HL Deb 15 June 1977 vol 384 cc159-62

2.45 p.m.

Lord PLATT

My Lords, I beg leave to ask the Question which stands in my name on the Order Paper, and I hope to give more satisfactory response to the noble Lord.

The Question was as follows:

To ask Her Majesty's Government whether, in view of the admittedly unsatisfactory Answer to the Question asked by Baroness Masham of Ilton (4th May, cols. 992–994) they are now able to give a more definite answer with regard to the screening of immigrants for tuberculosis; and whether at the same time they can give an assurance that all immigrants working in schools or kitchens are screened for the carrier-state of typhoid and other bowel-conveyed diseases.

Lord WELLS-PESTELL

My Lords, it is always an intention of mine to try to give satisfactory Answers. I am now able to confirm that foreign nationals and Commonwealth citizens coming to settle in this country are normally seen at ports of entry by a medical inspector appointed under the Immigration Act 1971. Arrangements have also been made in most Commonwealth countries for local medical examination of applicants for employment vouchers or entry certificates and this includes, where appropriate, X-ray examination. According to the circumstances, admission may be refused or may be granted on condition of reporting to the medical officer for environmental health at the destination. Routine pre-employment screening for typhoid and other bowel-conveyed diseases involving laboratory examination is not in our view required. The difficulty is that carriers of these diseases may be symptomless and, furthermore, in such cases excretion of infectious organisms may be only intermittent.

Lord PLATT

My Lords, with regard to the second part of my Question, will the noble Lord observe that I mentioned that, immigrants working in schools or kitchens should be screened? I was not thinking of everybody being screened for these particular diseases which are conveyed by the bowels.

Lord WELLS-PESTELL

My Lords, I am advised that any medical examination designed to pick out symptomless excreters (in other words, carriers) would need to include laboratory examination of stool specimens. This would mean a heavy drain on scarce medical manpower and laboratory resources. I am told that these are not reliable because, when we consider the number of cases of typhoid, paratyphoid and other similar complaints, it is very difficult to distinguish whether they are a result of personal contact or of contaminated food. Much of it is found to have been brought back by people of this country who have been abroad.

Lord WADE

My Lords, would the noble Lord agree that one must use the word "immigrants" with care? Quite wrongly, often that expression is used to apply to those who have lived all their lives in this country and who were, perhaps, born here. We must be sure that we use the word in its right sense. So far as tuberculosis is concerned, is it not correct that this is very much related to change of climate? Where someone comes to live here from a part of the world where there is much more sunshine and where the diet is different, the liability to tuberculosis may be greater. Screening on arrival is not the sole solution.

Lord WELLS-PESTELL

My Lords, my understanding of the situation is that it is not so much one of screening on arrival but that before anybody can come to this country from Commonweath countries they have to satisfy our High Commissioner in that particular country that they have a clean bill of health. He has a medical adviser. Notwithstanding that, when they arrive at Heathrow, the Immigration Department also can refer people to further examination if they have any doubt as a result of the medical certificate which they have. I would point out that the only people we admit into this country where there is any history of tuberculosis or the presence of tuberculosis are those who are entitled to come, and we cannot stop them.

Baroness MASHAM of ILTON

My Lords, is the noble Lord aware of the excellent work being done by the community medicine people in Bradford? Is he aware that they have found, as the noble Lord, Lord Wade, has said, that people are developing tuberculosis after, say, a year in this country because of lack of vitamin D? Is he also aware that it has been suggested in Bradford that vitamin D be added to the flour which makes chapattis?

Lord WELLS-PESTELL

My Lords, I am not aware of the last point. So far as the first point is concerned, one has to remember that everybody in this country has access to a doctor. It is for the local general practitioner to pick these matters up.

Baroness HORNSBY-SMITH

My Lords, would the noble Lord agree that, after the very high level of tuberculosis following the war, a dramatic drop took place and people are very concerned at the increase again of this disease? Although in theory many of these immigrants and families come to this country with medical certificates, we are well aware that certificates can be easily obtained abroad, particularly if only one member of the family may be a sufferer, a situation which would perhaps debar the whole family. In order to eradicate the disease, would it not be more useful if, instead of merely advising people to consult their medical officer, the people were followed up? We should endeavour to ensure that anybody who conies into the country with tuberculosis does not have the opportunity of spreading it and, in their own and the country's interest, has to take treatment.

Lord WELLS-PESTELL

My Lords, anybody coming into the United Kingdom with tuberculosis is required to see the medical officer for environmental health in the district to which he or she is going. It is not left to their discretion. The medical officer for environmental health in that area is notified, and he follows that case up. We recently had a survey into that matter.