House of Commons Hansard Debates for 28 Mar 1991

Column 1137

kidney donor numbers must be increased by at least 1,000 a year. In other words, the number of cadaveric organ donors coming from the ITUs must be doubled.

Can that be done, and are there any other untapped organ sources? Certainly studies suggest that some cerebro-vascular patients who die in general wards could be organ donors, and that, if that method were replicated nationally, a further 16.7 donors per million per year could be added to the current United Kingdom rate of 14.6 donors per million per year. Obviously, that would be a valuable addition ; perhaps my hon. Friend the Minister can tell me how those studies are being transferred into practice.

The kidney waiting list of 3,931 must be broken down into patients who are not sensitised to transplants--that is, those who have not yet had a transplant--and those who are sensitised, perhaps because they have had a failed transplant. Some 35 per cent. of the waiting list consists of unsensitised patients. Perhaps they, like me, will not have to wait very long to obtain a transplant ; I had to wait only six weeks after being approved for the waiting list. Those who are sensitised will inevitably have to wait much longer, because for them the right kidney will take some time to appear.

The questions that remain are where we are to find the additional donors, and whether the ITUs are producing the maximum possible number. They are, I think, the principal source for the foreseeable future. Everyone whom I have consulted agrees that success in finding donors rests on the enthusiasm of the transplant team, and on the sensitivity and effectiveness of the transplant co-ordinators. Theirs is a stressful job, because it involves both arranging for the organs to be taken by the individual surgical teams and seeing, talking to and winning the confidence of the next of kin, without whose consent the donation cannot be made.

In the Oxford region--the region that I know best--there are two to three co-ordinators to the 2.8 million people who are served by the region. It is felt that more co-ordinators would produce more organs, not necessarily in Oxford but in the regions that have fewer co-ordinators. What steps is the Department taking to increase the number of co-ordinators--or is that strictly a matter for the region? As we know, 30 per cent. of those who are asked to consent to the removal of organs say no. Although many probably have strong religious and ethical grounds for their refusal, it is widely believed that the doctors who make the initial approach to the next of kin would benefit from bereavement counselling before performing that task. As theirs is the first approach, it is clearly of the greatest importance. Is such counselling now becoming standard practice throughout the regions of the health service? If not, why not?

That initial approach is followed by the work of the co-ordinators, to whom I have already referred. We also know that 5 per cent. of the next of kin are never approached about organ donations, probably because the ITU where the donor has originated is not sufficiently motivated, or perhaps because it lacks the facilities to care for a donor--electric ventilation machinery, and other such equipment. Can the Minister enumerate the ITUs that currently cannot handle organ donations because of a lack of facilities? What steps are being taken to bring them up to date?

Column 1138

I was glad to learn recently from the United Kingdom transplant service that every health region is both an exporter and an importer of organs. That is to say, they are providing organs for other regions, as well as bringing in organs to meet their own needs. I was not surprised to hear that Oxford is at the top of the list. Last year it had 96 exports and 61 imports. I was disappointed to hear that a group of London hospitals was at the bottom of the list, with eight exports and 37 imports.

One must wonder why there is such a disparity, whether the Department is taking steps to find out why such disparities exist, and what can be done to produce a more general and even flow between the regions, and why, in 1989, Euro-transplant retrieved more kidneys per million of population than we did and why Austria in particular acquired 52 kidneys per million of population against our figure of 31.7. What magic do the Austrians have that we do not possess? What can be done to improve our retrieval rate? If we could match the Austrian figure, the waiting list would largely disappear. Recently I was asked why, when a transplant case receives favourable publicity, organ availability increases. The answer seems to be that next of kin--those who give their consent, or otherwise, to organ donation--temporarily become more sympathetic to the idea. That suggests to me the need for still more education and a rather higher publicity profile than has been the case with organ transplantation. I welcome the fact that this year there is to be a national transplant week. I hope that the Department will use the opportunity to highlight the remarkable success of the United Kingdom's transplant programme to date. I hope also that schools will join in and include, perhaps, a reference to transplantation in biology lessons so that young people, like their families, will talk about transplantation among themselves and see it as the gift of life that it is- -a gift that they may wish to have one day, a gift that, sadly, they may want to give. I hope that live donor transplants, although likely to be small in number, will increase, where appropriate. I do not underestimate the difficulty of increasing organ donations, particularly if we are to bring in people of 65 and over for transplants. I hope that I have suggested some possible ways that could help to improve the supply of organs. I take comfort from a recent article in the Wall Street Journal that describes the problem in America. For once, their problem is worse than ours. Now they are even considering payment of the funeral costs of organ donors as an inducement to donation. I very much hope that we do not have to go down that road. I shall listen with great interest to my hon. Friend's reply.

12.42 pm

The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell) : By leave of the House, Mr. Deputy Speaker, may I say thatI think I should speak for the whole House, if the whole House were here, if I said that there can be few more popular testimonies to the success of the transplant programme than my hon. Friend the Member for Newbury (Sir M.McNair-Wilson). He was an object lesson in courage to all of us during the time that he suffered from kidney problems. It is pleasant to see him looking more tanned and healthy than we have seen him

Column 1139

for several years. He is, as he said, a walking example of the scientific advance represented by the organ transplant programme. I echo almost every aspect of my hon. Friend's approach to the problem. My hon. Friend began by saying, rightly, that the transplant programme is one of the great success stories of modern medicine and that it is a particular success story of the British national health service. My first memory of the transplant programme is of flickering black and white television photographs from the Groote Schuur hospital in 1969, when Professor Christiaan Barnard carried out the first heart transplant.

When I became Under-Secretary of State for Health last year, my knowledge of medical advances was such that, while I understood that we had come some way since those days, I had no conception of the extent to which organ transplantation is now a routine operation in the national health service. It is done every day and thousands of patients throughout the country now leading normal lives are testimony to its success.

I shall briefly weary the House with some statistics as that is the best way to illustrate the size and importance of the transplanting programme. The number of kidney transplants perforned in Britain has risen from 849 in 1978 to 1,732 in 1989--an increase of more than 100 per cent. in 11 years. More directly relevant to the Christiaan Barnard precedent, 295 hearts were transplanted in 1989, compared with only three in 1979. I shall not seek to calculate that figure in percentage terms, but nearly 300 heart transplants were carried out as routine operations within the national health service. In 1989, there were 295 liver transplants and 94 heart-lung transplants. In 1980, 3,145 people in Britain had functioning transplanted kidneys. By 1988, the figure had risen to 8,000 people, and it has continued to rise since. Like my hon. Friend the Member for Newbury, those people lead virtually normal lives as a result of that great scientific advance.

My hon. Friend was also right to nail one bugbear or

misunderstanding of the transplantation programme when he drew attention to the fact that, at least in regard to kidney patients, transplantation is not high-tech medicine which is diverting the resources of the health service away from patients elsewhere in the service. It is more economic than other lower-tech services because, once a successful kidney transplant has been carried out, the health service is no longer committed to the extremely expensive and, from the patient's point of view, dramatically less satisfactory procedures related to various forms of dialysis. That is not to say that dialysis itself is not an advance and that advances have not been made within dialysis, but no one with any understanding of the economics or the quality arguments about the treatment of kidney patients can be under any doubt about the value attached to successful kidney transplantation and the benefits which that scientific advance has brought to patients through the NHS. It is worth remembering that it is a medical advance available throughout the world, but our record in Britain stands comparison with that of any other country in Europe. We have more kidney transplant patients now alive than any other country in Europe. The NHS has helped to develop and taken full advantage of the significant developments in transplant

Column 1140

technology over the past decade, including improved drug treatment to prevent the rejection of organs. In view of some of the issues that were the main burden of my hon. Friend's speech, clearly reducing the rejection of organs makes a vital contribution to cutting waiting lists and to the effective use of donated organs. We have also been able to improve methods of preserving organs, which also increases the number of organs available.

It is a major success story, but, as my hon. Friend quite rightly pointed out, there are still more people on the waiting lists for transplant operations than many of us would like. Unlike most other waiting lists in the health service, this list is not determined by the pace at which resources can be made available ; it is not a resources-determined waiting list but one which exists, by and large, because of the lack of donors. Each of us can do something about cutting the list by ensuring that, if anything untoward happens to us, our family and friends know that we want our organs to be made available to others. We would all have the opportunity to help cut the list if a tragedy should occur.

I shall now deal with the question how to increase the flow of organ availability because, as my hon. Friend said and as I have also stressed, that is the key to cutting the waiting list and to helping those on NHS waiting lists to benefit from this major advance in health. I entirely agree with the philosophy expounded by my hon. Friend about the way in which we should approach the subject. We must accept that nobody has a right to anybody else's organs. If something untoward happens, our organs may be of value to someone else but that should be the result of an altruistic decision about how we want our bodies to be used when we die. It should not be as a result of a right of the recipient. We must make that philosophical approach clear and accept it as the basis on which we encourage organ donorship. It is our responsibility to make such a decision and to ensure that our friends and relatives are aware of our views. It is the responsibility of the living whose organs may be of use to someone else ; it is not anyone else's job to claim the organs. I agree with my hon. Friend that it is not a decision from which we should be required to opt out. It should be a positive decision that, when we die, we want our organs to be available to someone else. It is up to the individual to make his decision known. Furthermore, we should not make much progress if we imposed a statutory requirement on the professional people present at a bereavement to make a request for organs in conditions which they do not believe they can handle or which are unlikely to produce a positive result. It would make the law an ass to require them to make a request which they believed as professionals, to be inappropriate. The law would be absurd. I do not support the principle of requiring someone to opt out of, as it were, organ harvest ; nor do I believe that we shall make progress by imposing a statutory obligation on professional people to make such request in the circumstances that I have described.

We must find a way of eliminating the barriers to donorship which exist partly as a result of inadequate professional training but, perhaps pre- eminently, as a result of a misunderstanding by the majority of NHS patients and by society as a whole of what organ donorship means and the circumstances in which organs

Column 1141

can be taken from a dead or dying donor. I must correct that. The issue of donorship may arise when the patient is dying, but those organs are taken when the patient is dead.

It is important to consider how to encourage organ donorship. My hon. Friend concentrated on the number of people who die in intensive therapy units whose organs could be of value to the transplant programme but who do not donate them. We have set up a national audit system to try to establish precisely how many people die in those units without their organs being available for transplant and why. This is an important matter, and we are seeking to inform ourselves not only of the number of missed opportunities as a result of that phenomenon but how we can ensure that that flow of organs improves. My hon. Friend is right in believing that that is the most effective way in which to conduct discussions on the issue.

It is also important to consider the motivation of the intensive therapy units. The professional staff are emotionally involved in attempting to save a patient's life. When a patient dies, the staff often suffer the same feelings of bereavement as the family. Such deaths are demotivating and demoralising for the staff, but it is important to remind the staff that that death is an opportunity for secondary benefit, however great the primary tragedy. Such motivation must be included in the training of staff.

My hon. Friend will also be aware of the recompense for costs incurred in intensive therapy units when they provide organs for use in another hospital. I assure my hon. Friend that we are addressing that question. We are also considering the training of professional staff so that they are aware of the secondary benefits of the primary tragedy to which I referred. We are also considering training on how to ask the next of kin for the consent which must be given before a dead patient's organs are taken.

Column 1142

My hon. Friend was right to stress the importance of the transplant co-ordinators and, if I may, I shall write to my hon. Friend on the specific question that he asked about them. They have a key role to play in raising the awareness of the public of the importance of reaching a decision on organ donorship.

We should all face the fact that, without notice, we might find ourselves fighting for our lives in an intensive therapy unit as a result of an accident. That would bring us face to face with the possibility of our death, as well as of the fact that parts of our body may be of value to someone else. In those circumstances, surely it is better to have discussed the matter with our families so that they know our views. It is important that our concerns should have been addressed and allayed before we have to reach a decision on such donorship. The emotionally charged atmosphere of an intensive therapy unit is no occasion to be approaching this issue for the first time. It is a matter about which, as citizens, we should know our views and be sure that our families know those views so that when the question is asked the answer is automatic. We should be trained, as it were, in knowing what to do in such circumstances. We should be like the parachutist presenting himself at the back door of the aeroplane. He knows what his reaction will be, because he has done it often on the ground. His reaction becomes second nature and automatic.

The most important step we can take is to be sure that the public understand the benefits that can come from transplantation. They must know that the subject requires everyone to make a decision and to be sure that that decision is known to our families. We must also be sure that all of that happens before we find ourselves in an intensive therapy unit having to make the decision for the first time in anger.

Column 1143

Disabled People

1 pm

Mr. John Hughes (Coventry, North-East) : I appreciate this opportunity to raise the important issue of the disabled. Perhaps any debate on this subject should begin with a quotation from "Breaking the Chain," a campaign issue publication by the Spastics Society : "Because I'm disabled I don't even get a second look when applying for a job, so there is no way that I can get out from under the poverty line. I'm disabled and I live in a society that doesn't recognise the disabled. I can work. I should have that opportunity." The House has failed to acknowledge the many problems facing Britain's 6 million disabled people. The Americans with Disabilities Act 1990 makes it clear that society has historically tended to isolate and segregate individuals with disabilities, causing discrimination to be a serious and pervasive social problem. The Act recognises that such discrimination persists in such critical areas as employment, housing, public accommodation, education, transportation, communications, recreation, health services and access to public services. Many individuals have little or no legal recourse to redress such discrimination.

I hope that hon. Members in all parts of the House recognise that, while society denies people with disabilities the opportunity fully to participate in the life of society, much human talent and energy are wasted and that the consequent dependency and non-productivity results in high costs to the nation.

Britain has a poor track record, and it is time that Parliament made it a key subject for debate and legislation. Without a change in public attitude and Government action, the idea to which the Prime Minister subscribes, of a classless society in which opportunity prevails, is so much hot air. The present Prime Minister, when Minister for the disabled, did not rule out the possibility of anti-discrimination legislation.

Because I am anxious to give the Minister ample time in which to reply to the debate--and since hon. Members could site sufficient cases from their constituencies to more than occupy the time available today--I shall give only a few examples of the way in which the disabled suffer in society.

The disabled already have enormous barriers of fear and ignorance to overcome before being able to get a job. According to a recent Government report, the 3 per cent. quota law has been a dramatic failure. The best region is Yorkshire, where, at 1.5 per cent., the take-up rate is half the legal minimum. The worst take-up rate is in the south-east, where, at 0.7 per cent., it is only a quarter of the legal minimum. Lambeth council is one of the few authorities to have made great efforts to live up to the law. It has committed itself to offering jobs only to people with disabilities. Otherwise, the reasons for the extremely low take-up rates seem to relate to ridiculous fears, prejudices and ignorance about the problems of the disabled at work.

Too often, people think of wheelchairs when the word "disabled" is mentioned. Disabilities range from relatively minor impairments, such as epilepsy, to total impairment such as paraplegia. The simple mention of a disability seems to put employers' backs up. They often assume the worst and do not even bother to interview disabled people.

The Centre for Integrated Living in Ripley, Derbyshire operates an employment agency. It had on its books an

Column 1144

epileptic, a skilled worker, who was not even considered for a job by a company that thought that his wheelchair could not cope with stairs.

Disabled people should not all be lumped into a vast homogeneous mass. A change in popular attitudes towards disabled people is needed. In turn, that requires the Government to take the lead in introducing comprehensive legislation. They cannot wash their hands of the problem. There is frightening evidence of discrimination in the Government's agency, Remploy, which has the specific job of providing employment for disabled people in sheltered accommodation. According to observers quoted in the publication of Mainstream, an organisation that promotes integrated opportunities for disabled people, disabled people who were interviewed said :

"They want able-bodied people with dandruff. They want fit people for a very hard working job. There are lads down there throwing cardboard into one end of a machine and running to get to the other end before it comes out. They want their pound of flesh at Remploy. It is not top of the pops with me."

Such criticism deserves an inquiry and a decent response. Regrettably, Remploy seems to be a case study in what goes wrong when the Government throw such agencies to the wall for market forces and instruct them to break even. The more such agencies adopt that approach, the less able they will be to do their jobs. The disabled deserve better than that.

Although the evidence of substantial and systematic discrimination against disabled people is overwhelming, it is persistently ignored. Ten years after the Committee on Restrictions Against Disabled People's report on restrictions on disability, and as we near the end of the United Nations Decade of Disability, there has been monumental inaction.

I am not alone in arguing that the Government are complacent about the burning issue of discrimination against disabled people. Even the Tory- dominated Select Committee on Employment remains unconvinced about the Government's view that no new legislation is needed, at least for employment. The Select Committee agreed that the Government should

"explore urgently the possibility of equal opportunities legislation for the employment of disabled people and report to Parliament on its potential effects and costs to the labour market." The Government argue that anti- discrimination laws are too complicated to draft and enforce, that they frighten employers and that they are too expensive and bureaucratic. They are so confident of their arguments that they are frightened even to commission reports on the one country that has laws to challenge such nonsense--the United States. Ministers in the United States no doubt used to express the view that the Government regularly trot out--that little action should be taken and that the disabled should wait their turn and the munificence of municipal authorities and businesses. However, the United States Ministers were defeated in the early 1970s when that country first introduced anti-discrimination laws, which have been widely accepted. Indeed, they have been strengthened by the Americans with Disabilities Act 1990.

The House should recognise that the American Act provides a good model for legislation to outlaw discrimination against disabled people in this country. It details the way in which disadvantage in employment, public services and telecommunications can be rectified.

Column 1145

For instance, all public transport vehicles built after a certain time must have facilities to carry disabled people in comfort, particularly those in wheelchairs. I am sure that in years to come the Government's inaction over the discrimination and disadvantage suffered by disabled people will be seen as one of the great moral scandals of their term, and, to be fair, the terms of other Governments.

The Government should also commission studies on the operation of the law in Germany, where a quota system of 6 per cent. is combined with a punitive levy or tax on those firms that do not comply. Those moneys are then directed to a fund to provide employment opportunities for disabled people. The Government should also commission reports on the operation of the law in Canada and Australia. They should take a leaf from the American book, but they have refused even to study that law. Why?

The Minister cannot continue to play each of the three wise monkeys by himself--see no evil, hear no evil and speak no evil. It is high time that the Government opened their eyes to the dreadful disadvantage and discrimination suffered by all too many disabled people and set in train a cross-party effort to undermine and reverse it.

1.10 pm

Mr. Dave Nellist (Coventry, South-East) : I am grateful to my hon. Friend the Member for Coventry, North-East (Mr. Hughes) and to the Minister for Social Securityy and Disabled People for allowing me a couple of minutes in which to raise two matters which I hope that the Minister will note. I appreciate the fact that the right hon. Gentleman has not had notice of my points, but if he will promise to write to me during the recess, that will do. My hon. Friend spoke about discrimination against the disabled, about employment problems even at Remploy, which was supposed to end such problems, and about anti-discrimination laws.

I wish to refer to allowances and travel. As the Minister remembers, we have crossed swords more than once on social security issues, not least a couple of years ago in the debate on whether to extend attendance allowance to severely disabled babies under two. Although the announcement was made in a statement and the money was not redistributed as well as I should have wished, no one was more pleased than I was to learn that the exclusion was to end from 9 April 1990.

As the Minister remembers, I tabled a new clause on this matter, but there is no need to rehearse that point now. The current edition of "Counter Claim", a Merseyside welfare rights magazine, contains an article which states that Social Security Commissioner Hoolahan ruled against the Department of Social Security adjudication officer under cases CA/380/1990 and CA/381/1990. He declared that it was illegal for the Department to have denied families the attendance allowance of almost £40 a week before 9 April. He ruled that the exclusion of children under two by regulation 6(2)(b) was not a modification but an exclusion and disallowed the appeal by the adjudication officer. The article stated :

"It's difficult to know how many parents of disabled babies have been deterred from applying for Attendance Allowance because of this unlawful restriction, but when Attendance Allowance was formally extended to cover babies under two, the Government estimated the move would benefit 3,000 families. If this is an annual figure some 45,000 families may have lost up to £75 million at today's prices."

Column 1146

Ex-gratia payments should be awarded in such cases. What is the Department doing to track down those 45,000 families and to make ex gratia payments, not least to the family from Nuneaton who came here a couple of years ago, as the Minister may remember?

The Minister will know Hereward college in Coventry. An article in the Evening Telegraph on Tuesday should shock him. I shall let the Minister read it after the debate.

At present, people in wheelchairs who wish to travel by train are placed in the guard's van with the parcels. They have no access to toilets or to food, but they pay exactly the same fare on British Rail as other travellers. It is a scandal that people are treated like luggage. British Rail says that 130 stations have been upgraded to facilitate the disabled. Such upgrading is welcome, but it is proceeding too slowly. Travel facilities from Coventry to London and, indeed, to other parts of the country are a disgrace.

I hope that the Minister will assure us that he will liaise with his colleagues in the Department of Transport and inform me by letter or, better still, by an announcement in the House that this state of affairs will end and that people in wheelchairs will have exactly the same rights of access to public transport as those who are able to walk.

1.16 pm

The Minister for Social Security and Disabled People (Mr. Nicholas Scott) : I shall start with a story that might illustrate some of thproblems that have been mentioned by the hon. Members for Coventry, North -East (Mr. Hughes) and for Coventry, South-East (Mr. Nellist). A few days ago, I was speaking to a young lady in a wheelchair who told me about an incident that happened when she was setting out on a trip on British Rail with her mother. After a cup of coffee, her mother had gone to buy a newspaper, leaving the young lady sitting in her wheelchair holding an empty coffee cup. A passer-by put 50p in the cup. That shows that many people perceive the disabled as pathetic creatures who are in need of help.

I have been in this job for four years, and I know that the overwhelming majority of disabled people wish to be independent, to be integrated into able-bodied society, and to have opportunities for employment, leisure activities, transportation and so on. For the time being at least, most people take those things for granted. I welcome this debate as another small step in raising awareness about the ambitions of disabled people in our society and about the duty of central and local government and society to enable them to achieve those ambitions.

I am not sure whether the blanket anti-discrimination legislation mentioned by both hon. Gentlemen is the appropriate way to proceed. There is no doubt that we are making progress. A few days ago, I was reminded of my visit to the mid-Cheshire sheltered workshop, which caters for the needs of people with cerebral palsy and mentally handicapped young people. I was told that 12 people from there have been taken on by a local factory and are living independently in flats in the same town as the factory. Anti-discrimination legislation is no magic wand. I understand, although I have not been able to check it, that, although the Americans with Disabilities Act 1990 has been passed, no federal funds have been made available to implement it.

The hon. Member for Coventry, North-East said that we have a bad track record on this matter. I take issue with that. I have travelled widely in the United States and

Column 1147

Europe, and I know that we have made steady progress in helping disabled people. It is untrue to say that there has been monumental inaction. Any fair-minded person looking at what has happened to the quality of life for disabled people in the past 10 years would have to admit that substantial progress has been made. For reasons that I shall later outline, the next 10 years will be even more exciting and important in improving the lives of disabled people.

As the House knows, I have direct responsibility only for the benefit system for disabled people. Like my predecessor, now the Prime Minister, and others who have held the job, including the right hon. Member for Manchester, Wythenshawe (Mr. Morris), the first ever Minister for the Disabled, I have set targets across the whole of Government to encourage and persuade my colleagues to place the needs of disabled people in the forefront of their priorities.

The hon. Member for Coventry, North-East was right to make employment the first of his concerns. I shall come back to what my colleagues in the Department of Employment are doing about that. My second priority would be access to transport, buildings and homes. The third priority, which in the next 10 years may turn out to be the most important in enabling disabled people to acquire both independence and integration in our society, is the impact of information technology and new technology on their lives. The hon. Member for Coventry, South-East talked about babies under two who survive now as they never would have done given the state of medical technology 10 years ago. He gave me a rough ride on that subject in two sittings of the Committees examining two social security Bills. After the second debate, I made it clear that I was not prepared to defend the policy on that any further, so we have amended it. As to the decision by Commissioner Hoolahan, on this issue, I shall write to the hon. Gentleman about the matter. We are studying the judgment. I think that it is probably not a reflection on the law as it stood before, but I should not want to prejudge more careful consideration of that judgment.

I have a key interest in promoting the interests of all people who suffer from disabilities of one sort or another. I am as anxious as any other hon. Member to ensure that people with disabilities should not be denied their rightful place in society simply because of their disability. Nor would I deny that discrimination exists--of course it does. We have to battle against it, but, rather than legislating, the most constructive and productive way forward is through raising awareness in the community as a whole.

As I have said before, demographic trends over the coming decades mean that fewer 18-year-olds will come on to the job market, with the result that employers will be compelled to look beyond the disability that is all too often their only perception of the disabled person to the abilities that lie behind. Anyone who has the privilege, as I have, of meeting people with disabilities week after week, will be impressed, as I am time after time, by the abilities of disabled people and their determination to use those abilities in the interest of society. I remain convinced that the way to achieve the integration of disabled people into society is to give them, as far as possible, equality of

Column 1148

opportunity and to make it easier for them to live, work and engage in social activities along with their able-bodied peers.

In the time remaining in this short debate, I shall concentrate on the practical measures that the Government want to introduce rather than on the concept of generalised anti-discrimination legislation. I start, as did the hon. Member for Coventry, North-East, with employment. My colleagues in the Department of Employment have been giving serious consideration to the need for legislation on employment policy. The issue was addressed, as everyone will be aware, in some detail in the Department's consultative document "Employment and Training for People with Disabilities", which was published last June. Chapter 5 of that document, a copy of which was placed in the Library, looked at the present arrangements, including the quota system, and considered a number of alternatives.

As hon. Members will be aware, one of the problems with the quota system is that, if every employer ensured that 3 per cent. of his work force comprised registered disabled people, there would not be enough people on the register to go round. We know that many disabled people do not want to hang around their necks the label "registered disabled". Those suffering disability should be in our sights as we seek to improve the employment position for disabled people. A considerable number of responses to the consultative document have been received. Ministers are considering the issue and will announce their decisions in due course. I have no doubt that some employers' recruitment practices discriminate unfairly against people with disabilities. Indeed, they discriminate unfairly against other groups, such as the elderly and women. Often, an employer discriminates against a disabled person because of ignorance of that person's capabilities, not from ill will. However, it is difficult to assess the scale of the problem.

Some companies implement excellent policies for employing disabled people. Indeed, a number of them have joined together in the Employers Forum on Disability to share experiences and good practice. Some examples of good practice are the Department of Employment's code of good practice--the first in Europe--launched in 1984 ; the establishment of the Disablement Advisory Service in 1983 ; the offer of financial help to employers to overcome particular difficulties ; and just recently, the introduction of a new symbol for employers--we should not underestimate the importance of symbolic moves--that demonstrates their commitment to good practice. I believe that the appearance of that symbol in advertisements for jobs will help a disabled job seeker, who may be anxious about starting or changing employment, to have confidence that the employer is committed to good practice.

The hon. Member for Coventry, South-East mentioned transport, which is an immensely emotive subject. The whole concept of putting wheelchair people into a guard's van, along with the livestock and the luggage, is offensive to anyone who thinks about it. We are making progress, and there is a special unit within the Department of Transport that is planning and achieving considerable advances. The Department is working on a prototype of a wheelchair-accessible bus. It hopes that there will be a Europewide standard on a low-level access bus for wheelchair users. London has wheelchair-accessible mobility buses in 11 boroughs. As I think the House is

Column 1149

aware, all new taxis must be accessible to wheelchair users. A number of other local authorities are now also saying that they will license new taxis only if they meet the standard of the new wheelchair-accessible taxis in London.

The hon. Gentleman mentioned the problems with British Rail. Mr. Bill Buchanan, who advises on these matters and is himself in a wheelchair, tells me that there is considerable progress in making services and stations more accessible. It is all very well ensuring that trains are wheelchair-accessible, but that is not a great deal of use if the stations are not wheelchair-accessible. All new InterCity trains now have wheelchair places and properly accessible toilets. The real problem with which we must deal is Network SouthEast, whose stock is very old, and it will take some time to replace it. However, we are making steady progress, and I know that the Department of Transport and British Rail are committed to that. Within Government as a whole, and across the Departments of Employment, Environment, Health, and Social Security, the needs of people with disabilities are receiving considerable weight. The Department of Health has wide-ranging and comprehensive plans for the future of community care, designed to give disabled people a greater say in how they live their lives and greater opportunities for choice and independence. Those are themes which underpin the philosophy of community care, and as they begin to take hold after 1993, they will increasingly help disabled people to become or remain full contributors to our society.

The interests of disabled children will be promoted by the implementation of the Children Act 1989, which integrates local authorities' responsibilities for children with disabilities with those for other children who are in need. One of the Act's key features is its emphasis on the need for the child and its parents to participate in decisions affecting the child.

I end on this note. All the progress that we can make in the area of coping with the needs of people with disabilities will be set at nought unless disabled people can find out what is available. Therefore, both through the European Community Handynet agreement--through which we have given some £275,000 to the Disabled Living Foundation to improve information technology--for services and equipment available to disabled people, and through the national disability information project launched by the Department of Health, we are determined to see that, increasingly, people with disabilities are aware of the services, the equipment and other help that are available to them to enable them to improve the quality of their lives and, progressively, to overcome the discrimination which undoubtedly still exists about their employment.

Column 1150

Papworth Hospital

1.30 pm

Sir Anthony Grant (Cambridgeshire, South-West) : I am proud to have the Papworth hospital within my constituency. It is, as is well known, world famous for heart surgery and treatment. It is long past the research and experimental stage of other transplant surgery and it has a proven track record. It has saved many lives and improved the quality of life for many others.

Papworth hospital is notable for the expertise and the exceptionally high morale of staff at all levels--consultants, doctors, nurses and all ancillary staff--which compares favourably with that at many other hospitals. Above all, and most importantly, patients are delighted with the treatment that they receive there. I do not think that I have met a single patient who has not been full of praise of the way in which he has been treated and the way in which he has recovered from a serious operation at Papworth hospital. All, whether consultants, staff or patients, have one thing in common--they do not want to move to the equally famous Addenbrooke's hospital, also in my constituency. There are many reasons for that. I will not go into all the details, but they include staffing, parking of vehicles, accommodation for relatives and amenities, particularly for the long-stay patients, and the patients there are necessarily of a long-stay nature compared with those in a district hospital. All those are easier at Papworth than they are in Cambridge. Addenbrooke's, excellent hospital though it is, with some of the highest skills available in the world, is already much too large and ought not to become larger. That is the view I take, and it is the view that the people who work there and the customers take. It is also, I have to say, a view shared by my colleagues in the House who represent the county of Cambridgeshire.

But there is a serious problem, which is the reason why I have sought this Adjournment debate. Papworth has a waiting list of 900, double what it was nine months ago. I am told that patients are having to wait so long that when they are admitted they are already either urgent or emergency cases. Currently, more than 80 per cent. of the patients are thus classified. The remaining 20 per cent. on the waiting list have to wait an average of 11 months. That is not good enough. I am advised by those who know that the maximum waiting time for patients of that nature should be six months and that patients in that category should not make up more than 40 per cent. of the total.

During the last year, Papworth has received letters about the waiting list on behalf of patients from many Members of Parliament, including no less a person than the Prime Minister himself and, significantly, from my hon. Friend the Minister's boss, the Secretary of State for Health, who has had occasion to write to the hospital on behalf of patients who have been waiting too long.

The hospital is working harder than ever and has increased productivity, and there is a record number of operations using the same number of beds. The number of heart specialists has doubled from five to 10. However, despite all that admirable activity and work, the hospital is failing to match demand, which has doubled in 12 months. With new treatments and wider knowledge, there is no likelihood that that demand will diminish for the foreseeable future.

Column 1151

Bearing that in mind, a new operating theatre will be available in 1992. Indeed, a few months ago I had the privilege of digging the first sod for the work on that splendid new operating theatre. In addition, a second angiography suite will be opened in 1992, thus enabling the workload to double, at a cost of about £3 million to public funds.

However, beds are needed if the new facilities are to be used and the waiting lists eased. The position is rather absurd. The only analogy that I can offer is that it is like a marvellous train standing in a station, with the most expert drivers and crew and a long line of passengers waiting and longing to get on board, but the train is unable to move because there are not enough coaches. It is no solution to tell people that they will have to move to another station : we need extra coaches.

What will the new wing cost ?--a substantial amount, £1.5 million. How does one deal with the problem ? One could ask the regional health authority, but it already has heavy demands upon its money, added to which it will not make up its mind because it says that the future of Papworth is uncertain. The uncertainty has been created by the regional health authority, in my judgment, because people in my constituency, and I myself, wish that Papworth should stay where it is. That uncertainty, which the regional health authority has not resolved, makes it reluctant to produce the money, even if it had it.

However, there is a simpler solution, which will not cost the regional health authority anything in hard cash, because at least four private companies are prepared to invest in the new wing, at no expense to the public, but they must be certain that they will get a return on their investment. If they could be certain that Papworth hospital would stay where it is for 10 years and that the new wing would be used for that time, they would get a return on their investment. However, if the wing is used for only six or seven years, they will not get an adequate return.

Therefore, we are in a Catch-22 position. The simple solution is for a guarantee to be given that Papworth will either stay as it is for at least 10 years or, in the event of the hospital being moved to Addenbrooke's hospital, the health authority will guarantee repayment to those who invest in the new wing. What are the benefits if that solution is adopted? I can think of three important benefits. First and foremost, the patient waiting lists for cardiac services will shorten. Secondly, district health authorities will benefit. Papworth is in an excellent authority in the Hunts district which is run very efficiently by its staff--all of whom, from the chairman downwards, are dedicated people whose work I greatly admire. Such authorities will be able to purchase more services by virtue of the new wing, and, what is more, the income from private patients will enable them to do so more cheaply. Thirdly--this should commend itself not only to the Department of Health but to the Treasury--the taxpayer would see the £3 million already spent on the new operating theatre and angiography suite working to optimum capacity rather than its present 50 per cent.

All the arguments point to the solution that I have suggested. I think that it is in the interests of patients, doctors, staff and everyone else who is concerned with this remarkable hospital. I do not expect the Minister to make

Column 1152

a decision this afternoon ; Ministers cannot be expected to construct policy on the hoof. I merely wish to alert the Government and the public to an important health problem, and--perhaps equally important--to point out that there is a relatively simple solution, if only those in charge will grasp the facts, make a firm decision and remove all uncertainty.

1.41 pm

The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell) : I hope that my hon. Friend the Member for Cambridgeshire,South-West (Sir A. Grant) will forgive me if I begin by saying that I was a little concerned to discover yesterday that I would be answering a debate in which he would be putting the questions. Having witnessed the effectiveness of his questioning of the Opposition yesterday, I did not want to find myself in the same position. My hon. Friend has not let his constituents down. He has presented a very effective espousal of the case of those concerned about future investment in Papworth hospital, and those who support his solution. As well as highlighting the appealing simplicity of that solution, he has left no stone unturned in his cogent presentation of the arguments.

If my hon. Friend had been present earlier, he would know that only an hour ago I was describing the dramatic advances that we have achieved in the national health service : the expansion of the transplant programme, and the enormous health benefits that the improvements in modern medicine have unleashed. I was replying to a speech made by my hon. Friend the Member for Newbury (Sir M. McNair-Wilson), who has benefited from a different kind of transplant from those with which Papworth is primarily concerned--but that transplant is another manifestation of the importance of the programme to which Papworth makes such a distinguished contribution. As I told my hon. Friend the Member for Newbury, before I became a Health Minister last May my exposure to transplanting in general, and heart transplants in particular, had been that of a layman. I vaguely remembered the flickering black and white television pictures from the Groote Schuur hospital in Capetown in the late 1960s, when Dr. Christiaan Barnard first performed a heart transplant operation. I thought of heart transplantation as a major technical advance that was still very much on the leading edge of technology. I did not think of heart transplants in the context in which they now take place. They are now routine operations in the national health service. Thousands of people who are walking the streets of this country have benefited from the surgery that has been developed to such a high pitch at Papworth hospital. It is one of the major benefits of modern medicine, and it has been provided to the people of this country through the agency of the national health service. At the beginning of his speech my hon. Friend was keen to put on record the very considerable achievements of his constituents within Papworth hospital and to draw attention to the fact that he has the privilege of representing two hospitals, both of which have international reputations, earned from very successful clinical records and the exploitation of medical advances. Since 1979, the number of heart bypass operations

Column 1153

performed at Papworth hospital has increased by nearly 300 per cent. That is a measure of the advance that has been made possible by modern medicine at Papworth hospital.

The hospital is to receive £250,000 from the East Anglian regional health authority's waiting lists fund to do 70 more bypass operations next year than were previously planned. Apart, therefore, from Papworth hospital having a distinguished track record, it has also received support from the East Anglian regional health authority to deal with the waiting list problem that my hon. Friend identified as one of the managerial issues that the hospital has to face. Furthermore, as my hon. Friend briefly mentioned, the hospital has also benefited from a significant capital expenditure programme that is currently under way. It is a £2.7 million scheme for a third operating theatre at the hospital, which is due to open in April 1992. No one could argue that Papworth is not a major success story within the national health service, or that its success story has not been reinforced and supported by national health service management in general and the East Anglian regional health authority in particular. Due to its success and reputation, both nationally and internationally, Papworth hospital has received the letters to which my hon. Friend referred from my right hon. Friend the Secretary of State for Health and my right hon. Friend the Prime Minister, both of whom are concerned about constituents who are on the Papworth hospital waiting list because they wish to benefit from the surgery that that hospital can provide.

I am grateful to my hon. Friend for drawing my attention to the fact that, apart from having to guard myself against the effective questioning of which he has so recently shown himself to be a master, I must ensure that whatever I say will read well in the constituency press both of my immediate boss and of my ultimate boss. In responding, therefore, to my hon. Friend's speech, I have to choose my words extremely carefully.

My hon. Friend argued vigorously that the current waiting list problem at Papworth hospital could most effectively be addressed and reduced by accepting the offer of private capital to provide an additional ward, thus increasing Papworth hospital's capacity. To adopt the metaphor used by my hon. Friend this afternoon and in a recent letter to my right hon. Friend the Secretary of State for Health, it would add an extra coach to the train.

Whether the extra ward is funded by the regional health authority or by private capital, the issue clearly needs to be examined to find out whether the additional ward would provide the relatively low marginal cost benefit to patients on the waiting list. I shall certainly ensure that the proposal is carefully examined. If it is true that for the relatively modest expenditure involved in providing an additional ward in the hospital the rest of the resources, not least the £2.7 million new third operating theatre coming on stream in April 1992, could be used more effectively to produce a lower average cost per operation and to treat more patients within the hospital as a result of having an additional ward, that is clearly a powerful argument which those responsible for the routine front- line management of the health service in Cambridgeshire will have to address.

I pause for a second to reflect on the role that private capital could play in the provision of that additional ward space. It is quite explicitly one of the benefits that should flow from the reformed structure of the NHS that comes

Column 1154

into effect next Monday and the introduction of the concept of purchaser-provider that we should be more open minded about the employment of privately funded capital stock for the treatment of health service patients.

The burden of my hon. Friend's argument was not only that a relatively small additional investment would yield large benefits for patients if placed at the Papworth hospital, but that the health service need not expect to finance that investment because private capital is available. It makes my hon. Friend's approach that much more attractive, and is a clear and timely illustration of the benefits of an effective and flexibly managed health service from the employment of the principles of purchaser- provider that come into effect next Monday.

Those reforms concentrate the mind on the core activity of the NHS. We must remember that the NHS should not be principally about running hospitals. It exists to provide equal access to health care for patients. It is an enabling mechanism to ensure that access to health care is determined on the basis of clinical need and not ability to pay. If that can best be done by using public funds through the agency of a purchaser district health authority to purchase health care from a privately funded provider, that is an entirely benign result which I am sure every patient on a Papworth waiting list would applaud with vigour.

I pause to reflect upon the significance of my hon. Friend's suggestion and to stress that not only are we open-minded towards it but we embrace the concept of a privately funded facility if the benefit is to enhance the quality of patient care to health service patients waiting for treatment at Papworth hospital. I find that aspect of his argument extremely attractive.

My hon. Friend went on to express concern about what he felt was the potential uncertainty about the future of Papworth hospital. I should like to address that concern directly ; it is clearly critical to the viability of the privately funded ward for which my hon. Friend was keen to argue this afternoon. Clearly he is right in believing that we shall not be able to recruit private capital to a hospital when its future is limited to a relatively few years. I wish to explain in more detail the current position on the future of the hospital. Papworth hospital was built in 1928 as a tuberculosis sanitorium and chest hospital. The surroundings of the hospital are attractive, but the existing capital stock of the hospital is relatively old and fragmented and the running costs for the buildings are relatively high.

The management of the health service believes that for the hospital to remain viable for the practice of high-tech open heart surgery and transplantation a significant rebuilding, expansion and investment programme will be needed to ensure that the buildings in which the high quality clinical care is offered are able to provide the security and conditions in which high-tech medicine can be properly and best offered. Such a programme would also ensure that the buildings were not wasteful in terms of the revenue expenditure which is necessary to keep them operating. It would be crazy to have a high-tech hospital where money that should be spent on high-tech medicine was spent on propping up extremely low-tech buildings. After some initial appraisal work, the regional health authority invited Huntingdon district health authority in April last year to consult locally on options for the future of Papworth services. Having done so, it asked it to submit its recommendations to the regional health authority for a

Next Section

Home Page