House of Commons Hansard Debates for 24 May 1990

Column 428

that? Secondly, it would be helpful if the Minister could clarify what can be achieved by route action plans. I have already referred to the significant improvements made to the A96. I accept that significant improvements can be made, but what do they add up to? I understand that, perfectly properly, the Government are trying to reduce accidents by up to a third by the year 2000, and I support that because it is welcome. I also understand that some new money--not a large amount in the global totality of capital expenditure on roads--is available. How much of that money can we expect to be devoted to the A7 south of Hawick?

Thirdly, I understand that the local authority has identified half a dozen or so proposals for improvement schemes that would all come with a price tag of less than £1 million for each individual project. If carried out over a reasonable period--put into the planning process over the next five years--they would make a significant improvement to overtaking opportunities on the A7 south of Hawick. That would be just about adequate to cope with the road's present needs. At the higher level there are two major road work schemes that would cost more than £1 million, although not much more. The Borders roads authority has identified them on the stretch of road from Hawick to the Dumfries boundary. If they could be brought into the planning process during a five-year period, they would bring the road up to a state at which it could be argued that it was beginning to be adequate to cope with the needs of the local community.

I know that the trunk and key principal road network review that the Government are undertaking for the road network in central Scotland will compete with some of the claims and requests that I am making this morning. However, according to the study, the total motorway budget is £650 million, so the amount of money that I am asking for is not extravagant in terms of the whole budget. There is a degree of confusion about whether the Minister is coming to see us and, if he is, who he is coming to see. He kindly wrote to me about that, and an answer will clarify some of the confusion. If he comes--I hope that he does--I hope that he will not ignore either the roads authority or me. I recognise that there is a particular head of steam among the public in the town about the state of the A7 south of Hawick. It would be good if the Minister were prepared to come and expose himself to public opinion. If he is willing to come and discuss these important matters, I am sure that he would not dream of doing so without taking the roads authority and the sitting Members of Parliament into account.

As a result of the trunk road that goes straight through the centre of Hawick, there is internal traffic chaos at present that is building up unacceptably in the town. There are now real problems. I fully understand that some are claiming that we should have a bypass, but my information is that a bypass would take only 10 per cent. of the through traffic away from the town and so it will, by itself, not be a long-term solution. The only long-term solution would be internal new traffic arrangements with single flows in both the north and south directions to separate the trunk route traffic. In addition, the River Teviot will have to be crossed again by another bridge in order to rationalise the internal traffic congestion that is building up.

I hope that the Minister will not leave the local roads authority to rely on its section 94 consent but will

Column 429

substantially assist it with any major capital schemes to try to resolve some of the problems in Hawick. It would be helpful if he could say something about the time scale that will be used to deal with that problem. If we could have some reaction to the work that the local authority has done on the congestion, it would go a long way to alleviating some of the evident anxieties in the town. As one of the principal users of trunk routes south of Edinburgh is the Lowland-Scottish Bus Group and there is a great deal of expectancy, anticipation and concern about the group's disposal in the near future, I hope that the Minister, if he has time, will say when we may expect a Government decision on that important matter. 11.39 am

The Parliamentary Under-Secretary of State for Scotland (Lord James Douglas-Hamilton) : I should tell the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) that the proposals for Lowland-Scottish are now being considered and we hope that a decision will soon be made. We are aware of the interest in that subject. I thank the hon. Gentleman for his welcome for the consultation about routes south of Edinburgh. This is a worthwhile debate and I am keenly aware of the interest in the matter shown by the hon. Gentleman and by other hon. Members.

As I said in April, our consultation about routes south of Edinburgh was a successful exercise. There were more than 220 responses covering a wide range of interests. I announced at that time our response to the views that were presented and our decisions on the way ahead. Those will result in a package of major road improvements likely to cost upwards of £140 million which will complement and enhance the existing roads programmes.

We have set in hand the A1 past Dunglass improvement scheme which provides a bypass to Cockburnspath and quality overtaking opportunities. That work will begin in the summer. Secondly, we have announced plans and proposals for dualling sections of that route. I have announced that consultants will be appointed as soon as possible to start preparing a dualling scheme to Haddington bypassing Glasgow, and they will carry out detailed evaluation of further dualling in due course to Dunbar. It is envisaged that the dualling will initially terminate near Haddington, but that will be the subject of a feasibility study and safety will be taken into account. A natural break point in traffic levels will be an appropriate point for the dualling to start. It is too early to comment on phasing of the further dualling past Haddington and onwards to Dunbar, but it may be possible to undertake the rolling programme for this work and it is likely that the same group of consultants will be used.

The hon. Member for East Lothian (Mr. Home Robertson) also expressed interest in this matter, and I shall deal quickly with the points that he made about heavy commercial traffic using the route to east coast ports. Our study considered all types of traffic using the route and concluded that dualling the whole road would not attract enough traffic to justify the high cost. The joint working group will lead local authorities to monitor the situation, and we shall also press on with the dualling to Haddington and with improvements east of Haddington.

Generally, we need and are developing an improvement strategy for the more likely traffic route south of Dunbar.

Column 430

Detailed plans will be prepared as quickly as possible on the dualling to Haddington. Consultants will be commissioned to prepare dualling plans as far as Dunbar and will consider phasing the work. It is certainly possible that the dual bypass of Haddington could follow at a fairly early stage and perhaps as a direct follow-up to the dualling up to the town.

I was asked about the planning timetable. The economic appraisal of road schemes looks forward over 30 years. The hon. Member for Roxburgh and Berwickshire asked about the time scale for improvements. I am glad that he recognised that we are looking 15 to 20 years ahead and fully appreciated that there will be changes in traffic levels and society over that time. Our consultants for the main study looked at traffic levels, but the A1 steering group will continue to monitor traffic and councils, and other consultants who are looking at the A7 will also take a wide and long-term view. The hon. Gentleman asked about the steering group. It will monitor traffic and, more immediately, will identify accident remedial and overtaking opportunity schemes. The time scale for accident remedial schemes can be rapid or immediate and there should be no delay in implementation. Other schemes may take longer to prepare, but I hope for early action in relation to overtaking.

The stretch of road which crosses the border will soon be considered by the steering group with a view to a possible joint dualling scheme in conjunction with the Department of Transport. I take the hon. Gentleman's point that there would be no sense in having a dual carriageway that suddenly stopped at what in road terms is an artificial border. He asked about A7 schemes that had been identified by regional councils. All possible schemes identified by councils or other parties will certainly be considered as part of the remit given for further study of proposals for the A7 south of Hawick. I agree that a single high quality carriageway is fully justified. The Tower to Dunbar scheme is an important step towards this, and in both England and Scotland the general policy for the A1 between Newcastle and Edinburgh is to provide sections of improved road to allow safe overtaking opportunities and improve road safety. Work is now under way on the A96 Inverness to Aberdeen trunk road to develop techniques to identify effective sets of schemes which, taken together, prevent the build up of long platoons of traffic. That will be done by providing the necessary overtaking opportunities where they are needed and are most economic to provide.

It may be possible to take advantage of these new techniques to provide a similar improvement package for the A1. The hon. Gentleman is correct about that. That is why, following discussions with the hon. Members for Roxburgh and Berwickshire, for East Lothian, for Berwick-upon-Tweed (Mr. Beith) and for Wansbeck (Mr. Thompson), I announced that a steering group with representatives from local and central Government from north and south of the border will be formed to monitor traffic growth on the A1 and to develop a suitable programme of improvements. That has rightly been welcomed. Terms of reference are currently being drafted and will be considered at the first meeting of the group which it is expected will take place on 21 June. Invitations will shortly be sent out to the participating roads authorities.

Column 431

The package of improvements that are planned for the A1 is likely to cost about £50 million and will provide substantial benefits to road users. The hon. Member for Roxburgh and Berwickshire will be interested to know whether the steering group will include elected members. It will primarily be a technical working group and will therefore be at official level, but I am sure that regular reports will be made to elected representatives and of course we can always have meetings with elected representatives as and when they are required.

I shall now deal with the proposals for the Borders. The most important immediate improvements will be to the A68 Dalkeith bypass for which draft orders will be published in June. More generally, traffic volumes clearly show that the greatest need for the Borders is quality access to the capital. Such access would be greatly improved by our proposal to dual the A7 between Edinburgh and Galashiels. We shall appoint consultants to investigate possible alignments for this improvement and they will take full account of the environmental issues that are involved. The consultants will also consider the scope for further improvements between Galashiels and Hawick and will define the strategic benefits of an A68-A7 link. The Borders communities will benefit substantially from our plans for the A68- A7 which are likely to cost at least £100 million. This major improvements programme will be further augmented by the route action plan that we are commissioning for south of Hawick. I am confident that this package of measures, which was formulated in the light of responses to our consultation paper, will provide a substantial improvement to the network.

I am aware of the anxiety that the hon. Gentleman expressed in connection with a section of the A7 south of Hawick. That road is important to the local economy, especially to the tourist and textile industries. The possibility of a bypass at Hawick can certainly be considered, but I cannot give a commitment at this stage. To be economically viable, an improved A7 would have to attract traffic from the M74, and, as motorways are the safest category of road, the consultants' study predicted a reduction in road safety. Money to fund the improvements cannot be diverted from the A74 project without economic and environmental penalties.

Constructing a three-lane M74 allows Scotland's main artery, the A74, to be kept fully open during the decade of construction. It also allows much of the new road to be constructed on line, thereby reducing severance and adverse environmental impacts on local communities and the surrounding countryside. For south of Hawick, improvements to the A7 will continue to be made to achieve specific local objectives. I have announced our intention to commission regional councils to design a route action plan. That will involve accident remedial schemes and smaller improvement schemes, especially for improving overtaking opportunities as and where appropriate. Langholm bypass is already in the traffic road programme and the required preparatory work and statutory procedures are under way. My hon. Friend the Member for Dumfries (Sir H. Monro) made strong representations about the A7. He is very much involved because it runs through his constituency.

Column 432

The hon. Member for Roxburgh and Berwickshire may be assured that any proposals already identified by regional councils or others will be considered as a matter of course. I said in April that improvements from Galashiels to Hawick would together cost up to £20 million and that still more would be spent south of Hawick. That will bring substantial benefits and ensure that any traffic coming off the future dual carriageway at Galashiels will find a continuing high standard road on which it can travel safely.

The remit to the councils will also specifically include Hawick, where it is clear that some early improvements are required for trunk road traffic through the town itself. Consideration will be given to suitable traffic management measures in the town to provide more satisfactory arrangements for both through traffic and local people. The most advanced traffic signals are already located in the town of Hawick. They are the only signals of their sort currently in operation in Scotland. Our proposals for the Borders are expected to cost upwards of £100 million and will provide significant long-term benefits to the whole area. It is obviously necessary to introduce remedial action programmes for safety reasons.

It has been confirmed that the M74 fast link is a potentially useful addition to the Scottish road network. With a substantially increased public investment in motorways and trunk roads, especially in central and southern Scotland, resources for the project cannot be found in the foreseeable future without a significant impact on other schemes. It is intended further to examine the feasibility of introducing private finance. We have commissioned management consultants to hold detailed discussions with the many private sector interests that have indicated that they may wish to pursue the option of a privately funded fast link.

The proposals outlined in our route south of Edinburgh study are clear evidence of our substantial commitment to the improvement of the road network in south-east Scotland. I have already dealt with the hon. Gentleman's point about the dual carriageway stopping at the border and I have made our position clear. On the question of road improvements south of Dunbar and the costs involved, we must first assess need. The new steering group will advise us on the needs and the priorities. Of course, the Borders need access by a good A7 to the M6 and the motorway network. I agree that the A7 from Hawick to the border should be a good quality single carriageway and the remit to the consultants will reflect that. The consultants will also take full account of the need for a smooth transition over a safe, high-quality single carriageway south of Hawick.

I have already referred to our plans for Hawick. A bypass would be unlikely to bring the town a great deal of relief from traffic, and because of the surrounding hills it would be very expensive. It is likely that we will concentrate on traffic management measures, but I shall look to the regional councils for their advice on that matter.

Sir Michael McNair-Wilson (Newbury) : On a point of order--

Lord James Douglas-Hamilton : I have another two minutes. That is what Mr. Speaker said.

Column 433

Sir Michael McNair-Wilson : My understanding is that Mr. Speaker asked the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) to reduce his speech by 10 minutes. I have now lost 10 minutes of my speech.

Madam Deputy Speaker (Miss Betty Boothroyd) : Order. The Minister has until 11.55 am.

Lord James Douglas-Hamilton : That was my clear understanding of Mr. Speaker's request. I should not dream of taking a single second from the next debate.

Safety on all trunk roads is of absolute priority. We intend route action programmes for remedial schemes to be prepared as quickly as possible and to be implemented without delay. Our proposals show that we have a strong commitment.

A trunk and key principal road network review for Scotland has been going on for some time. It is essential that the increased funds that we are providing are directed to the right places. The study is expected to be completed in about a year's time and we shall examine all the relevant issues.

The hon. Gentleman asked me about a meeting with Members of Parliament and those locally elected. The chief executive has contacted Mrs. Findlay- Maxwell and an approach has been made to me on behalf of the council and the elected members and the proper procedures will be followed. I look forward to suitable arrangements being made in due course. I thank the hon. Gentleman for raising these relevant and important matters.

Mr. Harry Greenway (Ealing, North) : On a point of order, Madam Deputy Speaker. In a speech in the House on Tuesday evening I mentioned the firm of Taylor Woodrow, with which I have a small professional interest which is registered in the Register of Members' Interests, and omitted to mention that interest before I made my speech. I am sorry about that. It was a complete oversight and I apologise.

Madam Deputy Speaker : Thank you. The hon. Gentleman has made his point, but it provides an opportunity for me to remind all hon. Members that during debates it is now a rule of the House--not a convention, as was previously the case--for every hon. Member to declare any relevant pecuniary interest or benefit of whatever nature, whether direct or indirect, that he may have had, may have or may be expecting to have. It is wise for hon. Members to declare that interest at the beginning of a speech.

Column 434

Kidney Patients

11.56 am

Sir Michael McNair-Wilson (Newbury) : I am grateful for the opportunity to initiate an Adjournment debate to air some of the problems facing kidney patients--that is, those suffering from end-stage renal failure who are either on dialysis or awaiting a transplant.

First, I must declare an interest : I am a kidney patient on haemo-dialysis which I receive at home, and I am president of the National Federation of Kidney Patients Associations.

Kidney disease is the fifth most prevalent and fatal illness in Britain, but, with the advent of an ever-increasing number of haemo-dialysis machines and the introduction of continuous ambulatory peritoneal dialysis, it is no longer the killer disease that it once was. With successful transplantation, it is an illness which can be almost completely overcome. The United Kingdom used to lag behind many European countries in the number of patients receiving dialysis, but my most recent figure of 55 patients per million of the population receiving treatment bears favourable comparison with many of our neighbours, even if we still have a fair way to go to catch up with the Federal Republic of West Germany and Switzerland in the number of patients receiving dialysis per million of the population. But I understand that those needing dialysis are increasing at the rate of 500 patients per year and that probably between 80 and 100 patients per million now require renal support, although, sadly, many of them do not get it. Kidney transplantation has been on a steadily rising trend since 1983 and has almost doubled during the past 10 years. All that says much for the Department of Health and the regional and district health authorities which have accepted renal replacement therapy as a form of treatment which should be available for all who need it. A dialysis machine manufacturer recently told me that demand for his equipment had fallen back to a fairly steady figure of about 300 machines a year from the time when two of three times that number were being ordered.

What matters now is to update the older machines and encourage the creation of small, more localised, minimum care dialysis units so that kidney patients will not need to be bussed long distances to a general hospital with a dialysis ward. As I suggested during the debate on the National Health Service and Community Care Bill, money going with the patient may have a beneficial effect in that direction, particularly when districts realise how much they are spending on kidney dialysis in regional hospitals.

Continuous ambulatory peritoneal dialysis has made huge strides and is running neck and neck with haemo-dialysis in the number of patients using it. CAPD allows the kidney patient to be free of machines and to live at home. Home-based haemodialysis machines achieve almost the same result, except that the patient must have a carer in attendance, or at least in earshot, all the time while he or she spends four to six hours hooked up to the machine. However, home-based dialysis, like CAPD, takes the pressure off hospital dialysis units and gives patients much greater freedom.

As my hon. Friend the Minister knows, dialysis requires the placing of two needles in one of the patient's arms, from which blood is drawn into the dialysis machine, cleaned by the dialyser, and then returned to the body. The

Column 435

arm being used for that purpose cannot be moved, so if the machine alarms, the helper must put matters right--as she does in linking the patient up to the machine and taking him off it.

A dialysis session lasts between four and six hours, so the attendant has to give up a fair proportion of the day to be available to the patient. All kidney patients on home dialysis receive an attendance allowance of £25. That may be enough if it is the husband or wife who helps, but not if the patient has to engage the services of a carer. My first plea to my hon. Friend the Minister is to discuss with our right hon. Friend the Secretary of State for Social Security whether more money can be provided. Some charitable funds are available in certain areas to help boost the money available to pay carers, but not everywhere. Few carers will work for much less than £25 per day.

When I first suffered kidney failure, I suffered--as others do--the attendant problems. In particular, I suffered from acute anaemia, as what was left of my kidneys was failing to secrete the substance that creates haemoglobin, except at a very low level--rather less than 50 per cent. of normal. I had the characteristic yellow-white face of the anaemic renal patient, and I was aware of my acute lack of energy and a loss of general well-being.

In 1988, my consultant asked whether I would be willing to be a guinea pig in clinical trials of what is in effect a wonder drug called erythropoetin, which aims to replicate the secretion missing from the kidneys of renal patients--and which could, he assured me, give me back my haemoglobin, my energy, and the colour to my cheeks. I agreed to join the programme, and today I would find it hard to be a kidney patient not in receipt of EPO, as it is known for short. I am well aware that I am one of the lucky ones. I know that EPO is very expensive, and I know also that some regional health authorities will not allow it to be prescribed to any of their kidney patients because their budgets are already overstretched. But I cannot stay silent. Not every kidney patient needs or would benefit from erythropoetin. My consultant suggests that about 1,500 of the 8,000 patients on dialysis ought to receive it, but in Oxford where I am treated he has funds enough for only 50 per cent. of those who could benefit.

Elsewhere, the story is too often the same, yet I am told by so many, "Yes, we know that it is a wonder drug, that it can offer a dialysis patient a much-improved quality of life, and help him to return to employment--but we do not have the funds to pay for it." That is a heartbreaking message--as tough on the consultant who wants to prescribe EPO as on the patient who knows by hearsay what he or she is missing.

I appeal to my hon. Friend the Minister to re-examine that issue, and I ask him to consider this question : what is the point of creating wonder drugs if, when they have been developed, the medical authorities cannot afford to prescribe them? I know that I will be told that it is for regional health authorities to decide how they spend their budgets, and that it is for them to include or exclude something such as EPO--but surely the Department can earmark part of the money going to regions specifically for

Column 436

meeting the costs of new drugs, or hold back that money unless a region gives details of the drugs on which it is to be spent. Something must be done as a matter of urgency--or EPO must be licensed and made available on prescription from local general practitioners, even if patients still come under hospital renal consultants. I am aware that the Department of Health quite rightly believes that successful transplantation is a better and less expensive treatment than dialysis, but it has to be accepted that not everyone can have a successful transplant. While there is a shortage of organs for transplantation, dialysis is the only remedy. Naturally, that brings me to the subject of the transplant programme and the supply of organs. More organs are needed. We should applaud the increasing number of transplants that have taken place in the past six years, and the efforts that have been made to improve supply, but one cannot escape the ethical questions involved in transplanting pieces of the human body. Transplantation in my opinion is acceptable only when the organ is a voluntary gift from one family to another. To that extent, I am opposed to opting-out schemes, which mean that if one does not state that one's organs are not to be taken they can be plundered, whether the next of kin like it or not. However, I welcome every initiative to improve the supply of organs. The audit carried out under the auspices of the Medical Research Council last year gave us a much clearer picture of how many potential donors arise in intensive therapy units. It came up with a figure of 1,700, which is roughly half the old estimate, and that clarifies how much more needs to be done.

I pay tribute to my hon. Friend the Member for Kettering (Mr. Freeman)--who was the Under-Secretary of State for Health--who organised a seminar last November, given by the Department, on the subject of the donor scheme and the constructive suggestions that came out of that meeting.

I wish to dwell on one idea--that of enhancing the kidney donor card scheme, or perhaps I should have said the organ donor card. The scheme could be more successful. The idea of a donor card is excellent. If one wants to give an organ, one carries a card to say so, and if anything happens, the card is there for the hospital staff to see and to act upon. It sounds so simple. However, the chance of the card going into the intensive therapy unit with the casualty is extremely slight, as the first thing that happens is that clothes are taken away before anyone is taken into the unit. Staff in the unit will not spend a great deal of time searching through possessions to see if the patients have a donor card, as they are concerned with saving life.

A consultant asked me to question the Department about how many times the donor card produced organs for transplantation. It was unable to give me an answer. That speaks volumes about the fact that the card is not working as we would wish.

Even if staff in the intensive therapy unit find the card, they only act upon it to the extent that they will then telephone next of kin to ask for permission to take organs. They do not only ask next of kin : they will almost certainly ask the husband or wife and other close members of the family. If anyone objects, the organs will not be taken. That seems to fly in the face of what the donor card system is meant to achieve. While there is no legal requirement for anyone to be consulted if the card is signed by the donor,

Column 437

I understand that the medical profession believes it has a duty to obtain family consent, or at least the consent of the next of kin, before taking organs, and I do not wish to argue with that. That does not entirely invalidate the donor card, as it performs another important role. It encourages people to think about and to accept organ donation as part of everyday life, and it has been valuable. It is true also that too many card carriers have not told their families that they carry cards and therefore that they wish to donate their organs. I suggest to my hon. Friend the new slogan "Carry the card and tell your family."

If the card is not accepted by the medical profession as having the same legal imperative as a person's will--clearly, removing organs is of a different order from leaving goods and chattels--perhaps the solution lies in the donor card being countersigned by the next of kin. It would then be unnecessary for the transplant co-ordinator to telephone the next of kin, and it would mean an end to the emotional trauma that follows the death of a loved one, when those being asked whether organs may be taken are in the wrong frame of mind to consent. That so many people consent speaks volumes for the skill and diplomacy of transplant co-ordinators who are currently at work. I go one stage further. I want my hon. Friend the Minister to consider the schemes in Wales and Derbyshire--Lifeline Wales and Lifeline Derbyshire ; I believe that there is a similar scheme in Glasgow--whereby the names of all those carrying donor cards are stored on computers that are available to intensive therapy units. The name, address and age of a donor is placed on the computer register. Of course, if I have my way, the request to be a donor will have been made known to the next of kin. That system works in Wales. Lifeline Wales has a donation rate of 20 donors per million of population--the best in the country. There are more than 300,000 on the computer register, with a further 400 being signed up every week. The computer is connected to all intensive care units in Wales. Lifeline Derbyshire is similar, except that it works on a computer at Manchester university, with a terminal situated in the Chesterfield royal hospital, and is connected to local hospitals in which there are intensive therapy units. Lifeline Derbyshire has produced a modified donor card, on which is added a form on which the information to be put on to the computer can be added. I understand that, like Lifeline Wales, Lifeline Derbyshire is proving to be effective.

Using either example, it is clear to me that putting the names of organ donors on computer is the way to make the donor card a real success. I have given my own opinion about the countersignature by the next of kin, because people responsible for Lifeline Wales agreed that that procedure would help. However, I ask my hon. Friend the Minister carefully to consider this procedure, even if it is only the donor's name which is put on the computer and the next of kin still telephoned.

I know that there are resource implications in the proposal but, if it was possible to put the names of people wishing to give organs--all those currently carrying donor cards ; I am speaking not only about kidney donors but about all those who wish to give organs--on a national computer held by the United Kingdom transplant service or on regional computers held by the various regional health authorities connected to intensive therapy units, we might increase the number of organ donors, in line with

Column 438

the Welsh and Derbyshire experience. In turn, we might increase the supply of organs that are so desperately needed at this time. I do not need to tell my hon. Friend the Minister that successful kidney transplants are a much more economical way of overcoming end-stage renal failure than dialysis or dialysis coupled with the use of erythropeotin. I therefore commend the idea to him. 12.14 pm

The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell) : I congratulate my hon. Friend the Member for Newbury (SirM. McNair-Wilson) on securing this debate on an issue of great importance not only to him, but to the whole community. I appreciate the irony that my arrival at the Department of Health was prompted by the departure from Government of my right hon. Friend the Member for Worcester (Mr. Walker), with whom my hon. Friend the Member for Newbury and I share a link. I followed my hon. Friend the Member for Newbury as parliamentary private secretary to our right hon. Friend. My hon. Friend set a high standard which I sought to

emulate--incompletely, I suspect.

It is a great pleasure to respond to the Adjournment debate initiated by my hon. Friend. Today, as always, his speech has demonstrated the depth of his experience and his understanding of the problems associated with the treatment of kidney patients within the National Health Service.

It is important to set the issues my hon. Friend raised within the context of the NHS treatment of kidney patients, which is one of the great success stories of recent years. The increase in the number of patients whose lives have been extended by renal care since 1979 has been considerable, both for patients on various forms of dialysis and for patients who have benefited from transplants. Both groups have increased substantially. In 1979, there were just over 6,000 patients whose lives had been extended by renal care. That figure has now risen to more than 16,000 patients whose lives have been saved by the NHS because of advances in renal medicine. That is a great success story, of which everyone associated with the NHS has every reason to be proud.

It is also important to say that we are not complacent about the future development of this aspect of care within the NHS. My hon. Friend mentioned the work sponsored by the Renal Association, which shows the scale of need for renal care in the community. The study suggests that we need to increase the number of new patients coming into renal support above the level already achieved, based on epidemiological research.

The Renal Association came to see me last week to talk about that and I complimented the association on the quality of its research, which I believe to be soundly based and to be an object lesson, from which I hope that others will learn, on how the new health authorities after the Health Service reforms next April should discharge their responsibilities for seeking to measure need and to establish the level of need for different types of care in the NHS. In that way, as in many others, those involved in the care of kidney patients have led the way.

My hon. Friend began by arguing the case for an extension of local dialysis units and he suggested that it might be a more appropriate way to treat kidney dialysis patients than to encourage them to come into large centres

Column 439

in hospitals. Ultimately, that is a matter for each health authority to decide according to the available resources and circumstances in its own area. That issue will certainly present itself in a new and acute form after next April, when the health authorities will be established as purchasing agents on behalf of kidney patients and they will seek to ensure that the treatment available to patients is the most appropriate for those patients. It is wholly possible that that development will occur after next April.

That change will impact to a degree on my hon. Friend's first request about the extension of attendance allowance payments to those who need carers to assist in the dialysis process at home. I understand my hon. Friend's argument, but have just one reservation about it. Other issues may argue against the provision of dialysis at home for patients who, in the normal course of events, live alone. My hon. Friend may well have suggested an alternative way forward when he referred to the need for local dialysis units rather than for assistance to be given for dialysis at home in the form of more generous attendance allowance payments. I simply enter that reservation.

However, that is ultimately a matter for the Department of Social Security, which, in these new enlightened days, has been split from the Department of Health. I shall therefore communicate with my hon. Friend the Under- Secretary of State for Social Security, who is just down the corridor from me, but in another Department. I shall write to my hon. Friend the Member for Newbury when my hon. Friend and I have had the chance to consider his suggestion in more detail. The second of my hon. Friend's substantial points related to the future of the wonder drug which I shall call EPO, because, unlike my hon. Friend, I have not learnt to pronounce its name in full. I am very much aware of the tremendous advance that that drug represents for renal medicine and of the need to ensure that we can find a way to make it available to kidney patients just as, over the past 15 years, we have made available to kidney patients all the other advances that have been made, many of which are much more expensive than EPO. We must find a way of making certain that the drug is available to the patients who need it. There is no division between my hon. Friend and I on that point.

However, I am afraid that I do not accept my hon. Friend's suggestion that the way to achieve that is through some form of central funding of the local authority's need for that drug. Ultimately, central funding can be achieved only by top-slicing the money--to use the jargon of the Department of Health--that is provided by us to the regions, and from the regions to the districts. In other words, if the Department of Health funds something centrally, less money is available for the regions and the districts to spend on their own account. That happens from time to time, but in my view it should happen only for the purpose of concentrating resources in areas where there might be some regional disparities. If, as is the case for kidney patients, facilities are spread fairly evenly across the country, there seems little point in top-slicing the budget of, for example, the Northern regional health authority simply to return to that health

Column 440

authority a roughly equivalent amount of money that will allow it to purchase the drug or any other form of treatment.

Therefore, I do not think that top slicing and central funding, which are two sides of the same coin, would advance the argument very far. However, I undertake to seek to work with the regions and the health authorities to ensure that, as far as possible, that drug is available. Following my meeting last week with the Renal Association, I have already asked to be given the up-to-date position about the availability of the drug, region by region. It is important that each region carefully assesses the clinical need for the drug within its own facilities and makes the appropriate plans to ensure that that need is met. That is the way forward, rather than attempting to centralise control at Richmond house.

Sir Michael McNair-Wilson : Perhaps my hon. Friend is not aware that a kidney patient who receives erythropoetin can go back to work. If a person with a manual job suffers kidney failure, he cannot normally work, but that is not the case for someone receiving erythropoetin. If the patient goes back to work, he starts to pay taxes and those taxes go into a central pool. My hon. Friend is right to talk about top-slicing that which would otherwise go to the region in total, but I am suggesting that, through erythropoetin, the Treasury might gain more money than my hon. Friend would be giving the regions. Perhaps that additional money could be considered to be part of the grant funding.

Mr. Dorrell : My hon. Friend, as always, advances a seductive argument. Unfortunately, it is one that he must ultimately address not to me but to my right hon. Friend the Chief Secretary to the Treasury. We have to work on the basis that the budget available to the NHS is fixed and is part of the public expenditure survey round. I am sure that there is no division between me and my hon. Friend about the enormous advance that EPO represents and the desirability of making it available. It is simply a question of mechanics and how that can be done. The correct way is to seek to work with the regions to eliminate any blockages in the system. I should add that that is another example of a blockage in the NHS management system. We shall seek to eliminate such blockages through the reforms that will be introduced next April.

As soon as we establish more clearly the principle that money should follow patients and that money should be directed to where patients need to be treated, problems which currently seem to represent substantial bureaucratic logjams suddenly seem simpler to resolve.

My hon. Friend's third point was about transplants. I accept the principle that he espoused, that it is preferable, both from a clinical and a financial view, to treat a patient ultimately by a transplant rather than on dialysis. I agree entirely with what my hon. Friend said against moving to a system of opting out of donorship. I do not believe that that represents the way forward. Various options should be considered to encourage voluntary donorship of organs. I sought to do that at breakfast time this morning. I had been asked to attend the launch of a new balloon that is sponsored by two drug companies--Sandoz and Du Pont--to draw attention to the donor card system. On the way to the launch I made certain that I had my donor card with me because I was conscious that there was a risk--

Column 441

Mr. Kenneth Carlisle (Lincoln) : I am glad that my hon. Friend survived.

Mr. Dorrell : I am, too. I wondered whether I would survive when the balloon collapsed on top of me. I thought that it was perhaps a new way of promoting transplants. The balloon is a serious attempt to attract media interest in the donor card system. I welcome that, and will do everything that I can to support it.

My hon. Friend correctly drew attention to the enormously valuable work of my predecessor on organ donorship. If I can do as well as he did to promote the cause, I shall be pleased.

My hon. Friend also mentioned some of the disadvantages of donor cards and suggested ways in which the system could be enhanced. In particular, he suggested that the card should be countersigned by the next of kin to avoid the problem of medical ethics that doctors are unwilling to use organs simply on the basis of a signed donor card. I should not like to become involved in medical ethics. They are not properly the province of politicians. However, I take note of my hon. Friend's point. Perhaps he would like to take up the matter with the appropriate medical authorities. When politicians start to advise doctors on ethical values, I suspect that we are getting into relatively deep water.

My hon. Friend argued the case for a central computerised register, a cause which he has espoused before and for which he is well known to be an enthusiast. We are not opposed to that idea, but, in view of the practical problems, the Government should not commit taxpayers' money to a central register unless there is clear evidence from the local schemes to which my hon. Friend referred that a register would be a cost-effective way of

Column 442

increasing the availability of organs for transplant. That was the conclusion reached by the working party chaired by Sir Raymond Hoffenberg which reported to us in 1987. We have implemented its main recommendations.

I am aware of the scheme in Wales to which my hon. Friend referred. I suspect that there are other factors in the Welsh experience in addition to the register which contribute to accounting for the improved donorship record there. Indeed, the previous Secretary of State for Wales may have played a part in that ; I do not know. We are looking at the Welsh experience and the experience in Birmingham. Although I have not been informed that we are looking at the scheme in Derby, we shall do so.

We recognise the complexity of organ donation and accept the conclusion of the Hoffenberg working party that there is unlikely to be a simple answer to the shortage of organs. There is no panacea, but I hope that we have begun to pinpoint the real issues. As many of them are medical questions, the royal colleges have agreed to take them forward and we shall await the outcome of their deliberations with considerable interest.

ROYAL ASSENT

Madam Deputy Speaker (Miss Betty Boothroyd) : Before I call the next hon. Member, I have to notify the House, in accordance with the Royal Assent Act 1967, that the Queen has signified Her Royal Assent to the following Acts :

1. Pensions (Miscellaneous Provisions) Act 1990.

2. Town and Country Planning Act 1990.

3. Planning (Listed Building and Conservation Areas Act 1990. 4. Planning (Hazardous Substances) Act 1990.

5. Planning (Consequential Provisions) Act 1990.

Column 443

Telephone Tapping

12.30 pm

Mr. Robin Cook (Livingston) : You will recall, Madam Deputy Speaker, that in 1985 one of your predecessors announced to the House that the Queen had graciously assented to the passage of the Interception of Communications Act. It was the result of long concern in the House, among the public, and, in particular, among the personnel of British Telecommunications. I am particularly pleased that today's debate is attended by my hon. Friend the Member for Blaydon (Mr. McWilliam), who has a long record of representing the union that organises members within British Telecommunications.

The Act was not forced on the House by public pressure, nor by the unease of British Telecommunications' employees. It was forced on the Government by a decision of the European Court of Human Rights in the Malone judgment. The Act provides the minimum degree of protection and it is deeply flawed in several ways. First, it provides a remedy only to those who are able and choose to complain about their telephone having been tapped. That implies that the person concerned knew of the tap in the first place and of the nature of its operation. In 99 out of 100 cases there is no such knowledge. Moreover, there is no requirement in the Act to inform the subject, either subsequently or during tapping, that the tap is in place. An amendment moved to the Bill before it was enacted is highly relevant to this Adjournment debate. It would have provided immunity to employees of British Telecom should they choose to report what they believed to be an unauthorised and unlawful tap. The amendment was rejected by the then Government.

Perhaps the biggest flaw of all is that the Act created an interception of communications tribunal to which an aggrieved member of the public could complain. However, the tribunal is limited to investigating only those cases where a warrant has been issued to identify whether a warrant has been properly issued. It has no authority to investigate whether a tap has been placed without a warrant. If the aggrieved complainant has a tap placed without a proper warrant, the tribunal cannot proceed further. It will not notify the aggrieved complainant that his or her telephone has been tapped without a warrant. All that happens is that the complainant receives a response from the tribunal concluding that there has been no contravention of section 5(2) of the Act.

That information can mean one of two things : either that a warrant was properly granted and the tribunal, having examined the matter, has concluded that there was full authority and therefore no contravention of the Act, or that there was no warrant and no authority and the tap was placed unlawfully, but the person receiving that information was none the wiser and did not have the information available for further action.

As a result of the Act at least we have an annual statement from the commissioner of the tribunal who provides a report on the scale of telephone tapping. I have with me the most recent report that provides figures for the warrants issued by the Home Secretary and the Secretary of State for Scotland in each year since 1985. There is an intriguing feature to those figures in each of those five years as the number of warrants issued in Scotland is far higher pro rata of population than the number issued for

Column 444

England by the Home Secretary. If one made a simple arithmetical calculation based on population--I appreciate that that is a crude approach to a complex subject--the number of warrants issued in Scotland is consistently 50 per cent. higher than the number issued in England. I find that puzzling as I am not aware that Scotland is facing a significantly greater terrorist or subversion threat than the metropolitan areas of England. I would appreciate some guidance from the Minister when he replies about why a consistently larger number of warrants is granted in Scotland than in England. The great omission from the report is that the figures provided by it relate only to the warrants issued by the Home Secretary and the Secretary of State for Scotland. They do not cover any warrants or authorisations issued by the Foreign Secretary. That is a critical point as there is a growing belief that most telephone tapping, given the sophisticated nature of electronic communications, is now conducted by GCHQ--not MI5 or special branch--which answers to the Foreign Secretary and therefore obtains its authorisations from the Foreign Office.

Two weeks ago a senior official of the National Communications Union was quoted in The Guardian as saying :

"If there was an independent investigation into the number of taps at any one time, the public would be amazed"

Against that background I want to consider the specific case of my constituent, Mr. T. McSherry. The history of his experience can be briefly told. Mr. McSherry is the acting manager of the telephone exchange in Livingston new town, in my constituency. He experienced a pattern of interference on his home telephone line and, being a technician and the acting manager of the telephone exchange, he reasonably decided to sort out the problem himself. He climbed up a set of stairs and traced his line in the attic of the exchange. I am sure that "attic" is not the proper term, but my hon. Friend the Member for Blaydon will put me right on that.

In a remote corner of the telephone exchange Mr. McSherry found that a device had been placed on his line, which he traced to a connection in Edinburgh. As he is a technician for British Telecom, he is capable of recognising a telephone tap. Just to be certain, however, he summoned two fellow qualified engineers in the exchange to act as witnesses to the existence of the device and to the probable explanation of the device as a tap on his home telephone line.

British Telecom has since responded to that alarming discovery by explaining that the device was one that it had placed on a number of telephone lines at random at the request of Oftel to provide random checks on the precision of the billing mechanism of British Telecom. That device would record all the telephone numbers that were called by that line.

There are, however, a number of problems with that explanation. First, British Telecom initially responded that it had been unaware that the line belonged to one of its employees because the line was in the name of the employee's wife. That is factually incorrect : the line is in the name of Mr. McSherry and the bill is sent to him. Secondly, it is inconceivable that any engineer intending to place such a device on a line to provide a check on the billing and pricing mechanism on that line would climb to the top of the exchange, go round the back of the display unit and place the device in a hidden corner of the exchange. Any engineer placing a number of such devices

Next Section

Home Page