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Baroness Thornton: My Lords, I should have guessed that the noble Baroness might ask a question that was not covered in my brief. I will have to get back to her about this. I know that that activity is taking place; we are developing the countrys first national end-of-life care strategy for adults, the delivery of which is about increased choice for all adult patients to cover all
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Earl Howe: My Lords, the noble Baroness may know that a national survey of direct payments published last year revealed that mental health service users have the greatest difficulty of all users in accessing direct payments, and that the statutory requirement to offer direct payments to this group has made no substantial difference to the level of provision. Will the Next Stage review look at ways of improving access to direct payments for that group of patients?
Baroness Thornton: My Lords, the Governments aim is to give people with particular long-term conditions control over their treatment, as I have said. Access to direct payments should be available to all people eligible to receive them. Indeed, as the noble Earl may well be aware, there is a proposal under the Health and Social Care Bill to extend direct payments provisions to people who have those sorts of difficulties and disabilities.
Baroness Gardner of Parkes: My Lords, I turn to the part of the Question referring to carers. Some people have had long-term carers. It is claimed the great majority of the terminally ill would like to die at home. At the very end, they do not necessarily need a great deal of intensive nursing, but their carers are terribly important to them. Would not direct payments help to ensure continuity with these same carers?
Lord Patel: My Lords, accepting that the prediction of prognosis is difficult, does the Minister agree that the DS1500 fast-track for attendance allowance should be instigated early enough for patients to get the care that they feel they need?
Baroness Thornton: My Lords, Panton-Valentine leukocidinPVLinfections are not a specific problem for playgrounds or parks. This is an uncommon infection that has been known about for many years. Like other infections, PVL is controlled by good infection control. However, these infections can be very serious. Health Protection Agency guidance on management of PVL, available since 2006, is currently being updated and new guidance from expert groups in diagnosis and treatment was published in March.
Baroness Gardner of Parkes: My Lords, I thank the Minister for that reply, but the extensive press coverage on this over the past week indicates that the cases have arisen from playgrounds. There has been so much coverage, including on television, that many parents are anxious about the situation. Can the Minister tell us what information the department has, and what it thinks should be done to allay these anxieties and explain what should be done to protect children?
Baroness Thornton: My Lords, I know that noble Lords may have read about PVL infections in the past few days. However, as I repeat, it is not a new condition; in fact, it was first described in the 1930s. The risk to the general public of becoming infected with PVL is small. Our advice to parents is always to maintain the good practice of appropriate hygiene measures, including proper cleansing and disinfection of cuts and minor wounds. Wounds should be covered with a dressing until healed and individuals should avoid contact with other peoples bandages and lesions. However, parents should not stop their children from going out to play. If the infection spreads or recurs, go to your GP or to an accident and emergency department for further investigation or treatment. The chances of contracting all types of these infections are reduced by maintaining good hand hygiene and not sharing personal items.
Baroness Tonge: My Lords, in view of the recent hysterical response of the press in the run-up to the local elections, I am rather surprised that the Government have not announced that in the next few weeks there will be a deep-clean of all school playgrounds. Perhaps they are more sensible. The pharmaceutical companies are reluctant to invest in research in new antibiotics because the return is badantibiotic treatments are very short term. What incentives are being given to pharmaceutical companies to develop new antibiotics for these dangerous, resistant strains of bacteria?
Baroness Thornton: My Lords, that is slightly wide of this Question. I have received no information that pharmaceutical companies are reluctant to continue their excellent research and development work. Indeed, the range of antibiotics available for a whole range of infections increases by the day.
Baroness Finlay of Llandaff:My Lords, does not the Minister recognise that we all have a wide range of organisms on our skin? Indeed, 50 per cent of the populationthat includes your Lordships Househave candida on them. These bugs become a problem only when the immune system is compromised and when there has been antibiotic overuse, because they become more virulent.
Do the Government recognise that we need to be encouraging children to be exposed to social interaction for their development and because it seems to have a protective effect against developing childhood leukaemia and may even have some protective effect against allergies and so on in the long term?
Baroness Thornton: My Lords, the noble Baroness is absolutely correct. In fact, the doctors who were briefing me on this Question said that I could share with your Lordships' House the fact that 30 per cent of you will have the bacteria that creates this condition.
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Lord Soley: My Lords, does the Minister accept that the most important message that should go out from this House on this issue has already been alluded to: it is to the media not to create a crisis out of a fairly normal affair that occasionally ends in a tragedy? Some reports in the media lead one to believe that they really want to put children in a totally fumigated room and throw away the key, whereas most of us are prepared to take the risks that inevitably arise in life and let children have a normal life.
Baroness Knight of Collingtree: My Lords, is it not the case that there is some doubt about precisely how the problem arises? Some children have contracted it from falling down and grazing or cutting themselves, whereas one 23 year-old lady contracted it with no knowledgeable links, as she had not fallen down. Does that not indicate that we need to have a little more research into this, and is such research going on?
Baroness Thornton: My Lords, the noble Baroness is quite correct. This is not a new condition, but little is known about its origin and the spread of these particular strains. Infections are rare and most can be treated by antibiotics. Indeed, PVL infections occur in patients who have no previous history of direct or indirect healthcare contact. Research is being undertaken, and I will write to the noble Baroness detailing that.
Baroness Masham of Ilton: My Lords, is the Minister aware that on 8 February 2007, I asked a Question on this subject? Is she also aware that it affects not only children, but also the military, people in colleges and people living together in close contact? Is it not the case that it may be being misdiagnosed as leukaemia or pneumonia? The white cells just pack up. Is it not time for statutory reporting?
Baroness Thornton: My Lords, in response to this question and that asked by the noble Baroness, Lady Knight, we are funding a project through the HPA to look at the prevalence of community-associated PVL infections, which are the ones that have been in the news recently. The HPA is looking at technical developments in testing. However, I return to my original Answer which is that a lot of this is to do with hygiene, cleanliness, not touching things we should not touch and issues of that sort which feed into people living in close proximity to each other.
Baroness Walmsley: My Lords, does the Minister agree that a childs best protection from these infections is a strong immune system and vigorous good health, and that those come from a healthy diet, plenty of exercise and plenty of sleep?
The noble Earl said: My Lords, I warmly thank our Convenor and my fellow Cross-Bench Peers for giving me this opportunity to address the issue of the millennium development goals. I also welcome the Minister and, as a former staff and board member of Christian Aid and former trustee of Anti-Slavery, I congratulate DfID on its inclusiveness. Many of its staff now come from the voluntary sector and its more recent policies owe a great deal to NGOs and civil society. These policies place the UK firmly in the avant-garde of international development. A French madrigal reminds us that May is a good month to open the window and think positively, even daringly. Today is May Day and this debate is about world poverty. This is the year of action on the millennium development goals.
I shall avoid the overused word crisis, but the background in poor countries in 2008 is rising prices, the old inequalities of gender, caste and class, and the ravages of conflict. Any poverty or debt reduction today is being cancelled by the effects of steeply rising food and energy prices. While the number of poor remains at about 800 million, the number of extreme poor is still rising and is close to 300 million. The number of malnourished children is set to rise in 32 countries. Some statistics are quite startling. Two million children die on their first day of life and four people die of TB every minute. I do not have to persuade noble Lords that poverty is a scourge much greater than terrorism or even natural disaster. It is an insidious and avoidable waste of human life, and for millions it is intolerable. Yet we go on tolerating it as inevitable. It was for that reason, and to mark the start of a new millennium, that world leaders decided to establish the MDGs, only to realise that they had set targets that they could not possibly reach.
We are now more than halfway to 2015 and it is clear that, although there are gains in health and education, especially in Asia, we are missing most of those goals altogether in the countries where they matter most: in the poorest, least developed, landlocked and conflict-ridden countries. That is confirmed by all the UN websites and the highly respected Countdown initiative.
The MDGs have accelerated the rate of aid giving, and perhaps the level of awareness, but I suspect that they have also become a vast propaganda weapon, a means by which donor Governments can claim almost systematically that they are doing far more than they possibly can. In Davos, the Prime Minister accepted failure. He said that the only means of attaining the MDGs now is through an emergency response, and we know that that will not happen. But I welcome his commitment and his current efforts to engage the private sector in this Herculean task.
I will concentrate on the health MDGs, MDGs 4, 5 and 6, today, because so much preventable ill health lies at the root of poverty. Men and women cannot
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MDG 4 is to reduce child mortality. Here the results are generally quite positive. Under-five mortality rates on average fell from 185 to 166 per thousand live births between 1999 and 2005, but the target is two-thirds. Measles cases and deaths on the Asian subcontinent fell by nearly 75 per cent between 1999 and 2005, but there are 50 per cent more infant deaths in conflict countries than in peaceful ones. Save the Children recently published a telling wealth and survival index showing which countries could do much better.
MDG 5 is to reduce maternal mortality. DfID admits that that target is way off track. The odds that a sub-Saharan African woman will die from complications in pregnancy or childbirth in her life are one in 16, compared to one in 3,800 in the developed world. The global target is to reduce that ratio by three-quarters. Many more women who survive suffer disability and serious illness.
In Afghanistan, I am glad to say that the number of women receiving antenatal care or skilled assistance through childbirth has increased more than threefold since 2002, but such support is available only to one woman in five. Maternal mortality rates there remain among the highest in the world. We must do more about training. Can the Government explain why they are not placing more emphasis on the upgrading of traditional birth attendants in the poorest countries? I was disappointed in the Minister's answer earlier this year that TBA training has little demonstrable impact on reducing maternal death. I shall return to that later.
MDG 6 is to reverse HIV/AIDS, malaria, TB and other diseases. Prevalence rates of AIDS have levelled off, but new cases have grown, and there is a high level of new TB cases in sub-Saharan Africa. We all know that malaria is defying drugs, but out of 9 million new TB cases annually, only half a million are now multi-drug resistant. The Government have made a long-term commitment to the global fund against AIDS, TB and malaria and claim to be active in 132 countries with the aim of halving TB by 2015. Vulnerable groups, such as HIV/AIDS patients, are much more susceptible to TB. In Africa, one in three living with HIV/AIDS is dying of TB.
Here I briefly mention mental health, which is a gap in international health policy. According to the health charity BasicNeeds, neuropsychiatric disorder alone accounts for 14 per cent of all death and disability in the world. There is evidence that mental illness is a factor contributing to poverty, and this has not been adequately addressed through the MDGs. The noble Lord, Lord Joffe, will say more about that. Studies carried out in south Asia showed that children of depressed mothers were four times more likely to be underweight. Depression among mothers also increases their vulnerability to sexual abuse, which in turn exposes them to HIV/AIDS.
There is, paradoxically, a risk that if we throw money at individual MDGs, we may ignore the wider picture. Bold new initiatives to deal with major life-threatening disease or to meet a particular target can
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One answer is to work more through NGOs, but more important is the way in which governments engage with one another and the partnerships that can be forged between richer and poorer countries. My noble friend Lord Crisp will, I am sure, refer to his former departments latest response to his ground-breaking report last year. This signals a new relationship between our own government departments and the developing world. The International Health Partnership, which was launched last September, already places more emphasis on better links from within our own health services.
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