HL Deb 30 November 1978 vol 396 cc1433-42

4.42 p.m.


My Lords, I beg to move that this Bill be now read a second time. The Public Health Laboratory Service Bill is a very short enabling measure, designed primarily to allow my right honourable friend the Secretary of State for Social Services to extend the scope of the service provided by the Public Health Laboratory Service Board. The need for such legislation was indicated in another place by my right honourable friend on 8th March 1978, in answering a Question about the future of the Microbiological Research Establishment at Porton. In the light of studies by the Central Policy Review Staff and the Medical Research Council, the Government decided that many of the capabilities and facilities of the Microbiological Research Establishment formed a valuable national asset, and that it should be retained as a civil establishment with a reduced scale of activity. Further study suggested that this civil establishment could most appropriately be managed by the Public Health Laboratory Service Board, which has agreed to assume management responsibility from 1st April 1979, when the establishment will become known as the Centre for Applied Microbiology and Research.

Under the National Health Service Act 1977, the Public Health Laboratory Service Board provides a microbiological service for the control of infectious diseases. Not all the work at the centre will fall strictly within the scope of the already authorised microbiological service. For example, work is likely to be done on the extraction of therapeutic, diagnostic and research agents from human, animal and plant tissues; though not microbiological, this is work which can suitably be carried on in an environment appropriate for microbiological work. There is also likely to be work done involving the design and production of equipment for microbiological laboratories. The work of the establishment will be given a health and preventive orientation: it will, for example, include diagnostic functions relating to dangerous pathogens and the production of vaccines. A most important aspect of the work will be the setting up of a reference laboratory dealing with laboratory safety. This will be concerned with the development and testing of safety equipment, and with the safety of equipment used in medical and cognate laboratories.

It is therefore proposed that the Secretary of State should be enabled to extend the already authorised microbiological service to include such other activities as, in his opinion, can conveniently be carried on in conjunction with it. Provision is made for this in Clause 1 of the Bill. Following from this, the Bill enables the functions of the Public Health Laboratory Service Board to be corespondingly extended. It also contains a wider provision than the one which now exists under the National Health Service Act for charges to be made for services and materials provided as part of the Public Health Laboratory Service.

A further provision of the Bill relates to the remuneration of members of the Public Health Laboratory Service Board, in addition to the compensation for loss of remunerative time and the travelling and other allowances which are already authorised. While it extends the range of payments possible to board members, the Bill transfers the power to determine them from the board to the Secretary of State, who is required to gain the approval of the Minister for the Civil Service. The Government have no immediate intention of introducing new payments to members of the board, but considers it desirable to bring legislation relating to the board into line with other similar bodies. I do not think that there is any need for me to add anything to what I have said. It may sound complicated, but it is really a simple enabling Bill.

In conclusion, I ask to be allowed to strain the patience of your Lordships to say on quite another matter, not in the least connected with this Bill, that I shall be placing in the Library, at the request of some of your Lordships, a supply of kidney donor cards. My Lords, I beg to move.

Moved, That the Bill be now read 2a.—(Lord Wells-Pestell.)

4.48 p.m.


My Lords, the House will be grateful to the noble Lord, Lord Wells-Pestell, for explaining the provisions of this Bill and, while we are in no way critical of its provisions, there are two questions on which I should like to ask for clarification. As I understand it, the staff of the Microbiological Research Establishment is to be reduced by one-third, effected by natural wastage, transfers to vacancies elsewhere in the Civil Service and redundancies. The remaining 220 are to receive protection on Civil Service pay and conditions, so long as they remain in the Public Health Laboratory Service equivalent of their present grade, or transfer to PHLS pay and conditions. We learn from the Explanatory Memorandum that the estimated net cost to the DHSS will be between £2 million and £2½ million a year, and that the existing cost to the Ministry of Defence will be discontinued. In order that we may get the picture in better perspective, I should be grateful if the noble Lord would tell the House what is the present cost of the MRE to the Ministry of Defence. I trust, in view of the one-third reduction in staff, that he will be able to tell us that this transfer of the MRE from the Ministry of Defence to the DHSS will result in a reasonable saving.

My second question concerns Clause 2, which authorises the payment of such remuneration and allowances as the Secretary of State may with the approval of the Minister for the Civil Service determine". Noble Lords who suspect the birth of another QUANGO will be interested to know to whom these payments are to be made. I notice that the Minister says that it is not intended to make such payments at present, but presumably they will be so made when the transfer to the DHSS occurs in April 1979. Perhaps the Minister would tell the House how many people are to be remunerated and what the likely level of payments will be.

Apart from these two questions, we regard the transfer of the MRE from the Ministry of Defence to the DHSS and the extension of the scope of the service as a constructive step, and we are in accord that appropriate charges should be made for the services provided.

4.52 p.m.


My Lords, I should like, with your Lordships' indulgence, to say a few words about the current epidemic of whooping cough, not only on account of its intrinsic importance but also because it demonstrates, I think, the sort of difficulties which are imposed on those who have the job of protecting our public health by a form of public opinion which is always vigorous but not always well informed. What I want to talk about may be the end of a myth and, if that is so, that end is substantially due to the Public Health Laboratory Service.

So far this year, 12 children are known to have died of whooping cough, and this figure will certainly be raised as further death certificates are examined. But it is not only a question of mortality. In the last 12 months, 50,000 cases have been notified among children in England and Wales, many of considerable severity, causing great distress to the sufferers and their parents, quite apart from the ill consequences which may occur in later life. Yet of the first 100 cases admitted to the East Birmingham Hospital, not one single child had been immunised, and there is no doubt that a similarly low level of immunisation exists in other parts of the country, for reasons to which I should like to draw your Lordships' attention.

In 1974, there appeared in the Archives of Disease in Childhood—a highly regarded and responsible journal published by the British Medical Association—a paper concerning neurological disorders which had occurred in children following immunisation against whooping cough with a vaccine called DTP. Following this, an association of parents conducted a campaign to obtain compensation for children alleged to have suffered brain damage from DTP, and this inevitably led to a campaign for the withdrawal of the vaccine from use. There were one or two doctors who supported this campaign, and at least one Member of the other House gained major publicity for this cause through the medium of television. The result was a sharp rise in the number of parents exercising their right to refuse vaccination of their children, so that the proportion accepting vaccination fell from the previous level of 70 per cent. to 80 per cent. to less than 40 per cent. in 1976. Then came the present epidemic which began in November 1977, rising quickly to the highest quarterly rate of new cases since 1960 and continuing ever since, with 1,000 or more new cases a week.

A distressing aspect of the disease is that most deaths occur in infants under one year old, and it is precisely to protect infants from infection in the home that immunisation of older children is so valuable. Seventy-five per cent. of cases in the present epidemic have involved children under five, and it is difficult to escape the inference, although conclusive statistics are not yet available, that the majority of these are victims of the campaign against whooping vaccine which began in 1974.

Doctors and public health officials cannot delay action while they wait to establish the cause of the deaths they are trying to prevent, but I think your Lordships would support their interim judgment in accepting the evidence of two local studies regarding the efficacy of the vaccine. In Hertfordshire, Dr. Church found during the 1977 epidemic that the incidence of whooping cough among children under five was 10 times lower for those who had been immunised than for those who had not, and in 1978 an analysis by another general practitioner found that the incidence was six times lower.

The anti-vaccination lobby defended itself by suggesting that the current epidemic is an illusion, due to diagnostic confusion with respiratory virus infection, but from bacteriological analysis by the Public Health Laboratory Service it is now clear that the rise in the number of cases diagnosed as whooping cough has been matched pari passu with an equivalent rise in the number of cases confirmed in the Laboratory. Here this myth dies in the face of scientific fact produced by this invaluable public service.

We must hesitate to discount entirely the possibility that the vaccine may be associated in certain cases with neurological after-effects, such as screaming attacks, convulsions or retarded development. The answer is not known with any statistical certainty. But I would draw your Lordships' attention to a study called The National Childhood Encephalopathy Study which was initiated by the Vaccine Complications Sub-Committee of the British Joint Committee on Immunisation, which is directed by Professor David Miller of the Middlesex Hospital Medical School. This embraced all children under three years of age who were admitted to hospital suffering from nervous disorders, and it shows that children who had not been vaccinated with DTP were just as liable to such disorders as those who had.

Against the background of a sustained anti-vaccine campaign, it is natural that parents, doctors and even Her Majesty's Government should be apprehensive about the possible risk. General practitioners have for some years been advising against the use of the vaccine where there has been a history of neo-natal illness or neurological disturbance, while the Government now accept the principle of compensation and have already made some ex gratia payments in cases of alleged vaccine damage. Nevertheless, it does appear from the evidence available that the risks from not using the vaccine—now, unhappily, measured in death and suffering —greatly outweigh any risks that there are from using it. However, there are still some, doubtless well meaning, persons who seek to have the vaccine officially withdrawn and continue to repeat the allegation of risk. Public confidence, once upset, is slow to return, and doctors and nurses concerned with administering the vaccine find their work frustrated in the extreme by this carefully nurtured controversy.

I draw your Lordships' attention to this matter because it appears to me and my medical colleagues to represent a triumph of emotion over reason—but, more than that, a triumph engineered with the best of intentions by people of goodwill in public life, in the Press and in the broadcasting media. It is a clear indication that the continuing movement in the direction of more open government will impose responsibilities upon the individual citizen greater than he or she has hitherto had to bear.

5 p.m.


My Lords, I am grateful to the noble Lords who have taken part. Perhaps I could deal with the two questions which were asked me by the noble Lord, Lord Cullen of Ashbourne. The spending by the Ministry of Defence on the Medical Research Establishment is in the region, I understand, of £1.6 million and. as the noble Lord has quite rightly pointed out, we are envisaging under the change an expenditure of something like £2 million to £2.5 million, and he quite rightly says that we are going to do it with a staff of only two-thirds the original number. While that is perfectly true, what I want to point out is that for some appreciable time the Medical Research Establishment has been quite deliberately running down and there is no doubt that so far as the Centre for Applied Microbiology and Research is concerned this must be very much strengthened. It must be built up, there must be quite a substantial amount of money allowed for capital expenditure for alterations and adaptations and it must cover certain repayment charges as well. Although I accept the concern of the noble Lord, I think that on balance, having regard to the fact that something has been running down and therefore costing less, now that it has to be built up and to some extent to be recreated, that expenditure of £2 million to £2.5 million is not unreasonable.

With regard to the second question that he asked, on remuneration and pay, it is something of an anomaly that we should have a board where the expenditure on reimbursement of fares and reimbursement of time lost should be the criteria to be applied to the board. This is most unusual and so steps are being taken to include in the Bill the right of the Secretary of State to decide to change that if, in his wisdom, he thinks it is desirable to do so; but I must emphasise that this does not mean that it will automatically take place on 1st April, 1979. I can tell your Lordships quite truthfully that my right honourable friend the Secretary of State has not made up his mind on this matter at all. He will take advice and, as I explained in my opening speech, it will need the approval of the Minister in charge of the Civil Service; so I am not anticipating that there should be any anxiety on that particular score.

The only other matter that I want to mention is the contribution made by the noble Lord, Lord Hunter of Newington. The first thing I should like to do, and I do it very gladly indeed and with some sense of privilege, is to be the first in your Lordships' House to congratulate him on his maiden speech. If I may say so, one of the joys to people like myself—and I am not alone—is that by being Members of your Lordships' House we are privileged to hear some of the most outstanding people that we can find anywhere in the country on certain matters. Your Lordships' House is rich with people who bring to it a wide experience, a fund of knowledge on almost everything that we discuss, and those of us who do not posses that kind of ability in those particular fields find it a privilege to listen to people such as the noble Lord, Lord Hunter. In him we have a very distinguished member of the medical profession, a vice-chancellor of a university—really it is not for me to go through Who's Who because he is so well-known and it is a privilege to have heard him today. He has touched on something which has caused my Department a good deal of anxiety and concern, and before I make any further comment I should like to say—and I am sure I say it for everybody in your Lordships' Chamber—that we hope to see him here regularly, and that he will take part in those debates in which he has an undoubted qualification to make a contribution.

I do not want to enter the field of discussion on the vaccine affecting the whole problem of whooping cough, except to say that we are hoping to present to Parliament a Bill known as the Vaccine Damage Payments Bill. I have to stress that title because I think the noble Lord used the word "compensation". I think there is a great legal difficulty about the difference between accepting the need to pay compensation and making a payment. So this Bill, the Vaccine Damage Payments Bill, should be available soon and will be presented to your Lordships in due course. As your Lordships know, it will provide for those who suffer severe damage following routine public policy vaccination, and it is a once-for-all payment of £10,000.

The noble Lord, Lord Hunter, drew attention to the need to be very careful about the vaccines which are used, and none of us would disagree with him there. I think I might say that the whole purpose of a centre for Applied Microbiology and Research is chiefly to try, as we have been trying and as his profession has been trying for a good many years, to produce purer vaccines. I will read to your Lordships something that I read quite recently about the Centre for Applied Microbiology and Research. It says: The technique will be employed in identifying the fractions of bacteria which give the protective effect of vaccines with the object of enabling the bulk production of protective material without the toxic effects often present in whole bacteria". That will mean much more to the noble Lord, Lord Hunter, than it does to me and to many of your Lordships, but this is a matter which the medical profession, my right honourable friend and my Department took on board a long time ago and we shall not be satisfied until every effort has been made to produce purer vaccines in the future. I am grateful to noble Lords for having taken part in this debate.

On Question, Bill read 2a, and committed to a Committee of the Whole House.


My Lords, I beg to move that the House do adjourn during pleasure until 5.15 p.m.

Moved accordingly, and, on Question, Motion agreed to.

House adjourned during pleasure.

House resumed.