House of Commons Hansard Debates for 29 Jun 1992

Creutzfeldt-Jakob Disease

Mr. Hinchliffe : To ask the Secretary of State for Health (1) when her Department's survey into Creutzfeldt-Jakob disease will be published ; and if this will be publicly available ;

(2) how many cases of Creutzfeldt-Jakob disease (a) deaths and (b) patients were reported in the last year for which figures are available ;

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(3) how many persons have died from Creutzfeldt-Jakob disease in the Yorkshire and Humberside area in the last two years for which records are available.

Mr. Sackville : I refer the hon. Member to the reply that my hon. Friend the Parliamentary Under-Secretary of State gave to my hon. Friend the Member for Torridge and West Devon (Miss Nicholson) on 23 June at columns 155-56. The report from Dr. Will contains the relevant information requested on incidence in the Yorkshire and Humberside area.

Mr. Hinchliffe : To ask the Secretary of State for Health (1) how the information booklet, dealing with the cause and effects of Creutzfeldt- Jakob disease, has been distributed ;

(2) how many booklets have been produced to inform relatives of patients suffering from Creutzfeldt-Jakob disease about the cause and nature of the condition.

Mr. Sackville : The information booklet "Creutzfeldt-Jakob Disease-- A Guide" produced by the national Creutzfeldt-Jakob disease surveillance unit, based in Edinburgh, which is funded by the Department of Health and the Scottish Office Home and Health Department is distributed on a case-by- case basis to sufferers, their families, friends and carers. It has also been supplied to individuals who have written to the unit for more information.

Mr. Hinchliffe : To ask the Secretary of State for Health what processes are available to identify Creutzfeldt-Jakob disease in living individuals.

Mr. Sackville : Diagnosis of Creutzfeldt-Jakob disease in living individuals is by expert clinical assessment. There are no satisfactory tests that identify the disease conclusively, although electro- encephelographic testing can assist diagnosis.

Histopathological testing of brain tissue can be used, very rarely, to confirm the diagnosis where there is a major doubt over the diagnosis.

Mr. Hinchliffe : To ask the Secretary of State for Health what information she has available to identify the cause of

Creutzfeldt-Jakob disease.

Mr. Sackville : The cause of Creutzfeldt-Jakob disease (CJD) has not yet been identified. The agent of the disease appears to be small, atypical --compared to conventional microbes--and transmissible. There also seems to be a genetic influence on the development of the disease. The precise nature of the interaction between the host and the agent remains unclear, but there is considerable research under way both in the United Kingdom and abroad to elucidate the factors producing the disease.

Most cases are sporadic and the factors which cause illness in these cases are not fully understood. However, in a few cases certain routes of transmisssion have been identified involving the use of human dura, corneal grafts or human growth hormone, and the exposure of the contaminated instruments during neurosurgical procedures. The Department has taken action to ensure that any potentially infected human tissue is no longer used in medical treatment.

Mr. Hinchliffe : To ask the Secretary of State for Health (1) what action she will take to ensure that families with relatives suffering from Creutzfeldt-Jakob disease are provided with advice on the cause and effects of the disease ;

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(2) what action has been taken to create a supportive agency in order to help patients' relatives where Creutzfeldt- Jakob disease is suspected to be the cause of illness.

Mr. Sackville : Clinicians are responsible for providing information to patients under their care and to their families. In addition, when the national Creutzfeldt-Jakob disease surveillance unit in Edinburgh is notified, the patient and family are visited and information is provided about the disease. The unit also provides advice on the cause and effect of the disease to family members, friends and carers at other times, and is available to provide more information on Creutzfeldt-Jakob disease to other people who have individual concerns.

Mr. Hinchliffe : To ask the Secretary of State for Health when procedures in neuro-surgery operations were altered in order to take precautions against contamination from agents causing

Creutzfeldt-Jakob disease.

Mr. Sackville : Advice was first issued by the Advisory Group on the Management of Patients with Creutzfeldt-Jakob Disease to NHS hospitals in 1981. The guidance recommended that special precautions, including disposal of instruments, should be taken in surgical procedures involving the brain, spinal cord or eye. This advice remains current.

Mr. Hinchliffe : To ask the Secretary of State for Health (1) what information she has available to identify the number of Creutzfeldt-Jakob disease patients in (a) national health service hospitals, (b) private hospitals, (c) private nursing homes and (d) family homes ;

(2) what provision is available within the national health service in order to treat Creutzfeldt-Jakob disease patients who suffer from the disease over a period of years.

Mr. Sackville : The national health service submits diagnostic information which would provide a broad estimate of the number of cases of Creutzfeldt-Jakob disease (CJD) which had been treated annually as in- patients in NHS hospitals. Information is not held centrally about the number of CJD patients in NHS hospitals, private hospitals, private nursing homes and family homes. Depending on their medical condition and personal circumstances, individual patients may be looked after in more than one location during the course of their illness.

Such patients have access to the full range of diagnostic and care facilities provided by the NHS.

Mr. Hinchliffe : To ask the Secretary of State for Health how many persons have contracted Creutzfeldt-Jakob disease who have not been treated with human growth hormone or involved in any neuro-surgical operations.

Mr. Sackville : It is not possible to determine causal or contributory factors in the majority of the 456 cases of Creutzfeldt-Jakob disease (CJD) identified since 1970. Of these, four are known to have had previous neurosurgery, which would not appear to be related to the development of their CJD, and a further 10 definite and one suspected case are known where transmission has occurred from other treatment.

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Population Statistics

Mr. Barry Jones : To ask the Secretary of State for Health if she will list for each travel-to-work area and for each district the estimated population as a percentage of the enumerated population according to the 1981 census.

Mr. Sackville : The Registrar-General does not make annual population estimates for travel-to-work areas. A comparison between the resident population enumerated in the 1981 census and the mid-year population estimates for 1981 for each local authority district is available in the Library. The population estimates include an allowance for under-enumeration. They also include students at their term-time address and armed forces where they were stationed, rather than where they were living on census day.

Mr. Barry Jones : To ask the Secretary of State for Health if she will list the travel-to-work areas and districts in rank order according to the 1991 census population as a percentage of the 1981 census population.

Mr. Sackville : Census figures from the 1991 census are not yet available for the resident populations of all local authority districts, nor have travel-to-work areas based on the 1991 census yet been calculated. The 1991 census preliminary report for England and Wales, a copy of which is in the Library, contains provisional figures for the population present on census day in 1981 and 1991 in each local authority district. Table 5 of the report ranks counties in order of percentage change.

Human Growth Hormone

Mr. Hinchliffe : To ask the Secretary of State for Health if persons who have received human growth hormone treatment are excluded from organ donor programmes.

Mr. Sackville : The Department has advised clinicians, when considering organ transplantation, to check whether or not the donor had been treated with human growth hormone at any time prior to May 1985 when that treatment was withdrawn.

Mr. Hinchliffe : To ask the Secretary of State for Health what steps have been taken to prevent recipients of human growth hormone treatments becoming blood donors.

Mr. Sackville : Recipients of pituitary derived human growth hormone are included in a list of specific groups who must not give blood. This list is shown to all potential blood donors. Furthermore, when human growth hormone recipients are counselled as part of the national counselling programme now under way they are advised not to give blood.

Spongiform Encephalopathies

Mr. Hinchliffe : To ask the Secretary of State for Health (1) when she received a copy of the World Health Organisation report dealing with spongiform encephalopathies in humans and animals ; and what response she has given ;

(2) if she will make a statement on the reasons for restricting the distribution of the World Health Organisation consultation paper dealing with spongiform encephalopathies in humans and animals ; and if she will now publish it :

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(3) if she will list those who have received a copy of the World Health Organisation consultation paper dealing with spongiform encephalopathies in humans and animals ;

(4) if she will place in the Library a copy of the World Health Organisation consultation paper dealing with spongiform encephalopathies in humans and animals.

Mr. Sackville : I understand the report was first issued by the World Health Organisation in November 1991 on a limited basis to member Governments. However, a memorandum based on the report has not been published in the Bulletin of the World Health Organisation, volume 70, No. 2 at pages 183-90, and copies have been placed in the Library. We have also asked the Spongiform Encephalopathy Advisory Committee to consider the report and advise on its implications.

Opencast Mining

Mr. Gunnell : To ask the Secretary of State for Health what studies have been undertaken into the link between respiratory problems in individuals and the proximity of opencast mining sites ; and if she will establish such an inquiry.

Mr. Sackville : A detailed examination of evidence relating to the possible effects of opencast mining upon the health of local residents was undertaken in 1988 and 1989 in connection with an application to establish a mine in south Wales. It concluded that there was insufficient evidence of harm arising from opencast mining operations to justify the refusal of the application. The findings were accepted by my right hon. Friend the Secretary of State for Wales and further investigation was not considered necessary.

Juvenile Smoking

Mr. Eastham : To ask the Secretary of State for Health if, as part of her departmental campaign to discourage juvenile smoking, she will consider the curtailment of tobacco advertising in amusement arcades where children participate in video games simulating motor racing.

Dr. Mawhinney : The voluntary agreement between the Government and the tobacco industry on tobacco advertising and promotion does not allow advertisements which appeal to children more than to adults. If the hon. Member has examples of tobacco advertisements which he considers breach this agreement, he should bring them to the attention of the Committee for Monitoring Agreements on Tobacco Advertising and Sponsorship.

Medical Training

Ms. Lynne : To ask the Secretary of State for Health which of the EC directives governing the system of specialist medical training have not been implemented in the United Kingdom over the last 15 years ; and if she will make a statement.

Dr. Mawhinney : Directives 75/362/EEC and 75/363/EEC were implemented into United Kingdom law by the Medical Qualifications (EEC Recognition) Order 1977. However, doubt has been cast on whether the present United Kingdom system relating to specialist training fully reflects these directives. The Chief Medical Officer is holding a series of meetings with the medical profession to address these issues.

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Directives 89/594/EEC and 90/658/EEC, which made minor amendments to 75/362/EEC, have not been implemented. Steps are being taken to introduce them into United Kingdom law.

Ms Lynne : To ask the Secretary of State for Health if she will make it her policy to hold in public the discussions between her Department, the medical royal colleges, the General Medical Council and the British Medical Association concerning the sytem of specialist medical training in the United Kingdom ; and if she will make it her policy to ensure that a wide- ranging debate, including patients' representatives, will be held on the proposals that emerge.

Dr. Mawhinney : No. Discussions will continue to be held in private. However, consultation will take place on any proposals that emerge.

NHS Superannuation Scheme

Mr. Milburn : To ask the Secretary of State for Health when the framework document of the "next steps" agency for the national health service superannuation scheme will be published for England and Wales.

Mr. Sackville : In a reply to my hon. Friend the Member for Blackpool, North (Mr. Elletson) on 14 May at column 167, I announced the Department of Health's NHS superannuation branch which administers the scheme for England and Wales, is to be launched as a "next steps"

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agency in the second half of 1992. The framework document under which the agency will operate will be published before the launch date.

Market Testing

Mr. Terry Davis : To ask the Secretary of State for Health who has been appointed as a consultant to her Department for market testing.

Mr. Sackville : In line with the proposals in the "Competing for Quality" White Paper, KPMG Management Consulting assisted the Department in identifying activities that might be suitable for market testing. Symonds Facilities Management plc was appointed to advise on a market-testing strategy for office services for the Department's new buildings at Quarry house, Leeds, and 80 London road, London.