Health: Contaminated Blood Products — Debate

– in the House of Lords at 11:36 am on 23rd April 2009.

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Moved By Lord Morris of Manchester

To call attention to the findings of the Independent Public Inquiry headed by Lord Archer of Sandwell into the infection and deaths of patients with HIV and hepatitis C by contaminated National Health Service blood and blood products; and to move for Papers.

Photo of Lord Morris of Manchester Lord Morris of Manchester Labour 11:37 am, 23rd April 2009

My Lords, we are met to seek the Government's response to a report of landmark importance to a small and stricken community of congenitally disabled people for whom acquaintance with grief—recurrent and abject grief—is an inescapable fact of life. Already disabled by a rare, life-long blood disorder requiring continuous medical treatment, haemophilia patients have twice been infected en masse by contaminated blood and blood products used in their NHS treatment. Of a patient group of barely 5,000, 95 per cent were infected with hepatitis C and one in four with HIV, involving for the haemophilia community a loss of life more grievous in proportion to the numbers of people at risk than the Black Death.

Thus of the 1,243 haemophilia patients infected by their NHS treatment with HIV only 361—29 per cent—are still alive; and the much higher number of deaths among hepatitis C-infected patients is still increasing. Moreover while stigma is less explicit today than the warning cross scrawled on a plague-victim's door, it is no less cruelly oppressive in terms of social exclusion at a time of dire need.

I have two interests to declare in the debate, not pecuniary, as president of the Haemophilia Society, and as the architect of the independent public inquiry headed so admirably by my noble and learned Friend Lord Archer of Sandwell. I am most deeply grateful to him and his colleagues—Dr Norman Jones, emeritus consultant physician at St Thomas's Hospital, and Judith Willetts, chief executive of the British Society for Immunology. No inquiry team could possibly have shown more commitment or have been more eminently qualified for the arduous task they so readily and so ably undertook, entirely without remuneration.

Their report, exhaustively researched, is one also of excelling integrity and humane concern for arguably the most needful minority in Britain today. I warmly acknowledge, too, the help of my noble friend Lord Turnberg who, as immediate past president of the Royal College of Physicians, served the inquiry with such skill and dedication until he and his wife Edna were so tragically bereaved. I am indebted to all noble Lords who will be participating in the debate and delighted that my noble and learned friend Lord Archer is speaking. He deserves well of this House for the example he sets in practical concern for the well-being of vulnerable people to whom all of us here owe the duty of care.

I thank also my good and noble friend Lady Thornton, who will be replying to the debate. We have worked in close fellowship over many years in active support of the co-operative movement, and I know that she will readily understand why I am so glad also that my friend, the noble Baroness, Lady Campbell, whose triumph over severe disability is so deeply moving, honours us with her presence here this morning.

When I announced the setting up of the inquiry two years ago, 1,757 haemophilia patients had already died from being infected by their NHS treatment with HIV and/or hepatitis C. The death toll has since risen by over 200 and many more are left terminally ill by what my noble friend Lord Winston, vice-president of the Haemophilia Society, describes as the worst ever treatment disaster in the history of the NHS.

Yet the grievous death toll is not the whole story: the haemophilia community suffers privation at a depth most other people can barely imagine. Not surprisingly, I receive many letters from infected haemophilia patients. They speak of no longer being able to work full time; of having become uninsurable due to the prohibitively high premiums demanded of them by insurers; and of other costs now being too dear to cope with.

For parliamentarians, there can be no higher duty than that of ensuring just treatment for those afflicted and bereaved by life-threatening medication supplied by the state, and the emphatic backing for the Archer report's recommendations by the mass media shows how clearly that duty is understood by the people of this country. Just as clearly, it was quickly understood by my right honourable friend Harriet Harman, deputy leader of the Labour Party and Leader of the House of Commons. Speaking on 5 March, she praised my noble and learned friend Lord Archer for his "important work" and added her "congratulations to the campaigners" on having,

"brought to the public's attention the injustice" suffered by the recipients of contaminated NHS blood and blood products. She then told MPs:

"The Government will respond shortly"—[Hansard, Commons, 5/3/09; col. 999.]— to the report.

That was seven weeks ago. More recently, on 17 March, my noble friend Lady Thornton, speaking in Grand Committee during the Committee stage of the Health Bill, described my noble and learned friend Lord Archer's report as "a wonderful document" and concluded:

"I warmly thank him again".—[Official Report, 17/2/09; col. GC96.]

My noble friend's remarks, like those of Harriet Harman, were much appreciated by the haemophilia community and taken as a clear pointer to an early and positive response from the Government.

As everyone in touch with the community knows, what they yearn for now is closure with the Department of Health on terms reflecting the severity of the pain and suffering endured by the afflicted and bereaved. But to date, although my noble and learned friend sent his report under personal and urgent cover to the Secretary of State for Health eight weeks ago, on 20 February, there has still been no response from him.

Often where despair from living with serious long-term illness is compounded by stressful delay, anguish can turn to anger; and sadly this is now being reflected in letters I receive from infected patients and their families. In a letter dated 15 April, the wife of a man now terminally ill asked me:

"Why was no Health Minister willing even to give evidence to Lord Archer's Inquiry when people living with terminal illnesses and in poverty, many of whom have since died, went all the way to Westminster to do so?".

Her letter went on:

"In other words, poor as we are, we traipsed all across the country to help forward an inquiry for which no Minister was prepared even to cross Whitehall. Worse still, why were Health Department officials forbidden, clearly by Ministers, from attending any public hearing of the Inquiry?".

My reply to her as to other such correspondents was that, while I could not answer for the Department of Health's decisions, I have known and respected the present Secretary of State for many years; that I was sure he must share the admiration of Members in all parts of both Houses of Parliament for my noble and learned friend Lord Archer's integrity and judgment as a former law officer of the Crown; and that he would certainly be aware of the huge public backing for the report. I also sent the Hansard coverage of ministerial comments on the report in both Houses of Parliament.

Turning now to issues raised in the report that merit close attention in this debate, I want first to raise the sombre threat now of a third deadly scourge to patients dependent on NHS blood and blood products. In response to Parliamentary Questions about the growing number of haemophilia patients known by the Department of Health to have been treated with blood from donors who have since died of variant CJD, I was told on the authority of the Chief Medical Officer that the risk of infection in such cases was purely "hypothetical". Today that demonstrably is no longer true, a recent post-mortem on a hepatitis C-infected patient having found vCJD in his spleen.

Thus an urgent updating of ministerial statements made to Parliament on the vCJD threat is called for. Specifically we need to know the department's current figures for the number of patients treated with blood from vCJD-infected donors. We need also to know what action Ministers have taken since the post-mortem on the implications of its findings. Again, how do the Government now assess the risk facing patients treated with blood taken from such donors; and further, what protection is now in place to safeguard recipients of donated blood?

I was told on 17 March that no screening test is currently available and that securing,

"a validated screening test is a priority".—[Official Report, 17/3/09; col. GC96.]

Meanwhile, however, many noble Lords are aware that technology already available to remove by filter the abnormal prions which are the causative agent of vCJD is not being used by the Department of Health, despite having passed EU-wide safety testing and clinical trials as required for use in the United Kingdom. Failure to use that technology could cost lives and here again we need an updating today of ministerial statements on this vitally important issue of making NHS blood and blood products free of prion disease agents.

I move now to the issue of Crown immunity, which the Archer report raises in commenting on the behaviour of the Blood Products Laboratory—the BPL. It states:

"In July 1979, the Medicines Inspectorate visited BPL, following which they reported that the buildings were never designed for the scale of production envisaged and commented that, if this were a commercial operation, they would have had no hesitation in recommending that manufacture should cease until the facility was upgraded to a minimum acceptable level".

Starkly, the Archer report then states:

"BPL was rescued by Crown Immunity", adding that,

"BPL's existing plant continued production, relying on Crown Immunity to dispense with all the requirements of the Medicines Act, but was able to meet only 40 per cent of the national requirements".

Words have surely lost their meaning if this does not mean that by the use of Crown immunity, a relic of feudal England, the lives of countless haemophilia patients were put blatantly and gravely at risk.

Speaking in this House on 16 March, my noble friend Lord Darzi, responding to me in exchanges about thalidomide, referred to,

"the tremendous amount of work that has gone into the marketing, testing and regulation of drugs, as encapsulated in the Medicines Act 1968, from which society has benefited greatly".—[Hansard, 16/3/09; col. 1059.]

There could be no clearer text than this for describing the enormity of the use by the BPL of Crown immunity to dispense with all the requirements of that renowned and so vitally important statute. Hence we need to reflect in this debate on from whom the BPL was "rescued" by its use of Crown immunity.

First and foremost, of course, it was "rescued" from the afflicted and bereaved of this worst-ever NHS treatment disaster by denying them any prospect of legal redress, a denial made all the more cruelly unjust by the refusals of successive Governments to agree to a public inquiry, thus leaving them with no hope of any independent assessment of responsibility for their plight until the Archer inquiry was announced.

Crown immunity has now been abolished. It was ended by John Major's Conservative Government in 1991, and infected NHS patients ask why the present Government, who clearly have no intention of reinstating Crown immunity, cannot now review the claims of the victims of contaminated NHS blood from whom the BPL was "rescued" by Crown immunity. If anyone thinks that there is no way now of reversing what happened here or of doing any more to help infected NHS patients, they should look at how the Canadian and Irish Governments have found ways of compensating victims there by more than anything even contemplated by Ministers for NHS-infected patients here.

My noble friend Lord Warner, speaking for the Department of Health on 25 March 2004, told the noble Earl, Lord Howe, that this was because it was found both in Canada and the Irish Republic that legally wrongful acts were committed by the providers of blood and blood products but that this had not been established in the UK. Of course we now know the shaming reason why, namely, that the use of Crown immunity prevented our courts even from being approached. It was because there was no such thing as Crown immunity in Canada and the Republic that legal wrong could be established there.

Among other issues of concern, the non-availability of recombinant therapy still rankles with infected NHS patients made to wait longer for it in some parts of this country than elsewhere. In England it was given only to patients under 16, but in Scotland and Wales it was available irrespective of age. It is said that this was almost certainly Treasury-driven but, for whatever reason, patients made to wait felt that they were treated unjustly and with scant regard for the effects on their health.

Another injustice said to have been Treasury-driven is that of crudely discriminatory treatment of widows of NHS-infected patients in deciding eligibility for financial assistance solely on the dates when their husbands died, even where they died within two days of each other from exactly the same cause. The Archer report's recommendation to end such illogicality and inequity is warmly welcomed by the haemophilia community.

I come now briefly to two further issues that we must not overlook today: first, the need for action now, at no great cost, to implement the Archer inquiry's call for improved access for infected patients to NHS facilities; and, secondly, the inquiry's recommendation on securing the financial future of the Haemophilia Society, faced as it is now by ever-increasing calls for help from NHS-infected patients. That this recommendation has not already been implemented has appalled noble Lords in all parts of the House, and I honour those who have made clear the depth of their concern, more particularly the noble Baroness, Lady O'Cathain, for her active support for restoring at once the punitive 70 per cent cut recently made by the Department of Health in the society's government grant.

The history of the contaminated blood disaster has been described as one of a "gallery of heroes" locked in an unequal struggle with terminal illness and the power of executive government. That is so, but there is also a "gallery of heroines" left widowed and bereaved by the disaster. I reflect in particular today on the courage, constancy and tireless campaigning of wives and mothers such as Harriet Bullock, Carol Grayson, Gaynor Lewis, Liz Rizzuto, Sue Threakall to whom I know my good and noble friend Lord Corbett will refer, Colette Wintle and, of course, the noble Baroness, Lady Campbell, all of whom belong in that gallery.

In none of the many parliamentary campaigns I have been closely involved in over 45 years in Parliament—even thalidomide, vaccine damage, and those nearly 40 years ago for statutory recognition of dyslexia and autism—have I had so strong a sense that no campaigning should ever have been necessary to right the wrongs suffered by the haemophilia community. Support for their cause, as I believe this debate will demonstrate again, is everywhere seen today as an issue not of right and left, but of Right and Wrong.

I conclude now in renewed appreciation of the nobility and humanity of my noble and learned friend Lord Archer and his inquiry team. Humanity was never more humane. I beg to move.

Photo of Lord Thomas of Gresford Lord Thomas of Gresford Shadow Attorney General 11:56 am, 23rd April 2009

My Lords, it is my privilege to be the first to congratulate the noble Lord, Lord Morris of Manchester, on securing the debate and to pay tribute to him for his dogged and determined campaign over 45 years in Parliament on behalf of disabled people. He was appointed the Minister for Disabled People—the first of anybody to achieve that post anywhere in the world—and in this House he has continued to show exactly the quality of the advocacy that he has for disabled people. He is much to be congratulated.

I also congratulate the noble and learned Lord, Lord Archer of Sandwell, the noble Lord, Lord Turnberg, Ms Judith Willets and Dr Norman Jones for their very thorough examination of the issues involving the examination of some 300 statements that were sent to them, the examination of 64 witnesses who gave evidence orally and something like 20,000 documents. As the noble Lord, Lord Morris, said a moment ago, this is not an issue of right or left; it is not a party matter. Nevertheless, the Government have resisted the appointment of a statutory public inquiry. They no doubt will explain why they have done that in due course, but it is deplorable that the Department of Health refused to provide witnesses for public examination and cross-examination.

There are a number of unsatisfactory aspects. Since it was not a statutory inquiry under the Inquiries Act 2005, the noble and learned Lord, Lord Archer, did not have power to compel witnesses or to call for papers. Counsel was not provided to the committee to assist in the marshalling of evidence and to cross-examine witnesses. In particular, there was no funding other than private donations, which public spirited people—or a person, I believe—put forward to fund the inquiry.

It is true that the Department of Health did supply documents, but many of the relevant documents had been destroyed under what was described as the 10-year rule. In its report, the inquiry makes it clear that it was never able to get to the bottom of that. Nobody from the department gave a public explanation. It appears to be a serious error of judgment; that is the only explanation that has ever been given, but it was not given to the inquiry. There has been some suspicion that this has been the reason for resisting a public inquiry and failing to co-operate in the inquiry of the noble and learned Lord, Lord Archer. I await an explanation from the Minister.

The noble Lord, Lord Owen, who gave evidence to the inquiry of the noble and learned Lord, Lord Archer, was of the view that the documents might have been destroyed a long time ago in a desire to draw a line under the whole story. The absence of a statutory public inquiry in this country contrasts strongly with what is happening as a result of an opinion of my friend the noble and learned Lord, Lord Mackay of Drumadoon. The Scottish Government are setting up a statutory inquiry, and no doubt we shall have a full report from them in due course. I only hope that it will match the thoroughness of the report of the noble and learned Lord, Lord Archer.

I see that it may be difficult for the medical community to keep up with the development of new and newly identified diseases. These issues have come forward over a period of time. However, the report demonstrates that there has been clinical and research confusion. There has been limited and contradictory advice given to practitioners. One must have some concern that lack of resources has affected the care of patients and the caution that should have been taken with them. It is undoubtedly the case that contaminated blood contributed to the wider dissemination of these illnesses: hepatitis in its various forms, HIV/AIDS and, latterly, as the noble Lord, Lord Morris, pointed out, vCJD.

One recipient's widow is a friend of mine; his name was Graham. Graham had only three treatments with blood products. The last was in 1971 when he was only 13 years old. He was then admitted with a bleed in December 1984. By January 1985, he had seroconverted and contracted HIV and non-A, non-B hepatitis, currently known as hepatitis C. Graham was not informed of his HIV status for a considerable time—years after those who were treating him had realised that he was suffering from it. He suffered from numerous minor ailments, including flu-like symptoms, extensive rashes, exhaustion and depression. In addition, he suffered life-threatening illnesses including severe anaemia. When he learnt of the nature of his condition, he was unable to have any more children. Fortunately, he had had one daughter before the condition had developed, but he was unable to have any more children for fear of infecting them and his wife.

His job was affected, and he lost it. After redundancy, he could not fill in application forms without disclosing his status, so Graham took self-employed locum work and lost many days' pay going to hospital appointments. He could not explain to his employer why he was absent so often, and he eventually lost that work. The noble Lord, Lord Morris, referred to insurance, and Graham could not get life cover. His family and social life were severely curtailed. Perhaps the worst part was that he had to lie about his condition to neighbours and friends, and even to his own daughter; of course, at that time there was a great fear of the conditions from which he was suffering.

He died at the age of 40 in 1998. Samples of his body were sent to the National CJD Surveillance Unit without his wife's knowledge. Four days after his death, she was told by the unit, "Well, haemophiliacs make an excellent model for this kind of study". She was refused an inquest and did not qualify for the Skipton payments or, indeed, any other payments, because her husband had died too soon. Therefore, she did not qualify for the reasons to which the noble Lord, Lord Morris, referred. She spent four years going through independent review of the treatment and ombudsman inquiry and suffered post-traumatic stress disorder. I have mentioned this case to illustrate to your Lordships the devastating effect of what happened to Graham before he was 13, and the impact that it had on him and his family.

The report of the noble and learned Lord, Lord Archer, sets out the chronology of events, which demonstrates time and again a lack of urgency and shows how much the Government were in denial. Despite targets to ensure self-sufficiency in blood products in the United Kingdom within two to three years being set in 1975 by the then Minister, the noble Lord, Lord Owen, that goal was never met either in his timeframe or anybody else's. Ultimately, by 1990, the attempt to make this country self-sufficient in blood products was abandoned. Government continued to rely on the importation of blood products from the United States in spite of warnings. For example, in 1983 Dr Galbraith, the director of the Communicable Disease Surveillance Centre, warned of the nature of US blood products. When, in that same year, Susan Douglas wrote an article in the Mail on Sunday referring to killer blood from high-risk donors, she was reported to the Press Council, which concluded that her article was alarmist and extravagant. Therefore, you can see the attitudes of resistance and denial that existed at that time.

When the United States introduced regulations to exclude donors from high-risk groups for plasma collected after March 1983, the old stocks were not withdrawn, either in the United States or in the United Kingdom. The noble Lord, Lord Morris, referred to Crown immunity as the cloak behind which the government department concerned hid. It is always possible not to use Crown immunity. Negligence could not have been proved unless it was shown that there was a failure by the standards of care as known at that time. The law does not require that today's knowledge about medical matters be imported back to that time. However, by using Crown immunity, the government department concerned was able to avoid an investigation into whether, by the standards of that time, there had been negligence in what had occurred. It is not too late. If the Government chose to waive Crown immunity dating back to that time, I am sure that it would be possible for actions to be brought. However, I do not suppose that they will.

The lack of participation by the Department of Health in the inquiry of the noble and learned Lord, Lord Archer, indicates to me a worrying complacency and an assumption that no other disease communicable by blood products will ever again emerge, but vCJD emerged after the problem became known. Who knows what other disease may emerge in the future which may cause the problems that I have discussed?

We on these Benches support the recommendations of the report, particularly that there should be a statutory committee to advise Government on the management of haemophilia in this country, with patient and family representation. We agree that there should be direct financial relief for those who have been infected and for their carers, on whom much of the burden so often falls. We also agree that there should be free access to National Health Service benefits. We accept that there should be government assistance for access to insurance.

The noble Lord, Lord Morris, reminded us that this whole thing has been described as a treatment disaster, as, indeed, it was. It behoves this Government and any future Government to take the report of the noble and learned Lord, Lord Archer, seriously on board and to implement it.

Photo of Baroness Campbell of Surbiton Baroness Campbell of Surbiton Crossbench 12:09 pm, 23rd April 2009

My Lords, I thank the noble Lord, Lord Morris, for bringing forward this debate on the report by the noble and learned Lord, Lord Archer, who I am thrilled to see in the Chamber today; I look forward to hearing what he has to say.

We know that the noble Lord, Lord Morris, is a tireless campaigner on behalf of people with haemophilia, especially those tragically affected by contaminated blood products. I declare an interest. On 19 December 1993, my first husband, Graham Ingleson, died, 18 months after his brother Anthony. They both lost their lives as a result of receiving contaminated factor 8 blood products in the mid-1980s. This inquiry is not just about those who were infected with contaminated blood products; there is another strong, underlying story. It is a story of mothers, fathers, sisters, brothers, wives, husbands and friends who continue to endure the effects—psychological and economic—of seeing their loved ones die or become gravely ill. We have needed this inquiry for a long, long time and now we even more need a response from a Government who have been too silent on this issue.

Noble Lords will know from reading the report that the UK Haemophilia Society has campaigned for a public inquiry since 1988. However, successive Governments have declined to establish a statutory public inquiry. On 12 January 2006, the noble Lord, Lord Warner, then Minister of State at the Department of Health, put it clearly when he said in reply to a Question that,

"we do not consider that a public inquiry is justified as we do not believe that any new light will be shed on this issue as a result".—[Hansard, 12/1/06; col. 299.]

Fortunately, we are blessed with the dogged tenacity of the noble Lord, Lord Morris. He knew that there was light to be shed on this issue and he knew that the story had to be told. He believed that a public inquiry should be held for three simple reasons: first, to learn lessons for the future; secondly, to go some small way to help victims and their families to articulate their stories and to gain public recognition of their plight—truth and reconciliation are often at the heart of the pain; and, thirdly, to make recommendations that would give practical help and assistance to those living with the effects of treatment contamination.

In February 2007, the independent public inquiry was launched under the considerable weight of the noble and learned Lord, Lord Archer. Even though it had no statutory power to compel evidence from the Government or the health service, it heard from 300 witnesses and examined over 20,000 documents—that is a lot of documents. Before us today, we have a remarkable report. It is born out of selfless commitments from solicitors and experts, the majority of whom gave their time and expertise free of charge.

The fact that this report was produced independent of government and the Haemophilia Society means that it is truly independent. The report states that there is absolutely "no hidden agenda". For many of us this is probably the most significant point and only adds to the report's power and importance. In it, noble Lords will read about the scandalously slow reaction by successive Governments to the need to safeguard blood products imported from the United States during the 1980s. This meant that we failed to protect nearly 5,000 people who died or are now living with HIV/AIDS, hepatitis C or CJD. The noble Lord, Lord Winston, was absolutely right when he said that this has been,

"the worst treatment disaster in the history of the NHS".

He should know.

UK self-sufficiency in producing blood products could have been established much sooner than it was. It took five years in Ireland, but 13 in England and Wales. This was just one of the scandalous ways in which the state reacted to the lethal health risk of contaminated blood products. Noble Lords will have read again and again throughout the report of the inappropriate and simply wrong responses to this situation.

However, it is impossible to relive those years. Quite frankly, we do not want to keep reliving them. The noble and learned Lord, Lord Archer, is right when he says that we must now look ahead. The purpose of his inquiry was to help the truth to surface and to learn important lessons for the future. It does not seek to apportion blame.

I am hoping that the recently withdrawn amendment tabled by the noble Lord, Lord Morris, to the current Health Bill, seeking to establish a statutory committee to provide and give advice to government and haemophiliacs on services and to help those still suffering from the results of contaminated blood products, will return at Report stage and will be supported. The amendment would implement one of the inquiry's recommendations. Given the decades of injustice, the amendment offers one small practical way to right a great wrong and it sends out a strong message to those who are waiting for a little more. I should be interested to hear the Minister's view as to whether this recommendation, which is not costly, and others in the report will gain the support of the Government. I am also looking forward to the possibility that the Minister will give us a timeline.

When the amendment was debated in Grand Committee, I explained to noble Lords present that every year, on the anniversary of my husband's death, I visit the church of St Botolph without Bishopsgate in the City of London. It is a beautiful church and noble Lords should visit it. At the back is a small memorial book. In it you will find the names of those haemophiliacs who have died as a result of contaminated blood products. Every year, new names are entered in the book. Haemophiliacs living with the consequences of lethal treatment require the best information, the best support and the best advice. The proposed statutory committee can provide that. The Government have the opportunity to show at last that they recognise the extraordinary plight of haemophiliacs. I hope that they and noble Lords will feel able to support the amendment, should it be laid again at the Report stage of the Health Bill.

p

For every Factor 8 infection from the US, there are 50 clearly audited and admitted infections of hcv from the NHS local blood supply. Our Self Sufficient blood was 2.6% infectious per surgery. 100,000 people need to be diagnosed fast, their death rate is tripling due to our obsession with compensation and one blood product. Cambridge PCT records 20 dialysis infections to each factor 8 infection alone. An amendment is not going to find 100,000 NHS infected survivors or 250,000 overseas survivors.
Support the 6 Hepatitis Asks, millions of safety checks will protect hundreds of thousands of lives by 2012. 5000 people die each year with hcv, no death certificate, no book or even an awareness for decades.
Our Baroness Campbell is quite right, our haemophiliacs have not been told in 1994 HCV was classified as carciogenic as smoking. They were forced into the compensation by December 1993 for a minor infection. All 2700 of them, any human deserves better treatment, we've paid to be helped with the truth, not outwitted by a compensation legal crew.

I'll get in touch personally Baroness.

Paul Desmond.

Submitted by paul desmond

Photo of Lord Archer of Sandwell Lord Archer of Sandwell Labour 12:20 pm, 23rd April 2009

My Lords, I add my congratulations to those that we have already heard from the noble Lord, Lord Thomas, and the noble Baroness, Lady Campbell. I wonder whether at this point it is also in order to add my congratulations on my noble friend's forthcoming election as a fellow of the Royal College of Physicians. It is proper recognition of a lifetime spent in the service of those who suffer.

I express my felicitations, too, on the timing of this debate. Those responsible in government needed time to read and consider our report, and to consult and discuss it, so we never expected an immediate reaction from the Government. Of course, a listening Government are an asset only if they are also a reflecting Government, and their value diminishes if they then become a dithering Government. It is nine weeks since we reported, and my noble friend's timing of this debate cannot be faulted.

I express my thanks, too, to the noble Lord, Lord Thomas, and the noble Baroness, Lady Campbell, for the kind things that they said about us. I speak on behalf of my colleagues on the inquiry in saying that we greatly appreciated the encouragement that we received both during the inquiry and since we reported.

Our report could have been more informative if we had been appointed 20 years ago—a point already made by contributors to this debate. Memories would have been fresher, the principal participants would still have been alive and all the records and documentary evidence would probably still have been available. That is the position, which it is too late to alter. We had to deal with the situation as we found it and, although the Government continued the policies of their predecessors in declining to provide oral evidence, it is fair to say that they tried to assist us within the boundaries that they had established. Even this week, we were offered documents that until then had been withheld. Sadly, of course, it was too late to refer to them in our report.

It is always a pleasure to have the ear of my noble friend Lady Thornton. Once again, I suspect that she has been assigned as wicket keeper when it is expected that there may be some fast bowling. The Government's strategy is, I suspect, transparent. There was a need for a Minister on the Front Bench who is cool and persuasive, who is known for her compassion to those who suffer and who bears no responsibility for any aspect of the tragedy.

It was inevitable that in reporting on this sad history we would feel compelled to comment on some of the decisions that were reached or on decisions that were not reached at all when it mattered. We tried to make allowances for the fact that the past is another country; we are judging from a body of knowledge that was not available at the time, as my noble friend Lord Morris pointed out, when perspectives were very different. The noble Lord, Lord Thomas, properly drew our attention to those limitations; we were very conscious of them. We did not consider it our major task to apportion blame, as the noble Baroness, Lady Campbell, pointed out.

The past cannot be changed. It may sometimes be rewritten but the reality remains with us. What is still open to change is the future, which remains open in two ways. First, we may learn lessons that help us to ensure that we do not make those mistakes again and, secondly, although we cannot prevent past mistakes, we may be able to mitigate the consequences. The effects of infection not only on patients but, as the noble Baroness, Lady Campbell, pointed out, on their families are almost impossible for those of us who have not suffered to appreciate. We had a moving example from the noble Lord, Lord Thomas.

For that reason we invited those who read our report to consider first how to ensure that future Governments have the maximum available expertise and experience. Among our recommendations, as earlier contributors to the debate pointed out, is a proposal for a statutory advisory committee, including clinicians, a representative from the Department of Health and, at least as important, patient representation—members from the Haemophilia Society and from other bodies who represent patients. Patient participation in relation to both individual treatment and national policy was conspicuously lacking when this tragedy occurred. Since then we have heard of the success achieved in Ireland, Canada, Japan, Thailand and the USA. Of course, there is a need for the very best expertise available, but that is enriched by an input from some of those who have actually been there.

I seem to remember that Aristotle said somewhere, although I have not been able to trace it in the past few days, that if you seek an opinion on the building of a house you should ask two people—the architect and the person who has to live in it. The second way of mitigating the consequences of the tragedy, as my noble friend Lord Morris reminded us, is to consider the financial position of someone who is already affected with haemophilia and is then affected with hepatitis C, HIV or both. In addition to the loss of the normal amenities, of which we have already been reminded, the patient is faced with additional expenses, such as extra heating, special diet, assistance with transport and domestic help and additional premiums for travel and life insurance. As living expenses escalate, earnings may well diminish. The patient may lose not only earning capacity but such additional benefits as pension rights. Families who formerly enjoyed good living standards are forced to live on benefits.

The present Government have been at the receiving end of a great deal of criticism in this case, but we have to remember that we are considering successive Governments. The details are set out in our report as to the provision that some Governments have attempted to make to alleviate financial hardship, but they compare poorly with the provision available in Ireland, Canada, New Zealand and Italy, to cite just a few examples. In most cases, that provision came about by way of settlement of claims that were being pursued in the courts. Part of the indignation felt here is that it was necessary to initiate proceedings in the courts. We believe that such action is not the appropriate way of approaching this question.

It is understandable that those who have suffered have looked for someone to blame and equally understandable that Governments have said that they were not to blame and regarded that as an end to the discussion. We said in our report that argument in the courts addresses the wrong questions in such situations. It does not matter whether claimants are time-barred by the Limitation Act, whether they were persuaded as a condition of the relief that has been available to sign a release exempting the Government from further claims, whether participants are now dead or whether records have been lost. We believe that it is unworthy for the Government to argue, "It wasn't our fault, so we won't relieve the financial hardship". The party that I joined more than 60 years ago believed that the Government had a duty to ensure for all their citizens a reasonable standard of living and relief from poverty—poverty for which they were not responsible—particularly where it is attributable to a specific misfortune that is clearly identifiable. I recollect Lord Ackner asking in this Chamber on more than one occasion how this situation could be distinguished from the criminal injury legislation; a victim of crime is compensated by the Government without anyone asking whether the misfortune was the Government's fault.

I am very conscious that this is not the optimum time to choose to press on the Government the need for expenditure adequate to address the hardship, but the relief has been withheld for too long. Many whose final years might have been passed free from financial pressures are already dead. Others have only a limited time left. For too long, the debate has been about what might have been. What needs to be discussed now is what may yet be.

Photo of Lord Rooker Lord Rooker Labour 12:32 pm, 23rd April 2009

My Lords, I intervene briefly to support my noble friend and others. Other than a Written Question and an Oral Question in the other place, probably in the 1970s, when the noble Lord, Lord Owen, was trying to get things moving, I do not think that I have spoken on this issue in the House. However, having followed the debate, if—as I was in the past as a constituency Member of Parliament—I were asked by constituents, "Are blood transfusions safe?", I would have some doubt today about giving the answer that I gave then. There are people who are opposed on ideological and ethical grounds to blood transfusion. Occasionally one gets called in to persuade them that it is a good thing. However, the reluctance of the department to have full disclosure—no one is interested in blame, I am not looking for who to blame and neither is my noble and learned friend Lord Archer or other noble Lords—naturally leads to suspicion.

I have no grounds for saying what I am about to allude to, but my experience is that somewhere advice will have been given about the risk of precedent because of the possible discovery of X, Y or Z that is not in the public domain. I do not know about that; what I know is that, to take vCJD for example, we still do not know the incubation period. When in 1998 I took the order for the beef-on-the-bone ban through the other place in a raucous House late at night, the one way I silenced the House was to point out the simple fact that when the post mortems were done, the medical instruments could not be used again. Sterilisation was not an answer—they simply could not be used again because it is so infectious. As I said, we do not know the incubation period of that disease. I do not know whether there are other examples, but natural doubt and suspicion is created where there is reluctance to disclose information in a no-blame situation—the individuals concerned are not around because of the time lapse.

I very much regret that we have reached that the position. The National Blood Transfusion Service is always campaigning because we need blood for transfusions for all kinds of things, but there is bound to be a festering doubt in people's minds. I regret that. We have to ask, as others have: "What is government for?". I always taken the view that government is for the public good, to do the things that people cannot do for themselves privately. People say that government interferes, but that is what government is for. Public good works—that is what the Government are for. However, if in doing those public good works the Government harm people—inadvertently; no one is saying that anyone went out to do this deliberately—how then do we as a society care for those who we have harmed collectively by the action or inaction of the Government? There is enough evidence of the warnings about buying blood products created from blood paid for in suspicious circumstances, especially from prisoners in United States. It is all there on the record from the 1970s and 1980s. It is there for anyone to see. It is not as though doubts were not around; they were.

The issue comes up occasionally in respect of the Armed Forces. We have a moral responsibility and a public duty. The Government—I use government as a generic term to cover all Governments—and the machinery of government, our professional civil servants, are basically there to make sure that we do not have a collapse in the standards of conduct of public administration. When there is reluctance to have an inquiry because it is said that there is nothing more to learn—"Oh, and by the way, on the inside track, we might be creating a precedent for something else coming down the line"—that is a collapse of or a lapse in standards of conduct of public administration.

I look—I looked as a Minister—to the guidance we get from civil servants to make sure that we do not fall into that trap as Ministers come and go. There is an issue here that transcends the technicalities and the human tragedies that we have heard about this morning. I shall not repeat those, but there is a serious issue of the doubt, uncertainty and pressures on individual families. I just make one point about finance, which was drawn to my attention by one of my former constituents from many years ago, whose name has already been mentioned. The £140 million paid out to the 5,000 people averaged out at £28,000. That is a sum not adjacent to £124,000, which is a sum bandied about in the other place as the annual second-home allowance. One can see what a pitiful amount it is if you have lost your career and have caring responsibilities, doubt about work and other extra pressures. It is a pittance—and many people have been denied even that.

I doubt that my noble friend will be able to answer all our questions, but, by and large, the Civil Service is frightened of this place—that is my experience from working in four departments—because civil servants do not understand it. The one thing they know about it is that the Government do not control it, unlike the other place. As long as we keep off the money side, we can be taken far more seriously and there is always the chance that we can get some action. I do not imply a threat about the legislation that is coming. Governments are judged in some ways on the big issues of the day—yesterday's Budget is a good example—but they are also judged in people's hearts and minds and, in the minds of opinion-formers, by the smaller matters of how they deal with people who cannot help themselves. There may be 100 people here, 50 there, 1,000 there, whose lives are devastated and harmed because of the state doing its function. That is a test by which any Government must be judged. The question is how they react when the small people are damaged by them—how they handle not the big financial and industrial issues of the day but these issues. The eyes of the country are on this place, and indeed on the Government—as they should be because they are the Government of the day, and as they should be on any Government—to see how a case such as this is handled. I look forward to my noble friend's response on the issues that have been raised here today, and hope that she will take them back to the department and consider them seriously. The one message that the department will get from this debate is that this debate is not the end.

Photo of Lord Corbett of Castle Vale Lord Corbett of Castle Vale Labour 12:40 pm, 23rd April 2009

My Lords, it is with great sadness that I thank and congratulate my noble friend Lord Morris of Manchester on staging this debate. There is a huge monument of shame to successive Governments, who for more than 20 years have found ways of avoiding what are clearly their responsibilities to the victims who were infected with dirty blood and to their carers, often spouses, who are left behind and condemned to abject poverty.

One of my former constituents, Mrs Sue Threakall, who gave evidence to my noble friend's inquiry—I congratulate him and his colleagues on it—e-mailed me this morning to say that she wanted to be here to sit in the Public Gallery and listen to this debate but could not afford the train fare from Somerset. It should shame everyone that we allow this to happen.

My noble and learned friend Lord Archer of Sandwell so aptly described this as an horrific human tragedy. That is exactly what it is. What was the response of an unnamed spokeswoman from the Department of Health, which was published in the Times on 24 February this year, to my noble and learned friend's report? She is quoted as saying:

"We have great sympathy for the patients and families affected by contaminated blood products in the 1970s and 1980s".

My former constituent Mrs Threakall does not want sympathy; she finds it offensive. She wants relief from the shattering poverty to which she is condemned because her breadwinner husband, Bob Threakall, who was given dirty blood, died on the wrong date in the wrong country. He died at the age of 47 in 1991, having been infected by HIV and hepatitis B and C in 1977. Since then, Mrs Threakall has been forced on to means-tested benefits as she tries to come to terms with her loss. That personal tragedy, which is repeated all around the haemophilia community, is made worse by a state that supplied contaminated blood without accepting its moral responsibilities for the consequences of that action.

As the Archer report says on page 101:

"Without necessarily apportioning blame, the state needs to act responsibly in addressing the tragedy of patients being infected with potentially fatal diseases through NHS prescribed treatment".

When her husband died, Mrs Threakall said, "It just ripped the family apart". It takes no great imagination to understand the full force of those words. Had her husband Bob died after August 2003, the Government would have made a compassionate payment, but as he died in 1991 she and the family got nothing, not even any kind of apology. There was no well thought out and well argued principle; there was simply an arbitrary date that had been snatched for a reason that was not explained, and that was it. If you died that side of the line, you got nothing; if you died this side of the line, you got something. That is both offensive and indefensible. It is unfair and unjust, and it has condemned Mrs Threakall, who is now 55, to severe financial problems that deserve and demand to be met. A date on a calendar and an accident of geography have denied Mrs Threakall and others justice. Had that family lived in Ireland, up to £100,000 would have been paid to Bob as a patient infected by HIV, and an average of £750,000 would have been paid to those like Mrs Threakall's husband who went on to contract hepatitis C from the dirty blood.

My noble and learned friend's report gives this Government the chance to right a huge wrong. No one is arguing whether it is right or wrong. As my noble and learned friend says, there is no point in trying to apportion blame. This happened, and it had severe, known consequences for the patients who were given the dirty blood and for the carers who were left behind. There is no argument about that, but successive Governments have displayed stubbornness: "Yes, that's alright. We know all about that but we can't do anything about it". However, it is not a question of "can't do anything about it", but, "won't do anything about it". This Government should understand, as should other Governments, that if this is not dealt with, it will not, as my noble friend Lord Rooker said, go away. There is a determination in this House and the other place, and certainly in the community that is so seriously affected by this, not to give up this fight. I made a promise to my former constituent Mrs Threakall that I would not give it up either, because I stand proudly alongside her.

I hope in the process that the Government will find a way not to express sympathy but to apologise to the community for what happened, because we are entitled to trust our National Health Service to take all proper care, and to trust the treatment that is on offer to us. That trust was betrayed in this case, which again underlines the moral responsibility of Governments in this matter.

It is no proper response for successive Governments to argue that the NHS acted in good faith. No one doubts that; what matters are the terrible consequences of judgments made in good faith, of which this is an example. Those judgments have cost lives and have left relatives hurt and in severe financial circumstances. Those judgments, which I accept were made in good faith, were simply wrong, and victims and relatives have an unanswerable moral case to have that loss recognised.

My noble and learned friend Lord Archer mentioned the words of the late Lord Ackner—I remember him standing in the Chamber on 21 November 2002. He summed this up—this is the lawyer's skill—in this way:

"My Lords, how does the noble Lord differentiate between this case and the extensive compensation provided for victims of crime? There is no obligation on the Government to provide a penny piece for victims of crime, but, in the past, it was provided on the same basis as the ordinary civil liability. Subsequently, it went on to a tariff system. Many millions of pounds are provided for victims of crime. Why is there a differentiation between them and the haemophiliacs whom we are discussing?".—[Hansard, 21/11/02; col. 508.]

Why indeed? The question that he asked then is as relevant today as it was on the day when he asked it.

Finally, page 108 of the Archer report says:

"Direct financial relief should be provided for those infected, and for carers who have been prevented from working. We propose that the scheme should have the following characteristics".

I shall not read them all out, but I draw the attention of your Lordships, and of my noble friend, particularly to paragraph (e) on page 109. It states:

"The anomalies which at present apply according to the age when the recipient was first infected, or when the infection took place or, in the case of dependents, the date of death of the original patient should be rectified. In particular, the Government should review the conditions under which the widow of a patient", for haemophilia,

"now becomes eligible for benefit from the Eileen Trust and from the Skipton Fund".

I hope that when my noble friend replies she can at the very least assure us that the Government intend to accept and implement the report's recommendations and bring to an end this dreadful agony.

Photo of Lord Low of Dalston Lord Low of Dalston Crossbench 12:50 pm, 23rd April 2009

My Lords, I remember a Question Time one Thursday morning when the noble Lord, Lord Bilimoria, rose to ask a particularly pertinent question which he prefaced by saying that he had got off a plane from India at 6 o'clock that morning. I never expected to find myself in the same position, but I now do. Having been in India for the past 10 days or so and not being aware of the debate on the Order Paper, I was not able to put my name down to speak. In those circumstances, perhaps your Lordships will extend me your indulgence for a minute or two so that I may make one or two observations. I intervene with some diffidence because I also recall the noble Lord, Lord James of Blackheath, speaking in the gap on one occasion when he said that although people had drawn his attention to the procedural opportunity of speaking in the gap, he had always received the advice, "Know about it. Don't do it".

This debate puts me in some difficulty. Arriving in the House this morning and seeing the debate on the Order Paper, I was of course anxious to support my noble friend Lord Morris, with whom I have worked particularly closely over a very long period. As I say, I would not normally intervene because I am comparatively unbriefed on the report of the noble and learned Lord, Lord Archer, which everyone has commended so eloquently this morning, and I am not as well versed in the issues as the rest of your Lordships are. However, I am moved to intervene briefly for four reasons.

First, as your Lordships know, the noble Lord, Lord Morris, is very persuasive. Secondly, although many people have referred to his tireless campaigning over a lifetime in politics, and I have known and worked closely with him for a long time, I have never heard him speak with such eloquence and authority as he has this morning. That is one reason that leads me to want to give him such support as I can.

Thirdly, in some respects, being comparatively unbriefed about the issues enables me to make a distinctive contribution, because my lack of briefing puts me in the position of the man in the street who listens to the case that noble Lords have been deploying. Anybody coming to this debate untutored is bound to get an impression of heartlessness, obfuscation and prevarication. It seems to me that the Government, in that situation, have the job of defusing that impression. From what I have heard, there is a case to answer and I hope very much that we shall hear some persuasive answers from the Minister.

My final reason for intervening is simply to underline the point mentioned by the noble Lord, Lord Corbett, at the end of his contribution—namely, that the National Health Service is a public and government service to which people look for healing and cure. The irony of people being injured or, indeed, killed by the treatment that they receive in the health service casts a heavy responsibility on those responsible for running it to make proper amends to those who have suffered in the way that noble Lords have so eloquently described this morning.

Photo of Baroness Barker Baroness Barker Spokesperson for Health 12:56 pm, 23rd April 2009

My Lords, I am delighted to congratulate the noble Lord, Lord Morris, and the noble and learned Lord, Lord Archer of Sandwell, as well as the noble Lord, Lord Turnberg, on producing a fascinating report into a complex series of issues. It is a commendable document in every sense. Sitting down to read it a couple of weeks ago, in preparation for this debate, brought back memories from the early 1980s: of friends of mine becoming ill and, later, starting to die and of fear, prejudice and hysteria about the new illness, which at that point had no name but seemed to affect minority groups disproportionately. I remembered that at the time somebody had produced a T-shirt with the slogan, "Prejudice Kills". The report that we read today shows how long and devastating the effects of prejudice can be on the health of a nation; I have no doubt that the fear and prejudice that were around then led to many of the problems for people that the report of the noble and learned Lord, Lord Archer, so eloquently describes.

Noble Lords have heard me talk before about the American book And the Band Played On, written by Randy Shilts, which attempted to document the origin and spread of HIV on the west coast of America. In that book, Randy Shilts looked at the incidence of illnesses and how different communities responded to them. There is a startling point when the staff of the Center for Disease Control in Atlanta have figured out that the thing, whatever it is, is a blood-borne entity. They go along to meet the charities that, in the United States, were responsible for what was a commercial activity—the collection and distribution and blood. They try to explain their suspicions about the unfolding disaster to those charities, and to the companies and doctors who work with them. The charities ignore them, because they cannot afford the commercial decision to take their advice. In the book, the gentleman from the Center for Disease Control says, "When doctors become businessmen, where does someone who needs a doctor go?". I remember reading that and thinking, "Thank goodness I live in the UK where we have a National Health Service and these issues cannot arise". Then along comes the report of the noble and learned Lord, Lord Archer.

Let me pick up on the points made by the noble Lord, Lord Rooker, about why the noble and learned Lord's report is as it is. If this matter was being discussed in America, it would be sorted out in court, because it would be an issue of commercial liability. In Britain, it is not. We have the National Health Service. Consequently, the responsibilities of politicians and the Government are different. That is why it is important to fulfil some of those roles that the noble Lord, Lord Rooker, set out so well. We must guide the Government towards the role that they have to play, which is not just to mitigate the terrible devastation that has been wreaked on individuals but also to consider the good of public health.

When I have worked on issues of medical negligence, particularly during the passage of the NHS Redress Bill, I have always come away in the knowledge that the victims of medical negligence principally want three things. They want to know what happened and why, because they want to prevent the same mistakes from happening to others, and they want acknowledgement of their suffering. Only rarely do they want to ascribe blame, but sometimes they need financial reparation to enable them to deal with the devastation that has been wreaked on them. In so far as it could, the report of the noble and learned Lord, Lord Archer, attempts to do the first and the third of those things. It does not deal with preventing similar mistakes or deal directly with financial compensation, nor should it, because that is the role of the Government. I shall concentrate on those two issues.

On reading such a report, one's first instinct is to ask what lessons we can learn for the future. However, it is important to acknowledge that we are talking about a period of about 35 years, during which a great deal changed. There has been extensive development of clinical knowledge; for example, the diagnosis of viruses is different. There have been changes in medical ethics and the way in which patients are involved in decisions about their treatment. Protocols governing patient information and consent to trials have changed. We now have the National Patient Safety Agency, NICE and the Healthcare Commission, which is now rolled into the CQC, all of which are involved in the development and auditing of standards of safety.

However, some issues are timeless; they tend to be the boring, basic issues, such as record keeping and the integrity of data. Since those days, there has been one big change in the NHS. Management and government in the NHS have become far more fragmented and complex. We do not work so much to national standardised systems. Therefore, when the Government respond, I hope that they will take from the report of the noble and learned Lord, Lord Archer, the need to ensure that the basic systems of information and the basic principles about data retention are enduring. In these days of electronic communication, greater attention should be given to the training of civil servants and officials in the Department of Health than ever there was in the past in order to ensure that something like this is never repeated.

I should like to ask the noble Baroness, Lady Thornton, in her reply, or later, to think about another difference. A few weeks ago, she and I were involved in the debate on the report of the noble Lord, Lord Soley, into the role and efficacy of international organisations in the detection and containment of infectious diseases. I commend that extremely good report to noble Lords. The noble Baroness will remember that we talked about how the systems of surveillance and the ways in which treatment information is transmitted internationally have become much more important than they were in days gone by. Given the report of the noble and learned Lord, I should like her to comment on the current state of the Government's domestic systems of surveillance for infectious diseases and to say whether the international systems to which the Government subscribe are of a sufficient standard to ensure that a disaster of this kind could not happen again. On what basis would she have confidence that it would not?

Noble Lords have alluded to the three or four trust funds set up to compensate the victims of contaminated blood products. I shall make a few points on that. First, we have a number of trusts, all of which have different criteria, all of which have specific limitations on which they can work and all of which are based on a principle that they are there to mitigate and to offer relief. They do not work in the same way as other compensation schemes, such as that involving compensation to accident victims, whereby the victims are given a sum of money to use in whichever way they choose in order to deal with the issues in their lives resulting from an accident. I do not understand why in relation to these diseases the Government have taken the form of charitable trust that they have as their model. Why is that so?

Secondly, many of the beneficiaries of those trusts now have a longer life expectancy than was ever envisaged when those trusts were set up. In the light of that, does the noble Baroness agree that not only the levels of compensation but the way in which those trusts are administered need to be reviewed? Finally, on a technical point, I picked up in the report that the reason why there are so many different trusts seems to be based on a technicality of charity law. Does the noble Baroness agree that it is perhaps time to review the existence of those different trusts to see whether they could be rationalised and run more efficiently as one?

I shall finish with a few questions that I hope will enable us to glean from this report lessons that are applicable now. Will the Government advise people who were treated with NHS blood products between 1973 and 1986 to be tested for HIV and hepatitis C? In so doing, will they notify them of the existence of the Macfarlane Trust? That seems to be exactly the point made by the noble Lord, Lord Rooker. The Government have an enduring role not just reactively to mitigate the terrible personal circumstances of individuals but proactively to attend to issues of public health. This will go on for many years. The latency period of these diseases is such that there are people who will not know about their status for some considerable time.

Secondly, in the 2000 audit review of the Advisory Committee on the Virological Safety of Blood, a recommendation was made that new and existing staff should receive training about the importance of record keeping and observing guidance. Is that being done for all new staff? Are the conditions under which the testing of blood products is conducted kept under continuous review? How often is the review system tested?

The noble and learned Lord, Lord Archer, is absolutely right to state that we cannot undo the past. All we can do is acknowledge the failures of our national health system. If we do nothing else today, in making our attempt to ensure that prejudice no longer kills people, we should take the advice of the noble Lord, Lord Rooker, and acknowledge that it is the role of government to ensure that the standing of the health service is as high as it can be so that people can have confidence in the NHS as the body that oversees public health in this country. If we can do that, in our own way we will have contributed a fitting testimony to the people who have died as a result of this terrible tragedy.

Photo of Baroness Morris of Bolton Baroness Morris of Bolton Shadow Minister, Health 1:11 pm, 23rd April 2009

My Lords, I start by adding my thanks to those already given to the noble Lord, Lord Morris of Manchester, for calling for this debate and for his powerful speech. He has been tireless in raising this issue successively in the other place and in your Lordships' House, and for that he deserves our gratitude and appreciation. The infection and deaths of patients with HIV and hepatitis C through contaminated National Health Service blood and blood products was, as the noble and learned Lord, Lord Archer of Sandwell, stated in his report on 24 February, a "horrific human tragedy". It is therefore appropriate and just that the noble Lord, Lord Morris, should fight so hard for attention to be drawn to this report and I thank him for that.

It is also fitting that at this time we should extend our gratitude to the noble and learned Lord, Lord Archer, and his colleagues for their enormous efforts in producing this thorough, detailed and truly informative report. It is to be hoped that the two years of hard work that went into the report will now result in many more years of hard work for successive Governments as the insights raised are taken into account and, where appropriate, acted on. I acknowledge that this affects successive Governments, and the report was careful not to apportion blame. We on these Benches believe, however, that the Department of Health has done a great wrong by not taking part in the inquiry publicly. The noble Lord, Lord Thomas of Gresford, called it a "worrying complacency". The few meetings that it did have were held behind closed doors.

This report outlines a tragedy that has resulted in the deaths of over 1,700 people and has meant great hardship and distress for many other haemophilia patients and their families. The strong underlying story of the psychological effects has been movingly told by the noble Baroness, Lady Campbell of Surbiton, and the noble Lord, Lord Corbett of Castle Vale. As the noble Lord, Lord Morris, reminded us, the noble Lord, Lord Winston, has described this as,

"the worst treatment disaster in the history of the NHS".

Can the Minister shed some light on why the Department of Health would not allow files and documents relating to the case to be examined? According to the Times, 35 documents were withheld on grounds of confidentiality. I will be most grateful if the Minister could elaborate further on the nature of these documents, the reasons for the secrecy and why the decision was then taken to make some of the documents available—but too late, as we heard today, for the noble and learned Lord, Lord Archer.

In 2006, the noble Lord, Lord Warner, stated that the Government's position on an inquiry was that,

"we do not consider that a public inquiry is justified as we do not believe that any new light will be shed on this issue as a result".—[Hansard, 12/1/06; col. 299.]

I doubt that anyone reading this excellent report could agree with those sentiments. In pleasing contrast, on the last day of Grand Committee on the Health Bill, the noble Baroness said in response to an amendment tabled by the noble Lord, Lord Morris of Manchester, that the report of the noble and learned Lord, Lord Archer, was "a wonderful document" and that,

"the Government take the report very seriously ... giving careful consideration to all the recommendations".—[Official Report, 17/9/09; col. GC 95.]

The Minister also informed us that there might be some feedback from the Government on this report before the next stage of the Bill. The next stage is to begin on Tuesday. Do the Government plan to release any useful feedback between now and then, or could it be that today the Minister will announce whether the Government intend to adopt any of the measures recommended? I ask that because there is an understandably pressing desire to hear something.

In particular, do the Government intend to establish a committee to advise on the management of haemophilia within the UK, and what is their opinion about a look-back exercise, which would attempt to identify as far as possible those who may have been infected and are still unaware of it? Regardless of whether the Government decide to accept the findings of the report, does the Minister not agree that this is an important public health factor on its own? Will she also assure your Lordships' House that the United Kingdom will continue to be self-sufficient in haemophiliac clotting products for the foreseeable future? Have the Government had any discussions with the companies involved in this tragedy, such as Baxter, on the issue of donations to the charitable victim funds that have been established in a manner similar to those for thalidomide victims?

The report not only demonstrates the horrific consequences of the terrible tragedy surrounding contaminated NHS blood and blood products, but also warns against renewed dangers which could mean that a similar disaster may occur again. It states:

"The problems surrounding vCJD are a reminder that new infections may yet arise with serious results".

The noble Lord, Lord Morris of Manchester, called it a "deadly scourge", and the noble Lord, Lord Rooker, graphically described the problem. Is the Minister able to say whether any action is being undertaken to address this?

When we are ill, we have faith that the treatment that we receive will help to make us better, or will help us to manage the disease so that we can lead as full and dignified a life as possible. To receive treatment that leads to such tragic consequences is unimaginably cruel. I look forward to the Minister's response to this timely debate.

Photo of Baroness Thornton Baroness Thornton Government Whip, Baroness in Waiting (HM Household) (Whip) 1:18 pm, 23rd April 2009

My Lords, I begin, as have all other noble Lords, by paying tribute to my noble friend Lord Morris of Manchester, a fellow corporator, for his dedicated and tireless work over many years on behalf of haemophilia patients and their families. It was he who initiated the inquiry chaired by my noble and learned friend Lord Archer of Sandwell, to whom, together with Dr Norman Jones, Judith Willetts and my noble friend Lord Turnbull, we owe a debt of gratitude for their well considered report. The Government acknowledge its importance and value to those who have suffered as a result of the very treatments which should have transformed their lives for the better. There is no doubt that the tragic consequences of these treatments have seriously impaired the lives of many people and those of their families, as outlined by noble Lords, and I appreciate and commend that many noble Lords wish to take every opportunity to seek further steps to remedy this situation.

The Government take the report of my noble and learned friend Lord Archer very seriously. I have now read the report and its recommendations twice and I was struck again this past week by its reasoned and passionate tone; it manages to incorporate both. As noble Lords know, the Government are giving careful consideration to all the recommendations. However, in light of this, it would be premature of me to address today the recommendations in any detail while my right honourable friend the Secretary of State for Health was still considering the implications in the round. I would dearly have loved to be able to give your Lordships further enlightenment on the Government's view of the detail but I am not in a position to do so. In answer to the point made by the noble Baroness, Lady Morris, I am pushing hard, shall we say, in terms of the next stage of the Health Bill.

Before returning to some of the salient points of my noble and learned friend's report, I should say to your Lordships' House that we fully acknowledge the pain and suffering—physical, psychological and economic—that has afflicted so many people and which has permeated the lives of the friends and families of those affected. As the noble Baroness, Lady Campbell, eloquently described, the wives, husbands, partners and friends have had to, and still do, take care of their loved ones and support other family members.

Many Members of past Governments have expressed their regret for what happened. Perhaps I may I say on behalf of this Government how deeply sorry we are for what happened. We acknowledge that these serious infections, which were acquired as a result of NHS treatment some two or more decades ago, have struck a particularly cruel blow to patients suffering from haemophilia and other bleeding disorders, who saw treatment with clotting factor concentrates as giving hope of a much improved and possibly near normal life.

Legal proceedings were initiated and concluded several years ago and successive Governments have established three schemes to provide financial relief to those affected. In the light of the recommendations made by the Archer report and remarks made by, for example, the noble Baroness, Lady Barker, I should say that the whole issue of financial relief is being considered as part of the Government's consideration of the report. I assure your Lordships that that is happening but I cannot tell you what the outcome will be. While Governments have taken steps to provide financial relief, the contribution of the Haemophilia Society in supporting these patients and their families cannot be overstated. I pay tribute to the work of the society and its officers, past and present, and to those members who have worked tirelessly in support of the society's aims. I know that my noble friend is concerned about the funding position of the Haemophilia Society and that this is a matter for ongoing discussion with the department.

Understandably, haemophilia patients, together with their clinicians, initially welcomed a product which improved their quality of life so greatly. As my noble and learned friend observes in his report on page 26, it was recognised at an early stage that there was some risk of infection associated with blood products, but the balance of the risk assessment was in favour of continuing to provide access to clotting factor concentrates derived from US plasma obtained from high-risk donors. With the benefit of hindsight, we now recognise the tragic consequences of the decisions about treatment that were made in good faith and with every intention to improve the quality of life. We must remember, though, that even if this country could have met its own need for the supply and processing of plasma, the risk could not have been completely eliminated. The seriousness of chronic hepatitis C infection only became apparent after full characterisation of the virus in 1989, a problem not unique to the UK.

As noble Lords know, our ability now to make properly informed assessments of the relevant events and decisions taken throughout the period in question—the 15 years from 1970 to 1985—is limited by the incompleteness of the documentary record, for which this and former Governments have apologised. The noble Baroness, Lady Barker, made some very pertinent points about record keeping. The Department of Health has acknowledged that it fell well short of expected standards of records management—a number of documents that it held were misplaced or destroyed in error—but considerable efforts have been made to identify and release all documents that can now be traced. Following an internal audit, the department reviewed all its remaining documents from the period in question and has now published over 5,000 documents, comprising more than 20,000 pages, on its website. These include documents that were withheld from the court in 1990. I am pleased that my noble and learned friend's report stated that,

"we have discovered no evidence of malicious destruction of relevant records".

The department remains committed to publishing, in line with the Freedom of Information Act, any further relevant documents from these years. That is why it has reviewed the 35 remaining documents and I am pleased to report to the House that there are now only nine documents outstanding, and these contain personalised information within the terms of the Freedom of Information Act. We will also provide assistance to the official inquiry in Scotland under Lord Penrose, beginning with a list of all relevant files held by the department.

Turning to the question of the inadequacy of information given to some patients by their clinicians, I deeply regret that this occurred. It is a reflection of the accepted norms of clinical practice at that time. That is not an excuse but we need to recognise that we live in different times. The medical profession now takes a different approach to the assessment of relative risks and the communication of those risks to patients.

Human blood and the products derived from it can never be completely safe. I should say to my noble friend Lord Rooker that great strides have been made. There have been great improvements in safety since the 1980s, and European-wide standards are now mandatory for the safety and quality of blood and blood components used within the European Union. Multiple layers of safeguards are in place to protect against the transmission of blood-borne infection.

Products derived from blood, such as clotting factors, are medicinal products and are required to meet the strict criteria of European medicines regulation. The risk to haemophiliacs from transmission of blood-borne infection has further been significantly reduced through the introduction, for all those patients for whom they are suitable, of synthetic products not derived from human blood. This represents a major advance in safer treatment for many patients.

The threat posed by variant CJD, which has been mentioned by many noble Lords, is currently uncertain. Risk estimates are refined as new knowledge emerges, but there is still much that we do not yet understand about the transmission of this disease. We have implemented a series of precautionary measures over the past decade to protect the blood supply and we continue to monitor this area very closely in conjunction with our expert advisory committees. I know there is much interest in the introduction of a blood test but it is crucially important that any such test is properly validated.

In response to the question of my noble friend Lord Morris, I should say that studies show that the composition of blood changes as a consequence of filtration. Therefore NHS Blood and Transplant and the Department of Health require that all prion filters undergo appropriate quality and safety trials. None of the filters currently available has yet completed the necessary safety and efficacy trials. Once they have, the Department of Health will seek independent expert advice from the Advisory Committee on the Safety of Blood, Tissues and Organs in deciding whether to introduce prion filtration. I will keep the House informed of progress on that matter.

We are certainly not complacent on this issue. As scientific knowledge progresses and new technologies are developed, our independent expert scientific Advisory Committee on the Safety of Blood, Tissues and Organs continues the task of assessing options for making blood even safer, taking account of up-to-date, validated scientific evidence and its potential impact on supply and cost-effectiveness. Further, we continue to support the NHS through the National Blood Transfusion Committee and others to embed best practice so that blood is used only when clinically necessary. Current initiatives on the better use of blood are having a positive impact in clinical practice.

I turn now to some of the specific points raised by noble Lords. My noble friend Lord Morris asked, as did other noble Lords, why a Minister or an official did not give public evidence to the Archer inquiry. Apart from the fact that no one in the department has any direct knowledge of this, the department agreed that the evidence it held was documentary, which is why over 5,000 documents were released and copied to the noble and learned Lord for his inquiry. I appreciate that that may not completely satisfy noble Lords on this matter, but I also make the point that, as several noble Lords have indicated, this is the beginning of a process of accountability for the Government on this important matter, and I do not doubt that we will have several opportunities to discuss it and take it forward.

My noble friend Lord Morris and the noble Lord, Lord Thomas of Gresford, raised the issue of Crown immunity, which applied at the time. Following the Burton judgment of 2001, there is strict liability under the Consumer Protection Act for the supply of any defective products. The noble Lord also raised the issue of why the department gave no explanation for the loss of documents. I have given the best explanation that we can: some documents were lost. We have carried out an audit and we have released all the documents that have been retrieved. We have retrieved documents that we thought were lost and made them available. We have apologised for the fact that in the past we fell short of the standards that one would expect.

My noble friend Lord Rooker raised the issue of full disclosure. I make the point that the Government have gone further than any other in making information available on this. We are committed to releasing all the relevant information that we hold from 1970 to 1985, when the safeguards for blood products were in place. As I say, 5,000 documents were released and we have every intention of co-operating with the Penrose inquiry.

My noble friend put his finger on the ethical matter in this debate. My noble friend Lord Morris and those who are championing the Archer report will be pleased that they have my noble friend Lord Rooker as a champion in this issue; I have no doubt that his trenchant comments will have a desired effect in the right places, because he has made them.

I looked at the list of speakers today and thought, "Oh my goodness—here are all these noble colleagues who have such vast experience in these matters". If I were looking for people to support me in a campaign, this list of speakers would pretty much be it. My noble friend Lord Corbett made a passionate and pointed speech. We acknowledge that the point he made is one of the key recommendations of the Archer report and, although I cannot say anything specific about this, I know that it is one of the matters that the Minister is considering.

The noble Baroness, Lady Barker, raised the current system of domestic surveillance for infectious agents. We have made considerable investment in disease surveillance systems and continue to look at how they may be further improved. I would like to come back to her about this, because I remember that in the discussion we had previously on this issue there was significantly more detail about it, including the international work.

The noble Baroness also raised the issue of testing people other than haemophiliacs who received blood transfusions during the 1970s and 1980s. We are currently funding a national public awareness campaign to encourage people who may have been exposed to risks for hepatitis C factors, including blood transfusions, to consult their GPs and discuss having tests done.

The noble Baroness, Lady Campbell of Surbiton, raised various issues that I hope I have addressed. She mentioned the amendment to the Health Bill. I believe that that has already been tabled, so I will limit myself to saying that we are going to revisit this issue and that there will be further discussion at the next stage of the Bill. I have no doubt that many of these remarks will be made again at that time, and I hope I will have a more detailed answer then.

I have listened carefully to the moving, wise and considered contributions that noble Lords have made to this debate, and I am grateful to my noble friend Lord Morris for securing it. As my noble friends Lord Rooker and Lord Corbett have said, this is the beginning of this discussion. It remains for me to reaffirm the Government's commitment to consider carefully all the recommendations put forward by my noble and learned friend Lord Archer, and to say again to those affected how sorry we are and how much we regret the events that resulted in the tragic outcomes for their families.

Photo of Lord Morris of Manchester Lord Morris of Manchester Labour 1:35 pm, 23rd April 2009

My Lords, many unanswered questions remain, and clearly we must return soon to the urgency of the haemophilia community's plea for closure now on the basis of my noble and learned friend's landmark recommendations.

Meanwhile, I thank all noble Lords who have taken part in this debate, which I am sure we will find has nudged things forward considerably for the haemophilia community. I beg leave to withdraw the Motion.

Motion withdrawn.

p

Tragically not a single Lord did the simple math. Our 10,000,000 post war blood use procedures were 2.5% infectious, infecting 250,000 people by 1994. As admitted by the NHS and printed in the WHO HCV Epidemic Map 1999. Every one of the Lords above has been told this both during the Inquiry and by...

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