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Of course, the cost must be assessed, but let us know the estimated cost to treat these people. We need some sort of assessment. I have no quarrel with the Department for International Development with which I worked for many years. It is the best department in government. No doubt we shall be called bleeding hearts, Mother Teresa and Albert Schweizer—does anybody remember him? He was my hero when I was at school. The noble Lord, Lord Judd, was so right about the tabloid press. This initially was a reaction to what the tabloid press would say about a stupid government who let people in to use all our health services, and that we are fools to accept it. I am sure that that was the main reason.

Lord Judd: Does the noble Baroness agree that another issue that needs to be looked at when considering how far what is intended by policy makers is pursued on the front line is the perception that all GPs are the same? They read the tabloid press and are influenced by it so that they then approach their patients in the

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context of a tabloid press perception. We have to get it across that the medical profession has a duty to follow through the procedures that Ministers and others lay down. It is not just that the profession has a discretion to do it; it is its job to do it.

Baroness Tonge: The noble Lord is absolutely right and I thank him for his intervention. I repeat that what is decided in the ivory towers of Richmond House is not always what filters through. I have said it many times on issues of management in the NHS. You set up a great scheme and do not realise what the lower echelons do with it. I am not blaming the Minister; I guess I am blaming the system. I think that it was done so that the Government appeared tough and pleased the likes of the Daily Express, the Daily Mail and the Sun.

This is a matter of human rights. I thought we were a country that always cared passionately about human rights. I am not so sure whether we have adhered to that in recent years. I look forward to the review but give due warning that I shall probably bring back my amendments on Report. In the mean time I beg leave to withdraw the amendment.

Amendment 130 withdrawn.

Amendment 131

Moved by Baroness Greengross

131: After Clause 32, insert the following new Clause—

“Patient transport services

It shall be the duty of primary care trusts and hospital trusts to work with passenger transport authorities, unitary authorities and county councils, as appropriate, to co-ordinate the provision of patient transport services provided by primary care trusts and hospital trusts with the provision of other passenger transport within the trusts’ areas.”

Baroness Greengross: This is a non-clinical and very practical amendment. I shall be very brief, because there is one other important amendment to consider tonight. I have tabled the amendment because of concerns that I have been made aware of that an existing failure to co-ordinate transport for patients is both wasting public funds and making travel to and from hospital unnecessarily difficult for many people.

For example, I have been told that 25 per cent of the “did not attends” at Newham Hospital can be attributed to transport problems. This is a problem that will have been distressing for the patients concerned, who may not get another appointment for some time, and it is at an incredible cost to the NHS, which has a statutory duty to provide patient transport. While it is right for patients to have such transport provided, I suggest that it is not sensible for the NHS to be providing this service without any consideration as to whether passenger transport authorities, unitary authorities and county councils might assist in meeting that need, possibly at a much lower cost than that faced by the NHS.



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My amendment seeks to insert a clause requiring primary care trusts and hospital trusts to co-ordinate and co-operate with those other authorities to address this issue. I beg to move.

Baroness Thornton: Amendment 131, tabled by the noble Baroness, Lady Greengross, would place a duty on primary care trusts and hospital trusts to work with passenger transport authorities, unitary authorities, and county councils to co-ordinate patient transport services with the provision of other passenger transport services.

The noble Baroness is absolutely correct that it is vital for the NHS to engage with its local passenger transport authorities and key partners. Providing a health service that is of high quality and is responsive to the needs of the patient lies at the heart of our vision of a modern NHS. Ensuring that people can access those services is part of this aim. I hope that significant steps have already been taken in this area. The Government have introduced a comprehensive policy framework on patient transport services, which clearly sets out the expectation that NHS transport commissioners will work with other transport services when co-ordinating access to healthcare facilities.

Following a public consultation, guidance to PCTs published in August 2007 clearly states that they are responsible for commissioning ambulance services and patient transport services to such extent as the PCT considers necessary. Where necessary, patients with a social need for transport may seek reimbursement, as the noble Baroness will know. Alternatively, they may seek assistance in the form of a Social Fund payment. Patients not receiving a qualifying benefit may be eligible for assistance through the NHS Low Income Scheme.

We remain clear that multi-agency working can lead to more effective, user-focused transport services. For example, the Northwest Regional Centre of Excellence is soon to publish a document presenting examples of good practice on passenger transport. This will show how health organisations and local authorities have worked together across a range of health, transport, education and social care services to ensure that patients are offered the most appropriate transport service that best meets their individual needs. We are committed to supporting the NHS in ensuring that good practice such as this can be spread more widely. That is the core of what we want to do.

There is already a framework in place to support and encourage the NHS to work in partnership with other passenger transport agencies. I hope that the noble Baroness will feel reassured by this brief and rushed answer. As she rightly noted, we have one more amendment to discuss. I hope that she will feel able to withdraw her amendment.

Baroness Greengross: I thank the Minister for that very full reply. I know that there is willingness to pilot such co-operation and co-ordination in some areas, but it is not quite the same as imposing a duty to do so. With that, I shall take this back and think about whether I can take it forward in some way. I beg leave to withdraw the amendment.

Amendment 131 withdrawn.

Amendment 132 not moved.



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Amendment 133

Moved by Lord Morris of Manchester

133: After Clause 32, insert the following new Clause—

“Committee to advise on treatment of haemophilia

(1) The Secretary of State shall by regulations establish a Committee to advise on the treatment of haemophilia in the United Kingdom.

(2) The Committee shall in particular provide advice on—

(a) the selection, procurement and delivery of available therapies for haemophilia patients;

(b) patients accessibility to treatments for haemophilia or any conditions which arise from consequent haemophilia therapy;

(c) the financial and other needs of haemophilia patients.

(3) The membership of the Committee shall include—

(a) specialist haemophilia clinicians;

(b) representatives from the Haemophilia Society;

(c) representatives from the Department of Health;

(d) representatives of haemophilia patients, through nomination by the Haemophilia Society and other bodies working to support the haemophilia community.

(4) The Secretary of State shall consult the Committee before making substantial changes in policy regarding the treatment of haemophilia patients and before introducing legislation which affects them.

(5) Regulations made by the Secretary of State under this section are—

(a) to be made by statutory instrument, and

(b) subject to annulment in pursuance of a resolution of either House of Parliament.”

Lord Morris of Manchester: At last, completion of the Bill’s Committee stage is at hand. For one dread moment, such was the heat generated by the debates on tobacco, I thought that we might all go up in smoke; but mercifully, due not least to the customary fortitude of my noble friend Lady Thornton, we have survived to address now the urgency of the needs of a small community of congenitally disabled people who, in the words from the scriptures, are living in sorrow and acquainted with grief.

I have interests to declare, not pecuniary, as president of the Haemophilia Society and architect of the independent public inquiry, headed so admirably by my noble and learned friend Lord Archer, into NHS-supplied contaminated blood and blood products, some of whose recommendations could be implemented by acceptance of the new clause, either now or on Report, pending fuller debate and further action on its findings as a whole.

I am most deeply grateful to my noble and learned friend and his colleagues in the inquiry team, Dr Norman Jones and Judith Willetts. Their report, exhaustively researched, is one also of excelling integrity and humane concern for arguably the most stricken minority in Britain today. I warmly acknowledge, too, the help of my noble friend Lord Turnberg who, as immediate past president of the Royal College of Physicians, served the inquiry with such skill and commitment until he and his wife Edna were so tragically bereaved.

When I set up the inquiry two years ago, 1,757 haemophilia patients had already died from being infected by their NHS treatment with HIV and/or

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hepatitis C. The death toll has since risen by more than 200, and many more are left terminally ill by what my noble friend Lord Winston, vice-president of the Haemophilia Society, has described as the worst-ever treatment disaster in the history of the National Health Service.

Yet the grievous death toll is not the whole story; the haemophilia community suffers privation at a depth that most other people can barely imagine. I had a letter yesterday from a friend of a haemophilia patient infected with hepatitis C, which described his plight. He is uninsured due to the prohibitive premiums imposed by insurers on people with his condition. He can no longer work full time and his income is in sharp decline. Travel and other costs are becoming too high for him to cope with, and a mortgage deal is out of the question. In the noble tradition of Good Samaritans, the man who wrote to me has himself been helping his friend financially, but now he, too, is facing the loss of full-time employment. This is but one example of the urgency of the need now for purposeful action on the Archer report, of which approval of this new clause would be a clear signal to the haemophilia community that at long last its plight has been recognised at Westminster and in Whitehall.

For parliamentarians, there can be no higher duty than that of ensuring just treatment for those afflicted and bereaved by contaminated and life-threatening medication supplied by the state, and the emphatic backing of the report's recommendations by the mass media as a whole shows how clearly that duty is understood by the people of this country. It was just as clearly understood, too, by my right honourable friend Harriet Harman MP, Deputy Leader of the Labour Party and Leader of the House of Commons, when speaking on 5 March. Already having thanked my noble and learned friend Lord Archer for his “important work”, she told my honourable friend Dr Brian Iddon of her,

on having,

from contaminated NHS blood and blood products. She also made it clear to the House of Commons that:

Thus the Haemophilia Society now looks forward to a positive response to the landmark report that she so fulsomely welcomed.

7.15 pm

There are two other issues to which I must briefly refer. The first is the sombre threat now of a third scourge facing the haemophilia community. I refer to the increasing number of haemophilia patients known by the Department of Health to have received blood from donors who subsequently died of vCJD, and the recently reported case of one hepatitis C-infected patient, a post mortem on whom revealed vCJD in his spleen. I was informed more than once on the authority of the Chief Medical Officer that the risk for recipients of blood donors who subsequently died of vCJD was purely “hypothetical”; but that demonstrably is not the case now.



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Is donated blood currently being screened, or filtered to remove vCJD infection? If it is not, can my noble friend in replying to the debate say what protection is in place to safeguard recipients of donated blood? I understand, and my noble friend will confirm whether it is so, that technology is now available to remove by filter the abnormal prions which are the causative agent of vCJD, and that it has passed EU-wide safety testing and clinical trials as required for its use in the UK. The haemophilia community, like Members on both sides of both Houses of Parliament, are anxious to secure ministerial assurances of urgent and effective action in this policy area, and I look forward to my noble friend’s response to the questions that I have raised.

The other issue to which I must finally refer is that of Crown immunity, which the Archer report raises in commenting on the behaviour of the Blood Products Laboratory (BPL). The report says:

“In July 1979, the Medicines Inspectorate visited BPL. They reported that the buildings were never designed for the scale of production envisaged. They commented: ‘If this were a commercial operation we would have no hesitation in recommending that manufacture should cease until the facility was upgraded to a minimum acceptable level’”.

The report then says:

“BPL was rescued by Crown Immunity”,

and goes on to say that,

Surely, words have lost their meaning if this does not mean that by the use of Crown immunity, a relic of feudal England, the lives of countless haemophilia patients were blatantly and gravely put at risk.

In this House on 10 March, the noble Lord, Lord Darzi, responding to me in exchanges about thalidomide, referred to,

There could be no clearer text for describing the enormity of the use by the BPL of Crown immunity to dispense with all the requirements of that renowned and vital statute. I beg to move.

Baroness Campbell of Surbiton: I welcome and support this excellent amendment tabled by the noble Lord, Lord Morris. It is late, so I will attempt to get my words out quickly. The noble Lord, Lord Morris, has been a vigilant campaigner on behalf of people with haemophilia, especially those affected by contaminated blood products. He is to be applauded for calling the independent public inquiry chaired by the noble and learned Lord, Lord Archer, which reported last month.

I declare an interest: my first husband, Graham Ingleson, and his brother, Anthony, died as a result of receiving contaminated factor VIII blood products. Graham was 34 years old when he died and, at the same age, I became a widow. The scandalously slow reaction by previous Governments to safeguard blood products imported from the United States meant that

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we failed to protect nearly 5,000 people who died or are now living with HIV/AIDS, hepatitis C or, now, CJD.

The amendment proposes establishing a committee that will go some way to righting a great wrong which was done to those people. It is not a big initiative—it is just a committee—which would be a small, uncostly affair. The committee would not only improve the care of those who have suffered from the blood scandal, it would also help thousands of people with haemophilia who, with the right treatment, could lead long and active lives, working and building families. They are great when they have their treatment. You would not even know that they have a disability. Finally, as I have often said in the past, those with the most expertise of long-term conditions are those who experience them. I welcome, under subsection (3) of the proposed new clause, the holistic spread of the proposed commissioners; namely, charity supporters, Department of Health officials and, most importantly, the patients.

Every year on the anniversary of my husband’s death, I visit the church of St Botolph without Bishopsgate in the City of London. At the back of the church is a small memorial book, which names those haemophiliacs who have died as a result of contaminated blood products. Every year, new names appear. Every year, haemophiliacs living with the consequences of lethal treatment—it was lethal treatment—require the very best information, advice and support. The proposed committee could provide that help. The Government have this opportunity to show that they recognise the extraordinary plight of haemophiliacs and I hope that they, and Members of the Committee, will feel able to support this amendment.

Baroness Barker: At this late hour, it would not be right to go into the many issues raised in the Archer inquiry. It is a very good report, which deserves serious and detailed consideration by this House. If it has established one thing, it is that people from all political parties were in different ways involved and that some have taken responsibility. This is not a partisan issue. I would suggest that it is an issue that the House of Lords is well placed to look at in some depth. I do not want to dishearten the noble Lord, Lord Morris of Manchester. I am not sure whether his proposal for a committee is right, but I am willing to listen to the Committee on that. What I am most concerned about is that the Government’s response should be timely and appropriate. It is a great shame that the Government did not contribute to the inquiry chaired by the noble and learned Lord, Lord Archer, but they are under an obligation to respond in a timely fashion. The government response perhaps needs to be in two parts: one an urgent response to the needs of people who are currently living with the consequences of being given these blood products, whose needs are urgent and serious, and the other on the wider question of what we should learn from the inquiry. That response would be much longer and more detailed.

We would do well to consider things that happen in other healthcare systems, particularly the response in the American healthcare system, although it is an entirely different system, and what should happen in our healthcare system is not the same. Many deep

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questions of policy and practice emerge from the report of the inquiry chaired by the noble and learned Lord, Lord Archer. They deserve to be looked at, but let us not use them as a reason to delay responding to the urgent needs of people who need help now. Similarly, let us not use the urgent needs of people now as a reason to give a cursory response to those quite deep questions.

Earl Howe: I shall be very brief, as we are up against the clock. I hope that we will have a constructive reply from the Minister this evening in so far as she has time to deliver one. I understand that the Government did not provide witnesses to the inquiry chaired so ably by the noble and learned Lord, Lord Archer. That was regrettable. I join the noble Baroness in congratulating the noble and learned Lord on an excellent and thorough report. Great credit is due to him, his colleagues and all those who gave evidence to him. One of the things that I have learnt from the report is that there are too many haemophilia patients currently suffering hardship and serious distress as a result of this worst of all healthcare accidents in the history of the NHS. The Government have a moral obligation to give careful consideration to the report and to respond to its recommendations for the sake of those patients.

Baroness Masham of Ilton: I declare an interest as a vice-president of the Haemophilia Association. This seems to be a reasonable amendment. People with haemophilia have had the most unfortunate time over the years since the emergence of HIV/AIDS. In the early years of HIV, it was found that 75 per cent of haemophiliacs at the Newcastle upon Tyne unit developed HIV, and many of them have died. Hepatitis C was also found to be a problem. So was variant CJD, and nobody knows whether it will present itself and to whom. It has been horrific for people who have died from CJD and for their families.

Safety in blood and blood products is of the utmost importance. While I was visiting a haemophilia unit in Leeds, the telephone rang. It was a teacher from a school asking if a haemophiliac boy could play football. There are so many questions to be asked and answered. A united committee could give support and information to those involved with this challenging speciality, which needs all the support it can get. This amendment may be the last on the Bill, but this is an important issue. The work with prions needs top scientists to find a way of protecting everybody from the dangers of contaminated or tainted blood. It could affect anyone at any time.

7.30 pm

Baroness Thornton: The Committee is supposed to finish in one minute.

Lord Rea: I have a quote from the report, which sums up the problem in a nutshell. Page 105 states:

“We must now look to the future. We cannot undo the damage done, nor turn back the clock to take a closer view of those past events and decisions. We must address the ongoing needs of those affected and consider how the state can ensure these citizens are recompensed”.

This amendment does just that.



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Baroness Thornton: I regret enormously that we could not have at this stage of the Bill the full discussion that this report merits, but self-regulation rules in your Lordships' House, including in Grand Committee. Noble Lords must have been aware of that earlier this afternoon.

Amendment 133, laid by my noble friends Lord Morris and Lord Corbett, is based on a recommendation made by the noble and learned Lord, Lord Archer, in his recent report, published on 23 February. The report, as we all know, considered the supply of virus-contaminated blood and blood products, and its devastating effect on the haemophilia community in particular from the early 1970s until tests became available for hepatitis C and HIV.


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