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21 May 2008 : Column 109WH—continued
Recent estimates show that approximately 326,000 people have hepatitis B. I read somewhere that 85 per cent. of developing countries—I assume that it must have been developing countries because it is hard to believe that that is a global figure—have implemented a universal hepatitis B vaccination campaign. However, the UK operates only a system of selective vaccination for high-risk groups. When the Minister sums up, it would be helpful if he outlined whether the Government’s thinking on that has changed. In the past, because new incidences have often been in the immigrant community, the attitude has been that there is no point having a wholesale vaccination programme. Given that the disease is highly infectious and can spread quite rapidly, however, I hope that the situation is under regular review so that the public health impact can be assessed.
The Government are trying to tackle the problem of alcohol misuse, but whichever way one looks at the figures, they are quite a frightening statement about society today. The cost to the NHS of alcohol misuse is £1.7 billion a year. In 2005, 4,160 people died in England and Wales from alcoholic liver disease—a 37 per cent. increase on 1999. The figures for deaths from alcohol-related causes are even starker, with 4,437 people in England alone dying in 1997 and 6,517 dying in 2006.
I recently visited Southampton general hospital and talked to one of the consultant hepatologists. It was fascinating. He said that he could not really show me anything, but that he would just run through his patient list—his work load—for the day, because it was typical of the cases that he was seeing. Compared with 10 years ago, the people on the list were much younger, and there was a higher proportion of women. The other worrying thing was that one person on the list felt that it was pretty much bad luck that she was there at all. She was not a binge drinker and most people—particularly given the drinking patterns in the House of Commons—would not regard her as an alcoholic. This woman simply shared a bottle of wine with her husband every night, and if he is anything like my husband, he will have drunk the lion’s share. Like many others, this lady thought that a few units of alcohol were perfectly acceptable, but she is now faced with a problem.
I recognise that the recent Government campaign is all about trying to increase people’s awareness of how much they drink. I was looking at consumption figures from Office for National Statistics, which all had to be revised upwards recently. If one looked at the figures year on year, it looked as though there had not been much of an increase in alcohol consumption. However, the ONS suddenly thought, “Hang on a minute. We are all drinking from bigger glasses”—that is just the sort of thing that the Government tried to highlight—“and alcohol has got a bit stronger.” When it factored in the increased glass size and the increased strength of what people were drinking, it found that consumption rates had gone up by about 50 per cent., which was quite frightening. Most people are not aware of how much they are drinking. I welcome the Government’s campaign, but I hope that it will be backed by the compulsory use of labels showing the number of units in the bottle. I know that there is a voluntary agreement, but it covers only about two thirds of what is on the shop shelves. Compulsory labels would help those who are minded to do something about the problem to decide which wine to drink. They may just choose to drink a lower-alcohol wine because they can drink more of it.
The thorny question of alcohol taxation also arises, although I do not expect the Minister to answer questions on that. Last week, however, I went on a Health Committee visit to Norway, where the cost of wine is astronomical—indeed, the Select Committee drank far less on that visit than on any other I have been on. I do not think that any of us consider ourselves problem drinkers, but if people want proof that pricing can control the problem, our experience in Norway speaks for itself.
A lot of the European evidence shows that increasing tax—there are ways to do that selectively to target problem drinks—has the greatest impact on the behaviour of binge drinkers and those with a chronic drink problem. Such measures are unpopular, but we must consider them in the long run. We must, however, balance that with ensuring that pubs stay viable and do not go out of business. The good old-fashioned English pub provides a useful social function for those who may live alone and who want to meet friends.
The other cause of regret—I hope that this will be tackled later in the Government’s campaign on alcohol—is the lack of thrust behind efforts to tackle binge-drinking. To an extent, the problem is cultural: young people seem to think that it is perfectly acceptable to go out on a Saturday night and drink large amounts of alcohol. That seems to be the thing to do here, but such behaviour is just not cool in many other European countries. We have to work hard with our young people to change attitudes. That will not be easy, but we must find ways to tackle the problems if we are not to replicate them in the future. The younger people start drinking, the longer they will drink and the greater the impact on society will be.
I have not said much about obesity, because that is not what the debate is about. However, one of the messages that is not getting across to people is that being overweight increases their chances not only of developing diabetes or heart disease, but of dying much more quickly from another disease. I would also welcome a little more focus on that, perhaps from patient groups. It must be brought to the attention of MPs.
I want to end by saying that having an alcohol problem and liver disease does not necessarily mean the end of the world for everyone. Some people will die, and that is the end of it, but in some cases, if people stop drinking, their liver can recover and they can have many years of life. I have witnessed both outcomes. The problem is that it is extremely difficult to get access to alcohol rehabilitation services. In Southampton, the only alcohol-specific charity closed down. If one visits a drug and alcohol rehab centre, most of the workers will say that drink is a large part of the problem, but that it is much easier to get the funding and to treat people if there is a linked problem as well as the drink problem. If the Government are serious about tackling the issue, they must stop thinking that problems are always drug-related. They must ensure that there are resources for those whose drug of choice is alcohol, which is not regarded as a mainstream drug of abuse.
3.21 pm
Mike Penning (Hemel Hempstead) (Con):
I congratulate the hon. Member for Derby, North on his contribution this afternoon, and on stepping into the shoes of the hon. Member for Bolton, South-East. I know the hon.
Gentleman fairly well as a good friend of Gibraltar, and can only imagine that he must find his inability to speak the most difficult situation that he has been in for many a year.
Dr. Iddon: I am the Member for Bolton, South-East, and the other hon. Member is my hon. Friend the Member for Derby, North (Mr. Laxton).
Mike Penning: The hon. Gentleman spoke brilliantly today—and I am sure that he is a good friend of Gibraltar as well. I apologise for getting the constituencies mixed up.
The work of the all-party group on hepatology, and its reports, have been very useful not only to the House but also to those who suffer so much. Until I took on my Front Bench responsibility I was lucky enough to chair the all-party group on haemophilia, and would like to join in the call made by the hon. Member for Bolton, South-East for the Government to take seriously the current Archer inquiry, so that we can get to the bottom of the problems that so many people have had, through no fault of their own, because of contaminated blood. I pay tribute to the many groups that have been mentioned, in particular the Hepatitis B Foundation, the Hepatitis C Trust, and the British Liver Trust, which have sent us some excellent briefings. I share the concern that has been expressed that there are not more hon. Members in the Chamber for such an important debate.
The title of the debate encompasses myriad problems that can affect the liver. We heard about many of them, and I shall try to cover as many as possible. The Minister knows that I shall not take a party political line in this debate, but I do not understand the Government’s position on immunisation and inoculation, especially with regard to hepatitis B. I was a serviceman for many years and was inoculated, and my wife was an NHS employee for many years, and was also inoculated. It is obviously only in the more advanced parts of the world that inoculation is carried out, and I want to ask the Minister why the Government have not gone down that route. If he cannot answer now, perhaps he can write to us about the exact position.
Time has moved on; I have heard that initially there was concern about immigration, but as we have seen from newspaper figures in the past couple of days, immigration is rising fast, and the issue cannot just be ignored. We must address the question why, when other countries have taken protection against hepatitis B seriously, we do not appear to want to look at the problem. I do not say that it must be done; I am just trying to find out the reason for the situation, because there seems to be pretty good evidence to support taking action. We heard earlier that mutations occur, almost on a daily basis, I think, in the different hepatitis groups, although, as has been said, it is particularly hepatitis C that is affected.
Liver disease as a whole must be taken seriously. As we have heard, 38 people a day die of liver disease in this country. There are many different reasons for that. The liver is a remarkable organ. I am no doctor, although I think there are hon. Members present who are; but the key is that the liver can regenerate. A couple of weeks ago, a surgeon told me that he had removed 80 per cent. of a liver in an operation, and the liver had regenerated. It is a remarkable organ, which can do what most other
organs cannot—repair itself, and regenerate. Bearing that in mind, it is frightening that so many people die of liver disease each day, and so many young people—particularly in relation to alcohol—are seeing consultants.
It is not normal for me to praise the BBC, but it has done some excellent research and produced an interesting report on the topic. It spoke to 115 consultants, 101 of whom responded. Seventy-seven said that they were treating patients under 25 years of age for alcohol problems affecting their liver. That is frightening. I am the father of daughters aged 17 and 19. One of them, who is at Portsmouth as we speak, studying marine biology, is, I think, trying to drink Portsmouth dry. I am told that the Royal Marines have tried to do it for several hundred years and not succeeded.
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): You should be grateful for that.
Mike Penning: Absolutely; perhaps that will get some sense into her head.
There is a cultural problem with young people. I shall not be a hypocrite. I was in the military at 16, and I freely admit that we went out and had some beers on a regular basis. I stress the word beers. The groups of young people that my daughter goes out with talk quite openly about the fact that they drink before they go out—normally vodka—until they get to the tipping point. Then they go out and enjoy themselves. That can be done, I stress, only because the pubs are open so late. The Minister has heard me say this before, but a mixed message is going out to young people, because we have what is called 24-hour drinking which, although we know it is not 24-hour drinking, is late drinking, and is expensive. If young people can drink cheaply early on they do not spend so much money when they are out. However, they are already half smashed, to be perfectly frank, before they hit the pubs—not the clubs, but the pubs. That is a cultural and educational problem that we must deal with. If we do not address that with young people the NHS will never be able to cope with it.
We talk a lot about obesity problems, and that is quite right. We all need to work on that; I am working on it myself, and am on a sponsored slim as we speak, but it is massively important not to forget one subject while another is the focus of topical debates in the press.
A subject that the hon. Member for Romsey (Sandra Gidley) touched on earlier in the debate was the availability of organs for transplant. I have a particular interest in that, and have been asking questions, because I am worried that we shall begin to debate an opting-out approach to donation before we have found out how many available organs have not been used. As the Minister may be aware, I have asked parliamentary questions about the number of viable human organs available for transplant that are not used.
I recently received information from the East of England strategic health authority, which happens to cover my hospital trust area. It had 22 patients waiting for a liver transplant, but five viable human livers were not used, and were destroyed.
Sandra Gidley:
The hon. Gentleman’s figures are interesting, but we must be careful how we consider this matter. Clearly, he is aware that we cannot put any old
liver into any recipient. A large number of organs need to be available so that appropriate tissue typing can be done, and then those 22 people on the waiting list will be able to receive an organ. It is a shame that some organs are unused, but that is the nature of what is available and what is needed. We have to get that right.
Mike Penning: I thank the hon. Lady for that intervention. I am very aware that we need to match organs with people, so I went further and asked questions about whether that was the problem. We cannot have people saying, “We couldn’t find a match quickly enough.” The technology exists to keep organs viable for much longer. We just pack them in ice at the moment, which seems a bit archaic in the 21st century. Technology is being piloted at Papworth hospital that will allow us to keep a liver for much longer while we search for a patient whose requirements make them a match for it.
Mike Penning: Let me just finish the point. It is not necessarily that we cannot find a match for the organs. Often, the organ deteriorates before we find a match, but the technology exists to assist us in that respect and I want the Minister to address why we are not using it.
Sandra Gidley: I think that the hon. Gentleman has just answered my point. I was going to say that although I understand that what is taking place is a trial it is having good results and there seems to be a reluctance to adopt the technology in the NHS. Is the hon. Gentleman aware whether that was a national decision or whether trusts were just tightening purse strings and not purchasing anything new?
Mike Penning: It appears that other countries have conducted the trials and the technology has been adopted. I am afraid that it has something to do with money. I understand that each unit costs about £10,000, but when we consider the number of organs involved and the fact that the NHS budget is about £110 billion, it is not a huge amount. That technology is a way forward and we must look to such technologies before pushing on to the public the great debate that may need to happen. We must be certain that we are using every organ that is donated. Very difficult decisions are taken when an organ is donated, and we must ensure that we use every viable organ wherever possible. The technology exists. Perhaps we need to consider seriously whether the Government can look at that or whether it is just left to a local trust—of course, we all know about the funding problems in different trusts throughout the country.
Dr. Ian Gibson (Norwich, North) (Lab): I apologise for coming into the Chamber late. I was talking to a reporter from The Guardian about articles that we would like to write on myths and cancer. Before people get to the stage of liver transplants, what about picking up the hepatitis viruses that cause the problem? What about developing a vaccine, as has been done in Cuba, to ensure that hepatitis B, for example, is eliminated from the population? Should we not go the way of prevention, rather than looking for livers that are compatible with individuals?
Mike Penning: I completely agree. That issue was discussed earlier, but I understand that the hon. Gentleman is not a mind reader. An important point was raised. I understand from the experts that there are real problems with vaccines for hepatitis C, not least because, as we discussed, it mutates so fast. As a result, it is difficult to develop inoculation. I agree with the hon. Gentleman—we should use medicine before surgical practice wherever possible. I hope that the Minister will comment on that.
Dr. Gibson: I apologise for mentioning something that had been discussed before. I do not know whether it has already been mentioned that about 80 per cent. of liver cancers are compatible with infection by hepatitis viruses. People sit up and take notice when the word “cancer” is mentioned, so I wonder whether the way to make politicians and Parliament sit up and take notice is to point out that the chances of getting a cancer—it may take 10, 20 or 30 years—are much greater in the circumstances that we are discussing. Early development of procedures, vaccines and so on might eliminate many of those cancers, which are viewed as rarer but still take thousands of lives down the line—not tomorrow, but in 10 or 20 years’ time.
Mike Penning: Again, I agree that whatever we as politicians and the NHS can do in preventive terms has to be the answer to how we make progress. We have heard about how bad the situation is becoming in terms of people having liver problems, particularly as a result of hepatitis; I will come on to alcoholism and obesity. If we do not address those problems early, the NHS will never be able to cope—not to mention the personal impact on anybody who has cancer. If something is preventable, we should do everything possible to ensure that preventive measures are taken. I am sure that the Minister will agree.
Non-alcoholic fatty liver disease has been mentioned. I was very concerned when I read a report that a consultant from King’s College hospital in London had stated that the disease has overtaken alcohol and viral infections as the commonest cause of liver disease in Britain. That is quite a frightening situation, which we as politicians should address. The public do not understand just how dangerous obesity is and how the human body simply cannot take the things that we are doing to it. The liver is one of the only organs that is able to regenerate itself. If consultants today are seeing more people with that disease, which is related to obesity, the Government’s programme needs to be much more focused and sharp. We may need to scare the public into realising the dangers that they are exposing themselves to.
I remember vividly that when I was a fireman back in the 1980s in Essex, the first magistrates court put a driver in prison for drink-driving over Christmas. I think it was in 1983, after a huge Government and public campaign to show how dangerous drink-driving was and the effects that it had. Eventually, scare tactics had to be used. We had won the argument with most of the public, but people were still drink-driving—there are still such people today; sadly, we seem to be going in the wrong direction now—who needed to be frightened. They needed to be told that they would lose their licence and go to prison if they continued to drink-drive.
Public campaigns are quite gentle nowadays. We have talked at length with the Food Standards Agency about whether we should have GDAs—guideline daily
amounts—a traffic light system or both. The public are an interesting group of people. They will not listen until they think that something affects them. It is important that a public education campaign explains how dangerous—indeed, terminal—obesity can be. The effects in terms of liver disease could be at the forefront of such a campaign.
This is a very important area, but one in which public awareness is limited. I agree with the hon. Member for Norwich, North (Dr. Gibson) that if we talk about other effects of liver disease—in particular, cancer—people might start to listen. That is what the newspapers are interested in today. We also need to start to talk about the damage caused to young people. We need a joined-up Government campaign. The Government need to come together on the different problems caused by liver disease. We cannot just talk about the different forms of hepatitis on their own. We have to talk about the effects of alcohol and of obesity.
People who have done nothing wrong—they perhaps had haemophilia and were given contaminated blood—need to know the truth about what has happened to them. I hope that the Government will listen to the Archer inquiry. I stepped down as chairman of the all-party haemophilia group when it first started, not because I was not interested in the group—I was a member—but because I took up Front-Bench responsibilities and I thought that there was a slight conflict of interest. I did not want to jeopardise the group in that way.
I congratulate the members of the all-party group on hepatology for the work that they are doing. It is an excellent group and produces detailed analysis. It is sad that the Government’s action plan is not being addressed, because it is a good one. The Government should ensure that primary care trusts and other organisations throughout the country are implementing the action plan so that we protect all members of the public, not just people who happen to live in a particular postcode and come under a particular PCT.
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