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The Earl of Clanwilliam: My Lords, perhaps the Minister will give way. It was only five years ago that the same epidemiological study was started in Edinburgh. It lasted for two years and was shut down. Will the information it gained, which was sufficiently important to stop it, be put forward to the new discussion?

Baroness Hayman: My Lords, the noble Earl raises an important point. Perhaps I can take the opportunity to look into it and write to him on that issue. He points out that there is a considerable body of current scientific literature on OPs. One of the things we are doing is subjecting that to rigorous scrutiny. A specially convened working group of the committee on toxicity is doing that important work and I know that the noble Countess is one of many people who have given evidence to that group.

The COT's advice will include recommendations for further research if appropriate, and when its report is published next year the relevant advisory committees and the official group will be asked to consider their recommendations and report to Ministers. That will be the context in which we look at the possibility of research into potential effects on children highlighted by the noble Lord, Lord Clement-Jones.

In relation to the OP mechanisms of toxicity other than the depression of cholinesterase, the Government are funding research into the effects of OPs on enzymes at Newcastle University and Porton Down. There is also important research funded by the Medical Research Council. As the results are produced they are being carefully evaluated by the expert scientific committees but to date have not offered any new advice on the safety of OPs.

While that research is going on we fully recognise that there is a group of people whose suffering is occurring at the present time and is undoubtedly very real. Whether or not their illnesses can definitively be proved as being due to exposure to OPs, they deserve

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the best medical care and treatment that can be provided. Much has already been done to inform doctors. Chief medical officers have written to doctors alerting them to the possibility of adverse effects from exposure to pesticides and certain veterinary medicines.

An article in the October 1995 edition of the Chief Medical Officer's update--a quarterly publication sent to all doctors in England--dealt with both the chronic effects of OPs and how to report adverse reactions to them. In 1996 the book Pesticide Poisoning: Notes for the Guidance of Medical Practitioners was sent by all UK health departments to general practitioners, accident and emergency departments and others. Presidents of the Royal Colleges were encouraged to draw the book to the attention of their fellows and members through their continuing medical education programmes.

It was in recognition that more needed to be done, and at the behest in no small measure of the noble Countess, that the Department of Health, through the noble Baroness, Lady Cumberlege, encouraged the Royal Colleges to carry out further work in relation to their awareness that this was an area that needed to be looked at, particularly in regard to ways of improving the treatment and the knowledge that was available to GPs.

That was the provenance of the report that is being discussed tonight. The Royal Colleges set up a working party to look at clinical aspects of patients with symptoms that may be attributable to long-term exposure to low levels of OP sheep dip. They did not specifically consider the question of causation as this is the subject of many other avenues of investigation being pursued by the Government, of which I have already given some details tonight.

The working party was independent of government. Their report was produced by the Royal Colleges, which also decided upon the membership. Perhaps I might give an outline tonight of the steps that we have taken in response to that report. However, given the detailed and very critical nature of the comments of the noble Countess, I will need to look at those as well, in terms of the response.

We have already opened discussions with directors of the National Poisons Information Services in suitable areas on the report's recommendations for providing specialist advice in areas where it may not currently

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exist, and for improving the level of support to GPs who have patients who may be suffering from the effects of OP poisoning. We will announce the outcome of these discussions as soon as action has been agreed. The report also makes recommendations for further research. We are therefore asking the COT working group and the relevant statutory advisory committees to consider the report overall and, in particular, the research recommendations, and how they may be taken forward.

One of the positives about the report is that it has emphasised the role of the GP in diagnosis and patient management, but it also recognised the practical difficulties faced by GPs and the limitations of current knowledge of the causes and mechanisms underlying the condition. The report recommends adopting a strategy of supportive treatment because, it says, the principles of rehabilitation following substantial illness are similar. That is not the same as saying that the condition is not real, nor that it has no physical cause, but only that it may be the best way of treating the symptoms, whatever the cause may be.

The report contains some useful advice for GPs on diagnosis and management and we will be discussing it with the Royal College of General Practitioners and looking to the next edition of the Chief Medical Officer's update in February of next year to encourage those in rural areas in particular to consider the advice that is contained in it, as part of the drive to improve the treatment of sufferers.

I hope that the actions I have outlined clearly indicate our determination both to gain a better understanding of the human health effect of OPs and our commitment to ensuring that the concerns expressed by the noble Countess and others that the healthcare needs of those who may be suffering from the effects of OPs are fully addressed. I should like to assure the House that we will be keeping the diagnosis and treatment of this group of patients under active review in the light of emerging findings from the research and reviews of the scientific evidence currently under way. We will take whatever steps are necessary as our understanding of the condition grows. For the present time, however, I believe that the Royal Colleges' report offers an opportunity to increase awareness among the medical profession that these patients have genuine needs, and to improve the general level of care that is offered to them.

        House adjourned at six minutes before nine o'clock.

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