Vaccine Damage Payments Act

Russell Brown Excerpts

Tuesday 24th March 2015 Westminster Hall

[Mr Russell Brown (Dumfries and Galloway) (Lab)]

A few colleagues are here this afternoon, Mr Caton, but our all-party parliamentary group for vaccine damaged people has more than 120 members, so I suspect that some of them will be dropping in and out as the afternoon progresses.

I am delighted to have secured today’s debate and I am pleased that we have been joined by the families of vaccine-damaged people, some of whom have seen their children grow from having been vaccine-damaged in infancy to men and women who are now in their 40s and 50s. However, when I say I am delighted to have secured the debate, after attempting to do so regularly since early January, the fact is that the all-party group, of which I am the chairman, really wanted at some point to meet the Minister, so that she could hear what the families go through on a daily basis with their—it is a bit difficult to say “children”, because, as I said, some of those children are now in their 40s and 50s. However, I want to share some of those experiences and difficulties, and I know that colleagues in the Chamber today will want to do likewise.

The all-party group supports families in their view that the Vaccine Damage Payments Act 1979 is now out-of-date and should be reformed. Let me be absolutely clear: from the very first meeting that I attended in the ’90s of the then all-party parliamentary group for vaccine-damaged children, the families have been resolute in their support for the Government’s vaccination programme, and they firmly believe in the concept of herd immunisation.

The Pearson commission was a major inquiry into civil damages in the 1970s. It recommended that the Government should accept liability to pay full compensation for vaccine injury on the basis that vaccine injury is the very occasional price that society pays for the benefit of defeating disease through national vaccination programmes.

At that time, vaccines were not such a major part of the public health programme as they are today. During the intervening years, vaccines have greatly grown in importance and use. It was always intended to be a temporary measure—a £10,000 payment on account pending the outcome of the Loveday case. Now the award is £120,000, but that is not adequate compensation for someone who is seriously and profoundly disabled.

It is not adequate to say that consumers should sue as an alternative. No civil claim has ever succeeded for vaccine injury in this jurisdiction. That is not because people in the UK are different from elsewhere in the world; it reflects the fact that our legal system is not claimant-friendly. The situation has got much worse since legal aid has been abolished. It is now impossible to take on a multinational pharmaceutical corporation, as the costs of a claim are so high that no one could possibly afford it. Court fees have just been increased by some 600%, so it costs £10,000 just to issue a claim, which has not helped the situation.

It is in the interests of society that the rate of uptake of vaccines is kept high to achieve that herd immunity. That needs an effective safety net, so that consumers are assured that in the event of a serious disablement, they will be looked after. The system needs to be reformed to be more consumer-friendly, so that on close calls on causation, consumers or patients are given the benefit of any doubt, as we see in the USA. In the last four years, no awards of any compensation have been made for vaccine injury, despite hundreds of applications. The system is not working.

[Mr Tom Clarke (Coatbridge, Chryston and Bellshill) (Lab)]

I use this opportunity to apologise to you, Mr Caton, and to my hon. Friend, because I have to leave soon to be at Downing street at 3 o’clock to present a petition with people with learning disabilities about things, such as Winterbourne View home, that ought not to be happening. I apologise that I have to leave, but I congratulate my hon. Friend on his wonderful work, and the all-party group. Above all, I congratulate the vaccine victim support group and the indomitable Olivia Price on the fantastic fight that they have conducted over many years. I hope that they get the success and the response that my hon. Friend and this debate invites.

[Mr Brown]

I thank my right hon. Friend for his intervention. Those of us who know him realise that he is a champion for those less fortunate in society, and especially for the disabled. I recognise that he has a family member who was vaccine damaged as a child.

Why is the coverage of the scheme so patchy here in the UK? Adults are almost all excluded—why should that be? All seasonal flu vaccines and all hepatitis vaccines are excluded—why? That is not an effective safety net.

Recently, more than 70 people suffered narcolepsy as a result of the swine flu vaccine. That is a very serious condition, but the Department for Work and Pensions has refused to accept that it amounts to a 60% disability and has appealed against a tribunal finding that it is a severe disability. The Department should fight consumers less and support them more.

Awards of compensation for vaccine injury should be available—that is compensation measured by the amount of loss actually suffered, not an arbitrary amount. Reform could be a win-win, in that we could promote social justice and ensure an increase in the rate of vaccination that will benefit society as a whole.

[Richard Burden (Birmingham, Northfield) (Lab)]

I also congratulate my hon. Friend on securing the debate and give my apologies because I, too, will have to leave before the end of the debate. Does he agree that some of the reluctance to reform the current procedures and the Act is similar to some of the reluctance that was there when we tried to uprate it in the first place? These things are complex and there are all sorts of aspects to them, but the first thing to do, surely, is sit down, work through where the problems are and work out what needs to be done. From my point of view, the important thing is that the Minister should meet the families to look at what is going on in practice and what can be done about it.

[Mr Brown]

My hon. Friend is exactly right. Today, we are looking at—it is in the debate’s long title—reform of this legislation. As will become clear as I progress through my contribution, we really need to reach a decision on whether this is about reform or about ripping it up, throwing it in the bin and starting again, because we have moved on significantly since 1979.

As I was saying, reform could be a win-win, in that we could promote social justice and ensure an increase in the rate of vaccination that would benefit society. I believe that vaccine manufacturers are strongly in favour of such a change and are willing to contribute to a fund—and, I hope, to discussions.

It is unconscionable to relegate so many people who are disabled to a battle over causation, and for justice, and it undermines rates of uptake of vaccines not to have an effective system. The numbers of those seriously injured are low, so the total cost of full compensation would be affordable and would be self-financed through the increase in vaccination and the reduction in the burden of disease in society.

Towards the end of last year, I met two parents down here in London. They related to me the stories of their daughters, who had both had a reaction to the human papilloma virus vaccine. We dedicated the last meeting of the all-party group, on 14 January, to hearing from some young women who were able to attend, but mainly from the parents of several young women who had had a severe reaction to the HPV vaccine. I think that it is safe to say that the majority of those cases centred on those young women now finding themselves profoundly affected by what can only be described as symptoms similar to those of ME—myalgic encephalomyelitis—or chronic fatigue syndrome. All those girls had been fit and healthy, were doing well academically and had the social life that we would expect any teenager to have.

[Sir Tony Cunningham (Workington) (Lab)]

To emphasise just how serious the consequences are, I point out that Steve Hinks’s daughter, to whom my hon. Friend may be referring, is often asleep for 23 hours a day. That is how serious the consequences are.

[Mr Brown]

I thank my hon. Friend for his intervention. He is exactly right. It was absolutely astounding to hear the heartbreaking stories at our last meeting and to think that a young woman who had been fit and healthy now suddenly finds herself asleep for most of the day and has to be awakened on an ongoing basis to be fed. That is no quality of life at all. Something is seriously wrong. The worlds of these young women have been turned upside down. For some of them, to spend a few hours at school in a week is a major challenge. That issue could probably merit an Adjournment debate on its own. I am aware that the hon. Member for Reigate (Crispin Blunt) held a short debate on the topic back in May 2009. It is worth pointing out that there are serious concerns about the manner in which an individual’s allergic reaction to a vaccine is recorded—it might be better put as “not recorded” in many cases. Where there is an allergic reaction, it is only right that it is properly recorded, so that we can not only determine what is happening to the individual but get a broader perspective.

In October 2011, a proposal paper was produced by the vaccine victim support group—an unincorporated association with more than 300 members—and the all-party group for vaccine damaged people. They came together and were looking for reform of the Vaccine Damage Payments Act, which established in the UK a statutory no-fault system of a single lump sum payment from public funds for cases of proven serious permanent disablement resulting from vaccination. Most developed countries have established such systems. The scheme in this country is administered by the Department for Work and Pensions, with appeals being resolved within Her Majesty’s Courts and Tribunals Service. We are now 36 years on, and the system has continued, with relatively minor changes only.

The vaccine victim support group and the all-party group contend that reform of the system is highly desirable to deal with anomalies that now exist in the system, to reflect the changing landscape of today, to reassure the public about the safety and efficacy of vaccination, to reduce litigation and to promote and extend the uptake of vaccination to promote health and the elimination of disease. Both groups support the UK national vaccination programme and recognise that the benefits of vaccination outweigh the risks. Vaccines have significantly contributed to the elimination of disease, the increase in life expectancy and the improvement in public health.

Reform of the UK system of statutory vaccine injury compensation has the prospect of achieving important tangible benefits for the UK that mean that it would be irresponsible not to explore and effect reform through consultation with all relevant stakeholders, which include the pharmaceutical industry, the Department of Health immunisation team, the DWP and, via support groups, affected individuals.

The Act was brought into being by Parliament to put on a statutory footing a system of ex gratia awards of compensation for vaccine injury that had developed during the 1970s, largely as a result of whole-cell whooping cough and smallpox vaccine injury. The Department of Health had made a number of ex gratia awards to individuals who had suffered serious permanent disability as a result of catastrophic brain injury that they had suffered as infants shortly after DPT—diphtheria, pertussis and tetanus—vaccination.

The Government had commissioned Professor David Miller to conduct the national childhood encephalopathy study—NCES—a large-scale epidemiological study of incidents of brain injury and onset of seizure disorders following DPT vaccination. The study, published in May 1981, found a significant association between DPT vaccination and severe neurological injury and death.

The statutory scheme initially required an 80% and permanent level of disability to have been suffered, but later that threshold was reduced to 60%. Awards were initially £10,000. That was increased, in various changes, to £20,000, then £30,000 and then £40,000. The level of payment was largely based on the understanding that that was interim compensation pending the outcome of the litigation against the Wellcome Foundation.

In 1986, the United States enacted the National Childhood Vaccine Injury Act. That established a system of compensation in the US court of federal claims. Until four years ago, that had awarded compensatory damages in 2,806 cases, of which 1,266 involved the DPT vaccine, use of which ceased in 1996. That involved an outlay at that time of $2.2 billion. The fund to administer the scheme is established from a small tax on each dose of vaccine. That has proved relatively successful in the United States, and our all-party group has wondered for a long time why we do not in the UK, for every vaccine that is given, put into a fund a couple of pence. That is all it would take to deal with this issue. However, that has been rejected not only by this Government, but by the Labour Government in the 13 years for which they were in office. I think that we need to reconsider where we are.

In 1988, the court in Loveday v. Renton and the Wellcome Foundation dismissed the claimants’ claims. The judge found that the claimants had failed to establish causation to the required standard of proof. That was based on his findings of flaws in the data analysis of the NCES. Professor Miller and his NCES team subsequently published a follow-up study, in November 1993, which addressed the judge’s criticisms of the original study. The conclusions of the follow-up study were essentially the same as those originally: on rare occasions, the vaccine can cause severe neurological injury. Then in 2000 the Government decided that the initial awards should be “topped up” to the real-terms equivalent of £100,000.

It had been suggested that anyone deemed to be vaccine damaged was carrying the SCN1A gene. That has been disproved by testing victims: they have all proved negative.

In 2010, the Legal Services Commission agreed in principle to fund a further review of the prospects of success of the surviving DPT claimants. Further litigation is therefore pending in that respect against the manufacturers and/or the Department of Health. The award now made for a successful application for vaccine damage payment is a single lump sum of £120,000. However, the majority of applicants—approximately 750 —have received only £78,000, because they received an initial payment of some £10,000. The payment is invariably made into a personal injury special needs trust, so that it is excluded, by statutory provision, from any assessment for means-tested benefits. That is done to ensure that it is received in addition to means-tested benefits such as incapacity benefit and disability living allowance, including components for care and mobility.

According to information supplied by the vaccine damage payments unit in 2011, a total of 931 awards had been made under the 1979 Act, of which 570 were related to the DPT vaccine. There were 89 applications to the unit in 2010 and 71 in 2011. One award was made in 2010, and no awards were made in 2011. So far, 3,983 applications have been rejected on medical grounds and 814 have been rejected for non-medical reasons—because the application was made either out of time or out of the scope of the scheme. The operation of the system has settled down, and after a flurry of historic awards in the early years, very few awards are now being made. The unit at one point consisted of two part-time members of staff. An appeal against the decision to refuse an award is made to the social security lower-tier tribunal, which is part of Her Majesty’s Courts and Tribunals Service.

The fact that surprisingly few awards are being made probably reflects the withdrawal of the DPT wholesale vaccine, the improvement in vaccine technology and the increased levels of safety and efficacy of vaccination. During the past few years, more vaccines, such as HPV and meningitis C, have been added to the national programme. It is likely that further vaccines—for example, varicella, H1N1, swine flu and hepatitis A and B—will be added in coming years. Many new types of vaccines are likely to become available in future years, because they are being developed to combat many sources of disease, such as malaria, candida, chlamydia, E. coli, genital herpes, hepatitis E, strep, rheumatoid arthritis, various cancers and numerous others.

There have been episodes of public concern about adverse reaction to vaccinations such as DPT in the 1970s, MMR in the late 1990s and early 2000s and, more recently, the HPV vaccine. Those episodes of concern have led to litigation, media sensationalism and public anxiety, and they have significantly reduced uptake of the vaccination, which has reduced the level of herd immunity on occasions and increased the incidence of outbreak of pandemic disease among unvaccinated populations. Those episodes of public concern caused anxiety and confusion to the public and resulted in considerable legal defence costs for pharmaceutical corporations and considerable cost to the UK legal aid purse. Litigation resolved few of the disputes, because hardly any cases reached trial. The public health programme was damaged by falling levels of vaccine uptake, and diseases in some cases were resurgent.

In 2003, uptake of the MMR vaccine fell to only 82%, largely as a result of Wakefield’s discredited autism theory. Even by the end of the MMR litigation, uptake had not fully recovered. In contrast, the United States achieves 98% vaccination uptake, possibly because all claims have to be brought in the federal courts under the vaccine programme rather than against a manufacturer. That shows that a proper safety net can boost the numbers of people who take part in a herd immunisation programme. Other countries have avoided the problem by enabling disputes over vaccine injury to be efficiently and proportionately resolved within a statutory compensation scheme, where individual cases can be thoroughly investigated and adjudicated. The lack of a fully comprehensive system for determining vaccine injury applications in the UK has contributed to the problems we face, so all stakeholders have an interest in reform.

The UK’s vaccine injury compensation scheme, as established in the 1979 Act, contains a number of serious anomalies. Not all vaccines are covered. Vaccines for swine flu, smallpox, hepatitis A and B, and yellow fever are not covered. A separate scheme for smallpox vaccine compensation had to be set up by the Department of Health for workers to encourage front-line health workers to participate in vaccination. The vaccine programme is no longer just for children, as it was initially. Many people in their professional careers need to be vaccinated, otherwise they cannot work.

The influenza vaccine is not covered. The safety net has holes in it, and the vaccine victim support group and the all-party group submit that the gaps should be addressed. We believe that everyone who is resident in the UK and is vaccinated should be able to have recourse to the compensation scheme in the event of a serious adverse effect. The current scheme is aimed mainly at compensating children, although adults are also, on rare occasions, covered. The coverage is therefore patchy and not comprehensive. Given the very small numbers involved, the scheme could easily cover children and all adults.

Children who die before the age of two are not covered. That exception is difficult to justify, because losing a child at 18 months is as tragic and devastating as losing a child six months later, at the age of two. That exception should be abolished. The 60% injury threshold is a real issue. An arbitrary distinction is made in the scheme for injuries that are still significant, but that amount to 59% or lower. The refusal of any compensation for someone with a 59% permanent disability cannot objectively be justified, bearing in mind the very small number of awards that are made. To qualify for criminal injury compensation, the minimum threshold value of injury is £1,000, and a similar level should apply in vaccine injury cases.

The current compensation award of £120,000, rather than compensatory damages, creates anomalies. A child with catastrophic injury resulting from clinical negligence in the administration of a vaccine—in other words, in breach of contra-indication—may receive £3 million. A child with a similar injury resulting from an adverse reaction to a vaccine would receive only one twenty-fifth of that compensation. That means that the burden of caring for the disabled person falls largely on their families. The current vaccine injury award amounts to the cost of care for a seriously disabled person for less than one year. That cannot properly be described as compensation; it is only a token.

[Sir Alan Beith (Berwick-upon-Tweed) (LD)]

I welcome the attention that the hon. Gentleman has brought to this matter, as he has on previous occasions. The root of the problem is the distinction between compensation for negligence, which rightly exists to ensure that a negligent organisation pays a penalty, and the provision of the help that people who have suffered vaccine damage ought to get, even if there is no possibility of proving negligence. The hon. Gentleman has identified that that is a no-fault system. We really need to have such a system, which meets the genuine need of those who have faced such consequences without their having to prove negligence.

[Mr Brown]

I thank the right hon. Gentleman for that intervention. The point is the balance of probability, as I indicated earlier in relation to the United States. I know that we do not always like to compare our health service with that in the United States, but theirs is definitely based on the balance of probability. We need to be much more realistic and consider what that could mean for us in relation to vaccination and a vaccination programme. The level of award cannot be justified. Instead, the system should provide common-law damages. The numbers of awards made are such that that would place little burden on the public purse. Similarly, the scheme should also meet reasonable legal costs, so that clients do not have to enter damages-based contingency agreements to fund appeals.

There should be provision in the scheme for some flexibility on the date by which an application has to be made. The current scheme allows no extension of the time limit, even when the applicant does not have knowledge of the scheme or that they have a claim. Earlier today, the families made it abundantly clear to me that if a child suddenly becomes vaccine-damaged, the trauma that runs through the household and the family is such that they probably cannot think straight about what the future holds. It is about recognising the extremely difficult and traumatic time that families are going through. There should not be time bars that mean people get the response, “I’m very sorry, but you’re out of time for any kind of claim.” That just is not the way we should be operating in the 21st century.

The current scheme does not contain any table of injury where causation may, in certain circumstances, be presumed. The absence of such a table leaves open to doubt—and litigation—the question of causation, which makes the system more difficult to administer. The table under the US scheme recognises, for example, that if someone has a severe allergic reaction within four hours of receiving the tetanus vaccine, it is presumed that the tetanus vaccine caused the injury if no other cause is found. That goes back to the point raised by the right hon. Member for Berwick-upon-Tweed (Sir Alan Beith) and my response—that the absolute probability is that the tetanus vaccine was the cause. The table in the US is periodically revised after independent expert review, such as the reports published by the Institute of Medicine on the causality of injury by vaccines in 1991, 1994 and 2011.

The UK system of vaccine injury compensation has now existed for 36 years. It was created as an interim solution, but it has become a permanent one. There are many anomalies in coverage, and it does not fulfil the safety net function that would promote confidence in the uptake of vaccines. Fortunately, cases of serious permanent disablement and death caused by vaccines are extremely rare. The cost of extending the scheme to give comprehensive coverage and provide compensatory damages would be extremely low. If one award of medium severity is made in an average year, for example, the cost might be in the order of, say, £500,000. There would be some initial additional expenditure in paying a further top-up, in line with the level of compensatory damages, for the 931 cases that received a £100,000 top-up payment in 2000. However, that would mean no further ongoing litigation in respect of historical cases. The current award of £100,000 is difficult to justify in cases involving catastrophic injury and a lifetime of care and loss of earnings.

Vaccines have become safer, but the number of vaccines has grown and is likely to continue growing. The vast majority of adverse effects are mild and/or temporary, and only on extremely rare occasions are they serious and permanent. However, it is likely that there will always be a small number of casualties, and a no-fault safety net of compensatory damages will relieve the unfair burden of care and support from victims’ families and redistribute the cost across society. Crucially, it would avoid the need for litigation, promote confidence in the national vaccination programme and increase vaccine uptake, thereby reducing the incidence and cost of disease.

I hope the Minister will consider the points that she hears today. The timing of this debate might be wrong, but I have attempted to raise the profile of this issue over the past 12 months. In the dying days of this Parliament, perhaps the timing could not be better because, with both the Minister and my hon. Friend the shadow Minister in attendance, the next Government might want to consider this issue more closely. The electorate deserve a better deal than they have had previously.

There should have been significant publicity for this debate, and the families tried to encourage such publicity. They came close to getting support from the BBC, but the plug was apparently pulled at the last minute. The families are becoming increasingly suspicious that people do not want to discuss this issue, but it is an issue from which we cannot run away. The families lead their lives as best they can under extremely difficult circumstances. There is no escape for them. On a daily basis, life can be troublesome to say the least, and I suspect that life can often be very trying indeed. They have fought for decades, and they deserve some kind of light at the end of the tunnel, if that is possible. I gave an indication of this earlier, but is it reform of the legislation that we need or is it now time, 36 years after the original legislation was introduced, that we as parliamentarians sat down with the families and the pharmaceutical companies and asked, “Is there a better way of doing this?”? I honestly believe that we require not reform but a whole new concept of where we are going.

My right hon. Friend the Member for Coatbridge, Chryston and Bellshill (Mr Clarke) and I attended a meeting a few years ago when our good former colleague Ian Stewart was chair of the all-party group. We asked for a meeting with the pharmaceutical companies, which brought their legal teams with them. Those who know my right hon. Friend will recognise him as a placid and tolerant individual, but he walked out of that meeting, which he had not previously done in his entire political career. He was so disgusted with what the legal representatives of the pharmaceutical companies were saying that they tried his patience and he immediately left the room. He and, I hope, everyone in this room recognises the challenge that the families are going through. There is a better way of doing it, and I hope that today’s debate can be a starting point for us all.

--- Later in debate ---

[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.

NHS Specialised Services

Russell Brown Excerpts

Thursday 15th January 2015 Westminster Hall

[Mr Russell Brown (Dumfries and Galloway) (Lab)]

The hon. Gentleman and my hon. Friend the Member for Aberdeen South (Dame Anne Begg) have spoken about consistent service delivery. Does he see co-commissioning as something of a problem in delivering that?

[Stephen Gilbert]

There is a huge danger that we will move away from the improved patient experience that we have seen during the past year while national commissioning has been in place for specialised services towards more of a patchwork quilt approach in which patients may not get the same care in different parts of the country or the same pathways to care.

UK Ebola Preparedness

Russell Brown Excerpts

Monday 5th January 2015 Commons Chamber

[Mr Hunt]

I would like to reassure the hon. Gentleman that isolation facilities are available at other London hospitals. The ones he mentioned happen to be the closest, so they are the ones we would use first. Let me briefly clarify that it has always been the case that if someone showed any symptoms, we would isolate them and put them into quarantine. The change in protocol I am announcing today—we enacted it last week, but I wanted to report it to the House at the earliest opportunity—will mean that even if someone is not displaying the symptoms but says that they are feeling a bit under the weather, they will be isolated if they are in the high-risk category.

[Mr Russell Brown (Dumfries and Galloway) (Lab)]

It is somewhat ironic that only a couple of days before Christmas, I wrote to the Prime Minister saying that we should fully recognise all the volunteers who leave this country to do this excellent, selfless work, putting themselves in danger—and here we are today discussing the case of Pauline Cafferkey. Everyone’s thoughts are with Pauline and her friends and family.

I am led to believe that any problem should be dealt with at source, and there is still great concern about the amount of contaminated material, medical waste and contaminated protective equipment that is perhaps not being dealt with properly at source—being buried rather than incinerated, for example. I contacted the office of Professor Dame Sally Davies, and was told to write to her. I did so last week, asking her to look at finding a means of disposing of waste in a far better manner. So far, I have not had word back from her, but I am sure the Secretary of State will want to take this matter on board and ensure that it is dealt with better at the source of the infection.

[Mr Hunt]

To clarify the question, I think the hon. Gentleman is talking about how waste is disposed of in Sierra Leone, as we are satisfied with the way in which it is disposed of in the UK.

[Mr Brown]

indicated assent.

[Mr Hunt]

That being the case, I will ask the Secretary of State for International Development to write to the hon. Gentleman with her assessment of how satisfactorily that process is handled in Sierra Leone.

Oral Answers to Questions

Russell Brown Excerpts

Tuesday 25th November 2014 Commons Chamber

[George Freeman]

My hon. Friend raises a important example of an innovation that, despite costing a little extra at the beginning, saves substantially downstream. One of the challenges in our national health service is tackling a series of ways in which the system is not well geared to incentivising such innovations. NHS England recently set out its five-year forward view, which has, for the first time, a strong commitment to tackling such issues, and we are working with it to see what we can do to remove barriers and promote incentives for earlier adoption.

[Mr Russell Brown (Dumfries and Galloway) (Lab)]

What steps are being taken to ensure that emerging treatments for Duchenne muscular dystrophy that receive conditional approval are available through the early access to medicines scheme as early as possible?

[George Freeman]

I was delighted, when we launched the early access to medicines scheme earlier this year, to see the very strong support that we got from the Duchenne dystrophy group. Dystrophy is one of those terrible diseases that desperately need the fast-tracking of new medicines. As I said, last week we launched a major review of our landscape for the earlier adoption of innovative medicines in the NHS, so that patients in the most severe clinical need can take part in cutting-edge research and we get drugs to patients more quickly.

Oral Answers to Questions

Russell Brown Excerpts

Tuesday 21st October 2014 Commons Chamber

[Jane Ellison]

We had a good debate last week in Westminster Hall. My reply remains what it was then: there is not complete clarity in clinical evidence on safe levels of drinking. That is exactly why the chief medical officer—[Interruption.] From the Opposition Front Bench, I hear cries of “Yes, there is.” I am sorry, but I am backing the UK’s chief medical officer over Opposition Front Benchers when it comes to the clinical basis for this. The review is important and is under way. I know that all Members will be interested in its outcome, and in how we can help to publicise good guidance to women on this very important issue.

[Mr Russell Brown (Dumfries and Galloway) (Lab)]

13. What steps he is taking to improve access to and reduce waiting times for children’s mental health services.

[The Minister of State, Department of Health (Norman Lamb)]

The taskforce on child and adolescent mental health is considering ways to improve access to children’s mental health services. The plan that we published earlier this month, “Achieving Better Access to Mental Health Services by 2020” sets out the ambition to extend waiting time standards across all mental health services by 2020. We are investing £7 million this year in providing an additional 50 beds.

[Mr Brown]

More and more children are being treated on adult psychiatric wards, with many having to travel hundreds of miles across the country for treatment, as has been said today. The chief executive of YoungMinds has said that the increase in the number of children being placed in adult wards was predictable, following the cuts to mental health services. Why did the Minister not see it coming and do something sooner?

[Norman Lamb]

We did see a problem emerging. That is why NHS England set up a taskforce to look at that precise problem. Its recommendation earlier this year was to add 50 beds, and that is what we are doing. The indication from October is that there is a significant increase in spare bed capacity within the system, so the problem is being addressed.

Oral Answers to Questions

Russell Brown Excerpts

Tuesday 26th February 2013 Commons Chamber

[Mr Hunt]

Really, from a party that closed or downgraded 12 A and E departments when in office, I would expect a slightly more mature attitude to an extremely difficult and complex problem. We will not take any lessons in meeting A and E targets from that lot. The reality is that we met our A and E targets last year, but in Wales, where Labour cut the NHS budget by 8%, they have not met their A and E targets since 2009.

[Mr Russell Brown (Dumfries and Galloway) (Lab)]

4. What the reason is for the time taken to produce the Government’s sexual health policy document; and when he now expects it to be published.

[Kate Green (Stretford and Urmston) (Lab)]

11. What the reason is for the time taken to produce the Government’s sexual health policy document.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

This is an important document, which we want to get right. I anticipate that it will be published next month.

[Mr Brown]

Will the sexual health policy document contain a strategic plan, effectively resourced by Government, to address and reduce HIV stigma, especially among health care professionals, the police, media, teachers and social services? Perhaps a good starting point could be to draw on the lessons and the success of the Government’s anti-stigma work on mental health.

[Anna Soubry]

I certainly support the sentiment behind the hon. Gentleman’s question, and make it clear that I wanted to ensure that the document included the need for everybody to eradicate prejudice in all sexual health work. I was very keen to put that in the document, and I am sure he will join me in welcoming its publication, which will, we hope, be next month.

Oral Answers to Questions

Russell Brown Excerpts

Tuesday 21st February 2012 Commons Chamber

[Teresa Pearce (Erith and Thamesmead) (Lab)]

6. What assessment he has made of the future of private health care.

[Mr Russell Brown (Dumfries and Galloway) (Lab)]

13. What assessment he has made of the involvement of the private health care sector in the NHS.

[The Minister of State, Department of Health (Mr Simon Burns)]

The Department has made no assessment of the future of private health care. This is not the role of the Department of Health. The private sector has always provided services to the NHS and the Department monitors trends where it does so—for example, the number of NHS patients choosing a private provider under patient choice.

--- Later in debate ---

[Mr Burns]

I am sorry—the hon. Lady has obviously not listened properly to me. It has been my guiding principle and my core belief from the day I entered politics that we should have a national health service free at the point of use for all those eligible to use it. In no shape or form does the Bill, or any actions by this Government, compromise that core belief of mine.

[Mr Brown]

The Minister is aware that funding for the health service in Wales and Scotland is through the Barnett formula. For every pound saved by the Government—in other words, for every pound less spent per person in England—there is a knock-on consequence for the budgets in Wales and Scotland. What assessment has he made of the fact that he will be funding NHS provision from private patient fees, rather than the public purse?

[Mr Burns]

As the hon. Gentleman knows better than I do, the running of the NHS in Scotland and Wales is a matter for the devolved authorities. I speak for the English NHS, and I can tell him that that we have guaranteed that the budget of the NHS in England will be a protected one for this Parliament in which there will be real-terms increases, albeit more modest than in the past. But we have seen in Wales in particular a fall of just over 8% in funding. That is the decision of a Labour Welsh Government. The moneys that are saved in the health service in England through cutting out bureaucracy and through greater effectiveness in delivering care will be totally reinvested—100%—in the NHS in England.

Oral Answers to Questions

Russell Brown Excerpts

Tuesday 7th December 2010 Commons Chamber

[Mr Speaker]

Order. The Minister will resume his seat. His answers have been excessively long-winded and repetitive—and it must not happen again. I have made the position clear and I hope that the Minister will learn from that.

[Mr Russell Brown (Dumfries and Galloway) (Lab)]

18. What estimate he has made of the change in average waiting times for patients waiting for diagnostic tests since May 2010.

[The Minister of State, Department of Health (Mr Simon Burns)]

Patients are continuing to receive timely access to diagnostic tests. In September 2010, the median waiting time for 15 key diagnostic tests was 1.7 weeks, compared with 1.8 weeks in May.

[Mr Brown]

I thank the Minister. Does he expect waiting times to stay down now that they have been scrapped or will they simply be ignored by no longer being performance-managed?

[Mr Burns]

I suggest that the hon. Gentleman studies the response given earlier by my right hon. Friend the Secretary of State to the right hon. Member for Exeter (Mr Bradshaw). By concentrating resources and reforming the system to improve outcomes, we will provide enhanced health care for all our constituents in England.

HIV

Russell Brown Excerpts

Wednesday 1st December 2010 Westminster Hall

[David Cairns]

My hon. Friend makes an excellent point. The new agency has real potential to make a difference. We are all relieved that some of the world’s appalling, oppressive, anti-women regimes that were muscling in have been set to one side, which will allow the agency to focus on the issues that he mentioned.

A saying that we hear over and again now in Africa is that the face of the epidemic is female. That is not just because of mother-to-child transmissions, but because of the disempowerment of women and the limiting of women’s ability to make choices about their own sexual and reproductive health. Of course, that is not the case solely in Africa; it is the case elsewhere in the world as well. However, it is a particularly pressing problem in Africa and one that we must not lose sight of.

I was talking about the need to ensure that people who are HIV-positive know that they are HIV-positive. That is why the all-party group is pleased to support the Halve It campaign, which is composed of many agencies, clinicians and groups advocating on behalf of people with HIV. It is campaigning to halve the number of late diagnoses by 2015. That is an ambitious target, but the document sets out steps that can be taken to meet it, and I would be grateful for the Minister’s comments on them.

Yesterday, I was pleased that when I urged the Secretary of State for Health, while he was making his statement on the public health White Paper in the House, to look at the Halve It campaign, he gave an undertaking to do so and see whether it could form part of the HIV and sexual health strategy. I would be grateful if the Minister confirmed that she will look at the campaign’s document, particularly at the steps that can be taken to halve the numbers of late diagnoses and of those living with undiagnosed HIV by 2015.

I shall press on because I know other hon. Members are keen to take part and I want to hear the Minister’s reply. Once a person is diagnosed––I shall speak about some of the hurdles in a moment––the virus changes from being in its potentially lethal undiagnosed state, which poses a wide public health risk due to how it can be transmitted, to being a more normal—I use that word advisedly—long-term managed condition. That brings different challenges with it.

One thing that we are looking for in the detail of the NHS restructuring plan is how people will access services in the long-term managed phase of the condition. Who will commission those services, particularly in low-prevalence areas? Until those questions are answered, there will be uncertainty in the community. I want the Minister to answer specifically the question of who will commission HIV services in the new restructured NHS. Will it always be the GP? Is the GP the best placed person to do so? Do GPs have the time and the expertise, particularly in low-prevalence areas? I am sure that GPs in much of London, Brighton, Manchester or Glasgow have the necessary expertise because they have the caseload, but in other areas that might not be the case. Is a one-size-fits-all approach across the NHS the right solution or is something a little more granulated necessary to deal with the full complexity of the issue?

We have to face up to the fact that a lot of people who are HIV-positive simply do not want to access services through their local GP. Whether it is wise or unwise, it is understandable in some areas, particularly in smaller towns or villages, where everyone knows everyone else, and you know who works in your GP’s surgery and they know everybody and everything about you. Under those circumstances and given that the stigma prevails, and the myths, misunderstandings and prejudice that people with HIV face, it is understandable that there are those who will not want their status to be known in their own community. In evidence put forward yesterday by the National AIDS Trust, we saw how many people face discrimination in the workplace due to their HIV status.

AIDS is a complex condition. It affects people physically, emotionally and psychologically. In that complex mix, it is important that the NHS is responsive to that and allows people pathways to treatment that might not always be the same in every place. I would be grateful for the Minister’s views on that.

[Mr Russell Brown (Dumfries and Galloway) (Lab)]

I congratulate my hon. Friend on securing the debate. Because stigma is still attached to this condition, people in rural localities, such as mine, will seek advice and help from further afield, thereby distorting the figures on the prevalence of the condition in certain parts of the country.

[David Cairns]

My hon. Friend is absolutely right. He represents an area that is not only largely rural but on the borders of Scotland and England, which brings me to the point that I mentioned at the very beginning. I imagine that many of his constituents will be accessing HIV services in Carlisle, for all sorts of reasons, but partly due to the stigma still associated with the condition. They do not want to access services in small villages and towns. Ultimately, we have to get to a situation in which there is no stigma, prejudice or discrimination and people can happily access GP services for a long-term managed condition, as people with diabetes, asthma and other long-term managed conditions can. Until such a time, we have to be sensitive to these issues.

Another reason why people are wary about always accessing services through GPs is the lack of awareness and understanding that many GPs demonstrate. Part of the reason why we have so many late diagnoses is that GPs do not pick up the telltale signs often enough. An alarming number of people had seen their GP on many occasions during the 12 months before they were eventually diagnosed as HIV-positive, and it was not picked up that they might have been HIV-positive. An astonishing number of people had been in-patients in the 12 months preceding their diagnosis; they were almost certainly HIV-positive while they were in hospital, but it was not picked up.

A lady recently got in touch with the all-party group—a middle-aged, professional, white lady—who had suffered serious recurrent health problems for two years and had seen numerous clinicians, including a GP on many occasions, before anyone thought to offer her an HIV test, which brings me back to the point that the hon. Member for Cardiff Central made. That lady was a textbook case: she had every symptom and yet her GP never thought to offer her an HIV test. That is clearly happening across the country, which explains why we have 22,000 people who are HIV-positive, but do not know it. It is not the case that none of them ever visits their doctor—they regularly visit their GPs, perhaps they even go into hospital as in-patients, and yet their status is not picked up. That is a public health disaster because the ability of those people to infect others is much greater than it would be if they were receiving the correct course of ARVs.

We need assurance that, within the restructuring, GPs will get very good guidelines and necessary training, and be encouraged to offer people an HIV test in the routine manner suggested earlier, to tackle undiagnosed HIV.

Oral Answers to Questions

Russell Brown Excerpts

Tuesday 2nd November 2010 Commons Chamber

[Mr Lansley]

Yes, indeed I do. It is sad to report that we have the highest rate of teenage pregnancies in western Europe. At the heart of this is the fact that we must have community strategies that are geared not least to improving the self-confidence and self-esteem of young people, so that they are able to make better decisions. We must assist them in doing that, but I would also mention the importance of ensuring that we have long-acting reversible contraception available for young people.

[Mr Russell Brown (Dumfries and Galloway) (Lab)]

Each year, around 7,000 more people in the UK are diagnosed with HIV, and more people than ever are living with the virus. How will the Government’s new public health White Paper address HIV prevention?

[Mr Lansley]

The hon. Gentleman will know that the White Paper is yet to be published, so I will not pre-empt it, but it will be important to ensuring that there is a clear strategy for improving sexual health services. He will share our view that we want to deal with the extent of undiagnosed HIV and the extent to which people coming into contact with health care services are not offered HIV tests.