Health and Social Care Bill

Baroness Randerson Excerpts

Wednesday 16th November 2011 Lords Chamber

[Baroness Masham of Ilton]

My Lords, these amendments relating to campaigns are very important. My question is: who will be carrying them out? I would like to highlight the problems of late diagnosis of HIV/AIDS, tuberculosis, hepatitis B and C, and meningitis.

Many people are living with HIV/AIDS who do not know that they are infected. There needs to be sensitive targeting of campaigns. If diagnosis is late, the condition is much more difficult and expensive to treat, as has been said. There are often co-infections of HIV/AIDS and tuberculosis. Late diagnosis in TB is very dangerous. Along with the growing problem of drug-resistant TB, there is extensively drug-resistant tuberculosis, which is very dangerous and much more expensive to treat and takes much longer.

I would like to mention the effective and important work of the group Find & Treat, which goes out to find homeless and other people who are difficult to find, who may have TB, and test them. The group now wants to test for co-infections, which would be much more effective and less expensive in the long run. This type of infection is on the increase. There is a fear that, unless local authorities and the National Health Service work together, there may be fragmentation, and these people, who should be treated early, may fall through the net. Find & Treat needs all the support that it can get to carry on this very important work.

Hepatitis B is very infectious, but there is now a vaccination, which is good. However, there is no vaccination for hepatitis C. Both types of hepatitis have been found to be a huge problem in prisons. There is a problem of liver disease with hepatitis C. Early diagnosis is important for all infections. In the case of meningitis, there have been far too many tragedies because of late diagnosis. The public—and doctors—need to be reminded continually how important this issue is by means of campaigns and guidelines. My GP always waits for guidelines from the Department of Health.

[Baroness Randerson]

My Lords, I speak in support of these amendments tabled by my noble friend. I strongly welcome the provisions in this Bill that ensure that the NHS and local governments work together on public health. I believe that these provisions are long overdue. However, as my noble friend said, we need to ensure that central responsibility and control is retained to be able to have high-profile, national public health campaigns.

I am the co-chair of the All-Party Parliamentary Group on Hepatology and I participate today from that perspective. I wish to speak especially about hepatitis C. In the summer, the group produced a report emphasising the points that I am making about the importance of national public health campaigns. The current proposals will affect those suffering from this disease and will improve the response at a local level. However, they will also ensure that we need a national response. Hepatitis C is a preventable and curable cancer-causing, blood-borne virus. The main groups affected are intravenous drug users, or those who have been, and certain ethnic groups from south Asia who were also badly affected because, very tragically, they were immunised in childhood during mass immunisation campaigns using dirty needles.

As has been said, a stigma is attached to hepatitis C, as it is to HIV/AIDS. As a result of that stigma, it has largely been ignored by government ever since it was first identified in the late 1980s. Deaths from the disease are rising; mortality has risen by between 39 and 45 per cent since 2005 and the number estimated to be affected is between 250,000 and 466,000. I say “estimated” because the majority of those affected are undiagnosed. That is the key point in relation to public health campaigns.

The picture in Britain is not the same as the picture in most of the rest of Europe. Elsewhere deaths from the disease are falling because there have been high-profile public campaigns and strategies to deal with the disease. As a result, diagnosis has been very much earlier. I said that the majority of people suffering from the disease are undiagnosed, but why is that? They are undiagnosed because it is a tricky disease. It remains asymptomatic for 10, 20 or even 30 years, and by the time the symptoms occur it may be too late for a cure. It is certainly very possible that any attempts at treatment are very complex and expensive. That outcome can be a result of the stigma, but it can also be a result of ignorance because we have had no big public health campaigns. There is ignorance on the part of clinicians and the public. Delayed diagnosis costs not just lives but a great deal of money. There is a range of clinically effective and cost-effective treatments for the disease that can cure and that are recommended by NICE, and more and better treatments, due to go to NICE in the near future, are in the pipeline.

That is the background. As I see it, that is how the Bill will help, but it needs to be improved in order to help even more. The local government NHS LINk will enable local public health campaigns to focus on local needs. Given the list of at-risk groups that I have described, it is obvious that an area with a high population of those from south Asia, for example, will be enabled to target their health messages appropriately. An area that is aware that it has a particular problem with drug use will do the same. Of course, many people will be affected by the disease who do not live in those target areas, and they need to be screened and treated in the same way, so local campaigns need to supplement and bolster national information campaigns, not replace them.

We have already heard from my noble friend reference to the dementia campaign that is currently being run, and there has been reference to the AIDS campaign. I would say very strongly to the Minister that we need a hepatitis C campaign of similar impact. Without the proposals in these amendments, I believe that there might not be sufficient obligation on the Government to co-ordinate these campaigns. I very much look forward to Minister’s response on this issue.

My final point is that successful national and local campaigns will inevitably have a knock-on effect on commissioning services. More patients will be diagnosed, and that will mean more needing treatment. In the long term, of course, there will be a fall-off in the demand for treatment because of higher public awareness and, one hopes, very much safer behaviour as a result. That fall-off will take years, however, and it is essential that GP services, hospitals services and, for example, drug and alcohol action teams all have the increased capacity brought into line at the same time as such campaigns take place. It is therefore even more important that there is the central control and direction to which I referred. That is just one example; other noble Lords have given similar examples, and I urge the Minister to give this serious consideration.