1.44 pm

Mr. Alfred Morris (Manchester, Wythenshawe): I was glad to learn that the hon. Member for Hendon, South (Mr. Marshall) had secured this timely debate, and I most warmly endorse his moving plea.

Sadly, more than 60 of the victims of the tragedy have already gone to their graves with a deep sense of injustice. The achievement of elementary justice for some very needful people is at the heart of our campaign, which, as the hon. Member said, is now supported by more than 270 Members of Parliament of all parties. Our campaign is also about morality. The Government accepted their moral responsibility in the case of HIV infection in the course of national health service treatment. They now have the same responsibility in the hepatitis C cases.

It is morally wrong to deny the victims of this appalling further tragedy in the haemophilia community the modest help they seek. What is morally wrong ought no longer to be tolerated in Britain. There is ample parliamentary time available. The Government's legislative programme is gossamer thin, and, given the nod by Ministers, I am sure that the House would approve within an hour the help we seek.

1.45 pm

The Parliamentary Under-Secretary of State for Health (Mr. John Horam): It is almost exactly a year since we had a similar debate on this subject. At that time, it was the hon. Member for Leeds, East (Mr. Mudie) who was successful in the ballot. Today, it is my hon. Friend the Member for Hendon, South (Mr. Marshall) who has initiated the debate. That is entirely appropriate. Not only is his constituent Rev. Alan Tanner the chairman of the Haemophilia Society, whose work in this field we all applaud, but my hon. Friend has himself taken a continuing interest in the plight of those patients with haemophilia who were inadvertently infected with hepatitis C through blood products, before those products began to be heat-treated in 1985.

I was interested to learn that my hon. Friend's first Adjournment debate on this subject was as long ago as October 1990, which must be some sort of record. He stated his case today not only movingly, as the right hon. Member for Manchester, Wythenshawe (Mr. Morris) said, but extremely eloquently. I answered a related question

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Health Ministers have had the opportunity twice this year to meet with my hon Friend to discuss these issues. The discussions which I have had with my hon Friend and with representatives of the Haemophilia Society have brought home to me very clearly the plight of those who find themselves infected with hepatitis C, in addition to suffering from haemophilia. Nobody could fail to sympathise with the distress of people who, already suffering from one disorder, have found that the treatment for that disorder has given them another.

That is especially true because factor 8 transformed the lives of many people with haemophilia--we should not forget that it greatly increased their life expectancy and improved their quality of life. It was undoubtedly the best treatment available for people with haemophilia in the light of medical knowledge at the time. However, medical procedures rarely come without risk, and those are not always known about or capable of being guarded against in time.

Factor 8, at the time at which the people we are talking about were infected, was made from human plasma and, for the most part, it still is. We have a very safe blood supply, thanks to the voluntary basis of the scheme--that contrasts with the scheme in America, to which my hon. Friend referred--and because of the screening and other safety measures that are in place. I am glad to say that UK blood remains among the safest in the world.

Sir Geoffrey Johnson Smith (Wealden): Will my hon. Friend clear up a point about factor 8? In a previous debate, I asked about factor 8 treatment. None of us is a medical scientist, but I believe that there is a genetically manufactured form of factor 8, called, I think, recombinant factor 8. Am I right in saying that it could help to prevent further infection?

Mr. Horam: In answer to my right hon. Friend, whose interest in this area I also acknowledge, it is for clinicians to decide whether to use the plasma-based factor 8 or recombinant factor 8. I should stress that, although recombinant factor 8 has some advantages, it is not without disadvantages. For example, it can encourage the development of inhibitors, a problem that has been encountered by some of those who have used recombinant factor 8. So neither is without a small element of risk.

My right hon. Friend will recall that recombinant factor 8 uses plasma-derived albumin as a stabiliser, and therefore is not entirely free of problems. Nothing is totally risk-free, and it must be for clinicians to decide which of the two, given also their relative cost, is best to use.

May I return to the issue of blood and blood products? All reasonable steps are taken to ensure their safety, including the careful questioning of donors to exclude those likely to represent a risk of transmitting infection, and the testing of donations for hepatitis B and C, HIV 1 and 2, and syphilis. Pools of plasma from which blood products are to be made are tested again, and, wherever it is possible, as it is with factor 8, undergo manufacturing

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The safety of blood and blood products is kept under regular review by the expert Advisory Committee on the Microbiological Safety of Blood and Tissues for Transplantation, which advises Health Ministers.

Not all the current safety measures that I have mentioned were available at the time that we are discussing today. That was a long time ago--before blood products began to be heat-treated in 1985 to destroy viruses. I stress that factor 8, which has been treated to destroy viruses, has an excellent safety record.

Nor was there at the time a test available for detecting hepatitis C in blood donations. Such testing was introduced in 1991 as soon as reliable tests first became available. The people we are discussing today therefore received the best treatment available at the time.

My hon. Friend the Member for Hendon, South mentioned numbers. Let me remind the House of the number of people we are talking about. It is thought that some 4,000 people with haemophilia may have been infected with hepatitis C through blood products before heat treatment of those products was introduced. Of those, about 1,000 were, sadly, also infected with HIV, and have received payments under the HIV-haemophilia scheme. In addition, possibly a further 3,000 people who are still alive, who had blood transfusions before September 1991 and who have been infected with hepatitis C as a result, are likely to be identified by the look-back exercise that is in progress.

It has been suggested in this debate that there have been more than 50 deaths of haemophiliacs from liver disease so far. We have no reason to dispute that figure. However, many people infected with hepatitis C may enjoy a long period without any symptoms appearing. Some 50 per cent. of sufferers may progress to chronic hepatitis with varying degrees of good and ill health. Some 20 per cent. of infected patients may develop cirrhosis, a progressive destruction of the liver, which may take 20 to 30 years. Fortunately, the majority of those years will be trouble-free in terms of health.

Since last year's debate, I have studied the final version of a report from the Haemophilia Society on the plight of the people we are discussing today, and in March I met representatives of the society to discuss it. The meeting covered a range of issues concerning haemophiliacs infected with hepatitis C, and I outlined the action that the Government are taking, including research and support for voluntary organisations working in that field.

The Haemophilia Society subsequently wrote to me in June asking for the Government to set up a trust fund to make payments to those infected who were in financial need, and their dependants, and also to make payments to each person who had been infected. As my hon. Friend stressed, that is similar to the help previously given to those infected with HIV.

I took time to consider these proposals carefully before replying to the Haemophilia Society in October. Most hon. Members will by now be aware that I did not accept the society's proposals for payments for those infected with hepatitis C, but I stressed that I remained open to further arguments. I also outlined the support that we are giving to work with those infected, and to research in this area.

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I should mention that the society understandably prefers that the financial assistance that it requested should not be described as "compensation"--particularly as it does not consider the NHS to have been negligent in this matter. However, my reasons for not agreeing to provide the help requested hold good, however we describe the financial help sought.

First, we do not accept--I disagree with my hon. Friend on this--that the NHS has been negligent. As I said, the Haemophilia Society has confirmed that it does not dispute that point. Tragic though it may be that the treatment designed to help those infected patients should have harmed them, there can be no question but that they received the best treatment available at the time. That treatment was essential for their survival. There was no alternative. We take the view that compensation is appropriate only where there has been negligence.

If we were to provide payment on the basis of non-negligent harm, that would very quickly develop into a general no-fault compensation scheme, which would be both unworkable and unfair. That point was considered in relation to the settlement of HIV cases. On that occasion, we were convinced by the very special nature of the disease, by public reaction to it, and by arguments that it would not lead to further similar claims for compensation.

We are not convinced that hepatitis C falls into the same special category. We need to remember that, at the time of the HIV settlement, it was believed that HIV would lead speedily to death and that some haemophiliacs infected with HIV, especially children, were subject to some appalling examples of ostracism. We now know rather more about the effects of HIV, and there is a much greater public understanding of how relatively limited are the ways in which it can be passed on. We are all grateful for that.

Secondly, as my hon. Friend said, all the proposals for payment schemes involve the expenditure of substantial sums of public money. I have considered a wide range of options for such schemes--I really have done that--including the possibility of a scheme limited to those who go on to develop cirrhosis only. But they all have significant costs. As a Health Minister, I have a duty to consider the effect of such a sizeable sum on other heath service expenditure. That duty has led me to conclude that funds that are available to the NHS, from whatever source, are best used in direct patient care.

It has been suggested--it was reiterated today by my hon. Friend--that there should be funding compensation sources other than from the national health service budget. Naturally, I am sympathetic to that suggestion. Given their knowledge of how the Government work, right hon. and hon. Members who have spoken in this debate will understand that those matters are not within the compass

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In its letter to me in June, the Haemophilia Society suggested a need for progress in a number of areas of work on hepatitis C, such as the treatment and care of those infected, research and public education. I want to help the society in supporting its work in that area.

A key priority must be to improve our understanding of the disease. We have made an additional £1 million available to aid research into hepatitis C, its natural history, transmission and prevalence. Although primarily geared to improving the understanding of the disease, any developments will be important to co-sufferers of haemophilia.

One of the best ways to improve still further the treatments available is to establish the relative effectiveness of new treatments such as alpha interferon. Local purchasers can then make informed decisions on using resources for the most effective treatments available for both haemophilia and hepatitis C. The standing group on health technology has identified the evaluation of the use of alpha interferon in the treatment of hepatitis C as a priority for the NHS. That work is being taken forward as speedily as possible by the National Coordinating Centre for Health Technology.

We have also been providing assistance to the Haemophilia Society in the form of grants from a Department of Health scheme for voluntary organisations, which includes a grant for a project concerned with the needs of those with haemophilia, who have also been infected with hepatitis C. I made it made clear to the society that we shall welcome proposals from it to provide continuing support to haemophiliacs infected with hepatitis C, as part of the society's on-going activities.

I regard this as a useful and practical approach, which would draw on the valuable findings of the research that the society is already undertaking. This is an area where resources can be directly targeted to provide practical help in such forms as advice and information. It will thereby improve services to infected haemophiliacs. I have assured the society that I shall take a positive view of any application for further assistance from the Department under our section 64 scheme to take this matter forward.

It being Two o'clock, the motion for the Adjournment of the House lapsed, without Question put.

Sitting suspended, pursuant to Standing Order No. 10 (Wednesday sittings), till half-past Two o'clock.