Penrose Inquiry

Pamela Nash Excerpts

Thursday 26th March 2015 Commons Chamber

[Jane Ellison]

Of course. In my response to the Backbench business debate, I gave Members a sense of how to represent constituents as regards the latest NHS treatments. The latest treatments available for hepatitis C are of a different order of effectiveness and have many fewer side-effects than the older treatments and it is important that anyone affected is seen by a hepatologist and referred appropriately. NICE and the NHS are currently considering the new treatments.

[Pamela Nash (Airdrie and Shotts) (Lab)]

The report published yesterday suggests that NHS staff were working according to the best available knowledge at the time. As chair of the all-party group on HIV and AIDS, however, I often hear about current incidents in which NHS staff do not have the best available knowledge at their fingertips. What have the Government done and what are they doing to ensure that we have a well-informed NHS? Is the Minister confident that there is not a similar tragedy brewing within the NHS today?

[Jane Ellison]

For blood donations, the picture is thankfully very different today from the situation in the 1970s and ’80s that Lord Penrose was considering. Today, blood donations are screened for both HIV and hep C as well as a number of other infections. I recently visited the blood processing site at Colindale to see the rigorous and high-tech approach to blood safety in this country. Members can be more reassured in that regard. Of course, synthetic products are available for the treatment of all haemophilia patients for whom they are suitable. On the question of the latest knowledge, I can only reiterate that NHS England is considering a further early access policy to include patients with cirrhosis. It is aiming to have that in place in the first half of this year. Importantly, NICE guidance on the use of such therapies is also expected in the first half of this year.

Oral Hormone Pregnancy Tests

Pamela Nash Excerpts

Thursday 23rd October 2014 Commons Chamber

[Pamela Nash (Airdrie and Shotts) (Lab)]

I add my congratulations to my hon. Friend the Member for Bolton South East (Yasmin Qureshi) not just on securing this debate along with the hon. Members for Enfield North (Nick de Bois) and for North East Somerset (Jacob Rees-Mogg), but on her determined campaign on behalf of her constituent Nichola Williams. It is a measure of the success of this recent campaign that we are talking about this matter in the House and that there is rapidly increasing public awareness. Marie Lyons has also contributed to the campaign. In Scotland, my constituent Rose Stallard has been campaigning on the matter. Recently, she featured in an article in the Daily Record talking about her family and their experience.

Long before today’s commonly used urine-based pregnancy test, women were reliant on their doctors and the Government to prescribe what they believed to be safe oral pregnancy tests. One such test was primodos, which came in a small green packet of two small pills containing hormones. Patients were advised to take one tablet and then, if they did not bleed, a second 12 hours later. But in the 1960s and 1970s, the concentration of those strong hormones was extremely high. One dose of primodos equates to 13 morning-after pills or 157 oral contraceptive pills, which seems unbelievable given our increased knowledge now.

It is not yet clear how many people have suffered as a result of this drug, but at least one family in my constituency has been affected, and I suspect that there are many more. Mrs Stallard was one of the 1.5 million women who were prescribed primodos, which we now believe had such terrible consequences for their children, which included being born with under-developed limbs and facial deformities and many other medical problems, some of which we have heard about today.

Members are here today to represent their constituents and highlight the impact on their lives of the disabilities that resulted from their mothers being given that tablet, but we must remember that the drug is also suspected to have caused many miscarriages. I hope that that will be included in any review or inquiry resulting from the campaign and, indeed, from today’s debate.

Mrs Stallard told me that she was offered primodos by her GP when she thought that she was pregnant back in 1969. Having taken the test and bled, she thought that she was not pregnant after all, but she soon realised that she was indeed pregnant. She had a very normal pregnancy and gave birth to her third child—her first and only daughter—to her delight and that of her husband, Bobby. Unlike other cases we have heard about today, it was not until Elizabeth was over a year old that Rose noticed something was wrong, as Elizabeth was not developing at the same rate as her niece, who was the same age, and indeed her other children. Despite that, the family were advised that there was nothing wrong with her.

Eventually, when Elizabeth was three, the family were told by their doctor that she had “slight retardation”. That is the only diagnosis she has ever received, and she is now 44 years of age. She went to mainstream primary school, but it soon became apparent that she needed specialist help and she was transferred to a school that could provide it. At 15 she began to experience physical impairments. Only recently was she eventually given a brain scan, which showed that parts of her brain are now shrinking.

I want to highlight the fact that Elizabeth is now 44, so she has lived for more than four decades without any diagnosis, treatment or support. I also want to highlight that that is the age of the people affected. I agree with my hon. Friend the Member for Coventry North West (Mr Robinson), who highlighted the fact that one of the main purposes of the campaign is to gain closure for the families affected. It is also about getting support for those men and women. They are now in their 40s and 50s and really need the care and support that can be provided by a full inquiry and compensation. Their parents, who are providing their care needs, are also getting older and are increasingly concerned about the future for their children. For more than four decades Rose has had to live with the aftermath of having been prescribed those pills.

What angers me most is the fact that the evidence now available suggests that serious concerns about the safety of primodos were already being expressed years before Rose, and thousands of other women, took the test. It should have been taken off the market when those concerns were first expressed, and doctors should not have been prescribing it after the warnings were given. All those affected deserve to know exactly why that was not the case. Why was it not taken off the market and why did it continue to be prescribed in our NHS?

Back in 1968, Schering’s lead scientist wrote to the company’s headquarters in Berlin and made it clear that he was deeply disturbed by the evidence he was seeing of the impact the drug was having on children. Indeed, it is deeply disturbing not only that those effects were apparent, but that they were not acted upon immediately. If that research had been published then, rather than only recently, Rose and thousands of other women might not have given birth to children with life-limiting disabilities or might not have miscarried.

Let us be clear—this point has not yet been made—that primodos was not a necessary medication. The risks and benefits of new medications have to be weighed up, and there can be debate over whether the benefits outweigh the risks. Although knowing for certain whether a woman is pregnant is helpful, and for some it is definitely medically helpful, it is not essential. I suspect that most women, if not all, presented with the risks of that test would rather wait a few weeks to know for certain whether they were pregnant. These women did not get the opportunity to make an informed decision, because they did not know about the risks at the time, even though they were known to others.

The hon. Member for Enfield North mentioned the work done in this place by the late Jack Ashley, who was the Member of Parliament for Stoke-on-Trent South. When I was doing my research before the debate, I read a response that he had received to a written question in 1977. He was told by the then Secretary of State for Social Services:

“In 1975 the Committee of Safety of Medicines advised the Health Departments that hormonal preparations, including Primodos, should not be indicated for pregnancy testing and that a warning about a possible hazard in pregnancy should be inserted in all promotional literature.”—[Official Report, 13 December 1977; Vol. 941, c. 152W.]

More than 30 years ago, in the House of Commons, this drug was declared to be hazardous. I find it hard to understand why the need for an investigation of something that was deemed hazardous, and was taken by many women on whose pregnancies it had hazardous effects, is still being debated in the House. Furthermore, it was revealed over the summer, in response to freedom of information requests to the Medicines and Healthcare Products Regulatory Agency, that letters had been written to GPs warning them about

“an increased incidence of congenital abnormalities”

in babies born to women who took the drug. Yet it was not until 1975 that the drug company finally placed a simple warning on the packaging.

Let me put to the Minister some of the questions that have been raised by me, by other Members who are present, and by our constituents. Mrs Stallard and the many families who have been affected are very clear about their need for answers to these questions. Why were papers not published when research was being conducted in the 1960s that would have shown the dangers of primodos at the time? Why did it take until this year to publish the documents? What other related documents are being held by the Government, and indeed by Bayer, and are yet to be published? Will the Government undertake to publish immediately every single document that is available to them? Why was primodos not removed completely from use until 1975—or, according to some reports, 1978—years after the dangers were known? Most important, why was it still being prescribed after the Committee on Safety of Medicines had issued official warnings?

I ask the Government to commit themselves today to establishing an independent panel to examine those documents. I also ask them to acknowledge the need for an independent inquiry if a review by the panel reveals that it is required.

This morning I was visited by my aunt, who asked what the day held for me. I told her about the debate and about primodos, its suspected impact, and the fact that we were campaigning for and requesting an independent panel review. She simply looked at me and said, “I do not understand. Why does this require a debate? Why will the Government not agree to it immediately?” I could not agree with her more, and I hope that the Minister agrees with her too.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (George Freeman)]

I congratulate the hon. Member for Bolton South East (Yasmin Qureshi)—I pay tribute to her work—and my hon. Friend the Member for Enfield North (Nick de Bois) on securing the debate. I also congratulate the Backbench Business Committee. I did not rebel very often during my first four years in Parliament, but I am proud that one of my rebellions was in support of the Committee. The debates it brings to the House are often of the very highest quality, as today’s has again illustrated. I am delighted to have the chance to come to the Dispatch Box and speak on this important subject. I pay tribute to the victims’ association for its work, as well as to Marie Lyon, Jack Ashley and the many hon. Members who cannot be here today but take a very close interest in this issue.

I welcome the opportunity to update the House on the Department’s view of this important issue. I first want to assure all hon. Members that the current Government take very seriously the concerns that have been expressed. I want to take this opportunity to express my and other Ministers’ deepest sympathy to those who believe they have been affected by these products. I absolutely commit that this matter will receive the highest attention that it deserves, although hon. Members will appreciate that this is not an easy issue, given the many years—40-odd years—that have passed since the tests were first used.

We have heard some very powerful speeches from hon. Members on both sides of the House, and I want to highlight some of the points made. The hon. Member for Bolton South East spoke powerfully about the era of cover-ups. We have heard a lot in recent years about the cover-up of medical and sexual scandals—in Rotherham, Sheffield, Mid Staffs and, frankly, other areas—which have not been given the attention that they deserve. I suggest that we now need, and we are seeing, a new era of transparency, and that is all to the good. Medical professionals in the NHS and across the system have a duty of care and, like them, Ministers have a duty of care to the people we represent, and a duty of transparency as part of that.

My hon. Friend the Member for Aberconwy (Guto Bebb) spoke powerfully about his constituent Mrs Roberts and his experience of premature births in his family, and the hon. Member for Coventry North West (Mr Robinson) also spoke powerfully. My hon. Friend the Member for Enfield North made an important point about the trust that citizens and patients place in the medical profession and the health system. In return, we owe them a duty of trust and transparency. The hon. Member for City of Durham (Roberta Blackman-Woods) made an important point about how those involved in these cases need to receive some degree of closure and to know that the issue has been looked at properly.

My hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) spoke powerfully about her constituents. The hon. Member for Hayes and Harlington (John McDonnell) made an important point about the historical relationship between the pharmaceutical industry and the medical profession. Let me make this point very clearly: this Minister and this Front-Bench team are here to represent only one special interest group, and that is the patients whom the NHS, the health system and the Department are here to serve. I say that as someone who has come from the industry. We also heard powerful contributions from the right hon. Member for Sutton and Cheam (Paul Burstow) and the hon. Member for Airdrie and Shotts (Pamela Nash).

I want to deal with some of the key points made in those speeches. In particular, several hon. Members mentioned the difficulty caused by the lack of retention of medical records. I have personal experience of that. My father died when I was 19—a year after I had met him—and I was not able to get to the hospital or, later, to find out exactly how he died and what he died of. These days, our system is much better at recording information. This problem is one of the reasons why I believe we should support electronic patient records. Once records are recorded electronically, they are much easier to keep and track, so we would not have many of the difficulties that we face today. The Department is not aware of any documents requesting the destruction of papers or records. I am happy to make the commitment to review and action any papers that come to light.

I should point out for the benefit of the House that Dr Briggs, who is deceased, did not confess to falsifying any studies on hormone pregnancy tests.

It has been said that thousands of children were affected. The evidence on that is not clear and it is difficult to find accurate information. There have been various estimates at different times and the best estimate seems to come from the victims’ association. In 2009, it said that by October 1978 it had gathered information on more than 700 children who might have been affected, and that it had received additional responses and inquiries from other parents every time the topic received publicity. Despite the references to thousands of children, it is unclear how many we are dealing with.

I want to highlight an important quote from Dr Sarah- Jane Richards, who is a senior solicitor in medical negligence at Secure Law in Cardiff, that demonstrates that there is still a lack of clarity and no definitive proof of causality. She said that primodos patients need more definitive data, namely medical notes from several hundred subjects, to strengthen their case. She said:

“The facts are compelling… There are snippets of information which are extremely insightful—but at present, there is an abundance of circumstantial evidence and a great insufficiency of scientific evidence. That is a real hurdle when we see a health issue such as handicap, which happens to an unfortunate two per cent of the population anyway.”

Hon. Members would expect the Government to be guided by the best scientific advice, so I wanted to share that with the House.

I want to address a number of points that have been raised in this debate, in earlier debates and in the work of the all-party group, including the eight-year gap between the first reports of a possible danger and the circulation of an official warning; the continued prescribing of the pregnancy tests by doctors in the 1970s; the need for full disclosure of the documents held by the Department; and the need for an independent panel to examine those documents. I confirm that I will be happy to instruct the release of all information that is held by the Department on this case, and the setting up of an independent panel of inquiry. I will say more about that at the end of my remarks.

First, I want to set the scene, because it is complex and difficult. I know that Members will be interested. As Members are aware, we have in the United Kingdom an agency whose sole responsibility is to ensure that all medicines in the UK work and are acceptably safe. That role is underpinned by robust legislation and guidance. In fact, we lead the world in medical regulation. However, we were not always this fortunate. In the late 1950s, when this story has its roots and hormone pregnancy tests were introduced, there was no legislation on the use of medicines in the UK, believe it or not. Unfortunately, it took the thalidomide tragedy in the early ’60s to highlight that serious deficiency, which now seems extraordinary to everyone in the House. Although sweeping changes to the legislation were made as a result, culminating in the Medicines Act 1971, by that time, hormone pregnancy tests were widely used.

The Committee on Safety of Medicines, to which my hon. Friend the Member for Enfield North referred, was first established as the Committee on Safety of Drugs in 1963 and took on its later incarnation in 1971. I will refer to it henceforth as the committee. Not long after the committee was established, a study was published by Dr Gal that suggested that there was a link between the use of oral hormone pregnancy tests and birth defects. The study was reviewed by the committee, but considered to be methodologically flawed. At that time, the committee was not aware of other evidence to support such an effect. Nevertheless, the committee undertook its own study to investigate the matter further. Over the next few years, a number of studies were published, but the evidence for an association remained limited and the findings inconsistent. The committee carefully evaluated all new evidence as it emerged and, in 1978, concluded that

“to date there is no proof of the existence of a causal relationship between the use of hormonal pregnancy tests and congenital abnormalities”.

As a result of the campaigning of my hon. Friend the Member for Enfield North and other hon. Members, earlier this year the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) commissioned the Medicines and Healthcare Products Regulatory Agency—the lead regulator—to review all the key evidence on this issue and produce a report on its findings, which I believe hon. Members have been sent. The report has also been posted on the MHRA’s website.

Based on studies published between 1960 and 2013, the MHRA’s view is that the results are inconsistent, with some finding no association, some a weak association, and some a strong association. Its conclusion is that the data do not provide conclusive evidence of an association between hormone pregnancy tests and birth defects. As hon. Members will appreciate, the Government have a duty to ensure that they are acting at all times on the best advice available from specialist agencies set up to advise them, which in this case is the MHRA. I believe that in commissioning the report, the Government have listened to and acted on the concerns that have been raised about this drug.

What I believe makes the conclusion difficult to accept is that several studies did show an association that was statistically significant and, of course, many people have visible defects and feel that their lives have been damaged by these drugs. However, there are good reasons why both those observations do not yet constitute the proof that a causal association exists—proof that hon. Members and citizens would expect the Government to acquire before taking action.

As hon. Members will know, it is always exceptionally difficult to know for sure that a medicine taken by a mother during pregnancy is responsible for a defect in the child. It is almost impossible to know whether the condition would have developed regardless of whether the medicine had been taken, and that is especially true for birth defects, which are relatively common and occur in up to four in every 100 live births.

With the studies there is an added complexity in that a statistically significant association is not necessarily the same as a causal association, because limitations in the design of the studies may mean that the results are not reliable. Examples of that include poor recording of what was prescribed by doctors—that, I am afraid, has been all too common; another reason for the digitalisation of health records—as well as biased recall of what was taken by sufferers, the preferential prescribing of pregnancy tests for women who were at higher risk of a difficult pregnancy in the first place, and a number of other complicating factors.

One of the key concerns of the hon. Member for Bolton South East related to the eight-year gap between the publication of the first study finding a link and the committee alerting doctors to a potential risk. Although I appreciate that that may seem an unacceptable delay, it is worth remembering that such a charge assumes that the committee believed there was a causal association. However, the report that I referred to previously suggests that that is not the case, and that the committee at no time considered those pregnancy tests to be responsible for the observed birth defects.

Despite that, in 1969, just two years after Dr Gal’s study was published, the committee took the precaution of asking companies to stop promoting the tests to doctors. As more evidence was published and alternative methods of diagnosing pregnancy became available, the committee considered there to be no reason to use the hormonal methods anymore, and advised doctors of that in 1975. As Members may know, despite the committee’s warnings it became apparent that doctors were still using those outmoded tests, so it issued a further alert in 1977.

At this point I remind the House that guidance provided by the General Medical Council gives doctors in the United Kingdom the freedom to prescribe any medicine if they judge it to be in the best interests of their patient, and they take responsibility for their prescribing decisions. In that respect, I believe the evidence suggests that the committee acted in a proportionate and responsible way given the evidence before it—that is the only test that we can apply at this point.

[Pamela Nash]

The Minister said that the committee had to issue a further warning in 1977. I appreciate what he says about responsibility being with the GP, but why would a GP prescribe those pregnancy tests if they knew and were clear that they were dangerous? Is it the responsibility of the committee that it did not communicate that danger aptly enough?

[George Freeman]

Unfortunately, as I have been trying to explain, in our system the sovereignty for prescribing lies with clinicians. Guidance can be issued and we would expect GPs to comply with it. Today that is more often the case, but we are dealing with a period when things were different. I cannot at this point tell the hon. Lady why a number of GPs did not comply with the guidance provided, but it was given very clearly.

Hon. Members have asked that the Department fully disclose all documents on hormone pregnancy tests held between 1953 and 1978. While I support that request, I remind the House that we are talking about an era that mostly predated medicines legislation and companies were not required even to submit evidence to support the efficacy, quality and safety of their products—extraordinary though that may seem to us today. As a result of that, and the fact that the pregnancy tests were withdrawn from use more than 35 years ago, the Department holds very limited information and what it does hold is already in the public domain. That said, I am happy to confirm to the House this afternoon that I will instruct that all relevant documents held by the Department be released.

The MHRA will of course review any new data that emerge as a matter of priority and seek independent expert advice as needed. I am happy to go further and confirm to the House that I will instruct an independent review of the papers and all the evidence. I suggest that that be carried out by the Medicines for Women’s Health Expert Advisory Group, which exists to advise the Department on such matters. It comprises independent members who are experts in their field, and I am happy to take submissions from colleagues to ensure that the association is properly represented and has a chance to give evidence.

HPV Vaccine

Pamela Nash Excerpts

Tuesday 2nd July 2013 Commons Chamber

[Mike Freer]

The hon. Gentleman makes a good point. On a small island such as ours it is important that men who are having sex with women, or men having sex with men, are having sex with partners who are vaccinated, and I believe that is a matter not just for England and Wales, but for the whole of the United Kingdom, and we would also then be setting an example for the rest of the world.

Herd immunity is valuable, but it is not foolproof for heterosexual men. I have mentioned that it is valuable where heterosexual men are having sex with vaccinated women, but men who have sex with men are not subject to herd immunity, and that is another element of inequality. Evidence from other countries suggests herd immunity will eventually prevent most, but not all, cases of HPV-related cancer in heterosexual men. There is still work to be done, therefore, on all men having vaccinations against HPV-related cancers.

Some HPV-related cancers are on the rise in the UK, despite the vaccination programme. Throat cancer has overtaken cervical cancer as the leading HPV-related cancer in the UK. Men who have sex with women who are not vaccinated remain at risk. This is of concern to men who, for example, have sex while on holiday or while living outside the UK, or who have sex with unvaccinated migrants to the UK—but men, straight or gay, remain at risk.

The current programme is inequitable, as those men who “stray from the herd” by having sex with unvaccinated women or men will remain at risk. That is why I am seeking a commitment for the HPV vaccination programme to be widened.

The key issue I wish to press is the health inequality in respect of gay men and anal cancer, an inequality perpetuated by the current vaccination policy. Gay men already experience poorer sexual health as a group; they are at an increasing and far higher risk of HIV and other sexually transmitted infections compared with the wider population. Rates of anal cancer in gay men are now equivalent to those for cervical cancer in women before the cervical cancer screening programme was introduced in 1988. HPV is associated with 80% to 85% of anal cancer in men, yet it is not yet possible to screen for or effectively treat anal pre-cancer, as it is for cervical cancer; HPV vaccination is the only effective form of prevention, and it is being denied to men.

Gay men with HIV are particularly susceptible to HPV-related anal cancer and as the number of gay men with HIV continues to rise year on year, so will cases of anal cancer, other HPV-related cancers and warts. In addition to having a disproportionate effect in HIV-positive men, HPV can increase the risk of HIV transmission. HPV can increase skin fragility and overt anal warts can bleed, which enhances the risks of acquisition or transmission of HIV infection. This health inequality between gay men and the general population will continue to widen as long as gay men remain unprotected against HPV. I stress this point as it relates to gay men, but it also affects heterosexual men who are equally unprotected.

[Pamela Nash (Airdrie and Shotts) (Lab)]

I congratulate the hon. Gentleman on making a powerful argument on a difficult subject. Michael Douglas, the actor, was given much criticism in the press recently for talking about these difficult issues. I know about this, because I had the HPV vaccine as a 17-year-old, so I am glad the hon. Gentleman has brought the matter to the Floor of the House. I just want to highlight the fact that this is an issue not only for homosexual men in terms of the vast health inequalities they have here in the UK, but for heterosexual men. Although we have a successful HPV vaccination programme for young women, we by no means have the whole herd vaccinated just yet.

[Mike Freer]

The hon. Lady makes a good point. Herd immunity is valuable only for those who are sleeping within the herd. Those who have sex outside the herd are at risk, and that inequality needs to be addressed.

The best way to protect all males against HPV-related cancers and warts would be to offer the vaccine to all boys aged 12 to 13, as well as girls, as part of the school-based immunisation programme. The vaccine is most effective when given at this younger age, before people start having sex and before exposure to the strains of HPV. Other countries are starting to do that; the vaccine is available for boys in a number of other countries, including Australia and the United States. I firmly believe that we should follow suit.

If we do not have a widespread vaccination programme for boys, at least, and as a bare minimum, gay men should be offered the vaccine when they first present at a sexual health clinic as men who have sex with men. That would match the current policy on offering hepatitis B vaccinations to gay men. Given the expense of treating HPV-related cancers and warts, there is a strong cost-effectiveness argument for extending the availability of the HPV vaccine. If the inequality is not a powerful argument, the cost savings to the Department of Health must be.

The Joint Committee on Vaccination and Immunisation inquiry that began last year is welcome, although little is known of the progress it is making. If the JCVI looks into the cost-effectiveness of vaccination initiatives, it will find that the case to extend the programme to boys is irrefutable.

Each HPV vaccination for the three-dose programme costs £260. Compare that with the lifetime treatment and care cost of an HIV-positive man or woman at £280,000 a year, the £13,000 cost of treating anal cancer, the £11,500 cost of treating penile cancer, the £15,000 cost of treating for oropharyngeal cancer or the £13,600 cost of treating vulval and vaginal cancer transmitted by an infected male. In 2010, the cost of treating anogenital warts was £52.4 million.

--- Later in debate ---

[Anna Soubry]

I am going to struggle, because that is another good point. I always try to be honest when I come to the Dispatch Box and when hon. Members make good points—points that were made not only by my hon. Friend, but by the hon. Member for Airdrie and Shotts (Pamela Nash).

The point raised by the right hon. Member for Wolverhampton South East (Mr McFadden) is related to the actual vaccine, and I am more than happy to discuss that case, or any other adverse reactions of young women to the vaccine, with him. I am very sorry for his constituent, and I am more than happy to have that discussion with him and help in any way I can. He raises an important point.

As we have heard, in June 2012 the JCVI was presented with data on HPV infections and it noted that there is early evidence to suggest that the HPV immunisation programme in England is lowering the number of HPV 16 and 18 infections—the strains of HPV that are linked to these unpleasant cancers—in females in birth cohorts that have been eligible for vaccination.

I accept that the data are very limited on the prevalence of HPV infections among men who have sex with men, but we hope that research under way at University College London will provide more data and an age profile of HPV prevalence. HPVs, particularly types 16 and 18, are associated with the majority of anal cancers as well as cervical cancers, and to a lesser degree with penile, vaginal, vulval and head and neck cancers, but HPV types 16 and 18 predominate in cancers at those sites that are HPV-related. Data on the impact of HPV vaccination on infection at some of these non-cervical sites are limited.

The JCVI noted that the potential impact of HPV vaccination on non-cervical cancers would make the current HPV immunisation programme even more cost-effective, but it would remain the case that, given the expected effects of immunisation on HPV transmission and the indirect protection of boys that accrues from high coverage of HPV vaccination in girls, vaccination of boys in addition to girls was unlikely to be cost-effective. That argument, which we know is advanced, is combated by all that has been said by my hon. Friends the Members for Sherwood (Mr Spencer) and for Finchley and Golders Green, who urge us to consider the cost of treating someone who has one of these cancers.

Evidence for indirect protection would continue to be evaluated by the ongoing HPV surveillance programme at the former Health Protection Agency, now part of Public Health England, but the JCVI agreed that there may be little indirect protection of men who have sex with men from the current immunisation programme. Therefore, the impact and cost-effectiveness of vaccination strategies for men who have sex with men, with the offer of vaccination through general practice and/or at genito-urinary medicine clinics, needed to be assessed. In addition, data on the prevalence by age of HPV infections in men who have sex with men and in the settings where vaccination could be offered to them were needed to determine the potential effectiveness and cost-effectiveness of HPV vaccination of men who have sex with men. It would also be important to understand better the rates of HPV-related disease in men who have sex with men and the influence of HPV on HIV infection.

As we have heard, in August 2012, the JCVI issued a call for evidence from interested parties, including for information to inform a study on the impact and cost-effectiveness of HPV vaccination of men who have sex with men. Any new proposals for the vaccination of additional groups will require supporting evidence to show that this would be a cost-effective use of resources. The JCVI also asked the HPA, now part of PHE, to undertake that study. The study is under way and, once completed, will be considered by the JCVI, at the earliest in 2014. The Department will consider carefully the advice from JCVI, once the committee has completed its assessment.

[Pamela Nash]

May I reiterate the point the hon. Member for Strangford (Jim Shannon) made about the need to have conversations with ministerial colleagues in Scotland, Wales and Northern Ireland? As the hon. Member for Finchley and Golders Green (Mike Freer) argued powerfully, this is about homosexual men and men who have sex with men, but also about men who have sex with women who have not been vaccinated. It is important to have those conversations with the other nations.

[Anna Soubry]

I am grateful for that intervention. I was about to conclude by saying that it is only fair and right to acknowledge the powerful arguments that have been advanced by a number of hon. Members this evening. They have certainly caused me to take the view that I will not hesitate to contact the JCVI, as a matter of urgency, to raise all these important points with them. The committee is an independent expert body, and when it gives its advice to the Government, the Government are—quite rightly—bound to accept that advice.

Oral Answers to Questions

Pamela Nash Excerpts

Tuesday 15th January 2013 Commons Chamber

[Pamela Nash (Airdrie and Shotts) (Lab)]

T7. The implications of HIV go well beyond health issues alone, yet the Government have so far refused to implement a new, cross-departmental HIV strategy. The Scottish and Welsh Governments have implemented their own such strategies, but 95% of people in the UK living with HIV reside in England. Will the Secretary of State commit to discussing this issue with his Cabinet colleagues, particularly those in the Department for Work and Pensions and the Department for Education?

[Norman Lamb]

I take extremely seriously the point that the hon. Lady makes. It seems to make more sense to be part of a comprehensive, integrated sexual health strategy, which the Government are planning and which will be published very soon. Services tend to be delivered together in the same units, so it makes sense to have a single strategy to deal with all those issues.

HIV

Pamela Nash Excerpts

Tuesday 29th November 2011 Westminster Hall

[Pamela Nash (Airdrie and Shotts) (Lab)]

I am grateful to have secured this debate during the week in which world AIDS day is marked. The HIV virus was discovered 30 years ago, since when it has claimed the lives of more than 30 million people throughout the world, including 20,000 in the UK. Over the past 20 years, we have seen remarkable progress in the medication available to people living with HIV, including today’s welcome approval of a drug that will provide triple antiretroviral therapy in a single tablet taken once a day. That does not, however, diminish the fact that there is still no vaccine or cure for HIV, and more efforts must be made to prevent the transmission of the virus.

Let me take this opportunity to pay tribute to my predecessor as chair of the all-party group on HIV and AIDS, the late David Cairns. One year ago in this Chamber, he spoke on this topic with eloquence and passion, and he consistently spoke out against the stigma and discrimination faced by people living with HIV both in the UK and overseas. I am glad that his work continues in the all-party group and through the David Cairns Foundation set up in his name, which was launched last week.

The House of Lords Committee on HIV and AIDS, led by the vice-chair of the all-party group and former Health Minister, Lord Fowler, recently published a report on HIV in the UK. Lord Fowler has done much to champion the cause over his long and distinguished career, and I believe that many owe their lives to the work he carried out as HIV began to take hold in the United Kingdom. The needle exchange programme that he introduced is a good example of that work, and it changed the course of the epidemic, particularly in Edinburgh and the rest of Scotland. In September this year, the Committee concluded that the Government’s current policies on tackling HIV in the UK are “woefully inadequate.” I will focus on some of the report’s recommendations, and I look forward to the Minister setting out the Government’s response to that report.

I will start with some startling headline figures. Some 30 years after the virus was discovered, almost 100,000 people in the UK live with HIV. Newly diagnosed cases of HIV among young people have risen by 48% over the past decade, and it is estimated that about a quarter of those living with HIV in the UK do not know that they have the virus. Half of all cases of HIV in the UK are diagnosed late, meaning a greater cost to public health and the public purse. HIV is spreading for many reasons, but principally because of high levels of undiagnosed HIV, too few people with HIV receiving stable treatment, persistent risk-taking behaviour, and a lack of HIV awareness. That is set against a dangerous backdrop of inconsistent sex and relationships education in our schools and beyond.

Early diagnosis of HIV for one person can obviously translate into prevention of the disease for their future sexual partners. People diagnosed with HIV are far less likely to pass the virus to others, as they can take steps to prevent transmission such as using a condom. Once diagnosed, people can receive HIV treatment that dramatically reduces levels of the virus in the body, so that the risk of transmission can be reduced to almost zero. This year I was surprised by the results of a remarkable clinical trial in South Africa that proved that putting people on medication for HIV can reduce the risk of transmission by an enormous 96%. That has extraordinary ramifications for efforts to tackle the HIV epidemic around the world and makes the need for the early diagnosis of HIV all the more pressing.

It is estimated that 51% of all people with HIV in the UK have undetectable levels of the virus. That is great news, although the UK should aim to increase that percentage to at least 65% over the next four years.

[Mike Weatherley (Hove) (Con)]

I congratulate the hon. Lady on securing this important debate. Does she agree with the recent remarks made by the US Secretary of State, Hillary Clinton, who said that an “AIDS-free generation” should be a policy priority for all Governments, including that of the UK?

[Pamela Nash]

I completely agree with the Secretary of State’s remarks. I raised the issue during Deputy Prime Minister’s questions last week. I hope that the coalition will take that aim on board and that it will be raised by the Prime Minister. The all-party group on HIV and AIDS is a member of the “Halve It” coalition that campaigns for levels of late-diagnosed and undiagnosed HIV to be halved in five years through more testing. That will help to stop the spread of HIV, improve health outcomes for those living with the virus, and in the long term save the Government money.

Patients and doctors have a large role to play. A study of people of sub-Saharan African origin in the UK who were diagnosed late with HIV found that three quarters had visited a doctor in the year preceding their diagnosis. Doctors and patients must be more aware of the primary infection symptoms of HIV. Incentivising HIV testing, particularly in areas with a high prevalence of HIV, is vital to ensure that people are diagnosed in time. One powerful incentive would be to ensure the inclusion of the late HIV diagnosis indicator in the Government’s revised public health outcomes framework. We have heard several times that a decision on that will be made later in the year. Will the Minister assure hon. Members that that indicator will be included, or at least say when the Department will reach a final decision?

As I understand it, the Department is investigating the possibility of legalising home-testing kits. I look forward to the outcome of that investigation. It is clear from the House of Lords report that home-testing kits ordered from overseas, usually over the internet, are already in use in the UK. If legalised, that practice could be regulated and allow people to test themselves securely and safely in their own home, again producing savings for public health and the public purse.

How else can we prevent the transmission of the HIV virus? The House of Lords report stated:

“More resources must be provided at national and local levels… The current levels of investment in national HIV prevention programmes are insufficient to provide the level of intervention required.”

Hon. Members may be surprised to learn that the Department of Health currently spends just £2.9 million a year on two national HIV prevention programmes for gay men and black Africans. That compares with an enormous £762 million spent on treatment. Preventing one infection avoids lifetime treatment costs for HIV of between £280,000 and £360,000, but as local service cuts kick in throughout the country, HIV prevention programmes are being reduced.

Under the new NHS structure, local HIV prevention work, campaigns and testing will be commissioned by local authorities, leading—we hope—to additional national campaigns, but I am concerned about the possible fragmentation and subsequent prioritisation of prevention work between HIV treatment that is commissioned nationally by the commissioning board, prevention and testing work commissioned by local authorities, and national campaigns overseen by Public Health England. Within local authorities, HIV prevention work is likely to face strong competition for funding within constrained budgets. A fragmented health care system will not deliver the results that we desperately need, or enable us to make headway against the rising tide of new HIV infections. We do not want a postcode lottery, or for sexual health services to be sidelined because of local sensitivities.

[Guto Bebb (Aberconwy) (Con)]

I congratulate the hon. Lady on securing the debate. In my north Wales constituency there is an HIV respite centre, which is extremely well supported by the local community. The problem that the centre has is that many of the people who take advantage of the respite care are coming in from north-west England and are therefore not funded by the local health authority in Wales—health is devolved. A centre that is able to serve people from north-west England therefore finds it very difficult to secure funding, because it is based in Wales, but its patients are from England. Is that the type of postcode lottery problem that the all-party group could deal with?

[Pamela Nash]

We can certainly campaign on the matter. I will be happy to discuss that with the hon. Gentleman outside the Chamber. He makes a very important point: this issue is not just about the NHS and the Health and Social Care Bill in England, but about achieving agreements with the other Assemblies and Parliaments in the United Kingdom to ensure nationwide consistency in the treatment and support for people living with HIV.

I shall now discuss public awareness in the UK. Twenty-five years ago, Lord Fowler led huge public health campaigns about the virus. Leaflets were sent to every household in the country and there were very visible television campaigns. However, public awareness of HIV has undoubtedly fallen during the past 10 years. For my generation, it is just not a priority any more. Despite the very high increase in the number of young women contracting HIV, when I speak to my friends about this issue I find they rarely regard themselves as at risk.

Unbelievably, earlier this year, an Ipsos MORI poll found that one in five people do not realise that HIV is transmitted through sex without a condom between a man and a woman, and the same proportion do not know that HIV is passed on through sex without a condom between two men.

[Stuart Andrew (Pudsey) (Con)]

I congratulate the hon. Lady on securing the debate. It is a shame that it is only a half-hour debate, because the last time that we debated the issue, we had an hour and a half, I think, and even that was too brief. The figures that she is giving now are shocking, certainly for my generation, who are getting older now. I remember the HIV debate and campaign that she refers to and how phenomenally successful it was and how aware we all were of the dangers. Something needs to be done so that the younger generation realise the very severe dangers of having sex without protection.

[Pamela Nash]

The all-party group has consistently campaigned for the Government to put more funding into another national 1980s-style campaign. I hope that today’s debate and the events taking place throughout the week will get the message across to the Government that it is necessary to have that style of campaign again.

An increasing proportion of adults—about 10% at the moment—incorrectly believe that HIV can be transmitted through impossible routes, such as kissing and spitting. That is not helped by scaremongering media reporting. There was recently a report in Edinburgh about a couple who, when being arrested by the police, had bitten a police officer. Both members of the couple were HIV-positive, and that was the primary headline in the Scottish media, much to my disappointment. Misinformation fuels stigma and discrimination, which are still a daily reality for many people living with HIV.

[Naomi Long (Belfast East) (Alliance)]

The hon. Lady has rightly referred to the importance of people being tested, but she has also referred to stigma. Does she agree that unless we overcome the stigma surrounding simply having been tested for HIV and for AIDS and not having the disease—the stigma that still exists in society about going for those tests—that will decrease the number of people who come forward to submit themselves for testing and take care of their health as they should?

[Pamela Nash]

Yes, that is a crucial point. I hope that any future public campaign would incorporate looking at the stigma about the virus. Unfortunately, in the meantime, it persists. That is why I would also push for the home testing kits to become available, but that is not the ultimate solution.

In a recent study in east London, one in three people living with HIV said that they had been victims of discrimination, but most alarmingly the study showed that half of all that discrimination was in the health care system. The Department of Health must take a lead on tackling stigma and develop training resources for its staff that are aimed at stopping such discrimination. Those resources must be used by all current and new NHS and professional bodies.

--- Later in debate ---

[Pamela Nash]

Since I took on the role of chair of the all-party group, I have been extremely surprised by the high levels of inaccurate and sensationalist reporting in the UK’s press on HIV. That reflects a wider lack of public awareness.

The lack of basic information fuels prejudice and leads to the exploitation of people, as was tragically illustrated in recent weeks by the frightening cases of HIV-positive patients being told by evangelical pastors that they could be cured of HIV through the power of prayer alone and that they should stop taking their antiretroviral drugs. The BBC has reported at least three deaths resulting in London, which I am sure the Minister will agree is a grave tragedy on her own doorstep. I am aware that the Department already funds work through its partners to raise awareness among religious communities, but in light of the shocking revelations and the relatively small budget that is allocated to HIV prevention in the UK, does the Minister think that that is enough? Is the Department planning to do more to tackle that issue?

The Government must take a lead in acting to improve the understanding of HIV. It is vital that all young people learn about HIV in school, and HIV must be included in local and national sexual health promotion campaigns and information. Such measures will help not only to tackle HIV stigma, but to enable people to protect themselves and others to improve public health.

HIV treatment services in the UK are generally of a high calibre, but access to other elements of care, such as primary care services, social care and psychological support, can vary widely. Unfortunately, time and time again, individuals living with HIV have contacted the all-party group to tell us that the social impacts of HIV on their lives are much greater than the health impacts. Generic services are often ill-prepared to meet the specific needs of people living with HIV. Individuals can be apprehensive about accessing services because of concerns about confidentiality or lack of expertise. Numerous clinical guidelines relate to care and support for people with HIV, but there is no coherent and authoritative guidance that integrates clinical, social and psychological care and covers the different stages and eventualities of the condition. Integrated guidelines from the National Institute for Health and Clinical Excellence or a national care pathway would help to make the responsibilities of different bodies and professionals clearer and make service provision more consistent and cost-effective.

The House of Lords’ report recommended that NICE develop treatment and care standards for HIV patients, and the Government’s response acknowledged that they should consider the value that NICE could add in developing standards for HIV. The Government also cited the British HIV Association’s clinical guidelines, but the guidelines do not address the need to co-ordinate specialist HIV services with other services. We in the all-party group urge the Government to act on the Lords’ Committee’s recommendations.

People with HIV live with a fluctuating, long-term condition. However, like many other people with long-term conditions, with the right support, people with HIV can play a full and productive part in society. Social care services are being cut across many local authorities and are often limited to the most severely disabled people. It is not acceptable to limit social care only to the most acute cases. Social care has a vital preventive function, particularly in treating fluctuating conditions such as HIV. Social care can also play a crucial role in dealing with the new phenomenon of the increasing number of older people who are living with HIV.

It is clear that the Government understand the value of HIV social care. That is shown by the inclusion of a specific funding line for HIV/AIDS support in the formula grant. However, local authorities are no longer required to report on the spending of that grant to the Department of Health and we have heard of several cases—for example, in Hertfordshire and Leicestershire—where money for HIV/AIDS support has been siphoned off into other areas of spending. Once that expertise in HIV/AIDS support has been lost, it will be difficult to recover. The Government must ensure that the performance of HIV social care is effectively and consistently measured, and that the needs of people living with HIV are reflected in the social care outcomes framework. It is also clear that NICE must prioritise a social care quality standard for HIV.

To conclude, I am proud that the UK has nobly led the international community during the last 30 years in the response to AIDS, advocating universal access to HIV treatment throughout the world for all those who need it. It is my great hope that that leadership role will continue to be performed by the current Government, particularly at a time when we have such an incredible opportunity to improve the quality of life for those living with HIV, to make a dramatic impact on the number of new infections and to stamp out this epidemic for good.