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14 Dec 2006 : Column 1624
Lord Hurd of Westwell: My Lords—
Lord Rooker: My Lords, it is the turn of the Cross Benches.
Lord Bilimoria: My Lords, the term “co-ordination” was mentioned. Although it is laudable to take things as close to the people as possible, my experience of dealing with India, for example, is that there is often duplication among the regions or that one region does something and another region does not even know that it is going on. What are the Government doing about co-ordination between the regions?
Baroness Andrews: My Lords, RDAs are accountable to the DTI and the regional assemblies speak to our department. We ensure that they network together and speak to us jointly. So, in fact, we build in as much co-ordination as possible.
Lord Morgan: My Lords, is not the Government’s case for strong regional bodies getting stronger all the time, given, as my noble friend said, the growing economic disparities between regions and the growing powers and success of devolution in Wales? Whatever uncertainties there may be in the ancestral history of the Liberal Democrats on this matter, is it not the case that, since the time of RH Tawney, the Labour Party has always stood for strong regional government?
Baroness Andrews: My Lords, we could not have a better historical perspective than from my noble friend.
Afghanistan: Police Training
11.29 am
Lord Astor of Hever asked Her Majesty’s Government:
What is their response to the report on the training of the Afghanistan police force prepared by the State Department and the Department of Defense of the Government of the United States.
Baroness Royall of Blaisdon: My Lords, the document is a report produced by the US State Department for internal use, and we have not received a copy.
Lord Astor of Hever: My Lords, I am disappointed to hear that. This is a very worrying situation. The UK is responsible for counter-narcotics but we have to rely on the American-trained Afghan police, who, according to this report, are corrupt and incapable of carrying out even routine law enforcement work. How is the UK contributing to the vital work of reconstructing the ANP, and how is that co-ordinated among coalition partners, who, apart from the US, appear to be doing very little?
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Baroness Royall of Blaisdon: My Lords, I understand the seriousness of the report as it was reported in the New York Times article. If the allegation is correct then Her Majesty’s Government will express their concerns to the United States because a well functioning police force is vital to democratic society. Noble Lords may be interested to know that, in the summer, Ken Deane, the UK Chief Police Adviser who has a seat on the new international police co-ordination board, suggested an overall review of all police training. I trust that that will happen in the not too distant future. As for the counter-narcotics operation, as noble Lords will be aware, the UK helped to establish the counter-narcotics police of Afghanistan. I understand that the UK is responsible for training the police in that organisation.
Lord Garden: My Lords, could the Minister update us on the status of Mohammed Daoud, until recently the governor of Helmand province, who was appointed with British support and seemed to be doing a good job? If the reports of his sacking are correct—they also allege it was done at the behest of certain US personnel out there—then what does it mean for the police training we are talking about, the rule of law and the eradication of the poppies in Helmand province?
Baroness Royall of Blaisdon: My Lords, we are aware of the situation but the appointment of governors is a matter for the democratically elected Government of Afghanistan. As the noble Lord will be aware, Governor Daoud has made very good progress in his engagement with local communities in Helmand province. We trust that whoever replaces him will have the same sort of record and follow on from his excellent work.
Earl Attlee: My Lords, does the UK police career structure encourage or discourage UK police officers from undertaking duties overseas in places like Afghanistan and Iraq?
Baroness Royall of Blaisdon: My Lords, I am not equipped to comment on the UK police structure. However, I know that a sizable number of police are working in Afghanistan advising various government ministries and working in the provinces. That is taking place also in other situations where we need to assist in building a well functioning police force, for example in Iraq.
Business
Lord Grocott: My Lords, with the leave of the House, a Statement on the post office network will be repeated later today by my noble friend Lord Truscott. We will, with permission, take it immediately after the debate initiated by the noble Lord, Lord Fowler.
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HIV/AIDS and Sexual Health
11.34 am
Lord Fowler rose to call attention to the Government’s policy on HIV/AIDS and sexual health; and to move for Papers.
The noble Lord said: My Lords, we very much look forward to the maiden speech of the noble Baroness, Lady Paisley of St George’s. I also understand that last night it was announced that today may see the swansong speech of the noble Lord, Lord Warner, who I gather is retiring at the end of this year. I will make no jokes about him spending more time with his family but I would like to thank him for all the work that he has done in this House on health. In moving for Papers, I should mention that I am a trustee of the Terrence Higgins Trust and am connected with the National Aids Trust, which I set up.
When we speak of HIV/AIDS we almost automatically think of the global position—the position in Africa, India and south-east Asia. We think of the 25 million people who have already died, the 40 million people who are now infected, the millions who are infected and will die over the next few years for lack of drugs, and the millions who will be infected in the near future because there are no sensible prevention measures. We think of the orphans, the widows and the suffering that has been created. In short, we think of a global crisis, which in one way or another has affected virtually every country in the world. Perhaps the magnitude of the international figures takes away the focus from the deteriorating position in the United Kingdom. This debate allows both the national and the international positions to be raised. If I were to say one thing on the international position, I would wish to pay tribute to the efforts of the Global Fund and Richard Feachem in tackling the situation worldwide.
I want to concentrate on the national position, which I do for these reasons: too often, the sexual health crisis in this country is ignored and swept under the carpet; too often, over the past 20 years, politicians have been embarrassed to get properly involved; and too often, sexual health has come bottom in the priorities of health Ministers and health authorities. In this House a week or two ago, a speaker bemoaned the difficulty of getting the public involved in the issues of mental health; she should try to get support for sexual health clinics or better facilities for clean needle exchanges for drug users.
What is the position in the UK? There are now 70,000 people living with HIV. On present trends, the figure will reach 100,000 in three years’ time. We have already seen a threefold increase in the number of people accessing HIV treatment and care services since 1997. Compared with other west European countries, our position was once the best, but we now rest at the bottom of the scale. The Health Protection Agency now identifies HIV as one of the most serious infectious diseases facing this country.
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On other sexual diseases, last year there were 110,000 new diagnoses of chlamydia, a 200 per cent increase since 1996; almost 20,000 new cases of gonorrhoea, a 50 per cent increase since 1996; and 2,800 new cases of syphilis, another big increase over the same period. Add to that the undoubted pressure that the GUM clinics—the sexual health clinics—are under and one can see why the professionals on the ground talk about a sexual health crisis in this country. Above all, they want serious and effective action to counter it.
I speak in this debate with the following experience. Exactly 20 years ago, I was launching the then Government’s public health campaign on HIV/AIDS. Just before Christmas 1986, we put up posters around the country on the theme,
We followed that up with television and radio advertising using the tombstone theme and then the iceberg. We sent leaflets to every household in the country and, in spite of a great deal of opposition, we introduced clean needle exchanges for drug users. The results of that campaign were startling. Our follow-up campaign showed that, as a result, 98 per cent of the public understood how HIV was transmitted—the figures for today are not remotely as good as that—and 95 per cent of the public said that the Government were right to carry out a campaign of this kind, which should persuade the nervous in Whitehall to follow suit. Most of all, new diagnoses not only of HIV but of sexual diseases came down markedly as a result, while the free needle exchange undoubtedly saved lives, as it undoubtedly continues to do.
Contrary to much advice that we received—at that time we received a great deal of advice on how the campaign should be conducted—we did not preach at the public. We gave them the best medical advice that we had. We also gave them this advice on every poster: the more partners, the greater the risk; protect yourself; use a condom. That remains very much the advice today. Using a condom is the most effective means of preventing disease.
I am going to be critical of the Government’s policy in this area, but there is one comment that I applaud. The Prime Minister said in his interview on World AIDS Day that the Roman Catholic Church should change its attitude to the use of condoms and recognise it as a way of preventing disease and protecting lives. There is a curious contrast in attitude here. I remember going to New York during my campaign and visiting the Roman Catholic St Clare’s Hospital. There was some magnificent work being carried out there but, in those days, because AIDS was fatal, it was to ease AIDS patients into death. Surely it is possible to look at the use of condoms as a way of preserving life—which it is if you have no drugs—and of preventing disease and suffering. The good that could still be done by a change of stance by the church is considerable. So I welcome the Prime Minister’s lead here.
I wish that I could say the same for all the other policies that have been followed since the Prime Minister came to power. Incidentally, I do not in any
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- “we remain committed to improving the sexual health of the nation and continue to make it a government priority. We have already invested £300m as part of our Public Health Paper—the largest amount ever for this area”.
Of course, the trouble was that they had not already invested £300 million. They had said that they would invest that money. They had said that they would allocate £130 million for modernising the clinics, £80 million for accelerated implementation of chlamydia screening, £40 million for contraceptive services, and £50 million for a new national advertising campaign. Take that £50 million for a national advertising campaign: a campaign was indeed launched last month, but it did not cost £50 million, £40 million or even £10 million. It cost £3.6 million. So far there has been absolutely no guarantee that the remaining £46 million will be spent, although we know how effective such spending can be.
Whatever may be the case elsewhere, this is a direct Department of Health responsibility. This is not down to the primary care trusts; it is down to the department and the Ministers. What of the other money? Much of that has not been spent either. The Independent Advisory Group on Sexual Health and HIV, under the chairmanship of the noble Baroness, Lady Gould—to whom I pay tribute in the hope that it will not do her too much harm—carried out a survey of primary care trusts. I quote directly from the group’s report, which for some reason has not been published in full by the Government:
“Almost two-thirds of PCTs from whom we have received evidence have withheld some or all of their Choosing Health allocation for sexual health, primarily to address their financial deficits. This has affected all aspects of sexual health covered in Choosing Health: contraception, chlamydia screening, and GUM services. Not even the high priority public service agreement (PSA) targets for chlamydia screening and 48 hour GUM access have protected these funding allocations, and contraception remains the ‘Cinderella’ service”.
The independent advisory group is not alone in making such comments. I have also received a joint letter from the presidents of the British Association for Sexual Health and HIV and the Faculty of Family Planning & Reproductive Health Care. They have been pressing the Government on this, and said:
“The result of this disinvestment is poor access to services, increases in waiting times and in some cases the closure of clinics, which will ultimately lead to further increases in sexually transmitted diseases, unplanned pregnancies and abortions”.
Similar points have been made by other organisations, such as the Terrence Higgins Trust, the National AIDS Trust and, again today, the independent advisory group.
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Part of the tragedy is that no one can seriously argue that extravagance in sexual services provision has led to the financial problems of the health service. All too often, the clinics are housed in poor, almost rundown accommodation where the pressure of demand is constant and unremitting, yet precisely those services are being penalised. Doubtless, the hope is that economies here will not produce the same public outcry as they would in some obviously more popular medical services.
We should be under no illusion about the impact of the diversion of resources. It means not just that expansion money has been cut back locally, but also that regular budgets have been cut in some areas. The Wandsworth PCT issued a press release saying that, due to financial pressures, none of the new funding intended for sexual health was going to be committed during the 2006-07 financial year. In some way—ring-fencing, if necessary—we must ensure that money allocated for sexual health actually reaches these services. It is not enough to say that it is a local decision when the result is plainly unacceptable. The Government have a national responsibility for public health. What is happening today is clearly against the public interest. It means that there is even greater pressure on overstretched services, that infection spreads as patients waiting for appointments remain untreated and that the eventual cost to the health service will be not less, but substantially greater.
Ultimately, this is not a financial question, but a moral issue. Just as we know what works internationally, we know what can be done to bring down our figures in the United Kingdom. We know that a major national advertising campaign can be effective in changing behaviour, but we have failed to mount one for 20 years. We know that modern clinics provide the right environment for advice and treatment, but we struggle on in outdated premises. We know that well staffed services can have a real impact in providing proper care, yet we are content to see cuts being made in the already inadequate. As things stand, there is not much here for your Lordships’ comfort. Political commitment will be necessary to change the position. I hope that such a commitment will be forthcoming. I beg to move for Papers.
11.48 pm
Baroness Gould of Potternewton: My Lords, I thank the noble Lord, Lord Fowler, for initiating this debate on the crucial subject of sexual health and for his kind comments.
Today, the Independent Advisory Group on Sexual Health and HIV—which, as the noble Lord said, I chair; I therefore declare an interest—launched its third annual report. It makes many positive recommendations for the future. Key areas considered are what constitutes effective leadership for sexual health, commissioning frameworks, training and development, prevention, and health promotion. We also say that we welcome the constructive steps taken by the Government and the department.
The 2004 Choosing Health White Paper, mentioned by the noble Lord, Lord Fowler, recognised—crucially, for the first time—that sexual health was a public health issue. Important commitments were
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Those aims can be achieved only by drawing national funding into identified local delivery. The noble Lord, Lord Fowler, quoted the experience of £300 million of Choosing Health funding not reaching the front-line services for which it was intended. Experience has taught us that if the Government really want the money spent where it should be spent, it must be ring-fenced. Caroline Flint, the public health Minister, speaking at the annual conference of the Association of Directors of Public Health, hinted that the Government may consider ring-fencing funds for specific public health initiatives. Can my noble friend the Minister elaborate on that statement?
The National Strategy for Sexual Health and HIV, published in 2001, recognised the need to modernise and improve sexual health services based on the need for a holistic service. But there is a danger that the current reconfiguration and the introduction of payment by results encourages the fragmentation of sexual health services rather than the holistic approach envisaged by the national strategy. There are many benefits to the new commissioning structure and the modernisation initiative, not least the encouragement of innovative solutions to local problems. But against that background, and too often the lack of support at local level, the Government should ensure that sexual health services are protected and that the commissioning of services is reviewed on a national basis.
Ideally, there should be an over-arching, comprehensive strategy that incorporates all aspects of sexual health, similar to the extremely detailed strategy produced earlier this year on targets for reducing teenage pregnancy rates. Such a strategy is particularly important in light of the recent HPA report, A Complex Picture, which makes it clear that the current situation presents a substantial challenge to sexual health strategies across the UK. The problem is that the majority of PCTs have no formal strategy in place to address the rising STI rates or to maintain adequate contraceptive services.
The noble Lord, Lord Fowler, graphically presented the HPA findings and they do make disturbing reading. HIV prevalence continues to increase steadily, STIs diagnosed in GUM clinics in the UK have increased in the last year by nearly 23,000 and there is a further substantial increase in syphilis. There has in the past few years been a continuing decline in gonorrhoea but a disproportionate number of young people are affected by it as they are by genital warts and chlamydia. Over 100,000 young people have chlamydia, part of the 200 per cent increase which the noble Lord, Lord Fowler, mentioned. Overall, however, the picture is much more complex as there are many cases of co-infections of HIV, syphilis and gonorrhoea.
The 48-hour target for GUM access is an immensely powerful lever, but the rising HIV workload, estimated at 20 per cent, can have a disproportionate impact on access to GUM. There is clearly a need for existing
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