| Health Protection Agency Bill [Lords]
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Dr. Murrison: The Minister is being very generous. Would not subsection (8) also allow the authority to give the agency a task along the lines of those suggested by the hon. Member for Sutton and Cheam? Miss Johnson: Indeed. The Chairman: Order. Perhaps we can cover that when we discuss clause 4. Miss Johnson: Thank you, Mr. Forth. Given that injunction, I have finished answering the points made by Opposition Members, and I trust that the Committee will resist the amendments. Dr. Murrison: We have rattled along at a rate of knots, and have made very good progress. Hon. Members may have been lulled into a false sense of security because we are now at the meat of the Bill—the health functions—which has exercised most of us in our consideration of this material in the past few days. Health functions were the sticking point on Second Reading, if there is a sticking point in this largely uncontroversial measure, so I hope that the Committee will forgive me if I dwell on them a little. The Minister has been very helpful in clarifying her perception of the HPA's functions and how they will be discharged. I confess that it was not clear before or on Second Reading exactly what direction the HPA would take. We have now established that its principal function will be to tackle infectious disease and other hazards, such as chemical and radiological incidents, that may cause an acute public health problem. We must accept, however, that the Bill includes powers to extend those functions dramatically. Quite rightly, Mr. Forth, you corrected me when I tried to talk about clause 4(8). I will not go down that path, because you will undoubtedly tell me that I am out of order, but that subsection does give the Minister swingeing powers to direct the work of the HPA. It would be open to the Minister to decide that the HPA, despite its name, should embark on public health activity that is broader in scope and of the sort that I discussed this morning. I make no comment about that because I, too, believe that such things are important. Nevertheless, we must be clear that we will not dilute this body's very important function, which is to protect the public against infectious diseases of the sort that probably concern many of our constituents, and against the sorts of novel threat that, sadly, we have seen in recent years. Indeed, many of our constituents have seen us conducting exercises against such threats—belatedly in London, and in Newcastle, where exercise Magpie enacted an attack on a population from the nerve agent sarin. I am grateful to the Minister for clarifying many of my thoughts on the issue. However, some bits remain opaque. I think that it was Lord Clement-Jones who raised in another place the matter of zoonosis— Column Number: 054 infections passed from animals to humans. He tabled an amendment to include that specifically as a subsection on infectious disease, and I think that he was correct to do so, because I am not clear about the interaction between the HPA and various veterinary bodies. That is important, because one of the biggest recent health scares was over BSE and Creutzfeldt-Jakob disease, and BSE is of course principally a veterinary not a human disease. It is passed on by means of a prion, which is not specifically mentioned in the Bill. We are left to assume that the Minister understands the term ''infectious''.Miss Johnson: The hon. Gentleman is raising points in summing up that he did not raise earlier. If he had mentioned animal diseases, I would have told him that the HPA is closely involved in such matters and that DEFRA has a role too. I should have been happy to debate the issues had he raised them in his opening remarks. Dr. Murrison: I am glad that the Minister would have been happy to address them. Perhaps she would prefer to return to them on Report; I shall be happy to raise them then, but it might save time if she were to consider them now. Lord Clement-Jones probably had a point, particularly in connection with prions. It is a legitimate thing to debate, as we are debating infectious diseases, and my probing amendment required that a reference to infectious diseases be deleted. I merely probe the Minister on her understanding of the term ''prion'' and whether it is sufficient to include it in the general term ''infectious diseases'', in the same way as she includes zoonosis. That is a perfectly reasonable question to put to the Minister. In connection with that, it would be interesting to know—hypothetically at the moment, as is to be announced next month—the result of the review of overarching bodies. One of the agencies in the frame, so to speak, will be the National Patient Safety Agency. It would not surprise me at all if it were shut down. That would be an example of the Government's marching their agencies to the top of the hill and marching them down again. Of all the agencies under review, about half were created by the Government, so it will be interesting to see the bonfire of Government-created agencies next month. If, as I suspect, one of them is the National Patient Safety Agency, it will be interesting to see which of its health functions will be transferred to the HPA. Might it be its work—or should I say lack of it—on prions in connection with Creutzfeldt-Jakob disease? The Minister will know that my interest in the matter has to do with tonsillectomy, and the tragedy that has befallen the son of one of my correspondents, who died as a result of haemorrhage post-tonsillectomy, carried out using a disposable tonsillectomy kit. The kit was introduced because of policy made on the hoof due to fears about the possibility of transmitting prions by means of instruments used during surgical operations, particularly tonsillectomies. It would be nice if the Minister could say, ''Yes, that is exactly the sort of thing that the HPA will look at.'' That might go some way to assuaging the concerns of my correspondent who, some time after Column Number: 055 his son's death, is still concerned that Ministers are not taking the issue seriously. So far, my correspondence with the NPSA has drawn a blank; the joint chairs of that agency do not seem to be particularly concerned that they have not considered the way in which the tragedy occurred. I hope that the HPA would look at that and, furthermore, be in a position to make recommendations about a more joined-up way of addressing the threat from prions. That would certainly help the gentleman with whom I am corresponding. If that were the case, it would be nice if the Minister could say so and help me to get my head around exactly what the HPA will be doing, especially in relation to infectious disease.Miss Johnson: I can help the hon. Gentleman in a limited way on that point. He raised that point on Second Reading, although he had not done so previously in this debate. The HPA has no responsibility for tonsillectomy operations, as I am sure he appreciates, but it will be responsible for collecting tonsils for the archive. That is important for the research into such a difficult and vexed question, on which the science is still in its infancy. Dr. Murrison: I am grateful for the Minister's reply. She might have led me along a path down which you would rule me out of order, Mr. Forth, but I commend the work of the national tonsil archive, which has collected some 10,000 tonsils to date. Incidentally, I was concerned that the Human Tissue Bill would result in the archive's closure. It was only after a number of hon. Members raised the potential problem yesterday that we managed to secure changes to safeguard that valuable collection. What better example— The Chairman: Order. Before we go on to examples, can I remind the hon. Gentleman and the Minister that we are discussing the amendment? Can the hon. Gentleman stick to that or at least tell us from time to time in what context he is doing so? Dr. Murrison rose—
Miss Johnson: I do apologise, Mr. Forth, but I believe that the hon. Gentleman has been leading me astray. The Chairman: Order. Ministers are not supposed to lead astray—not in this Committee. Dr. Murrison: I am grateful for your guidance, Mr. Forth. The tonsil archive is a great example of how the HPA might discharge its functions. The archive will be examined for the prevalence of prions, which potentially cause a devastating illness. I am grateful that the Minister raised the issue, and I have no doubt that one of the agency's functions will be to liaise closely with the archive. One of the biggest perceived threats to the population—''perceived'' is important—is that from prions, specifically in connection with Creutzfeldt-Jakob disease, although the jury is still out on the ultimate impact. Disease registration has not been listed under health functions. I should like briefly to touch on that, but if the Minister objects to my raising the issue in the Column Number: 056 clause stand part debate, I should be happy to return to it on Report. Disease registration is important in the context of some of the HPA's functions. We had problems with cancer registration in the not-too-distant past and associated difficulties with data protection. It is essential that we register disease adequately; otherwise the epidemiological function on which the HPA's health functions are based cannot work at all.Central to that process is the national programme for IT in the NHS. Without that, we are going to struggle. It would be nice if the Minister could confirm that the national IT programme is on course for the HPA. There have been indications that the programme might either have been derailed or not be going entirely to plan. In such a crucial area, however, where there are so many threats to public health, it would nice to know that the national programme for IT in the NHS was going according to plan. If it was not, we might have problems.
3.30 pmWe have had a good debate on the various health functions that the agency may discharge. I am grateful for the Minister's announcement that the action plan for hepatitis C is now on the streets, although I regret that the plan for tuberculosis is not. I cannot think of anything more germane to the HPA's work than a national TB plan. If the HPA is to be the wonderful body that the Minister envisages, with the holistic benefit that will come from amalgamating those arms of government, perhaps we should already have a TB action plan. That said, however, it is important to note that, in general, action plans tend to come from the chief medical officer. We may have clarified to some extent what the agency will do, but its interaction with the CMO is not entirely clear. Will the HPA carry out surveillance, or gather and collate information in order to inform the CMO's reports and recommendations; or will it assume some of those responsibilities for itself? ''Winning Ways'', recently published by the CMO, was concerned with another extremely important issue to do with hospital-acquired infections that most definitely come within the remit of health functions. That report was put out by the CMO, not the agency. Will that continue, or will one of the agency's functions be publishing reports that are really the bailiwick of the CMO? I am a little unclear about that. The Minister might let us know her thoughts. I am grateful for the Minister's comments on TB. We will continue to press her on the action plan for TB. The situation is not under control, but I welcome the pragmatic way in which she plans to deal with the problem in relation to immigrants. She assures me that screening is voluntary. I have not heard her say that before, and it was not said in answer to a question of mine. Nevertheless, I am reassured to hear that there is a high take-up of voluntary screening at ports and airports. It helps a great deal, and informs the thinking of many. However, as suggested in the CMO document ''Getting Ahead of the Curve'', we need a TB action plan soonest. If the HPA had been in place, we might already have seen that. Were the Minister to Column Number: 057 give us her thoughts on the matter, we would welcome the measure even more.The Library has published an extremely useful document on the Bill, which includes a section dealing with clause 2. I apologise for going on about this clause, but it is fundamental. It is the meat of the Bill, so if the Committee will allow me I shall continue. Page 22 of that research paper lists what the HPA has done to date. It says that it has responded to the threat from SARS and avian influenza, and has noted an increase in the number of sexually transmitted diseases. It also notes that we have the highest rate of TB in Europe. It noted increased concern with bioterrorism, such as threats of anthrax and smallpox, and with the emergence of new disease. It makes specific mention of zoonosis—Lord Clement-Jones will doubtless be interested in that—and the rising instance of hospital-acquired infections and MRSA. It seems that the HPA has scored about three out of six. The fifth point, on new diseases, is debatable. It has dealt with 50 per cent. of those points satisfactorily, but it has not done particularly well on sexually transmitted diseases, and we are clearly not on top of tuberculosis despite the Minister's remarks. Instances of that disease are rising, particularly in certain wards London, and hospital-acquired infections are going through the roof. We are not doing terribly well. I have pressed the Minister before on how the HPA might add value. My hon. Friend the Member for South Cambridgeshire said on Second Reading that we should not assume that bolting all those arms of government together will necessarily be beneficial. Large organisations often are not beneficial, and my hon. Friend said that if we continue bolting agencies together—I am sure that we shall see some of that next month, with the result of the review—we will end up simply with the Department of Health. That is not a sensible direction of travel. We need to look more closely at hospital-acquired infections such as MRSA. The public perception is that there have been a lot of edicts from Government agencies on that. The HPA will probably continue to issue edicts on hospital-acquired infections, but how will things be carried out on the ground? I am still unclear about how practically they will be carried out. We have seen, no doubt with the connivance of the HPA in its infectious-disease role, the creation of directors of infection control, and all sorts of publications about best practice for ward hygiene, yet it seems that the basics still are not being carried out. I accept the good point that the Minister made on Second Reading, that part of the problem is cramped, dark wards, and that the hospital-building programme on which her colleagues have embarked has helped. It may have helped, but the incidence of hospital-acquired infection has continued to rise. Obviously, we are doing well in one part, but less well in others. Control has to do with proper hygiene, especially by medical practitioners. As I said on Second Reading, when I was a practising doctor on the ward, I rarely Column Number: 058 changed my white coat, and I certainly never changed my tie—I am probably still wearing the same one as I wore on the ward 20 years ago. If one were to swab doctors' ties microbiologically, one would find all sorts of horrible things. The solution would appear to be straightforward: forbid doctors from wearing neck ties and get them to wear something else, yet something that simple seems to be beyond the capability of health protection and other agencies. Instead, we faff around creating new tiers of management when we should be trying to sort things out at the coal face, so to speak.Clearly, we have not sorted things out: the incidence of hospital-acquired infection varies dramatically from one end of the country to another. In Yorkshire, it is seven times less than in Cambridgeshire and—
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| ©Parliamentary copyright 2004 | Prepared 29 June 2004 |
