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Mr. John Marshall: Does my hon. Friend agree that, if a relatively small proportion of sufferers will develop cirrhosis of the liver and die prematurely, the cost of helping them will be correspondingly small?
Mr. Horam: Yes. That is a valuable point, which my hon. Friend makes for the first time. The Haemophilia Society--understandably, as it has not completed its study--has not made full and costed proposals. We have never received such a suggestion to study, and I would be interested to hear details of the relatively modest and restricted proposal which my hon. Friend has made during the debate. We understand that the final report of Haemophilia Society will be published in 1996.
Infection with the virus will not necessarily lead to hepatitis, but if it should, it can be treated with the drug alpha interferon. Alpha interferon is not a universal panacea for hepatitis patients. It can have unpleasant side effects, and it is still not clear whether a permanent cure is possible. However, it has been shown to have real benefits for a proportion of sufferers. We have said all along that those people who could benefit from it should be able to receive alpha interferon.
My hon. Friend alleged that patients whose consultants wished to prescribe alpha interferon had been refused treatment due to a lack of resources. My predecessor said during the Adjournment debate on 11 July that he would investigate the issue of medication supplies. Officials are continuing to make inquiries and have done so since that date. We are very serious about this. If my hon. Friend or any other hon. Member has any examples of cases in which alpha interferon has not been made available because of the cost, I will be delighted to hear from them. I shall certainly ask my officials to follow that up, as it would be very serious if that were happening. So far, there is little evidence of significant difficulties, and we have not been able to track down any particular examples. Hon. Members must let the Government know if any such examples come to their attention.
My Department is supporting an initiative by the Haemophilia Society to undertake a study of the best way to support its members who are infected with hepatitis C, and has made available substantial funds in 1995-1996 with a commitment to further funding in 1996-1997 and
1997-1998 for this purpose. My Department is also looking at what appropriate research may be undertaken to increase knowledge of hepatitis C, its natural history and its optimal treatment.
One example of that is that the standing group on health technology has identified the evaluation of the use of alpha interferon in the treatment of hepatitis C as a top priority in the NHS. Such developments are important to increase the evidence base upon which decisions can be made on the best treatment for each individual patient.
It is the Government's view that the most effective use of resources is to seek to improve the understanding, management and treatment of the condition. This is the best way to minimise the impact of the disease--which the hon. Gentleman described so graphically-- on individual patients and their families. The Haemophilia Society's recent report gives examples of that.
All that I have heard in today's debate suggests that I should read the Haemophilia Society's report extremely closely, and I promise the House that I shall look at the matter afresh in the light of what is said in the report. We have also heard from my hon. Friend a sensible suggestion for a more modest and restricted compensation scheme than has been hitherto mentioned. For those reasons, I shall leave the matter at this stage, although I give my full sympathy to those who have the disease.
Mr. Michael Spicer (South Worcestershire):
I am grateful for the opportunity to raise the issue of the Government's intended decision, announced yesterday, to move the Army Technical Services Agency from Malvern to a collocated site at Chertsey. I am relieved that my hon. Friend the Minister of State for the Armed Forces, rather than the management of ATSA, has the final word on the matter. That was not immediately apparent from a letter that I received dated 5 December from the parliamentary branch of the Ministry of Defence, which said:
I should be grateful to have the Minister's assurance that the decision is ultimately for him and my right hon. Friend the Secretary of State to take and not one for the management of an agency.
I am not clear about the precise status of the decision to move the agency. In his letter to me which I received today, my hon. Friend the Minister says two things about the decision. First, he says:
In a subsequent paragraph, he says:
I hope that the position is that expressed in the second quotation and not that implied in the first, and that my hon. Friend is in a position to change his mind on the matter if he is persuaded to do so.
The Minister's decision seems to spring from advice which is a reversal of advice that his predecessor received just over two years ago. I have here a document which, inevitably, as it is from the Ministry of Defence, is identified by numbers. It is the MAN S(ORG) study No. 761 dated May 1993. It is clear as to the advice that the Minister of the day had received. Paragraph 5.30c on page 73 says:
that is, comparing Chertsey and Hullavington--
which has now transferred to Bristol--
The point is that the advice is all based on criteria which are clearly laid out, and rather more clearly so than the advice report, to which I shall refer in a moment. The
criteria are laid out in terms of costs, suitability of site, availability, any political considerations, environmental impact, recruitment potential and accessibility to senior management, customers and others.
Under the cost heading, the report clearly says that the investment appraisals
In relation to Malvern, the report says:
that is an important point--
There are important issues on the question of recruitment. The report says:
The obvious question is, what has changed in the past two years completely to reverse the present advice on the decision from the advice that the Minister of the day received just a few years ago? That question is particularly relevant when one considers the nature of the new advice which has been given to the Minister.
I have a document with the reference QMG/205, dated 15 November 1995, which is headed "Loose Minute"-- I am not sure what that means.
The Minister of State for the Armed Forces (Mr. Nicholas Soames):
It is an MOD speciality.
Mr. Spicer:
I have not had time to check, but I think that QMG/205 is the same document as the one which the Minister issued last night as the basis for the advice that he gave. Some strange things are mentioned in the advice, to which I believe the Minister should respond.
In relation to cost, for example, which is clearly an important issue, the general tone and content of the paper--I am not trying to cast aspersions--is much less substantive and analytical and much more bland and assertive than the paper to which I have previously referred. This paper simply states that the cost of refurbishing Malvern, which it accepts is an option, would be £317 million or £319 million if everything were to be rebuilt. The paper goes on to say that the cost of totally rebuilding a site at Chertsey would be £312 million, which is some £5 million less than refurbishing at Malvern.
At this stage, one can only work on a gut feeling. The argument that the cost of refurbishing Malvern, which is in an area where costs are generally much lower than in the south-east, is £5 million more than the cost of completely rebuilding Chertsey needs further justification.
There are further matters in the report, and I shall write to the Minister about them, because there is not enough time on this occasion to get through them all. I have 16 fairly substantive questions that I want to put to him about the report. I will put two to him now. The first is on the rather crucial issue of where ATSA's client base will be should it move, or even if it does not move. The report which is the basis for the Minister's decision says that the agency has
It goes on to imply that, because Andover is much closer to Chertsey, having those customers nearby would be another reason for collocating at Chertsey.
The work done at Andover is in fact related to the quartermaster general's operations. But half of ATSA's work--this was anticipated in the earlier report--is now undertaken for the MOD procurement executive at Bristol, which is considerably closer to Malvern than is Chertsey. That, too, should be given rather more consideration than it is given in the report.
According to the report, there is scope for hard roads for tank movements at Chertsey. The report does not mention it, but Malvern too has a hard road that is used for tanks: that too could be analysed. This report--which is slim in comparison with the earlier one--contains discrepancies, and refers to matters that need more careful examination.
Although I agree that the final decision should be made in the best interests of national defence--in other words, in the most cost-effective way--the fact remains that the original advice was accurate. Malvern has the experience, the buildings and the relative cost structures that are likely to make it more cost-effective for purposes of collocation than Chertsey, which has been sucked into the cost structures of London and the south-east.
I ask the Minister not to rely exclusively on the second report and on the advice of the internal accountants who prepared it, and who might be thought to be fitting the figures to suit the decisions required of them by senior management in ATSA and elsewhere. I ask him to secure the independent advice of an independent accountant or auditor and have the figures checked--especially those relating to the investment appraisal--before making his decision. At present, the figures do not seem to add up.
1.30 pm
"The Defence Secretary has asked me to thank you for your letter of 29 November about the collocation of ATSA. The matters raised are, however, the responsibility of the Chief Executive, Army Technical Support Agency and I have therefore transferred the correspondence to that Department and asked them to reply to you direct."
"I have decided that, subject to the outcome of a period of consultation, the ATSA should collocate at Chertsey."
"I can assure you that I will take full account of all representations before making a final decision."
"Malvern is the cheapest option,"--
"with a range of buildings which would seem suited to the type of organization we are proposing. It is Army owned and could be adopted with the least difficulty of the three sites to the requirements of the TSA, although Married Quarters and a Mess will be required. Of the three sites, it offers the best prospect of retaining quality non-mobile staff and it has a nucleus of electronics trained personnel (who may be particularly difficult to replace elsewhere). Also it would offer some possibilities for long distance career development. Finally, although it is some distance from Andover, it is within easy reach of Bristol and Donnington, (the recommended site for the PPD)"--
"and has good road transport links.
Given the savings that would result, the apparently favourable condition and structure of the accommodation, reasonable employment prospects and geographical location, we recommend that the TSA should be located at Malvern".
"show that locating the TSA at Malvern would result in the greatest savings (some £18M over the LTC period)".
"The effect of the increase in staffing levels would have less impact than at Chertsey as the site is large, considerable refurbishment has taken place already"--
"and more existing buildings are available for use."
"Chertsey is not a promising recruitment area given that it is in the London travel to work area, housing is expensive, unemployment is low and there is competition from the many private companies in the area who generally pay more than MOD."
"its Owner and main customers at Andover".
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