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Lord Clement-Jones: My Lords, I apologise for interrupting the Minister in full flow. Is there not a good case to be made for having a similar inquiry in England?

Lord Hunt of Kings Heath: No, my Lords, I do not think so. The best approach is to await the outcome of

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the Scottish investigation. I do not think there is a case for saying that there needs to be an investigation into the English circumstances.

Noble Lords have asked about services. We clearly want the health service as a whole to have good quality, modern, dependent services and we want people with haemophilia to benefit from the improvements in services that we intend to make. In that context, let me turn to one key issue which has been mentioned today, the availability of the latest drug treatments for hepatitis C.

Until recently, the only treatment available for hepatitis C was Alpha Interferon. This had a limited success rate--around 20 per cent--in removing the virus and is not suitable for all patients. However, the use of Alpha Interferon in combination with Ribavirin appears to be significantly more effective, clearing the virus in around 40 per cent of those treated. This combination therapy is now licensed. I can confirm to the noble Earl, Lord Howe, that we have asked NICE to assess this as a matter of urgency. We look forward to receiving its guidance later this year.

Several other therapeutic agents are in development which show great promise--a point raised by the noble Lord, Lord Clement-Jones. Other treatments are being researched such as different combinations of drugs. We hope that the next few years will see significant developments and improvements in the treatments available.

All noble Lords referred to the recent coverage of cases where health authorities have said that they cannot prescribe combination therapy on grounds of cost. I wish to make two points in regard to that. It is important that we do not seek to pre-empt the independence of NICE on the cost-effectiveness of this treatment. To do so would undermine the effectiveness of NICE, which has been set up to put an end to postcode prescribing. In the meantime, I would expect local decisions on providing combination therapy for hepatitis C to be based on the available evidence of clinical and cost effectiveness, taking account of the needs of individual patients.

Both my noble friend and the noble Lord, Lord Clement-Jones, asked about the availability of counselling services. When I met members of the Haemophilia Society last year, they told me that they considered there was insufficient counselling available. We have therefore given careful consideration to how we may help to improve that situation. As a first step, we have asked the UK Haemophilia Centre doctors' organisation to ensure that counselling provision is available and accessible to all haemophiliacs with hepatitis C. This will mean that the facilities at the 22 comprehensive care centres in the UK are available to the smaller haemophilia centres. I hope that that will be a significant improvement.

We are also working with the organisation to collect better data on the number of people with haemophilia infected with hepatitis C. This can be used to support better service delivery and provision. We are also

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talking to the Haemophilia Society and the Manor House Group to see how counselling and support services might be further developed.

The professional groups with an interest in haemophilia have also recommended the development of a set of minimum standards for service delivery. Both the noble Earl, Lord Howe, and the noble Lord, Lord Clement-Jones, asked about how we might develop a national strategy in relation to service provision. I believe that the development of a set of minimum standards would be an effective way of improving counselling provision and other aspects of haemophilia services in the longer term.

With this in mind, the recently formed Haemophilia Alliance has started work on a proposed national specification. This specification will outline the key components of a high-quality haemophilia service, whether this is provided in the larger comprehensive care centres or the smaller haemophilia centres. The Alliance has asked the NHS Executive to circulate information about its work on the service specification through our national networks, and we have done that.

We have also identified haemophilia services as appropriate for specialist service commissioning, and three regional specialised commissioning groups--in London, the west Midlands and the south-east--are looking at designating their services at present. I hope that that combination of measures will help to put haemophilia services at the top of their agendas and support those services in performance managing the services for people with haemophilia in the NHS as a whole.

To underpin the work of the Haemophilia Society, we give an annual grant towards its administration. We also provide individual grants to help with the excellent projects it develops to support people with haemophilia and hepatitis C. For example, over the past two years we have supported a Haemophilia Society project to develop and produce material on hepatitis C for young people, their families and teachers. The booklets are: Living Life to the Full; Alive and Kicking; Being There; and Haemophilia and School. These are available from the Haemophilia Society. All have been highly praised, and rightly so.

We are also funding a seminar for professionals on co-infection with HIV and hepatitis C. That will take place later this year. The Haemophilia Society is developing the programme and arrangements. We are keen to build on our work with the society and I am sure that there will be further projects we can take forward.

Looking at hepatitis C in a wider context, we are aware that it is a significant public health issue. We recognise the need to increase knowledge about the natural history, prevalence, transmission and treatment of hepatitis C. This will ensure that the NHS is equipped to deliver services based on the best scientific and medical evidence available.

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In order to address this, we have commissioned research totalling £1 million. We are currently in the process of investing a further £0.5 million of research money specifically into the area of hepatitis C and injecting drug misuse. This is currently responsible for most new cases of hepatitis C. The research will investigate ways of reducing the incidence, spread and progression of the disease. There is also a trial under way into the possible benefit of treating hepatitis C in the early, mild stage.

I was asked a number of questions concerning the case of the hepatitis C-infected surgeons. We are aware of these incidents. We have worked hard to identify other patients who may have been at risk. Although we believe that the risk to the individual patient will be very small, patient notification allows those who may have been at risk to receive advice and the offer of hepatitis C testing. Any found to be infected can then be referred for specialist assessment and advice.

As part of our programme of measures, we have also funded a group from the Royal College of Physicians, the British Society of Gastroenterology and the British Association for the Study of the Liver to draw up evidence-based guidelines for the management of patients with hepatitis C. These guidelines will form part of NICE's consideration. In addition, we support the work of voluntary organisations working with people who have hepatitis C. I have already mentioned the Haemophilia Society projects. The British Liver Trust, a charity representing all patients with liver disease, has received grant aid for projects to raise awareness of hepatitis C, to produce information leaflets and run a telephone helpline, and to develop its chronic disease self management programme.

My noble friend asked about a "look back" for HCV. He is quite right. There has not been a specific look back study for HCV. That is because the haemophilia centres are regularly attended by people with haemophilia and are tested for the virus. A small number may not have been tested. We have written to the UK haemophilia doctors to ensure that they recall those attending their centres and offer them counselling and, if they wish, HCV testing.

In conclusion, I should like to assure my noble friend of my great sympathy for people with haemophilia who have been inadvertently infected with hepatitis C. I understand only too well the difficult dilemma where treatment and care can lead to harm where none is intended. This is an area of clinical practice that we are determined to address through our investment in quality systems in the NHS. I fully recognise that for people with haemophilia the clock cannot be turned back and we can only consider with great regret what better progress in anti-viral technology might have helped us to avoid.

However, the constructive, forward-looking initiatives we have in hand with the Haemophilia Society and other groups, the ever newer treatments

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for hepatitis C and our overall drive to raise quality in the NHS as a whole should improve the services and support available to haemophiliacs with hepatitis C.

Lord Burlison: My Lords, I beg to move that the House do now adjourn during pleasure until 8.38 p.m.

Moved accordingly, and, on Question, Motion agreed to.

[The Sitting was suspended from 8.32 to 8.38 p.m.]

Financial Services and Markets Bill

House again in Committee.

Clause 301 [Investigations by Director General of Fair Trading]:

[Amendments Nos. 257D and 257E not moved.]

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