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Mr. Lansley:
I am grateful to my hon. Friend, whose expertise on the subject of response to such emergencies is greater than mine. Clause 5 sets out a general duty to co-operate, which is presumably intended to embrace
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local authorities, the Ministry of Defence and everyone concerned with response to civil emergencies, but the Bill tells us nothing about how that duty will be exercised. I hope that in the course of questions from the Opposition and debate in Committee, the Government will flesh out how they intend that co-operation to work. They were tested on the matter in another place and had little to say. We will return to it in due course.
The chief medical officer's strategy document, "Getting ahead of the Curve", identified TB as a "massive international health problem" and showed that the illness, which had dramatically declined in the UK until the late 1980s, was making a comeback. The CMO report listed reduction strategies that had worked in the past, including immunisation and treating those in the very early stages of infection. It suggested that the Department of Health put in place a TB action plan by "early 2003".
In March this year the World Health Organisation confirmed that drug-resistant strains of TB common in eastern Europe and central Asia pose a major threat to the European Union. Perhaps the Minister can tell us whether there has been any incidence of multi-drug-resistant TB in the UK. I am aware from my visit to St. Mary's, Paddington that for reasons of civil emergency and in relation to TB, the number of cases of which is rising sharply, isolation rooms and arrangements have been put in place, so the hospital could deal with multi-drug-resistant TB, should it encounter the disease.
However, the TB action plan has still not appeared. The Minister's predecessor in 2002 promised it
"by the end of the year"—[Official Report, 4 November 2002; Vol. 392, c. 137W.]
When my hon. Friend the Member for Westbury (Dr. Murrison) asked in March 2004 where the action plan had got to, it was promised
"in the next few months",—[Official Report, 25 March 2004; Vol. 419, c. 1051W.]
but there is still no indication from the Department when it will be published, let alone implemented.
According to the British Thoracic Society, up to half of patients attending accident and emergency departments with TB are "slipping through the net". The BTS considers, and I think it is a fair concern, that the homeless, refugees and asylum seekers are particularly at risk, and points out, along with others, that the incidence of TB in some London boroughs is at third-world levels. In Brent there are 116 cases per 100,000 population, and in China 113 cases per 100,000 population—broadly equivalent. TB in Britain rose by 20 per cent. in the past decade, but in London by 80 per cent.
Why is there no action plan? Why are Ministers avoiding the sensitive issues of screening for disease or identifying the groups at risk? We have examined the issues. We do not believe that compulsory screening is the way forward, but Ministers have access to the HPA and their own surveillance resources, and their appraisal may be different. This would be a good time for the Government to tell us when they propose to publish the long-overdue TB action plan.
On hepatitis C, the Minister corrected my hon. Friend the Member for Mid-Worcestershire (Mr. Luff). The Government estimate that there are 200,000 people with
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hepatitis C, but there may be significantly more. The majority are undiagnosed. Effective treatments are available. "Getting ahead of the Curve", the report produced by the chief medical officer, stated that
"good surveillance is the cornerstone of a system to control infectious diseases".
However, we do not have surveillance; we have an awareness campaign, which does not appear to be working.
In a report in December 2003, the HPA found that transmission among those who inject had increased. The action plan—a familiar refrain, Madam Deputy Speaker—was first promised in 2002, and by May 2003, it was promised
"in the next few months".
The Under-Secretary of State for Health, the hon. Member for Welwyn Hatfield (Miss Johnson), now says:
"The plan will be forthcoming over the summer and into the autumn".—[Official Report, 8 June 2004; Vol. 422, c. 142.]
"Whilst costs of not treating are low initially, as the disease progresses, many more people move to decompensated cirrhosis where the treatment costs, which may include liver transplantation, increase dramatically".
The disease is undiagnosed in 90 per cent. of cases, and up to 85 per cent. of people with it will develop chronic disease if it remains untreated—many such people would suffer the severe consequences arising from advanced liver disease. Surveillance now will forestall those costs later.
Finally, has a national pandemic strategy on flu been agreed between the Department of Health and the HPA? Do the Government intend to stockpile antiviral drugs such as Relenza and Tamiflu? Avian flu was only a precursor to the threat that we may face—we do not know when the threat will occur, and it may take some time. The spread of severe acute respiratory syndrome shows the speed with which a new virus to which we do not have immunity can travel around the world. As Ministers know, developing a vaccine when a virus is introduced into this country can take months. The availability of antiviral drugs is important to offset the risks associated with the outbreak of such an infection. I do not know whether this judgment is correct, but it has been put to the Government that stockpiling antiviral drugs would enable us to respond to such a threat. Is stockpiling happening, is it intended to happen and is a strategy in place?
In this debate, we have heard two different speeches, one about public health and one about organisational matters inside the arm's length bodies of the Department of Health. As far as the public are concerned, public health matters: a sexual health and sexually transmitted infections crisis is occurring; TB is rising and we do not have an action plan; perhaps 200,000 people with hepatitis C could be identified and treated, but such plans do not, as yet, exist; and while the incidence of HIV increases, the response is uncertain.
The Government have failed to live up to their responsibilities on infection control. More than any other aspect of health care, public health is the
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Department's concern. We are currently debating obesity, which has increased contrary to the Government's so-called public health objectives. Binge drinking has increased, and while smoking has reduced among men, it has not significantly decreased among women. The Secretary of State for Health helps no one by treating smoking as one of life's few remaining pleasures.
Dr. Julian Lewis: Under this Government, perhaps it is.
Mr. Lansley: If my hon. Friend will allow me, I shall not go down that path.
Right across the board, the Government have not delivered a public health strategy. They have not delivered specific strategies for the particular infectious diseases that are the subject of this afternoon's discussions and that are the responsibility of the HPA. It is a travesty to say that those infectious diseases will be better combated by the creation of the HPA, when the responsibility still lies with the Department, which, even in response to the CMO's recommendations, has failed to ensure the deployment throughout the NHS of the resources and standards of care to deliver the action plan.
We are content not to oppose the Bill, but its contents are no substitute for a Government who can give the necessary lead on public health and provide the public health strategies and the ways in which to deliver them that are needed in the light of the current Government's failures on public health. We therefore criticise the Government but not the Health Protection Agency. We want it to deliver its functions more effectively in future.
5.40 pm
Liz Blackman (Erewash) (Lab): I shall be brief and use my time to ask a few practical questions about the nuts and bolts of the Health Protection Agency. It is generally agreed that the Bill is timely. It creates a more responsive body to deal with a climate of increasing threats and risks, which include: the escalation of known diseases such as TB, HIV/AIDS and sexually transmitted infections; the appearance of new diseases such as severe acute respiratory syndrome; and the threat of the release of pathogens—small pox, anthrax and chemical and radioactive agents.
A weighty responsibility to provide specialist support for health protection to the NHS and local authorities is placed on the body but a more co-ordinated response was needed to find a way forward. The Government's two-stage approach has been logical. They created a special health authority in England and Wales and subsequently moved to the UK-wide body that we are considering, thereby acknowledging the risks that the whole UK faces.
There is a rationale for the creation of such a body, which will provide wide expertise in a single framework and, most important, a single reference point. It should create a co-operative ethos. There will be cross-fertilisation of good ideas, scope for high standards across the board, the spread of best practice and an enhancement of the UK's international contribution through initiatives and surveillance.
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It is encouraging that work is already well under way through the special health authority, which focuses on improving skills, widening research, co-ordinating several training exercises, setting up nine regional and 36 local health protection teams, creating memorandums of understanding with the local primary care trusts and, as my hon. Friend the Under-Secretary said when she opened the debate, playing a vital part in combating the SARS epidemic. The modelling work that it contributed was especially valuable and the World Health Organisation complimented it on that.
The Bill creates a body that has a legislative basis for exercising health protection functions in every part of the UK. Working practices already reflect that, for example, in the unified HIV/AIDS surveillance programme throughout the UK. It also improves the body's flexibility to respond to future threats by allowing the agency to be directed to take on other powers, enabling future flexibility and allowing devolved Administrations to shape the use of the agency to fit their needs.
I read the Hansard report of the debate in the other place. I was surprised that the Opposition did not mention it because it was a lively debate on the way in which the agency will publish and be allowed to publish information and advice. Indeed, the hon. Member for South Cambridgeshire (Mr. Lansley) was right that the measure confers strong powers on the Health Protection Agency. That is encouraging and gives the agency a great deal of freedom and opportunity to publish what it likes when it likes. However, there is obviously a proviso that it does not contravene the Data Protection Act 1998 or publish information that is not in the public interest. It also has to publish an annual report, which, I hope, will be debated in the House.
What will make the agency maximise its effectiveness is not only sensible structures, but a high degree of co-operation from people, as well as their preparedness.
There was also a lively debate about primary care trusts, to which the hon. Member for South Cambridgeshire referred. It has to be said that there are concerns that PCTs receive 75 per cent. of the NHS budget and have an enormous range of responsibilities, but I do not go down the hon. Gentleman's road of saying, "Well, so they can't cope."
We know already that there are differently performing PCTs, and the key to ensuring that this measure works and that PCTs play their full part in relation to the agency is giving them support, but also ensuring that mechanisms are in place to support their capacity to respond to what the agency requires of them. Where will the facilities to monitor their performance and any necessary additional support be located? Will the Minister say something about that? Similarly, local authorities have an enormous role to play. How will their performance in this regard be monitored and their quality assured across the board?
"In the exercise of its functions the Agency must co-operate with other bodies which exercise functions relating to health or any other matter in relation to which the Agency also exercises functions."
I accept that it is not sensible to name the bodies in the Bill if that has never been practised, but it would be interesting to know the range of other bodies that we are
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thinking about that may have a relationship with the agency and how they are to be prepared to work with it as effectively as they can.
I want to flag up the issue of information exchange, which is vital if the agency is to work to its maximum. What protocols will be put in place to ensure that that goes smoothly? This was flagged up in another place by Earl Howe:
"If a local authority, in pursuit of its duty of co-operation, receives sensitive personal data of a medical nature, who in the authority, and indeed outside, should be entitled to read that information? How should it be stored? Suppose after a while there is no strict need to continue holding the data, because the matter has been dealt with, what should be done with the files? Should the local authority retain the data just in case, or should they be destroyed? All these questions arise as a matter of practice."—[Official Report, House of Lords, 29 April 2004; Vol. 660, c. 941.]
So, it is important as we progress that these issues are clearly dealt with.
The other issue involving information exchange is information technology infrastructure. Will the Minister say a few words about where we are with that infrastructure, which will allow the speedy and accurate exchange of information between the agency and the various bodies that it will work with?
That is not meant as a criticism of the Bill, which I welcome. It is extremely encouraging that the special health authorities are making such progress already. I consider this an extremely positive move, but I would like the Minister to comment on the issues I have raised.
5.49 pm
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