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Baroness Finlay of Llandaff: I thank the Minister for that reply and for his assurances with regard to the memorandums of understanding. I also thank all noble Lords who have contributed to the debate. While listening to the tone of our discussions, I was struck by the tensions that appear to exist between the devolved governments and the need for a UK-wide remit. I am not sure that I would agree with the noble Lord, Lord Thomson, that there is a degree of incompatibility in seeking to meet the needs of Wales as expressed by the National Assembly for Wales and maintaining a UK-wide responsibility in broadcasting to the whole nation.
All the contributions have been extremely interesting in relation to the way in which the devolved administrations will look at the rolling responsibilities and monitoring through Ofcom. At this stage, I would like to withhold any decision with regard to my amendments. I shall read carefully all that has been said.
Lord Thomas of Gresford: Before the noble Baroness formally withdraws her amendment, perhaps I may say a few words or I shall not have a Motion before the House.
In relation to Amendment No. 27A, of course I shall withdraw it if the noble Baroness withdraws her Amendment No. 27. However, I should like to make one or two comments on the Minister's response. A memorandum of understanding made with a Secretary of State is in no way satisfactory. As the noble Lord, Lord Roberts, pointed out, the noble Lord underestimates the head of steam which has built up on this issue. The Secretary of State, who, by the Government's own choosing is a part-time Secretary of State because he also spends time in Europe, does not have the direct confidence of the people of Wales enjoyed by the National Assembly. If the noble Lord thinks that the people of Wales are going to be satisfied with some kind of agreement hammered out with the Secretary of State, then he is much mistaken.
The Minister did not respond to the point that a conflict is arising between the Assembly and the Government and that, as the noble Lord said, it may very well come to machinery being employed to resolve it. The Minister will be building up a great deal of trouble if the views expressed today are not taken seriously by the Government. I beg leave to withdraw my amendment.
Amendment No. 27A, as an amendment to Amendment No. 27, by leave, withdrawn.
Baroness Finlay of Llandaff: I am grateful to the noble Lord, Lord Thomas of Gresford, for that intervention. Extremely serious points have been made and it may be very important to consult outside the Committee and to come back later to the House having considered all the points in hand. This is probably not the time to seek the opinion of the Committee and I beg leave to withdraw the amendment.
Amendment No. 27, by leave, withdrawn.
Lord Davies of Oldham: I beg to move that the House do now resume. In doing so, I suggest that the Committee stage begin again not before 9.1 p.m.
Moved accordingly, and, on Question, Motion agreed to.
Tuberculosis and SARS
8.1 p.m.
Baroness Masham of Ilton rose to ask Her Majesty's Government what is being done to combat the spread of tuberculosis and severe acute respiratory syndrome; and what facilities for treatment and after-care are available in the United Kingdom.
The noble Baroness said: My Lords, my Question on tuberculosis has been queuing up for several months—well before the problem of severe acute respiratory syndrome was made public—but, as much TB is caused by the bacteria mycobacterium tuberculosis and is spread through the air like a common cold, I thought that the subject of SARS would fit into this short but none the less important debate, and so I have included it.
SARS is easily transmitted by droplets that can travel two to three feet when an infected person coughs or sneezes. Some people are saying that it is a difficult disease to catch. There are confusing messages and the public should know the truth.
TB is of high prevalence in China, where SARS originated. As a cousin of mine who visited the street markets in southern China said, "They are too horrible for words" and perfect breeding grounds for bugs. In southern China some people live close to birds and animals. Historically the region has been an important source of epidemics, and some diseases can be transmitted from animals and poultry to humans.
I am most grateful to all noble Lords and noble Baronesses who will speak today. I could not have asked for better Members of your Lordships' House. As the House will know, the noble Lord, Lord Soulsby of Swaffham Prior, is a world expert on zoonoses and other infectious diseases, including tuberculosis. I hope that the Minister will be able to answer some of the questions we will raise in the debate.
I recently asked two nurses, who work as district nurses in London, what we should do to stop TB. They both said, simultaneously, "Stop people spitting". Spit had landed in the eye of one of the nurses. I checked to see what legislation there is and the Library drew a blank. It seems that footballers who spit at opponents on the pitch are the only people who get fined. When I was young, there used to be signs in trains and public places stating that you could be fined for spitting. Is it not now time that this was brought back as a matter of public health?
SARS has made the world realise how important are new infectious diseases. We should be looking with equal interest at diseases such as HIV/AIDS and tuberculosis. As Sir William Stewart, the Chief Scientific Adviser to the Cabinet, said:
- "It is the combination of global bugs in global numbers, all with a propensity to mutate across the globe, that is an increasing concern".
There is concern that the scale, the size and the resources of publicly-funded research facilities no longer match their equivalents in the US, Canada, the Netherlands and Germany. The Public Health Laboratory Service, now being subsumed into the new Health Protection Agency, operates from one floor in Colindale, North London, and yet it is expected to deal with a huge range of infectious diseases such as the current avian influenza, Lassa fever, Ebola and the threat of bioterrorism. The Government have laid all these problems at the door of the HPA, which faces the massive task of rebuilding our research base.
One of my cousins is a microbiologist and loves research. When he was working in Leeds he got frustrated as he did not have time to do his clinical research in the way he felt it should be done. He is now working in Western Australia, with a well-settled family, enjoying sport and his work, which gives him time for research. Unless the Government are prepared to give scientists the backing that they need, it will be a long time before Britain can again take its place in the front ranks of medical science.
I was most impressed when I heard the right honourable Ian McCartney speak in a personal capacity at a campaign to stop TB. Perhaps he was not what most people expect as typical of the person who gets TB. He was well paid, well housed, well fed; he is white, middle aged and a Member of Parliament. He had become increasingly tired and listless and developed acute abdominal pain in his left side, and the symptoms spread to his groin and testes. It was all put down to stress. Finally, after months, he was diagnosed and treated for non-respiratory TB. This is an example of how TB can affect anyone, anywhere in the body. After the right honourable Member for Makerfield was treated, he suffered a great deal of pain which, after years, was found to be from adhesions.
The right honourable Member's case illustrates the need for correct diagnosis and for more specialists who can diagnose and treat patients with the expertise they need. I have been in touch with the right honourable Ian McCartney, and I told him about this debate.
One has to ask what happens in the UK to those on the street or those who have a chaotic lifestyle. The simple requirement of a regular supply of fresh running water is difficult for many, yet to fail to maintain the drug regime is potentially disastrous for the individual and for society as a whole as we see the emergence of drug-resistant strains of tuberculosis.
Three million people a year die from TB and about 7,000 people are affected in England and Wales every year. There are outbreaks from time to time all over the country in places such as Leicester, Glasgow, Kent and Liverpool, but the highest numbers are in London,
which have been compared with third world countries. The areas affected are Newham, Brent, Tower Hamlets, Ealing, Hackney, Islington and Camden.With the increase in active cases which is expected in the future, the correct treatment is vital. The most common cause of treatment failure and acquired drug resistance is non-adherence. Predicting non-adherence is highly problematic. Directly observed therapy is the most effective means of combating non-adherence; intermittent—less than daily—regimes facilitate the therapy. Testing the susceptibility of mycobacterium tuberculosis to drugs is essential for identifying resistance and tailoring treatment. Managing multi-drug-resistant tuberculosis is complex and should, when possible, be done in specialised programmes.
In New York, DOTS was tried, and it worked. The World Health Organisation recommends it throughout the world. Is DOTS currently carried out in Britain and, if not, why not? I was concerned to read in the press that of 43 TB hotspots in England and Wales 86 per cent had insufficient staff to treat patients with the disease.
As we know, the modern world is small, and air travel is fast. Many of the people developing TB here in the UK have lived abroad; many with HIV/AIDS also have TB. To know the approximate numbers is important for planning health services. Perhaps the Minister can tell us what is being done about testing and ensuring there are adequate treatment and aftercare facilities. Is BCG vaccination being given in schools, and how effective is it?
It would be most helpful for a global, unified response to the WHO's global fund to fight AIDS, tuberculosis and malaria, as it needs more support from most donor countries. The WHO predicts that by 2020 nearly 1 billion people will be newly infected with TB, of whom 70 million will die.
I look forward to the contributions of your Lordships and the Minister's reply.
8.12 p.m.
Lord Soulsby of Swaffham Prior: My Lords, the House should be grateful to the noble Baroness, Lady Masham, for putting down this debate on these two important entities— the old and the new. The old—tuberculosis—is often called the captain of death, and the newest is SARS, or severe acute respiratory syndrome. I declare an interest as chairman of the sub-committee of the Science and Technology Committee on fighting infection. We take a strong interest in both these entities.
It is not many years ago that we tended to believe that as an island we were secure from many global diseases, but that is no longer so. As the noble Baroness said, Sir William Stewart, the recently appointed chairman of the Health Protection Agency, made the point that global disease entities are our neighbours. As an example of how diseases an spread, he estimates that there were 750,000 flights into the United Kingdom last year, bringing 72 million passengers into this country. We are a nation of 60 million or so, and we are exposed to the infections of 6.3 billion people on a global scale. Global infection is the norm.
Tuberculosis is now classed along with HIV/AIDS and malaria as a major killer. The figures are horrendous, as the noble Baroness said. The WHO has said that between now and 2020 there will be 1,000 million new infections. Two hundred million people will become sick and 35 to 50 million will die. We believed that we had TB under control. Infection rates were progressively declining. But two entities changed the situation, one of which was the occurrence of HIV/AIDS. The two diseases go together, and the occurrence of tuberculosis is 30 times higher in HIV/AIDS communities. The other important factor is the antibiotic-resistant forms of the tubercle bacillus. In England and Wales in 1987, when we believed that the major problem was over, prevalence rates began to rise again. Whereas, in 1987, 14 per cent of all TB cases occurred in London, now 50 per cent occur there.
As the noble Baroness said, the most effective therapy is directly observed therapy—or DOTS. There are five elements to DOTS, all of which must be accomplished for the programme to be effective. First, there must be political commitment to it. Secondly, there must be case detection, either by sputum testing or possibly by a new blood test, as was mentioned recently. Thirdly, standard treatment must be provided under direct observation. Fourthly, there must be an uninterrupted supply of drugs and, fifthly, standard recording and reporting.
When introduced on a national scale in various countries, the cure rate has been very high. For example, in India DOTS has achieved a 95 per cent cure rate, at a relatively small cost of 6 to 20 dollars per patient. However, it is no easy task to satisfy all the criteria of DOTS, and unsatisfactory completion will lead to failure.
In the United States, especially in the Harlem hospital which members of my committee had the pleasure and honour to visit, there is a very effective programme. They have extensive community outreach. Since the hospital is in a low socio-economic area, incentives for therapy are provided by way of food coupons and travel cards. Most impressive of all was the commitment of hospital staff, from cleaners to the chief medical officer, to getting rid of TB. The concept of the individual patient was that helping himself or herself to be cured of TB helped the community by clearing the infection from the local population and stopping transmission. Thus it became an outreach control programme.
I join the noble Baroness in asking the Minister if such centres exist in the United Kingdom, how they are functioning and what plans there are for their expansion. Other areas on which she may wish to comment are vaccination, especially the availability of BCG vaccine and the development of new drugs to overcome the problem of multi-drug resistance.
In the few remaining minutes I shall refer to SARS, which on the scale compared to tuberculosis is infinitesimal in terms of infection and death rate. Nevertheless, we do not yet know how far it is going to go. The main focus is the Far East, in China and Hong
Kong, where there have been hundreds or thousands of infections with hundreds of deaths. We are fortunate in this country that we have had only six reported cases and no deaths. In the European Union, there have been 100 cases and no deaths.We need to ask about a number of entities in this matter. First, what are the facilities for isolation in this country of SARS cases? Have special nursing facilities been identified? What research developments have occurred in the field of antiviral drugs? Is there good collaboration and exchange of information between this country and the United States, where major developments in vaccines and antiviral drugs are taking place?
SARS is an example of the truth of the adage that the price of freedom is eternal vigilance. We now know that that is best achieved by national and international collaboration, as has been well demonstrated by the response of the global community to SARS.
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