§ Order for Second Reading read.12.22 pm
§ Mr. Gavin Strang (Edinburgh, East)
I beg to move, That the bill be now read a Second time.
Parliament can be in no doubt about the threat of AIDS to our society. According to the December figures 610 AIDS cases had been registered in the United Kingdom, and about half those people had already died. When the Secretary of State for Social Services opened the AIDS debate on 21 November he estimated that there were about 30,000 HIV—human immune deficiency virus—carriers in the country. We know that the median time between becoming infected and developing AIDS is around five years, and according to latest estimates it is likely that about 40 per cent. of those infected with the virus will acquire AIDS within five years.
There is no cure for AIDS. Everyone who has the disease dies of it. It was first described only in 1981, and although a great deal has been learnt about it since then there is no good ground for believing that a cure will be discovered in the next few years.
Edinburgh is especially concerned about the disease. Although two thirds of the AIDS cases to which I referred occurred in the London area, hon. Members will be aware that in Edinburgh well over 50 per cent. of injecting drug misusers are HIV carriers. It is feared—I do not think there can be any doubt about it—that in a few years the percentage of the population who will develop AIDS in Edinburgh will be higher than in any other city in the United Kingdom.
We had a useful debate on 21 December, when the Government announced their public education campaign, which I support. I believe that the campaign, and the work of many broadcasters and journalists throughout the country, has helped to raise public awareness of this issue. It is vital that people should learn about the facts.
We have learnt a great deal about the disease. We know how it is transmitted. We know also that people understand the facts about the disease. If they respond to the guidance that they receive, they can reduce to a negligible level their chances of becoming infected. However, it has to be assumed that there will not be a cure for some considerable time. Even on the best assumptions about the efficacy of the Government's campaign and the response to it by society as a whole, this crisis will be with us until the end of the century. It is the biggest public health crisis for over half a century.
§ Mr. Robert Rhodes James (Cambridge)
I strongly support the Bill and congratulate the hon. Member for Edinburgh, East (Mr. Strang) on introducing it. However, in view of the speed of events, does he think that an annual report is sufficient?
§ Mr. Strang
I shall deal with that point when I turn to the provisions of the Bill.
If enacted, the Bill will make an important contribution to our fight against the disease. Other steps will have to be taken, and I have no doubt that they will be taken. In some respects the Bill will complement the work that the Government have already set in hand.
In response to the intervention of the hon. Member for Cambridge (Mr. Rhodes James), it might be helpful if I take hon. Members through the Bill. Clause 1 is the 1169 substantive clause, and subsection (1) spells out the central purpose of the Bill. It lays a statutory duty on every district health authority in England and Wales, and on every health board in Scotland, to produce an annual report on AIDS. The first report will become available to Parliament on 1 February 1988. The statistical data will refer to the position at 30 November of the previous year. Therefore, the data included in the first published report will relate to what has happened up to 30 November 1987.
The Government will be obtaining data continuously and they may choose to ask for monthly or quarterly statistics. There is a very real case to be made for laying a statutory requirement on district health authorities to produce reports. However, it would be unwise to ask for more than one report each year. An annual report is the right approach for Parliament and the wider public, but the Government may choose to ask for more frequent reports from the district health authorities and health boards.
Subsection (2) sets out the prescribed form for each report. If the data from the reports can be collated, it will then be easy to compare the reports. Therefore, it is necessary to lay down a format that can be developed subsequently.
Clause 1(2) lays down the areas which the report should cover. Paragraphs (a) to (e) refer to the statistics in relation to 30 November of the previous year; that is, the number of sufferers, the percentage of the population, and the number of carriers. Those data are of great importance. There may be some scope for making adjustments to the precise nature of the data required, but it is vital that the figures should be available to Parliament for each district health authority and health board.
Paragraphs (a) to (e) relate to the past, and paragraph (f) asks the boards and authorities to estimate the number of persons who are likely either to become infected by the virus or to develop AIDS in the next 12 months. Paragraph (g) is important, because it is crucial that we recognise that this is a report not on what the authority has done, but on everything being done within the area of the authority in relation to AIDS. It will help to promote better co-ordination between the different agencies—the local authorities as well as the health authorities and voluntary bodies. It is vital that we have a report on treatment and counselling—counselling is important to the high-risk groups—those who become carriers and are known to be carriers, and, those who sadly, develop AIDS.
Paragraph (h) relates to the action taken not only by the authority or board, but by public agencies and voluntary organisations to control the spread of the virus. Paragraph (i) relates to education. This is important. I do not intend to criticise the Government's campaign—I am sure that the Minister will acknowledge this—but a media campaign can only be part of the process of education. It is important that we have an annual report on what is being done in the schools and elsewhere to educate people and give them the facts about the disease, thus enabling them to alter their lifestyles and reduce their chances of becoming infected. Paragraph (j) enables the Secretary of State to bring forward additional requirements for information in the report. This is the substantive clause.
1170 Clauses 2 and 4 relate to Northern Ireland because the Bill will apply to England, Scotland and Wales.
Clause 3 contains a provision which may not be necessary. We may reach a judgment which accepts that there is not any significant net increase in public expenditure for the purposes of the Bill.
The Bill has broad professional support, including that of the British Medical Association. In practice, the work will be done by the AIDS co-ordinator and his staff, but I believe that the statutory requirement on the authorities and the boards to produce the first report by February 1988 will have the effect of galvanising them into action where this is needed. There is no question but that a range of organisations must become involved. The Government have an overriding responsibility, and local authorities have a major responsibility, but society as a whole has a responsibility and I hope that one effect of the Bill will be to help to galvanise the areas into action.
Secondly, there is no doubt that the Bill will provide a viable data base. I stress that it is essential that that data should be publicly available. In a sense, the nub of the Bill is that information will be published and made available to Members of Parliament, the local media and everyone else and it will be easy to collate. Indeed, one assumes that that will be done on a regional and national basis.
Thirdly—this comes up at conferences on the issue—different professionals would like to learn about what is happening in other areas. I shall not name the English authorities, but some are well up front and must be applauded for that. At least one is represented on the Conservative Benches today. But Edinburgh is well down the road in taking action, while other authorities have not yet started. The social work department is planning a hospice and all the work is well in hand. We shall, sadly, be hit within a year or so with perhaps up to 100 AIDS cases. There is a strong wish among professionals to learn more about what is happening in the different areas, and the reports will enable that to happen.
Fourthly, the Bill will achieve better co-ordination within the areas. The very fact that the report has to cover not just the authority but all the public agencies and voluntary organisations will enable that to happen. There will have to be good co-ordination. There is a great challenge to society in caring for the sufferers.
I was at a religious conference yesterday organised by Scottish Television, attended by people of all denominations, not just Christians, and there was a real recognition on the part of the Church leaders that the churches and everyone else could make a contribution to the work in the voluntary sector if they so wished. Parliament and the public will be better able to understand the scale of the problem as a result of the reports.
Sixthly, the Bill will be important for resource planning. In London, but also in Edinburgh and other parts of the country, decisions already have to be taken in relation to provisions for the sufferers of AIDS, and, of course, counselling.
Seventhly, and finally, as I have said, we shall be dealing with this problem for the rest of the century. The reports will help us to evaluate the success of society's efforts to combat the disease.
The Bill will make an important contribution to meeting the challenge of AIDS. This means that it will help us to reduce the rate of spread and to support the sufferers and their families.
§ Mr. Andrew Rowe (Mid-Kent)
I congratulate the hon. Member for Edinburgh, East (Mr. Strang) on having brought the Bill before the House and I am proud to have been associated with him as one of its sponsors. I understand that at this early stage in our coming to terms with this major epidemic, it is much better to advance steadily from a base of agreed knowledge than to panic and rush into extreme activity.
However, while I welcome the Bill, it is proper to say that in the comparatively short term it does not go far enough. I say that advisedly because the largest experience of the disease and unfortunately—or, in one sense, fortunately—its most dramatic incidence is overseas. The hon. Member for Edinburgh, East said that the hallmark of almost all the professionals operating in this area is that they are desperate to get as much information as they can from one another, whether they are within the boundaries of the United Kingdom or outside them.
Yesterday I went to my first meeting as a newly elected member of the council of the Save The Children Fund and was impressed to learn of the considerable co-operation between the international voluntary organisations dealing with AIDS, and of the sophistication of much of the thinking that they are putting in to their handling of the matter. Very real lessons can be learned for the collection of information for which the Bill is pressing. It is, for example, true to say that the Edinburgh office of the Save The Children Fund is co-ordinating the Save The Children Fund effort. One of the hallmarks of the large voluntary organisations is that all of them have seen the vital importance of informing their staff about the disease and how to handle it in their work. Many of those organisations are, of course, screening their volunteers and workers before they take up their posts abroad and have already developed an encouraging level of communication with their staff about the dangers of the disease.
I ask the Minister to assure the House that the Government are pressing upon firms that send people overseas the need to exercise the same amount of responsible communication with their staff that the international voluntary organisations seem to be able to do.
The scale of the disease has already been discussed in the House on several occasions and I shall not go into it in great detail. However, it is worth remembering that in Kinshasa alone about 45,000 cases have been confirmed out of a population of 3 million. That is a sizeable and terrifying figure. The World Health Organisation has pointed out that about 86,000 cases have already been notified from the Americas, the bulk of which come from the USA. Therefore, as we know, this is not a small matter.
§ Mr. Ian Mikardo (Bow and Poplar)
Like the hon. Gentleman, I am a supporter of the Bill and I have followed very closely and with great interest what he is saying. He said that he wished that the Bill went a bit further. A doctor of my acquaintance used those very words to me two or three days ago. I asked the doctor what he would like the Bill to contain that it does not contain already, and the chap could not answer the question. Therefore, I put it to the hon. Gentleman: what would he like to see in the Bill that is not there?
§ Mr. Rowe
I should like to see two things. First, I should like to see a statement about the extent to which 1172 health authorities are co-operating with and learning from international agencies, because that is something that they could usefully do. Secondly, I am not wholly satisfied that the Bill, as it stands, demands enough information about the progress of educational and counselling procedures. We could consider those two points with advantage later on.
It is interesting that people in the countries where there is much greater experience of the disease have learnt two things. First, in most of the countries where it is most obvious, it is transmitted principally by heterosexual rather than homosexual activity. That is a matter of enormous importance for the public in this country to understand. Secondly, those people have already learnt the lesson, which our medical people have not been slow to learn, that it is possible to sterilise equipment in ways that kill the disease, and it is possible for simple sterilisation and anti viral procedures to be operated. The virus cannot survive in temperatures much above 60 deg C. It is killed by household bleach. It cannot survive an attack by chlorine. Those are important matters, when people think of the disease as a monster about which one can do nothing of substance.
Already, in many parts of the world it is clear that if one could make absolutely certain that the blood used for transfusions and the blood products used in operations and for other purposes were properly sterile, one could give the spread of the disease a considerable check. Those are matters upon which we need to make as much progress as possible.
I should like to refer to the reaction at home to AIDS sufferers. Even if it is difficult to measure it in the information that will be required of health authorities, we should not lose sight of it. In the current issue of the community Caremagazine there is a horrifying story. A young man was arrested during an affray and cried out that he had AIDS. He was instantly treated as some sort of pariah and leper. It was a sorry saga of how the social work staff, the police and every one else reacted to him. I should hate to see that repeated on a wide scale.
We already know that some workers in the public health system, in the social service departments of some local authorities, and so on will not go into the house of someone who has been shown to have positive signs of AIDS in his blood—not even an AIDS case. That information should be treated with extreme confidentiality anyway. That shows the desperate need for much better information and education for those who are naturally anxious not to catch the disease while serving the public in the way in which they have been recruited to do.
That raises the matter of who make the most appropriate counsellors for those who are known to have the disease or to be at risk. There is a strong case for saying that some counsellors, particularly people disseminating information and education to young people, should themselves be young people. I have dealings with a voluntary organisation that is anxious to be allowed to put its long experience of using young people to educate young people to work, in producing a breed of AIDS counsellors who will be able to go round schools and youth clubs and talk, as contemporaries, to people at risk about the ways in which to avoid the disease. In some cases they might go further than that and offer counselling to those who have contracted it. Any reports produced by the health authorities could give some suggestion of the scale of that sort of work.
1173 I believe that we are going seriously wrong in Britain in our debate about sexuality and people's personal sexual lives. Those local authorities—I am not as trenchant in my criticism of them as some of my colleagues—which advertise for lesbians to work in particular areas have got the wrong end of the stick. People's sexual lives are a private matter and it becomes a matter of public interest or of concern to a wider group than the individual and their immediate family only if, in some way or another, they are wrongfully involving other people in it. It is of no importance whether a school teacher is homosexually inclined as long as the children in his care have no reason to know that and no reason to feel threatened by it.
The same is true of heterosexual activity. It does not matter how people express themselves heterosexually in the privacy of their own homes with consenting partners. It matters only if it seems to interfere with the way in which they do their work and the relationships they have with people in their care. If we could get back to an understanding of that I believe that we would considerably diminish the very real danger that I perceive, which is that people who are known, by whatever mechanism, to have AIDS will be victimised.
I am prepared to bet that many people who are diagnosed as having positive indications in the blood will, in the initial horror of the revelation, be far too free in telling people about it. It is a human reaction to share it with everyone and news will get around. Those people will be shunned, ignored and ill treated by our society unless we have a much more balanced view of the causes of AIDS. After all, there will be many more people in a few years who could not conceivably have contracted the disease through immoral or improper practices. They may contract it by being married to someone who did not even know they had it when they got married. Therefore, it will be improper to discriminate against them or to stigmatise them.
It is important that there should be good education about how the disease is contracted. There should be good counselling for everybody about how to handle people who have the disease and, above all, there should be a much clearer understanding that people's private sexual lives are their own concern, unless and until they interfere with or threaten someone outside. For those reasons, I believe that the more information we can have on this epidemic the better it will be. I welcome the Bill.
§ Ms. Jo Richardson (Barking)
I welcome the constructive and useful Bill that has been introduced by my hon. Friend the Member for Edinburgh, East (Mr. Strang). It seems to initiate some sort of long-term strategy for combating AIDS. Clearly, it is a modest Bill, but it is a measure that will be of long-term practical use to Parliament and hopefully, and more importantly in many ways, to the people who have to tackle AIDS at local level—such as those who are in daily contact with the disease.
When I first read the Bill my immediate reaction was, "What does it do?" It is very modest in its language. When I read it, I thought, "Where are the references to screening, needles and—dare I say it—to condoms?" My hon. 1174 Friend the Member for Edinburgh, East was right to leave out those complex problems and to tackle this specific part of the question.
I have very positive views about what action the Government should be taking to tackle the wider question. The Select Committee on Social Services is currently considering these issues and I am sure that all hon. Members look forward to an early and clear response from that Committee.
The Bill recognises the clear splits that exist between the Government and the "experts". It recognises the division and the impossibility of a private Member introducing legislation that would take into account all the various aspects of this terrible problem which presents moral dilemmas for the Government and society. The Bill introduces measures to which certainly no one could possibly object. These measures should have been in practice for a number of years, if only we had woken up to the problem earlier.
I note that the Bill provides that the report which each district health authority will have to produce will be in a "prescribed form". That means that the figures that will be produced will be based on standard criteria throughout Britain. That will provide more accurate statistics than any that exist now. However, there is no point in producing statistics for the sake of it. The figures of cases of AIDS and HIV carriers will allow a targeting of funds to cope with the disease which is not possible at the moment. I am aware that the Secretary of State has now received proposals from district health authorities in that area. The Bill will make that process much easier and more accurate for all concerned.
The very fact that district health authorities will have to produce a report will galvanise those more reluctant authorities into action over AIDS. I am sure that hon. Members will recognise that in some areas the reaction is still, "It can't happen here," or, "Even if it does happen here, it cannot affect us." We have a duty in Parliament to explain to people that this is not a problem which unfortunately affects a small number of people or one group of people. It can affect everyone.
Obviously, some areas have already had more experience than others in dealing with AIDS. The cumulative figures for the total number of AIDS cases until the end of December 1986, as my hon. Friend the Member for Edinburgh, East said, show that, of the 610 cases in the United Kingdom, the North West Thames regional health authority has 302 and altogether, London has 473 cases. However, there are just two cases in Northern Ireland.
The Bill will facilitate the process whereby authorities in Northern Ireland would be able to gain easy access to the experience of, for example, the North West Thames regional health authority or any other area and learn from its success or failure. The report would also show those areas without a large number of AIDS cases at present, but which are expecting what might almost be called an explosion of cases in the next 12 months. In that respect, I can mention Edinburgh. I do not recall that my hon. Friend the Member for Edinburgh, East referred to this point, but there was an explosion in Edinburgh in the 1970s of hepatitis B, which caused many problems. There are parallels with AIDS, but only in the sense that it came about through drug injection. We must look at the 1175 experience and knowledge that Edinburgh gained from that, which I am sure it will be only too willing to pass on to district health authorities.
Clause 1(2) (j) allows the Secretary of State to add to the Bill any extra provision which he feels is necessary and I hope that he will bear in mind how the disease affects women. The history of AIDS in England and Wales is closely identified with gay men. Indeed, the less informed, and perhaps more reactionary, among us liked to refer to it as the "gay plague".
§ Ms. Richardson
Indeed, some still do.
However, that is not the case in Scotland or other parts of the world. AIDS is not a gay disease, never has been and never will be. It spread among the gay community in London mainly because it was introduced there. In the United States of America it spread from San Francisco, where there is a greater concentration of gay men, to the rest of the country.
The repression and, often, discrimination of gay people sometimes brings pressures which result in their having a high number of sexual partners. The experience in Scotland is that the AIDS virus, HIV, is transmitted mainly among those who inject drugs. In other words, AIDS is transmitted completely differently. Those people account for over 60 per cent. of all those who are HIV-positive in Scotland. However, in England and Wales, 97 per cent. of HIV carriers are men who have contracted the disease from sexual contact. In Africa, most HIV infection is transmitted heterosexually and almost as many women as men are sufferers.
Unfortunately, women will account for an increasing proportion of the total number of AIDS and HIV cases in Britain. I must add that it is also unfortunate for men. Already one third of the HIV-positive drug injecters in Scotland are women. In that context I was worried to read the Office of Health Economics' booklet which forecast the AIDS virus. It showed rising intravenous drug abuse among young women. Their number increased by more than a third between 1982 and 1984. The problem is further compounded by the necessity of many drug addicts to turn to prostitution to finance the habit. In heterosexual intercourse, women are more likely to get AIDS from a man than to give it to a man.
Pregnancy throws up a twofold problem for mother and baby. At present we are not sure why some people with HIV develop AIDS and others do not. It has something to do with the state of a person's health and especially with the state of the immune system. The immense suppression of the immune system during pregnancy almost certainly increases the chances of an HIV mother developing AIDS.
The other side of the coin is the danger to the foetus. The virus can be transmitted to the foetus through the mother's blood or to the baby through her milk. Statistics show that there is a 50:50 chance of an HIV mother giving birth to an HIV child. Clearly, that raises all sorts of issues, ranging from the need for better advice, contraception and abortion facilities to much more freely available screening for those wishing to have a baby and the use of condoms to prevent cervical cancer.
The hon. Member for Mid-Kent (Mr. Rowe) touched on the question of confidentiality. Bisexual and heterosexual men and women who have more than one 1176 partner will clearly be at risk from the disease. We must think with the greatest care how, without breaking confidentiality, we can try to counsel people that they must tell each other, and that they do not have to risk passing on the virus simply because they have more than one partner. They are placed in a dilemma. It will need careful thought to determine how that counselling may be done without breaking confidentiality, or, indeed, breaking a relationship between a man and a woman.
§ Mr. Rowe
Does the hon. Lady also not agree—she made this extremely important point—that the ease with which it will be possible to counsel people to share this information will depend substantially on the progress that we manage to make in preventing the community from stigmatising people who are known to carry the virus?
Absolutely. We have made a small amount of progress in that respect, but it is only small. There is beginning to be a slight change of attitude in the public mind. There will be phases. In the first phase, they do not wish to know; in the second phase they do not wish to have anything to do with anybody who has had anything to do with it; in the third phase they do not come to terms with it. It will be difficult for anybody to come to terms with the problem in that sense. We must develop our attitudes and work out carefully and closely how we do it. Certainly, we must not allow people who are unfortunate enough to contract the disease to be stigmatised in any way.
Having made those few remarks and having pointed to some of the problems that are not tackled by the Bill, I welcome my hon. Friend's attempt to make some progress. I do not suggest that the problems that I have outlined are suitable to be included in a private Member's Bill. My hon. Friend's Bill will pave the way for proper statistical information to be collected on an even basis throughout the country to give us, the Government and society a much clearer idea of what is happening and of what can perhaps be done in the future to help in this dreadful situation.
§ 1.7 pm
§ Mr. David Crouch (Canterbury)
When we last debated the AIDS problem, I commented on the high level of the debate, the seriousness with which it was treated and the universal acceptance of the problem, with no party differences expressed. Already, we have had the same experience today. This is not a party matter; it is a serious national problem. After considering the Bill, I decided that it was necessary. I congratulate the hon. Member for Edinburgh, East (Mr. Strang) on having brought it before the House as a private Member's Bill.
It is rather odd that a problem as serious as AIDS—a new disease spreading in this country and in the rest of the world—should be tackled by a private Member's Bill. I hasten to say to my hon. Friend the Minister that this is no criticism of the Government. It represents many hon. Member's awareness of the seriousness of the matter. We all wish to do something about it.
In health debates, it is proper that I declare that I have an interest. I am a member of the Medical Research Council and a director of a pharmaceutical company. I do not seek to draw on any of that expertise, as I did when I spoke in the last AIDS debate. I wish to speak to the Bill. The Bill is not so much about whether sufficient research has been carried out to find a cure or a vaccine for HIV 1177 —for AIDS—as about work in health authorities, social services, in voluntary bodies, in the home and in society. I congratulate the hon. Gentleman on the fact that he has brought forward the important point that we need to tackle the problem and obtain information about it.
Why is the Bill necessary? We are facing the beginning of an epidemic. We need more information so that we can properly assess the scale of the problem and find out where it is concentrated, where it is developing and where the danger spots are. Hon Members have said that the disease is developing in some areas—for example, among drug users in Edinburgh—but is spreading more rapidly among the gay community in London. We need to determine where the growth points are and the cause of the growth. We need to find out where the disease might spread.
We do not have as much experience of this disease as we do of others. We do not need to have a special debate if there is an outbreak of diseases known to the World Health Organisation, the Department of Health and Social Security and the Government. There are set plans for coping with those diseases and they are immediately put into action. With this disease, we are at the beginning of an epidemic and we do not know enough. The Bill will help us to find out much more.
§ Mr. Mikardo
I am very interested in what the hon. Gentleman is saying about the value of obtaining information about what is happening with AIDS. Perhaps it would be worth considering in Committee whether the statistics that are requested under paragraphs (a), (b), (c), (d) and (e)should be subdivided according to sex, age, drug use and—although I am a little more doubtful about this—marital status.
§ Mr. Crouch
If we were considering an illness and we knew its varieties and degrees, there might have been a series of schedules to the Bill prescribing the categories to which the hon. Gentleman referred, so that they were all considered in detail. Bills with nothing to do with health contain schedule after schedule which dot every i and cross every t. I am sure that that point can be picked up in Committee.
This is a time for planning, not for panic. We can only plan and mobilise our resources—money, medical resources and social and voluntary work—if we know what we are up against. Those plans must be approved by Parliament, so we have a Bill. It is right that we should have legislation.
We must ensure that the right actions and the right amount of action are taken to prevent the spread of the disease—for example, by education and by advertising, which in a way resulted from our previous debate, not only in its present form on television and radio and in the press but by seminars for those in danger, such as drug users and young people. We must talk in the right areas in the right language. We must go out into the field with the right people to communicate, not preach—in other words, to educate.
We must take the right action in not only medical but caring treatment. Are we sure yet that we know enough about how to care for AIDS sufferers? My hon. Friend the Member for Mid-Kent (Mr. Rowe) properly referred to the need not to stigmatise people who suffer from that disease. Why should we stigmatise anyone for any disease, 1178 no matter how they have caught it? To suffer from that disease is to suffer from a physical ailment and to suffer shame, remorse and regret. Those people need care and concern from those who look after them. They need not only medical care but care in the sense that I am trying to describe.
In terms of the resources we are considering, we shall need to find not only hospital beds but hospice beds, facilities for treatment at home, out-patient care, training of social workers and encouragement of the voluntary bodies, some of which already exist. I pay tribute to the Terrence Higgins Trust, which has achieved miracles in its work so far on a minimum budget. It is helped, of course, by the Government and I congratulate the Government on that. The trust has achieved a great deal but we need more of such knowledgeable, voluntary and helpful work.
§ Ms. Richardson
I have followed the hon. Gentleman's arguments carefully. I agree with the tribute he paid—to which I add my own voice—to the voluntary bodies, but we must balance their contributions with care in the community into which money is put by local authorities, or the district health authorities. I would hate to think—I am sure that the hon. Gentleman is not implying—that the voluntary agencies could become in caring terms the substitute for the resources that should be put in by the Government or local authorities.
§ Mr. Crouch
I did not mean to imply that. I did not wish to neglect to refer to the great work already done in the first few years of this epidemic by the voluntary bodies.
I shall continue to develop my point that the data we seek to collect by this Bill to produce action must result in a combination of Government action through the health authorities and the social service departments and embrace the voluntary work in the hospice and counselling movements.
§ Mr. Crouch
And in the family. I was going to mention that that was another important area where we want to ensure that we have enough resources for counselling as well as just for caring for sufferers and providing medical help to those who are in the final stages of the illness. Counselling is needed much earlier. Counselling is necessary when someone asks to be screened and then learns that he carries the HIV virus. Such a person urgently needs well trained counselling.
That is a serious dilemma. Such people have volunteered to come forward and find to their dismay that they are carrying the virus. At that stage, they will need to be counselled and trained people will be needed to do it. We need to be sure from Government and from the Department that an understanding of how that counselling should be done is passed on regionally and in districts so that it becomes a specialisation and a professional approach is adopted to a serious matter. We must ensure that we do not neglect that.
In the Bill we call for support for the health authorities. They are always under pressure for money, as we have heard endlessly during health debates, but now they are under pressure for yet more money to be spent on providing adequate medical provision in hospitals—out-patient treatment and other hospital departments. The general practitioners may need much more training on AIDS. Hospital authorities must consider whether they 1179 can provide the beds, the trained persons and all the other facilities that are necessary. They will have to train their staff in the special preventive measures that are necessary in treating AIDS patients so that the staff can treat them with confidence and not feel fearful of doing so. All this requires a great deal of attention from the centre, and it is so proper that we are reminding the Government today of that need.
We should be calling on all social service departments to consider their approach to the problem. As the House knows, I served for 15 years on the South East Thames health authority, and in October 1986 I received a copy of "The Fight against AIDS". Action has been taken by that health authority. The document is extremely good and I cannot fault it. It is a complete study of the problem that we are considering. The only omission is a recommendation that there should be an annual report, but there is a requirement that all the districts under the authority should consider the problems. All the issues that have to be considered are listed, but there is no call for an anual report. That is a minor omission, because such a report would come forward in the normal course of events: all districts have to report to their regions and the regions report to the Secretary of State.
I am glad to report that one region with which I am familiar—it covers my constituency—has already taken action. I imagine that similar reports have come forward already from all the regions. I should like an assurance from my hon. Friend the Minister for Health when he intervenes that there has been a similarly good response from health authorities generally in facing the problem.
I have mentioned the important work of the social services and have said that they should study the problem that is presented by AIDS. I have mentioned also the voluntary bodies. It is clear that co-ordination is important. We shall receive information and we shall have a measure of the danger of a spreading epidemic. We shall have a measure also of our resources, and information will be provided by the various statutory bodies on the danger that is coming forward, but we shall need to co-ordinate. There must be co-ordination between health and social services, voluntary bodies and the Departments. There is a case for the Government to set up a war cabinet or a crisis centre.
I remind my hon. Friend the Minister of a proposal that was made in a paper that was sent to him recently by a friend of mine, the former director of social services in Kent, Mr. Nicholas Stacey. The paper is not confidential and it contains the proposal that there should be a national AIDS council. I have read the paper and have studied it carefully, and I believe there is much to commend the idea of establishing such a council. The council should be a blend of health workers, health officials, social service officials, voluntary officials and others. I do not have in mind a council of Cabinet Ministers. The council should have the authority to call on the resources that are required and ensure that they are deployed on a district and regional basis to meet the task of fighting a spreading disease.
There is a tendency already to preach about AIDS, and it is one which I condemn. That is not the way to face the danger of a health war. Our problem is to beat the danger. There is a tendency also to think, "I'm all right, Jack." That is something to which the hon. Member for Barking (Ms. Richardson) referred. Another tendency is to think, "It's not for me, so I do not need to bother." Finally, there 1180 is a tendency to think that AIDS will go away, that people will change their habits or even, after the current advertising campaign, stick to one partner and use a condom. It is thought by some that drug users will use only clean needles and not share them. It is argued that that will take care of the problem, and that if they do not follow those practices it is their lookout. That is not the way to consider this problem. however, if they do not, AIDS sufferers will be like so many other people who do not take advice—those who continue to smoke cigarettes when the Government have advised them not to, those who do not use their seat belts against Government law. One cannot stop the rugged individualism of the British or indeed any people.
We must approach the problem and deal with this epidemic by taking note of what is in the Bill. We must get the facts and the figures and marshal our resources in a proper way. In this country we are in danger of whistling in the dark. The Government have taken action through advertising—that I commend—but we must not think that that is enough.
I wonder what the Secretary of State thinks after his recent and I am sure revealing visit to San Francisco. I would like to know his feelings about the importance of care in the community—I am sure that that was revealed to him in San Francisco where such community care, as opposed to hospital treatment, is important. How many days does an AIDS victim stay in hospital in San Francisco? I understand that many AIDS sufferers stay in hospital in San Francisco for only 11 days but that in New York they stay for 65 days. Why is there such a difference? Is there no co-ordination of treatment patterns in the United States? The average length of stay in St Thomas's or in the Middlesex hospital is between 17 and 18 days. That does not mean that that is the end of the treatment for the AIDS sufferer; it means that hospitalisation is not the only answer. Clearly, community care has an important part to play and we need to know Government views on developing that care.
To control this epidemic, we must remove the danger, assemble the facts and he aware of the size of the problem. In New York, for example, 30 per cent. of new AIDS cases are intravenous drug users and there are not so many from the gay community, but again the situation is different in San Francisco.
The proper strategy to prevent the spread of AIDS should be based on education and advertising. However, it is important that Government advertising must appear to be an important message and not, as it was delivered to me, wrapped up with a lot of junk mail on double glazing. That was the Post Office's fault and I have written to the Minister to draw his attention to that problem. A number of my constituents were delivered this important pamphlet wrapped up in an elastic band with double glazing advertisements, direct mail advertisements and so on. That was done by the Post Office and it was a great pity. The AIDS message is important and we must try to avoid mixing it up with the wrong sort of advertising.
We want, by correct personal and medical practices, to prevent the spread of AIDS. Here I come to a contentious issue. We must not neglect the question of blood transfusions. Recently there has been an argument between the British Medical Association and the Department about this matter. It is understandable that there should be an argument, because once two or three medical men are gathered together there will be two or 1181 three different views. In the end, the problem was sorted out and the Department and the BMA issued a joint statement.
§ The Minister for Health (Mr. Tony Newton)
I hesitate to interrupt but I wish to make it absolutely clear that it was not simply an argument between the BMA and the Government—there was a good deal of disagreement within the BMA and it is important that that should be understood.
§ Mr. Crouch
I entirely agree. I have read the report of that BMA meeting and Sir Christopher Booth, president of the BMA, utterly condemned the scare caused by the statement issued by one speaker.
I raise the question of blood transfusions only because I think that we ought to consider what is called autologous blood transfusion. In the British Medical Journal there is a leading article on the need for autologous blood transfusion.
§ Mr. Crouch
Perhaps the hon. Gentleman will forgive me if I do not allow him to intervene at this stage. Before he does so, I should like to read what is said in this article, which appeared in the British Medical Journal on Saturday 17 January 1987.
Referring to the discussion on blood transfusion the article says:It will also encourage further consideration of collecting the patient's own blood before an elective operation and then transfusing it into him during the operation if necessary".Then there is a quotation from a report by the Public Health Laboratory Service communicable disease surveillance centre. It says:Although all blood donations in developed countries are now tested for antibodies to HIV, concern remains that some donations may transmit the virus.Having acquired the virus, a person may take three to six months to develop the marker antibody, and the virus's remarkable capacity for antigenic change may make the antibodies evoked undetectable by conventional testing.The article then says:As the virus spreads into the general hetrosexual community, asking male homosexuals, drug addicts, prostitutes, and their partners to refrain from donation becomes less helpful, as even the traditionally safe volunteer donor may be affected. So far, 65 positive donations have been detected in Britain.It is no good ducking facts. The article then says:Autologous transfusion eliminates these risks of serious infection and also avoids sensitisation to red cell, white cell, and platelet antigens in donor blood".Autologous blood transfusions are not accepted in many parts of the medical profession. The article also says:Autologous transfusion programmes have been used successfully in orthopaedic surgery, including paediatric cases, cardiothoracic and general surgery, and urological and head and neck surgery. It has also been used for women undergoing caesarian section. As many as 55 per cent. of elective surgical operations could be performed using autologous blood—that is, about a quarter of all surgical operations.I read that article with interest. It should prompt further consideration of the use of a persons's own blood in transfusions where that is thought medically possible and is agreed by the patient.
We must care for AIDS patients in hospitals, in hospices, at home and in society. If we can marshal our 1182 resources and ensure that they are used correctly, and if we do not neglect the enormous importance of social care, we shall go a long way towards overcoming this problem. The epidemic must be conquered by these means. We must pull out every stop in international medical research to find the vaccine to bring that about.
§ Mr. Simon Hughes (Southwark and Bermondsey)
I am grateful to the hon. Member for Edinburgh, East (Mr. Strang) for choosing this subject for his private Member's Bill. The contributions to the debate so far show how welcome is his initiative. We are all aware that the city of Edinburgh needs particular attention and help to deal with what the hon. Member for Barking (Ms. Richardson) described as an aspect of the AIDS problem that is peculiar to Edinburgh because of its size and expansiveness. It is a commonly known fact that Edinburgh, probably more than any other United Kingdom city, suffers from drug-related AIDS.
I was not in the House on 21 November, nine weeks ago today, when the House spent the whole of a Friday debating AIDS. It was clear from the reports and from Hansard that that was a highly responsible and well respected and reported debate which demonstrated the general concern for urgent action.
In the nine weeks between the debate on 21 November and today, statistics—which appear to be accepted—show that over 3,000 additional people will have been infected with the virus. It is that sort of statistic that should reach home to people up and down the land. It is the sort of statistic that was rightly quoted and publicised by the Secretary of State at the beginning of the month when he introduced his publicity campaign, warning people, as he is bound to do, that about 4,000 people in Britain will die of AIDS in the next three years. The Institute of Medical Laboratory Sciences says that the number of cases of those infected with the virus is likely to double every 10 months.
Every opportunity must be taken to warn, advise, inform and assist people. Therefore, it is entirely appropriate that soon after that general debate the hon. Member for Edinburgh, East has introduced his Bill, which, I expect, will receive its Second Reading today, go into Committee and soon be law. The hon. Gentleman intends that the first report of each district health authoity and board will be forthcoming in a year's time from now, with exactly the sort of information that each health authority should be seeking and providing.
Today's debate is also appropriate because of all the parallel events connected with AIDS that have been striking the public consciousness this week. The advertising campaign is well under way on the hoardings, and in the past few days the public have received—mine arrived a couple of days ago—the leaflet from the Department of Health that was published for each household. I say to the hon. Member for Canterbury (Mr. Crouch) that my leaflet arrived separately from the rest of the post, and I agree that it is important that the leaflet is brought to the attention of people.
It may be that another leaflet will be required quite soon particularly for places such as London, where there are many people in multiple occupancy dwellings and other housing, who are difficult to reach with any literature. We have seen the advertising posters and leaflets, the launch of the Government's publicity campaign and the welcome visit of the Secretary of State 1183 to the United States, which has been well reported in Britain. The initiatives there will help considerably to show the Minister and his Department what they should be doing, and television coverage of the visit will make even more people aware of the issue.
We have seen the opening of the first AIDS wards in London, with the welcome blessing and endorsement by the royal family and others. The Middlesex hospital has added to the clear lead which it, with St. Mary's and St. Stephen's hospitals, has given. They are determined to break through the prejudices and show that they have a duty to treat, support and help people who are victims of this illness. At 11.30 this morning BBC Radio 4's "International Assignment" programme was dedicated to reporting the comparative figures on AIDS as it affects the different continents, not just ourselves.
In spite of all these opportunities, as other Members have made clear, the message does not necessarily reach home, and I say that with an admission. Ten days ago, or thereabouts, I was appointed to the job of spokesman on health for the alliance parties. In all honesty, I had not until then addressed myself in detail to the issue of AIDS in the way that I now have to do. I am sure that there are many like myself, who are not entirely unintelligent and who are fairly aware of what is going on, but who do not think that they need to be particularly informed about AIDS. They see the advertisements, register the problem, are aware of the clichéd responses and then say, "But it is not affecting me."
Most people in Britain, like me, will not yet know of anybody who is carrying the virus or dying from the disease. I am not aware of anybody whom I know within either of those categories, and most people would be in the same position. Therefore, one feels protected. Much more work needs to be done.
The clear horror of the disease is that it strikes down the healthiest people in the prime of life. It is most likely to affect not the elderly but the relatively young or the young middle-aged. Therefore, we must think about how we can do much more.
One person in a thousand in Britain is now estimated to be a carrier of the virus. That is at least one or two Members of the two Houses of Parliament, let alone the staff and all who visit. Such statistics need to register with people so that they begin to think that the disease does affect them and they must respond.
As the Secretary of State rightly said, public information is the only vaccine that we have. We must think of ways in which to make that the most effective vaccine. I congratulate the Government on what they have done. Once they got off the mark they responded, and quickly. I am prepared to accept that they may now be accelerating in the outside lane compared with other countries and their Governments. I applaud that and I encourage them to do more—to allow health authorities to spend the money necessary and to support the voluntary agencies which are doing, and are willing to do, the work.
The Department's initiatives are welcome and are complemented by the proposals in the Bill that the health authorities should do the same, which is equally welcome. I am in the same regional health authority area as the hon. Member for Canterbury and the consultative and later final document produced by the South-East Thames regional health authority is excellent. I think that it was produced in advance of that of any other region, but I stand to be corrected on that. That is exactly the sort of 1184 work that needs to be done urgently. There should be a set of recommendations that can then be implemented and monitored. I congratulate my regional health authority, as I have done in writing long before today's debate.
Clearly, the Bill is welcome, not only because it will enable and require that that be done, but because, as the hon. Member for Mid-Kent (Mr. Rowe) rightly said, it will look at the other side of the coin, which is the need to be informed about what we are doing to care for the victims. There are horrendous phsychological problems for someone confronted with the diagnosis that he or she is a carrier. The hospice movement is not yet geared to cater for AIDS victims, but it could be, and is willing to be. People in the medical profession are willing to do a lot of work and to adapt their own professional careers to respond because their duty is one of service.
The double responsibility for information and medical knowledge—facts and figures—and to ensure that we have a network of care, is contained in the Bill. It is supported by both sides of the House and by my hon. Friend the Member for Roxburgh and Berwickshire (Mr. Kirkwood), who has been much involved in this issue over recent months.
I should like at this point briefly to pay tribute to my hon. Friend. When someone is reshuffled and disappears to take a different parliamentary responsibility overnight, he has to take up his new responsibilities and not continue with what he was doing. Up to 21 November 1986 my hon. Friend had asked more than 50 parliamentary questions on AIDS. That is five times more—I do not say this in criticism, but just to enhance my hon. Friend's reputation—than the Labour Front Bench asked over the same period. He clearly led the campaign for information in the House, quite properly and responsibly. I pay tribute to his foresight and keenness, which perhaps has something to do with his constituency being near to Edinburgh on the one hand and being a pharmacist on the other. He also had two very good and committed research assistants, who made sure that he was always up to the mark.
§ Dr. John Marek (Wrexham)
One of the things that the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) did not do was to try to score petty party points about who had asked the most parliamentary questions. He tried to approach the topic in a multi-partisan spirit. If the hon. Gentleman thinks that a solution to the problem is to ask more questions than any other hon. Member, he is sadly mistaken and is setting the limits far too low.
§ Mr. Hughes
I shall come back to that in a moment. I am more concerned about some of the answers that the Minister has not given us than about the questions. I shall not let him off the hook, and hope that he will be able to enlighten us shortly.
Those of us in political parties also have a responsibility to make sure that our parties address the AIDS issue and commit, through our membership, the political emphasis to make sure that necessary work is done in community health councils, district health authorities and so on. I am glad to say that at my party's council meeting in Bristol in November last year we did just that. I think I am right in saying that we became the first party to adopt a widespread and far-reaching policy on this subject.
1185 Finally, I should like to ask the Minister some questions about what is being done. As I have suggested, there may need to be additional money for certain of the voluntary organisations. Will it be found?
I understand that the needle exchange scheme which operates in 12 cities is still a pilot scheme. I do not know what will be required to take it from being a pilot scheme to being a scheme available wherever it is wanted locally. However, I hope that if there is any local pressure for the scheme to be available in any other town, city or health authority area, the Department will permit that. I am entirely persuaded that it is right to have a one-for-one needle exchange scheme, and we should not moralise about that. It is better that we deal first with getting rid of the infected needle and separately start trying to deal with the drugs problem that faces those people.
I have seen the television advertisement only once, but I must advise the Minister that I am not certain that it is as effective as the literature, for those who read the literature. When I saw the television advert my reaction was that it generates fear and does not convey much information. That is a mistake. I understand the desire to make sure that people register that the advert is there. However, what people desperately need is information.
At the end of the last year I went to speak to a London sixth form. After lunch some of the sixth form students came back to the House to watch a debate from the Gallery. Four or five of them drove back with me and between them AIDS came up as a topic of conversation—sexual topics are often likely to be topics of conversation among teenagers——
§ Mr. Hughes
Indeed. It was a very clichéd conversation—AIDS, reaction, condoms. The conversation was not developed intelligently.
It led me to fear that the advertising campaign is doing two things. First, it is over-simplifying the message, which may be necessary in the first stage, but we should go beyond that. Secondly, it is likely to generate fear rather than information. The Family Planning Association has written to me and, I imagine, to other hon. Members. If one is to discuss how condoms can be helpful, it is important to stress how to use them effectively. The FPA has given me to understand that a badly used condom will be inadequate and that not all condoms are up to the task. That information is important, especially to youngsters, many of whom will have sexual relationships at an early stage.
It is also important to tell people, and to reassure them about how they will not contract AIDS, otherwise the minority groups, which are likely to be the most frequent victims, are likely to suffer from greater isolation and being spurned by others, and alienation will result.
The other day the Secretary of State went to visit and meet AIDS victims in the States. He did what my predecessor, as Liberal party health spokesman my hon. Friend the Member for Roxburgh and Berwickshire did here in London in the autumn, when he went to visit someone at St. Mary's hospital. The AIDS patient whom my hon. Friend met was resigned to his position. He was not bitter. He knew that he would die in a year's time. He was full of praise for his medical treatment and had been able to have a reconciliation with his brother. However 1186 —and the hon. Member for Mid-Kent made this exact point—the one thing that he was frightened of was the reaction of the community when he went home. He had a great fear of being taken home and regarded as a leper in the community. The myth that the handshake, the contact, the hug or even nearness to someone is sufficient for a person to contract AIDS has to be one of the main targets of the Government's information activities. It appears still to be a mythology, but it is the most dangerous and hurtful mythology for the victim——
§ Mr. Hughes
And indeed it is fostered by many newspapers on a regular basis. I do not know whether the Department has done so, but it could call in the newspaper editors and tell them to get their facts right. That would be helpful. We should see whether they responded.
My hon. Friend the Member for Roxburgh and Berwickshire and the hon. Members for Gower (Mr. Wardell) and for Islington, South and Finsbury, (Mr. Smith) tabled questions in October, before the end of the previous Session, seeking information on, for example, whether regional health authorities had forwarded circulars and plans, the number of victims so far, and what funds had been allocated. I understand that the Minister has not replied to those questions. I am not blaming him personally, but no letter has been received. The only answer received was:I shall write to the hon. Members."—[Official Report, 6 November 1986; Vol. 103, c. 578.]No letter has been received—and I checked this morning. That is just the sort of information that is required and it is why the hon. Member for Edinburgh, East has introduced his Bill and asked for important information. Even now we need the information that is in the Government's hands. We need to know which health authorities have taken initiatives and made progress.
I fully support the Bill. I am grateful to the hon. Member for Edinburgh, East for introducing it. I am sure that it will receive its Second Reading today, but it is only the second step in a campaign that still entails much hard work if most people are to understand the severity of the message and of the need for their personal response before it is too late.
§ Mr. Roger Sims (Chislehurst)
It is good to hear the hon. Member for Southwark and Bermondsey (Mr. Hughes) congratulating the Government on their response to this new disease and public concern about it. Those congratulations are well merited because, after all, the Government have committed substantial resources to dealing with the problem.
The hon. Gentleman mentioned briefing newspapers. My impression is that a good deal of that has been done with some success. Not all the newspaper articles have been as helpful and accurate as others, but there has been a good deal of press publicity. The Government have reconstituted the Health Education Council as a special health authority and have embarked on a massive publicity campaign. The leaflet is very good in that it was intended for general distribution. It trod carefully the difficult line between giving explicit information and not causing offence. I hope that in due course other leaflets will be available, perhaps in different styles and directed to particular audiences.
1187 I have my reservations about the television advertisement. The hon. Member for Southwark and Bermondsey may have misunderstood its intention, which I believe was simply to draw attention to the leaflet, and not to give information, but I am not sure that it was successful in doing that. It drew attention to volcanoes, but it was seeking to draw attention to the leaflet itself, not the envelope in which it arrived. For the reasons given by my hon. Friend the Member for Canterbury (Mr. Crouch), the most important thing would have been to do that.
Issuing the leaflet was certainly a good first step. Because there is no known cure for AIDS, the first priority must be education and the second must be the identification and care of the victims. On both those matters there is obviously a limit to what the Government can do and responsibility moves to the district health authorities. That is why I welcome the Bill and congratulate the hon. Member for Edinburgh, East (Mr. Strang) on his intiative in drawing it up and presenting it to the House. As the hon. Gentleman said, it will give the health authorities that extra incentive to do what many are doing already and to provide the Department with vital information.
If I have any reservations about the Bill it is that I would put a question mark over clause 1(2)(f). I wonder whether it is practical for a health authority to give estimates of the number of peoplewho are likely to fall within each of the paragraphs…above"—in other words, those likely to contract AIDS. The figures can be only estimates and, as we know, in Britain and in America the estimates vary wildly and can only be the result of guesswork because there are so many imponderables and because we know so little about the way in which the disease develops. I wonder whether it is reasonable to expect district health authorities to put into an official report figures that could not be supported. Some may be able to draw conclusions from current figures, but I am not sure that district health authorities should put estimates of that sort into what would be a statutory document.
We had a full debate on AIDS in November, to which I made a brief contribution. I do not intend to go into detail now about this serious and complex subject. I must stress, however, that although there is currently no known cure for AIDS it is not true, as has been said in some quarters, that little is being done to find one. The Government have made an additional £1 million available for research, over and above the 21 projects already under way at a cost of some £2.4 million. Several drug companies—I have a local interest in Burroughs Wellcome—are devoting substantial resources to research into AIDS, often at the expense of work on possible cures for diseases that are currently causing more deaths and suffering than AIDS. Any drug company that could prodice a cure would be doing not only an enormous service to the community but would benefit financially. There is no doubt that the drug companies are working hard to try to find a vaccine or a cure. However, I fear that it will be a long time before we can be sure that we have found such a cure. Even if the companies appear to be having successes it is important that the drugs are properly tested because, in recent memory, there have been cases of drugs coming on to the market that have been found to have unfortunate side effects.
1188 One is not being part of any campaign against homosexuals by pointing out that at present in the United Kingdom AIDS is primarily a homosexual disease. Of the 610 patients up to the end of 1986, 538 were male homosexuals or bisexuals. Of the 293 deaths, 244 were in that category. Therefore, I suggest that there is a special responsibility on homosexuals as to how they behave among themselves and the extent to which they seek to interest and involve others, especially the young, in homosexual activity.
Discussion often centres on whether this is a moral issue and whether Ministers and others should be moralising. I am sure that Ministers should not he moralising and I am not sure whether chief constables should, but sometimes I should like to see more members of the clergy moralising, especially on issues such as this. However, when one hears of clergymen calling themselves "gay Christians' it is a little difficult to know in which direction they are going.
I suggest that this is a moral issue because when we talk of morals we are referring to a code of personal conduct and the way in which we conduct our personal relationships with other people, whether that is based on a religious ethic or not. That is surely what morals are all about. Therefore, AIDS should be taken into account in our personal moral codes, particularly with regard to the homosexual community. It is very important that all of us, and especially the homosexual community, realise the implicatons of AIDS, how it can be caught and what can follow from it.
I return to the point, therefore, that we must have as much information as possible and that that information should be conveyed to as many people as possible. Although the Government and the DHSS have a great responsibility, a great deal of responsibility rests with the district health authorities in this matter. In that connection, I return to the Bill which, as the hon. Member for Edinburgh, East said in his opening remarks, should serve to galvanise district health authorities into action. I hope that it will do just that. I warmly support the Bill and wish it well.
§ 2 pm
§ Dr. John Marek (Wrexham)
We know that a system of voluntary reporting of cases on a confidential basis to the communicable disease surveillance centre has been established. However, last October the Minister stated that no decision had been made to go beyond that.
The Bill goes beyond that and will put our knowledge about the spread of AIDS on a quantifiable basis. Some of the information is already being obtained and there should be no insuperable difficulty about health authorities and health boards instituting the administrative procedures necessary to gather and collate information.
To increase the accuracy of the statistics, but I realise primarily to help stop the spread of the disease, voluntary screening should also be made available on a totally confidential basis. Information can no doubt be gathered from VD clinics, counselling centres and other sources within the districts or region of any health board. I emphasise that it is important to obtain that information confidentially and it is important to demonstrate to those at risk that confidentiality will be observed.
In due course, the Bill will enable us to verify the scope of the problem and whether it is being appreciated properly. It will also help us to decide whether estimates 1189 made some years ago were accurate. If they are not, they will be shown to be inaccurate much earlier than if the Bill had not been enacted. If our predictions or the Government's predictions are seen as not being fulfilled, early reappraisal will be possible.
The Opposition also believe that the Bill is important because it will provide some check on whether the Government's advertising is having an effect. Many comments are being passed throughout the country and even in the Tea Rooms of the House of Commons about the efficacy or otherwise of the advertising campaign. However, we will be able to decide whether the Government are spending their money wisely in their advertising campaign only if the information is available.
There are many ways to solve a problem. One is to chuck money at it. However, resources are too precious to be frittered away, and the Bill will enable us to check that resources are not being wasted. I am not arguing that resources should not be deployed. I am merely asking for wise and sensible deployment. Unfortunately, this Government too often use that argument for not spending any money at all. If they were to adopt that policy with regard to the containment of AIDS, it would be disastrous.
The effects of the Bill will also help to counter ignorance, the spread of alarm and scaremongering. There is no substitute for accurate information as a means of making the public aware of the scale of the problem. We should be seeking the public's help and generating a responsible attitude throughout society.
§ Mr. Tony Banks
Would my hon. Friend care to comment on the fact that the Government are spending about £20 million on an advertising campaign yet it appears from the figures that they are spending only about £3.5 million on research into a cure for AIDS? Is that not a rather strange scale of priorities?
§ Dr. Marek
My hon. Friend is right and I shall make some comments on research later. If the Government do not want a bipartisan approach to the problem, the Opposition are willing to co-operate, but they must take the comments of Opposition Members and concerned people seriously and ensure that resources are not taken away from AIDS research, advertising and education simply because they do not want to spend money and this is a case in which they need not spend it.
The Bill will ensure that much better information on carriers becomes available. Officially, there are 30,000 carriers, but some put the figure at 100,000. That may be alarmist, and if the Bill is passed, we shall have a better appreciation of how many carriers there are. More information will become available as to how the disease is transmitted. We are continually learning about it, but the Bill will help that process. Our knowledge is growing, but a whole population study will be invaluable as a means of control and observation of the incidence of the disease and its eventual eradication. The title of the Bill is "AIDS (Control) Etc. Bill." I wish that we could interpret "Control" as eradication, but, unfortunately, it must rather be interpreted as observation and monitoring. Sadly, at present there is no cure.
If the Bill is given a Second Reading today, and I hope that it will, perhaps my hon. Friend the Member for Edinburgh, East will go further and ask the Government what provision they are making. Would it be possible for 1190 the Government to prepare an annual report from these district and health board reports? If they were to produce an annual report, they could say what funds were being applied where, what research projects were being undertaken, what we were learning from other countries and what we were doing to develop counselling and education.
We must face the problem of confidentiality versus availability of information. In some areas the number of people registered as carrying the AIDS virus could be as low as one, two or three. If there were a problem of identification caused by the statistics, clearly confidentiality must take priority. However, that is not an excuse for the Government to say, "We cannot release any information." The Government are obliged to provide as detailed information as possible, subject only to the overriding criterion of maintaining confidentiality.
If the Government prepare a report, they could give the basis for the distribution of resources and we could check that the resources were being properly targeted. The Bill is not an excuse for the Government to do nothing until information from the reports starts to come in.
This is an example of where additional income is required by the National Health Service. AIDS was unknown less than a decade ago; it has come upon us in the past four years. The Government are fond of saying that the growth in the NHS budget has been 24 per cent. above the rate of inflation, but that does not take account of the medical retail price index, medical advances and operations that we can do now but could not do five years ago. The figure does not take into account the effects of greatly increased unemployment and the increased resources that must be employed as a result. Nor does it take into account the fact that we have an increasingly aging population. AIDS is yet another reason why that 24 per cent. is not all that it seems to be. AIDS requires additional expenditure.
The Opposition, together with the Government, consider that this is an important issue. We should like a bipartisan approach. It is only as a united country that we can tackle this dreadful disease. For a bipartisan approach we need to be convinced that the Government not only are taking the issues seriously—I believe they are—but are putting the resources into the right places to back up their concern. In particular, it is not acceptable for the Secretary of State for the Environment, in reply to a question by my hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) on 12 January this year, to say that it was for local authorities to assess their own priorities for expenditure. My hon. Friend had asked the Secretary of State what advice he gave local councils on the priority to be attached to spending money on local campaigns to warn people of the dangers of AIDS.
Of course, we all know that in many ways local authorities are strapped for cash and cannot have the freedom to take the measures that they consider they should take to educate people about the dangers of AIDS.
§ Mr. Tony Banks
My hon. Friend had made a good point. The London borough of Newham is trying to run an imaginative series of schemes to educate people—its staff and members of the public generally—about the problem of AIDS. The borough is faced with a 10 per cent. cut in the resources that it is to get from the Government. How can a borough such as Newham manage to equate the two positions?
§ Dr. Marek
My hon. Friend has made a good point. I know that he will try to make a contribution to the debate later. I hope that he will forgive me—I agree with him completely—if I do not comment any further.
The money being spent on research is not sufficient. Again, in a written reply to my hon. Friend the Member for Gower (Mr. Wardell) on 16 January the Minister said that the amounts of money being listed were not by any means large enough.
As was pointed out earlier, the Opposition wish to see the Government earnestly address themselves to research and to committing resources to it. If the Minister—I think he said this a few months ago—still maintains that all worthwhile projects are being funded, I should like him to say so again now. I should like that fact to be known publicly. It would be valuable to know of any research projects in this country, or perhaps in other countries so that we can tackle this disease, and the money should be available. It should be available as an extra. NHS patients who have a broken leg, who require a by-pass operation, or who have cancer, do not want to be told, "Sorry, you cannot come in for your operation because the money is required for AIDS. We do not know when we can have you in, but you may come in at a later time." Money for AIDS research must be provided over and above any other provision for the National Health Service.
This is an important subject. I do not wish to conclude my remarks—many more important points still must be made—but other hon. Members and the Minister wish to speak. The Bill is supported by informed and responsible opinion. It is supported by the British Medical Association and, to my knowledge, all the bodies that are concerned with AIDS and its treatment. I congratulate my hon. Friend the Member for Edinburgh, East on bring forward this Bill. I ask the House to give it a Second Reading.
§ The Minister for Health (Mr. Tony Newton)
I shall rattle away, because the time available is rather short. I wish to make some points about the Bill as well as answer those that have been asked of me during the debate. If my opening words are brief, I hope that the hon. Member for Edinburgh, East (Mr. Strang) will not misunderstand it as failing to wish to congratulate him on his luck in the ballot and on bringing forward this measure. I am aware of the importance he attaches to the AIDS problem, and for good reasons, given the nature and scale of the problem in the city of which he represents part.
I say gently to the hon. Member for Wrexham (Dr. Marek) that if the Government were looking for excuses to do nothing, as he suggested towards the end of his speech, I doubt whether I should be standing here in the friendly way in which I am at the moment. We could perfectly easily have thought of endless reasons for not having the Bill and for seeking to prevent it being passed. I am bound to tell the House, if only as a matter of propriety, that, strictly speaking, we do not consider that the Bill is needed. Quite apart from the existing accounting arrangements for reporting within the Health Service, the National Health Service Act 1977 already contains provisions that enable the Secretary of State to direct local authorities to provide him with certain information. 1192 Having made those points, I certainly do not intend to use them as reasons for advising the House not to proceed with the Bill.
However, I have some anxieties about the details of the provisions of the Bill as it stands—anxieties which have been echoed by my hon. Friend the Member for Chislehurst (Mr. Sims), the hon. Member for Wrexham (Dr. Marek) and, to a responsible degree, the hon. Member for Edinburgh, East. There is no doubt that, in our judgment, a number of problems would be created if the Bill were to be enacted in exactly its present form. The most serious of those difficulties is the one on which hon. Members have touched—the threat to the confidentiality of AIDS patients which it could pose in some circumstances.
Although the number of AIDS cases is increasing, the number of patients being treated is relatively small, as several hon. Members have said—only a few hundred—and will remain so for some years. The number will grow but will remain small relative to the instances of many other diseases. That means that in many health authority areas there will be only a handful of AIDS patients. The hon. Member for Bow and Poplar (Mr. Mikardo)—who has not made a speech but has made some helpful, or otherwise interventions—wished to have a breakdown of AIDS patients by sex and sexual proclivity and the route by which it was thought that transmission had occurred. Such an analysis would probably be easy in a district that had only one AIDS patient, but it would certainly raise questions as to how far the confidentiality of that patient was being safeguarded.
Leaving aside the Thames regions, no region—let alone district—has more than 13 live AIDS patients. In other words, if the number of cases in each health district is published, there is a risk to the confidentiality of an individual patient. It is vital, as I think everyone accepts, that we should preserve such confidentiality. If we cannot guarantee it, many people will be unwilling to come forward for testing and treatment, and AIDS will be driven underground. This is quite apart from the moral issues which would be raised by breaking confidentiality about a matter of this kind.
Another consequence is that some doctors, to protect their patients, would cease to report cases of AIDS, and the effective national reporting system operated by the communicable disease surveillance centre, to which the hon. Member for Wrexham referred, would be undermined.
The problem of district analysis of antibody-positive patients, which is called for in one subsection, is considerable. At present, we have no central record of in which district such patients reside. The present system of testing and reporting, which I think we all have agreed works well, is not district-based. Some districts do not have laboratories that undertake antibody testing.
Some patients—this is an important point because this probably happens with other sexually transmitted diseases as well—travel on purpose outside their districts for testing and-or diagnosis. Even to collect data on the district from which positive blood samples originated would impose a considerable burden on the people collecting those reports at the CDSC and is likely to produce misleading data. In any case, the number of known antibody-positives in each district is not in itself helpful, in that only a small proportion of those that have been infected have been identified. Projections of how 1193 many extra might be identified in the following 12 months would not have a great deal of value for planning purposes, other than to help estimate the additional counselling load.
I must make it clear to the House that we do not believe that it is sensible at present to attempt any local analysis in that degree of detail of cases and of reporting antibody-positives other than at regional level. Interpretation of the data obtained from blood testing requires skills that may not be available in each district. The communicable disease surveillance centre would not have the resources to assist each and every district in attempting its projections. Even at regional level, there are problems in making projections even as far ahead as 12 months. When the numbers are small, the errors involved can be large.
To sum up, although we would not oppose analysis of data at regional level and would see some advantages in doing that, we think it important not to run the risks that I have just sought to describe of jeopardising the present excellent national system at the communicable disease surveillance centre.
In reply to the point made earlier, we have already undertaken to make regular national figures available on the number of AIDS cases on monthly and quaterly bases and to provide a broad analysis including an assessment of the trend, insofar as it can be identified, in the number of HIV positives. That picks up a point made by my hon. Friend the Member for Cambridge (Mr. Rhodes James). There is no suggestion that we should make information available about AIDS only once a year. It is appropriate to impose that obligation annually on health authorities.
I shall not attempt to cover all the technical problems in the Bill, some of which are minor but cannot be dismissed. However, I should touch on one of them which is that the Bill imposes some obligations on health authorities with which in practice they probably could not comply. Whatever they sought to do, they could not easily establish exactly what "treatment and counselling" was being provided by "other public or voluntary bodies" as stated in the Bill.
Such bodies cannot be made to supply the relevant information to health authorities which may not even be aware—although we hope that they would be—of all the organisations operating in their area. It would be difficult for a health authority to obtain every detail of the work being carried out by a private clinic. That is not a major problem, but we must keep an eye on it when considering the drafting and the amending which will no doubt need to be considered as the Bill goes into Committee, should the House give it a Second Reading.
Leaving aside pure nit-picking points, something in the Bill is rather ironic and in the circumstances I see it as a defect. Manifestly, the assumption and the wish on both sides of the House has been that that data should be made available by the district health authorities and the regional health authorities to the Secretary of State so that it can be communicated to the public at large. But there is, as I read the Bill, no requirement for the information to be published. The House may wish to consider that, too. The Government are ready to accept the basic purpose of the Bill but has serious reservations about the detail of some of the drafting. I know that the hon. Member for Edinburgh, East will understand that.
1194 I must apologise for the fact that I shall have little time to reply to all the points made. However, It would be right to devote a moment or two to them, especially in view of the reference by the hon. Member for Southwark and Bermondsey (Mr. Hughes) to the information that the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) sought earlier about district facts. I must apologise that there has not yet apparently been a reply to that letter.
I shall give the House a quick rundown on how that matter stands at present. In January 1986, a health circular was issued to regional and district health authorities giving them resource assumptions as the basis for their planning. It requested all districts to develop a plan of action concentrating on high-risk groups, complementing the national publicity campaign and including provision for testing and counselling services and for treating clinical AIDS cases. Those plans were to be submitted by the end of June 1986, and subsequently included in regional short-term programmes.
That advice has been amplified in various ways in the intervening period and on 23 December 1986, the secretary of State wrote to all district health chairmen stressing that he expected the plans to reflect the needs of those parts of the Health Service which would be under additional pressures because of AIDS, especially clinics for sexually transmitted diseases. They were also asked to provide details of their proposals for future years in their short-term plans. That material is now being analysed and I am happy to tell the House that we have received reports from all district health authorities with one possible exception, which tells us that its report is in the post.
§ Mr. Newton
I hesitated to make the old joke, with which many hon. Members will be familiar.
The Government's intention—this ties in with the purpose of the hon. Member for Edinburgh, East—is that a national picture should be obtained from the reports, from which, among other things, examples of good practice will be identified. Details of the national strategy which emerge, together with a commentary on it and examples of good practice, will be fed back to regional and district authorities and to other bodies with an interest in health care planning.
To my regret, it is hardly possible for me to say much about the many issues that have been raised during the debate. I shall try to respond to one or two of them in the short time that remains. My hon. Friend the Member for Chislehurst (Mr. Sims) and the hon. Member for Southwark and Bermondsey (Mr. Hughes) spoke about the television advertising. The advertisement was intended merely to draw attention to the leaflet in a way which would be dramatic. It has had to compete with all the other things that appear during a television commercial break, and I believe that it has been effective. I think that even the hon. Member for Southwark and Bermondsey will agree with me that a television commercial that attempted to tell people what the risks were, to communicate what are not risks and to tell young people how to use condoms, which was one of his suggestions, would be a television programme and not a commercial.
There is a great deal going on, and the broadcasting authorities have been extremely co-operative. The Government will be seeking to build on the public 1195 education campaign and to move on from merely drawing attention to the leaflet to conveying particular messages. I hope that it is clearly understood that the purpose of that which we have done so far is to draw attention to the source of the information, which is the leaflet.
In courtesy to the House, and to ensure that I do not inadvertently talk out the Bill, I leave the matter there. I am prepared to advise the House to let the Bill have a Second Reading on the basis that we shall need to do a good deal of work in Committee.
§ Mr. Strang
With the leave of the House, Mr. Deputy Speaker, I shall reply briefly to the debate in the short time that remains.
I am grateful to all those who have participated in the debate. Everyone who has done so has supported the Bill in principle. I am grateful to hon. Members for the manner in which the debate has been conducted. Like the debate which took place on 21 November, it has been an instructive and sensible contribution to the wiser debate that will continue in the country on this issue.
I am sure that it will be understood if I do not refer to individual contributions save to thank the occupants of both Front Benches and the spokesperson of the Liberal party, the hon. Member for Bermondsey (Mr. Hughes). I say a special "thank you" to the Minister for Health for the help that he has given. It is fair to acknowledge that we had a constructive exchange during the parliamentary recess. Had it not been for that meeting, I doubt whether I would have reached the stage of being able to introduce a Bill that would have the support of hon. Members on both sides of the House.
The Minister has raised a number of important issues. I acknowledge that confidentiality is important and I respect that point of view. I doubt whether there will be any difficulty about that. The Minister referred to a number of practical matters, including the requirement of statistics. It is important that we cover that area of the Bill in a more pragmatic way. I am sure that there will be no difficulty in doing that should the House give the Bill a Second Reading and enable it to be considered in Committee.
The comments made and issues raised in debating the Bill have been basically supportive. The Bill, however, should not be regarded as being primarily about statistics. It is not.
§ Mr. Strang
The Minister recognises that.
The Bill is directed to an area of activity and I believe that it will make a valuable contribution to resource planning. I accept what the Minister has said about district and regional statistics, and resources will have to be targeted into different areas of the country. I am grateful for the support which has been given to the Bill and I hope that the House will give it a Second Reading.
§ Question put and agreed to.
§ Bill accordingly read a Second time.
§ Bill committed to a Standing Committee pursuant to Standing Order No. 61 (Committal of Bills).