§ Motion made, and Question proposed. That this House do now adjourn.—[Mr. Humphrey Atkins.]
§ 10.27 p.m.
§ Mr. Greville Janner (Leicester, North-West)
I am happy to have the opportunity to draw to the attention of the House the monstrous and quite unnecessary suffering caused through the accidental poisoning of children. The problem is a very large one indeed. It is estimated that this year some 25,000 children will find their way into hospital suffering from accidental poisoning. This is nothing more than the tip of the poisoned iceberg. There are also thousands more children who are treated by their general practitioners or indeed by their parents.
The worst aspect of the problem is that it is so very unnecessary and its causes are obvious. The first cause is carelessness—carelessness on the part of the parents, and also on the part of those who welcome small children to their homes and who forget that anything that is available is likely to be popped into the mouth of a child under the age of five and to cause harm.
The figures for Leicester are quite shocking. Already this year some 139 children have been admitted to Leicester hospitals, mainly to the Leicester Royal Infirmary, suffering from poisoning, as opposed to 145 for the whole of last year. In other words, the figure appears nearly to have doubled.
The information provided by the Minister to my hon. Friend the Member for Liverpool, West Derby (Mr. Ogden), shows that the figures have increased every year—17,171 in 1966; 20,616 in 1967; 23,409 in 1968. The increase shows in all types of poisoning, but medicinal poisoning is the most important and severe. In 1968, of 20,285 children under the age of five who were accidentally poisoned, nearly 14,000 cases resulted from the adverse effects of medicinal agencies.
The other cause of this poisoning has been the unhappy lack of Government action—and I do not attack the present Administration any more than past Ad- 1480 ministrations. This problem has been ignored by all Governments. A great deal can be done by parents, by health visitors and especially by the Government.
First, parents must learn to keep out of the reach of children not only pills and potions, not only those pills that they regard as dangerous—tranquillisers, antidepressants and the like—but also common pills like aspirin. Even more important, because this is so little known, they must keep out of the way of children products which have caused a considerable number of poisonings in the past year—paraffin, nail varnish remover, turpentine, travel sickness pills, toilet cleaners, Brasso, bleach, weed killers, ant killers, caustic soda and anti-freeze. Even ordinary detergents can cause grave harm to a child who drinks them. Parents do not take care to keep these substances away from their children. In general there is no indication on the canister, the box or the container that these articles are capable of poisoning.
I hope that it will not be said that the reason is that only perhaps 50 or 100 children die as a result of these poisons. That is still a considerable number; if the debate saves only one life it will have been worth while.
A considerable number of children are injured as a result of the poisoning and no one knows how many children there are with damaged kidneys and livers and, in certain cases, whose mental capacities have been damaged. These children must be considered. This is not just a question of cost.
Last Christmas, when I visited a hospital in Leicester, I saw a child come in with his parents after having taken an overdose of aspirin. Terror and anxiety had been caused to the parents, although the child did not know much about it. One only hopes and prays that he has returned to excellent health. No doubt he has, because he was detained for only a short time.
I understand that the majority of poisoned children are detained in hospital for only a day or two, but a number stay much longer. It depends on the nature and quantity of the poison. They stay in at great cost—not just in money but above all in suffering. This matter should be treated very seriously. Parents 1481 must learn that, when they bring the shopping home they must put the dangerous items out of reach.
Health visitors do a marvellous job, but the Minister might issue a circular advising them to keep an eye on the medicine bottles in the houses they visit and to advise people to make proper use of high cupboards and locked cupboards. They should help to keep an eye, along with the rest of us, on such toxic, dangerous and everyday items as common garden weed killers which are all too often left lying around on the table in the shed. They should be kept out of the reach of children at all times.
What can the Government do about this? First, through the Health Council or some other organisation or body, they should initiate a publicity campaign to draw these matters to the attention of children, of their parents, of their hosts, and of schools, but not in the way which is all to often adopted at the moment and which simply suggests to people that others are careless but not they themselves. Situations should be drawn to their attention. For example, thousands of people use empty soft drink bottles as containers for turpentine and other poisons. A child thinks that any liquid in such a bottle is a soft drink, and he swallows it. This practice is an act of gross stupidity, and people do not realise what they are doing. Kindly, good people are accidental poisoners, and they should be taught. The Government should initiate a campaign which effects that teaching.
Secondly, the Government should make it impossible for any more medicines or pills, which are the major source of poisoning, to be put on the market other than in child-proof containers. I understand that legislation is not necessary, so that I can raise this aspect of the matter in this debate. However, if the answer that I receive is not satisfactory, I am glad to say that I shall have an opportunity next week to ask leave to introduce legislation dealing specifically with this point.
The answers which my hon. Friend the Member for West Derby, and I have received to Parliamentary Questions indicate that the Government are not satisfied with these containers. At this hour, I shall not produce the large number of containers that I have in my 1482 possession, but, if I did, I hope that hon. Members would not succeed in opening them. The more expensive of them might well prove to be unopenable without strict instructions.
A child under five years of age should not have available medicines or pills in containers which he can open with one hand or, even worse, which will come apart or open in his mother's bag, the pills falling out and the child thinking that they are a well-known brand of chocolate bean. Young children believe them to be sweets. It is not their fault.
Very often, parents cannot buy safe containers from chemists. Even if they are prepared to pay extra, the containers are not available. I am glad to say that some are coming on to the market, some highly-priced and others very cheap, so that people will be able to buy them if they wish. At the moment, they are not available. They should not only be made available; their use should be made compulsory. Even if they are not perfect, they are a great deal better than the containers that people have to put up with at the moment.
According to the Department, the cost is likely to be about £500,000 a year. Assuming that 25,000 children reach hospitals and each of them spends two days there, adding to that the cost of ambulances and nursing, and leaving out of account the cost in human suffering, one still makes a national profit as a result of spending £500,000. If one takes into account the time that parents are off work because they are looking after their children when they leave hospital, an expenditure of £500,000 is very small.
If it means saving the lives of 25 children, if it prevents 1,000 children from being permanently physically or mentally injured, if it spares 50,000 parents day's and nights of misery worrying about their children, in the context of the national economy or in the context of the National Health Service, £500,000 is a small price to pay.
I hope that, in the circumstances, the Minister will indicate when he replies that he will change his mind and introduce regulations under the Medicines Act which would make it compulsory that child-proof containers, perhaps of varying designs, should be introduced and should be provided. Even if he is not prepared to do that, I hope that he will at least 1483 take such steps as are in his power to ensure that containers of this sort are made available to all chemists at all times and that where medicines are not sold in such containers and are dangerous, they will be sold otherwise in approved forms of sealed plastic strips or other dispensers which cannot be torn apart by small children and which cannot cause the sort of danger and damage which drugs are causing to so many children.
If we have a combined publicity drive from the Government, a new awareness from parents, teachers and grandparents and all those who love children and look after them of the dangers not only of pills and medicines, but of common household substances which should be kept out of the reach of children; if we also take the ordinary measures to make it more difficult for people to be careless—nothing will make it impossible, but we can make it more difficult and help people to keep their own children alive—the Minister will have made a significant contribution, and one which he and the Government can make at minimal expense. I hope that in that event he would have the support of hon. Members on all sides of the House.
§ 10.42 p.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Michael Alison)
I can readily understand the concern for the safety of young children expressed by the hon. and learned Member for Leicester, North-West (Mr. Greville Janner). I assure him not only that I am quite certain that the whole House shares his concern but that I particularly and personally share it, because I fall into the category of those who indirectly have suffered in this way. At the age of 2½ my own little girl, now aged seven, opened her grandmother's handbag and extracted a packet of seasickness-pills. She swallowed half of them and had to be rapidly removed to hospital to have her stomach pumped. Luckily, she was all right and she returned home quickly. That illustrates my background of considerable personal sympathy towards the question raised tonight by the hon. and learned Member.
The problem is not, however, a straightforward one which admits of clearcut, simple and straightforward solutions. As I indicated in my recent Written Answer 1484 to the hon. Member for Liverpool, West Derby (Mr. Ogden), which the hon. and learned Member may have seen, some of the figures, for example, of deaths quoted in some sections of the Press have exaggerated the scale of the problem.
In default of further information on the incidence of poisoning, we tend to look to hospital admissions as the only certain guide, but these, again, tell only part of the story. In the first place, they reflect the changing attitudes of parents and doctors to the need for a hospital check as much as the actual numbers of poisonings.
Well over two-thirds of all children under the age of five who are admitted to hospital because of poisoning, or suspected or possible poisoning, are discharged within 48 hours. The steady increase in the numbers of admissions to hospital thus shows a growing awareness of the dangers whenever there is even the risk of poisoning.
Among the things that we need to know—and we are taking steps to find these things out in departmental sample surveys—are the extent of serious injury, the precise form in which the various drugs were taken in or ingested by the children concerned, whether any drugs concerned were prescribed items or bought over the counter as household remedies and, in general, the circumstances in which poisoning or suspected poisoning incidents occur. These things we are studying and investigating.
Although accidental poisoning accounts for only a small fraction—under 2 per cent.—of all accidental deaths of young children, however, we entirely agree with the point made by the hon. and learned Member that even one death is a disaster and that life should, if possible, be saved. What is a good deal less clear is how best it could, and should, be protected. This does not mean that we are declining to act until someone comes up with a 100 per cent. watertight, complete answer, because I am far from sure that there is likely to be a full and foolproof perfect solution, although we shall certainly continue to examine each remedy which is suggested. It would, however, be wrong for the Government to be hustled into taking ineffective or largely wasteful action out of, as it were, panic sympathies.
1485 It has been claimed that whilst we have been identifying the problem at home, authorities elsewhere have acted. There has, for example, been recent legislation in the United States, though the powers taken there are essentially no wider than those conferred in this country by Sections 85 and 87 of the Medicines Act. And I understand that no regulations have as yet been made in America. Certainly there have been reports of trials of various kinds, but on a small scale compared with the size of the National Health Service market.
We have considered all the evidence so far available, and I am bound to tell the hon. and learned Gentleman that I remain unconvinced either that industry should be urged to use particular types of packaging or that the extent to which various containers are claimed to be child resistant would be likely to reduce poisonings would justify the diversion of, on present estimates, at least £500,000 of scarce National Health Service resources from the treatment of patients.
§ Dr. Gerard Vaughan (Reading)
Would the £500,000 to which my hon. Friend has referred be extra to the present cost of containers? If not, that figure would have to be set against the present cost. My hon. Friend might like to consider carrying out a trial in some part of the country to see what effect the introduction of this kind of container would have on the number of accidents amongst children, because this is a very serious problem.
§ Mr. Alison
Perhaps I could go on to refer to the trials that have taken place. The £500,000 that I have mentioned would be additional. I think that it would involve extra cost to introduce a particular kind of safety container for children.
Coming to the idea of experiments and trials to find a particular kind of container, I think it may be of interest to the House to know what has been done in this respect. In a trial carried out in Australia, about 40 per cent. of children aged 4½ were able to open a child-resistant container within five minutes, and the average lime taken with constant urging to open 10 tablets in foil-strip was eight minutes, so I think that we must not underestimate the ingenuity of even the youngest children in reacting to 1486 the challenge presented by an intriguing container which at first defies attempts to open it. They are extremely clever with their little fingers, as most parents know, in getting round devices which are meant to defeat them.
General matters of home safety are, of course, for my right hon. Friend the Home Secretary, but he has advised me that domestic bleaches—and I think that the hon. and learned Member originally had in mind some of the hazards arising from domestic bleaches—are not regarded by his medical advisers as a major toxic hazard, and as far as can be judged from the available information are not often concerned in child poisoning cases. In 1970, for example, out of 12,224 poisoning cases know to the Poisons Information Service, 183 were due to bleach—five adults, and 178 children. Most of the children were aged between one and 2½ years. None died, and the great majority were discharged from hospital after 24 hours.
Following a recommendation made by the Home Office in 1966, manufacturers are voluntarily labelling bleaches to the effect that they should not be mixed with other substances, in view of the risk of the generation of chlorine gas if this is done. In addition, there are warnings to avoid accidents, and advice on the action to be taken should one occur.
As a result of another approach from the Home Office, there is also a longstanding agreement among bleach manufacturers that bleaches shall not be marketed in containers likely to be associated by the public with food and drink. Bottles of bleach should already be appropriately labelled and packaged, therefore, but if this is shown not to be the case in respect of any particular brand, the Home Office will gladly take up the matter with the manufacturer concerned. I have no doubt that the hon. and learned Gentleman would draw to my attention any particular case that he can.
It is often suggested that all household substances, including bleach, should be subject to a statutory labelling requirement. Particularly harmful products are already required by law to bear warning labels of some kind. These controls do not apply to bleaches most of which are based on sodium hypochlorite, not itself a listed poison.
1487 The hon. Gentleman mentioned pesticides. The Ministry of Agriculture, Fisheries and Food administers what we know as the Pesticides Safety Precautions Scheme, with the help of the Advisory Committee on Pesticides and other Toxic Chemicals. All pesticides cleared under the scheme on sale in this country are labelled by the manufacturers with appropriate warnings and instructions.
As regards the general run of other household products with their varying degrees of toxicity and potential risk there are still difficulties in deciding which of these products should be labelled with a warning of some kind. If every product which might conceivably cause harm to a child were required to bear a warning of some kind, it would probably mean that a very large number of substances in use in the home would have to bear a warning. Any such proliferation of warning labels would ultimately defeat its own ends, as the warnings would tend to lose their impact. If, on the other hand, it was decided to confine the warnings to a selected range of products, chosen because of their toxicity or the frequency with which they were involved in accidental poisonings, there is a possibility that the public might be encouraged to assume that the other products which bore no warning label were completely harmless. The Pharmaceutical Society has pointed out that similar difficulties could apply to the provision of safety containers for medicines unless these were provided across the board; even the comparatively safe analgesics freely available for purchase may be lethal for the young children at risk if taken in quantity. Even with drugs in such containers there could be a false sense of security if they were left in accessible places or the closure was not secure.
Unfortunately, some people just fail to read warning labels, however prominent, and their value can also be lost if harmful substances used in the home are stored in containers other than those in which they are supplied by the manufacturers, or when industrial compounds such as cleaning fluids or concentrated weed-killers which are not normally on sale to the public are brought into the home. Containers such as soft drink bottles, specified by the hon. and learned Gentleman, are often used for the storage of these harmful liquids, the 1488 bottles being unlabelled or, even worse, still bearing their original soft drink labels. This creates a particularly dangerous situation.
In these circumstances, the Government are concerned to promote publicity designed to ensure that all household substances likely to cause harm are kept in a safe place out of the reach of children. The hon. and learned Gentleman touched on the need for publicity of that kind. The Home Office, for example, have made television-filler films on this subject which are shown quite often by the B.B.C. and Independent Television companies in breaks between programmes. The Royal Society for the Prevention of Accidents promotes frequent national campaigns covering various aspects of safety in the home and these usually include advice on the prevention of poisoning accidents. In addition, the Society produces and stocks a wide range of publicity material including posters and leaflets about accidental poisoning. These are made available to local authorities and local home safety committees throughout the country for use in local home safety campaigns. We understand that very good use is made of the material thus supplied.
Regarding the labelling of medicines, I have explained that there are already powers in the Medicines Act, although I regard this as being largely for the professions and a matter which they take most seriously. Inasmuch as labelling has an educative rôle, responsibility lies with the Health Education Council; but there is one recent professional development to which I should refer. The agreement between the medical and pharmaceutical professions that the medicine dispensed will be identified on the label of the container unless the prescriber indicates to the contrary may not prevent accidental poisoning, but it is likely to assist the speedy and effective treatment of some cases of poisoning. We have, therefore, welcomed the agreement and my Department is studying the implications for the National Health Service of implementing it.
Particularly in respect of medicines, we await the conclusions of researches which may throw up some fundamental pointers to the basic facts and problems involved and specifically to the comparative value of education and packaging.
1489 But I must stress that we continue to look at all the evidence, from whatever source it comes, either home or abroad, and that we appreciate and welcome the concern that has been expressed tonight. This debate has served an important purpose in drawing attention to the real and tragic hazards involved in allowing young children access to dangerous substances.
What we have been talking about in the main have been possible second and third lines of defence; and I hope that nothing which has been said will detract from what I believe to be the first line—or discourage the professional, local government, and voluntary bodies and, incidentally, the manufacturers of proprietary medicines, from continuing to advocate it—namely, the golden rule "Keep all medicines out of the reach of children".
I hope that parents and all who are in touch with young children will recognise the need for constant vigilance in this respect. As a result of all that is being done both nationally and locally, we trust that they will become increasingly aware of the need to keep other household substances, such as bleach, safely out of children's reach.
Young children are active, lively and curious, and it is for the rest of us to recognise this and see that they remain safe. In many ways I think we do. The bodies I have mentioned and parents themselves must be entitled to take credit for the fact that children's deaths from poisonings in this country seem to be low compared with some other developed countries.
I trust we shall keep it that way; and my Department will continue to review 1490 what more can and ought to be done in consultation with those organisations, including in particular the Health Education Council, concerned with home safety and other bodies representative of the pharmaceutical profession and industry.
§ Mr. Greville Janner
The hon. Gentleman will be aware of the considerable increase in the number of poisonings in this country over the years. What steps does he propose to take to deal with this matter? One naturally agrees with all he says about the first line, but he is in charge of the second and third lines. What is he doing about them?
§ Mr. Alison
I referred at the beginning of my remarks to the departmental pilot survey, which is in hand, into the real figures which lie behind the number of hospital admissions, many of which are ostensibly poisonings but in the event prove not to be. There are many facts that we do not know and the sort of figures which the hon. and learned Gentleman quoted prove to be very generalised and do not give a full insight into the size of the problem. Many of the facts and figures which are given are often substantially exaggerated. If the hon. Gentleman will read in the OFFICIAL REPORT the list of steps that are being taken, the number of bodies concerned with this matter and the various alternatives that are available—
§ The Question having been proposed after Ten o'clock and the debate having continued for half an hour, Mr. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
§ Adjourned at three minutes to Eleven o'clock.