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Baroness Blackstone: My Lords, I am grateful to the noble Earl and the noble Baroness for their response to the regulations. As I have said, their purpose is to enable us to continue to test new and innovative ways of helping unemployed people aged 25 and over back into work, as both the noble Earl and the noble Baroness recognise.
I shall try to deal with the questions that have been put. The noble Earl asked about sanctions. The pilots are designed to offer individually tailored help to people to improve their employability and to help them back into work. It is therefore right to expect people who are unemployed to take advantage of the help that is provided. We want them to have a right to that help; but with that goes the responsibility for taking advantage of it. It cannot be right that people can claim JSA while not taking any steps to improve their employability and their prospects of finding work. People who refuse that offer of work and have no good cause for failing to take part in the pilots will lose their entitlement to JSA for two weeks in the first instance and for four weeks for any subsequent offence. However, they may be eligible for hardship payments. The noble Earl is aware that people in vulnerable groups, including those who have children and those who have health problems, have immediate access to hardship payments.
This is a national programme. The pilots contain rights but also responsibilities. Those in the New Deal who are over 25 are JSA claimants and therefore remain subject to conditions which contain sanctions if they unreasonably cause or perpetuate their unemployment. This is a long-standing feature of benefits for the unemployed. Sanctions are a deterrent to refusal to take up what we believe to be important and helpful support to unemployed people.
The noble Earl asked why the unit cost of the New Deal for those over 25 was lower than for young people. The options in the New Deal for Young People last at least six months, but the intensive activity periods in the pilots that we are discussing today last for three months. For that reason the costs are lower.
The noble Earl also asked about underspend. Falls in unemployment have led directly to lower expenditure. To date, there has been a lower take-up of the subsidy. That also means lower expenditure. Measures such as the pilots will help us to make a greater number of people more employable and attractive to employers, and therefore they may not want to make use of the subsidies.
The noble Earl's next point was that the pilots did not provide enough education and training. It is important to remember that this is a different pilot client group from that comprising 18 to 24 year-olds. Many of the people in this group will already have skills and a lot of experience of work, but the pilots make provision for training to be delivered to meet individual needs. Training support can be available throughout the pilots. In addition, clients have the opportunity to study for up to one year while remaining on JSA. I hope that that provides the noble Earl with some reassurance.
The noble Earl asked whether these pilots had been successful so far. It is too early to judge their success. To make a sound assessment we need to monitor what happens to people who have benefited from all the help on offer. It is also recommended evaluation practice to allow new programmes to bed in for a while before one attempts to draw conclusions about their impact. As the pilots did not begin until the end of November of last year, the first results of the evaluation will not be published until the end of this year and the beginning of next. I shall ensure that the noble Earl and the noble Baroness have a copy of the outcome of any evaluation as soon as it is available.
The noble Earl asked whether the evaluation would be able to monitor discrimination on such matters as age, gender, race and disability with regard to entry into the labour market. Certainly, that is something I am happy to take back to ensure that it is considered. The noble Earl raises an important point.
The noble Earl also asked about the number of people who have been sanctioned. Just as in the New Deal for young people, the vast majority of people in the pilot schemes responded well to the opportunities on offer. However, regrettably, a small minority did not. Our early statistics suggest that 1 per cent of those who started the pilot schemes in Great Britain have been sanctioned. That amounts to fewer than 400 people.
I turn to the noble Earl's amendment. I accept that he is making an important point and it is vital that we measure the impact of the New Deal on individuals. The published objectives of the New Deal make it clear that a reduction in social exclusion is one of the Government's aims. Therefore, as regards some of the groups to which he explicitly drew our attention, we must take care to ensure that they are not permanently socially excluded.
The evaluation strategy which we already have in place for the New Deal, including the pilot schemes, will enable us to explore what happens to those who have been subject to benefit sanctions, through both surveys and one-to-one interviews. I hope that that provides the noble Earl with some reassurance. The evaluation will be able to examine all the comparisons he suggests. If the noble Earl would find it useful, I should be happy to write to him giving further precise details of our evaluation plans.
I hope that my reply has reassured the noble Earl and that he will feel able to withdraw his amendment. I do not believe that it would serve a useful purpose because we are doing exactly what he intends. That laudable curiosity to which he refers is well embedded in the Department for Education and Employment.
The noble Baroness, Lady Seccombe, asked whether we have consulted the various parties to the development of the pilot schemes. I can confirm that that is the case. It would be difficult for us to undertake the work had not the agencies to which she referred been fully engaged in the discussions that took place when we set them up.
I hope that I have covered all the questions that have been asked. If I have failed in any way, I shall write to the noble Earl and the noble Baroness. I hope that the noble Earl will feel able to withdraw his amendment and that we can agree these regulations.
Earl Russell: My Lords, I thank the Minister for a full and generous reply. I am extremely interested in what she says about the evaluation. It seems to go a long way towards meeting what I am asking. She appreciates that the key issue that concerns me is the means of subsistence available to those concerned. Having praised laudable curiosity, I must practise what I preach. I should be most grateful to see the further documents on evaluation, which the Minister so generously offered to send me. In the light of those remarks, I shall of course beg leave to withdraw my amendment.
The noble Lord said: My Lords, I welcome those speakers who have stayed behind in the middle of Friday afternoon. My idea of introducing this small debate came from the initiative of the noble Baroness, Lady Hayman, who arranged for a mobile blood unit to come to your Lordships' House earlier this year. I think
I confess to having no medical knowledge but have been a blood donor for many years. I simply cannot understand why only 6 per cent of the adult population donate blood. It has been 7 per cent, which is the figure in most European countries. I would go further and say I consider it an indictment of society that people do not give blood as much as they should.
Before I become "holier than thou" and try to avoid blowing a gasket, I shall explain how I started to be a blood donor. I am sure there are other ways of becoming a donor but for me it was in 1954 when I was doing my national service in the ranks in the Army. The Medical Officer was a man of some years of distinction. Most of his life had been in the Indian Medical Service. I recall that he was a Medical Officer in Jodphur and that in the last war he commanded a hospital in Basra--robustly. His fury would always rise when a soldier's documentation was incorrect, which it often was. For instance, if a doctor forgot to record inoculations in the soldier's paybook the unfortunate soldier had to have them all over again. Hence, when the blood unit was set up there was no question of anyone not giving blood. One wretched corporal refused and he was subjected to a number of undignified tests. Sadly it took me after that time another 20 years before I donated again, basically, I must confess, through apathy. But then one finally got round to it and for the past 25 years I have given blood. At this stage perhaps it is worth while to give a little background to the history of blood donation.
The first successful blood transfusion took place in 1665 by Dr Richard Lower, who used animals as subjects. But human blood transfusions continued to cause unexplained deaths until 1900, when Dr Karl Landsteiner of Vienna discovered that there were four different blood groups. Again an interesting fact of early British history is reflected in the distribution of blood groups. Within the UK as invading Anglo Saxons came in--mostly Group A--they pushed the native Bronze Age Celts--mostly Group O--to the west and north.
I could cover a great deal more of this subject but I think it would be a good idea if I took up the cudgels again to destroy some of the myths that allow people to make what are sometimes absurd excuses. As I have already said, the attitude of most people is appalling. From time to time I have asked people whether they give blood. Some look askance as if one has made an improper suggestion. People usually say they would like to but never got round to it, or they produce one of the following myths. Sufferers from hay fever can donate provided they are well on the day. Many people believe they can never give blood after contracting hepatitis or jaundice, whereas except for certain types they can give blood after a period. So that is another myth gone.
The National Blood Service should be congratulated on improving its service. An appointments system has been introduced following complaints from people who thought they had been waiting for an inordinate length of time. I believe that those complaints were somewhat exaggerated. If you feel antisocial and you do not want to chat with your fellow donors, I suggest that you bring a good book. The age limits have also changed. You can start as young as 17 and continue until you are 70 provided you started donating before you reached the age of 60 years.
Noble Lords may think that my next point is a little trite, but quite a number of people go to give blood when they have not had anything to eat. You really must have something to eat, preferably something with iron in it or, I am told, red wine. Perhaps the noble Lord who is to answer the debate will dispel that theory. On a few occasions I have not been allowed to donate because my haemoglobin count has not been high enough. On one occasion I arrived to give blood, having had the said glass of red wine, but my count was not high enough. When I related this to a tough lady attendant, she said, "Next time you must have two glasses".
I shall now come onto a very sad point. The service is costly to run but it spends £163;1.5 million a year on advertising to get people there, which it really must do. Surely such a large sum of money could be better used as a grant or spent on research. The demand for blood is now static. In 1946 the need was only 200,000 donations a year. The figure is now more than 2 million.
I have probably said enough. I shall leave it to others to make their points. I fully appreciate the co-operation that I have received from the service and from the noble Lord, Lord Burlison, who is to reply. Before I sit down I shall give out the telephone number for people to become donors. It is 0345 711711. The telephone is answered fairly quickly and the people are extremely helpful. I should also mention--I know that the Minister will refer to this--that a great many more donations are needed at the turn of the millennium.
Lord Addington: My Lords, I thank the noble Lord, Lord Teviot, for raising this important subject. I start my speech with one slight apology. My noble friend Lord Clement-Jones is unable to be here so I am his stand-in, as it were.
I also have to make one confession. I have never given blood. I tried once when I was at university but managed to turn up five minutes after the booth closed. More recently, when a special centre was set up
The noble Lord said that £163;1.5 million is spent on advertising. I must disagree with him. That would seem to be a very small price to pay to get enough people to give blood. I feel quite guilty about it. I give an undertaking that by Christmas I will have at least started the process. We should all give more blood or at least start to give blood. I shall resist the temptation to come out with jokes and comments like, "One unit, that's nearly an armful", and other quotes from that famous sketch by Tony Hancock.
The National Blood Service has a rather chequered recent past. As a result of events in the Liverpool area, we have lost a chairman. Sir Colin Walker has been replaced by Mr Mike Fogden. That was as a result of a report by Professor Cash on the events in Liverpool. The report showed that the management in Liverpool had broken down and was no longer doing its job. There was inadequate leadership and people were being overloaded within the system. All credit must be given to the then Secretary of State for acting promptly once he received that report.
A major point I should like to put to the noble Lord who is to reply to this debate on behalf of the Government is this: how much progress have the Government made in their implementation of the recommendations in Professor Cash's report? We have learnt one thing from this matter: when it comes to dealing with the primary problems of the nation's healthcare, a regular blood supply is one of the building blocks that enables many functions to be carried out. Demand is rising because new discoveries have been made and more uses for blood are being found, not just for the raw material but for its components once they have been broken down. The number of cancer patients who require blood products is quite staggering. The more I read in preparation for the debate, the more surprised I became at the large number of uses for blood.
The National Blood Authority has been caught up, shall we say, in some of the major health scares of our time. Over the past decade and a half, it has had to deal with the problem of scanning for HIV infection. Unfortunately, some people became infected with that virus because the systems for detecting it in blood donations were not in place. There have also been problems with the various forms of hepatitis. Now there is the spectre of new variant CJD, which casts a dull light--if that is the correct expression--across the whole process. What progress has been made in the identification and eradication of this new danger from our blood supplies?
On the matter of advertising, I feel that we need to do more. I am living proof that we should do more. I am one of those well-intentioned people for whom the £163;1.5 million worth of advertising was not enough to get me into the booth.
Earl Howe: My Lords, my noble friend Lord Teviot has stolen a march on the rest of us with his Question today and I congratulate him. This issue is very important and achieved prominence among many noble Lords when, as my noble friend reminded us, earlier this year the so-called "Bloodmobile" parked itself in Black Rod's Garden, so generating some welcome national publicity as well as some high quality blood.
I doubt whether I am alone in regarding the work of the National Blood Service as one of this country's minor miracles. The statistics are extraordinary. Every day the service needs some 10,000 units of blood to meet demand from 350 hospitals in England and Wales. That demand has risen steadily over recent years, almost entirely as a result of advances in medical treatment. In 1946 only 200,000 donations were needed to serve the requirements of the entire country. Nowadays, some 2.4 million donations are collected every year from 1.9 million donors. As my noble friend said, that is equivalent to about 6 per cent of the population giving blood one, two, or occasionally three, times a year.
It is a characteristic of blood that some of its valuable components have only a limited shelf life. Red cells, for example, which are used in routine surgery, last only 35 days, and platelets, which are needed by patients undergoing cancer therapy, only five days. That means that there is a constant need to collect new blood. It is the reason why the National Blood Service refers to blood stocks in "days' worth".
When I was a Minister in MAFF, I had a fascinating introduction to the system of stock control and replenishment practised by the major supermarket multiples. At the heart of that system lies what is known as the "just in time" philosophy. It is a philosophy that also governs the supply of blood, but with a difference. For the supermarket, failure to maintain stocks at below the optimum level will result in empty shelves and lost profit. For the National Blood Service the consequences are far more serious.
I happen to have in front of me the figures for red cell stock levels as at 26th October at 9.00 a.m. My noble friend may be impressed to hear that. On the other hand, he may feel that I am just showing off. The figures show stocks of O positive at 17,933 units--well
What is perhaps more illuminating than the figures for a particular day is the picture over a period of months. The National Blood Service has published figures which show that on 49 out of 251 working days during 1996-97--in other words, roughly 20 per cent of that year--total blood stocks in England fell below the critical threshold of 15,000 units. However, if we look at the first six months of the following year, the picture shows a dramatic improvement: the critical threshold of 15,000 units was never once breached. It would be interesting to hear from the Minister whether that general improvement has been sustained to the present, not least in the light of the additional strains imposed by the Government's waiting list initiative.
My noble friend's Question rightly draws attention not only to the demand for blood but also to the other side of the equation: the need for adequate supplies. I should be grateful if the Minister could tell us whether the NHS Executive is satisfied that the rate of increase in the demand for blood is not outstripping the rate at which new donors are recruited. Can he confirm also my understanding that over the past four years hospitals have increased their demand for blood by around 12 per cent? Is that upward trend expected to continue or to level out?
I believe in giving credit to the Government where it is due. One such bouquet must surely be appropriate when we look back at the advertising campaign for blood donations which took place between January and March this year. It led to blood stocks rising from under 15,000 units, a dangerously low level, to more than 40,000. Earlier this month the noble Lord, Lord Hunt, relaunched that campaign in preparation for Christmas and the millennium holiday. I should be interested to hear from the Minister the extent to which the National Blood Service has come to be reliant on campaigns such as this to maintain adequate stocks. I ask him two specific questions: what will be the cost of the latest campaign in relation to the anticipated quantity of blood supplies that will result from it? Furthermore, how has the ratio changed in recent years between the cost of obtaining blood and the supplies of blood actually donated?
The cost of obtaining adequate supplies of blood is also influenced by the need to maintain public confidence. In 1998 the decision was taken to cease the fractionation of blood plasma from donors in England and Wales in the light of scientific advice on the theoretical risk of transmitting new variant CJD. All such plasma is now imported. In addition, since mid-1998, all donated blood has been subjected, as a precautionary measure, to a process known as leucodepletion, again to minimise any risk of new variant CJD being passed from donor to patient.
The maintenance of public confidence is vital and I do not in the least criticise the Government for taking those precautionary measures. However, will the Minister say what is the cost of those measures and how long they are likely to remain in place?
The voluntary and altruistic basis of blood donation is both precious and essential to our system of collection. What attitude surveys have been carried out, particularly among the young, to establish what may be the likely trend of the donor pool over the next few years? What are the obstacles to attracting new donors? Have the Government given any thought to promoting blood donation other than by advertising; for example, by story lines in popular television soap operas?
I am aware that at NHS trust level much can be done to conserve blood stocks by following good practice in transfusions and by minimising wastage. Will the Minister say whether all hospitals have disseminated up-to-date protocols for blood transfusions to the relevant staff and whether and to what extent autologous blood transfusions are becoming a practical possibility, particularly the practice known as perioperative cell salvage? How many partnerships has the National Blood Service established with district general hospitals to augment the number of collection centres?
As the noble Lord, Lord Addington, reminded us, it is public knowledge that the National Blood Service, at an organisational level, has had its share of difficulties over the past two years. I pay tribute to the chief executive, Martin Goreham, who has identified and tackled head on a number of organisational shortcomings and who, with his management team, has formulated and implemented the necessary internal changes. I hope that the Minister shares my view that the NBS is better structured and focused than it has been in the past and that there is cause to hope that staff morale, which was patchy, is improving.
It is the efforts of the staff of the NBS and the continuing generosity of the British public in donating blood which underpin the work of our hospitals and which mean quite literally the difference between life and death for thousands of our fellow citizens. The occasion of this debate, for which I pay tribute to my noble friend, enables us to express our appreciation to blood donors and the NBS on whom we depend so greatly.
Lord Burlison: My Lords, I am grateful to the noble Lord, Lord Teviot, for asking this Question. It is extremely important to keep blood donation at the forefront of people's minds. I know that this House has a good record in relation to giving blood and in helping generally to publicise the need to do so. As the noble Earl, Lord Howe, reminded us, noble Lords rolled up their sleeves in April of this year in order to give blood.
At present the stocks of blood held centrally are at a high level--about 50,000 units in England. At present, there is only a small variation, up and down. That means that the National Health Service's need for blood can be fully met. As has been mentioned, 50,000 units is about five days' supply. The intention is to approach the millennium with between six and seven days' supply--about 60,000 to 70,000 units--so that we can be sure that we can cope.
Donations tend to drop during the festive season and are expected to drop a little more than usual this year because of the extended festivities. The contingency plans are in hand to cope with that. They are also in place to cope with future demand. Some forms of cancer, such as leukaemia or intensive treatment of breast cancer, require many units of blood.
In answer to the first part of the noble Lord's question, there are adequate stocks of blood, and they will become even more adequate. There have been times not so long ago when supplies have had to be managed very carefully indeed. As the noble Earl, Lord Howe, mentioned, it was not unusual for the central stock to be around 15,000 units, which is just less than 2 days supply. The units of blood would be collected from the donors, taken to the blood centre where they were tested and processed, and taken as quickly as possible to hospitals all round the country for the patients who depend on them. The blood services can, and have, managed with 15,000 units of stock. That is a tribute to them and to the hospitals that gave their co-operation. But 50,000 units is a more reasonable amount. Red blood cells have a 35-day shelf life. The blood services ensure that when the hospitals receive the red cells, there are at least 10 days shelf life left.
The noble Earl also asked whether public participation in blood donation is adequate. That question needs some thought because it might suggest an expectation of the public, or a duty on their part, and this has involved some thorny issues. As regards the adequacy of public participation, ours was the first voluntary blood service in the world. The first volunteers gave blood at King's College Hospital in 1921. And in 1946, when the blood service in roughly its present form started, 200,000 donations a year were needed. Now it is somewhere near 2 million.
Comparing January this year with January 1998, 25 per cent more donors gave blood and the number who registered as donors almost doubled. So I think that public participation in blood donation is adequate, and those who donate blood make a much valued gift.
I am therefore faced with a dilemma. I must be honest and tell the noble Lord that our blood stocks are adequate and that our donors are more than adequate. However, it is very important for the blood service that I add that for the blood stocks to continue to be adequate we are ever reliant on the donors continuing to be generous.
Altruism and blood donation was the subject of research commissioned in 1998 by the Central Office of Information on behalf of the Department of Health and the National Blood Service. It found that the moral imperative was very strong. People feel they ought to give blood, whether or not they do. If they do not give blood, they find reasons to explain it rather than saying that it is not important or that it is not relevant to them.
There was evidence in this survey and in others that altruistic attitudes and behaviour were declining, especially among young people, but I am pleased to say that giving blood seemed to have escaped that trend. The survey proposed that there were two major factors affecting altruistic behaviour: namely; is the potential beneficiary deserving? How much effort is involved in giving help?
People did not question the fact that people needing blood deserved help. They also thought that relatively little effort was required to give blood. It should be easy, with convenient blood donor sessions and little effort needed to find out about them.
Potential donors claimed that if they were made conscious of the constant need for blood, this would spur them into donating. That prompted careful thought about the best way to attract donors in these times. Television came to mind.
In the course of the past year, the National Blood Service (working with the Department of Health and the Central Office of Information) launched major initiatives to help potential donors to donate and to build up the number of regular donors. To back up the publicity, in December 1998, a national call centre was set up to take all the calls about blood donation; give information on donor sessions; make appointments or rearrange them, and refer callers to the blood service's doctors if they had a medical query. It answered over 700,000 calls and registered 90,000 donors.
Between Christmas and New Year, Members from another place turned out in their constituencies and gave blood. A picture of Joanna Lumley appeared on the front page of the Guardian. She was with a small boy whose life had been saved through a blood transfusion. On 5th January 1999, just after New Year, the television advert for blood donation came on air for the first time and ran from January until the end of March. While the TV advert was running, blood
As part of a plan to have two complementary TV adverts, a second one has just been made and appeared on TV for the first time yesterday. It shows a busy street and focuses on a young man who, the voiceover says, is "about to save a life". The film cuts to a brief shot of an operating theatre and a successful operation. The voiceover concludes, "Yesterday, he gave blood". The overall message is, "Do something amazing today. Save a Life. Give Blood".
I have spoken so far of the level of central blood stocks held at blood centres and in the blood service's blood banks. Those stocks are delivered to individual hospitals which hold manageable amounts. The blood service has been working with hospitals in the national blood stocks project to ensure that there is an improvement in the physical management of the stocks and that there is a continual improvement in the relationship between blood centres and hospitals based on mutual trust and co-operation. Donated blood is a very valuable resource and it is important that it is carefully managed and used.
NHS trusts and clinicians are also being asked to improve transfusion practice so that it is first class. That includes initiatives such as ensuring that all trusts in which blood is transfused have hospital transfusion committees in place to oversee all aspects of transfusion.
I turn to some of the points raised. The noble Lord, Lord Addington, raised the question of blood services and leucodepletion--the process referred to in reference to CJD. The blood services in the UK have carried through a number of changes as a precautionary measure against the theoretical risk of CJD. The blood centres filter the blood for transfusion so that white cells are removed--a process called "leucodepletion"--because it is thought by the expert group that if a variant CJD infectious agent were to be present in blood, it would most likely be in the white cells. It has been an enormously complex process for the blood service to install all the filters of appropriate quality, and I am pleased to say that from Monday next, 1st November, all blood collected will be leucodepleted.
With regard to the comparison between expenditure and supply, the supply is excellent. I am happy to write to the noble Lord on that with more comprehensive details, but we are pleased with the progress which has been made at the moment.
I turn now to the point made by the noble Earl, Lord Howe, regarding surveys taken on younger donors. Such surveys are regularly carried out in this area. Young people feel able to give if they believe that the cause is a deserving one. However, once again, it is really a matter of getting the message over. It is not too hard, but young people need to be pressed a little so that they see this as being a priority.
Mention was also made of the Liverpool issue. Without going into it in any great detail, I should like to tell noble Lords that we are very pleased with the direction in which Liverpool is going. A good deal of cash has been put into that area, and I believe we will find that the blood centre there proves to be an excellent resource with an excellent future. There are a number of points which I have not covered because I am mindful of the time. However, with the agreement of noble Lords, I shall be pleased to write to them on the issues not mentioned in my response.
One of the main features of the Question tabled by the noble Lord, Lord Tebbit, and of his comments, was the cost of television advertising. I believe that the total cost of both advertisements that were created was about £163;1.5 million. That may seem to be a lot of money, but when one weighs it up in relation to the blood resources and the generation of new donors, it is clear that this is cash which has been well worth spending.
We should be proud, not complacent, about the current level of blood stocks. We should be proud of the donors we have, because they are personally far more than adequate. However, we shall always need more of them and must continue to make every effort to increase their numbers. As the noble Earl, Lord Howe, said, the blood donation service is now better structured, better staffed and, indeed, more efficient. Indeed, it really has a healthy future in front of it.
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