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DELEGATED LEGISLATION
Motion made, and Question put forthwith, pursuant to Standing Order No. 118(6) (Standing Committees on Delegated Legislation),
That the draft Local Government (Northern Ireland) Order 2005, which was laid before this House on 2nd March, in the last Session of Parliament, be approved.—[Mr. Dhanda]
Motion made, and Question put forthwith, pursuant to Standing Order No. 118(6) (Standing Committees on Delegated Legislation),
That the draft Companies (Audit, Investigations and Community Enterprise) (Northern Ireland) Order 2005, which was laid before this House on 27th June, be approved.—[Mr. Dhanda]
Motion made, and Question put forthwith, pursuant to Standing Order No. 118(6) (Standing Committees on Delegated Legislation),
That the draft Criminal Justice (Northern Ireland) Order 2005, which was laid before this House on 28th June, be approved. —[Mr. Dhanda.]
Motion made, and Question put forthwith, pursuant to Standing Order No. 118(6) (Standing Committees on Delegated Legislation),
That the draft Army, Air Force and Naval Discipline Acts (Continuation) Order 2005, which was laid before this House on 4th April, in the last Session of Parliament, be approved.—[Mr. Dhanda.]
That the Serious Organised Crime and Police Act 2005 (Designated Area) Order 2005 (S.I., 2005, No. 1537) dated 8th June 2005, be referred to a Standing Committee on Delegated Legislation.— [Mr. Dhanda.]
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Hepatitis C
Motion made, and Question proposed, That this House do now adjourn.— [Mr. Dhanda]
10.17 pm
Mr. Bob Laxton (Derby, North) (Lab): In the last Parliament, I was an officer of the all-party parliamentary group on hepatology, which produced a report on hepatitis C in March of this year. My hon. Friend the Minister will have had a copy. Yes, it was hard hitting; it was hard hitting because it deserved to be.
The action taken so far by the Government is failing and will continue to fail those who carry the disease, fail the standards of care that we have come to expect of the welfare state after the second world war and fail to head off a largely preventable disease load described authoritatively by a former US Surgeon-General as a "timebomb" until they recognise that this is a serious threat to public health that has to be prioritised.
Colleagues will not be surprised to learn that I do not often read The Sun, but last week its health writer Jane Symons did an interesting piece that reflected the fact that anyone can catch hepatitis C, including Pamela Anderson from "Baywatch", who caught it sharing her husband's tattoo needle. There are a number of ways hepatitis C is transmitted—from sharing needles to blood transfusions that took place before 1991 and sharing razors or toothbrushes with someone who has the virus.
There are estimated to be between 200,000 and 500,000 people who are HCV positive in the UK, but nobody knows exactly how many, although the so-called "Action Plan on Hepatitis C" published in 2004 promised, in the future tense, to develop modelling techniques to assess future numbers of patients requiring treatment. Perhaps my hon. Friend could let me know how far we have come since then on defining numerical parameters of the disease. We know that the great majority of those carrying the infection—80 to 90 per cent. of the total—do not know that they are incubating the disease and are storing up future problems for themselves and for society.
The Government's overall approach could be described—charitably, in my view—as "watch and wait". Actually, it is more like wait, because with 90 per cent. of infections undiagnosed, watch is hardly applicable. Besides, there are no plans for any of the proactive screening programmes that are recommended in the report. With the best will in the world, how can we expect to identify the HCV-positive population otherwise? Perhaps the Government have targets to identify that population. If so, let us hear them today to assess how ambitious and realistic they are and to measure future progress against them.
Watch and wait also fails on two other counts. First, there is increasing evidence from the American Association for the Study of Liver Diseases and from the European Association for the Study of the Liver that the earlier and younger that patients are treated—even if they have perfectly normal liver enzyme levels—the more likely we are to achieve a sustained virological response indicative of a cure. Effective treatments involving ribavirin and pegylated interferon are available and can cure some 60 per cent. of the patients who take them.
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Secondly, while watch and wait saves expenditure on cures in the short term, it costs so much more in the long term. Eventually, without treatment, 20 to 50 per cent. of HCV-positive people will develop very unpleasant liver disease—blighting and shortening their lives and placing an extremely heavy burden on the NHS as the number of people with this infectious and transmissible condition grows. I hope that the Treasury has no hand in this short-termism.
No doubt the Minister has been studying our report, which makes 13 recommendations. They would bear repetition in a longer debate, but it would be helpful to know now whether the Government are minded to accept any of those recommendations. My hon. Friend may find it more convenient to write to me at length with her evaluation of the points made. There are, however, two areas that I would particularly like to stress.
First, I was disappointed by the skimpy, one-page chapter in the hepatitis C action plan, which boldly set the question, "International Outlook: How do we Compare?" It proceeded not to answer that question. Basically, this underwhelming chapter tells us something of the incidence of the disease in other countries but nothing—absolutely nothing—about the lessons that we can learn from their successes and failures.
For instance, in France, where the challenge and burden of disease is even greater, 50 per cent. of the HCV-positive population has been identified and a target of 85 per cent. identification set. Where are the targets for England? Closer to home, it is quite clear that the Scots have addressed this issue with more seriousness and speed than we have in England. Some 36 per cent. of the HCV-positive population have been identified—approximately double the 19 per cent. claimed as diagnosed in England in the action plan. I should say that that depends on the Government's low estimate of 200,000 HCV-positive people being correct. All the specialist hepatologists that we spoke to felt that the number was closer to the top of the range—500,000. In that case, the proportion diagnosed in England falls to something like 8 per cent.
It is also clear that Scottish data collection and thinking on screening is in advance of the position in England. Health Protection Scotland is producing an annual report on its Hepatitis C action plan. Where is the English equivalent? Is it not time that we in England set the old exam question of compare and contrast so that officials absorb and apply the lessons from elsewhere?
I hope that my hon. Friend will join me in congratulating the Hepatitis C Trust, which has listened to the recommendation of the report and commissioned a comparison study between what is happening here and what has been done in France, Germany, Italy and Spain. Surely, in such an important area of public health, the Government should be working in partnership with the voluntary sector and taking advantage of its expert knowledge and networks to provide a clear picture of how other countries are dealing with the condition. The compact between the Government and the voluntary sector commits the Department of Health to forge long-term strategic partnerships with the sector and involve it in the
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planning and delivery of treatment and services. However, in this case it appears that the Department is happy to leave the Hepatitis C Trust to it.
Secondly, I am convinced that we are not adequately addressing the challenge of the disease in UK prisons. Prisons are certainly reservoirs, if not hotbeds, of the disease. I have written to the Minister already about that to give her some advance warning of the matter. A study of a Scottish prison in the American Journal of Epidemiology showed a rising incidence of hepatitis C in inmate cohorts the longer they remain in jail. The most likely explanation for that is injecting in prison. The Scottish study found an initial incidence of 16 per cent. infection among inmates in 1999–2000. That is considerably higher than the percentage quoted to me from some now rather aged statistics of 1997–98, which was 9 per cent. among adult men in English prisons. We appear to have a significant proportion of male prisoners in the UK who are HCV positive, with prisoners more likely to emerge HCV positive than when they went in, with the most likely cause of the rising incidence being injected drug use.
The Minister will no doubt say that responsibility is delegated and that patient care trusts bear responsibility for the treatment of prisoners. The reality is that the prison population is transient and inmates can be moved from one end of the country to the other with little or no warning. Unfortunately, the response time for securing treatment is seldom as swift, resulting in halved treatment regimes for some and an absence of treatment for others. It is shocking that prisoners, who are in society's care, should appear to be more likely to emerge from prison with hepatitis C than when they went in and that effective and available methods of preventing that are not being deployed. Action is needed to ensure that the punishment for prisoners with hepatitis C is not an irreparably damaged liver.
Prisoners are not routinely screened for hepatitis C. They should be, because they are a clearly identifiable high-risk population that would be easy to target. We are missing a significant opportunity to address a problem, which will only grow to be far more damaging, by effectively ignoring it. As a former senior medical officer, Dr. S. Hopkins wrote in The Daily Telegraph on 24 August 2004:
"The crisis is no longer in waiting. It is here now, fermented in prisons and released in a continuous stream into the general population."
It is a crisis that should be addressed rather than ignored.
I believe that the Government should be doing more, particularly on public education. Hepatitis C is preventable, but unlike HIV/AIDS it is not a virus that many people know much about. Because of the common absence of symptoms, many people tend to be unaware that they have a hepatitis C infection until some time afterwards. For instance, 30 per cent. of people diagnosed with hepatitis C do not display any symptoms and are often unsure of where they caught the virus. A public education programme or campaign should focus on how hepatitis C is caught and, for anyone who already has the virus, how to avoid transmitting it. General practitioners should also be given more support in the treatment of viral hepatitis, perhaps as an enhanced service. A small pilot with specially trained GPs supported by a helpline and a clear set of referral guidelines would be useful.
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Prevention is better than cure, and that certainly applies to hepatitis C. Allowing the problem to fester only stores up bigger shocks for the future. Different people react differently to hepatitis C. The lucky ones will suffer from chronic fatigue and not have the ability to live their day to day lives as fully as they would like. The unlucky will die of liver disease.
I previously presented a debate on childhood anaemia, a condition that has long-lasting problems in adulthood if left untreated. Hepatitis C is the same. I urge my hon. Friend the Minister to consider the points that I have made and very much look forward to her response.
10.28 pm
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