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Umbilical Cord Blood

Volume 503: debated on Thursday 7 January 2010

Motion made, and Question proposed, That this House do now adjourn.—(Lyn Brown.)

It is a great pleasure to have secured this Adjournment debate. I think that I was the first Member to raise the issue of umbilical cord blood as a private Member’s Bill, and subsequently I raised it with other hon. Members during the passage of the Human Fertilisation and Embryology Act 2008. Courtesy no doubt of Google word searches, my interest has led to a number of academics contacting me about their research into cord blood. I imagine that this debate will keep me at the top of the umbilical cord blood search page. However, my concern is to increase the understanding and application of cord blood.

After I first raised the issue, several hon. Members spoke to me of their previous ignorance of umbilical cord blood. It is an ignorance that I shared, despite being a parent of six children and living close to one of the NHS hospitals that collects umbilical cord blood.

Like the majority of parents in Britain, my wife and I thought that the umbilical cord once clamped was simply a waste product. We were totally unaware of the potential benefits of donating our children's umbilical cord blood. My understanding has grown over the years, aided by some excellent individuals in the charitable, private and public sectors who are passionate about cord blood. I pay tribute and thank the Anthony Nolan Trust and UK cord blood working group for their work and assistance and for rubbing off some of their passion on me. What inspires me to keep flying the flag for umbilical cord blood is meeting those children who are alive because of cord blood. This is a subject that can be literally a matter of life and death.

Patients in the UK requiring a bone marrow donor currently have a one in four chance of survival. Only 50 per cent. of those looking for a donor will find one, and of those only 50 per cent. will survive. For those who find a bone marrow donor, many get their donor too late in their disease for the treatment to achieve success and that contributes to the 50 per cent. failure rate. Greater provision of cord blood could help those patients to get treatment faster and improve their chances of survival. For those who currently have no bone marrow donor, a larger provision of cord blood would give many of them a potentially life-saving option.

Despite an increase in the awareness of those reading or listening to this debate, I feel that a short explanation of umbilical cord blood is in order. The baby's blood which is left behind in the umbilical cord contains many different types of cells. Some of these cells are stem cells, which have been shown to have a number of medical applications. Over the past 20 years, collected cord blood has been used for transplantation in the same way as bone marrow. It has been used to treat patients suffering from diseases such as leukaemia, sickle-cell diseases, immune deficiencies and others. Currently, there are over 85 treatments based on cord blood and there are more clinical trials in the pipeline.

Researchers believe that cord blood has the potential to treat many more diseases, once adult stem cells are properly understood. There have been trials that show that cord blood may be helpful in treating brain injuries in children. It is also being developed for other possible treatments such as diabetes, liver therapy, multiple sclerosis, testicular cancer and to regenerate damaged heart cells. The medical and financial value of cord blood should not be underestimated. Early indications from research conducted in the UK suggests that many of the patients currently receiving enzyme treatments at a cost of well over £100,000 per annum to the taxpayer, could find a cure through a cord blood transplant.

Cord blood is particularly valuable in the treatment of leukaemia. It can be used as an alternative to bone marrow transplants. Collection of umbilical cord blood is a far less invasive procedure than extracting bone marrow. Units can be collected, frozen and then stored for years. That leads to fewer complications and makes transplants more readily available than bone marrow. Most importantly, it is easier to find matching stem cells from cord blood than from bone marrow. A properly developed infrastructure for the collection and storage of cord blood will do much to alleviate the severe shortage of life-saving stem cells needed for transplantation and to facilitate research.

Cord blood is a natural, safe, ethical and sustainable resource. It offers many advantages over using traditional bone marrow transplants from adult donors and would offer researchers an alternative to using embryonic stem cells.

The previous time cord blood was debated in the House was during the passage of the HFE Act in the context of allowing so-called saviour siblings. I took part in the debate, and an irony was revealed in it: the contrast between the Government stretching ethical boundaries to accommodate so-called saviour siblings, but restricting the natural, safe, ethical and sustainable life-saving resource of cord blood, with 99.5 per cent. of umbilical cords thrown away.

However, it is important to be charitable, and over the years there has been success and progress in the field of cord blood. The NHS was one of the first bodies to recognise the potential importance of cord blood, and some of the most important breakthroughs were made here in Britain. The NHS cord blood bank was established in 1996, and at the time it was one of only a handful in the world. Last year, the fifth umbilical cord blood collection facility, at St George’s hospital in Tooting, was opened. The NHS CBB has moved into a state-of-the-art facility in Filton, which provides greater capacity and the flexibility to meet future clinical standards. I have visited one of the collection hospitals at Barnet, near my constituency, and I was impressed by the professional service, with all donations collected ex utero in a separate room so that the focus remains upon the care of the mother and baby.

As of October 2009, the NHS CBB had banked approximately 14,000 donations and provided 279 units of cord blood to British patients, with 34 per cent. coming from black and minority ethnic communities. Given that there is only a 30 to 40 per cent. chance of a BME patient finding a matched unrelated donor, it is right that there is a focus on increasing cord collection within these communities.

However, this progress has not gone far enough. The vast majority of parents in this country do not have access to NHS umbilical cord blood collection centres, which are in London, Luton and Watford. Expecting parents are not being informed about the many benefits of donating their baby’s cord blood. Even parents who have a history of blood-related disorders are not properly informed and have limited options to have their cord blood collected. Last year, an Enfield resident whose family had suffered from a rare anaemic disease contacted me in a desperate state. Her daughter was due to give birth any day and she had only just discovered by chance the value of collecting the cord blood. Fortunately, they lived near Barnet hospital, which collects cord blood, but only then at certain times; they were told that unless the birth happened between 9 and 5, Monday to Thursday, the collection would not take place. Therefore, even if someone is fortunate enough to live near one of the five NHS collection hospitals, and even if they are fortunate enough to be fully informed about the potential life-saving value of cord blood to their child if they are at risk of developing a family blood-related disorder, the cord blood may still be thrown in the bin.

At a time when the health service is so mindful of the need fully to inform patients about their health care, the issue of the collection of a mother-baby’s cord blood does not seem to get the same level of attention. The principles of full information and consent do not seem to apply to cord blood, which is generally treated as a waste product, unbeknown to the parent apart from in exceptional circumstances.

These circumstances of collection are more often dictated by the NHS collection targets than the wishes of the parents. It is hardly surprising that private companies come in to fill the void. Competition and tight regulation by the Human Tissue Authority have ensured that good practice predominates, but at a financial cost to parents. Private banking has its place, but what is lacking is access to sufficient cords available for public benefit from whatever source.

In previous debates, I have said that the NHS bank of 14,000 blood cord units is too low. Last year, academic research confirmed that for a truly effective transplantation infrastructure to operate in a country of the UK’s size and population, we will need to bank about 50,000 units of cord blood, and some people think the bar should be raised even higher. Either way, there is an urgent need for a sound projection of what is required, which should form the foundation of a comprehensive strategy for cord blood in the UK.

At present, many patients—particularly those from ethnic minorities—who need transplants are unable to find matches. That has resulted in the NHS importing cords from the continent. The Anthony Nolan Trust has responded by collecting cords at King’s College hospital, and has plans to extend this to 10 collection centres in maternity units around the country. At the request of the Government, a funding bid was submitted last June. The cord blood working group is also putting together the clinical and economic case for expansion. Will the Minister give a view on the progress of these plans?

The UK is falling behind our European neighbours and other developed countries. Our NHS cord blood bank is smaller than those of countries of a similar size, such as France. Greater attention and resources are paid to this issue in other countries such as Spain, Italy, Germany and the United States. At present, cord blood can be used only to treat a fairly narrow set of illnesses, but scientists believe that with more research and investment it could be used to treat a much wider range of illnesses. Research in this important area has been hindered by lack of public awareness and by embryonic research crowding out other forms of research into stem cells. As a result, leading figures in this field such as Professor McGuckin and Dr. Forraz have left the UK to pursue their research in other countries that are more open to the possibilities offered by cord blood research.

A key difficulty with cord blood transplants is the problem of engraftment where the body rejects the transplants, particularly in adolescents and adults. Until recently, UK transplanters have tended to opt for other established treatments because the reported results of cord blood usage have not been as promising. Indeed, I received news today of a health commissioner asking for a business case to be made for a prospective cord blood transplant—perhaps the Minister would comment on this worrying case.

However, recent overseas advances in the use of cord blood and the launch last month of the first UK clinical trials of cord blood have greatly encouraged clinicians. At the instigation and under the management of Dr. Rachael Hough of University college London hospital, two clinical trials are running across the UK. The aim is to establish the safety and efficacy of using unrelated cord blood to bridge the engraftment problem, and to establish conditioning protocols. For example, it may be that by increasing the amount of cord blood stem cells—given the unique mobility involved—unrelated cord blood can provide safer and more effective life-saving treatments.

The scientific development and application of cord blood in other countries has reached a point where it would be neglectful for the UK not to embrace to the full this exciting option. It is becoming clear that having a large range of cord blood donations available for patients to find compatible transplants would save both lives and money. It is not just the Government who need to keep up with progress in the field of umbilical cord blood; the Royal College of Obstetricians and Gynaecologists’ last word on this was a 2006 report in reaction to perceived problems with some private operators, but the umbilical cord blood world in the public, charitable and private sector has made significant advances since then.

To its credit, the Department of Health agreed to undertake a review of the collection and use of umbilical cord blood, and seminars and discussions have taken place. However, the progress of the review has been very slow. In October 2008, I asked the Secretary of State when the conclusions of these studies would be published. I was assured by the relevant Minister that the report would be made available later that year. When that did not occur, I asked the same question again—this time in March 2009—and the relevant Minister replied that these conclusions would be published in due course. It is now January 2010—happy new year—and the Department of Health has still to publish its findings.

It is not sufficient for the Minister simply to rely on the report published by the consultant Technopolis. Indeed that report made the point when it concluded:

“No explicit national policy has been formulated on cord blood banking in the UK, either as part of health or science policy or as part of blood bank policy.”

It went on to say:

“We recommend that the UK…consider… Creating a high-level advisory committee to provide the Minister and policy teams with advice on the detail of such a policy.”

What is the Government’s response to this recommendation and progress on it? I hope that we will hear something of the Government’s conclusions from their review but will the Minister at least accept the long-standing invitation to speak to the all-party group on umbilical cord blood and adult stem cells, which I have the privilege of chairing?

May I also ask the Government to provide regular updates on how many units of cord blood have been collected, stored and transplanted in the UK? The Government must make their views clearly known. Do they recognise the need to collect 50,000 units of cord blood? Does the Minister have a view on plans to increase numbers of blood cord transplants? I hope the Government will demonstrate a clear commitment to funding cord blood research and to the many lives that it could save.

In September 2008, the then Health Secretary opened the Anthony Nolan Trust’s excellent storage facility for cord blood with a stem cell research centre in Nottingham. He called it a “crucial development” and went on to say that there was a

“wonderful opportunity to take advantage of”

in terms of cord blood. There is an opportunity for more lives to be saved, for valuable scientific research to be undertaken and for the UK to become a centre for excellence in cord blood. Two people die every day waiting for a stem cell transplant and 65,000 litres of cord blood are discarded every year. Will the Minister assure the House today that the Government are taking advantage of the wonderful opportunity offered by cord blood rather than, as seems to be the case, literally throwing it away?

I congratulate the hon. Member for Enfield, Southgate (Mr. Burrowes) on securing this debate. I well know of his interest in this matter as chair of the all-party group and I look forward to taking up the invitation that he has generously extended to me. I understand his passion about and interest in the subject and I have come to share them as I have become more familiar with it.

This is a very interesting and extremely exciting time for the people who stand to benefit from the possibilities held out by improving science and clinical practice. New approaches to stem cell transplantation hold out fresh hope for patients with leukaemia and other blood disorders and, of course, cord blood is becoming an increasingly important source of stem cells, particularly for those with rare tissue types not served by the bone marrow register.

Our knowledge of the potential of cord blood is growing year on year as a result of the Government’s investment in research and our commitment to supporting those who seek to find new answers for those who seek transplants and, because of this, the use of cord blood is increasing in terms of numbers and is broadening in scope. For example, it is likely that more adults than children will receive cord blood treatments this year for the first time, just one sign of how these treatments are evolving in use. I agree absolutely with the hon. Gentleman: cord blood can play an important role in treating blood disorders and cancers in the future and we want to be in a strong position to take advantage of these breakthroughs.

I know that the efficient and co-ordinated collection and storage of cord blood are crucial to that ambition and change. Our NHS cord blood bank is a world leader, holding the second largest inventory of unique tissue types in the world, and it is the world’s fourth largest bank. As we have heard today, the bank will shortly be entirely based at the new £60 million blood processing facility in Filton, Bristol, which will be the largest facility of its kind in the world. Our current focus is on collecting from groups that are under-represented on the bone marrow register, because this is where we believe cord blood can make the most immediate and biggest contribution by extending new hope and providing life-saving treatment to those who have difficulty finding an appropriate tissue match.

In England, we now have five NHS hospitals that can collect cord blood, all chosen because they serve families from a diverse multicultural mix, as was correctly pointed out by the hon. Gentleman. In October, I had the pleasure of opening the newest site at St. George’s hospital in Tooting. While I was there, I was lucky enough to witness the collection of a cord blood unit. My officials told me that I could not have chosen a better time, as a woman had conveniently just given birth, and she donated cord blood while I was there. I was struck by how such a simple procedure could provide such a valuable resource, and it left me absolutely determined to promote cord blood collection and use.

We have taken massive strides forward in recent years, but I am conscious that there is more to do. That is why we have agreed to provide a further £10 million to increase the size of the cord blood bank to 20,000 stored units by 2013. That reflects our commitment to support cord blood treatments into the future.

In a moment. I have listened carefully to the hon. Gentleman’s arguments about the need for a larger bank. I understand his points, and I will keep an open mind on whether further expansion may be necessary. Before I take his intervention, though, I want to add that the issue goes even deeper, because we cannot settle on an optimal size for the bank until we have a clear view of how cord blood fits within the whole landscape of stem cell transplantation.

Those comments help with my question. Is it not the case that we need a comprehensive strategy to deal with all aspects of collection, storage, use and transplantation? We need to consider those issues and come to a settled view on what should be the optimal level, which might well be more than 20,000 units. I should like to know whether the door is open to consider the established academic figure of 50,000 or more.

Perhaps if the hon. Gentleman allows me to continue a little, he will be pleased with some of my comments about how we should move forward. I hope that the all-party group will be part of that moving forward.

The hon. Gentleman argued that we should move towards the routine collection of cord blood. Again, I understand the point about widening the range of collection, but there is not a strong call for that approach from the research or medical communities.

Let me clear up this point. I have called not for routine collection but for the routine provision of information. It should be a matter of routine that all expectant parents are advised about cord blood, its value and benefits, and where it can be collected.

I thank the hon. Gentleman for that clarification, and I understand his point, but we need to give routine information that is linked to a whole approach to dealing with cord blood collection. Our priority has to be a focus on quality rather than quantity. That means finding good matches to treat those with rare tissue types.

If we want to go further in utilising the benefits of cord blood, we need to understand how it best complements other sources of stem cell transplants, most notably bone marrow. We have to decide what the future of stem cell transplantation should look like, and what resources we will need to support it. Only when we have that can we make an informed decision on the size and scope of the NHS cord blood bank. I know that the hon. Gentleman is concerned about that.

The hon. Gentleman mentioned the Technopolis report on cord blood that the Department of Health commissioned in 2008. That report was an important starting point, and I am happy to support many of its recommendations. Since its publication, departmental officials have been in lengthy discussions with NHS Blood and Transplant, the Anthony Nolan Trust and other players to take forward many aspects of the review. We are now working closely with the recently established umbilical cord blood transplant working group, and I believe that that will give us real insight into what is really holding back cord blood collection and use. It will delve into the practicalities of improving clinical awareness and the need for better patient information, which the hon. Gentleman has called for. It will also help us to understand where the latest research may take us in future.

The key recommendation that came out of the Technopolis report was the need for a national strategy on cord blood. As I have said, we cannot approach the issue of cord blood transplantation in isolation. We have to think about how bone marrow and cord blood collection can complement each other and about the challenges facing us, now and in future, in relation to those sources of stem cells. We also need to define the role for all key partners, and start to bring together the various systems and structures that support stem cell transplantation to ensure even closer working. There are, of course, many different interest groups involved and I want to be absolutely sure that their views are fully represented as we take things forward, but we all have the same, singular objective—to help save more lives.

That is what this work is really about. We can discuss bank size, the pros and cons of one system over another or who is best at doing what—and those are all important discussions and decisions that we have to make—but all that really matters is whether we can make the difference between a person living or dying. We have to make choices that will make the biggest difference to those patients so, for me, that is what will drive our work in the future.

I am sure that the hon. Gentleman will be delighted, therefore, when I tell the House that we are establishing an expert strategic forum that will be led by NHS Blood and Transplant, in partnership with the Department of Health and other stakeholders. This group will operate as a high-level taskforce to advise Ministers on the best options going forward, and that will mean getting to the heart of many of the issues that he quite rightly raised today in the House.

I shall also write to my ministerial counterparts in the devolved Administrations to ask if they will be represented, so that we can get strong dialogue and co-operation across borders. My intention is for this group to produce a discussion paper in the spring of this year that will provide the basis for a new strategy on the collection and use of stem cells for transplant.

In conclusion, like the hon. Gentleman I am extremely enthusiastic about the role that cord blood can play in the future. The reason is simple—it saves lives. It holds out the possibility of saving people who would otherwise die because of a lack of matched tissue.

We have to make the right strategic decisions for the future, based on real expert insight into how stem cell technology is evolving and on what will deliver the very best results for patients. I am confident that the new forum, drawing on the work of the cord blood working group, will help to guide us to the right answers.

Do we not need some form of mechanism, as well as the regular reports, for making information available—for instance, about the number of units of cord blood that have been collected or are in storage or used in transplants? That information is important, because it will allow us to see the progress being made and to make adequate responses.

I shall be very happy to make that information available, as it will of course assist us as we move forward.

We have a strong heritage in this area or work, having pioneered bone marrow transplants in the 1970s and 1980s. As science opens up new possibilities, I am determined that we maintain that tradition, because we are well placed to take advantage of the great promise that cord blood—indeed, that all forms of stem cell transplantation—can offer patients.

I thank the Minister for giving way one last time, but I want to use all the time available for this important subject. She will be aware of the proposals put forward last June—with Government encouragement, I understand—from the Anthony Nolan Trust, and she has already referred to the work of the core blood working group to develop an economic case. How do those proposals fit into the timeline of the April date that she gave?

By way of clarification to the House, I should say that I referred to the spring because I want to make sure that the work is done properly, but my intention is that the work will be done sooner rather than later in the year ahead. The hon. Gentleman’s comments can of course be read into the review, and I shall be very happy to discuss this matter in even greater detail at the all-party group, whose meeting I look forward to attending.

I thank the hon. Gentleman for raising what I believe is a very important matter, and for his commitment to taking it forward.

Question put and agreed to.

House adjourned.