§ Motion made, and Question proposed, That this House do now adjourn.—[Janet Anderson.]
2.30 pm§ Ms Karen Buck (Regent's Park and Kensington, North)I am grateful for the opportunity to raise an issue that is of grave concern to a good many people with HIV and AIDS, and to my community in north Kensington: the future of the London Lighthouse. I am grateful to my hon. Friend the Minister for the personal help that she has given to the London Lighthouse, and to me, during a month in which we have negotiated over its future. That warm help was gratefully received. I hope that, in her reply, my hon. Friend will continue to express strong support for the Lighthouse's work, and for our attempts to secure a changed future for it.
As my hon. Friend knows, the London Lighthouse was founded in 1986 as a user-led service to meet the needs of people with HIV and AIDS, at a time when we were struggling—indeed, Governments were struggling—to come to terms with a pandemic that was affecting a new group of people, mostly young, who were looking for a way to live and to die with dignity.
The London Lighthouse offered from the start, and has continued to develop over the past decade, an holistic and user-centred model of services to meet the demands of a new service user group. It has clearly been dedicated to the support of people with HIV and AIDS over the years; moreover, it was independently validated by researchers who drew attention to its distinctive model of care, which combines social and medical, formal and informal, emotional and practical services in a community-based service centre.
The Lighthouse is seen across the country as a centre of excellence and a source of inspiration for others working with HIV and AIDS, but it also has an international reputation. Its staff have travelled across the globe offering training and consultancy services, especially to poorer countries in the developing world which are having to come to terms with the devastating effects of the AIDS pandemic.
As well as providing a service for people with HIV and AIDS, the London Lighthouse is an integral part of my home community of north Kensington. The building has a hugely important function as a community centre. It is used as a base for meetings by a wide range of community groups, including north Kensington pensioners' groups. Literally hundreds of north Kensington people go to the building every week to use its cafe and garden. It is a uniquely beautiful building—an oasis of calm and peace in the middle of the highly stressed inner-city community of Ladbroke Grove.
Yet today, as the Minister is aware, London Lighthouse is facing the greatest challenge in its 12-year history. After two years of reduced national health service funding, in the financial year 1998–99 Lighthouse will lose £1.7 million, or a third of its total budget. Foreseeing those cuts, Lighthouse began restructuring to reduce the management and administrative costs, but, in doing so, it has exhausted its cash reserves. There is no money left in the bank to draw on. Sadly, Lighthouse was not successful in its attempts to obtain transitional funding from the health authorities to help it to survive that crushing blow to its finances in a single financial year.
678 The Government have now allowed Lighthouse a loan to manage that transitional period over the coming months. I am extremely grateful to the Minister and to Baroness Jay for their very hard work in helping to secure that loan. However, the loan must be repaid at the end of September. Time is very short for Lighthouse if it is to be able to develop its alternative strategy.
Nobody could fail to welcome the new combination drug therapies that have so greatly improved the prognosis for people with HIV and AIDS across the country, and dramatically reduced the demand for residential care services. I am only too aware of the financial pressure that has been placed on health authority budgets to meet the cost of new combination therapies. However, we have several anxieties that set in context the changes that are affecting Lighthouse.
The first concerns a position that I do not think will change. High-cost drug therapies should not be financed at the expense of that sizeable minority of people with HIV and AIDS who are unlikely ever to be able to benefit from them. That is a central point.
A further concern is that combination therapy is still too new, and the research insufficiently conclusive, to justify too early a reclassification of HIV and AIDS as a chronic but manageable condition. I am aware that, only this week, new research has been published in American medical journals such as Science, and in Nature, that shows that combination therapies are even more successful than we had previously realised, which is marvellous news, which we all welcome. We all know that there has been a history of new drugs, combinations and treatments coming on stream, and it is only after many years that we can be absolutely confident that they have permanently changed health care and treatment.
Over and above those notes of caution about the impact of combination therapies, North Thames public health department, in its HIV and AIDS strategy, has recognised that existing services are not yet meeting the needs of all those who are affected, particularly people in the African communities and, particularly among them, women and children. Those are groups to whom Lighthouse has an excellent record of reaching out. Increasingly, Lighthouse's services have been drawing in members of black and ethnic minority communities, and women and children.
In the light of those factors, I admit that I query the wisdom of dismantling Lighthouse's residential care service while the long-term effects of drug therapies remain uncertain, especially as the unit is purpose-built, and has recently been refurbished. I confess also to being mystified by the fact that the health authority has not, over the past year, demonstrated its belief that Lighthouse is the jewel in the crown of the local health service.
The local health service has not covered itself in glory in its consultation procedures on this issue. It has seemed over the past few months to be in a defensive mode, rather than an open and explanatory mode that welcomes the changed service and seeks a new role for Lighthouse. However, we must be realistic about continuing a service for which there is insufficient health authority funding. Lighthouse has embraced the need for change, and is planning a future without a residential care element.
During this time, Lighthouse has been working on new service models and developing a fundamentally revised package including day care, drop-in services, pastoral 679 care, support and advice, complementary therapies, home care and support and child care. There is a new perspectives programme of assistance with return to work and study. Help with transport is provided. Lighthouse also offers training and consultancy for other organisations. It provides a base for counselling and welfare services that are offered by other organisations. We want those services to continue and develop in the Lancaster road building.
Local people, backed by many Lighthouse supporters throughout the country, are determined to maintain the building as a community resource for health and social care, and they hope that the Lighthouse will continue to provide services as long as they are needed for people with HIV and AIDS. We require either a cash injection of £2 million or a solution involving other organisations coming in as partners to share the building.
The most likely option, and the one that is being most actively explored, is the sale of part of the building for a compatible use, such as social housing, and the retention of enough space to meet the needs of service users. Lighthouse is putting together a funding package to achieve that in partnership with Notting Hill housing trust, which is a substantial provider of local social housing. I hope that the Minister will do everything within her power to support Lighthouse in its attempt to conclude those negotiations.
I thank the Minister for her help so far. I congratulate the managers of Lighthouse and those in the support campaign and their many friends in the community on their work so far in achieving changes and raising the profile of London Lighthouse. I thank those people in Notting Hill housing trust, in Kensington and Chelsea council and in the health service who have worked constructively for a positive conclusion.
The way forward must be clear by the end of July. There is no time to be lost if that magnificent building is to be saved as a resource for Londoners with HIV and AIDS and for the north Kensington community. It must be saved also for the many people throughout the world to whom Lighthouse is, as the name implies, a beacon of hope.
§ The Minister for Public Health (Ms Tessa Jowell)I pay tribute to my hon. Friend the Member for Regent's Park and Kensington, North (Ms Buck) for providing leadership in the efforts to find a new future for London Lighthouse. As she has said, for 12 years the Lighthouse has led the way, along with other key organisations, in providing expert and sensitive care and support for people with HIV and AIDS.
In carrying out its work, Lighthouse has been supported by many individuals and organisations, and has received substantial funding from the national health service. Over the past 12 years, 80 per cent. of its income has come from the NHS, and most of that was for residential services. In addition, the Department of Health provided section 64 grants of more than £4 million, which will continue into this financial year.
People are deeply attached to the Lighthouse because of the services that it provides from Lancaster road, and the great symbolic value that it has acquired. Recent 680 developments there have raised important issues not just for the Lighthouse but for the provision of HIV and AIDS services throughout London and more generally. I shall do my best to set out the Government's perspective on those issues and on how they relate to the Lighthouse in particular.
When the Lighthouse was founded, AIDS was an incurable disease. That remains the case, but there has been progress in its treatment. That means that the needs of people with HIV and AIDS have changed significantly since 1986. So far, the development of combination drug therapies has been effective in helping people to maintain their health and to live longer. Last year, there was a 44 per cent. reduction in deaths from AIDS, and a 30 per cent. reduction in AIDS cases.
However, those are not grounds for complacency. It is important, as my hon. Friend has made clear, that we maintain the messages and action on prevention. It is the success of our messages in relation to prevention that has done so much to curb the impact of the pandemic in the United Kingdom. Combination therapies are expensive. That is why I was happy to announce an extra £23 million for treatment and care this year, bringing the total budget to £228 million, a 10 per cent. increase on last year.
Nevertheless, the costs and benefits of combination therapies mean that health authorities have reassessed the most effective way in which to use their resources to meet the needs of people with HIV and AIDS. That allocation of money into new, effective drug treatments is affecting not just the Lighthouse, but other HIV-AIDS organisations that provided care before long-term remission was possible.
Lighthouse has faced other factors. Until two years ago, services for people with HIV and AIDS were commissioned for the whole of London by its local health authority: Kensington, Chelsea and Westminster. Since then, individual London health authorities have taken on responsibility for their populations, and many have responded by arranging services locally, rather than from the Lighthouse.
The needs of people with HIV and AIDS have been changing; many prefer to use more local services or to have support at home. It is right that health authorities should respond to those needs, and should reflect the needs and preferences of their local populations.
Lighthouse has undertaken two major restructuring exercises, resulting in significant redundancy costs—financed, as my hon. Friend has said, from its cash reserves. That left it facing a large deficit in 1998. It made its position known to the Department earlier this year, when it looked as if it might have to close if it could not find some more substantial financial assistance.
I met the Lighthouse on 19 February and again on 4 March to discuss its position, and I asked it and Kensington, Chelsea and Westminster health authority to work together to find a viable future for the Lighthouse. The conclusion was that keeping the Lighthouse's current accommodation in Lancaster road in its present capacity would need financial support that was both substantial and sustained.
In view of all the competing demands on resources, changing service needs and the general need to ensure the best possible value for money from public spending, I could not, with the best will in the world, justify providing the Lighthouse with the very large grant that it 681 requested from public funds to allow it to carry on as it was. Other services were available, and other HIV and AIDS organisations were also under financial pressure.
The London Lighthouse council of trustees considered its options, and decided to restructure Lighthouse services. That means discontinuing its residential services, disposing of the building on Lancaster road and resiting its other services for people with HIV and AIDS in new premises from September this year.
I was told of that decision when I met the Lighthouse, with Kensington, Chelsea and Westminster health authority officials, on 4 March. I was advised that alternative accommodation for residential care was not expected to pose any difficulties, and I now understand that the health authority has already found good alternative accommodation for the Lighthouse's residential patients after September 1998. I also understand that the health authority is to undertake a public consultation about the future of residential HIV services.
The option chosen by the Lighthouse trustees thus offers the prospect of the Lighthouse being able to continue providing high-quality day care and support services to my hon. Friend's constituency and beyond it. I have approved a continuation for this year of the Lighthouse's grant of £150,000 from the Department's section 64 allocation, so that it can continue to provide those services to people in the community with HIV.
As my hon. Friend said, the restructuring will require transitional funding to make it work. The Government have therefore agreed that Kensington, Chelsea and Westminster health authority can provide that funding, in the form of a loan secured on the sale of the Lancaster road building. The loan has to be subject to the usual audit and financial controls, and a maximum limit of £925,000 has been set. In line with Government accounting requirements, the health authority will be required to charge interest on the loan. I am pleased that the loan agreement has now been agreed by the Lighthouse council of management.
Kensington, Chelsea and Westminster health authority is continuing to work with the Lighthouse through the transitional period, and the Lighthouse building is being actively marketed. I am aware that the Lighthouse is also exploring the alternative arrangements mentioned by my hon. Friend—such as a sale and lease-back arrangement or partial sale of the Lancaster road building—to allow it, as it strongly prefers, continued use of part of the building to provide its services, instead of moving to a new site.
I understand perfectly the Lighthouse's desire to remain in its present building, and I wish it all the very best in its endeavours. However, if the Lighthouse is to achieve its desire to stay on in its present building, it will have to raise sufficient capital to meet its current financial commitments and to secure future viability.
It is generally realised that "no change" is not an option for the Lighthouse. I pay warm tribute to the Lighthouse's staff and trustees, who—with my hon. Friend, in her strong and effective advocacy—have dealt with a difficult period with great courage and evident common sense. They have at all times kept at the front of their minds the best interests of those who use the Lighthouse's services.
682 In dealing with the process of change, the Lighthouse will have to recognise and evolve with the changing world of HIV and AIDS, and with the changing needs of the communities that are affected by HIV and AIDS. Ultimately, of course, the decision will be for the trustees of London Lighthouse to make. I am aware that they remain committed to securing repayment of the loan which we have agreed can be made to help restructure the Lighthouse's services in line with local needs. I welcome that commitment. I am also pleased that we are able to provide support through a critical transition period.
Both the Department of Health and the national health service have committed significant sums from public money to support the Lighthouse through this period of change, and to ensure that it is effectively provided with support and equipped in its new role of providing a different type of service to people with HIV in the community. Those public funds have to be safeguarded, and certain conditions have to be attached to their use.
Although the Government and the Kensington, Chelsea and Westminster health authority will continue to do what we can to help the Lighthouse in the transition to its new role, we all have to ensure that those public funds are used in line with the agreed terms—that the Lighthouse continues to provide services to meet local needs and gives value for money, and that the loan is repaid within the agreed time scale.
Given the wealth of experience that resides with London Lighthouse, it is important that we safeguard and support its ability to provide national leadership in the development of services for people with AIDS and HIV in future as it has in the past. For that purpose, the Department of Health granted £150,000 in section 64 funding for this financial year.
I began by praising the invaluable work that the Lighthouse has done over the years. That was not an obituary. HIV is not going away, and nor is the need for top-quality care for people affected by it. The challenges facing the Lighthouse now are the same for other providers for people with AIDS and HIV throughout the country.
The Department of Health is seeking to do everything possible to drive that change, and ensure that resources continue to be used most effectively, delivering the highest-quality care to achieve the proper balance between prevention that has led to our success in containing the scale of AIDS and HIV, together with ensuring that all the benefits of ensuring that new drug treatments beyond the triple-combination therapy that has been so successful in recent years can be made available to treat and extend the healthy lives of those who are affected by HIV.
I believe that, by evolving and adapting now, the Lighthouse has the opportunity to secure a stable, long-term and extremely worthwhile future for itself, those it serves now and those it will continue to serve in future. It might not always be easy, or what it would necessarily have chosen given all the right conditions, but I am sure that, in the years to come, many people will continue to find cause to be grateful to the London Lighthouse.
§ Question put and agreed to.
§ Adjourned accordingly at three minutes to Three o'clock.