§ Order for Second Reading read.
§ 3.37 p.m.
§ The Secretary of State for Social Services (Mr. David Ennals)
I beg to move, That the Bill be now read a Second Time.
The Bill is a quite short and, I very much hope, uncontroversial measure. None the less it is important, since its aim is to provide a measure of financial support to people severely disabled as a result of vaccination, and to their families and others involved in looking after them. There can be no doubt that those concerned pay a high price in terms of personal disablement, often at a very early age before their lives have properly begun, and that their families share in that price.
For most people, vaccination is a beneficial procedure, and it is right for the community to give financial aid and support to those who suffer as the result of vaccinations given as part of the public policy programme. I am sure that the whole House will support the humane motivation of the Bill.
Hon. Members will recall that on 14 June 1977 I informed the House that we accepted in principle that there should be a Government scheme of payments in respect of vaccine damage once the Pearson Royal Commission's report was published. It then seemed likely that the Commission would make detailed recommendations which we would need to take account of in designing the scheme.
The report was published in March last year, and included only a general recommendation about strict liability in tort for vaccine-damaged people. It was immediately clear that the Government would need to give detailed consideration to this and the other Pearson recommendations as a whole, which would inevitably take time, and, in view of the urgent need to assist vaccine-damaged children and those who cared for them, we decided on a scheme to provide payment of a lump sum of £10,000 in respect of those severely damaged by vaccination under a routine public policy vaccination programme.
33 The scheme was outlined in my statement to the House on 9 May 1978, and I gave further details in answer to a question by my hon. Friend the Member for Stoke-onTrent, South (Mr. Ashley) on 2 August last year. In referring to my hon. Friend, I should like to say how much I appreciate, and how much those involved have appreciated, the tremendous interest he has taken in this measure and this cause.
I said on 2 August that a Bill to cover the scheme could be introduced as soon as parliamentary circumstances permitted, but that in view of the urgency of the need arrangements would be made in advance of legislation to ensure that families who had already waited a long time could make their claims as quickly as possible. In fact, I am glad to be able to tell the House that we shall shortly be making payments in some 50 cases in which we have already notified an award to the claimants.
There have been some beneficial modifications in the details of the scheme that I outlined on 2 August. In particular, the residence qualification has been abandoned, and there is in the Bill a provision for payment in certain additional cases. It now covers damage suffered by a person as a result of vaccination of the mother before birth, vaccination against polio at any age, and any vaccination to anyone given during an outbreak of the disease in question.
I want to make it clear that the Government remain convinced of the benefits of routine vaccination as part of the public health programme. The massive overall benefits of immunisation against these diseases far outweigh the associated risks, and we must continue to provide this protection to our children and to the community at large, while providing for the tiny minority who suffer disablement as a result.
§ Mr. Jack Ashley (Stoke-on-Trent, South)
I am glad that my right hon. Friend has made that point. He knows that those of us who have been active in this matter strongly support the immunisation programme, but we are never reported when we make that point. Will he tell the House that all those who are active in this campaign have strongly supported the immunisation programme?
§ Mr. Ennals
I am grateful to my hon. Friend for his intervention. What he has said is absolutely true. The more people recognise the value of the vaccination programme and stand up and say so, as my hon. Friend has done, the better it will be for the public at large as well as for individuals.
The Bill is designed to provide a lump sum payment now for the support of those severely disabled by vaccination. On the wider issue of the Royal Commission's recommendation about strict liability in tort in respect of vaccine damage, I can only repeat what I said in the debate on the Pearson report on 17 November last, that, in consultation with the medical profession, we are studying this recommendation, and we still have a good deal more work to do. But the House will fully take the point that this Bill does not in any event purport to provide a compensation scheme. It follows that a £10,000 payment is not in any way a bar to any subsequent civil proceedings for compensation, and does not prejudice any rights, though it would be taken into account in assessing the amount of any damages.
Much the most difficult part of a scheme of the sort which this Bill provides for is the method of determining whether a particular disability can be attributed to vaccination. I think that the House would wish me to explain how we approach this matter. Most of the controversy in this area is in relation to cases of brain damage attributed to vaccination against whooping cough, and it will probably be helpful if I relate my remarks most closely to this situation.
In fact, there is no medical consensus about whether whooping cough vaccination can produce brain damage. Some experts argue that there is no firm evidence that whooping cough vaccine has ever caused any such damage. Others have argued that in a small but definite proportion of cases such damage occurs in consequence of vaccination. I consulted my expert advisory body on the matter, the Joint Committee on Vaccination and Immunisation, and in May 1977 it provided me with a very thorough review of the evidence. This has since been published. From a retrospective analysis of cases involving conditions such as childhood convulsions or encephalopathy, the committee concluded that it 35 was not possible to differentiate between those cases which were and those which were not apparently caused by vaccination. On the other hand, it recognised that the risk that pertussis vaccine induces reactions, sometimes mild, occasionaly severe, and rarely of an extremely serious character, is not negligible.
The problem of identifying the vaccine damage cases is, therefore, difficult. If we were to insist on proof, in the legal sense, of such damage, very few, if any, would succeed. What we propose, therefore, is that the test of the balance of probability is to apply—and that is what the Bill provides. This will entail looking at each case as a whole, taking into account the medical history and the current condition of the disabled person.
In some cases there is a clear record of vaccination, closely followed by febrile convulsions, and evidence of brain damage within a week or so. In such a case, unless there is some compelling evidence of another cause, the claim will clearly be accepted. At the other extreme, there are cases where there is a long gap between vaccination and any symptoms, and where there are grounds for assigning some other cause, for example, a congenital condition. But I emphasise that, while, in the first place, my Department's medical officers are looking at cases on this basis, there is no question of the decision on the issue being made finally in my Department. I am sure that that would be wholly wrong. It is, therefore, a two-stage process. In each case there will be a right to have the case considered by an independent expert tribunal. If, on the balance of probability, the tribunal is satisfied that the conditions in the Bill are met, payments will be made. The same general principles apply to claims in respect of damage due to vaccination from diseases other than whooping cough.
I now turn to the detailed provisions of the Bill. Clauses 1 and 2 provide for a payment of £10,000 to be made for anyone severely disabled as a result of vaccination under a routine public policy vaccination programme. Generally speaking, a payment can be made only to a person who suffers, or has suffered, 80 per cent. or more disablement caused by vaccination against certain specific diseases which was carried out in the United Kingdom or the Isle of Man after 36 the National Health Service came into existence on 5 July 1948 and before those concerned have themselves reached the age of 18.
Provision is also made for people who have suffered disablement either because their mothers were vaccinated before they were born or because of the vaccination of someone else with whom they were in close contact. I believe that there will be few such cases. In addition, the Bill covers damage due to vaccination at any age against rubella—German measles—or poliomyelitis. The general age-18 rule reflects the fact that, except for these two diseases, the present routine public policy vaccination scheme is for the vaccination of children.
The establishment of the extent of disablement will be based on well-established social security principles. By fixing 80 per cent., we have, I believe, brought in all those who are really severely disabled. This will ensure that those who receive mobility allowance or attendance allowance in respect of the disability in question will qualify.
Clause 3 sets out the prescribed manner for claims to be submitted and determined by the Secretary of State in the first instance. The question whether severe disablement has resulted from vaccination will, as I have already said, be decided on the balance of probability. If a claim is disallowed for any reason, the claimant will be notified as soon as possible, and the reasons for disallowance will be given. Where the claim fails because the disabled person is considered not to be severely disabled as a result of vaccination, the procedure for appeal to an independent medical tribunal will be explained in the notification of disallowance.
Clause 4 provides for the establishment of independent medical tribunals to review cases referred to them which have been disallowed by the Secretary of State because he is not satisfied that the disabled person is severely disabled as a result of vaccination. The details of the appointment and procedure of these tribunals will be dealt with by regulations, and I must add that the Secretary of State will be bound by the decision of the review tribunals.
Clause 5 permits the Secretary of State to reconsider a determination made on 37 his behalf because of a change of circumstances since the determination, or because of ignorance or mistake in respect of some material fact at the time of determination.
Clause 6 sets out the proceedure by which payments will be made either direct to the disabled person, if he is over 18 and capable of managing his own affairs, or, if not, to trustees appointed by the Secretary of State. It is envisaged that these trustees will be those responsible for looking after the disabled person, generally his parents or relatives. The terms of the trust deed will be widely drawn to allow trustees considerable discretion in spending money.
§ Mrs. Helene Hayman (Welwyn and Hatfield)
I should be grateful if the Secretary of State could clarify a matter which arises on clause 6(4). Let us suppose that civil proceedings are taking place and a person already has the payment. It is conceivable that such a claim could be against a drug manufacturer and not the Government, yet the money paid over by the Government would be taken into account by the courts in assessing damages. What would be the position on the £10,000 between the drug company and the Government?
§ Mr. Ennals
I have noted the question, but I shall leave it to my right hon. Friend to answer it later.
Clause 7 makes it possible for those who have claimed before Royal Assent, and who have not been successful, to take their cases to a tribunal after Royal Assent.
Clauses 8 to 12 are of a technical nature. They cover the provisions for financing the scheme, for making regulations in respect of procedural details and so on.
Finally, I should like to remind the House that the payments to be made under the Bill are additional to the wider social security provisions for disabled people—part, indeed, of the continuing programme to improve the lives and prospects of disabled people to which my right hon. Friend the Minister responsible for the disabled devotes all his time and energy. Many of the people being helped from the Bill will already benefit from mobility and attendance allowances.
38 I am sure that I am right in assuming that the Bill has wide support in the House as I know it has in the country as a whole. It may not go as far as some hon. Members would like, but I commend it to the House as an immediate measure. As such it goes a long way towards providing relief and support for those who have suffered the tragic consequences of what for the overwhelming part of the community is a vital life and health-saving programme.
§ Mr. Robert Boscawen (Wells)
I apologise for not being here at the beginning of the debate. Could the Secretary of State state the position on supplementary benefit? Is there any disregard of the total sum of £10,000 as opposed to the capital holding of the individual?
§ Mr. Ennals
That is another question that I shall specifically ask my right hon. Friend to deal with. We are trying to complete the debate before seven o'clock and I promised to be brief.
The Bill seeks to alleviate the cruel paradox that, because the great majority benefit, a minority, albeit a very small minority, has suffered. I feel sure that the House will welcome this humane measure.
§ 3.53 p.m.
§ Dr. Gerard Vaughan (Reading, South)
I, too, shall be brief. This is a most important Bill, but the debate is to be short and a number of hon. Members wish to speak.
There will be satisfaction on both sides of the House that the Bill has come before us today. It is rather pleasing to be able to congratulate the Secretary of State—and I do so now—on having presented the Bill in the way that he has. However much the Bill may mean to us, our satisfaction is nothing compared to that felt by Mrs. Rosemary Fox and the parents who formed the Association of Parents of Vaccine-Damaged Children. They have compaigned magnificently on behalf of their own and other children. Looking back on it, one sees that they had to face difficulties of understanding among members of the medical profession, who consistently said that we were concerned with a small number of children, not perhaps of great social importance. They then had to battle against the views of society. We have been through that un- 39 fortunate stage where many parents wrongly assumed that it would be a mistake to have, for example, whooping cough vaccination. There was a panic that led to problems for all kinds of vaccination. These parents then had to battle through the difficulties of persuading this House and the Government.
This is essentially a matter of personal tragedy, not only for the child who is permanently damaged but also for the parents. I well remember the first time I came across one of these children, who was a bright, vivacious, delightfully normal child before the vaccination but a total vegetable afterwards. These are normal children who end up in a totally damaged condition, and that makes these cases so special. It leads not only to great practical burdens for the family but also to enormous guilt and doubts about whether the child should have had the vaccination. It is a stressful condition, as the House realises.
I thought at one time that the Government were in danger of brushing the problem aside because the numbers were said to be small. We are now aware that we do not know the total numbers. In many cases it is difficult to know whether to attribute the damage to vaccination or to birth disorders and other conditions. There is still an argument about this. One advantage to emerge has been the setting up of the special inquiry, and we shall in the next year have an answer to two questions—and I hope it will be sooner rather than later. First, we shall have some idea of the numbers involved. Secondly, we shall have a better idea of the efficacy of some of the vaccines, particularly the whooping cough vaccine.
Once the problem was recognised, the next doubt was one about which I feel strongly. It was whether it was right for society to pick out one group of damaged children, in addition to the thalidomide children, for preferential help over other handicapped children. With the attendance allowance we have to a limited extent achieved help for all handicapped children. We on this side of the House recognise that there are special difficulties about this. The hon. Member for Stoke-on-Trent, South (Mr. Ashley) and the hon. Member for Eccles (Mr. Carter-Jones), who is not in 40 the Chamber at the moment, recognised from the start that there were special problems about vaccine-damaged children. Right from the start we on this side have put to the Government that there is a special responsibility on the part of society. A child is vaccinated partly for his own protection but also for the sake of society. We need to ensure that there is an adequate number of immunised children in the community to guard against epidemics. Society has asked for children to be vaccinated and the Government, representing society, have endorsed the procedure. It is therefore right that society should shoulder some of the responsibility when the procedure goes wrong. This has been recognised in other countries, particularly West Germany.
One argument that we shall wish to consider in Committee is whether £10,000 is the right amount. The amount does not seem much, but the Secretary of State has made it quite clear that it is not intended as compensation; it is simply an interim payment. We have already had representations that, as this is only an interim award, something more should be done for the children rather than leaving it to the parents to go to court, if necessary. I do not know what is the right course. My first reaction was that £10,000 was a good start which showed Government recognition of the problem. For many parents who are in the middle of this tragedy, the fact that society will make a contribution to help them will ease some of their burdens.
There is one other matter about which I feel very strongly. As a result of the thalidomide tragedy I was asked to set up a panel to examine these children objectively and medically. The message that came out of that was that a great deal of unnecessary suffering was caused by delays in the procedure. Those of us involved with the thalidomide children were anxious that there should be some more rapid procedure for dealing with these cases. The Government have recognised this, and I congratulate them. They have set up a procedure giving the benefit of doubt to the children and avoiding the long and harrowing delays that were experienced by the thalidomide children.
There are a number of points that we shall want to examine in Committee. We 41 have already had representations about the interim payment. There is some difference of opinion on what is happening at present. In his letter to me about the Bill, the Secretary of State said that payments were already under way. However, I had a letter dated 18 January from the Association of Parents of Vaccine-Damaged Children which indicated that no payments had yet been made. We have also had queries about families who were resident in this country—in some cases for many years—but who are now overseas. About half a dozen such families are involved. Will they have a claim on the interim payment? Examples like this need examining in Committee.
The Opposition have some reservations about the detail, but in general this Bill has their full support.
§ 4.3 p.m.
§ Mr. Jack Ashley (Stoke-on-Trent, South)
I welcome this Bill, which will ease the burden on families whose lives have been devastated as a result of the vaccination of their children. Happy, healthy children have been blinded, deafened and paralysed or mentally retarded after vaccination. Although they can never be fully recompensed, the parents are grateful to the Government for the interim payment outlined in the Bill.
The hon. Member for Reading, South (Dr. Vaughan) made some very important points in his speech. I am glad to echo his compliment to Mrs. Rosemary Fox, who, virtually alone, has made the nation, the Government and the whole medical profession aware of what only a handful of specialists knew—that, although the immunisation scheme is invaluable, a tiny minority of children can be damaged by vaccination.
That fact has been recognised by the introduction of compensation schemes in several other countries such as West Germany, France, Denmark, Switzerland, Sweden and Hungary, but despite this there was a conspiracy of silence in Britain. Successive Governments and the medical profession refused to disclose the risks for fear of frightening people away. But, as the Ombudsman pointed out, people have a right to know, however small the risks are, so that they can then decide for themselves. It is to Mrs. Fox's credit that the Government have not only recognised the fact but have also decided 42 to give financial help to the families concerned.
Equally important is [...] fact that as a result of the campaign doctors are now much more cautious, about vaccine procedures. Vaccinations were being done on the conveyor belt principle and we were given evidence from experts in the field that some doctors were vaccinating when there were contra indications, such as fevers, a history of fits and epilepsy, so that children were being damaged unnecessarily by the negligent use of vaccine. The number of children damaged in this way must have fallen as doctors are now much more careful about the children they vaccinate. This is a valuable and underestimated benefit from the campaign.
Some people have objected to payments to vaccine-damaged children, and these objectors fall into two categories. The first includes those who deny that vaccination can cause any damage at all, notwithstanding the facts that other countries have these schemes in operation, that the Royal Commission accepted that vaccine-damaged children should be helped and that the Government have accepted the case after careful study. This group includes some of the more eccentric doctors, some of whom have been offensive to the parents concerned.
The other group opposing payment includes some admirable doctors and sociologists, whose views I respect. They believe that all disabled people should be compensated, irrespective of the cause of their disability. Personally I favour a comprehensive disability income, and in an ideal world all disabled people would be compensated for loss of income and normality and for the costs of disability. In our imperfect world some disabled people get more help than others. The outstanding examples are war disabled and industrially disabled people and those proving negligence in the courts. These are special cases.
Vaccine-damaged children are also a special case because, like the war disabled, their injuries arise from particular circumstances. Although vaccination benefits the individual, it also benefits the community. In the case of whooping cough, young children are vaccinated only partly for their own benefit. They are vaccinated mainly for society's sake, and especially 43 for the sake of siblings. It is because they are wounded in the war against disease, a battle fought [...] behalf of the whole community, that this small group of children should be comp[...]ted.
However, the Government have now introduced this Bill and I congratulate my right hon. Friend the Secretary of State on bringing it forward. Our clashes in the House have been angry at times, but the House should recognise that the Secretary of State has initiated an important step forward in social policy, and moreover he has done so at a time of very great economic difficulty and in the face of strong opposition from some parts of the medical profession. I recognise the problems and I thank my right hon. Friend most warmly for the way in which he has handled the Bill. It is greatly appreciated.
Although I welcome the Bill, I want to leave the House in no doubt about my criticisms of it. The Pearson Commission recommended strict liability for vaccine-damaged children. On that principle, the children will receive an average of more than £100,000, and not the £10,000 provided for in the Bill. Under the Commission's recommendation, they would get that sum in a court because they were vaccine-damaged. They would not have to prove negligence.
The payment of £10,000 is clearly inadequate. It represents only about three years' average earnings and it is to go to children who have been damaged for a lifetime. The Bill can be regarded only as a stopgap interim measure until an adequate compensation scheme is prepared. That should be done as soon as possible. There are various ways of establishing such a scheme, and perhaps the best would be to introduce a system based on the war injuries scheme or a system similar to that for industrial injuries.
The great advantage of such a scheme, compared with the lump sum given by a court, is that it would be properly inflation-proofed and could be adjusted to any changes in the effect of damage on individuals. I hope that the Minister who is responsible for the disabled will be able to announce categorically that the £10,000 is only an interim payment and is not to 44 be regarded as discharging the Government's obligations to vaccine-damaged children and that the Pearson Commission recommendations will be urgently considered by the Government.
When the payments in the Bill and those under any subsequent scheme have to be implemented, I hope that the Government will give the children the benefit of the doubt. The Secretary of State spoke about the "balance of probability", and that is the right attitude. I hope that that tolerant approach will be consistently maintained. I am sure that the families would appreciate that. I hope that it will be recognised that, in the nature of these cases, direct evidence will be hard to find because when the children were damaged neither doctors nor parents were likely to concentrate on the need for careful documentation.
I also believe that it is wrong to deny payment to children who are 75 per cent. damaged or even 20 per cent. damaged. Why should they be denied payment? The 80 per cent. condition is rigid and arbitrary and should be removed. I suggest that the Government should think again and bring in a two-tier system, perhaps paying the £10,000 to those children who were more than 80 per cent. damaged and £5,000 for the others. That would be rough justice, but it would be less rough than that which excludes a number of deserving cases.
I wish to make a plea for the families whose children have died. I know that the payment is not for bereavement, but if a child and his family suffered as a result of the State policy on vaccination a payment should be made. I hope that the Government will reconsider their decision not to pay those families.
The other category to be considered is the children vaccinated before 1948. I realise that vaccination became State policy in 1948, but some vaccinations, including smallpox, were compulsory before then and I have no doubt that Ministers and doctors recommended vaccination in the interests of the community. I hope that the Government will relent on their hitherto inflexible stand on this aspect. I assume that the trust scheme will be a generous one and that the needs of the family, as well as the needs of the child, will be considered. Indeed, I believe that that is one reason why the 45 Secretary of State has hastened this payment to help hard-pressed families.
Today is an important day for the families of vaccine-damaged children. They have been neglected in the past and vilified for daring to mention the plight of their children in case other children took fright. They have borne heavy financial burdens and, above all, have seen their children condemned to suffer a lifetime of pain and disability and be robbed of the magic of childhood.
The Government should be congratulated, but they should specify that this is an interim payment and should include all vaccine-damaged children, whenever they were damaged, and help the families of children who have died. If they do all that, they will not only deserve congratulation but will earn the gratitude of a group of people whose years of suffering and frustration have bent and nearly broken them.
§ 4.16 p.m.
§ Mr. Robin Hodgson (Walsall North)
When one follows in debate the hon. Member for Stoke-on-Trent, South (Mr. Ashley), who has for so long had such an attentive interest in the problems of vaccine damage, one has obviously been listening to an expert. I listened with a great deal of care and attention to what he said and I echo much of it.
I welcome the Bill. It is almost impossible to find general grounds for opposing it. It would be like opposing motherhood and apple pie, because no sum of money could possibly compensate the children or the families for the suffering, extra work and psychological hardship that they have undergone and are still undergoing.
However, I wish to make a number of points on which I hope the Minister who is to reply will comment. I start with two small and specific matters. Clause 2 deals with the conditions of entitlement and subsection (5) provides that the inoculation must have been given within the United Kingdom, except in the case of children of serving members of Her Majesty's Armed Forces.
I have a constituent who was employed in the Diplomatic Service and the inoculation of his child was carried out by a doctor attached to his embassy. He is not strictly a member of the Armed Forces, but I should be grateful for an 46 assurance that that fact will not mean his exclusion from the payment. I am sure that there are only a small number of such cases, but they are a great worry to the parents.
The second specific point concerns the right of appeal. The Secretary of State said that the decision of the tribunal was final and that there was no right of appeal to him. It was not clear from what he said whether there would be a right of appeal to the courts or whether once the tribunal had given its decision that would be the end of the matter.
I turn now to the major considerations arising from the Bill. My hon. Friend the Member for Wells (Mr. Boscawen) referred to the question of social security benefits. I know that several of my hon. Friends wish to deal with that matter, so I shall not dwell on it for long except to say that it is a key point. It is extraordinary that the Secretary of State should not be prepared to give an answer now and that he should defer a reply to what is the most critical aspect of today's debate—how the overlap of entitlement to existing social security benefits will be affected.
Paragraph 182, on page 47, of the Pearson report reads:Sixthly, we have found that even well informed witnesses consistently underestimate the present and prospective value of social security benefits. It is possible for a person with family responsibilities to receive £40 or £50 a week, or more, tax free, by way of sickness or invalidity benefits. … A man totally incapacitated early in life through an accident at work could, by the time he is 65, receive in all a total of £150,000 in benefits at current prices. The payments are 'inflation proofed', and most of them free of tax. Except where particularly high earnings have been lost, the overall value of social security benefits, particularly for industrial injuries, compares favourably with lump sum damages which make no allowance for future inflation.Much of what is in that paragraph impinges heavily on what we are talking about today. First, there is the question of the present value of future earnings which Pearson says is £150,000 and which is £10,000 in the Bill. Secondly, there is the question of inflation-proofing and freedom from tax of social security benefits. Thirdly, there is the broad assertion by Pearson that the overall value of social security benefits compares favourably with lump sum damages.
It is critical that we should have a clear guide early in our deliberations about 47 how this payment will fit into the overall scheme.
§ Mr. Ennals
The Supplementary Benefits Commission has agreed that if the damaged person is a child it will ignore the £10,000 payment. If the damaged person is an adult, the payment will be taken into account and the Commission will give sympathetic consideration to special circumstances. I am sure that the hon. Member will welcome the decision on children.
§ Mr. Hodgson
I am grateful to the Secretary of State for that reassurance.
I now turn to the question how the Bill fits into the overall scheme. I was glad to hear the Secretary of State refer to the debate on the Pearson report. Much of what he said today seemed to contradict what he said on 17 November. This afternoon he talked about the Bill being a first step—I was delighted to hear that—but in the debate last year he said:it is true to say that there is a general feeling that we may have gone about as far as is sensible in the construction of further individual benefits for particular kinds of disablement, with the range of benefits which now exist.This afternoon we seem to be discussing another form of benefit. The right hon. Gentleman went on to say:So what we are talking about is not the bringing into benefit of a class of people who are at present without any cover; what is suggested is the provision of benefit at rates which are higher, sometimes a great deal higher, than are available to ordinary beneficiaries."—[Official Report, 17 November 1978; Vol. 958, c. 773–4.]That has a considerable impact on today's discussion.
§ Mr. Ennals
In that debate I indicated that I had some sympathy for the idea of a general disability benefit which was linked to the extent rather than the nature of the disability. Clearly such a decision would take a considerable time and, if taken, a considerable time to implement. The whole House feels that we should not delay in dealing with vaccine damage. That is why I feel that we must move ahead regardless of the decision taken on the bigger and more fundamental question of a general disability allowance.
§ Mr. Hodgson
I am sure that I speak for many in saying that we are delighted 48 to have had the opportunity for debate and that the Government have introduced this Bill.
We are in danger of setting precedents which will have considerable implications for relative payments for different classes of disabled people.
I am aware that disabled children have particular clout. They are politically attractive. Other categories of disabled people are less attractive and the wave of public sympathy for them is not so great. I worry in case other less politically, socially and publicly attractive groups of disabled people are left behind.
An elderly constituent of mine was hit by a vehicle driven by an uninsured driver. She is now severely disadvantaged, through no fault of hers. At her time of life she cannot hope to attract the public sympathy that the hon. Member for Stoke-on-Trent, South is able to arouse on behalf of children. I understand that.
The Bill is worth while, but I am also anxious about the other groups of people who were discussed in the Pearson report and who might be left behind because they cannot engage public sympathy. I was particularly pleased to note that the Secretary of State said that this was a first step in the setting up of a comprehensive scheme to ensure that disabled people are treated even-handedly, whatever their age, experience or relative disablement.
§ 4.27 p.m.
§ Mr. Hugh Jenkins (Putney)
I apologise to the Secretary of State for not being here when he opened the debate. But he has made it even by leaving the Chamber now. Perhaps we can call it square.
The Bill indicates the humane nature of my right hon. Friend and of the Government when dealing with these problems. So much for the hysterical abuse to which my right hon. Friend and the Government have been subjected particularly in such wretched journals as the Daily Mail which are not fit to be put to the basest possible use.
My hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley) deserves to be congratulated. He has brought to the subject a consistency and determination which deserve our praise. It is recognised that he has for these problems a compassion which is in no way dependent 49 upon the fact that he himself suffers from a serious disability.
I wish to discuss the problems of another category of children, the parents of whom believe them to have been seriously damaged by hormone pregnancy tests. There are many such children. The parents have formed an association to try to achieve similar protection for their children.
There are psychological pressures upon parents of children who have been damaged as a result of hormone pregnancy tests. I accept that there are arguments against the belief that children can be so damaged, but there is a strong case for believing that they can be and have been. Some people say that the case is not proved, but I urge my right hon. Friend to exercise the compassion which he has brought to the wider problem. I hope that my right hon. Friend will not exclude the possibility of amending the Bill in Committee so as to include this additional category of children and thus prevent them from having to wait for more general legislation.
The circumstances are similar, but the psychological pressures upon the parents are probably even worse than with vaccine-damaged children. At least the parents have the consolation of knowing, if vaccination goes wrong, that it was being done for the benefit of the child. That is denied the parents of children who may have been damaged as a result of hormone pregnancy testing. The pressures on the parents in these circumstances, while not as gravely distressing as the physical damage suffered by the children, are very serious.
To include this category in the Bill would be in accordance with the fine attitude that the Government have brought to this problem. If my right hon. Friend could make this exception, he would go even further to bring to the Government the appreciation that is their due under the Bill.
§ 4.33 p.m.
§ Mr. David Crouch (Canterbury)
Before I deal with the question of vaccine-damaged children, I should like to echo the words and thoughts of other hon. Members, particularly the Secretary of State, who have expressed great concern for the other groups of childen and adults who have suffered grave physical and 50 mental damage from causes other than that of vaccination. It is important that we continue to show our concern for these people by doing something for them along the lines of this generous Bill.
A constituent came to see me recently. Her husband had survived a car crash which killed two others. He had hitherto been successful, and, although he is not now exactly a vegetable, he is in a psychiatric hospital and is allowed out only occasionally. He can no longer manage his own affairs. His wife is required to devote her whole life to looking after a person who now cannot look after her or their family.
I cite that example to show that there are others who merit our concern, and serious thought should be given to whether we are providing enough to enable them to shoulder an awful burden that results from a tragedy that has hit them.
Another constituent came to see me 10 years ago. I was very impressed by the man. He told me that he had a son who was severely handicapped. At that time the boy was about four years old. Since then the constituent has returned to see me regularly. We now know that his son suffered damage from an injection of whooping cough vaccine. My constituent will welcome the Bill and the generous payment of £10,000. However, I think that I should explain to the House a little about my constituent and his family.
The result of this tragedy was that the father had to give up his job and go on to social security. When one first hears that sort of thing, without knowing the background, one tends to think that the man may have been a malingerer, that he may have been searching for an excuse not to work and to get a generous social security payment. One might ask whether his wife could not look after the seriously disabled child. I have discovered that this man is not a malingerer but is something of a hero.
The man has had to give up the opportunity of pursuing his career and of providing for his family. He has had to forsake that opportunity of pride and must, instead, seek his pride in looking after his wife and his children who include the severely disabled child. Never once has that man, in all his visits to me, complained about his bad luck and 51 the tragedy that overtook his family. He has come to see me only to see whether I can help him to find extra aid, or, perhaps, to find a place in a summer home for two weeks for his son so that the wife and husband can enjoy a two-week rest on holiday at home. He has come in search of the difficult type of medical help that is needed for a severely handicapped person who is now becoming a young teenager but who has to be treated like a baby.
Members of Parliament are sometimes asked what sort of people come to see them at their interview centres. I say that I see all sorts—those with serious criticisms of Government policy or of the Opposition's attitude or of one's own political views. There are those who come to complain of a Member's failure to support a particular course of action that a constituent thinks merits support. Of course, we get many people with cranky ideas and others with serious personal worries about whether they are getting the right pension or whether they are entitled to some social security allowance or other. But the most distressing cases are those of people who have suffered the sorts of tragedies that I have described this afternoon.
Those cases set one back and make one feel that, whatever else one does as a Member of Parliament, one should do all one can to help these people who come in desperation. They come not with a begging bowl—that is not their way—but merely to ask for any help we can give to ease their lot. They ask a Member to approach the director of social services to take up their case, or to ask the health visitor or the welfare officer to call.
In the correspondence concerning this constituent which I have had with the Secretary of State for Social Services and the Minister with responsibility for the disabled, I have received nothing but help. However, I still go home, having seen such a person, with a feeling of not having done enough. I shall go home tonight feeling that not enough is being done in this Bill. I do not want to niggle over the compensation figure, but the hon. Member for Stoke-on-Trent, South (Mr. Ashley) said that £10,000 represented peris probably only two years' earnings the haps three years' earnings. I say that it 52 way that things are going. My constituent who had to give up working and devote his life to his family is worth more than two or three years' wages.
Therefore, I welcome the Bill as an interim measure, as a step in the right direction. But when we hear the claims ringing in the ears of the Government, Parliament and the press for more pay by those who say that increases of 5 per cent., 10 per cent. or even 17 per cent. are not enough, and who take vigorous action to get their way, let us think of the people with whom the Bill is concerned. There may be only a few hundred of them, but they are very important people. If we can do right by them, we will show that we intend to do right by all those others who have suffered. We should remember that these people have made a contribution to the betterment of society; a contribution towards the improvement of health in our society, but, because of the tragedies and mistakes that occur—even though the figure may be one in a million—these people have paid a terrible price—a price on a par with that paid by those severely wounded in war. That price is paid not only by the child as it goes through life without any real enjoyment but by noble parents as well. We must remember them and decide whether £10,000 by way of compensation is sufficient.
We must also consider whether we are providing enough for other people who have suffered tragedy and who need the right to compensation. I was delighted that the Secretary of State assured the House that the payment of £10,000 would not be taken into account in relation to claims on behalf of children for subsequent social security benefit. As a result, we now know where we stand. When the Secretary of State considers claims under the Bill—I hope that it will soon become an Act—he should remember what my hon. Friend the Member for Reading, South (Dr. Vaughan) said, that he hoped that children would be given the benefit of the doubt over claims for compensation. I hope that there will not be too much haggling over claims. If there is a doubt, the benefit of that doubt should go to the children. I hope that the Government will err on the side of generosity. Even in these hard economic times, the Opposition will support the Government if they do so, and, though I 53 do not speak for the Opposition Front Bench, I am sure that I echo its sentiments. I wish the Bill speedy success.
§ 4.45 p.m.
§ Mr. Ronald Atkins (Preston, North)
I share the feelings of the hon. Member for Canterbury (Mr. Crouch). I have been impressed by the way in which two victims in my constituency came to see me almost apologetically. They sought help but were not demanding it, though they had a right to demand it. Such people need others to fight their battles for them and I am glad that the compaign was established. It is one of the best of our British traditions that we campaign for the rights of people who do not fight for themselves. This is why the Bill came into being.
I congratulate my right hon. Friend on introducing the Bill without delay. The making of an interim payment is a good method of dealing with compensation, but I hope that it is definitely an interim payment and that it falls far short of the final payment which we should make to these unfortunate people. They suffer distress through no fault of their own.
I agree with my hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley), who believes that a two-tier system is necessary to cater for those families which would be excluded if there were not such a system. Through no fault of their own, they are in the unfortunate position that the happiness of the whole family is affected. I hope that the Minister will think on the words of my hon. Friend the Member for Stoke-on-Trent, South.
When a parent agrees to vaccination, he does so, I suppose, by way of his duty as a citizen but also as an act of faith in the medical services, and we can imagine his reaction when he is let down. It is not just a matter of measuring our compassion; it is the granting of a right to compensation for people who have been victims of a system which has not worked properly. I am sure that all hon. Members agree that no amount of money can compensate a family for a disability of this kind. The purpose of the National Health Service is to reduce illness and disability, and when, as a result of the methods used in the medical services, illness or disability is increased, generous compensation naturally has to be paid.
54 We may imagine the distress of parents, having consented to vaccination, when great disability is subsequently caused. That distress is all the greater if they do not have the financial means to make up for the suffering caused to the child. We must therefore be generous with compensation. Because of the opposition of my father to vaccination, I have over the years taken particular notice of the use of vaccines and the misuse of drugs. I did not agree with him even though some of his arguments were valid, but I get the impression that many of the tragedies following vaccination could have been avoided if there had been more testing and research before the drugs or vaccines were put on the market.
There may be too much of a hurry to get drugs on the market. Sometimes this flows from compassion, but at other times it flows from an eagerness to make money, although I appreciate that research costs a great deal of money. The National Health Service, as an enormous consumer and with unified controls, is in a strong position to insist on more safeguards in order to reduce these terrible tragedies.
§ Dr. Vaughan
The hon. Gentleman mentioned interim payments. What size of payment does he think would be correct? Since this is a difficult area, should one regard this as compensation or as token recognition of the damage done?
§ Mr. Atkins
I regard it first as a right. If one seeks to establish a right, it should be related to the amount of damage done. Secondly, there is the question of compassion. I believe that there should be some kind of assessment panel since we are no longer in such a hurry because interim payments are to be made. Such a panel could assess the needs of those affected and the amount of injury inflicted on the victim. I believe that this is possible, because there are not many people involved.
§ Dr. Vaughan
It was said earlier in the debate that the Bill covers children with 80 per cent. damage and upwards. What does the hon. Gentleman feel should be done to deal with children who have a lesser degree of damage? Does he feel that they should be included?
§ Mr. Atkins
I said earlier that I supported the views of my hon. Friend the 55 Member for Stoke-on-Trent, South on a two-tier system.
My hon. Friend also mentioned an interim payment of at least £5,000. I, too, was thinking on those lines. I did not want to prolong the debate, but I wholeheartedly supported the views of my hon. Friend. I am glad that the hon. Member for Reading, South (Dr. Vaughan) raised that matter in an intervention, and I am happy to know that there is such united feeling on this subject in all parts of the House.
§ 4.53 p.m.
§ Mr. Robert Boscawen (Wells)
I wholeheartedly agree with the hon. Member for Preston, North (Mr. Atkins) that no amount of money can undo vaccine damage. I wish to echo the remarks of the hon. Member for Stoke-on-Trent, South (Mr. Ashley), who wishes to see prevention rather than cure. I hope that the House will do all it can to prevent this kind of damage, even though it may happen only rarely. Such a course of action is far better than having to discuss compensation after damage has been done. Society, the family concerned and, of course, the child affected all will be thankful if such tragedies can be averted in future.
We owe a debt of gratitude to Mrs. Fox of the Association of Parents of Vaccine-Damaged Children. I wish to pay full credit to her for the work she has done, and certainly for the way she has brought these matters to the attention of hon. Members in voluminous correspondence. We have all been well served by the many individuals who have done an excellent job on a voluntary basis.
Two of these cases occurred in my constituency. One case resulted from whooping cough immunisation, and the other was a more difficult case involving a child who was damaged following inoculation for yellow fever or cholera. The child's parents had the child immunised following the taking up of an appointment with a foreign Government. I understand that the inoculation was carried out by a foreign airline. That was a difficult type of case, and I hope that that and other matters will be pursued in Committee to discover whether compensation is payable.
Next to the child, it is the parents who are most deeply affected by the terrible 56 trauma that occurs when it is discovered that a child's brain has been damaged. That trauma does occur and is that much worse because of the voluntary nature of the decision by the parents in agreeing to vaccination. I know from my contacts with a family so affected in my constituency that the effect was devastating. Difficulty arose when relatives almost blamed the mother for allowing the child to be vaccinated and thus for allegedly causing the damage.
I am wholly in favour of making the £10,000 payment rather than that there should be a weekly benefit in the form of invalidity allowance, or whatever disablement benefit is due. The payment of £10,000 at an early stage is a special, one-off payment and can be easily understood. It is some small compensation to the parents, particularly the mother, that the trauma has been recognised by society.
This Bill deals with interim payments, but we must look to the future. Where do we go from here? Shall we go for a larger compensatory payment, or shall we take up the interesting suggestions put forward in correspondence by Mrs. Fox? She believes that there should be a lump sum payment to cater for the early years of the child, particularly in the expensive items of education, clothing and transport to special schools. The cost of transport can be particularly difficult for families who find themselves in this predicament.
We must consider whether we should provide that kind of assistance in the early years, followed by a benefit such as suggested by Mrs. Fox, namely, a war pension type of benefit, presumably based on percentages. That is an interesting suggestion which should be examined in Committee so that the Government's view can be canvassed.
Furthermore, we must not ignore the position of the family fund. The Minister with responsibility for the disabled—and I congratulate him on his Privy Councillorship—may be able to say a few words about the future of that fund. I believe that it can be used for post-natally brain-damaged children as well as for children who are damaged pre-natally.
The family fund will help some of the children who do not quite qualify for the 80 per cent. compensation. There 57 are always difficult borderline individuals who do not qualify for the full payment for one reason or another. The family fund, which is not subject to all the rigidities of other State benefits, could be useful in the difficult situation where a child has not quite fallen within the category which vaccine damage compensation will benefit.
We are beginning to meet the problem of post-natal and pre-natal brain-damaged children, but there is a long way to go. By no means have we got all the answers yet. The Bill is a beginning. I welcome the fact that we are progressing, but I should also welcome a great deal more thought, both inside the House and outside, on where we go from here.
§ 5.1 p.m.
§ Mrs. Helene Hayman (Welwyn and Hatfield)
I support this Bill, as every other speaker has done. I do not think than anyone can be anything but grateful to the Government for having acknowledged the need of this particular group of children. The acknowledgment of their need is particularly important to the families concerned, for reasons mentioned by other hon. Members this afternoon.
A large amount of personal guilt is felt—however wrongly—by the parents who are involved. They feel that they were, somehow, the agent in the process that has resulted in their children being handicapped by their decision to go ahead with vaccination. It is very fitting that through this Bill we should recognise how much we as a society share that responsibility with those parents because of the public policy of an immunisation programme.
I do not want to undermine the general immunisation programme that has undoubtedly brought enormous benefit to the health of children and adults in this country. However, it would be wrong for us to pretend that decisions do not have to be made by individual parents when they are considering whether to go ahead with vaccination.
What we must learn from the drop in the number of immunisations under the immunisation programme for diseases other than whooping cough, following the scare which resulted in the linking of whooping cough vaccine with brain damage, is that it is not enough for us 58 simply to say that immunisation is a good thing and, therefore, that parents ought to go ahead with it without giving those parents detailed information on which to base their decisions.
We know that there is more risk from some vaccines than from others. We know that parents who have concern about whooping cough vaccination should not be deterred from other vaccinations available, as they are at the moment, because they see all vaccinations under a blanket heading. We know also that some children are more at risk than others. That sort of information must be made available to parents when they are making a decision. It is not enough for us to pontificate on the overall value to society of an immunisation programme without accepting that individuals within society must make their own decisions and that they ought to make them based on the best possible information available.
Within that context, it is fitting that we have singled out this group of children for assistance. The hon. Member for Wells (Mr. Boscawen), when talking about brain damage, referred to circumstances in which children can be brain-damaged other than those covered narrowly by this Bill. There are other vaccinations and immunisations which can have tragic consequences. There are other aspects of pre-natal care and neo-natal care which can, unfortunately, result in far greater numbers of brain-damaged children. Prevention is far better in all these cases than £10,000 or £100,000 after the damage has been done.
In addition to the present immunisation programme and this Bill, I think that we must look at other measures—expensive and important measures—that can be introduced in our maternity services, the neo-natal services, the general educational programme on planning for parenthood, and the training of people on the needs of women during pregnancy and the needs of very young children in order to prevent handicap of this kind.
In this Bill we deal with a very narrow group of children but a group of children that I think we can justify picking out for special attention because of the State's involvement in the immunisation programme. However, once one starts picking out groups of children, one inevitably brings in other groups whose needs 59 must be compared. One brain-damaged child looks very like another brain-damaged child to the parents involved, particularly when there has been some intervention through a medical process in which the State has been involved through the National Health Service.
Only today I had a letter from a constituent whose child is, she believes, brain-damaged because of the use of a hormone pregnancy testing drug during pregnancy. That is another group. Although we can say that the vaccination programme is different, in terms of public policy, from the administration of a hormone pregnancy testing drug, it is a very difficult line to justify in the case of two families who face much the same problem.
I am not a doctor and I speak from relative ignorance, but we must look at the whole issue of the administration of an influenza vaccine to a pregnant woman, as we looked at the administration of the rubella vaccine to pregnant women.
An even greater group which inevitably will use this Bill as an example are women who have suffered thrombosis, or other health hazards, from the use of the contraceptive pill. I agree that it does not come within the vaccination programme, but we have a family planning programme. There is certainly a policy of encouraging people to plan their families. Free contraceptives are available through the National Health Service. Women have suffered death and disablement because of the use of the contraceptive pill.
At present the Bill is narrowly drawn. I think that that is right. It is an important start for the families concerned. However, an enormous number of adults and children are in some way damaged and equally in need of the kind of help which will be given to these children. This measure, important though it is, is limited. We must recognise that we shall have to face the problems of those other groups one by one as they arise.
§ 5.8 p.m.
§ Mr. John Hannam (Exeter)
The hon. Member for Welwyn and Hatfield (Mrs. Hayman) raised some important points about pre-natal care, particularly in her references to the need to educate and inform parents about certain precautions 60 and about the effect of the drugs which they may be taking during pregnancy. I fully concur with her view that we are not doing enough yet in this regard and that we are not sufficiently protecting the unborn child.
Certainly the information provided by the Office of Health Economics shows that, for example, if we had the same system as Sweden has, some 16,000 children would be prevented from suffering illness and disability at birth. I understand that the French have introduced a new system which requires mothers-to-be to attend a certain percentage of the pre-birth courses and classes, otherwise they do not receive child benefit. That is a pretty strict regime, but it is resulting in well over 90 per cent. attendances at those classes.
I agree with the hon. Lady that in connection with vaccine-damaged children there is a great deal of fear and ignorance on the part of parents which I do not believe has yet been fully alleviated. Therefore, that must play a full and important part in our approach to the question of compensation for vaccine damage.
My hon. Friend the Member for Canterbury (Mr. Crouch) related a very moving account to the House of the effect of severe disablement upon a family in his constituency. I think that all of us have come across similar cases in our constituencies. I know a family in mine in similar distressing circumstances. Both parents are severely disabled themselves, and one of the two daughters is also severely disabled. I have got to know that family well and the problems that they face in housing, education, clothing, aids and adaptation and transportation, and medical help itself. The obstacles they face are immense, yet their determination and fortitude in overcoming them has made me proud to know them and determined to help as much as I can.
Such examples have affected the attitude of many hon. Members, and I therefore give a very warm welcome to the Bill. I echo the congratulations of my hon. Fried the Member for Reading, South (Dr. Vaughan) to Rosemary Fox and her association. I recall the early days in the all-party disablement group when Mrs. Fox and other parents of vaccine-damaged children were coming to the 61 House regularly to try to persuade us of the case for this compensation. I think that all members of the group who attended the meetings quickly accepted the validity of the case, but its success was very much due to the efforts of the hon. Member for Stoke-on-Trent, South (Mr. Ashley). He spearheaded the thalidomide campaign, and followed it up with the campaign for compensation for the vaccine-damaged children. He underwent a great deal of, I would say, abuse from writers and others in the media, and even some difficulties with the Government in exchanges in the House. Nevertheless, he stuck to the campaign and spearheaded it, and he and Rosemary Fox must be feeling proud of the outcome today.
As my hon. Friend the Member for Reading, South pointed out, the problems of overcoming the medical objections, and also the financial objections inevitably faced in calling for expenditure, could have resulted in damaging delay to the families themselves and the immunisation programme as a whole. I know the agony of parents faced with the decision as to whether to have their babies vaccinated, because at the time when the verbal battle was being waged, both in the press and on radio and television, more and more parents became scared and withdrew from the general whooping cough immunisation programme. Many withdrew from the other programmes as well.
Two years ago, my wife and I faced this decision ourselves. Our two-year-old daughter was then in the middle of her vaccination programme. The agony of the uncertainty and fear that my wife and I underwent in deciding whether to proceed with whooping cough immunisation caused us many sleepless nights. We know the consequences. There was a sharp drop in the number of children receiving whooping cough immunisation, and since then there has been a sharp increase in the incidence of the illness.
I therefore support the Bill as an interim measure—and I stress the word "interim"—of compensation. I hope that it will be followed by further action and attempts to ensure that the costs of providing proper care for the severely handicapped children—and grown-ups, as they will be—will be covered throughout their lives, because, although the Bill goes part of the way towards helping them at an early stage, we must remem- 62 ber that problems and costs increase as they grow older.
The Pearson Commission's recommendations showed clearly that substantially higher damages are required for such severe disabilities, and therefore this sum of £10,000 must be regarded as just the beginning rather than the end. I was pleased that the Secretary of State, in answer to questions from my hon. Friends the Member or Wells (Mr. Boscawen) and Walsall, North (Mr. Hodgson) concerning disregards for supplementary benefits, was able to say that this money would in fact be disregarded for that purpose.
It would indeed be cruel if this payment meant that some benefits were reduced in such a way as to force a family to find some means of disposing of the money at a very early stage in order to restore their rightful benefits. We know that such a situation exists in other areas—we hear about it repeatedly at our advice surgeries from constituents who have had to think in terms of restoring their social security benefits by getting rid of whatever amount of money they have which has been regarded for supplementary benefit purposes.
This compensation as an interim payment helps in several ways. It gives some confidence back to the whole immunisation programme; it signifies the validity of the parents' campaign and the campaign by hon. Memberes; it also lays the foundation stone for a proper scheme of compensation for all those severely disabled and handicapped in various ways. I hope that we shall indeed regard it as the foundation stone for a much wider scheme. I congratulate the Secretary of State on the Bill. I know that the whole House will wish it a speedy passage, and I have great pleasure in supporting it.
§ 5.17 p.m.
§ Mr. Andrew MacKay (Birmingham, Stechford)
I apologise for not being present throughout the debate, but for personal reasons I was late in arriving at the House. But there is a special reason why I, like my hon. Friend the Member for Exeter (Mr. Hannam), want to speak.
Until recently, I had taken only a general interest in the problems of vaccine-damaged children, but then I had the 63 case of a constituent whose child had had whooping cough vaccination when only a few months old. That child is now eight years old. I have visited the family on several occasions. The state that that child is in so appalled me that it has shaken me out of what was perhaps a sense of complaceency and almost of disinterest. We in this House have so many problems, both constituency problems and national problems, that it is easy to be blase and uncommitted and to say "It has not happened to me or my family or to any of my constituents; I am sorry, but I have not time to look into it."
Three particular problems about this family worry me immensely. The first is that the family have not received any aid for eight years from the State, except for an attendance allowance. I believe that that is quite disgraceful. Secondly, I was glad to hear the Secretary of State say that the £10,000 is an interim award, because £10,000 now, bearing in mind not just the suffering of this family but also their future needs, appears quite inadequate.
When people ask, as a writer in the local press did recently, "What do they need £10,000 for? Are they not cashing in on the misfortune of their child?", I find the question easy to answer. In this case the mother is near a nervous breakdown. She is totally run down. It is obvious even to inexpert eyes that nursing facilities must be made available, because the child is severely brain-damaged and is incapable of looking after itself or coping in any way. It is even unable to go out to a special day nursery. To employ a nurse on a part-time or semi full-time basis is immensely expensive.
Thirdly, I am also distressed that the family have had no proper holiday in these eight years. The parents could not possibly take the child on holiday with them. It has meant that the other two children have not had a proper holiday either. So the £10,000 will go towards having a nurse in to look after the child full-time while the rest of the family go for the holiday that they so desperately need.
I hope that the Minister takes on board the fact that the £10,000 is totally inadequate, although those affected will be 64 delighted to accept it. They will appreciate that it is an interim award. Whatever the lump sum, there should be some form of pension made payable at a certain age, presumably after the age of 16 or 18, to a vaccine-damaged child. The parents will not live for ever. I do not think that the other children should have to care for the vaccine-damaged child for the rest of their lives. I know that the parents of such a child would like to think that he would be adequately looked after thereafter. Something along the lines of war disablement pension would be highly appropriate. The Minister received many representations along these lines. He must be looking carefully at the question of what form of pension should be given. It would be interesting to hear about this today or in the near future.
I am immensely worried about the delay. I appreciate that we must be absolutely certain of the medical facts. We do not shell out money whenever somebody thinks that he should have aid. However, it has been proved without any shadow of doubt in at least my constituents' case, and I assume in many other cases, that the brain damage was caused by the whooping cough vaccine. Local doctors and specialists confirmed that to me. The parents were diligent. They thought they were doing right eight years ago. They read the various pamphlets, many of which were issued by the DHSS. They took careful note of what they should do as parents. They came to the conclusion that it was right and proper to vaccinate their children against whooping cough.
Therefore, the State has a moral obligation. This is not a matter of whether public money should be spent. This is a special case of, first, compassion and, secondly, a moral obligation on behalf of the State to ensure that these people are properly looked after.
It is amazing that in eight years these people have not received one penny apart from the attendance allowance. That is disgraceful. I do not blame individual Ministers or bodies. It is a disgrace which reflects on the House. In what we call a civilised, compassionate society we should hold our heads in shame when we see a family such as that in Stechford who suffered so much and received so little compensation.
65 I end on a more optimistic note. I am slightly worried about this matter. Therefore, I should like to hear what the Minister says about it. I refer to a problem that affects many parents. I am a parent. My wife gave birth to a baby daughter in the past week. That is one reason why I was late in coming to the House today.
Many parents are worried about the word "vaccine". Therefore, vaccination has suddenly become a dirty word. We have not vaccinated our two-year-old son against whooping cough. However, we shall vaccinate him against other diseases. I think immediately of polio. I am worried about this. I speak to many of my constituents who say "We shall not vaccinate our children against anything. We have seen those television programmes and have read the articles in the press." This might do considerable harm.
The DHSS must introduce a major public relations exercise to explain that the majority of vaccinations carry with them no risk or such a negligible risk that it is well worth taking. Some diseases may kill or cripple for life. It would be sad if we went backwards by risking the health of our children even more by not vaccinating them. Therefore, I ask the Minister to give special consideration to allaying the real fears of parents.
§ 5.26 p.m.
§ Mr. Victor Goodhew (St. Albans)
I welcome the Bill. Many Members must have come across the impact on parents and know what it is like to be faced with severely mentally or physically handicapped children. I came across this problem first when I became a Member of Parliament 20 years ago.
Before the boundary changes my constituency of St. Albans contained four psychiatric hospitals, which I visited. Having two healthy children, my reaction, upon going round and seeing the unfortunate children, was to realise how grateful I should be every morning that I am fortunate to have healthy children who have not suffered, for a reason that no one could have imagined, the terrible backwardness and disablement that come in certain circumstances. When one realises how grateful one should be for not having suffered when confronted with the sight of children who are afflicted in 66 this way, one understands all the more that, as a result of a quirk of science, something that was intended to benefit all has been of great disadvantage to a small limited number.
I doubt whether there is anyone in the House, or indeed in the country, who would not be in favour of a Bill such as this which is designed to recompense those who have suffered as a result of what has basically been good for people as a whole but has turned out to be deeply unfortunate for those who have suffered from this quirk of science, which caused a vaccination to be good for many people but bad for a few.
When considering a Bill such as this, we must have very much in our minds the feelings of the parents who have this responsibility. They were urged to do this for the benefit of their children. Suddenly the tragedy hit them in the face. We say "Yes, it is right", but then it is heartbreaking for parents to discover that their children suffer as a result. There is nothing that can fully recompense the child or parents in a case such as this. The parents are bound to feel that they had the choice and that if they had not made the choice they did they would have spared their children these problems. As a result, the children are left with disabilities for life and will need help.
Therefore, when we talk of sums such as £10,000 I am inclined to think that we are being somewhat mean. I do not suggest that the Government are being mean, because they are setting off on a road on which clearly in future we shall have to increase the payments. We live in a time of great inflation. The sum of £10,000 seems large today, but a few years ago £5,000 seemed a large sum and in 10 or 20 years it will appear very small.
The House will have to watch the matter closely over the years. We are responsible for making sure that our present aims are achieved in the years to come as the children grow older and the problems of life become greater. Who knows whether the children will be fortunate enough to have the support of their parents until the parents reach a great age? Some of us are fortunate enough to have had that support for a long time, but others lose their parents very young. I am one who was lucky and whose parents lived into their eighties. I enjoyed their care for many years, but we cannot 67 assume that that will be so for all children. Therefore, we shall have to be prepared to increase the amount that we pay to those who suffer from the misfortune with which we are dealing.
Having said that with feeling—and confidence that the House, which is always a compassionate and sympathetic place, will ensure that once we have put the measure on the statute book we continue to look after those who are affected—I add my voice to those who have said that nevertheless the vast majority of people benefit from vaccination. I should hate to say anything that would discourage others from taking advantage of any medical treatment of the sort in question, where the opportunities of its going wrong are so small. Such discouragement could cause others to suffer even worse health than they might if their parents decided to have them treated.
I welcome the Bill and express gratitude to the House for its attitude. As time goes on and we experiment with other drugs we may, alas, have to face other such cases. But that is no reason why we should not try to prevent illness from spreading amongst our children, seeing that, where necessary, we compensate to the maximum possible, though nothing can really recompense those who suffer and their parents who have taken the decisions that caused that suffering.
§ 5.33 p.m.
§ Mr. Patrick Jenkin (Wanstead and Woodford)
The House has been impressed by the case advanced this afternoon in favour of the Bill. Anyone listening to our debate, brief though it will have been, will have been impressed by the sense of sympathy and the desire to make some form of recompense that has been expressed on both sides of the House.
This is a fairly long story. It is certainly not finished, but this is an important stage in it. The anxieties and fears that began to be voiced about the effects of certain kinds of vaccination on children stretches back a number of years. The feeling that some recompense should be made to them has grown steadily in force.
I should like to add my voice to the voices of the Secretary of State, my hon. Friend the Member for Reading, South (Dr. Vaughan) and others who have paid tribute to Mrs. Rosemary Fox and her 68 association for the way in which, always using constitutional and proper means and using them effectively and well, they have brought to the attention of hon. Members the need to do something to meet their grievance.
As a matter of history, the first Bill on the subject that I have been able to find was presented by my hon. Friend the Member for Christchurch and Lymington (Mr. Adley). It was a Ten-Minute Bill which had its First Reading on 3 February 1977. It was after that, on 14 June, that the Government accepted in principle that there should be some form of payment to families whose children could be established to have been damaged by vaccine.
I think that the case had been conceded by the Government earlier. It is interesting to note that when it gave evidence to the Pearson Commission the Department of Health and Social Security Standing Medical Advisory Committee said:As vaccination was encouraged by the medical profession and the Department of Health for the benefit not only of the individual but also the community, a reasonable case could be made for paying compensation.Those who are familiar with the Whitehall jargon might well have recognised that that was an important step on the path to the decision that was eventually announced to pay some form of compensation.
The argument in its later stages in recent years had been dominated by the knowledge that the Pearson Commission was sitting, having been set up by my right hon. Friend the Member for Sidcup (Mr. Heath) in the aftermath of the thalidomide disaster. It was natural that Ministers in all Governments should have taken refuge—I do not use that word in any pejorative sense—in the Commission's existence, knowing that the question of vaccine damage to children was firmly within its terms of reference and that it could be expected to report. But the pressure grew, and in the aftermath of the pressure we saw a sharp falling off in the number of children taken for vaccination, not only for whooping cough but for the other, in many ways more serious, diseases against which vaccination is a sure and necessary protection—diseases such as poliomyelitis, diphtheria and tetanus.
69 I think that it was the knowledge that public health was being put at risk by the fears that had been aroused, and the fact that in a tiny minority of cases severe personal damage had occurred, coupled with the growing sense of the injustice to families that had done something not only for their own benefit but for the benefit of the community at large, that persuaded the House and the Government that it was essential to do something.
Here we are today with the Bill and with the process of adjudication and payment well under way. I should like to make it clear that in such circumstances I make no complaint about that. In no way do I want to take a purist stand on financial grounds. I am told that the way in which the matter was dealt with last year in the Estimates was entirely in accordance with precedent. Perhaps we can welcome the fact that that was done, although the Bill has been a little delayed.
I have a number of questions, picking up questions that have been asked from all parts of the House, which I hope the Minister with special responsibility for the disabled will be able to clarify. The first is the key question: is the proposed payment an interim payment? I have carefully studied all the Secretary of State's statements, from the first on 14 June 1977 through to that on 9 May 1978, when he announced the scheme, and I listened to him carefully today. I do not think that at any stage has the right hon. Gentleman used the phrase "an interim payment". He has been most meticulously careful not to do so. Yet a number of hon. Members throughout the House have seemed to assume that, becauss it clearly falls far short of what, in the kind of circumstances we are considering, a child would be awarded if he could establish a claim before the courts, £10,000 must be an interim payment. But the right hon. Gentleman has been extremely careful at no stage ever to use that expression.
§ Mr. Jenkin
I am grateful to have the right hon. Gentleman's confirmation. I thought that I had read carefully what he said and his comment suggests that I have. He was asked about this on a number of occasions and gave a number of answers, one of which was that 70 this is not a payment of compensation. If this is not compensation, why should it be taken into account if subsequently any of the families succeed in establishing a claim to compensation under an action of tort? Perhaps that is a matter which the Minister with responsibility for the disabled can deal with later. If this is not compensation, should not it perhaps be left out of account?
One of the other points made by the right hon. Gentleman relates to what he said last year in reply to my hon. Friend the Member for Canterbury (Mr. Crouch). He said:The second point that the hon. Gentleman must recognise is that this is not a compensation scheme, as I made clear. This is not saying, 'This is the end. We are wiping the slate clean'. This is some way in which we can help these people now, and I do not think that anyone ought to say that it is a small sum."—[Official Report, 9 May 1978; Vol. 949, c. 980.]There he is making it clear that this is some form of help now. That, I believe, has always been the Government's intention. But the question is, where do we go from here?
The Pearson report recommended that there should be some such payment. Paragraph 1398 stated:We concluded that there is a special case for paying compensation for vaccine damage where vaccination is recommended by a public authority and is undertaken to protect the community. We had reached this conclusion when we were asked by the Government for our views.A little later, in paragraph 1406 under the heading "Our proposals", it said:We do not think it is right to try to distinguish one severely disabled child from another, and to produce a situation where two children have the same needs, but one is compensated and the other is not. We decided, therefore, that vaccine damaged children should be considered with other severely disabled children, irrespective of the cause of disablement. We explain our conclusions in chapter 27.The right hon. Gentleman reminded us that chapter 27 recommended that there should be a special disability benefit for disabled children, which, on 1977 figures, should be £4 a week. That was felt to be the average extra cost to a family of bringing up a severely disabled child. But the Secretary of State was pretty clear in his conclusions on that Pearson recommendation—the disability benefit—when he 71 opened the debate on the Pearson report last year. He said:I am sure that the House will agree that it would be difficult to accept this recommendation without knowing what may be the outcome of our long-term consideration of a general disablement allowance.A little later he added:Therefore, I must reserve the Government's position on this recommendation until we can announce decisions on the issues that I have been talking about."—[Official Report, 17 November 1978; Vol. 958, c. 777–8.]He and I both took part in that debate, and we remember that no conclusions emerged. It was a general, if somewhat brief, exploration of the large and exceedingly complex area covered by the Pearson report.
Pearson recommended that there should be compensation for vaccine-damaged children, which it saw in the context of a general disablement benefit, whereas under this Bill that is left hanging in the air on its own. As a result, what is happening is precisely what Pearson recommended should not happen —that where two children suffer the same degree of disability one is compensated and the other not. Quite frankly, I do not see the way out of this impasse until, as is agreed on both sides of the House, we can move forward to a more general disability scheme. I think that that is the Secretary of State's view, and that is our view.
I do not want the Government to be under any illusions. Under this Bill, some families with severely brain-damaged children will get £10,000 whereas others, where damage has been caused by some other accident, perhaps congenital, will not. That is not a state of affairs which any of us can view with equanimity. Therefore, however long it may last, we are in an interim period.
§ Mr. Ennals
We are in an interim period in the sense that no decisions have been taken as to what the next stage is. I absolutely recognise that Pearson made the case against having a benefit which, in a sense, would discriminate as between one child and another. I am really trying to explore whether there is any difference between us. I suspect that there is not. Before Pearson reported, this House decided that, regardless of what happened to other disabled children, those who had 72 been disabled from vaccine damage which was public policy had a very special reason for assistance. I am just trying to explore whether there is any difference in philosophy here, because I suspect that there is not.
§ Mr. Jenkin
I think that the right hon. Gentleman is right. I believe that I made the point about public policy before he returned to the Chamber. I do not think that there is a lot of difference between us. In fact, all that I am seeking to do is to point out that, although this is not properly described as an interim payment—I see the reasons for that—we are nevertheless in an interim situation which cannot continue indefinitely. That is something to which any Government clearly must address themselves.
I return to the position facing the families of children who stand to benefit under the Bill.
§ Mr. Ashley
The right hon. Gentleman says that we are doing precisely what Pearson said we should not do—because Pearson said that we should help all disabled children—but is it not a fact that Pearson was contradictory, because simultaneously the report said that we should pay vaccine-damaged children? Therefore, we should not really quote Pearson as being against this payment for vaccine-damaged children.
§ Mr. Jenkin
I was not quoting Pearson against that. I was pointing out that the Pearson report, having accepted that there was a special case for vaccine-damaged children, then said that it was to be merged with support for all seriously handicapped children. That is a proposal to which as yet, having regard to our economic position, neither side of the House has felt able to commit itself. Therefore, this is an interim situation, and we must recognise that.
I turn to the problem facing the parents and families of these children. The right to sue is preserved. Nothing affects that. But unless the law is changed to provide for strict liability, and the question upon whom, it must be exceedingly doubtful whether any parent can establish negligence in such a way as to establish a claim for damages. One area where a possibility might be opened up is in relation to the conclusion in the report of the 73 Ombudsman which was published in October 1977. He said:I consider that the Departments must accept a large measure of responsibility and I believe that they should have recognised earlier the desirability of alerting parents, as they have now done. I believe the Association"—that is, the Fox association—have performed a valuable service in bringing this matter to the attention of the public and the authorities.Therefore, there was clearly a finding that the Department—I completely concede the point that this occurred under successive Governments—had fallen short of the standards that the Ombudsman felt were right.
It is interesting to note that in a statement made on the publication of that by the Secretary of State, a copy of which I have in front of me, he said:On balance I accept that this criticism is justified. Attitudes as to how much information parents should be given on such matters have rightly changed over the years. These days parents want—and in my view they should be given—as much information as possible before taking decisions that affect their children's welfare.There may be something there that could found a claim against the Department, but that is a legal matter. I do not expect that the Under-Secretary will be able to say anything about that. But, as for establishing a claim against a doctor or a drug company, the parents face almost insuperable difficulties unless there are special circumstances. I hope that the Minister will mention that briefly in his reply.
I was out of the Chamber when the Secretary of State finally clarified the position about supplementary benefits. I had been relying on the statement he made on 2 August in which he said:The effect of payment under the scheme on eligibility for supplementary benefit has been carefully considered by the Supplementary Benefits Commission. They have decided that, where the vaccine damaged person is a child, it would be right in assessing the parent's entitlement to supplementary benefit, to disregard the payment to the extent that it is held in trust for the benefit of the child or earmarked for particular major items of expenditure such as adaptations to the home. Where the vaccine damaged person is an adult, the payment will normally remove his or her means for supplementary benefit …He went on to talk of the Commission giving sympathetic consideration to special cases. Does anything that the right hon. 74 Gentleman has said today alter that position?
§ Mr. Jenkin
I am grateful for that confirmation. My hon. Friends may wish to probe this matter in Committee. There are a number of different aspects which may give rise to questions in particular cases.
§ Mr. Crouch
My right hon. Friend was satisfied by the nod or murmur from the Secretary of State, but I am not quite satisfied. The matter concerns a child, and I am wondering when a child is still a child. A child who has suffered vaccine damage at the age of two or three will reach the age of 15 or 16, but could be damaged in such a way as still to be a child. Will the Department consider that person to be still a child?
§ Mr. Jenkin
I hope that the Under-Secretary will be able to answer my hon. Friend's question. I was concerned only to discover whether anything different had been said today.
§ Mr. Jenkin
On legal aid, if there is to be any question of parents suing for damages—and it may be possible to get a case on its feet on the basis perhaps of the Ombudsman's report—will the family be entitled to legal aid without taking account of the £10,000 that has been paid? On 2 August the Secretary of State said:The effect of the payment on eligibility for legal aid in matters relating to vaccine damage is being further considered.That is an important question, and I hope that the Minister will deal with it today.
In the Bill it is said that cases will be decided on the balance of probability. A number of hon. Members have interpreted this as meaning that the claimant will be given the benefit of the doubt. Although it is some time since I was involved with the law, I do not think those two phrases mean the same. If the balance lies 50.001 per cent. in favour of the claimant, he is entitled to a decision in his favour on the balance of probability. But if there was not the necessary evidence for a decision although some factors were present, the applicant could be given the benefit of the doubt 75 and get the payment under the Bill. But that is not what the Bill says. Perhaps the Minister could deal with this, and it may need to be further explored in Committee.
On the system of payment, in his statement on 2 August the Secretary of State said:We propose to pay the money to them—that is to say, the family—one half in trust for the benefit of the damaged person and the remainder so that it can benefit the family and their needs as a whole."—[Official Report, 2 August 1978; Vol. 955, c. 425.]Is it intended that the trusts spelt out in clause 6(3) of the Bill shall provide for that half-and-half split, or is there to be some system whereby the circumstances of the family can be examined and the trust drawn according to their need? If that is so, it will add to the complication and delay. It may be right, but I should like to know what the Government have in mind.
The courts have always regarded it as perfectly proper for some of the money awarded to a family, one member of which is disabled, to be spent for the benefit of the family as a whole. In a family with a severely disabled child, the other children are in many ways socially handicapped. Some arrangement should be made that the money, or part of it, can be spent for the family as a whole. My hon. Friend the Member for Birmingham, Stechford (Mr. MacKay) mentioned a family with a child of eight years of age which had not had a holiday. The family fund is there to help in such cases, but this kind of money could also be properly used for that purpose.
The vaccination programme has had a somewhat chequered history. We need to know where we stand following the continued dispute about the need to compensate vaccine-damaged children and the resulting publicity. Even the word "vaccination" came to have an alarming connotation. The numbers of children having all forms of vaccine fell off sharply.
There followed a difficult period when there appeared to be—although I am assured that there was not—a difference of view between the Joint Committee on Vaccination and Immunisation, under the chairmanship of Sir Charles Stuart- 76 Harris, and the Committee on Safety of Medicines, under the chairmanship of Sir Eric Scowen. Having had full discussions with these eminent gentlemen, I accept that there was in no sense a conflict of view. They were looking at different aspects of the same problem. But it led to the postponement of the campaign envisaged by the right hon. Gentleman. He announced that decision on 21 November 1977, in a written answer to the hon. Member for Eccles (Mr. Carter-Jones). It is a long answer and I shall not attempt to summarise it. But he thought that there was sufficient doubt about the balance between the efficacy of pertussis vaccine and the possible risk to children that it would not be right at that stage to launch a major publicity campaign. In a remarkably short time, however, that difficulty appeared to have been withdrawn. In an answer to my hon. Friend the Member for Manchester, Withington (Mr. Silvester) on 7 February 1978—a little less than three months later—the right hon. Gentleman announced the decision to launch the publicity campaign.
There really was a difference. One was a publicity campaign to the effect that on balance one should have one's child vaccinated. It was clear that this was not the advice that I received from the Joint Committee. Therefore, the campaign that we launched was educational, so that people knew what questions to ask and what to say to the doctors in their clinics. What we did was to change the nature of the campaign from one of advocacy to one of inquiry.
§ Mr. Jenkin
I do not need to tell the Secretary of State that there are still anxieties and uncertainties. It is true that the medical profession is very much more alerted to the contra indications than it was previously. This point was made earlier in the debate by the hon. Member for Stoke-on-Trent, South (Mr. Ashley), who said that not enough attention had been given to the specific circumstances of vaccinations in the past.
I remain firmly convinced that it is absolutely essential that the whole programme of pulic vaccination of children should be given every possible encouragement to go ahead. I can think of nothing that would do more to undermine 77 everything that has been said about prevention than if we were to be satisfied with the relatively low levels of vaccination that are currently being achieved. Whereas one may wish to be cautious about whooping cough—and I can understand a parent who will not have a child vaccinated against whooping cough unless there were an epidemic posing an immediate threat—the same is most emphatically not true of diphtheria, tetanus and polio. I hope that none of the anxieties that have surrounded this issue will lead any parent to decide not to have those other most important vaccines.
A very important paper appeared in the British Medical Journal on 1 April last year. It was by Dr. A. H. Griffith, who is deputy director of research at the Wellcome research laboratories. It is a long paper and I shall not attempt to summarise it, but Dr. Griffith makes two important points. The first is that vaccines differ substantially and one cannot draw from the results of one vaccine conclusions about what might happen with another. His second point was quoted in a leading article in the British Medical Journal, which said:Dr. Griffith's study shows that any manufacturer who accepts his obligation to collect, record, and consider the incidence of reactions to his vaccine faces a frustrating and indeed nearly impossible task.If we are trying to develop safer vaccines and refine our understanding of the indications and contra indications of their use, that is a pretty serious statement coming from someone who is personally faced with the problem. I hope that the Government have given serious consideration to how best they can improve this aspect of community medicine, so that we may hope to reduce to the absolute minimum the cases where, in pursuance of a public campaign for vaccination, a tiny number of children become seriously damaged. If there is a gap between the manufacturers trying to assess the value and safety of their vaccine and the information that should be fed back to them, we should take this extremely seriously. It is most important to restore full confidence in the vaccine programme.
Dr. Alastair Dudgeon made an important statement the other day when he said that there had been a considerable increase in the number of cases of whooping cough. This continues to indicate 78 the need for children to be vaccinated against it. Fortunately, we have had a mild strain during this last wave and mercifully relatively few children have died. But if the next strain turns out to be more serious we would be in a most unhappy position if a significant number of children died from whooping cough because their parents had been frightened off vaccination as a result of the disputes of the last two years.
I have spoken long enough and I have asked the Minister a number of questions. The Opposition very much welcome the Bill and we shall do what we can to ensure its speedy passage. This is an important new benefit for a very deserving category of people. We wish the Bill well.
§ 6.6 p.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Alfred Morris)
This has been a brief and businesslike debate but, in human terms, an important one. It has also been a very well-informed debate. In replying, I should like to express my appreciation of the way in which the Bill has been received by the House. I readily join the hon. Member for Reading, South (Dr. Vaughan) in the tribute he paid to the leaders of the campaign to help those who have been vaccine-damaged. In particular the hon. Member congratulated Mrs. Rosemary Fox and my hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley). They have both worked long and hard and with great sincerity to advance this important cause, and they deserve our deepest respect.
The right hon. Member for Wanstead and Woodford (Mr. Jenkin) seemed to imply that one of his hon. Friends first raised this issue in 1977, following which Government action was promised. In fact, my hon. Friend the Member for Stoke-on-Trent, South raised it as long ago as 1974, and has done so continually since then. He asked for vaccine-damaged children to be regarded as a special case. They are treated as such in this Bill. As my hon. Friend said, the Bill is an important step forward in social policy and we are proposing it at a time of great economic difficulty.
We should, of course, like to go further than the Bill provides, but no matter how far we went in increasing its scope there would still be a dividing line somewhere 79 between successful and unsuccessful claimants. Although there has been some constructive criticism, there is clearly also the feeling in the House that this Bill strikes a reasonable balance, having regard to its purpose. That purpose is to provide a rapid measure of present and future help for those who have been damaged by public health vaccination programmes and for the families who support them.
Several hon. Members have made clear their concern about whether the payments under this Bill are all that we hope or intend to do for people who have suffered vaccine damage. As my right hon. Friend made clear in opening the debate, it is still too early to announce the Government's decisions on the recommendations in the report of the Pearson Royal Commission on civil liability and compensation for personal injury.
The recommendation in the report on vaccine damage was that the Department or local authority concerned should be strictly liable in tort for severe damage suffered by anyone as the result of a vaccination recommended in the interests of the community. That would mean, in effect, that people wishing to pursue claims for compensation in the courts would need to prove the fact of severe damage due to vaccination but would not need to prove negligence. My right hon. Friend has today again made plain that we are studying the recommendation in consultation with the medical profession and that there is still a good deal of work to do. The recommendation has to be considered with others in the report which are also relevant. They include such matters as product liability, medical injury and cover for exceptional risks, all of which have a bearing on vaccine damage. So, too, does the whole question of the assessment of damages, on which the Royal Commission made some far-reaching proposals.
In this context, the Bill is a particularly valuable measure, because it provides a means of bringing help now and not in the future. Whatever one may think about the amount of compensation which might, in any future scheme, be expected to flow from the courts, the payments under the Bill are available now, without litigation, to all who meet the tests laid down.
80 Even today, £10,000 tax-free is not an inconsiderable sum of money. It will clearly be right that this sum should be taken into account in any assessment of compensatory damages obtained through civil proceedings in the future; and this is provided for in clause 6(4). My hon. Friend the Member for Welwyn and Hatfield (Mrs. Hayman) referred to this matter and I shall return to it later.
The Government hope that the Bill will be seen as a valuable and practicable step towards alleviating distress. The House will wish to know that about 2,000 claims have so far been received, and we think that that number may well represent the bulk of the total number of claims to be expected. Of the cases so far scrutinised, we have reached the position where, as my right hon. Friend said earlier, some 50 claimants have been notified that payments will be made to them shortly. In those cases, all that remains to be done is for the necessary deeds of trust to be executed.
The main constraint on processing claims at the moment is the need for each case to be examined in detail by the Department's medical officers, but we are pressing ahead and should have a good many more decisions ready for notification quite soon. Indeed, without wanting to give hostages to fortune, I hope that all cases will have passed through the initial processing stage by the middle of the year.
All those whose claims has been disallowed will, of course, have the right to ask for their case to be considered by one of the medical review tribunals to which my right hon. Friend referred earlier. The tribunals will, of course, be wholly independent of my Department and their decisions will be binding.
§ Mr. Patrick Jenkin
Earlier in this matter, the figures of 700 cases, and £7 million given from the Dispatch Box by the Secretary of State. I appreciate the uncertainties in this matter, but is there any particular reason why the Government should think it right to write into the Bill a reduction in the estimates of 100 cases and £1 million?
§ Mr. Morris
I should emphasis again that, in the nature of vaccine damage, the basis of any estimate must be more than usually speculative. As my hon. Friend the Member for Stoke-on-Trent, South 81 noted, we are breaking entirely new ground. This is the first time that any Government have proposed special help for vaccine-damaged people. We are conscious of the speculative nature of the estimate and we shall seek to keep the House fully informed of the number of applications and the response to them.
It must he emphasised, however, that, if a large proportion of claimants who are unsuccessful at the initial stage ask, as they are entitled to do, for a review of their cases by the independent tribunals, there will inevitably be delays. That is because there are not many consultants with the required degree of specialist knowledge to man tribunals dealing with these difficult issues.
I think that it would be helpful to the House if I make one further point. In the financial memorandum to the Bill, we give an estimate of 600 eligible cases at a possible cost, therefore, of £6 million for the scheme. But in the nature of vaccine damage, the basis for this estimate is more than normally speculative. The figure of 600 was put in merely in order to earmark funds of a broad order of magnitude and, whether the final figure turns out to be more or less than that, we shall of course honour our commitment. But it would be impossible at this stage to attempt to offer any more precise figure when only a quite small proportion of the claims has so far reached full medical scrutiny and when the independent medical tribunals for which the Bill provides have not yet started to function.
I referred briefly to the deeds of trust, and the House may like me to explain a little more fully what we have in mind in relation to the provisions in clause 6(3), which deals with the trust arrangements which may be declared by the Secretary of State. In the great majority of cases, the disabled persons are living with their families, and our objective is to make the sum of £10,000 available in the most flexible way possible for the general benefit of the family. Ordinarily, the parents themselves will be the trustees, and the trust deed will give the utmost discretion to the trustees. The money can, for example, be spent on buying or extending the family home, buying a car or covering the cost of holidays for the whole family or even for members of the family other than the disabled person.
82 The trust deed will necessarily be a somewhat complex legal document, but we shall be supplying parents, where they agree to act as trustees, with a note which explains the arrangements in simple terms.
§ Dr. Vaughan
This is a very important point. Will there be any control on how the money is spent, or will it be left to the parents to spend the money in whatever way they feel is best?
§ Mr. Morris
I have said that the arrangements are very broad. I shall he coming back to the question of trust deed arrangements and I hope that what I have to tell the House will be helpful, but what I have said is about as far as I can go at the moment. There will be further opportunities for detailed debate.
Where the disabled person is not living with his or her family or, for whatever other reasons, parents or other close relatives are not appointed as the trustees, we envisage that normally the Public Trustee will administer the trust. In either case, however, I must stress that, once the trust deed has been fully executed, my right hon. Friend will not be concerned with the disposition of the money. That will be for the trustees to deal with in accordance with the provisions of the trust deed and of normal trust law.
In a written reply on 2 August, my right hon. Friend the Secretary of State described the arrangements for payments in trust. He saidIf the damaged person is under 18 and living at home in normal family circumstances, with the parents responsible for his or her care, we propose to pay the money to them, one half in trust for the benefit of the damaged person and the remainder so that it can benefit the family and their needs as a whole".—[Official Report 2 August 1978; Vol. 955, c. 425.]The matter has since been reviewed and we have reached the conclusion that it would be better, instead of dividing the payments in two in that way, to make an undivided payment subject to a single trust which enables the entirety of the payment to be spent for the benefit of the family as a whole. This is a more flexible arrangement than that originally envisaged because, under the original proposal, £5,000 of the payment was reserved strictly for the benefit of the disabled person and could not have been used to 83 benefit him indirectly by helping with the family situation as a whole.
We have been in touch about these arrangements with the Association of Parents of Vaccine-Damaged Children and it has expressed misgivings about this aspect. It is particularly concerned about the case where the parents have been caring for the disabled child for a considerable number of years and have had, on this account, to deplete their financial resources, for example, by the constant needs to replace furniture and fittings damaged by a hyper-active or incontinent child. The association apparently construed the original announcement as enabling the £5,000 of the payment to be immediately set aside to make up for the depletion of the parents' resources through such expenditure.
But this could not have been the case either with the orginal arrangement or with the revised version and it is difficult to see how an express provision of this sort could be fitted into a scheme which is essentially not one for payment of compensation for past expenditure but one for providing some help with the current and future burdens of the family concerned.
However, my officials are due to meet representatives of the association in the near future, and, if it has any specific proposals to put forward to deal with this matter, we shall look at them sympathetically.
There is one other important point that I want to emphasise about the subject matter of this important debate. That the Bill deals with vaccine damage should not obscure the fact that the proportion of children and others damaged by vaccination is small. I know that the House as a whole would want to make it clear that nothing that has been said today should be allowed to give any impression that vaccination programmes are to be discouraged. On the contrary, they have the full and unqualified backing and support of the expert bodies which advise my right hon. Friend and, indeed, of the medical profession in general. I want to remind the House of this again and to re-emphasise what my right hon. Friend said earlier.
84 I turn to some other matters which have been raised during the debate. If I am unable to deal with a particular point, I shall be pleased to do so later in writing.
My hon. Friend the Member for Welwyn and Hatfield has explained to me that she has had to leave the Chamber because of another pressing commitment. She mentioned clause 6(4). The Bill deals only with payments of the £10,000 being taken into account if there is a subsequent award of damages in civil proceedings. The purpose of the Bill is to prevent the total payment in such a case from being greater by £10,000 than it would be if there were no entitlement to the £10,000 but only compensation.
What might happen subsequent to any successful compensation proceedings is a separate matter which is not dealt with in the Bill. I regret that I cannot speculate on that matter today.
The hon. Member for Walsall, North (Mr. Hodgson) referred to clause 2(5). That provision does not cover the diplomatic services. The Bill applies to the United Kingdom public vaccination policy. The extension to the Forces takes into account special circumstances, but it would be to go beyond the Bill's stated purposes to cover the diplomatic services.
The hon. Member for Reading, South referred to the residence test. That is not provided for in the Bill. It was included in the details given in my right hon. Friend's parliamentary reply on 2 August and in the leaflet. The Bill represents an improvement in the original proposals.
In a few cases claimants were told that they would not qualify because of residence abroad. The House will be glad to know that such claims will now be processed.
My hon. Friend the Member for Putney (Mr. Jenkins) asked about hormone pregnancy tests. I regret that, because of the long title, such tests could not come within the scope of the Bill. There is no real parallel with vaccine damage because there is no public policy programme for such tests.
§ Mr. Robert Adley (Christchurch and Lymington)
I apologise for not being here throughout the debate. Can the Minister deal with the reduction in the numbers involved? He will be aware of 85 the grey area of whether certain children are covered by the Bill. Why has the number involved been reduced? Have the Government some information which has caused them to reduce the number.
§ Mr. Morris
It is too early to give such detailed information. I shall write to the hon. Member as soon as possible.
§ Mr. Hugh Jenkins
My hon. Friend says, rightly, that hormone pregnancy testing is outwith the long title. But there are certain parallels in the consequences felt by families who feel that their children are suffering because of hormone pregnancy testing.
Do the Government recognise that this matter should become part of the general approach to disability? Are there any plans to give earlier priority to hormone pregnancy testing disability than to a general disability Bill?
§ Mr. Morris
As my hon. Friend the Member for Stoke-on-Trent, South said, we are taking an entirely new step forward in social policy. I can give no definite commitment. However, my hon. Friend's remarks will be examined by my Department.
The hon. Member for Birmingham, Stechford (Mr. MacKay) referred to a vaccine-damaged child who receives no other benefits than the attendance allowance. But that is a valuable form of help. There is also the mobility allowance which is paid to many thousands of handicapped children. As the hon. Member for Wells (Mr. Boscawen) said, there is also the family fund at York. I hold that fund in the highest regard and I shall examine the suggestion sympathetically.
The right hon. Member for Wanstead and Woodford talked about legal aid. That matter requires further consideration. The legal aid scheme's rules are complex. It would not be advisable for me to be categoric since I might mislead the House. I shall be in touch with the right hon. Member.
The Bill is the latest in a long series of contributions to the welfare of handicapped children that it has been possible to introduce over recent years. Both sides of the House have participated in examining constructively the measures that we have introduced, some of which have been large and others small. Essen- 86 tially, all that we have done starts from the premise that having a handicapped child imposes a severe strain upon a family and that the Government have a duty to improve services and cash benefits to reduce the burden on families.
The first cash help was the attendance allowance which was originally proposed by Dick Crossman and put into effect by his successor as Secretary of State and which is now being paid to the families of about 47,000 severely handicapped children. There is now also the mobility allowance which is payable to children over the age of five who are unable, or virtually unable, to walk. In addition, there is the family fund, to which I have already referred. Service provision is also essential, and the aid and support that are given to families under section 2 of the Chronically Sick and Disabled Persons Act have been no less important than the provision of cash benefits in enabling handicapped children to remain with their families in the community.
The Bill is the most recent contribution to helping severely handicapped children. Right hon. and hon. Members have made its importance clear, and I ask the House to give it a Second Reading.
§ Question put and agreed to.
§ Bill accordingly read a Second time.
§ Bill committed to a Committee of the whole House.—[Mr. Tinn.]
§ Committee tomorrow.