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As he mentioned, this is the second occasion within a year that he has presented such a Bill to this House. As he will know from his recent discussions with my right honourable friend the Minister of State for Public Health, the Government have considerable sympathy with the motivation behind his Bill. He will also know that the Government are seeking to encourage the alcohol industry to implement a more wide-ranging alcohol labelling regime, the details of which were set out by my noble friend Lord Hunt last April.
In May 2007, the Government announced that we have reached an agreement with the industry to include health and other information on alcohol product labels. This will include: the drink's unit content and the recommended government sensible drinking guidelines; UK health departments recommend men do not regularly exceed three to four units daily and women two to three units daily; and the Drinkaware website address, detailing sensible drinking messages from the charity Drinkaware. For wines and spirits, unit information will normally be given per glass and per bottle, but I recognise the difficulties raised by the noble Lord, Lord McColl. We did not, unfortunately, reach full agreement with the trade associations to include the Government’s wording, or an alternative logo, on alcohol and pregnancy. We know that some trade associations are encouraging this, and a number of major producers and most supermarkets are willing to do this. We expect most of the industry to approach this positively. We are strongly encouraging all the others to do so as far as possible, and hope to see widespread implementation.
We are very shortly to commission independent monitoring of the progress that is being made by the industry in fulfilling the terms of the agreement. I am aware that my noble friend is somewhat sceptical about the industry’s full commitment to fulfilling the agreement, and the likelihood of implementation of our wording on alcohol and pregnancy. For the Government’s part, I hope that this scepticism is unfounded and that the noble Baroness, Lady Coussins, is correct. Certainly, from our dealings with them, there does seem to be a genuine desire by most sections of the alcohol and retail industries to
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My noble friend Lord Mitchell and the noble Baroness, Lady Coussins, referred to confusion about guidance to pregnant women. The new UK advice to women is that as a general rule pregnant women or women trying to conceive should avoid drinking alcohol. If they do choose to drink, to protect the baby they should not drink more than one to two units of alcohol once or twice a week and they should not get drunk. A short version of the revised message on pregnancy for inclusion on labels also agreed by the four UK chief medical officers was included in our February 2007 proposals to the alcohol industry for labelling. The message is, avoid alcohol if pregnant or trying to conceive. To date, NICE has consulted about its final guidance but I am confident that as both NICE and the four chief medical officers all base their evidence on the same scientific evidence, it is unlikely that there will be conflicting advice. I do not think that we can allow there to be conflicting advice.
The noble Earl, Lord Listowel, rightly has strong concern about pregnant women who are dependent on alcohol and asked how many there are. In 2005, one in five—20 per cent—of women in the UK drank more than the recommended guidance and it is estimated that more than 6,000 children are born each year with foetal alcohol spectrum disorder. That is about 1 per cent of live births. This reflects the amount of alcohol consumed by pregnant women; that is, drinking at harmful levels, which includes those dependent on alcohol. However, an increasing number of women give up alcohol completely, as has the daughter of my noble friend.
The noble Lord, Lord McColl, spoke of dosage and the link between a person’s weight and their tolerance—if I might put it like that—of alcohol. I shall give the noble Lord further details on that in writing, but I have to confess that, like his wife, I become talkative after one glass. He gave me advance warning, as he mentioned, about sulphites. The European Union, as part of its allergens labelling regulation for food and beverages, stipulated that all wine sold in the EU must include a statement that wine contains sulphites if there is any detectable
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Much has been said about the need to examine the relationship between alcohol price, promotion, consumption and harm. Safe. Sensible. Social does, of course, include a commitment to carry out an independent review into this relationship. I am pleased to report to the House that a research team from the University of Sheffield has been selected to carry out this important work. The review will seek to establish, through a systematic review of the evidence, to what extent and in what circumstances price—including discounting, advertising and other forms of promotion—drives consumption of alcohol and all forms of alcohol-related harm. As part of this, the review team is asked to look at evidence on whether the current advertising restrictions are sufficient to protect children and young people, taking into account the work undertaken by Ofcom and the Advertising Standards Authority.
The Government will use the review’s findings, which they expect to receive in July 2008, to assess whether particular types of discounting, linked to purchasing of bigger quantities, and promotional activities contribute to alcohol-related harm; and will, if necessary, consider the need for regulatory change in the future, following public consultation.
Responsibility for the Alcohol Education and Research Council passed to the Department of Health at the beginning last year. For the past six years, it has been ably led by Dr Noel Olsen, during which time he oversaw an independent review of the council’s work and organisation and its transfer to the Department of Health. It is a testament to his chairmanship that the transfer of the council from the Department for Culture, Media and Sport to the Department of Health passed off so smoothly. Unfortunately, his term of office comes to an end on 31 January. I am pleased to announce that Professor Robin Davidson has been appointed to succeed him as chairman of the Alcohol Education and Research Council for a period of three years effective from 1 February. The council has a strong reputation for delivering high quality, evidence-based research, and we look forward to working with him as we work to tackle the harms that are caused by alcohol misuse.
Noble Lords will recall that we have debated issues surrounding misuse of alcohol on a number of occasions recently. I do not propose to rehearse those arguments, but I emphasise the Government’s commitment and determination to reducing the long-term harms caused by alcohol, both in dealing with specific harms such as foetal alcohol syndrome, as well as more generally seeking actively to encourage a culture that accepts sensible drinking as the norm and frowns on the excesses brought about by binge drinking. We see labelling as part of a wider programme of action by the Government and the
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The noble Lord, Lord Addington, asked about advertising. We will shortly be embarking on a sustained national £10 million communication campaign to challenge public tolerance of drunkenness and drinking that causes harm to health and to raise the public’s knowledge about units of alcohol and ensure that everyone has the information that they need to estimate how much they really drink.
This has been an excellent debate, and I am grateful to my noble friend for his persistence in raising these important issues. It is clear that both the Government and this House want to ensure that information about pregnancy and alcohol consumption is on bottles. We differ slightly on the method of getting there, but get there we will.
11.12 am
Lord Mitchell: My Lords, with the leave of the House and on behalf of my noble friend Lord Griffiths, who kindly moved the Second Reading on my behalf, I will now reply to the debate.
I am very grateful to all noble Lords who participated in the debate. It was predictable beforehand and was true in reality that the quality was of the very highest order. I believe that the noble Baroness, Lady Finlay, did not speak, but no doubt she has a speech that she will let me read, which would be useful. I missed the contribution made by my noble friend Lord Griffiths. I heard only half of what the noble Baroness, Lady Coussins, said. She has tremendous experience in the industry; I think she was chief executive of the Portman Group at some point. She really understands the industry perspective, so I am very grateful for her contribution. I will read all the speeches in Hansard with great interest.
At the end of the day, this Bill is about whether one believes that a voluntary code will work 100 per cent. As the Minister said, I am somewhat sceptical that it will work 100 per cent. In the case of tobacco, it was mandatory. All that I will say in summary is that it was a good debate.
On Question, Bill read a second time, and committed to a Committee of the Whole House.
Kidney Transplant Bill [HL]
11.14 am
Baroness Finlay of Llandaff: My Lords, I beg to move that this Bill be now read a second time.
I am delighted to introduce this Bill, particularly after the clear support of the Prime Minister and this week’s report from the Organ Donation Taskforce which details all the needed infrastructure improvements. This Bill, if passed into law, will authorise doctors to remove from dead patients over the age of 18 one kidney for transplant purposes. There are strictly defined conditions under which such action may be taken. In particular, the kidney to be removed must be suitable for transplantation and there must be no evidence
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Why do we need such legislation? More people are waiting for kidney transplants than for any other organ. More than 7,500 people are this morning waiting for an organ transplant and of those over 88 per cent need a kidney, an organ without which they will soon die. But that does not tell the whole story. There are more than 20,000 patients on dialysis who have end-stage renal failure, many of whom should have a transplant but are not registered because the list is already dauntingly long.
Since I introduced the Bill on 28 November last year, a further 45 people have been added to the kidney transplant list—nearly one a day. Make no mistake: we have an organ donation crisis in this country, but that should not be the case. Kidney transplantation is now routine surgery, with a very high success rate. The closer the tissue match genetically, the better is the chance that the kidney will not be rejected. Yet in some parts of the country, the number of donated organs is lamentably low. These are often areas whose population has a fourfold higher incidence of end-stage renal failure and need for transplant. Sadly, despite an annual 8 per cent increase in the number registered for transplant, the overall number of donors is not rising.
Every year in England and Wales there are nearly 3,000 deaths from brain tumours, nearly 7,500 deaths from intracranial haemorrhage and 20,000 deaths in accidents of various kinds. If only one in five of those people had a kidney suitable for transplantation and it could be established that they had no objection to its removal after death, we would virtually eliminate the waiting list for kidneys at a stroke. But the sad reality is that it is only in intensive care units that the necessary conversations with relatives tend to occur and a transplant co-ordinator is introduced to the family. When that happens, many families want to donate, despite their grief, but the conversations are just not happening often enough.
No one should underestimate the terrible trauma for these families, faced with an unexpected tragedy and then, on top of that, having to decide about organ donation. They have to try to guess what the deceased person would have really wanted in the circumstances and often end up feeling that they just cannot face anything else. It is not surprising that 40 per cent decline consent in the acute pangs of their grief. Sadly, very many of them subsequently regret the decision. Interestingly, the task force report estimates that the infrastructure improvements which it recommends should over five years increase the consent rate for all organs from 60 per cent to at least 70 per cent, but that would still leave a growing gap between supply and need.
We know that 24 per cent of the population have registered a wish to donate organs, but data suggest that about 90 per cent of the population support donation after death. However, when the time comes to donate, in 40 per cent of cases that wish will not be
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How would my Bill change the situation? It presumes the deceased’s willingness to donate, a presumption which would have to be validated before a kidney could be removed. This would be done by a check to establish whether the deceased had registered not to donate and by discussions with his or her family members about their understanding of the wishes of the deceased. So the Bill contains a clear safeguard. If the family states that the person would not have wanted to donate, the kidney cannot be taken.
There is no provision here forcibly to remove a kidney; such action would be unlawful and unethical. It would devastatingly compound the overwhelming grief of the family—who anyway would not supply the important background information about the person’s medical history which is part of the process to determine an organ’s suitability for donation. However, the Bill would ensure that these all-important but difficult conversations happen. Today, the opposite is too common an experience—clinical staff do not even ask. As Mrs Stoner said about her daughter’s death after she was hit by a car:
I emphasise, in case it is not completely clear, that we are talking about taking organs after death. Even though it is possible, as noble Lords will be aware, to remove one kidney from a living person without harm, my Bill contains no provision for harvesting organs during a patient’s lifetime. Let there be no mistake: we are talking about when someone is dead and their organs are of no further use to them.
I hope I have demonstrated that there are strong humanitarian grounds for the Bill, to save the lives of literally thousands of people in need of kidney transplants, but there are other reasons on which we should reflect. A kidney transplant costs around £46,000 in total, plus about £3,000 a year in follow-up medication. So if a transplanted kidney lasts 10 years, the total cost to the NHS is nearly £80,000. Without a kidney transplant, the same patient on haemodialysis would cost more than £300,000—nearly four times as much in the same period.
Moreover, the life expectancy of someone on haemodialysis at the age of 40 is 10 years, but with a kidney transplant the same person’s life expectancy doubles to 20 years. These people are contributing economically to our society; they are often young patients who are the breadwinners. The proportion of patients who can return fully to work is much higher post-transplant than with dialysis, and their reported quality of life is much higher. The Bill therefore makes sense in economic terms alone. However, when we add in the cost to society of young parents dying much earlier than they otherwise would for lack of a kidney—the social cost of bereaved children, and the loss to the nation of potential income from people
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I shall briefly address some specific concerns that have been raised with me. Why is the Bill restricted to kidney donation? First, the major need for organs is for kidneys. Secondly, there is a despicable trade in selling kidneys in some parts of the world by people who are desperate for money for their families to live on. They need international aid, not a market for kidneys that puts their lives in jeopardy and flagrantly exploits their terrible poverty. My Bill will discourage this trade because UK patients will no longer go abroad in desperation to buy a trafficked kidney. Thirdly, there is no emotional or ethical complexity regarding the removal of one kidney; almost everyone has two, one is almost a spare part. It is not like the concerns that some have about taking a heart, lung or liver, or even about the new horizons of face transplants.
The Bill concerns only England and Wales. It concerns those above the age of 18, not children. While in law a minor aged 16 or 17 can consent to a procedure, their withholding consent—
Lord Foulkes of Cumnock: My Lords, the noble Baroness says that the Bill extends only to England and Wales—which is specified in the “Short title and extent” clause. However, Clause 2(2)(e) states that one of the conditions should be that,
Is there not some discrepancy there?
Baroness Finlay of Llandaff: My Lords, I am grateful to the noble Lord. We have borders that are not borders at all. Someone from Scotland may be on a day trip south of the Border and have a fatal road accident. He may be taken in and his identity may be established, in addition to the fact that he is dead and has a good tissue match with someone waiting on the transplant register. However, this House cannot legislate for health matters in the devolved Administration in Scotland. I would hope that if my Bill became law, the Scottish Parliament would follow and introduce its own compatible legislation. Indeed, we have seen compatible legislation on issues such as mental capacity. I hope that that answers the question.
I return to the issue of age. In law, a minor aged 16 or 17 can consent to a procedure and their withholding consent can be overridden at this age. The Bill concerns instructions left to the family about what a person wants done with their body parts after death. It concerns gifting after death; in this case, the gifting of organs. The Human Tissue Act applies in this case more than any other legislation, and in that Act 18 is the age of adult consent in England and Wales. Thus, for anyone under 18, a parent would have to consent to use of the organ. The Mental Capacity Act seems not to apply after death; the Bill does not concern consent to remove organs for
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The maintenance of a register of those who have opted out could be held on a separate database by UK Transplant or by the NHS body that has been tentatively proposed as overseeing transplantation in the UK. However, the individual should write out any objection to donating and discuss it with their family and GP so that their wishes are clear.
There are also specific safeguards in the Bill to address concerns raised by the task force. The doctor certifying death must be independent to avoid any pressures that might affect end-of-life decision making. Clear protocols already exist for establishing brain-stem death, but kidneys can certainly be taken also from donors whose hearts have stopped and who have died more in accordance with what one might call the more old-fashioned, and more standard, way of certifying death. Only an authorised transplant team can remove the kidney for human transplantation to a UK resident who is already on the transplant register, and only after carefully establishing that there is no evidence of an opt-out. The team must discuss that with the family or next of kin. In practice, if a family was too distraught to give medical details of the dead donor then that would effectively mean that the organ was unreliable and could not be used.
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