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Mr. Duncan: I accept the Secretary of State's apology for the delay, and I am grateful for his statement, but on this issue the devil is in the detail and there is still much more to learn.
Will the right hon. Gentleman now widen the scope of the national BSE-CJD inquiry to cover the handling of events since 1997? In particular, why did the Government choose to consider beef on the bone a much greater risk than that posed by surgical instruments, bearing in mind the fact that SEAC and the Advisory Committee on Dangerous Pathogens assessed the risks respectively as "minimal" and "very small"?
Is it not the case that, in April, the right hon. Gentleman promised the House, as he sacked the head of the national blood service, that all British-derived blood products would be banned by September this year? Can he confirm that the Department of Health now privately concedes, as he appears now to have confirmed, that many of the potential sources of nvCJD transmission will continue to be used on NHS patients until next summer?
The right hon. Gentleman, in his response to my written question on autoclave sterilisation, recognised the expert guidance that routine sterilisation procedures are insufficient to destroy the infective agent of nvCJD. What action is his Department taking to modify autoclave practices to ensure the proper destruction of the prion protein in the light of this finding? His earlier written answer was brilliantly obtuse.
If the Department is aware that four of those who have so far died from nvCJD were also blood donors, what efforts has it made to trace and destroy this potentially infectious blood and all the associated products? Such action has already been taken in the United States; why not here as well?
We now also have two clusters of nvCJD infection, one near Ashford and one near Leicester. What assessment has the Department made of those clusters; and what efforts has it made to identify whether there is a common source for the infection?
Will the right hon. Gentleman today issue a list of all products that are at risk of contamination with nvCJD, and will he immediately ensure that alternatives to British-derived anti-D and gamma globulin are made available as soon as possible? Patients need to know the risks and they need to exercise an informed choice. We are dealing here with people, not cattle.
What happens if the risk is not theoretical and is proven? That is the very risk which has now been identified. In the meantime, thousands of women and others are being put at risk.
The right hon. Gentleman must not tell the House that, for a price, he can acquire anti-D. He must acquire it--will he now do so? And if there is no shortage of gamma globulin, why has he not already acquired it?
My recent written questions to the Department and work done by the Daily Express have, I detect, flushed out some reluctance to make a clear statement to the House, and has shown a Department that is near paralysed in deciding what to do.
Will the right hon. Gentleman confirm that funds will be specially available and that no NHS trust will be financially burdened as a result of tackling the problem?
There are clearly problems of which the general public has, until now, been unaware, and which have caused profound consternation within the Department. As the right hon. Gentleman knows, I have been asking parliamentary questions now for more than a fortnight, and it is only the Opposition's questions which have induced him to make this long overdue statement.
I have already written to the right hon. Gentleman and today the issue has been raised in the House. We will co-operate with him fully, but today we want answers to these questions. Will he give a personal undertaking to keep Britain fully informed at all stages?
Mr. Dobson:
The hon. Gentleman started off on the right lines when he said that we have much more to learn. I made that clear in my statement. We do not know how many people are suffering from nvCJD and it is unlikely that we will know for several years, despite the efforts of scientists who were put on to the job by my predecessors. That is no criticism of either the scientists or my predecessors. It is a difficult task. Furthermore, we do not know how new variant CJD arises or is transmitted, so it is extremely difficult to deal with.
However, it is simply not true that any truthful information that has appeared recently in the newspapers is new. All the information that I have given today, and all the information that has appeared in the newspapers, has come from information that I have deliberately placed on the public record since November last year when this issue first arose, because I am determined to ensure that everyone knows as much as the Department of Health about new variant CJD and how we may or may not be able to deal with it.
Thus, no new information is available. Information has been made available by me or my Department at every stage in the proceedings. On receiving advice, we have acted on it and, with the help of my right hon. Friend the Chancellor of the Exchequer, have found the money to do everything that we have been advised to do. There is no question of not finding the money or of anything being held back because of lack of funds; but there are practical problems in getting from abroad plasma that can be used in blood products. I freely admit that that has proved to be more difficult than I was advised it would be when I told the House that I hoped that everything would be done by September this year. I regret that everything was not done by September, but I accept the practical problems and delays that have arisen.
On the sterilisation of equipment, as I said in my statement, which the hon. Member for Rutland and Melton (Mr. Duncan) appeared to ignore, I have already asked my officials to get on as best they can with looking at ways of preventing or reducing the likely spread of new variant CJD through medical instruments, in case the experts advise me to do that. That includes looking not just at autoclaves but at other methods of sterilisation and, in some cases, possibly changing the design and structure of instruments used during operations. Some of them, however, are immensely complex and would be difficult to make any safer or less liable to carry infections.
As for the 31 people who have died from new variant CJD, the latest figure that I have is that four of them had donated blood. That blood has been tracked down and, where it was not used, it has been destroyed. We are therefore not remiss compared with other countries: we got on with that.
SEAC is looking into the Ashford and Leicestershire clusters to see whether there appears to be a pattern or an explanation for them. To date, it has been unable to come up with an explanation. One of the problems with new variant CJD is that explanations are thin on the ground because no one has yet formulated them.
In trying to ensure that the public know the risks, I have made every bit of information that has been available to me available to them. The problem is that I cannot assess the risks, and nor can the public, because we do not know the incidence of new variant CJD. We do not know whether the risk is high or low. No one can make any sort of formulation. When I arrived in the Department I asked whether there were any estimates and was told that computer modelling had been done by scientists. The figures ranged from 30 to several hundred thousand cases. My view was that those were not computer models but guesses. They may have been sophisticated guesses, but that is what we are reduced to.
We have no way of identifying the risks. I emphasise again that people who have suffered serious injury and need major surgery, or are in a condition that requires the replacement of their blood or the use of a blood product, face immediate death or injury if they do not get treatment using blood products or a blood transfusion.
We are doing our best to make sure that blood products and blood used in transfusions are as safe as possible. The experts who advise me are trying to balance out the unquantifiable risk of transmitting new variant CJD against the certainty that people who need a massive blood transfusion will die if they do not get it. We are cleaning up blood products and the blood supply as quickly as possible, and the only restraint is the practicalities--it is nothing to do with finance, and it has been nothing to do with Government delays.
Jacqui Smith (Redditch):
I declare both a personal and a constituency interest: first, a family in my constituency tragically lost one of its members to new variant CJD; secondly, like many women in my constituency, I have recently had an anti-D injection.
Although I recognise the hard work that has undoubtedly been carried out in the Department of Health by my right hon. and hon. Friends, does my right hon. Friend accept that uncertainty surrounding the safety of anti-D injections will result in some women refusing them, thereby putting future pregnancies at risk? Can he assure me that swift action will be taken to ensure the safety of the anti-D injection, to protect women and babies?
Mr. Dobson:
I can give my hon. Friend that assurance--the swiftest possible action is being taken. Women who are faced with the choice should seek the advice of the clinicians who are dealing with them and, if they feel so inclined, take that advice. I cannot give general advice from the Dispatch Box, because it will be dependent in part on the needs and circumstances of each woman, and it is up to her and her clinician to decide what is best. I wish that they did not face that dilemma, but they do, and we are trying to deal with it as fast as humanly possible.
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