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Mr. Andrew Lansley (South Cambridgeshire) (Con): I am grateful to the Secretary of State for giving me the opportunity to see his statement in advance. I am sure that hon. Members are also grateful to him for returning to the House to give further details, which he undertook to do on 17 December. His statement will come as no great surprise, in the light of some of the research that has been published since his December statement. I am particularly aware, for example, that in The Lancet of 6 February, Llewelyn et al reported on the surveys of patients identified by the national CJD surveillance unit as receiving blood transfusions. Looking particularly at the case that the Secretary of State highlighted in his December statement, they concluded:
- "The chance of observing a case of vCJD in a recipient in the absence of transfusion transmitted infection is about 1 in 15,000 to 1 in 30,000."
The case in question, which the Secretary of State told the House about on 17 December, arose from a blood transfusion in 1996. The precautionary process of leucodepletion was instigated, as he said, in 1999, so the first question that arises is, what has been the relevance and effectiveness of that process? The particular case in question does not tell us whether leucodepletion has succeeded in reducing or even removing the risk of infectivity being introduced through blood transfusions. What conclusions, if any, have he and his advisers reached on the effectiveness of that process over the last four and a half years?
Turning to the measures that the Secretary of State has announced, I am aware that he says that the 5 April date is intended to give the National Blood Service time to respond. Will he confirm that it will also, presumably, allow an accelerated call to donors, should that be necessary? I understand that the blood service may have about a week's supply, which is, in the circumstances, a very healthy stock of blood to have available, but it needs to be replenished continuously, so it is important to ensure that there is no drop-off in donations, even in the short run.
Can the Secretary of State confirm, as he did previously, that there has been advance co-ordination with the Scottish and Welsh Administrations? I understand that the National Blood Service looks after England and north Wales, but clearly there are separate arrangements in Wales, Scotland and Northern Ireland. Perhaps he can confirm that those Administrations are taking parallel measures.
Can the Secretary of State also explain the intentions in relation to those who have transfusions in future? Presumably, those who have had transfusions since 1980 will be excluded, but the logic of his statement is that those who have transfusions after 5 April this year will not be excluded, because they, by definition, will receive blood that we have made as safe as we can make it.
The Secretary of State talked about the measures that the chief medical officer is taking for a revised approach on "better blood transfusion". I do not wish to be difficult with the right hon. Gentleman, but I have to say that he described a process. He did not describe any outcomes, so perhaps he will tell us what progress has been made in reducing the use of blood products in the national health service to the minimum level that is clinically necessary, because we need to compare that progress inside the NHS with a reducing profile of blood donations.
The figures that I have received suggest that 2.38 million units were donated in 2001–02 and 2.365 million in 2002–03, while 2.31 million units is the estimate for this financial year and that for next year is 2.275 million. That is a 1.5 to 2 per cent. reduction year on year in the number of blood donations. What the Secretary of State has described today represents a 3.2 per cent. reduction
in the donor base, so this year, other things being equal, there might be a 4 to 5 per cent. reduction in blood donation.In those circumstances, it is important either for the marketing campaign to be able to compensate for that reduction—presumably, the Secretary of State knows that there is no certainty about that—or for NHS use of blood donations to make additional progress. However, there is no measure in the right hon. Gentleman statement of the progress made up to now.
What further research is the Secretary of State putting in hand? I understand that he has taken advice from the Advisory Committee on the Microbiological Safety of Blood and Tissues for Transplantation, but when I asked him recently about advice from the Spongiform Encephalopathy Advisory Committee he said that that body would be included, as others would. SEAC has particular expertise in the infectivity and transmission of BSE. We know that, so far, 146 variant CJD cases have been identified, so information is progressively being established about the characteristics of persons infected with new variant CJD and conclusions can be drawn. At some point, it will be necessary to balance the harm that could be done by such highly precautionary measures—even if it could be mitigated—against the unknown benefits of a highly precautionary approach.
In that context, in the past disposable instruments were used for tonsillectomies. Known harm clearly resulted from the practice for an unknown and unquantifiable benefit, and that decision had to be reversed. I would hate to reach the position where harm resulted from a persistently highly precautionary approach.
The Secretary of State said that the use of imported fresh frozen plasma that is virally inactivated is to be extended to older children. That development was first announced in August 2002, with the intention that such plasma would be used from the end of 2003. The right hon. Gentleman is now saying that virally inactivated fresh frozen plasma will be used for newborn children. Presumably a timetable exists for extending that use to children born since January 1996. When does the Secretary of State anticipate that timetable will, as a matter of some importance, be completed?
The right hon. Gentleman did not mention the infectivity of urine-derived products. In the past, the Department has said that it does not acknowledge any such evidence, but, in The Journal of Biological Chemistry in 2001, Shaked and others suggested that there was such a route of infectivity. If highly precautionary approaches are sought, perhaps the Secretary of State will comment on his attitude to that aspect.
I entirely share the right hon. Gentleman's regret at newspaper stories this morning and would not wish the Government to proceed other than on the basis of scientific evidence. Continuing research is needed because a highly precautionary approach is being taken in the absence of evidence about the true route of infectivity. If the Secretary of State is right and the public listen carefully, they will recognise that that is the right way to proceed. Blood is a vital resource for the NHS and we greatly value those persons who donate it. Blood must be used efficiently and effectively, but we
must also encourage people to give blood to the NHS in the hope that that will meet the health service's continuing needs.
Dr. Reid: I thank the hon. Gentleman for his comments and particularly for his reference to the manner of publication and reporting. His reaction, as we would expect, was responsible. I hope that any reporting of this issue will be sober and non-sensational.
The hon. Gentleman referred to a series of publications and produced some statistical evidence. I will not comment on their substance, but I agree that a range of statistical evidence has been placed in the public domain, albeit not of a causal nature. We proceed with caution, despite the fact that there is no proven causal relationship between the description I reported in December of a possible link between someone who had donated blood and someone who had received blood.
At the time when leucodepletion came into effect, our experts believed that the only source of infectivity was through white cells. Leucodepletion is the removal of white cells from the plasma. More recent research suggests that there could be infectivity in other blood components, which is why we are taking further action. As the hon. Gentleman knows, we are guided by experts. We believe that leucodepletion has been effective and efficient in countering risks. I am certainly not aware of any evidence to the contrary.
The hon. Gentleman referred to the chief medical officer's "better blood transfusion" strategy, which is currently being reinforced. Hospitals are encouraged to run pre-operation assessment clinics and to advise patients of the various alternatives. Hospitals are also encouraged to use the technology that allows doctors to rescue and give blood back to patients during an operation. That technology is readily available and should be used when a patient needs more than two units of blood.
It is too early to make an overall assessment of the complete effectiveness or otherwise of the strategy but we continually monitor it and believe that it is making an improvement. When we have completed a comprehensive and robust assessment, we will place that information in the public domain.
The hon. Gentleman expressed the hope that the three weeks before 5 April will be used at least in part to encourage people to donate blood to compensate for any effect that today's statement may have. I share his hope, which is part of the reason for giving the blood service proper time to produce publications and circulars before this statement.
The hon. Gentleman is correct in stating that current blood stocks are relatively high—from memory, we have 62,000 units. This morning, I spoke with, among others, the manager of the National Blood Service, Dr. Angela Robinson, and with individuals in Scotland. My hon. Friend the Minister of State spoke to our colleagues in Wales yesterday. We confirm that we shall do everything possible to ensure that the level of blood donations is maintained.
The decision to import fresh frozen plasma from the United States to treat certain groups was taken to reduce the possible risk of variant CJD. There have been no reported cases of vCJD in the United States and we thought it important not to introduce different risks
with this initiative. Viral inactivation of US-derived fresh frozen plasma was therefore introduced in this country.We hope to complete by the end of this year our plans for ensuring that all children are treated using the fresh frozen plasma method. We hope that that timetable will not slip.
My hon. Friend the Minister responded to a recent question on urinary infection. There is no evidence of urinary infection occurring—although, as we adopt a precautionary approach, we obviously keep an open mind. I cannot report the specific contents of the discussions with the spongiform encephalopathy expert group, but I will write to the hon. Gentleman on that point.
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