Westminster Hall Sitting of 6 June 2000

Preamble
[SIR ALAN HASELHURST in the Chair]

Vaccine Damage Payment Scheme
Motion made, and Question proposed, That the sitting be now adjourned.—[Mr. Jamieson.]
10.30 am
Mr. Ian Stewart: Hon. Members will know that, since 1979, a child who has been severely damaged or disabled by vaccines has been able to claim a one-off vaccine damage payment from the vaccine damage payments unit in Lancaster street, Preston, which is now a branch of the Benefits Agency. The payment scheme covers the common childhood vaccines of diphtheria, tetanus, whooping cough, polio, measles, mumps, rubella and tuberculosis. Unlike most other social security benefits, the vaccine damage payment scheme has undergone no revision, upgrading or improvement since 1979. I stress from the outset that children who have been damaged by vaccines were born without impairment or disability. They have suffered what is, thankfully, a rare adverse reaction to a publicly promoted vaccine.
Although I am pleased to debate this issue again, I regret that it is necessary. When I initiated a previous Adjournment debate on this matter 18 months ago, the then Minister promised a Government review of the payment scheme early in the following year. There were two well-attended parliamentary lobbies on the matter in January and November 1999, and the affected families have scheduled another for 28 June. They have also handed in a petition to Downing street.
Representatives of the parents' organisations have met Ministers and there has been intermittent press interest, culminating in a welcome and sustained campaign by The Express to gain justice for vaccine victims. At a parliamentary level, the all-party group has continued to meet regularly and to Tabby Ministers. I thank all Members of Parliament who cannot be here today but who have sent messages expressing their continued support for the work of the all-party group.
I hope to find out when the Government's review of the vaccine damage payment scheme will be published and whether it will be a consultation document or will make positive recommendations. I know that good policy is not made on the hoof, but this one has been around the paddock too many times. I appreciate the complexity of the issue, which requires detailed investigation. I also appreciate the interdepartmental issues that are at the heart of the matter. The Government are rightly promoting vaccination to safeguard our health and to protect our children against disabling and fatal diseases. I support that policy, as do the parents' groups that are campaigning for better financial support for vaccine victims.
The vaccination programme works Some 18 months ago, I outlined the success of the whooping cough vaccine in drastically reducing the number of cases and deaths from the disease in the early 1990s, when the
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vaccine coverage rate reached 94 per cent. of the target population. The meningitis C vaccine is the most recent success. Full figures will not be available until later this year, but my hon. Friend the Under-Secretary of State for Health, the hon. Member for Pontefract and Castleford (Yvette Cooper), has said that anecdotal evidence suggests that between 80 and 95 per cent. of 15 to 17-year-olds have been immunised, with the uptake in babies being even higher. Yet it was reported last month in The Independent on Sunday that the Department of Health fears that a measles epidemic could be triggered by a drop in the immunisation rate to 88 per cent. of the population. That is all the more worrying, as I understand that the take-up rate for vaccination must be at least 85 per cent. of the eligible population to ensure the viability of the programme and proper public protection.
I know that some people in the Department of Health do not believe in vaccine damage. I was told in answer to a recent parliamentary question to the Department of Health that
a report of a particular suspected reaction does not necessarily mean that it has been caused by the vaccine. There is no evidence to support the suggestion of a causal link between any childhood vaccines recommended in the UK and death.—[Official Report, 15 May 2000; Vol. 350, c. 17W.]
The same Department of Health answer went on to inform me that 50 cases of children dying of suspected adverse reaction to routine vaccination were reported from 1990 to 1999.
Professor Gordon Stewart, an expert in the field, pointed out in a recent letter to me that
one of the main difficulties since 1974 is that the Department of Health, the Committee on the Safety of Medicines and now the Medical Control Agency have always denied that there is a problem or have related the problem only to the past.
The Government are therefore faced with a stark choice. Either they accept such medical advice and tell the parents honestly that they believe, with hindsight, that the Vaccine Damage Payments Act 1979 was misguided and that no further financial support will be forthcoming, or they accept that the Act was based on good medical science and recognise, 20 years later, that it is in urgent need of reform and improvement. Needless to say, my view and that of the all-party group is that they should take the latter course.
I believe that the Government will safeguard their vaccination programmes only if people know that there will be adequate support and compensation in the small number of cases where things go tragically wrong. All new parents, even the high-profile ones, have to make a fundamental decision about the vaccination of their children. I make these points, which are essentially directed to Health Ministers, to underline my commitment to the success of the vaccination programme, and I know that my hon. Friend the Minister will draw them to the attention of Government colleagues.
Let us be clear that we are not present to debate causation which, as far as I am concerned, was settled in the 1979 Act. My constituents Gary Hunt and Brendan Hanlon have a Government-issued trust deed that says that they have been damaged by vaccine. To date, they have received a derisory £10,000 each. Gary Hunt, who is 31 years of age, is profoundly mentally and physically handicapped. He is wheelchair-bound, cannot feed

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himself and cannot speak. He is doubly incontinent. Needless to say, he requires round-the-clock care, which he receives from his parents.
Brendan Hanlon is 39 years of age, but has the academic age of a child of less than two years old. He suffers from severe and unpredictable epileptic fits which all too often lead to physical injury. He, too, is cared for by his parents and close family. Both those families have received just £10,000 for responding in good faith to protect their child and to protect the rest of us in the wider community.
Other specific cases will no doubt be highlighted by other hon. Members. It is now way past the time for the wider community to discharge fully its responsibility to the victims and their families. I mention both the vaccine victims and their families because the families suffer greatly—this is a whole family issue. Parents have full-time responsibility for their sons and daughters for the whole of their lives, and relationships with partners and their other children can sometimes be adversely affected.
The Government should recognise the contribution made by those families. Had they not struggled on in the way that they have, significant extra strain would have been placed on already overstretched national health service resources. I and members of the all-party group for vaccine-damaged children want fair support and compensation for those children and their families and positive reforms of the vaccine damage payment scheme.
If prudence has been the Chancellor's hallmark, patience has been the hallmark of those parents. They have conducted their campaign for justice with extraordinary dignity, courage and forbearance. They have rightly felt anger, extreme frustration and desperation as politicians over the years have expressed sympathy with their cause but failed to deliver even when they had the power to do so. I hope that the Government will now do the right thing and deliver for vaccine victims.
Whatever heroic qualities the parents and carers may have—and they have many—they are not immortal. Since our previous debate, at least three parents of vaccine victims have died and yet another vaccine victim, Rachel Murray, has died at only 29 years of age. I can only imagine the devastation felt by her family, who are constituents of my hon. Friend the Member for Middlesbrough, South and Cleveland, East (Dr. Kumar). He cannot be here today because of constituency commitments, but he is an active supporter of the work of the all-party group. Again, I am sure that other hon. Members will want to highlight the specific cases of their constituents.
We know that the Government are currently undertaking a review of the 1979 Act, which, if I may take issue with The Express, is not a grubby payment scheme, although it is a restrictive and inadequate payment scheme. The Act established the Government's responsibility for vaccine victims. The scheme has not stood the test of time, but I believe that it was not designed to do so. The measure was devised to deliver urgently needed money to support vaccine victims. The general assumption of Jack Ashley, how Lord Ashley,
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and others was that it would provide an interim payment. The then Health Secretary, the late Lord Ennals, said that the payment would not
pre-empt decisions which the Government still have to take.
Sadly, the incoming Conservative Government insensitively and wrongly kicked those further decisions into touch. They did nothing to improve the scheme and managed only irregular upratings of the payment in 1985 and 1991. However, I was pleased to read in The Express that the hon. Member for Brentwood and Ongar (Mr. Pickles), the official Opposition spokesman on social security, 5 aid that the Conservative party
is very sympathetic to a generous and sensible settlement of this.
Good. That is a welcome development, which I hope will be confirmed today.
What is the scale of the issue? As of June 1998, a total of 890 payments had been made under the 1979 Act, from a total of 4,000 claims. Successive Governments since 1979 have acknowledged that almost 900 people were damaged by vaccines. The vast majority of the payments—795—were set at about £10,000. Claimants, of course, must meet a stringent 80 per cent. disability test before being eligible for an award under the Act. A person who is severely damaged by a vaccine and suffers a 70 per cent. impairment receives no payment because the disability does not meet the 80 per cent. threshold. There is no justice in such a system.
Parents' groups have raised other issues relating to vaccine damage. They believe that the number of victims is higher than the official figures that I have given. There is concern about clinical trials that allegedly took place between 1948 and 1956. It has been alleged that children suffered severe brain damage or even died during the trials and that their parents were not aware that the children were part of such clinical trials. There is also considerable concern about children who might have been damaged by vaccine but who are denied a payment under the Act as their medical records have been mislaid. Such matters are for investigation; I do not intend to pursue them today. The focus of the debate is rightly on the Government's review of the 1979 vaccine damage payment scheme.
What do we want from the Government's review? To summarise, the proposals put to the Government by the parents' groups include a substantial lump-sump payment and the payment of a severe disability pension analogous to war pensions and industrial injury pensions. They want recognition that the longest-suffering children and families have had the most expense and the least help. Further, they want the 80 per cent. disability rule tapered and the removal of the six-year time limit during which claims must be made.
The groups have also asked for the pharmaceutical industry to contribute towards additional funding. The Government have pursued the matter with the industry and parents are grateful for that as, by so doing, the Government have shown that they accept that vaccine victims constitute a special case. The response from the pharmaceutical industry has been negative. I appreciate the economic realities of taxing or levying vaccine manufacturers under a publicly funded health system. However, a spark of compassion and a measure of generosity on the part of the industry and its well-paid chief executives would have been welcomed.

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As The Express noted, SmithKline Beecham, one of the world's largest vaccine manufacturers, had worldwide sales of vaccines worth £780 million last year. Diageo has recently announced additional money for the fund for thalidomide victims to ensure that the fund is inflation proofed. Celebrity criticism and the firm's concerns of the impact that that would have on its Guinness beer market no doubt prompted that action. Parents of vaccine victims could perhaps learn lessons here. The industry should take note that this is not the end.
However, it is now clear that any additional funding at present will be from public sources. Ministers have in the past said that additional funding—most specifically, compensation—is a matter to be pursued in the courts. I recently received a letter from the chief executive of the Legal Services Commission, which was previously known as the Legal Aid Board, informing me that as, of 1 April, it was likely to be able to fund claims on behalf of vaccine-damaged children and adults if there was a significant wider public interest, such as concern about the general safety of a widely available vaccine, and if not only the individual claimant would benefit.
By contrast, a typical individual claim relating to negligence by vaccination in the face of a contraindication or adverse reaction would not be funded, although it could be pursued privately under the conditional fee arrangement for legal aid. However, legal aid has already supported extensive litigation in relation to the pertussis vaccine, which was unsuccessful. The outstanding legal aid certificates for pertussis vaccine victims relate mainly to cases in which the vaccine was given after an adverse reaction to the first dose.
Families do not want and should not be forced to pursue the legal lottery that I have described under such restrictions. Additional public funding for vaccine victims is justifiable and necessary. In December 1998, I pointed out that it would cost only £79.5 million for all the children who received the original £10,000 to receive £100,000. I assume, therefore, that £200,000 each would cost about £160 million and that £300,000 per child would cost around £240 million.
My arithmetic tells me that the lowest level of £100,000 could have been funded by the additional monies vired since the beginning of the year to prop up that large plastic tent down the river. We should remind ourselves that an additional £55 million was released in February and a further £30 million last month. We sometimes need spectacle in our lives, but we need always to secure the health of the nation and to accept the responsibilities that result when accidents happen.
We must get our priorities right and do the right thing. Above all, we need a resolution to the matter now. Every Minister whom I have met to date has been sympathetic to the plight of vaccine victims and their families. The all-party group for vaccine-damaged children has requested a joint meeting with the Secretaries of State for Health and for Social Security. If we do not obtain satisfaction there, we shall he knocking on the door of 10 Downing street. Before that happens, will the Minister confirm whether his Department has requested or will request that the Treasury provide increased and adequate funds for the vaccine damage payment scheme?
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In 1986, my right hon. Friend the Chancellor of the Exchequer said that the vaccine damage payment scheme was grossly inadequate for a lifetime of severe disability. He was right then. He can act now. In 1979, the late Lord Ennals, answering an hon. Member who expressed dismay that the £10.000 payment was not larger, said:
This is not saying, "This is the end. We are wiping the slate clean".—[Official Report, 9 May 1979; Vol. 949, c. 980.]
Unfortunately, the commitment given by Lord Ennals has yet to be met. I hope that the Government will give the House a commitment to finish the business that the previous Labour Government rightly got under way and publish their review of the 1979 vaccine damage payment scheme by the end of July.
Parents are weary and uncertain. They and their sons and daughters deserve a conclusion to their campaign and a full, final and positive settlement now.
10.25 am
Mr. Tony Baldry: I hope that the support of all hon. Members for everything that the hon. Member for Eccles (Mr. Stewart) said is clear. We fully support his approach to the Minister and to Treasury Ministers.
As a student, I worked as a gardener for the local hospital. One of the nursing homes had formerly been an isolation clinic for teenage sufferers of tuberculosis. Among the stinging nettles in the wilder parts of the ground the old mortuary building remained. However many years passed, that place still smelt of death. As I scythed the poppies and the long grass, I used to think how terrible it was that so many children and young men and women had been cut down randomly by tuberculosis.
I visited a secondary school in Banbury the other day and asked a group of sixth formers what they understood by the initials TB. Not one associated them with tuberculosis. Why should they? To all intents and purposes, thanks to advances in medical science and to mass immunisation campaigns, TB has effectively been eradicated in the United Kingdom—likewise, polio and several other diseases that had hitherto killed, or blighted the lives of, many children. I suspect that many of us know people older than us, who were born before the possibility of inoculation against polio, who contracted it as children and survived but were in some way scarred for life.
Mass vaccination programmes have brought about amazing advances in public health and, over the past 50 or so years, in the reduction of infant mortality rates. To be effective, mass vaccination campaigns require the overwhelming majority of parents to ensure, as a matter of course, that their children are inoculated. A take-up rate of at least 85 per cent. is needed for their success, but it has become apparent over the years that, although they have brought enormous benefit to many, they have left a tiny few severely damaged—physically, mentally or both.
I do not believe that any Minister, civil servant or doctor genuinely believes that the children whom we are considering this morning have received their severe afflictions in any way other than as a consequence of vaccine damage. Suggestions that those children would have experienced mental or physical handicap quite

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independently of their involvement in the campaign of mass vaccination are offensive and are not borne out by the facts. Nor is there evidence to suggest that the injuries have necessarily come about as a consequence of negligence on the part of the drugs companies manufacturing the vaccines. I do not believe that any Minister, properly informed civil servant or public health official believes that the argument can be sustained that the children were damaged by medical negligence. The simple, straightforward, inescapable fact is that in mass vaccination campaigns, such as those for measles, mumps and rubella or for polio, statistically a tiny percentage of children will, it appears, experience adverse consequences that could not have been predicted, and which will be devastating for them and their parents for the rest of their lives.
It is in the interest of the totality of the community—the public good or the commonwealth—that the relevant vaccinations should be taken up by the overwhelming majority of parents and should thus succeed. The consequence, as night follows day, is that we—society, the state or the commonwealth—should properly compensate, support and indemnify the children who tragically are not, in the event, protected by such mass vaccination but severely injured and damaged. I suspect that most, if not all, hon. Members taking part in the debate have a constituent or constituents who, sadly, fall into that group and whose parents have been battling for some time to ensure financial support for their children. A young constituent of mine, Hamish Thompson, who is now aged two, contracted paralytic poliomyelitis 10 days after receiving his polio vaccine in December 1997.
I note that the issue of proof of causation often arose in debates in the House on the Vaccine Damage Payments Act 1979. Ministers tend to suggest that there is no proof that the vaccine has directly caused the recipient's condition, as it is difficult to prove the link between brain damage and the whooping cough and measles, mumps and rubella vaccines.
Hamish had what is known in the medical world as vaccine-associated paralytic poliomyelitis; the strain of the polio virus isolated in his stools matched that of the virus and there is total scientific proof that he contracted his polio as a direct result of being administered the polio vaccine. As of January 2000, the United States of America stopped using the live polio vaccine because of the risk of contracting polio from it: the inactive polio vaccine is just as effective and does not carry the same risk. To provide the best possible immunity against polio, it is suggested that people are given two doses of the inactive IPP vaccine and one dose of the oral vaccine. The first two doses are administered by injection and provide immunity to the body, while the third dose provides gut immunity, thus maintaining the immunity benefit to society.
We know that young babies such as Hamish have suffered from the polio vaccine. Is it still the Department of Health's advice that polio vaccine should be administered in the way in which it was administered to Hamish?
Hamish was awarded a £40,000 vaccine damage payment a few weeks ago. Objectively, that might seem a lot of money, but, as a member of the Bar who has
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done a fair amount of personal injuries work, I know that that is a pittance compared to the compensation that he would properly have received if the matter had been assessed by a High Court judge. For a child of two who, as the hon. Member for Eccles said, must by definition be 80 per cent. damaged to receive any compensation and who will require nursing, care and support for the rest of his life, £40,000 is an insult. Much of that has already been spent on settling debts incurred in trying to provide a reasonable standard of nursing care for Hamish.
I fully support what the hon. Member for Eccles has proposed, but this is a simple matter; only a tiny number of children are involved. There should be a no-blame scheme, under which a High Court judge would assess their needs, as he would if negligence had been proved. A High Court judge or a court can objectively determine fair and proper compensation, having regard to the severity of the medical condition, life expectancy and all the other matters that are normally taken into account in personal injury cases.
It is a diabolical shame when a child is damaged by a Government campaign, and is then told by the same Government health service that he cannot have the equipment that he needs as there is a funding problem and should instead start to beg from charities to raise the funds. An inelegant pass-the-parcel has been going on between Whitehall Departments. The Department of Health seems to have tried to shuffle responsibility on to the Department of Social Security, the Department of Social Security has tried to shuffle responsibility on to the Department of Health and the two Departments have tried to shuffle responsibility on to the pharmaceutical industry. The whole House says, "Enough".
The time for passing the parcel on this policy must come to an end; the Government must collectively sort the matter out. Parents such as Mr. and Mrs. Thompson have been incredibly patient and long-suffering, but they and many others are entitled to know that they and their children will receive the financial support necessary to maintain them in the future. It is time for the Government to act. If they will not or do not act, that will be a scandal.
10.34 am
Mr. Tom Clarke: I warmly congratulate my hon. Friend the Member for Eccles (Mr. Stewart) on his excellent and well-informed speech and on his marvellous leadership of the all-party group for vaccine-damaged children. I wish him well in all the activities that he is pursuing. Indeed, the case that he presented was so comprehensive that we could almost have finished the debate at that point and gone home. I feel almost apologetic to be taking up hon. Members' time, and I do so only to add my support, for what it is worth, to the comments made by my hon. Friend and by the hon. Member for Banbury (Mr. Baldry).
I disagreed with the hon. Member for Banbury on only one point. I believe that the pharmaceutical industry has a responsibility, and is in a strong position to join us in appealing to the Government to move forward more quickly if they will accept the responsibility to do so. However, I agree with him that the game of pass-the-parcel to which he referred should come to an end.

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I hope that hon. Members will forgive me if, in adding my support to the splendid plea made this morning by my hon. Friend, I thank the Minister in anticipation for his reply and for the work that he is doing, because he has met me to discuss the case to which I shall refer. My hon. Friend the Member for Eccles and I both know how much a Minister is free to say. We are also aware of the colossal influence that the Treasury has on these matters. If the Treasury is following our debate, I hope that it will accept our plea that it is time to move on, and to loosen the purse strings. We cannot achieve even the minimum objectives that parents rightly demand unless the Treasury accepts that reality.
I should like to refer to the constituency case that I discussed with my hon. Friend the Minister, and to declare straight away that it is a family case. I refer to it—having spoken to the mother of my nephew and godson, Anthony Clarke, on Sunday—not only because this debate has implications for his case but because, as his mother reminded me, if we make progress for Anthony, we can make progress for other people as well. She said that she knows what other parents are going through. I can say with great humility, from my knowledge of the family, that Sadie is an absolute heroine.
Anthony was born in 1966; he is now 34 years old. There are two other younger children, now adult young women. My late brother, Robert, was killed in a car crash in 1973, when Anthony was seven. By that time, it was obvious that Anthony was profoundly mentally and physically disabled, and required 24-hour attention and a great deal of other support. It saddens me that local authorities have come under a great deal of criticism. A few weeks ago, when Anthony's mother was told that his respite care was being cut from eight weeks to four, she did not blame the local authority. I do not blame it, but I say to the Treasury, as I recall my background in local government, that we must examine our perspectives on these matters.
It will be helpful to the cause that my hon. Friend seeks so admirably to promote if I refer specifically to this case. I shall quote from a letter from the Benefits Agency to my sister-in-law, dated 30 July 1999, because it encapsulates many of the points that my hon. Friend made in his speech, and many of the demands that the various groups and parents involved in this issue are making. In response to my sister-in-law's letter of 14 July 1999, it stated:
In your letter you have asked for a further appeal because Anthony's condition has deteriorated. Under the 1979 Vaccine Damage Payments Act you can either request a reconsideration of the original decision within six years of the decision being made or ask for a review of the original decision by the Independent Tribunal Service. Because it is over six years since the original decision was made—
I remind hon. Members that Anthony is now 34—
it is no longer possible to request a reconsideration. As regards a review of the Independent Tribunal Service, you are only entitled to one review. Because you had a review in 1981 it is not possible to ask for another one. Furthermore, under the Vaccine Damage Payments Act, there is no provision for appeals.
It is with regret, therefore, that I have to inform you that I cannot accept your request for an appeal. Furthermore, there is no other means of changing the original decision.
The mother and family of this young man have undergone many pressures. Since the 1979 Act, we have learned a great deal more about the circumstances that
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lead to such conditions and the demands on families who are trying to cope with them. There is a great will among Members of Parliament to do something about that. In many cases, parents become ill and less able to cope as they get older. They need the kind of recognition that my hon. Friend the Member for Eccles seeks.
Before I conclude, I should like to re-emphasise three points that my hon. Friend made. First, it is manifestly absurd to stick to the 80 per cent. condition, because that assumes that it is less difficult for the parents of a child who has a 79 per cent. acceptance to cope with the situation than it is for those of a child who has an 81 per cent. acceptance. The arguments in favour of the taper are therefore overwhelming.
Secondly, despite all the facts that have been made available, there should be more research into ways of dealing with these matters. I passionately believe that the pharmaceutical industry has a role to play in that.
Thirdly, we should consider what is happening in other countries, because we can learn a great deal from them. I hope that the time will come when they look to us as a model for the treatment of the condition and its consequences for children and their parents.
I congratulate my hon. Friend on his success in securing the debate, and on his contribution to it, and wish him God speed in everything that he seeks to achieve. As many of us know from cases in our constituencies, such situations can be tragic for families and friends. If the debate has at least offered some aspect of healing and hope, it will have achieved a great deal.
10.43 am
Mr. David Chidgey: I, too, congratulate the hon. Member for Eccles (Mr. Stewart) on the way in which he led the debate and on the way in which he has, over many months, led the campaign. I lend him all my support.
In common with many hon. Members, I have examples of such tragedies in my constituency. I should especially like to mention Roy and Jean Stokes and their son Keith. Keith suffered severe brain damage as a result of a vaccination when he was a baby. As in many such cases, he is now in his late 30s, but remains at the mental age of an infant. We have heard dramatic descriptions of what that means to parents.
I am pleased to mention Roy Stokes because, for more than 35 years, he has been a leading campaigner on behalf of parents throughout the country who are trying to get justice for their children. As a Member of Parliament, I feel shame that, during that period, nothing was done—regardless of which party was in power—to address seriously the injustices that parents have suffered. The Labour party promised much in its pre-election pledges, and we were all hopeful. However, it is now time to deliver; the Minister should realise that.
The hon. Member for Eccles mentioned the compensation that was offered by the Government of Lord Callaghan. The Vaccine Damage Payments Act 1979 came into force as a result of the report produced by the Pearson commission, which was accepted by everyone as a fair interpretation of the situation. The payment of £10,000 was to be an interim payment, not the end of the affair.
The hon. Gentleman mentioned the deed of trust. I have a copy of Roy Stokes's deed of trust, which states clearly that

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the Secretary of State is satisfied that Keith Roy Stokes—
the son—
was born … disabled as a result of vaccination and is about to make a payment of £10,000 to the First Trustees to hold on the trust.
There is the statement. There is no question that there is any reason other than vaccination for the child being so severely disabled. As the Pearson commission said, there should be, in cases involving severe brain damage, a right to court judgment and to just and appropriate compensation. That was 25 or more years ago, but nothing of any substance has happened since. The ensuing Governments must recognise that, to their eternal shame, they have not grasped the issue. They have ignored the key issues and have changed the rules.
I shall illustrate what I mean by changing the rules. How can a logical mind accept the view that a child who is brain damaged by vaccine should be treated the same as a child who is born with brain damage? There is a world of difference between a tragic accident of nature and the effects of a vaccination programme for which, as Governments know, it is a statistical certainty that there will be casualties, even if the health of the nation as a whole will be improved. More importantly, parents also know that there will be casualties, which might explain why take-up rates are falling. That worries those of us who are concerned about the health of the nation.
It is important that parents know that, if they are unfortunate enough to suffer this tragedy, they will get just compensation. Over the past few years, the confidence of parents that they will be supported if there is an accident has been eroded. It is not acceptable to offer the normal social services support packages, as if the children had suffered natural damage. We all know the hoops and hurdles that people must navigate to win what should be theirs as of right. Often, there is means testing, or the funds in local authority budgets are curtailed. That is an almost bestial way to approach the problem. We are supposed to be a civilised society, in which people in need are cared for. We should be able to take pride in the fact that, in our society, such people are not left wanting, through no fault of their own.
We should follow the examples provided by other countries, where parents have received compensation adequate to allow them to ensure that their children are properly cared for. We need to reassure parents, who are offering their babies for vaccination for the public good, that they will be compensated with sufficient funds to help them cope with the burden of a lifetime of caring, if something goes tragically wrong.
I would like to draw attention to the five key points made by the Association of Parents of Vaccine Damaged Children. First, we should take the Pearson report off the shelf, dust it down and, 20 years on, establish what to make of it. It makes some very good points. Secondly, we should consider awarding a lump sum in accordance with what would be achieved in the courts. Thirdly, we could pay a lump sum to top up existing allowances, but that must be additional to, and not a substitute for, local authority services. Fourthly, we could set up a special fund through the pharmaceutical industry. If that worked in the thalidomide case, why should not it work for vaccine damage? I see no difference between the two cases.
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Fifthly, the exceptionally severe disability payment pension could be paid to children, which would take the burden off parents.
The Government have a chance to act, and they should take it. They should also recognise that the cost of supporting causalities in a vaccine programme should be costed into that programme—it should be part of the package. We need to live in the real world.
Finally, I return to my constituents, Roy and Jean Stokes, who are now in their seventies and who have given a lifetime of care to their son, Keith. One can only begin to imagine how that affected their quality of life, although they gave willingly and lovingly. As they grow older and more infirm, they are less able to support their son. However, rather than getting extra help, the fact that they are in their seventies means that they have lost their marriage allowance and their carers allowance. Roy's pension is also now taxable, which leaves them £3,000 a year worse off. That is, frankly, a disgrace.
10.51 am
Dr. Peter Brand: I join others in congratulating the hon. Member for Eccles (Mr. Stewart) on securing this debate. Powerful speeches have been made today and were made on 2 December 1998. There is a sense of déjà vu about today's debate—the review that was promised in 1998 has still not taken place.
I am glad that the Under-Secretary of State for Social Security, the hon. Member for City of York (Mr. Bayley), will respond to our debate. My hon. Friend the Member for Eastleigh (Mr. Chidgey) pointed out that this matter involves not only benefit payments but public health, so it might have been more appropriate if the Minister for Public Health had been present to respond. Unless we ensure that there is confidence in the immunisation system, take-up will drop. The imminent measles epidemic which has been predicted for parts of Europe may be relevant in this context.
The hon. Member for Banbury (Mr. Baldry) made a powerful speech, but I disagree with him—TB has not been eradicated. One of the lessons that we have to learn is that such diseases are always around. We must remain vigilant and find the best form of protection for the wider community. However, if we are to do that, we must compensate those individuals who have suffered from, or whose condition is linked to, receiving a vaccination.
As a medical practitioner, I cannot be certain in every case I see that there is a distinct causal link when a person becomes ill after an immunisation. However, one must give the benefit of the doubt to anyone who had a perfectly nice, normal baby who became ill after a course of immunisation. There are conditions that do not show themselves until a baby is about three months old, which is the age when immunisations are usually offered. To have the population's confidence, we need to protect our society at large.
Frankly, this matter should not be left to the pharmaceutical industry. In this area, there is not a competitive market. Selected manufacturers are chosen by the Department of Health to supply a vaccine, and it is that Department and the state that should take responsibility.

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I am wary of the Department of Health's statement that the vaccines are safe—it has maintained that for many years. At the same time, it is encouraging research into newer, safer vaccines. If a safe vaccine already exists, why are we conducting research into newer, safer ones? As with the 1979 Act, that is an admission of a link; it admits that a small number of people run a statistical risk of suffering the devastating consequences of immunisation.
The willingness of successive Governments to allow people to litigate against deliverers or producers of the vaccine has not proved particularly helpful, and runs against a desire to protect the community. Manufacturers are being restricted and are increasing the number of contraindications. For example, it is nonsense to regard a history of epilepsy as a contraindicator to giving vaccine, but should a condition worsen after vaccination the manufacturer could be sued. That illustrates the need for some form of no-fault compensation, to which the hon. Member for Banbury referred.
The right hon. Member for Coatbridge and Chryston (Mr. Clarke) illustrated clearly why the 1979 Act is failing older people. I, too, have a number of constituents whose parents are elderly and can no longer cope, and they need to know that the work that they have carried out devotedly for 30 or 40 years will be continued. The hon. Member for Eccles said that nothing has changed since 1979, but the initial payment, which was understood to be an interim payment, has become a final payment. The 1979 Act acknowledged that some people carry an extra burden. Such people are owed a review, and it is our collective responsibility to do something about this issue.
I do not want to have to participate in yet another debate on this issue in 18 months' time. The Government cannot keep shirking their responsibility, and they certainly should riot pass responsibility to the pharmaceutical industry or the courts.
10.57 am
Mr. Eric Pickles: This is the second time that I have contributed to a vaccine damage debate initiated by the hon. Member for Eccles (Mr. Stewart). It is clearly a subject about which he feels passionately and, once again, he has spoken most powerfully. However, his language was simple and unemotional, and his argument was the more powerful for that.
Hon. Members have spoken eloquently on this issue today. The right hon. Member for Coatbridge and Chryston (Mr. Clarke) neatly illustrated that it is not only children who have been damaged by vaccines, but adults. He also mentioned carers. Carers who have been dealing with such problems for many decades are no longer able to provide the same level of personal care that was provided previously. There is a duty on the House and the Government's shoulders to find a solution to the problem.
As hon. Members have said, the previous debate on this subject took place on 2 December 1998, which was a significant date. There was a certain amount of excitement about compensation for vaccine damage and a feeling that an announcement from the Government was imminent. The Government made several promises.
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The hon. Member for Eccles described it as a run around the paddock, so let me make it clear what that run involved.
On 23 June, in the First Standing Committee on Delegated Legislation, the then Minister of State referred to
the vaccine damage payment scheme being considered as part of the welfare review.—[Official Report, First Standing Committee on Delegated Legislation, 23 June 1998; c. 3.]
Shortly before that debate, in a written answer on 2 November, Baroness Hollis said in the other place that
an announcement will be made in due course.—[Official Report, House of Lords, 2 November 1998; Vol. 594, c. 28W.]
In replying to the debate on 2 December, the then Minister of State said that the Under-Secretary of State for Social Security
hopes to conclude our review early in the new year.—[Official Report, 2 December 1998; Vol. 321, c. 817.]
That was 1999. Early that year, on 27 April, Baroness Hollis said that
an announcement will be made as soon as possible.—[Official Report, House of Lords, 27 April 1999; Vol. 600, c. 26W.]
We heard recently from the Minister that the Government are examining the feasibility of setting up a fund to provide help for people who have suffered vaccine damage. That seems to represent a slight pulling back in that the Government are no longer saying that they will do something as soon as possible; they are just looking into the matter. I agree with the hon. Member for Eccles that we should try to ensure that the review is concluded by July at the latest. We know from the newspapers that negotiations between the Government and drugs companies seem to have broken down. It would be helpful if the Minister would take the Chamber into his confidence and tell us a little about the progress of those negotiations.
There are good reasons why we should reach a decision reasonably quickly. Every time the story raises its head and every time it receives news coverage, fears are raised among parents about the immunisation programme and this may cause some people not to have their children vaccinated. Of course, most newspaper coverage has been serious and sensible but, regrettably, some has been sensational. My godson is of an age to receive immunisation. I know that his parents have genuine worries and there is a niggling doubt at the back of their minds about whether the process is sensible.
As hon. Members have said, the public vaccination programme has been a great success. I look around Westminster Hall and, with the exception of one or two senior and distinguished hon. Members, I see that we are all of much the same age, an age that benefited from the vaccination programme. When I was a child, there were 157,000 cases of whooping cough a year, of which 300 resulted in death. Now, 40 years later, there is, fortunately and pleasingly, only one death a year. Those childhood illnesses killed many and denied many children the opportunity to develop a happy and successful life. The vaccination programme has enabled many children to live, and many of us perhaps owe our existence to it.

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As the then Minister of State, the hon. Member for Southampton, Itchen (Mr. Denham), said in reply to the last debate,
No child in England and Wales has died from acute measles-related illness since 1992. All those figures establish that the immunisation programme provides benefits not only to society as a whole but to the individual and his or her family.—[Official Report, 2 December 1998; Vol. 321, c. 816.]
There cannot be a better illustration of the need for vaccination programmes than tuberculosis, to which my hon. Friend the Member for Banbury (Mr. Baldry) and the hon. Member for Isle of Wight (Dr. Brand) referred. As you may know, Mr. Deputy Speaker, there is an acute shortage of the tuberculosis vaccine, and there is a backlog in the school immunisation programme which can cause delays of up to two years in our schools. A comparison of last year's figures with those of 1970 is unsurprising in the light of that shortage. In 1970, 1,901 cases of tuberculosis were reported; last year, 6,144 were reported. If ever there was an illustration of the need for a vaccination programme, surely it is tuberculosis.
There is a further reason why we should solve the problem. Vaccination policy is there in the public interest; it saves lives. However, any mass vaccination programme involves a risk—it may be slight, but it is a risk nevertheless. Mr. Mike Watson, the medical director of Aventis Pasteur, which distributes vaccines, said:
There is a quantifiable risk, even though it is tiny, so you should have a scheme in place to compensate people—
the people who suffer from vaccine damage. In the United States, the vaccine companies contribute to a central fund.
Parliament, the Department of Health and the Department of Social Security say that parents should immunise their children, because the argument in favour of doing so is overwhelming. We advance that argument in the full and certain knowledge that accidents will occur and that the victims are victims for the common good. Those people deserve our protection, and it is the protection of compensation that the House should offer.
Two principal changes, to which hon. Members have already referred, can be made. First, good and compelling arguments suggest that there should be a sliding scale below the 80 per cent. disability limit, although that rule is common to most methods of calculating disability. Secondly, it is argued that the six-year rule for making a claim, which involves a cut-off point, is too restrictive and should be abandoned. Those arguments were addressed by Ministers on two recent occasions in the Chamber and in another place. On 29 June, when she introduced uprating, Baroness Hollis said:
Fixing the extent of disablement at 80 per cent. or more was based on a well-established social security principle assessed for the purposes of section 57 of the Social Security Act 1975. In fact, it is the same basis as the industrial injuries benefits scheme and the 80 per cent. threshold reads across the severe disablement allowance. So it is a fairly standard measure for disability.—[Official Report, House of Lords, 29 June 1998; Vol. 590, c. 509.]
On 2 December 1998, in response to points about the six-year rule, the then Minister of State for Health said:
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Marginal changes in the time limit would not assist in the overwhelming majority of cases. The substantial length of the process would make obtaining medical and other relevant evidence after long periods increasingly difficult.—[Official Report, 2 December 1998; Vol. 321, c. 816.]
I believe that those views are wrong in two important respects, which have been addressed by hon. Members this morning. The difference is that the 80 per cent. disability rule has been engendered by the state on its own behalf and is part of the immunisation process of which some people are victims. The suggestion that the rule makes no difference belies the fact that appeals and applications are turned down. An average of 73 per cent. of cases have been turned down each year since 1992 because applications have been made more than six years after vaccination.
One point that my hon. Friend the Member for Banbury made about the 80 per cent. rule needs to be emphasised. The 80 per cent. disability must relate to vaccine damage. An application from a person who, in the opinion of the assessors, is 70 per cent. disabled through vaccine damage and 10 per cent. disabled through another cause would fail. That makes no sense.
I disagree with the hon. Member for Isle of Wight, who said that it was a pity that the Minister for Public Health is not present. I have every confidence in the Under-Secretary with regard to the settlement of the case—he does not share the views of hon. Members mentioned previously. We know that he wishes to see an end to the 80 per cent. rule and to the six-year period because he was a signatory to two early-day motions—one on 16 April 1996 and another on 23 May 1994.
People sometimes sign early-day motions that come back to haunt them, but that is not the case here. The Under-Secretary signed both motions and was not isolated in doing so. More than 300 signatures were gained. The Minister of State for Social Security signed one of the motions. His colleagues, the parliamentary private secretaries in the Department of Social Security and the Whip responsible for that Department, signed. If the hon. Member for Eccles is right to say that the argument is between officials and politicians, the weight of the political argument lies in the Department. Everyone signed the early-day motions, with the exception of the present Secretary of State, who no doubt was precluded from signing because of his position then as a member of the shadow Cabinet. The entire Department—possibly with the exception of Ministers serving in another place—are behind ending the 80 per cent. limit and the six-year rule. I have no doubt that the Under-Secretary will make clear the way in which it is intended to end them.
The matter should not become political. However, politics enter the question of what is in a Government's programme. I want to make it absolutely clear that, if the Government seek to amend the Act or to make the necessary changes by secondary legislation, Opposition Members promise to do everything in their power to co-operate and to work towards a speedy resolution of the case.
11.13 am
The Parliamentary Under-Secretary of State for Social Security (Mr. Hugh Bayley): I congratulate my hon. Friend the Member for Eccles (Mr. Stewart) on securing the debate, which is important not only for

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those who have received vaccine damage payments but for their parents, families and carers. Many of us have constituents who must contend daily with the difficult circumstances of caring for a severely disabled child or, too often now, a severely disabled adult. I pay tribute to the relentless devotion of the families to their children, and to the tenacity of their campaigns to establish a vaccine damage payment scheme in the 1970s and to have that reviewed.
I also pay tribute to my hon. Friend the Member for Eccles for his constructive and helpful role—which has not always been comfortable for me as a Social Security Minister—in leading the all-party group on vaccine damage. His speech reflected his depth of feeling on the issue and his sensitivity towards the families involved. I congratulate other hon. Members who, for many years, have tried to bring the matter to the attention of the House.
I shall begin by responding to specific points. The hon. Member for Banbury (Mr. Baldry) mentioned the case of his constituent, Hamish Thompson. There is medical evidence of a causal link between polio vaccine and injury, which I shall address in more detail if I have time. The hon. Gentleman asked whether it remains Department of Health policy to administer polio vaccine in the way in which it was given to his constituent. The Department of Health programme is based on advice from the Joint Committee on Vaccination and Immunisation. It continues to recommend oral polio vaccine for the United Kingdom. The situation in the United States is different. The whole of the Americas, from Baffin island in Canada to the tip of Chile, is declared free of polio, which is not the case in our hemisphere.
I differ from the hon. Gentleman on one point: the policy has not been subject to a game of pass-the-parcel between Departments—certainly not by this Government. Departments have worked closely together. Indeed, I have worked with colleagues in the Department of Health and other Departments. I do not want to make this a party political issue, but if there was a time when Departments tried to duck their responsibility, it was in the 18 years of the Conservative party's Administration when. despite requests for a review, none took place.
My right hon. Friend the Member for Coatbridge and Chryston (Mr. Clarke) has discussed his nephew's case with me. I acknowledge and congratulate him on his role as a long-standing and committed campaigner for all disabled people, not just members of his family. Indeed, he has outlined the Labour party's policies to disability groups in my constituency. He graphically explained how the six-year time limit restricts the ability of his nephew to receive further consideration of his case. I assure him that the review is addressing that issue, and the Government's views will be made known when it is published.
The hon. Member for Isle of Wight (Dr. Brand) made several points on the medical benefits and risks of vaccination. I agree with much of what he said. He asked whether the initial vaccine damage payment scheme was envisaged as being an interim scheme. It was not. At Second Reading of the Vaccine Damage Payments Bill, the Opposition spokesman, Patrick Jenkin, said to the Secretary of State, the late Lord Ennals:
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I do not think that at any stage has the right hon. Gentleman used the phrase "an interim payment" … the right hon. Gentleman has been extremely careful at no stage ever to use that expression. —[Official Report, 5 February 1979; Vol. 962, c. 69.]
David Ennals's reply was "Quite right." In Committee he said that he had never looked on the Bill as an interim measure.
Mr. Stewart: How can the late Lord Ennals's statement that the issue was not at an end be squared with the statement that the payment was not an interim measure?
Mr. Bayley: I cannot, of course, speak for the Secretary of State 20 years ago, but I imagine that he had in mind the many and varied recommendations of the Pearson report. It dealt with people damaged by vaccine and there was a recommendation on vaccine damage, but it was a much wider-ranging royal commission, and the debate concerned the wider issue. It was made clear during the passage of the Vaccine Damage Payments Act 1979 that there would be a response at some point to wider issues raised by the Pearson committee.
It might help my hon. Friend and hon. Members if I said something about the background to the review of the vaccine damage payment scheme announced by the Government. Of course, through the 18 years when the Conservatives were in power, parents pressed for a review of the scheme. Shortly after the general election, Labour Ministers were approached both by the organisations campaigning on the victims' behalf and by the newly formed all-party group. On 19 May 1998, my right hon. Friend Baroness Hollis announced that a review would be undertaken in consultation with the Department of Health as part of the Government's welfare review programme. During the review, several meetings have taken place between Ministers and members of the all-party group. On occasion, they have been attended by members of the parents' groups, who have powerfully and movingly made their case to me and to others.
The parents' groups want several changes and not all have made the same points. However, they want five principle issues to be dealt with: the abolition of a six-year time limit; a reduction in the 80 per cent. disability threshold and/or its replacement with a sliding-scale basis for vaccine damage payment awards; an additional lump sum for previous recipients of vaccine damage payments; a specific on-going benefit for those damaged following vaccination; and a contribution from the pharmaceutical industry towards the support of those damaged by vaccines. They have also raised questions about vaccination incentive payments and the promotion of vaccines.
To return to the origins of the scheme, after a campaign by parents in the 1970s an extra-statutory scheme was begun in May 1978 and the Bill relating to the present statutory scheme was introduced in February 1979. That provided for a lump sum for people severely damaged as a result of vaccination under a routine public vaccination programme. I have read carefully the Hansard reports of debates on the Floor of the House and in Committee and perhaps I should pay tribute to three people. One is Rosemary Fox, who was cited time after time in those debates as a parent and campaigner who brought the issue to the attention of

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Parliament. I firmly believe that, without her campaigning, the Vaccine Damage Payments Act 1979 would never have reached the statute book. The other two people are Jack Ashley and Alf Morris, who was then in my shoes, as the junior Minister responsible for the Bill.
When the Bill was introduced, the Secretary of State for Social Services, the late Lord Ennals, made it clear that the scheme was not about compensation but about payments. It was designed to provide a lump sum payment of £10,000 to ease the present and future burdens of those suffering from severe vaccine damage. The amount has been progressively increased over the years and was last raised to £40,000 on 1 July 1998, shortly after my right hon. Friend announced the Government's review. That increase more than restored the payment to its 1991 value, when it was previously increased. Based on the retail prices index, simple indexation would have produced a figure of £38,194.
Mr. Andy King: Does my hon. Friend agree that, even though the original figure has been upgraded to £40,000, it is a derisory sum which does not ease the burden of care on the families, to which he has referred so eloquently?
Mr. Bayley: I thank my hon. Friend for raising the issue. In the time that is available, I shall explain as much as I can about the progress of the review. The sum is one of the issues under review.
I said in response to the hon. Member for Banbury that, although there is a one-in-a-million risk of contracting paralytic polio from the oral polio vaccine, as the Government acknowledge, there is a lack of clear scientific evidence linking routine childhood vaccinations to permanent damage. The High Court judgment in 1988 in the Loveday case dealt with whether, on the balance of probability and for the purpose of tort damages, it had been proved that the pertussis vaccine had caused permanent brain damage. In his judgment, Lord Justice Stuart-Smith concluded:
I have now come to the clear conclusion that the plaintiff—
Loveday—
fails to satisfy me on the balance of probability that pertussis vaccine can cause permanent brain damage in young children. It is possible that it does; the contrary cannot be proved.
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That is not the same as saying that disability as a result of vaccination cannot happen. For that reason, each claim is given individual consideration. I say to my hon. Friend the Member for Eccles that nobody from the Government is seeking to open the question of causation in any cases in which a vaccine damage payment has been made.
Mr. Stewart: My hon. Friend took a risk in mentioning names before, because there are many names, not least of which is Olivia Price of the Vaccine Victims Support Group. She tells me, and I believe that it is correct, that confidence is directly related to the success of the vaccine programmes. Does my hon. Friend accept that and accept that a lack of confidence in one vaccine programme can have a negative knock-on effect on other vaccine programmes?
Mr. Bayley: Yes, I agree, but I am heartened by what a number of hon. Members have said today about the importance in public health terms of a vaccination programme.
I recently wrote a foreword to a book by a constituent, Brian Sanctuary, about the open-air schools in York, the hospital schools which were the predecessors of special schools. In 1922, out of 112 pupils in the Fulford school in my constituency, 25 were suffering from TB, seven from polio and two from diphtheria. As a result of the vaccination scheme, the health of the children who receive education in special schools has changed beyond recognition.
In the short time available, I must respond to the questions about the timetable and the conduct of the review. My hon. Friend the Member for Eccles asked whether the DSS has requested additional funds from the Treasury. He is right to say that the review involves several Departments, including the Treasury. It is not normal for a Minister to comment on internal Government processes, but I can confirm that, when an announcement is made, it will be with the full agreement of the Treasury. That will need to be built into the timetable.
I very much regret that the review was not concluded earlier, and I know that the parents concerned are desperate that it should be concluded. Two years is indeed a long time.
Mr. Deputy Speaker (Mr. John McWilliam): Order. Time is up.

Rural Abattoirs
11.30 am
Mr. Christopher Gill: I preface my remarks by drawing attention to the declaration under my name in the Register of Members' Interests and by stating that I am a paid-up member of the National Trust and the Country Landowners Association and a life member of the Rare Breeds Survival Trust. Those are three of the seven national organisations that are campaigning to save Britain's smaller abattoirs. However, they are only the tip of the iceberg. In March this year, no less than 137 bodies and associations were co-signatories to a letter that was sent to the Minister of Agriculture, Fisheries and Food. That is a huge increase on the 12 national organisations that endorsed a letter that I wrote to Baroness Hayman last August.
Given that small abattoirs represent a tiny sector of a relatively small industry, that level of concern and support is unprecedented. It is about to be underscored by a public petition that is being organised by the Country Landowners Association, the Council for the Protection of Rural England, the National Federation of Meat and Food Traders, the Rare Breeds Survival Trust, the National Trust, the Royal Society for the Protection of Birds and the Soil Association.
My constituent, Mr. Colin Kinmond, is one of those business men on behalf of whom the campaign is being waged. Mr. Kinmond is the proprietor of the Bishop's Castle Meat Company. When I visited him 10 days ago, he was beside himself with anger and frustration—not about the state of the trade or his ability to supply a product, as between a willing buyer and a willing seller, but about the oppression and interference that he experiences from the Meat Hygiene Service. He is not alone in that. Scores of other craftsmen running small abattoirs feel the same way: pilloried and persecuted by what is euphemistically called a service—and for which, ironically, they must pay—but is in fact an enforcement agency, which should, if there were any justice and consistency, be paid for out of public funds.
That brings me to the nub of the issue: the level of meat inspection charges. I am grateful to Mr. John Chadwick of the Small Abattoir Federation for supplying the following statistic. He calculates that, when 100 per cent. veterinary supervision is implemented next April, a low-volume abattoir will pay £44 per unit for inspection. That is 11 times the unit charge of £4.14 in a high-throughput abattoir. Those figures are entirely consistent with those that were given to me by the noble Lady in her letter of 21 September, in which she stated that the current hourly rates of official veterinary surgeons employed in abattoirs range from £25.01 to £106.18. I am sure that the Minister will appreciate that that is intolerable and unsustainable for small abattoirs paying the higher charges. The inevitable consequence will be an acceleration of closures as the April 2001 deadline approaches—unless something is done, such as scrapping the present charging regime in favour of a universally applied headage charge.
I shall avoid going over the same ground that I have covered in parliamentary debates, at Question Time and in countless meetings and frequent correspondence with Ministers, so as to be able to devote some time to another aspect of the matter. On 1 April this year, the
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Meat Hygiene Service, which had previously been under the aegis of Agriculture Ministers, became the responsibility of Health Ministers. I welcome that change because it creates a better environment in which to examine the issues involved more objectively than was previously the case. The issues at stake—no pun intended—are those of public health and the safety of individual consumers.
In another place, Baroness Hayman said that
red meat slaughterhouses in this country declined in number from 1,385 in 1975 to 339 last year. Over the past 25 years, there has been an inexorable reduction.
One of the most important things we can do is to move from a prescriptive approach to a risk-based approach in abattoirs.—[Official Report, House of Lords, 6 March 2000; Vol. 610, c. 797.]
I trust that Health Ministers will endorse that sentiment, and I hope that they will also accept my invitation to reassess the risks and hazards associated with abattoirs in the context of all their other public health responsibilities.
A recent report by the National Audit OfficeHC230—entitled "The Management and Control of Hospital Acquired Infection in Acute NHS Trusts in England" says:
Around 9 per cent. of patients have a hospital acquired infection at any one time.
It goes on to say:
None of the studies … took into account hospital acquired infections that develop after a patient leaves hospital … This suggests that the true extent of hospital acquired infection is higher than the prevalence or incidence studies suggest.
Another paragraph is headed:
Some patients die each year as a result of hospital acquired infections.
It goes on to say that
a crude comparison indicates that if US—
that is, United States of America—
rates were applicable in the United Kingdom, 5,000 deaths … might be primarily attributable to hospital acquired infection and in a further 15,000 cases … hospital acquired infection might he a substantial contributor.
To the best of my knowledge, there are no such horror stories associated with abattoirs, least of all with craft abattoirs regularly producing bacteriologically sounder carcases than is often possible in plant abattoirs. I am sure that the Minister will recognise that any breakdown of hygiene standards in big abattoirs obviously prejudices the health of many more consumers than such occurrences in small abattoirs. However, the risk of fresh meat causing illness, whether sourced from large or small abattoirs, is infinitesimal because almost no meat is eaten raw in this country, and such bacteria as there might be are destroyed in the cooking process. Current methods of inspection in abattoirs cannot detect bacteria in any case. My plea to Health Ministers, now that they have assumed responsibility for the integrity of meat hygiene, is that they should carry out an urgent reassessment of risks.
An editorial in The Daily Telegraph on 4 April 2000 stated:
Worrying about food safety has become a slightly batty and extremely damaging national obsession.
It is hard to disagree with that assessment in the context of fresh meat being low risk compared with other comestibles, of more cases of sickness and death being

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caused by hospitals than are ever caused by abattoirs, and of small craft abattoirs being driven out of business by the burden and cost of a totally disproportionate inspection regime that does not exist in hospital—as we have seen from recent scandals such as the Rodney Ledward case. The facts speak for themselves—abattoirs and slaughtermen must, by law, be licensed and supervised, while hospitals are neither licensed nor monitored.
Mr. Richard Livsey: Does the hon. Gentleman agree that the recent closure of Mead Webber, an abattoir in Herefordshire, perfectly illustrates his argument? It closed because totally unacceptable conditions were placed on it, which meant that throughput went down and it ceased to be economically viable.
Mr. Gill: Had time permitted, I should have discussed the Mead Webber abattoir in more detail. As the hon. Gentleman said, that case illustrates my point to a T. A new official veterinary surgeon imposed arbitrary conditions on the continuation of its licence, notwithstanding the fact that 16 predecessors in his office thought that it should continue in production.
I continue my theme of inspection. The Public Health Laboratory Service Board monitors food poisoning, but there is not an equivalent body for hospitals. One in 11 acute admissions to hospital ends up with some form of hospital infection, but there is no independent certification of hospital standards or of causes of death. With regard to communicable diseases, hospitals are the biggest single source of infection. Whichever way one examines the matter, it is hard to escape the conclusion that failings in terms of public health occur not so much in abattoirs as in other areas. To coin a phrase, Ministers and Departments are looking through the wrong end of the microscope.
The number of hon. Members who signed early-day motions 187 and 689 during this Parliament and early-day motion 845 during the previous Parliament shows that this issue is not party political and that it involves common sense and natural justice.
Mr. Anthony Steen: Before my hon. Friend ends his interesting speech—I congratulate him on his delivery—I draw his attention to the problems that face Henry Lang, a small craft boutique abattoir in Ashburton in my constituency. I have fought its cause for six months, but it has only just received a full licence. The bureaucracy, rules and regulations and limited throughput may drive it out of business during the coming months. The proof of the pudding lies with the quality of the abattoir—the goods that have been produced during the past 100 years show that my hon. Friend's comments on hospitals are spot on. I should rather have products from Mr. Lang's abattoir than from the local hospital.
Mr. Gill: I would be grateful to my hon. Friend if he would convey to his constituent my sincere sympathy. I am a fourth generation butcher—my family has produced meat for consumers in the west midlands for four generations. We operated before there was relevant
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legislation, compulsory meat inspections or refrigeration. There is a presumption that those who have not spent any length of time in the industry, and who may have obtained their learning from studies and books, know more about the industry than those of us who have been in it for generations. My hon. Friend's constituent has my full sympathies.
The Under-Secretary, who is obviously an astute politician—that is evidenced by her rapid rise to the Front Bench since her entry into Parliament in May 1997—has my assurance that the consensus on the Back Benches is that small abattoirs should be supported. However, I am sure that she recognises that, if the action that is needed to save small abattoirs is not taken urgently, the odium for that failure will inevitably attach itself to the Government, of whom she is a member.
When the Under-Secretary replies to the debate, I hope that she will give us four assurances. If she does so, the industry will be relieved and thankful. First, will she give an assurance that she will reassess the specific level of risk to human health posed by abattoirs, given her Department's overall responsibility for health matters? Secondly, will she take the initiative to move from the prescriptive method of meat inspection to one based on a realistic assessment of risk? Thirdly, will she champion the cause that meat inspection, like almost every public health protection measure, should be carried out at public expense? Fourthly—but much more urgently—we should put Britain on a similar footing to other European Union countries, by instituting a charging regime based on headage payments. I urge the Government to do that while there is still time to save the relatively few remaining rural abattoirs, which are central to the aspirations of people of all parties and none for the future well-being of the rural economy.
11.45 am
The Parliamentary Under-Secretary of State for Health (Yvette Cooper): I congratulate the hon. Member for Ludlow (Mr. Gill) on securing a debate on such an important topic. I know that he takes a particular interest in the issue and that he has been involved with it for a long time. As his speech demonstrated, it is an area in which, as I readily acknowledge, he has expertise.
From the outset, I must emphasise the fact that the Government recognise the importance of small and specialist abattoirs to the rural economy. The Minister of State, Ministry of Agriculture, Fisheries and Food, my right hon. Friend the Member for Gateshead, East and Washington, West (Ms Quin), made that clear in the House on 25 May, during Agriculture questions. The hon. Gentleman described some of the problems faced by the sector and referred to individual cases. I will respond to the points that he made and set out details of the action that we are taking in response to those concerns.
Hon. Members will be aware that food safety is the first priority of the Food Standards Agency, which is responsible for meat hygiene. The agency is, rightly, determined to ensure that fresh meat is produced as hygienically as possible and will not accept any lessening of public health safeguards, no matter what the size or location of the abattoir concerned. The current system of veterinary supervision and official meat inspection

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provides key public health safeguards. However, as the Department of Health agrees, the system is outdated and expensive. The Food Standards Agency, therefore, is pressing for early changes to European meat hygiene law, so that we move from the prescriptive system to one based on risk. That is an important matter, and we are pressing for the change to be made. Such an approach is better for addressing modern microbiological hazards, puts the responsibility for the production of safe meat on the shoulders of the industry and brings abattoirs into line with other food-producing sectors. We must be realistic and accept that it may not be an easy task. Inevitably, it will take time, but it is important that we move in that direction.
We also understand the importance of local slaughtering facilities, especially those that service small rural communities. We want all animals to be slaughtered as near as possible to their farms of origin. If animals have to travel, welfare legislation provides a number of controls to protect them, including maximum journey times, vehicle standards and transporter competence. Those rules are rigorously enforced. In the meantime, current inspection rules will apply.
We acknowledge that there are difficulties that result from increased levels of veterinary supervision and the associated Meat Hygiene Service costs. We have, therefore, acted in a number of ways to help small and medium-sized abattoirs and the farmers who supply them, while we try to make progress on the key issue of changing the European position. As my right hon. Friend the Minister of Agriculture, Fisheries and Food announced last year, the Government continue to meet the cost of enforcing specified risk material controls and cattle passports. We will do so until 2002–03, at the earliest. Together, the two measures will save the industry £89 million, over three years.
Mr. Gill: I understand exactly what the hon. Lady is saying. We have heard it from Ministers so many times. Does she realise that it is no consolation to people who run abattoirs that the Government have not imposed a charge that might otherwise have been imposed? Such people already face cost burdens that they cannot sustain.
Yvette Cooper: I appreciate the concerns that the hon. Gentleman raises. We are making progress and I shall outline other measures that I think will prove helpful, but it is important to point out that this measure makes a difference. Although others might make a greater difference, it would be wrong to dismiss it out of hand.
Mr. Steen: The Minister is blaming the European Union for much of the cost, but does she agree that the real problem is the Government's interpretation of the EU directive? It is our fault that charges in British abattoirs are horrifically higher than in other European countries.
Yvette Cooper: I will come on to the Government's implementation of the EU directive and action taken by the European Commission, and I hope that that will address the point that the hon. Gentleman raises.
My right hon. Friend the Minister of Agriculture, Fisheries and Food announced in December that the Government froze Meat Hygiene Service hourly rates
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for 1999–2000 at 1998–99 levels, saving the meat industry about £7 million. We also restricted the increase in hourly rates for 2000–01 to 2.2 per cent. from 1 May, which is in line with inflation and the commitment made by the Government last year. That restriction is worth about £4.5 million to the meat industry.
The Government also obtained and published advice from the European Commission stating that full-time supervision by a veterinarian of permanently derogated low-throughput abattoirs is not required during post mortem inspection, but is required during ante mortem inspection. The Food Standards Agency is considering how best to give full effect to the Commission's advice, so that there is maximum benefit to low-throughput plants while maintaining public health safeguards.
Mr. Lembit ÖOpik: I am glad to hear that, because derogation is extremely important to low-throughput abattoirs. When will the Ministry of Agriculture, Fisheries and Food make a formal policy statement on implementation?
Yvette Cooper: I cannot answer that now. It is a matter for the Food Standards Agency, but I shall write to the hon. Gentleman with an answer.
The Meat Hygiene Service has frozen veterinary supervision in low-throughput plants at May 1999 levels while work is on-going. In addition, the Government have accepted, or are considering, 32 of 35 recommendations made by the meat industry red tape working group—the Pooley group—and are pressing on with implementation. The Food Standards Agency is taking forward the 29 recommendations that fall to it, and will consult widely on specific proposals as they emerge.
Mr. Gill: I am glad that the Minister has mentioned the Pooley report, and I am delighted that, by and large, the Government have accepted it. We realise that there are two or three recommendations on which the Government cannot proceed without European Union approval, but can the Minister confirm that shifting charges for British abattoirs on to a headage basis is within the Government's power, and requires no sanction from Brussels? Will she also promise today that she will institute immediately the change that is desperately needed to preserve our small abattoirs?
Yvette Cooper: The issue is being considered by the meat charges task force, which is due to report later this month, so I cannot give a specific answer at this stage. We are implementing most of the Pooley group's recommendations, including the radical overhaul of meat inspection. As I have said, the Food Standards Agency is pressing hard for the early introduction of a risk-based control system for fresh meat plants. In addition, the agency is supporting the Commission's initiative for a fundamental review of meat inspection procedures. Early discussions in Brussels have indicated almost unanimous member state support for a rapid review of those procedures. They are recognised to be outdated and it is accepted that they must be replaced by controls that are based on risk.
As the hon. Gentleman said, we are unable to accept some of the recommendations because it is not legally possible to do so without changes in the European

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position. For example, the need for increased veterinary supervision arises from the previous Government's under-implementation of Community meat hygiene rules, for which the European Commission has begun infraction proceedings against the United Kingdom. The legislation specifies the level and frequency of such supervision and the Commission has made it clear that it regards under-implementation by the UK of veterinary supervision requirements as a serious matter.
Mr. David Heath: Does the hon. Lady accept that the way in which the veterinary inspection is carried out in this country is different from how it is done in other EU member states? British abattoirs undoubtedly have to meet an additional cost. Will she also confirm that the time scale for reform of the EU processes is likely to be elongated and that the changes may come too late for many of our smaller abattoirs?
Yvette Cooper: The European Commission is currently undertaking infraction proceedings against the British Government because of under-implementation by the previous Government. We must accept that and respond to it. Obviously, a timetable is involved and the process will take time, but we must recognise our legal position.
The Pooley group has considered many of the issues in detail and has made recommendations, which we are taking forward. We will continue to explore solutions to the problems faced by small and medium-sized abattoirs, as long as they allow the public health safeguards to be maintained. The Food Standards Agency has set up a task force, as was recommended by the Pooley group, to explore the issues associated with a capping approach to meat hygiene inspection charges for low-volume abattoirs.
Following the meeting of stakeholders in March, Colin MacLean, the former director general of the Meat and Livestock Commission, was appointed as chairman. The remaining members have an understanding of the wider meat industry and of the way in which it works, and collectively represent the interests of the industry as a whole. As I said, the task force is due to report back to the wider stakeholder group before submitting its report and recommendations to the Food Standards Agency.
Mr. Gill: Will the hon. Lady assure us that she and her Department are conscious of the facts and that they will
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re-examine and reassess the levels of risk associated with meat produced in abattoirs in conjunction with risk in all other areas of public health for which she and her Department are responsible, so that we can get the matter into proportion?
Yvette Cooper: Questions about risk in this area are a matter for the Food Standards Agency. It is right for that independent agency to take that responsibility, not least for the sake of consumer confidence. The hon. Gentleman mentioned broader risks; indeed, there are risks that we should be working to reduce across the national health service. We are doing so and are undertaking a programme of action to address risks associated with hospital-acquired infection. For example, we introduced the Commission for Health Improvement to take further action on that matter. I do not think that many people would regard the fact that we need to take further action in one area as a reason to relax some public health safeguards in another. The hon. Gentleman's question about the assessment of risk must be addressed as part of making the changes that are necessary in Europe, which will be a matter for the Food Standards Agency.
The agency is also tackling the issue in another way. It has established a task force to study the burden of food regulation on small food businesses, in whose scope small abattoirs will be included. This is a major programme of Government support, especially for the small rural abattoir.
Mead Webber has been mentioned. I am unable to comment on the matter, not only because of lack of time but because it is the subject of an independent investigation by the Food Standards Agency. The outcome of its investigation will be published, in line with its principles of openness and transparency.
I have noted the hon. Gentleman's comments. We share his concern about the future of small abattoirs. They are important to the rural economy, which is why we have introduced a programme of support. In addition, we are pressing for changes in Europe and for implementation of the Pooley group recommendations. We are committed to putting the consumer first, as are the Food Standards Agency and the Meat Hygiene Service. The protection of public health in relation to food must be our priority.

Former British POWs
12 noon
Mr. David Winnick: The Minister will know of the long-running campaign to compensate former British prisoners of war who were held by the Japanese. The campaign, which will continue until it is successful, aims to get these prisoners of war financial recognition of the immense suffering and outright brutality and torture that they endured under the Japanese. I pay tribute to organisations such as the Japanese Labour Camp Survivors Association, the Far East Prisoners of War Association and the Royal British Legion, which have done much to keep the issue alive. I also pay tribute to hon. Members on both sides of the House who have raised the subject in this and the previous Parliament and who, like me, are determined to keep it going.
Five years ago, on the 50th anniversary of the ending of the war, I and many other Members of Parliament and the Lords—perhaps you, too, Mr. Deputy Speaker—attended a large gathering at Church house. The former prisoners of war of the Japanese who were there expressed two strongly felt views—that the present Japanese Government should apologise for what happened and that there should be financial compensation. It would be fair to say that, according to their custom and tradition, the Japanese have properly apologised, but that is all. It goes without saying that those of us who have asked the British Government to make a financial contribution would have preferred the Japanese authorities to do so, but that was not the case. All representations to the Japanese Government have been without success and, moreover, the recent court case there failed.
The Japanese argument. which has been reiterated many times outside and inside Parliament, is that the 1951 San Francisco treaty concluded the matter and that there was no need for the British authorities to continue to raise the issue. The treaty awarded a maximum of £76—some people received less—to former British POWs. That sum nearly 50 years ago was obviously worth more than it is today, but at most it was equal to eight to 10 weeks' average pay. It was totally inadequate, and no one could say otherwise.
The situation has moved on somewhat. On 3 May, in reply to a question from the hon. Member for Tatton (Mr. Bell), my right hon. Friend the Prime Minister informed the House that former POWs had told him about the appalling suffering that they had endured. He said:
They are immensely brave people, to whom we owe a great debt.—[Official Report, 3 May 2000; Vol. 349, c. 143.]
Indeed, we do owe them a great debt, and their contribution to our allied victory in 1945 can never be forgotten. It was encouraging to hear my right hon. Friend say that he and the Under-Secretary of State for Defence had met the Royal British Legion and agreed to reconsider the issue of compensation for former POWs. It is understandable, in response to a question on the Floor of the House and, indeed, to a later question, that my right hon. Friend wanted to make it clear that he was not making a commitment, but his assurance is the closest that we have come to a Minister—and the most senior of Ministers at that—recognising that there is a case for the Government to consider. That was encouraging.
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This debate is intended as a plea for no further delay in coming to a favourable decision, which is the wish of the House. Hon. Members divide on many issues, with disagreements between individuals and between parties, but there is agreement on this issue, if not on others; perhaps even among Ministers. There should be financial compensation to our fellow citizens who suffered so much at the hands of the Japanese during the war.
The numbers involved are inevitably and sadly growing smaller. The longer the delay, the smaller the number of people who will receive financial recognition and compensation. That is why I asked for the debate. The House is to break for the summer recess by the end of July at the latest. I hope that my hon. Friend the Minister will reply favourably today and that the House will not go into recess with the situation outstanding and certainly not with a negative response from the Government.
The point has been made that the Government at the time could have done more long ago to press for further compensation from Japan. In May 1955, the then Minister of State in the Foreign Office, Lord Reading, took the view that the Government should not take advantage of article 26 of the San Francisco treaty. That treaty provided for further claims if Japan concluded agreements with other countries involving sums more advantageous than those originally agreed three years earlier. That was the position concerning Burma. The Government could have taken advantage of the situation at that time. They might not have been successful—who knows?—but at least they would have taken the opportunity. Lord Reading's point, which was not put into the public domain, was that the Government's pursuit of the matter would have been unpopular with the Japanese. What did he mean by that? Did we have a guilt complex? What would have made us more unpopular? Were we so unpopular in 1955? I find the decision somewhat odd but make no party point—the same decision was likely to have been reached even if another Government had been in power. However, the decision was wrong.
The Canadian Government have agreed to pay compensation to its former POWs held by the Japanese. That is welcome. I do not accept that such payments might lead to other claims by ex-POWs, which, I suspect, has been one reason why the Government have been reluctant to come to a favourable decision and to concede on the issue. What other claims would there be from former POWs? I have no reason to believe that those held by the Germans or those held as POWs in Korea are pressing such claims. The Germans treated Russian prisoners of war brutally, starving or beating them to death in some cases. However, they abided by the Geneva convention with regard to British prisoners of war. The Japanese did not abide by that treaty, having not signed it. The Government must come to a favourable decision on those matters.
I want to conclude by referring to two of my constituents and what they suffered during the war. I have mentioned the position of one of them before. The first case concerns Mr. Stephen Long, who was 19 when he was taken prisoner in Singapore. Like many others, Mr. Long was put to work on railway construction, known to POWs as the railway of death. On more than one occasion, he was given what was described as the

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water treatment. He was squeezed into a box, where, for eight hours, he could not move at all. When he was dragged out, the Japanese soldiers forced a hosepipe into his mouth and then jumped up and down on his stomach for some time. That was the experience of so many people who were held by the Japanese. It is no wonder that Mr. Long has suffered nightmares since and feels such bitterness. It is no wonder that, when Mr. Long attended the gathering in 1995, he was so keen to receive an apology and would like to receive financial compensation. I do not know how long he has to live—I hope that it is a long time—but if compensation is to be paid, there is no reason why he should wait any longer.
Another of my constituents, Mr. John Mitchell, was a POW who worked on the Burma railway. He was made to work 12 to 18 hours a day. The prisoners were often subject to beatings and they were on a near starvation diet. As we talk about such immense suffering, let us also remember all those British POWs, our fellow citizens, and other allied prisoners of war held by the Japanese, who would receive no compensation whatsoever since they died at the time because of the ill-treatment and brutality that they endured.
The time has come for justice. The time has come for the British Government to make a payment in recognition of that suffering, about which my right hon. Friend the Prime Minister has spoken and to which I have referred, and to concede that this is a special and unique case. Whoever must decide what should be done, whether it is the Ministry of Defence or the Treasury, I beg them—I use that word, which I do not usually use in Parliament—to make a favourable decision before the House breaks up for the summer recess.
12.12 pm
The Minister for the Armed Forces (Mr. John Spellar): As hon. Members know, we addressed this subject only recently in the House in the debate secured by the hon. Member for Tatton (Mr. Bell), whom I am pleased to see in the Chamber today. In that debate, he eloquently set out his request on behalf of those held as POWs in the far east during the second world war and surviving widows of deceased former far east POWs.
This further debate, secured by my hon. Friend and neighbour the Member for Walsall, North (Mr. Winnick), is a demonstration of my hon. Friend's support and concern for those held as POWs in the far east during the second world war, a cause that he has championed in the House on several occasions, both in debates and through various questions. That concern is widely held. Those hon. Members who are involved in all-party groups on this or related matters and hon. Members who have raised the matter on behalf of constituents have similarly championed the cause of those ex-service men, whose case naturally arouses sympathy. I congratulate my hon. Friend on gaining an opportunity to air again so soon the claims of that group for further compensation and I note the hope that he expressed in the House recently for a fresh and positive approach from the Government.
The Royal British Legion is also conducting a vigorous campaign in support of the claims of those men. Senior representatives of the Royal British Legion
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met my right hon. Friend the Prime Minister and my hon. Friend the Under-Secretary a few weeks ago to discuss the matter, and I shall return to that meeting later in my speech. I regret the fact that my hon. Friend the Under-Secretary was unable to be here today to address the issue, but he was already scheduled to conduct other ministerial business.
The question of compensation and support for those held as prisoners of war in the far east during the second world war is, as my hon. Friend said, dealt with by several Departments. My response today therefore embraces issues that also fall within the responsibility of my colleagues in the Foreign and Commonwealth Office, the Department of Social Security and the Department of Health.
The subject arises from the historical events of the second world war. With the fall of Hong Kong and subsequently of Singapore and other areas in early 1942, just over 50,000 British service men were captured by the Japanese. During that conflict, prisoners of war were in theory protected by the 1929 Geneva convention. Japan had not ratified the convention but said that in general it would recognise its provisions. However, as the world knows, it did not keep that promise. The prisoners of war of this and other nations were held in camps throughout the far east, where conditions and supplies varied. In almost all camps, even the best, conditions were demanding and often debilitating, particularly where prisoners had to carry out heavy physical work, often in terrible conditions. That. together with undernourishment, made them even more vulnerable to disease, as my hon. Friend graphically described. In addition to those factors, indifference and sometimes deliberately brutal treatment by guards took a toll on prisoners, 25 per cent. of whom did not survive their captivity. My hon. Friend was right to draw attention to the need to remember them as well as those who survived.
During the war, the British Government were unable to achieve much improvement in the conditions of the prisoners, but in the aftermath of Japan's defeat, in conjunction with our allies, they brought some of those responsible for the ill-treatment of prisoners of war to justice before allied courts. Furthermore, under the terms of the 1951 peace treaty, the former far east prisoners of war, uniquely, as a group, received some compensation from their former captors. In addition, the British made other funds available from Japanese resources, to which there was an entitlement under the peace treaty, to provide further compensation for the prisoners of war and some compensation for certain British civilian internees—another group who suffered grievously under the regime.
We fully accept that many people consider that the amount that became available in that way was too small. My hon. Friend mentioned the £76 maximum, which is roughly equivalent, in cost-of-living terms, to £1,200 today. Nevertheless, that payment established the principle of the responsibility of the captor for the proper treatment of detainees. That was at the time a firmly stated primary goal of the former far east prisoners of war and their organisations. Subsequently, as we know, there have been many calls for the Japanese to make further compensation payments. That is, of course, a matter for my right hon. Friend the Foreign Secretary. However, we have several times raised the

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matter with the Japanese Government at the highest levels, reminding them of the strength of feeling that the issue arouses in the House and throughout the country.
Mr. Mark Oaten: Does the Foreign Office plan to continue to raise the issue of an apology in discussions with Japan?
Mr. Spellar: The hon. Gentleman anticipates my next sentence. We have examined matters, including the responses of the Japanese Government, most carefully, and the clear legal advice is that the peace treaty many years ago closed the matter of further compensation from the Japanese Government. We have raised this matter with the Japanese Government at a range of levels, and that is the position that the Foreign Office has reached in that regard. Nevertheless, we continue to seek ways of achieving reconciliation between our two nations to overcome the legacy of past conflict and the associated feelings of those who suffered, who understandably may find it hard to be reconciled.
We are aware of the argument advanced in recent times that, in 1955, the British Government consciously let down the far east prisoners of war through their handling of the peace treaty negotiations and over the amount of compensation that was obtained as a result. Although we understand the feelings that lead to this view, which were expressed by my hon. Friend the Member for Walsall, North, that argument is not borne out by the evidence, which is based on the views and actions of the Conservative Government in 1955 in deciding not to seek to invoke article 26 of the treaty to claim more compensation on the ground that other countries had signed more favourable agreements.
Examination of the contemporary records that have been publicly available for many years shows that that decision reflected the fact that it was extremely difficult to ascertain what additional benefits, if any, this country would in practice be entitled to and what their worth might be, or whether, had the treaty been reopened, Britain would have received additional funds from Japan to enable individual far east prisoners of war to receive further compensation. It is perhaps a broader issue than the one outlined by my hon. Friend.
Linked to the claim about the 1955 decisions is the view that, as further compensation cannot be obtained from Japan, the Government should make an ex gratia payment. As my hon. Friend the Member for Walsall, North will be aware, that suggestion represents a major shift from the position of those speaking on behalf of far east prisoners of war in the early 1950s, when the issue was thoroughly aired in public discussion and in the House. At that time, they made it clear that they were making no claim on the British taxpayer. Brigadier Smythe, a leading champion of the cause in the House, said:
On no account will they accept money from the British taxpayer. If it cannot be obtained from the Japanese, they do not want anything at all.—[Official Report, 10 May 1951; Vol. 447, c. 2223.]
We accept that times and views change and that the conclusions of the 1950s, which were based on the experience at that time, may not be the same today. Furthermore, many hon. Members and the Royal British Legion consider that recent payments by the Canadian Government to their former far east prisoners
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of war, which amounted to some £10,000 each, and a motion in the Isle of Man's Tynwald, which proposes to make a similar payment to its small number of former far east prisoners of war, are precedents that should guide us in resolving this matter. Therefore, external circumstances have changed.
Although we understand that view, decisions of this nature are a matter for individual Governments and authorities to decide in the light of all the circumstances in their countries. Their decisions reflect the different ways available to them to address their citizens' needs. We acknowledge, and have always acknowledged, the harsh treatment and suffering that characterised detention for those held as prisoners of war in the far east and led to the death of some 25 per cent. of those in captivity or to ill health, which often continued following repatriation at the end of the war and which, in a number of cases, still seriously affects individuals. My hon. Friend the Member for Walsall, North drew attention to two moving cases in his constituency, but many other hon. Members can outline similar cases and describe the long-term physical and psychological impact of such suffering.
As hon. Members know, in this country the emphasis has been consistently placed on addressing the suffering and needs of those whose health has been adversely affected as a result of their military service, including any period of captivity—whether in the far east or elsewhere—primarily through the provision of war pensions by the Department of Social Security. Such pensions are available to the dependants of those who died during their service, or whose subsequent deaths can be linked to their service, and to those service men who have received a war pension since they left the forces because of the impact of their suffering on their long-term health.
Mr. Winnick: In reply to the hon. Member for Tatton (Mr. Bell) on 3 May, my right hon. Friend the Prime Minister, having met the British Legion to discuss this issue, said:
I make no commitment at this stage, but we told them that we would consider carefully the points and the representations that they had made, and we will do so.—[Official Report, 3 May 2000; Vol. 349, c. 143.]
Will my hon. Friend tell us, working on the basis that a decision will be reached, whether his answer is final? I hope that it is not. Will the House be given the answer—yes or no—before the recess? As I have said, it is the wish of the overwhelming majority of right hon. and hon. Members that this matter should be resolved with a favourable decision.
Mr. Spellar: I am coming to the outcome of the meeting with the Royal British Legion in the next couple of paragraphs of my notes.
I shall complete my previous point by saying that people whose health disabilities from service have appeared or worsened later in life have received war pensions at that point. The special health needs and problems of far east prisoners of war are also recognised in the availability to them of special tropical disease investigations, so that problems peculiar to the far east, which might not otherwise be recognised as relating to their military service, can be picked up.

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However, we are aware that, as hon. Members and the Royal British Legion have commented to us, the understandable perception of many British far east prisoners of war and their families is that the provisions that form the basis of the present support system through war pensions and health care do not adequately meet their needs. Although we believe that that judgment may be harsh, such feelings are a matter of concern.
My colleague the Under-Secretary of State heard those concerns expressed again at a recent meeting of the Royal British Legion, which he attended with the Prime Minister. During that meeting, the Royal British Legion, in setting out the case for additional compensation to be paid, described clearly the facts of the ill-treatment and suffering, and the subsequent problems that they have caused. Following that meeting in April, my right hon. Friend the Prime Minister assured the House, in the statement drawn to our attention by my hon. Friend, that, although he could make no commitment at that point, he had promised the Royal British Legion that the points and representations that they had made on behalf of former prisoners of war in the far east would be carefully considered.
That is what we are doing. We are re-examining the policy on far east prisoners of war, including the question of compensation. I mentioned earlier that, given the range of aspects involved, this subject concerns several Departments. We are, therefore, in touch with colleagues across Government to consider these points. We have not set any rigid parameters or ruled out particular solutions, but the consultation and consideration process is not yet complete. When it is, it will be considered by my right hon. Friend the Prime Minister.
I fully understand that hon. Members would have preferred me to give them further news or hints on the tenor of our considerations. However, as we have reached no conclusions, hon. Members will understand that it would be difficult for me to say any more at this stage. We look forward to being able to say more in the future. I shall draw to the attention of Ministers engaged in the consultation process my hon. Friend's request that an announcement be made before the recess. I cannot give him a commitment today: his views have been strongly represented, and I shall make sure that his message is relayed to those concerned.

Asthma
12.29 pm
Mr. David Amess: I begin by registering an interest. In common with many thousands of people, I suffer from hayfever. In my case, by the end of the hayfever season it will have turned into asthma. My first challenge to the Minister is to come up with a cure for hayfever, which would delight me and many others.
When I developed hayfever as a child, I was told that I would grow out of it, but I am nowhere near having done so. I have tried every medication available. I applaud pharmaceutical companies, which seem to produce a different nasal spray or tablet every year. I have had injections. I have been to a major hospital to be tested for allergies. On discovering that I was allergic to practically everything, I decided to forget it. Eventually, my wife, annoyed by my constant fits of sneezing, told me to go to the doctor to get it sorted out with the latest product on the market, with which I was injected using a huge needle. It made no difference whatsoever. I have even been to a Chinese herbalist. I faithfully followed the instructions for boiling up the leaves, but it tasted revolting and had no effect.
If the Minister is unable to come up with a cure today, she will do me a great favour if she can reassure me that she recognises that it is a real problem that causes misery to many people. Although I may appear to be perfectly fine at the moment, it can start up again at any time. The problem affects the quality of people's lives—for example, children taking examinations—and seems, for whatever reason, to be getting worse. People are developing it at all ages.
I want to concentrate on a call for national standards of health care for people with asthma. I pay tribute to the National Asthma Campaign, which I am sure all hon. Members regard highly and which is, as much as any organisation can be, above politics. It would like me, with another hon. Member, to highlight the issue with the aim of trying to find a solution.
We all have constituents who are affected by the problem. Regardless of their postcode or their medical condition, they should have the best possible treatment available. As Members of Parliament, we have a responsibility to ensure that constituents who live with long-term medical conditions receive proper care. I accept that that has cost implications, but I would like to suggest to the Minister an idea that might not cost too much.
No one pretends that achieving consistent standards of care across the country is easy—it is difficult, but it is something for which we should strive. Unfortunately, many patients are bypassed as a result of where they live or because their illness is not on the Government's target list of health priorities. I understand why the Government target coronary heart disease and cancer. I tried to get stroke included on the list. Important as those conditions are, I hope that they will consider widening the terms of reference to include people with chronic long-term medical conditions, including asthma.
National standards of care are nothing without the expertise and impetus to implement them where it matters—locally on the ground, in health authorities

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and in primary care groups and trusts. Although I am critical of primary care groups and trusts, the Government support them, and if they can run with this issue I shall be delighted.
The Government and the Minister should take the opportunity to give greater direction from the centre, ensure that local health care professionals recognise asthma as a long-term problem, which they do not always do, and provide the means for people with asthma to receive the quality care that enables them to take charge of their own condition instead of simply struggling on valiantly, as many do.
Mr. David Drew: I should declare an interest. I suffer from hay fever and, as a result, am asthmatic.
We welcome the asthma clinics that many surgeries now operate, although they tend to be for newly recognised symptoms. Does the hon. Gentleman agree that one of the biggest problems is that people who have had asthma for a long time think that they are using their inhalers properly but often need educating in better ways of treating themselves?
Mr. Amess: The hon. Gentleman makes an excellent point. Although such clinics do a superb job, like accident and emergency units, long-term sufferers, as he eloquently said, badly need this extra help. I hope that the Minister will acknowledge that. If the clinics are to make an impact, national direction must be backed up by local initiatives.
The National Asthma Campaign, the independent United Kingdom charity, works as hard as it can, with others, on research to combat this problem, which is suffered by 3.4 million people. That is a huge number, which would fill 7,000 jumbo jets or sell out Wembley stadium more than 40 times. In my constituency 2,600 people suffer from asthma. which is one in 25 adults. More disturbing—I know that the Minister has a child herself—is the fact that in Southend, West one in seven children suffers from asthma, and in the rest of the country on average four or five children in every classroom will have asthma.
Apart from hay fever, the symptoms are difficulty in breathing, tightness of the chest, wheezing, coughing and sleepless nights. One feels absolutely miserable because one does not get a good night's sleep and wakes up feeling like death warmed up. Inflammation and constriction of the airways can be triggered by different things including tobacco smoke—something that I am not particularly enamoured with—house dust mites, pollen or even a sharp change in temperature. As many as 20 per cent. of people with asthma experience it so severely that they have to make frequent trips to hospital. As the national health service is under such pressure, it would be wonderful if we could make it unnecessary for people who have an attack to go to hospital.
More children miss lessons because of asthma than because of truancy. A National Asthma Campaign survey found that nearly a third of children with asthma miss more than a week of school because of their illness. According to Devon's health and safety adviser, 100,000 school days are lost in that county every year because of asthma, 10 times more than are lost through truancy. Large numbers of children are losing out on their education as a result of the failure of all of us, not just the Government, to help people with asthma.
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Asthma does not simply affect children. As I said, I have not grown out of it yet. People from all walks of life and in all areas, rural and urban, suffer from asthma, and I am sure that every hon. Member has constituents who suffer from it. It is extraordinary that at the beginning of the new century asthma is on the increase, and no one seems to know why. We all have theories about it, but no one has come up with a convincing, well-tested explanation.
The number of children aged between five and 11 who reported an asthma attack during the past 12 months was three times higher than the figure for 10 years ago. A comparison of the health survey results for England for 1991 and those for 1996 shows that the percentage of people who reported attacks of wheezing or whistling in the chest increased last year from 16 per cent. to 21 per cent.
The Minister knows only too well that, unfortunately, asthma is not going to go away. The National Asthma Campaign tells me that, sadly, we are a long way from establishing the cause of the increase. The problem impacts on many people's lives. In broad terms, the cost of hospital admissions due to asthma is more than £50 million a year. We could use that money to train extra nurses.
More than 1,500 people die from asthma each year. A young man and close family friend who lived in my previous constituency died in tragic circumstances—no one could get to him when he was at the peak of an asthma attack.
Excellent initiatives are being carried out in some parts of the country. I am advised that Leicestershire—I believe that no hon. Member who is present has a constituency interest in this—has an effective local health improvement management plan. In Birmingham, the Small Heath primary care group, which is close to the constituency of one of the health Ministers, is working to improve local care of children with asthma by producing new standardised documentation that will be held in the child's medical notes. My own South Essex health authority has, according to a survey conducted by the National Asthma Campaign, recognised the importance of asthma in its HIMP. Such efforts are commendable, but the situation throughout the country is patchy. In some parts of the UK, health professionals pay only scant regard to the problem. The primary care groups offer us an opportunity to do much better.
We understand that there will be local variations, but such diversity should be reflected in the methods that are used to tackle the disease, not in the level and quality of care that is available to people with asthma. Treatment is currently a bit of a lottery, and we need national standards so that health professionals and people with asthma know what is expected of them.
I return to a point that I made eight or nine minutes ago: a small investment by the Government could solve the problem and promote a sea change in the way in which people with asthma are cared for and manage their illness. I welcome the fact that the Government identified the need for national standards in health care, but the delivery of those standards is currently inadequate. National standards would benefit our constituents by giving them access to better care and a benchmark against which to measure their experience.

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They would also know that they would be treated similarly to patients elsewhere in the country. Will the Minister explain, either in her response or later in writing, when national standards might become a reality for people with asthma? National standards are vital if the present inequalities are to be ended.
People with asthma have the right to expect equal access to the best possible asthma care, which should be delivered by experienced and committed health professionals according to nationally agreed guidelines. What progress is being made in that regard? Specially trained health professionals should review the management of a person's asthma at least once a year. When a GP and a practice nurse share asthma care, the nurse should expect to have access to the best available asthma training and to regular updates—which is probably what the hon. Member for Stroud (Mr. Drew) had in mind. He also made the point that, when the severity of a person's asthma warrants it, prompt referral to a specialist should be provided as a matter of course. Young children, young people in transfer to adult care and elderly people with asthma should receive special consideration. I hate the expression "joined-up government", but the Minister will know what I mean with regard to the need for that kind of provision.
Scientific research has proved the safety and effectiveness of complementary therapies. I condemned Chinese medicine at the outset of my speech, but I am sure that all other aspects of such therapies are marvellous. Perhaps the Minister would like to comment on that. If appropriate standards were implemented nationwide, every person with asthma would be able to make informed choices about their own care.
Does the Minister agree that people with asthma have the right to expect care from the NHS on a broader basis? What are the Government doing to encourage health authorities to include asthma in their HIMPs? What instructions are being given to primary care groups? National standards are useless without effective mechanisms to ensure that they are implemented and monitored locally. It would be more than possible for the Government to establish national guidelines for asthma care relatively quickly. Some guidelines already exist, but they are somewhat out of date.
I draw the Minister's attention to early-day motion 676, supported by 91 hon. Members, which calls on the National Institute for Clinical Excellence—of which I have also been critical, but, none the less, we have it—to update the British guidelines on asthma management as soon as is practicable. Will she also give us an idea of the timetable for revising and issuing new guidelines?
I congratulate those asthma sufferers who are able to control their condition, but that is not always easy. It is no wonder that people panic when they suffer a serious attack. Asthma currently costs the NHS about £670 million a year, including GP consultations and accident and emergency visits. That is an even larger figure than the £500 million that I mentioned earlier.
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Finally, I shall leave the Minister with these thoughts. Any hon. Members who visit schools will be shown the headmaster's secretary's room. Nine times out of 10, the secretary will open the medicine cupboard, out of which will fall a variety of ventilators. Young people are our future. This is a real problem and I should be grateful if the Minister would take on board the points that I and the hon. Member for Stroud have made, and give us some hope for the future.
12.48 pm
The Parliamentary Under-Secretary of State for Health (Yvette Cooper): I congratulate the hon. Member for Southend, West (Mr. Amess) on raising the subject of asthma. I only wish that I could come up with a cure for hayfever. As a fellow sufferer, I have a personal interest in that, and would certainly derive a great deal of relief from such a discovery. I find that sea air helps, so perhaps additional constituency duties will help the hon. Gentleman with his condition during the worst time of year.
I shall respond to many of the points that the hon. Gentleman has made about asthma, which is a most important issue. It is the most common of all chronic diseases, affecting thousands of families every year. I welcome many of the points that he has made, and his support for Government action to introduce national standards and to tackle the problem of the postcode lottery in care. The Government feel strongly about that issue, and have set out a programme of action to tackle many of the variations in care across the country.
The hon. Gentleman is right to say that the prevalence of asthma has increased in recent years. In the mid-1950s, when the population was about 44 million, the first national survey of morbidity in general practice estimated that 380,000 people had consulted a doctor about asthma at least once. According to figures published in the document "Key Health Statistics for General Practice 1996", the prevalence of asthma in England and Wales was 6.7 per cent. for men and 6.9 per cent. for women. That amounts to as many as 3.5 million sufferers.
It is difficult to be precise about the trend, given variations in measurement, improvements in diagnosis and wide variations in the way in which figures are recorded, but it is clear that the number of cases of asthma has increased in the past few decades. As a result of improvements in diagnosis, drug development and changing diagnostic thresholds, more people are prepared to consult general practitioners to get prescriptions for asthma. Nevertheless, however one looks at the matter, the figures are going up, and that is a cause for serious concern.
For general practitioners and nurses, the increase is also very real. My hon. Friend the Member for Stroud (Mr. Drew) talked about services provided in primary care, and average general practice staff will see a tenfold increase in the number of asthma patients, compared with figures when the NHS was formed. Treatment options are now clearer. Beta 2 stimulants are used to prevent the potentially lethal symptoms of asthma in young children. As a result of such improvements, and

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despite the increase in prevalence, the number of deaths for which asthma is the underlying cause is declining, and the number of patients requiring hospital admission is on the wane.
The number of asthma-related deaths in England and Wales fell from 1,700 in 1993 to 1,366 in 1998, and the number of hospital admissions also declined. The number of children who were admitted in that period fell by almost a third—from 47,700 to 32,000. Despite those changes and improvements, I share the hon. Gentleman's concern that too many people are suffering. In particular, I share his concern about asthma among children. I join him in paying tribute to doctors, nurses and other health professionals who have done so much to make the improvements a reality, and to those patients who have taken responsibility for managing their own care. I, too, would like to mention the National Asthma Campaign, which has played a vital role in providing information and support to patients and their families for many years. It has been at the leading edge of asthma-related research, and it worked with the British Thoracic Society to establish important guidelines on asthma care.
Progress has been made, but there is still much more to do. The hon. Gentleman is right to say that asthma imposes substantial costs on the NHS. The NHS spends almost £500 million a year on GP-prescribed drugs for asthma, and the Government spend almost £4 million a year on research into asthma. The National Asthma Campaign estimates that a substantial number of working days—and, as the hon. Gentleman rightly said, school days—are lost every year through asthma. I am particularly concerned about the impact of inequalities in this regard. Often, it is the children of parents on low incomes who are most likely to die from asthma attacks.
The hon. Gentleman referred to making improvements by establishing national standards. The Government recognise the importance of national standards and the need to tackle the postcode lottery, and we have put in place measures to that effect. He also mentioned the national service frameworks for coronary heart disease and mental health, which have been published, and for older people and diabetics, which are still in progress. They are not simply about acute conditions, but include long-term chronic care issues and require considerable time and investment from the NHS and from experts and patient groups. In addition, we are working with the National Institute for Clinical Excellence to improve the clinical effectiveness of health services.
The role of NICE is to ensure that, by identifying best practice, every patient in England and Wales has fair access to quality treatment. NICE will promote the uptake of successful innovations and will appraise treatments, both new and old, to ensure that there is good evidence to support their effectiveness. On asthma, NICE is carrying out an appraisal of inhaler systems, and its guidance is expected in the late summer. In addition, two major reports from our health technology assessment programme on inhaled steroids are expected
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later this year. They, too, will provide the evidence base to supply clinical guidelines and better care for people with asthma.
The Department of Health is assessing a number of topics for possible referral to NICE in the next year. Clearly, NICE has a finite capacity and cannot look at every technology or intervention with evidence of variations in practice in the first year. No service anywhere in the world, no matter how it was funded, could do so. The selection criteria will include the potential impact on patient care, on Government priorities and policies and on NHS resources. The Department will also consider whether NICE is likely to add value. We are considering the programme of work for NICE for next year, and announcements will be made about that programme later this year. Unfortunately, I cannot pre-empt those announcements.
While NICE and the NSFs are vital steps forward, they are not the only way to spread best practice, provide high-quality care and tackle the postcode lottery across the NHS. Systems must be put in place across the board, not simply in priority areas or for asthma but in every area, to promote the rapid take-up of new technologies, to promote improvements and best practice and to ensure that that best practice is spread across the country. Those issues are being addressed as part of the development of the national plan. Experts and patient groups across the field are being drawn together to study the key priorities and ensure that the systems are in place to implement best practice, as the hon. Member for Southend, West described, and not simply to set national standards.
The national plan will set out the way in which we intend to use the record extra resources available to the NHS not simply to expand services but to reform them fundamentally. A key aim is to ensure that patients are at the centre of the process. The hon. Gentleman referred to the need for patients to take responsibility and manage their own care. Last year, in the "Saving Lives" White Paper, we signalled our intention to introduce an expert patients programme to help those with chronic illnesses better to manage their health. The expert patients task force, which has been set up by the chief medical officer, will promote self-help and self-management for asthma patients and others and will ensure greater awareness among asthmatics of their condition. That is being done through a series of joined-up initiatives—that wonderful phrase that the hon. Gentleman used. That includes working not only with patients but also, as he said, with various aspects of the NHS, linking in-patients, out-patients, emergency care and primary care.
The health improvement programme is one way to do that. Its main role is to develop the programme to improve the health of the local population. We have highlighted key national priorities for heart disease, cancer and mental health, but local areas must look at their own strengths and weaknesses and at their needs and set their own priorities. We expect areas that have problems with asthma care to address them as part of the health improvement programmes. Many already recognise the needs of people with asthma.

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The hon. Gentleman mentioned other examples. I know that primary care groups in Croydon and west Kent have identified asthma as a key local priority, and a scheme in Cornwall involves giving grants to councils to fund central heating and insulation improvements for homes occupied by families with children suffering from asthma.
To make a long-term difference, we must tackle prevention as well as treatment, which means taking action on smoking. That is why we have done so much to reduce smoking and have taken action in schools as
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part of the national healthy schools programme and the national healthy schools standard to help pupils to understand and manage their own illnesses. We are also undertaking more research, because the hon. Gentleman is right: we must know about this illness and the difference that we can make.
We are addressing many of the hon. Gentleman's concerns. I hope that we shall continue to do so, because this is clearly an important issue for many children and families across the country.
It being One o'clock, the motion for the Adjournment of the sitting lapsed, without Question put.