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10.45 am

The Minister of State, Department of Social Security (Mr. John Denham): I congratulate my hon. Friend the Member for Eccles (Mr. Stewart) on securing this debate and on raising an issue of concern to the House. It is a complex and emotive subject, and my hon. Friend spoke clearly and with great sensitivity.

I know that the matter is of considerable interest and that an all-party group on vaccine damage has recently been formed. I acknowledge the work of my hon. and learned Friend the Member for Dudley, North (Mr. Cranston)--now the Solicitor-General--who has been active on the issue since he entered the House. Although he is now a Minister, and so unable to speak in the debate, he found time to join me on the Front Bench this morning.

There were many good contributions. I hope that I will address most of the points raised; hon. Members will forgive me if I do not ascribe them to each Member who spoke. The hon. Member for Newbury (Mr. Rendel) made several important points. My hon. Friend the Member for Birmingham, Northfield (Mr. Burden) has been active in the campaign for a long time. My hon. Friend the Member for Bristol, East (Ms Corston) spoke movingly about a constituency case that she is pursuing with one of my colleagues. The hon. Member for Isle of Wight (Dr. Brand) spoke about the importance of the immunisation programme, as did several other hon. Members. The hon. Member for Brentwood and Ongar (Mr. Pickles) posed several questions.

Before I go into how the scheme operates, may I say that I recognise the difficulties that many children, and their families, must tackle daily? Like other hon. Members who have spoken, I have constituents who must deal with all the pressure on them and their families that comes from being the parent of a severely disabled child. I, too, recognise that where it is believed that a disability arises from vaccine damage, whether or not it can always be established as fact, that belief can add greatly to the sense of distress, anger and even guilt that parents may feel. In common with parents of other disabled children, many such parents grow increasingly concerned about how their children will be provided for when they become adults: they begin to wonder what will happen when they can no longer offer care in the way that they have for so long.

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The national immunisation programme is, as was acknowledged throughout the debate, an important programme and the responsibility of the Department of Health. The diseases covered by it are diphtheria, tetanus, pertussis, poliomyelitis, measles, rubella, tuberculosis, mumps and haemophilus influenza type B. I should restate, although it was noted by hon. Members on both sides of the House, that the programme was introduced for a good reason.

The diseases covered by the childhood immunisation programme can lead to serious illness and be life threatening. How well vaccines work is shown by the incidence of diseases before and after the introduction of immunisation. Between 1951 and 1955, there were more than 620,000 cases of whooping cough, to which the hon. Member for Brentwood and Ongar alluded, in England and Wales, resulting in more than 1,000 deaths. Between 1991 and 1995, when vaccine coverage reached 94 per cent., there were only five deaths, and the incidence of the disease fell to much lower levels, with only 1,873 cases in 1995.

The success of mumps, measles and rubella, or MMR, vaccine has resulted in notifications of measles reaching their lowest ever levels. Measles vaccine was introduced in 1968, and by the late 1980s, notifications had fallen from a maximum of 800,000 per annum to a maximum of 100,000 per annum. MMR was introduced in 1988, and cases fell to between 10,000 and 20,000 per annum between 1990 and 1994. Slightly more than 4,000 cases were notified in 1997, and the true figure is thought to be much lower, because many reported cases were misdiagnoses. No child in England and Wales has died from acute measles-related illness since 1992. All those figures establish that the immunisation programme provides benefits not only to society as a whole but to the individual and his or her family.

After the separation of the Health and Social Security Departments in 1988, the administration of the payments scheme under the Vaccine Damage Payments Act 1979 was placed in the custody of the Department of Social Security . A payment under the scheme is not in any way a bar to any subsequent legal proceedings. It does not prejudice the rights of a disabled person and his or her family to seek compensation. Indeed, cases have been taken to court, although it is true that, to date, there has been no successful case on the issue. However, as hon. Members are aware and have mentioned in this debate, some parents have obtained legal aid to pursue their claims against manufacturers of the MMR vaccine.

Hon. Members have asked about legal aid. My understanding is that, notwithstanding the Government's proposals, the current MMR legal aid cases that have been mentioned will be protected while they continue to satisfy the eligibility criteria. The Government have made it clear that we wish personal injury cases to be funded by conditional fee agreements. I acknowledge the issues in the vaccine damage cases that have been raised in the debate, and I shall of course draw those concerns to the attention of the Lord Chancellor.

Since our return to office, many hon. Members have pressed us about the scheme. As my hon. Friend the Member for Eccles will recall, on 5 November, the Under-Secretary of State for Social Security, my hon. Friend the Member for East Ham (Mr. Timms) met representatives of the all-party group on vaccine damage for a very useful discussion. We are aware of concerns on

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time limits, the disablement threshold, the adequacy of the £10,000 payments under the 1979 Act and other matters. We are aware also that medical opinion on vaccine damage has changed in the past decade or so.

It is important to stress that no prior assumption is made about the possibility of vaccine damage in any individual case. Each claim is dealt with on its merits. However, it is important to state the current understanding of the prevalence of vaccine damage.

Reports in the mid-1970s linking pertussis vaccine and encephalitis resulting in brain damage were based on anecdotal evidence concerning a small number of affected children. Since then, several large studies, such as the national childhood encephalopathy study, have shown no scientific evidence of a causal link between vaccination and brain damage. As such a causal link remains a theoretical possibility, each claim for a vaccine damage payment is carefully considered, taking into account the facts and evidence in the individual case.

The suggestion of a link between MMR and inflammatory bowel disease--particularly Crohn's disease--and autism, has been carefully studied by several independent expert groups. None of the groups has found any evidence to support such a link. Indeed, it is often forgotten in the coverage given to the issue that the original paper by researchers at the Royal Free hospital, published earlier this year in The Lancet, clearly stated:

The World Health Organisation has also written to stress the safety of the MMR vaccine and to support the United Kingdom's immunisation programme.

The United States Institute of Medicine pointed out that the background rate of encephalopathy--which is a general term used by doctors to describe a disturbance in brain function--in children under two is about five to 10 cases per 100,000 population.

Whatever the prevalence of vaccine damage, at the very least, parents of vaccine-damaged children face the same challenges as parents of other severely disabled children. The vaccine damage payment is not, of course, the only response that the Government make to meet the needs of those and other disabled people.

As a Government, we have a broader challenge: to ensure adequate support to all disabled people. Hon. Members will be aware of the significant improvements in provision for the severely disabled, of extra support for the most severely disabled three and four-year-olds and those disabled before the age of 20, and of our recent proposal in the House of a disability income guarantee, on which we are consulting organisations of and for disabled people.

The vaccine damage payment scheme provides substantial preference for children who are severely disabled as a result of vaccination over children who have been equally severely disabled from some other source. The payment does not preclude payment of other disability benefits and non-means tested benefits such as disability living allowance and severe disablement allowance. If it is held in a trust fund, the vaccine damage payment will be ignored for the purposes of income

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support, income-based job seeker's allowance, family credit, disability working allowance, council tax benefit and housing benefit.

Recipients, like other severely disabled people, may also be able to get help from the independent living fund and local authority social services. Perhaps the most significant recent development was the announcement, on Monday, by my right hon. Friend the Secretary of State for Health on important action to modernise social services. Specifically, the "quality protects" programme will target an extra £375 million to transform all of children's social services.

There has been a sustained campaign to improve the vaccine damage payment system. Today's debate, secured by my hon. Friend the Member for Eccles, is part of that campaign, as have been the early-day motions and the meetings with my hon. Friend the Under-Secretary of State for Social Security. I am pleased that, in July 1998, the Government were able to increase the payment from £30,000 to £40,000.

Some specific points were raised in the debate, such as that on the 80 per cent. disability criterion. I think that Parliament's view in passing the 1979 Act was that the scheme should be straightforward and aimed at those who are severely disabled. The Act defines severe disablement as disablement to 80 per cent. or more, as assessed for the purposes of determining the rate of disablement pension under the industrial injuries scheme.

In making the assessment, regard is paid to the scale provided in social security regulations. Blindness and deafness, for example, are each described as 100 per cent. disablement, although they clearly do not represent the greatest possible extent of disablement. Therefore, 80 per cent. is regarded as the lower end of the defined severe disablement spectrum.

Occasionally, people have asked about the possibility of a sliding scale of disability. I think that extension of a scheme providing significant preference for one group of people with disabilities over another would run counter to the objective of building a coherent benefits system for all disabled people, regardless of the cause of disability. A scale of disability payments would also run counter to the scheme's principle of providing a straightforward single payment for those who are clearly severely disabled because of vaccination.

Questions were asked in the debate also about time limits. Time limits in the scheme are quite generous. There is a limit of six years after vaccination or the second birthday, whichever is later, for new claims. There is no limit on the time in which a claimant may request a review by an independent tribunal of a medical disallowance of that initial claim. The claimant may request an indefinite adjournment during a tribunal hearing.

Marginal changes in the time limit would not assist in the overwhelming majority of cases. The substantial length of the process would make obtaining medical and other relevant evidence after long periods increasingly difficult, and make the scheme unsatisfactory or even unworkable. However--with the wide range of views about the incidence of vaccine damage, the adequacy of the payment scheme, the position of early recipients and

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the extent to which those who suffered vaccine damage should receive preferential treatment because they were responding to a publicly promoted health programme--we announced, on 19 May, that the scheme would be considered as part of the welfare review.

My hon. Friend the Under-Secretary of State for Social Security has said that he hopes to conclude our review early in the new year. I am sure that the House will accept that finding the right answer is more important than hitting any specific date. The campaign has made a presentation on disability benefits--

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