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Disposable Surgical Instruments

Volume 622: debated on Thursday 15 February 2001

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3.13 p.m.

What delays there now are in carrying out operations because hospitals are waiting for the disposable surgical instruments required to avoid the risks associated with variant CJD.

The Parliamentary Under-Secretary of State, Department of Health
(Lord Hunt of Kings Heath)

My Lords, on 4th January the Government announced the introduction of single-use instruments for tonsil surgery during 2001. Supplies of those instruments are expected to come on-stream during the late spring and summer. In the meantime, the Deputy Chief Medical Officer has advised that surgeons should review individual cases to ensure that no serious conditions are missed. Guidance has also been issued to the NHS to ensure that, so far as possible, other ear, nose and throat procedures are substituted for cancelled tonsil operations.

My Lords, I am grateful to the noble Lord for his Answer. Have hospitals in England and Wales yet caught up with their programmes of non-urgent operations following the delays arising from the instruction that only disposable instruments should be used? Are sufficient disposable instruments now available to meet all the hospitals' requirements?

My Lords, approximately 74,000 operations are carried out in the UK each year. So far as concerns the question of supply, an initial order has been placed for 3,000 sets of instruments, which will be delivered in February and March. The remainder of the available instruments will be delivered over the next few months. There will be a delay for some patients who are waiting for a tonsil operation. However, I believe that, under the precautionary principle, that outcome is probably inevitable. With regard to waiting lists, I can confirm that the number of patients on those lists is currently 124,000 below the number that we inherited.

My Lords, the Minister's recent announcement referred to tonsillectomies and instruments used in those operations. However, the acting chairman of SEAC was recently quoted as saying:

"If there is a risk of transmission of vCJD through tonsillectomy instruments, I think it is likely that there is risk through other surgical procedures—particularly those involving the brain and central nervous system".
Can the Minister say whether the Government's recent risk assessment report, which is still unpublished, confirms that view, and what are the Government's plans in that respect?

My Lords, the risk assessment report will be published soon. Noble Lords will be glad to know that it will also be available on the Department of Health's website. The noble Lord is right to say that at its meeting last November SEAC welcomed the overall risk reduction strategy. Indeed, it also welcomed the advances that are being made with regard to decontamination, which plays an important part in the way in which we deal with these issues. It endorsed the concept of using tonsils in a pilot scheme to see how single instrument use would work in practice. However, the noble Lord is right. There are other procedures, particularly in relation to brain and posterior eye surgery, where single instrument use may need to be considered. We are committed to working with and talking to the profession about the practicalities of that.

My Lords, is the Minister aware of any evidence which shows that disposable instruments are better than or preferable to instruments which are properly cleaned and denuded of all protein during the cleaning process before sterilisation?

My Lords, the risk assessment programme carried out by SEAC certainly made the point that the first line of attack must be to ensure that proper decontamination processes are in place. The issue of single instrument use must be considered as a second line of attack. It is important that hospital decontamination procedures are right. That is why the Government have authorised expenditure of £200 million over two years and why we are putting into place a strong performance management approach to decontamination. That is where we need to focus many of our efforts.

My Lords, is the Minister able to confirm the figures published in a paper which says that civil servants have calculated the cost of introducing disposable instruments at £630 million a year? If abdominal surgery were to be included, that figure would reach over £2 billion£that is, 4 per cent of the national health budget. Therefore, does the Minister agree that it is particularly important to move ahead with the halted programme of research into whether instruments can transfer infection? Will he confirm that £30 million has been set aside by the Government for that research, which was agreed two years ago but then halted? When will that programme of research start?

My Lords, with regard to the research programme, we are funding a portfolio of research projects in relation to the decontamination of surgical instruments. That funding totals more than £3 million. The programme is being overseen by a Department of Health steering group. Of course, I agree with the noble Baroness that it is important that the research is developed as speedily as possible. So far as concerns the overall costs suggested by the noble Baroness, the cost of single-use instruments for tonsils is estimated at £25 million per year. If we were to consider back-of-the-eye procedures, the cost would be between approximately £450 million and £500 million.

My Lords, does my noble friend agree that CJD is particularly difficult to deal with because it is a prion, which makes it impossible to disinfect surgical instruments?

My Lords, yes. SEAC concluded that tonsillectomies should be chosen for specific attention because prions have been found in the tonsil tissue of people who died of variant CJD. Moreover, most tonsil surgery is carried out on children, who have their lives ahead of them. It was on the basis of the SEAC risk assessment that the decision was made to phase in single-use instruments in relation to tonsils.

My Lords, the Minister's answer seems to indicate that instruments are not being properly cleaned or sterilised in some hospitals, which could lead to the passing on of diseases other than CJD. What steps are the Government taking to ensure that all surgical instruments are properly cleaned and sterilised?

My Lords, the noble Lord is right—concerns have been expressed about the standards of decontamination procedures in our hospitals. That is why the Government announced a £200 million programme to modernise decontamination and sterilisation procedures. We have issued a circular to the NHS emphasising the importance of its urgently reviewing its management arrangements and the need to carry out a health and safety audit. We have appointed a high-level support team to go into individual trusts to help them to get right their decontamination procedures. We want new training programmes to be established to reinforce those points. We take this matter very seriously.