Penrose Inquiry

Debate between Lord Fowler and Earl Howe

Thursday 26th March 2015 Lords Chamber

[Earl Howe]

My Lords, I am grateful to the noble Lord, Lord Hunt, for his comments and questions. There is no doubt that Lord Penrose has done a very thorough job in examining the facts. It is worth understanding that he has considered the evidence from England as well as Scotland.

I pay tribute to those who showed tremendous courage in telling the inquiry about the impact of infection on their lives and the lives of their families. The report has systematically examined the facts and set them out. As well as other inquires, such as the Archer inquiry, with which the noble Lord is familiar, this report has now given us a detailed account of what happened, which is extremely valuable. I agree that there will be a need to reach a formal view on Penrose’s conclusions once my department and the next Government have had an opportunity properly to consider the conclusions that he reached.

As for Lord Penrose’s recommendation to offer a hepatitis C test to everyone who had a blood transfusion before 1991, the department conducted a look-back exercise in 1995 to try to identify everyone who might have received infected blood prior to 1991. We will consider whether anything more can be done on this in England, although obviously Lord Penrose’s recommendation relates specifically to the Scottish Government taking steps along these lines. We have already done an exercise to identify anyone who could have been affected, and we will consider whether anything more should be done on this.

The noble Lord asked about the Skipton Fund, which, as noble Lords will remember, is there to make non-discretionary payments to patients infected with hepatitis C. To date, over 5,100 individuals in the UK have received the stage one payment and around 1,500 have received a stage two lump sum in the UK, with around 700 receiving annual payments in the UK.

[Lord Fowler (Con)]

My Lords, I am very glad to hear the Government’s pledge to give all possible help to those who have been harmed through no fault of their own. However, with respect that pledge has been given before. It is very important this time that it is properly, and above all generously, followed through.

Does my noble friend agree that we should take note of Lord Penrose’s statement, following his very detailed and long inquiry, when he said yesterday:

“Much of the comment made over the years on the topics discussed in the Final Report has reflected strongly-held beliefs. Some commentators believe that more could have been done to prevent infection in particular groups of patients. Careful consideration of the evidence has, however, revealed few respects in which matters could or”—

more importantly—

“should have been handled differently”.

Will my noble friend endorse that conclusion?

[Earl Howe]

My Lords, if my noble friend will forgive me, I do not want to be drawn too closely on Lord Penrose’s comments, as we should reflect on them carefully. However, it is clear that, as knowledge of these viruses began to emerge in the 1970s and early 1980s, no tests were available to screen blood donations and no means existed to inactivate the virus in blood or blood products. By 1985, a screening test for HIV was available, and heat-treated plasma products that inactivated the virus had been developed. It was not until 1990 that an effective screening test for hepatitis C was available. It is important to put that into context, because Lord Penrose found that clinicians acted in accordance with the technical facilities that they had available to them and in accordance with the ethical frameworks that were in place during the 1970s and 1980s. The ethical frameworks in which clinicians operate today are of course very different from those that were in place then.

HIV

Debate between Lord Fowler and Earl Howe

Thursday 15th January 2015 Lords Chamber

[Lord Fowler]

To ask Her Majesty’s Government what estimate they have made of the proportion of people living with HIV who are undiagnosed.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, Public Health England estimates that in 2013 107,800 people were living with HIV in the United Kingdom. Of these, 24%, some 26,100, down from 25% in 2012, were undiagnosed and unaware of their infection. Early diagnosis is important to ensure people can get early treatment and to prevent them infecting others.

[Lord Fowler (Con)]

My Lords, surely we cannot ever eradicate HIV in Britain, which currently is costing the health service something like £650 million a year, when there are at any one time, as my noble friend has just said, 26,000 people who have contracted HIV but are undiagnosed and untested and can obviously spread the infection further. Will my noble friend consider setting up a working party to report on how testing in this country can be improved, which would be of benefit to those people affected and also to the benefit of the public generally?

[Earl Howe]

I will gladly take that suggestion from my noble friend away and give it consideration and I am grateful to him for it. The position on testing is, however, quite encouraging. We have seen more than 1 million HIV tests in sexual health clinics in 2013, which is up 5% from the previous year, and that is only in sexual health clinics. As my noble friend knows, there are other routes to testing through GP surgeries, self-sampling kits and so on. Additional testing is vital if we are going to make sufficient inroads into diagnosing this condition.

NHS: Medical Staff

Debate between Lord Fowler and Earl Howe

Monday 15th December 2014 Lords Chamber

[Lord Fowler]

To ask Her Majesty’s Government how many medical staff working in the National Health Service today, including doctors and nurses, were trained in Africa.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, in 2013, the latest year for which figures are available, there were 6,472 doctors working in the NHS—that is 4.4%—who gained their primary medical qualification in Africa and 13,969 nurses on the Nursing and Midwifery Council’s register who trained in Africa. In that same year, 12,203 professional clinically qualified staff working in the NHS—that is 1.8%—held nationality with an African country.

[Lord Fowler (Con)]

My Lords, I pay tribute to the job that these people do for the National Health Service, but is not the lesson of the Ebola crisis that many of the health services in Africa are seriously underresourced? Can it be justified that not only Britain but other countries in Europe and the Middle East are taking much needed doctors and nurses away from Africa? Could we look at our own training policies to see how that position can be improved?

[Earl Howe]

My noble friend makes a very important point. As he will know, the UK signed the World Health Organization code of practice on the international recruitment of health personnel. My department worked together with the Department for International Development to produce a definitive list of developing countries—based on economic status and the availability of healthcare professionals—that should not be targeted for recruitment. He may like to know that the WHO is planning an assessment of the implementation of that code of practice and is due to report in 2016. However, we are mindful of the point made by my noble friend. Particularly with the Ebola crisis, it is important that we are sensitive to the serious issues that pertain in Sierra Leone in particular.

HIV: Stigma

Debate between Lord Fowler and Earl Howe

Monday 1st December 2014 Lords Chamber

[Earl Howe]

My Lords, there is certainly still too much stigma, although I believe opinion has moved in the right direction generally. The campaigns in the 1980s played a key part in providing information to the general public about AIDS and later HIV, but for some years it has, I think, been widely accepted that campaigns targeting groups at increased risk of HIV are more effective. That is why, for many years, my department has funded the Terrence Higgins Trust for targeted HIV prevention. HIV Prevention England, the unit set up by the Terrence Higgins Trust, is leading that, and is delivering innovative social marketing campaigns, including some mainstream advertising, on things like condom use and testing. There is also a DH-funded national programme, which has been successfully piloted with Public Health England.

[Lord Fowler (Con)]

My Lords, do we not need to fight stigma and discrimination overseas as well as at home? Around the world, some 18 million people have HIV and are untested, many because of their fear of discrimination. Given that many of them are in Commonwealth countries, should we not use all our influence to persuade such countries to follow policies of equal and fair treatment for all minorities?

[Earl Howe]

My noble friend, with his immense knowledge of this subject, is of course absolutely right. The 2011 UN Political Declaration on HIV and AIDS specifically includes a goal to eliminate by 2015 stigma and discrimination against people living with and affected by HIV through the promotion of laws and policies which ensure that human rights and fundamental freedoms are protected. Progress towards universal access cannot be made unless stigma and discrimination are tackled. They are a particular barrier with regard to the criminalisation of gay men and women, transgender people and sex workers. DfID is a constant champion of these groups internationally.

NHS: Five Year Forward View

Debate between Lord Fowler and Earl Howe

Thursday 23rd October 2014 Lords Chamber

[Lord Fowler (Con)]

My Lords, the strategy seems to be very sensible, but I hope that not only the Government but also all the parties will do what the chief executive of the National Health Service said on the radio this morning and recognise that there is no appetite inside the health service for any further top-down reorganisation. Will they also recognise that we need to put much more emphasis on preventing ill health? Pharmacists, who are highly qualified and well trained, should have a much bigger role to play, which would reduce the present burden on general practitioners.

[Earl Howe]

My noble friend is absolutely right in what he says. The report lays great emphasis on the prevention agenda, not only through the work done in the public health arena by Public Health England and local authorities, but also through secondary prevention by the NHS itself: preventing the need for people to enter hospital in the first place. I fully agree with my noble friend about the potential role of pharmacists. Actually, that role has been enlarged over the past few years in an encouraging way with such things as medicines use reviews and the Healthy Living Pharmacy agenda. We want to go further and pharmacists are keen that we should do so.

Ebola

Debate between Lord Fowler and Earl Howe

Monday 13th October 2014 Lords Chamber

[Earl Howe]

There is a limited amount that I can say to the noble Lord about his second question. A general answer is that we would naturally want to give as fast a passage as possible through the regulatory process to any breakthrough treatment for Ebola. It should be borne in mind, however, that safety is the paramount concern. This is why it is important that the vaccine, which is now in clinical trials, is thoroughly tested for safety as well as efficacy. If there is further news on this that I can impart to the noble Lord, I will be happy to write to him.

The noble Lord asked whether staff who volunteer will be repatriated if they contract the disease. My advice is that decisions on repatriation would be taken on a case-by-case basis, taking into account the clinical condition of the person and the benefit they may gain from repatriation. Repatriation involves a long journey that can potentially be dangerous for the patient. Once there is high-quality treatment available in Sierra Leone, it will not necessarily be in the best interests of the patient to be repatriated. That is why we are building the 12-bed unit specifically for national and international healthcare workers.

[Lord Fowler (Con)]

My Lords, I totally support the measures set out by the Minister. It is obviously sensible, as it has been in past events, for the Government to follow carefully the guidance of the Chief Medical Officer. Is not the real long-term task permanently to strengthen the inadequate and underfinanced health systems in so many parts of Africa? Would that not be to the benefit of tackling not just Ebola but other life-threatening conditions such as malaria, TB and HIV/AIDS?

[Earl Howe]

My noble friend has immense experience in this area and I completely agree with him. I attended a conference in Washington a few days ago which was called by the President of the United States at which 44 Health Ministers from around the world were present. I emphasised the very point my noble friend has made: yes, it is important to provide assistance to deal with the current emergency—everybody is agreed about that—but we must not lose sight of the need for the health systems in those poor countries to be bolstered in the way my noble friend mentioned and for there to be adequately trained clinicians and healthcare staff on the ground as well as diagnostic facilities so that in future those countries are capable of some resilience if they are hit by such an emergency again. I can tell my noble friend that DfID funding is going into that effort, as it has been systematically over the past few years.

Health: HIV

Debate between Lord Fowler and Earl Howe

Thursday 29th November 2012 Lords Chamber

[Earl Howe]

My Lords, the noble Lord is quite correct. Self-management is one of the BHIVA standards. I agree that self-management and supporting patients to manage their own care, both for HIV and, for that matter, any other long-term condition, are very important for promoting the best treatment outcomes for individuals. A variety of approaches will be needed to support individuals to self-manage their HIV. There are already some innovative programmes, such as the online resource, My HIV, for people living with HIV, delivered by the Terrence Higgins Trust. The key to this is for commissioners of services to work together in future to ensure that self-care is part of the HIV care pathway, and GPs will have a role to play in that.

[Lord Fowler]

My Lords, I declare an interest as patron of the British HIV Association. Is it not the case that we now have 100,000 people living with HIV in this country but that a quarter of them are undiagnosed, so obviously risk spreading the infection further? Does that not mean that we must persuade even more people to come forward for testing? In that respect, will the Government now commit themselves to bringing forward proposals to allow home testing?

Health: HIV/AIDS

Debate between Lord Fowler and Earl Howe

Monday 5th September 2011 Lords Chamber

[Lord Fowler]

To ask Her Majesty’s Government what steps they are taking to prevent the spread of HIV and AIDS in the United Kingdom.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, the Government fund national HIV health promotion programmes for men who have sex with men and for African communities, the groups most affected by HIV in the UK. This is in addition to harm minimisation programmes for injecting drug users, NHS HIV prevention programmes and open-access testing and treatment services. The White Paper, Healthy Lives, Healthy People, sets out the Government’s strategy for reform of public health in England. This includes sexual health and HIV.

[Lord Fowler]

My Lords, I thank my noble friend for that reply, but does he really think that we are getting the message over on the dangers of HIV? Is it not a fact that the number of people accessing care for HIV has trebled in the past 10 years, that we now have almost 100,000 people with HIV in the United Kingdom and that the cost of treatment and care has now risen to almost £1 billion a year? Given that this is an entirely preventable disease, does not my noble friend agree that we have devoted disgracefully little to HIV prevention programmes over the past decade and that our efforts here should now be urgently increased?

[Earl Howe]

My Lords, may I begin by paying tribute to my noble friend Lord Fowler in his continuing interest in HIV and AIDS, here and internationally? He has done a huge amount to raise the issue’s profile in Parliament and more widely. I agree with much of the thrust of what he said; there is no doubt that over the past 10 or 12 years great progress has been made in a number of areas, but we are still concerned about the increasing incidence of HIV among men who have sex with men and sub-Saharan African communities, which are the groups most affected and vulnerable to HIV in the UK. That is why our prevention campaigns have been targeted primarily at those communities. There is much more work to do. The sexual health framework report that we are publishing later this year will have a separate section on HIV, and I hope that in that document my noble friend will be reassured that our efforts in this area will not let up.