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NHS Direct
12. Ms Gisela Stuart (Birmingham, Edgbaston): What plans he has for extending NHS Direct. [50987]
The Secretary of State for Health (Mr. Frank Dobson): The new 24-hour, nurse-led telephone helpline, NHS Direct, will be nationwide in 2000. It is currently being piloted in three areas, and, by the end of this financial year, it will be extended to cover at least 20 per cent. of the population. Three of the new areas to be covered will be Manchester, Birmingham and Cornwall, and the others will be announced in early August.
Ms Stuart: I welcome my right hon. Friend's announcement that NHS Direct will be extended to the country's second city, Birmingham. That is very much welcomed by all my constituents. Has my right hon. Friend analysed the success of the first wave of areas in which NHS Direct was used so that I may give my constituents a clear idea of what benefits they may receive from it?
Mr. Dobson: I am glad that my hon. Friend welcomes the proposed extension of the scheme to cover the great city of Birmingham. It may interest her constituents to know that some 80 per cent. of those who called said that they were following a course of action different from the one that they had intended to follow before making their call. Thus 80 per cent. of people were influenced by the nurse on the end of the helpline. Some 30 per cent. of callers were directed by the nurse to less resource- intensive care and some 25 per cent. were guided towards more resource-intensive care. In other words, when people were told, "Little Johnny has a bit of a fever, but will probably be all right in the morning," no care was provided, whereas arrangements were immediately made for an ambulance to be sent to take people in desperate need of care off to hospital.
The object of the scheme is to provide an additional service which is not available at present. The three pilot schemes clearly showed that lots of people all over the country would not go to accident and emergency, get their
doctor out in the middle of the night or ring for an ambulance, but would ring up for advice, reassurance or, in some cases, urgent treatment.
Mrs. Marion Roe (Broxbourne):
Will the Secretary of State confirm that NHS Direct will not be funded at the expense of other nursing-led activities?
Mr. Dobson:
Special funding has been made available this year for the pilot schemes, and will also be made
Points of Order
3.30 pm
Mr. Julian Brazier (Canterbury): On a point of order, Madam Speaker. Would you rule on a point affecting the Parliament Acts 1911 and 1949, which may help hon. Members later this evening? It has been widely canvassed that, if the House decides to drop the amendment relating to the gay age of consent, it may come back in a new measure in the new Session. Would you rule on whether the 12-month delaying power of the other place would be triggered tonight or on Second Reading of any new measure?
Madam Speaker: I am grateful to the hon. Gentleman for giving me notice of his point of order.
I read the Parliament Acts as applying to Bills originating in this House, but not to Bills that began in the House of Lords. That is also the view that happens to be taken by "Erskine May" at page 569. Thus, the Parliament Acts do not apply to the Crime and Disorder Bill, but they would apply to a Bill introduced in this House, if that were to follow today's proceedings.
Mr. Owen Paterson (North Shropshire):
On a point of order, Madam Speaker. Today, a White Paper on Welsh trunk roads has been published. One copy is available in the Library and 40 copies have been sent to Welsh Members, but no copies are available in the Vote Office. I am a member of the Welsh Affairs Committee and the Welsh Grand Committee. The A483, which is nominated as a priority road, runs straight through my constituency. Would you please clarify what the rules are concerning the availability of that document?
Madam Speaker:
If a White Paper has been laid before the House, it certainly should be available to hon. Members in the Vote Office. I hope that those on the Treasury Bench will take heed of what I say.
Mr. Robert Syms (Poole):
Further to that point of order, Madam Speaker. I also requested that document, which is a review of the trunk roads of Wales, from the Vote Office, as a Member of the United Kingdom Parliament. I was told that it was unavailable. There is to be a decision later this week on English trunk roads. Would it be appropriate for that document to be available from the Vote Office, for all Members of Parliament?
Madam Speaker:
It very much depends on the time and date when documents are laid before this House. These are the procedures that we have always followed: when documents are laid before the House, they should be available for Members. I see that those on the Front Bench have heeded what I have said about this matter.
Organ Donation
3.33 pm
Dr. Evan Harris (Oxford, West and Abingdon): I beg to move,
- That leave be given to bring in a Bill to provide that the organs of potential donors are available for transplant on death unless the potential donor has previously indicated a wish to the contrary.
The latest available Government figures show that more than 200 patients die each year on the waiting lists for liver, heart, lung or heart-lung transplants alone. That figure does not include those waiting for kidney transplants. The number has been increasing in recent years, and is almost certainly an underestimate, as many patients do not even reach the waiting lists when the supply of organs is short.
The figures for kidney donations show that, in 1997, there were 1,635 kidney transplants, but the waiting list stands at 5,732. The number of kidney transplants has fallen for three successive years. The liver transplant waiting list has risen over the past three years, and the number of cadaveric solid organ donations and donors is diminishing--that is, the number of donations of hearts, hearts and lungs, livers and kidneys. It is not clear why the number of donations is falling, but part of the reason may be improved road safety. Nevertheless, there is a problem, and I think that the House should address itself to how that problem can be solved.
It may be useful to look at the current law, which, in the case of cadaveric organ donations, is governed by the Human Tissue Act 1961. The Act allows the person defined as lawfully in possession of the patient's body after death to authorise removal of parts of the body if either the patient has formally expressed the wish for his or her body to be used in that way or, after such inquiries as may be practicable, the person in possession of the body has no reason to believe either that the deceased expressed an objection to removal or that the surviving spouse or any surviving relatives object.
There are already problems with that law, because it does not clearly define who is in lawful possession of the body. It does not state whether it is the hospital authorities, as is currently believed, or whether relatives have a greater claim. It also does not state whether, if relatives establish a greater claim, there is a pecking order in the event of disagreement about authorisation.
If relatives are lawfully in possession, they are not required to allow the organs to be used to save other people's lives; they are merely authorised to do so. If, before death, the patient expressed the wish that his or her organs should be used to save others' lives, it does not automatically follow that they will be. Similarly, if the patient did not clearly express an opinion, the relatives are asked for their opinion. Therefore, relatives have an effective veto in both circumstances.
That is the contracting-in system, which we use in this country. Other European countries use a contracting-out system. France introduced such a system in 1977, under which people can register as being unwilling to let their organs be used in such a way. Since 1988, when the regulations were changed, they have been able to do that by means of a computerised national register.
I think that this country should seriously consider introducing a contracting-out scheme, which could better be described as "presumed consent". There is a moral argument in favour of that. On 30 May, Professor Ian Kennedy--who, as hon. Members will know, was appointed to run the inquiry into the Bristol hospital scandal--published a paper in The Lancet on behalf of the International Forum for Transplant Ethics. That paper--of which I was unaware when I chose the long title of the Bill--clearly sets out the philosophical arguments and premises. It states that there is a moral case for changing the law regulating organ donation from a system of contracting in to presumed consent in countries that have not yet done so. That is because it is accepted that, generally speaking, such a system would increase the supply of organs for transplantation. That would improve and save lives, and would be a good measure.
In countries such as the United Kingdom that, since 1990, do not operate a system of presumed consent, the supply of organs and the gap between demand and supply has widened. Some people, such as professionals who, in this country, are split on the matter, argue that public education and measures to simplify the process of donation and retrieval could improve the supply of organs. However, the evidence suggests that that is not entirely clear and that countries that have switched to presumed consent have a better supply.
The methods in various countries are analysed in the Kennedy paper. Of the countries that are considered in that document, only the UK takes organs following the consent of the person who is lawfully in possession of the body, and that is subject to the express objection of the deceased or of the relatives if they are available. An alternative, which operates in Norway and elsewhere, is that after relatives have been informed of the intention to remove organs, irrespective of their consent, donation and retrieval take place. In Italy, that is done when it has been ascertained that the relatives do not object and in Belgium, which I shall shortly deal with in more detail, the process is carried out when the dead person has not expressed a prior objection. When that is confirmed by the relatives, consent is presumed.
People in Britain have said that the differences in the rates of organ donation between countries can be explained by religious or cultural factors, by the rate of road traffic accidents, by gun laws or by the ability of specialist teams in intensive care units better to retrieve organs for donation. According to the Kennedy paper, in Belgium, there is well-documented and convincing evidence that, in 1986, a change in law from contracting in to presumed consent--that is, contracting out--led to an increase in organ supply.
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