on his point about prevention. We are committed to preventing type 2 diabetes. All our work on promoting an active lifestyle and tackling obesity will support that aim. The NHS Health Check programme has the potential to prevent many cases of type 2 diabetes and, as the noble Lord said, to identify thousands more cases earlier in their development. The Change4Life programme—the campaign that started under the previous Government, which we are continuing —raises awareness of maintaining a healthy weight and being physically active. A great deal of work is going on in this area, which is one of the major focuses of our public health programme.

Health: Hepatitis C

Debate between Lord Morris of Manchester and Earl Howe

Monday 20th June 2011 Lords Chamber

[Earl Howe]

My noble friend is absolutely right that there is a range of estimates of both the incidence and the prevalence of hepatitis C. I could spend some time explaining why that is, but it is partly to do with the long incubation period of hepatitis C, the symptoms of which do not manifest themselves for many years. My noble friend is also right that prisons tend to be a repository of this condition. In recent years, the story there has been good. The provision of information for prisoners and prison staff on hepatitis C and other blood-borne viruses has increased. There has also been increased access to hepatitis C testing for prisoners. We have had improved access to treatment for prisoners with hepatitis C and to drug treatment generally, which is of course absolutely germane to this condition. I believe that the focus is there, but that there is more to do.

[Lord Morris of Manchester]

My Lords, can the Minister tell the House how many patients infected with hepatitis C by contaminated NHS blood have since died in consequence?

[Earl Howe]

My Lords, I am sure that the noble Lord will know that precise figures are not available for that group, but I hope he will also recognise that we have taken steps to improve the financial help available to these unfortunate victims of the contaminated blood disaster of the 1970s and 1980s.

NHS: Chiropody and Podiatry Services

Debate between Lord Morris of Manchester and Earl Howe

Tuesday 26th April 2011 Lords Chamber

[Earl Howe]

I am grateful to my noble friend. She will know that the injuries sustained by our service men and women in the theatres of conflict form a high priority for the National Health Service and the Defence Medical Services. Indeed, chiropody and foot care will play a large part, I am sure, in ensuring the mobility of those wounded personnel. The key will be to ensure that there are sufficient chiropodists and podiatrists to deliver the services required, and that requires a process of local determination and prioritisation to ensure that workforce numbers meet healthcare needs.

[Lord Morris of Manchester]

My Lords, I have an interest to declare as president of the Society of Chiropodists and Podiatrists. Can the Minister give the House the Government’s estimate of the number of NHS patients who have suffered preventable amputations due to lack of state-qualified podiatric care?

[Earl Howe]

My Lords, it is obviously difficult for me to give the noble Lord a precise figure but his central point is absolutely correct. We know that many people suffer needless amputations who, if they had had early intervention, would be spared that appalling outcome. The role of chiropodists and podiatrists, as he will know more than anyone, is in the field of prevention not least for patients with diabetes but also in the care of the elderly to ensure mobility and proper foot care.

Blood and Blood Products

Debate between Lord Morris of Manchester and Earl Howe

Monday 10th January 2011 Lords Chamber

[Lord Morris of Manchester]

My Lords, I have two interests to declare, both non-pecuniary: as president of the Haemophilia Society, and as the architect of the independent public inquiry into the contaminated blood disaster headed by my noble and learned friend Lord Archer of Sandwell.

Is the Minister aware that, of the 1,241 haemophilia patients infected with HIV, only 361—29 per cent—are still alive, and that the number of deaths in the hepatitis C-infected community is much higher and continues to rise? Is he further aware that, as of now, an estimated 2,007 people have died from being treated with contaminated NHS blood and blood products? I congratulate the Minister on the progress that he has made, but will he now meet the haemophilia community and listen again to its plea for a response that is more in keeping with the scale of the disaster?

[Earl Howe]

My Lords, the noble Lord, Lord Morris of Manchester, to whose efforts I pay particular tribute in the context of this debate, as in many other contexts, has reminded us of the devastating effect of this tragedy on individuals and families. The previous Government recognised this and significantly improved the payments that were available to the victims of this disaster. We felt that there was still further to go, hence today’s Statement. We have arrived at this point following a brief but nevertheless thorough review of the arrangements, informed by a scientific report which is also published today—noble Lords can read the advice that we received—to enable us to understand rather better the suffering that these victims endure in clinical terms as well as in human terms. On the basis of that, we have arrived at the arrangements whose details I have repeated.

We believe that this is a fair and reasonable package of support for these poor victims. We do not intend to revisit it in the future. I acknowledge that some people might have different views on the appropriate level of payments for this patient group, but the package needs to be considered in the context of the whole range of support that is available for the group, especially Department for Work and Pensions benefits, the care available under the NHS and the care available from social services. Having consulted widely, we consider that the sums announced in this package, taken in the round with the other support available to this patient group, are both appropriate and reasonable. So, while I understand the noble Lord’s request, I am not in a position to accede to it at this point.

Contaminated Blood (Support for Infected and Bereaved Persons) Bill [HL]

Debate between Lord Morris of Manchester and Earl Howe

Friday 22nd October 2010 Lords Chamber

[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.

Health: Contaminated Blood Products

Debate between Lord Morris of Manchester and Earl Howe

Wednesday 2nd June 2010 Lords Chamber

[Lord Morris of Manchester]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and, in doing so, declare a non-pecuniary interest as president of the Haemophilia Society.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, we have decided not to seek leave to appeal the judgment, and we shall be writing shortly to let the court know of our decision. We are considering our response to the judgment and will announce our decision in due course. In the mean time, ex-gratia payments will continue to be paid at current levels to those affected.

[Lord Morris of Manchester]

My Lords, I am grateful to the noble Earl and congratulate him on his well merited ministerial post, which I know he will grace with all his customary integrity. Is he aware that 1,982 haemophilia patients have now died from being infected with HIV and hepatitis C by contaminated NHS blood products in this worst ever treatment disaster? Given the High Court’s landmark judgment, the wide all-party acclaim for the Archer inquiry’s findings and David Cameron’s strongly positive response to the Haemophilia Society’s pre-election call for urgent new help for the afflicted and bereaved, can the Minister confirm that there will be no delay now in ensuring a just settlement for this cruelly stricken and arguably most needful minority in Britain today?

[Earl Howe]

My Lords, perhaps I may begin by thanking the noble Lord for his kind words. I am sure he knows how seriously I take these matters. I hope he can take as read my wish to see that those whose health is suffering as a result of this tragedy are properly looked after by the NHS. I know that the noble Lord will understand that we are looking at the court judgment. It is early days yet, but we are considering very carefully what the court has said and I cannot be of more help to him at this stage than I already have been in my earlier Answer. I stand ready to talk to him, either inside or outside this Chamber, on these important matters.