§ Mr. Nicholas Brown (Newcastle upon Tyne, East)
I beg to move,That this House pays tribute to the nation's two million blood donors, on whose goodwill and generosity the National Blood Service and National Health Service depend; congratulates blood service staff in the regional blood transfusion centres for maintaining a high quality service despite the continuing uncertainty surrounding the service; deplores the proposal to close testing and/or processing facilities at Liverpool, Lancaster, Oxford, Brentwood and Plymouth blood centres in the absence of any conclusive evidence that closure will lead to improvements in the quality of service to people living in those areas; condemns the National Blood Authority for pre-empting the Secretary of State's decision on the future of the National Blood Service by pushing ahead with its proposed re-organisation before any final announcement; and calls on the Secretary of State to visit each threatened centre to hear at first hand the concerns of donors and staff and take account of their representations before finalising his decision about the future organisation of the blood service.It is appropriate to begin on the point that is not held in contention between ourselves and the Government. I pay tribute to the 2 million people, our fellow citizens, who every year give blood voluntarily and generously, often at their own expense and inconvenience. They do so because they care about the health of other people—[Interruption.]
§ Madam Speaker
Order. I cannot hear a word that the hon. Member for Newcastle upon Tyne, East (Mr. Brown) is saying.
§ Mr. Brown
It is always such a pleasure to be urged on by the hon. Lady, who seems to have a special and, dare I say it, unique affection for listening to me speak from the Dispatch Box. I welcome her to this debate.
The blood service is a central part of the national health service. It is a symbol of the enduring philosophical truth that lies behind a health service which is comprehensive, unified, publicly owned, publicly accountable and free at the point of need—the principle that we can achieve more by acting together than if we act alone.
There are currently 15 English regional blood transfusion centres. Each centre carries out blood collection, testing, processing, delivery and specialist services such as research and development. In 1993, the National Blood Authority was set up to oversee the administration of the blood service. It was instructed to carry out a review of the service to maximise efficiency and to minimise waste and inefficiency. There is nothing wrong with that intention. The annual budget of the blood service is about £130 million and it is important that public money is wisely spent.
414 As part of the review, the National Blood Authority commissioned several private firms of management consultants to offer advice on possible reorganisation—advice which has cost the taxpayer £1.25 million. It is interesting to note that management consultants employed by Government Departments in the past three years have cost on average £500 million per year. It is even more revealing to note that, according to a report from the Cabinet office efficiency unit in August 1994, the savings achieved by those management consultants amount to an average of £12.2 million per year. A total of £500 million pounds spent on achieving savings of £12.2 million is not a ringing endorsement of those management consultants, nor of the Ministers responsible for hiring them.
However, let us be generous and give the consultants the benefit of the doubt, at least for the purposes of the debate. Perhaps the advice offered to the National Blood Authority was of a higher quality than the other advice that management consultants offer to Departments and quangos. Let us look at the advice that the consultants, Bain and Co., provided in exchange for more than £1 million of public money.
Bain and Co. suggested a streamlining of donor sessions, proposing that it should take 9.5 minutes to take a unit of blood. Clearly the consultants were unaware that the current regulations require almost double that time—17.5 minutes—to be taken. They also proposed to end smaller "inefficient" sessions yielding fewer than 90 donations per day, despite the fact that such sessions account for 30 per cent. of all donations.
Next, the consultants proposed using fewer units of blood for operations. That is the sort of recommendation that one would expect from management consultants. According to Bain and Co., such a measure would reduce demand for blood by 23 per cent. The idea is that if we give people less blood the demand will fall. But it seems rather a dangerous proposition. Last Friday the British Medical Journal contained advice contradicting that of the consultants. Leading haematologists suggested that even current practices leave critically ill patients short of blood. So there is hardly a case for reducing the amount of blood given.
Bain and Co. also suggested that money could be saved by leaving blood at room temperature for 24 hours before refrigeration. I am sure that it could, but there is a danger that blood products could be infected by bacteria and become unsuitable for use.
The consultants also proposed—this is the heart of the issue that we are debating—that five of the 15 regional transfusion centres should be closed and the blood service restructured into three administrative zones. That is the proposal which has proved so universally unpopular with clinicians, staff and donors. It means that the public will be required to travel further to larger, more impersonal donation sessions, with a consequent fall in donations.
§ The Minister for Health (Mr. Gerald Malone)
It is rather a shame that the debate has kicked off to a false start, with the hon. Gentleman suggesting that the centres are to close. It has been suggested that certain processing functions will be moved away from them, but donors will not have to travel further. The centres will still be available for the donation of blood, so what the hon. Gentleman has said is simply not true.
§ Mr. Brown
The proposals are based on what is called option D of the Bain report, which recommends full 415 closure of five or six centres. Gary Austin, the designated chief executive of the midlands and south-western zone, has written to representatives of the Oxford blood centre about the "closure" of that centre. That is his word, and if the Minister wishes to dispute it his quarrel is with Gary Austin, not with me.
§ Mr. Andrew Smith (Oxford, East)
Given the scale of public and donor opposition to the closure proposals—Oxfordshire has produced the county's biggest ever petition—and given the scale of clinical and consultant concern, with more than 100 clinicians, including world-leading heart surgeons, having signed a statement opposing closure and expressing concern about the effects of the withdrawal of the testing and processing functions, is it not time that the National Blood Authority and the Government took notice and acted to keep the centres, including their testing and processing functions, open?
§ Ms Angela Eagle (Wallasey)
Does my hon. Friend agree that part of the confusion about language arises from the National Blood Authority itself? Initially, in its shoddy consultation document, it announced closure. Then it started to back-track. Those of us who have tried to pin the authority down to some reasonable proposals are amazed at the way in which it keeps shifting the meaning of language and deliberately confusing the debate, while at the same time implementing the proposals which are so strongly opposed throughout the country.
§ Mr. Brown
I shall say something later about the way in which the proposals are being implemented, but my hon. Friend is absolutely right. She speaks for the country, while the Minister will have difficulty being treated with respect by those who are following the debate. I shall have something to say about statements by Ministers, too.
§ Mr. Bernard Jenkin (Colchester, North)
Will the hon. Gentleman explain why the Labour party wants to take the advice of clinicians only on some occasions? For instance, it entirely ignores the advice of GP fundholders on its policy. Why is it not more consistent?
§ Mr. Brown
I am being lured slightly away from the main thrust of the debate, but I must tell the hon. Gentleman that in Fundholding magazine, a periodical specifically for GP fundholders, 75 per cent. of the fundholders polled said that they opposed fundholding. So we are listening to the majority of clinicians. We are more than happy to take advice, as the hon. Gentleman urges. Having satisfied him completely, I shall continue with my speech.
The second implication of the proposals for the blood service is that specialist centres of excellence will be lost. Thirdly, some specialist services, such as transplant technology and cancer treatment research, will be 416 threatened. Above all, we believe that the review has underestimated the future growth in demand for blood and overestimated the excess capacity in the service.
There is a real risk that future supplies of blood to national health service hospitals may be inadequate. What the review calls an excess the service calls a safety margin, to deal with events such as war, or the purchase of Tuta bags. [Interruption.] The Minister seems surprised that I refer to wars, but he should think back to the Falklands conflict and the Gulf war. We were all grateful that masses of blood products were not needed, but they might have been.
§ Mr. Malone
That was not the reason for my incredulity. The suggestion that the problem experienced with Tuta bags can be compared with war is absurd. The hon. Gentleman does himself no credit by making such a comparison.
§ Mr. Brown
The Minister has missed the point. Both examples represent events which put pressure on the supply of blood products. It is perfectly obvious to most people following the debate that both events, although quite different in their nature, would put pressure on short-term supplies of blood products. That is why it is necessary to have a surplus. It is far better to have a surplus than a deficit.
The proposals are paralleled by other initiatives which have met with considerable opposition. The first, of course, is the sale of blood products—and the confidence of the House in the Conservative party's reform agenda for the blood service is unlikely to have been shored up by the answers that have been given to the House. On 12 December 1994, in a written answer to my hon. Friend the Member for Barnsley, Central (Mr. Illsley), the Parliamentary Under-Secretary of State for Health said:Blood collected by the national blood service is for the needs of the national health service not for sale or export."—[Official Report, 12 December 1994; Vol. 251, c. 473.]Given that assurance, many of us were concerned to learn that the National Blood Authority does sell blood to the private sector and does sell blood products overseas. These transactions were said to be worth about £5 million a year. More concern was caused by newspaper reports suggesting that the NBA was considering increasing the volume of sales abroad to around £14 million per annum. That may well be standard practice for a private profit-driven firm in a competitive market, but it surely has no place in an ethically based public service, the overriding purpose of which is to meet the needs of patients. The proposal also does not go down well with donors.
§ Mr. Eric Pickles (Brentwood and Ongar)
The blood products sold—in particular, factor VIII—are surplus to requirements in Britain, they are provided at cost and they are provided to help people who are ill. What is wrong with helping people in that way? Surely the hon. Gentleman does not want to stop helping people who need factor VIII just because they are not English. Is that not taking xenophobia a stage too far?
§ Mr. Brown
I am slightly surprised to be accused of xenophobia by the hon. Member for Brentwood and Ongar (Mr. Pickles) and his party. I followed with some interest the speech of the Secretary of State for Defence at the Conservative party conference. Perhaps the hon. 417 Gentleman would like to have a word with his right hon. Friend before he starts throwing around charges of xenophobia.
The point I am making is that our fellow citizens give blood freely and altruistically as a public service. They do not give blood to have it treated as a tradeable commodity. The hon. Gentleman implied that all the blood products that are sold are surplus, whereas in fact that is not the case. Blood products are now being treated as a tradeable commodity to generate income for the authority. It is not a question of selling off the surplus.
§ Mr. David Alton (Liverpool, Mossley Hill)
I entirely agree with the hon. Member for Newcastle upon Tyne, East (Mr. Brown). People who give blood do so altruistically and generously and because they want to give their blood for humanitarian reasons. What they find offensive is that they are not even told when their blood is sold on to second and third agencies who may well make money out of the transactions.
§ Mr. Brown
I agree completely with the hon. Gentleman, and I believe that the further the National Blood Authority goes down that route, the more it will put in jeopardy the altruism of those providing blood.
In a survey conducted by the NBA, donors were asked whether theysupport the sale of surplus plasma derivatives for countries in the European Community provided the monies raised offset running costs to the National Blood Service".I submit that it would be difficult to write the question in such a way as to make it more likely that the answer received would be yes. Nevertheless, more than 8 per cent. of donors who responded were opposed to the idea of selling surplus blood products in the very narrow circumstances outlined in the question.
§ Mr. Malone
No, but I hope that the hon. Gentleman will be honest with the House. He should make the point that if the surplus blood products were not sold and the cash brought back into the NHS, the products would be destroyed. Does he think that donors would prefer to see part of what they have given destroyed rather than given to patients, wherever else they may be? That is an extraordinary suggestion.
§ Mr. Alex Carlile (Montgomery)
Is the hon. Gentleman aware of the price lists in Turkish publications which appear to show that middlemen are making massive profits out of the sale of blood products bought from the National Blood Authority?
§ Mr. Brown
I was aware of the general market in Turkey, although I was not aware of the price lists or the profit margins of middlemen. No doubt the Minister knows more about the matter than I do.
418 The point I wanted to make was that if 8 per cent. of donors decided to withhold their gift—and it is a gift—of blood, the effect on national blood stocks would be disastrous. The Government are doing a very dangerous thing in undermining the ethical base of the service.
In addition to the sale of blood and blood products, there is evidence of creeping commercialisation of the service. The removal of the crown emblem from the national blood service logo has met with opposition from donors and blood service staff, and a petition was presented against the plan to the Prime Minister this morning. Why should the crown emblem—the symbol of our country—be removed from something that is supposed to be a public service? What emblem will replace it? Will it be something like the Conservative party torch or an advertisement for Ribena? Who knows?
It was recently revealed that the National Blood Authority is considering plans to allow Ribena and McVitie to provide sponsorship for the service, and it has been suggested that in exchange for that commercial sponsorship access to the database of 1.8 million blood donors could be facilitated so that the poor old blood donors can be targeted with junk mail.
In fairness, I received a letter from Smith Kline Beecham stating that there was never any question of that firm accessing the donor database. Nevertheless, meetings have taken place and surely no one can be in any doubt that commercial involvement puts further pressure on the principle that blood is given freely by altruistic citizens because they care about the health of others.
That brings me to my next point about dangerous cost-cutting. The procurement of Tuta blood bags with faulty and potentially dangerous seals was an ill-thought-out decision made by national blood service chiefs more concerned about cost than about quality. That kind of decision-making undermines people's trust and confidence in the service. Trust and confidence are commodities on which the service relies. They are principles without which the service could not function. The Government's encouragement of commercialisation and cost cutting poses a real threat to the central ethos of the service—that of altruism and public service.
The House should concern itself also with the effect of all this on the morale of staff. The proposals are unpopular, and the uncertainty and confusion which surrounds their implementation has had a damaging effect on staff morale. Resignations and early retirement are the most extreme expressions of disenchantment among staff. Among those who have left the service in recent months are Doctor Hugh Lloyd, from my city of Newcastle; Belinda Phipps, the director of the south London centre at Tooting; Douglas Jinks, chief executive of the Birmingham service; and Doctor Colin Entwistle, head of the Oxford service. The low levels of staff morale are threatening the viability of the service. This summer, Peter Bowells, a laboratory services manager in Oxford, told The Observer:If more staff were to leave prematurely, it would be very hard to maintain the service.As well as staff morale, there are concerns about the levels of stock. The national blood service exists to ensure that NHS hospitals have access to all the blood supplies that are needed. Keeping adequate blood stocks is, therefore, a central imperative. But blood stock levels have fallen below the NBA's recommended absolute minimum levels on a number of occasions this year. In 419 January, stock levels were below the recommended minimum level of 15,000 units on 10 out of 23 recorded days—in other words, 43 per cent. of the time. In June, the picture was equally worrying.
Before I bring my remarks to a conclusion, I want to refer to two constitutional issues which I think should worry the House and should be of concern to every hon Member, regardless of party political affiliation. The points that I want to raise relate directly to the rights of Parliament and the rights of hon. Members of the House of Commons. The NBA's proposed restructuring plans have led to commercialisation, corner-cutting and the alienation of staff and donors. It is my submission that it has also acted outside its authority and has pre-empted parliamentary approval.
Although the NBA proposals were put out for a three-month formal consultation in September 1994, no final decision from the NBA has been presented to Parliament for approval, despite repeated promises from Ministers. That might give us cause to think that the NBA was reconsidering its proposals in the light of the strong opposition from the national blood service staff and the general public, including the donors. Much as we might like to think the best of the NBA, however, the truth is rather far removed from that. The authority has already hired the senior officials—the top brass—for the new zonal administration. It has already filled between 20 and 25 newly created senior posts at a cost to the taxpayer of at least £1.5 million. Those people have been drawing salaries and driving around in company cars for the best part of this year but, it would appear—no doubt the Minister will be able to deal with this point—with no work to do.
The shadow Secretary for Health, my right hon. Friend the Member for Derby, South (Mrs. Beckett), has referred the matter to the Comptroller and Auditor General for investigation. As parliamentarians, it is clearly right that we should consider carefully the circumstances in which a quango proceeds to make such appointments without having the parliamentary authority that it requires. The matter has not yet been agreed and it should not have proceeded.
That brings me to the second matter, which also ought to concern parliamentarians on both sides of the House, regardless of party affiliation. As well as spending public money without Parliament's approval, the National Blood Authority has issued a gagging clause to its staff which in my view threatens the relationship between Members of Parliament and their constituents. The clause threatens disciplinary action against an employee of the authority for no greater offence than approaching a Member of Parliament. The authority's code states:Staff must exhaust the procedures laid down in this document",which would take around 40 days by my reckoning,before contemplating consulting his or her Member of Parliament or disclosing information to the public or media. Failure to do so could undermine public confidence in the service"—depending, of course, on what they intend to say to their Member of Parliament—and may result in disciplinary action being taken.It is an affront to this House and to every Member of Parliament that a body which is supposedly under parliamentary control can insert in its code a restraint on the rights of citizens to approach their Members of Parliament. It is an affront to this House and it should not 420 be allowed. It is a direct contravention of the constitutional right of every citizen to approach his or her Member of Parliament. Also, it flouts the guidance on staff relations with the public and the media laid down by the national health service management executive. No doubt the Minister will want to brush that matter to one side, but I do not see how he can easily do so.
We therefore ask hon. Members to join together to pay tribute to the nation's 2 million blood donors, on whose altruism and good will the national health service depends and to congratulate the staff of the regional transfusion centres for maintaining a high quality service despite continuing uncertainty about future reorganisations.
We must also deplore the proposals under consideration for the closure of facilities in five regional centres and must condemn the NBA for pre-empting parliamentary approval for its plans and attempting to gag its staff.
Finally, I call on the Secretary of State to consider carefully the proposals in the light of the overwhelming opposition to them and to reject them as ill conceived, damaging to the service and potentially threatening for the well-being of patients.
§ The Minister for Health (Mr. Gerald Malone)
I beg to move, to leave out from "House" to the end of the Question and to add instead thereof:'commends the continued support of blood donors, on which the Blood Service is founded and which is at the heart of the National Health Service; and fully recognises the commitment of blood service regional staff and the importance of ensuring that this vital national service continues to improve and develop into an integrated national service, based on high and uniform standards of safety, reliability and efficiency.'.I start by assuring the hon. Member for Newcastle upon Tyne, East (Mr. Brown) that my right hon. Friend the Secretary of State is considering extremely carefully the proposals that have been put before him. The hon. Gentleman is probably aware of the fact that they were put before the then Secretary of State in early July. My right hon. Friend has been considering them with great care since. Indeed, a number of meetings with the hon. Gentleman's colleagues and others still have to take place before a final decision is taken on this important matter and I have no doubt that my right hon. Friend will read with great care the Hansard report of this debate.
Before we enter into detailed debate, let us be clear about the quality of the services that we are discussing. Our blood service is among the world's safest, through the reliability and quality of our donors and the thoroughness of our screening and testing systems. Another system not far from this country in Europe with 1.2 million donations per annum has a high prevalence of HIV—0.129 per thousand. In this country, the figure is much lower at 0.007 per thousand. I draw the attention of the House to that figure because it is a very important one and it underpins the quality of our service.
Last year in England, 2.4 million donations were given through the generosity of our unpaid voluntary donors for the direct benefit of about 800,000 desperately ill patients. The voluntary principle guarantees not only the basic supply, but its quality. In other countries where the voluntary principle does not pertain—in some where it appears to do so it does not in reality as payments are made by a number of means—the quality of blood donated is much worse than in the United Kingdom.
421 Contamination rates in some countries range from 2.5 times the United Kingdom level to a massive 280 times that level.
The Government clearly understand that the voluntary principle underpins the quality of supply. Our system works and I am pleased to be able to tell the House that it is the Government's firm undertaking and principle in this debate that that principle will remain.
§ Mr. Nigel Spearing (Newham, South)
I am grateful to the Minister for giving way, especially as he wishes to close the east London supply centre in Brentwood. He has paid tribute to blood donors and those of us who are past that age are happy to pay taxes for the process to continue. He has praised and emphasised the voluntary factor. Does he agree that that means that there should be no element of commercialism in anything that happens to the blood subsequently? If there is such commercialism, it is absolutely wrong. It is something that taxpayers and blood donors oppose and they will oppose any Government who change that principle.
§ Mr. Malone
Before the hon. Gentleman becomes hysterical about commercialism, let me set the matter in context. I was intending to do so later. Blood and the red cells derived from it are not for sale. They are provided at a price—a cost production price—to the national health service and the private sector in this country. With the increasing number of donations, there is an increasing quantity of blood products. The hon. Gentleman must ask himself what donors would say if products derived from blood donations were destroyed rather than sold in other marketplaces.
§ Mr. Malone
I will gladly give way when I have finished this point.
The cash received for those products is put back into the national health service to pay for increased patient care. That is something that, when properly explained rather than described in the rather absurd tones that the hon. Gentleman used, would be welcomed by the population of this country.
§ Mr. Spearing
I was keeping my intervention short. I was excluding the question of the sale of products abroad. I am talking about the attitude of cutting costs and of making one area compete against another and reducing costs, possibly at the expense and risk of providing a lower-quality service. The hon. Gentleman cannot deny that that is happening. Surely that was the way in which the consultants mentioned by my hon. Friend the Member for Newcastle upon Tyne, East (Mr. Brown) went about their task.
§ Mr. Malone
I do not agree and, as I get on with my speech, the hon. Gentleman will understand that the proposals put forward for consultation, which are now with the Secretary of State, are designed to get rid of the inequalities in the service—any number of ranges of standards and costs—so that we can have a truly national service.
§ Mr. Alton
Does the Minister accept that the objection is not so much to the reinvestment of money within the national health and blood services, as to the fact that blood 422 is being sold overseas at a list price of £90, but is then sold in countries such as Turkey at a list price of £399. Can he justify the profit made, given that he, his colleagues and the National Blood Authority have said that no profit is made out of blood? The profit is made by middlemen, who are creaming off substantial sums of money from donations given generously out of the good hearts of people in this country. Should not people in this country rightly object to that?
§ Mr. Malone
Those lists have been drawn to my attention. If the hon. Gentleman suggests that we should have custody from the Dispatch Box of arrangements as to when and in what circumstances blood products will move on from this country or from the national blood service, I must say that that is an extension of control beyond anything that even he should expect. The corollary of what he is saying is that it would be impossible to pass such products into any marketplace because it is not possible to control where they would go from there. Such controls simply do not exist.
§ Mr. Malone
The hon. Gentleman, from a sedentary position, asks why. It is impossible to have controls on passing such products into marketplaces because, as he would know if he were to look at the arrangements for competition policy, for example, in the European Union, it would not be allowed.
§ Mr. Malone
No, I cannot give way to the hon. Lady. I have given way significantly already and I must move on.
The NBA was set up in 1993 because of a range of concerns. Despite the high standards of care achieved by our service, there was clearly some room for improvement. The large number of regional blood centres had led to variable administrative practices, duplication of effort, wasteful use of resources and inadequate co-ordination. Let me give the House some examples to support that suggestion.
First, there are the donor selection criteria. There was a detailed national list of risk factors designed to ensure exclusion of donors at risk of infection. It was subject however to different interpretation of detail from region to region, which meant the unnecessary exclusion of some donors for reasons that did not add to blood safety but was due to an over-rigid interpretation.
The criteria for determining the suitability of locations for collection sessions varied from region to region. There were different methods of processing blood into its different parts, some of which could affect the efficacy of the product, though not its safety.
§ Mr. Malone
If I can get through this point, I will give way to the hon. Lady.
The reserve stockholding considered necessary for each centre varied between one day's supply and seven days' supply. Whatever can be said about that, one of those figures was clearly wrong and a view had to be taken about which was right.
423 There is also the question of use of stocks. Some regions aimed at self-sufficiency to the extent that they would ration their hospitals at times of temporary shortage rather than call on stocks that were available from other regions.
There is a wide variety of different arrangements for 24-hour on-call access to consultant specialist advice. That causes confusion to doctors who, in the course of their employment, move to other regions.
There was also the question of dissemination of information to donors. The forms, leaflets and other communications to donors varied in content, quality and frequency from region to region. There was clearly an agenda that had to be addressed and that is why the investigation was undertaken
§ Mr. Malone
I shall deal not with closing down centres but with the restructuring that is proposed in the consultation document and the withdrawal of certain facilities from those centres. I was interested that the hon. Member for Newcastle upon Tyne, East (Mr. Brown) got it right in his concluding remarks when he stopped referring to closure, as he had been doing at the beginning of his speech, and referred to the withdrawal of certain services from centres. I am glad that my intervention in his speech was effective.
§ Mr. Malone
I hardly need to refer the hon. Gentleman to the English dictionary for him to understand that there is a great distinction there. The withdrawal of processing facilities is taking place but the centres will remain as centres for blood donation and other activities; that is very different from closure.
I turn to the principles that lay behind the need for the reorganisation and what will underpin it. From the outset, the NBA has made the broad principles behind its proposals clear.
First, the blood service must remain a voluntary, unpaid donor system within the NHS. That is its great strength, as I have already acknowledged.
Secondly, we want to establish for the first time a truly national blood service based on high and uniform standards of safety, reliability and efficiency. Thirdly, we want to increase supply in line with increasing demand from increasing hospital activity and rapidly developing clinical techniques.
Fourthly, there is a moral obligation to use the generous gift of donors as efficiently as possible. That means working with hospital teams to use blood and blood products in the best possible way for each patient, to improve the safety and quality of the products and to make the services for donors better than they are now.
Fifthly, we want to collect blood at the most convenient locations for donors and ensure that the collection service is cost-effective. Sixthly, we want to rationalise administration to make it more efficient and effective and to remove waste arising from duplication, excess capacity or lack of co-ordination.
424 In summary, the proposals outlined in the consultation document are designed to increase supply; improve the way the blood supply is used; improve the safety and quality of blood products; improve services for donors; improve services for patients; and provide an efficient, cost-effective, national service.
The first step in the process was to establish the NBA and its main headquarters structure so that it could begin to plan. In effect, this provided a national blood service in name but the substance needed to be added to that. What are now under consideration are the NBA proposals to deliver the key second step of implementing the management arrangements that will convert the goal of a truly integrated national service into a practical reality.
The NBA consulted widely on its initial proposals in 1994 and gave full and detailed consideration to the responses received before arriving at the proposals which are before my right hon. Friend the Secretary of State.
§ Mr. Andrew Smith
On consultation, will the hon. Gentleman tell the House how many of those consulted agreed with the proposals and how many opposed them?
§ Mr. Malone
The hon. Gentleman says put it in the Library. If he tables a parliamentary question he will get an answer, as he would to a question on any other point.
The consultation process was wide and it has been validated. It was far wider than Opposition Members believe and the proposals that followed from it are now before my right hon. Friend, who expects to reach a conclusion shortly.
I find the cries that we hear from the Opposition on all such matters surprising. Faced with any change, the Labour party always in some way demands the restoration or retention of the status quo. Faced with the status quo, it always demands change. Faced with a consultation process it always demands more time; if due time is given for proper consultation, the next cry is, "Why the great delay?"
Throughout the consultation process, absurd and groundless fears have been raised by the Labour party. It has placed or provoked countless scare stories in the tabloid press. I seek to tackle the worst of them head on.
How many scare stories stores have we had about privatisation? They are not true. There is no question of privatising the national blood service.
We dealt with commercialisation earlier in the debate but let me make a final point on it. We produce vastly more blood products, as opposed to the main ingredients of transfusions, than we can use. The NBA disposes of surplus blood products such as factor 8, which is used in the treatment of haemophilia, by selling them abroad. That is a long-standing practice based on the sound and humanitarian principle that someone can at least benefit from what would otherwise be destroyed.
The NBA seeks to recover its costs without any element of profit at all. It is unfortunate that the accusation has been repeated tonight that the NBA is somehow getting inflated prices in places such as Turkey. That is rubbish. Price setting outside the UK has nothing to do with the NBA and is not within the control of the Government.
425 On the scare about the closure of blood centres, the transfer of certain functions, as we have already established in exchanges across the Dispatch Box, does not amount to the closure of a service.
§ Ms Eagle
I thank the Minister for giving way again. Will he admit that, buried within the Bain report, which is some 600 pages long, support was canvassed for possible privatisation but was dismissed. However, there was widespread support for the proposition that the English blood service should pursue profitable commercial opportunities outside the UK. How does the Minister square what he has just told the House with the information that is buried in the Bain report, which cost £600,000 of public money to produce?
§ Mr. Malone
I am telling the House the policy and what will happen. There is no policy along the lines suggested by the hon. Lady. The Bain report will not drive this process; it will be driven by the Secretary of State's decision, based on proposals put to him by the NBA.
The question of donor confidentiality has also been raised. I confirm, for the sake of donors, that information will remain strictly confidential and will not be made available to commercial companies for any purpose or under any circumstances. There is one simple reason for that. I remind the House that the relationship between the blood service and its donors is exactly the same as the relationship between a doctor and a patient.
As for scares about the safety of supply, it has been wrongly suggested that reorganisation will somehow prejudice security of supply. At present, excess capacity in processing, testing and grouping blood is about 50 per cent.
The hon. Member for Newcastle upon Tyne, East made what he thought was an amusing remark about a possible debate on how many pints of blood it is sensible to use in a particular operation. The practice varies across the country, and one purpose of reorganising the service is to establish credibility in the clinical techniques for transfusion so that there can be a proper level of supply for certain operations. If it now ranges, as it often does in orthopaedic surgery for the same procedure, between zero pints and some 2.5 to 3 pints or even more, one of the clinicians has clearly got it wrong. The transfusion service needs to develop its clinical abilities and disseminate them across the country so that a proper view can be taken.
The new service will have three prime objectives: an improved service to donors, an improved service to hospitals and their patients, and lower operating costs and less bureaucracy by removing the present duplication, variation and wasteful use of resources. The hon. Member for Newcastle upon Tyne, East is fast enough to ask questions at the Dispatch Box or on the Order Paper about management costs in the health service. I should have thought that he would welcome the objective of cutting out bureaucracy in our national transfusion service rather than seeming to be entirely against it.
§ Mr. Nicholas Brown
I said in my speech that the efficient running of the service was an objective of ours 426 as well as a claimed objective of the Minister. I raised two important constitutional matters with him and I hope that he will deal with them both before he sits down.
§ Mr. Malone
I shall indeed. On the hon. Gentleman's first point, a number of people have been employed by the service with a view to putting planning into effect. That is common practice where change is proposed. It would be absurd to suggest that a service facing change should not plan for it and put in place the proper structures to do so. I do not know quite what the hon. Gentleman suggests. Had that not been done, I bet that he would have suggested that there had been a failure of anticipation and would have said that the seamless service now provided by the blood transfusion service had been prejudiced.
The hon. Gentleman's second point, which he always makes, was about gagging clauses. The position is simple. Everybody has a right to talk to his or her Member of Parliament if he or she so wishes. The rules that will affect people in the National Blood Authority are the same because it is a special health authority. It is not a quango, as has been suggested in the House tonight. The rules are the same as those that affect any other employee within the family of the national health service, and the same standards apply.
As has been pointed out in letters issued by the chief executive of the service, it would be absurd if a Member of Parliament were the first resort without exercising the right to talk to the direct employers. So the point made by the hon. Gentleman has no worth at all. My right hon. Friend has taken, and is taking, the keenest interest in the revised proposals submitted to the Department in early July. It is clearly important for the future of the service that decisions are taken as quickly as possible, but it is even more important that they are the right decisions.
§ Mr. Malone
I am concluding my speech.
The principles on which those decisions will be taken, and on which this important service will continue to be based once they are taken, are ones on which the House, the country and donors will be able to rely.
§ 8.5 pm
§ Mrs. Jane Kennedy (Liverpool, Broadgreen)
First, I declare an interest in this debate. My candidacy at the general election is sponsored by Unison, a trade union that represents a number of the staff affected by the proposals that we are considering tonight. I also have a constituency interest, which is that many donors and users of the service in Liverpool have expressed their concerns to me. Secondly, surgeons and consultants at the cardiothoracic centre, which is a regional centre providing treatment for heart and lung disease, have expressed their grave concerns, not only to me but to Ministers, about the proposals. I shall return to that shortly.
The Minister said that if we were to table a question, he would place in the Library a list of the people who had responded to the consultation document. On 9 February 1995, my hon. Friend the Member for Barnsley, Central (Mr. Illsley) asked whether the Secretary of State wouldpublish (a) all the responses to the National Blood Authority consultation document and (b) a list of all the organisations and individuals who have opposed the reorganisation proposals".— [Official Report, 9 February 1995; Vol. 254, c. 367.]427 The answer was that those were responses to the National Blood Authority and that therefore the replies were the property of the NBA. Will the Minister publish that information if we table a question now directly to the Secretary of State?
§ Mr. Alton
I support what the hon. Lady says. She will recall from our meetings that John Adey assured us that there would be a rethink if clinical opinion were opposed to the changes. How can there be a rethink if we do not know what clinical opinion was—most of us could have a guess—and if the Government will not publish the responses?
§ Mrs. Kennedy
I agree with the hon. Gentleman. At that public meeting he had a further assurance from the platform in front of hundreds of people in Liverpool's St. George's hall.
A member of the Liberal Democrat party, Councillor Frank Doran, asked of the Mersey NBA:The Liverpool centre is an acknowledged 'centre of excellence'. An assurance has been given that no changes will be implemented if clinical opinion remains opposed. If clinical opinion remains opposed will the changes still go ahead?The National Blood Authority replied:Clinical opinion has been listened to very seriously and further meetings held. Sir Colin has met with the Mersey branch of the BMA, which is concerned about whether the proposals are workable and deliverable.That was it. It was no answer at all. Clinical opinion throughout Merseyside remains extremely concerned about the proposals.
From as early as February this year, a referendum has been conducted among senior clinicians in Merseyside, north Wales and the Isle of Man. More than 300 top clinicians have stated that they are strongly opposed to the proposals because of the risks to patients' lives.
The former Secretary of State was sent a copy of the results of that referendum, which I am afraid demonstrates that the Government are prepared to ignore clinical opinion to drive through a change that, as currently proposed, is not in anyone's interest.
§ Mr. Allan Rogers (Rhondda)
The problems encountered in north Wales and Merseyside have been repeated in south Wales, where the specialised screening unit at Cardiff is to be transferred to London. None of its skilled staff are able to transfer, which means that an extremely valuable facility will be lost not just to Wales but to the whole country.
§ Mrs. Kennedy
Before I outline the risks, I should like to deal with the survey of clinical opinion that was taken on Merseyside. Given the failure of the NBA to reiterate assurances previously given, will the Minister now offer them to us? Will he say that so long as clinical opinion remains deeply unhappy about the proposals he will not force through a closure that his own professional staff have told him they do not believe to be in the interests of patients? [HON. MEMBERS: " Answer"] We do not want 428 any more weasel words; we want a straight answer to a plain question. I was asked to outline the risks, but they have been dismissed by Ministers. That is outrageous.
§ Mr. Malone
The hon. Lady knows perfectly well that it is not the outcome of a referendum upon which Ministers make their decisions. Proper clinical judgments will be considered and will form part of my right hon. Friend's decision. The hon. Lady is talking about petitions that are circulated and simply signed—I do not know on what basis. They are not what I would represent as clinical opinion in the sense of providing the best basis of evidence upon which to proceed.
§ Mrs. Kennedy
My hon. Friend is absolutely right.
Clinicians and cardiothoracic surgeons at the cardiothoracic centre in my constituency in Liverpool expressed their concern about the proposal last October in a letter to Sir Colin Walker, the chairman of the NBA. They stated:The figure you quote of two hours travelling time in an emergency as a maximum is far too long for the work that we undertake. In the sorts of emergencies that we deal with, such a delay will result in the death of a number of patients.That is quite plain and straightforward. Those are the risks and it is disturbing that Ministers are prepared to dismiss such comments.
§ Mr. Malone
Given the way in which the hon. Lady puts them, I am certainly not prepared to accept that they are accurate. Let me remind her that hospitals keep their own store of blood and often it is sufficient to last them for at least one, two or perhaps even more days. Secondly, the standard of two hours is an absolute maximum time. Many hospitals will still be able to receive supplies if they need to call upon them within a far shorter time. Therefore, for the hon. Lady to suggest that two hours will be the norm for anyone who needs to call upon a blood supply is rubbish.
§ Mrs. Kennedy
I am not making a suggestion but quoting directly from a letter written by clinicians and surgeons at a hospital in my constituency who are deeply concerned about the proposals.
§ Mr. Andrew Smith
Does my hon. Friend agree that concern has been expressed by clinicians across the country? For example, the regius professor of medicine at the university of Oxford has written:This is a complex hospital with both a busy Accident and Emergency service and a number of specialised services, particularly related to diseases of the blood. We remain unconvinced that a safe and effective service could be maintained for the local population if it were centred in Birmingham or Bristol.People will know who to believe between the Minister and the regius professor of medicine.
§ Mrs. Kennedy
My hon. Friend is absolutely right. I do not intend to say any more on that subject, but I will 429 ensure that clinicians at the cardiothoracic centre at Liverpool receive a copy of Hansard so that they can see how their concerns have been dealt with in the House.
In their letter to the chairman of the NBA, the clinicians and surgeons also said that without the services of the local blood transfusion centre they would have to "dramatically increase" their in-hospital blood stores. The Minister is quite right to say that hospitals have their own stores, but those clinicians have said that they will have to "dramatically increase" them. That is one way in which the notional £10 million saving that the blood transfusion service claims will be made will be passed on to hospitals. The real savings to the health service must be seriously questioned in the House, especially since we have been unable to get to the bottom of the figures produced during the whole sorry business. The clinicians also said in their letter:This whole process would be both costly and wasteful of donated blood and blood products.New information technology systems have been proposed. I am pleased that the NBA has agreed that the new system should operate in tandem with the old one for a pilot period of six months. That is a great relief because the original proposal was to introduce and operate the new system from a standing start. I have been disturbed, however, to hear about plans to trade access to lists of donors in exchange for sponsorship of donor sessions. I firmly believe that throughout this process donors have been treated with scant respect by the people who manage the National Blood Authority and the blood transfusion service.
§ Mr. Barry Porter
I have listened with great interest to the hon. Lady. I also represent part of Merseyside and I have had considerable correspondence on this matter. The hon. Lady obviously knows a great deal about the issue. Is she suggesting that the present arrangements governing the blood service on Merseyside are absolutely perfect? Is there no room for improvement and, if so—I presume she knows it all—have the clinicians who have come to her door in droves suggested any?
§ Mrs. Kennedy
The hon. Gentleman need not be patronising. I do not claim to be an expert. His question is a fair one. None of the staff involved in this process have said that they oppose change full stop. I would be the first to recognise that the introduction of a national information system to which all centres have access, as well doctors and clinicians at every hospital, is an improvement on current services. I welcome that.
Donors are concerned at being treated in a cavalier fashion by the managers of the service. They are concerned that their trust in the service has proved to be misplaced. A press report, which has been denied, but the rumours continue, suggested that access to the lists of donors kept on computer was to be sold. I have already referred to sponsorship. Donors could be invited to a centre and, with their invitation, might receive advertisements for Ribena and McVities. Concern has been expressed to blood transfusion staff that donors have lost their free supply of biscuits as a result of that story. Such is the attitude of senior managers in the blood transfusion service. It is symptomatic of the way in which they have dealt with the whole business. Their cavalier attitude has been appalling.
430 I should like to quote a direct example of the attitude of those managers by quoting from Sir Colin Walker, who had a meeting on 12 September with representatives of Liverpool city council.
In order to extol the virtues of the new information technology system, the chairman said:If someone in Liverpool"—for example—was brought in needing an urgent infusion of a rare blood group and the local donorwasaway on holiday—then, rather than having to ring around, the doctordealing with the patientcould tap into the computer and find that the unit ofthe requiredblood was in, say, Taunton.Councillors expressed incredulity that blood could be brought from Taunton to Liverpool in any short time, let alone two hours. Sir Colin remarked that there was a good rail network between Taunton and Liverpool. But then he conceded that perhaps that might have been a bad example to use.
That is a typical example of the way in which the people responsible, placed in that position of responsibility by Conservative Ministers, have dealt with that process. It has been a public relations disaster. Donors have been dismayed, to say the least, by the way in which their trust has been betrayed. It is about time that Ministers took seriously the anxieties that are being expressed by hon. Members on both sides of the House.
§ Dame Elaine Kellett-Bowman (Lancaster)
The more sophisticated our medical techniques become—with the obvious exception of keyhole and laser surgery—the more we depend on regular supplies of blood products prepared to the highest standard. We are one of the few countries—it is a proud boast—where donors give blood freely, unlike other countries, where it is paid for.
That being so, it is the clear duty of a Government to ensure that that freely donated blood is collected as conveniently as possible from donors in the best possible surroundings and prepared and used in the most effective way for the benefit of patients.
Few, if any, services can more truly claim to be life saving than the blood transfusion service, and no hon. Member in the Chamber tonight can know when we may become grateful recipients.
We are fortunate in having an excellent blood centre in Lancaster and a devoted and committed rota of donors, especially anti-D donors, of whom we have no fewer than 14 per cent. of the national total. We serve eight hospitals in the region, including the Victoria hospital, Blackpool and our local hospitals, and they have a right to expect a high standard of service.
I am proud that 20 of our local plasma donors recently took part in the study of a revolutionary antibody to help mothers with rhesus-negative babies, yet another feather in Lancaster's cap.
When the National Blood Authority's proposals were first published, many of the donors feared that they might have to travel to Manchester to donate blood. I do not know how that rumour got around, but it certainly did get 431 around and it took a great deal of uprooting. However, I am happy to say that that fear has been put at rest. As the Minister emphasised, donors will continue to be able to donate locally with the teams who have worked with them so long—and the relationship of donors and teams who have serviced them is crucial.
However, the building from which our centre now works is a long way out of the city and it is far from ideal, in spite of efforts to make it as good as it possibly can be. Currently—and we have been striving for that for 20 years, to my certain knowledge—we are in the process of completing phase 3 of the modernisation of the Royal Lancaster infirmary, due to be finished in January. I should very much like consideration to be given to transferring the blood centre to the new RLI, where it could have purpose-built facilities and vastly improved conditions for donors and staff, and an even closer liaison—if that is possible, because it is already very close—with haematologists at the hospital.
The uncertainty that has prevailed for the past year, which was mentioned by Opposition Members, has been bad for the morale of donors and their teams. If the suggestion that the Secretary of State should visit all centres and that service provision be altered were to be adopted, that uncertainty would be unacceptably prolonged. Already, skilled staff are applying for jobs elsewhere. We cannot allow that haemorrhage to continue, or the service that we all wish to protect really will be endangered.
I should like the Secretary of State, who already has all the information regarding the Lancaster centre in his possession, to make a quick decision.
On a quite different subject, there has been a great deal of misunderstanding and misrepresentation about the sale of blood products abroad. Yesterday, I received an excellent, well-balanced letter from the Haemophilia Society—it is an exceptional society—on that subject. It said clearly that the society does not object in principle to the sale of surplus stocks of blood products, provided that does not cause shortages in the United Kingdom and that income earners remained in the national health service.
I am bound to say that I would go further than that and require the money to remain within the NBA for the constant improvement of the service, where technology is evolving with frightening rapidity. We must keep up with the best available techniques. It is our duty to do so and not to waste that valuable product.
The chairman of the NBA, Sir Colin Walker, gave his assurance when he came to talk to donors and staff at our centre last year. He has been several times, not only that time. He said that the only alternative to selling surplus product was to burn it. Hon. Members should have seen the expressions on people's faces when he said that, but that happens to be the truth. I did not know that. It is the only sensible, clean way of disposing of it. That appears to be an awful waste.
Obviously, not all blood components are required in equal quantities, as Opposition Members admitted. It is entirely logical, highly to be recommended and in everyone's interest to earn money on surplus product, as I am sure that no donor would like to feel that any part of his blood had been burnt.
In all our discussions, we must never forget that it is the donors who give their blood freely and regularly whom we must consider. They are the star performers in 432 the act. I believe that a spanking new centre at the RLI, in the centre of the city, would be perfect for them. I urge the Minister to pass on what I have said to the Secretary of State, to ensure that that is the solution he chooses—and quickly, so that our excellent centre can continue happily and efficiently with its life-saving work.
§ Mr. Jenkin
On a point of order, Mr. Deputy Speaker. I understand that activities may be taking place in the Committee Room upstairs that have recently been outlawed by the European Court of Justice, regarding the elections to the Labour shadow Cabinet, which—
§ Mr. Deputy Speaker (Sir Geoffrey Lofthouse)
That is nothing whatever to do with the Chair, and the hon. Gentleman well knows it.
§ Mr. Alex Carlile (Montgomery)
The voluntary principle has been mentioned by several hon. Members. It is the crucial principle underlying the existence of the blood donorship scheme in this country. No one in the House would wish that voluntary principle to be lost to the country.
The National Blood Authority appears to have harmed the reputation of that voluntary system in the way in which it has mistakenly allowed some aspects of the sales abroad of factor 8 to take place.
I belong to the school of thought that believes that it would be ridiculous to throw away surplus blood products for some xenophobic reason. I doubt that many people in the House believe that one should throw away surplus factor 8. It should be made available to others who need it. If possible, in the light of the voluntary principle, it should be given to those needing it in other countries. As the Minister of State said, it may be that there are difficulties in doing so for international legal reasons. Also, it is a reasonable argument that the National Blood Authority should cover its costs. I have no quarrel with it for doing that.
In his speech, the Minister of State, who is a lawyer, seemed to be being extremely naive in imagining that it was not possible to regulate, quite simply, what happens to factor 8 after it is sold abroad.
I have in my hand a copy of a price list taken from a Turkish publication. My Turkish hardly runs to a restaurant menu, but it is plain from the price list that blood products—indeed, factor 8—which can be traced to the National Blood Authority, and which has been sold by it, is being sold on at a profit margin of about 450 per cent. I do not understand why the National Blood Authority, when selling that important product abroad, cannot establish in its contracts of sale enforceable conditions to ensure that that does not happen. It is quite normal for international contracts to contain restrictive conditions on what should happen to the product that is sold. It happens regularly with regard to defence material and I do not see why it should not happen in relation to blood.
Bearing in mind the voluntary principle, I ask the Government to reconsider the issue. Is it right that blood products donated freely by people in Britain should be the subject of profiteering by middle men, whether in Turkey or in any other country, when there is a means available to prevent it? Why, at least, does not the National Blood Authority, urged by the Government, try to improve that 433 unhappy and unsatisfactory trade? It is not simply a question of the morality of the contracting procedures, but of whether the National Blood Authority can justify the reputation that it must earn if the voluntary principle is to continue as successfully as before.
§ Mr. Alton
Does my hon. and learned Friend agree that one of the most scurrilous factors involves the question put to people in a survey which offered them the crude choice of whether they would prefer to have their blood products and donations burnt or sold? Does he agree that options other than those two stark contrasts are available? One such option is to give those blood products to people in underdeveloped countries who will not live beyond their twenties if they are haemophiliacs and unable to obtain factor 8. We should deny those people who profiteer in a commercial and exploitative way the opportunity of making money out of products that have been voluntarily given by people out of the generosity of their hearts.
§ Mr. Carlile
As ever, my hon. Friend makes his point extremely well. It is right that people are entitled to expect that, when they are consulted about such issues, they are asked questions that do not ensure an answer that is to the Government's tune. It is a bit like having a referendum in Iraq on who should be the president without having more than one candidate.
The reorganisation proposals justify other criticisms—perhaps it is unfair to say that they are criticisms only of the National Blood Authority. It seems that the criticism could equally be levelled at the Government who, after all, have the disposition of the future of the National Blood Authority in their hands.
Hon. Members have already raised the issue of assurances, given by the National Blood Authority, which have not been fulfilled. I understand from my hon. Friend the Member for Liverpool, Mossley Hill (Mr. Alton) and the hon. Member for Liverpool, Broadgreen (Mrs. Kennedy) that that is particularly true of assurances given in meetings in Liverpool. It is plainly on record that John Adey, the chief executive of the National Blood Authority, underlined an assurance that had already been given by Sir Colin Walker. The assurance was made in the clearest possible terms. It was stated that unless a majority of consultant haematologists and other relevant medical experts in the area agreed that patient services could be at least maintained or preferably improved, the changes would not take place.
We have heard a lame suggestion from the Minister of State that the views of consultant haematologists and other medical experts are the property of the National Blood Authority and therefore we are not entitled to hear about them. Is it a new principle that Members of Parliament are not entitled to be told about consultations in relation to organisations that are part of the Government service, whatever their exact status? That does not ring true when we compare it with what we now know of what was going on in the Prison Service despite its agency status.
I am not seeking to draw a conclusion from what has been said by Opposition parties. I am drawing my conclusion from what is said in the Learmont report. It is clear that there are many precedents, of which the Prison Service is but one—Learmont provides some evidence— 434 to show that Ministers can and do interfere in operational decisions, particularly those that determine the future of a service.
It is outrageous that the clinical opinion that has been given to the National Blood Authority is being concealed from Members of Parliament. One is bound to draw the conclusion that it is being concealed because it is not the same conclusion as that reached by the Government and the National Blood Authority's chief executive and chairman. When the Under-Secretary winds up the debate, I challenge him to tell the House that, having heard the views on the subject, he is prepared to place those representations in the Library of the House so that we can see what they were. It is perhaps an indication of the views of the consultant haematologists that the National Health Service Consultants Association recently passed a motion of no confidence in the National Blood Authority's proposals.
Another criticism that can readily and justifiably be made is that the strategic view has been founded on conclusions based on invalid premises. The most obvious one is the strategic review's fundamental conclusion that blood demand was rising at about 2.6 per cent. year on year. Since that was said it has been demonstrated and admitted that blood demand is now rising at 4 per cent. a year—a significant difference.
The point has been made again and again—it is right and fair to accept it—that blood collection is less affected by the proposals than processing and testing. But processing and testing are significant issues. We have heard some eloquent voices from Liverpool about the effect on that city. But my constituency, which is situated 70 or so miles from Liverpool, and all points in between, will be affected by what happens to processing and testing in Liverpool. Very little regard has been paid to issues relating to transport, cost of transport, and the consequences of delays in transport.
I can only presume that Sir Colin Walker was so confused by his geography that he mixed up Taunton and Wigan—or possibly Welshpool. [Interruption.] Does the hon. Member for Wirral, South (Mr. Porter) wish me to give way? It is always a pleasure to let him into a debate.
§ Mr. Barry Porter
I was wondering whether, in some magic way, the hon. and learned Gentleman could put Montgomery closer to Liverpool than it has hitherto been.
§ Mr. Carlile
Not at all. I am not sure when the hon. Gentleman last visited my constituency, but I can assure him that on the newer roads it is a good deal easier to reach a hospital in Liverpool than some of the much closer hospitals in Wales.
Another issue that seems to have been addressed on the basis of false premises is the cost of holding stock. It has not been possible to find any assessment of the cost of stockholding in the National Blood Authority's proposals. It is said that there will be a national saving of £10 million. However, one must question whether that will be so with the introduction of a completely new management tier, involving 25 senior managers.
As the Labour Front-Bench spokesman, the hon. Member for Newcastle upon Tyne, East (Mr. Brown), said, the appointment of so many new managers is unprecedented before reorganisation. I ask the Under-Secretary to inform the House whether the Government have taken advice from the Government 435 Legal Service as to whether the appointment of 25 senior executives before reorganisation is ultra vires action on the part of the National Blood Authority. I believe that that may be the case as a straightforward matter of law.
§ Ms Eagle
The hon. and learned Gentleman raises an interesting point about the cost of holding blood in stockholder units. I believe that we must take into account another factor if the Manchester centre prevails in the production of blood. It will cost more to process blood per unit at that centre than at the Liverpool centre and hospitals in the Merseyside area have estimated that it will cost them an extra £3 million to buy the stocks that they currently purchase from the Liverpool centre. Perhaps the hon. and learned Gentleman should also take that sum away from the £10 million saving that Mr. Adey and his cohorts are trying to persuade us that they can achieve.
§ Mr. Carlile
The hon. Lady, with her usual capacity for detail, has made a very good point and I accept what she said. As I understand it, eight key committees were established to advise the National Blood Authority steering group about rationalisation. The membership of the key strategy group could hardly be described as balanced. Liverpool had no representatives on the group, although Manchester did, and Liverpool is to be "reorganised"—to use the euphemism. Lancaster had no representative on the group, although Manchester did, and Lancaster is to be reorganised. I also understand that Oxford had no representative on the group and it is to be reorganised as well.
The Government were asking for trouble—which they now have—by attempting to make a well supported and rational economic change to an important public service without seeking proper representation from the areas that were most likely to be affected. The Government cannot run away from the fact that the public have no confidence in the Government's proposed reorganisation of the National Blood Authority. There are six main points to be made in that regard and I shall summarise them.
The reorganisation is founded upon conclusions, the evidence for which the Government are refusing to publish. Therefore, the case is unsubstantiated. The conclusions are based on inadequate consultation for the reason that I have given in relation to the membership of the steering group and for a whole host of other reasons that we may read about almost daily in the medical literature.
The assurances that were given—when at least three hon. Members were present—have been broken quite outrageously. As a result, the morale of service staff has been undermined. A long list of distinguished haematology experts who have worked in the blood service have left or are leaving as a result of the reorganisation.
Another point is that the Government have undermined donors' faith in the service and they will have to fight hard to restore that faith. All hon. Members hope that the Government will do so, but to succeed they will need to produce a reorganisation that is credible to the donors.
Finally, as the Minister's speech in the debate demonstrated, the Government and the NBA have conspired in a public relations disaster that is hard to parallel—even in the history of the Government's stewardship of the national health service. I hope that 436 when Ministers mull over the debate they will decide that the proposals are flawed and that they will be revised substantially.
§ Mr. Eric Pickles (Brentwood and Ongar)
The Brentwood centre in my constituency is affected by the proposals. I think that it is correct to stress the good work of the National Blood Authority. Our supply of blood is probably one of the best in the world, and only the Australian Red Cross comes close to meeting our standards. It is also correct to pay tribute to the many thousands of blood donors who freely give their blood and so guarantee a constant supply of high quality blood.
As a former member of a regional health authority, I can recall those early days when the fear of HIV was widespread and when we did not quite understand some of the problems associated with hepatitis. The National Blood Authority and the regional units moved quickly to ensure that our blood supplies remained trouble-free.
If we are to make changes to what is a very successful service, we must be certain that the changes will be lasting and that they will enjoy the support of the most valuable component of the service: the donors. I do not believe that there can be any substantial argument against the need for reform. With the reduction in the size of regional health authorities, we can make a case for moving to a zoning policy. A move to three zones should improve the management of the service and ensure an equalisation of supply. It makes not a jot of sense to ration blood supplies in some hospitals when supplies are available in other parts of the country.
It makes sense to have a system that allows computers to talk to one another so that shortages of blood products in one area can be matched to over-production in another. The problem with the report is that the devil is in the detail. The Bain report's recommendations fly in the face of many of its findings, and its recommendation about Brentwood is perverse.
I thank my hon. Friend the Parliamentary Under-Secretary of State for Health, who is in the Chamber, for his patience and courtesy in listening to my arguments and to those of my constituents. The Government should take their time and listen to such representations. However, the time for a final decision is approaching swiftly. A year is a long time, and we are beginning to see staff drift and a lack of authority within the service to make changes.
I congratulate the Labour party on its choice of motion today. It is quite a feat to complain about the time available for reorganisation while tabling a motion calling for an extension of the consultation exercise.
We come into contact with the national health service when we are ill. We do not often have an opportunity to give something back to the NHS—except through our taxation system—but blood donation gives the ordinary citizen an opportunity to do just that. In our stewardship of the national health service we must be accountable and that is doubly important when it comes to the blood 437 service. There would be no service without the active co-operation of donors. The proposals must continue to attract donors and to enjoy their support.
§ Mr. Nigel Waterson (Eastbourne)
Does my hon. Friend agree that the sort of scare stories that we have heard from Labour Members tonight may discourage donors from giving blood in the future?
§ Mr. Pickles
I am afraid that my hon. Friend is absolutely right. We know from the Bain report that 70 per cent. of donors are happy with the current system and only 1 per cent. are strongly against it. The shift towards mobile collections must not risk jeopardising regular established collection sites. After all, we know that special donors attend the Brentwood centre to donate plasma and platelets and we must retain their confidence.
The staff of Brentwood blood transfusion service have not engaged in opposition for its own sake; they have certainly not engaged in the some of the silly scare stories or the nonsense about the sale of blood products. The hon. and learned Member for Montgomery (Mr. Carlile) said that he was not concerned with matters of xenophobia about the sale of factor 8 and then gave us a lecture on the perfidy of Johnny Turk in making a profit. We know where the Liberal Democrats stand. They would give the product to people abroad. That means that we would have to subsidise the product to go abroad as we would have to pay for its shipping, transportation and distribution.
§ Mr. Alex Carlile
If the hon. Gentleman had taken the trouble and had the courtesy to listen, he would have heard me say that it is our view that the National Blood Authority is entitled to cover its costs, so will he now withdraw the entirely false accusation that he made or will he perpetuate such a myth?
§ Mr. Pickles
I am happy to clarify what the hon. and learned Gentleman has said on a number of occasions from a sedentary position. He said, "Let us give it." As the present arrangements are to cover the costs—exactly what he suggests—perhaps it might be sensible if he withdrew his objections and supported factor 8 which has no international boundaries. [Interruption.] The problem is that the hon. and learned Gentleman is jumping from bandwagon to bandwagon and he must understand that he will occasionally fall between them.
§ Mr. Pickles
I shall come to that point in a few moments. First, I should like to give the views of the staff at Brentwood. I have had no problems with gagging; they 438 have given me full briefing on all the matters concerned. Let us see what concerns them. They are not against the proposals in principle. They say in a detailed document:We acknowledge and support the following initiatives which would yield significant cost savings in the short-term:—Zonal centralisation Administration, financial services (including payroll) and personal services.Negotiation of purchase contracts on a national basis.Rationalisation of low volume product production and low volume testing to fewer sites within the NBS.The introduction of a national IT system to replace the various different IT systems in use.So why are the recommendation about Brentwood wrong? It is not sensible to transfer Brentwood's facilities to Collingdale. I have yet to meet a health economist, clinician or health worker who thinks that it makes sense. Considerable sums of public money have already been spent on renovating the Brentwood centre, as my hon. Friend the Minister has seen for himself.
I understand the arguments about the storage of blood, but they must not obscure the arguments for having good regional coverage for the processing plants. The initial confusion of the hon. Member for Newcastle upon Tyne, East (Mr. Brown) does not help matters. Our objection is not about the centre, which would remain open as a storage facility, but about the removal of the processing plant. Brentwood transfusion provides reference services on a 24-hour, seven-day week basis for hospital users. Cross matching blood and antibodies is sometimes required urgently. To restrict facilities for Essex and the rest of East Anglia to Collingdale and Cambridge is not a good use of resources.
Essex, in common with the rest of East Anglia, is a rapidly growing county. Its population is growing rapidly. Brentwood is close to the M25, the M11, the A12 and the A13. Blood can be quickly processed and used from an area covering north London and beyond to the whole of East Anglia. Blood from the most remote part of our region can be returned for processing within a relatively short period.
We know from the Bain report that the optimum size for a processing plant is somewhere between 250,000 and 300,000 units per year. Brentwood processes 160,000 units, Cambridge 100,000 units and Collingdale 220,000 units. Collingdale is beginning to approach the upper limits of what Bain considered sensible. Collingdale and Cambridge have restricted sites and the need for blood products within the north London and East Anglia region will continue to grow. Additional space would have to be found in Collingdale to process blood from the north-east Thames region. Brentwood can easily absorb that expansion without any additional building. There is a possibility within the Brentwood centre for a second independent processing line. There is sufficient room to take all the processing from Cambridge.
Cambridge, in addition to blood processing, carries out outstanding research of the storage of human tissue. That work on human tissues is not dependent on its processing work. It is a restricted site and in my view it is in the best interests of the National Blood Authority and the national health service if Cambridge is allowed to continue its research and storage of human tissue and that its facilities for blood processing are transferred to Brentwood.
In conclusion, I ask my hon. Friend to make the decision as quickly as possible, to have high regard to the use of processing and the work of Brentwood and to 439 ensure that, in the retention of Brentwood, we have the possibility of ensuring that a growing region has the facilities to process blood.
§ Ms Angela Eagle (Wallasey)
First, I should declare that I am sponsored by Unison, which has members who are affected by some of the proposals as they work in the blood service, but no personal payment is made to me as a result of that sponsorship.
We need to assess what has been going on. I pay tribute to the hon. Member for Brentwood and Ongar (Mr. Pickles) for the work he has been doing in his own area to try to preserve the facilities that he discussed so eloquently. We have been doing similar work. Many of us agree with and recognise his plea that to remove the processing part of a transfusion centre is to rip out its heart and thereafter it is difficult for it to retain its specialist services and operate as anything more than a glorified fridge.
I pay tribute to the hon. Gentleman, but I shall take the same line as I make a plea for the Liverpool centre. The people of Merseyside have affection for it and know how vital it is to their own well-being. I am not going to plead for the Liverpool centre to be kept open at the expense of another centre. I believe that the entire approach to the rationalisation that we have been discussing has been fundamentally wrong, and that we must take a completely new look at the issue.
The motion suggests that the Secretary of State should visit all five centres that are threatened with—I will continue to call it closure. As the hon. Member for Brentwood and Ongar pointed out, when we take processing facilities away from centres we are effectively taking the heart out of them. "Closure" strikes me as a reasonably accurate description of what is planned for these centres—and it is the description that the National Blood Authority applied from the beginning in its consultation. It began to drop the term only when it realised what the opposition was.
I associate myself with all that has been said about the precious nature of our donor system, which is based on altruism and relies on trust and confidence. No one, I hope, would deny that it is the highest-quality system of blood provision that any country has managed to design so far. We should all be very proud of that, and pay tribute not only to donors but to the staff who work in the centres and to the national blood service. I am careful not to call it the National Blood Authority, as I have had a rather lower opinion of the body since it was made a special health authority in 1993—partly as a result of my own dealings with it, which I shall mention later.
Why, then, are we trying to introduce a fundamental, root-and-branch reform of a system that has worked so well? Why are we trying to force that reform through? Why was the decision made in secret, and why are we not allowed access to the results—
§ Mr. Marshall
Does the hon. Lady not accept that there has been a consultation procedure and that, until a decision has been made following that procedure, nothing has in fact been decided?
§ Ms Eagle
I only wish that that were true. A zonal system is already operating, however, involving 25 new jobs and very large cars. There is a sense of inevitability about the whole business. The process and our trust in the service have been undermined by the way in which members of the National Blood Authority—particularly Sir Colin Walker and Mr. Adey—have conducted themselves during the past year while the so-called consultation has taken place.
Let us examine the history. First there was the Bain report, which, as was pointed out earlier, was set in train six months after the creation of the new special health authority—the National Blood Authority. After some rather dubious procedures, it came up with a saving of what it says was £10 million out of the overall cost of running the service—£135 million. The consultation document, however, contained few figures and no facts. There was no way of proving where savings could be made, and no obvious sign that any detailed work had been done to establish that. The figures seemed to have been plucked from the air.
The report—all 600 pages of it—cost £682,000 of public money to produce. Bain and Co. also carried out a consultancy job for the National Blood Authority on the future of the bio-products laboratory, which cost £350,000 of taxpayers' money. Of the £1.25 million of taxpayers' money that the National Blood Authority spent on consultants' reports last year, Bain has taken home £1,032,000—a large proportion of the total and, in my view, money for old rope, given the understanding of the workings of the system displayed in some of its recommendations. I consider its standard of work lamentable. It has little understanding of the technical side of blood collection, let alone any idea of the concept of altruism and the "gift relationship" that is so special and central to the way in which our blood service operates. I suppose that that is to be expected.
I am concerned about a number of the proposals, but I shall mention only three. It is clear that Bain canvassed management reaction to privatisation; having said that the idea had been dismissed, it found considerable management support—after circulating a questionnaire—for the idea thatThe English blood service should adopt a more commercial attitude".It also found overwhelming support among managers for the proposal that the bio-products laboratory shouldsell surplus blood products outside the UK",and the proposal thatThe English blood service should pursue profitable commercial opportunities outside the UK".That is a wide-ranging statement, which does not refer just to the sale of surplus blood products. Goodness knows what other "profitable commercial opportunities" 441 are envisaged. There was even more support for selling plasma. There is a hint of commercialisation, if not privatisation, in all this.
§ Ms Eagle
No. I am in the middle of dealing with an issue.
I can demonstrate that Bain did not know what it was talking about in other parts of the report as well, and adopted a wholly inappropriate attitude to the gift relationship and donors in particular. It seems that efficiency is measured by the number of pints of blood collected per employee, which strikes me as rather an unfortunate view of what success should mean in a national blood service. The report then glibly argues:Collection teams can be easily designated to collect 140-plus donations per day".We already know that 30 per cent. of all blood supplies are collected from donation points. Fewer than 90 pints are collected each day. People give blood to nearby villages; they do not want to have to traipse to some central point. They want to go to the local church hall and have a cup of tea with the person who has always collected their blood before giving it. The report suggests, however, that it is not economical to organise collection points for fewer then 140 donations a day. It goes on to say—I can only think that a time-and-motion study was carried out—that a rapid through-put system would enable that target to be reached—that being the "efficient" level of donation.
So, in this 18-minute process, 2.3 minutes are allocated to checking people in; 2.4 minutes to screening and questioning, just to check that the blood products to be donated so kindly are safe; 3.5 minutes to a quick haemoglobin test; and a frantic 9.8 minutes to taking the unit of blood. Rules are already in place—this fantastic firm of consultants who were paid so much did not seem to know anything about them—stating that 17.5 minutes is the minimum time in which to take a pint of blood, for all kinds of reasons. That means that the maximum throughput possible for a bloodmobile of the sort that would go to local villages is 60 or 70 units a day, barely half the recommended efficient amount—which just goes to show how much the consultants understand about blood collection and about what donors want.
The consultants also decided to take a look at keeping the blood at room temperature, to see whether that would be a viable efficiency saving. They concluded that it would, saying:room temperature hold is a most desirable approach from a logistical and cost perspective … estimated saving potential £500,000".Thus, to save £500,000, they recommended doing away with fridges. After all, people have to check that they are at the right temperature, which requires staff. Doing away with all those visits to the fridge would surely ease work scheduling and reduce processing and testing costs. The consultants add, at the bottom of the page, that there would be arisk of enhancement of selected bacterial growth".That just means that someone given a bad bag of blood will die or become seriously ill.
442 It is astonishing that people can come up with such ideas and then write them down. If I had paid £600,000 for such a report, I would feel seriously cheated—but of course the National Blood Authority is not paying for it out of its own pocket. The money is coming from taxpayers' pockets, so Sir Colin Walker can rest easy in his bed.
The consultation document that emerged from this fantastic piece of work was disgracefully shoddy: a masterpiece of doublespeak. It contained very few facts, and had clearly been written back from the conclusions that it created. Graphs were included, but without the relevant identifying axes, so no one could take a close look at what they really meant. They were meaningless, as any GCSE mathematics student could point out. The axes that appeared in the Bain report were removed because the published graphs showed that some of the centres it was felt should close were more efficient than the ones that were to be kept open.
That sort of approach is not only dishonest; it is shoddy and amateurish, and it immediately creates the impression that the wool is being pulled over people's eyes. It dissipates any confidence that we have in management when we see them employing such techniques.
§ Mr. Waterson
Inherent in the hon. Lady's last few remarks was the notion that efficiency matters, especially in organisations like the one we are debating, and that some centres are more or less efficient than others, as she conceded. If so, why was she so scathing about attempts by the consultants to examine efficiency in a fairly standard sort of fashion?
§ Ms Eagle
I do not want to get into a philosophical argument about efficiency. Of course efficiency matters; the point is that it must be put in a health context. When bed through-put is measured for efficiency in the usual economic way, it measures the number of patients who are put through beds, but it does not record whether they were dead or alive when they left the beds; so a slightly more sophisticated approach is called for when applying economic principles to the health service.
The consultation document offers a two-hour delivery guarantee for blood, and there has been some discussion this evening of whether that is adequate. It has been said that that would be a maximum time. But if the Liverpool centre closed, and production and supplies of blood went to Manchester, that would represent a gross deterioration in the service supplying the people of Merseyside, my constituents in Wallasey, and the 350,000 people who live in the Wirral. At present, most Liverpool hospitals can get supplies of blood in five to 15 minutes. Wirral hospitals can have supplies from Liverpool sent within 15 to 25 minutes. Wales, the most isolated area of the region, can expect blood supplies within 60 to 75 minutes. If my mathematics is correct, all those times are shorter than the two hours guaranteed once production facilities are closed in Liverpool.
The issue has come up in discussion and consultation with the National Blood Authority. It said, "Of course the centres won't close. Of course we'll have stockholding units." That was the phrase that Mr. Adey and Sir Colin Walker—my friends whom I admire so much—started to use.
We asked what was meant by the term "stockholding units", as they are not mentioned in any detail in the consultation report. In fact, those of us who were lobbying 443 the National Blood Authority with our concerns were of the opinion that the authority was making it up as it went along. Stockholding units are some kind of enhanced fridge facility where, apparently, one can keep extra supplies of blood in hospitals. The Liverpool centre holds 3,500 units of blood; the average so-called stockholding unit in a major hospital holds about 100. If stockholding units are to be put into local hospitals—for example, Arrowe Park, my local hospital—the cost would be significant. They would need a cold storage room, a fridge, administrators, people to look after the blood and people to dispatch the blood, so I do not see where the saving is if that is what stockholding units are.
I am interested in what Dr. Bill Wagstaff, one of the newly appointed heads of the northern zone, told the Health Care Management magazine. He said that there might be no new stockholding units at all and that a stockholding unit just means the old hospital fridge. He said:Since some hospitals already holds supplies of blood and blood components for others in their area these may take on the official title of stockholders.In other words, these are weasel words—something that we have come to expect from Mr. Adey and Sir Colin Walker. I met them and am sorry that the hon. Member for Wirral, South (Mr. Porter) has left his place, because he was also at the all-party meeting of Wirral Members of Parliament. We were given an assurance at that meeting that there would be no changes to the current arrangementsunless a majority of consultant haematologists and other relevant medical experts in the area agreed that patient services could be maintained or improved.Mr. Adey then backtracked and said that he did not want the majority idea to be involved in the agreement that he had made. He then said that, instead of having a majority,We will talk to consultant haematologists and other medical experts in the area about our plans to maintain and improve patient care and will listen very carefully to their views and will move forward only if medical opinion is satisfied.Medical opinion in Liverpool and Merseyside is not satisfied. These changes are opposed by all expert medical opinion. They are opposed by the people of Merseyside, of whom more than 1,000 attended a public meeting and told Mr. Adey and his blood authority exactly what they thought of these proposals. We will continue to fight them.
We hope that Ministers are listening, not only to medical and clinical experts but to the people of this country, and that they will reassess these disgraceful, damaging proposals and bring back something that we can all support and work for.
§ Mr. Bernard Jenkin (Colchester, North)
I congratulate the hon. Member for Wallasey (Ms Eagle) on an extremely well researched and well argued speech, but when I compare it with that made by my hon. Friend the Member for Brentwood and Ongar (Mr. Pickles) the contrast in tone could not be more marked.
There is a great problem in dealing with a national health service which needs to learn to cope with an ever faster pace of change. Whatever one's views about particular changes as they are proposed, I much prefer the approach of my hon. Friend, who recognises the need for change, the need for things to adapt and to modernise, as 444 opposed to the speech of the hon. Lady and other Opposition Members, who tend to display a wanton disregard for the need for change and to fall back on age-old prejudices that do not help the health service in any way at all.
If we had not managed to change the health service in the past 17 years of Conservative Government, goodness me the health service would be in a great mess today. We would not be treating an extra 3,500 patients per day in the modern NHS. If one looks at all the different reforms that the Conservatives have pushed through the House over the years, I am afraid that there is a rather consistent theme which runs alongside every one of them—that however good the reforms have been and however effective and successful they have proved eventually, the Opposition have exploited every opportunity to oppose them, to scare the public and to put around endless scare stories and myths about what is likely to happen.
That theme goes right back to the much missed, we were to understand, area health authorities. They were abolished in the early 1980s. Who talks about re-establishing them or mourns their passing now? Yet we were told then that the abolition of the area health authorities was the abolition of the NHS as we knew it.
The same happened with the introduction of the limited list system for drugs. We were told that it would be a great curtailment of the choices of clinicians and doctors in the health service and that it would be the end of the national health service as we knew it. The necessary savings and limitations that were put on doctors were totally disregarded, but they are now broadly accepted. Had we listened to all the doctors then, and had we behaved like the walking opinion poll of a Government that the Opposition seem to expect us to be, we would not have made those savings or that progress.
The same was true of the introduction of the NHS trusts, and what a success they have been. They have been so successful that even the Labour party is trying to pretend that its policy will emulate the advantages of NHS trusts in all but name. The Labour party still has a bit to learn about GP fundholders, although fundholding has been an extremely successful reform.
Most recently, there was the abolition of the regional health authorities through the Health Authorities Bill this year. No one, not even the Labour party, now seriously suggests that the regional authorities should be re-established after the next election. If we now allowed the prejudices and the opportunism of the Opposition to exploit public opinion on the extremely sensitive issue of the National Blood Authority and the blood transfusion service and to block progress in this area of the health service, it would be a setback and the Government are right to resist that.
I use the word "prejudice" in the strongest sense. I noted the way in which the hon. Member for Wallasey read out the extract from the Bain report and criticised the recommendation that the NBA should look for profitable commercial opportunities outside the United Kingdom. Why should we be against profit for the national health service? We should be explaining to blood donors that the blood that they give is primarily for the national health service, but if there are surpluses we should let the profit 445 accrue to the national health service instead of the surpluses being burnt and sent up the chimney, which would mean the money going to waste.
§ Mr. Waterson
Does my hon. Friend agree that if, for example, a third-world country wanted advice on setting up its own blood service and came to the NBA, it would be perfectly right for the NBA to give that advice for humanitarian reasons—a point on which the hon. Member for Wallasey (Ms Eagle) refused me the opportunity to intervene—in terms of giving humanitarian assistance to that country, and also right that the NBA should charge consultancy fees for so doing?
§ Mr. Jenkin
Yes, of course. However, as we have heard endlessly in this debate, the Opposition do not understand the word "consultancy". They wantonly criticise anything that purports to be a consultancy document and they would not begin to understand that a consultancy document prepared by the NBA for another country might be worth a great deal of money for the national health service and for the National Blood Authority.
§ Mr. Jenkin
I will not give way because I know that others wish to speak in the debate.
The representations that hon. Members have received from constituents probably reflect the proximity of blood transfusion centres that are likely to be affected. In my constituency I have had virtually no representations on the subject. Brentwood is just across the county and it is probably where most of the blood for the Colchester general hospital comes from. The alternative may be Cambridge or Colindale.
In fact, the people who give blood and the hospitals that receive it will see hardly any change in the service. The people who may suffer, and to whom we should pay tribute at a time of change, are the staff—those who will have to change the most. However, it does them little service to gallop off with all the scare stories, making matters worse than they need be instead of helping the Government and the service to provide the change that is so sorely needed.
§ Mr. John Marshall (Hendon, South)
Like other hon. Members, I pay tribute to those who work for the blood service. I know that in my constituency on Sunday there will be people collecting blood from volunteers such as myself. Indeed, I understand that blood has even been collected from members of the Treasury team, although whether the service managed to get blood out of the Chief Secretary to the Treasury I would not like to say.
It has already been pointed out that the blood service in Britain produces the safest blood in the world, but those who rely on blood products from the national health service have not always been able to do so with that assurance. I therefore ask the Minister to think again about the haemophiliacs who were infected with hepatitis C as a result of being given infected blood products. The Government acted generously towards haemophiliacs who were infected with HIV, and I would like my hon. Friend 446 to talk again, either in private or in public, about that issue and tell me what progress has been made on providing funds to ensure that those with hepatitis C are being give adequate treatment.
I also reiterate another point, because the chairman of the Haemophilia Society is a constituent of mine: the Haemophilia Society has confirmed that it has no objection to the export of surplus factor 8. The society sees no sense in saying that we should not export it. If we do not, we deny other people a chance of life and the at the same time deny a small sum to the NHS.
Those who give blood do so to save life, and it would be wrong if that donated blood were burnt instead of being used to save lives. I am appalled that people can put political prejudice before the saving of life, and we have heard some pretty unctuous humbug and nonsense talked on that subject tonight.
§ Mr. Nigel Waterson (Eastbourne)
I am delighted to have an opportunity, albeit brief, to contribute to the debate. Above all, the debate is a tribute to the willingness of the British people, in places such as Eastbourne and other places all over the country, to give their blood on a perfectly voluntary basis, out of pure altruism.
There were 2.4 million such donations last year, and about 800,000 patients received the benefit of transfusions. I heartily endorse what the Minister said in his opening speech: we support and emphasise the importance of the voluntary principle in the blood service in this country.
If you were a Martian listening to the debate—although I know that you are not, Mr. Deputy Speaker—you might think that Conservatives would be the people who oppose change. I believe that it was Lord Kilmuir who said:If it is not necessary to change, it is necessary not to change.That has been a strong Conservative tradition, but it means two things. It means preserving traditions which are useful, but it also means testing on a regular basis to find out whether change would bring greater benefits and efficiency.
In the debate it has emerged that it is the Labour party which resists sensible and constructive change. Labour Members are the advocates of continuing a system of bureaucracy which has its roots merely in the historical system which produced 14 or 15 different centres. For the Labour party everything must always remain the same, but the National Blood Authority and I believe that we need a fully integrated modern national blood transfusion service in this country.
What we are talking about tonight will not directly affect donors. We are talking about the consolidation and administration and processing of blood supplies. In doing that, we are aiming for the highest possible standards of safety—in the light of HIV and hepatitis—and reliability of supply. My hon. Friend the Member for Brentwood and Ongar (Mr. Pickles) spoke at length about the problems of inequality of supply in different parts of the country. We are looking for a reduction in cost and the pursuit in the right circumstances of commercial opportunities—such as the example that I gave in an intervention—which would bring extra revenue into the NHS, as well as save money.
447 Donors will not have to travel further. Already the majority of blood is donated at mobile centres and units. We have heard a lot of scare stories from the Opposition today. Those scare stories have been a disgrace, and may have led to donors being unwilling to continue providing blood—the very thing of which Opposition Members warned during the debate. Nor, for that matter, is there any threat to specialist services, which will continue to be provided under the proposals. Those services include, for example, platelets for the treatment of leukaemia.
I am grateful to have had the chance to speak in the debate. I wish that I had more time, but Opposition speakers spoke at some length. The Government's proposals are well thought out and there has been very wide consultation. The weight of expert opinion is behind the proposals, which provide a sensible way forward for the blood service of this country—a much loved British institution.
§ Ms Tessa Jowell (Dulwich)
Tonight's debate has shown clearly that the future of the blood service concerns hon Members on both sides of the House. It has also been an occasion on which hon. Members have had a chance to restate the enormous debt of gratitude we owe to the nation's 2 million blood donors and to the staff who collect, test and process the blood at 15 regional centres.
We have the safest blood service in the world. Our tradition of donors giving blood for nothing to help those in need is almost unique in world medicine. We have every reason to be proud of it. Richard Titmuss demonstrated 30 years ago that, on the grounds of efficiency, price and safety, the commercialised blood market was wasteful, inefficient and risky to patients. Nothing has changed.
Our motion tonight reflects the public's outrage and its lack of confidence in the National Blood Authority. The proposed reorganisation of the blood service has attracted criticism from across the board. If the need for change is shown, that change should be brought about with the support and guidance of donors and those who work in the service, and not in the teeth of their opposition.
The NBA's chief executive, John Adey, promised my hon. Friend the Member for Liverpool, Broadgreen (Mrs. Kennedy) that the Liverpool centre would not close unless its closure was supported by clinicians. I ask the Minister whether he can confirm that the Government stand by that pledge. Will he also confirm that the Oxford centre will stay open, given—as my hon. Friend the Member for Oxford, East (Mr. Smith) has made clear—the opposition to its closure from more than 100 eminent clinicians? Hon. Members from all parts of the House, and not least those hon. Members whose seats will be affected by closures, will no doubt want such assurances before they decide how to vote tonight.
The Opposition motion asks the Secretary of State to intervene directly, to visit all the centres currently threatened with closure and to review the National Blood Authority's proposals in the light of what he hears. These are reasonable requests in anybody's language. The Secretary of State must reach beyond the swelling bureaucracy of the National Blood Authority and speak directly to the staff and donors concerned.
448 The loss of public confidence in the NBA stems directly from the false values which that bureaucracy is adopting. It offers a classic example of how simple virtues of public service have become distorted and lost in the new market culture. What was once a hard-working and lean branch of the NHS is now an independent organisation with its own agenda, a new hierarchy, a new layer of management and—it goes without saying—a new logo and corporate identity, which cost £46,000 and goodness knows how much management time. A health authority with all the pretensions of a macho commercial organisation is slowly suffocating a public service which is admired around the world.
The National Blood Authority's chairman, Sir Colin Walker, has been quoted as saying that all publicity is good publicity for the NBA, however bad. In that case, let me congratulate him on a public relations triumph.
If the language of priorities is the religion of socialism, then competition is the totem pole of the market—any competition. One is not a macho bureaucracy if one does not introduce competition—competition however unnecessary, competition however inefficient, competition however destructive. Competing is macho; simple public service is for wimps in this brave new corporate world.
The direct and immediate result of the new orthodoxy was this summer's blood bag fiasco, to which many hon. Members have referred. It was intolerable to the new macho managers that one firm—Baxter's—was supplying all the blood bags to the national health service. The fact that the bags worked was completely irrelevant. So, for a claimed saving of £700,000, about 20 per cent. of the contract was withdrawn from Baxter's and given to Tuta instead. We all know what happened then—10,000 units of blood, each and every one the product of someone's selflessness, were poured down the drain.
There are other examples of the NBA's commercial madness. It has entered into secret discussions about sponsorship of blood donor sessions with McVitie and Ribena. Donors want to give for the good of others and to repay the debt that many feel they owe for their own transfusions, but they do not want to be at the sharp end of a sales pitch.
The next initiative was to organise a donor recruitment drive in July, just when blood stocks are rightly kept low because of the small amount of surgery that is carried out in August.
On top of that, as other hon. Members have said, the authority has shown a contempt for the House and the Secretary of State by appointing 12 new members of staff to the reorganised organisation before it has been approved. The NBA then compounded its contempt by trying to gag its staff, warning them that if they tried to raise matters of concern with their Members of Parliament, they might be the subject of disciplinary action.
It is not difficult to state what the blood service needs to produce its best results, and I have four straightforward proposals which I challenge the Minister to adopt. All have come directly from my six visits to various blood centres. They have all come from staff and donors involved in the work of those centres.
First, steps need to be taken to reduce blood wastage by ensuring that all centres are brought up to the efficiency standards of the best. Secondly, the way in which blood 449 is supplied to London needs to be reviewed. At present, some 40,000 to 60,000 units are imported to London, mostly to the two northern London blood centres. If the adjoining centres at Oxford and Cambridge were allowed to provide blood to the London hospitals on their side of London, it would ease the difficulty of matching supply and demand.
Thirdly, the authority should remove the new zonal tier of management. It costs nearly £2 million a year. The proposed organisation would be more unwieldy, with longer lines of communication and decision times, and flies against all the current theories of good management.
The Secretary of State said that he is a bureau-sceptic. Now is his chance to show some healthy scepticism in the bureaucracy that he has created.
§ Mr. Malone
Does the hon. Lady agree that the best thing for a bureau-sceptic is to get rid of 15 bureaucracies and replace them by only three?
§ Ms Jowell
The Secretary of State should listen to some of the excellent ideas for changing, developing and improving the service that he would hear if he took the time and trouble to go and talk directly to the staff.
We must also make it the practice that no plasma is sold without donors' permission. Many hon. Members have expressed concern about that this evening. What matters is not that surplus factor 8 is being sold to Europe and other countries but that Ministers have stated in the House that there will be no sale of factor 8 or other blood products until there is a surplus. We do not have a surplus of factor 8. We have a sufficiency only because we import it for various clinical reasons. Ministers should make the position clear to donors, because it is open to confusion and misinterpretation. It would be fatal if the impression were ever formed that donors are giving their blood so that it could be sold at a profit.
Hon. Members from both sides of the House have raised specific worries about their local centres. I would like to pay tribute to my hon. Friends the Members for Wallasey (Ms Eagle) and for Liverpool, Broadgreen (Mrs. Kennedy) for their sterling work in defence of the Liverpool blood centre and to my hon. Friend the Member for Oxford, East (Mr. Smith) who spoke so eloquently about the concerns of clinicians in Oxford about the threatened closure of the Oxford centre.
The Minister claims that the Labour party is scaremongering. The problem is that the Government always look for somebody else to blame. We are happy to share with the Minister the hundreds of letters from clinicians who are worried about standards of safety, and we hope that he will take their concerns seriously in considering the recommendations for the future.
The National Blood Authority and the Government seem to base their argument on two grounds. First, they argue that blood centres are currently working below capacity. The Bain report uses a calculation that bears no relation to reality and ignores the fact that machines have to be serviced; that they work five, not six, days a week; and that there are variations in the level of donation. A just-in-time service, as it is known, cannot possibly operate at full or near capacity all the time.
450 We should not forget that new viral tests are already in use in the United States, France and Japan. If they are introduced in this country, another 28 per cent. of testing capacity will be needed. The Government have trotted out the capacity argument in respect of other parts of the health service. It was the capacity argument that led to the closure of acute beds and produced Bottomley wards—patients on trolleys in corridors for hours on end.
The second area of dispute focuses on projections of likely future demand for blood. Bain foresaw an annual increase of about 1 to 2 per cent. On that basis, the NBA decided to reduce the number of centres. However, the NBA itself, and Ministers, had forecast the growth in need at 4 per cent. and 5 per cent. respectively. In those circumstances, there must be doubts about the level of future need. It would be foolish in the extreme to risk exposing the service to shortages.
Tonight's debate gives the House a real opportunity to send a clear message to the Government and the National Blood Authority that the country does not want its precious donor-based blood service messed about by the new breed of macho managers. The giving of blood creates a unique ethical bond between donors, those who manage the service and the patients whose lives depend on it. It is difficult to imagine a relationship further removed from the marketplace or one where crass commercialisation is more out of place.
I ask all hon. Members, many of whom will themselves be donors or recipients, to join us in the Lobby and send a message of support to the people who give their blood and a message of comfort to those patients whose lives depend it.
§ The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville)
I shall not accede to the invitation of the hon. Member for Dulwich (Ms Jowell) but I congratulate her on this red letter day because, for once, the Labour party is devoting some time from its Supply days—half a day—to health. That is very welcome and also very rare.
§ Mr. Sackville
Have we heard anything about Labour's health policies? Have we heard anything about how Labour will face up to the great opportunities and challenges of the NHS in the future? No. We have simply heard a series of recycled headlines—thoroughly misleading and damaging headlines—many of which were inspired by the Labour party in the first place.
The speech of the hon. Member for Newcastle upon Tyne, East (Mr. Brown), who opened the debate, consisted of one headline after another. He began on the question of selling blood and we were reminded of an article in Today dated 16 December 1994 entitled "Stop Selling Our Blood". That was Germany; he went on to Turkey with an article dated 9 January 1994 entitled "Donors Kebabed". We then heard about the crown on the National Blood Authority's logo, which was totally irrelevant. The headline there wasCharles out for blood over vanishing crown".451 That completes the irrelevance.
§ Ms Jowell
The removal of the crown from the National Blood Authority's logo was not irrelevant to the people who came to Downing street this morning with the signatures of more than 3,000 people who object to the arbitrary removal of the crown—a logo that they were proud of—with no consultation whatever by the NBA.
§ Mr. Sackville
The hon. Member for Newcastle upon Tyne, East went on to talk about blood shortages. A headline on 30 March 1995 read:Blood banks in new crisis".Within six weeks, we had another headline in the Sunday Times about surpluses of blood—"Hospitals dumping surplus blood"—which just shows that one cannot win.
The hon. Member for Liverpool, Broadgreen (Mrs. Kennedy) made a number of sensible points about clinical consensus. Clearly, we shall do nothing which, in general clinical opinion, poses dangers to patients. Neither on this occasion nor at other times when we have debated this matter in the House—the hon. Lady and I have discussed this matter in an Adjournment debate—have we heard any evidence that the proposals, which are still before the Secretary of State, pose a danger to patients.
There are large towns and cities all over the country with hospitals that do not have blood processing, testing or transfusion facilities. I remind the hon. Lady that large cities with one or two acute hospitals, such as Leicester, Nottingham, Coventry, Middlesbrough, Sunderland, Durham, Hull and Bradford have never had processing or bulk testing facilities.
§ Mrs. Jane Kennedy
Will the Minister publish the responses from clinicians on Merseyside? If those are as he says and if the points that they make can be answered adequately, it will silence the criticism that we have made on that point. But if he will not publish those responses, not only will the clinicians continue to doubt what he says but so will hon. Members, the public and the donors who contribute to the service.
§ Mr. Sackville
Any of the people who submitted returns during the consultation are free to publish whatever they wrote, but those consultations were conducted on the basis that what was written was confidential and addressed to the NBA. No one is being prevented, however, from saying exactly what they think.
Since the survey was conducted there has been much communication between consultants in the hon. Lady's area and the NBA. Any of those consultants is free to provide evidence that there is some danger to patients in Liverpool, but, as far as I know, none has been forthcoming. It would be deeply insulting to the NBA and all those who have made the proposals to suggest that they would make any that would be dangerous to patients.
The location of processing and testing facilities is not fundamental. What matters is that there is an adequate network of such facilities across the country to provide those services to all hospitals. The hon. Lady is well aware that the blood banks kept at hospitals or at large transfusion centres which may not have access to processing and testing facilities in the future will still be able to benefit from a perfectly adequate service. There are a great many scare stories around and we must have some evidence before we take them seriously.
452 The hon. and learned Member for Montgomery (Mr. Carlile) was particularly interested in the sale of factor 8 and other plasma-based blood products. I cannot help feeling that he is chasing a headline. The price of such products in Turkey or anywhere else is a sufficiently abstruse subject. As has been said to him repeatedly, if we sell such products when they are surplus to requirement it is not possible to control their end price in all markets. There is no mechanism for doing so.
§ Mr. Jenkin
I half wondered whether the complaint from those on the Liberal Benches was that the price obtained for blood products abroad was not high enough.
§ Mr. Sackville
If we have surplus products, we must get an acceptable price for them. If we failed to do so, we would be denying funds to the NBA which could be reinvested in the service. If we refused to sell those products, we would have to destroy them. That would be foolish, as several of my hon. Friends have already pointed out, with the support, I understand, of the Haemophilia Society.
§ Mr. Alex Carlile
I am grateful to the Minister for dealing with the points that I raised, but will he answer my question? Is there any reason why the Government should not insist that the contracts for the sale of factor 8 should include conditions that would avoid profiteering with it thereafter: yes or no?
§ Mr. Sackville
We are keen to hear the hon. and learned Gentleman's ideas on the subject. We do not wish to encourage profiteering by pharmaceutical middlemen. We are all ears to hear how the hon. and learned Gentleman would avoid that. For the moment we will stick to our policy of disposing of those blood products when they are surplus to requirement. They are high-quality pharmaceutical products for which there is a world market. If they are surplus here, we will sell them abroad.
The hon. and learned Gentleman also said that we have undermined donors' faith in the service. I refute that charge utterly. If anything has undermined their faith—there is no evidence that it has—it is the press campaign encouraged by Opposition Members. It is clear that that might have discouraged donors.
My hon. Friend the Member for Lancaster (Dame E. Kellett-Bowman) made several arguments. She said that it was important that donors should be able to donate locally, as now, and that the myth that had got around, which was part of the general black propaganda campaign, is entirely false. Specialist donors and other donors will be able to donate locally, as now.
My hon. Friend made a strong bid for a new blood centre. I am sure that the NBA will have heard that, and perhaps there will be a case for it. She reminded us of the need for an early decision about those matters. Obviously, the uncertainty has been very unsettling.
My hon. Friend the Member for Brentwood and Ongar (Mr. Pickles) made several helpful comments. He was kind enough to thank me for my patience in listening to his eloquent pleas on behalf of Brentwood. I am sure that the NBA will have heard those pleas. I know that my hon. Friend has met representatives of the NBA several times and that those matters have been considered. He said—using several technical arguments—that he saw no reason 453 to move facilities into Colindale or Cambridge. I understand his arguments, and assure him that they will be considered very carefully.
My hon. Friend the Member for Hendon, South (Mr. Marshall) reminded us of the fate of haemophiliacs who had had the misfortune to contract hepatitis C. I heard what he argued so eloquently. His arguments will all be considered, but I must tell him that there is a continuing policy that, where no negligence is proved, the Government do not pay compensation. However, I understand well what he said.
The hon. Member for Wallasey (Ms Eagle) informed us that decisions have been taken in secret. I refute that absolutely. She also said that we have spoken, or that Bain has spoken, about commercialising the blood service. I refute that, but we need to have a blood service that is run along business lines and which does everything possible to improve quality throughout the system.
§ Mr. Sackville
I will not; I have only three minutes.
I also say to the hon. Member for Wallasey that what appeared in the Bain report is not policy; it is suggestions to the NBA. There is no reason to suppose that, simply because something appeared in the Bain report, it will become policy.
The cynical and underhand campaign that has gone on in the past year to disrupt the blood service has failed. It has not succeeded in deterring our donors, who have ignored all the headlines and scare stories, and have continued to give blood magnificently. The reality is not what has been communicated in various absurd headlines. The reality is that, in each of the past 10 months, the number of donations has been higher than in the equivalent month of last year.
The NBA has succeeded in improving the use of the blood collected by better co-ordination of stock movements—a fundamental part of the new proposals—so supply has better matched demand and wastage has been sharply reduced. That is an important success.
Conservative Members have become used to the fairly systematic denigration of the NHS by the Labour party, but I believe that people are increasingly aware of the contrast between their experience and all that denigration, and increasingly discount what they hear from the Labour party.
The blood service should be exempt from all that because if such attempts to disrupt the service succeeded the consequences would be dire. We all know that if there was a sudden drop in donations, routine operations such as hip and knee replacements and non-emergency cardiac surgery would cease and rationing would start.
It has been a disreputable campaign to disrupt the health service and the blood service that is vital to it. I reject the motion, which I think has flowed directly from that campaign. I hope that the House will treat it with the contempt that it deserves.
§ Mr. Dennis Turner (Wolverhampton, South-East)
rose in his place, and claimed to move, That the Question be now put.
§ Question, That the Question be now put, put and agreed to.454
§ Question put accordingly, That the original words stand part of the Question:—
§ The House divided: Ayes 249, Noes 290457
|Division No. 218]||[10.00 pm|
|Abbott, Ms Diane||Dewar, Donald|
|Adams, Mrs Irene||Dixon, Don|
|Ainger, Nick||Dobson, Frank|
|Allen, Graham||Donohoe, Brian H|
|Alton, David||Dowd, Jim|
|Anderson, Donald (Swansea E)||Dunwoody, Mrs Gwyneth|
|Anderson, Ms Janet (Ros'dale)||Eagle, Ms Angela|
|Armstrong, Hilary||Eastham, Ken|
|Ashdown, Rt Hon Paddy||Etherington, Bill|
|Ashton, Joe||Evans, John (St Helens N)|
|Austin-Walker, John||Fatchett, Derek|
|Banks, Tony (Newham NW)||Field, Frank (Birkenhead)|
|Barnes, Harry||Fisher, Mark|
|Barron, Kevin||Flynn, Paul|
|Battle, John||Foster, Rt Hon Derek|
|Bayley, Hugh||Foster, Don (Bath)|
|Beckett, Rt Hon Margaret||Foulkes, George|
|Beith, Rt Hon A J||Fraser, John|
|Bell, Stuart||Fyfe, Maria|
|Benn, Rt Hon Tony||Galloway, George|
|Bennett, Andrew F||Garrett, John|
|Benton, Joe||Gerrard, Neil|
|Bermingham, Gerald||Gilbert, Rt Hon Dr John|
|Berry, Roger||Godman, Dr Norman A|
|Betts, Clive||Godsiff, Roger|
|Blair, Rt Hon Tony||Golding, Mrs Llin|
|Boateng, Paul||Graham, Thomas|
|Bradley, Keith||Griffiths, Nigel (Edinburgh S)|
|Bray, Dr Jeremy||Griffiths, Win (Bridgend)|
|Brown, Gordon (Dunfermline E)||Grocott, Bruce|
|Brown, N (N'c'tle upon Tyne E)||Gunnell, John|
|Bruce, Malcolm (Gordon)||Hain, Peter|
|Byers, Stephen||Hall, Mike|
|Caborn, Richard||Hanson, David|
|Callaghan, Jim||Harman, Ms Harriet|
|Campbell, Mrs Anne (C'bridge)||Hattersley, Rt Hon Roy|
|Campbell, Menzies (Fife NE)||Henderson, Doug|
|Campbell, Ronnie (Blyth V)||Heppell, John|
|Campbell-Savours, D N||Hill, Keith (Streatham)|
|Cann, Jamie||Hinchliffe, David|
|Carlile, Alexander (Montgomery)||Hodge, Margaret|
|Chisholm, Malcolm||Hoey, Kate|
|Church, Judith||Hogg, Norman (Cumbernauld)|
|Clapham, Michael||Home Robertson, John|
|Clark, Dr David (South Shields)||Hood, Jimmy|
|Clarke, Eric (Midlothian)||Howarth, Alan (Strat'rd-on-A)|
|Clarke, Tom (Monklands W)||Howarth, George (Knowsley North)|
|Clelland, David||Howells, Dr Kim (Pontypridd)|
|Clwyd, Mrs Ann||Hoyle, Doug|
|Coffey, Ann||Hughes, Kevin (Doncaster N)|
|Cohen, Harry||Hughes, Roy (Newport E)|
|Cook, Robin (Livingston)||Hughes, Simon (Southwark)|
|Corbett, Robin||Hutton, John|
|Corbyn, Jeremy||Illsley, Eric|
|Corston, Jean||Ingram, Adam|
|Cousins, Jim||Jackson, Glenda (H'stead)|
|Cox, Tom||Jackson, Helen (Shef'ld, H)|
|Cummings, John||Janner, Greville|
|Cunliffe, Lawrence||Jones, Barry (Alyn and D'side)|
|Cunningham, Jim (Covy SE)||Jones, Lynne (B'ham S O)|
|Dafis, Cynog||Jones, Martyn (Clwyd, SW)|
|Dalyell, Tam||Jones, Nigel (Cheltenham)|
|Darling, Alistair||Jowell, Tessa|
|Davies, Bryan (Oldham C'tral)||Kaufman, Rt Hon Gerald|
|Davies, Chris (L'Boro & S'worth)||Keen, Alan|
|Davies, Rt Hon Denzil (Llanelli)||Kennedy, Charles (Ross, C&S)|
|Davies, Ron (Caerphilly)||Kennedy, Jane (Lpool Brdgn)|
|Denham, John||Khabra, Piara S|
|Kilfoyle, Peter||Prescott, Rt Hon John|
|Lestor, Joan (Eccles)||Primarolo, Dawn|
|Lewis, Terry||Purchase, Ken|
|Liddell, Mrs Helen||Quin, Ms Joyce|
|Litherland, Robert||Radice, Giles|
|Lloyd, Tony (Stretford)||Raynsford, Nick|
|Llwyd, Elfyn||Reid, Dr John|
|Loyden, Eddie||Rendel, David|
|Lynne, Ms Liz||Robertson, George (Hamilton)|
|McAllion, John||Roche, Mrs Barbara|
|McAvoy, Thomas||Rogers, Allan|
|McCartney, Ian||Rooker, Jeff|
|McCartney, Robert||Rooney, Terry|
|McFall, John||Ross, Ernie (Dundee W)|
|McKelvey, William||Ruddock, Joan|
|Mackinlay, Andrew||Sheerman, Barry|
|McLeish, Henry||Sheldon, Rt Hon Robert|
|McMaster, Gordon||Short, Clare|
|McNamara, Kevin||Simpson, Alan|
|MacShane, Denis||Skinner, Dennis|
|Madden, Max||Smith, Andrew (Oxford E)|
|Maddock, Diana||Smith, Chris (Isl'ton S & F'sbury)|
|Mahon, Alice||Smith, Llew (Blaenau Gwent)|
|Mandelson, Peter||Snape, Peter|
|Marek, Dr John||Soley, Clive|
|Marshall, David (Shettleston)||Spearing, Nigel|
|Martin, Michael J (Springburn)||Spellar, John|
|Maxton, John||Squire, Rachel (Dunfermline W)|
|Meacher, Michael||Steel, Rt Hon Sir David|
|Meale, Alan||Stevenson, George|
|Michael, Alun||Stott, Roger|
|Michie, Bill (Sheffield Heeley)||Strang, Dr. Gavin|
|Michie, Mrs Ray (Argyll & Bute)||Sutcliffe, Gerry|
|Milburn, Alan||Taylor, Mrs Ann (Dewsbury)|
|Miller, Andrew||Taylor, Matthew (Truro)|
|Mitchell, Austin (Gt Grimsby)||Tipping, Paddy|
|Morgan, Rhodri||Touhig, Don|
|Morley, Elliot||Turner, Dennis|
|Morris, Rt Hon Alfred (Wy'nshawe)||Tyler, Paul|
|Morris, Estelle (B'ham Yardley)||Vaz, Keith|
|Morris, Rt Hon John (Aberavon)||Walker, Rt Hon Sir Harold|
|Mowlam, Marjorie||Wallace, James|
|Mullin, Chris||Walley, Joan|
|Murphy, Paul||Welsh, Andrew|
|Oakes, Rt Hon Gordon||Wicks, Malcolm|
|O'Brien, Mike (N W'kshire)||Williams, Rt Hon Alan (Sw'n W)|
|O'Brien, William (Normanton)||Williams, Alan W (Carmarthen)|
|Olner, Bill||Wilson, Brian|
|O'Neill, Martin||Winnick, David|
|Orme, Rt Hon Stanley||Wise, Audrey|
|Parry, Robert||Worthington, Tony|
|Pearson, Ian||Wray, Jimmy|
|Pendry, Tom||Wright, Dr Tony|
|Pickthall, Colin||Young, David (Bolton SE)|
|Pike, Peter L|
|Powell, Ray (Ogmore)||Tellers for the Ayes:|
|Prentice, Bridget (Lew'm E)||Mr. Geoffrey Hoon and Mr. Robert Ainsworth.|
|Prentice, Gordon (Pendle)|
|Ainsworth, Peter (East Surrey)||Baldry, Tony|
|Aitken, Rt Hon Jonathan||Banks, Matthew (Southport)|
|Alexander, Richard||Banks, Robert (Harrogate)|
|Alison, Rt Hon Michael (Selby)||Bates, Michael|
|Allason, Rupert (Torbay)||Batiste, Spencer|
|Amess, David||Bellingham, Henry|
|Ancram, Michael||Bendall, Vivian|
|Arbuthnot, James||Beresford, Sir Paul|
|Arnold, Jacques (Gravesham)||Biffen, Rt Hon John|
|Arnold, Sir Thomas (Hazel Grv)||Bonsor, Sir Nicholas|
|Ashby, David||Booth, Hartley|
|Atkins, Rt Hon Robert||Boswell, Tim|
|Atkinson, David (Bour'mouth E)||Bottomley, Peter (Eltham)|
|Atkinson, Peter (Hexham)||Bottomley, Rt Hon Virginia|
|Baker, Nicholas (North Dorset)||Bowden, Sir Andrew|
|Bowis, John||Goodlad, Rt Hon Alastair|
|Boyson, Rt Hon Sir Rhodes||Goodson-Wickes, Dr Charles|
|Brandreth, Gyles||Gorman, Mrs Teresa|
|Brazier, Julian||Gorst, Sir John|
|Bright, Sir Graham||Grant, Sir A (SW Cambs)|
|Brooke, Rt Hon Peter||Greenway, Harry (Ealing N)|
|Brown, M (Brigg & Cl'thorpes)||Griffiths, Peter (Portsmouth, N)|
|Browning, Mrs Angela||Grylls, Sir Michael|
|Bruce, Ian (Dorset)||Gummer, Rt Hon John Selwyn|
|Budgen, Nicholas||Hague, Rt Hon William|
|Burns, Simon||Hamilton, Sir Archibald|
|Burt, Alistair||Hamilton, Neil (Tatton)|
|Butcher, John||Hampson, Dr Keith|
|Butler, Peter||Hanley, Rt Hon Jeremy|
|Butterfill, John||Hannam, Sir John|
|Carlisle, John (Luton North)||Hargreaves, Andrew|
|Carlisle, Sir Kenneth (Lincoln)||Haselhurst, Sir Alan|
|Carrington, Matthew||Hawkins, Nick|
|Carttiss, Michael||Hawksley, Warren|
|Cash, William||Hayes, Jerry|
|Channon, Rt Hon Paul||Heald, Oliver|
|Chapman, Sir Sydney||Heath, Rt Hon Sir Edward|
|Churchill, Mr||Heathcoat-Amory, David|
|Clappison, James||Hendry, Charles|
|Clark, Dr Michael (Rochford)||Heseltine, Rt Hon Michael|
|Clarke, Rt Hon Kenneth (Ru'clif)||Higgins, Rt Hon Sir Terence|
|Clifton-Brown, Geoffrey||Hill, James (Southampton Test)|
|Coe, Sebastian||Hogg, Rt Hon Douglas (G'tham)|
|Congdon, David||Horam, John|
|Conway, Derek||Hordern, Rt Hon Sir Peter|
|Coombs, Anthony (Wyre For'st)||Howard, Rt Hon Michael|
|Coombs, Simon (Swindon)||Howell, Sir Ralph (N Norfolk)|
|Cope, Rt Hon Sir John||Hughes, Robert G (Harrow W)|
|Couchman, James||Hunt, Rt Hon David (Wirral W)|
|Cran, James||Hunt, Sir John (Ravensbourne)|
|Currie, Mrs Edwina (S D'by'ire)||Hunter, Andrew|
|Curry, David (Skipton & Ripon)||Hurd, Rt Hon Douglas|
|Davies, Quentin (Stamford)||Jack, Michael|
|Davis, David (Boothferry)||Jackson, Robert (Wantage)|
|Day, Stephen||Jenkin, Bernard|
|Devlin, Tim||Jessel, Toby|
|Dicks, Terry||Johnson Smith, Sir Geoffrey|
|Dorrell, Rt Hon Stephen||Jones, Gwilym (Cardiff N)|
|Douglas-Hamilton, Lord James||Jones, Robert B (W Hertfdshr)|
|Dover, Den||Kellett-Bowman, Dame Elaine|
|Duncan, Alan||King, Rt Hon Tom|
|Duncan-Smith, Iain||Kirkhope, Timothy|
|Dunn, Bob||Knight, Mrs Angela (Erewash)|
|Durant, Sir Anthony||Knight, Rt Hon Greg (Derby N)|
|Dykes, Hugh||Knight, Dame Jill (Bir'm E'st'n)|
|Eggar, Rt Hon Tim||Knox, Sir David|
|Elletson, Harold||Kynoch, George (Kincardine)|
|Evans, David (Welwyn Hatfield)||Lait, Mrs Jacqui|
|Evans, Jonathan (Brecon)||Lang, Rt Hon Ian|
|Evans, Nigel (Ribble Valley)||Lawrence, Sir Ivan|
|Evans, Roger (Monmouth)||Legg, Barry|
|Evennett, David||Leigh, Edward|
|Faber, David||Lennox-Boyd, Sir Mark|
|Fabricant, Michael||Lidington, David|
|Fenner, Dame Peggy||Lightbown, Sir David|
|Field, Barry (Isle of Wight)||Lilley, Rt Hon Peter|
|Fishburn, Dudley||Lloyd, Rt Hon Sir Peter (Fareham)|
|Forman, Nigel||Lord, Michael|
|Forsyth, Rt Hon Michael (Stirling)||Luff, Peter|
|Forth, Eric||Lyell, Rt Hon Sir Nicholas|
|Fox, Dr Liam (Woodspring)||MacKay, Andrew|
|Fox, Sir Marcus (Shipley)||Maclean, Rt Hon David|
|Freeman, Rt Hon Roger||McLoughlin, Patrick|
|French, Douglas||McNair-Wilson, Sir Patrick|
|Fry, Sir Peter||Madel, Sir David|
|Gale, Roger||Major, Rt Hon John|
|Gallie, Phil||Malone, Gerald|
|Gardiner, Sir George||Mans, Keith|
|Garnier, Edward||Marland, Paul|
|Gill, Christopher||Marlow, Tony|
|Gillan, Cheryl||Marshall, John (Hendon S)|
|Marshall, Sir Michael (Arundel)||Spicer, Sir James (W Dorset)|
|Martin, David (Portsmouth S)||Spicer, Michael (S Worcs)|
|Mates, Michael||Spring, Richard|
|Mawhinney, Rt Hon Dr Brian||Sproat, Iain|
|Mellor, Rt Hon David||Squire, Robin (Hornchurch)|
|Merchant, Piers||Steen, Anthony|
|Mills, Iain||Stephen, Michael|
|Mitchell, Andrew (Gedling)||Stern, Michael|
|Mitchell, Sir David (NW Hants)||Stewart, Allan|
|Moate, Sir Roger||Streeter, Gary|
|Monro, Rt Hon Sir Hector||Sumberg, David|
|Montgomery, Sir Fergus||Sweeney, Walter|
|Needham, Rt Hon Richard||Sykes, John|
|Neubert, Sir Michael||Tapsell, Sir Peter|
|Newton, Rt Hon Tony||Taylor, Ian (Esher)|
|Nicholls, Patrick||Taylor, John M (Solihull)|
|Nicholson, David (Taunton)||Taylor, Sir Teddy (Southend, E)|
|Norris, Steve||Temple-Morris, Peter|
|Onslow, Rt Hon Sir Cranley||Thompson, Sir Donald (C'er V)|
|Oppenheim, Phillip||Thomason, Roy|
|Ottaway, Richard||Thompson, Patrick (Norwich N)|
|Page, Richard||Thurnham, Peter|
|Paice, James||Townend, John (Bridlington)|
|Patnick, Sir Irvine||Townsend, Cyril D (Bexl'yh'th)|
|Patten, Rt Hon John||Tracey, Richard|
|Pattie, Rt Hon Sir Geoffrey||Tredinnick, David|
|Pawsey, James||Trend, Michael|
|Peacock, Mrs Elizabeth||Trotter, Neville|
|Pickles, Eric||Twinn, Dr Ian|
|Porter, Barry (Wirral S)||Vaughan, Sir Gerard|
|Portillo, Rt Hon Michael||Viggers, Peter|
|Powell, William (Corby)||Waldegrave, Rt Hon William|
|Rathbone, Tim||Walden, George|
|Redwood, Rt Hon John||Walker, Bill (N Tayside)|
|Renton, Rt Hon Tim||Waller, Gary|
|Richards, Rod||Ward, John|
|Robathan, Andrew||Wardle, Charles (Bexhill)|
|Roberts, Rt Hon Sir Wyn||Waterson, Nigel|
|Robertson, Raymond (Ab'd'n S)||Watts, John|
|Robinson, Mark (Somerton)||Wells, Bowen|
|Rowe, Andrew (Mid Kent)||Whitney, Ray|
|Rumbold, Rt Hon Dame Angela||Whittingdale, John|
|Ryder, Rt Hon Richard||Widdecombe, Ann|
|Sackville, Tom||Wiggin, Sir Jerry|
|Sainsbury, Rt Hon Sir Timothy||Wilkinson, John|
|Scott, Rt Hon Sir Nicholas||Willetts, David|
|Shaw, David (Dover)||Wilshire, David|
|Shaw, Sir Giles (Pudsey)||Winterton, Mrs Ann (Congleton)|
|Shephard, Rt Hon Gillian||Winterton, Nicholas (Macc'f'ld)|
|Shepherd, Colin (Hereford)||Wolfson, Mark|
|Shepherd, Richard (Aldridge)||Yeo, Tim|
|Shersby, Sir Michael||Young, Rt Hon Sir George|
|Skeet, Sir Trevor||Tellers for the Noes:|
|Smith, Tim (Beaconsfield)||Mr. Timothy Wood and Mr. Roger Knapman.|
§ Question accordingly negatived.
§ Question, That the proposed words be there added, put forthwith pursuant to Standing Order No. 30 (Questions on amendments) and agreed to.
§ MR. DEPUTY SPEAKER forthwith declared the main Question, as amended, to be agreed to.
That this House commends the continued support of blood donors, on which the Blood Service is founded and which is at the heart of the National Health Service; and fully recognises the commitment of blood service regional staff and the importance of ensuring that this vital national service continues to improve and develop into an integrated national service, based on high and uniform standards of safety, reliability and efficiency.