Queen's Speech

Lord Fowler Excerpts

Thursday 3rd June 2010 Lords Chamber

[Lord Fowler]

My Lords, I congratulate the maiden speakers on their contributions, all of which were of a very high standard. I particularly congratulate my noble friend Lord Hill of Oareford on his speech. We worked together in the 1992 election, when we travelled the length of the land with John Major. We braved egg throwers on the south coast and a near riot in Bolton. Some people say that it was a surprise that we won that election and that there must have been a secret ingredient. Modesty prevents me from claiming too much about our effort in that campaign, but my noble friend certainly had a major impact. I say to him sincerely that it is very good to see him in this House. I also congratulate my noble friend Lord Howe on his appointment as a Minister. He did some fantastic work in opposition—no one was more effective—and it is extremely good to see him on the Front Bench.

In the time available for speeches in this debate, there is just the opportunity to leave a visiting card, but my purpose is to emphasise the vast importance of public health policy in fighting disease in this country, an issue that is dealt with in the coalition Government’s priority programme. This country used to have a proud record in this area, but our efforts in recent years have not been so distinguished. That is a vast pity because, if you can prevent disease, not only is that good for the individual but it is also self-evidently valuable for the Exchequer, which can avoid the cost of expensive treatment.

At the weekend, I was listening to Harry Evans, the legendary editor of the Sunday Times. Talking of one his campaigns, he said: “If something bad is preventable, why not prevent it?”. That is not a bad lesson. Let me give just two examples of disease and death that can be prevented. The worldwide toll for HIV/AIDS and for hepatitis B and hepatitis C runs into hundreds of thousands, if not several million. Just in case anyone should believe that this affects exclusively countries overseas, let me give some figures. In the United Kingdom, the number of people living with HIV will soon go through the 100,000 mark. There are somewhere between 250,000 and 460,000 people living with hepatitis C, while the latest estimate is that 326,000 people are living with hepatitis B in the UK. The result, in the case of hepatitis, is that increasing numbers of people are dying from liver cancer and end-stage liver disease as a result of viruses that can be prevented or treated. That is the tragedy.

Unhappily, the crucial link between all these conditions is that they are often undiagnosed. People do not know or find out after the damage has been done. The majority of people affected by hepatitis B are undiagnosed, while half those with HIV are diagnosed late, which means that that they do not get the treatment when it is ideally needed. This also means that the infection can be passed on by people unaware of what they are doing. Taken together, this represents a major public health issue.

In this respect, the position has changed radically since I was doing the health job at the end of the 1980s. For example, HIV need not now be a death sentence—we now have antiretroviral drugs that will preserve life—and the same goes for the other two viruses. It seems to me that the chief priority now must be testing, so that knowledge can lead to action. Self-evidently it is in the interests of the individual concerned to have access to treatment and it is in the interest of public health generally that disease is not spread.

We need to adopt a frank and open policy in warning the public and advising them of the position. We should not be too nervous about putting over a public message. In 1986 and 1987, we tried an entirely open approach with our “Don’t Die of Ignorance” campaign. I do not say that there were not concerns about that public education campaign, which involved advertising on television and posters. I remember a reservation from a very influential figure—none less than the Prime Minister herself. In March 1986, I was sent a minute that said:

“The Prime Minister has emphasised that she still remains against certain parts of the advertisement. She thinks that the anxiety on the part of parents and many teenagers, who would never be in danger from AIDS, would exceed the good which the advertisement might do”.

My private secretary was told:

“Your Secretary of State will now wish to consider how to proceed in the light of the Prime Minster’s firmly held views”.

I think that one can hear the authentic voice of No. 10 coming through. In the event, we went on with the campaign. We formed a special Cabinet committee to oversee it and the result was that we had very few complaints from the public. That is the significant point. The public are sensible and mature on issues of this kind. If they think that there are good public health reasons for a campaign, they will support it.

That is important when considering the issue of migration into this country from countries where, for example, the incidence of hepatitis B may be greater than it is here. I am talking about migration not just from Africa but from Asia and eastern Europe. A group of consultants wrote to the Times at the end of last month proposing the screening of people coming here from high-risk countries. That is an altogether sensible point.

Lastly, there is one other important step that we can take. For hepatitis B, there is a vaccine; it can be prevented. If only that was the case for HIV/AIDS there would be rejoicing throughout the world. Most other countries in the European Union have a policy of 100 per cent vaccination against hepatitis B. We do not. We follow a policy of vaccination of selected groups, which self-evidently is not working. In 2002, the previous Government published a paper entitled Getting Ahead of the Curve. Unfortunately, that did not happen. By 2010, the incidence of hepatitis B has not reduced; it has almost doubled.

There is a challenge here for the new coalition Government, who now have the ability to put some of these things right. It is an opportunity that we should take because a strong policy on public health is capable of delivering immense benefits to this country.