HC Deb 17 December 2003 vol 415 cc1571-85 12.31 pm
The Secretary of State for Health(Dr. John Reid)

With permission, Mr. Speaker, I wish to make a statement about a blood transfusion incident involving variant Creutzfeldt-Jakob disease, better known as vCJD. It might assist the House if I begin by setting out the basic facts, before coming on to discuss the implications of the incident that I shall describe.

In March 1996, a blood donor, who was at the time free of signs of vCJD, donated blood to the National Blood Service. Shortly after this, the donated blood was transfused into a patient who underwent surgery for a serious illness. In continuing my description of these events, I will refer to the individuals as the donor and the recipient. The donor showed no signs of vCJD at the time when blood was given, but developed the disease three years later—in 1999 —and died from it. The recipient died in the autumn of this year. Initial post-mortem examination of the recipient showed changes in the brain indicative of CJD. Further examinations and tests of the patient's brain confirmed the diagnosis of variant CJD. The link between the donor and the recipient was first reported to officials in my Department on 9 December 2003, at which time the diagnosis of vCJD in the recipient was still being confirmed.

I was first alerted to the developments on Friday 12 December, and was briefed by the chief medical officer on Monday and Tuesday of this week. Today, I am bringing this information to the House at the earliest opportunity. I have given, and will give, minimal personal and clinical details of the recipient, because the family concerned wish to have their privacy respected.

In the light of the facts that I have outlined, it is therefore possible that the disease was transmitted from donor to recipient by blood transfusion, that the blood of the donor was infectious three years before the donor developed vCJD, and that the recipient developed vCJD after a six-and-a-half-year incubation period. This is a possibility, not a proven causal connection, because it is also possible that both individuals separately acquired vCJD by eating bovine spongiform encephalopathy-infected meat or meat products. This is a single incident, so the possibility of the infection being transfusion-related cannot be discounted, although it is impossible to be sure what the exact route of infection was. That is the conclusion of the chief medical officer and the experts who report to me.

It is because this is the first report from anywhere in the world of the possible transmission of variant CJD from person to person via blood that I thought it right to come to the Dispatch Box and inform the House, even if only on a precautionary basis.

The incident was discovered by good surveillance. In 1997 the Department of Health funded a research study, the transfusion medicine epidemiology review TM ER—study, to examine links between all the variant CJD cases and any form of blood transfusion. It is through that research study that the association between those two patients was identified. I should also point out that this emphasises the importance of post-mortem examination. Without it we would never have known about those matters, and I would like to thank our national health service pathologists for their expertise and constant vigilance.

I can inform the House that, as some will already know, there is as yet no blood test for variant CJD—or, for that matter, for BSE—let alone one that could detect the disease years before symptoms develop, so there is no way of screening blood donations for the presence of the CJD group of diseases. Fortunately, however, a range of precautionary measures have been put in place by the Government since 1997, even though there was at that time no evidence of the risk of person-to-person transmission of the disease via blood. For the benefit and reassurance of the House, I think it right to set out the action that has been taken to date and the further action that we now propose.

First, since 1997 all cases of variant CJD reported to the national CJD surveillance unit and diagnosed as having "probable" variant CJD result in a search of the National Blood Service blood donor records. If the patient has given blood, any stocks of that blood are immediately destroyed.

Secondly, on 17 July 1998, acting on expert advice, the Government announced a £70 million programme to remove most of the white cells from blood destined for transfusion. White cells were considered by experts to be a potential source of infection. This process of so-called leuco-depletion was then a highly precautionary measure to reduce what was then a hypothetical source of infectivity. The process of leuco-depletion—the removal of the white blood cells—was implemented by the National Blood Service over time, and completed by October 1999.

Thirdly, in November 1998, again acting on expert committee advice, the Government announced a £30 million programme to phase out the use of United Kingdom-sourced plasma in the manufacture of blood products. At the time, in the absence of any defined risks, that was another highly precautionary measure. From the end of 1999, therefore, all blood products have been made using plasma sourced from the United States of America. To ensure continuity of supply, the Department of Health purchased on 17 December 2002 the largest remaining independent US plasma collector, Life Resources Incorporated. as part of our attempt to ensure that plasma and plasma-related products were derived from sources outside the United Kingdom.

Fourthly, the National Blood Service has informed us that 15 people received donations of blood from donors who subsequently developed variant CJD. Of the 15 individuals, we have been informed that five received blood after leuco-depletion had been implemented, and the remainder before. The earliest of those 15 transfusions was in 1993 and the latest in 2001. Working with the National Blood Service, the Health Protection Agency is in the process of contacting those individuals. All will be told about the circumstances of their case and have the opportunity to discuss the risks with an expert counsellor.

Many more patients, of course, including haemophiliacs, will have received plasma products before plasma was sourced from the USA. They will have received products derived from large pools of plasma donated from many thousands of people and thus heavily diluted. The UK-wide CJD incidents panel considers the risks for that group to be even lower than for those who received whole blood. It is very difficult to trace all individual recipients of such products made from these plasma pools. However, the panel will be advising, on a case-by-case basis, which recipients will need to be contacted as the necessary information becomes available. That group of patients will also have the opportunity for a discussion with an expert on an individual basis. Any person with any concerns may ring NHS Direct on 0845 4647.

Fifthly, before these events, expert groups were already deliberating on whether further measures were required in relation to vCJD and blood. In October this year our expert Advisory Committee on the Microbiological Safety of Blood and Tissues for Transplantation advised, on the basis of a risk assessment, that further action, such as stopping people who have received a blood transfusion giving blood, was not necessary. However, in the light of today's statement, we have asked that committee to look comprehensively at whether further precautionary measures could be taken that would not adversely impact on the safety or availability of blood.

Sixthly, it is apparent that much more blood and blood products are used clinically than need to be used. There have been many past attempts to reduce the use of blood to situations where it is absolutely needed medically, but these have been only partially successful. I will therefore be asking the National Blood Service to have urgent discussions with the medical royal colleges and NHS hospitals to address that area of clinical practice. More appropriate blood usage will reduce all the risks associated with blood and will make more effective use of our precious blood supplies.

A finding of this kind, albeit one whose full medical significance is still far from clear, will inevitably give rise to concern. It is therefore important to take account of the wider context in two respects. First, since the events in 1996, approximately 24 million units of blood or blood components have been given to patients in the United Kingdom. Blood transfusion can be a life-saving treatment, but no medical treatment is free from all risks. Indeed, it is an unfortunate fact that already approximately 12 people die each year from complications of blood transfusion. Many people receiving blood transfusion are already very ill, some in life and death situations. A wide range of measures are routinely used to reduce the risks of transfusion by screening for HIV/AIDS, hepatitis B and C and other infections. For specific high-risk patients, even more detailed screening takes place.

Those wider measures should be seen in the context of the precautionary action already taken on vCJD and the recognition that so far we have only one single report of a possible link between a single donor and a single recipient. We are generally regarded internationally as having a very safe blood service, especially because of our precautionary approach to screening for infection, careful donor selection and the tradition of volunteering in this country, which means that our donors generally have a lower incidence of many viral diseases compared with those in other countries who are paid for their donations.

Finally, as to the wider situation for vCJD, we have thankfully not so far seen the thousands of cases of vCJD that some projections suggested. As of 1 December 2003, there had been a cumulative total of 143 cases of vCJD in the United Kingdom. Over the past three years, the annual number of new cases has fallen each year. However, there should be no complacency, as it remains premature to conclude that the epidemic has peaked, and in any case, any single case of vCJD is tragic for the patients and families concerned.

I hope that my statement has given the House a clear and accurate account of the finding in the full context in which it needs to be seen. I have asked the chief medical officer to oversee the further work and investigation required, and to keep me closely informed. I will, of course, also keep the House informed of any major developments in this area.

Mr. Andrew Lansley (South Cambridgeshire) (Con)

I am grateful to the Secretary of State for his having given me the opportunity to see the statement in advance, and I am sure the whole House is grateful to him for his openness and for the speed with which he has given us details of what is, as he said, a tragic event. We understand and respect entirely the privacy of the family concerned, but I am sure that they will receive from us our sincere condolences. I am also sure that the Secretary of State will be able to confirm that they, like other families affected by variant CJD, will be beneficiaries of the compensation scheme.

It is important to identify what we do not know. The Secretary of State was right to illustrate the limits of our knowledge about this tragic event. We do not know what, if any, means of transmission exists between blood and infection with variant CJD—we do not know whether blood is the source of the infection. He will be aware that, because there have so far been so few identified cases of variant CJD in a large population who were exposed to BSE-contaminated beef, the chances of the recipient contracting variant CJD other than by exposure to blood transfusion must be regarded as less likely than by some means connected with the blood transfusion, although I freely accept that we cannot quantify either risk, given the nature of the two populations involved. Equally, having been unable to establish the risks, we cannot go on to screen blood donations—the technology to enable us to do so does not exist—or to test for variant CJD.

Nevertheless, I hope that the Secretary of State can answer some questions. Although precautionary measures are being taken in relation to blood transfusions both of whole blood donations and of blood products and plasma, will he confirm that the transfusion in the case in question was a transfusion of whole blood and, therefore, of red cells? The transfusion occurred in 1996, and therefore before the implementation of precautionary measures in relation to leuco-depletion. If in this case there is a connection to blood donation, it may well be that the risk has been substantially reduced by the introduction of the precautionary measure adopted in 1998. What research is continuing into the impact and the benefits of leuco-depletion in relation to blood transfusions of whole blood donations?

I have a few detailed questions to ask. The Secretary of State said that the Advisory Committee on the Microbiological Safety of Blood and Tissues for Transplantation is to advise him on whether blood donations should be accepted from people who have themselves received blood transfusions. In 1998, when the right hon. Member for Holborn and St. Pancras (Mr. Dobson) told the House of other precautionary measures, he had sought and received advice from the Spongiform Encephalopathy Advisory Committee. Time will not have allowed both committees to have given advice to the current Health Secretary, but will he confirm that he will also be taking advice from SEAC? Clearly, advice must come from those who have expert knowledge of the characteristics of BSE and variant CJD; the issue should not be seen only from the viewpoint of the National Blood Service.

The Secretary of State said that thus far there had been 15 cases of blood donors subsequently contracting variant CJD, and he will recall that at least one of those cases occurred in Scotland. Questions regarding the ability to follow up patients who were potentially recipients of blood donations arose at that time.

Can he confirm that the different Administrations are now able to deal with people who have dispersed across the UK or the world? Are patients who might have received such blood donations being contacted and followed up?

What conclusions has the Secretary of State reached in response to the advice given by the CJD incidents panel on the risk of exposure to variant CJD from surgical instruments? What action will he take in that respect? It is a matter that has been under consideration for a long time.

In the wider context of blood transfusions generally, I turn now to children born since 1 January 1996. They could not have been exposed to BSE-contaminated beef, and to reduce the risk to that vulnerable population group it is intended to secure for them in early 2004 what is described as single-unit—that is, not pooled—virally inactivated donations from non-UK—in this case American—untransfused males. What consideration will the Secretary of State give to the availability of that form of blood product—plasma—for a wider group of vulnerable patients? Those patients include people who require regular transfusions, such as haemophiliacs, or those who need large-scale transfusions or blood products on a regular basis. What difference has the purchase of the plasmaphoresis centres in the US from Life Resources Incorporated made to the availability here of blood products for that purpose?

It is important for the House to recognise that 2 million people donate blood each year in the UK. They provide a vital, life-saving resource. The number of lives that are saved and the number of incidences of disease prevented by those donations far outweigh any risks associated with them. At the same time, the reporting structure on the serious hazards of transfusion needs greater compliance from NHS hospitals. More hospitals must act on the recommendations, make them part of their clinical governance and report back in full. In that way, the openness of the reporting structure will mean that we learn from mistakes and thus reduce risks overall. Will the Secretary of State ensure that the responses in the NHS to the transfusion hazard recommendations are acted on as fully as possible?

The Secretary of State made a welcome statement in August about hepatitis C compensation, and we are awaiting the details of the scheme. Now is not the time for a detailed debate on that, but will he confirm that those who contracted hepatitis C through blood donations, and their families, will get some news soon about the compensation scheme?

The Secretary of State said that he would be considering advice in relation to people who have received transfusions. Will that extend to people who have had transplants? There has been speculation about the measures that he might take. He referred to the availability of blood donations, which it is important to bear in mind. What has been the reduction in the number of blood donations in recent years? If there were to be a substantial and adverse impact on blood donations, the health consequences could be very serious.

Finally, I strongly endorse what the Secretary of State said about seeking alternatives to blood donations in treatment. The UK does not adopt such measures as much as some other countries. He may be aware of the possibilities offered by erythropoietin, known in short as EPO, as an alternative to large-scale transfusions for cancer patients suffering from anaemia. Will he update the House on the extent to which clinical trials and consideration of the costs and benefits offered by EPO are making progress? The use of EPO may help to reduce the need for blood donations to a minimum, and allow us to use the blood that is donated as well as we can.

Dr. Reid

I begin by thanking the hon. Member for South Cambridgeshire (Mr. Lansley) for his remarks, and especially for the condolences that he expressed to the families of anyone afflicted by variant CJD. We all share those sentiments. He also asked a number of perfectly legitimate questions, which I shall try to answer.

The hon. Gentleman ended his remarks by talking about EPO. The National Institute for Clinical Excellence is considering the matter very seriously, and I hope to have the result of that work not too far into next year.

The hon. Gentleman asked about compensation for CJD victims and their families. Those people are entitled to compensation from the CJD compensation fund, which is run by independent trustees. I cannot make a statement that might pre-empt the fund's decision on such matters, but I am sure that it will consider all cases—including the latest one—sympathetically.

The hon. Gentleman asked about the route of infection. He is right to be cautious and to weigh the matter in the balance. Although we cannot rule out the possibility that a person might be infected by receiving blood from a donor who subsequently dies from CJD, we cannot prove that it happens. However, I thought it appropriate to come to the House today, as for the first time we have evidence that it is possible. As he said, the incidence has been very low in the past; as far as we know, this case is the first of its kind. Intuitively, we might feel that the case could suggest that the pattern might be much more widespread if blood were truly the source of CJD transmission. However, intuition is not always reliable in these circumstances. We need empirical evidence, and that is why I have asked the chief medical officer and various expert advisers to investigate the matter. I confirm that they will include at least two of the people to whom the hon. Gentleman referred.

The hon. Gentleman asked about the transfusion of whole blood rather than plasma. To the best of my knowledge, the transfusion involved in this case was of blood, not plasma. The blood was donated in 1996, before the precautionary measures, including leuco-depletion, were introduced towards the end of the 1990s. The donor died about three years later from variant CJD, and the recipient has now died more than six years later. I shall not go into the range of causes behind the recipient's death, but the discovery that the recipient was suffering from variant CJD was made at the postmortem examination.

It is important that we adopt a cross-border approach to this matter, and that we co-ordinate our actions. My Ministers have spoken this morning to the other Administrations in the UK to inform them that I was to make a statement. However, medical experts around the country were in touch with one another last Friday, by teleconferencing and other means. It was at that stage that the matter was brought to my attention. I can therefore confirm that we work as closely and in as coordinated a way as possible with the devolved Administrations.

Two other questions arise in connection with the 15 identified recipients to which the hon. Gentleman referred. The first has to do with tracing and tracking them. Quite apart from the difficulties caused by cross-border movements, people can also move around inside England, for instance. That is not always easy to deal with. Secondly, before we contact them, we must weigh the risk factor involved. Some of the cases have been known for a considerable time, but experts have considered that the balance of risk meant that more distress would have been caused if the people involved had been contacted and informed. I hope that further distress will not have been caused by today's statement. Obviously, the fact that the single new piece of evidence has arisen means that an immediate contact process has been put in place, but there will be difficulties with tracing and movement, which the hon. Gentleman mentioned.

On transplants, all the work that we are doing extends to tissues as well as blood. The hon. Gentleman asked about leuco-depletion and I can tell him that a whole range of research is being conducted, in academia as well as by the research councils. The Spongiform Encephalopathy Advisory Committee, which is an expert committee, will consider its activity on a range of issues at its forthcoming meeting early next year.

The hon. Gentleman mentioned surgical instruments. He will be aware, as will many hon. Members, that we have been examining that matter for some time. Such consideration is not easy because the various possible substitutes and methods to diminish potential opportunities for cross-infection, such as the use of disposable surgical implements, have potential risks. Many surgeons in England have indicated that they would be unhappy with using such disposable implements when operating. We are investing some £200 million in improving decontamination standards

precisely because we are committed to minimising the risk of the transmission of vCJD via surgical procedures, as the hon. Gentleman would expect. The NHS Purchasing and Supply Agency is working with manufacturers to improve the quality and reliability of single-use instruments.

I confirm to the hon. Gentleman that we are taking advice from a range of committees, including SEAC, which he mentioned, the Advisory Committee on Dangerous Pathogens, the Committee on Safety of Medicine and the Advisory Committee on the Microbiological Safety of Blood and Tissues for Transplantation. I suspect that other independent agencies will immediately try—without instruction or the need for persuasion—to examine their own procedures and determine whether there are implications for them. We are also examining with the National Blood Service the practicality and cost of making fresh frozen plasma available to higher-risk groups. As I said earlier, the purchase of an American blood plasma company has ensured an adequate supply of plasma products from a BSE-free country.

The hon. Gentleman asked about the state and volume of stocks in the health service and levels of donations to it. We keep them at an optimum level—I can confirm that they are at an optimum level—and if there were a reduction beneath that level, we would obviously take emergency action.

Mr. Paul Burstow (Sutton and Cheam) (LD)

May I, too, thank the Secretary of State for his statement, his courtesy in allowing us to see it in advance and the open way in which he has dealt with the matter by coming to the House only a short time after learning of the situation? I also associate myself with the condolences that have been expressed throughout the Chamber to the families involved.

Will the Secretary of State say a little more about the time line behind the diagnosis? Given that the donation of blood occurred in 1996 and the death of the donor occurred in 1999, what steps were taken to trace those who had received blood from the donor, and how many of the 15 people to whom the Secretary of State referred received blood from that donor?

The company Life Resources Incorporated was purchased in 2002. Can the Secretary of State tell us what assessment was made before and since the purchase of the risk to US supplies from the sources from which it acquires its blood? Concerns have been raised about indications that drug addicts and prisoners in the US could be used as potential sources of blood, so I should be grateful if he would indicate what assessment of that has been made.

Can the Secretary of State clear up a little confusion that I have as a result of reading both his statement and material from the National Blood Service? I understand that the first consignments of fresh frozen plasma from the United States are due to arrive in the UK in January 2004 and that components of it will be issued from the spring. When will all children born on or after I January 1996 have access to US-sourced plasma? Do they have such access now and, if they do not, when will they have it?

The Secretary of State's statement referred to the fact that no blood test is currently available for vCJD. What advice has he received from his experts about the likely

time scale in which we could expect such a test to become available? I understand that the National Blood Service has expressed concern that there could be as much as a 50 per cent. drop in supply if a test became available, so what contingency arrangements is he putting in place to avoid such a collapse in supply?

Haemophiliacs have been mentioned. When will they have access to recombinant factor 8? Reference has been made to the need to manage better and use more wisely the blood that people donate? What steps are the Government taking to allow people to store their own blood as one way of managing the use of, and demand for, blood?

With that, I thank the Secretary of State for his statement and look forward to his answers.

Dr. Reid

I thank the hon. Gentleman for his remarks about my bringing the matter to the House. There is always a fine balance between, on one hand, bringing a matter to the House and thus raising the status of the announcement that one is making and, on the other hand. retaining information that should be legitimately available to the House and the public. Although there was one single incident on this occasion, I decided that provided that the reports were accurately reflected and not over-dramatised, it would be a better path to bring the matter to the House as soon as possible.

The hon. Gentleman asked whether only one person had received blood from the donor. The best information that I have suggests that one other person received blood, although hon. Members will understand that we do not have every single fact and figure. He asked about the length of time that has passed since we knew about the 15 recipients. We have known about that for a considerable time—I do not necessarily mean my Department when I say, "we". The names have been known for a considerable time, but in the absence of evidence during that time, such as that which we have today, the decision was taken that on balance, it would be more beneficial to the patients who received the blood to carry out a full assessment of the risk. That process has been ongoing for some two years, during which expert panels have investigated the matter—although the hon. Gentleman will realise that such an assessment was pretty difficult. It was decided that it was better to do that rather than causing distress in the face of any evidence, but that situation has changed because of today's statement.

Consequently, action on risk assessment and risk communication, which is a complex matter, was already proceeding. Several expert committees were involved, but the risk assessment for individual patients who might have received plasma is not yet completed. I was told during briefings in the past two days that the UK-wide CJD incidents panel met in October this year and received a report showing that the complex risk calculations for blood and plasma products were nearing completion. The panel recommended at the meeting that following the completion of the process, a package of action should be designed with the Health Protection Agency to communicate the level of risk faced by individual patients to the patients themselves. Today's action initiates the first steps in that process, because we cannot reasonably wait any longer.

I do not want to deceive the hon. Gentleman by implying that we have only just found out the names of those 15 people; the names were known but the risk assessment was such that it was decided, until we received this evidence, to make a far more complex assessment rather than cause them undue distress in the absence of that work. As I said, had those people been contacted earlier they would have been given a degree of reassurance that we should now have had to qualify—perhaps causing them more distress.

The hon. Gentleman asked about the sources of US blood supplies. We are satisfied about the blood supplies that we receive. My understanding is that a fair percentage of the blood comes not from the sources that he mentioned but from native Americans, for instance, and others to whom some of the points that he made would not apply. The American company, Life Resources Incorporated, which we have acquired, requires vigorous tests for assessing the blood products that it supplies us. Other appropriate quality assurance procedures are in place, as hon. Members would expect. As soon as the products become available in the new year, children will receive them.

The hon. Gentleman asked about factor 8 for haemophiliacs. That will be available shortly, and the programme is being rolled out at present.

The hon. Gentleman asked about tests. Tragically, the truth is that there is no diagnostic—

Mr. Speaker

Order. I am sorry to interrupt the Secretary of State, but perhaps he could write to the hon. Member for Sutton and Cheam (Mr. Burstow). I am obliged to call Back Benchers, as a statement must include them. Front-Bench speakers have taken 40 minutes, which is unfair to Back Benchers.

Mr. David Hinchliffe (Wakefield) (Lab)

Although I realise that we have had a long session of questions from the Front Benches, I am sure that everyone has noted the value of the questions. May I, too, express my appreciation to the Secretary of State for coming to the House with a thorough and detailed statement? I appreciate the precautions that are being taken in this difficult situation.

May I raise two wider points that were not touched on in the previous questions? First, my right hon. Friend will recall that not long ago there was publicity about the case of a vCJD sufferer who, according to the media, showed some response to a particular form of treatment. What is the Government's position on treatability? As my right hon. Friend knows, the issue is of concern to many people.

Secondly, may I press my right hon. Friend about the care packages available for people facing the problems of vCJD and their family carers? He will be aware of the concerns expressed by people close to some of the sufferers and their families that it has taken a considerable time to put the packages together, which has caused difficulties for patients and their families. Will he address that point? Is he satisfied that when a person is diagnosed every effort is made to ensure that a proper care package is put together as soon as possible?

Dr. Reid

On the last question, we are doing that, as far as I am aware; but as I know that my hon. Friend takes a great interest in these matters, especially given his position as Chairman of the Select Committee on Health, I shall reassure myself on that point. The problem is not so much treatment after diagnosis, but the diagnosis itself, because there is no diagnostic test for vCJD —there is no blood test—so, with reference to today's discussion, there is no test to screen potential blood donors.

My hon. Friend asked about possible treatments. He will know that the Department of Health agreed in principle to fund the trial of Quinacrine for the treatment of CJD. The trial will be undertaken through the Medical Research Council and is expected to commence in early 2004. A small number of patients with clinical symptoms were treated prior to the establishment of the clinical trial. We continue to seek out appropriate treatment wherever we can, but at present I cannot say that diagnosis or treatment are available on anything that we could describe as an effective scale.

Mr. John Greenway (Ryedale) (Con)

The Secretary of State referred to the fact that some successful operations have been carried out. Recently, an 18-year-old girl in my constituency successfully underwent such an operation —by the intraventricular installation of Pentosan polysulphate. I welcome what the right hon. Gentleman said about the trials; the operation was carried out the day after that decision was made. However, despite the fact that the operation was sanctioned by the local hospital and primary care trusts, surgeons in the hospital refused to permit use of the necessary sterotactic frame equipment due to their concerns about contamination, so the equipment had to be purchased from Sweden at the eleventh hour at a cost of about £38,000. Although the operation was carried out by the national health service, the NHS executive has so far declined to sanction payment for the equipment from NHS funds.

I am sorry to spring that matter on the Secretary of State on this occasion, but I hope that he will understand my concern and the concern of the patient's parents —I was about to write to him about the case. I hope that I have been positive in showing that treatment is available and we celebrate the fact that the girl is alive and improving, but I hope that he will recognise the need to look into the matter in respect of the cost of the equipment.

Dr. Reid

Of course, I cannot respond on an individual case. Any family who found themselves in such a position would obviously seek out every possible avenue for relieving pain, removing symptoms or curing the disease itself —all of us would do that. That is perfectly understandable, but we have not yet found a medically verifiable way of diagnosing or treating this terrible disease.

The hon. Gentleman referred to Pentosan. It is not licensed in the United Kingdom—I do not think that he mentioned that —although it is licensed in the United States as a treatment for cystitis. There can be adverse side effects, such as bleeding, hypersensitivity and a number of others. The most recent advice from the Committee on Safety of Medicines is that there is some very limited evidence from animal studies that Pentosan may be an effective prophylactic agent, although the committee also advises that there is no rational basis for describing the drug as a prophylactic. It is not licensed for use in the UK and could thus be prescribed only under a doctor's personal responsibility as an unlicensed treatment.

I do not know about the case described by the hon. Gentleman, but I do not doubt what he says. However, matters are sometimes slightly more complex as we have to consider medical ethics and the advice that we are given, as well as the anguish of individual patients.

Dr. Ian Gibson (Norwich, North) (Lab)

I, too, congratulate my right hon. Friend on the alacrity with which he has brought the situation to the attention of the House. More than anything, that will reassure the public that the matter is being looked at seriously. In the interests of that reassurance, has my right hon. Friend left open consideration of the possibility that there may have been separate infection of the two individuals? Will he ask the Food Standards Agency to make a statement about the current position in respect of meat and meat products in this country and their sources? That would further reassure the public that we have that aspect under control.

Dr. Reid

The answer is yes on both points. Although the donor and the recipient were obviously connected through the transfusion of blood, it is possible that each of them was independently infected through meat products rather than through blood. Yes, I shall certainly speak to the FSA to find out what it can do to bolster confidence in our approach in these difficult circumstances and to reduce any over-dramatisation of the evidence.

Mr. Douglas Hogg (Sleaford and North Hykeham) (Con)

The right hon. Gentleman will know that one of the problems of determining how large the incidence of CJD will be is uncertainty as to the incubation period. If there is a causal relationship between the donor and the recipient in this case—we know that, if there was such a relationship, there was a six-year incubation period —does not that give us a clearish indication of the incubation period and would not that give some modest encouragement to the belief that we shall not see a very large number of new vCJD cases?

Dr. Reid

There are a number of difficult words in the right hon. and learned Gentleman's question. The first and most difficult is the first word in his question, which was "if". It is true that we are not clear on the incubation period; it is also true that we do not have the method of diagnosis. Today will add further uncertainty to a number of those areas.

As I said earlier, it is also true that the number of incidents that are verifiable by post mortem and through obvious symptoms of vCJD is much lower than some projections at the beginning insisted. We must calmly reflect on today's evidence. I am not sure, within a few days of this being produced, whether we can draw any conclusions on the incubation period. I hear what the right hon. and learned Gentleman says on that matter.

Mr. Dai Havard (Merthyr Tydfil and Rhymney) (Lab)

As my right hon. Friend will he aware, I have written to him recently about issues related to blood safety, and particularly its usage for cancer patients with anaemia. I have been trying for the past two years to organise initiatives in the House in that regard. There are known questions that need answers. I think that most of the questions that have been asked today relate to issues that have been previously identified. I welcome the idea that there will be changes in clinical practice, particularly in the use of alternatives for cancer patients who have anaemia. I received a letter from the National Institute for Clinical Excellence telling me that it does not know when such an initiative will be started.

A couple of weeks ago, the All Wales Medicines Strategy Group was saying that it was not prepared to advise that alternatives could be used for cancer patients with solid tumours. There are simple and immediate step changes that could be recognised and carried out. I would welcome the opportunity to support my right hon. Friend in dealing with some of the old boys and old girls clubs that stop good practices in the health service, that could be initiated on the back of this activity.

Dr. Reid

I understand both the substance of the problem to which my hon. Friend has referred and the level of commitment that he has brought to campaigning on the issue of EPO. I can only repeat what I said earlier. We referred the matter to the National Institute for Clinical Excellence. We instituted such a body so that we could take these decisions on priorities, and decisions on the availability of treatments as well as on the availability of drugs and equipment, independently of political decisions. I understood that NICE was looking at the matter and that there would be an outcome next year. I do not think that I can advance on that. If my hon. Friend has other information, I shall be prepared to speak to him about it. Both of us will be reassured that NICE will look at the matter expeditiously.

Hywel Williams (Caernarfon) (PC)

Will the Secretary of State ensure that there is the highest level of cooperation and information exchange on this difficult issue between NHS Direct in England and NHS Direct in Wales? Many Welsh people live some of the time in England but would normally access services in Wales. However, I have had direct evidence recently that the information held by NHS Direct in England about services in Wales is up to three years old in the written form and is considerably out of date in some respects.

Dr. Reid

We do try to update that information. We shall attempt to ensure that the information available on this subject is as up to date as possible throughout the United Kingdom.

Mr. Andrew Miller (Ellesmere Port and Neston) (Lab)

Although this is obviously a tragedy for the families affected, and we are all sympathetic about that, it is important that the matter be kept in perspective. Will my right hon. Friend talk to the chief medical officer about ways of ensuring that the advice and support lines that he sets up are backed by expert help in putting these matters in perspective? We are thousands of times more likely to be killed on the roads than to contract vCJD. The matter needs to be put into perspective, especially for the media.

Dr. Reid

I agree with my hon. Friend. The information has been put into the public domain through the House so that everybody can be fully informed and reassured that we are approaching this matter in as open and transparent a fashion as possible. However, it is true that about 24 million units of blood have been made available over the course of recent years and that this is the first case that we have ever found where there is a link between a donor and a recipient as regards vCJD. However, there are other possible ways in which both of them could have been infected. It is not proof of a causal relationship, or that this has been transmitted through blood. I hope that we shall not be in the least complacent. On the other hand, we should not over-dramatise the situation, which could lead to widespread over-concern and panic.

Rev. Martin Smyth (Belfast, South) (UUP)

The Secretary of State has put us all in his debt by coming so soon to the House with this information. I welcome it, but with a deal of caution, particularly in terms of incubation. May I press the right hon. Gentleman a little on his answers to the hon. Members for Wakefield (Mr. Hinchliffe) and for South Cambridgeshire (Mr. Lansley), who talked about a new treatment? Over a year ago, I was in touch with the right hon. Gentleman's predecessor about a new treatment, and finally the family had to go to the courts. They got that treatment. The doctor who looked after the patient said that if he were ever diagnosed with vCJD he would want that treatment to be started immediately. If the treatment is available, it is important that it be used immediately following diagnosis. Bearing in mind that many others may yet develop vCJD, I think that researchers should be working more positively. The young man concerned would have died before last Christmas, but he is now at home in the care of his family, showing decided improvement. As he was so far down the road, it is doubtful whether he will ever be completely cured.

Dr. Reid

I am obviously aware of the case that the hon. Gentleman raises. It was in Northern Ireland, as it happened, and there was a subsequent court case. We took cognisance of what was said in that case, and the experience of it, and we arranged for pilot schemes to be carried out. Following the initial success, or apparent success, in treating the patient, we decided last year that we would carry out tests.

I do not think for a moment that we should be irresolute or hesitate in attempting to improve diagnosis or treatment. However, a degree of responsibility at the Government Dispatch Box is necessary. I say to the House that, thus far, none of our efforts has indicated a medically verifiable way of diagnosis or treatment for this disease. For me to indicate otherwise would be to raise hopes to an extent that would not be warranted.

Mr. Jon Owen Jones (Cardiff, Central) (Lab)

All the early victims of vCJD shared a particular genetic piece of information for the manufacture of certain proteins. Is it still the case that all the victims are in this genetic subgroup? Is that so for this new case? If it is, have we looked at the 15 possible recipients of blood to ascertain whether they are in the same vulnerable group, or whether some of them are?

Dr. Reid

The simple answer is that I do not know. By this afternoon, I will have asked those questions.

Paddy Tipping (Sherwood) (Lab)

In his detailed and thoughtful statement, my right hon. Friend rightly laid out the tragic consequences not only for the sufferer but for his or her wider family. Against that background, is he in a position to tell the House a little more about the compensation scheme for hepatitis C patients, which was agreed in principle in the summer? When will he be able to make an announcement about the way forward?

Dr. Reid

The answer is shortly. The Under–;Secretary of State for Health, my hon. Friend the Member for Welwyn Hatfield (Miss Johnson). has been working hard on this. and it should not be too long before we can make a public announcement.

Mr. Tom Harris (Glasgow. Cathcart) (Lab):

At this time of year, the National Blood Service encourages donors to make time in our busy schedules to ensure that we give blood. The timing of the announcement is probably unhelpful, because a number of people will understandably be reluctant to give blood, as happened following incidents in the 1980s and 1990s. What reassurance can my right hon. Friend offer blood donors to encourage them to continue giving blood and reassure them that that is a valuable thing to do?

Furthermore, can my right hon. Friend advise—

Mr. Speaker

Order. The hon. Gentleman has only one question.

Dr. Reid

At this late stage in the questions, I thank my hon. Friend for giving me the opportunity to make the position clear. People who give blood in this country perform a great and valuable service. I thank them for everything that they have done in the past, and we shall continue to seek their support in the future. Nothing that we have said today should in any way diminish the fact that over the years the lives of thousands, perhaps hundreds of thousands or even millions, of people have been improved, protected and saved by the public service performed by blood donors. As we approach Christmas and the new year and all the difficulties of the season, I hope that everyone remembers that, and will continue to give blood as a service to their fellow citizens.