§ Mr. David Blunkett (Sheffield, Brightside)
(by private notice): To ask the Secretary of State for Health if she will make a statement on issuing fresh guidelines in relation to key medical staff found to be HIV positive or who die from AIDS-related diseases and further consideration by the advisory group on the testing of medical staff involved in invasive surgery.
§ The Secretary of State for Health (Mrs. Virginia Bottomley)
All health care workers have an overriding ethical duty to protect the health and safety of their patients. The relevant professional bodies—the General Medical Council, the General Dental Council and the United Kingdom Central Council for Nursing, Midwifery and Health Visiting—have issued guidelines which make this absolutely clear. The guidelines tell health care workers what they must do if they know, or suspect, that they may be infected with HIV.
It is absolutely essential that these guidelines are scrupulously observed. My Department's chief professional officers wrote to the heads of the GMC, GDC and UKCC on Monday stressing this messge. I have now asked them to summon those leaders to the Department to make clear our concern that the guidelines ae up to date and sufficiently robust and to examine whether any further steps can be taken to ensure that they are known and understood by all health care workers.
It is also the duty of all health authorities and trusts to ensure that the health care workers that they employ are aware of the guidelines and that they follow them to the letter. My Department has given guidance as to the correct procedures for handling incidents involving an HIV infected health care worker in the past on a case-by-case basis. This guidance is now being urgently reviewed and will be issued this month to all health authorities and trusts.
The Department's guidance already requires that the relevant professional guidance should be shown to prospective NHS employees. I intend to re-emphasise the need for this, particularly for those workers who may be involved in invasive procedures. They must be asked to confirm that they have read and understood the professional guidance.
All health care workers who believe that they may have any condition, including HIV infection, which might put their patient's safety at risk must seek medical advice. They must put their patient's safety first. Failure to do so would be a serious breach of professional practice.
As regards routine testing of health care workers for HIV infection, this is not a requirement anywhere in the world. The expert advisory group on AIDS, which met again on Tuesday, has reconfirmed its previous advice that routine testing of health care workers is not justified.
It must be stressed that the cases recently reported should be seen in the worldwide context. There are no reported cases of any doctor, nurse or midwife transmitting HIV infection to a patient.
I shall continue to keep the House fully informed of the progress of discussions with the regulatory authorities and I will place the advice that I will be issuing to health authorities and trusts in the Library of the House.
§ Mr. Blunkett
May I thank the Secretary of State for her statement? Will she accept that in asking her to make a statement we seek a bipartisan approach to the most important and sensitive issue that faces us—allaying fears, putting the protection of patients at the forefront of our actions and overcoming an atmosphere of worry and concern which does no good to patients and which reduces the likelihood that those in the NHS who believe themselves to be HIV-positive will come forward? Will the right hon. Lady join me in deprecating the unnecessary and provocative headlines and coverage given to those issues?
In welcoming the review announced by the Secretary of State and the chief medical officer, may I ask her to ensure that it is clear and unambiguous so as to avoid the situation which arose in Mid Glamorgan, which created fear and concern rather than reducing it? Will she assure the public of openness and clarity in the NHS so that staff and patients may feel protected and supported if they come forward for advice and treatment?
Despite her statement on the advisory committee's deliberations earlier this week, will the Secretary of State ask the committee to look again at the circumstances in which patients are asked if they will take a test but those involved in invasive surgery are not? Will she ensure that cash for HIV and AIDS education and health promotion work is not cut by the 10 per cent. projected for the coming year, but is restored and improved?
Will the Secretary of State accept the support of the whole House in putting the events of the past few weeks behind us and assuring the people of their safety and protection?
§ Mrs. Bottomley
I thank the hon. Gentleman for his approach to the subject, which is of understandable concern to our constituents and patients. I make it clear that the safety of patients must always be paramount. At the same time, within the health service we must be sure that all health care workers understand the guidance and that it is scrupulously followed.
The hon. Gentleman is right to make it clear that, if a climate of fear is generated, the danger is that HIV and AIDS will be driven underground and people will be reluctant to come forward for testing, whether they be patients or health care workers.
I shall certainly continue to make the maximum information available. I agree with the hon. Gentleman that we are much more effective when the mass media understand the issues involved and help spread the message that HIV and AIDS are extremely serious threats to life and have to be tackled effectively, sensibly and responsibly. That is exactly my intention, and I am most grateful to the hon. Gentleman for taking a similar approach.
§ Dame Peggy Fenner (Medway)
Will my hon. Friend accept that, while the guidelines produced by her Department are good, I am not wholly satisfied with the way in which the risk is assessed in this country? In my view, people will not come forward if they are instructed that they should alter their life style if they know that they are at high risk. This is their chosen life style. Assuring patients that all is well is accepted because there has never been a proven case, but there is suspicion if the statistics come from the same Department which assures us that the risk to heterosexuals is as great as to homosexuals. Can my 1109 right hon. Friend say whether her guidance specifically includes the high-risk nature of homosexual life, because I fear that patients will not be wholly satisfied until it does?
§ Mrs. Bottomley
My hon. Friend is right. There is no room for euphemisms in spreading the message about HIV and AIDS. Our health education messages must be direct and meaningful, particularly to those involved in high-risk behaviour. That is clearly the case from the statistics. At the same time, HIV and AIDS are an issue which affect the whole population, albeit that the incidence is higher in particular groups. My hon. Friend is right to make it clear that we should focus our messages on the particular groups involved. For patients, the risk of infection from a health worker is minimal. Unless some invasive procedure is undertaken, the risk should not cause anxiety to the public or hon. Members.
Ms Liz, Lynne (Rochdale)
What guidelines has the right hon. Lady issued to health authorities and trusts about the best way to inform patients that their health worker has been infected by HIV? Will she mount a campaign to raise awareness of how HIV is contracted, particularly in the medical context, to stop patients panicking when their health worker is diagnosed HIV-positive?
§ Mrs. Bottomley
The hon. Lady asks some pertinent questions. Only in cases where there has been an invasive procedure—in other words, where blood is involved—is HIV likely to be contracted. In any other tasks within the health service there is no risk of HIV infection. The guidance that we have provided from the centre is that a small incident team should be established, that a helpline should be introduced and that there should be a search of cases to see which may have involved invasive procedures. That has been done so far on a case-by-case basis. I have made it clear to the House today that we shall issue that guidance so that it is available readily to all health authorities.
§ Mr. Andrew Rowe (Mid-Kent)
Does my right hon. Friend share my perception that the Medway health authority and British Telecom jointly reacted with commendable speed and efficiency when the problems first became apparent of Mr. Shuttleworth working in the hospital? Will she take special heed of the fact that there still exists throughout the health service a curious kind of deference being paid to consultants which often weakens the effectiveness of management in applying rules to consultants which are applied rather more easily to junior staff?
§ Mrs. Bottomley
I commend the approach taken by the Medway health authority and the way in which it responded to the issue. I endorse my hon. Friend's comments about all health care workers and I quote from the guidance from the General Medical Council to doctors:It is unethical for doctors who know or believe themselves to be infected with HIV to put patients at risk by failing to seek appropriate counselling or to act upon it when given.
§ Dr. Kim Howells (Pontypridd)
Is the Secretary of State aware that there are many families in Mid Glamorgan like my own, who use the district hospitals and who are worried not so much about the medical implications of the 1110 case—because it seems that HIV will not be transmitted in any case—as about the pointless secrecy that was practised by the administration of Mid Glamorgan area health authority? Who will be brought to account for that secrecy and for the botch-up that occurred when the news filtered out and appeared in the newspapers?
§ Mrs. Bottomley
The Secretary of State for Wales and the Minister are here today and I know that they are still examining the circumstances of that incident. It is also a fact—I refer to cases that have occurred in England—that there is a distinction between informing patients who may have been involved and informing the public. That judgment is sensitive and in some earlier cases of which we have experience in England, we sought to make contact with patients before the matter got into the public domain, simply to reduce anxiety.
§ Dame Jill Knight (Birmingham, Edgbaston)
Does my right hon. Friend accept that this is a two-sided matter? While it is of immense importance to protect patients and save them from unnecessary fears, doctors and nurses in the health service should themselves have protection from patients who, like the staff to whom she referred, might have reason to suppose that they have AIDS. Does she recall that I recently reminded her of the case of surgeon who cut himself during an operation and the patient refused to have an AIDS test? It takes some time for AIDS to become obvious. In such a case, the surgeon is unable for months to operate, to sleep with his wife or to follow his normal professional or private life. Does she think that that is correct?
§ Mrs. Bottomley
My hon. Friend reminded the House of that case recently. I believe that we should all adopt a determined and practical approach to the fight against HIV and AIDS. I am pleased to say that the guidance relating to people coming forward for tests has changed over the years; although counselling is required before a test is performed, I feel that people throughout the country should be encouraged to come forward.
The expert advisory group on AIDS continues to review this and other matters. If at any stage we find a better way of protecting the public, we shall not hesitate to take further action. At present, the choice is between a somewhat coercive approach which would drive HIV and AIDS underground and a vigorous, determined approach, whereby we encourage people to come forward for tests and provide appropriate services to meet their needs if they prove to be HIV-positive.
My hon. Friend is right to remind the House of the risk that may be posed to health-care workers by HIV-infected patients.
§ Mr. Ieuan Wyn Jones (Ynys Môn)
Does the Secretary of State acknowledge that, if a surgeon or any other health worker contracts AIDS, it is crucial for the health authority to be absolutely open, not only with the patients but with the public? Keeping such matters in the dark heightens fear rather than allaying it.
Will the Secretary of State look at the guidelines again? If patients are told of such cases, the issue must then be in the public domain. Perhaps a simultaneous announcement is the answer.
§ Mrs. Bottomley
In my view, fact is much more effective than fantasy and usually less alarming. I believe that openness about such matters is very important. Questions 1111 arise about confidentiality in regard to both patients and health care workers. We are satisfied that all health care workers understand and abide by the guidelines, I hope that it will be possible to take appropriate action without alarming the public unduly. I remind the hon. Gentleman and the House that there is no known case in this country of any patient being infected by a doctor, nurse, midwife or dentist.
§ Mr. James Couchman (Gillingham)
May I join my hon. Friend the Member for Mid-Kent (Mr. Rowe) in congratulating Medway health authority, together with the regional health authority and, indeed, my right hon. Friend's Department, on the actions that they took when the Shuttleworth case became known last week? They have done much to assuage the worry and concern of the many people who have been Mr. Shuttleworth's patients over the years.
Will my right hon. Friend reiterate yet again that routine testing would only give us a series of snapshots showing the position of key workers infected by HIV? It would take no account of the three-month period before HIV becomes identifiable, and the results could become out of date within a few days.
§ Mrs. Bottomley
My hon. Friend is very well informed. I endorse his recognition of the skill and sensitivity with which Medway health authority handled the case.
My attitude to the testing of health care workers is one of practical common sense, as opposed to any theoretical or ideological commitment. Routine testing would involve three-monthly testing at vast numbers of health care workers and a huge risk of driving the matter underground. We shall, of course, continue to review the best way in which to tackle the issue: that is what the expert advisory group is for. At present, I share the concern of hon. Members who wish to be absolutely certain that all health care workers are aware of the guidelines and that the professional authorities will take appropriate action against any who have wilfully flouted those guidelines. They are there to protect patients.
§ Mrs. Gwyneth Dunwoody (Crewe and Nantwich)
Should not the Secretary of State have begun her statement by pointing out that there is no known case in this country of a health worker having passed on HIV? [Interruption.] She said that as a secondary piece of information. It is very important that she should point out that by far the greatest risk for those involved in invasive surgery is from patient to health care worker. Would not it have been helpful for her to have pointed out the absurdity of the hysteria and bigotry which is being deliberately whipped up in these circumstances because there have been no clear statements from her Ministry?
§ Mrs. Bottomley
It is not often that the hon. Lady makes the same statement as my hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight), but this is one such occasion. I thank the hon. Lady for reiterating the point that I may not have made first, but which I made several times: that there is no known case in this country of any patient being infected by a doctor, nurse, midwife or dentist.
§ Mrs. Marion Roe (Broxbourne)
I thank my right hon. Friend for her statement and welcome her commitment to putting patients first. Does she agree that common sense must prevail and that there has been only one reported 1112 case of a health worker having passed HIV to a patient and that that case involved a dentist in America? Will she confirm that the panic witnessed in this country is wholly unfounded?
§ Mrs. Bottomley
I thank my hon. Friend for her responsible attitude. It is right that we should reassure the public that patients can be confident of their safety. My hon. Friend referred to the one case in America of a dentist whose patients were infected by contaminated equipment. I must make it clear to the House that there were special factors in that case.
§ Mr. Gareth Wardell (Gower)
Is the Secretary of State aware of the one-day conference held earlier this year at the Royal College of Surgeons at which one surgeon, Miss Katherine Mills, pointed out that a survey in the county of Gwynedd had shown that only 25 per cent. of dentists regularly autoclaved handpieces between patients, that as many as one in four never autoclaved their handpieces at all and that only 29 per cent. sometimes wore gloves? Miss Mills' conclusion was that, these days, cost deterred dental practitioners from disposing of gloves between patients and from autoclaving their handpieces. Will the Secretary of State give a commitment that, from this day forward, all dentists will have to use a different pair of disposable gloves for each patient?
§ Mrs. Bottomley
I was not aware of the conference to which the hon. Gentleman referred. I shall ask the expert advisory group on AIDS to have regard to that point.
§ Mr. Roger Sims (Chislehurst)
But, after all aspects of the issue have been considered, does not my right hon. Friend agree that responsibility must lie with members of the medical profession? Should not they report it to the appropriate authority if they believe that they are in any way a risk to their patients, in accordance with the professional guidance that they have already been given?
§ Mrs. Bottomley
My hon. Friend, who is a distinguished member of the General Medical Council, is absolutely right. I have already referred to the guidance from the GMC and now refer to that from the General Dental Council. Its guidance to dentists states:By failing to obtain appropriate medical advice or to act upon the advice that has been given to them, dentists who know that they are, or believe that they may be, HIV positive and might jeopardise the well-being of their patients are behaving unethically … Behaviour of this kind may raise a question of serious professional misconduct.Those are strong points. I want to ensure that all health care workers are aware of the clear guidelines published by the professional associations.
§ Dr. Tony Wright (Cannock and Burntwood)
While agreeing with the general thrust of what the Secretary of State said, may I ask her not to close her mind completely to all routine screening of some medical staff? I ask her to think for a moment not of HIV but of hepatitis B, of which we had an outbreak in Staffordshire only a few weeks ago.
Although the Secretary of State rightly says that there has been no known case of transfer of HIV from doctor to patient, in the Staffordshire case there was transfer. Certainly, there was a strong feeling locally—I think that it is shared more widely—that all the existing guidelines were followed in that case. The doctor was offered screening, but rejected it. That was an entirely proper 1113 procedure, but it had serious consequences. On that specific point, will the Secretary of State reconsider what she said about non-routine screening?
§ Mrs. Bottomley
The hon. Gentleman rightly refers to conditions other than HIV and AIDS. There are a number of conditions which may have an adverse effect on the ability of health care workers to undertake their tasks. As for hepatitis B, we have consulted on further guidelines which we hope to issue shortly.
It is for the General Medical Council and other professional bodies to decide whether to take action in the face of a health care worker who has flagrantly disregarded advice which is there to protect patients. The chief medical officer will be discussing that subject with Sir Robert Kilpatrick when they meet shortly.
§ Mr. Patrick Nicholls (Teignbridge)
Does my right hon. Friend agree that the mere fact that no other country in the world tests its health workers is no reason why we should not test our health workers? Does she also agree that the small number of health service workers who are involved in invasive procedures and who know that their sexual proclivities or non-drug abuse do not in any way mean that they will be a risk would have no reasonable or understandable grounds for refusing to take a test? Therefore, is not the case for taking a test made out? Although it would not be politically correct, it would at least have the virtue of being morally right.
§ Mrs. Bottomley
I am not bothered about being politically correct or incorrect: I am interested in saving patients. It is the interests of patients, purely and simply, which motivate me as the Secretary of State for Health, and the chief medical officer, working with the head of the General Medical Council, Sir Robert Kilpatrick.
If the advice changes and there appears to be merit in screening health care workers, I will have no difficulty in introducing such a policy. The present advice is that it would be counter-productive. There is some suggestion that Cuba has some compulsory screening, but Cuba is the only country which I have been able to identify. The issue is that health care workers who believe that they may have been at risk should report the matter. That is strong advice and they should act on it.