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Baroness Finlay of Llandaff: I, too, would like to speak to the amendment and to build on some of the remarks already made by noble Lords. Clause 4 outlines what the agency may do, but to fulfil all those functions costs money. The importance of resources should not be underestimated. If the agency becomes strapped for resources, one would have to ask where the services would be squeezed, cut or downgraded. But that is not the only concern. Services need to keep developing and to keep modern, and that requires ongoing investment. Good equipment costs money. Training of specialist registrars, technicians at local level, epidemiologists and scientists all takes money.
New diagnostic techniques are emerging all the time, especially for viruses and fungal infections, some of which are notoriously difficult to diagnose. If there are insufficient resources locally for accurate diagnosis, lives will be lost. I am not trying to be a scaremonger, but it is a reality that if a diagnosis is missed, someone will die. If it is missed several times, several people will die.
The other difficulty is that new diseases are emerging annually—outlined in the report Fighting Infection—especially given the changes in travel, industrial exposure and zoonoses, which was mentioned earlier; that is, the mutation of organisms, particularly in the animal kingdom, which are transferred to humans. The contracting arrangements appear to be increasingly complex for services and create some difficulties. It is important to ensure that services delivered directly affecting patient care have
the resources they need. The services need to be delivered not only today, but also tomorrow, next year and thereafter. There needs to be a modern service, not one that just ticks over.
Baroness Masham of Ilton: I have a query on the amendment regarding the local level. As has been said, there are some infections and diseases that are so complex and difficult that I do not believe that they could all be dealt with at the local level.
Lord Warner: A number of issues were raised during the debate on this amendment, the scope of which became rather wider than that of the Bill.
The noble Baroness, Lady Barker, raised issues relating to the transfer of the old PHLS laboratories back into the NHS. That is not essentially an issue for the HPA. I am not saying that there have not been disagreements; there have been disagreements with the Department of Health about the transfer of resources to primary care trusts. We hope that the final discussions on the issue are taking place, and that the transfers will then be put in place. I hope that we will then be able to draw a line under that activity. I do not think that we will resolve the issue by amending the Bill; it is about reassuring the PCTs about the adequate transfer of funding when they take over responsibility for laboratories.
Lord Clement-Jones: I do not wish to allow the Minister to misinterpret what has been said. There have been transfers in the other direction, with resource implications for the HPA.
Lord Warner: My understanding of the noble Baroness's point was that laboratories at local level were her concern. If we are talking about laboratories that the HPA has taken over, that is a question of local management decisions. As I said during our debate on the earlier amendment about local services, 20 per cent of the HPA budget is allocated to local and regional services. As an example of how some of those are being strengthened, the HPA is already addressing the matter through its plans to deliver radiological protection support and training to its local and regional services divisions, in close collaboration with the National Radiological Protection Board. That is an example of where local specialist services are being strengthened as a result of the HPA.
In debating this Bill, we cannot go through the detailed operational financial arrangements between the HPA and other parts of its services, although I will be happy to make more enquiries and to write to Members of the Committee.
I am full of admiration for the commitment of the noble Lord, Lord Fowler, on HIV/AIDS, and his ability to take every opportunity to remind us of the issues involved. It is easy to say that there are problems in the area, but it is equally easy to forget that there is a government strategy on the matter, which is backed by an initial investment of £47.5 million, plus a further £40 million committed over the next two years. In addition, a further £11.4 million was announced in response to concerns raised by the Health Select Committee and
stakeholders, plus a further £15 million capital to modernise premises for genito-urinary medicine. In the context of a sexual health strategy, a substantial amount of new resources is being allocated. We share the noble Lord's concerns about the poor state of sexual health, but we do not agree that there is a crisis, or that the response has been inadequate.People have been saying a lot about concerns regarding funding for local services and specialist services. We now have a situation in which 75 per cent of the resources available to the NHS are allocated by PCTs. This is now a health service in which PCTs shape their spending on the basis of local priorities. We must simply accept that devolution in this area means that PCTs will reshape their budgets and expenditure plans to meet their service needs and the needs of their local community. That is not something that we shall continue to prescribe in great detail from the centre.
I am not sure exactly what the amendment means. There is no definition of specialist services. Does it mean that there are specialist services that the HPA should provide across all parts of the country? I have already said in response to an earlier amendment that the HPA has been constructing a memorandum of understanding with all PCTs, so that there is consistency of service provision across the country in health protection. We must allow those memoranda of understanding to play out and be more confident that the joint working between the PCTs and the HPA will be beneficial.
It is easy to view change as being for the worse. I would say that we are moving into an era where combined working between the HPA and PCTs will mean a more consistent approach to health protection across the country as a result of the initiatives being taken by the HPA. I suggest that the amendment is unnecessary.
5.30 p.m.
Baroness Masham of Ilton: Yesterday, I attended a meeting in Portcullis House on the health problems of Greater Manchester. I sat next to the chairman of a local hospital who said that it was in total crisis over sexually transmitted diseases. The Government may be pouring in more and more money, but there needs to be a national campaign. The public do not know; young people do not realise what they are doing. The situation is out of control and at crisis level.
Lord Warner: I am sorry but I simply do not agree with the noble Baroness that there is a crisis. The issue is serious. I remind the noble Baroness—I will send her details—of the sexual health strategy and the "Sex Lottery" campaign that is being run with a good deal of success, as I explained at an international conference only a couple of weeks ago in a European Union meeting. We are doing much more to educate our young people in that area than many other countries. We may not always be as successful as we would like, but it is misleading to suggest that nothing is being done. We will monitor the results of that campaign and publish them later.
The noble Baroness's intervention also allowed me to find a bit more briefing in my folder which may be of use to the Committee. To reassure the noble Baroness, Lady Barker, and others, the HPA has some ideas about how it will use its resources in 2004–05. For example, nearly £54 million will go on regional laboratories; about £41 million on local and regional services; and nearly £21 million on specialist laboratories. I could go on but I say that just to reassure the Committee that we have an agency that is considering the local and regional dimension and, through its work plans and budgeting system, is providing adequate funding for those services.
Baroness Barker: I thank the Minister for his reply. I apologise if there was any misunderstanding or lack of clarity on my part. I was trying to direct my comments to the level of concern that exists about those public health laboratory service operations that have been transferred to the HPA. I return to the point made by the Faculty of Public Health that many local teams inherited by the HPA are well below the level of resource that they were deemed to need. It was on those teams I mainly focused.
I return to the fact that in his report last week, Mr Wanless pointed out that the roles of the HPA and PCTs in health protection need further clarification. He pointed out that directors of public health and chief executives of PCTs are concerned that, although health protection teams have been transferred to the HPA, PCTs are still expected to perform some of the functions previously undertaken by those teams—for example, emergency planning under Section 47 of the National Assistance Act 1948.
I may be more of a devolutionist than many Members of the Committee, but I have a great deal of sympathy with the remark of the noble Lord, Lord Fowler, that public health remains a government responsibility. I have always believed that devolution in the health service should involve more than the shifting of blame and passing of the buck. That was the disappointing tenor of the Minister's remarks. The memoranda of understanding require clarification.
The Minister was somewhat disparaging in his treatment of my amendment—why spoil the habit of a lifetime?—and the term "specialist services". I refer him to the points made by the faculty of health. We are talking about improving national priority inspections, which include STDs. That does not just mean HIV/AIDS; I refer the Minister to our recent debate on undetected chlamydia. It is a huge public health crisis which, as we know, has immediate but also latent effects that may be incalculable in their cost to health.
On providing a service that covers chemical and environmental hazards at local and national level, the Faculty of Public Health is clear and unambiguous. It states that it believes that the inherited resource cannot manage such a service. As we know from Getting Ahead of the Curve, several major instances of widespread public health problems have emerged from chemical incidents. If we have learnt nothing else from
the Camelford disaster of 1988, we must surely have learnt the need to be prepared for such incidents. We need improved training for HPA staff and their partners in the NHS.I talked to PCT staff during the SARS outbreak last year. We were extremely fortunate, but for around 10 days staff envisaged most of their work stopping while they were hauled off to be trained in what to do about the problem. That must have been a great disruption to their normal ongoing activity, such as research and development. Any PCT that manages to prioritise research and development activity—in particular, integration with university research facilities—above immediate demand is pulling off something of a miracle in the current financial climate. Providing information to the public is also a specialist function which, the Faculty of Public Health makes clear, remains to be addressed.
We have made clear that there is a problem that needs to be addressed. I do not find the Minister's response wholly convincing. As we are in Grand Committee, I shall withdraw the amendment, but we will be back to discuss the matter later. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendment No. 18 not moved.]
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