Health: Women and Low-income Groups

Baroness Suttie Excerpts

Thursday 20th March 2014 Grand Committee

[Baroness Suttie (LD)]

My Lords, I thank my noble friend Lady Manzoor for instigating this debate. It is a hugely important subject. I will concentrate most of my remarks on the growing problem of TB and, in particular, drug-resistant TB.

Overcrowding is perhaps the biggest risk factor for the transmission of TB. Anyone who has TB and is not treated will remain infectious, potentially passing the disease on to those who live with them. For those in temporary accommodation, TB is a threat to keeping their accommodation. TB is infectious and difficult to treat, and patients are often scared of losing their accommodation if they admit to having TB.

People with lower incomes are statistically more likely to experience drug or alcohol abuse problems, which reduce their immune response and heighten their risk of contracting TB and other infectious diseases. Cases in the UK are centred around big cities. London has an average rate of 42 cases per 100,000. As my noble friend Lady Manzoor has already remarked, two of the boroughs with the most severe problems with overcrowding and temporary accommodation, Brent and Newham, are also those with the highest rates of TB in the UK.

The problem becomes even more severe among the homeless population. The disease attacks people with reduced immune systems, so the impact of rough sleeping, poor nutrition and other factors associated with the chaotic lifestyles of the homeless can increase their chances of developing TB in the first place. In addition, the homeless community is less likely to present to primary healthcare when experiencing symptoms of TB or any other disease. That increases their likelihood of remaining infectious and transmitting the disease to others. It also increases the likelihood of them developing more severe and difficult-to-treat symptoms, due to the opportunity for the disease to progress further.

Homelessness was also found to increase the likelihood of developing drug-resistant strains of TB, including a much greater risk of developing multi-drug-resistant TB. It was also found that homeless people are a dozen times more likely not to adhere to treatment, which puts them at even greater risk of developing, and transmitting, infectious TB.

The central thread running through all this is a critical problem with housing. Once admitted, hospitals cannot discharge people without a home address. If the disease is not advanced and they have no other health complications, most patients will not be admitted. TB treatment is extremely long: the average treatment duration is 220 days and the average cost of a bed per night is £500. A patient who cannot be discharged can cost the NHS £110,000 in bed fees alone. Specialist hostel accommodation is available and needs supporting. One project that I visited just two weeks ago in Euston costs £60 to £80 a day, including all food, a room, training, language skills and social support for TB treatment.

Does my noble friend the Minister agree that a holistic package of care, if widely adopted by the NHS in high-risk TB areas, could save taxpayers millions and greatly improve treatment outcomes, as well as reduce the spread of the disease?