Hepatitis C
The final item of business is a members' business debate on motion S2M-1481, in the name of Keith Raffan, on the urgent need to tackle hepatitis C, public health crisis. The debate will be concluded without any question being put.
Motion debated,
That the Parliament welcomes the launch of the UK Hepatitis C Resource Centre for Scotland; recognises the urgent need to raise awareness of what the Royal College of Physicians of Edinburgh described in their UK Hepatitis C Consensus Statement of April 2004 as a "public health crisis" which affects between 45,000 and 65,000 people in Scotland, and believes that the Scottish Executive should acknowledge that, as with HIV/AIDS, this epidemic can only be effectively tackled through central, ring-fenced funding for both treatment and prevention.
I am glad to have the opportunity to open this debate, which in my view is the most important in which I have ever spoken in this Parliament. The hepatitis C epidemic is a public health crisis. That was the opening key message of the final consensus statement that was produced at the end of the conference on hepatitis C that was held by the Royal College of Physicians of Edinburgh in April.
Hepatitis C is a blood-borne virus that affects more than 200 million people worldwide. Dr C Everett Koop, who as surgeon general of the United States under President Reagan first had to meet the challenge of HIV/AIDS, has described hepatitis C as
"an even greater threat to our public health".
In the United States, HCV—as the hepatitis C virus is known medically—already infects three times more people than AIDS does. It is responsible for more than one third of all liver transplants, and it already kills more people than AIDS each year.
Here in Scotland, at the beginning of the last parliamentary session the then Minister for Health and Community Care, Susan Deacon, commissioned a SNAP—or Scottish needs assessment programme—report on HCV. Published in 2000, that report estimated that 35,000 people were infected with HCV in Scotland. Last week, at the launch in Edinburgh of the United Kingdom hepatitis C resource centre, the chief medical officer Dr Mac Armstrong raised that estimate to 45,000. The resource centre itself estimates that the figure could be as high as 60,000 to 65,000.
The truth is that we simply do not know how many people in Scotland are infected with HCV. What we do know, according to the latest figures published by the Scottish centre for infection and environmental health today, is that up to 31 December 2003 18,109 people in Scotland had been reported to be hepatitis C antibody-positive, that intravenous drug users comprise the vast majority of cases, and that our rate of infection is approaching three times that of England and Wales.
We also know that although between 20 and 25 per cent of those who are infected clear the virus naturally, between 60 and 80 per cent become chronically infected. The majority of those people develop liver inflammation, which may eventually lead to cirrhosis and liver cancer. Up to 1,000 people who are infected with HCV in Scotland have already developed liver failure, and that is just the figure to date. If we do not make treatment more widely available, the number of people who develop liver failure will escalate by 60 to 70 cases a year, rising to 150 a year by 2020.
The treatment of HCV involves a combination therapy of pegylated interferon and ribavirin, a course of which costs between £7,000 and £9,000 per patient. It is therefore unsurprising that a former chief executive of one of the health boards in the region that I represent has described hepatitis C as
"a financial time bomb under the NHS in Scotland."
Quite simply, HCV is a grave threat to public health. The health boards cannot be left to carry the burden on their own, or waiting times for treatment will continue to be up to three or four years in certain areas. Just as happened for HIV/AIDS for more than 10 years, central ring-fenced funding must be provided to counter the disease. That is the only way in which we can meet the huge challenge that HCV represents.
We need urgently to introduce priority screening for former intravenous drug users who are over 35. I pay tribute to Professor David Goldberg of the Scottish centre for infection and environmental health for the help that he has given me in preparing this speech, although any mistakes and all opinions are my own. As Professor Goldberg wrote in the paper that he presented with Dr Eleanor Anderson to the hepatitis C conference, the great majority of those former IDUs
"would have been infected for a period, sufficient for progression to moderate, but insufficient for progression to severe, disease."
In other words, the group of over-35 former IDUs is the one that is most likely to benefit from combination therapy. To target those people, we must identify them through general practitioners, through posters and leaflets in health care waiting areas and in prisons, where more than 1,000 people have already tested positive for HCV antibodies.
I have spoken of treatment and screening, which are part of secondary prevention, but what of primary prevention? What do we need to do to help intravenous drug users avoid contracting HCV? During the 1980s, 80 to 90 per cent of drug injectors became infected with HCV in the first year of their injecting career. By the mid-1990s, thanks to harm-reduction measures and needle and syringe exchanges, the figure had decreased to between 20 to 30 per cent of drug injectors. Sadly, since then, there has been an increase in needle sharing, despite the fact that in 2003 the Lord Advocate raised the limit on the number of needles and syringes that could be distributed to each drug injector from 15 a day to 60 a day and 120 at weekends. The Lord Advocate also permitted the distribution of drug paraphernalia, such as spoons and filters—which can cause infection—but only four health boards have funded that and one of them is about to stop doing so.
The Executive must commission research urgently to find out why there has been an increase in needle sharing; to evaluate the harm-reduction measures that are in place and the effect of the lifting of restrictions on needles and syringes; and to monitor how effective health boards have been in needle exchange. There is a worryingly large gap between the 2 million to 2.5 million needles that are distributed to drug injectors each year and the estimated 18 million injections that they give themselves.
"Services are already struggling to cope with the burden of infection and disease.
Significant resources must urgently be directed at improving prevention and delivery of care.
High priority for case finding should be given to former injecting drug users."
Those are not my words, but further key messages from the consensus statement with which I opened my speech. The Executive must act now; if it does not, the hepatitis C epidemic will develop into an epidemic of cirrhosis and liver cancer, the number of deaths will far exceed that from the AIDS epidemic at its height in this country, and the national health service in Scotland will be put under unprecedented strain, which many of those who work within it believe it will not be able to withstand. The situation is a public health crisis that demands a comprehensive response from the Government of Scotland, and it demands that response now.
I congratulate Keith Raffan on securing the debate. We discussed his motion at the launch of the UK hepatitis C resource centre for Scotland, from where much of my information came.
Keith Raffan rightly made considerable reference to the "Consensus" conference statement from the Royal College of Physicians of Edinburgh, which makes chilling reading. I will address one or two points, only some of which Keith Raffan addressed. He reckoned that there might be between 45,000 and 65,000 hep C sufferers in Scotland but, of those, only 18,000 are identified. That is a chilling statistic. Those sufferers will, at some point, enter the NHS, which cannot cope now, let alone cope with that time bomb, which is ready to explode.
As the minister is aware, I have lodged 10 parliamentary questions that focus on issues that are raised in the consensus statement. I look forward to detailed and specific answers, such as we always receive in the Scottish Parliament. I certainly hope that I will not receive the answer, "That information is not held centrally."
Keith Raffan referred to needle exchanges. With regard to the distribution of needles and syringes in Glasgow, the January 2004 issue of the Scottish Drugs Forum bulletin states:
"But while almost one million needles and syringes were distributed locally, between seven and 12 million were needed to cope with the estimated number of injecting episodes".
That answers in part Keith Raffan's question about why people are sharing needles: there are not enough to exchange. That information
"comes as the latest figures show that 259 new cases of HIV"—
not hep C, but HIV—
"were recorded across Scotland in 2003—their highest annual numbers since the mid-1980s."
Some very simple steps can be taken. For example, the Executive must increase needle exchanges. I refer to the Scottish Drugs Forum report of February 2004, "A Brief Survey on Drug Paraphernalia Distribution following Amendments to the Misuse of Drugs Act (1971)". The SDF sent out a questionnaire to various pharmacies, its member organisations and other voluntary sector organisations. Thirty-nine questionnaires were returned, and some of the responses were extremely interesting. The report states:
"Almost two thirds would like to supply sterile water and acidifiers, and half would like to supply stericups and filters.
It continues:
"17 responses cited financial barriers—uncertainty that monies would be available, and additional costs had not been anticipated. One respondent estimated an extra £120,000 would be required annually, within their region."
That is not a lot of money when we consider the latent costs that the NHS will incur in due course.
I return to the Scottish Drugs Forum bulletin for a comment on funding, on which I would like the minister to respond, because I do not know where we are with regard to the point that is made. The bulletin states:
"Meanwhile, Scottish councils have also been advised that the £6.8 million granted yearly for local authority rehabilitation services will continue—although it will be built into the mainstream revenue grant system permanently and not ring-fenced."
Keith Raffan talked about the availability of national money, but not even the money that is available to the Scottish councils is ring fenced. Obviously, fears are growing that that money will be used to alleviate other pressures within the council system.
I will finish with a quotation from the Royal College of Physicians, which is not known for being melodramatic in its use of language:
"What is certain is that, if we do not invest adequately now, we will not be able to afford the consequences of failing to tackle this epidemic."
Those are serious words indeed, minister.
I, too, congratulate Keith Raffan on securing the debate, which clearly concerns a matter of serious proportions.
Irrespective of a certain vagueness in the figures, there is no doubt that hepatitis C has the capacity to cause grave problems for the national health service's infrastructure and a significant proportion of the Scottish population. Keith Raffan is correct to highlight those problems and suggest how the matter may be resolved.
In most cases, hepatitis C is a tragic by-product of the history of drug abuse that we have witnessed over the past 20 to 25 years. Irrespective of the actions of successive Governments, drug abuse has still not been overcome in our society in Scotland or elsewhere. Until such time as we are able to do something about the cause of the problem, we are unlikely to come up with sufficient answers for the effect. We should seek some way of cutting the degree and extent of drug abuse. That is no easy question to pose and I will be the first to admit that I do not have the answers. Education is a very important factor, both education to avoid the use of drugs and education about the nature of hepatitis C, its consequences and how it might be avoided.
I was disturbed to learn from Keith Raffan's discourse that needle exchange is not providing the answers that so many of us hoped that it would. The minister must carry out some research to find out why the needle-exchange scheme is not working as we had all hoped and why it is failing to make the appropriate impact by way of a reduction in the incidence of hepatitis C.
A drugs clampdown in education and a resolution of the problems with needle sharing might not provide the complete answer. A question of personal responsibility comes into it. Sometimes, that is forgotten. We must work on the assumption that a small proportion of society is not prepared to assume that personal responsibility. How do we cope with that?
Will the member take an intervention?
Will the member take an intervention?
I will give way to Mr Raffan, as it is his debate.
I am a little bit worried about the direction in which Mr Aitken is going. I hope that he can assure the Parliament that he is not suggesting that those who, sadly, suffer from an addiction—drug addiction is a disease—should in any way be victimised for that disease, any more than alcoholics or those who smoke cigarettes, whose addiction is harder to kick and probably causes the greatest burden on the national health service.
The bottom line is that we are left with a proportion of the population who are, as Keith Raffan said, addicted. I am not for one moment saying that they should be cast adrift to meet whatever fate awaits them. It is obviously our responsibility to do something to ensure that they can be helped in the parlous situation in which many of them find themselves.
What is the answer? I am not attracted to the idea of ring fencing funding for any aspect of the national health service.
But the Tory Government did that for ages.
That is as may be. However, the fact is that, inevitably, that would lead to competing priorities for funding, which is never desirable.
The first thing that we must do is address the question of needle sharing, which Mr Raffan was totally correct to raise. Why is needle exchange not working? If it is a question of resources, we would happily explore that route.
I tender the apologies of my colleague Patrick Harvie, who had hoped to take part in the debate, but who is unable to be here. He wishes to inform the Parliament, however, that he will be jumping off a large building in Glasgow later this week in the cause of hepatitis C charities and that his sponsorship is still open and may be added to.
I very much welcome this debate on what Keith Raffan rightly called a public health crisis. In the public eye, there are almost two categories of hepatitis C sufferers. There are those who contracted hepatitis C from infected blood products before the current safety measures were in place. That applies, in particular, to people with haemophilia. There is widespread public sympathy for that group of patients and there is a feeling that the system has not treated them well at all.
There is a stigma attached to the other group, on whom we have been focusing tonight. That leads to a particular problem, on which I would like to focus by quoting from the final "Consensus" conference statement from the Royal College of Physicians. It is about case finding among groups that are at risk. The statement says:
"A high priority for case finding should be given to former injecting drug users".
Those are people who have been drug injectors in the past, but who have stopped injecting and who are, hopefully, living a much healthier lifestyle now, getting on with their lives and looking forward to the future. They might not be aware that they are infected with the virus but, if they were identified, they could be treated. The statement goes on to say that priority should be given especially to
"those over 40, who are likely to have a stage of disease which would benefit from treatment. Cost-effective methods of identifying this group, through public awareness initiatives, primary care, drug treatment services and prisons, should be established."
That group should probably be chased up. The issue of stigma might come into play, in that some people might not want to come forward and might feel that they have put that part of their life behind them. However, the matter is important because, as the document says,
"It must be faced that identifying more patients will mean increased demands and costs."
That is certainly true in the short term. In the long term these patients, if they are not treated at an earlier stage, will present with much more significant, expensive and devastating illnesses. It would be appropriate to do a serious case-finding exercise on former drug injectors to see whether we can catch them at a stage at which the disease is treatable. It is better to pay the cost up front now as that will save for the future—that is one of the most important considerations.
Keith Raffan and I are members of the cross-party group in the Scottish Parliament on drug and alcohol misuse and this debate is near to our hearts.
The statistics that Keith Raffan read out alert us to a growing problem that is a big fear for all of us. I must admit that the figures came as a bit of a shock as they are three times the figures for England and Wales. Although most people regard the matter as a problem, it has to some extent drifted to the back of our minds. Perhaps the issues that Keith Raffan has raised today need to be brought to the front of people's minds so that they are more aware of them. Anything that we can do to achieve that is well worth doing, including education and the provision of information in general practitioners' surgeries. We see many issues on news broadcasts and it is all too easy to forget about hepatitis C.
Bill Aitken mentioned the problem in relation to expenditure in the NHS. That is an important issue, particularly given the effects of hepatitis C on the liver. As Keith Raffan mentioned, the drugs concerned cost £6,000 to £9,000 per patient and the problem will be a financial time bomb if it continues to increase at the current rate.
I hesitate to say, although I am afraid that I have to say, that the problem is a financial time bomb whatever happens. It is expensive to treat people with combination therapy, which costs £7,000 to £9,000 for a course of treatment but, if we do not do that, we will have an epidemic of cirrhosis and liver cancer further down the line. There will be bedblocking the like of which we have never seen and a huge strain on the NHS.
I thank the member for outlining that point.
Christine Grahame mentioned how important it is for us to identify hepatitis C sufferers. Keith Raffan said that one way to do that is through GPs, but another issue that we have discussed in depth at the cross-party group is how we can get people who come out of prison into effective treatment. At today's lunchtime meeting we were given startling figures about people who leave prison with drug problems. If such people are not treated, the chance of death in the first few weeks is high; the statistics are alarming.
When the probability of hepatitis C has been identified, screening comes into play. I will be interested to hear the minister state what work we are doing on identifying the problem and on screening, but the bigger issue, which has been mentioned by everyone who has spoken today, is needle exchange. What is the position of the various health boards on greater availability of free needles to deal with the problem of shared needles, which pass on this dreadful disease?
This is one of the most important debates that we have had and I hope that we will move forward and raise awareness of the matter rather than letting it drift away to the back of our minds.
I support Keith Raffan's motion on this important issue. Hepatitis C was one of the main issues that the Health and Community Care Committee considered in the previous session; indeed, the committee was key in ensuring that the Executive took action on compensation payments for those infected through contact with NHS blood products. The current Health Committee followed that up to ensure that the action that the minister promised was taken.
I am pleased that, after some unfortunate delay, the Skipton fund, which is being set up to manage the United Kingdom-wide ex gratia payments for people infected with hepatitis C from blood products, will go live in just five days' time. In itself, that is a major achievement. Although the process was slow, that is undoubtedly a major advance. It certainly is the case that developments in the Scottish Parliament have made the United Kingdom Parliament sit up and pay attention, hence the UK-wide initiative.
The motion is not about compensation for victims of hepatitis C, however; it is about taking effective action in treating and preventing the disease. The motion calls on the Executive to recognise the fact that the major public health crisis can be tackled effectively only through ring-fenced funding for treatment and preventive action. I believe that Keith Raffan made the case for urgent action absolutely clear. Investment now will—to some extent—save the NHS from the impending financial time bomb.
The Executive is rightly proud of its policy of devolving decision making on many health matters to the health boards. However, surely there is a need to ensure that, on issues such as hepatitis C, effective action is taken on a Scotland-wide basis.
Bill Aitken said that he was wary of the idea of ring fencing the funding. I am not often accused of praising Conservative Administrations, but I have to say that it is to the credit of the previous Conservative UK Government that it recognised the importance of ring fencing funding specifically to tackle the HIV/AIDS crisis and, responsibly, took action in that regard. That is an example of what Keith Raffan's motion says must be done to tackle the impending hepatitis C crisis. I support Keith Raffan's call and believe that that is precisely the action that is required to avoid an even larger public health crisis in the future.
I congratulate Keith Raffan on securing this important debate. Watching the minister scurrying to his advisers at the back of the chamber throughout the debate, we can tell that a wide range of issues has been raised that he is committed to responding to.
One of the issues that we should return to is that of hepatitis C in our society and the way in which we view people who suffer from the disease. Of course, as other members have said, one of the immediate problems is that we do not know all the people who suffer from the disease, which, in its early stages, is relatively hidden—a silent killer. Some people have contracted hepatitis C through their lifestyles but, of course, addicts rarely choose their lifestyles—virtually no one is an addict through choice. Other people have inadvertently become infected with hepatitis C.
It is interesting that a social stigma is attached to hepatitis C. We do not speak about methicillin resistant staphylococcus aureus victims in hospitals in the same way, yet in a sense people can become infected by hepatitis C just as innocently as they can fall victim to MRSA.
If we stigmatise people who suffer from HCV, we will make it harder to find out who they are and to provide support to them. That is a moral issue, but there is also a practical issue about not stigmatising hepatitis C sufferers. If we do not support them, they are more likely to pass the disease to others. Therefore, besides the moral case for being non-judgmental, self-interest is involved.
From the various documents on the subject, it is perfectly clear that the means of transmission of the disease are imperfectly understood. There are clear paths through which transmission of the disease is understood to happen—in particular, in relation to injecting drug users who share their gear—but we must remember that there are other ways of transmission. Whether mother-to-baby infection can take place to any significant extent and to what extent the disease can be passed on through sexual contact or through sharing shaving instruments, for example, is not clear.
Addicts are victims, but everyone who is a victim of the disease is not an addict. There is a high incidence of the disease among prisoners because the chaotic lifestyles of injecting drug users throughout Scotland often lead those people into criminality. Therefore, we must address the continuing scandal of inadequate throughcare from prison to reintegration into normal life. Of course, that is partly a financial issue, but it is also an issue of priorities. We must recognise that supporting prisoners should not be at the bottom of our pile of priorities; we should treat that matter seriously if prisoners are not to be a reservoir of infection for others.
I close by highlighting one fact from the statement issued on 22 April by the "Consensus" conference on hepatitis C. The statement says:
"Only half of those referred attend clinics".
We need more people in the community to make non-judgmental contact with people who are infected by the disease. It is in all our interests, and not only in the interests of those who are infected, that we step up the action.
I congratulate Keith Raffan on securing the debate. Hepatitis C, which is sometimes called "the silent epidemic", is one of the most serious and significant public health risks of our generation.
As Keith Raffan said, there are 18,109 reported cases, but the latest estimate from the Scottish centre for infection and environmental health suggests that a total of between 40,000 and 50,000 people in Scotland have hepatitis C. The reality is that, however we describe the present situation—whether as a crisis, an epidemic or a threat—we are faced with a public health risk of significant and increasing proportions.
In recognition of that emerging threat, the Scottish needs assessment programme was commissioned in 1999 to carry out a needs assessment of hepatitis C in Scotland. The resultant report, which was published in August 2000, set the framework for the Executive's response to addressing the key challenges that are posed by hepatitis C.
I emphasise this point because it may not be widely appreciated that the Executive has been active on this front for a number of years, has already set in train a spectrum of measures and has committed substantial resources to tackling the threat from the disease. I will give some flavour of what we have already done, although I realise, of course, that more must be done.
In order to bring further coherence and impetus to the programme of activity in Scotland, we have in hand the preparation of an updated action plan that will set out the action that is in progress and the additional measures that we propose to take. Some key issues have been raised by members today. Eleanor Scott talked about the importance of following up former drug users. We entirely agree that former drug users must be a targeted group and a focus for screening and wider attention.
Christine Grahame talked about the need for more needle exchanges. That matter will certainly be dealt with in the action plan, of which I will say more in the context of current activity.
Keith Raffan and Bill Aitken mentioned more research, which is also important. I point to two studies that are being done—an examination of the injecting practices of injecting drug users and an evaluation of the impact of changes in the Lord Advocate's guidance on needle exchange, which several members called for. Therefore, some work that has been called for is in hand. Obviously, we will have to make decisions about other work in the light of the debate.
I welcome the minister's announcement of an updated action plan and additional measures. When will that plan be published, what resources will be made available to back it up and will it include a specific screening plan and further harm-reduction measures?
The issue of screening will be dealt with and the plan should be ready later in the year. We will be able to say something about resources when it is published. I will talk about resources in a moment, although I am alarmed to see that three minutes of my time have gone already.
In the light of the recommendation from the HIV health promotion strategy review group in 2001, we extended the earmarked HIV prevention funding that is given annually to NHS boards to cover other blood-borne viruses, including hepatitis C. To enhance the scope for such prevention activity, we increased the available funds from £6.1 million to £8.1 million per annum. Boards use those resources in a variety of ways, including the funding of awareness-raising initiatives and needle exchange schemes. I stress that resources are already earmarked specifically for the prevention of blood-borne viruses such as hepatitis C.
Also in 2002, the Executive issued new information materials that aimed to give health professionals and patients as much information as possible about hepatitis C. As members have said, the predominant source of transmission is through injecting drug misuse and a range of information materials have been issued to drug services and prisons throughout Scotland to highlight the risks from injecting, including the risk of contracting hepatitis C. Over the past three years, we have invested an additional £34 million to expand and improve treatment and rehabilitation services for drug misusers. The money that goes to NHS boards for that is ring fenced. We also issued revised guidance on increasing the limits on the number of needles and syringes to be made available. That has already been discussed, so I will say no more about it.
Good treatment and care are of the essence, and decisions about the suitability of patients for treatment are essentially for individual clinicians to make.
Will the minister give way?
I have only two minutes left.
The guidelines that were issued earlier this year by the National Institute for Clinical Excellence and NHS Quality Improvement Scotland give advice on the use of combination therapy with pegylated interferon alpha and ribavirin. We are also giving a grant for the United Kingdom hepatitis resource centre in Scotland, which offers support and advice on testing and treatment to those who are affected by hepatitis C.
On the treatment side, we are funding the establishment of a national clinical database of patients who have been diagnosed with hepatitis C, with the aim of identifying treatments that patients have received and evaluating how effective those have been against the disease as it affects them. That will help in planning the organisation and resourcing of treatment services and will inform funding decisions. The Executive has also been discussing with clinicians the potential for setting up a managed clinical network—or networks—for hepatitis C, and funding has been earmarked for the appointment of a network manager. Networks of that sort will help to ensure that the considerable expertise that is available in Scotland can be accessed and utilised for the benefit of all patients. In addition, a Scottish intercollegiate guidelines network guideline is being developed that will address all aspects of the management of hepatitis C and will be a useful and practical tool for clinicians and others.
Will the minister give way?
I do not have time. I have only one minute. If a motion is passed to extend the debate, I can take an intervention—otherwise, I cannot.
I will allow the intervention, if the minister wishes.
It is very good to have an increase in the number of needles that are available. However, in dealing with addicts, it is important to ensure that the needle exchanges are near where people stay. The money has to go towards making it possible for needle exchanges to be very close to where addicts are. If addicts cannot get their needles quickly where they stay, they will not bother getting them and they will share needles. Has money been allocated to bring the needle exchanges closer to where addicts stay?
I agree entirely with Jean Turner and thank her for making that point. The £8.1 million to which I have referred is for that, along with other things.
The issue of ring fencing funding for treatment has been at the heart of the debate. Dedicated funds are not given now for the treatment of HIV/AIDS. Such an approach was discontinued some years ago on the ground that boards were best placed to allocate resources for treatment on the basis of local assessment of need. Such decisions are always hard and I am called on to ring fence money for a great many things in the health service. I will reflect on what members have said, but there is always a tension between local decision making and national determination on such matters. It is not the norm to allocate resources for the treatment of specific illnesses.
That said, I acknowledge the pressure on services, perhaps particularly in Lothian. I am pleased that Lothian NHS Board has identified recurrent funding this year to support further capacity for the treatment of patients with hepatitis C. We shall certainly be monitoring that through the chief medical officer's group. The CMO is already working with Lothian NHS Board on that matter.
In my final minute, I will talk about the future. Resources for prevention, treatment and care will continue to be paramount, but we have to be sure that we focus on the right issues and that our planning and initiatives are soundly based. To that end, we have commissioned SCIEH to carry out work to provide robust estimates of the total number of persons who are living with hepatitis C, diagnosed and undiagnosed, including estimates of the distribution of cases by region and disease stage. In addition, SCIEH is undertaking work to estimate the future burden, including cost, of hepatitis C during the next two decades. Preliminary results from that work should be available shortly and will inform the development of prevention initiatives and the development of the assessment of care and treatment needs.
The Executive's effective interventions unit is also currently funding a substantial programme of research, totalling some £300,000 since 2002, to find better and more creative ways of changing the behaviour of injecting drugs misusers.
Members will understand that I have been struggling to get across all the initiatives that are under way. That is not to say that more does not have to be done. Hepatitis C is a priority that we have acknowledged during the past two or three years and we will reflect on all the points that were made in the debate as we finalise our updated action plan.
Meeting closed at 17:41.