Public Petitions Committee, 15 Apr 2008

Meeting date: Tuesday, April 15, 2008

Official Report 314KB pdf

---

New Petitions

Good morning and welcome to the sixth meeting in 2008 of the Scottish Parliament's Public Petitions Committee. Please ensure that all mobile phones and other electronic devices are switched off.

I welcome back to the committee Angela Constance, who has been on maternity leave. Her substitute for that period was John Wilson, who so enjoyed his experience on the committee that he is now a substitute again, for a short period, for Nigel Don. Welcome back, John. John got enough praise at our previous meeting, so I am not going to praise him again for his contribution as a committee member.

We have an extensive agenda, so without further ado we move to item 1, which is consideration of new petitions. PE1136 has been withdrawn by the petitioner, so we now have two new and 22 current petitions before us. Some of the current petitions will be considered together this afternoon. As agreed at our previous meeting on 19 February, we will take oral evidence on the last two current petitions, PE1086 and PE1091, on national health service hospital car parking charges.

---

Blood Donation (PE1135)

The first new petition is PE1135, from Rob McDowall, calling on the Scottish Parliament to urge the Scottish Government to review existing guidelines and risk assessment procedures to allow healthy gay and bisexual men to donate blood.

I welcome Rob McDowall and Nick Henderson to the meeting. Mr McDowall, you have a chance to make a three-minute statement on the petition. I will then invite questions from committee members.

Good afternoon. Thanks very much for inviting me to come here today. I apologise for the absence of Angela Paton, who was to have accompanied me today. Due to ill health, she could not come.

Each day, 1,000 blood donations are needed in Scotland to maintain the blood stocks that are required to keep Scotland going and to meet our health needs with regard to blood. Dr Moira Carter of the Scottish National Blood Transfusion Service has said that there are not enough donors to meet Scottish health care needs at the moment. Supplies are dangerously low, as committee members will be aware from the multitude of adverts by the blood transfusion service.

"Have a heart", "Give blood", "Save a life" and "Give the gift of life" are all slogans of the National Blood Service in the United Kingdom, which are designed to capture the attention and sympathy of people in the UK in order to convince them to give blood. I ask the committee to consider the position that I was in, when I was 19 years old, as I queued up to give blood. I was full of excitement and wanted to make a difference—to give the gift of life. However, I was told that, unfortunately, I could not give blood due to my lifestyle choices.

Giving blood in the UK is not met with a payment, unlike the situation in other countries. Money does not change hands—unless tea and biscuits are legal tender in Scotland. It is a selfless act, and it is one of the only things left in the world that is done for the good of mankind. The NHS blood transfusion service says that the issue is specific behaviours that put people at risk and that it is not about being gay or bisexual. The blood transfusion service says that there is no exclusion of gay men who have never had sex with another man.

The blood transfusion service refers to being gay as a lifestyle choice that puts people at risk. I would say that being gay is no more a lifestyle choice than being born with brown eyes or a German accent. Our society—and particularly the Parliament, and Scotland as a whole—is one that celebrates diversity and equality. Being gay is recognised as a fundamental part of the human condition. The petition is not about a blood amnesty, and it is not demanding that the doors should be opened tomorrow to everyone who wants to give blood. There are certain people who should not give blood due to their individual behaviour, such as participating in unprotected sex. It is not about pushing a statute to introduce the right for everyone to give blood. The only person who has a right is the person who receives the blood, who has a right to safe blood. We are asking for a commonsense approach on the part of the blood transfusion service. Specific behaviour, such as having unprotected sex, would exclude someone from giving blood. That should be the case for gay and heterosexual males who present themselves at the transfusion service.

Australia, Spain, South Africa, Russia, Italy and Thailand allow men who identify themselves as being gay or bisexual to give blood. In Australia and South Africa, donors are asked whether they have had sexual contact with another male in the past 12 months. If the answer is no, they can give blood. The UK blood transfusion service imports blood products from Australia, where gay and bisexual men can give blood. I would ask the committee to consider urging the Scottish Government to change its stance and to adopt a more flexible approach, in which we hold people capable of judging their own risk and each person has their individual behaviours assessed. A blanket ban is not the answer. I would love to be able to give blood—I would do it today if I could.

The committee is quite severe, but we are not asking you to do that.

It is clear that there is a host of anomalies on the issue, and very little common sense connecting them together. The petition should be taken further and referred to the Government or to the Health and Sport Committee—whichever we decide.

As a blood donor, I am not sure whether I should declare an interest. Is the questioning in the solutions proposed by the petitioners not more intrusive than the questioning that happens at the moment? Is it acceptable to ask people about how they live their lives?

There is a simple question to ask donors to assess whether they present a risk, which is whether they have participated in unprotected sex. If the answer is yes, they should not be allowed to give blood, but if it is no, and someone has safe sex—it does not matter whether it is with men or women—they should be allowed to give blood. Introducing that question could make blood donation much safer. When Italy introduced that question in 2001 and removed the blanket ban on gay and bisexual men giving blood, there was a drop of two thirds in the number of people who contracted HIV from blood donations. Spain introduced a similar policy and the number of people contracting HIV from blood is now a sixth of what it was before the ban was lifted. Introducing a simple question that asks about unprotected sex will make all blood safer.

Have you assessed the impact of that? You are depending on individuals to be honest in response to that question. If people are honest, how many folk would fall off the donation numbers?

Thank you for asking. The blood transfusion service feels that introducing that question may put people off giving blood in the first instance. The current questioning goes into great detail—it asks people whether they have had sexual contact with someone who has been in an excluded country, whether they have had a tattoo and whether they have used drugs intravenously, and it asks men whether they have had protected or unprotected sex with another male. An element of honesty is required to answer those questions. The blood transfusion service asks potential male donors whether they have had sex with another male, but if someone answers that they have not, they could give blood—no polygraph test is run to determine whether that is the case. The system already involves an element of trust.

It is a question of moving forward and recognising that there is a significant shortage in the availability of blood. There are no definitive figures on how many gay, lesbian and bisexual people there are in the UK, so we could not say that there would be a 10 per cent increase in the number of people who donate blood. However, in other countries the lifting of the ban has had a positive impact on the safety of blood tissue and organs—there have been fewer cases of infection from donated blood because donors have been asked about particular risks. Gay donors have not simply been told that they have made a lifestyle choice.

As a former blood donor whose blood is no longer accepted because of the medication that I have been on in recent years, I can understand where you are coming from. However, with my medical hat on, I note that the list of people who are turned down for blood donation is extremely long—potential donors are turned down for all sorts of reasons.

I have a slight difficulty with the petition in that with matters such as blood donation public safety must be paramount, in so far as that is possible. We know that in the past there have been problems with blood infected with hepatitis C, for example, and I am pretty sure that I am right in saying that people who have had a blood transfusion are not allowed to be blood donors because of the extremely small chance that they have picked up CJD.

My difficulty is not to do with any sort of prejudice. There are serious issues at stake, and I can understand the reason for the rules and regulations that the blood transfusion service has in place. That is not to say that we should not seek opinions on the matter or get an update on the present state of thinking and research. The petition deals with an extremely serious issue. Given that we are acutely conscious of public health and the risk of litigation, I think that the service would think extremely long and hard before it changed the rules, but that is just my personal opinion.

As someone who has given blood, I, like Rob, feel that giving blood is one of the most simple but positive and affirming things one can do.

Even though I have given blood and have gone through the tick-box exercise, I was surprised to learn about the reliance on trust and disclosure. It also surprised me to find out that gay men were excluded from giving blood but that heterosexual men who had slept with prostitutes were debarred from doing so only for a year. The cynic in me wonders how many people will be open about sleeping with prostitutes, for example. Is there a far simpler method that would bypass the need for honesty? I am sure that the vast majority of people are perfectly honest, but is there some way in which blood could be screened for viruses? I am not a medical person, but I know that screening does not necessarily pick up a virus at the time of testing because there is always a window period.

In Scotland, the testing mechanism that is used to detect HIV is called nucleic acid testing. In general, there is a window period of three months, within which the antibodies cannot be fully detected. Nucleic acid testing cuts down the window period to about 16 days. I am not a doctor, but I have read about different testing mechanisms that are used in different countries. All blood is screened. The Scottish National Blood Transfusion Service is of the opinion that cutting out people who are seen to have been at high risk will minimise exposure to HIV/AIDS and other infections. That is a preventive measure that relies on trust.

At the moment, there is a campaign in England to enable gay people who are willing to give blood to go to a centre, for example, to be tested for HIV/AIDS. They could be given a certificate to indicate that everything is okay, which they could present when giving blood. That would remove the element of the system that relies on trust. Many people would not be prepared to take such a test, as they would regard it as another hurdle, but I would, as I want to give blood. I would be prepared to be tested and to say that I have not had unprotected sex with anyone, that I have not placed myself at high risk and that I have a certificate that indicates that I have no infections of any description. The campaign in England is suggesting that approach as the way forward.

Nick Henderson has information on the testing that is available in different countries.

Nanette Milne made the point that the Scottish National Blood Transfusion Service believes that gay men are at higher risk of HIV infection. Department of Health figures show that, in the past year, 2,732 heterosexual people and 2,145 gay people were infected with HIV. Straight people are now more at risk than gay people of contracting HIV, partly because the safe sex message is really getting through to gay and bisexual people. Very few gay and bisexual people would even consider having unprotected sex. That view is much less prevalent among straight people—I do not know how well the safe sex message is getting through to them. I do not think that gay and bisexual men are at any more risk than others of contracting HIV.

The nucleic acid testing window period is the same—16 days—for straight people and gay people. The chance that infection will not be detected is the same for a straight person who has HIV and has not been asked whether they have had unprotected sex as it is for a gay person who has HIV. There is no justification for a blanket ban on gay people giving blood.

Nick Henderson has made many of the points that I intended to make in response to Nanette Milne's point about public risk. The figures that Nick has just presented to us indicate that the risk of getting infections from unprotected sex is exactly the same for gay people as it is for heterosexual people. From my days as a guidance teacher, I remember that there was a time when Scotland was branded—quite unfairly—as the HIV capital of Europe. Later there was a period when the highest increase in the number of HIV infections was among young girls. We should be aware of that history. The numbers are even at the moment, but they could easily move in the direction of more heterosexual people than gay people becoming infected. From the point of view of public risk, it would make more sense for us to ask heterosexual people, especially heterosexual young people, who want to give blood whether they have had unprotected sex.

Rob McDowall mentioned the suggestion in England that gay people who want to give blood be tested for HIV and be given a certificate to show that they are not infected. I understand that being tested has insurance implications. If someone takes out new insurance, they must disclose that they have been tested, which suggests to people that they are more at risk and makes it more difficult for them to get insurance, mortgages and the like. Much as people would like to give blood, it would be asking a bit much to have them put their future financial viability on the line.

I accept the point that you make. I have been told that if someone goes to their general practitioner to be tested for HIV/AIDS, they are demonstrating that they have behaved in a way that has put them at risk.

There are different screening centres, including confidential screening centres that are aimed at the lesbian, gay, bisexual and transgender community and which try to offer more discreet testing. Instead of having to ask their GP for a test a person can go to the screening centre for a general MOT. Various providers offer such a service and, as I understand it, they do not go back to the GP and say, "We tested this person for X, Y and Z."

Is there a uniform view among pressure groups and organisations that assist gay and bisexual individuals? There is evidence that the Terrence Higgins Trust thinks that on balance the current formula is not discriminatory, although it acknowledges the concerns of individuals such as you who have presented themselves to donate blood. Do you understand why the Terrence Higgins Trust arrived at its conclusion?

Nick Henderson and I have spoken to various organisations throughout the campaign. The Terrence Higgins Trust has said that currently it is satisfied with the epidemiological data and that it is happy with where we are. Every service provider has its own agenda and aims and objectives, and all seek to promote holistic health among gay and lesbian communities, but the THT focuses on education and awareness. I have considered the information and asked questions and, in all honesty, I am not sure how the THT, which represents a large number of people in the gay and lesbian community, reached its conclusion. Its policy document seems to have been produced in response to a request from the blood transfusion service for a position statement. The THT has said, "This is where we stand."

Many of my friends in the gay and lesbian community and many other people to whom we have spoken throughout the campaign fail to understand why the THT has come to its conclusion and why there appears to be no uniform approach. It has been suggested that people could get personal health certificates, which would show that they are not at risk, or that people who have abstained from sexual contact for 12 months could give blood, as happens in Australia. Many suggestions are flying around.

For me, the issue is individual behaviour. Someone who has multiple sexual partners or unprotected sex puts themselves at high risk. The risk should be measured, as opposed to refusing someone because they belong to the LGBT community. Of course, the blood transfusion service says that the issue is not the person's being gay but their lifestyle choices. As I said, being gay is not a lifestyle choice. It is certainly not a lifestyle choice for me or for many members of the gay community; it is about who we are.

I do not think that anyone on the committee disagrees with that—that is a legitimate position. The issue is the risk and the evidence from the blood transfusion service and others on higher-risk groups, which is to do with the choices that a person makes and their behaviour, rather than who a person is. I accept that there are people in the heterosexual community whose behaviour is equally high risk, but the figures per head of population show markedly higher risk in the male homosexual community, primarily. The issue is how you reassure the likes of the blood transfusion service that there are processes that are worth adopting. The Terrence Higgins Trust said that it would be happy for there to be a review of the procedures, given that there are different approaches internationally.

Nanette Milne, who has a medical background, asked a legitimate question about litigation. If no action was taken to address the risk and someone was given contaminated blood, the person might have reasonable cause to take legal action against the blood transfusion service. That would undermine the wider commitment of you and everybody in the committee to donate blood, because we would worry that we could be part of that. Navigating through that is difficult.

You raise legitimate and critically important issues about personal rights. How do we engage with the agencies—the blood transfusion service and others—to address those concerns? Is there a better way to operate? The information that we have asks pretty challenging questions. That is what I am trying to draw out from you.

I agree completely with what you have said and Nanette Milne made a really good point. The issue is a talking point. No matter who someone is in this world, everything is about safety, and not just because people might make a legal claim against the blood transfusion service. The demand for blood is significant. I accept that gay people and others might put themselves at high risk through individual behaviour. When we started the petition, I saw the position as discriminatory and almost homophobic, but I have now reached the view that the point about safety is strong. No one around this table is homophobic—the issue is not as clear cut as that.

Many questions need to be answered. When I lodged the petition, I wanted first and foremost to raise members' awareness of the issue and to get it out there for people to consider. There are always differences of opinion among doctors. I am not a GP or a doctor, so I cannot say specifically what we could do.

The question was asked how we sell the proposal to encourage people to agree with it. Thailand has set an example. In that country, 30 per cent of gay and bisexual men are HIV positive, but it has instituted a policy of asking all donors whether they have had unprotected sex and has lifted the blanket ban on gay and bisexual men giving blood. I return to Rhoda Grant's point that people who have been tested for HIV must pay a higher insurance premium, which shows the fear about the issue. In addition to the gay blood campaign, much more must be done to tackle HIV.

Thailand has managed to institute the policy that I described, as have other countries such as Russia, South Africa, Spain and Italy, as we have said. Asking the simple questions of all donors and allowing other people to give blood improve health, blood stocks and the safety of blood stocks.

We will now determine the next stage for the petition. I am open to committee members' suggestions on progressing the petition and obtaining further information.

How can we find out the scientific detail of the situation and the standard of research or results in the countries that Nick Henderson mentioned? I am not sure who would find that out. Would the National Institute for Biological Standards and Control cover that? I ask because I do not know. Some scientific body—perhaps the blood transfusion service itself—must have information.

Having such information would be worth while. Perhaps we could ask the Scottish Parliament information centre to obtain information on standards throughout the world. The pressures are different. Thailand and South Africa, which have been mentioned, have particular social and behavioural structures. In South Africa, heterosexual carriers of HIV are the predominant problem. Nuances in each country need to be reflected. It would help to get SPICe on to that.

I imagine that organisations that are involved in the gay and lesbian community, such as BloodBan, have gathered information. The Terrence Higgins Trust has its view and BloodBan has its view but, underneath that, pretty good evidence will be available. We should gather that before we obtain further information.

We should write to ask the responsible minister whether the health department has undertaken any review, because the issue is not new. In my brief period as the Deputy Minister for Health and Community Care, one issue was that newcomers to Scotland could be in high-risk groups, because of the countries from which they came. Some evidence suggests that that has had an impact, particularly in west central Scotland. The service is aware of those pressures, so we would be happy to get its views. Is there anyone else from whom members think it would be worth getting further information or views?

What about the Advisory Committee on the Safety of Blood, Tissues and Organs?

We will get a balance between health organisations that are specialists on blood and tissue and a cross-section of campaigning organisations that represent the diversity of the LGBT community. We will also contact the health department and the responsible minister. Is there anyone else?

What about the blood transfusion service itself? It should be consulted.

That would be useful.

I will explain the process to the petitioners: stage 1 was the petition; stage 2 is to gather other views on the issue—objective and subjective, as some of them will be. Then we will come back to the committee with recommendations on what it can do next—whether it can take direct action or whether it should ask the Health and Sport Committee to explore the issue, if it has a remit to do so. The petitioners will be kept fully informed. They have raised a critical issue that people do not often think about. The question is how we explore and try to address it.

I hope that we have been helpful enough today and that it has not been too intimidating. The petitioners are relatively young to come to the committee, so it is good to see them here raising an issue that is of concern to them. I hope that, should it ever be resolved, they will both be donors in future.

It has not been as nerve-wracking as I was expecting it to be. I was expecting a "Dragons' Den" type of experience.

We are just back from recess so we are in a good mood this week. Next week, we will be hellish. I thank you both for your time.

---

Bond of Caution (PE1134)

I had hoped to have two verbal presentations, but the petitioners for the second one had to cancel due to circumstances that we will discuss later. Instead, we come to petition PE1134, by Bill McDowell, which calls on the Parliament to urge the Government to amend the law of succession to end the requirement for a bond of caution for an executor-dative when seeking confirmation to any intestate estate.

The papers are before us. Do committee members have any comments or observations?

I did not know anything about this before I looked at the papers, but I noticed that the Scottish Law Commission has recently carried out a consultation on whether to retain the bond of caution. The commission is not due to report until early next year, so I do not know whether there is any point in us trying to do anything further until such time as we hear the result of those deliberations.

Paragraph 6 of our note on the petition gives the timescale for the commission's report as being early 2009, which is a long time away when the consultation ended in December 2007; it is a year and a bit. Is that an inordinate time or is it naive of me to think that the commission could move more quickly? Is that just lawyers for you?

I can understand where the petitioner is coming from and the arguments against having a bond of caution, but I am not clear about the arguments for it. Will somebody explain them to me? It is a sort of insurance bond. Is it to prevent people from running off with money? Is it some sort of back-up, in case they do?

Probably. That is my summary of the mumbled discussions that I have just had with the clerk.

My understanding is that if someone leaves a will a bond is not needed, whereas if somebody has not left a will it is—but what makes an executor of an unwilled estate more liable to be corrupt than an executor of an estate where there is a will? Can we pass the petition to the Scottish Law Commission for its consideration as part of the review?

The clerk to the committee will inform us accurately on the issue.

Members may formally refer the petition only to another committee of the Parliament. If you wish to get the views of the Law Commission, you will have to approach it formally in the usual way, but the petition would be retained here.

If we write to the commission to ask for its views, it will say that it is reviewing the matter and will report early in 2009. I am not suggesting that we ask for its views on the petition, but we could ask whether it is aware of the issues that the petitioner raises. One imagines that it must be, if it is carrying out a review. What I am getting at is that we could close the petition, but ensure that the Scottish Law Commission is aware of it. We could tell the petitioner that the Law Commission will report in 2009. If, thereafter, there are issues with what the Law Commission comes up with, the petitioner would be able to resurrect the petition with the committee quickly. I am not sure that asking the commission for its comments at this stage would gain anything.

The point that you made just before that final one is right. We are waiting for the consultation and the final review to take place, and if the petitioner is still not happy, or if further issues are raised, they have the perfect right to pursue the matter. However, in the context, we can probably close the petition and await the conclusion of the review process. Can that be done?

You can close the petition as long as you demonstrate a reason for doing so. It would be acceptable then to pass a copy of the petition to the Law Commission for it to consider.

That is a reasonable course of action. Issues will come out of the review, and I would have thought that the petitioner or others will raise some, too. Are we happy with the proposed course of action?

Members indicated agreement.

The next petition was to have been PE1136, by Mr George McAulay, but it has been withdrawn, so we will move on to the next item.