Vaccine Damage Payments Act

Jane Ellison Excerpts

Tuesday 24th March 2015 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I congratulate all hon. Members who have taken part in this debate. In particular, I congratulate the hon. Member for Dumfries and Galloway (Mr Brown) on securing the time to discuss an issue that is never easy to discuss. Other Members have alluded to the fact that when I, as a Health Minister, have looked at schemes about population-level health, sometimes there are discussions about the impact on individuals within that population and those discussions are very difficult to have.

I also congratulate the hon. Gentleman on the tone in which he has conducted this debate and indeed on the way that he has represented families and individuals over some years because, as I say, sometimes these are difficult issues to discuss. He has chaired the all-party group in a constructive way and I am sure that that has been appreciated by successive Ministers.

Also, the hon. Gentleman has said it before in this House, but I was very pleased that today he reiterated his support and that of the all-party group for a public vaccination programme. We are lucky to have a comprehensive and world-class national immunisation programme. I note that the vast majority of people who have concerns about the issue that we are discussing today do not disagree with the need for vaccination programmes of that nature.

Such programmes are a vital way of protecting individuals and the community as a whole from serious diseases. Vaccination is recognised by the World Health Organisation as the most effective public health intervention after the provision of clean drinking water. It has led to the eradication or major reductions in infectious diseases that used to be a serious threat to public health. British parents no longer see their children being crippled by polio, because that disease has been eliminated from the UK and, thankfully, from most of the world. Before measles vaccines were introduced, there were as many as 750,000 cases of measles in England and Wales in epidemic years, and about one in every 1,000 children infected would die.

Vaccinations are now safer than they have ever been, notwithstanding—obviously—the concerns that have been expressed during this debate. However, I recognise that on the very rare occasions when vaccinations can cause severe disability, that places both the person themselves and their families under enormous strain. Right hon. and hon. Members have spoken about that most movingly during the afternoon.

Of course, that is one of the main reasons why the vaccine damage payment scheme was introduced. As others have said, it was intended to help ease the present and future burdens of those individuals who are severely disabled as a result of vaccine damage.

I am sure it has been said before, but it is worth clarifying for the House that the VDPS payment is not compensation and it does not prejudice the right of the disabled person to pursue a claim against the manufacturer of the vaccine, although I of course acknowledge the obstacles that many people face in doing that. The hon. Member for Dumfries and Galloway, who led the debate, spelled them out. However, such payments would of course be taken into account if compensation was awarded.

The scheme, introduced in 1979, provides a tax-free, lump sum payment—as others have said, it is now up to £120,000—for those who are severely disabled as a result of a vaccination against those diseases listed in the 1979 Act and those that have been specified since 1979 by statutory instrument. It acknowledges that people who are severely disabled early in life have less opportunity to earn and save, and the degree of disablement is assessed on the same basis as for the industrial injuries disablement benefit scheme.

The disability threshold is set at 60%. I understand, of course, that there are those who argue that the level of disability should be assessed on a sliding scale. However, such a sliding scale of disability and payments would run counter to the scheme’s principle of providing a straightforward single payment for those who the Secretary of State for Health is satisfied are severely disabled as a result of vaccination.

To qualify for the scheme, a person must have become severely disabled as a result of vaccination. As I think the shadow Minister, the hon. Member for Liverpool, Wavertree (Luciana Berger), acknowledged, that causative link is needed for the scheme to be workable, but it does make for some difficult cases and some difficult conversations. I understand that, but that causative link helps us to target public funds properly for people who suffer disablement as a consequence of vaccination.

As with all civil matters, the standard of proof for causation is “on the balance of probabilities”. So, based on the available evidence, does the medical adviser consider that vaccination caused the disability? Notwithstanding the suggestions made to change, improve or even replace the scheme, there would always need to be an assessment of causation and it would always be the case that for some people who had suffered a disability, it would be viewed that the cause was not vaccination. There would always be instances that did not meet that criterion.

The scheme does not require the medical adviser to be certain or sure but only to consider that it is more likely than not that vaccination caused disability. These independent medical advisers are well placed and experienced enough to make that judgment, which is not made by politicians but by people who are carefully trained. For example, doctors who assess claims must be approved to carry out assessments by the chief medical adviser to the Department for Work and Pensions, and that approval is only granted when they have demonstrated full competence. Also, those doctors are subject to strict 100% quality audits until approval is achieved. I say that to make the point that there is a considerable degree of both medical expertise and independence involved in those assessments. I can also confirm that mental health, which I think was mentioned by the hon. Member for Strangford (Jim Shannon), is taken into account in those assessments of individuals.

The payment scheme is not intended to address all the financial implications of disablement for those affected by vaccines, which we have heard about this afternoon, and, as I have said, there is nothing to prevent people from bringing claims, although I understand that that process is difficult, as has been outlined.

The scheme is only one part of the wide range of support and help available to severely disabled people in the UK. For example, as many hon. Members will be aware, disability living allowance provides an important non-contributory, non-means-tested and tax-free cash contribution towards the disability-related extra costs of severely disabled children.

The VDPS covers immunisation provided in the routine childhood vaccination programme against specified diseases. It also temporarily covered vaccination against pandemic swine flu during the swine flu pandemic in 2009 and 2010. Hon. Members have raised applications to the scheme from individuals who developed narcolepsy and cataplexy following immunisation that used the swine flu pandemic vaccine, pandemrix. I will take this opportunity to emphasise that we appreciate how distressing narcolepsy and cataplexy are, and we understand the concerns of those who have been affected, and the concerns of their families. The DWP administers the VDPS and takes professional medical advice on the degree of disability involved, and obviously the Department of Health is responsible for policy in this area.

Swine flu vaccines were developed specifically for use in a flu pandemic, when the number of lives that could be lost and the number of people who could suffer serious illness would have been enormous. In the circumstances, it was considered by Ministers at the time that it was suitable to extend the VDPS temporarily, but in the circumstances that currently prevail it is inappropriate for me to comment on individual cases; I hope the House understands that.

The Government are advised on all immunisation matters by the Joint Committee on Vaccination and Immunisation, which is a statutory and independent body. The JCVI is also a departmental expert committee, constituted for the purpose of advising the Secretary of State for Health, and it keeps all immunisation matters under review, providing advice and recommendations to Ministers on all current and potential programmes, and advising the UK health Departments on national immunisation policy, including the safety and efficacy of a programme.

The Department of Health ensures that all its information on vaccination is clear that vaccines may have side effects, which thankfully are usually minor. However, the fact that a vaccine has been licensed shows that the benefits have been assessed as outweighing any known possible side effects. Nevertheless, as with any medicine or health care product, unfortunately a vaccine may cause side effects in some people. We have heard the stories of some of those who have been affected in that way.

Vaccine safety is of paramount importance and, as with all medicines and health care products, the Medicines and Healthcare Products Regulatory Agency and the Government’s independent expert advisory Commission on Human Medicines keep the safety of all vaccines under close and continual review. In response to the concerns that were raised by Members during the time that I have been the Minister with responsibility for public health, I have sought the advice of the MHRA, and had discussions with it, to raise some of the issues that Members have put to me, and to understand in some detail that process of continual review. I was satisfied that it is very robust and based on a continual review of the available evidence, both in this country and internationally.

The UK’s childhood immunisation schedule has been recommended by experts after consideration of a wide range of evidence, which, as I have said, includes evidence about safety reactions. That evidence is both national and international. The vaccines have undergone rigorous testing with large numbers of people before they are licensed, and their safety is continuously monitored to discover and assess any rare side effects. Vaccines are among the safest medicines available and as such, and as I have said before, side effects are rare. I am concerned that the hon. Gentleman thinks that reactions are not being captured properly. Again, I asked the MHRA about that. Obviously, the hon. Gentleman is well aware of the yellow card scheme, but perhaps he wants to give me more detail after the debate about reactions not being captured.

[Mr Brown]

On that point, it became abundantly clear, when I met the two ladies whom I mentioned in respect of their daughters and the HPV vaccine, that one of those mothers faced a major challenge in pursuing the local health authority to get the card recording exactly what had happened. There appeared to be some reluctance, although I am not sure what was underpinning all that. Some people have faced a challenge getting it properly recorded.

[Jane Ellison]

I am sure it would help the MHRA if the hon. Gentleman sent it details of that example. However, it sounds a little bit more as if there was a problem with a local clinician recording adverse reaction than with the scheme itself. I note what he says.

The UK’s programme has been a considerable success. I know that, in the context of such a debate, it seems hard to assert that, but I think that all hon. Members would acknowledge that generally speaking this country is seen as having a successful immunisation programme. Regarding MMR, which has been mentioned, coverage in England for children reaching their second birthday rose to 92.7% in 2013-14, compared with 92.3% in 2012-13. That is the sixth consecutive year that a rise in MMR coverage has been reported, and coverage is at its highest level since the vaccine was first introduced in 1988.

I note the hon. Gentleman’s concern that the current level of award may limit the take-up of vaccines, but I am hesitant to accept that as evidence, given the improved take-up of the MMR vaccine during a period when the VDPS has not changed. I am hesitant to accept what he says, but if there is peer-reviewed evidence of the link between the level of the scheme and the take-up of particular vaccines, I suggest he submits that to the Department.

Hon. Members will know that, since 1 May 2014, the VDPS has been the joint responsibility of the Department for Work and Pensions and the Department of Health. As set out in the 1979 Act, the Department of Health is responsible for policy, for example, changes to the list of infectious diseases covered by the Act in line with changes to the immunisation programme. The shadow Minister mentioned diseases added to the scheme. As has been said, the Department for Work and Pensions remains responsible for assessing the claims.

Hon. Members have put on the record the number of claims and awards made. I note concerns about awards made in recent years, but again it is perhaps not entirely right to assume that that is, in some sense, because the criteria have been changed, or anything like that. I have outlined the independent expertise of the medical assessors, and said that vaccines have got safer. Again, the causative link needs to be proved. However, I note the hon. Gentleman’s concern, and that of other hon. Members, about the lack of recent awards.

The vaccine damage payment scheme has always covered diseases vaccinated against as part of the childhood immunisation programme. That approach underlines successive Governments’ intention that the scheme should help children who are rarely, but regrettably, severely disabled. As I said, changes to and recommendations about that programme are made by the JCVI.

In 2002, the scheme was reviewed and changes were made. The threshold of disability was reduced from 80% to 60% and, as we have said, the payment increased to £120,000.

[Mr Brown]

I appreciate what the Minister is saying. Will she give hon. Members in the Chamber her personal thoughts on the balance of probability?

[Jane Ellison]

My sense is that the scheme, which aims to provide proportionate help, has got the balance about right, but I have heard the concerns expressed today. It is worth noting that successive Governments have considered this matter and chosen not to alter the scheme. That consideration would have involved looking at it in some detail. Equally, I note gently that the shadow Minister, analysed the situation and asked many questions, but made no commitments, although she aspires to sit in my place in just a few weeks.

The House will note that many successive Governments of different parties have looked at the scheme and have, I think, drawn the same conclusion, which is that the balance is about right. That is not to say that the hon. Gentleman’s concerns are not listened to: far from it. I have listened to his concerns and will take those away and reflect on them.

There are no current plans to make any changes to the time limits. Again, the hon. Gentleman made his case about that, as did other hon. Members.

[Barbara Keeley]

I hear what the Minister is saying, but this may be the last chance to comment. I talked about a case where the payments are not in any way compensatory. Previous Governments lifted the level of payment substantially up to £120,000. Can she not give any hope to parents in their 60s who are struggling with care? Care is expensive, and increasingly so under her Government. What can she say to give some hope to parents in that situation, of whom, as we have heard, there are very many, including my constituents?

[Jane Ellison]

The challenge is that a number of aspects of the scheme, which has existed under successive Governments, make some individual cases particularly hard. The hon. Lady has touched on some reasons for that in her contribution.

The Government have no plans to change how the scheme is run, as one might expect in the last week before the House rises before the general election, and there are no plans to review it, as I have said. However, we are about to have a new Parliament. I am sure that the hon. Member for Dumfries and Galloway and other hon. Members may wish to return to this subject. The work of the all-party group will continue. The hon. Gentleman has indicated that he wants to raise the reform of the Act in the new Parliament. The shadow Minister has made some points, but no commitments. The hon. Member for Dumfries and Galloway may therefore wish to use the next few weeks lobbying within his own party, if he cannot speak in Parliament, making his case forcefully to his colleague.

I note the concerns expressed today. I am not in a position to say that the scheme will be reviewed. As is the way of these things, all these matters will now be for a new Government to consider. However, the hon. Member for Dumfries and Galloway put his points thoughtfully, as ever, and they have been thoughtfully taken on board and will be considered.