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Umbilical Cord Blood

Volume 522: debated on Monday 31 January 2011

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

I am pleased to have secured this vital debate. At first sight, a debate about umbilical cord blood might seem highly specialised and marginal in terms of its interest and application, but I hope that the debate that I have initiated will highlight the importance of the issue, and its wide application to the saving of lives and money. We have just completed the Second Reading of the Health and Social Care Bill, and this debate chimes with the Government’s policy of creating a modern health service that is open to innovation and excellence, providing life-saving treatments.

I described this as a vital debate. “Vital” is a word used commonly in the Chamber. In fact, a quick search of Hansard will reveal that it was used 2,997 times in 2010—that is, an average of about 20 times each sitting day. It has been used in connection with banking reform, the G20, libraries and ladybirds. While all those are no doubt crucial subjects and worthy of parliamentary attention, my use of the word “vital” in this debate relates to the number of people who, sadly, die each year from blood disorders and cancers without the vital resource of umbilical cord blood.

I introduced the issue of umbilical cord blood to the House on 8 January 2008 through a private Member’s Bill on the subject. A number of hon. Members approached me afterwards, in a state of ignorance to which they openly confessed, to ask what it was all about. Since then the issue has been raised on a number of occasions—notably the debates on the Bill that became the Human Fertilisation and Embryology Act 2008—and great progress has been made in raising parliamentary awareness of the benefits that these life-saving cords can provide for people suffering from tragic illnesses. In 2008 an all-party parliamentary group was established, and I see that its chair, the hon. Member for Alyn and Deeside (Mark Tami), is present. I am sure that the House will wish to join me in paying tribute to the work of organisations such as the Anthony Nolan Trust, whose efforts have helped to keep the importance of cord blood at the forefront of the minds of many hon. Members, including Ministers.

I hope that tonight’s debate will remind Members of the value of this vital resource. Blood cancers are killers. According to Cancer Research UK, 4,000 new myeloma cases are diagnosed each year in Britain, and 2,500 myeloma sufferers die. There are 11,000 lymphoma diagnoses each year and 4,000 deaths; there are 7,000 leukaemia diagnoses each year and 4,000 deaths. For many sufferers, the only hope is a blood stem cell transplant. It may result from a bone marrow match, or from the taking of blood cells from the bloodstream of an adult donor or an umbilical cord donated by a mother after childbirth.

The procedure is complex, and there can be a range of complications that pose a threat to the patient. However, although it may seem awful that only 50% of blood transplant patients survive the treatment, almost none would survive without it. Blood stem cell transplants really are the last chance for people to whom no other treatment is available. For some of those people, a transplant is not just a treatment that saves their lives for a while, but an outright cure. At any given time, about 1,600 people in Britain are waiting for a matched donor for a transplant, hoping to survive long enough to get that chance.

Five-year-old Sorrel Mason was one such person. Three years ago Sorrel’s father noticed that she was looking pale, and she was eventually diagnosed with a rare strain of acute myeloid leukaemia. Her mother Samantha recalled the terrible fear and sense of helplessness that they felt at the time. She said:

“I remember the first time I saw her hooked up to all those machines. It broke my heart.”

After two doses of chemotherapy Sorrel was able to have a transplant, and received suitable stem cells from a mother’s umbilical cord from Tokyo—albeit an expensive imported cord; that is a point to which I shall return later. Thankfully, the procedure was a great success. In Samantha’s own words:

“Every day we waited for the daily blood counts. It was a miracle when eventually they came up okay.”

We are on relatively new ground here, because the first time a stem cell transplant took place using cells retrieved from a donated umbilical cord was in 1988. Since then, scientists have been discovering many advantages to the use of cord blood. You, Mr Speaker, will be relieved to know that I will refrain from reciting numerous tracts from the many academic papers on this subject. However, one especially noteworthy example of the great research work being carried out is the Cancer Research UK-funded trial being led by Dr Rachel Hough into the use of umbilical cord blood from unrelated donors for people who have cancer of the bone marrow or lymphatic system. Her team aims to investigate whether a transplant using cord blood cells can help cancer patients who cannot be matched to a bone marrow donor. This is an exciting and promising development that highlights the great potential for uncovering further benefits of cord blood.

The immediate benefit of a transplant from cord blood is that it achieves the same level of success for the patient at a significantly lesser degree of tissue matching. When I first raised this subject three years ago, we relied on speculation about the number of cord blood units needed for this country’s health needs. Now we know from evidence and with authority that a cord blood bank would have to maintain only 50,000 units to provide for the bulk of Britain’s unmet need for stem cells beyond the 770,000 registered adult donors. A great advantage of umbilical cords is the availability of the stem cells retrieved. They are collected, tissue-typed and frozen after the birth of the child, and then made available as soon as a patient requires them. That radically reduces the waiting time before a patient can access a transplant. Currently, the average time it takes for a patient to receive their transplant after the search for a match is started is some 160 days, during which time many patients become progressively weaker and the likely success of the transplant can thus be reduced.

Cord blood transplants save lives that other methods cannot, so it is no surprise that, globally, the proportion of transplants undertaken using cord blood is increasing every year. Great Ormond Street hospital, a leading transplant centre, will now use only cord blood where it is available. The pace of advance in this arena is excellent. Each year, the prognosis for patients treated is better than for those treated the year before, and that is because of the research taking place in the UK and around the world. Not only are blood cancers and similar disorders subject to increasingly effective treatments, but an active investigation is taking place into the use of cord blood in the treatment of sickle cell anaemia and HIV.

The hon. Gentleman will be aware that minority ethnic patients make up almost 20% of the unmet need for stem cell transplants, which is disproportionate to our 10% representation in the population. Does he agree that one of the important uses of this blood is in enabling ethnic minority patients, who find it more difficult to get a match, to have some hope?

I am very grateful for that intervention. The hon. Lady and I share an interest in both sickle cell anaemia and the thalassaemia issue. The UK Thalassaemia Society, whose headquarters are in my constituency, has great interest in this area and, in particular, in the black and minority ethnic communities, who are not able to get matches through the bone marrow register and are acutely in need. That is particularly the case for mixed-race families, who struggle to find any match and are sometimes wholly reliant on a cord blood solution. That is why it is welcome that over the years the previous Government and this Government have increased the number of collection centres to make more of those units available.

However, more needs to be done because, sadly, where Britain once led, it is now falling behind the United States, France, Germany and Spain. All those countries now outstrip our cord blood collection, inhibiting our research capacity. There are 700,000 births each year in the UK and in almost every single instance the cord blood is discarded as medical waste. I am not proposing routine collection, but we must question the health and economic value of throwing all these potentially life-saving cords away. I welcome the fact that the Government are nudging people to agree voluntarily to donate their organs upon death, and I would encourage a similar nudge in encouraging mothers to consider donating umbilical cord blood.

Progress has been made, but more needs to be done. There are 1,600 people waiting for a stem cell transplant, but the unmet need in annual terms is only 440 transplants per year. A bank of just 50,000 umbilical cords would provide the bulk of that need. Sadly, simply increasing the size of the adult register is not an alternative to having cord blood. We already have access to more than 16 million donors on registers worldwide. The work of the Anthony Nolan Trust and others helps us to access that adult register, but we would need a UK adult register of a similar size to approach the effectiveness of a 50,000-unit cord blood bank.

I thank the hon. Gentleman for his earlier comments. It is difficult to talk in financial terms about such issues, but with patients who do not get a transplant, there is a huge ongoing medical cost for their treatment, whereas a transplant could save that money, which could then be reinvested in the health service.

We often talk about investing to save, but this is an area in which investment would save both money and lives. I shall go into that in more detail.

A report on transplantation by the UK Stem Cell Strategic Forum, ably chaired by Professor Charles Craddock, was published in December 2010 by NHS Blood and Transplant. The Minister discussed the report, which makes important recommendations, with the all-party group on the day of its publication. The report recommended, first, investing in expanding Britain’s cord blood bank capacity to 50,000 units. Those proposals have been properly costed and the costs have been balanced against effectiveness by NHS Blood and Transplant. For an investment of £50 million, spread over five years, Britain could have that 50,000-unit cord blood bank.

I thank my hon. Friend for giving way. I want to congratulate him on the work that he has consistently put into this issue over the past three years, which is to be commended. Would he endorse the proposal that certain hospitals or regions could be piloted or allocated as regions to collect and donate the necessary 50,000 units? Rather than having routine testing across the country, it could be just in specific regions or units.

I am grateful to my hon. Friend for making that point. There has been some progress on the areas that could retrieve unit cords, particularly from members of BME communities who lack those matches, but we also need to look further at matching that up with regional centres of excellence. I shall return to that point.

First, let me deal with the money issue, which we cannot ignore in this area of health. For an investment of £50 million over five years, we could get that 50,000-unit blood bank. Although it would be difficult to find £10 million a year for five years in these austere times, the financial benefits make sense. The blood bank would provide economies of scale that would reduce the cost to the NHS of every treatment and would radically reduce the need to import expensive stem cell units from abroad, which is, sadly, too common a practice today. The saving that would bring to the NHS has been calculated at £6 million a year in perpetuity. Within 10 years, the entire investment would have been repaid and the programme would save the NHS money for the foreseeable future—and then there are the 200 lives we can choose to save each year by taking that step. So, it would save £6 million and 200 lives a year, and those figures are with currently available treatments at success rates that are currently being achieved.

I am very grateful to the hon. Gentleman for giving way. He has mentioned money several times. Is he aware of the work of the Round Table around Britain and Ireland, of which I am a member? It has consistently raised large sums for the Anthony Nolan Trust. Will he place on record his thanks to the Round Table movement for its support for the trust and this matter?

I am grateful to that movement and other groups and charities that support this important work.

We need to ensure that we do well what we can do well by adopting the report’s second recommendation to establish regional centres of excellence in cord blood transplants. That would reduce the number of UK centres from 30 to 12, leading to a £12 million saving over 10 years. The report makes the point that that would, crucially, ensure that we had specialised, life-saving therapies in safe, publicly accountable environments. That is fully in line with the Government’s commissioning policy for specialised procedures and would provide great benefit.

The third, really exciting recommendation is about providing an opportunity to build on Britain’s unique strategic advantages, encouraging world-class research and private and voluntary sector growth that will provide new jobs and save further lives. The proposal to create a national trial programme in stem cell transplantation would take advantage of world-class centres of scientific research and the easy and sustained access to patients that the NHS provides. The proposal offers the potential for inward investment, private sector job creation and third sector involvement, as is well demonstrated by the success of the Centre for Clinical Haematology at the Queen Elizabeth hospital in Birmingham. To quote Professor Craddock:

“The unique international trials network will be highly attractive to pharmaceutical and biotechnology companies who wish to rapidly evaluate new drug therapies and can be anticipated to make a major contribution to the growth of private sector jobs in this sector.”

The Government, as we know, are encouraging growth. Where better than in the field of cord blood stem cell transplantation? The Minister has been kind enough to keep me informed of the progress that her Department is making in the development of a response to the proposals in the report. I hope the time is nearing when she will be able to make a statement on her plans in this area. I trust that in the complexities and scientific details of that report, her Department will be clear about the central message that 200 lives and £6 million can be saved each year.

In conclusion, I draw upon the story of Sorrel Mason. Prior to her life-saving procedure, her parents had never heard of the importance of cord blood donation and its benefits for stem cell transplant patients. No one could put it better than they did when they said:

“It’s quite hard in this country to donate your umbilical cord. Hopefully as time goes by there’ll be more places that offer this lifesaving opportunity.”

In a Parliament that will be characterised by the difficult decisions that it makes, this is one decision that we cannot afford not to take, and yes, I will say it again: it is vital to do so.

I thank my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) for securing this debate on a topic that is vital. He is right to state that this is yet another opportunity to highlight the issue. All opportunities are useful to raise it in the minds not only of those in the House this evening, but of the public and of those in a position to influence what goes on.

The Department recognised the importance of this issue when it asked the NHS Blood and Transplant Authority to review the UK’s collection, supply and use of stem cells from both bone marrow and umbilical cord blood. The general consensus was that the UK Stem Cell Strategic Forum did a superb job on the review. Its report, which was published in December last year, involved a well thought through, strategic and costed analysis. It provided us, probably for the first time, with an honest appraisal of the use of stem cell units in the UK in the public and charitable sectors. Unfortunately, as is often the case if such reports are honest and frank, some of it made uncomfortable reading.

The review found that the delivery of stem cell units for transplant in the UK is not as efficient or effective as it should be. As my hon. Friend stated, we lag behind many other comparative countries, including Germany and the United States. Some 400 patients each year fail to find suitable donors. Then delays in the system mean that those who find a donor are sometimes, sadly, much too ill to receive a transplant. For these patients the prognosis is very poor.

As the hon. Member for Hackney North and Stoke Newington (Ms Abbott) pointed out, for patients from a black or minority ethnic background, the problem is compounded by the lack of donors or suitable stem cell units available in the first place. Disadvantaged from the outset, their chances drop drastically. On average, about 90% of Caucasians can find a suitably matched donor, compared with only 30% to 40% of those from other ethnic backgrounds. That is unacceptable and pretty shocking. As I said when I announced the report’s publication at a meeting of the all-party group on stem cell transplantation, I am determined to do all that I can to see services improve. I want service providers to develop plans for providing the most effective and efficient service possible in the interests of both the patient and the taxpayer.

My hon. Friend has highlighted a rapidly developing area. Some progress has been made, but it is going at an extraordinary pace. The report not only highlighted what needs to be done, but contained 20 recommendations for the improvement and development of services for the benefit of patients. They include comprehensive changes to the way services are delivered, with a view to establishing the UK once again as a world leader; a more streamlined collection, processing and delivery service, with much more of a focus on results, rather than process; and a radical reconfiguration of transplant services.

The greatest improvements and the quickest gains will be delivered by better bone marrow and umbilical cord blood stem cell services. By making services more efficient, we will see a marked improvement in the treatment, care and support received by patients. We will be able to reduce the time it takes to find a matching donor, address any inequalities in the current system and provide a better service with fewer resources. That will lead to better quality, better management, better planning, better delivery, better outcomes and, crucially, more lives saved. We want those principles to be diligently and consistently applied across the board. The objective is clear: to improve the life chances of those in need of a stem cell transplant.

A considerable amount of work has been done behind the scenes since the publication of the report to see that vision implemented. I have asked officials to work with the forum, NHS Blood and Transplant and Anthony Nolan to develop ways to get a single bone marrow register and cord blood inventory for the NHS in England. We will explore what can be achieved by collective effort, using what is already available and planning for the provision of future services.

Further to that point, has the Minister had any discussions with the Scottish Government on their plans for ScotBlood, which is the equivalent service in Scotland? Does she agree that the solution is to have a single register for the whole UK?

There is no doubt that close discussions with all the devolved Administrations are critical. We have a patchy and disjointed service, but as the hon. Gentleman rightly says we need a single register. I am pleased to say that some work is already bearing fruit. At the last meeting of the forum, well-advanced plans were put forward on how NHSBT and Anthony Nolan can work together in future, with targets for reducing the average search time by six weeks and the establishment, for the first time in England, of a single bone marrow register and cord blood inventory. However, we must go further. I cannot praise enough that type of innovative and professional approach. It is collaboration like that that means real improvement for patients. We must have notable improvements on the wards, not just on the spreadsheets.

The UK Stem Cell Strategic Forum review was a Department initiative, and the work was paid for by the Department. We have heard of the efforts of organisations such as Round Table. I would like to take the opportunity to thank Lynda Hamlyn, the chief executive of NHSBT, Henny Braund, her counterpart at Anthony Nolan, and their dedicated, hard-working staff for the work they have done so far. I have no doubt that there is more work to be done and that it will continue in the future.

I am grateful to my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) for securing this incredibly important debate. I confess that this is something about which I knew nothing. He mentioned the importance of education and the need for a programme that is similar to that for organ donations so that mothers are informed about the value of umbilical blood and blood products before giving birth. Certainly, that is something that I was never informed about. Is the Department considering any sort of education programme so that people can opt in to the system as donors?

I thank my hon. Friend for that intervention. It would be terribly simplistic to think that it is just a matter of donors coming forward. We know from organ donation—it is also the case for umbilical cord blood—that it is important to streamline the processes, because there are unacceptable delays. The report’s recommendations cover the whole process from beginning to end. I do not underestimate the need to raise the importance of this issue. Many hon. Members can play a critical role in their local areas and with their local media by highlighting the importance of organ donation.

I am conscious of the time but happy to give way, because the hon. Gentleman has done a lot of work on this issue.

Does the Minister agree that Anthony Nolan has done an awful lot—particularly with the introduction of spit and swab tests—to help people to take that first step on the ladder? Before, when it was a case of just giving blood, that put a lot of people off, particularly males, such as myself, who are rather squeamish about these things, but it is very important to get the maximum number of people to take that first step forward.

Yes, absolutely. The hon. Gentleman is quite right to highlight yet again the work of Anthony Nolan, which is crucial, but I urge him and all male Members to remember that they have nothing to fear from needles and no need to be squeamish about those things; it is about potentially saving lives.

It is a challenging time financially, and we cannot put that behind us. It is important that we get the UK back on a secure financial footing, and that means funding will be tight, but I want to reach out further to our partners in charities to see how we can work together. We are not short of offers in that field. My hon. Friend the Member for Enfield, Southgate will know that I am shortly meeting Cord Blood Charity to see what part it can play, and Anthony Nolan is making every effort to provide additional funding for the important work that I have spoken about.

On Government funding, the Department of Health will provide some £4 million in additional funding to help with service development, but, more than that, we will continue to help in other ways, bringing together key stakeholders to ensure that all opportunities to bring about those further improvements and to implement those recommendations are taken. We are also working towards increasing the size of the cord blood bank by funding NHS Blood and Transplant to increase the bank to 20,000 units by 2013—an increase in stored units of almost 100% since 2008. I know that my hon. Friend would like to me go on, and as part of future strategic planning I shall ask NHS Blood and Transplant to consider the options for developing the bank even further, with the final goal of reaching a stock of 50,000 stored cord blood units, accessible to all NHS patients.

In the development of that new commissioning structure within the NHS, we will listen closely to the recommendations of the forum report, with respect to improving NHS practices and commissioning. The forum has met since the report’s publication, and I hope that it will continue to meet to advise the sector on best practice and to provide innovative solutions to implement those recommendations. I shall keep closely in touch with all those who have shown such a close interest.

Improving the health care pathway for stem cell transplantation to treat life-threatening diseases is a vital part of that work. I use those words cautiously, but I want to see NHS patients having access to the best possible services. We are meeting my hon. Friend soon to discuss the issues raised in the report and some that have come out of this debate. As always, his contributions to the debate are welcomed, highly respected and, like those of many Members, motivated by the best possible intention, which is to save lives.

Question put and agreed to.

House adjourned.