Blood Products

– in the Scottish Parliament at 9:15 am on 22nd December 2005.

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Photo of George Reid George Reid None 9:15 am, 22nd December 2005

Good morning. The first item of business is a debate on motion S2M-3767, in the name of Carolyn Leckie, on blood products.

Photo of Carolyn Leckie Carolyn Leckie SSP

I acknowledge that many people have suffered and died as a result of the contamination of blood products. Nothing will ever compensate for that. As a result, valiant groups and individuals have worked tirelessly, and continue to do so, in the pursuit of knowledge and truth around the complex questions that surround the contamination of blood products and infection of patients with viruses such as HIV and hepatitis C. Some redress has been achieved through financial compensation, but that avenue has not been exhausted. Today, having obtained counsel from campaigners, I intend to concentrate on the outstanding and very much alive demand for a full, independent public inquiry.

To date, we have been asked to accept the judgment of ministers past and present. Until the freedom of information regime was introduced, campaigners had no access to any documents that would enable them to test the judgment of ministers. Years of resistance to publish are cause for concern alone and the Executive continues to withhold substantial documentation. I do not believe that its position is sustainable. I have spent many months sourcing primary materials to help me form my judgment. In the short time that I have this morning, I will pick out some facts from many that require independent examination, investigation and judgment. My points can be substantiated by documents that have been obtained not just from the Executive, but from primary sources including the Scottish National Blood Transfusion Service, health boards, other bodies and individuals.

As early as 1978, the medical authorities were aware that abnormal liver function tests were associated with large donor pool products such as factor VIII. On access to patient records, it was discovered that at least one patient was documented as testing positive for non-A, non-B hepatitis, which became hepatitis C, in 1979.

In a letter that I received yesterday from a top clinician in the field, I discovered that in 1983 the prevalence of non-A, non-B hepatitis in the donor population was estimated to be one in 200. Anyone who received more than 200 international units of cryoprecipitate prepared from a much smaller donor pool than factor VIII had a 100 per cent chance of contracting hepatitis non-A, non-B. Recipients of factor VIII who were exposed to thousands of donors per vial had a 100 per cent chance of contracting that virus from even fewer doses. The statistical chances of contracting any blood-borne virus were higher from factor VIII.

By 1983, the risks of contamination of blood products were well understood and documented. As a result, cryoprecipitate was designated as the preferred treatment for haemophiliac children, but that option and information were not communicated to adult patients.

In 1983, Council of Europe recommendation 8 was issued. It stated that recipients of blood products should be exposed to a minimum number of donations; countries should achieve self-sufficiency in blood from voluntary, unpaid donors; imports from countries of high risk should be avoided; haemophiliacs should be informed of potential health hazards; and the possibilities of minimising risks should be explained.

The Scottish National Blood Transfusion Service continues to claim that by the time of Council of Europe recommendation 8, it was already compliant with its content. However, a leading medical authority in haemophiliac treatment during the 1980s says that he did not know about the Council of Europe recommendations.

Defences that were made by Lothian NHS Board in past litigation confirm that following extensive discussion between haemophilia directors and Scottish National Blood Transfusion Service management, a decision was taken not to inform patients of the potential danger of exposure to HIV-1 infection from factor VIII.

The Council of Europe recommendation was not cascaded through the system. Patients in Scotland were not given the information and no alternatives were offered. Commercial factor VIII sourced from paid and high-risk populations continued to be used in Scotland when self-sufficiency was supposed to have been achieved. I received the information yesterday that in 1983, in Edinburgh alone, 151,000 units of unheated commercial factor VIII were used, and that in 1984, 35,850 such units were used.

Patients were not told that they had been infected, even though their case records show that the medical authorities knew that. A patient who was infected with hepatitis in 1979 was not told of that until 1991. A patient who was infected with HIV in 1984 was not told of that until 1987.

Compelling evidence suggests that public bodies and the Government placed financial considerations ahead of patient safety. I have documents that show that more sensitive screening of blood was not undertaken because of unwillingness to provide funding, among other reasons. A medicines inspectorate report of 1 October 1981 said that Scottish facilities would not have been granted a licence if they had been commercial enterprises because of poor handling and storage facilities. Crown immunity was used to circumvent any need to upgrade facilities. In 1985, the Government refused additional money to provide safe laboratory and clinical facilities for staff; it did, however, offer sympathy.

The introduction of effective heat treatment for blood was delayed. Medical authorities had evidence in March 1985 that heating factor VIII to 68° was insufficient and that other places were heating it to 80°, which worked. Scotland did not start to produce factor VIII that had been heated to 80° until 1987. Even then, the introduction of blood products that had been heated to 80° was slow and fragmented. No withdrawal notice was issued for the older products, which were liable to be infected. Patients continued to receive factor VIII from stocks that had been heated to only 68°, despite clear evidence of likely infection with hepatitis non-A, non-B. I can produce documents that show that authorities admit that quantity was favoured over quality.

Those are just some questions that require full investigation. Was it just a case of well-intentioned error, or is there culpability? What has been the role of civil servants in advising successive ministers? Have ministers availed themselves of primary sources or relied on second-hand advice? If they have seen the documents that I have seen, I question their judgment. If they have not seen those documents, they are not in a position to make a properly informed judgment. It is clear that internal dissent has been voiced throughout events. The public are entitled to hear conflicting testimonies and to judge for themselves.

Following my research, which is not exhaustive, I have formed my opinion. I do not rule out guilt, but I want a focus on responsibility. I do not rule out punishment, but I want to focus on accountability. Why should patients, families and the wider public trust the judgment of successive ministers when they do not have the ability to challenge the information and rationale that led to that judgment? If the Executive is confident of its judgment—patients, relatives and campaigners are not—surely it is in its interest to have that judgment tested and finally laid to rest by a full independent public inquiry.

I move,

That the Parliament recognises the dogged efforts of patients, relatives, campaigners and all those who have highlighted the issues around the contamination of blood products, including those with viruses such as Hepatitis C and HIV, in the past and the serious consequences for the recipients of these products and their families; acknowledges the previous and continuing work of the Parliament's Health Committee and MSPs; accepts that campaigners' demands for a full, independent, public inquiry remain outstanding; believes that there is now more information in the public domain and that the debate has moved on, and agrees that there should now be a full, independent public inquiry.

Photo of Lewis Macdonald Lewis Macdonald Labour 9:24 am, 22nd December 2005

It is important first to express the profound sympathy that everyone who has dealt with the matter feels for the individuals and families who have been affected. Whatever the circumstances, it must be enormously difficult to come to terms with living with a condition such as hepatitis C, which can be serious and distressing, and it must be even more difficult to accept with the knowledge that it was contracted as a result of medical treatment.

As Carolyn Leckie suggested, it is important to be clear about the circumstances in which the situation arose. As we know, the events took place several years ago, when knowledge about blood-borne virus infections was much more limited. When the events took place, the basic science that is involved was not understood. There were indications that an unidentified virus existed that affected blood supplies and there was a scientific debate about its importance and what precautions should be taken, but it was only in 1989 that the hepatitis C virus was specifically and clearly identified. Heat treatment of blood concentrate products meant that they were safe from hepatitis C from 1987 and measures were in place to screen blood donations and safeguard blood supplies from hepatitis C by 1991. The development of knowledge about hepatitis C is largely a matter of public record. I am sure that members who have examined the matters in question will be aware that there was considerable debate in scientific journals and conferences at the time.

Members will be aware that Andy Kerr met Scottish representatives of the Haemophilia Society earlier this year. At that meeting, he promised to release documents relating to the issue that the Executive held. That was done on 12 December 2005, when we released everything that had a bearing on the matter and which was not exempt under the Freedom of Information (Scotland) Act 2002. Some of those documents have already been referred to. Information has been placed in the public domain where doing so is appropriate.

Photo of Carolyn Leckie Carolyn Leckie SSP

On information that has been placed in the public domain, I understand that the Executive has said that it has reviewed more than 100 documents. How many documents have been reviewed and how many have been withheld?

Photo of Lewis Macdonald Lewis Macdonald Labour

We have retrieved and collated 150 separate files in order to establish the position. More than 100 of those files have been placed in the public domain.

We have taken steps to ensure as far as we can that hepatitis C cannot now be transmitted through national health service treatment with blood or blood products. Our approach to patient safety and communication is now much more precautionary than it once was. We have a real commitment to openness and we are committed to ensuring the safety of blood products and to communicating known risks as openly as possible. That is why, for example, we have invested substantial resources and have taken significant other measures in recent years to minimise the risks of new variant CJD to the blood supply.

Last year, we and Government departments elsewhere in the United Kingdom established the Skipton Fund scheme to address the issues that are faced by those who are living with the consequences of what has happened.

Photo of Shona Robison Shona Robison Scottish National Party

Why has there been a delay in establishing an appeals process for the Skipton Fund? Is the minister aware that more than 50 people have been turned down by the Skipton Fund and that they have no right of appeal?

Photo of Lewis Macdonald Lewis Macdonald Labour

I am aware of that. Shona Robison will be aware that a commitment to establish an appeals fund has been made and that that fund will be established. We are continuing to discuss bringing that forward with the Department of Health and are keen to see a fund in place as soon as possible.

The Skipton Fund has been operational for 18 months. In that time, ex gratia payments have been made to more than 4,000 people, of whom 640 are resident in Scotland. Payments in excess of £12 million have been made to date to people with hepatitis C in Scotland who have contracted it as a result of treatment with blood or blood products by the NHS.

Carolyn Leckie's motion calls for an independent public inquiry. It is worth emphasising that a number of inquiries have already been held on different aspects of the tragedy. There have been inquiries by the Health Department, which investigated the issues relating to the heat treatment of blood products and published its report; by the Health and Community Care Committee, which concluded that there was nothing to be gained by further inquiry into the issues that have been raised; and by Lord Ross's expert group, which was instrumental in laying the foundations for the Skipton Fund.

Our amendment argues that the main objective now is for the NHS to continue to implement the lessons that have been learned and to ensure that the supply of blood and blood products is as safe as possible for the benefit of patients now and in the future. I hope that that view will command wide support.

I move amendment S2M-3767.2, to leave out from "recognises" to end and insert:

"expresses its profound sympathy for those patients who have been infected with Hepatitis C through NHS treatment with blood or blood products; welcomes the payments which are being made by the Scottish Executive to help with the suffering and hardship involved; notes that there have been significant improvements in knowledge and in the safety of blood products since these events took place; believes that there is now more information in the public domain and that the debate has moved on, and believes that the focus should now be on practical action which would benefit the future delivery of services or patient care."

Photo of Nanette Milne Nanette Milne Conservative 9:29 am, 22nd December 2005

When I heard that the Scottish Socialist Party had selected blood products as a topic for debate this week, my reaction was the same as that of several other members. I thought that members of that party had a nerve. If it was not for the removal of members of that party from the Parliament following their childish demonstration and disgraceful lack of respect for this institution on 30 June, the families of those victims who contracted hepatitis C from contaminated blood products and who died before 29 August 2003 would now be entitled to the ex gratia payments that are on offer to others who survived beyond that arbitrary date.

Photo of Nanette Milne Nanette Milne Conservative

No, I will not.

By playing their part in defeating the Executive on that day, SSP members would have given real, practical help to those people, but today's debate will merely produce yet another public record of the contaminated blood products issue—a record that will almost certainly be ignored by the Executive.

The plight of patients who have been infected with hepatitis C through contaminated blood products has exercised the Parliament throughout its existence. The Health Committee has, over the years, considered petitions and heard a huge amount of evidence, most of it before either Carolyn Leckie or I became members of the Scottish Parliament. The result of the committee's deliberations from as far back as 2001 was that there was no case for a further independent inquiry that would focus mainly on exploring questions of alleged fault. The committee judged that such an inquiry would only delay consideration of whether and how financial and practical help could be provided to sufferers. The recommendation was made that such help should be awarded on a no-fault basis.

It took until last year for that to happen. As we know, however, on 5 July 2004 the Skipton Fund started processing claims from hepatitis C sufferers who had been infected by contaminated blood product transfusions—apart, of course, from those who would have been included but for the antics of the SSP.

This year, documents that came into the public domain show that there was a significant time lag between concerns being raised that potentially infected blood from American prisoners was being used and the cessation of the practice of taking blood from those people. Effective heat treatment to kill both the hepatitis C and HIV viruses was not available until 1987—three years after donations from prisoners were stopped.

In February of this year, the Minister for Health and Community Care offered to release all information that was held on file on hepatitis C. The minister stated that there was no new evidence in the files, that their contents had always been available to officials and ministers, and that all that was new was their release to the public.

As we know, the Executive still does not see the need for a public inquiry, on the basis that treatment was provided in good faith by health professionals at the time and that the ex gratia payments that are being offered to victims and their families fulfil the moral obligation to help them. Despite that, it is the Health Committee's intention, in response to pleas from campaigners, to hold an evidence session with the Scottish haemophilia forum and the Minister for Health and Community Care.

Unfortunately, this year the Department of Health in England admitted that relevant files had been destroyed. Of course, that led to the suspicion that there had been a cover-up to avoid the risk of large compensation payouts.

We on this side of the chamber are fully in sympathy with the affected patients and their families, and we understand why they continue to campaign vigorously for an independent public inquiry. However, as things stand, the Scottish Conservative and Unionist Party feels that the speediest and best way of getting the answers that are needed would be for the campaigners to bring a test case to the courts. Indeed, if there is a case of suppression of information to be answered, it should be brought to law as soon as possible.

The costs of such a case would be considerable, but there is a parallel to the case that Mrs Margaret McTear brought in her bid to sue Imperial Tobacco over her husband's death from lung cancer. Her case was dealt with by a legal team on a no-win, no-fee basis, which overcame the issue of costly fees. We feel that a similar arrangement could be arrived at on a contaminated blood products case. We feel, too, that a court case would reach a clear decision in a relatively short time whereas a public inquiry would be likely to be very protracted and to lead to a series of recommendations that could take many years to work through.

Although we sympathise fully with the campaigners, we feel that a public inquiry is not the best option for the victims of hepatitis C caused by infected blood products. As a result, we do not support the motion.

I move amendment S2M-3767.1, to leave out from "accepts" to end and insert:

"extends its sympathy to those infected with Hepatitis C through contaminated blood products; welcomes the move to place information in the public domain, and believes at this moment in time that the best way to get clear decisive answers would be for those campaigners to bring forward a test case to the courts."

Photo of Shona Robison Shona Robison Scottish National Party 9:35 am, 22nd December 2005

Since the Parliament was established, the Scottish National Party has a long track record of supporting hepatitis C sufferers in their campaign for a public inquiry. Although we will support the SSP motion, I remain to be convinced about the timing of the debate. History tells us that the limited gains for hepatitis C sufferers that have been made in the Parliament have been made through the Health Committee rather than on the floor of the Parliament. I am not convinced that another defeat for a public inquiry will be helpful at this point.

Limited gains have been made during the 14-year battle by campaigners, and of course it was the Health and Community Care Committee that forced the Executive into agreeing to offer limited financial assistance—something that it had resisted for some time. The Skipton Fund is to be welcomed. It was also the Health and Community Care Committee that supported my attempts to extend the assistance to cover bereaved families who had been excluded. That support was overturned here in the chamber by the Executive—and I have to say that it was disappointing, given the closeness of the vote, that some people were missing from the chamber that day. All I will say is that they know who they are.

However, we are where we are now. The Health Committee will take further evidence from the Minister for Health and Community Care at the end of January. The meeting will focus on a number of things, one of which will be whether any new evidence has arisen. We remember the commitment of the previous minister that he would hold a public inquiry should new evidence arise.

A problem now is that we have almost too much information in the public domain. It can be difficult to extract what is new and what is pertinent. A cynic might say that that is precisely why the minister released documents into the public domain on the same day as campaigners lost the right to cap the costs of the judicial review.

Nanette Milne spoke about a test case. However, test cases cost money. It is not easy for people to bring test cases to court; it is a very expensive way of getting to the truth. That is why the SNP will continue to support calls for a public inquiry.

The minister referred to the Health and Community Care Committee's report and what he said was factually correct. However, at that time, the committee was focused on the issue of financial assistance. It is true to say that we did not want any delay in progress towards an offer of such assistance, but the committee was not hostile to the idea of a public inquiry. Our focus was elsewhere because we wanted to get money into the hands of those who were suffering.

Many questions remain to be answered and an inquiry could answer some of them by distilling all the information in the public domain. Who knew what and when? What were the Scottish National Blood Transfusion Service's practices at the time? What were the sources of blood? The people affected, and their families, deserve nothing less than answers to those questions. We will continue to support their campaign for an independent public inquiry.

Photo of Euan Robson Euan Robson Liberal Democrat 9:38 am, 22nd December 2005

This is a difficult and emotive subject. I know from first hand the strength of the feelings that are aroused by what happened to an estimated 4,800 people who were infected with hepatitis C by infected national health service blood products in the 1980s and 1990s. I associate myself and my party with the minister's profound sympathy for the patients who were affected, which is expressed in his amendment. To say that such a thing should never have happened is as obvious as saying that all efforts should now be made to ensure that it never happens again. However, it happened—because, as I understand it, medical science was not aware of the risks and dangers at the time.

Like other parties, the Liberal Democrats welcome the payments that are being made to hepatitis C victims. Indeed, my colleague Mike Rumbles lodged a parliamentary motion in January 2004 to say that the payments of £20,000 to 400 people in Scotland were right. Like Shona Robison, I urge the minister to ensure that an appeals mechanism is available for the Skipton Fund. I know that it is not entirely at his hand, but I am sure that he can make progress.

We believe that significant improvements have been made in knowledge about blood products and their safety and that more information is now in the public domain. Like a number of other members, we do not believe that a public inquiry at this time would help or add to that knowledge. Apart from anything else, a public inquiry would take some months—perhaps as long as 18 months—and, as the minister said and other members have mentioned, there have already been inquiries and reports. In that regard, I acknowledge the work of the Health and Community Care Committee—of which my colleague Margaret Smith was convener for a long time—during the first session of Parliament and that of the present Health Committee. It is welcome that the Health Committee continues to monitor progress on the matter.

I welcome, too, the Minister for Health and Community Care's release of information dating from the 1970s through to the early 1990s on 12 December and his undertaking to meet campaigners, presumably to discuss the contents of that information.

I have first-hand understanding of the strength of feelings on the issue because one of my constituents has been profoundly affected by it. Meeting that individual was one of the most moving experiences that I have had. He worked outdoors and shared with me an interest in fishing, but he is no longer able to fish. His anger is profound and entirely understandable. In his circumstances, I am sure that I would probably feel much the same way. He is particularly angry about what has happened to his family and his relatives, who have suffered along with him. They understand and share his agony as they care for him. Almost nothing that I can say or do would turn the clock back for him. However, compensation should be paid, practical lessons need to be learned and practical actions need to be taken to improve future delivery of services and patient care. That is what we owe victims such as my constituent and that is the way forward.

Photo of George Reid George Reid None

We move to open debate. There are four speakers. All will get in if they stick rigidly to four minutes.

Photo of Janis Hughes Janis Hughes Labour 9:42 am, 22nd December 2005

The subject of contaminated blood products is an important and emotive issue and there is much in Carolyn Leckie's motion on which we can all agree. However, I am not convinced that the approach that she suggests is the best way forward. As Nanette Milne mentioned, if Carolyn Leckie and other members of her party had not managed to get themselves suspended from Parliament in June, they would have been able to participate more fully in consideration of the amendment to the Smoking, Health and Social Care (Scotland) Bill that dealt with payments to hepatitis C sufferers.

There is no doubt that we should acknowledge the work that patients, relatives and campaigners have done. I am especially pleased that Carolyn Leckie has seen fit to acknowledge the work that the Health Committee has done on the matter, in which I have been involved since the first session of Parliament. The Health and Community Care Committee published its report on hepatitis C in October 2001 following an 18-month inquiry into the issue. That initial report recommended that the Executive should provide financial and other assistance to those people who had become infected with hepatitis C as a result of the use of contaminated blood products and that such assistance should be awarded on the basis of need.

At that stage, the Executive ruled out the provision of financial assistance unless it could be proved that the NHS had been legally negligent in individual cases and the committee's inquiry found no evidence of that. It may well be the case that the NHS was not to blame, but those who contracted the disease were not to blame, either, and it was surely incumbent on the Executive to acknowledge that. Eventually it did so. I believe that the work of the committee was crucial in persuading the Executive to authorise ex gratia payments to those who were infected with hepatitis C. We should welcome those payments and acknowledge that those who have been affected are receiving some justice. We now have a far better understanding of the issues surrounding blood products and such information should be used to ensure that such tragic consequences never ensue again.

The question of a public inquiry is more complex. Although many campaign groups call on the Parliament to hold public inquiries, I believe that in considering such requests we should ask whether an inquiry would make a positive difference to the lives of the people affected and, in this case, I am not convinced that an inquiry would make such a difference.

As we have heard many times—we heard it again from the minister this morning—hepatitis C infections took place at a time when the nature of the condition and its effects were not fully known. The fact that the Executive has published all the documents that it holds on the topic, under the Freedom of Information (Scotland) Act 2002, and the fact that lessons have clearly been learned make me question whether a public inquiry would be the best way forward. We should note that the Health and Community Care Committee's inquiry took some 18 months and did not establish any evidence of negligence.

However, we should recognise the efforts of campaigners and patients. Those who are involved in raising awareness have kept the issue at the top of the political agenda, and I do not believe that a public inquiry would advance the matter any further. The SSP motion acknowledges that the debate has moved on, and so should the SSP. If SSP members believed the issue to be so important, they should never have indulged in their childish protest back in June.

As Shona Robison said, the Health Committee continues to take an interest in the matter, and I would like to see the Executive continue to work to ensure that sufferers are given the support that they need. I cannot support the motion in Carolyn Leckie's name, but I support the Executive amendment.

Photo of Eleanor Scott Eleanor Scott Green 9:46 am, 22nd December 2005

I welcome the debate and will support the motion in the name of Carolyn Leckie. I understand the Executive amendment and what the minister said in his statement, but I feel that although we have moved on in some respects—practical measures to ensure that similar contamination does not happen again because of procedures in our blood and blood products service and payments to sufferers who have been affected—the emotional side of things is missing. People need to understand how this could happen to them, and that is why I support the call for a public inquiry.

I do not do so lightly. I hear all the things that Janis Hughes said, and I know that a public inquiry can be a cumbersome and unwieldy procedure, but I think that it is necessary in this case. We are talking about people who may have been infected in childhood by a product that was supposed to be life saving but has ended up being life threatening. I believe that, if we are to achieve any sort of closure, we need to get all that out in the open.

As the minister mentioned, many documents have been put into the public domain and much information has been released. However, when that happens in dribs and drabs and is never complete—because it never can be complete—there is always the feeling that something is being held back. That feeling may not be justified and could be proven at an inquiry not to be justified, but there is always the feeling that we are not getting the whole story.

I am not suggesting that we should go down the route that some countries have taken, with a punitive judicial process condemning people in law and criminalising those who have been involved—I do not think that that is what campaigners are calling for—but there is a need to tease out the issues and to track what happened and how it was able to happen, so that people can understand what happened. People cannot move on until that process has taken place. The more things are revealed, the more it sounds as if something is being kept back.

Most members will have received campaign material from the campaigners and will have seen the letter from the Department of Health to Lord Jenkin, regretting the fact that so many documents were unwittingly destroyed. That may have been a complete accident—it probably was—but it needs to be said in public and we need to hear an explanation of how that could happen.

There is also the issue of responsibility, and I do not mean that in a punitive sense. For example, in answer to a question by John Farquhar Munro on whether imported blood products were used between 1980 and 1988, Andy Kerr said:

"demand for blood plasma based products, mainly Factor VIII for the treatment of haemophilia A patients, exceeded available supplies ... and some products were imported during the period. Responsibility for the purchase of imported products lay with local health boards and, consequently, the Executive does not hold this information centrally."—[Official Report, Written Answers, 8 November 2005; S2W-20017.]

There is a feeling that the information has never been properly pulled together.

People who were infected, and their families, now feel stigmatised. They feel that, because they have haemophilia, they are seen as being potentially infected and as a potential source of infection of others. There may be no real risk to anybody, but that is how they believe they are perceived by the public.

A lot of emotional baggage exists that will never be dealt with until all the issues are pulled together in an inquiry that considers everything, right from what went wrong at the beginning, both scientifically and in blood procurement, and that takes into account the level of understanding in those days, which has now moved on. I reiterate that I do not envisage an inquiry that is in any way punitive, but we need to map out the issues to achieve understanding. To a great extent, the practical issues have been dealt with through financial payments and the introduction of procedures that will, we hope, stop similar incidents happening in future, but we have not dealt with the important issue of the emotional needs of the people who are affected. An inquiry could do so.

Photo of Roseanna Cunningham Roseanna Cunningham Scottish National Party 9:50 am, 22nd December 2005

Some members have been debating this matter for longer than the Parliament has existed. In 1998, I had a member's debate in the House of Commons that called for the provision of synthetic factor VIII to haemophiliacs in Scotland. I sought that debate because I had a constituent who, along with others, had taken the stand of refusing treatment until synthetic factor VIII was made available. Obviously, people were concerned about infection and felt that the synthetic form would provide protection for them. The refusal of treatment speaks volumes for the strength of feeling that there was in the wake of the cases of HIV and hepatitis C virus among people with haemophilia. A few days before the debate, the Department of Health and the Scottish Office announced that certain blood products, including factor VIII, were to be banned. Of course, recombinant factor VIII is now available. I suppose that, if I had been slightly more cynical and opportunist, I might have claimed that victory for myself, but it was really for those who had refused treatment—that was probably what brought about the move.

It was unavoidable that the advent of the Scottish Parliament would be met by serious continued campaigning by and on behalf of the people who were affected. I do not want to rehearse the entire history of the problem, as most members have a fair awareness of the difficulties that are experienced, particularly by those who suffer from hepatitis C. The motion rightly refers to the work of the Health and Community Care Committee in the first parliamentary session and the work that the Health Committee continues to do on the matter. The Executive published a report in October 2000, but the Health and Community Care Committee had by then undertaken extensive petition consideration since 1999. That work culminated in the committee's 2001 report on the issue, to which several members have referred.

The Health Committee has revisited the subject recently. Earlier this year, we agreed to take evidence on the case for an independent public inquiry into the infection of patients with hepatitis C through treatment by the NHS. We attempted to hold an evidence session on 10 May, but it had to be postponed because a petition for judicial review was lodged that morning with the Court of Session. As the minister said that he would find it difficult to give evidence and the committee was concerned about the sub judice aspect, all consideration of the subject was postponed until the various legal issues were clarified. I am glad to say that we can now proceed and will take evidence on Tuesday 31 January. Of course, I cannot pre-empt any final views that the committee may take as a result of that meeting, but I can say that I wish that the Health Committee had been allowed time to complete its work before we debated the issue in the Parliament, as members of all views would then have been in a stronger position to debate the matter.

I have a couple of personal points to make. As I understand it, only about 568 people were infected with hepatitis C through blood products in Scotland, so when it comes to paying out compensation, we are not dealing with a great number of people. Since the campaign started, several of those affected have either died or become seriously ill. Because of the small number of people who are involved and the seriousness of the illness that they have contracted, the establishment appears hard-hearted on the issue of accepting liability.

Liability is the big problem. Actually, though, the problem is the system of fault-based compensation that prevails in this country in respect of all medical negligence cases. Back in 2001, the Health and Community Care Committee called for a review of the current system with a view to outlining alternatives. I could not agree more with that call and I am sorry that we have not moved further down that road, whether in relation to the hepatitis C issue or to other hard-fought cases of medical negligence. I believe strongly that an argument can be made for a shift to a system of no-fault liability in medical cases.

That already happens in New Zealand, and the last time I looked its world had not come to an end. I know that it is not within the minister's remit to consider shifting over to a system of no-fault liability, but it is time that we began to consider that across the board. We would get away from the kind of problem that we are striking in this case, which is that people want to lay blame, which is perhaps not the right way to address it.

Photo of Helen Eadie Helen Eadie Labour 9:55 am, 22nd December 2005

I, too, place on record my profound sympathy for anyone who has contracted a blood disease of any sort, but especially hepatitis C and HIV. I commend the work of the Health and Community Care Committee in the first session of the Parliament and of the current Health Committee, and I pay tribute to all who have given their time and support and who continue to give of themselves to further the interests of those who have been affected by blood-borne illnesses.

I am not persuaded that a public inquiry is the right way forward and I question whether we would learn anything that is not already firmly in the public domain. There are people who think that a public inquiry would be a magic bullet or some kind of panacea, but the arguments against that approach are overwhelming. I contend that, because of the progress made by the Health Committee, the sentiments in the motion, which the SSP support so vociferously, are not shared by the vast majority of those affected by blood-borne illnesses. The motion is a shabby attempt by the SSP to hijack a reasonable and well-argued case from the groups who truly represent those affected by the illnesses.

We must consider the sheer enormity of the costs involved in having a public inquiry, when every fact is already in the public domain following the major release of information by ministers earlier this month. Such an inquiry would not be a viable or desirable use of resources. Rather than an SSP witch hunt, I would prefer proactive measures, such as health-screening programmes to ensure early diagnosis and treatment.

I bring the Parliament's attention to the damage to morale among health service staff that could flow from such a ridiculous inquiry, when we could be harnessing the skills and ability of those involved in our national health service to fight these debilitating illnesses. The Parliament should listen to what the victims, no matter how they contracted hepatitis C and HIV, are calling for—we all know that those illnesses can be contracted in a number of ways. Rather than joining the SSP in its constant negativity, we have a duty to find solutions. The SSP happily bandies a corrosive culture of blame around the Parliament—when it is not excluded from it. We must remember that it was the SSP that decided that it was appropriate to make a pointless and, frankly, sad show of itself in the chamber earlier this year. Rather than looking after the people whom it claims to represent, it focused on its selfish aim of embarrassing Scotland. That is typical of a party that is out of ideas and, it appears, leadership.

Photo of Helen Eadie Helen Eadie Labour

Carolyn Leckie has had her say and will continue to do so.

We should note that the Scottish Executive has undertaken a three-month consultation on a proposed action plan to tackle hepatitis C. That is a clear indication of the Executive's strength of feeling on the need to tackle the issues.

The victims of blood-borne illnesses are calling for a strong plan of action that will reduce the transmission of the virus through awareness raising. I completely agree with their aim. I hope that the Executive will continue to listen to hep C groups rather than the din created by the SSP. Hep C groups have called for early screening, diagnosis and treatment. The action plan on which the Scottish Executive has been consulting includes precisely those things, and I applaud the minister for realising the importance of the issue. At the forefront of our deliberations this morning should be the key messages that we are receiving from the Hepatitis C Trust, which says that the United Kingdom lags behind many other European countries in treating hepatitis C and that, without urgent action, thousands could die prematurely. I am sure that that concerns everyone in the chamber who is involved in the issue. I call on the minister to ensure that officials take on board the full gamut of European experience before producing advice. Furthermore, I call on the minister to take representations from the hep C groups, to listen to their concerns and to make a real difference to their lives. I urge him to ignore the SSP and to get on with the real work, rather than the politics of the playground.

Photo of John Farquhar Munro John Farquhar Munro Liberal Democrat 9:59 am, 22nd December 2005

Like many people here today, I am pleased that the Parliament has decided to debate this issue. I welcome the debate about the unfortunate people who were affected by blood contaminated by hepatitis and HIV, to whom I offer my deepest sympathy. I am sure that no one in this room can begin to understand what living with those conditions must do to those affected and to their families.

While I have every sympathy with the campaigners and understand what motivates their call for a public inquiry, like others I have come to the conclusion that undertaking an inquiry would do little to improve the lives of those affected by the issue. It is understandable that they want to know the truth about why this happened to them and who should be held to account but, although the Scottish Executive has not entirely closed the door on an inquiry—and I am sure that we will hear more about that in the new year—and that might be an appropriate route to take if new evidence came to light, people should remember that such an inquiry could take many years to complete and would probably cost many millions of pounds. In addition, a great deal of the evidence around contaminated blood products is already in the public domain. There is no lack of evidence.

I would argue strongly that the money that would be spent on a public inquiry would be better spent on practical steps to improve the lives of the individuals affected and to ensure that lessons are learned and that this situation never again arises.

I was pleased to hear the minister accept the difficulties arising from the trauma that individuals and their families have suffered. He indicated that there is a continuing dialogue with patients and that, in the future, an appeals procedure will be established. We heard about that from Euan Robson as well. That is a new initiative and I am sure that it is welcomed by the Parliament and the individuals who find themselves in this difficulty.

Shona Robison mentioned the excellent work that was done by the Health and Community Care Committee in the first session of the Parliament. I, too, welcome that action. Through work done with the Scottish Executive, it managed to secure a funding package of several million pounds to help the affected individuals and their families. It is certainly worth considering whether the UK Government would have gone that far and whether such a package would have been delivered were it not for devolution. We have much to be proud of in this Parliament. We achieved that success at least.

Because of that success, we were able to offer a lump sum of £20,000 to the individuals affected and a further £25,000 to those who have reached a more advanced stage of the disease. However, I do not feel that a total of £45,000 is a great deal of money for those who are affected. What price can we put on a life? I do not think that £45,000 is the value of a human life. Many sufferers cannot get jobs, mortgages or insurance and face many other difficulties that we do not even know about but which affect their daily lives.

I ask the Scottish Executive to consider investing some more money to help those who cannot expect to live as well or as long as many of the rest of us. That is a reasonable request and I am sure that the Parliament could be encouraged to support it. After all, we have demonstrated in this debate and in the actions that we have taken that we are a caring and compassionate Parliament.

Photo of Mary Scanlon Mary Scanlon Conservative 10:05 am, 22nd December 2005

There have been some excellent speeches in the debate, which have highlighted the commitment and compassion of the Parliament on the issue of contaminated blood and hep C sufferers.

The SSP's motion begins:

"That the Parliament recognises the dogged efforts of patients, relatives, campaigners and all those who have highlighted the issues around the contamination of blood products".

What a pity that the SSP members did not give a fleeting thought to those dogged efforts when their shameful behaviour disrupted the Parliament on 30 June, resulting in increased hardship for the group that they pretend to care about. I received a Christmas card from a long-term campaigner on the issue. He wrote:

"Thank you for your support over the years—pity about the ... SSP".

It is a pity about the SSP members. Their antics were disgraceful, and those who have campaigned on the issue over many years are unlikely to forgive them even in this festive season.

As Nanette Milne said, in the first session, the Parliament took substantial evidence and spent considerable time examining the issue. As a member of the then Health and Community Care Committee, I confirm that, under the leadership of Margaret Smith, the convener, and Margaret Jamieson, the deputy convener, hep C was constantly on the agenda for the first four years. Since Roseanna Cunningham took over the convenership of the Health Committee and other members have joined it, the issue has continued to be on the agenda. At the time, I did not think that there was a need for a public inquiry, and I do not think that that would be the way forward now.

A test case in court, on a no-win, no-fee basis, would set the precedent for future cases and take into account all the available evidence. I declare an interest, as my daughter is a trainee lawyer in one of the largest personal injury firms in Scotland. That could be done quickly, whereas a public inquiry could take months or years. All the information that the SSP claims to have would be taken into account.

In her speech, Carolyn Leckie never referred to any of the evidence or the on-going work that Roseanna Cunningham mentioned, nor did she refer to the Health and Community Care Committee's report, the ministerial responses, the statements, the debates or any of the work that has been done in the Parliament since 1999. She mentioned only the few comments that seem to be solely in her domain. It is disgusting and shameful that the SSP does not recognise and give credit to those who have worked on and been committed to the issue since 1999. Given the fact that the Health Committee is still working on the issue, I trust that Carolyn Leckie will work with the committee to ensure that all the information that she claims to have is fully taken into account and presented to the committee.

We do not support the Scottish Socialist Party's motion, but we fully support and empathise with all the patients and families who have been affected by hep C and contaminated blood products.

Photo of Brian Adam Brian Adam Scottish National Party 10:08 am, 22nd December 2005

I ask the Deputy Minister for Health and Community Care to explain why around 50 documents have not been released. It would be useful to know that. By retaining some documents, the Executive has given rise to suspicion that that is where the smoking gun is. I am not suggesting that that is the case, but it would be helpful if the minister could tell us why those documents have not been released.

Since 1999 in the Scottish Parliament—and since before then at Westminster—contaminated blood products have been an on-going issue. Devolution has done a lot for this group of unfortunate individuals who, through no fault of their own, have ended up with serious illness or who have died. Devolution has moved the issue up the agenda.

We now have a compensation scheme. It is not universally accepted, but such outcomes are never accepted by everybody, and the scheme is a major step forward. If it had been left to Westminster, I doubt whether we would have had such a scheme for those who suffer in Scotland or, indeed, for those who suffer elsewhere in the United Kingdom; it might still be languishing as a wrong that needed to be righted.

Many of us in the Parliament have been involved with the issue and some were involved with it beforehand in another place. Therefore, I do not think that it is right that any one individual should attempt to claim the credit for moving things on.

The Skipton Fund appeal arrangements need to be resolved quickly. Carolyn Leckie's motion mentions blood-borne viruses and reference has obviously been made to hepatitis C and HIV—these days, HIV is not an automatic death sentence, nor is hepatitis C—but there are other blood-borne viruses that can have the same or similar effects. Cytomegalovirus, or CMV, is another fairly well-known virus that might not cause problems for so many people but which has affected the life of one of my constituents extremely adversely. We ought to deal with the problem not just for individual viruses; we must consider the whole range of viruses and illnesses for which it can be established, on the balance of probability, that they have been contracted because of contaminated blood products.

I echo the calls for us to consider a no-fault basis for compensation, not just in this scenario but in general. The idea of no-win, no-fee lawyers dealing with all such cases in the courts is not really the direction that we should be taking; we should not have to prove negligence or liability. Almost all the cases that we are talking about resulted from accidents; there was nothing particularly wilful, and I believe that the treatment was provided in good faith. Conducting a witch hunt at this stage in proceedings is not desperately useful.

There are still concerns about how we got to this point. Irrespective of what happened at the internal inquiry, of the release of the information to which the minister referred, and of the sterling work done by the Health Committee and the Haemophilia Society, those who suffer still have genuine concerns. The call for a public inquiry still holds up, even if this debate is rather premature because the Health Committee is still considering the issue.

It is particularly disappointing that when the Haemophilia Society tried to take a test case to the courts, it was effectively priced out of justice because the Lord Advocate and the minister denied the setting of a cap on expenses. That might well have been a much cheaper route for the Executive to take and it might have satisfied the campaigners.

Along with the rest of the SNP, I will support the SSP at 5 o' clock, 4 o'clock or whenever we finally get round to finishing this afternoon.


It is 3 o'clock.

Photo of Lewis Macdonald Lewis Macdonald Labour 10:14 am, 22nd December 2005

All speeches have acknowledged the grief and suffering that have been caused to some hundreds of people who were infected by blood products. We, too, recognise the courage of those people in the face of adversity and the efforts of the many who have worked on their behalf. The Health Committee can take credit for having focused attention on the issue over the years. Scottish ministers have also played their part in providing significant financial recognition of the issue through the Skipton Fund.

I was asked about the appeals procedure and I can report that, following our discussions with the Department of Health, it has advised that it will advertise early in the new year for members of the appeals panel. I am sure that that step forward will be widely welcomed.

I have listened carefully to the arguments that have been made about the additional lessons that might be learned if we had a public inquiry into matters that took place some years ago. Many questions have been raised. However, although I welcome the fact that the Health Committee continues to take an interest in the subject, I do not believe that we have heard any convincing evidence that a public inquiry would provide practical lessons for the future.

We have already put large amounts of detailed information into the public domain by releasing the Executive's documentation on the topic, which covers the past 30 years. We have provided a full evidence base, but the evidence does not suggest that the key decisions and actions that were taken were unreasonable in the context of the scientific knowledge that was available at the time.

Photo of Carolyn Leckie Carolyn Leckie SSP

On the matter of documentation, will the minister explain why possibly more than 50 documents have been withheld? Has the minister looked at those documents in detail? Has he accessed the primary documents that have been withheld?

Photo of Lewis Macdonald Lewis Macdonald Labour

Carolyn Leckie echoes the point that Brian Adam made, and I will deal with that in a moment. However, it was bizarre to hear Shona Robison complain that we had put too much information into the public domain while she called for a full public inquiry. Our position is more defensible than that.

In not releasing some documents along with the large amounts of information that were made public a few days ago, officials acted in line with the provisions of the Freedom of Information (Scotland) Act 2002. They extracted relevant information from the range of files that were examined and made that information public. However, internal communications and advice to ministers—which, in the main, do not bear on the substantive issues—were not made public.

Several points were made about clinical judgments that were made 20 years ago, but the treatment of patients must be ultimately a matter for individual clinicians. The evidence suggests that clinicians acted in good faith, in the interests of their patients and in the light of the knowledge that was available to them at that time.

Lessons have certainly been learned about the need to ensure that patients are fully involved in, and informed about, their own care and treatment. An example of that is the public consultation on "Hepatitis C: Proposed Action Plan in Scotland", which Helen Eadie mentioned. As she will know, the plan is mainly concerned with addressing public health issues and treating those with hepatitis C, rather than about people affected specifically by NHS treatment with blood products, but the plan is out for public consultation. The Scottish representatives of the Haemophilia Society have been given the opportunity to comment on treatment plans and awareness-raising initiatives, so we will certainly take into account any comments that the society makes, as well as the points that have been made by members today.

Photo of Brian Adam Brian Adam Scottish National Party

Will the deputy minister explain why, when the Haemophilia Society went to court, his boss, the Minister for Health and Community Care, and the Lord Advocate would not allow a cap of £50,000 on the society's expenses?

Photo of Lewis Macdonald Lewis Macdonald Labour

I would rather focus on the issue at hand, which is how to secure improvements for the future. That is the key issue to which priority should be given.

With improved knowledge and improved products, the level of safety is now extremely high. There is little more to be learned about the safety of blood products today. As I said, the debate has moved on and the documents that were recently released have been considered carefully.

As Helen Eadie and others said, undertaking a public inquiry is a serious business that involves time, effort and human and financial resources. A public inquiry should not be called for as a gesture of sympathy, or just in case there is something to be inquired into, but should be justified only on the basis of significant evidence that more remains to be learned. We have not heard such evidence this morning. Much more is known about blood-borne viruses today than was known 20 years ago. The Executive is as keen as anybody to ensure that lessons are learned so that such things do not happen again. We would not ignore compelling new evidence that suggested that more could be achieved by looking further into events in the past but, equally, we will not support calls for an inquiry in the absence of such evidence.

All speakers have expressed their sympathy with those who have been affected by this tragedy, but I believe that the priority now is to ensure that the best quality of care can be provided in the NHS within the resources and the scientific knowledge that are now available to us.

Photo of Carolyn Leckie Carolyn Leckie SSP 10:19 am, 22nd December 2005

The minister's closing speech just about sums up the arguments for an independent public inquiry. The purpose of such an inquiry would be to achieve independent judgment, because the campaigners and sufferers—rather than the SSP—do not trust the judgments that were arrived at in private. They want the confidence that would come from an independent judgment.

The fact that there is a debate about whether there was an understanding of the science involved demonstrates the need for a public inquiry. The fact that there are differing opinions in the chamber today demonstrates the need for a public inquiry. Families, relatives and campaigners need to have confidence that everything that can be learned has been learned, that everything is in the public domain and that a judgment has been made in the public domain.

Unfortunately, the minister's speech reflects the briefing to ministers that has been released under FOI legislation—which I have seen—about what the line is. Lewis Macdonald has just repeated that line.

Photo of Lewis Macdonald Lewis Macdonald Labour

Is the logic of what Carolyn Leckie has just said that any issue that is subject to public debate in the chamber is, by definition, appropriate for a public inquiry, whatever the cost?

Photo of Carolyn Leckie Carolyn Leckie SSP

The debate in the chamber reflects the debates in society, the demands of campaigners and the fact that the issue of a public inquiry has been raised. I am reflecting the demands of campaigners, not of the SSP. Members who oppose the motion would do well to listen to those demands. They would also do well to read my opening speech in the Official Report , because it is obvious that members have not taken on board some of the points that I made.

In response to Nanette Milne, I point out that the motion refers clearly to the work that was done previously by MSPs and campaigners. That is included in the motion, so the member can vote for it. I spoke to the convener of the Health and Community Care Committee at the time of its inquiry into hepatitis C. She made it clear that the committee focused on the practicalities at the time, but did not rule out an independent public inquiry. The committee focused on getting some kind of redress for suffers. It also acknowledged that it was not able to access primary sources of evidence and relied on oral evidence. The Health and Community Care Committee did not close the door on an independent public inquiry.

Brian Adam summed up well the reason that the Conservative amendment is completely impractical, out of date and ill informed. There have been attempts to pursue test cases, and they have been prohibited. That is why society and the establishment should facilitate an independent public inquiry.

If members refuse to support an independent public inquiry, families and patients will still be immersed in the issues. The problem will not go away and their stress, worry and suffering will not go away. However long it takes, an independent public inquiry offers a chance of finally achieving closure. No member has the right to deny people that. One of the Health and Community Care Committee's original judgments was that, throughout the period during which these events took place, there was evidence of a paternalistic culture in the health service and among the authorities. Continuing to reject the demands of the people who know best and are suffering, here in 2005, would be a continuation, at best, of that paternalistic culture.

In summing up, I have concentrated on the important issues, but I must comment in passing on some of the undignified remarks that have been made in the chamber today. There has been breathtaking hypocrisy on show, particularly from Janis Hughes and Helen Eadie. They were two of the 56 members who supported the Executive's shameful amendment of the Smoking, Health and Social Care (Scotland) Bill on 30 June. If anyone is responsible for denying compensation to families, it is the 56 people who voted for that amendment; they are sitting on the Labour and Liberal Democrat benches. Twenty members were absent from the chamber on that day, but only four of them had been shamefully banned for conducting a peaceful protest. It is very convenient for members to scapegoat four banned MSPs, when those present voted for the amendment that denied compensation to sufferers. Even more interestingly, four Executive MSPs who had managed to be in the chamber just prior to the debate on the amendment were suddenly absent for the vote. They were Patricia Ferguson, Paul Martin, Mike Rumbles and Jack McConnell. Members should be a bit more careful before they start to cast aspersions.

Janis Hughes asked whether it will make a difference to the lives of people if we grant an independent public inquiry. Campaigners have pursued the issues for 14 years. Concerns have been apparent for more than 20 years. Campaigners have consistently demanded an independent public inquiry which, to its credit, the SNP has consistently supported and pursued. What a cheek for Janis Hughes to say to the people who have suffered, and reached and maintained their conclusion through thick and thin, that she does not believe that an independent public inquiry will make a difference to their lives. That is further evidence of continued paternalism. It is absolutely shameful.

The fact that campaigners want an independent public inquiry to give them peace of mind is enough reason to agree to one. We need to move on, but the families and campaigners will not be able to move on until they are confident that every light possible has been shone on the issues, and that conclusions and judgments have been reached independently, not in private by ministers who are briefed by civil servants.

I asked Lewis Macdonald whether he had read the documents. He did not answer. I was asked whether I would share my information with other members in the chamber. Absolutely. I will share the documents that I obtained, and which are in my office, with anybody in the chamber. We can compare and contrast the information. Lewis Macdonald's dismissal of my opening speech and of some of the facts that I referred to as not being significant or new evidence was a pre-prepared line.

I finish by commenting on the fact that, despite the tragedy and the complex and sad issues that are at hand, the minister with the responsibility and power to grant an independent public inquiry is not in the chamber to hear the debate.