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Chamber and committees

Meeting date: Tuesday, November 29, 2016

Meeting of the Parliament 29 November 2016

Agenda: Time for Reflection, Topical Question Time, Culture, Creative Industries and Tourism (European Union Referendum), St Andrew’s Day, Business Motion, Decision Time, Blood Donation


Contents


Blood Donation

The next item of business is a members’ business debate on motion S5M-01537, in the name of Rona Mackay, on men who have sex with men—blood donations. The debate will be concluded without any question being put.

Motion debated,

That the Parliament acknowledges that, in 2011, the law regarding men who have sex with men being allowed to donate blood changed from a lifetime ban to a 12-month temporary deferral, subject to sexual abstinence; notes the view that, in the name of equality, Scotland needs to go further to ensure that all people can donate blood and that they should not be assessed on their sexual orientation, with the introduction of new non-discriminatory risk assessment in line with organ, stem cell and bone marrow donations, and believes that this would increase the number of much-needed donors in Strathkelvin and Bearsden and nationally.

17:05  

I am delighted that, for the first time, we are debating this hugely important issue in the chamber, and I am grateful for the great level of cross-party support that my motion on men who have sex with men being treated equally with regard to blood donations has had.

At our party’s autumn conference, the First Minister said that the key message that she wanted to promote above all else was inclusion, and my motion is about exactly that—equality and inclusion. Scotland has led the way on equality in recent years, and our party has an unblemished track record on promoting equal rights. In 2005, discrimination on the basis of sexual orientation and gender was banned; in 2009, same-sex couples were allowed to adopt children; and in 2014, we legalised same-sex marriage.

As the law stands, no men who have had sex with men in the previous 12 months, or women who have had sex with men who have had sex with men, may give blood within the 12-month deferral period. Those rules are archaic and have their origins in the 1980s, when little was known of the risk of HIV, the modes of contracting it or its prevalence in specific communities.

In last week’s debate on adoption, I spoke of close friends of mine who are in a same-sex marriage and who have just gone through the adoption process. How will those men, who are in a loving, monogamous relationship, explain to their child why they are being treated differently when it comes to giving blood? Shockingly, if their child ever needed a blood transfusion and they were a match, they would not be allowed to save their own child’s life in an emergency. In the name of equality, it is time to end the current discriminatory process and to base donor eligibility on risk, regardless of sexual orientation.

The current rules on blood donation make no reference to someone’s personal risk of being a carrier of HIV. A promiscuous straight person would be able to donate blood, while a monogamous gay or bisexual man would not. Scotland has a chance to address one major area where inequality still exists and, at the same time, to tackle the chronic lack of uptake in blood donation and the need for new donors to come forward to meet our demand for blood products. Over the past 10 years, there has been a 40 per cent drop in the number of people who give blood, and current figures suggest that only 4 per cent of people in the United Kingdom regularly donate, yet 6,000 blood transfusions are needed in the UK every day.

Stonewall Scotland believes that excluding thousands of gay and bisexual men who may safely be eligible to donate threatens the blood supply that one in four people will rely on at some point in their life. The fact is that the breakdown shows that the number of heterosexual people with HIV is rising, and the eligibility rules take no account of that. In addition, the regulation of men who have sex with men donating is based on self-declaration and it is incredibly simple to hide sexual activity in order to give blood.

Of course there must be stringent donor selection criteria that are aimed at protecting donors and recipients of blood transfusions—no one would ever argue otherwise—but those criteria should be based on participation in high-risk behaviour rather than sexual orientation.

The public need to have confidence in the transfusion system, and it is important to stress that all blood is screened to the highest level. That said, the fact that the statistics show that only one bag of blood has tested positive for HIV in the past four years puts what we are talking about in perspective.

We need to introduce a non-discriminatory risk assessment policy that will judge each individual equally, whether they are straight, bisexual or gay. The current rules were put in place in 2011, after the Advisory Committee on the Safety of Blood, Tissues and Organs—SaBTO—reviewed the donation rules. SaBTO recommended reducing the lifetime ban to a one-year deferment for men who have sex with men, and that recommendation was accepted.

Scotland needs to go further to ensure that all people can donate blood on the basis of their personal risk of blood-borne virus transmission, not their sexual orientation. Although health matters are devolved to the Scottish Parliament, blood donation policy has so far been in line with approaches in England and Wales, following the guidance provided by SaBTO.

In June 2016, an all-party parliamentary group at Westminster on blood donation began an inquiry into the current rules. That debate is happening alongside a review by SaBTO of the blood donor selection criteria. Stewart McDonald, the MP for Glasgow South, recently chaired an evidence-taking session at Westminster on the issue, and the APPG is due to make a recommendation early in 2017.

The Scottish National Blood Transfusion Service could determine its own policies and restrictions for men who have sex with men, but it would be unlikely to be willing to implement a policy that was contrary to the evidence-based guidance of the Advisory Committee on the Safety of Blood, Tissues and Organs. However, in 2011, the Northern Ireland Executive chose not to implement SaBTO’s proposed change to the deferral criteria for that group and maintained a ban. Wales, England and Scotland all moved to a 12-month deferral period after the last MSM sexual contact. Northern Ireland changed its criteria this year to fall into line with the rest of the United Kingdom, which sets a precedent for autonomy.

To highlight the great anomaly, gay men can join the bone marrow register and donate organs and stem cells. Everyone goes through the same health and suitability checks—sexuality does not matter one bit. Whatever a person’s age, health or sexual orientation, they can donate.

Argentina, Chile, Colombia, Costa Rica, Spain, Italy and Mexico are some of the countries that accept donations without basing eligibility on sexual orientation. Spain has a deferral period of at least six months after a change of partner for heterosexual and MSM donors, with permanent deferral for individuals who have multiple sexual partners. In Italy, a deferral period of four months applies to people who have multiple partners when they have had a change in regular partner.

It should be possible to ask donors more detailed questions about their sexual activity rather than just whether they have had sex with another man in the past year. We would thereby gain more accurate information on risk and make the blood supply safer, which is of paramount importance. Of course, the current law also affects transgender people who want to donate blood, as it means that any man who transitioned to being a woman is still classed as an MSM and is therefore not allowed to donate, even though it might be a number of years since they last identified as being an MSM. Lifting the ban on MSM donating blood and replacing it with a more equal, non-discriminatory risk assessment is fairer, particularly since one in three 16 to 24-year-olds do not identify as heterosexual.

The Scottish National Blood Transfusion Service recently published a document with an updated position on gay blood donation. That document recognises the principles of kindness and mutual trust that are expected between all blood donors and the blood transfusion service. However, the mutual trust that the service expects is not reflected in the selection and deferral criteria, which is evident from the fact that there is no consideration of the position of thousands of gay and bisexual men who are in committed relationships, where the risk of HIV transmission is negligible.

For the sake of equality, Scotland needs to go further to ensure that all people can donate blood on the basis of their personal risk of blood-borne virus transmission, not their sexual orientation. We need to introduce a non-discriminatory risk assessment policy that will judge each individual equally, whether they are straight, bisexual or gay. That would increase the number of much-needed donors throughout Scotland.

As I mentioned, my motion is about equality and inclusion. As my colleague Patrick Grady MP recently said at the first meeting of the APPG on blood donation, for many gay men, a 12-month deferral is, in effect, a lifetime deferral. Even if we shortened the deferral period to three months, it would still, without doubt, be a discriminatory measure against MSM couples who are in stable, loving relationships. That is not equal or inclusive. Let us go further, Scotland, and end that inequality now.

17:13  

We have moved a long way since homosexual relations between men over 21 and in private ceased to be illegal in 1967. We would think that, by now, being gay should not be an issue. Like gender inequality, the notion of homophobia ought to have fallen out of use by now. I do not know why we find ourselves exposed to discrimination of any kind wherever it is directed, but I recognise that it is still with us, as we discussed only a few weeks ago in a debate on hate crime.

When discrimination is built into the official system, we need to be very wary. Not long ago, as Rona Mackay said, gay couples could not apply to adopt children. Thankfully, we have changed that. The public good must always be linked to the human rights of any individual.

There are solid clinical reasons why certain groups of people cannot give blood, although they could well become recipients of someone else’s donation. Those with type 1 diabetes, which is controlled by insulin, cannot donate. That is not because there is anything wrong with their blood, but because the blood donation service deems the risk too high for the potential donor. There are some medications that preclude someone from giving blood, and the same restriction applies to people with certain blood conditions or a history of specific diseases that could potentially be passed on to a recipient.

Those criteria are clear and widely accepted. We would be in a dangerous situation if clinical filtering mechanisms did not exist and life events such as birth and major road traffic accidents, and all the diseases that we can now control and manage, would become far greater threats. That aside, the critical point is that those criteria involve decisions that are made on scientific grounds, not as a result of some sort of irrational discrimination. They are, as it were, the outcomes of positive or rational discrimination.

We all know that blood donations must be safe. Anyone can acquire a blood-borne virus or a sexually transmitted disease, but some people have an increased risk of exposure and so might not be able to give blood or will be excluded for a certain period of time; we heard about that in Rona Mackay’s speech.

In June this year, it was revealed that UK blood is safer since the lifetime ban on gay men donating blood was changed in 2011. The Department of Health in England said:

“Surveillance data derived from the tests carried out on every blood donation in England, Scotland and Wales since the policy change show that fewer infections are being detected in donated blood”.

Major HIV charities, including the Terrence Higgins Trust, supported the change from a total ban on MSM giving blood to a 12-month exclusion period. However, we are now hearing calls for that exclusion to be revisited and, in April, SaBTO set up a working group to review the current donor acceptance criteria and consider any available new evidence. I support those calls.

Stonewall has described the move as

“a step in the right direction”

and highlighted the fact that a high-risk heterosexual would be less controlled than a low-risk gay man who was in a monogamous relationship.

I hope that all organisations with an interest in ending this discrimination will work with SaBTO to ensure that the policy and procedures maintain safety for everyone who uses transfusion and blood services, irrespective of sexual orientation.

HIV Scotland tells us in its briefing that

“every blood donation in Scotland is screened and the tests for HIV are now highly accurate”.

It also says that men who have had sex with one man in the past 12 months are likely to be of lower risk than many of those who are allowed to donate blood, including men and women who have unprotected sex with different partners.

It is time that we moved to non-discriminatory risk assessments to end this inequality. I support the motion in my friend Rona Mackay’s name and congratulate her on bringing the issue to the chamber.

17:18  

I, too, congratulate Rona Mackay on securing the debate.

It is pretty obvious to anyone that the primary objective of the blood transfusion service should be to maximise the safety of the supply of blood that is needed in critical services. However, there is a good argument that the current irrational criteria that are being applied do not maximise safety or supply. Additionally, there is an argument that applies to every aspect of our public services, which is that any element of discrimination or prejudice that is built into the way in which they work either strengthens or fails to challenge discrimination and prejudice in wider society, which means that there is a principled reason why every aspect of our public services must avoid discrimination.

In addition, on a third level, there is a case for saying that the discrimination itself undermines that first objective of maximising safety and supply. There will be many people who might well be willing and able safely to donate blood that is needed in Scotland but who choose not to, because of the way that they feel they might be judged or spoken to, or because they feel that they might be asked inappropriate questions.

That does not apply just to gay or bisexual men, or to men who have sex with men. Underlying some of the criteria that are being applied—in my view, they are quite irrational—we must also consider, for example, trans or non-binary people, who, if they are asked to explain whether they have had same-sex relationships in the past 12 months, may feel unable to give a straightforward answer that is both honest to themselves and gives the person asking for it the information that is being sought. They may simply feel unwilling to be categorised in a binary sense by being asked to give that information in the first place.

The most important thing that we have to do to ensure safety of the blood supply is testing, which is now being done to a far higher standard than it was in the past—certainly to a far higher standard than was possible when the original criteria were set down. We also have to ensure that people feel that giving blood is something that is valued. If some people are simply being told that their blood is not valued, or indeed if they have to tell lies in order to supply safe blood—which they know is safe—we are undermining that second goal of increasing the supply of blood that is needed.

I want to say something about another aspect of the criteria that we are not talking about. If a woman is asked whether she has had sex with a man who has ever had sex with a man, or if anyone is asked whether they have had sex with someone who has ever had sex for money, how many of them could give a 100 per cent guarantee that they know the correct answer? Again, we are asking for information that people may not be able to give with 100 per cent certainty and which is not in fact needed to ensure 100 per cent certainty of the safety of blood that is being donated.

I thank—I am sure that we all do—all those many people who donate blood and the people who deliver the service in communities up and down the country. It is a vital service, which genuinely save lives. We should value everyone who chooses to donate blood and everyone who works to ensure that the supply of that blood is available and is safe where it is needed. We should change the irrational rules that undermine both those objectives.

17:22  

I, too, congratulate Rona Mackay on securing this evening’s debate and on the campaigning that she has undertaken on this issue since she was elected.

The 2011 change, which was initiated by the UK Government’s Advisory Committee on the Safety of Blood, Tissues and Organs, was a welcome step forward. However, looking at it now, it looks like just a small step forward. I acknowledge that many men who have sex with men—including many gay couples in long-term, monogamous relationships—and who want to donate blood remain deeply disappointed and frustrated that they are still unable to do so. As Patrick Harvie said, there have been advances in technology and testing. I think that we would all agree that it is the right time to look again at the matter, with the aim of blood donation risk assessments being carried out, as happens with organ, stem cell and bone marrow donations.

I am very sympathetic to the suggestion that sexual behaviour and not sexual orientation should be the determining factor in whether someone can donate blood and that individual, risk-based assessments are thus more appropriate than a blanket-ban approach.

I welcome the fact that the UK Government’s advisory committee has initiated a new review of policy in this area and I think that we all look forward to its conclusions in order to move the issue forward.

A number of other developed nations, including our European partners Italy and Spain, do not discriminate on the basis of sexual orientation but, rather, use the individual risk assessment approach. We should look at how those countries manage their systems of blood donations safely and effectively and see what we can learn from them.

Like other members, I thank all those who work for the Scottish National Blood Transfusion Service and all the blood donors—not only in my Lothian region, but across Scotland—for the literally life-saving contribution that they make. They really do help to save lives and we must do all that we can to support them and to encourage more people to come forward and donate blood.

Last Friday, I met representatives of a local cancer charity in my region, who informed me that, on average, patients with leukaemia commonly require up to eight units of blood or blood products each day during treatment, for weeks at a time. It is estimated that 18 blood donors are required to provide the blood that is needed for just one leukaemia patient undergoing a month’s treatment.

It is therefore of real concern that the Scottish National Blood Transfusion Service has said that the number of new blood donors in Scotland has declined by 30 per cent in the past five years. Statistics show that 96 per cent of new donors are under the age of 55, but the blood transfusion service is increasingly relying on donors aged over 55 to make sure that there is always enough blood for patients. Less than 4 per cent of the eligible population in Scotland are active blood donors, so we need to look at new and imaginative ways of getting more people to become active donors.

When the minister responds to the debate, I would like her to outline the Scottish Government’s position on people who have had blood transfusions who are currently excluded from donating blood, as that is another potentially large group in society who would very much like to give blood. We need to look at that area and move it forward.

I again welcome the debate and recognise the cross-party support that exists for a better assessment policy. I believe that, working together, we can introduce such a system and I look forward to progress being made to implement it.

17:26  

I commend Rona Mackay for bringing her important motion to the chamber for debate and for the work that she and many groups across Scotland have done to raise awareness of an important issue.

All members agree that the absolute priority for blood donations is to ensure that we have a safe and reliable supply of blood for those who need it. That means having enough blood to meet demand and it means ensuring, with confidence, that the blood that is available to the public is free from infection or disease.

Current trends in Scotland show that the number of registered blood donors has fallen by 30 per cent since 2011. At present, only 4 per cent of the eligible population—people who are aged between 17 and 70—are registered to donate blood. In preparing for this evening’s debate, I checked the Scottish National Blood Transfusion Service’s current stock levels and they showed that stocks of type O negative blood are below the service’s six-day supply target. We owe a real debt of gratitude to the people who donate blood, but it is clear that more needs to be done to encourage those who are not blood donors to sign up and to give blood regularly.

The safety of the blood supply is, of course, of paramount importance but, as we have heard in the debate, the current rules are not focused on the safety of the supply. They were introduced in 2011 and placed a 12-month blanket deferral period for blood donations from men who have sex with men. That was a reduction of the previous lifetime deferral that had been introduced in the 1980s, but it does not go far enough.

The previous policy was born of fear of transmission of HIV and other infections to people who were receiving donated blood. The severity of those concerns cannot be downplayed. Since 2001, we have seen the number of HIV cases in Scotland rise annually—Health Protection Scotland calculates that 372 cases were reported in 2014. Of course, the rise in numbers can be attributed to many factors, including an increase in the number of people coming forward to be tested. Thanks to scientific advances it is now, with the right treatment, possible for someone living with HIV to have a normal healthy life expectancy if they are tested early and treatment begins as soon as possible.

Scientific advances mean that it is now appropriate to review the policy of a 12-month deferral period for blood donations from the men who have sex with men community, and to consider a new non-discriminatory risk assessment that is in line with those for organ, stem cell and bone marrow donations. As Patrick Harvie said, we know that testing is more accurate than ever. Nucleic acid testing, which is carried out on all blood donations, can detect HIV in the blood after nine days, which is a shorter window than for hepatitis B or syphilis.

It is clear that blood donation services accept that specific behaviours, rather than a person’s sexuality, determine risk of infection. A man who has had sex with one man in the past 12 months is likely to have a lower risk than many other people who are allowed to donate blood, including men and women who have had unprotected sex with different partners. If we assume that gay people are more promiscuous than heterosexuals, we make the same mistake as those who regarded HIV and AIDS as conditions that affected only gay men.

The issue raises the question—in light of the Equality Act 2010—whether it is unlawful to discriminate in blood donation on the basis of sexual orientation, because it relates to the provision of goods or services. Whether the current rules are lawful is an important question that we have to consider.

The 2010 act states that a donation can be lawfully refused if the decision is based on scientific evidence. However, it is becoming increasingly clear that the scientific evidence does not make it reasonable to refuse donations simply on the basis of a blanket ban.

Labour very much welcomes the motion. As Rona Mackay said, the current rules are archaic and do not promote equality. To continue to exclude people who may be able to donate threatens the provision of a sufficient supply of blood, on which one in four of us will rely at some point in our life.

17:30  

I join members in congratulating Rona Mackay on bringing this important debate to the chamber.

Quite simply, blood must be available 24/7 throughout Scotland, including in remote areas. However, blood has a very short shelf life and cannot be stockpiled. Every day, therefore, NHS Scotland depends on donors to help to maintain stock levels. As Colin Smyth said, the number of new donors has fallen by 30 per cent in just five years, and less than 4 per cent of the eligible population are active blood donors. It is important to note that funding for the Scottish National Blood Transfusion Service has fallen by 16 per cent since 2010, which I hope the minister will take into account.

We all agree that there is a need to encourage new people to give blood. A whole generation of Scots does not remember the television advert that featured Rowan Atkinson talking to a stone, which I recall seeing as a child; I remember the effect that it had on me and the importance of the matter that it addressed. We now need to think about how we encourage new people to give blood.

On the specific issue that we are debating, I believe that we cannot, when the need for more blood is so critical, afford to exclude any potential donors unjustly. I share the view that members all across the chamber have expressed: that men who have sex with men should not be prevented from donating blood based on their sexual orientation alone. Instead, their individual risk should be assessed by a healthcare professional. There is little chance that a potential donor of any sexual orientation will be allowed to donate blood if they are not entirely fit to do so. Just yesterday, at Inverclyde royal hospital, I met some nurses who work with blood-borne viruses, and they told me that cases of heterosexual HIV infection are going up. There is a huge amount of misconception about gay men and blood donation. Improvements in testing and many other safeguards have reduced the risk to an acceptable level.

Due to the drop in donors, we face a shortage of blood. Right now in Scotland there is only six days’ supply of type B negative and just seven days’ supply of A positive. That is a real problem for someone in one of those blood groups who has had an accident or will have an operation and needs blood. The issue really is affecting people in Scotland right now. I am sure that we all agree that it is in our interests not to prevent healthy people from giving blood. If the scientific evidence tells us that people do not pose a risk, we should allow them to give blood.

On a personal note, I am a card-carrying organ donor, but I have never given blood. That comes down in large part to the issue that Patrick Harvie raised—the stigma that people feel when having difficult private discussions about their sexual practices. We must make sure that our policies are based on scientific evidence and are in the best interests of the public. I welcome the Advisory Committee on the Safety of Blood, Tissues and Organs policy review, and I hope that the UK Government and the Scottish Government will try to implement any recommendations that come from it. We should remember that regulation of blood donation keeps us all safe—but it should also keep us all equal.

17:34  

Unfortunately, the Minister for Public Health and Sport is not able to be here today. As I have held that post previously and considered the issue, I am happy to be here to speak on this important matter. I thank all those members who have contributed to the debate.

We welcome the intentions that the motion reflects. Of course, we want to ensure that the NHS has sufficient blood to meet demand, so I also thank the many thousands of people who come forward to give blood every year. Demand for blood has reduced by 20 per cent in recent years, but we continue to ask for new donors to replace older ones who have dropped away, because we need donations from people who have certain types of blood. Anyone who wishes to join the register is very welcome indeed.

The motion talks about equality, which the Government takes seriously, but this is a matter of neither equality nor deliberate discrimination: it is a matter of the safety of the blood supply.

I will explain the rationale for the current restrictions. I know that some men who have sex with men feel that they are being unjustly prevented from donating blood, but the deferral is based on current epidemiology and a scientific assessment of risk. The Scottish National Blood Transfusion Service has a clear duty to minimise the risk of a blood transfusion transmitting any infection. When we go to give blood, we are all asked the same questions on the same questionnaire. In 2015, for example, approximately 25,000 potential donors were deferred for various reasons and 31 of them were men who have sex with men. The rest were deferred for other reasons, including people who had travelled to certain countries, people who had recently had a tattoo and people who take certain medication or have certain illnesses. People are not deferred on the basis of sexual orientation but on the basis of high-risk behaviours.

Does that low figure not suggest, as many of us did during the debate, that a great many people who identify as men and who are in stable and monogamous same-sex relationships just do not turn up? They are potentially valuable blood donors whose blood is not a risk because of their sexual activity, but they are just not turning up to offer blood in the first place.

I am not sure whether there are any figures for people who do not turn up to give blood in the first place, but everyone will agree that safety is paramount.

The deferral of men who have sex with men is based on two facts. First, they are at significantly higher risk of HIV than other groups, and secondly, it is not always possible to detect the presence of infections in donated blood. From Health Protection Scotland data, we know that in Scotland the prevalence rate of HIV among men who have sex with men is 7.7 per cent. In heterosexual individuals, that figure is 0.07 per cent. Men who have sex with men are therefore 100 times more likely to be infected with HIV than others.

Of course, monogamous relationships and the use of condoms reduces transmission of HIV and other infections, but they cannot eliminate the risk altogether. Approximately 30 per cent of men who have sex with men and who are infected with HIV are unaware of their infection. That would not represent such a significant risk if it was possible to always detect HIV infection in donated blood. The latest tests are very sensitive, but they are not perfect. Certain infections, including HIV, have what is called a window period immediately after infection when they are not yet detectable. The last two transfusion-related transmissions of HIV in the UK were as a result of the window period. That risk is not purely theoretical and it is why the deferral is currently recommended.

The motion specifically refers to the donation of organs and stem cells. However, it is important to understand why the criteria for those donations are different. For example, there is a limited supply of organs and, in those cases, the recipient will often be in a life-or-death situation. The life-saving benefit of a transplant will often outweigh the potential risk of HIV or other serious infections, so the risk assessment differs. That is not the case for blood donation, and as the blood transfusion service always has sufficient blood available to meet demand it does not need to take risks.

Decisions about the criteria for donating blood are based on the best available scientific evidence. This is complex, technical work, so we follow the advice of the expert advisory committee on the safety of blood, tissues and organs, which, as other members have mentioned, is also known as SaBTO.

SaBTO has set up a working group to review the donor selection criteria. As has been mentioned, it will report next year. The Cabinet Secretary for Health and Sport wrote to SaBTO earlier this year to encourage it to give consideration to other methods of managing the risk to the blood supply, including looking at other models of individualised assessment of donors’ risk. The review is welcome because it is assessing the latest evidence and considering different approaches to blood safety. The working group is also engaging with groups that may be affected by its recommendations, including organisations that represent men who have sex with men.

The advice from SaBTO is not static: it previously recommended a change in policy in 2011, which has been implemented.

I am grateful to be able to provide the Government’s position on the issue, to explain the good reasons for the current policy and to provide reassurance that it continues to be under review.

It is also important to reflect the historical experience of those who were infected with serious viruses, such as HIV or hepatitis C, as a result of NHS blood and blood products. The Penrose inquiry report on that matter was published last year. At the time of the report’s publication I met many of the families involved and I know that those affected would feel strongly that blood safety should never be compromised and that any risks should be mitigated as far as possible. That is what our deferral policies seek to do, based on expert advice.

One inadvertent infection via blood would be one too many. It would have lifelong consequences for those affected and could have a detrimental effect on trust in the blood transfusion service and the wider NHS.

We will seriously consider any recommendations from the review.

Will the minister take an intervention?

I will let the member intervene, because it is a serious and important debate, but it would have been helpful had you intervened earlier. I knew that you had been thinking about it for a long time.

Although I agree with the minister that safety is paramount, does she not agree that risk should be based on sexual behaviour rather than on orientation?

That is absolutely what I have said throughout my speech. It is about the high risk of certain behaviours, not about sexual orientation. I hope that I made that absolutely clear. I hope that members will also understand why the current deferrals are in place. Of course, if SaBTO comes up with recommendations that we should change that, that will be considered at the time. I hope that I have set out the current position.

Thank you very much minister, especially for stepping in for a colleague. I thank all members for a serious and thoughtful debate.

Meeting closed at 17:43.