HC Deb 11 July 1995 vol 263 cc857-62

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Kirkhope.)

10.47 pm
Mr. John Marshall (Hendon, South)

There is always a risk with an Adjournment debate held at this hour that the attendance does not reflect the support for a particular point of view. I can assure my hon. Friend the Minister that the hon. Member for Belfast, South (Rev. Martin Smyth), my hon. Friend the Member for Salisbury (Mr. Key), the right hon. Member for Manchester, Wythenshawe (Mr. Morris) and my right hon. Friend the Member for Worthing (Sir T. Higgins) would have been here if they could have been. Early-day motion 1219, which relates to this issue, has attracted 230 signatures.

I pay tribute to the Haemophilia Society—whose chairman, Rev. Alan Tanner, is a constituent of mine—which does so much for sufferers from haemophilia. I also pay tribute to the dedicated staff of the haemophilia centres around the country, who seek to treat those suffering from that disease, and particularly the staff of the centre at the Royal Free, which treats a number of sufferers from my constituency.

I have a sense of deja vu because, on 15 October 1990, I instigated another Adjournment debate on the plight of haemophiliacs who had been infected with HIV. The Minister who answered on that occasion was none other than my right hon. Friend the present Secretary of State for Health, then Under-Secretary of State. He said: The judge's argument is based on the proposition that the Government have a moral obligation to the victims in this case. The Government accept that moral obligation"—[Official Report, 15 October 1990; Vol. 177, c. 1033.] Within a few weeks of that speech, the Prime Minister, in answer to a question of mine at Prime Minister's Question Time, announced that the Government were to give an ex gratia payment to haemophiliacs infected with HIV. The Secretary of State for Health who persuaded the Government to do that was none other than our right hon. Friend the present Chief Secretary to the Treasury. I therefore suggest to my hon. Friend the Minister that his career has a chance of going right into the stratosphere if he can reveal a generous scheme today. He certainly deserves that boost as he was a first-class pairing Whip—the definition of a first-class pairing Whip being one who gives people a night off occasionally.

It is right to remind the House of the sequence of events in the 1970s and early 1980s. In 1974, the Medical Research Council, worried about the spread of hepatitis through infected blood, recommended that the United Kingdom should become self-sufficient in blood products. In other countries, individuals sell their blood, and among those who do so are drug addicts and others who are the origin of risk.

In 1975 Lord Owen, then Minister of Health, said that Britain would become self-sufficient in blood in two to three years. It is a chilling indictment of the locust years of the late 1970s that, if that promise had been kept, this debate would not need to be held and some of those who have died would be alive today.

There was a history of warnings in the early 1980s, as my hon. Friend the Member for Wealden (Sir G. Johnson Smith) would confirm from his wife's specialist knowledge of that issue. The first death of a haemophiliac as a result of infected blood products took place in January 1982 in Florida. In July 1982, the director of disease control in Atlanta published the first warning. There was a further warning in 1983 in The Lancet, but it was not until April 1985 that the NHS heat-treated factor VIII became available—10 years after the pledge by Lord Owen.

In January 1995, my hon. Friend the Minister announced a look-back exercise to try to find out how many people had been infected with hepatitis C. It is not yet known exactly how many people were infected with hepatitis C as a result of receiving infected blood products and infected blood, but it is obvious that about 3,000 haemophiliacs have been infected with hepatitis C and some of them have also been infected with HIV.

Although the position of those infected with hepatitis C is not the same as that of those infected with HIV, the parallels are close. It is wrong to ignore the financial plight of the latest batch of victims. The cause of infection is the same in both cases—infected blood products administered through the NHS. The consequences for many will be the same. For many, although obviously not for all, hepatitis will be just as sure a sentence of death as HIV.

The economic difficulties will be similar. Life insurance will be expensive, if not prohibitive, and mortgages will be difficult. The emotional problems will be the same. The incidence of hepatitis C varies with individuals and the timing of complications varies over a substantial period. We know, however, that, of the 3,000 haemophiliacs who have been infected with hepatitis C, about 600 will develop cirrhosis of the liver. When that happens, their chances of survival will be slim.

Whenever we debate such an issue, the Treasury talks about cost. If the onset of cirrhosis of the liver were to be the trigger for payments similar to those given to individuals infected with HIV, payments would be spread over a number of years and we would not face a huge bunching of payments in, for example, the current financial year.

The circumstances of those infected with hepatitis C vary greatly. Many will live for many years. Some—perhaps 25 per cent.—may be cured completely through interferon alpha. Others, however, will die, and already more than 50 have done so.

The current position is illogical. There was a family of three brothers: two died through having HIV and were, of course, compensated; the third, who died because he had been infected with hepatitis C, received no payment. How can one say to the mother of those three sons, "Your three sons have all died prematurely due to treatment received through the NHS. The two who died in one particularly unpleasant way were compensated, but the third, who also died in an unpleasant way for a similar reason, received no compensation whatever." The mother believes that the third son should receive not a penny more, but not a penny less, either.

Mr. Nicholas Winterton (Macclesfield)

I am grateful to my hon. Friend, because I entirely sympathise with the case that he is putting to the Minister. Am I not right in saying that the House has a moral duty to represent these people who, through no fault of their own, have been infected with hepatitis C? Am I not also right in saying that, overwhelmingly, the people of this country—as they did in the case of those infected with HIV—would be only too happy for the House, which represents the people and which has a moral duty, to provide compensation for those people who through no fault of their own have contracted what is, in some cases, a killer disease?

Mr. Marshall

Having served under my hon. Friend on the Mental Health (Patients in the Community) Bill, it is a pleasure to agree with him again, as I did so frequently during the passage of that Bill.

We are in a position that most people would regard as illogical and immoral. It has been claimed that haemophiliacs who become infected with hepatitis C would have died if they had not had the benefit of factor VIII. That is not so: factor VIII was designed to enhance the quality of life—it was not a life-saving treatment.

The Macfarlane trust has administered the scheme for haemophiliacs infected with HIV with care, dedication and skill. When the Government decide to give payments to those infected with hepatitis C, they should use the well established machinery of the Macfarlane trust rather than create a new body to do so.

Of course, we shall be told by my hon. Friend the Minister—if we are not told by him, he will certainly be told by the Treasury—that there is a risk of setting a precedent. That is what we were told in 1990. We were told that we would open the floodgates if we allowed haemophiliacs who suffered from HIV to be compensated. What happened was that, after much effort, another group were compensated—from memory I believe that there were fewer than 100 people—who were non-haemophiliacs and who had also been infected with HIV. Clotting factor concentrates have been heat-treated since 1986 and blood has been screened for HIV since 1991. I therefore do not believe that, if we concede this fair and right case, there will be a flood of cases thereafter.

It is always the weakest of weak arguments to say that something cannot be done because it creates a precedent. If patriotism is the last resort of a scoundrel, the argument about precedent is surely the last resort of mean-minded scoundrels in the Treasury. We have to ask ourselves whether there is a problem and whether that problem is the responsibility of the individuals concerned. The Government must not act like the Pharisee of old; they must help those people who are in an unfortunate position through no fault of their own.

In April 1995, the chief medical officer sent a circular to doctors about the treatment of hepatitis C, in which he stated: Interferon alpha is the only licensed therapy for chronic hepatitis C". I am sure that my hon. Friend the Minister will accept that the drug is successful in only a minority of cases. After three months of treatment, 50 per cent. of patients will have responded to the treatment and, of that 50 per cent., only 50 per cent. will be cured after 15 months of treatment. Interferon alpha can successfully treat 25 per cent.—one in four—of the individuals infected with hepatitis C.

It is also true that the earlier the treatment is applied, the more likely it is to be successful. I was upset to learn from the Haemophilia Society this morning that some haemophilia centres do not have sufficient supplies of interferon alpha to treat all those who need treatment. That seems quite wrong. I hope that my hon. Friend the Minister can assure us that there will be no shortage of interferon alpha at haemophilia centres and that the Government will provide central funding if that proves necessary. While interferon alpha is expensive initially, it will allow one in four of those infected with hepatitis C to lead a full, healthy and active life. It is a much less expensive treatment than a liver transplant or vaccinating infants against hepatitis C.

In the late 1980s, some viewed the issue as a legal matter; others said that it was a clinical matter and that the individuals concerned had received the best possible clinical treatment. I do not believe that it is a legal or a clinical issue: I believe that it is essentially a moral issue. I think that the majority of British people believe that those who receive unfortunate treatment and who become critically ill and, in some cases, economically inactive through no fault of their own should be compensated.

11.2 pm

The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville)

I agree with my hon. Friend the Member for Hendon, South (Mr. Marshall) that the relatively small number of hon. Members present in the Chamber does not indicate any lack of concern about the subject—a concern that I share.

My ministerial colleagues and I have great sympathy for those patients who may have become infected with hepatitis C through blood transfusions or blood products, as we do for anyone who is inadvertently harmed through medical treatment. Despite the recent well-publicised problems with allegedly defective equipment in the blood transfusion service, this country's record of blood safety is among the best in the world.

The debate reminds us that, alongside the great benefits to patients, medical procedures rarely come without some risk. It is important to remember that it is not always possible fully to appreciate the risk at the time or to avoid suspected or known risks. In the case of each individual patient, a balance must be struck between the benefit to be gained versus any possible risk.

Let us look at the facts of hepatitis C. Most haemophilia patients infected with hepatitis C were so infected before blood products were treated to destroy viruses in 1985. That was well before the first hepatitis C tests were available in 1989. Those patients received the best treatment available in the light of medical knowledge at the time. When those patients were infected, little was known about hepatitis C, or non-A, non-B hepatitis as it was then known, and even today a lot more information is needed.

The House will be well aware that, notwithstanding the subject of the debate, the availability of factor VIII concentrate has brought great benefits to patients with haemophilia. Previously, only about 5 per cent. of patients with severe haemophilia reached the age of 40, whereas by 1980 the life expectancy was very close to that of normal males. There was less need for long periods of hospitalisation and boys had a better chance of achieving a reasonable education. Additionally, the convenience of patients being able to keep concentrate in a domestic fridge and treat themselves at the first sign of a bleed meant a considerable reduction in long-term disability.

Before there was any test for non-A, non-B hepatitis, the only way to safeguard blood was to limit those from whom blood was taken by a system of self-deferral. It excluded, among others, those known to be suffering from hepatitis or any other liver disease; drug misusers; and men who were sexually active with other men.

No one should underestimate the effects of hepatitis C. The point that I am making, and this is at the heart of the debate, is that, contrary to views that have already been expressed in another place, patients who tragically contracted HIV through NHS treatment were in a different category. Their exceptional circumstances caused us to make special provision for them.

Many people infected with hepatitis C, as has already been said by my hon. Friend, may live for a long period without any symptoms appearing. However, 50 per cent. of sufferers may progress to chronic hepatitis with varying degrees of good or ill health. Perhaps 20 per cent. of infected patients will develop cirrhosis, a progressive destruction of the liver that may take 20 to 30 years. The majority of those years will be trouble-free in terms of ill health and, as I have mentioned, only a small proportion will die of liver disease, but every death is a tragedy for the family concerned.

In the case of those who contracted HIV through NHS treatment, special payments were made and trusts established to help sufferers or their families in cases of hardship. Those arrangements were put in place in recognition of the very special circumstances of those who contracted HIV. Those affected were all expected to die very shortly, although it has since become clear that, fortunately, that is not always the case. It meant that there might also be significant numbers of young children who had lost one parent or perhaps both if the disease had been transmitted also to their partner.

Sufferers were also subjected to stigmatism and a whole range of other social problems. There were cases of doors daubed with graffiti, lost jobs and children not allowed to mix with other children at school—in short, people were denied any normal family life.

I would in no way wish to minimise the physical suffering of those who have been infected with hepatitis C through blood or blood products—the suffering which may result or the worry which they or their family may experience—but each case has to be examined on its merits. I have to recognise that those who have contracted hepatitis C are not also subject to all the additional problems experienced by HIV sufferers, who were accepted as being a very special case.

Many people infected with hepatitis C may live for a long period without any symptoms appearing or may never experience any. In any case, some people would argue that although individuals were infected in different ways, they are entitled to payments—even though no fault on the part of the NHS was proved. The Government have never accepted the case for a no-fault scheme of compensation for medical accidents. There are sound reasons. Proof of causation would still be needed. It may be just as difficult to establish that medical treatment has caused injury as to prove that someone has been negligent. It also has to be demonstrated that the outcome was not a foreseeable and reasonable result of treatment.

It would be unfair to others if individuals whose plight was the result of a medical accident would be compensated, whereas those whose condition stemmed, for instance, from disease from birth would not. Health negligence is not considered fundamentally different from negligence in other walks of life, where claims for compensation are resolved through the courts.

The experience of other countries that have tried to follow the compensation path has strengthened the Government's view. The costs of the New Zealand scheme have proved extremely high—some 1 per cent. of gross domestic product, which is equivalent to £6 billion in the United Kingdom. In addition to practical difficulties, that scheme effectively denies access to the courts.

I understand that payments under Sweden's no-fault compensation scheme are much lower, but the authorities have found it necessary to make additional payments to individuals infected with HIV. I am not aware of any country in Europe that has made payments to patients with haemophilia infected with hepatitis C through blood products.

Every individual case in which a medical accident has occurred is a personal tragedy for the individual and his or her family. If the NHS is proved negligent in a court, of course the service accepts its liability to pay damages. It remains the Government's view that the most effective use of available resources is to seek to improve the understanding, management and treatment of the condition. Only in that way can the disease's impact on individual patients and their families be effectively minimised.

Sir Geoffrey Johnson Smith (Wealden)

My hon. Friend said that one way of trying to meet the problem is to improve treatment. My hon. Friend the Member for Hendon, South (Mr. Marshall) told the House that some patients are not receiving supplies of interferon alpha. We know that medication is not cheap but it offers relief—and in some cases a cure. Can my hon. Friend assure the House that the cost of supplying interferon alpha will be born by the Government, so that affected patients can be properly treated?

Mr. Sackville

I was about to assure the House that I will investigate the issue of medication supplies raised by my hon. Friend the Member for Hendon, South to see what can be done to ensure that the treatment promised is provided.

The Department is already supporting an initiative by the Haemophilia Society to undertake a study of the best way to support those of its members who are infected with hepatitis C. The Department has made available substantial funding in 1995 and 1996, with a commitment to further funding over a number of years. We are also discussing with haemophilia centres what must be done to ensure good practice in the treatment of people with haemophilia who also have hepatitis C.

If I may, I shall summarise what I have said. On behalf of the Government, I would like to express the greatest sympathy for those who have contracted hepatitis C through NHS treatment. We are taking a number of measures designed to enable them to receive the best possible advice and treatment. But it remains the Government's view that, in the absence of proven negligence on the part of the NHS, there is no case for using moneys which would otherwise be used for the care and treatment of other NHS patients to make special payments to those affected.

Question put and agreed to.

Adjourned accordingly at fourteen minutes past Eleven o'clock.