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Earl Howe moved Amendment No. 32:
- Page 5, line 27, at end insert—
The noble Earl said: I see that my noble friend Lord Fowler and I have been thinking along similar lines as regards the kind of leverage which the agency will be able to exert in practice. The agency may do its job superbly well, but unless there is a duty on Ministers to deliberate and act upon the advice that they receive, the effects of the agency's good work may not be felt to the fullest extent.
When the Government receive advice from the HPA, surely they have a duty at some stage to tell us what they are doing to address the issues which the agency has highlighted. Preferably they should be obliged to do so before the publication of the agency's annual report, because that might well be 18 months down the road from the submission of a particular paper. I am deliberately talking about the Government, rather than
Derek Wanless remarked in his recent report that that is exactly what has happened to every public health policy report for the past 30 years. I hope, as he does, that his thoughtful report breaks that mould, but the brutal fact is that there is no requirement on the Government to do anything at all in response to it if they choose not to.
One obvious answer is to have the agency report directly to Parliament, and for Parliament then to instruct the Government to consider the recommendations, to act on them appropriately and to report back at a suitable level. I am attracted to that idea, but another answer is to approach the issue in the manner attempted through the amendments. Either way, a central point is at issue. We must recognise that the protection of the public is, in the end, down to elected Ministers—a point already made by my noble friend Lord Fowler. The public have a right to know what policies and initiatives those Ministers are putting in place to fulfil that obligation.
I can detect no sense in the Bill that the Government recognise that element of the public health equation. That is a decided shortcoming that should be remedied. I beg to move.
Lord Fowler: I shall speak to Amendment No. 57, which stands in my name. The question is what follows the collection of information; that is the point. What action will be taken? I shall again concentrate for a few moments on HIV/AIDS and sexual disease as an example of what I have in mind. My major concern is that the collection and the analysis of information on sexually transmitted infection is excellent, but it is not some theoretical exercise; it must be accompanied by statements of action on how the problems are to be remedied.
What concerns me—and my noble friend Lord Howe—is that the Bill places many duties on the agency. All kinds of duties are placed on the agency—that it must produce an annual report and send it as soon as possible to the Secretary of State, and it must provide the Secretary of State with such other information and report as he directs. There is no question about the emphasis from the Government. But no duty is placed on the Secretary of State to respond to any reports, however serious, that reach him. That is what is lacking.
We had a short debate on another amendment when the noble Baroness, Lady Masham, raised the issue of whether there was a crisis in sexual health. The Minister said twice that there was no crisis. I must say that that is not my view but, much more importantly,
The Minister does not gain much by denying what is the widespread view of most experts on the ground. On 12 February, the Health Protection Agency produced a press statement to accompany its monthly board meeting, in which it stated that newly diagnosed cases of HIV had increased by 20 per cent between 2002 and 2003, and that, although the figures will rise further as late reports are received, 5,000 new diagnoses have so far been reported for 2003, compared to 4,204 at the same time last year.
According to indications, the rate of new diagnoses in 2003 will have been the highest ever—there were more than 7,000. Exactly the same position applies with sexually transmitted diseases. The figures on chlamydia, for example, are horrifying—a 141 per cent increase since 1996 and a 14 per cent increase over the previous year—and there are similar figures for gonorrhoea. The biggest increases of all have been in infectious syphilis.
I do not think that one needs to underline the point that there is a crisis; therefore, it is important that in policy terms we have some means of tackling that crisis. We are getting the information; there is no difficulty about that. I pay tribute to the staff, because in this country we get excellent information to guide policy. The trouble is a lack of policy. I am trying to tackle that issue through this amendment.
I do not claim that by placing a duty on the Government—or any duty on any government—to respond to the Health Protection Agency's report we will solve all the difficulties, but I certainly believe that it would help. I notice that the agency's own report of November 2003 contained 10 specific proposals, ranging from reducing waiting lists at clinics to increasing prevention efforts directed at gay and bisexual men. Again, what is lacking is the fact that the Government are not responding to those reports.
The point that I make in my amendment, which is in the same spirit as that of the noble Earl, Lord Howe, is that after a report has been published, there should be a requirement on government to respond and to say what they are going to do. That is the big deficiency in our defences at present. There is a crisis, and the Government should wake up and respond to that crisis.
Lord Clement-Jones: I support what the noble Lord, Lord Fowler, so eloquently said in his introduction to Amendment No. 57. The concept of the Secretary of
If we set up those bodies, they may be rationalised in due course, as mentioned in the Wanless report. But if we are to set up powerful bodies, particularly in the areas for which the HPA will have responsibility, we must ensure that there is a political response. There cannot just be one-way traffic; the HPA cannot simply be expected to submit endless reports without having a proper reaction from the Secretary of State. After all, when the Health Select Committee publishes a report, we expect the Government to produce a response in a reasonably timely fashion, which allows us to have a debate on it.
We need to make sure that the HPA has, in a sense, the entitlement to have that equal level of attention paid to its recommendations. For me, a very important perception came out at Second Reading that the noble Lord, Lord Fowler, has enshrined in an amendment. It has considerable merit.
Baroness Masham of Ilton: Last year I suggested that there should be a national service framework for sexually transmitted diseases. I wish that the Government had listened because, as the noble Lord, Lord Fowler, has said, the numbers are going up. The people on the ground are in a desperate situation. I repeat: there is a crisis. We would not say that had we not been told it by the people working on the ground. I hope that we can do something to stimulate the Government into doing more in the Bill about that very serious situation.
Lord Warner: I shall respond to a number of remarks about the Wanless report, which has been flourished during the afternoon. It is worth bearing in mind that it was the Government who commissioned Derek Wanless to produce that report; it has not come out of the blue. We will consider it very carefully and we will take many of the ideas forward in the public consultation on public health that my right honourable friend the Secretary of State announced fairly recently. We hope that that process of consultation will result in a White Paper on public health.
I did not mean to imply that we were complacent about HIV/AIDS and sexually transmitted infections. I was quibbling a little about the word "crisis", but we take the matter very seriously. I did not mean to imply that we did not. We are taking some pretty strong action in this area. I want to put that clearly on record.
Amendment No. 32 is about responding to advice, whereas Amendment No. 57 is about responding to the annual report. On Amendment No. 32, I am not sure whether Members of the Committee appreciate
There is frequent contact in very sensitive areas of the kind that we discussed earlier, of which information is not put in the public arena, with advice coming from the HPA. There are large amounts of informal advice. Frankly, the amendment would be unworkable. The other amendment is more workable but, if we are trying to use a term such as "advice" and to require the Government to respond to every piece of advice that they may get from the agency, it is not a practicable proposition to enshrine that in legislation. I ask the noble Earl to think about that.
Amendment No. 57 contains a very specific proposition—that is, to take the focus of the annual report and require a response within two months. I cannot use the same arguments I did in relation to Amendment No. 32, and even I would not try to do so.
I ask the noble Lord, Lord Fowler, to reflect on the fact that it is not standard practice to get government departments to respond to annual reports either as a standard practice or within that type of timescale. I am not in any sense trying to get the noble Lord to feel sorry for us. He would say that it was self-inflicted, but he played his part in some of that in a previous incarnation. The department now has more than 30 executive agencies, NDPBs and special health authorities, a large number of task force and ad hoc groups, and about 50 advisory NDPBs. A large number of people give us their thoughts on their work for annual reports.
We would say that the position has existed for a very long time. The reports are in the public arena. They are available to Parliament. There is a parliamentary process with parliamentary Questions, Select Committees, and debates, which hold Ministers to account on whether they have responded to those reports. Amendment No. 57 is unnecessary. It is not necessary to take the HPA annual report out of that context and have a special set of arrangements. We try to make those kind of responses fit for purpose when there is a parliamentary occasion or the public interest requires.
"(4) The appropriate authority must respond as soon as is reasonably possible to any advice that it receives from the Agency.
(5) The appropriate Authority must publish any such response unless—
(a) publication would contravene the Data Protection Act 1998 (c. 29) or an express restriction contained in any other enactment; or
(b) it considers that it is against the public interest to do so."
7.15 p.m.
"We have been appalled by the crisis in sexual health we have heard about and witnessed during our inquiry. We do not use the word 'crisis' lightly, but in this case it is appropriate".
There is also the letter from Professor Michael Adler, who, as the Committee will know, is a world expert in the area. He wrote to the Times in December:
"The Department of Health's desire to shift the balance and devolve responsibility to primary care trusts . . . means that no one takes responsibility for sexual health . . . The time has come for strong central political leadership and recognition that we are dealing with a major public health crisis".
7.30 p.m.
Lord Fowler: Perhaps I may respond further to what the Minister has said. If the Minister does not mind me saying so, basically, it is a weak argument. All he has said is that it is not standard practice in Whitehall to do so. Perhaps the answer to that is that if it was standard practice in Whitehall we might get rather better government—I do not particularly criticise just this Government. I see absolutely no point in the HPA and its skilled staff collecting information in the detail that it does and putting forward the important policy
proposals that it does, if then, somehow, the whole thing just vanishes and, as I think that my noble friend Lord Howe, said, simply gathers dust.
We do not want some bureaucratic reply. We do not want page after page of text. We want a succinct statement of government policy saying what they are going to do and how they intend to respond. That is what we want. This particular area is not really a matter of enormous party politics—at least, I hope not. What we want is some action. It seems to me that the amendment could trigger such action. Again, this is an issue to which we should return on Report.
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