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4.22 pm
The Minister of State, Department of Health (Dawn Primarolo): I congratulate my hon. Friend the Member for Hackney, North and Stoke Newington (Ms Abbott) on securing this debate, even though it has taken her a long time and a great deal of detective work to get answers to the questions that she and her constituents wish to see answered. I know that she has great concern about the tuberculosis services in her constituency, and she has touched on much of that today. The hon. Member for Cities of London and Westminster (Mr. Field) also made some pertinent points.
I shall do my best to give the House an indication of exactly how the Government intend to proceed, but I wish to start by echoing again the point that my hon. Friend made about the services in her constituency. Notwithstanding the very detailed questions and the specific experience involved in the case of Philip McCabe, my hon. Friend recognised that a lot of good work is being done by national health service staff and other organisations across the whole of Hackney and Stoke Newington, and I echo that. She is raising important and specific points, but she has made it clear that she values and accepts the work that others are doing, and I support that.
Ms Abbott: I do not want to turn this issue into a public health scare story about immigrants, but the danger is that because the issue involves excluded groups, it does not necessarily get the attention that it deserves.
Dawn Primarolo: My hon. Friend has been in the House as long as I have—we entered together in 1987—and she has a remarkable ability to predict what Ministers are about to say or to guide them to what they should say next. On this occasion, I was about to deal with that important point. In addressing the serious health issues for those infected with TB and ensuring that they get the services that they deserve and need, we need to be very careful—I think that the hon. Gentleman was trying to be careful—not to add further to stigma and alarm in our communities and, therefore, inadvertently put further barriers in the way of those people coming forward for treatment.
TB is not a threat to the general population of the UK—I do not think that the hon. Gentleman meant to imply that—and that is why the Government of the day stopped the inoculations for TB. I do not know whether the hon. Gentleman is old enough to remember—I certainly am—when we had to have those inoculations at school. The risks have considerably diminished, and the strategy to tackle TB—informed by the science and the analysis by the Department of Health—is now based around an action plan with three specific themes: first, to reduce the risk of people being newly infected with TB; secondly, to provide high-quality treatment and care for all people with TB; and thirdly to maintain low levels of drug resistance, especially multi-drug resistant TB. I shall explain why that is important, although having heard the details of my hon. Friend’s constituent’s case I can see why she thinks that those three principles were not followed.
Two thirds of all TB cases occur in people who have come to live in the UK, and some 39 per cent. of all cases in 2007 were in London. My hon. Friend mentioned screening, but most TB is categorised as latent and non-infectious, and is therefore difficult to detect. In as many as a third of all cases, especially in those travelling to the UK to live and work, the TB will be latent. Only roughly one in 10 will go on to develop active TB that is infectious to others.
Regrettably, there is no reliable test to determine which latent TB carrier will develop the active disease. That should reassure the hon. Gentleman about the work that the Department and the health service are doing to reach out to the very groups that he and my hon. Friend identified. Perhaps I should at this point address the question of whether there is screening. I suppose the answer is yes and no, so I shall try to be more specific.
The long-standing policy is that immigrants from high-prevalence countries who seek to enter the UK for more than six months are screened for TB on arrival at the port of entry. A scheme to test applicants overseas rather than at the point of entry began in 2005 and testing currently occurs in seven high-incidence countries. So, to answer my hon. Friend’s point, there is some screening, but she is quite right that it is not systematic screening of everyone, and nor could it be—nor should it be, in my opinion. Such proposals need to be proportionate to the risk, which means that there is not screening across the board for very obvious reasons.
As my hon. Friend pointed out, the PCT in Hackney has the 11th highest rate of TB in the city—just over 60 cases per 100,000 people. That is not the highest rate in London, but the lowest is 6.7 per 100,000. The data for the past five years show that rates in City and Hackney PCT have been declining and continue to do so.
Ms Abbott: Rates have declined, but the decline is a marginal decline. On screening, the problem is that too few people are known to the health authorities. A press report a few years ago said:
“Less than half of people who died from tuberculosis in two east London inner city boroughs were known to the health authorities during their illness. A survey of TB in Hackney and Tower Hamlets showed that even among those being treated, only 27 per cent were notified. Doctors warned that without notification the risks of spreading the infectious disease were increased.”
Dawn Primarolo:
I agree with my hon. Friend. The point that I wanted to make specifically arises from the chief medical officer’s action plan, which gave guidance on how to develop effective TB services. He made the same point as my hon. Friend about the need to reach out to those high-incidence areas and to communities and sections of our communities that are much more difficult to reach for a series of complex reasons, and where there is therefore the greatest risk of infection increasing. My hon. Friend and the hon. Member for Cities of London and Westminster both pointed out that people who are homeless traditionally find it much more difficult to access health care, as do people with alcohol dependency, injecting drug users and prisoners. All those issues are specifically addressed in the action plan, which provides detail about how the strategies in
areas of TB incidence should ensure that the cases are found and about how those areas should have an active policy of doing that.
Indeed, that was further underlined by the good practice guide in March 2006, when the National Institute for Health and Clinical Excellence—NICE—issued clinical guidance for the management of TB and measures for its prevention and control. That guidance made specific recommendations about the types of treatment that should be used, particularly directly observed therapies, and about how to reach out to those vulnerable groups.
The plan identified 10 action points. It said that there was a need to raise awareness among professionals to minimise delays in diagnosis and to ensure that treatment is completed. It also said that there should be high-quality surveillance. I am always nervous about using that word, but by that it meant that health providers should monitor their communities so that they know where the risks lie and where the services are located.
The plan also emphasised the necessity of excellence in clinical care, and it said that patient services should be well organised and co-ordinated—a point that my hon. Friend the Member for Hackney, North and Stoke Newington made with regard to her constituent. The plan said that there should be highly effective disease control and management, that there should be an expert work force with strong commitment and leadership and that international partnerships should be formed to ensure that effective contributions are made towards controlling TB globally.
Most important of all, in 2007 the Department initiated what it called a “find and treat” programme in London, under which team members have been working alongside local TB services to look for cases of the disease among the homeless and other vulnerable groups. The aim has been to help improve the completion of treatment and actively promote the use of directly observed therapy. The find-and-treatment teams are using equipment such as mobile X-ray units to screen systematically in places such as homeless hostels and, if she has not done so already, I hope that my hon. Friend gets an opportunity to see one of the units in action. The teams also ensure that suspected TB cases are taken to local services for diagnosis and treatment. Although the treatment must be implemented in a clear manner, most of the decisions about how it is delivered are taken at the local level.
I hope that the hon. Member for Cities of London and Westminster is reassured that the find-and-treat initiative in London takes account of all the issues that he raised, and that it attempts to focus on the vulnerable groups about whom he is concerned. My hon. Friend the Member for Hackney, North and Stoke Newington also said that we needed to do more for those groups, and she has used this debate to ask whether such work is being undertaken in her PCT area.
Ms Abbott: The Minister mentioned directly observed therapy. I did not want to talk at length about that, but it was one of the concerns raised by Mr. McCabe. As a result of his complaints, and of the Healthcare Commission report, the City and Hackney PCT conducted an audit of its directly observed therapy services, but the audit remains in draft form only. There are many problems about how it has been drawn up, so will the Minister put pressure on the PCT to publish the audit in a proper form and fashion?
Dawn Primarolo: I was about to return to what my hon. Friend said about the specific case of Philip. I have not seen the Healthcare Commission report to which she has referred, but I know from what she has said in other debates that she appreciates that local PCTs must make their own decisions, even if she does not agree with that approach. However, I have heard what she has said about this particular case this afternoon, and I am conscious of the respective roles played by myself at the Department of Health and the PCTs, so I was going to suggest to her that I should take away all the unanswered questions that she has asked. I understand clearly that she and her constituent seek reassurance that the PCT has learned lessons from that tragic experience and that services will be better in future. Will she give me time—not too much—to consider? I will then meet her to see how much further on I have managed to get in answering her questions.
Ms Abbott: As my right hon. Friend says, I simply want answers both to my questions and those of my constituent and it has taken far too long for the PCT to give them. I am grateful to my right hon. Friend for her offer. I shall confer with my constituent and write to my right hon. Friend setting out the questions that we think have not been answered. When she has had time to reflect, I should welcome the opportunity to meet her—perhaps with my constituent—so that we can discuss how to take matters forward and ensure that the PCT, which has many excellent members of staff at many levels, dealing with TB and other issues, can learn the lessons from this episode, so that people need not die in the tragic circumstances of Philip McCabe.
Dawn Primarolo: I am grateful to my hon. Friend for her generosity in accepting my offer. I absolutely agree. It would be very helpful if she could write to me with the specific points that she feels have either not been satisfactorily answered or not answered at all. I am more than happy to meet her and her constituent. I thanked my hon. Friend for her generosity because she and her constituent have already waited a long time for answers. Although I am unable to give them at the Dispatch Box today, I certainly intend to try to do so in my meeting with her. When I acknowledge her questions, I should like to give her an indication of a reasonable time frame for me to find the answers and arrange a meeting.
I am grateful to my hon. Friend and to the hon. Member for Cities of London and Westminster for participating in this debate about a vital public health issue. We have more or less eradicated the disease in the United Kingdom. Those of us with experience of TB, which struck down many members of my family, particularly on my father’s side, know only too well how dreadful the disease is. We know that it is absolutely vital to have proper clinical understanding, science that informs the best treatment and services that deliver it to all sections of our community. I am grateful for the opportunity to confirm today both the Government’s continuing commitment to achieving that aim and the arrangements that I shall make with my hon. Friend the Member for Hackney, North and Stoke Newington to pursue sensible answers on the case she raised.
4.43 pm
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