Health: HIV

Lord Scriven Excerpts

Monday 5th September 2016 Lords Chamber

[Lord Scriven (LD)]

My Lords, I start by thanking the noble Lord, Lord Black of Brentwood, for this timely and important debate. I personally believe that the good work that has happened with HIV prevention and treatment in the UK is now at a crossroads because of public policy. That may not be intentional, but we are at a crossroads. It is going to need political leadership—not the courts—to deal with the increasing number of HIV infections happening in the UK. I shall come back to that in a moment.

It is very nice to see our new Lord Speaker, the noble Lord, Lord Fowler, in his place. His voice has been not just important but critical in the fight against HIV, not just in the UK but across the world, and many thousands and millions of people owe him personal gratitude for the work that he has done.

I am not going to concentrate significantly on the key issues already raised about education, access to testing, treatment and stigma—although I shall come back to the point about stigma. I will major on one issue—that of PrEP, a treatment to stop the replication and transmission of HIV within the UK. It is a treatment widely available in France, the United States, Israel and Kenya, and other countries are using it. It is a treatment that Public Health England modelled: if PrEP were widely available to high-risk groups, particularly men who have sex with men, it could prevent 7,400 cases by 2020.

Noble Lords have already referred to the PROUD study, which showed that the treatment is 86% effective in preventing HIV transmission, and also to the cost. The noble Lord, Lord Black of Brentwood, made it very clear that the lifetime cost of treating somebody with HIV is up to £380,000; the cost of PrEP is £400 a month. That is the equivalent of 83 years’ worth of PrEP to treat one person living with HIV. The economics are not questionable in terms of the costs of PrEP.

So how have we got to the position whereby two parts of government are slugging it out in court over who is going to pay for this preventive treatment? Interestingly, as I am sure the Minister is aware, both parts of government are funded by the Department of Health. Local government’s prevention is funded by the Department of Health, as is NHS England. In July, I asked House of Lords Question 1425—what stops the Secretary of State intervening and asking the Department of Health to commission PrEP? I got a very nice Answer about NICE, but I did not get the answer to my Question. So I will ask the Minister: what legislation stops the Secretary of State tonight telling NHS England that it can commission PrEP? What law stops that? The advice given to NHS England made it very clear that that could actually happen, so I am interested to know why it does not happen, particularly when the NHS national plan puts prevention at the heart of future health care. The whole argument about why NHS England cannot provide PrEP is that it is a prevention measure. If the whole NHS five-year plan is about prevention, why cannot the NHS step up to do this?

There is a lack of political leadership on this issue. It is not a lack of managerial leadership, although there may be with NHS England. There is a lack of direction from the centre to say that PrEP is so important, as the studies have shown, that it should be commissioned by NHS England. I declare an interest in that my partner works for NHS England in specialised commissioning. The work does not have anything to do with this area, but it is an interest that needs to be on the record.

Political leadership is needed because NHS England is taking a particularly aggressive and nasty approach on PrEP and in the arguments for why it cannot be used. A statement by Dr Jonathan Fielden on 2 August, on the day of the judgment—he is the deputy medical director of NHS England and the director of specialised commissioning—was at best unfortunate and at worst showed institutionalised homophobic language by NHS England. I do not use those words simply for effect. I shall read out what the statement said, because it was highly emotive and highly charged and used language that I do not think is worthy of a senior doctor of this country. He said that PrEP is,

“to prevent HIV transmission, particularly for men who have high risk condomless sex with multiple male partners”.

He went on to compare it with not being able to afford treatment for children with cystic fibrosis or children who do not have limbs.

That is clearly an attempt to put it into the public mind that there are deserving and non-deserving people with regard to specialised commissioning, which is not the kind of approach or language we would expect from our National Health Service. As a number of noble Lords have said, it creates a stigma. It is not acceptable for a senior doctor in the commissioning part of one of our national treasures—the National Health Service—to use that kind of language about deserving or non-deserving people. Does the Minister agree with the sentiment or tone of that press release? If not, will he say exactly why he disagrees with what the deputy medical director of NHS England said?

Finally, I will turn to the pharmaceutical company manufacturing the drug Truvada, which is the PrEP drug of choice in the UK. It is clearly about to come off patent, so what discussions have the Government had to reduce the cost? One issue is to do with cost—that NHS England or local government cannot afford the drug. As someone who has been a council leader and is still a councillor, on the issue of local authorities buying the drug, I can go to any sexual health clinic in the country and be anonymous and get PrEP as a preventive measure. If it was down to one local authority to give way on this, everyone would go there, but if it is a national preventive service that we are trying to provide, only one organisation can provide it—the National Health Service. That is why it is important that NHS England is asked to look more seriously and urgently at providing PrEP as part of its National Health Service provision.

I hope that the Government will discuss these matters with the pharmaceutical industry, and in particular with the company promoting the drug, to reduce costs. That way, even if it were to go through NICE, the cost-effectiveness question would be unanswerable.

NHS England: Pre-exposure Prophylaxis for People at Risk of HIV

Lord Scriven Excerpts

Tuesday 7th June 2016 Lords Chamber

[Lord Prior of Brampton]

I would be very happy to meet with the noble Lord. It may be better for him to meet with my honourable friend in the other place who is responsible for public health, but either one of us will be very happy to meet with him.

[Lord Scriven (LD)]

My Lords, the UK now has the worst HIV epidemic of any large western European country, having overtaken Spain, France and Portugal, and every day, seven men who have sex with men are diagnosed with HIV. In the light of the legal argument and of what the noble Baroness said, the Secretary of State, under the legal advice that was given to NHS England, has the power under Section 7A to delegate who gives these PrEP pills. Could the Minister please ask the Secretary of State to do that until the legal issue is resolved, so that lives are saved, rather than our arguing about who funds this and who has the legal ability to do it?

[Lord Prior of Brampton]

I am not briefed on Section 7A and am not sure what the powers of the Secretary of State are. After this debate, I will research that and find out what powers he has.

Standardised Packaging of Tobacco Products Regulations 2015

Lord Scriven Excerpts

Monday 16th March 2015 Lords Chamber

[The Lord Bishop of Peterborough]

My Lords, I, too, was not planning to speak, but I am most grateful to the Minister for bringing this measure before us. I will make a very simple point. Packaging is designed to make the contents of the package attractive. This is about changing culture and changing the way that people think about tobacco and smoking. We all know the health arguments—they are indisputable and very clear. However, many young people, in particular, are still led astray and into dangerous behaviour—into self-harming of a very subtle but difficult sort.

It is our duty and responsibility in this place to care for what we in the church call the “common good”—to care for the well-being of society and, not least, of young people. It is very clear that making something look attractive will make it more appealing. Making it look, through its packaging, less attractive makes it less appealing. It is the simplest of all arguments. If people are allowed to dress up poison to look good, some people will take that poison. I ask noble Lords to please support this measure and oppose the amendment for the good of our young people and our society.

[Lord Scriven (LD)]

My Lords, I thank the Minister for putting before us these proposals to try to protect public health. I declare an interest—not that I am part of any cigar club, not that I have shares in any tobacco company and not that I have been wined and dined by a tobacco company. In the last few years, I have seen both my parents die through being long-term smokers, and I have seen the effect that that has had on families. Towards the end of my parents’ lives, when we were talking about their addiction to smoking, they explained that they were attracted to smoking when they were young. Once smokers are addicted, it is very hard indeed to get off the drug.

I want to follow the noble Baroness and the right reverend Prelate by spending a few minutes talking about why I think tobacco companies spend billions of pounds on marketing and packaging. It has become the fifth “P” in the marketing mix. For these companies, it is no longer just about price, promotion, product and placement; now, the package is the most important part in targeting young people. Research by RW Pollay shows that only 10% of people per annum change cigarette or tobacco brands.

On the history of packaging, the law suits, emails, memoranda and notes passed between Philip Morris and its marketing agency make it very clear that the company carries out research through focus groups on the colour, shape and design of its packaging, particularly for young people. Why does it do that? It does so because, if it can attract young people between the ages of 16 and 20—these are not my words but those of the tobacco industry—there is a high probability that the young people will not only start smoking but stay with the brand. That is what packaging is about: it is about addicting the young and keeping them with the brand; it is not about moving market share between brands.

Maybe my language is a bit harsh, but the packaging of cigarettes is about the marketing of death. Out of every two long-term smokers, one will die of smoking-related illness. I do not make that comment for effect or for headlines—the statistics show it to be the case. The evidence from Wakefield and Morley, who carried out research in Australia in the early 2000s, long before standardised packaging came in there, made it very clear that companies do a couple of things to try to ensure that people take up their brands. Companies can no longer advertise on TV, can no longer sponsor sport et cetera and can no longer have big billboards, so they look at the shape of their packaging. They experiment with colour—the lighter the colour, the more it is perceived that that brand is somehow safer, of milder tar. They use colour and shape for young people. They talk about the masculinity of colour and of shape. They go for women and say that certain colours and shapes can actually attract women.

Let us be very clear what this is about. This is not about waiting for evidence from Australia: there has been evidence since the 1950s, when Philip Morris used to spend $150,000—equivalent to $1 million today—on the shape and colour of its packaging to get people to take its product at a young age and to addict them for as long as possible. That is why I welcome what the Government and the Minister are doing.

We have been on a journey to try to deal with the harm. In answer to the noble Viscount, Lord Falkland, the reason that, as a former leader of Sheffield City Council, I would not have accepted this kind of approach for restaurants and licensing is because with this product, which is addictive, there is also a harm principle—harm not just to the individual concerned but to others in families and to others around people who smoke. The role of government is to balance that harm principle. I would never do that for people making a choice over a restaurant, but there is a difference with cigarettes and tobacco.

I conclude by saying that I sat with both my parents as they died. I have seen others who tried to get off this addictive drug, and have seen and read about the tactics of the tobacco industry. I understand that the small thing called a packet is now so powerful in getting people on to this drug that it is important that, as a Government and as legislators of this country, we do all we can to prevent those young children from starting on that journey of the marketing of death. It is for that reason that this is not just a sensible step but an essential one to save lives. We need to make sure that people do not use marketing to addict people to something that is both dangerous and effectively means that one out of every two smokers will die in the long run.

[Lord Walton of Detchant (CB)]

As a small boy in a mining village in County Durham, where my father was a schoolteacher, I was introduced to Woodbines at the age of 11 and started to smoke intermittently but frequently. When I went to medical school, I am horrified to tell your Lordships that we were advised by our teachers to smoke in the dissecting room to remove the smell of the carcasses which we were dissecting. The professor of physiology said that he could not live without smoking and that we were therefore fully entitled to smoke all the way through his lectures. Practically every medical student in those days did.

After graduation, when I eventually became second in command of a hospital ship sailing through the Mediterranean to Palestine and various other places, I could buy a 50-can of Senior Service cigarettes for one shilling and eight pence and that can would last me two days—25 a day I was smoking. None of us at that time knew the dangers of smoking. When I came back out of the Army and started to work in a hospital in Newcastle and then in the National Health Service, slowly but surely the work of Richard Doll and his colleagues on the desperate effects of smoking began to emerge. Eventually, thank goodness, I had the strength to give up smoking—with difficulty—in my late 30s. It was a struggle but I made that sensible decision and thank goodness I did; otherwise, I probably would not be here now.

Smoking tobacco is one of the most appalling health hazards of the age—there is no question at all about that. Not only does it cause cancer of the lung and of other organs such as the bowel and bladder, it has a very powerful effect on the cardiovascular system in causing coronary artery disease and stroke; it also has a desperate effect on the respiratory system in causing chronic obstructive pulmonary disease. It has a devastating effect on all kinds of illness. For that reason, I have been delighted to participate in debates in your Lordships’ House over the years leading to bans on advertising and on smoking in public places— bans that have all been introduced by Parliament in good sense. Any effort of any kind that can prevent young people taking up this appalling habit is well worth while.

I say to the noble Lord, Lord Naseby, that my friend Sir Cyril Chantler is not a master of the kind of market research that he talked about but he is an expert in epidemiology and in statistics, and his research clearly demonstrated that standardised packaging is,

“likely to lead to a modest but important reduction over time on the uptake and prevalence of smoking”.

Any measure that has that effect and prevents young people taking up smoking is well worth while, and for that reason I regard standardised packaging as another essential regulatory measure in addition to the ones that have been passed by your Lordships’ House and by Parliament in general in having the effect of preventing youngsters from taking up this appalling habit.

I therefore strongly support the regulations, I strongly support the excellent introduction by the noble Earl, and I am afraid that I regard this Amendment as having another devastating effect, which is without question not necessarily sponsored but supported by the tobacco industry, which has done so much to delay the development of these important public health measures, which have made such a great contribution to public health.