Health and Social Care Bill

Lord Fowler Excerpts

Wednesday 29th February 2012 Lords Chamber

Moved by

[Lord Fowler]

161: After Clause 59, insert the following new Clause—
“Charges to overseas visitors
(1) The National Health Service (Charges to Overseas Visitors) Regulations 2011 (S.I. 2011/1556) is amended as follows.
(2) In regulation 6 (services exempted from charges) for paragraph (e) substitute—
“(e) the diagnostic test for evidence of infection with the Human Immunodeficiency Virus (HIV) and counselling associated with that test and its results;(ea) all other services for the treatment of HIV provided to an overseas visitor who has been present in the United Kingdom for a period of not less than six months preceding the time when services are provided;(eb) treatment for sexually transmitted infections other than HIV;”.”

[Lord Fowler]

My Lords, I have the slightly unusual advantage in proposing this amendment in that not only do I find that the arguments I will be using have already been set out in the press, but also that we are told how the Government intend to respond. I am extremely grateful to the Daily Telegraph for the information, and I only hope that it is correct. I also hope, as my noble friend Lady Cumberlege so rightly put it, that at the moment the Government are on a roll so far as these things are concerned. The background to the amendment is clear: it is about promoting better public health. That was also the message of the recent Lords Select Committee report on HIV/AIDS in the UK. I was chairman of the committee, and three of its members have added their names to this amendment, which reflects one of the proposals made in the report.

The general position is that more than 100,000 people in this country are now living with HIV. The number of patients has trebled in the past 10 years, but, just as serious, around a quarter of those who are infected do not know their condition. So we have 25,000 people in the community who are ignorant of their condition and who by definition are not taking the treatment that is available. They are risking their own health and lives and, above all from the public health perspective, they risk passing on and spreading the infection further. If this is put into financial terms, every extra person who is infected in that way will, over his lifetime, cost around £300,000 in medical treatment. We should remember that the National Health Service is already spending over three-quarters of a billion pounds a year on drugs alone for the treatment of HIV. So from every point of view, personal and financial, a new emphasis needs to be placed on prevention. I underline that the whole intent here is to prevent the further spread of HIV in England, which I believe would be much to the public benefit.

The amendment concentrates on one important, albeit limited, area where we can make progress. For conditions such as TB and hepatitis, treatment on the National Health Service is already given absolutely free for anyone in the country whatever their residence status, whether they live here permanently or are in this country for some other reason. The public interest is that the infection should be contained, and the same is true of all the sexually transmitted infections, including HIV, with the following exception. There is a group of patients where treatment is not free and where instead the National Health Service tries to make a charge. This group includes, for example, the young student from overseas with HIV who happens to be here for a short stay, or the failed asylum seeker who has been allowed temporarily to stay in the country because his own country may be too dangerous, or the undocumented worker. They are exceptions and, here, a charge is attempted. I say “attempted” because, in the vast majority of cases, these people have no resources in any event—some are virtually destitute. So we get the worst of both worlds. The National Health Service never gets any money, but the story nevertheless goes out that those suffering from HIV will have to pay, which obviously deters people coming forward for treatment and does the exact opposite of what we want in public health terms. There is now very strong clinical evidence that treatment reduces onward transmission and, according to the surveys that have been done, late diagnosis is far greater among people who are liable to charging.

So why do we have this self-defeating policy? The answer seems to be a fear that if we were to say that treatment was free there would be a sudden influx of HIV sufferers from abroad—health tourism, in other words. There are at least three reasons why this is not the case. The first is the position in Scotland and Wales, where treatment is totally free and there has been no sudden increase in overseas visitors to Edinburgh, Cardiff and other such cities. Secondly, my amendment makes it quite clear that there is no prospect of sudden treatment for someone who just flies in. It applies to people who have been in the United Kingdom,

“for a period of not less than six months preceding the time when services are provided”.

That condition can doubtless be met in different ways, although the principle is very much the same. We are not in the business of providing HIV treatment for health tourists—that position is, I think, common to us all. That is not the effect of the amendment and it will not be the result of it.

Thirdly, the whole idea that you can suddenly arrive, pick up three months’ supply of antiretroviral drugs and then fly out is utterly misjudged. The acknowledged experts in the treatment area in this country are the clinicians of the British HIV Association. I asked its chair, Professor Jane Anderson, what the treatment position would be. She gave me a number of possible situations of which I shall take just one. A patient arrives at an HIV service and sees a doctor or nurse and says that he has the HIV infection. He would be fully assessed medically and his background circumstances explored. Reasons for being inside the United Kingdom would be clarified at that stage. Health and social care needs would be reviewed and previous treatment centres identified and documented, and so it goes on. The net result of that is that it is very unlikely that anyone will be given three months’ supply of antiretroviral drugs until the completion of three or six months.

I note two things about what Professor Anderson says there. First, the hospital would for clear reasons check on the immigration status in the UK of the person and seek to clarify it. Secondly, there is no prospect either of someone with HIV getting an instant supply of drugs.

Basically, and very shortly, that is the case. It is not, I stress, opening the floodgates or adding vast extra expense to the National Health Service. Indeed, the cost of the present policy to the National Health Service of every extra individual who is infected—£300,000 over a lifetime—needs to be recognised. We should also remember the considerable additional cost of people being deterred from coming forward who then have to be dealt with as an emergency in an intensive care ward, again at extremely high cost. The amendment makes not only humane sense but financial sense as well.

My point remains. If we are serious about public health and preventing new infections, the amendment should be supported. On the last occasion when we debated this issue the Government were encouraging in their response. I hope that tonight we will hear of action that will be to the benefit of the public in this country. I beg to move.

--- Later in debate ---

[Lord Fowler]

My Lords, let me say first and foremost that I am extraordinarily grateful, as I think all who have signed this amendment are, for that reply and the way in which my noble friend gave it. We are grateful for the absolute commitment that she has given. I have had commitments before; I do not think I have ever had an absolute commitment, but I do not think that there is any prospect of withdrawal from it and I am grateful for that. I thank the Ministers for all that they have done. Perhaps I might also thank the public health officials, who I know have worked extremely hard to get a sensible outcome on this. We do not often thank the officials in this House, but in this case I will.

I thank the noble Baronesses, Lady Masham and Lady Finlay, both of whom spoke, and of course I thank the noble Baroness, Lady Gould, who has long campaigned on this issue. As she said, there are very important organisations which have campaigned and put forward proposals over the years. The National AIDS Trust has taken a lead, as has the Terrence Higgins Trust and the British HIV Association. All of them have spoken with the same voice and their campaign has gone on not just for a few months but for six, seven or eight years. This is an extraordinarily good culmination to all those efforts. I congratulate again the Government. It reflects great credit on them and on the Department of Health that they have accepted the case and that common sense, frankly, has triumphed.

I would just add this to my noble friend. I notice that the Terrence Higgins Trust produced a document called HIV and Sexual Health: 12 things the Government can do. They have done one of them now with an absolute commitment. It would be wrong for me to say that they still have 11 to go, as I think they have done some of those as well, but there are other things to do in this area. It is an important area of public health. It does not get the public attention that it deserves but in my view it is absolutely crucial. I congratulate the Government and thank them for their reply. I beg leave to withdraw my amendment.

Amendment 161 withdrawn.