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24 Jun 2008 : Column 45WH—continued
I know that the Minister is aware of my position on this matter and I thank him for the conversations that we have had in private and at the meeting, which took
place almost by accident, with the “Hot water burns like fire” group a couple of weeks ago. I would like the Government to change the law so that thermostatic mixing valves, or TMVs as they are known in the industry, such as the one that I have with me and which I am happy to leave with the Minister as a paperweight, are fitted in all new, refurbished and change-of-use homes. Those valves set the bathwater temperature to a maximum of 48° C and it emerges from the taps at about 46° C, depending on the water pressure elsewhere in the home. That is not new technology; it was developed in the Glasgow laundries in the 1920s and ’30s. It is an old piece of engineering that has been updated over the years.
I shall put those temperatures in context. At 66° C, hot water burns through skin in two seconds. At 56° C, it burns through skin in 15 seconds. At 46° C—the temperature at which the valves would be set—it takes five minutes to burn through skin. If hon. Members take the temperature of their own supposedly scalding-hot baths, they will probably find that it is 40 to 42° C. Nobody can sit in a bath at 46° C, but, at that temperature, there would be a little bit of time for parents to rush back and pull out any child who fell in.
We wash our clothes at 40(o)( )C, and we have to educate people to wash their children and themselves at the same temperature. I pay tribute to Wakefield metropolitan district council, which, as far as I have been able to establish, is the only council in the country to have installed TMVs as standard across its housing stock. The main reason for that decision was the fact that it had a seriously high level of scalding injuries. Wakefield is an old mining community, and because the miners used coal to heat hot water through inefficient big back boilers that delivered water at high temperatures, we had a higher than average level of scalding.
A new scalding in the home risk is emerging with the installation and increasing popularity of solar panels. People rightly want to fit them to save energy and the environment, and to use the sun’s energy. The panels heat water to up to 100(o) C, and I have heard stories from people who say that the water coming out of their tap is incredibly hot. So there is an emerging risk from the increasing popularity of solar panels. People are saving the environment but they are unwittingly putting their family’s health at risk.
Since I began campaigning on this issue, I have been contacted by many people with tragic and heart-breaking stories of what has happened in their family. A 17-month-old child fell into his bath in Sunderland when his mother left the room for a few seconds to fetch his pyjamas. I have heard stories of children dropping toys into the bath and going in to get them. A recent high-profile scalding case involved Katie Price, otherwise known as the model Jordan, whose son Harvey, who is blind, was badly scalded after getting into a hot bath.
I have also heard stories of pensioners getting cramp in their legs while topping up their bath with hot water. Dr. Keith Judkins of the Pinderfields burns unit told me of one unfortunate patient he treated who had been scalded in his bath. He had gone into burns-related shock and was unable to get out of his bath. By the time his neighbours alerted people the next day, he had sat overnight in bath water that had turned cold, so he was admitted to hospital with third-degree burns but also suffering from hypothermia, which made his treatment extremely difficult. He had an appalling injury.
A person could have a heart attack or an epileptic fit or suffer a stroke in the bath. People may climb into the bath having had too much to drink or an overdose of prescription or illegal drugs and suffer terrible consequences. Each of those horrifying incidents could be prevented by a £40 TMV fixed to the bath.
The name of the campaign, “Hot Water Burns Like Fire”, is not just some cheap catch phrase. Scalds really do burn like fire. My friend Keith Judkins, who has been working on the issue with me, is a consultant and anaesthetist at Pinderfields hospital. He is also the chairman of the British Burn Association burn prevention committee. He says that scalds are equivalent to a petrol burn, and he should know. He sees terrible injuries every day and has often said that he would love the law to change and to put him out of business and out of work. He wishes for nothing more from our Government.
Keith Judkins told me that a scald over more than one fifth—20 per cent.—of the body has the same metabolic impact on a person’s physical chemistry as being hit by a bus. That change in the body’s chemistry can be life threatening. People can go into burns shock, and the suffering experienced by bath scald patients is substantial. Pain is a significant feature in the first two years after a scald. It can become chronic, with pathological pain mechanisms involved. Itching can also be a serious chronic problem and may disturb sleep, especially in the first two years. Patients of Mr. Judkins have been known to scratch their newly healed skin raw.
The most persistent scar-related problems are the need to wear pressure garments for one to two years and the need to moisturise all burned areas every night for ever, because burned skin loses its sebaceous sweat glands. Because of the loss of those glands and because healed skin is much more sensitive to sunlight, burn patients cannot stay in the sun for very long at all. They obviously have to be much more careful in the sun.
There are other issues around burns, apart from the physical ones. Psycho-socially, unless people have facial or hand burns, their injuries and scars will affect them whenever they are expected to expose them, for example, when swimming at school or on school sports days—they will obviously get comments from their classmates about their scars—and as they enter their teenage years, when faced with the beginnings of sexual attraction. Bath scalds in children almost invariably affect the groin area. I have no need to spell out the extreme anxiety and consequent social withdrawal that a scalded teenager feels when they realise that they are attracted to someone and are getting close to revealing previously concealed ugly scarring.
Legislation requiring homes to have TMVs came into force in Scotland in May 2006, after a magnificent campaign run by the lawyer, Alan Masterton. I pay tribute to the fantastic work that Mr. Masterton did in Scotland. Similar legislation has been passed in the United States, Canada, New Zealand and Australia, so why can we not do the same in England, Wales and Northern Ireland?
Over the past few years, I have pleaded with Ministers to widen the scope of consultations on building regulations to include the installation of TMVs. I am sorry to say that the Government’s position on this matter has not been consistent. I have with me today ministerial correspondence stretching back to 2004. In January
2004, my hon. Friend the Member for Corby (Phil Hope), then a Minister in the Office of the Deputy Prime Minister, issued a press release entitled “Government moves to stop bath time scalding injuries”, which stated:
“Safe water temperatures would be addressed by a review of part G of the building regulations and could come into force in early 2006”.
Clearly, our being here today shows that that did not happen. In March 2006, I introduced a ten-minute Bill. That is when Holly Davenport came to the House of Commons and launched the “Hot Water Burns Like Fire” campaign, along with the actress, Amanda Redman, who has given fantastic support to our campaign in the House and outside in wider society.
In 2006, my hon. Friend the hon. Member for Dudley, South (Ian Pearson), then a Minister in the Department for Environment, Food and Rural Affairs, wrote to me saying that a review of part G of the building regulations had been undertaken in 2005, although it had not included the TMV issue, but he reassured me that he would consider further the need for regulation to require TMVs at specified water outlets.
In January 2007, my hon. Friend the hon. Member for Basildon (Angela E. Smith) assured us that the Department for Communities and Local Government understood our concerns and wanted to reach a solution. I thought that we had finally persuaded DCLG when in a written ministerial statement in summer 2007 she stated:
“The Government are committed to ensuring that Building Regulations support the safety of hot water systems in the home.”—[Official Report, 21 June 2007; Vol. 461, c. 107WS.]
So I was disappointed when my hon. Friend the Minister, who is responding to the debate, released a written statement in March 2008, indicating that he was not minded to include TMVs in a review and would request further information only from stakeholders.
If we can prove that the cost-benefit analysis can be changed, will the Minister guarantee that he will include TMVs in the current review of part G of the building regulations? Even if the cost-benefit analysis is not conclusive, does he not agree that the costs cannot begin to cover the human costs of a scald? Most people, when asked to put a price on the skin of their child, would first shudder with horror and then say, “My child’s skin is priceless.”
I was disappointed when this measure was not included in the consultation. The published impact assessment, which I have with me today, claims that the costs of TMVs far outweigh the benefits. That contradicts the other cost-benefit analyses carried out in Scotland, which I also have in front of me, in Australia and in the United States, where studies have proved the efficacy of TMVs.
I understand the rationale for producing an impact assessment and I am aware that officials from the Minister’s Department have worked hard to produce an accurate report. I pay tribute to the work that has gone into this report; it is a thoughtful, meaty and considered document. However, even those officials would admit that it is difficult to apportion costs to the treatment of scalds. The impact assessment is written in a way that invites comments and I have comments to make. The report notes that, where calculations have been made in reference to surgical costs,
“it is anticipated that this can be verified by information provided during the public consultation”.
I get the feeling that the Department would like us to make the economic case for it. We are, of course, delighted to help it with its calculations. We are in a position to challenge some of the assessment’s key assumptions and to alter significantly the balance between cost and benefit.
Let us examine what have been described as the costs to the economy of reducing the number of children and elderly people scalded. The impact assessment established an annual average cost of £10 million a year, or £82 million in net present value terms over 10 years. Our industry partners in the “Hot Water Burns Like Fire” campaign agree broadly that the £40 cost quoted in the report for a TMV is correct. However, the impact assessment does not provide for the cost reductions that would be afforded by increased production of TMVs and greater competition if the regulation were changed.
I have been contacted by several firms that produce the devices. For reasons of commercial confidentiality, I shall not name the companies involved, but some have conducted detailed research into the likely reduction in cost of TMVs if the sales volume were to increase significantly. The industry believes that cost reductions of more than 30 per cent. are possible, and probably more when the market is commoditised and margins are squeezed. The cost could fall from £40 per TMV to £30, or maybe even £28 or £25.
Although the effect would not be immediate—it would not happen on day one after the law was changed—we believe that the costs quoted in the impact assessment could be reduced by more than £20 million, to less than £60 million over the 10-year period for which net present value is measured. I acknowledge that the house building industry is entering a difficult time, but despite that, an estimated 223,000 new homes will be built this year, at a very conservatively estimated cost of £2.5 billion. The £10 million-a-year cost would be absorbed by house builders, reflecting a less than 0.5 per cent. increase in the cost to them of building a house. That is a tiny amount of money.
The other part of the impact assessment that we believe is easy to challenge involves the costs associated with treating those dreadful injuries—costs that would no longer have to be borne by the NHS and the individual. At the moment, the costs to the NHS are economic, but the costs to the individual are social and environmental. As I said, I have a great deal of respect for the officials who prepared the impact assessment, but it is difficult for lay people to estimate the cost impact of scalds. Even the medical professionals with whom we have worked cannot attach a definite cost to complicated treatments. Scalds can include several skin grafts, repeated consultations and the application of medicines and creams for the rest of the patient’s life. The impact assessment considers only the immediate cost of treatment and perhaps the cost for the next six months, during the acute phase. However, most scald victims are under five, and thus require operations throughout their growing years, as skin grafts cannot grow and stretch like normal skin and the grafts must be repeated.
The good news for victims is that far fewer procedures are needed than in the past. However, we estimate an average of three substantial operative procedures over a 15 to 16-year period until the individual stops growing, each with a median in-patient stay of five days. That does not include at least one out-patient attendance a
year for 13 to 15 years, nor the cost of more frequent out-patient attendances or pressure garments in the first two years. Those are substantial extra costs. A conservative cost range is £15,000 to £20,000 for the average patient, but in severe cases, it could be as high as £50,000. That is a conservative calculation of the medical costs not included in the document.
The other significant cost not covered involves the possibility of quality adjusted life years, which measure the burden of a condition according to the quality and quantity of life lived as a means of quantifying the benefit of a medical intervention. Burn and scald victims suffer some loss of dexterity that limits activities, as well as varying degrees of pain, dependence on others for some personal care and the need to apply creams and dressings for the rest of their years. Our early estimates indicate a possible cost of as much as £150,000 in reduction of quality of life in the severest cases, and of £60,000 for an average patient. Those costs are not included in the impact assessment.
Other costs are not included: the cost to the NHS of scar management techniques such as silicon gel or custom-made face or hand conformers, the cost of disruptions to family life as a result of the need to attend hospital, the costs to families of transport to and from regional burn units or outreach clinics and, of course, the loss of earnings by family members who need to take time off work. Those are significant costs to the economy that have not been considered, and we believe that those extra medical and quality of life costs should be included. If they are, we can demonstrate much greater benefits to the NHS than are currently identified in the impact assessment.
I am happy to put all that I have said in writing, in detail, in a formal response to the consultation, before the 3 August deadline. We are keen to work with Department officials in formulating our response and to ensure that it will be formulated in the same format as is used by officials. I ask the Minister to ensure, therefore, that we will be provided with the spreadsheet that officials use to model the costs and benefits, so that we can do that.
At the moment the issues come down to the fact that children pay the price of non-installation of the valves in houses. They pay in pain and suffering and the impact on the whole family. When we consider an impact assessment we are considering what society is willing to pay to prevent such a terrible injury. There is a moral case too—it is not just an economic case—about what society will pay to protect children and keep them safe in the home.
This is child safety week. I urge the Minister to make it a landmark for child safety in England, Wales and Northern Ireland, and to consider option 5A—the option for making TMVs compulsory on baths in all new dwellings, conversions and refurbished bathrooms. I want to be able to go back to Wakefield in the summer and tell Holly Davenport that her courage in coming to the House and speaking to MPs about her injuries was worth it; that together we made a little difference; that the Minister listened and is now finally ready to act.
Miss Anne Begg (in the Chair): I call the hon. Member for Somerton and Frome (Mr. Heath) and ask him to speak very briefly.
12.51 pm
Mr. David Heath (Somerton and Frome) (LD): I simply want to say that I am grateful to the hon. Member for Wakefield (Mary Creagh) and congratulate her on the single-minded way in which she has pursued her campaign for years. I had a constituent who had a similar experience to what the hon. Lady described; Mrs. Leanne Seers lives in Barrington in my constituency and very sadly her 18-month old baby girl Katelyn fell into a hot bath, was badly scalded and died four days later in Frenchay hospital. Mrs. Seers brought home to me the need for action of the kind that the hon. Lady has outlined. I wrote to the Minister repeatedly and had a reply in June last year from the hon. Member for Basildon (Angela E. Smith), when she was the Under-Secretary, which said:
“The Government is well aware of the problem of scalding amongst young children and I agree with Ms Seers that the Government has to take action on this issue.”
“Recent tragic events involving injuries caused by hot water that have affected young children have persuaded me that this should be brought forward and there should be a further review of Part G that will give particular attention to all aspects of hot water safety.”
I simply feel that the time has come now for action on the basis of those assurances from Ministers, and I hope that that is what the Minister will tell us is happening.
12.53 pm
The Parliamentary Under-Secretary of State for Communities and Local Government (Mr. Iain Wright): It is an honour to serve under your chairmanship, Miss Begg. I congratulate my hon. Friend the Member for Wakefield (Mary Creagh) on securing the debate. As we have heard, it relates to an important issue which, unfortunately, as my hon. Friend has detailed, can drastically affect many people, including young children and their families and friends.
As a father of four children, I was filled with horror at the experiences that my hon. Friend has mentioned today, of Holly Devonport and others. I thank my hon. Friend for her kind words about my promotion. I am sure someone somewhere will shortly see sense and have me relegated, but, to make a serious point, I am determined in my time in this post to address the points on which my hon. Friend has so ably campaigned for several years, and sort the matter out to her satisfaction and the satisfaction of the people who campaign with her. I commend her passion and the vigour and hard work by which, from her ten-minute Bill onwards, she has kept the matter a high-profile one, which has ensured that her work with key stakeholders such as the “Hot Water Burns Like Fire” campaign is recognised by the Prime Minister and throughout Whitehall.
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