§ Mr. Dai Havard (Merthyr Tydfil and Rhymney)
The appropriate use of blood in the national health service is the subject of debate and I would first like to explain how I became interested in it. A newspaper article in October about the possible halving of blood supplies as a result of donors' fears about Creutzfeldt-Jakob disease testing alerted me to it. The article was about the position in Ireland, and it was clear from it and from subsequent research that there is a current problem with sustaining the supply of blood and that it could be jeopardised further.
The experience in Ireland was of crisis proportions. From a base of bad experience with other blood-related problems such as human immunodeficiency virus and hepatitis C, the confidence of donors in Ireland was already reduced, and effectively it crashed with the human variant CJD screening proposals. The net effect was the cancellation of surgery and the introduction of haemovigilance officers—the so-called "blood police"—into every hospital in Ireland in order to deal with the crisis caused by low supplies of an increasingly scarce and valuable commodity.
We know that in the coming year the United Kingdom will face an acute shortage of blood, which could be compounded if the problem is not properly tackled and the public given sufficient confidence to continue to donate blood. I am a blood donor and I will continue to donate my blood—and I encourage others to do so.
My concerns were heightened over Christmas when I sat at home in Wales listening to emergency radio appeals for donors because stocks were running out. I fear that when this shortage comes, non-emergency patients in the NHS—people with cancer, for example—will suffer most while the dwindling blood stocks are rightly used for life-saving procedures.
The National Blood Service is on record as saying that testing for vCJD will cause a donations crisis—perhaps as much as a 50 per cent. drop in supplies. I believe and I am glad that you, Minister, are planning for that eventuality. The appropriate use of the blood working group has been set up toensure the most effective use of blood as an increasingly scarce resource"—a recognition that blood will be a scarce resource.
In October last year the chief medical officer held a conference, at which our colleague, the Health Minister, Mr. Hutton, said:One of the important issues discussed was how to avoid the unnecessary use of blood in clinical practice in the face of decreasing supplies and numbers of blood donors".The Government clearly recognise the problem, and it is being addressed. I have been attempting to ascertain exactly how those deliberations concluded. To date my replies from the Department have been disappointing—hence my initiation of the debate.
Before Christmas, stories flourished in the media of people who had been transfused with blood donated by donors who had since gone on to develop vCJD. Neither the Department nor the NBS has challenged the authenticity of these stories. One alarming story—it was 111WH not denied by the NBS or Professor Banner—was that in an attempt to control the spread of vCJD, the Department was considering banning everyone who has ever received a blood transfusion from donating blood or their organs. My research has shown that if such a decision were ever made, it would instantly reduce the blood donor base by 15 per cent. Will you give me an assurance today that neither your Department nor the NBS is considering preventing recipients of blood transfusions from donating blood again?
We know that blood donations in the UK are already in decline. According to the Minister's predecessor, John Denham, between 1994 and 1999 blood donations fell by 17 per cent. Last year the NBS tried to reverse the downturn with a high-profile celebrity campaign for donations. If the figures given by your colleague Yvette Cooper to the hon. Member for Woodspring (Dr. Fox) on 14 January are correct—
§ Mr. Deputy Speaker (Mr. Nicholas Winterton)
Order. The hon. Gentleman should address Ministers by their constituency, not by their name.
§ Mr. Havard
I apologise. Mr. Deputy Speaker.
If the answer given on 14 January is correct, the campaign to which I refer is at best reducing the speed of decline. Last year saw another substantial reduction of 3.4 per cent. These figures led me to look at how blood is used. I am concerned both in terms of public responsibility and on a party political basis. As a party, we are trying to bring massive reform to the NHS. This is an area in which we are needlessly under attack.
According to the Department's figures, about 30 per cent of blood is used for cancer patients. I declare an interest; my constituency has one of the highest numbers of cancer patients in the UK. That is a significant problem that needs to be addressed by a step change. My information suggests that in practice 40 per cent. of blood is used for cancer patients, to overcome the debilitating effects of anaemia and related fatigue. Fatigue is consistently listed by cancer patients and patient groups as the worst side effect of treatment. Last year, more than 2,000 cancer patients responded to Cancer BACUP's advertisement on the subject of cancer-related fatigue. The International Myeloma Foundation said that it would like Government assurances that cancer patients would not suffer in the light of any future shortage of blood supplies.
I reinforce the IMF's sentiments and ask the Minister for an assurance that cancer patients will not suffer unnecessarily in the event of the NBS having to restrict blood supplies. To do otherwise would make a farce of the Government's cancer care plan. The Minister will recognise that the extensive additional resources given to the NHS to fight cancer are much needed and welcome. They will do a good deal to redress previous neglect. How we make a step forward change rather than mere incremental change to the health service is a political question that must be addressed. The plan was meant to help achieve that, but in terms of blood it could be undermined if we are not careful.
112WH What options are there to the use of blood for cancer patients, I asked myself when examining the figures, to help to avoid the impending crisis? I was pleased to accept an offer from the then Minister, my right hon. Friend the Member for Barrow and Furness (Mr. Hutton), to attend a meeting with officials, along with the NBS and other parts of the Department, to discuss what could be done. I thank them for brokering that meeting. I took along a leading haematologist, a Macmillan nurse who is a practitioner in the field, and a representative of the drug industry, to discuss options to using such a large proportion of the blood supply.
It became clear during the discussion that using the drug Erythropoietin to treat chronic fatigue in cancer patients could provide not only a better standard of care but also free up most of the 30 or 40 per cent. of the blood supply used in cancer treatment. Many leading specialists believe that transfusing blood to cancer patients is unnecessary. A leading haematologist, Dr. Ivor Cavill, says thatthe majority of cancer patients treated for anaemia are needlessly exposed to transfusions when there are better alternatives available".At the meeting we heard the experience of the Macmillan nurses at Whipps Cross hospital in London, where they have adopted the practice of using Erythropoietin in place of transfusions, which is appropriate for 70 per cent. of their cancer patients.
There is a debate that drugs may have a curative as well as a palliative effect. I believe that they provide a better base for the other treatments to take effect. I am carrying out more research in that area and I will be pleased to supply information to the Department. I examined also comparisons with European countries. There has been much talk recently about developing our health service to European standards.
Currently, in France, a cancer patient is six times more likely to be treated in this modern way, rather than by receiving a blood transfusion. In Spain, that would be seven times more likely, and it would be eight times more likely in Italy. American patients are 100 times more likely to receive such treatment, rather than the one that we have used over the years.
European standards are important, and we could match them quickly. That is the sort of step change to which I referred, rather than an incremental change. In Europe, modern options are used as a matter of course. Other countries preserve their blood supplies for emergencies and surgery. A report in yesterday's Evening Standard mentioned the possibility of sending our cancer patients to Greece. If they went to Greece, their chances of being treated with the use of drugs would be greater than those in Great Britain, although I do not know the exact figures because I have not had a chance to undertake the research.
Economic factors are involved. Obviously, drugs cost money and the way in which blood is costed must be examined. My research, which is based on the Government's figures, shows that if modern blood options were used for cancer patients, 250,000 bed days a year would be freed up. I gave that information during the meeting on 5 December. The argument that the drugs would cost must be set against potentially massive savings in other areas. The use of drugs would also deal with the chronic problems of bed blocking and insufficient resources in the health service.
113WH In a week during which we have been pilloried as a result of stories about people waiting on trolleys in emergency departments and unable to get beds, it is disappointing that I am still waiting for an answer about the information that I gave in December. I understood that the meeting's outcome was that the costs would be examined. The Department could not cost them properly and needed to find a way in which to do that. I have not received notification of any progress on the matter.
The Department was also to examine broadening people's involvement in the debate on blood policy. The issue of blood is about much more than transfusions; it must be examined in the round. Those who are involved with only transfusions may have a narrow perspective of the matter, and a broader perspective must be given.
I have received no recognition that things have moved forward. Obvious benefits would stem from the cancer plan and cancer patients' quality of life would be improved. Standards of care could be improved, and we could meet quickly European and international standards. We could move forward the reform agenda that is necessary for the NHS.
As a spending Ministry, the Department of Health must look to the Treasury. How can the Department demonstrate and account for the effective use of reformed resources, processes and procedures if it cannot answer questions such as mine about the effect and economic implications of changing procedures? The Department must address these matters quickly.
There would be benefits in moving to modern drug treatments for anaemia and fatigue-related treatment. The exposure of many people to transmission-related diseases would be reduced. The move would free up about 30 per cent. of the blood supply, and help to protect it. It would avoid a crisis in supplies and avoid also cancer patients being put in a position in which palliative care for them is penalised in order to allow emergencies to be dealt with. Better treatment standards would be available for cancer patients, and modern European standards could be adopted. It would free up quickly 250,000 bed days a year, and help with that crisis.
Such a change is not only possible, but would be effective and efficient for patient care and best practice. There is justification for it on grounds of both patients and economics.
The change would be politically advantageous. It is no secret that I must defend where I am and what I argue about the health service. We must make step changes. I will discuss how we can progress on the issues with my colleagues in Wales, because some involve devolved matters.
I remind the Minister of the assurances that I would like. I want confirmation that those who have given blood will be accepted as future donors, and an assurance that cancer patients will not suffer in the face of dwindling blood stocks. The economic case for using drugs and saving bed days, and ways of accounting for that, must be a priority for the Department of Health. Will the Minister consider broadening the involvement of the new transfusion committee, or using other methods to develop a consistent blood policy throughout the UK? That must be a matter of urgency.
I apologise for my indiscretion.
§ Mr. Deputy Speaker
The House thanks the hon. Member for Merthyr Tydfil and Rhymney (Mr. Havard) for his speech. The Minister to whom he referred two or three times is the right hon. Member for Barrow and Furness (Mr. Hutton). I call the Minister to reply.
§ The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears)
I congratulate my hon. Friend the Member for Merthyr Tydfil and Rhymney (Mr. Havard) on his success in having secured the debate. He has taken a special interest in the subject for some time, and from listening to his speech today, we can all appreciate the depth of his knowledge and expertise in a technical area about which I have had to learn a great deal recently. He raised some important issues in a clear analysis of how he believes that we can make progress in the national health service and in providing services to patients in need.
We should place on record that everyone in this country owes an enormous debt of gratitude to blood donors. I am delighted that my hon. Friend is himself a donor. Every year, about 2 million people take significant time out from busy lives to give blood. Having enough blood in the NHS is vital. As my hon. Friend said, the supply is not endless, and we must be careful to use blood efficiently and effectively.
I am pleased that the National Blood Service currently meets all NHS demands for blood. There are occasional media claims to the contrary, and we hear scare stories about blood just as we do about other matters. There have been no emergency appeals for blood in England for the past three years, so we have managed to keep a position of balance, which is important.
The blood service is itself constantly looking for ways in which to improve the way in which it operates to ensure that it has the maximum amount of blood possible. It is not complacent, and it does not feel that because it has been successful so far, it can relax. It is making huge efforts to anticipate and deal with possible health challenges, including the unknown risk from variant Creutzfeldt-Jakob disease, which my hon. Friend mentioned.
There is a constant drive to maintain our blood stocks and to introduce new scientific developments to make blood safer and to provide options to the use of human blood. As science and technology develop, we are beginning to see some exciting alternatives. My officials told me about the possibility of bloodless surgery, an exciting prospect for the future that may become a reality.
The blood service is doing much to modernise the way in which it operates and to draw in as much blood as possible. In encouraging the public, it is trying to ensure that giving blood is not so time consuming, so that people do not have to wait for literally hours. When people go to give blood these days, they need to complete a fairly detailed questionnaire about their background. The blood service is trying to introduce a system of sending out the questionnaire to donors in advance so that they can complete it in advance. They can then give blood on arrival, perhaps in their lunch hour, and get back to work. That is an important improvement.
115WH We must ensure that we seek blood donors in the places where they are and at the hours and places that suit them, after work if necessary, in shopping centres, or wherever possible, to try to maximise the supply of blood in the service. That is crucial.
We are trying to make the best use of available blood by encouraging clinicians to use it only when strictly necessary. That involves changing clinical attitudes and behaviour and putting the issue higher up the agenda. We are considering the increased use of safe, clinically appropriate and effective alternatives, which my hon. Friend highlighted. These are the criteria by which we judge almost everything in the health service—whether things are safe, clinically effective and appropriate, and cost-effective. Examples include Erythropoietin and the use of iron supplements for treating anaemia, and the use of synthetics such as recombinant clotting factors for treating haemophiliacs. Whenever we can develop new ways of working as part of our modernisation and reform agenda, as my hon. Friend emphasised, it is crucial that we do so. Making a step change in progress such as he outlined is important.
We are trying to develop plans to tackle a possible reduction in donors following the introduction of CJD screening tests. We believe that the tests may be introduced in three to five years' time, so we have a little time in which to plan for that contingency. However, we are aware that there could be a dramatic reduction in donors, and robust plans need to be in place to meet that contingency.
The safety of the United Kingdom blood supply is maintained through independent regulatory systems and through audit. However, there is an element of risk in every medical treatment or intervention that involves blood. The serious hazards of transfusion team has conducted four major studies, which have demonstrated that blood transfusion in the UK is safe. It is becoming safer, due to improving technology and clinical audit, but further improvements can be made. It is important to ensure that patients receive top-quality services, and that maximum safety is achieved. All hon. Members will be aware of the tragedies that have befallen people because of infected blood products, and of their families' feelings of devastation. Therefore, we must ensure that blood is as safe as possible.
We have taken precautionary measures against the theoretical risk that vCJD can be transmitted through blood. I stress that that is a theoretical risk at present. The white cells are removed from all transfused blood by a process called leucodepletion, because the experts consider that CJD is most likely to be transmitted through the white cells. We no longer use plasma from the UK in the manufacture of blood products, to ensure maximum safety. These precautions have been reviewed by the Spongiform Encephalopathy Advisory Committee on several occasions, and it has concluded that no further precautionary measures are currently necessary to protect public health. However, we are continuing to look at other possible risk reduction measures with regard to CJD, in the light of new scientific developments and advice.
My hon. Friend asked whether everyone who has received donated blood will be disallowed from donating. A risk assessment is being conducted into 116WH that. No decisions have yet been made, but the Department has engaged an expert adviser to consider the risk assessment, and whether to exclude transfusion recipients from giving blood. If we were to decide to do that, it would be another precautionary measure, because we are dealing with a scientific area where we do not know what would be the case. However, we are guided by previous experience, and the last thing in the world that we want is for people to be affected by infected blood. I undertake to keep my hon. Friend informed about the outcome of that process.
We must make the best use of the blood that we have. A major conference, the better blood transfusion conference, was held in October 2001. Its goal was to set the priorities for making the best use of the resource.
Within the coming few months, we intend to issue an action plan for the NHS. It will adopt a patient-focused approach: we have tried to involve patients in the process, because it is important to consult those who receive blood, as well as clinicians and other professionals.
The action plan will probably include guidance for clinicians on assessing patients' treatment needs—including the use of their own blood—and information for patients about transfusion and its alternatives, so that they possess the knowledge to be able to make informed decisions. That is an important thread that runs through all of our reforms of the NHS. It is one of our priorities to try to empower patients by giving them sufficient information and skills to be able to have a mature partnership with clinicians in making decisions about what is best for them, with regard to their health care.
A new national blood transfusion committee has been established to study practice. My hon. Friend stated that he wanted the broadest possible cross-section of people to be involved in that committee, and I assure him that it has representation not only from the royal colleges, the scientific and professional bodies, clinicians and the National Blood Service, but from patients, but is directly linked to a network of regional committees and committees in hospital trusts, so it is informed by what is being practised in the NHS.
My hon. Friend has referred to his meeting with my right hon. Friend the Minister of State, Department of Health. Following that meeting and my hon. Friend's intervention, we have taken a fresh look at the remit of the committee, and we have made it explicit that it covers exploring and facilitating the implementation of methods to reduce the need for blood transfusions. We have made it clear that we are considering alternatives.
Three working parties are considering how we can ensure the most effective and efficient use of the blood that we have. They are considering the alternatives, too, including autologous transfusion, all forms of blood substitute therapies, and the feasibility of bloodless surgery units, as I mentioned. They are also working on contingency plans for prolonged periods of blood shortages. The groups are representative of a range of people, including surgeons, anaesthetists, nurses, paediatric experts, haematologists and patients. The recommendations of the groups will be considered by the committee later this year and will be promulgated across the service.
117WH On Erythropoietin or EPO, as I understand it is referred to colloquially, I am aware that evidence is growing that by maintaining the patient's haemoglobin at near-normal levels, EPO may improve some patients' response to treatment, especially radiotherapy. It can improve quality of life by making patients feel better and less tired. Tiredness is a problem for many patients with cancer. The drug is licensed for that purpose.
Clinicians are free to prescribe the drug when they think that it is beneficial to the patient. It is a core part of the NHS that clinicians should make appropriate decisions in the interests of their patients. There are on-going trials at the Christie and Royal Marsden hospitals on the use of EPO for cancer patients. I am sure that my hon. Friend will be interested in the results when they are available.
We in the Department of Health have considered the issue of using EPO more widely on cancer patients. We have tried to make some costings, as my hon. Friend has said. The costings put forward by those who would like EPO to be used more widely in the service include the number of bed days that could be saved as a result of patients being not transfused, but instead being injected with EPO. I urge caution on the subject because many patients who are occupying a bed for a transfusion are also receiving other services and treatments, and a direct substitution of EPO for a transfusion would then not necessarily result in saved bed days. Although my hon. Friend has raised an important issue, there would be no direct equation.
Cost is also an issue. Our estimate is that if all cancer patients—and EPO is not suitable for them all—received EPO, the cost would increase by four to eight times. That is an important issue for us to consider. I must say that the estimate makes some assumptions. 118WH There is limitation on existing data and there is no typical treatment regime for cancer patients, so there are some variables in the estimates.
§ Mr. Havard
Would the Minister make available that information, including what criteria were used and how that cost was calculated?
§ Ms Blears
It is early days for costing such developments. I am happy to involve my hon. Friend in the discussions, but this is a new subject for us, and we should be conscious of the range of variables.
It is possible for patients to self-administer Erythropoietin. That might result in some saving, but the patients would probably need a couple of out-patient visits in order to be trained and assessed. That is a complex issue, but it is interesting to explore it, and we will continue to do so.
I hope that the initiatives that I have outlined for maximising the blood supply—making the best clinically effective use of the blood that we have—and considering scientific alternatives add up to a coherent approach. We are trying to ensure that we not only get the best deal for the NHS but, more importantly, provide the right services for patients who can take advantage of emerging technologies.
We still have an immense amount of work to do to make sure that we are providing the best quality services, but that work is in hand. I am delighted that my hon. Friend has raised such important issues, and we shall return to them. I am grateful to him for his vigorous analysis. The passion with which he has presented his argument shows how enthusiastic he is that the NHS should survive and prosper.