HIV: Barriers to Treatment

Baroness Gould of Potternewton Excerpts

Thursday 1st December 2016 Lords Chamber

[Lord Prior of Brampton]

I thank the noble Baroness for coming to my rescue on that. It is very difficult, as she knows, because the HIV virus is complex. What is remarkable is the extraordinary advances that have been made in treating HIV over the last 20 years; that has been a real triumph of the pharmaceutical industry. I will still write to the noble Baroness, Lady Tonge, about vaccines.

[Baroness Gould of Potternewton (Lab)]

My Lords, I was not going to refer to vaccines but to something else, but a report on the radio this morning said that South Africa believes it has developed a vaccine that will prevent HIV. Maybe we could find out more about that in due course.

I wanted to ask the Minister about barriers, of which there seem to be two. My noble friend has raised one—stigma—and I got the impression that the Minister felt it was perhaps not as serious as it used to be. It is very serious; there are still many examples, particularly of women, who will not go to a clinic, thus creating a barrier, because of the stigma that is attached. The other barrier that is equally important is that local authorities that fund testing are having huge difficulty in raising the funds to do so. Maybe we should be looking at whether there is a positive way in which the Government can help with resources to local government.

[Lord Prior of Brampton]

Frankly, this is an area where government can never do enough. We should take some comfort from the fact that the level of undiagnosed HIV is consistently coming down; it is now down to 13%, and we are within touching distance of the WHO’s 90% level. So we are making progress, but I accept what the noble Baroness says. On stigma, I am sure there is much more that we can do.

HIV Diagnosis: Clinical Guidance

Baroness Gould of Potternewton Excerpts

Thursday 1st December 2016 Lords Chamber

Asked by

[Baroness Gould of Potternewton]

To ask Her Majesty’s Government, in the light of the forthcoming review of testing guidelines in 2017, what steps they are taking to ensure new national clinical guidance is adopted by the National Health Service and local authorities to reach people in the United Kingdom still living with undiagnosed HIV.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, we welcome the new HIV testing guidelines from NICE, which are particularly timely on World AIDS Day. Early diagnosis of HIV through increased testing carries huge benefits. Progress is being made and in 2015 the rate of undiagnosed HIV fell to 13% from 25% in 2010. We will keep working with partners to use the guidelines to encourage people to get tested and fight the stigma associated with HIV.

[Baroness Gould of Potternewton (Lab)]

I thank the Minister for his reply. Can he elaborate a little on the Government’s plans for promoting the guidelines to raise awareness—which I hope they will do—and monitoring the use of the guidelines to reduce the 17% rate of undiagnosed HIV and the continuing levels of HIV? The responsibility of government is absolute in making sure that the guidelines are adopted. On the same basis, can the Minister indicate what support or otherwise the Government are giving to ensuring that PrEP is made available to all those who might be at risk of HIV transmission?

[Lord Prior of Brampton]

My Lords, the undiagnosed rate of HIV is not 17%, as the noble Baroness said. That was in 2014. It is 13% now. So there is an improvement here and the trend is in the right direction. We have a whole range of programmes to try to improve the rates of testing, including self-sampling, and 1.1 million people attended GUM clinics last year. There is the HIV Prevention Innovation Fund and all the work being done by the Terrence Higgins Trust. There is a Question on PrEP later. Perhaps I could deal with it then.

[Baroness Gould of Potternewton]

My Lords, I must declare that I was on the innovation panel for Public Health England.

[Lord Black of Brentwood (Con)]

My Lords, all those living with HIV, particularly those diagnosed late, require significant levels of care for both their physical and mental health. Does my noble friend agree that specialist doctors and nurses in the NHS provide exceptional care for those living with the virus, and join me in paying particular tribute to the work of pioneering centres, such as the Ian Charleson Day Centre at London’s Royal Free Hospital, which have made a real difference to the lives of thousands of patients?

Health: HIV

Baroness Gould of Potternewton Excerpts

Monday 4th July 2016 Lords Chamber

[Lord Prior of Brampton]

It is true that in the control group used in the PROUD trial there was a very high level of success—85% or 87%, I think—but it is critical to identify the right group of people. That is why NHS England is providing £2 million to test Truvada as a prophylactic among a wider group of people to see whether it is equally efficient.

[Baroness Gould of Potternewton (Lab)]

My Lords, I declare my interests as a member of the All-Party Parliamentary Group on HIV and AIDS and as a patron of many HIV organisations. Further to the Minister’s last reply and to the fact that trials are going to take place, will he indicate what action the Government are taking to ensure that there is no gap in the provision of Truvada—PrEP—for those who are on the PROUD trial? Those people will be in great difficulty if they have to stop taking the drug. Will they be included in the trial, how are the trials going to be determined and who is going to decide how the money is going to be spent? Lastly, we think the trial will be a two-year process, so it will be 2019 before we get a decision. Will the Minister say how the decision is ultimately going to be taken?

[Lord Prior of Brampton]

I can confirm that all the people who are receiving PrEP as part of the PROUD trial will continue to receive it going forward, which I think answers the main point made by the noble Baroness. In terms of the conduct of the trials that I referred to earlier, they will largely be organised and shaped by Public Health England.

Gender-based Violence: Women with HIV

Baroness Gould of Potternewton Excerpts

Wednesday 25th November 2015 Lords Chamber

Asked by

[Baroness Gould of Potternewton]

To ask Her Majesty’s Government what action they have taken to assist women with HIV who are experiencing gender-based violence.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, sexual health and HIV services are already sensitive to the risk of domestic abuse and sexual violence, including gender-based violence, in their routine consultations. In recent years, the Government have put nearly £40 million into specialist domestic and sexual violence support services and national helplines. We have also set up 15 new female rape support centres to raise the total to 86. We have taken strong action in the fight to eradicate female genital mutilation.

[Baroness Gould of Potternewton (Lab)]

I thank the Minister for that reply but, with respect, it is not sufficient to answer the Question that I asked, which was about the relationship between HIV and sexual and gender abuse. Does the Minister not accept that the Government have a responsibility to work across the relevant departments, as others have said, to ascertain the number of women who are in this dire situation, to encourage them to seek support and help, which they so desperately need but which many are prevented from doing because of the stigma of their situation; and crucially to provide the resources, both staffing and financial, to help these women in such terrible situations?

--- Later in debate ---

[Lord Prior of Brampton]

I have not been to the Upper Waiting Hall to see the exhibition but will endeavour to do so if I have time after Questions this afternoon. The noble Baroness referred to the research done at the Homerton in 2013. I think the figure that study came up with was 52%. There has been a subsequent study but I cannot remember the name of it. It may not have been as extensive as the one done at the Homerton and put a figure slightly less than 52%—but it was still very significant. I will ask officials the status of that subsequent research to see whether we need more.

[Baroness Gould of Potternewton]

To help the Minister, it was Positively UK that did the other piece of work.

Gender-based Violence: Screening

Baroness Gould of Potternewton Excerpts

Monday 9th March 2015 Lords Chamber

Asked by

[Baroness Gould of Potternewton]

To ask Her Majesty’s Government what steps they are taking to improve screenings at healthcare settings, including HIV clinics, to screen for gender-based violence and to provide the necessary support for affected women.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

Routine inquiry of domestic abuse is in place in maternity and mental health services. It will be introduced in maternity services for FGM from April 2015 and for child sexual abuse in some targeted services next year. Accident and emergency departments in England have been sharing data on attendances involving body injuries with their local police forces to help prevent violent crime.

--- Later in debate ---

[Baroness Gould of Potternewton (Lab)]

I thank the Minister for his reply. Currently, there is professional guidance on screening, particularly for domestic violence, for health visitors, school nursing programmes and antenatal clinics. Does he not agree that such guidance should be expanded to HIV clinics, because we know that there is a correlation between women who have HIV and domestic violence, so that they can get the help and support that they need, because they have two problems to sort out for themselves?

[Earl Howe]

I do agree. Sexual health and HIV services are already sensitive to the risk of domestic violence, including gender-based violence, in their routine consultations. One of the most important elements in that is to have an environment and atmosphere that is welcoming, comfortable and calm, so that it engenders a sense of trust. Most sexual health clinics have developed local templates to identify those at risk of domestic violence, with signposting and referral to police and other support services if needed.

Health: Human Papilloma Virus

Baroness Gould of Potternewton Excerpts

Tuesday 20th January 2015 Lords Chamber

[Baroness Gould of Potternewton (Lab)]

My Lords, I, too, congratulate my noble friend Lord Patel of Bradford on securing this important and rather urgent debate. It is urgent because there are more than 100 different types of HPV being passed from one person to another, not only by sexual contact but by skin-to-skin transmission and through non-sexual routes of HIV transmission, which include vertical transmission from mother to newborn baby. As my noble friend said, HPV is very easily acquired. It is reckoned that most women and men will acquire it at some time during their lives.

This discussion on vaccination for boys takes me back to the early 2000s, when we made similar requests for HPV vaccination for girls, when I was chair of the Independent Advisory Group on Sexual Health and HIV. We need only look at the success of that campaign. It is now the norm for secondary schoolgirls aged 11 to 13 to be routinely offered the vaccination as prevention against cervical cancer. Boys were not included at the time, although our campaign argued strongly that Gardasil should be the chosen vaccine so that they could be vaccinated against genital warts. Not to include boys was a mistake, which we are now trying to rectify.

Since then, the non-vaccination of boys has been a growing issue and concern, as it has become evident that in fact it has serious public health consequences. As a result, as has been said, the BMA reports that there is a growing consensus in the UK that extending vaccination to all boys represents the only effective answer to the question of how to ensure that all are protected against HPV infection. To add to the list of organisations that we have already heard, that is also supported by Cancer Research UK and Jo’s Cervical Cancer Trust and a large number of organisations that work in the field of men’s health.

As has been said, there is increasing evidence of the association between HPV and the many types of cancer and precancerous lesions caused by HPV. A reduction of precancerous lesions would help to reduce the rate of penile and anal cancer in men, as confirmed by Cancer Research UK. As it says, 90% of anal cancer in men is related to HPV infection. A recent statement by the Royal College of Surgeons makes it clear that scientific evidence suggests that the vaccination of boys could help to prevent anal cancer and cancer of the oropharynx and tonsils. The college goes on to say that those types of cancer are increasing. Data from 2012 showed that while there were 2,483 cases of cervical cancer and decreasing, there were also many cases of oropharyngeal cancer and tonsil cancer, which is fast growing.

On getting throat cancer, the actor Michael Douglas got a great deal of publicity—as though it was something unique—when he spoke out about the link between the virus and throat cancer. That view is supported by the Throat Cancer Foundation, which also firmly believes that schoolboys should receive the HPV vaccine to protect against throat cancer. James Rae, head of the foundation, has called the disease a “ticking timebomb”, because boys are routinely exposed to a virus that can cause loss of life. Nor should we ignore in that list of cancers, as has been said, the possibility of head and neck cancers occurring because of HPV.

The importance of the vaccine Gardasil is that it is a protection against genital warts. HPV is responsible for nearly all cases of genital warts. Genital warts are not only a source of infection but can be a source of sexual shame and embarrassment. The medical treatment can be long, often requiring multiple visits for treatments from which there is, unfortunately, no absolute cure. Clinical trials in Australia have shown that the vaccine is 89% effective in preventing genital warts but less effective in those who have already been exposed to HPV. That outcome surely illustrates and identifies not only the need but also the sense of early intervention well before boys become sexually active and are potentially exposed to the virus. To roll out the vaccine to boys would also help to reduce incidence of cervical cancer in women. Equally, at the appropriate age we should also give children information about the risks and about the protection that condoms and dental dams provide. However, they will not absolutely remove transmission; the greater guarantee has to be a vaccine.

At the start of the review in 2013 the JCVI set up a sub-committee to assess whether the programme should be extended to adolescent boys, men who have sex with men or both. As has been said, the review was due to report in 2015. The JCVI concluded that men who have sex with men should be offered the HPV vaccine, and of course that is welcome. However, that will not protect the majority of men who have sex with men because, as has been said, they attend GUM clinics at a rather later age, by which time they may have had multiple sexual partners and so be at risk before they attend a sexual health clinic.

The question that has to be asked, as other noble Lords have asked, is: why the two-year delay to 2017? That delay seems to focus on the model being developed by Public Health England. Maybe the Minister can tell the House if representation has been made to Public Health England, which I spoke to this evening, so that the Government can honour their original and welcome commitment.

I will make two final points. The cost of a jab of vaccine is £45. If that is multiplied by the nearly 400,000 boys who should be vaccinated, the total cost would be around £23 million per annum. We might say that that is a lot of money, but if that figure is set alongside the cost of the treatments for the consequences of HPV, there would be savings, be it in the treatment of the various cancers or of genital warts. To take just two instances, it is estimated that the treatment for throat cancer costs the NHS £45,000 per patient. The cases are not all caused by HPV, but the number that is caused by it is growing, so there could still be substantial savings. Add to that the cost of treating genital warts of the figure we just heard—£52 million each year—and add the cost of treatment for anal and penile cancers and head and neck cancers. Put it all together and it is clear that over a period there would be savings to the NHS. Can the Minister say whether that exercise has been undertaken, so that we can show that in fact there is a financial case for implementing the vaccination of boys against the HPV virus? In addition, the fact that the HPV vaccination schedule has been reduced to two doses should mean that there is the capacity within the existing school-based programme to extend that vaccination programme to include boys.

My second and last point relates to the question of equity. Withholding a health intervention from any group at risk of easily preventable diseases is inequitable and discriminatory. Not vaccinating boys may be, as has been said, in breach of the Equality Act—I think it is—because it discriminates against boys who are at risk because of the withholding of a particular health intervention. Vaccinating girls is not sufficient; men will continue to have sexual contact with unvaccinated women, whether in this country, where according to Public Health England the critical 80% threshold for girls is not being met in many parts of the UK, or they may have sexual partners outside the UK. It might also be said that providing vaccination to gay men only discriminates against heterosexual men. Therefore, this question of discrimination should be looked at.

The human cost of HPV-related diseases has to be the primary consideration, and this is a genuine opportunity to make progress in the fight against cancer by a simple jab at a cost of £45. Lives can be saved each year if boys are given the same vaccination that protects girls from developing cancer. Other countries have been named, such as Canada, Australia and the United States, but one country has not been mentioned: South Korea, which has vaccinated boys and shown the efficiency of the vaccine. I therefore ask the Minister why we have to wait another two years for a decision, or even longer before the programme starts. The answer has to be prevention—a programme of prevention that provides for a gender-neutral vaccination strategy in schools for all 11, 12 and 13 year-old boys and girls.

Health: Lesbian, Bisexual and Trans Women

Baroness Gould of Potternewton Excerpts

Wednesday 3rd December 2014 Lords Chamber

[Baroness Gould of Potternewton (Lab)]

My Lords, I, too, thank the noble Baroness, Lady Barker, for introducing this important debate. It may have been a very short debate and there may not be many of us who have participated, but the words that we have said will be on the record, which is the most important thing. I thank also my noble friend Lord Cashman for his kind remarks and for his being able to participate with his great experience on the subject.

As we have heard, there is no question but that people in the LGBT communities are more likely to report ill health and experience unfavourable and negative responses from parts of the NHS. Like the noble Baroness, Lady Barker, I will concentrate my remarks on trans women, for they and trans people in general often require the services of medical staff in a way that lesbian and bisexual women do not. Many trans women who consider and embark on transition require medical assistance such as psychotherapy, cross-gender hormone treatment and surgery.

It might be useful to give a brief explanation of the process of medically assisted transition and of where treatment is available. Initially, the individual’s GP refers the patient to a gender identity clinic, sometimes via a local mental health service. After a minimum of a year attending the gender identity clinic, the individual may be referred for various surgical procedures. Cross-gender hormone treatment does not usually start until after the second appointment at the clinic.

There are seven specialist clinics in England dealing with adults and three providers of gender assignment surgery, which take referrals from all over the country. The question has to be whether this is enough provision to satisfy the need, for the number of people seeking such medical assistance has increased by at least 11% each year since 2004, thereby substantially increasing the demand for the few specialist services which provide care and treatment for patients with gender dysphoria.

Some 7,700 people are being treated or waiting to be treated at gender identity clinics. Such clinics are exempt from the 18-week deadline to provide treatment on the grounds that they are currently classified as mental health providers, despite a government statement in 2002 that gender dysphoria is a widely accepted medical condition and not a mental illness. However, I understand that this is now under review. Can the Minister confirm that that is the case?

There are two areas where waits can occur: the initial referral to the clinic and any subsequent referrals for surgery. The average waiting time on both lists is currently around a year, but that time is likely to increase. Extreme examples of waits are not unknown, such as that of the woman who waited eight years for her first appointment at a gender identity clinic. Long waiting times can inevitably lead to anxiety, depression and even suicide attempts, and there is little support during that time for those patients. Surveys repeatedly indicate that between 30% and 40% of trans women have attempted suicide before or during treatment, a rate which drops close to the national average after treatment, which in itself says an awful lot.

This specialist service is now the responsibility of NHS England, which inherited a mixed system from various historical commissioning processes. The new centralised commissioning body should provide a more consistent approach for the benefit of trans women, who are becoming more aware about what treatment to expect and about their human rights.

To date, NHS England has produced an interim gender dysphoria protocol to be completed next year, as well as service guidelines. A task and finish group has been created to look at key areas. The latter arose after concerns raised by Healthwatch England and local Healthwatch committees around the country about trans people’s healthcare and treatment. Specifically, Healthwatch England identified miscommunication locally about who commissions or funds the service, considerable delays in accessing services, individuals being put on waiting lists when “money has run out” and changes in timelines for treatment. There is terrible inefficiency that means that individuals fall out of the access pathway and struggle to reaccess the service. One can only imagine the despair of the trans woman faced with such a dreadful situation.

It is disconcerting that issues that have been raised over the past decade were still being discussed at a consultation only last week. The consultation heard of a lack of patient care and the reluctance of GPs to refer to clinics or take responsibility for prescribing cross-gender hormones. Wider concerns were also expressed about health professionals’ treatment of trans people. Although there are trans women who receive satisfactory treatment, many others do not. That can arise because of our GPs’ lack of knowledge. As the noble Baroness, Lady Barker, said, GPs play an enormous role in ensuring that proper treatment is provided right across the field. GPs need to be provided with more detailed information so that they can ensure gender identity services in the process to transition. Lack of understanding by GPs and their staff can cause great distress. It is difficult enough to confide feelings of gender dysphoria to a doctor without feeling fear, guilt, shame and ridicule. All too often, trans people leave a consultation feeling worthless.

As for lesbian and bisexual women, examples of humiliation abound. For example, one woman says:

“I asked for advice on a gender identity issue and the doctor told me to go away once he’d stopped laughing”.

That can continue for life, as clearly shown by the trans woman who had been a female for 15 years who went to her GP for a flu jab and was called “Mr” very loudly in reception. When she expressed concern about the lack of confidentiality, she was told that revealing her birth gender was relevant to the procedure. The mind boggles. What utter and absolute nonsense that was, as it was in the case of a woman who went to a hearing consultant. He decided that it was appropriate to question her about her trans notes on her medical file.

That is just the tip of the iceberg. There are many more examples of stigma, discrimination and ignorance. Any kind of abuse of a patient is unacceptable. It is crucial that NHS England and all the services within the NHS safeguard patients from abuse of any sort.

To find the level of discrimination, evidence was collected last year which identified a number of allegations, 98 of which were reported to the GMC. Of those, 39% related to GPs, 22% to gender specialist services and 17% to mental health services. The GMC expressed interest in pursuing 39 of those cases, but it is not clear that any action has yet been taken.

Paragraph 59 of the GMC’s Good Medical Practice guidelines states:

“You must not unfairly discriminate against patients or colleagues by allowing your personal views to affect your professional relationships or the treatment you provide or arrange”.

It is the breaches of that rule that have caused many patients to have a complete lack of trust in their clinics. Additionally, more than half the complaints related to both gender specialist services and general practice with allegations of refusal to treat or refer—also directly prohibited by the GMC’s Good Medical Practice guidance. It may be because of the complete lack of solid research that some GPs have such bad attitudes. Most are unaware of what basic monitoring they should be carrying out for trans women or how to translate those results. Also, linked to this lack of research, oestrogen and hormone-blocking treatment is not currently licensed or regulated and therefore not always prescribed, but hormone therapy is essential to maintain the health of the trans woman. Further, it means that trans people can be tied to a GP who will prescribe, and face uncertainty if they have to move their home.

There are, however, discriminatory practices within the NHS itself. There is currently no national policy on access to gender-specific screening, such as prostate screening for trans women. The NHS pledges to all patients undergoing treatment which might affect their fertility that they will have access to reproductive services such as gamete storage so that in future they can, potentially, have children via IVF but there is substantial evidence of storage clinics turning trans women away. I wait to hear from the Minister what advice he will be giving to NHS England to correct these examples of discrimination, which I am sure he agrees cannot continue.

The only way to solve these injustices is for treatment and care to be clearly patient-centred and non-proscriptive, while recognising individual preferences and circumstances. I welcome the changes in the NHS protocols which recognise this solution, but I ask the Minister to try and get some sort of speed in the timescale for full implementation.

HIV: Stigma

Baroness Gould of Potternewton Excerpts

Monday 1st December 2014 Lords Chamber

Asked by

[Baroness Gould of Potternewton]

To ask Her Majesty’s Government what plans they have to develop a campaign to address HIV stigma along the lines of the “Time to Change” campaign on mental health stigma.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, the Department of Health funds the Terrence Higgins Trust for the HIV Prevention England programme, which helps to tackle stigma by social marketing programmes and by working closely with HIV voluntary organisations. Implementation of the department’s framework for sexual health improvement, 2013, will help reduce the stigma associated with HIV and sexual health issues. Public Health England is supporting the development of the “People Living with HIV Stigma Index” in the UK.

[Baroness Gould of Potternewton (Lab)]

My Lords, maybe I shall not start by asking the question that might be asked, which is: what is the Minister’s secret? I could ask that in the name of Prince Harry, who wants to know what everybody’s secret is, in order to try to encourage people to be able to say, “Yes, I am HIV positive”. But that is not the question I am going ask the Minister.

I thank the noble Earl for his reply, and yes, there are some activities going on—activities which, I have to admit, are not extremely well funded. It seems to me that the success of the Time to Change campaign, which I am delighted by, shows that anti-stigma campaigns can be, and are, very successful. Does the Minister agree that HIV is the other health condition consistently faced with stigma and discrimination? Why has there not been proper resourcing and funding so that we can have a similar anti-stigma campaign, to ensure that there is prevention and a reduction in the number of people who have HIV?

[Earl Howe]

My Lords, there is certainly still too much stigma, although I believe opinion has moved in the right direction generally. The campaigns in the 1980s played a key part in providing information to the general public about AIDS and later HIV, but for some years it has, I think, been widely accepted that campaigns targeting groups at increased risk of HIV are more effective. That is why, for many years, my department has funded the Terrence Higgins Trust for targeted HIV prevention. HIV Prevention England, the unit set up by the Terrence Higgins Trust, is leading that, and is delivering innovative social marketing campaigns, including some mainstream advertising, on things like condom use and testing. There is also a DH-funded national programme, which has been successfully piloted with Public Health England.

NHS: Out-of-Hours Services

Baroness Gould of Potternewton Excerpts

Monday 29th July 2013 Lords Chamber

[Earl Howe]

My Lords, we are straying a little from the Question before us, but I understand the relevance of the noble Lord’s point to the urgent care pathway generally. We are obviously looking very carefully at the GP contract. I cannot tell him at the moment how far negotiations have reached, because we are only at the start of the process. However, his point about primary care services in A&E departments is well made, and many A&E departments do indeed provide that to ensure safe triage of patients on arrival.

[Baroness Gould of Potternewton]

My Lords, during the process to establish this contract, concerns were raised by many GPs and others which, we are told, were ignored. Can there be a guarantee that this time there will be absolute full concentration and discussion with the relevant bodies, with the GPs and others, who want to be assured that the new contract, whenever it comes, is going to be valid and will work? How are we going to explain this process to the public, who are going to feel very uncertain about the future of 111?

[Earl Howe]

My Lords, I can give the noble Baroness that reassurance, because we want local commissioners and doctors involved in the process to be confident in the service that they are commissioning. We did not ignore the warnings from Dr Buckman and others in the BMA. Indeed, on the strength of that we allowed a six-month extension to those providers who felt they needed it to ensure that they were confident in providing a good service. Only two providers took us up on that, which seemed to indicate that our confidence in the service was not misplaced.

Public Health England Advisory Board Membership

Baroness Gould of Potternewton Excerpts

Thursday 4th July 2013 Lords Chamber

[Earl Howe]

I do not think that women necessarily have exclusive expertise in the field of vaccination. However, I take the noble Baroness’s point. It is something that we are closely bearing in mind in the context of the forthcoming appointments that I mentioned in my Answer.

[Baroness Gould of Potternewton]

My Lords, may I follow up on the question asked by my noble friend on the Front Bench? I have two specific points. First, if the Government have a diversity policy, why was such an appointment not made in the first place? Secondly, when are the adverts that we understand will extend the board going to go out? Are they going to look specifically for more women and more ethnic minority members?

[Earl Howe]

The advertisements will go out, I understand, in September, with a view to making the appointments by the end of the year. As regards the gender balance, the noble Baroness may like to know that within Public Health England itself there are almost twice as many women and men across the workforce, and in senior roles there are more women than men. I hope noble Lords will understand that Public Health England itself has no gender bias. The key thing is that appointments are made in accordance with the published criteria on merit. It is our aspiration to have gender balance, but the criteria must be related to those issues.