| Previous Section | Index | Home Page |
1.33 am
Mr. Neil Gerrard (Walthamstow): I am grateful to my right hon. Friend the Member for Edinburgh, East and Musselburgh (Dr. Strang) and to my hon. Friend the Minister for allowing me to make a brief contribution to the debate.
As my right hon. Friend said, the all-party group on AIDS did a significant piece of work last year when it looked at what the UK's strategy ought to be. I want to say a few words about some of the report's conclusions and where we are a year on. I welcome the work that the Department of Health is doing and the setting up of a steering group within the Department. Its composition is important, and it is not made up simply of civil servants. Its members include people who are living with HIV, workers in the field, academics and medical experts. We need a range of expertise to be introduced. In particular, we need people who have daily experience of living with HIV.
A national strategy can make a difference, as it has in Australia, where a strategy was developed a few years ago. Some complacency has crept in, not among health professionals or the Department, but among the public and in the media, as if we are somehow immune from what is happening in the rest of the world. One need merely consider the enormous changes in eastern Europe to see that that is not so, or the fact that of the 33 million infections across the world, 60 per cent. are in Commonwealth countries. We cannot regard ourselves as immune.
HIV is a public health issue, and my right hon. Friend noted what the Public Health Laboratory Service Board has said. However, wider issues, to do with discrimination and prejudice, remain very much alive. They may not be the primary responsibility of the Department of Health--legally, they fall to other Departments--but a strategy that reaches across the board must take those issues into account.
I shall end by naming four areas that a strategy should cover. First, it should deal with treatment and care, and with the setting of minimum standards across the country. Whether a person lives in an area of high or low prevalence, he or she should be able to expect minimum standards. Services must also be culturally appropriate. In London, problems arise particularly in the African communities, and it is sometimes difficult to get in touch with people in those communities, and to make them understand and participate in available services.
The second major issue is funding. We are moving towards district-of-residence funding, as the stock-taking group at the Department of Health recommended last year, and most people agree that we should. However, we should consider how we allocate funds. This year's allocations were announced late, causing problems for health authorities and for organisations with which they contract, including service providers that are voluntary organisations. We need to ensure longer-term funding, tying together funds provided by the Department of Health, and those provided separately through local authorities and the AIDS support grant.
The third issue is prevention. Whatever we do in care and treatment, we must first consider what we can do to prevent the spread of HIV. My right hon. Friend said that we should target to ensure that money is spent on the right people--those most at risk. I hope that allocations will continue to be ring-fenced as the National AIDS Trust report suggested that some money given to health authorities for prevention work was not necessarily being used in the areas of highest need.
Finally, we need to involve people who have the virus and who live with AIDS in the development of the strategy, both locally and nationally. Through that involvement, we are more likely to get a strategy that works, and that will be able to tackle discrimination and prejudice, which affect work on prevention. Prejudice and discrimination discourage people from coming forward for testing.
The Minister of State, Department of Health (Mr. John Denham):
I congratulate my right hon. Friend the Member for Edinburgh, East and Musselburgh (Dr. Strang) on his success in proposing this important topic for debate. I also acknowledge the contribution of my hon. Friend the Member for Walthamstow (Mr. Gerrard). They have both made an important personal contribution to this topic over the years.
The United Kingdom has fared much better than many other countries in limiting the spread of HIV infection. Over the last three years, important developments in drug therapies have led to a dramatic reduction in the number of deaths from AIDS. HIV-AIDS is now often referred to as a chronic disease rather than a disease with a rapidly fatal outcome.
As my right hon. Friend said, HIV and AIDS have not gone away. The people affected are living longer, but coupled with that is a continuing rate of new infections of between 2,500 and 3,000 each year. HIV and AIDS affect mostly young, economically active age groups. It remains an important public health issue that poses some particularly difficult challenges. For that reason, the Government have decided to develop a specific strategy for HIV-AIDS. Our plans to develop an HIV-AIDS strategy for England were contained in the Green Paper, "Our Healthier Nation." To pick up on the point made by my hon. Friend the Member for Walthamstow, we are determined that people who use or work in HIV-AIDS services will have every opportunity to make their contribution to the development of that strategy.
Early and sustained action to control the spread of HIV, such as screening of the blood supply, national health promotion campaigns, and the availability of free, open-access genito-urinary medicine clinics and needle exchanges, has contributed to the relatively low prevalence of HIV in the United Kingdom compared with some of our European neighbours. We have a good record on prevention, and we want that to continue. This year, we provided more than £53 million as a ring-fenced sum to health authorities to fund local HIV prevention activities, and centrally we provided some £5 million to carry out national HIV health promotion activities.
With regard to health service delivery of treatment and care for people with HIV and AIDS, the concentration of specialist treatment centres matches the geographical distribution of the disease. Delivery remains skewed towards London and other major cities. In the current year, we have provided £234 million to health authorities for the treatment and care of people with HIV and AIDS, and £15.5 million to local authorities for care in the community.
As I said, we continue to have 2,500 to 3,000 new infections each year. We have a high number of babies born with HIV. We need to ensure that we respond to the demand for new drugs and for common standards, that we maintain our efforts on prevention and that we ensure that we keep prevalence low. Those are some of the issues that the new strategy will tackle.
The process of developing the strategy was launched by my right hon. Friend the Minister for Public Health at a conference last October. The conference made an excellent start on the process that is now being taken forward by the steering group, which met for the first time last week. I am grateful to my right hon. and hon. Friends for their positive comments on that process. We hope that a draft document will be ready for consultation by spring next year. It will cover issues related to treatment and care and HIV testing and prevention, and it will draw on available evidence and relevant work already under way.
As for strategies for the United Kingdom, my right hon. Friend the Secretary of State for Scotland is tackling the issue, and an expert group, due to report later this year, is currently reviewing the HIV health promotion strategy in Scotland. In 1994, the Department of Health and Social Services in Northern Ireland issued a strategy for HIV and AIDS, which recognised the need for increased efforts in public education, alongside education programmes in schools and youth settings, and the need for support for those involved in this work. Such efforts are continuing.
In October 1998, the Welsh Office published the "Better Health, Better Wales" strategic framework, and work to implement the various strands of the framework is being done by expert groups. The sexual health working group has held its first meeting, and the group to develop the communicable diseases strategy is to hold its first meeting at the end of this month.
The policy context that will shape the strategy in England will include the White Papers, "The New NHS" and "Modernising Social Services", and the forthcoming White Paper, "Our Healthier Nation". We shall also wish to provide the necessary frameworks to monitor the implementation and progress of the strategy.
I want to say something about the role of the AIDS (Control) Act 1987 in the context of the HIV-AIDS strategy. My right hon. Friend was instrumental in the enactment of the legislation through his private Member's Bill some 12 years ago. I think there is no doubt that that legislation laid the foundations for one of the best surveillance systems in Europe for HIV and AIDS, and successive Governments have been able to build on it over the past decade. The Act has, uniquely, allowed the Department of Health and the NHS to build up information on service development and HIV prevention programmes undertaken by local health authorities over time throughout the country.
I am grateful for my right hon. Friend's continued interest in the matter, and for his suggestion that a review of the legislation would be timely and, perhaps, should be incorporated in HIV-AIDS strategy work. His suggestion was supported by a recommendation from the all-party parliamentary group on AIDS in its recent and very welcome parliamentary hearings report on national HIV-AIDS strategies.
I am pleased to report that the HIV-AIDS strategy steering group was satisfied that such a review would fit sensibly into its work plan. Any proposed changes in the
wording of the Act and its provisions will, of course, need careful consideration, but the development of a national HIV-AIDS strategy provides an excellent opportunity to update the Act in line with changes that have taken place in the epidemic, and in the provision of services. The Act provides for the submission of annual reports by health authorities on epidemiology, and on the use of resources for HIV-AIDS treatment and care and HIV prevention. Any changes in monitoring that are considered necessary will be indicated in the HIV-AIDS strategy document.
I recognise, and share, my right hon. Friend's wish for rapid progress. The strategy work provides the opportunity to get any review of the Act right, and I am keen that we should use it in full for that purpose.
The strategy development will also take into account developments on a number of different fronts that are of direct relevance to the formulation of the new strategy. Earlier this year, the Government announced their intention of drawing up an integrated strategy for the whole of sexual and reproductive health, with the aim of joining services and health promotion messages when that is relevant. We have known for some time that the presence of other sexually transmitted diseases can influence the spread of HIV, and it makes sense to link some health promotion messages.
A key component of the overarching sexual health strategy will be the separate and complementary strategy for HIV-AIDS. The separate strategy will provide a clear focus in a difficult area where there are major cost implications for the NHS. Our priorities remain to communicate clear messages about safer sex, to focus on groups at high risk of infection, and to continue to enlist the help of community organisations in delivering our messages.
The overall framework of the sexual health strategy will include key messages from other related programmes, including those involving HIV-AIDS, which will link with the communicable diseases strategy. We will thus be "joining up" health promotion messages when it makes sense to do so, but there will be no let-up in the important targeting of messages to the groups that are most vulnerable to HIV infection. Those are gay and bisexual men, people from countries with a high prevalence of HIV, currently sub-Saharan African countries, and injecting drug users.
This country's excellent surveillance systems keep us alert to the changing epidemiology of HIV and AIDS and allow us to assess the impact on the UK population of the HIV epidemic elsewhere in the world. They also allow us to keep a close watch on groups such as injecting drug users, among whom HIV prevalence has been at a steady level for years.
The NHS budget for drug misuse has been bolstered with funding from the NHS modernisation fund. This year, £12 million has been provided to health authorities. That will rise to £20 million over the next three years to achieve the key objective of increasing participation of problem drug misusers, including prisoners, in drug treatment programmes that have a positive impact on health and crime. The Government's anti-drug strategy is expected to strengthen prevention activities for vulnerable young people, particularly with regard to injecting behaviour.
The surveillance data show that mortality due to HIV and AIDS in 1998 was a quarter of that in 1995-96. That is a direct result of the success of combination drug
treatments that are delaying progress of the disease and decreasing the mortality rate. As a result, we have an increasing prevalence of HIV, which makes our HIV prevention activities even more vital.
Meanwhile, national work for African communities has produced new information resources on HIV issues for African men and women. A mass media and poster campaign and a weekly radio project are all under way. Health promotion directed at the general population to keep them alert to the seriousness of HIV, AIDS and other sexually transmitted infections has included a website and targeted work for young holiday makers. Health promotion work with gay men included a new media campaign that focused on awareness of undiagnosed HIV infection. A second conference on the community HIV and AIDS prevention strategy has taken place, which focused on HIV prevention, understanding risk and gay men with diagnosed HIV infection.
Recently, there have been activities with a direct bearing on future services for people with HIV and AIDS--for example, the published work on standards for HIV services and developing networks for HIV care in London, which we hope will be extended to the rest of the country. We believe that developing networks of services throughout the country, using published clinical guidelines and agreed standards, will be key elements in the success of our overall strategy.
Under the new arrangements, commissioning of services for HIV-AIDS and genito-urinary medicine will be commissioned at least at health authority level. The most complex level of HIV services involving the
administration and monitoring of combination therapies will probably be commissioned regionally. That should ensure that a coherent package of services that is based on previous experience and expertise is developed.
As part of commissioning in the new NHS, alongside work on partnerships between health and local authorities, development of guidance on long-term service agreements is under way. The guidance will build on good joint working and the introduction of three-year contracts, where possible. Many authorities, especially in London and other cities, have long worked in consortia with their constituent boroughs to place three-year contracts with their voluntary sector partners.
| Next Section
| Index | Home Page |