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that the House of Commons urges the Secretary of State for Communities and Local Government to do all in his power to oppose the building of this hazardous waste gasification and incineration plant and ensure that this proposed technology is not given permission to destroy a whole area of Chesterfield and North East Derbyshire.
Following is the full text of the petition:
[The Petition of residents of Dronfield, and others
Declares that a hazardous waste gasification/incineration plant is proposed to be built on the site of Sheepridge Business Park, only a few miles away from Dronfield; further declares that the technology proposed by the newly established company is untested and unproven; notes that there are no long term case studies on the health effects of these processes, while every day more and more evidence is coming to light of the harmful effects of airborne pollution from industry and traffic;
Believes that the site is too close to residents, with 19 schools and around 30,000 people living within just two miles of the proposed site; further notes that the site is in close proximity to many farms, livestock, fisheries and allotments, meaning there is a real danger of dioxins entering the local food chain; further notes that the site is bordered by greenbelt land and protected woodland, threatening the devastation of all the wildlife in the area and risking further contamination of the watercourses and food chain from the movement of wildlife in and around the site; further declares that the site is close to existing businesses that will move away, leading to hundreds of job losses and difficulties attracting any future investment;
Further notes that the waste, coming from a 30 mile radius, will need to travel past many schools, through small villages and country lanes to reach the proposed site; believes this is unsafe, unnecessary and unacceptable; further declares that residents have not been reassured by communications from Cyclamax, and do not trust the company to be running such a hazardous process; and considers that profit and money-making are being put before public health and safety.
The Petitioners therefore request that the House of Commons urges the Secretary of State for Communities and Local Government to do all in his power to oppose the building of this hazardous waste gasification and incineration plant and ensure that this proposed technology is not given permission to destroy a whole area of Chesterfield and North East Derbyshire.
And the Petitioners remain, etc. ]
Equitable Life (Meriden)
7.3 pm
Mrs. Caroline Spelman (Meriden) (Con):
I wish to present a petition from residents of my constituency,
who are members, former members or the personal representatives of deceased members of the Equitable Life Assurance Society. I have been handed 61 signatures in support of the petition, and, Madam Deputy Speaker, you are probably aware that more than 400 former members and members of Equitable Life attended a rally at Parliament today.
that the House of Commons urges the Government to uphold the constitutional standing of the Parliamentary Ombudsman by complying with the findings and recommendations of her Report upon Equitable Life and to act quickly so that policyholders receive the justice that they have so long been denied.
I stand in support of this petition and present it to the House.
Following is the full text of the petition:
[ The Petition of residents of the constituency of Meriden in the West Midlands,
Declares that the petitioners either are or they represent or support members, former members or personal representatives of deceased members of the Equitable Life Assurance Society who have suffered maladministration leading to injustice, as found by the Parliamentary Ombudsman in her report upon Equitable Life, ordered by the House of Commons to be printed on 16 July 2008 and bearing reference number HC 815; and further declares that the petitioners or those whom they represent or support have suffered regulatory failure on the part of the public bodies responsible from the year 1992 onwards, but have not received compensation for the resulting losses.
The Petitioners therefore request that the House of Commons urges the Government to uphold the constitutional standing of the Parliamentary Ombudsman by complying with the findings and recommendations of her Report upon Equitable Life and to act quickly so that policyholders receive the justice that they have so long been denied .
And the Petitioners remain, etc. ]
Scallop Dredging, Cardigan Bay
7.4 pm
Mark Williams (Ceredigion) (LD): I have a petition of 2,200 signatures on behalf of the Save Our Sea group based in the Ceredigion constituency.
The Petition of people of Ceredigion,
Declares that dredging of the sea bed has been banned and restricted in several areas of the marine environment due to the proven damage that can be caused by intensive and large-scale dredging; further declares that the increased use of dredges in Cardigan Bay has potentially caused severe damage to the marine environment and the habitats of the creatures living there.
The Petitioners therefore request that the House of Commons urges the Government to take all possible steps to encourage the Welsh Assembly Government to limit the number of scallop dredging boats licensed to dredge for scallops in Cardigan Bay, based on scientific assessments to be carried out while an interim ban is in place.
And the Petitioners remain, etc.
Pernicious Anaemia
Motion made, and Question proposed, That this House do now adjourn. -(Mr. McAvoy.)
7.5 pm
Mrs. Madeleine Moon (Bridgend) (Lab): I thank Mr. Speaker for giving me the opportunity to hold this debate.
I am grateful to the Pernicious Anaemia Society for its help in preparing the debate. This small but ambitious charity is based in my constituency and has members throughout the world who are working to bring attention to this common but often misunderstood condition.
First, I should like to say a few words about pernicious anaemia, its causes and consequences. The condition is caused by a lack of vitamin B12. Vitamin B12 cannot be produced or stored in the body, and deficiency is caused by a failure to absorb vitamin B12 from the diet. Vitamin B12 is vital for the manufacture of new red blood cells. When it is in short supply, red blood cells are produced in smaller numbers, are abnormally large in size-megaloblastic-and do not last as long as they should; and anaemia develops. While the peak incidence of pernicious anaemia occurs within the 60-plus demographic, it can afflict anyone at any age.
The condition has physiological and mental symptoms. Common physical symptoms include tiredness, fatigue or lethargy; a shortage of breath known as "the sighs"; a swollen tongue and feeling bloated; brittle, easily damaged nails; pins and needles; unaccountable sudden diarrhoea; and an increased sensitivity to sound, scent and taste. Common mental symptoms include "the fogs"-a lack of clarity and focus in everything the sufferer experiences-and irritability, impatience and, often, mood swings. In addition, when vitamin B12 is low, the cells of the nervous and digestive systems may be affected. Undiagnosed or untreated, the condition can lead to damage to the central and peripheral nervous systems with separate symptoms and consequences in itself such as numbness in the limbs, especially the legs; vertigo; balance problems; inability to concentrate; and confusion or forgetfulness.
The most common reason why pernicious anaemia sufferers develop nerve damage is that its insidious nature, coupled with its vague symptoms, can often lead to a late diagnosis. Consequently, nerve damage has often occurred before pernicious anaemia has been diagnosed. The severity of the symptoms depends on how much damage has been done to the central nervous system. Balance problems can make everyday tasks such as showering, dressing and walking a challenge.
It is possible that these symptoms are irreversible, so diagnosis of pernicious anaemia needs to be quick and accurate. However, there are problems with its timely and accurate diagnosis. The disease shares common symptoms with a number of other conditions, and the fact that there is no single definitive test can often mean that a diagnosis is delayed. Many sufferers are misdiagnosed with conditions such as depression, multiple sclerosis, myalgic encephalomyelitis or chronic fatigue syndrome, or with being totally well but feeling unwell.
For some sufferers, a simple blood test can diagnose anaemia and an examination of the red blood cells can determine whether they are larger than normal. If this
is the case, a Schilling test, which measures the body's ability to absorb vitamin B12 from the bowel, can determine whether it is pernicious anaemia. However, the Schilling test is no longer widely available. For most people on a normal diet, especially the elderly, a Schilling test is not thought necessary. Instead, a blood test is done to measure levels of vitamin B12. If the levels are low, pernicious anaemia is presumed and treatment started. However, the testing regime is not sufficient for the diagnosis of all patients with pernicious anaemia.
Typically, vitamin B12 deficiency is suspected when an individual presents with megaloblastic anaemia. However, that may occur only in the most severely vitamin B12-depleted individuals. As the Schilling test is no longer widely available, and the other main diagnostic signposts of low levels of serum B12 cannot be relied upon, sufferers can have high levels of serum B12 and still have pernicious anaemia.
The intrinsic factor antibody test, which is used to determine whether the patient is able to absorb intrinsic factor B12 from food, is only about 30 per cent. accurate. A better method of determining whether a patient is B12-deficient is based on their active B12 level, because only active B12 plays a part in the complex biochemistry. If a patient's active B12 level is low, he or she will still have the symptoms of pernicious anaemia even though the total level of B12 will be above the lower threshold for determining deficiency. There is a newly developed test that takes that into account and is widely used in Australia and Germany. Many people there who were not previously considered to be B12-deficient now receive B12 injections, with considerable improvement to their quality of life.
As well as difficulties in diagnosis, there are a number of other issues of concern to sufferers. Pernicious anaemia is treated in this country with injections of hydroxocobalamin, a form of vitamin B12. Patients receive three injections a week for the first two weeks, then one every three months for the rest of their life. More frequent regimes may be used in sufferers who have been diagnosed late and have neurological damage.
The main concern for sufferers is that the UK practice limits patients to an injection every three months, which is not sufficient. In the 1960s the treatment was an intramuscular injection every month. That changed to one every two months in the 1970s and one every three months in the 1980s. The Pernicious Anaemia Society cannot find any evidence that those changes to the prescription were related to new clinical research.
People with pernicious anaemia have widely different needs and respond differently to treatment. For some, an injection every three months is adequate, but for others, weekly or even daily injections may be required. In the UK, however, GPs on the whole stick to the three-monthly injections and feel that they are adequate. They generally refuse to allow more frequent injections. That means that sufferers often find themselves looking elsewhere for more regular sources of B12.
In the UK, vitamin B12 in injectable form is available only on prescription, under the Medicines Act 1968. It is, however, available over the counter in most European countries and readily available using the internet. Many people with pernicious anaemia travel abroad to get top-up injections or order infusions over the internet. That situation is far from ideal, and I know that my hon. Friend the Minister will be horrified to learn about
it. It is also extremely expensive and fraught with danger. I am sure that I am not alone in feeling uncomfortable with people ordering any medication over the internet.
Many people with pernicious anaemia also seek help from the private sector, from which B12 infusions can be bought. The form of B12 used is methylcobalimin, an extremely pure form of the vitamin that can be injected straight into the bloodstream. The patient can self-inject using the same needles used by diabetics. Many sufferers claim that if they return to their doctor to request an additional dose of B12, they are offered antidepressants. However, B12 is a harmless vitamin with no side effects, and it is cheaper than antidepressants. The PAS argues that allowing sufferers to self-inject using insulin needles would free up valuable nursing time, saving money from the NHS budget, and provide patients with a treatment regime based on need. It calculates that £20 million a year could be saved in nursing time by allowing patients to self-inject.
The PAS recently presented a petition to the Department of Health via the No. 10 e-petition system, highlighting the problems faced by people with the condition. In its response, the Department acknowledged:
"Too often, people with long-term chronic conditions have been made to fit themselves into the way care is provided locally, regardless of whether that meets their individual needs."
"Our changes to the NHS aim to deliver the right services where they are needed, working with all involved agencies to provide a seamless package of care."
People with pernicious anaemia are being made to fit in with a treatment that is imposed from the top down. The national service framework for long-term conditions, launched in March 2005, focuses on improving services for people with long-term conditions across England. It states that comprehensive assessment and regular reviews of people's problems should be held and that self-referral would allow people to refer themselves quickly back to services as their care needs change. However, that has not materialised for people with pernicious anaemia.
There are a number of ways that the Department of Health could improve the care provided to sufferers of pernicious anaemia, and a review of the disease's symptoms, diagnoses and treatment is needed. The current treatment regime would benefit from a review relating to its efficacy and cost-effectiveness. Modern, self-administered treatment regimes that are available should be evaluated to save medical staff time and to provide a more efficient treatment regime based on patients' needs.
The misdiagnosis of pernicious anaemia could be reduced by launching an education campaign for general practitioners. It should also be made clear that the current three-monthly injection cycle may not address the needs of every patient and that it should be more flexible. Any review could include a study investigating the feasibility of a return to the monthly dose, which was successfully administered with no side effect to a generation of sufferers in the 1960s.
The review should consider the type of B12 that could be used. Methylcobalamin, which is used in the private sector, is a purer form of B12 that absorbs in the body with better results. The PAS would like sufferers who have a more severe form of pernicious anaemia to have the option of self-injecting daily doses of B12
methylcobalamin. Monitoring such a regime would reveal whether it could be a modern way forward, in which patients can opt for a treatment style that is similar to diabetic provision. It would be helpful if the Department could support the creation of a charity helpline for sufferers, compile the statistics of current misdiagnosis and create a referral service so that sufferers can find the correct medical attention quickly.
The disease affects people in all right hon. and hon. Members' constituencies. An early-day motion highlighting many of the issues raised, tabled by my hon. Friend the Member for Bristol, North-West (Dr. Naysmith), has received 73 signatures. I hope the Department considers acting on many of the issues that I have raised this evening. I also hope that it will agree to a future meeting of officials and members of the PAS, so that their concerns can be adequately addressed.
7.18 pm
The Parliamentary Under-Secretary of State for Health (Ann Keen): May I congratulate my hon. Friend the Member for Bridgend (Mrs. Moon) on securing this debate, which is of course on an important subject? Her constituency has the honour of having the PAS in it, and I am aware of her work with society. She has taken a very close interest in pernicious anaemia and has previously tabled questions on behalf of patients who have that distressing condition.
As my hon. Friend has so eloquently described the condition, I will not go into the details again, but there are some rarer causes of vitamin B12 deficiency. The root cause of pernicious anaemia, however, is the deficiency of B12 due to the lack of what is known as the "intrinsic factor" needed for its absorption.
The inability to absorb vitamin B12 orally means that treatment in an injectable form is required, and because the lack of the intrinsic factor cannot be reversed, treatment must be continued for life. That is to avoid the problems associated with uncorrected anaemia as well as the possibility of damage to the central nervous system that can result from prolonged vitamin B12 deficiency.
My hon. Friend mentioned the role of GPs. In common with a wide range of chronic conditions, the diagnosis and treatment of pernicious anaemia is generally best carried out at primary care level. It is for general practitioners to diagnose the condition, arrange for blood tests and prescribe the treatment that they consider most appropriate. General practice and primary care have increasingly showed themselves to be the preferred settings for discussing and deciding on such treatments, and patients' preference has been supported by increased investment by this Government in a wide range of programmes to expand services locally.
I recall my days as a district nurse when I provided this facility locally to one of my patients who was a pig farmer. He was reluctant to come to the surgery, so the district nurse went to the pig farm. In fact, the patient was very reluctant to leave the pigs, so-in true district nurse style-my wellingtons came out of the boot of my car and I performed the service where the patient thought it most appropriate. I then went into the farmhouse to wash my hands and was given a cauliflower for my trouble. I remember those days with great warmth, but the advancement in primary care has made it much more possible for patients with chronic conditions to be treated at home or very close to home.
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