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Baroness Finlay of Llandaff: I want to ask the Minister about the freeing-up of resources from more streamlined back office provision. My information from people in radiation protection is that the moves that the Minister outlined are occurring and are generally welcome and that working relationships are good. The scientific weight of the National Radiological Protection Board has been added to the chemical hazards and poisons work of the Health Protection Agency.

I want some reassurance that those freed-up resources will still be available in radiation protection training. There is a potential problem with the interface at local and national level. At a local and regional level, people will have to know the point at which their expertise runs out and they should seek help from the Health Protection Agency. There is an ongoing, long-term training issue for staff, if we are to make sure that the interface between local services and the Health Protection Agency is clarified, so that the agency can function effectively.

Lord Warner: The noble Baroness will be surprised to know that I do not, I confess, have that level of detail at my fingertips. I will look into that point and write to her. I shall copy the letter to other Members of the Committee.

Earl Howe: The Minister's reply was, in large measure, reassuring. I recognise the synergies that the Minister referred to and the savings on back office costs, which are obviously desirable. However, my main concern was that there was a risk of loss of critical mass—perhaps inadvertently and for the good reason that staff might be seconded within the agency—and that, therefore, the discrete function of radiological protection might be weakened, albeit subtly. Much of what the Minister said has reassured me that such matters have been taken fully into account, and I thank him for going into the detail that he did.

Clause 3 agreed to.

Clause 4 [Functions: supplementary]:

Baroness Barker moved Amendment No. 17:

Page 3, line 33, at end insert—

"( ) ensure that specialist services at a local level are adequately resourced to enable them to provide appropriate services"

The noble Baroness said: When I was preparing for today's debate, my mind went back to an occasion a long time ago, when I was involved in doing some work on older people and HIV/AIDS. I took part in a conference that was organised by a hospital in the West Country. I met the two formidable ladies who

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ran the department of infection control and who had organised the conference. I asked, "What do you do?", and they said, in unison, "We listen to the experts, and then we tell people to wash their hands". In a way, that sums up a lot of what I will talk about today. The amendment would ensure that there were adequate resources for specialist laboratory services and that expertise, which is of fundamental importance—as anyone who has listened to the debate so far will know—was widely available not just in specialist services in the NHS but to those involved in the provision of community services, including diagnosis and management of conditions that arise from infection.

In the Select Committee report, there was a great deal of evidence from specialists that many of the difficulties then being experienced in fighting infection would continue, because of the shortage of qualified staff and the lack of access to specialist knowledge. The Government's response to that report will, I think, cause noble Lords to share that concern: it was somewhat lukewarm.

The main concern is that the integration of staff at local level—especially those who were employed by the Public Health Laboratory Service—into the HPA, rather than into primary care trust laboratories, is being done on the basis of inadequate resources. It is important, if that transfer is to go ahead and be effectual, that there are adequate resources. Throughout our debates, we have talked about the increased threat of biological incidents and biological terrorism, but there is a great deal of day-to-day work that continues and grows, as a result of infections. For example, Members of the Committee who have taken part in other debates in the House on, for example, the incidence of sexually transmitted disease will know about the ongoing, ordinary work—if one can call it that—of those laboratories. We are placing additional demands on them.

The Faculty of Public Health of the Royal College of Physicians provided an extremely useful briefing on the matter, in which it said that it understood that the Bill was to be introduced on a cost-neutral basis, which failed to take into account the fact that there was an existing deficit in the resources available to the laboratory services. When the last survey was carried out on behalf of the NHS Executive in an attempt to establish a baseline for those services, it was found that, in many areas, services were below that baseline. It is against that background that the Bill proposes to give people working in primary care trusts additional duties.

Primary care trusts are, as we know, a major focal point in the detection of the incidence of disease and in the management of disease. I note from some of the discussions that we have had that we are talking about incidences of disease that are extremely difficult to predict. Such diseases may occur in widespread and diffuse ways, which has an impact on detection. I draw to the Committee's attention the difference between the incidence of diseases such as pneumoconiosis, which occurred, by and large, in geographical areas in which it was possible for specialist knowledge to be

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developed, and the incidence of diseases such as mesothelioma, which occurs all over the place. Healthcare professionals know what the disease is, but they may not have come across an incidence of it for a long time and may have to start to learn about it all on their own.

The report of the Select Committee also raised an important aspect of all this. It talked about the need for surge capacity—the need to amass very swiftly a body of expertise within a particular area when an infection breaks out. It stated in the report that it doubted very much whether a system that was already coping with chronic underfunding could do that.

Finally, as Mr Derek Wanless said in his report last week, the role of PCTs and the HPA is as yet somewhat unclear. The memorandum of understanding between the two is unclear and needs to be further clarified. In many of our discussions so far we have focused on the diseases and infections which cause acute problems, but there are many infections and zoonotic agents, to which my noble friend Lord Clement-Jones referred, which cause chronic conditions. It is the management of chronic conditions that primary care is all about.

It is therefore important, not only for detection but also the management of cases, that there is quick, ready access by non-specialists throughout the health service to specialist facilities. It is for that reason that we believe there is a practical and laudable case for looking again at the resourcing of those specialist services and access to them. I beg to move.

5.15 p.m.

Lord Fowler: The noble Baroness, Lady Barker, is right to raise this issue and I should like to add to one aspect of what she said. If services in this area break down it will be at the local level. I am very much in favour of devolving responsibility for, say, the management of hospitals to the local level.

But it is not only a matter of resources; it is also a matter of the willingness of local organisations—and PCTs in particular—to use those resources. When it comes to the issue of public health, I have my doubts about devolution. I say that because I believe that the old Public Health Laboratory Service did well in this area and because public health is a crucial central government responsibility. That means that the Department of Health must act very speedily and very decisively.

Finally, I am not encouraged by the evidence so far that local priority is being given to these issues. Governments can appear embarrassed enough in areas such as sexual health, where they can be criticised or, worst of all, lampooned, but in many ways it gets worse in local areas. I seriously doubt whether, at the moment, primary care trusts are giving the right priority to these areas.

Let me give an example of what I mean. The second annual survey from three of the major agencies involved in sexual health in the United Kingdom—the British HIV Association, the providers of AIDS care and treatment and the Terence Higgins Trust—has

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just been published. They say, basically, that there are clearly instances of good practice and growing understanding, but in too many responses there are clear signs that the need at the local level is outstripping the ability of services to respond. That is their finding.

The key findings are, basically, that the United Kingdom's health planning system is continuing to fail to give the issues of sexual health and HIV the attention they deserve. That comes as no surprise. HIV and sexual health services do not have the resources they need to implement government policy; the majority of clinicians continue to warn that things are getting worse rather than better; and many services are at crisis point and in urgent need of modernisation.

The surveys found that almost a third of PCTs had carried out no assessment of needs around sexual health and HIV since their inception, despite the rising numbers of people needing those services. Somewhere between a third and a half of all PCTs have spent less per case in 2003 on sexual health and HIV, although the numbers have increased. That is not an encouraging picture of what is happening around the country at local level. I say to the Minister that there is a serious warning in those figures. Devolution by itself does not mean effective action or adequate resources. But at the local level it is a matter of priority being given to those areas. At the moment, no one can argue that that priority is being given. The Government, and we in Parliament, should be warned about what is now happening.

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