Siobhain McDonagh (Mitcham and Morden) (Lab): Does the Minister agree that in most cases, constituents letters in MPs postbags are not about waiting times or people being on trolleys at the weekend or overnight, but about care? They are rarely about brain surgery, but often about the human care that people get. Do we need to consider how we train nurses, and the qualifications that they require?
Mr. Lewis: My hon. Friend makes an important point. All the evidence is that personalisation, individual attention and treating each person differently according to their needs, experiences and preferences are the future challenges that face the health service and all public services in this country. That is why the reform of public services is important and giving maximum control as well as choice to those who use services really matters. Of course there are implications for the nature of the training experienceinitial and entry training and also continuing professional developmentin respect of the things that we focus on.
I also have a strong view on the role of senior managers in the health service. To inform their management decisions about what matters in their organisation, they should be on the front line, regularly engaging with staff and patients. I do not believe that that happens anything like enough. Chief executives and senior managers should spend time and be visible on the wards to experience for themselves the everyday realities for staff and patients.
Mr. Lewis: It is not for me to second-guess decisions, trust by trust and hospital by hospital; such judgments and decisions are for others. However, it is true that when we consider the responsibilities and priorities of a modern health care system, the personal, emotional and practical needs of the patient and family are incredibly important. They should not be given Cinderella status in comparison to other aspects of the health care providedparticularly, although not exclusively, when we are talking about older people. Recently, we have heard pretty horrendous stories about how people with learning disabilities have been treated by the mainstream health care system. Frankly, that is unacceptable in a modern society.
To conclude, I again congratulate the hon. Member for Carshalton and Wallington on raising some really important issues on behalf of individual constituents. The vast majority of people speak positively about the NHS and the vast majority of staff do an excellent job. However, we have to reflect and listen when people tell us, from their everyday experience, that the service is not as good as it needs to be.
Dr. Gavin Strang (Edinburgh, East) (Lab): We are all aware of the tragedy of HIV/AIDS and the impact of that pandemic throughout the world. The damage being done is particularly serious in a number of developing countries. We are looking forward to the launch of the Governments consultation on a new strategy for HIV/AIDS later this week. The Minister will not be able to anticipate the content of that document, but I hope that he will see the debate as an opportunity to set out the Governments assessment of the problem.
Some 40 million people now live with HIV. Last year alone, 3 million people died of AIDS and more than 4 million were newly infected. Two thirds of people with HIV live in sub-Saharan Africa and three quarters of all AIDS deaths occur in that region. In recent years, the most dramatic increases in the spread of HIV have been elsewhere. In east Asia, the number of people living with HIV rose by 17 per cent. in the last three years. In eastern Europe and central Asia, the number of new infections rose by almost 70 per cent. in the last two years.
HIV/AIDS in the developing world is predominantly a young persons disease. The leading causes of death in the UK tend to affect people as they get older; HIV/AIDS tends to strike young people. Life expectancies in many countries have plummeted and many of the people killed by AIDS are at an age when they would contribute most to the development of the country that they live in. So it is that in many developing countries, HIV/AIDS corrodes the economies, the services and the infrastructure. Vital sectorshealth, education and agricultureare put under intolerable strain as the work force are removed by AIDS.
The world has responded to the pandemic, but slowly. The $10 billion estimated to be available for HIV in low and middle-income countries this year is a significant increase on the $8.9 billion provided last year. However, that $10 billion is just over half of what is needed. Estimates of global resource needs for this year stand at $18 billion, and $22 billion will be needed next year.
One landmark development in the effort to combat HIV/AIDS has been the establishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has approved a total of $7 billion for more than 450 grants in 136 countries. A report on the first five years of the work of the global fund was published in February, and the fund has made a good start.
The focus has rightly been on expanding access to treatment. Until a few years ago, to become infected with HIV was in practice a death sentence. The question was not whether one would die of an AIDS-related condition, but when. That is no longer the case thanks to the development of antiretroviral drugs. With access to proper treatment and care, people with HIV can now live fairly normal lives. However, millions of people have died of AIDS despite the emergence of antiretroviral treatment because those drugs have been unavailable to much of the developing world.
In recent years, the international community has accepted the principle of universal access: as far as possible, everybody who needs antiretroviral drugs should receive them. Under the presidency of the UK in 2005, the G8 agreed the aim of universal access by 2010, which was taken up in the political declaration by the worlds Governments at the UN last June.
There have been improvements in access to antiretroviral drugs. UNAIDSthe Joint UN Programme on HIV/AIDSestimates that since 2002, some 2 million life years have been gained through expanded access to antiretroviral treatment. In December 2006, the number of people on treatment in low and middle-income countries was 54 per cent. higher than in the previous year.
Treatment still reaches only a small proportion of the people in need. The World Health Organisation estimates that just over a quarter of people in low and middle-income countries who need treatment receive it. There is a particular problem with children. Despite a 50 per cent. increase in the number of children receiving treatment in the past year, still only 15 per cent. of those in need get access to HIV treatment. The World Health Organisation and UNAIDS have called for urgent action to develop appropriate diagnostics and paediatric drugs.
A report published last month by the World Health Organisation, UNAIDS and UNICEF made it clear that universal access by 2010 will require a steep increase in the number of people who receive treatment each year. The UN Secretary-General has reported that many countries are struggling to scale up their work sufficiently to be on course for the 2010 commitment. If we continue at this pace, the UN estimates that less than half of those in urgent need of treatment will receive it by 2010. My hon. Friend the Minister will be aware of the campaign calling for a G8 funding plan to be put in place to achieve universal access, and I would be grateful for his thoughts on that.
Will my hon. Friend set out what is being done to enable developing countries to find their way through the legal complexities of TRIPSthe agreement on trade-related aspects of intellectual property? There are particular concerns about access to newer drugs, including second and third-line treatments. Since 2003, the price of most first-line antiretroviral treatments has decreased by at least 50 per cent. in low and middle-income countries. However, the World Health Organisation has found that the prices paid for second-line treatment tend to be unaffordably high in countries that lack generic alternatives.
In the years to come, more people will need access to second and third-line therapies as the first-line treatments will cease to be effective. UNITAID, the international drug purchasing facility of which the UK Government is a sponsor, is working to lower prices of second-line medicines and I was pleased to see the price reductions that the Clinton Foundation was able to announce last week. However, as patenting restrictions are tighter on newer drugs, a lot needs to be done before we can expect to see adequate reductions for second and third-line treatments.
On 30 August 2003, a decision was taken with the aim of allowing certain countries to import generic drugs. However, my hon. Friend is probably aware of
the conclusions of Médecins sans Frontières that the mechanism is unworkable. The Government have made clear their support for the right of developing countries to use TRIPS flexibilities to ensure affordable access to drugs, including the use of compulsory licensing provisions. My right hon. Friend the Secretary of State and his G8 counterparts agreed at their meeting in March that more needs to be done to help to lower the cost of some drugs
including the use of TRIPS flexibilities to the fullest extent.
My hon. Friend will be well aware of the calls from non-governmental organisations in the field for the G8 urgently to review the effectiveness of the TRIPS flexibilities and to identify and resolve all obstacles to their use. I would be most grateful for his perspective on the progress that has been made.
Perhaps my hon. Friend can also take the opportunity to update us on the new independent advisory body that was announced by his Department last month to help get more drugs to the worlds poorest people. The Secretary of State has also expressed an interest in patent pooling, and I should be grateful if my hon. Friend would tell me the Governments thinking on that point.
In order for antiretroviral treatment to be successful there must be a medical infrastructure in the country that ensures that people have regular access to their medication, and are properly instructed and supported in adhering to their regime. The UN Secretary-General has remarked that we must move from an emergency footing to a longer-term effort, laying the groundwork for sustainable progress and strengthening health and social service systems. Far greater investment is required in the infrastructure of health systems.
When we talk about getting drugs to people, there is a tendency to assume that Governments and Government services alone can deliver, but in many countries projects run by employers or the voluntary sector are equally important. Professor Richard Feachem, the previous executive director of the global fund, and the Secretary of State himself have singled out faith groups as being particularly important because of the work that they do in that area.
It is right that we focus tremendous effort on expanding access to treatment. It is a matter of international shame that so many have died and continue to die of a treatable disease. At the same time, we must dramatically step up our efforts to prevent the spread of HIV/AIDS. Work on a vaccine continues, and it seems that every few years we are told that a vaccine is 10 years away. I know that that work is supported by the UK Government. A vaccine would of course be a huge breakthrough, but in the meantime we need to improve prevention efforts dramatically. If we do not, meeting the commitments to universal access to treatment will be well-nigh impossible.
The rate of new infections far outstrips the expansion of HIV treatment. While 700,000 additional people got on to treatment last year, 4 million became infected with HIV. Treatment and prevention services must be scaled up in parallel. The World Health Organisation has called urgently for far more effective outreach work with at-risk populations and for prevention work to be done with people living with HIV/AIDS.
UNAIDS has identified three main problems with the current prevention effort: insufficient funding, inadequate access for populations with higher rates and risks of infection, and a lack of action against the social, economic and cultural factors that drive the spread of HIV, such as stigma, poverty and gender inequality. Access to prevention services for at-risk populations in low and middle-income countries remains generally very low. In 2005 it was less than 20 per cent.
Still only about 11 per cent. of pregnant women with HIV are given treatment to prevent mother-to-child transmission. That is a particularly depressing statistic when one bears in mind the fact that the treatment available for pregnant women with HIV is so effective that it virtually eliminates the possibility of the child being born with HIV. I presume that it is very different if no treatment is provided. I would have thought that most reasonable people would see it as a priority to get a lot more pregnant women on the treatment so that their children are not born HIV-positive. Just last year my hon. Friends Department cited an estimate that a comprehensive HIV prevention package costing $4.2 billion annually could avert 29 million of the 45 million new infections expected by 2010.
I cannot end my consideration of prevention work without mention of a recent development relating to male circumcision. As colleagues may well be aware, the World Health Organisation and UNAIDS have stated:
Male circumcision services should be recognized as an important intervention to reduce the risk of HIV infection.
This summer marks the halfway point in the work to achieve the millennium development goals. As one of those goals, the international community made a commitment to have halted and begun to reverse the spread of HIV/AIDS by 2015. A massively increased prevention programme is required if we are to meet that commitment. We must also consider the important role that diagnostic testing must play, as the availability of testing is vital for progress in prevention and access to treatment. The global coverage of HIV testing and counselling remains low. Available information is limited, but surveys done in a small number of countries in sub-Saharan Africa indicate that at most one quarter of people living with HIV were aware of their status. Late diagnosis not only impedes prevention work that can be done with people living with HIV but means that treatment for an individual is less likely to be successful.
The Government are playing an important role in the councils of the world. They have ensured that HIV/AIDS is on the agenda at the UN, the EU and the G8. They are also putting their money where their mouths are by increasing the amount that Britain spends on overseas aid. Will my hon. Friend give us his view of the prospects for progress at the G8? The Finance Ministers meet this Friday and the G8 summit is just more than three weeks away. I am sure that we all hope for progress.
I am pleased that we have had the opportunity to have this debate in the week when my hon. Friend the
Minister will be launching a consultation on a new strategy along with the interim evaluation of the current strategy. I look forward to hearing his comments.
The Parliamentary Under-Secretary of State for International Development (Mr. Gareth Thomas): I begin by saying, and particularly this time genuinely meaning, that I am grateful to my right hon. Friend the Member for Edinburgh, East (Dr. Strang) for persuading Mr. Speaker to allow us to debate this topic. As he said, the debate is timely, not least because of the launch on Thursday of a consultation on how we can step up our work on HIV/AIDS as a country and particularly as a Department, but also because we are a matter of weeks away from the G8. There will be considerable international attention on what else the G8 can do to focus attention on the terrifying growth in the incidence of HIV/AIDS across the world. I shall not repeat the statistics that he rightly reminded the House of.
My right hon. Friend ended his comments by drawing attention to the lead that the Government have taken on HIV and AIDS. It is perhaps worth noting that, in 2005, when we held the G8 and EU presidencies, we took the opportunity to use them to secure important commitments to universal access to HIV treatment and prevention. As he and the House will know, through the UN General Assembly we managed to secure a commitment to a broader definition of universal access, including prevention, treatment, care and support. I know that he supports that.
A year earlier, in July 2004, we attempted to prepare the ground for such a discussion at the UN by setting out an ambitious and, I hope the House will agree, progressive UK policy on tackling AIDS in the developing world in the document that we published called Taking Action. We shall have a chance to discuss on Thursday a review of that document and an assessment of where we have got to in implementing the commitments that we made in it. It set, for the first time, a spending target for funding through my Department of some £1.5 billion to support our response to AIDS, making us the worlds second largest bilateral donor. It took a strong stance on the importance of meeting the needs of vulnerable groups, including by committing to spend some £150 million on support for children affected by AIDS.
My right hon. Friend rightly sought to remind the UK and the international community of the need to follow through on the commitments made at that G8 summit and the UN millennium review summit. That is why we have sought to do our part by commissioning an independent interim evaluation of the Taking Action document to enable us to assess our performance at the midway point in the drive to make progress towards universal access, and to enable us to take any corrective action needed. Again, Thursday will offer the opportunity to review in more detail where we have got to.
It is also why we pushed to set ambitious targets in-country, led by the developing countries themselves, including interim targets for 2008, in the UN General
Assemblys political declaration on AIDS in June 2006 to help us to review progress towards the goal of universal access. It is also why we pressed the G8 at St. Petersburgand will press again at the summit in just a matter of weeksto report against the AIDS commitments that were made at Gleneagles.
On progress, it is clear from the UN and from civil society reports that there are areas where the AIDS response has progressed. We can be proud of that response, but it is also true, as my right hon. Friend said, that there is a considerable amount that we still need to do if we want to achieve our ambition of an AIDS-free generation.
On treatment, there have been huge increases in the number of people taking antiretroviral drugs, as my right hon. Friend said. According to UNAIDS, the World Health Organisation and UNICEF, more than 2 million people were receiving treatment at the end of 2006, a 54 per cent. increase in just one year. Of that number, more than 1.3 million people in sub-Saharan Africa were receiving treatment in December 2006, compared with just 100,000 in 2003.
However, the sad truth of those impressive statistics is that only 28 per cent. of those who need treatment actually have access to the drugs that they need. We must do more to boost access to treatment and diagnostics, in particular for children. We must take steps to reduce the cost of second-line AIDS drugs, which, as my right hon. Friend clearly knows, can cost as much as 10 times more than other treatments, and we must take more steps to tackle the stigma and discrimination that block peoples access to services, including treatment.
I am delighted that the UK played its part in tackling those issues by helping to set up UNITAID, the new international drug purchase facility. It has already approved, among other things, programmes of nearly $62 million for treatments for children and nearly $70 million for those second-line therapies that cost so much.
This week, UNITAID and the Clinton Foundation announced a major cut in the price of 16 AIDS treatments that will be available to 66 developing countries. That clearly is positive progress and an endorsement of the approach that mechanisms such as UNITAID allow. I am pleased, and I hope that my right hon. Friend is as well, that through the Medicines Transparency Alliance we can begin to tackle some of the fraud and other inefficiencies that can on occasion lead to a 300 per cent. mark-up in the price of medicines in developing countries.
My right hon. Friend drew attention to funding, and rightly said that we need to do more to ensure that the necessary resources are available to finance universal access. He said that an estimated $10 billion will be available in 2007 for HIV-related programmes in low and middle-income countries. As he said, that is a huge increase, but, as he also said, it is just over half of the $18 billion that UNAIDS estimates is needed in 2007, so the international community needs to do more work together to meet that funding gap.