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15 Dec 2009 : Column 235WH—continued
1.17 pm
The Minister of State, Department of Health (Gillian Merron): I congratulate my hon. Friend the Member for Vale of Clwyd (Chris Ruane) on securing this important debate, and on his campaigning on a crucial issue. I have listened closely and I am happy to respond to points that he raised, but I would like first to give some helpful context. I shall of course write to my hon. Friend on any matters that I do not get a chance to discuss. As always, I should be happy to arrange a meeting with him.
The context is the debate about stem cells, of which bone marrow is one source. Donation of bone marrow and other stem cell sources in the UK is managed by NHS Blood and Transplant. The NHS works closely with important partners such as the Anthony Nolan Trust. There are three bone marrow registries in the UK, which are monitored by clinical experts at NHSBT. Combined, they are the third largest registry in the world, and consist of the British Bone Marrow Registry, which is operated by the National Blood Service and includes services for Scotland and Northern Ireland; the Welsh Bone Marrow Donor Registry; and the Anthony Nolan Trust bone marrow registry, which holds the records of 400,000 donors.
Blood donation is of course an integral part of the work to identify bone marrow donors. The UK has an international reputation for work in that area. It is worth saying, in response to some of the points that my hon. Friend raised, that the registers form part of a network, via the organisation Bone Marrow Donors Worldwide. It provides search access to more than 13 million donors and cord blood units worldwide. The registers in the UK do not stand alone, but are part of a wider picture. The Government have a very proud record of working closely with charities, volunteer bodies and individuals, including on targeted campaigning and collection programmes. In October, we helped to fund an international event on the benefits of cord blood for transplant patients. On the same day the event took place, I opened the NHS cord blood bank's newest collection site at St. George's hospital, in Tooting. For me, the opening was testimony to the value of the Government's investment in research into life-threatening conditions.
As with all NHSBT's cord blood collection sites, St. George's was chosen because it serves families of a diverse multicultural mix. I was struck by how such a simple procedure could provide such a valuable resource. As my hon. Friend acknowledged, it adds an essential contribution to the work of supplying the NHS with stem cells for transplant. It saves lives, and it makes an important difference to families affected by blood disorders such as leukaemia. That is why, like my hon. Friend, I am determined to facilitate and promote discussion and debate on the way forward for the harvesting and use of stem cells for transplant.
I pay tribute to everyone who works to improve awareness and education, including those named by my hon. Friend. I also pay tribute to organisations such as the Anthony Nolan Trust and NHSBT. I look forward to seeing the greater results of closer working together in the future.
Donors for the British and Welsh registries are identified through the national blood donor programme, operated by NHSBT. The Anthony Nolan Trust also campaigns to promote donor registration. Indeed, I registered as a donor more than 20 years ago. All campaigns share the goal of raising awareness of the importance of donation and what it can mean for the lives of others.
I agree with my hon. Friend that it is vital that the message is heard by the young. They are indeed the donors of tomorrow. To help with that, the NHS has developed initiatives such as the "Give and Let Live" education campaign, designed to raise awareness among 14 to 16-year-olds. The campaign has been made available to 6,000 schools in the UK. "Register and be a Lifesaver", an initiative backed by the Anthony Nolan Trust, is campaigning for better education among young people. The Department of Health helped to fund a pilot programme, which was run by NHSBT.
Those campaigns came about following the death from leukaemia of Jeanette Crizzle and Adrian Sudbury. Both cases were tragic examples of how difficult it can be to provide treatment to all who need it. In Adrian's case, it was the rareness of the condition that proved an insurmountable hurdle. For Jeanette, the challenge was the richness of her genetic heritage.
That brings me to the question of matched donors and ethnic minorities. When treating acute blood disorders, it is important that the stem cell units come from a matched donor, usually a brother or sister. Unfortunately, only 25 to 35 per cent. of patients have a matched sibling. That means having to rely on unrelated donors. Finding a donor who is genetically matched, healthy and willing to donate is a mixture of hard work, professional dedication and chance. It is a mammoth task.
The task becomes even harder when the patient's genetic background is complex. Currently, most of the 13 million donors worldwide come from a Caucasian background. Patients from that group have a 90 per cent. chance of finding a matched unrelated donor. However, for patients from ethnic minorities or with a mixed genetic inheritance, the chance of finding a match is only 30 to 40 per cent. That is why I was so proud to open the new centre in Tooting, as it is making a direct contribution to dealing with the problem.
On the question of other sources of stem cells such as cord blood, the Government have taken and are continuing to take strategic and targeted action to tackle the challenge. As I said earlier, it is important to remember that bone marrow is not the only source of stem cells for transplant. Umbilical cord blood is an excellent source of stem cells, and has some clinical advantages over bone marrow.
The NHS cord blood bank is the fourth biggest in the world, with about 14,000 stored umbilical cord blood units. The Government are investing nearly £10 million in order to increase the size of the bank to 20,000 stored units by 2013. The cord blood bank aims to redress the imbalance on bone marrow registries by focusing collection at hospitals with catchment areas that are more ethnically diverse.
My hon. Friend asked about cord blood being discarded. I shall put that into context. In the UK, about 50 per cent. of the samples collected are discarded, but that is due to such things as contamination, infection or low cell counts. It compares favourably with the discarding rate in Spain, for instance, which is about 70 per cent.
The NHS cord blood bank has one of the best records of harvesting and banking cord blood in the world, and its inventory of unique tissue types is second to none. So far, about 280 units of cord blood have been issued, mostly for export. The number increases year on year, because medical advances mean that cord blood can be used to treat a wider range of patients. Just as cord blood collected in the UK can be used to find matches for patients overseas, so we are able to draw on international cord blood banks to find matches for patients here.
I know that my hon. Friend understands the need to look to the future-a time when cord blood may become even more important. A review commissioned by the Department of Health last year recommended further consideration of the collection and use of cord blood, and a joined-up approach to service provision. I assure my hon. Friend that since then discussions have been held with a range of partners on the collection, storage, commissioning and use of stem cells for transplant.
I know that my hon. Friend is interested in the question of swabs versus blood tests. I look forward to receiving the pack that he has promised me. I welcome the pilot that the Anthony Nolan Trust is running. I confirm that the NHS identifies donors through the blood donor programme. Using buccal or saliva swabs would, in the view of clinicians, add another unnecessary layer of testing, without an overall cost or clinical benefit. Blood samples are more efficient and give us more genetic material to work with.
The cost of the tissue typing is the same whether the DNA used is extracted from swabs or from blood. Although the quantity of DNA isolated from swabs is sufficient for the initial tissue testing, it does not give enough DNA to perform additional tests, such as confirmatory or high-resolution typing, which are normally requested by the transplant centres and are required prior to transplant. Additionally, transplant centres sometimes request DNA samples for repeated confirmatory tests. I remain interested in the Anthony Nolan Trust pilot.
My hon. Friend suggested that the UK was underperforming in some way. That is not a description that I recognise. We are the fourth largest in the world for cord banks; we have the second highest number of human leukocyte antigen unique samples stored; we have the second biggest registered cord blood bank after New York; and we have an excellent reputation in science. However, we can always do more, and we will continue to do so.
My hon. Friend also mentioned age limits. I confirm that the NHS recruits donors between the ages of 18 and 49. Donors remain on the registry until the age of 60. The other registries in the UK have lower age limits. Given the number of questions raised as a result of today's debate, I have asked officials to open discussions about bringing age limits in the UK into line with those of the NHS. The decision, of course, will be a matter for the registries themselves.
I thank my hon. Friend for his contribution and for his immense interest in what I believe is an important matter. I join him in wanting to ensure that the UK remains at the forefront of this work, and that we are able to meet our obligations in matching stem cell donations to patients in need of a transplant.
Fire Safety (Rented Accommodation)
1.30 pm
Mr. Adrian Sanders (Torbay) (LD): I wish to declare an interest, as the part-owner of two properties that are currently rented out.
Let me start by praising the measures that have improved fire safety in residential properties over the past 20 years. More than 80 per cent. of homes now have smoke alarms compared with 9 per cent. in 1987, and fire deaths halved from 1988 to 2008. Many fire authorities have carried out sterling work in increasing public awareness of not only the need to have working smoke alarms but a range of other fire safety measures.
I pay tribute to the Devon and Somerset fire and rescue service, which has worked hard on a range of prevention measures. Following a serious fire in my constituency, the authority installed more than 1,200 new smoke alarms in just two months. Building regulations currently dictate that new-build extensions and alterations should be equipped with hard-wired smoke and fire alarms. Furniture regulations also play their part in reducing the number of avoidable domestic fires, or lessening their impact, and Government have wisely invested in an effective publicity scheme. All those measures have had the impact of reducing fire deaths and increasing the number of working smoke alarms across the country.
Figures clearly show that as awareness about fire safety increases, deaths and injuries decrease, yet casualties and preventable fires continue. We have seen a number of tragic fire deaths in recent months, quite often involving rented properties. The figures speak for themselves. In 2007, there were 331 deaths from fire. Of those, 222-or two thirds-occurred in places in which there was no working smoke alarm. In 137 cases, there was no detection system at all. Is it not possible to argue that a working smoke alarm could have saved one of those 222 lives or helped to prevent one of the 9,066 non-fatal casualties from that year?
There are gaps in the regulations governing fire prevention. Outside houses in multiple occupation, it is only guidance or good practice that governs the provision of smoke and fire detection. The majority of landlords in the private and social sectors ensure that smoke alarms are available, which not only provides safety and reassurance for tenants, but is in the interests of landlords. However, a minority of rented homes do not have smoke alarms and they may well house some of the most vulnerable members of society. There is something of a correlation between the propensity to fire and the lack of fire safety devices. The Association of British Insurers highlighted that in 2001, 81 per cent. of homes had smoke alarms, but fewer than 60 per cent. of homes suffering fires had alarms.
Promoting voluntary good practice among landlords has been very positive. The number of landlords becoming accredited is increasing and that reassures tenants not only that their property is relatively safer, but that their landlord appreciates their duty of care to them. Sadly, the majority of private-sector landlords do not join landlord associations in which best practice can be shared and standards raised. The good landlords pay a heavy price in reputation for the actions of the bad.
Social housing providers also need to ensure that they are working to best practice. When a recent house
fire in my constituency highlighted the issue of fire safety, it was found that around a quarter of the properties of Riviera housing trust had no smoke alarm. Much to its credit, the association has now pledged to ensure that all properties have working smoke alarms by March 2010. Nevertheless, Government guidelines are clearly lacking if a housing association can provide a service to vulnerable people without needing to ensure safety from fire.
The key word here is "guidelines". The Housing Health and Safety Rating System highlights 29 factors that may be taken into consideration by local authorities when assessing risks to all residential properties. If fire is seen as a category 1 hazard, enforcement action can be taken. Other guidance documents over recent years have stressed the importance of smoke alarms, but local authorities are free to do as little as they wish.
A number of cases have highlighted the need for better regulation. At a recent inquest into a fatal fire in Yarcombe near Honiton in Devon, the coroner resolved to contact Ministers from the Department for Communities and Local Government to urge them to review whether smoke detection could be mandatory in rented domestic dwellings.
Earlier this year there were fire deaths in two incidents in Northumberland; at Ashington and Bedlington.
Chris Ruane (Vale of Clwyd) (Lab): Will the hon. Gentleman join me in congratulating 16-year-old Shannon Yates from Rhyl who, on Sunday night, risked life and limb to break into a neighbour's property to rescue a man who had succumbed to smoke? Does he also agree that the types of residence that are most vulnerable to fire are houses of multiple occupation, and still more needs to be done to ensure that landlords install smoke alarms?
Mr. Jim Hood (in the Chair): Order. Interventions should be shorter than that.
Mr. Sanders: I am more than happy to congratulate the young lady on her spirited civil action. The hon. Gentleman is right when he says that houses of multiple occupation have been identified as most at risk, which is why they already come under statutory legislation. My point today is that we need to extend that legislation to all housing.
In September, an elderly woman died in a fire in Porlock, Somerset. Again the fire authority found no smoke alarms. Indeed, fire officers have told me that they have never attended a fatal fire where working smoke alarms have been present. The number of cases reported in the local press of smoke alarms saving families from death and/or injury is significant. There should be a straightforward solution to the problem.
In 2004, the Office of the Deputy Prime Minister Select Committee, of which I was then a member, produced its report on the fire service with the following recommendation:
"We believe that functioning smoke alarms save lives and reduce injuries. The Committee congratulates those Fire Services which operate initiatives to fit free smoke alarms for the vulnerable. We welcome the requirement for alarms to be hard-wired in alterations, extensions and new buildings. We recommend this requirement be extended to include all existing tenanted properties, housing of multiple occupation and housing for vulnerable members
of society. If the design of such buildings makes installation of hard-wired alarms impossible, we recommend use of alarms fitted with 10 year batteries."
As those recommendations were not adopted, I feel that it is time to review the matter. Moreover, I should like to stress one further point in the recommendation and that is the hard-wired nature of smoke alarms. Many landlords in both private and social sectors rely on battery-powered alarms to serve as safety devices. Although they are good and far better than having no detection devices at all, they throw up some problems. They are not always as accurate as mains connected systems, and over-sensitive alarms can easily be turned off by disgruntled tenants having to hear an alarm every time they toast a piece of bread. Furthermore, such alarms require regular testing, and with vulnerable tenants that is not always something that can be devolved to personal responsibility.
A more serious issue is that of failure to trigger. Figures show that since 1997 the failure rate of mains-linked smoke alarms has been between 9 and 13 per cent. That compares rather starkly to the failure rates of 37 to 44 per cent. for battery-operated smoke alarms. The majority of the latter cases are due to flat or absent batteries. That is not to say that smoke alarms are the only solution; we need to explore issues such as more regular inspections of electrical systems in rented properties and more awareness of how to prevent fires starting in the first place. However, where saving lives and preventing injury from fire is the issue, it seems indisputable that smoke alarms have a significant beneficial effect. Making smoke detectors compulsory in all rented properties has broad support. I have already mentioned the ODPM Select Committee report. Early-day motion 263, which endorses mandatory detectors, has cross-party support.
I must also register my thanks to the hon. Member for Epsom and Ewell (Chris Grayling) for pledging his support to the cause in my local newspaper. Sir Jeremy Beecham, the then chair of the Local Government Association, also spoke in favour of compulsory smoke detectors in 2003. Landlords have a duty of care to ensure that gas systems are kept in good order-they even need an energy performance certificate-so why do we not ensure that all landlords provide adequate protection from fire? For the majority of landlords, such a requirement would not make any difference as they already fulfil all the guidelines. However, for tens of thousands of existing tenants and future tenants, it could provide considerable reassurance and, more importantly, save dozens of lives every year.
It is good progress that new dwellings are guaranteed a good standard of fire detection and warning, but it is fundamentally important that that protection is extended to those people who live in older properties and that guidelines should be turned into a necessity.
Research carried out earlier this year for the Australian Fire and Emergency Authorities Council showed that just less than a third of countries across the developed and developing worlds have legislation in place to make smoke alarms mandatory. So it is not an unusual or draconian law to consider introducing. As the deputy chief fire officer of the Devon and Somerset fire and rescue service has said on this issue:
"Some of our most vulnerable people are affected by this gap in the law."
We know that fire death rates are higher for the over-80s than for any other group.
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