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Extract from House of Commons Hansard, Debates for
14 Nov 2001
Westminster Hall
Hepatitis C
Mr. Neil Gerrard (Walthamstow):
I am grateful for the opportunity to contribute to
the debate. It concerns a serious public health issue, on which discussion is
long overdue. My hon. Friend the Member for Bolton, South-East (Dr. Iddon) has
spelled out questions about the levels of infection, the consequences for the
people who are infected, the costs of treatment and the need for a national
strategy to deal with hepatitis C. Work is being done on that, but rather
belatedly.
I agree with what the hon. Member for
Weston-super-Mare (Brian Cotter) said about haemophilia. There is a need for
compensation. We should recognise that need and act on it. We should also
conduct an inquiry into what has gone on, so that we can be clear in our mind
about the history, the causes and the problems. Without one, we can never be
absolutely sure that we have dealt with all the problems, however much we might
feel that we have.
The major route of transmission for hepatitis C has
been injecting drugs. I suspect that that is one of the reasons why the issue
has not received the attention that it should have received. Injecting drug
users are not popular causes. It is not difficult to see a connection between
the fact that that is the major route of transmission and the lack of attention
that has been given to the subject, the feeling being perhaps that the victims
of hepatitis C have brought it on themselves. As my hon. Friend the Member for
Bolton, South-East said, the disease is transmitted not just through the sharing
of syringes, but via other drug-injecting paraphernalia and possibly through
household contacts such as shared razors.
There is no doubt that we are behind other countries
when it comes to a national strategy to cope with hepatitis C. Most other
European countries have one. The Australians have had one for several years and
are on their second or third revision of it. If we do not have a national
strategy, we shall not know the true prevalence of the disease, monitor the
epidemic or be able to establish the most effective ways to deal with it. Nor
shall we be able to ensure that all those who need treatment get it—the problem
of prescription by postcode has been mentioned.
There are questions about the accuracy of the data.
The Advisory Council on the Misuse of Drugs said in one of its reports:
"It is regrettable that the country is encountering
an immensely threatening public health problem without the data with which to
monitor population trends and the effectiveness of policies."
That is the situation.
I am also concerned about treatment. What will
happen when we move to commissioning by primary care trusts? My hon. Friend the
Member for Bolton, South-East described clearly his views on the need for
centralised funding. Two or three weeks ago, I was in this Chamber for a debate
on HIV funding, and the same questions arose about what would happen when
commissioning took place under primary care trusts.
Dr. Iddon : Does my hon. Friend agree that
those questions apply to syringe exchange schemes, as well as to combination
therapy? Such schemes would be low on the agenda of most primary care trusts.
Mr. Gerrard : I agree. There is a difference
between what is happening in relation to hepatitis C and HIV. On HIV, many
health authorities have a history of specialised commissioning and have people
with expertise. I am worried about what will happen to that expertise when
commissioning takes place at primary care trust level. On hepatitis C, we have
not had specialised commissioning and no expertise has been developed in most
health authorities.
Dr. Gibson : In Norfolk, money that was
requested from the local health authority for a hepatitis C nurse was put
towards a bowel cancer nurse. Priorities such as hepatitis C nurses are stuck
low on the agenda time and again, which is why we need the money to be put
towards what the Government mean it to be put towards and not diverted to other
causes. Sometimes the money is even spent on car parks instead of staff to help
the likes of drug abuse units.
Mr. Gerrard : My hon. Friend's example
illustrates the problems, which I fear will worsen when the change is made and
specialised commissioning takes place at primary care trust level. What happens
to public health-related work generally, as a result of the change to primary
care trust commissioning, is a serious issue. In many health authorities, only a
few people have any expertise in public health. We must ensure that they
continue their work. In my area, workers in the health authorities who are
unsure about their future, especially those who work on narrow and specialised
subjects, are disappearing as the change to primary care trusts occurs. They are
taking the opportunity to find jobs elsewhere due to their uncertainty.
We certainly should consider public information
campaigns. I have no doubt that such a campaign on hepatitis C could be
cost-effective. The costs of treatment are so large that the prevention of even
a small number of infections represents a significant saving. We must improve
accessibility to treatment—a subject that has been covered by my hon. Friends
the Members for Bolton, South-East and for Norwich, North. Access to the
treatment that one should receive for a hepatitis C infection must not continue
to depend on where one lives. We need national guidelines for treatment and
clear agreement on who should receive therapies.
We also need to tackle the subject of testing
facilities. One can be tested at a drugs service or a genito-urinary medicine
clinic, but many people do not like going to such places, so we must think about
where testing should be provided and how people should be directed to it.
The subject is a major one in public health terms.
The figures—the number of infections, the likely number of deaths—speak for
themselves about what will happen if we do not get to grips with the problem. It
has been ignored for far too long. I am grateful to my hon. Friend the Member
for Bolton, South-East for securing the debate. I hope that we shall hear
proposals for action from the Government to start to tackle this public health
issue.
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