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Secondly, it is right that local decisions should be made by local health authorities, but some problems must be addressed centrally. For example, a fifth of patients with suspected TB are not seen by the TB team within two weeks of presenting themselves, as directed
by the chief medical officer. We have had a big drive on waiting lists, and the issue clearly needs to be addressed.
Another big issue is that the majority of PCTs are not proactive in raising awareness of TB, which can lead to delays in diagnosis and unnecessary deaths. For example, a little girl from London was diagnosed with TB only two days before she died at a hospital in the south of England, and the same happened to two health workers in Nottingham. We want to see the same investment in awareness-raising for TB as for other comparable communicable diseases, such as sexually transmitted infections and hepatitis C.
To conclude, the all-party group plans to produce a report annually. I would be grateful if the Minister could give me a personal assurance when she responds that more will be done to ensure that PCTs prioritise TB and that national guidelines are implemented through the director of public health and the other means available. Guidelines on what should be done have been set out nationally, and we are now looking for implementation and for PCTs to take this deadly disease seriously.
I urge the Minister to make a commitment that the Government will use awareness campaigns, in particular, to prevent this disease from getting out of control. I should emphasisethis is what makes the global situation so sadthat TB is easily cured, but it is important that we have early intervention. I remind her that the incidence of TB in New York in the late 1980s and early 1990s was similar to that in many of our cities now, but the administration there sat on their hands, not realising that they were on the brink of an epidemic that ultimately cost them billions of dollars in public money to resolve. I therefore urge my right hon. Friend to continue leading on this issue.
The Minister of State, Department of Health (Dawn Primarolo): I congratulate my hon. Friend the Member for Cardiff, North (Julie Morgan) on securing the debate. I know of her passionate work as one of the chairs of the all-party group on global tuberculosis and I am aware of her concern, which she reiterated today, that the fight against tuberculosis should remain a priority in this country.
My hon. Friend reflected on the history of the disease. When I was a child, TB was present in my extended family before immunisation was introduced, and I remember subsequently having vaccinations. As she rightly said, all of us, but particularly those of us of a certain age, remember the challenge posed by this disease.
My hon. Friend is right that TB is a massive international health problem. The World Health Organisation estimated that 1.6 million deaths resulted
from TB across the world in 2005. In England, the development of drugs to treat TB, together with improvements in housing and health throughout the 20th century, led to a steady decline in the number of cases. That was reflected in an all-time low of 5,000 cases in 1987. However, she is right that there has been an upward trend since the 1990s. In 2006, more than 7,500 cases were reported in England, with the London region accounting for 40 per cent. of all cases. Although the overall rate in the UK is low, at around 14 cases per 100,000 of population, TB remains a concern because the incidence is increasing and rates are high in certain inner-city areas, as well as among people born abroad.
As my hon. Friend said, the chief medical officer published his action plan in October 2004, which included key recommendations for action. He acknowledged that TB is so common in certain parts of the world that we must expect a continuing influx into this country of people who were infected, or who developed the disease, abroad. She touched on that when she urged us not be complacent about the challenges that we face. Although measures are in place to detect active disease in migrants entering the country for six months or more, who are subject to immigration control, such measures are unlikely to solve the problem of TB in this country. That is because about 80 per cent. of cases of active disease among such people occur only after they have been resident in this country for two years or longer.
My hon. Friend the Member for Keighley (Mrs. Cryer) touched on an important point when she stressed the need to encourage those who fear that they have the symptoms to seek diagnosis, advice and treatment. As she said, they should not be put under unjustifiable pressure to feel that their symptoms are somehow shameful and that they must conceal them.
In considering all those points, it is right to focus on strengthening services to improve early detection. That includes raising awareness among the population and health care professionals, especially in the primary care setting, of the need for the highest awareness of TB, on a continuing basis. The Government strategy needs to drive early detection and diagnosis, and to ensure that patients complete their courses of treatment.
Our strategy is to help to strengthen NHS provision across the board. To help to implement the TB action plan the NHS, the Department of Health and the Health Protection Agency have been working closely together, to make sure that we bring our resources to bear on the issue. My hon. Friend the Member for Cardiff, North mentioned the TB toolkit that we published in June 2007 for the NHS, to help commissioners take local demographics into account when planning TB services, respond quickly to changes in demography that may have an impact on risk in the future, and be very aware of the risk. The toolkits commissioning section is a practical guide for PCTs to use, so that they can ensure that an appropriate range of services is being commissioned and provided within that rational framework. The delivery section discusses a number of best-practice issues, including the use of specialist centres providing a multi-disciplinary team approach, with TB nurses co-ordinating a package of care. It also recommends that TB services should follow the National Institute for
Health and Clinical Excellence guidance on diagnosis and treatment of TB, which was published in March 2006.
Against that background, I want to discuss the recommendations in the excellent report by the all-party group on global tuberculosis and the British Thoracic Society. I welcome the recommendation regarding a national TB awareness campaign tailored to local circumstances and aimed at health care professionals and the general public. When my hon. Friend was talking about the report and the results of her survey, and despite the need for considerable improvement, to which I shall return, I felt, like her, very encouraged that there was a quite high response rate within a short time, and awareness in many PCTs of the issues and what needs to be done. I am pleased to say that the Department is providing funding this financial year to take exactly such action as she mentioned with respect to local circumstances and work with health care professionals and the general public. We have also commissioned market research to help us to shape such campaigns nationally, to complement what is happening locally. That research will be translated into carefully targeted messages for health care professionals, and we have funded the UK charity TB Alert to work with PCTs to develop awareness campaigns targeted according to local demographic needs.
The report recommended that PCTs must ensure, as my hon. Friend mentioned, that there is a clearly identified individual within their organisation with responsibility for service provision for TB. I agree wholeheartedly with that recommendation of my hon. Friend and the report; it is one of the key recommendations of the TB toolkit and we intend to take it forward. [Interruption.] It is unusual to be heckled by the intercom system.
The Department is focusing on that work now, and will continue by engaging with PCTs to arrange workshops and discussions with health care professionals, to make sure they know the existing prevalence of the disease and the indications of future risk; the fact that it is a public health priority requiring them to carry out a proper assessment of the risk in their areas; how they should respond to it; and what the public awareness campaigns are. A key factor
is the Departments active role in connection with the basis of the recommendations in the toolkit and the report. [Interruption.]
Dawn Primarolo: Yes, of course, Mr. OHara. I want to reinforce our recommendations to the NHS to follow the toolkit, and to welcome the important points in the all-party groups report, endorsing the advice, and my hon. Friends comments. Although, of course, the management and organisation of local NHS services is a matter for NHS managers, we shall expect and encourage the local management and organisations to focus on the implementation of the recommendations, and to put sensible plans in place.
I can assure my hon. Friends the Members for Cardiff, North and for Keighley that the Government take the matter of TB very seriously and that, despite our recognition of the devolving of responsibility for many decisions to PCTs, it is still important for the Department as a whole to stay focused on the matter and to encourage PCTs to do likewise. As I have said, our key strategy is to support the NHS and encourage the strengthening of TB services. To promote the use of the toolkit we supported a series of interactive workshops through the strategic health authorities in England and with PCTs. At those events commissioners, TB service providers and other stakeholders are encouraged, using the toolkit, to review and reconsider their local response, not just to current TB issues but to potential future challenges.
Finally, I note that the report proposes, as my hon. Friend the Member for Cardiff, North mentioned, repeating the survey on an annual basis. The timing of the survey was soon after the launch of the TB toolkit last year, and so perhaps we should not be surprised about how far we have to go, and how encouraging the results are; some PCTs have not implemented the recommendations. I shall certainly be interested to see from future surveys how well we have progressed in the work with PCTs, to ensure that the right services are being commissioned; I shall be interested in an assessment of that, and in the chance to consider how effective the changes in the local health service have been, alongside the work identified by the Department. My hon. Friend has clearly identified a major public health issue, which needs to be reinforced through the regional directors of public health; I intend to do that.
Mr. Richard Spring (West Suffolk) (Con): May I say what a pleasure it is to see you chairing our proceedings, Mrs. Anderson? I am most grateful to the Minister for being here to respond. I shall examine the bilateral relationship between the UK and Ukraine before considering developments in Ukraine itself. Some 100,000 Ukrainians live here, and a number of organisations exist to link our two countries. I should like to highlight one in particular, the Ukrainian-British City Club, which provides a lively forum for the increasing number of Ukrainians working in the City of London. There are also student groups at the universities of Oxford and Cambridge and the London School of Economics.
Last year, the British Ukrainian Society was established to act as a bridge between our two countries and as an umbrella for the many bilateral groups here and in Ukraine. It encompasses contact at political and economic, as well as social, cultural and educational levels, and it already enjoys a considerable range of activities. I should declare an interest as the chairman of the society. I am also delighted that a course in Ukrainian language and culture has been established at the department of Slavonic studies at Cambridge.
Many links bind Ukraine and the United Kingdom. Whether in trade, defence, development and business or in our work through the European Union and other international bodies, the ties between the two nations are getting stronger. In recent months, London has hosted a significant number of Ukrainian events. Last month the Foreign Minister, Mr. Ogryzko, was in town. He had successful meetings with the Foreign Secretary and the shadow Foreign Secretary. To coincide with his visit, an early-day motion was tabled welcoming the important progress made by Ukraine in its democratic development and hoping that the relationship between Ukraine, the UK, NATO and the EU can be strengthened even further. It encapsulates the views of MPs across the party political divide.
In September, Lady Thatcher held meetings with Yuliya Tymoshenko. More recently, President Yushchenko met my right hon. Friend the Leader of the Opposition at the World Economic Forum in Davos. It was a very successful meeting. Next month, President Yushchenko will visit Britain. One aspect of his visit will be his desire, which is felt deeply and widely in Ukraine, to publicise the famine that killed millions of Ukrainians in the 1930s: the Holodomor, which was deliberately caused by Stalin. There is a remarkable archive on the Holodomor, and an exhibition about it is being planned with the help of the embassy and the British Ukrainian Society. On Saturday, a concert is being held in London to commemorate the 75th anniversary of the famine.
I pay tribute to the hon. Member for Selby (Mr. Grogan), who has ably and imaginatively chaired the all-party group on Ukraine. He has done an outstanding job of bringing Ukraine alive for Members of Parliament, and I pay unreserved tribute to him for it. I am delighted that an Inter-Parliamentary Union visit to Kiev will take place in
early June to build links between parliamentarians. I also welcome the formation of a new group in the Rada to forge contact and friendship between our two Parliaments.
The relationship between our two countries has never been better. Ukraine vividly caught the UKs attention during the Orange revolution, when Ukrainians bravely poured on to the streets to fight for democracy. Ever since those remarkable events, Britain has supported Ukraine in its reform process. It is fair to say that no country in western Europe is keener to promote the success of Ukraine than ours. Ukraines geopolitical situation is fully recognised. Britain supported Ukraines accession to the World Trade Organisation and fully supports its aspirations to EU membership.
I am a governor of the Westminster Foundation for Democracy, which was established in 1992 to assist in building and strengthening democratic institutions overseas, particularly after the end of the cold war. We are sponsored by the Foreign and Commonwealth Office and work with political parties, Parliaments and non-governmental organisations to foster democracy through training, experience sharing and mentoring in countries around the world. Since its establishment, the WFD has worked in Ukraine to support civil society organisations, political parties through direct UK political party contact, independent media and free and fair elections.
Despite the hope and optimism that the Orange revolution brought to Ukraine, democracy did not immediately consolidate as many first hoped. I believe that Europe did not seize quickly enough the opportunities to build on the outcome of the Orange revolution so as to entrench it, and we did not sufficiently understand its significance. Ukraine has faced teething problems, learned valuable lessons and managed to overcome many challenges thrown in its way. Through sheer determination, it has transformed itself into a new, functioning democracy. It now boasts a strong record of democratic elections, respect for human rights and free media. Of course there are sharply defined differences of view in the internal politics of Ukraine. The constitutional balance between the roles of the President and the Prime Minister is now under review.
The importance of Ukraines development goes way beyond its own national interests. Ukraines success provides a positive political and economic incentive to its neighbours. It could be a shining example and model for others in the region. If Ukraine succeeds, it could encourage neighbouring countries such as Belarus and Moldova to choose a similar path to success. It is therefore critical that the democratic underpinnings in place in Ukraine are firmly consolidated. Last week, I received some excellent news about an event that could go some way towards making that happen.
The Foreign Office plans to give the Westminster Foundation for Democracy a substantial amount of matched funding towards a parliamentary strengthening programme in Ukraine£600,000 in total. It is a clear recognition of Ukraines importance that it has been singled out for the programme, and it is a hugely welcome development. As Ukraine is a new democracy, its Parliament has a limited number of people available
who are experienced and knowledgeable in parliamentary practice. The pace of development in that field has been inhibited by the lack of programmes to institutionalise the experience and knowledge of Ukrainian MPs and parliamentary staff and transfer relevant knowledge and experience from more developed Parliaments. The WFD has taken the lead to form a consortium of leading UK experts in parliamentary strengthening to address more effectively the issues faced by Parliaments such as Ukraines.
Despite the political problems, the country has been enjoying strong economic growth, and the signs of prosperity are apparent. I recently attended a Ukrainian investment seminar here in London. It was evident that despite growing inflation in Ukraine, its economy as a whole continues to go from strength to strength. From January to March this year, Ukraines gross domestic product grew by 6 per cent. annualised.
The drive for reform is led in many respects by the Ukrainian business community. Ferrexpo, the UK holding company that owns Ukraines largest iron ore exporter, began trading last year on the London stock exchange. Many other companies have been or will be listed here in London. Despite high inflation, the Ukrainian economy demonstrated robust economic growth in 2007, higher than that of most other countries in the region and central and south-eastern European impressive performance, despite huge increases in the price of imported natural gas and high world crude oil prices.
Investment opportunities continue to look good for exporters and investors. Britain is the fourth largest investor in Ukraine, and there are now more than 85 companies in Ukraine with British connections, representing a cross-section of sectors. Property and real estate, trade, finance, transport and communications and machine building currently attract most of the British investment.
Ukraine is an attractive investment destination for a number of important reasons. Ukraine has a highly educated work force with almost 60 per cent. university enrolment, a large domestic market with increasing purchasing power, an improving business climate, relatively low wages and excellent agricultural, industrial and high-tech potential, in addition to the prolonged period of economic growth that the country has enjoyed. Because all of us as parliamentarians are so acutely aware of it, it is worth pointing out that at a time of pressure on world agricultural production, Ukraine, with its huge agricultural potential, is in an increasingly important position to take advantage of it. It is not for nothing regarded as one of the worlds bread baskets. At a time of world food shortages and ever higher prices, Ukraine has lifted grain export restrictions, which is most welcome.
After 14 years of negotiations, Ukraine has been accepted as a member of the World Trade Organisation. Hailed, by President Yushchenko, as a truly historic moment and a decisive milestone in the countrys development, accession has been a joint accomplishment of the past four Governments, which I greatly welcome. Analysts predict that membership of the WTO will lead to an even greater acceleration of economic growth, resulting from an increase in exports and investment as European businesses are given greater access to the Ukrainian market.
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