Health: HIV

Baroness Bottomley of Nettlestone Excerpts

Monday 5th September 2016 Lords Chamber

[Baroness Bottomley of Nettlestone (Con)]

My Lords, warmest congratulations are due to my noble friend Lord Black of Brentwood on securing this important and particularly timely debate. The arrival and availability of PrEP, the benefit that it can provide, is something that I hope we all support and strongly urge. Even timelier, as my noble friend pointed out, is the arrival of the first male Lord Speaker. I appreciate that we have had the most distinguished female Lord Speakers, but perhaps it is now time for a male Lord Speaker. We welcome him most warmly to the Woolsack. As my noble friend said, the noble Lord, of all people, deserves enormous credit for his pioneering and courageous campaign, “Don’t die of Ignorance”, the shocking, bold, unstoppable campaign of 1987.

My noble friend mentioned the noble Lord, Lord Fowler, but I want to mention one other person, the then Chief Medical Officer, an eminent physician and epidemiologist, Sir Donald Acheson. Uncompromising, he on the whole thought that Ministers had to be tolerated. As long as he got his way, which he was determined to do, he was happy and easy to work with, and he worked with great principle and distinction. When he first became CMO in 1983, fewer than 30 AIDS cases had been seen. By 1985, two years later, 121 people had died and 10,000 were thought to have the condition. That was the most phenomenal situation: the greatest new public health threat of the 20th century.

Following that was a model of the way in which a Government can decide that they are going on a war footing against a new condition. There was not only the great public health education campaign in the health service. In the voluntary sector, my noble friend paid tribute to the Terrence Higgins Trust and the National AIDS Trust, but there was also London Lighthouse, Mildmay and Landmark. It was extraordinary how the voluntary sector mobilised, rather in the way that all the children’s charities mobilised at the end of the 19th century, holding the Government to account in every area, even in the Diplomatic Service.

I took over at the Department of Health, only being half the man of the Lord Speaker, because he manfully was able to handle both the enormous Department of Health and the then Department of Social Security, now the Department for Work and Pensions. No mere mortal Secretary of State has been able to handle those two enormous responsibilities since then, but he did so with great distinction, so perhaps he will be the man to handle our colleagues’ business here. At the time, there was a real problem internationally because in many African countries, acknowledging the development of HIV and AIDS was thought to be a threat to the tourism industry. I remember going to the World AIDS Conference in Paris in 1990, when the British ambassador to France was proud in his red ribbon, which I think his mother would have been amazed to see him wear. There was a campaign to try to persuade the Russians to accept that HIV/AIDS was a serious problem in Russia. All of us in our different times have had different campaigns to handle this real threat to the human race which so extraordinarily, through the work of our scientists and the pharmaceutical industry, has become a manageable chronic condition, if only it can be identified, diagnosed and treated.

I confess to a tension I held in my term of office, because there was resistance to testing when there was no available cure or treatment. I found it very difficult because, without going into too much detail, any women in the House who have had a baby will know that you are tested for all sorts of different things without any counselling or consent; that is what we are told we have to do. Nevertheless, at the time it was felt that people should not be forced to have assessment or treatment, even if they were going into hospital for a major operation, without counselling.

I tracked down where the source of all that lay and then declared war in the most joyful way on the insurance industry. The ABI used to weight people on their insurance if they had had an HIV test. It did not matter whether the test was negative—the fact that they had been tested meant that they were high risk and therefore should pay the penalty on their insurance premium. Prince Harry would then have been a wonderful example which one could have used. I fear that I was just rather aggressive, insistent and disagreeable, but I am delighted to say that since 1994, ABI policies have been absolutely clear that a negative test is not a barrier to obtaining insurance. All the way through, we see stigma, resistance and obstacles. Together we can unite and work to overcome these many barriers and improve diagnosis and treatment.

There is no doubt that that early campaign was a model which many of us felt proud of internationally. My noble friend has pointed out that we now have more to learn from other parts of the world which are developing their services and approach faster than us, but it remains the case that, as a percentage of the population, France, Spain and Italy each have twice as many people living with HIV as we do in the UK. As my noble friend said, HIV has been responsible for the deaths of over 35 million people worldwide, including 1.1 million in 2015 alone. There is still a long way to go. The WHO reported in 2015 that there were approximately 26.7 million people living with HIV worldwide. In South Africa, Zimbabwe and Uganda, 19%, 14.9% and 7.1% respectively of the adult population is living with HIV. In the UK, it is 0.3% and in the US 0.6%, but any percentage, any number, is something we cannot tolerate without greater effort.

The UN sustainable development goals, established in 2015 to end poverty and fight inequality and injustice, include the commitment to end the epidemic of AIDS by 2030. UNAIDS has set interim targets for 2020 which have been agreed by political declaration by UN members, including the UK. This goes back to the part we can play internationally as well as nationally. Noble Lords may feel that the international is not part of the debate today, but in this extraordinarily permeable world, with mass migration, there is no such thing as looking at the situation in the UK without having regard to the international situation, such is the movement of people. Whatever the outcome of Brexit may be, I doubt we will bring an end to the mass migration of populations.

As my noble friend has pointed out, we are not doing well enough because we are still finding that one in 6 of those 100,000 people living with HIV in the UK now is unaware of it. Only 82% of those with HIV know that they have the condition. If a person is diagnosed a long time after they have been infected with HIV, it is more likely that the virus will already have seriously damaged their immune system. Late diagnosis is a huge contributing factor to illness and death for people with HIV and, if an individual is unaware of the situation, to further transmission. In 2014 it was estimated that 40% of the adults in the UK—

[Baroness Mobarik (Con)]

My Lords, I apologise for interrupting the noble Baroness, but she will be aware that this is a time-limited debate. The guide time has been increased to eight minutes but I hope she will be seeking to conclude quite quickly.

[Baroness Bottomley of Nettlestone]

I apologise to the House; such is my enthusiasm to support my noble friend in his excellent work. I had another 40 minutes of speech here, but I will now bring it to an end and simply commend my noble friend and our most distinguished Lord Speaker. I hope to support them in every way that I can.

Southern Health NHS Foundation Trust

Baroness Bottomley of Nettlestone Excerpts

Tuesday 3rd May 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, a number of serious questions have been asked. I shall make a personal observation. This trust is the result of the merger of three trusts: a mental health care trust, a community trust and a learning disabilities trust, three very complex businesses being brought together as one. They have 250 separate locations with over 1 million patient contacts every year. The risk inherent in that kind of business at this time is huge. In putting in a governance structure, we have to be very careful that we do not just draw up such structures in a boardroom or come up with strategies that cannot be implemented.

In the report, I was very struck by the fact that now there is almost a tick-box approach to the duty of candour; you tick the box to say that you have done it. Culture is usually important in this. What is the culture in the trust? That is one of the big issues that the CQC report is trying to get at. In response to the question of whether we can give guarantees about patient safety: this is inherently a very risky activity. Putting in strong governance structures is very important, but much will depend on the culture within the trust.

I turn to some of the particular points. I, too, was struck by the fact that there were still problems with ligature points in some of the facilities, as had been pointed out by the CQC some time ago. I was struck by the fact that the epilepsy protocol for those being bathed or showered had not yet been approved two and half years after Connor Sparrowhawk’s death. Clearly, there were very significant problems at the trust. On the question of where accountability and responsibility lie, the chairman has resigned. The principal job over the next three or so months will be assessing the capability of the executive management. That seems the right way to approach this.

It is always tempting to call for a public inquiry; I understand that temptation. We have an independent regulator, the CQC. The inspection team was led by mental health professionals and is fully transparent. We now have to give the trust the chance to respond to the CQC’s report and watch for serious improvements.

The noble Baroness asks if there have been any improvements. There are some illustrations and examples in the CQC report of where there have been some improvements, but putting in a new governance structure, changing the whole culture about raising concerns about those kinds of issues, will not happen overnight. Of course, I appreciate that for Connor Sparrowhawk’s family this happened two and a half years ago, and one must never lose sight of that.

A question was asked about NHS Improvement. It put in an improvement director. These people do not grow on trees. If we are honest about the NHS, we are very short of highly qualified and highly skilled senior management, and it sometimes takes time to find the right people.

[Baroness Bottomley of Nettlestone (Con)]

My Lords, the history of people with learning disabilities and mental health problems and the institutions in which they live goes back a long way. Many appalling situations have taken place, and I do not want to belittle this deplorable situation. However, did the report also identify areas of very good-quality care and professional standards? The danger is that vilifying an institution—and even going on to a public inquiry, which prolongs the agony even further—does not give it the opportunity to build on its strengths and provide the quality of care that the hundreds of people working there wish to provide and wish to be proud of doing.

[Lord Prior of Brampton]

I am grateful to my noble friend for those comments. There are many examples in the CQC report of good care. In one of the domains that the CQC inspects, which is caring, it is clear that the vast majority of people who work for Southern Health are deeply caring, committed people. We have to be careful. I am afraid it is a question of the curate’s egg; the report is good in parts. I go back to what I said originally: an organisation this big is incredibly difficult to manage. That is one of the learnings that we need to take from this. The temptation to merge organisations to get centralised cost reduction, or whatever, is very tempting but leads to serious issues around governance.

Junior Doctors: Industrial Action

Baroness Bottomley of Nettlestone Excerpts

Monday 25th April 2016 Lords Chamber

[Baroness Bottomley of Nettlestone (Con)]

My Lords, is it not unworthy to describe the Secretary of State for Health as being anything other than unequivocally committed to improving patient safety in the NHS? Consistently and throughout his time as Secretary of State, this has been a priority of his with total dedication, and I much regret that anybody should question that. However, is it not equally deplorable that junior doctors, who are respected and loved by the public and are on a step on their career towards consultant posts, should take an action that will undermine the respect and confidence in which doctors have long been held? My noble friend rightly pointed out the many issues concerned with junior doctor training, but extra money for working on a Saturday, which junior doctors have always had to do, as have those in many other professions, is not the reason now to jeopardise their reputation among the public.

[Lord Prior of Brampton]

I can confirm both those points. If the Secretary of State for Health was to fall under a bus tomorrow and somebody was writing his obituary, it is “patient safety” that would be written on his tombstone. That is the one big issue that he has consistently fought for ever since the problems at Mid Staffordshire were uncovered three years ago. Patient safety is his guiding star as Secretary of State for Health. I agree with my noble friend that it is tragic to see thousands of highly committed, highly intelligent and otherwise sensible young people going out on strike.