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Mr. Andrew Lansley (South Cambridgeshire) (Con): I am grateful to the Secretary of State for his having given me the opportunity to see the statement in advance, and I am sure the whole House is grateful to him for his openness and for the speed with which he has given us details of what is, as he said, a tragic event. We understand and respect entirely the privacy of the family concerned, but I am sure that they will receive from us our sincere condolences. I am also sure that the Secretary of State will be able to confirm that they, like other families affected by variant CJD, will be beneficiaries of the compensation scheme.
It is important to identify what we do not know. The Secretary of State was right to illustrate the limits of our knowledge about this tragic event. We do not know what, if any, means of transmission exists between blood and infection with variant CJD—we do not know whether blood is the source of the infection. He will be aware that, because there have so far been so few identified cases of variant CJD in a large population who were exposed to BSE-contaminated beef, the chances of the recipient contracting variant CJD other than by exposure to blood transfusion must be regarded as less likely than by some means connected with the blood transfusion, although I freely accept that we cannot quantify either risk, given the nature of the two populations involved. Equally, having been unable to establish the risks, we cannot go on to screen blood donations—the technology to enable us to do so does not exist—or to test for variant CJD.
Nevertheless, I hope that the Secretary of State can answer some questions. Although precautionary measures are being taken in relation to blood transfusions both of whole blood donations and of blood products and plasma, will he confirm that the transfusion in the case in question was a transfusion of whole blood and, therefore, of red cells? The transfusion occurred in 1996, and therefore before the implementation of precautionary measures in relation to leuco-depletion. If in this case there is a connection to blood donation, it may well be that the risk has been substantially reduced by the introduction of the precautionary measure adopted in 1998. What research is continuing into the impact and the benefits of leuco-depletion in relation to blood transfusions of whole blood donations?
I have a few detailed questions to ask. The Secretary of State said that the Advisory Committee on the Microbiological Safety of Blood and Tissues for
Transplantation is to advise him on whether blood donations should be accepted from people who have themselves received blood transfusions. In 1998, when the right hon. Member for Holborn and St. Pancras (Mr. Dobson) told the House of other precautionary measures, he had sought and received advice from the Spongiform Encephalopathy Advisory Committee. Time will not have allowed both committees to have given advice to the current Health Secretary, but will he confirm that he will also be taking advice from SEAC? Clearly, advice must come from those who have expert knowledge of the characteristics of BSE and variant CJD; the issue should not be seen only from the viewpoint of the National Blood Service.The Secretary of State said that thus far there had been 15 cases of blood donors subsequently contracting variant CJD, and he will recall that at least one of those cases occurred in Scotland. Questions regarding the ability to follow up patients who were potentially recipients of blood donations arose at that time.
Can he confirm that the different Administrations are now able to deal with people who have dispersed across the UK or the world? Are patients who might have received such blood donations being contacted and followed up?
What conclusions has the Secretary of State reached in response to the advice given by the CJD incidents panel on the risk of exposure to variant CJD from surgical instruments? What action will he take in that respect? It is a matter that has been under consideration for a long time.
In the wider context of blood transfusions generally, I turn now to children born since 1 January 1996. They could not have been exposed to BSE-contaminated beef, and to reduce the risk to that vulnerable population group it is intended to secure for them in early 2004 what is described as single-unit—that is, not pooled—virally inactivated donations from non-UK—in this case American—untransfused males. What consideration will the Secretary of State give to the availability of that form of blood product—plasma—for a wider group of vulnerable patients? Those patients include people who require regular transfusions, such as haemophiliacs, or those who need large-scale transfusions or blood products on a regular basis. What difference has the purchase of the plasmaphoresis centres in the US from Life Resources Incorporated made to the availability here of blood products for that purpose?
It is important for the House to recognise that 2 million people donate blood each year in the UK. They provide a vital, life-saving resource. The number of lives that are saved and the number of incidences of disease prevented by those donations far outweigh any risks associated with them. At the same time, the reporting structure on the serious hazards of transfusion needs greater compliance from NHS hospitals. More hospitals must act on the recommendations, make them part of their clinical governance and report back in full. In that way, the openness of the reporting structure will mean that we learn from mistakes and thus reduce risks overall. Will the Secretary of State ensure that the responses in the NHS to the transfusion hazard recommendations are acted on as fully as possible?
The Secretary of State made a welcome statement in August about hepatitis C compensation, and we are awaiting the details of the scheme. Now is not the time for a detailed debate on that, but will he confirm that those who contracted hepatitis C through blood donations, and their families, will get some news soon about the compensation scheme?
The Secretary of State said that he would be considering advice in relation to people who have received transfusions. Will that extend to people who have had transplants? There has been speculation about the measures that he might take. He referred to the availability of blood donations, which it is important to bear in mind. What has been the reduction in the number of blood donations in recent years? If there were to be a substantial and adverse impact on blood donations, the health consequences could be very serious.
Finally, I strongly endorse what the Secretary of State said about seeking alternatives to blood donations in treatment. The UK does not adopt such measures as much as some other countries. He may be aware of the possibilities offered by erythropoietin, known in short as EPO, as an alternative to large-scale transfusions for cancer patients suffering from anaemia. Will he update the House on the extent to which clinical trials and consideration of the costs and benefits offered by EPO are making progress? The use of EPO may help to reduce the need for blood donations to a minimum, and allow us to use the blood that is donated as well as we can.
Dr. Reid: I begin by thanking the hon. Member for South Cambridgeshire (Mr. Lansley) for his remarks, and especially for the condolences that he expressed to the families of anyone afflicted by variant CJD. We all share those sentiments. He also asked a number of perfectly legitimate questions, which I shall try to answer.
The hon. Gentleman ended his remarks by talking about EPO. The National Institute for Clinical Excellence is considering the matter very seriously, and I hope to have the result of that work not too far into next year.
The hon. Gentleman asked about compensation for CJD victims and their families. Those people are entitled to compensation from the CJD compensation fund, which is run by independent trustees. I cannot make a statement that might pre-empt the fund's decision on such matters, but I am sure that it will consider all cases—including the latest one—sympathetically.
The hon. Gentleman asked about the route of infection. He is right to be cautious and to weigh the matter in the balance. Although we cannot rule out the possibility that a person might be infected by receiving blood from a donor who subsequently dies from CJD, we cannot prove that it happens. However, I thought it appropriate to come to the House today, as for the first time we have evidence that it is possible. As he said, the incidence has been very low in the past; as far as we know, this case is the first of its kind. Intuitively, we might feel that the case could suggest that the pattern might be much more widespread if blood were truly the source of CJD transmission. However, intuition is not
always reliable in these circumstances. We need empirical evidence, and that is why I have asked the chief medical officer and various expert advisers to investigate the matter. I confirm that they will include at least two of the people to whom the hon. Gentleman referred.The hon. Gentleman asked about the transfusion of whole blood rather than plasma. To the best of my knowledge, the transfusion involved in this case was of blood, not plasma. The blood was donated in 1996, before the precautionary measures, including leuco-depletion, were introduced towards the end of the 1990s. The donor died about three years later from variant CJD, and the recipient has now died more than six years later. I shall not go into the range of causes behind the recipient's death, but the discovery that the recipient was suffering from variant CJD was made at the post-mortem examination.
It is important that we adopt a cross-border approach to this matter, and that we co-ordinate our actions. My Ministers have spoken this morning to the other Administrations in the UK to inform them that I was to make a statement. However, medical experts around the country were in touch with one another last Friday, by teleconferencing and other means. It was at that stage that the matter was brought to my attention. I can therefore confirm that we work as closely and in as co-ordinated a way as possible with the devolved Administrations.
Two other questions arise in connection with the 15 identified recipients to which the hon. Gentleman referred. The first has to do with tracing and tracking them. Quite apart from the difficulties caused by cross-border movements, people can also move around inside England, for instance. That is not always easy to deal with. Secondly, before we contact them, we must weigh the risk factor involved. Some of the cases have been known for a considerable time, but experts have considered that the balance of risk meant that more distress would have been caused if the people involved had been contacted and informed. I hope that further distress will not have been caused by today's statement. Obviously, the fact that the single new piece of evidence has arisen means that an immediate contact process has been put in place, but there will be difficulties with tracing and movement, which the hon. Gentleman mentioned.
On transplants, all the work that we are doing extends to tissues as well as blood. The hon. Gentleman asked about leuco-depletion and I can tell him that a whole range of research is being conducted, in academia as well as by the research councils. The Spongiform Encephalopathy Advisory Committee, which is an expert committee, will consider its activity on a range of issues at its forthcoming meeting early next year.
The hon. Gentleman mentioned surgical instruments. He will be aware, as will many hon. Members, that we have been examining that matter for some time. Such consideration is not easy because the various possible substitutes and methods to diminish potential opportunities for cross-infection, such as the use of disposable surgical implements, have potential risks. Many surgeons in England have indicated that they would be unhappy with using such disposable implements when operating. We are investing some £200 million in improving decontamination standards
precisely because we are committed to minimising the risk of the transmission of vCJD via surgical procedures, as the hon. Gentleman would expect. The NHS Purchasing and Supply Agency is working with manufacturers to improve the quality and reliability of single-use instruments.I confirm to the hon. Gentleman that we are taking advice from a range of committees, including SEAC, which he mentioned, the Advisory Committee on Dangerous Pathogens, the Committee on Safety of Medicine and the Advisory Committee on the Microbiological Safety of Blood and Tissues for Transplantation. I suspect that other independent agencies will immediately try—without instruction or the need for persuasion—to examine their own procedures and determine whether there are implications for them. We are also examining with the National Blood Service the practicality and cost of making fresh frozen plasma available to higher-risk groups. As I said earlier, the purchase of an American blood plasma company has ensured an adequate supply of plasma products from a BSE-free country.
The hon. Gentleman asked about the state and volume of stocks in the health service and levels of donations to it. We keep them at an optimum level—I can confirm that they are at an optimum level—and if there were a reduction beneath that level, we would obviously take emergency action.
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