Penrose Inquiry

Lord Fowler Excerpts

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/AIDS

Lord Fowler Excerpts

Thursday 5th March 2015 Grand Committee

Asked by

[Lord Fowler]

To ask Her Majesty’s Government what steps they are taking to meet the continuing challenge of HIV and AIDS.

[Lord Fowler (Con)]

My Lords, we are nearing the end of a Parliament, which is, perhaps, a good time to assess what progress has been made in this important area, where we are and where we want to be. I start by congratulating the Government on two measures of immense importance. The first was their decision to enable equal marriage, which did a vast amount not only to encourage equality but at the same time to fight prejudice against gay people, which stands against progress in fighting HIV and AIDS literally around the world. The second was to double their contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria, which brings invaluable help to areas where the death toll has been immense. AIDS alone has been responsible for 35 million deaths around the world since the epidemic began. Frankly, the criticism of the National Audit Office that this was an example of a last-minute decision was about as far from the mark as it was possible to get. It was first promised not by the current Secretary of State but by her predecessor, Andrew Mitchell, and it was, as I say, extraordinarily welcome.

However, in this short debate I want to concentrate on this country and ask whether we are making the progress that we should. In bare statistics, last year there were almost 6,500 new HIV diagnoses. I have just come back from Russia, where I looked at the position there. Indeed, they were kind enough to present me with a medal for 25 years service. It is a damn sight more than I ever get from the Department of Health, I can tell noble Lords, but I fear that it makes me no more sympathetic to their policies, which last year resulted in 85,000 new HIV diagnoses. The figure goes up remorselessly each year.

The temptation is, against that background, to say about Britain, with fewer than 6,500 new HIV diagnoses, what are you worried about and what is the problem? The problem, basically, is that today in Britain there are 100,000 men, women and children living with HIV. That is almost double the number accessing care a decade ago. The National Health Service now spends £860 million a year on treatment and care: almost £1 billion a year. Worst of all, of those 100,000 with HIV, about a quarter are undiagnosed. They do not know that they have the virus and, of course, other things being equal, they spread HIV further. In other words we have, in my view, an undoubted public health crisis and, although we now have antiretroviral drugs which prolong life, we still face the situation which we faced, frankly, in the 1980s, with no cure and no vaccine.

Against such figures, what can we do and what are we doing? The obvious step is to put the maximum effort into prevention. We save £320,000 in lifetime costs for every infection which is prevented. Top of the list in prevention policy is to persuade ever more people to be tested. We are not going to win when we have around 25,000 people untested and undiagnosed in the community. Second to that is that we also need to persuade people to continue with their treatment once they are on it. Too many drop off. The point to recognise, generally, here is that persuasion can work, provided that sufficient imagination is put into the messages and it is backed by sufficient resources. We established that back in 1986-87 with the promotion of condom use and the warnings against shared needles.

The Select Committee that I chaired in 2011—I am glad to see that one of its members, my noble friend Lord Gardiner, is sitting very near me—raised this point with the Government. We said that publicity was inadequate and should be increased, so what did the department do? It cut it further. Today, the department spends about £2.4 million a year nationally on promoting prevention. I repeat that the cost of treatment and care is £860 million a year. It is, frankly, a ludicrous position. We spend hundreds of millions on treating the casualties but next to nothing on trying to prevent those casualties coming about. The defence for this is that, in addition to the national campaign, another £10 million or £11 million is spent by local authorities, although the figures suggest that some of the most affected local authorities are spending next to nothing, if anything at all.

Frankly, making every allowance in the book, the amount we spend on trying to prevent infection is seriously inadequate. Prevention is simply not being given the priority that it deserves. If it were not for the NGOs and the volunteers, our overall national policy would, in my view, be not only in trouble but in tatters.

Therefore, I say to the Government that we need a new campaign to encourage testing, which is the obvious glaring gap in our policy. A few weeks ago, I proposed to the Minister on the Floor of the House that a task force should be set up to explore how to take that forward. The Minister, as is his custom, was courteous—even encouraging—but, frankly, I have heard no more, doubtless because he was planning the detail of the campaign that I set out. Perhaps this afternoon he might come forward with those proposals.

I would like to make two further points. The first is on drugs and harm reduction policy generally. We introduced clean needles and then methadone as a policy back in the 1980s. Methadone is not injected and therefore has an obvious use in reducing transmission. It has been demonstrably successful as a policy. For the last 25 years the number contracting HIV in this country through shared needles has been around 1% of the total—almost imperceptible. Therefore, it is vastly important that that policy is maintained and that there is no lurching away from it. Why do I say, “lurching away from it”? In recent weeks there has been a suggestion that policy is changing. There has been a hint that drug users should be forced into taking treatment—taken not only off injecting drugs but off methadone as well. I say to the Minister that my only advice on this is to go very cautiously indeed.

Of course, we all want to see as many people as possible living a drug-free life, but we should not underestimate the difficulties, which are not going to be reconciled by a speedy review of a few weeks. If you want to see the alternative, again, go to Russia: see the treatment centres there and the attempt at rehabilitation, and look at the figures. They show that after 12 months of treatment and rehabilitation 80% or 90% go back to injecting drugs, and after five years virtually everyone does.

Given that drug users have never really been able to be forced off drugs in the way that seems to be imagined, I think we might also remember that methadone can lead to a recovered life. I remember visiting a clinic in Ukraine, where the doctor in charge basically said just that—that, although some of them had been on methadone for six, seven or eight years, they had at least been restored to society: they held down jobs and were relating to their families again. Basically, I would like an assurance that there is no intention on the part of the Government to turn their back on sensible harm reduction policies.

My last point I make in précis. The latest research shows that the drug Truvada can very substantially cut HIV for men who have sex with men. It prevents HIV infection. Given that men who have sex with men are the group most affected by HIV in this country, it seems obvious that we should develop that policy as quickly as we can. Of course, there are costs to the policy, but there are even greater costs in doing nothing.

My conclusion is this. On a number of issues, such as the increased contribution to the Global Fund, this country has been among the leaders in the world, but I fear that nationally, inside Britain, there are too many gaps in our policy to say that we lead the world. What we can say is that we have some of the finest and most devoted clinicians, NGOs, voluntary organisations and officials. If I had one word of advice for the Government, it would be that Ministers should raise their general policy game to the level of those doctors and volunteers who work so tirelessly in this country to eliminate HIV and AIDS.

HIV

Lord Fowler Excerpts

Thursday 15th January 2015 Lords Chamber

Asked by

[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

Lord Fowler Excerpts

Monday 15th December 2014 Lords Chamber

Asked by

[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

Lord Fowler Excerpts

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

Lord Fowler Excerpts

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

Lord Fowler Excerpts

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

Lord Fowler Excerpts

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 and Social Care Bill

Lord Fowler Excerpts

Monday 19th March 2012 Lords Chamber

[Lord Fowler]

My Lords, I intervene briefly. I listened carefully to what the noble Lord said, but I am not sure that this is just a matter of practice, as he said at the beginning—although by the end he was coming very firmly round to the view that he was an all-out opponent of the legislation itself. I think that there are questions of principle here as well, and not just the principles that he enunciated.

I am not a member of the “keep everything secret” brigade—rather the opposite. If we had taken more notice of the Information Commissioner’s report in 2006 on the unlawful trade in professional information, we might not have had to wait until 2012 for the inquiry into phone hacking, and the rest. I also argued against the 30-year rule for the disclosure of Cabinet papers as wrong and unnecessary and remain critical of the previous Government’s response to that, which was to reduce it to 20 rather than 15 years, as recommended. I think that had more to do with disclosure on Iraq than it did a matter of principle.

I also believe that when it comes to the publication of risk registers, other issues need to be taken into account, not least the relationship between Ministers and civil servants. I suggest that this is why no Government in the past has agreed to a policy of publication. In my view, Ministers are responsible for the decisions taken, and it is for civil servants to advise. That is their skill and their role, and anyone who has ever put a Bill through Parliament knows well enough that if they are any good, civil servants do not simply sit there saying, “Yes, Minister”. They debate and argue with the Minister and warn of the risks as they see them. It is one of the very good features of the relationship between Ministers and the Civil Service in this country.

The problem with publishing all the risks, from the possible to the highly improbable, is that the relationship itself seems to be brought into some doubt. Civil servants, whether they liked it or not, would be dragged into the debate. We all know exactly what would happen: the risk register would be used to undermine the measure being proposed. The aim would be to show that Ministers were in conflict with their own staff. The opponents of a Bill such as the one before us today could say that not only was the BMA against the Bill—it is not exactly news that the BMA is against any new measure put forward since 1947—but also, by selective quotation, that the Civil Service itself had profound doubts. Whether one liked it or not, the Civil Service would be brought into controversy and people would try to portray conflict. I do not see, frankly, how that is in the public interest.

The party opposite has not shown any interest or inclination in the past to go down this road as a general policy line. This would simply place new obstacles in the way of legislation and change. I wonder how a risk register could have been used at the inception of the health service in the 1940s. Doubtless it would have pointed to the problems implicit in such a massive reorganisation and to the risks that costs could escalate. Not every civil servant would have shared ministerial confidence that a better health service would mean improved health and therefore a reduction in costs.

It comes down to the fact that in these cases there is a matter of judgment on the part of Ministers, having listened to the arguments and the advice of the Civil Service, in putting their proposals before Parliament. I entirely understand the later amendment of the noble Baroness, Lady Thornton, which seeks to deny a Third Reading to this Bill. That is perfectly straightforward: she sets out the reasons for it. I do not happen to agree with her, as she knows, but I do not have any doubt about her right to do this. Frankly, however, I cannot see the value of this amendment seeking delay on grounds that I do not believe to be in the public interest.

[Lord Mackay of Clashfern]

My Lords, since Second Reading in this Chamber, this House has carried out a very thorough public scrutiny of this Bill. In doing so, it has had the advantage of the expertise of practitioners and former practitioners with great experience from across the medical, surgical, nursing and social work professions, and also those with experience of administration of those services. Further, it has had the advantage of former health service Ministers and of the skilled, eloquent probing of the Bill’s provisions by the opposition Front Bench: the noble Baroness, Lady Thornton, the noble Lords, Lord Hunt of Kings Heath and Lord Beecham, and the noble Baroness, Baroness Wheeler. We have also had the expertise of the noble Lord, Lord Owen, himself not only a former Health Minister and writer on health matters, but also a director of a large American pharmaceutical company for quite a number of years. In addition, as the Bill has proceeded, we have received detailed briefing from many people currently working in the health and social work services.

The scrutiny was completed last week. In that situation, we would grossly underestimate the breadth and depth of that scrutiny if we accepted that a register, prepared 15 months ago by civil servants in the privacy of the Department of Health before the Bill was introduced and before the very large number of amendments were made to it, could add substantially to our understanding of the Bill. Therefore, in my submission, at this stage this amendment to the Motion is inappropriate. At the very best, it refers only to the tribunal’s decision; it does not refer, except indirectly, to the register. In my submission to your Lordships, the register prepared so long ago in privacy by civil servants cannot be expected to add substantially to what we know already.

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.