§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Kevin Hughes.]9.33 am
§ Mr. Ian Stewart (Eccles)
I am delighted, after several unsuccessful attempts in the ballot, to have secured this debate today. This matter was last debated in the House in April 1996, when my hon. Friend the Member for Birmingham, Northfield (Mr. Burden) presented a Bill to review and amend the Vaccine Damage Payments Act 1979. He has given much commitment and hard work to the cause and he hopes to attend the debate later. I pay tribute also to the campaigning work done by my hon. and learned Friend the Solicitor-General before his elevation to the Government.
My particular interest in the issue results from my meeting two constituents, Brendan Hanlon and Gary Hunt, whose lives and those of their families have been blighted by vaccine damage. Gary Hunt, who is 30, is profoundly mentally and physically handicapped and needs 24-hour care seven days a week, 365 days a year. He is wheelchair bound, cannot feed himself, is blind and epileptic, still wears nappies because he is doubly incontinent and, to top it all, cannot speak. Three days a week he attends the Links day care centre in Salford.
Brendan Hanlon, who is 37, has an academic age of a child under two. He suffers from unpredictable and severe epileptic fits, which frequently lead to physical injury. Only yesterday, his mother and sister took him to hospital for treatment for an ankle injury. Brendan must be accompanied outside by two people at all times, which considerably restricts his life style. He attends Craig Hall day care centre at Irlam in Eccles most weekdays, fits permitting.
We commonly talk about vaccine-damaged children, although, like my constituents, victims of vaccine damage are often well past the age of majority. Those children and adults have a spectrum of needs. They and their families are all different and try to cope in their own, unique way. Some children live at home and some are in residential accommodation. Some families rely on respite care and others rely on the extended family to give that support. All families want the greatest degree of independence and choice. I want fair and comprehensive compensation for my disabled constituents and their parents.
Following a parliamentary lobby in May, a cross-party group for vaccine-damaged children was formed by Members of Parliament. The group's aims are to assist parents and children in obtaining fair 798 compensation and to further the reform of the vaccine damage payments system. Officers of the group had a meeting with the Minister of State, Department of Social Security, my hon. Friend the Member for Southampton, Itchen (Mr. Denham) last month to press the case for additional compensation. We told him that we hoped that the parliamentary group would be the shortest lived ever. The time has come for a just and adequate settlement for damaged people and their families.
This week I met two parents' groups—the Association of Parents of Vaccine Damaged Children and the Vaccine Victims Support Group—to discuss and agree on the components of a fair and adequate compensation scheme. I ask my hon. Friend the Minister to ensure that he arranges a meeting with them in the near future to hear their proposals.
I make it clear from the outset that the parents of those children and adults and the cross-party group for vaccine-damaged children are 100 per cent. behind a public vaccination programme. We are discussing today what responsibility the Government have adequately to compensate people when accidents occur.
Earlier this year I attended a briefing for Back-Bench Members on the measles, mumps and rubella vaccine. The Minister for Public Health and the recently retired chief public health officer, Sir Kenneth Calman, were present. Sir Kenneth made the point that politicians will always have to make hard decisions about any proposed Government vaccination programme in the full knowledge that there will always be accidents. I put it to him that if politicians make those hard decisions in the light of the wider public interest, it is surely politically, socially and morally right that before implementing the decisions, a system of adequate compensation for accident victims should be devised, and that funding should be shouldered jointly by the Government and the pharmaceutical industry. He replied simply, "Yes, I agree with you."
I am not here today to debate whether, or to what extent, vaccination is responsible for my constituents' disabilities. I know that the recent attempt to reopen that debate in a prominent Sunday newspaper has been very painful for parents. In my opinion, the Government accepted responsibility for vaccine victims with the 1979 Act and the scheme that was established a couple of years earlier. Successive Governments have honoured that responsibility—albeit inadequately—by periodically uprating the payment. The £10,000 payment of 1979 was increased to £20,000 in 1985, to £30,000 in 1991 and to £40,000 this year for new cases.
I shall focus on people damaged by the diphtheria, tetanus and whooping cough vaccination—DTP—and on the level of financial help given, although I shall mention the six-year time limit for claiming payments and the 80 per cent. disability threshold currently in operation. Other hon. Members may wish to speak about these issues and their concerns about the measles, mumps and rubella vaccine.
In the early 1970s, parents of vaccine-damaged children argued for compensation on the ground that they were encouraged to have their children vaccinated as much for public health reasons as for the interests of the individual child. The then Labour Government established a royal commission on civil liability and compensation for 799 personal injury, known popularly as the Pearson commission. It reported in March 1978. Recommendation 158 concluded that there wasa special case for paying tort compensation for vaccine damage, where vaccination is recommended by the state and is undertaken to protect the community.The 1974–79 Labour Government, keen to ensure an early measure of help, introduced the 1979 Act. The then Health Secretary, the late Lord Ennals, said that the payment would notpre-empt decisions which the Government still have to takeon the Pearson recommendations. Answering a Member who expressed great dismay that the payment was so small, he said:This is not saying, 'This is the end. We are wiping the slate clean'. This is some way in which we can help these people now".—[Official Report, 9 May 1979; Vol. 949, c. 977–80.]However, when the Conservative Government took office in 1979, parents were told that the £10,000 was a full and final payment.
The value of the scheme has deteriorated considerably between upratings. In 1984–85, the real value of the £10,000 was about £5,600. In 1985, the payment was increased to £20,000. Upratings have been irregular; families waited until 1991 for another increase, and a further seven years for the latest increase.
Many Members of Parliament, especially my hon. Friend the Member for Northfield, tried hard to persuade the previous Conservative Government to improve the level and scope of compensation. Their entreaties fell on deaf ears. I am glad that now several Conservative Members feel that they can support the case for adequate compensation and a review of the criteria laid down in the 1979 Act.
§ Mr. Llew Smith (Blaenau Gwent)
Does my hon. Friend accept that although the Government have set up a vaccine damage unit in Blackpool—in recognition of the fact that things can go wrong and that people should be compensated—in the case of some vaccinations, such as the triple MMR and also just measles and rubella, the Government refuse to believe that there might be a link between vaccination and damage to a child? Does my hon. Friend also accept that it is difficult to prove that the vaccination led to the damage, even when a perfectly healthy child who has never had a day's illness becomes seriously ill within minutes of vaccination? Is it his opinion that the Government should introduce a scheme whereby, instead of its being the parents' responsibility to prove that the child was damaged by the vaccination, it is the responsibility of the Government and the pharmaceutical industry to prove that the child was not damaged by that vaccination?
§ Mr. Stewart
Yes, I accept the validity of some of the points made by my hon. Friend. However, today I shall focus wholly on the DTP and the 1979 Act.
In April 1996, an early-day motion was tabled calling for comprehensive improvements to the 1979 Act. The motion attracted about 300 signatories, including 26 Labour Members who are now Ministers and several more who are now Whips. They include my hon. Friend the Member for Coventry, North-West (Mr. Robinson), 800 my right hon. Friends the Members for Tyneside, North (Mr. Byers) and for Dulwich and West Norwood (Ms Jowell) and my hon. Friend the Member for East Ham (Mr. Timms). My call for improved compensation therefore has supporters at the Department of Health and the Department of Social Security and—perhaps most important—I believe that it has friends at the Treasury.
On 23 June 1998, my hon. Friend the Minister told the First Standing Committee on Delegated Legislation:The vaccine damage payment scheme provides a substantial measure of preference for those … severely disabled as a result of vaccination over those … equally severely disabled from some other source.That acknowledgment of preference tells me that the Government have reviewed the evidence, identified vaccine damage victims as a special case and given some special support. However, I am afraid that I do not agree with my hon. Friend the Minister when he says that the preference is substantial. I believe that it is neither substantial nor remotely adequate.
My hon. Friend told the Committee that United Kingdom vaccination programmes had been very successful. We all agree. He said that, between 1951 and 1955, there were 627,033 cases of whooping cough in England and Wales, resulting in 1,103 deaths. Between 1991 and 1995, when vaccine coverage rates reached 94 per cent., there were only 1,873 reported cases and, thankfully, only five deaths. My hon. Friend said:The continued success of the immunisation programme is of enormous importance to individuals, their families and the country as a whole in reducing the incidence and effect of serious communicable diseases. Where, rarely, on the balance of probability, the programme does result in severe damage, the vaccine damage payments scheme provides a measure of financial help."—[Official Report, First Standing Committee on Delegated Legislation, 23 June 1998; c. 4–5.]Essentially, we are arguing about what is the right measure. The £10,000 received by Brendan Hanlon is an inadequate measure. Even the hon. Member for Rutland and Melton (Mr. Duncan) said that the figure was missing a nought or even more. It would have helped if the Conservative Government had shown the compassion and responsibility that some individual Conservative Members are now showing. If all the children who received the original £10,000 were to receive £100,000, it would cost only £79.5 million; and we all know of recent medical compensation cases in which payments of £1 million or more have been awarded to individuals.
As of June 1998, 890 payments had been made under the 1979 Act and the scheme which briefly pre-dated it. That is from a total of 3,999 claims—a success rate of just 22 per cent. The vast majority of payments—some 795 of the 890—have been at the £10,000 level. I believe that the low success rate is related to the highly restrictive 80 per cent. rule. Parents find it hard to accept that a child can have a considerable disability yet get no compensation. The 1979 Act also includes a six-year time limit on the period during which claims must be made. That disadvantages parents who might not have access to full information about the scheme. It might be well publicised now, but that has not always been the case.
It could and can take time for parents to become aware of the cause of their child's injury, and it can take many more months or even years before the necessary medical information is compiled. Up to 31 March 1995, 210 claims fell foul of the six-year rule. I am today calling for a review of the limitation on actions to relax those restrictions.
801 The Government must not hide behind the mantra that additional compensation is for the courts to decide, and my hon. Friend the Minister cannot continue to say that legal aid is not a matter for him. The Government are committed to a policy of co-ordination—joined-up thinking, as it is now routinely called.
Litigation is a dead duck for most parents, although I was delighted that on 17 November the Legal Aid Board allowed 16 families the right to re-apply for legal aid certificates to fight cases on behalf of their children where medical negligence is alleged. My constituents, Mr. and Mrs. Hanlon, had their legal aid certificate withdrawn in 1994 after 13 years. They are among the 16 families who can now re-apply for a certificate. Mr. and Mrs. Hanlon are 74 and 78 years old respectively, and they are tired of getting on and off the legal merry-go-round.
For many parents, the courts offer no solution. The relevant documents are missing, and vaccine batch numbers are lost, destroyed or missing. The Government's proposed changes to the qualifying criteria for legal aid may make such cases even more difficult to pursue. It has been argued that the conditional fee agreement that the Government are recommending would be particularly difficult in medical liability cases.
Victims of vaccine damage and their parents are looking to the Government to provide a decent and adequate compensation scheme. I know that various proposals have been advanced. One suggestion is for a substantial lump sum. Other proposals are for the payment of a severe disability pension like that paid for industrial or war injuries. Both suggestions may be appropriate. It is also time to revisit the Pearson report, which gave the issue a thorough investigation. I do not want to be too prescriptive, but the parents of vaccine-damaged children and I are looking to the Government to present some realistic options that will move the matter forward quickly.
A new or revised scheme should acknowledge five principles. First, it should recognise the need for a lump-sum payment which takes account of the wide spectrum of need among vaccine damage victims and the variety of suitable care provisions, ranging from full-time home care to full-time residential care. Families should have the financial wherewithal to make choices about the best care for their child now and in the future.
Secondly, it should be acknowledged that the longest suffering children and families have had the most expense and the least help. Any proposed settlement should recognise that. Thirdly, it must be accepted that in any vaccine programme, even in the future, inevitably there will be a small number of accidents. Therefore, an adequate and fair system of benefits and/or pensions should be established. Fourthly, the funding of such compensation should be the joint responsibility of Government and the pharmaceutical industry. Fifthly, the 80 per cent. and six-year criteria should be relaxed.
Since the early 1970s, parents have done all the right things. They have lobbied, they have tried litigation, they have persuaded sympathetic Members of Parliament to raise the matter, they have had an early-day motion tabled and they have lobbied Ministers, most recently in May this year at the House of Commons. I know that for many families it was a great struggle to get here, and that it was expensive for those who came from far-flung parts of the United Kingdom. They did so despite having to attend to 802 the constant needs of severely disabled children and adults. Now they want action. They want their sons and daughters' futures to be secured and they want an end to almost three decades of fighting for justice.
To my mind, the parents and sisters of Brendan Hanlon spoke for all the families and all the damaged children when they wrote:We have been extremely patient for many years, but the urgency of providing our sons and daughters with the financial muscle to purchase dignified care is ever pressing.Mr. and Mrs. Hanlon, who are in their 70s, want to ensure that during their lifetime they have secured and provided for the future care of their child. In that sense they are no different from all the other parents who have mature vaccine-damaged children. They know that they are stoic. They have been told that they are heroes, and undoubtedly they are, but time is running out. They want justice and concrete proposals for proper compensation now. I am confident that my hon. Friend the Minister and the Government will meet that challenge.
§ Mr. David Rendel (Newbury)
I congratulate the hon. Member for Eccles (Mr. Stewart) on raising the matter in the House and on his eloquent and moving speech, in which he put the arguments extremely well. I whole-heartedly support a great deal of what he said. He made a strong case and brought to the attention of the House, and, I hope, of the Government, the needs of families with a child damaged as a result of the vaccination programme.
I endorse what the hon. Gentleman said about the importance of that programme. However, one thing that should not come out of the House today is any scare story about the vaccination programme in general. The hon. Gentleman is right to say that it has proved an enormous success, leading to a huge reduction in the incidence of diseases, which have almost been eradicated from our country, and a huge reduction in the number of deaths, especially of young children, as a result of those diseases.
Our generation owes the greatest debt of gratitude to the medical services, as we were the first generation to enjoy the full benefits of the vaccination programme. In my very early years the vaccinations were just being introduced. As a result, most of my friends and my generation have not suffered as previous generations did.
It is important that the vaccination programme should continue. The hon. Gentleman is right to say that even the families of children who have suffered as a result of accidents following vaccinations are aware of the need for the programme to continue for the sake of the public. It is inevitable that there have been and always will be one or two children who are damaged as a result of vaccinations. We must take care of them. It is in the best traditions of the hon. Gentleman's party and of mine that in the House we should consider not just the public as a whole, but the individuals who, in one or two cases, may have suffered from what is in the best interests of society at large.
§ Mr. Llew Smith
Does the hon. Gentleman accept that we are speaking not about one or two cases, but about thousands of cases? If he is in any doubt about that, perhaps he should consult some of the solicitors and barristers dealing with those cases.
§ Mr. Rendel
I apologise if I gave the hon. Gentleman the impression that I was trying to minimise the 803 importance of the matter. The number of people damaged by vaccines, as opposed to other causes, is in dispute. The numbers now are small in comparison with the huge numbers being vaccinated in the overall vaccination programme.
§ Mr. Andrew Love (Edmonton)
It is not only the numbers that are in dispute, but whether the vaccine is responsible for what has happened in some cases. I attended the same meeting as my hon. Friend the Member for Eccles (Mr. Stewart) with the chief medical officer. For every statistic that we could throw up, the chief medical officer threw up a counter-statistic. Does that not tell us that more research is needed, so that we can establish whether and when vaccines are responsible? That would allow the people described by my hon. Friend to be adequately compensated when it is clear that the vaccine caused the damage.
§ Mr. Rendel
I am sure that we would all welcome more research, but for some families it is already too late—the damage has been done. We should concentrate on what can be done to help the families of people who have already been affected.
Many hon. Members have probably had the opportunity—the privilege—to visit such families, as I have, and will know how severe the effects of vaccine damage can be. Those affected may need direct care for as much as 24 hours a day. Young children who are disruptive as a result of mental disability must be watched for every moment of their lives, because they may be a danger to themselves and others. As the hon. Member for Eccles said, the current programme does not provide enough compensation to enable such people to be looked after properly.
In other cases involving medical accidents, compensation has run into millions of pounds. If we are to retain the system whereby lump sums are provided in compensation for some medical accidents—and I am not sure that it is the right system—such sums must be large enough to give the family a continuing income, so that proper care can be paid for. Compensation should be higher than the £40,000 agreed in the summer.
The hon. Gentleman was also right to point out that there are different degrees of damage. Some people will need more care than others. There is a good case for a sliding scale, and for a reduction in the current highly restrictive requirement for sufferers to be 80 per cent. disabled to receive compensation.
That the 80 per cent. requirement is restrictive was demonstrated last summer, when the Minister told us that the number of cases receiving compensation had fallen to about five a year. The hon. Member for Edmonton (Mr. Love) said that the figures that I had mentioned might be too low in relation to needs. Certainly, compensating a mere five families a year will not require much in terms of public resources.
There has also been a problem in regard to legal aid. I am delighted to learn that in a number of cases that is apparently being resolved, but if we are to continue with the programme as it is now we must consider the needs of families, many of whom, because of their difficulties, have few resources of their own. They should be given a chance to take their cases to court and to obtain compensation.
804 We have been told that a review of the whole scheme is under way, but the process seems to be rather slow. The Government are very keen on reviews: they are reviewing all sorts of things, and setting up working parties. Admittedly the issue is difficult, and, as has been said, a number of the medical problems have not been fully resolved. I accept that a review must be proper and thorough, but I hope that the Government will not consider the fact that fairly small numbers are involved to be an excuse for allowing this review to drag on and on. It should be speeded up as much as possible because the issue is critical for those involved, although they form a relatively small proportion of the population.
The Government may wish to consider a no-fault compensation scheme as a way of resolving not only this problem, but other medical problems. It is time that they did so. Many people have special needs as a result of medical damage of some kind, whether or not that damage was a result of negligence on the part of a doctor, and those caring for them experience difficulties in providing for those needs. Surely we should do what we can for them, regardless of the cause of the problem.
§ Mr. Simon Hughes (Southwark, North and Bermondsey)
One good reason for the Government to establish such a scheme is the possibility of avoiding endless actions against different health authorities and trusts which must then arrange for administrators and staff to deal with the litigation. A central system tied in with no-fault compensation would hugely reduce administration costs in the national health service, as well as making matters much easier for claimants.
§ Mr. Rendel
My hon. Friend is right. Sadly, the only people who are likely to benefit from the retention of the current system are the lawyers who, year after year, deal with these lengthy cases in the courts. It would be better for some of the money to be given to the victims of medical accidents. My hon. Friend was also right to mention trusts. A number of trusts are known to be in great difficulty after losing cases that they expected to win, and being stung for large amounts of compensation.
I ask the Minister to respond to the points that I have made, and to tell us whether he is considering a no-fault compensation scheme. I feel that that must be the answer in the end, and I hope that that end will come sooner than seems likely at present.
§ 10.7 am
§ Mr. Richard Burden (Birmingham, Northfield)
I congratulate my hon. Friend the Member for Eccles (Mr. Stewart) on securing the debate, and apologise to him, and to my hon. Friend the Minister, for the fact that I shall be unable to stay until the end.
I have been interested in vaccine damage for some time. In the last Parliament, I introduced a ten-minute Bill and tabled an early-day motion on the subject. Significantly, the early-day motion secured more than 200 signatures from hon. Members on both sides of the House, which demonstrates the strength of feeling in all parties.
My involvement, like that of many other hon. Members, began as a result of a constituency case. I pay tribute to Mrs. Olivia Price, and to all the other parents of vaccine-damaged children who have worked so hard over the years and have shown such resilience in campaigning for justice.
805 "Vaccine-damaged children" is, in a sense, a misnomer. As my hon. Friend pointed out, we are now dealing mainly with vaccine-damaged adults. That certainly applies to the cases approved under the Vaccine Damage Payments Act 1979. The parents of those concerned are getting on in years, and the time has come for us to address the issue. Indeed, such action may be overdue.
The position was clear back in 1978. The Pearson commission recommended a weekly disability benefit for all severely disabled children,irrespective of cause of disablement".It went on to say thatthe Government or local authority concerned should be strictly liable in tort for severe damages suffered by anyone (adult or child) as a result of vaccination which has been recommended in the interests of the community".That, surely, is the key issue. The vaccination programme, which I support, is a public health measure. Vastly more children have benefited from it than have suffered. Given that it is a public health measure, however—a measure promoted by the public for public health reasons—and given that there will always be a small number of children who are adversely affected by vaccines, we, as a community, have an obligation to look after them and their families. That is all that parents have been saying for all these years. The obligation is important not just in terms of justice for those families, but in terms of the credibility of the vaccination programme.
There are legitimate arguments about the MMR—measles, mumps and rubella—vaccine and other issues, on both sides. I am a supporter of vaccination, but, in all seriousness, I say to my hon. Friend the Minister that until we sort out the issue of compensation for the small number of families who have been affected, those two matters will continue to get mixed up. The credibility of the vaccination programme will suffer as a result of the issue of compensation not being adequately addressed.
Although I accept in many ways what the hon. Member for Newbury (Mr. Rendel) said about the need to examine an overall no-fault compensation scheme, we should not leave the addressing of the issue of compensation until we tackle those broader questions. This has gone on for too long already, and there are some fairly simple things that can and should be done. First, as my hon. Friend the Member for Eccles said, the level of compensation should be dramatically increased for all those affected. That is a vital component.
Secondly, we should remove the 80 per cent. rule, which has unjustly ruled out too many families. Thirdly, we should do something about the six-year rule, which has had a corrosive effect. That would not cost a great deal of money. The parents deserve it, and we as a community have an obligation to the families involved and to the credibility of the vaccination programme.
§ Ms Jean Corston (Bristol, East)
First, I congratulate my hon. Friend the Member for Eccles (Mr. Stewart) on securing the debate and on the moving content of his speech. I also pay tribute to my hon. Friend the Member for Birmingham, Northfield (Mr. Burden), who 806 did so much during the previous Parliament to call public attention to the number of children who have been casualties of an immunisation programme to which we are all committed and to which we want parents to be committed.
I am vice-chair of the newly formed all-party group on vaccine damage, and I put on record the fact that we are working to put pressure on the Government about promises and obligations that we think rightly fall on them. We have been assisted by my hon. and learned Friend the Solicitor-General, who, before his elevation to that august post, was an active member of our group.
I shall use the time available to me to detail a particular case in my constituency—that of Matthew Needs. Matthew, and his parents Enid and Ivor, became my constituents as a result of boundary changes following the general election. Before that, they had been the constituents of, in reverse order, my hon. Friend the Member for Kingswood (Mr. Berry); Mr. Rob Hayward, who was Conservative Member for Kingswood for a time; and my right hon. Friend the Member for Chesterfield (Mr. Benn), who at that time was the Member for Bristol, South-East. Mr. and Mrs. Needs have worked with all those Members of Parliament to try to achieve justice for Matthew.
The total sum of compensation available in the statutory scheme is slightly more than two years of the average wage. At the same time, children who have been damaged at birth or who have had a disability, and have been in the fortunate position of being able to prove negligence in civil law, are receiving damages counted in millions because of the cost of care for a lifetime. That is what is involved: a lifetime of care from parents, many of whom are reaching retirement, as my hon. Friends have said.
Matthew was born on 11 June 1975. There were no complications in his birth, and he held up his head at between six and seven weeks, which is quite forward. He sat up at six months, in December 1975. On 16 September 1975, he had his routine three-month check at the local authority children's health clinic. The doctor who saw him, Dr. Joan Boyd, had 43 years experience as a child health doctor by the time of her retirement. She said:My clinical examination in conjunction with peri-natal and post-natal hospital tests showed a very long baby with tests within the norm for his age, in my opinion.On 8 January 1976, Matthew had his first injection of the vaccine DTP—diphtheria, tetanus and pertussis. Pertussis is commonly known as whooping cough. Afterwards, his mother said that he had a prolonged screaming fit, became drowsy and slept for 17 hours. His behaviour was noticeably different when he woke, and he was unable to recognise his mother, which is extraordinary in a child of seven months.
Quite a long way down the road, and after lots of pennies had been put in the legal meter, a medical opinion was sought from two eminent specialists—Dr. F. Clifford Rose of Harley street and the Charing Cross hospital neurology department, and Professor G.T. Stewart of the University of Glasgow. They said:On the evidence submitted to us it would appear that he had a severe adverse reaction a few hours after this injection.Mrs. Needs said that heseemed suddenly lifeless and floppy … like a rag doll".807 A couple of days later—on or about 10 January—Matthew had brief seizures in which his body became rigid and his eyes stared for a few seconds. Mrs. Needs reported that to the clinic and to her doctor, but she was told that there was no need for concern, but Matthew remained backward and disturbed in the weeks thereafter. Dr. Clifford Rose and Professor Stewart said:We interpret this as a global disturbance of cerebral function which was followed immediately, as the record shows, by severe mental and physical retardation.At that point, some hearing loss was noticed, and Matthew saw a doctor at a hearing clinic in March. Nevertheless, on 4 March 1976 he had his second injection of the triple vaccine, because Mrs. Needs was told that there was no cause for concern. After that, Matthew had another prolonged screaming fit and the retardation increased.
On 16 March 1976, Matthew had his nine-month check-up with the same doctor, Dr. Boyd, at the children's clinic. She said:Clinical examination by me showed a very long child again with, in my opinion, poor muscle tone and some delay in the development of locomotive skills.I considered that development delay needed further investigation at specialist level. An appointment for Dr. Brian Speidel of Southmead Hospital, Bristol, to see Matthew in Out patients was made.Obviously he was being referred to a consultant because of the inexplicable deterioration in his condition, from being a normal baby at three months to a slow child at eight months.
On 7 May 1976, in Southmead hospital, it was discovered that Matthew was unable to sit unsupported. He later saw Dr. Carpenter at Purdown hospital in Bristol. He had an appointment with a paediatrician, who said that the child's condition was not related to vaccination. That seems to be the sole bit of evidence on which the Department relies in shutting Matthew out of the scheme altogether. My hon. Friends have made the point that the scheme as it stands is inadequate to compensate these children—most of whom are now adults—and their parents, but Matthew's parents have never received a penny because the Department relies on that one written comment from a paediatrician.
On 1 July 1976, despite that catalogue of horrors, Matthew was given his third injection of the vaccine. The consultants to whom I have referred said:There is no evidence of a pre-existing neurological or other lesion to account for his condition. We are therefore of the opinion that it is more likely than not that the first injection caused brain damage which was aggravated by the second and third injections. These were given in violation of scheduled contraindications and of doubts expressed by Matthew's parents.In this respect they were given negligently of the child's best interest especially since at the time of the third injection he was over one year of age and therefore no longer at serious risk of severe disease or complications from whooping cough.The Vaccine Damage Payments Act 1979 was passed in the dying days of the 1974–79 Labour Government. For its first 18 years on the statute book, it was the responsibility, and under the discretion of Conservative Secretaries of State. Cases were heard by a vaccine 808 damage tribunal. On 10 September 1979, the tribunal turned down Matthew's application. Its judgment says:From the history it appears far more probable that the influenza illness which coincided with the first immunisation caused this child's condition rather than the immunisation.In particular, it was noted thatthe second and third immunisations with the same vaccine did not result in any deterioration of the child's condition.That is a strange point to make. Furthermore, that was the first Mr. and Mrs. Needs had heard of Matthew having had influenza. It looked as though that had been entered on Matthew's medical records by his general practitioner.
Mr. and Mrs. Needs applied for a re-trial based on a mistake as to a material fact, which was that Matthew had suffered influenza at the time of his first vaccination. In October 1979, Dr. Carpenter, who was the consultant psychiatrist at Purdown hospital, said:Matthew's clinical picture at present certainly fits that of a brain damaged child and this, coupled with the fact that he appeared to be a perfectly normal developed baby before the alleged immunisation at seven months, must cast grave doubts upon the suggestion that his brain damage or deterioration was due to influenza. Certainly influenza, like many other viruses, probably could cause brain damage whether by direct infection or by an allergical mechanism but I cannot think of a single case off-hand and feel it must be excessively rare. Judged on probability therefore it is surely far more likely that it was the whooping cough vaccine.In 1980, the vaccine damage tribunal turned Matthew down again, and did not give any reasons. It just said that, on the balance of probabilities, it did not think that his condition was as a result of a vaccination.
A psychological assessment of Matthew in 1981 said:It is very difficult to imagine Matthew advancing to any degree, other than a physical increase in stature, regardless what treatment methods are used and to my mind"—the doctor was James B. Norman—having seen what milestones he had reached prior to the vaccination, I feel that he is less advanced now than he was prior to the vaccination which to my mind suggests very strongly that the vaccination may well have been the cause of his brain damage.Since that time, Mr. and Mrs. Needs have been on a legal merry-go-round. They do not have a batch number for the vaccination, because the records have been destroyed. I do not allege any malpractice. Matthew's medical records referred to influenza, but they have now gone, so no one has any evidence that influenza was given as a cause. It is impossible, or at least very difficult, to prove negligence.
The matter has gone backwards and forwards. It has gone to various Secretaries of State. Lord Henley said that the case was out of time. When the right hon. Member for Sutton Coldfield (Sir N. Fowler) was the Secretary of State, he turned down an application. In the interval, Mr. and Mrs. Needs have, to my knowledge, spent £5,361 of their own money trying to get justice for Matthew.
Some people have said that there is a question mark over whether vaccine damage exists, despite the 1979 Act. I have a letter from the Minister for Public Health, who referred to the findings of a national childhood encephalopathy study. She said that itfailed to identify a statistically significant link between pertussis vaccine and neurological damage.She went on:However, we do know that pertussis itself can cause brain damage.809 In 1976–77, the Parliamentary Commissioner for Administration reported on the yellow card system. He noted that doctors were not reporting suspect adverse reactions on the yellow card system as rigorously as they should, and that that was a matter of concern. Although there was no statutory requirement for doctors to do so, it was made clear that it was extremely important. The Department had reminded doctors from time to time of the yellow card system to help identify hazards, but the Commissioner felt that it was generally accepted that there was under-reporting.
The report made specific reference to the whooping cough vaccination. It said:The main reaction of triple vaccine apart from other local reactions which have been reported and which give cause for concern are first, convulsions and encephalopathy and secondly the sudden onset of shock or collapse and the shrill cry or screaming attacks which may persist for several hours.Those are precisely the symptoms that Mrs. Needs described. The report reviewed research from 1961 to 1974, and said thatthe sudden onset of collapse within 4 hours of immunization and the peculiar screaming attacks following the triple vaccination in the young infant may be attributed to the vaccine with greater confidence as they do not appear to have been observed after other prophylactics given at the same age or in children who have been given no vaccine.When Mr. and Mrs. Needs came to see me in my advice surgery last year, Matthew came with them. He was very frightened at being in a room with people he did not know, and sought refuge by constantly hugging his mother, as would a baby of seven months who was in a room with strangers. For reassurance, he put out his hand to his mother and said, "Round and round the garden." She had to stop and do "Round and round the garden like a teddy bear" on his palm—he was 22. That reassured Matthew and he beamed, but there was not a dry eye left among the rest of us in the room. This was a man of 22 exhibiting the familiar behaviour of a 7-month-old baby.
I pay tribute to Ivor and Enid Needs for the love and care they have given Matthew and his siblings. I cannot imagine how much patience they have required. I should like my hon. Friend the Minister to make it clear to the Secretary of State that the Vaccine Damage Payments Act 1979 gives him the discretion to make an order to add medical evidence, such as that submitted by many doctors in the case of Matthew Needs, in the absence of proof, such as a batch number or GP's records. If eminent specialists in the field say that the cause of disability is almost certainly vaccination, that should carry equal weight. I do not want to criticise the vaccination programme, but we have a responsibility towards its victims.
I am grateful to the Under-Secretary of State, my hon. Friend the Member for East Ham (Mr. Timms), who met me recently to discuss Matthew's case. However, I am not convinced that the Department is taking this matter seriously enough. I ask my hon. Friend the Minister to take careful note of what I have said and to recognise that young people such as Matthew, and their parents, deserve justice from the Government.
§ Dr. Peter Brand (Isle of Wight)
I am grateful for the opportunity to make a short contribution to this important debate. I am sure that there is consensus in the House on 810 this issue. The hon. Member for Eccles (Mr. Stewart) set out the case extremely well. I shall concentrate on the public health aspects, which were discussed by the hon. Member for Birmingham, Northfield (Mr. Burden), and shall touch on the case described by the hon. Member for Bristol, East (Ms Corston).
Many of my medical colleagues find it difficult to accept the concept of vaccine damage. There is an association between having an immunisation and neurological diseases occurring, but we know that many neurological diseases in small infants occur at about the time vaccines are given. It is extremely difficult to prove causality as opposed to a link. Many of my colleagues say that, if we allow causality, it may undermine the public's confidence in the vaccination programme. They are profoundly wrong.
Nowadays, for each individual child, it is safer to rely on herd immunity rather than to have a vaccination, but if many individual parents made that decision, herd immunity would disappear almost within weeks. Then we would all, as individuals, be at risk again of a number of diseases that, thankfully, we do not see very often now. Therefore, it is important that individual parents, when they make the responsible choice of having their child vaccinated on behalf of the community, have the assurance that should anything go wrong—whether or not cause and effect can be proved—if there is a link, they will be looked after by the very state and community that benefits from that selfless act.
It all sounds slightly dramatic, but that is a decision that each parent has to make. During some of the irresponsible scares that we have had recently, the focus on vaccine-damaged children not being treated properly by the state has created an on-going festering sore. All of us in the Chamber and everyone who has spoken know parents. The people affected are growing older. Parents are more anxious about those dependent individuals, clearly described by the hon. Member for Bristol, East.
It is in the interest of the Government and public health to make the decisions that parents have to make easier by acknowledging that, if there is any association between a disability and an immunisation procedure, the Government will face up to their responsibilities, without driving those people through the protracted misery of having to go through the courts.
§ Mr. Eric Pickles (Brentwood and Ongar)
This has been an interesting and thoughtful debate. I, too, congratulate the hon. Member for Eccles (Mr. Stewart) on his selection. He spoke movingly about the plight of his constituents and about the difficult decisions that have to be made, as did the hon. Member for Bristol, East (Ms Corston), whose description of her constituents' problems I found deeply moving. I could see that she, too, was moved by their plight. I hope that the Government will take the opportunity to reconsider the individual case that she mentioned.
The hon. Member for Eccles made a slight side swipe at the previous Government when he said that the late Lord Ennals had suggested that more reform might be forthcoming. The hon. Gentleman quoted from the official record. If he studies that debate carefully, he will find that Patrick Jenkin, now Lord Jenkin, remarked that Lord Ennals had gone out of his way not to say that it was an 811 interim payment. Part of the problem with which we have been bedevilled is that there have been hints and suggestions that something else is about to be done. I hope that the Minister of State will not be guilty of the same fault.
We are struck by the effects of vaccine damage on individuals and by the amount of injury that is suffered. Hon. Members have referred to the fact that a child must be classified as 80 per cent. disabled before qualifying for payments. The effect of that must be devastating not only for the individual but for the family; the hon. Member for Bristol, East gave a clear example.
It is also striking that the percentage of awards against claims has steadily gone down. The hon. Member for Newbury (Mr. Rendel) talked about a handful of awards; I think he mentioned five. It is interesting that there have been five awards against 260 claims in the past three years.
As the hon. Member for Birmingham, Northfield (Mr. Burden) said, we should not forget that the assistance given under the Vaccine Damage Payments Act 1979 was based on the principle that parents should be actively encouraged to have their children vaccinated on grounds of public health, as well as for the welfare of the individual child.
As hon. Members have pointed out, controversy continues over the measles, mumps and rubella vaccine. I have a letter from the Minister for Public Health in response to a constituent's inquiry about the safety of that medicine. I will not quote the whole letter; nor, for reasons of confidentiality, will I name my constituent. The letter says:There has been much adverse reporting in newspapers and on television about MMR vaccine over the preceding months. We very much regret the anxiety this has caused, especially since much of the reporting has been factually wrong.It talks about the Joint Committee on Vaccination and Immunisation and says:The Committee's view remains unequivocal that, on the scientific evidence available, there is no link between MMR vaccine and inflammatory bowel disease or autism.It is against that background that we seek to reassure families that vaccination remains safe.
The hon. Members for Eccles and for Newbury talked about whooping cough. I was born in the early 1950s—1952 to be precise.
§ Mr. Pickles
The Whip is right. I look a lot younger, but I thank him for that remark.
At that time, whooping cough was a great killer of children. Great fear stalked the streets. Years later, my mother talked about the constant fear, the effects on children and the effects on families in our locality whose children had died or contracted the disease.
In the early 1950s, the number of whooping cough cases was roughly 157,000 a year, compared with 2,000 today. The number of deaths was 300 a year, compared with one a year 40 years later. The public vaccination programmes remain safe and are a sensible precaution for parents to take for the well-being of their 812 children and their children's playmates. As hon. Members have said, however, when vaccinations go wrong, the consequences can be tragic.
Hon. Members have referred to the problems in the 1970s, when some members of the medical profession expressed doubts about the safety of whooping cough vaccine. The result was the 1979 Act. As several hon. Members have it made clear, that was not intended as compensation, but, to quote the late David Ennals, as an "urgent measure of health". He made several statements on Second Reading that have since been subject to different interpretations; indeed, we have had heard some differing interpretations today.
At the time of the debate, the royal commission on civil liability and compensation for personal injury had made recommendations on a limited compensation scheme, but as that would, in the words of the late Lord Ennals, "inevitably take time", the Government decided to introduce a lump-sum payment. It is important to emphasise that each uprating relates only to new cases.
Many people took that to mean that other measures would be introduced. Clearly, the sums that have been involved—£10,000, £20,000—are nothing like the levels that would be available in court. I have some briefing papers supplied by a lawyer on comparable schemes involving the courts covering 80 per cent. disability. The figures include £520,000 for an 11-week old girl; £708,000 for a five-year-old boy; a case from Leeds involving £105,000; a case involving £346,000; leading up to one involving £1.25 million compensation.
It is fair to say that, despite the legal aid changes, action on such cases has largely been ruled out because it is very difficult to prove causation: from the early 1980s until the recent cases, the Legal Aid Board refused to grant legal aid to pursue them.
It is to the Government's credit that in June they uprated the amount payable in new cases to £40,000—on roughly the same basis as the two previous upratings by the Conservative Government. In the debate, the Minister made some interesting points that suggested that there would be a further review. On the uprating, he said:I should also like to draw attention to the other part of the announcement about the vaccine damage payment scheme being considered as part of the welfare review, which includes disability."—[Official Report, First Standing Committee on Delegated Legislation, 23 June 1998; c. 3.]In a written answer in another place, the Under-Secretary said:The Vaccine Damage Payments Scheme is the responsibility of the Department of Social Security. Consideration is still being given to this complex and sensitive issue and an announcement will be made in due course."—[Official Report, House of Lords, 2 November 1998; Vol. 594, c. 28.]The promised statement on vaccine damage payments came in "A new contract for welfare: support for disabled people", which on page 41 states:We have increased by £10,000 to £40,000 the tax-free lump sum payment which is awarded, in addition to the normal range of disability benefits, to children who are severely disabled as a result of recommended childhood vaccines. We are continuing to consult with representative bodies on any future changes to the scheme.The Minister, for whom I have a great deal of time, would hardly have made those promises unless he was about to deliver on them; he has just nodded to that effect. I am delighted that he has taken the unusual course of 813 making that major announcement during a Wednesday Adjournment debate. To be worthwhile, the review must consider things beyond inflation uprating. At the end of his speech in the uprating debate, the Minister said that the uprating would stand "for some time". Let him say now how often it will be uprated.
Is the review only about the scheme's operation and administration, or are extensions proposed? Are there proposals to introduce a payment on the lines described by hon. Members, to institute a trust for those suffering, to reopen cases previously considered and/or to deal with the problems of adults? Will the 80 per cent. rule or the six-year rule be affected? Any review must consider those matters. Unless the Minister wants to follow the path of Lord Ennals and imply promises that perhaps cannot be kept, let him give us what the hon. Member for Eccles called his joined-up thinking on the issue.
§ The Minister of State, Department of Social Security (Mr. John Denham)
I congratulate my hon. Friend the Member for Eccles (Mr. Stewart) on securing this debate and on raising an issue of concern to the House. It is a complex and emotive subject, and my hon. Friend spoke clearly and with great sensitivity.
I know that the matter is of considerable interest and that an all-party group on vaccine damage has recently been formed. I acknowledge the work of my hon. and learned Friend the Member for Dudley, North (Mr. Cranston)—now the Solicitor-General—who has been active on the issue since he entered the House. Although he is now a Minister, and so unable to speak in the debate, he found time to join me on the Front Bench this morning.
There were many good contributions. I hope that I will address most of the points raised; hon. Members will forgive me if I do not ascribe them to each Member who spoke. The hon. Member for Newbury (Mr. Rendel) made several important points. My hon. Friend the Member for Birmingham, Northfield (Mr. Burden) has been active in the campaign for a long time. My hon. Friend the Member for Bristol, East (Ms Corston) spoke movingly about a constituency case that she is pursuing with one of my colleagues. The hon. Member for Isle of Wight (Dr. Brand) spoke about the importance of the immunisation programme, as did several other hon. Members. The hon. Member for Brentwood and Ongar (Mr. Pickles) posed several questions.
Before I go into how the scheme operates, may I say that I recognise the difficulties that many children, and their families, must tackle daily? Like other hon. Members who have spoken, I have constituents who must deal with all the pressure on them and their families that comes from being the parent of a severely disabled child. I, too, recognise that where it is believed that a disability arises from vaccine damage, whether or not it can always be established as fact, that belief can add greatly to the sense of distress, anger and even guilt that parents may feel. In common with parents of other disabled children, many such parents grow increasingly concerned about how their children will be provided for when they become adults: they begin to wonder what will happen when they can no longer offer care in the way that they have for so long.
814 The national immunisation programme is, as was acknowledged throughout the debate, an important programme and the responsibility of the Department of Health. The diseases covered by it are diphtheria, tetanus, pertussis, poliomyelitis, measles, rubella, tuberculosis, mumps and haemophilus influenza type B. I should restate, although it was noted by hon. Members on both sides of the House, that the programme was introduced for a good reason.
The diseases covered by the childhood immunisation programme can lead to serious illness and be life threatening. How well vaccines work is shown by the incidence of diseases before and after the introduction of immunisation. Between 1951 and 1955, there were more than 620,000 cases of whooping cough, to which the hon. Member for Brentwood and Ongar alluded, in England and Wales, resulting in more than 1,000 deaths. Between 1991 and 1995, when vaccine coverage reached 94 per cent., there were only five deaths, and the incidence of the disease fell to much lower levels, with only 1,873 cases in 1995.
The success of mumps, measles and rubella, or MMR, vaccine has resulted in notifications of measles reaching their lowest ever levels. Measles vaccine was introduced in 1968, and by the late 1980s, notifications had fallen from a maximum of 800,000 per annum to a maximum of 100,000 per annum. MMR was introduced in 1988, and cases fell to between 10,000 and 20,000 per annum between 1990 and 1994. Slightly more than 4,000 cases were notified in 1997, and the true figure is thought to be much lower, because many reported cases were misdiagnoses. No child in England and Wales has died from acute measles-related illness since 1992. All those figures establish that the immunisation programme provides benefits not only to society as a whole but to the individual and his or her family.
After the separation of the Health and Social Security Departments in 1988, the administration of the payments scheme under the Vaccine Damage Payments Act 1979 was placed in the custody of the Department of Social Security. A payment under the scheme is not in any way a bar to any subsequent legal proceedings. It does not prejudice the rights of a disabled person and his or her family to seek compensation. Indeed, cases have been taken to court, although it is true that, to date, there has been no successful case on the issue. However, as hon. Members are aware and have mentioned in this debate, some parents have obtained legal aid to pursue their claims against manufacturers of the MMR vaccine.
Hon. Members have asked about legal aid. My understanding is that, notwithstanding the Government's proposals, the current MMR legal aid cases that have been mentioned will be protected while they continue to satisfy the eligibility criteria. The Government have made it clear that we wish personal injury cases to be funded by conditional fee agreements. I acknowledge the issues in the vaccine damage cases that have been raised in the debate, and I shall of course draw those concerns to the attention of the Lord Chancellor.
Since our return to office, many hon. Members have pressed us about the scheme. As my hon. Friend the Member for Eccles will recall, on 5 November, the Under-Secretary of State for Social Security, my hon. Friend the Member for East Ham (Mr. Timms) met representatives of the all-party group on vaccine damage for a very useful discussion. We are aware of concerns on 815 time limits, the disablement threshold, the adequacy of the £10,000 payments under the 1979 Act and other matters. We are aware also that medical opinion on vaccine damage has changed in the past decade or so.
It is important to stress that no prior assumption is made about the possibility of vaccine damage in any individual case. Each claim is dealt with on its merits. However, it is important to state the current understanding of the prevalence of vaccine damage.
Reports in the mid-1970s linking pertussis vaccine and encephalitis resulting in brain damage were based on anecdotal evidence concerning a small number of affected children. Since then, several large studies, such as the national childhood encephalopathy study, have shown no scientific evidence of a causal link between vaccination and brain damage. As such a causal link remains a theoretical possibility, each claim for a vaccine damage payment is carefully considered, taking into account the facts and evidence in the individual case.
The suggestion of a link between MMR and inflammatory bowel disease—particularly Crohn's disease—and autism, has been carefully studied by several independent expert groups. None of the groups has found any evidence to support such a link. Indeed, it is often forgotten in the coverage given to the issue that the original paper by researchers at the Royal Free hospital, published earlier this year in The Lancet, clearly stated:We did not prove an association between MMR vaccine and the syndrome described".The World Health Organisation has also written to stress the safety of the MMR vaccine and to support the United Kingdom's immunisation programme.
The United States Institute of Medicine pointed out that the background rate of encephalopathy—which is a general term used by doctors to describe a disturbance in brain function—in children under two is about five to 10 cases per 100,000 population.
Whatever the prevalence of vaccine damage, at the very least, parents of vaccine-damaged children face the same challenges as parents of other severely disabled children. The vaccine damage payment is not, of course, the only response that the Government make to meet the needs of those and other disabled people.
As a Government, we have a broader challenge: to ensure adequate support to all disabled people. Hon. Members will be aware of the significant improvements in provision for the severely disabled, of extra support for the most severely disabled three and four-year-olds and those disabled before the age of 20, and of our recent proposal in the House of a disability income guarantee, on which we are consulting organisations of and for disabled people.
The vaccine damage payment scheme provides substantial preference for children who are severely disabled as a result of vaccination over children who have been equally severely disabled from some other source. The payment does not preclude payment of other disability benefits and non-means tested benefits such as disability living allowance and severe disablement allowance. If it is held in a trust fund, the vaccine damage payment will be ignored for the purposes of income 816 support, income-based job seeker's allowance, family credit, disability working allowance, council tax benefit and housing benefit.
Recipients, like other severely disabled people, may also be able to get help from the independent living fund and local authority social services. Perhaps the most significant recent development was the announcement, on Monday, by my right hon. Friend the Secretary of State for Health on important action to modernise social services. Specifically, the "quality protects" programme will target an extra £375 million to transform all of children's social services.
There has been a sustained campaign to improve the vaccine damage payment system. Today's debate, secured by my hon. Friend the Member for Eccles, is part of that campaign, as have been the early-day motions and the meetings with my hon. Friend the Under-Secretary of State for Social Security. I am pleased that, in July 1998, the Government were able to increase the payment from £30,000 to £40,000.
Some specific points were raised in the debate, such as that on the 80 per cent. disability criterion. I think that Parliament's view in passing the 1979 Act was that the scheme should be straightforward and aimed at those who are severely disabled. The Act defines severe disablement as disablement to 80 per cent. or more, as assessed for the purposes of determining the rate of disablement pension under the industrial injuries scheme.
In making the assessment, regard is paid to the scale provided in social security regulations. Blindness and deafness, for example, are each described as 100 per cent. disablement, although they clearly do not represent the greatest possible extent of disablement. Therefore, 80 per cent. is regarded as the lower end of the defined severe disablement spectrum.
Occasionally, people have asked about the possibility of a sliding scale of disability. I think that extension of a scheme providing significant preference for one group of people with disabilities over another would run counter to the objective of building a coherent benefits system for all disabled people, regardless of the cause of disability. A scale of disability payments would also run counter to the scheme's principle of providing a straightforward single payment for those who are clearly severely disabled because of vaccination.
Questions were asked in the debate also about time limits. Time limits in the scheme are quite generous. There is a limit of six years after vaccination or the second birthday, whichever is later, for new claims. There is no limit on the time in which a claimant may request a review by an independent tribunal of a medical disallowance of that initial claim. The claimant may request an indefinite adjournment during a tribunal hearing.
Marginal changes in the time limit would not assist in the overwhelming majority of cases. The substantial length of the process would make obtaining medical and other relevant evidence after long periods increasingly difficult, and make the scheme unsatisfactory or even unworkable. However—with the wide range of views about the incidence of vaccine damage, the adequacy of the payment scheme, the position of early recipients and 817 the extent to which those who suffered vaccine damage should receive preferential treatment because they were responding to a publicly promoted health programme—we announced, on 19 May, that the scheme would be considered as part of the welfare review.
My hon. Friend the Under-Secretary of State for Social Security has said that he hopes to conclude our review early in the new year. I am sure that the House will accept that finding the right answer is more important than hitting any specific date. The campaign has made a presentation on disability benefits—