§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Bates.]10.33 pm
§ Mr. David Alton (Liverpool, Mossley Hill)
First, may I, through you, Mr. Deputy Speaker, thank Madam Speaker for the opportunity to raise the subject of the future of the Liverpool blood transfusion centre on the Adjournment of the House? May I also take the opportunity of thanking the Minister for being in his place to answer the points that will be made, and my colleagues the hon. Members for Wallasey (Ms Eagle) and for Wirral, South (Mr. Porter), both of whom have indicated that they will seek to catch your eye. I have informed the Chair and the Minister of my willingness to give up some time to demonstrate the all-party nature of the concerns that are being expressed tonight. I also thank the hon. Members for Caernarfon (Mr. Wigley) and for Birkenhead (Mr. Field) who are also in their places. I know of their concern about the question as well. The hon. Member for Crosby (Sir M. Thornton) has asked me to mention his support for the arguments being put to the House, although he is unable to be present because he has engagements on Merseyside.
It may help the House if I outline what has happened so far and then say why parliamentary, public and clinical opinion is so staunchly opposed to the National Blood Authority plan. The House will be aware that the proposal is to close five transfusion centres to make savings of £10 million. One of the centres is situated in my constituency, in West Derby street, Liverpool.
When the announcement was made I immediately visited the centre and was extremely impressed by the competence, dedication and professionalism of Dr. Vanessa Martlew, the medical director, and the staff. I subsequently went to see Sir Colin Walker at the NBA's headquarters in Watford and I attended and spoke, together with the hon. Members for Liverpool, West Derby (Mr. Wareing), who has joined us for the debate, and for Wallasey (Ms Eagle) at the amazing meeting held at St. George's hall in Liverpool on 7 November. It was attended by more than 1,000 people. The hon. Member for West Derby said that he could not recall a scene like it since Lord Wilson held his eve-of-poll election rally there back in 1964. Since then, other colleagues have met Sir Colin and John Adey, the NBA's chief executive, and I have tabled two early-day motions and several parliamentary questions on the subject. The local newspaper, the Liverpool Echo, has run a well-informed and strong campaign to ensure that the 2.8 million people who will be affected on Merseyside and in north Wales are well aware of the implications of the ill-conceived and ill-considered plans.
I have rarely experienced the strength of feeling that I have encountered over this issue, but that is not surprising. The service has saved countless lives over the past 50 years. It is bitterly ironic that as the national service prepares to celebrate its half century in 1996, it should be simultaneously preparing to shut one of its most efficient and well-supported centres.
The Minister has, rightly, told me and other hon. Members that we have the finest blood transfusion service in the world. If the clock is not broken, why try to fix it? The Minister could save himself and the service 1044 considerable grief by abandoning the plans that the NBA has circulated throughout the length and breadth of the land.
Regardless of the reasoned and principled arguments for not proceeding with the plan, to which I shall come later, there is a technical reason for immediately discontinuing the consultation process. When the process began, the plans were clearly different from the slimmed-down proposals now on offer. Many of the representations have therefore been on a false prospectus. The basis on which the consultation process is proceeding is extremely dubious and highly suspect.
The most recent announcements from Sir Colin Walker point to four things. First, a stock holding facility will be retained in Liverpool to supply blood and blood components to hospitals in Merseyside and north Wales. However, as Melanie Phillips pointed out in a recent article in The Observer , there has been some uncertainty about what the undertaking really means. Secondly, the NBA recognises the advanced development of specialist clinical services and says that it will maintain the services in the future. Thirdly, local donations will be used to treat local people and, fourthly, as Sir Colin Walker made clear to me himself, the Liverpool centre will not be amalgamated with the Manchester centre if clinical opinion is opposed to such a move.
Even against the modified version of the original suggestions there remain compelling arguments. First, the transfer of blood from the periphery of the region, from places such as Barmouth or Anglesey, will take considerably longer to get to the Manchester centre than to Liverpool. The entire major road network was recently gridlocked for several hours and anyone who has travelled over the Thelwall viaduct will know that there are often considerable delays in travelling between Liverpool and Manchester and beyond, even in good weather.
It is crucial that plasma is separated from whole blood as soon as possible after it is donated in order to provide blood components of the highest quality. The unnecessary extension of travelling time would therefore diminish the quality of the blood available. No consideration of logistics or feasibility was ever undertaken before the proposals were issued and there has been no pilot study. Thirdly, despite frequent reminders from regional transfusion directors on the national blood executive committee in 1993-94, transport considerations were not included in the final proposal. The financial savings in the consultation document, therefore, may have been overestimated since transportation costs were never included. Such a glaring omission of such magnitude places in question the thoroughness and validity of the Bain report by the management consultants who were engaged to assist the NBA in its strategic planning.
On the subject of erroneous information, the consultation paper goes on to suggest splitting administration into three zones. Perhaps someone should tell the people involved that that has already happened and that zone executive directors are already in post. The jobs were advertised in July even before the consultation paper was published.
Since the transport scheme was not included under the proposed new arrangements, no guarantee can be given as to the available remaining shelf-life of products prepared out of Liverpool at a remote site in Manchester. Since the shelf-life of platelet concentrate, which is used in the treatment of many patients with cancer and leukaemia, 1045 is only five days, the loss of one or two working days considerably reduces the shelf-life of the product. What sort of message does that send to the countless women and men who voluntarily and generously give blood, often at their own expense and inconvenience, because they care about the health of other people?
A promise of large stockholding fridges in hospital blood banks is far from reassuring. Larger stocks mean higher wastage levels and the unavailability of fresh blood in an emergency. Nine times out of 10, older blood is unsuitable for emergency clinical use. If allowed to happen, that will result in a second-class service to patients and may result in death. Perhaps people who take those sorts of decisions should follow the generous example of the donors and care less about market practice and more about the well-being of patients. Saving money is important, but saving life is infinitely more so.
The removal of a processing facility from Liverpool would reduce the quality of service that is delivered to the supra-regional foetal medical centre situated at the heart of Liverpool. Red cells for intrauterine use are prepared to order and their use is recommended as soon as possible after preparation. The removal of processing and testing from the blood centre in Liverpool effectively stops part of its activity, so specialist services palpably will suffer.
Anyone who heard the moving and eloquent appeal made at the meeting in St. George's hall by a consultant paediatrician from the region's Alder Hey children's hospital, or those people who have read the letters signed by consultants at the cardiothoracic unit and consultant anaesthetists at Royal Liverpool University hospital, representations from the regional pathologists and the objections from Sir Donald Wilson and the regional health authority will know that acute concern exists across the spectrum about the loss of specialist expertise to Merseyside and north Wales which will arise if this wrong-headed decision goes ahead. The consultant anaesthetists at the Royal propose legal action if any harm should come to their patients.
John Adey, underlining what Sir Colin Walker had already said to me, told four local hon. Members, including the right hon. Member for Wirral, West (Mr. Hunt) that no changes would occurunless a majority of consultant haematologists and other relevant medical experts in the area agree that patient services can be maintained or improved.I have yet to meet a single doctor in favour of that plan, so why, if that statement is to be believed and taken as the basis for proceeding, should we persist with this exercise, unless it is all a charade and a fait accompli, which is the view of many people who have been following events closely?
The views of all the regional transfusion directors were sought when the consultation process began and when the analysis and preparation of the options were conceived. Most significantly, however, those same people were not consulted about the feasibility or implications for north-west England, notwithstanding the fact that the two directors affected at Liverpool and at Lancaster had between them in excess of 30 years' experience in the practice of transfusion medicine in our region.
It is extremely revealing that in the north-west, two out of three centres are listed for closure although no amalgamation is proposed in the north-east. Only one 1046 member of staff from the north-west was closely involved in the Bain analysis and he is employed in Manchester. Is it any wonder, therefore, that there is little public confidence in the process? The gravest danger of the proposals is that donors will be alienated. Why should we undermine the effectiveness of such a superb service? Why sever its arteries? Why risk its paralysis?
The extra costs involved in storage and transportation, the wastage of freely given blood, the subsequent alienation and loss of donors, the implications for emergencies or disasters, the effects on hospitals and on training facilities such as Liverpool's school of tropical medicine and the University hospital, all amount to a damning indictment of the plans.
Blood is not a commercial commodity. In Holland, there are spot markets in blood. In America, blood is bought and sold. We have successfully avoided such a dirigiste and commercialised approach. It would be profoundly foolish and destructive to jeopardise the service by proceeding with the proposals. I hope that the debate will help to underline all-party opposition to them in the area which I represent in part.
§ Ms Angela Eagle (Wallasey)
I shall speak only briefly because I am extremely interested in the Minister's response.
I congratulate the hon. Member for Liverpool, Mossley Hill (Mr. Alton) on securing the Adjournment debate. I thank him for allowing me to say a few words. All Merseyside Members have been working closely together to try to prevent consultation and proposals from being implemented. After our meeting with Mr. Adey, we have little confidence in what the National Blood Authority is telling us. It is telling people what they want to hear and then reneging on its statements.
We had a meeting at which, as the hon. Member for Mossley Hill said, we were told:There will be no changes to the current arrangements unless a majority of consultant haematologists and other relevant medical experts in the area agree that patient services can be maintained or improved.Those words were used by Mr. Adey before a television camera after the meeting. When we issued that information, we were informed by the press that Miss Sue Cunningham, who I understand works for the NBA as a public relations adviser, was briefing members of the press that we had brow-beaten Mr. Adey into making a claim that he did not mean.
We had a meeting in good faith. Miss Cunningham seemed to suggest that Mr. Adey should not be let out alone because he might make promises that he would be unable to deliver. What confidence does that give us in the way that the NBA is being run?
From the Wirral's point of view, there has been nothing but complete objection and opposition to the proposals. Dr. Spigge, who works at the Wirral health trust, states:It is not clear to us that the Wirral population will benefit in any way.The Wirral division of the British Medical Association states:These plans are a cause of serious disquiet and represent a serious threat to the well-being of our patients.Our constituents agree and are signing petitions.
1047 The NBA has spent £1,257,000 on consultants' fees to save money. Of that, £1 million went to Bain and Co. I have seen a copy of its report, and it is not worth £1 million. I hope that the Minister will justify the use of these consultancy moneys. Will the results of the consultation that we have had be published? We know that on Merseyside there is massive and overwhelming opposition to the proposals. Will the NBA publish an analysis of the results of its consultation? Will it then confirm— I hope that the Minister will do so tonight—that the plans will not be implemented if the majority of local consultant haematologists and other experts say that they do not agree with them? If we can have that assurance from the Minister tonight, we shall be given confidence that the consultation period is genuine and not a massive sham.
§ Mr. Barry Porter (Wirral, South)
What was said by the hon. Member for Wallasey (Ms Eagle) is entirely correct. I may not be quite as excited and emotional as the hon. Member for Liverpool, Mossley Hill (Mr. Alton), but I know that the people of Merseyside, and those of the Wirral in particular, were very concerned about what they thought might have been proposals. We had a cross-party meeting with the appropriate representatives of the National Blood Authority, and were given assurances.
I ask the Minister to assure me, first, that there will be a blood bank in Liverpool; secondly, that no steps will be taken to alter the present arrangements unless a majority of the consultant haematologists and others who have appropriate professional qualifications are in favour of it; and, thirdly—I consider this the most important point—that, whatever the new arrangements may be, the people of the Wirral will not suffer in any way.
I am all in favour of efficiency, cost-consciousness and so forth, and I do not think that anything is so good that it cannot be changed for the better; but if the arrangements are to be changed, I want to be persuaded on behalf of my constituents that the change will be for the better. If it is not for the better I will not wear it, even if a vote of confidence is involved.
§ The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville)
I congratulate the hon. Member for Liverpool, Mossley Hill (Mr. Alton) on raising an issue that clearly excites considerable emotions in his area. Let me repeat what he said at the beginning of his speech: we do indeed have the finest blood service in the world. I say that for a number of reasons. The service provides an enormous degree of quality assurance, and its high standards are well known throughout the world; I also applaud its level of testing, its safety and indeed the very fact that it is an entirely voluntary service. All those who give blood do so simply to help others: they have no other motive. There are other so-called voluntary services which offer travelling expenses, statutory days off work and other incentives that this service does not offer. It is 100 per cent. voluntary, and we intend to keep it that way.
The hon. Member for Wallasey (Ms Eagle) mentioned blood being bought and sold. There is no question of that happening in this country. We mean to keep our blood service, to improve it and to build on its many qualities.
1048 The present system results mainly from the existence of 13 regional transfusion services. The fact that there are 15 processing centres is largely due to that, rather than to any actual assessment of geographical spread. A national blood authority was recently set up for the first time, to bring together a loose federation of transfusion services that involved a good deal of duplication and fairly arbitrary organisation. It immediately set to work to find a way of streamlining the system and improving collection, quality, co-ordination and donor support.
Meanwhile, it was clear that there was excess capacity in processing and testing. The blood service is about collecting blood from voluntary donors, and making sure that that blood is then processed, tested and supplied to the hospitals that need it. If there is found to be excess capacity in those other operations, that is clearly a waste of manpower and resource that could be devoted to what the service is really about—sending out more mobile teams to collect blood from our precious core of donors.
There is no reason to suppose that the blood service should be entirely based on processing centres. Only about 5 per cent. of all donations are made at such centres, and there is no reason why collection teams that go out have to be based in them. In fact, the NBA proposal presupposes mobile teams going out from more bases that are not processing centres, and that will allow them greater flexibility to work more closely to where they are based. Such are the improvements foreseen by the NBA.
No one suggests that there is any reason to doubt the quality or the expertise at the Liverpool centre, or the commitment of those who work there. The question is whether we should have three processing and testing centres in the north-west when, for logistical and technical reasons, only one may be necessary. It is that question that we are now debating and, as the House knows, no final decision has yet been made.
I put it to the hon. Member for Mossley Hill that unless an absolute cast-iron case can be made that there is some danger—
§ Mr. Alton
It is not for me to make such a cast-iron case, any more than it is for the Minister to do so. All three hon. Members who have spoken in the debate have said that the views of the haematologists, clinicians, consultants and other medics should be the ones that really count. Will the Minister assure the House that if clinical opinion is united in its opposition to the proposals, yet the NBA proceeds with the plan and the decision, is referred to him, he will kill the proposal stone dead at that stage?
§ Mr. Sackville
I certainly would not expect anyone to welcome the closure of such a centre, especially when allegations are being made about safety—the hon. Member for Mossley Hill has made several technical points about shelf life, and so on. However, if the NBA comes to the conclusion that, from a logistical point of view, it is able to continue to provide all the specialist services to Liverpool hospitals and all the support to donors, and all the other specialist activities that are performed now, and that it is not necessary to continue processing and testing in Liverpool, that is something for the authority to decide.
1049 On the other hand, if, as I was saying, a cast-iron case is made that safety is in question or that donors, hospitals or the patients who need blood will suffer from such a development, that must be carefully taken into account. I am not aware that such a cast-iron case has been made.
§ Mr. Frank Field (Birkenhead)
We are not really discussing that, and that is not what we want guarantees about. The single point on which we seek the Minister's support arises from what happened when the four Wirral Members met representatives of the authority, when we were told that no changes would be made unless there was clear support for such changes among the medics most clearly involved. Will the Minister stand by what was said, or does he think that that undertaking should not have been given to us? Does he consider it foolish—or even worthless—that it was given?
§ Mr. Sackville
I have put it in another way. As I have said, if the NBA believes that it does not need processing in Liverpool, it is up to the authority to satisfy itself and us that there are no clinical dangers to patients. That is all that I can say at present.
May I answer a couple of the other questions—
§ Mr. Robert N. Wareing (Liverpool, West Derby)
If the Minister is to make the final decision, whose advice does he think best—that of haematologists or that of bureaucrats on the National Blood Authority, who are consulting the haematologists in Liverpool but who appear to be in danger of taking no notice of what they are told? What advice will the Minister accept? What is the best advice?
§ Mr. Sackville
We are in the first instance looking to the advice of the National Blood Authority. In its consultation process, it has to take the views of all the experts into account.
I shall deal with one or two other matters which were raised, such as consultancy costs. The NBA has indeed used consultants because a vast organisational change is being planned, involving, for example, the bringing together of all the disparate computer systems at the 1050 different transfusion centres, none of which can be linked with each other. Also, many logistical changes need to be made so that the current fairly arbitrary arrangements for transfer of blood around the system in cases where there are excesses and deficits and where particular blood groups are needed are worked out very carefully. The NBA does not have that sort of expertise in-house. If one visits the headquarters of the National Blood Authority at Watford, one finds that there are very few people in that office. I am glad to say that it is a very lean organisation, which has brought in expertise.
The question of consultation was also raised. I shall have to leave that matter in the form in which it was initially published. I hope that the NBA will be able to make available the maximum information.
§ Mr. Barry Porter
I am sorry to press the point with the Minister but I think that it is the nub of the matter. The four Wirral Members, whose intellectual capacity is clearly unparalleled, were clearly told that there would be no movement on the matter unless the medics, the professionals, agreed. Are we to understand that that was just a matter of consultation? Or were we to accept it, as I did at the time, as being a binding commitment?
§ Mr. Sackville
I can only say once again that it is a question of whether the case is made clinically that the closure would damage patients. That is what it is about in the end. Obviously, all the relevant advice will be taken into account. I would be very concerned if it were not.
We enormously value our voluntary donors. They are at the centre and they are what makes the blood transfusion service. Various hon. Members have mentioned that they may be alienated. They will be alienated if they are continually told, sometimes spuriously, that the blood service is being damaged by these proposals. I know well those who run the National Blood Authority. I was involved with the establishment of it. There is no way in which that authority would take actions which would damage the blood transfusion service and I would be the last person to sanction any actions which would alienate our greatly valued voluntary donors of blood in this country.
Question put and agreed to. Adjourned accordingly at two minutes past Eleven o'clock.