Tuberculosis

Lord Hunt of Kings Heath Excerpts

Thursday 11th December 2014 Grand Committee

[Lord Hunt of Kings Heath (Lab)]

My Lords, I, too, congratulate the noble Baroness, Lady Suttie, on securing the debate and on her comments. I associate myself with her remarks about praising the work of the all-party group on TB, which does excellent work. I am grateful to it for a specific briefing on issues in Birmingham, which I am particularly interested in. We have always had excellent briefs from Public Health England and the Local Government Association and it is credible that so many experts are now thinking about how we are going to address what are clearly very important problems.

Like the noble Baroness, I thought that TB had been virtually eradicated. It clearly has not been and we need to do something about it. Noble Lords have mentioned that the UK has one of the highest incidences in western Europe but if your Lordships look at the local authorities most affected, including my own Birmingham, there is a strong correlation between TB and general poor health. For instance, if you look at the list of the 20 local authorities with the highest rates of TB per 100,000 population, which I think gives a safer comparator, many of them have other very real health issues as well.

I say to the noble Baroness, Lady Jolly, that there is also an uncanny correlation between that list and the local authorities that have been affected worst by the funding formula switch. I ask her to reflect on this. It is rather ironic that if you read down this list of local authorities, which includes Manchester, Birmingham, Southwark and Hackney, many of them have taken huge hits in the changes to the local government funding formula. I know that some of this resource will obviously come from the Department of Health and that it has been ring-fenced, although health experts tell me they think that not all the money has actually reached public health. We can begin to see why; because of the squeeze on other resources in local government. The substantive point I put to the noble Baroness is given that, how can we ensure that the public health resources being allocated to local authorities are going to be spent on important issues such as TB?

The LGA and PHE produced a report called Tackling Tuberculosis—Local Government’s Public Health Role. It is an excellent piece of work and I endorse the fact that it should be the local authority that leads this work. The report has a lot of very good recommendations, such as that the scrutiny work of local government could address TB issues. There are also substantive recommendations, such as driving improvement through the overview and scrutiny committees and health and well-being boards. The report then says that:

“Local health service commissioners should prioritise the delivery of appropriate clinical and public health services for TB”,

and that local leadership should be promoted at all levels, with a senior co-ordinator being appointed,

“perhaps from the public health team”,

to take responsibility for TB. It recommends that local authorities:

“Encourage and empower the voice of people affected by TB”.

and use,

“‘TB cohort review’ and other methods to collect data to inform local needs assessment”.

It also says that they should:

“Facilitate appropriate access to information and services for underserved populations, such as homeless populations … Assist with supporting an individual’s social needs … Review how third sector organisations can help improve access to services and patient support”,

and,

“Ensure information about TB is cascaded into key teams—for example Children’s Services, Adult Services, Housing and Benefits, Citizen’s Advice”.

These are great recommendations.

At the heart of this is a recognition that if we are going to tackle TB effectively—to pick up the point the noble Baroness, Lady Ludford, made about London—you have to have one plan, an integrated programme and one body accountable for delivering it. Can the noble Baroness, Lady Jolly, see a way through to getting that single point of accountability through the local authority where it is absolutely clear who is responsible for reducing TB rates in the area?

This is very relevant to Birmingham. Unlike London, we have only one local authority, so it ought to be easier to get that kind of integration. None the less, we have three clinical commissioning groups, at least three NHS acute trusts which collectively provide a lot of clinical and preventive services, many GP practices and, because education plays such an important role in this, a lot of schools, academies and free schools as well as the local education authority. It is clear—the all-party group has also commented on this—that although the director of public health is taking this very seriously and giving leadership, at the moment it has not been pulled together into one plan with a commitment from everyone to sign up to it. That is really what is missing. There is a lot of good work with lots of outreach programmes. Working with sex workers in the city is one example. TB professionals have also conducted screening and health education in English as a second or other language, and through this route they have screened high numbers of people quickly and raised awareness of the disease among high-risk populations. So lots of good work is being done, but it does not quite hang together at the moment.

I want to put two other questions to the noble Baroness, Lady Jolly. The noble Baroness, Lady Suttie, mentioned the report published this morning on dealing with antimicrobial resistance. Of course, this is very relevant to TB. I have just glimpsed the report. Can the Minister say a little bit about any steps that the department is now going to take to find new treatments to tackle multidrug-resistant TB? Finally, the Collaborative Tuberculosis Strategy for England 2014 to 2019 was launched in March at a meeting organised by the all-party group. The strategy aims to learn from successful TB programmes internationally and adapt the learning to our specific circumstances in the UK. Will she give noble Lords a report on progress with the strategy and how she thinks it will be implemented?