§ 5.47 p.m.
§ Lord Kilmarnock rose to call attention to the measures announced by the Government to combat AIDS, to the research dimension, and to the problems of care and treatment posed by the disease; and to move for Papers.
§ The noble Lord said: My Lords, we have tabled this Motion because we believe that your Lordships' House has a constructive contribution to make to the national debate on AIDS. I shall not go into the characteristics of the disease, which have been 1193 frequently described in the press, on television, in the Government's leaflets and other leaflets and in advertisements. Despite the focus on the sexual aspects of transmission, I do not believe that there is widespread support in this country for retrospective moral judgments or punitive measures. I think that the general view is that we start from where we are and not from where we ought to be; and the important point is where we are going. I think that that is the Government's view, too.
§ Recently the Government announced a major public information and education campaign, which we welcome and on which we congratulate them. The Secretary of State's announcement was followed by a debate in another place in which the sense of national emergency cut right across party lines. At this point I should like to acknowledge the openness with which the Government have provided briefings for spokesmen of Opposition parties. All that helps to create an atmosphere in which members of all parties and none can join forces. However, we must all recognise that it will be a long, hard campaign.
§ My basic proposition this evening is that the campaign cannot ultimately succeed unless it is conducted simultaneously on three fronts: first, prevention, in which education aimed at modification of behaviour is the most powerful weapon: secondly, care and counselling of the afflicted in which the NHS must take the lead, though the voluntary bodies have a vital role, too; thirdly, research, which offers our only hope of defeating rather than containing the disease. An alternative to the military metaphor is that of a tripod which will not stand up unless all three legs are in place.
§ The Government have begun well on one leg—that of prevention. The Secretary of State has increased funding in that area from the £2 million originally pencilled in for 1986–87 to £20 million—a very substantial increase. The College of Health of my noble friend Lord Young of Dartington suggested £30 million. However, broadly we are in or on the threshold of a realistic level of expenditure. Even so, it is only if this campaign is properly backed up by the necessary services that it can achieve its full potential.
§ While still in the area of prevention, there is one sensitive issue on which I want to touch. Have the Government made up their mind about the recommendation of the McClelland report that clean needles and syringes should be issued to drug addicts on a new for old basis? I am aware of the objections, but we must rank our priorities. The Government say that there is very little spread into the heterosexual community so far. But we have to remember that addicted prostitutes are a major bridge into the community at large. Chilling evidence of this was provided by the ITN programme of 2nd December on prostitution in Edinburgh, which some of your Lordships may have seen. Naturally we hope that behaviour will change, but history offers no grounds for expecting it to change overnight. And it is likely to be slower among certain alienated and fringe groups. Perhaps the noble Baroness will be able to make an announcement about this tonight, or perhaps we shall have to wait for the Secretary of State's return from Amsterdam where this has been brought into practice. 1194 Either way, I hope that the Government will take the plunge.
§ I come now to the main problems confronting the National Health Service. First, there are those coming right up the track that will stem directly from the Government's publicity campaign. The voluntary demand for testing has already increased fourfold in some hospitals. After 23 million leaflets have gone through letterboxes, backed by television advertisements, this may well quadruple again, imposing a terrible strain on sexually transmitted disease clinics and voluntary bodies already working to capacity. I must therefore ask the noble Baroness what measures are in hand to meet this demand. It will severely vitiate the effects of the campaign if people coming in for testing or counselling are turned away; this could drive some people to despair and tip others back into the very anti-social behaviour that the campaign is designed to prevent.
§ Then there are the built-in demands that the system will face over the next five years or so and that it would still face if a vaccine were discovered tomorrow. There have been various estimates of carriers and potential cases. The surest guide is almost certainly the approximate doubling of patient numbers every year. Taking 600 cases this year, a simple geometrical progression gives us nearly 10,000 cases in 1990 and nearly 20,000 in 1991. The most reliable estimate of the cost to the NHS of an AIDS patient from presentation to death, based on a study of 40 cases by Mr. Malcolm Rees, is £18,000. Therefore, 20,000 cases would represent an NHS cost of £360 million compared to only £4.5 million attributable to the current year. These figures, which are not based on the most alarmist projections, indicate the scale of the problem confronting the NHS.
§ As regards human resources AIDS care, treatment and counselling are extremely labour-intensive. Training of new staff is, therefore, essential; otherwise, the dedicated teams that have been in the front line for several years with the same personnel are simply going to burn out.
§ It is also vital, on humane and financial grounds, that facilities should match the phases of the disease. Much of the treatment could take place in outpatient clinics with day beds to relieve the pressure on acute beds. In order to equip such a clinic, St. Stephens, Fulham, needs only £150,000 to top up a charitable gift of £500,000 and thereafter just under £200,000 a year revenue costs. I hope that the noble Baroness will be able to tell us that this will be approved.
§ St. Mary's Paddington, needs to increase seven or eight AIDS beds to 20, but not at the expense of other provision in the hospital. St. Mary's "path lab" may be crippled by a threatened cut of a few thousand pounds as part of the district squeeze. Surely, that would be folly. These relatively small demands, if not met, will cause great strains, and will soon be very much magnified. It is therefore vital to get a proper funding mechanism in place. I will return to that at the end of my speech.
§ I turn to voluntary bodies. Representing as they do the spontaneous reaction of society to this terrible disease, they clearly deserve, and must have, our support. I will not go into much detail because my noble friend Lord Young of Dartington is much more 1195 knowledgeable in this field. His college of health runs a healthline that includes AIDS information. The development of a hospice movement will clearly be important to relieve pressure on hospitals as the disease spreads. This is best done under non-governmental auspices, but it may need some government help. Perhaps the noble Baroness will say something about that.
§ The Terence Higgins Trust, which is running on only £300,000 a year, including a grant of £100,000 from the noble Baroness's department, desperately needs funds to move from its present warehouse warren to a place with a walk-in area and more space for information and live counselling. It has 300 volunteers on its books whom it cannot begin to deploy in present circumstances. It provides domiciliary care to about 100 patients, thus freeing hospital beds, and this number will clearly rise.
§ It is also the base of an extremely impressive flying squad called Frontliners, composed of AIDS victims who are still well enough and brave enough to succour their housebound fellow sufferers. The morality of our age is often denounced, but there is another side of the coin. Some truly admirable acts of mutual help have come to light among the worst afflicted. I, for one, should like to pay tribute to them. All is not doom and gloom on the moral front.
§ Before leaving current sufferers, may I raise the question of social security with the noble Baroness. There is no special benefit to AIDS victims who, like those with terminal cancer, notice the cold more and require special diets. Also, permanent doses of antibiotics devitaminise the body and may require up to £10 a week of vitamin supplements, while heavy sweats may require frequent changes of bed linen and clothing leading to high laundry bills. A single person's sickness benefit of £29 a week even when brought up to £38 or so by heating and laundry allowances is not much to get by on in these appalling circumstances. Will the noble Baroness look into this?
§ The Motion also embraces research. This is the third leg of my tripod. The present AIDS-related sums funded by the Medical Research Council are extremely modest—£1.5 million on 15 projects over two to three years, of which health departments have provided £300,000 entirely for epidemiology. Of course, the MRC is not the only—or even the largest—source of research funds, but it is almost certainly the best lead body for the AIDS epidemic. There is a strong case for its commissioning research in this field rather than just waiting for applications. It has been claimed that no worthwhile AIDS projects have been turned down, but there are other views on this.
When pressed on this precise point at Question Time on 4th December, the Foreign Secretary, Sir Geoffrey Howe—and I took down his words—said,
Have we got the right people in the right places where the money can be spent?".
He then added that if anyone could help to identify them, the sums were relatively small and there should be no difficulty. I welcome that, because identification is not difficult.
There are two essential points to make. First, we enjoy specially fertile conditions arising from the 1196 interface between academic medicine and the NHS, which we debated in your Lordships' House only the other day, and whose underfunding some of us sharply criticised then. This is peculiar to this country and offers unique opportunities for clinical research; that is, unless our excellent cadre of clinical scientists simply caves in under the strain of overwork and shortage of funds. Inspirationally-led teams are in danger of dispersal. That would be little less than a tragedy under the current circumstances.
§ Secondly, the easy-going notion that we can just leave it to the Americans is just not on. America tends to throw money at repetitive research; our research productivity, on a far lower budget, is very high. There are outstanding British achievements already in the AIDS field. It was precisely because of the quality of our basic research in molecular biology that we were able to develop an anti-body test in the fantastically short time of only one-and-a-half years after the discovery of the virus by the French. That is the sort of achievement, including a possible prototype vaccine, that we are putting in jeopardy by the Government's general policy of attrition of research funds by 2 per cent. per annum.
§ This is cutting off our nose to spite our face. It is one of the things that we are good at. If the Foreign Secretary, or any other member of the Government, were to talk to Professor Jarrett of Edinburgh, Professor Boyd of Manchester, Professors Weiss and Tedder, or Doctors Farthing and Pinching, here in London, I think that he would be left in no doubt that we have—so far—the right people in the right places and that a relatively small injection of money, by international standards, could be crucial in a field in which we excel.
§ There are many other important AIDS-related topics such as housing, employment and schools on which I have not touched and which time does not allow me to touch, but I am sure that other noble Lords will speak about them during the course of this debate.
§ In conclusion, I come to my main point, which is that we urgently need a national strategic plan in which money and method must go hand in hand. The Secretary of State has asked all health authorities to submit their plans for dealing with AIDS by the end of this month, but their plans in the final analysis must depend very largely on his; that is to say, on the Government's. He must reassure them that AIDS funding will not simply be sliced out of the main National Health Service budget, because that would set colleague against colleague and department against department and could lead to a rising tide of public resentment as other services were adversely affected. It must be new money.
§ I therefore propose something like this. The DHSS should certainly remain the lead department. Its AIDS unit should become the national command post. To avoid mismatch (which has occurred) between top-down allocation and evolving health authority needs, district authorities' bids should be fed directly into the AIDS unit, whose responses should be geared to the national strategic plan, which does not yet exist though elements of it are there in embryo.
§ How would this plan be agreed and how would it work? It would be negotiated by the Secretary of State 1197 for Social Services with the Cabinet on the advice of a national aids council constituted from elements of the chief medical officer's present advisory committee supplemented by the royal colleges, the MRC and health economists, presided over, I suggest, by the Minister of Health. Its main job would he to recommend, on the basis of all the national and international facts, the level of AIDS-related public expenditure on a medium-term basis of not less than three years. That should be outside the RAWP formula. After approval or amendment at Cabinet level, it would be the task of the administrative arm of the AIDS unit to see that the relevant sums were dispatched direct to destination and applied as intended.
§ One sub-committee of the council drawn from the MRC working party, clinical academics and industry should recommend the level of government-funded AIDS-related research; another sub-committee could deal with the needs of voluntary bodies, possibly in liaison with a new fund-raising charity. It may well be possible to devise a better model, a better perspective, from inside government; or possibly other noble Lords—and I am thinking of the noble Lord, Lord Hunter of Newington, with his great experience—may be able to suggest a better model than mine. What I am saying is that some such system is essential; otherwise we shall always be catching up and never be ahead of this deadly game.
§ On next year's funding, I do not want to be dogmatic. Allowing for increased NHS revenue and capital costs and some additional sums for research and voluntary bodies (and including the £20 million pledged by the Secretary of State), my guess is that we are looking at some £60 million. As to the future, I believe that the right levels will emerge from the kind of framework I am suggesting because we shall be asking the right questions and getting nearer, with experience, to the right answers.
§ Finally, if we really activate all the strengths of our National Health Service, the skills of research establishments, the commitment of our voluntary bodies and the commonsense morality of the British people, I believe that we can avert catastrophe. But we need all these interlocking elements if we are to win. My Lords, I beg to move for Papers.
§ 6.4 p.m.
§ Baroness Gardner of Parkes
My Lords, this is a highly emotional subject, and of course rightly so because unless we arouse people's feelings and interest to the extent that is necessary we shall not have the disease contained and people in general sufficiently aware of the need to take precautions. HIV—human immuno-deficiency virus infection—includes AIDS. The word "AIDS" is applied when it becomes the full-blown disease, and at that stage 90 per cent. of people affected die within three years. But there is a much larger number of people who are carriers, known or not known—people who are infected with this virus.
As the noble Lord mentioned, the number of cases has doubled every year since 1983. Half of the cases in the United Kingdom are in the north-west Thames region in London. The Praed Street clinic, which again 1198 has been referred to, operates an open door technique and it has always been famous for the excellent care it has given to patients with sexually-transmitted diseases. People go there because of the anonymity and availability of the service.
In fairness to the DHSS, I must say that they have made additional funds available there. In this year alone they gave an extra £500,000 through the region, so it is not that they have been expected to provide all the service without any help. There is of course a great need for the future to assess what is going to be needed from here on, and there is a case before that district health authority this very day to consider the various aspects of this matter.
The publicity given so far has been so successful that there has been an enormous increase in the number of people presenting themselves for screening just in the last month since these campaigns started. Of the 1,285 cases screened between October 1985 and 1986, 191 were antibody positive; that is, one for every seven cases tested. In October 1986 alone, 297 people applied for screening. That is the equivalent of 22 per cent of the number in the previous year in that one month. In the first two weeks of November 220 more came and asked for screening.
Of the 700 screened in the period from June to October 1986 there were only 11 per cent. positive cases; and indeed there has been no increase in the number. The number of positive cases has remained fairly constant. That is because as more and more people come there are more and more in the low-risk categories and therefore the good news is that the proportion is not increasing; but of course it is to everyone's advantage to discover, if possible, the cases which are the carriers.
The service is under great stress now, and there will be a need for more health advisers, research workers, contact tracers and support staff. All those categories will be needed if the new publicity campaign that we are going to see creates a great explosion. It is important to give people an awareness but not to create a great fear. That is a worry at the present time. A lot of people are quite unnecessarily frightened. I have heard of mothers whose children have picked up a toy somewhere. If such a child has blown a toy whistle someone has said, "Put that down. You will catch AIDS". That is a total misunderstanding of the way this disease is transmitted.
As a practising dentist I must say that we are very much at risk in this matter. People have a worry that they may go to the dentist and pick up AIDS. There is no known case yet where it has ever been transmitted through a dental surgery. There is no known case either of any dentist who has contracted it. Nevertheless, there has been a workshop of the dental health and science committee of the British Dental Association which has considered cross-infection in dentistry. It was originally set up because of hepatitis B, which is course of much greater risk to dentists but at least one can be immunised against it.
However, the Committee recommends that there should be comprehensive sterilisation in the surgery for all equipment used, and that all equipment should be sterilised between patients. Of course there are costs involved. An autoclave costs a minimum of £1,200, 1199 and because you need a lot of additional items of instruments and other equipment there is going to be expenditure of, say, £4,000 to provide adequate sterilisation.
Gloves are recommended for dentists to wear. Yesterday I saw a report in The Times saying that dentists should wear gloves, a mask and goggles. I thought "Heavens, people are frightened enough of a dentist already. Just imagine the reaction if you went in and got confronted by that." My research today—and I have spoken to all the experts on this matter in dentistry—indicates that goggles and a mouth mask are really not necessary, though some dentists may like to use them in a known case or in a advanced case.
On the subject of general hygiene, many members of the public do not know that bleach is a very effective disinfectant. A solution of one in ten household bleach will kill an AIDS virus, because it is a very low grade virus and is easily dealt with in that way. But not all materials can be treated with bleach. The woman who is at home and is very worried about her kitchen counter would be helped by knowing that just an ordinary household bleach solution used to wipe that bench and left in position would do that much good. The situation with dentists is to use good techniques, to sterilise and cleanse and to use disposable needles. I was interested to hear that 40 per cent. of the injuries to dentists through pricking themselves is because they are trying to put the cover back on a needle to keep it safe for someone else. I am pleased to see that needles are now being developed which will retract into the syringe after they have been used. That will be marvellous for all forms of disposal and a great protection to people.
The DHSS has played an important part in sending circulars round to all the dentists. There has been guidance from the chief dental officer on these precautions and postgraduate courses have been set up for general dental practitioners so that they can be brought right up to date with the techniques that are necessary. Instructions have been issued to family practitioner committees to check that good sterilisation procedures are being carried out in dental surgeries.
The message to go out from dentistry is that patients should not be concerned. If they are concerned they should ask the dentist and satisfy themselves that good techniques are being used. They should not put off necessary dental treatment simply because they are afraid as a result of rumours they have heard which are not based on fact. The only good thing that might come out of this terrible disease, which is such a scourge on our society, is the thought that the attention of the whole world is concentrated on trying to find a cure and a solution. With the resources that are being devoted throughout the world perhaps we may find that the researches solve more than just this disease. They may find the answers to other diseases that have troubled the world for so long. Let us hope so.
§ 6.3 p.m.
§ Lord Pitt of Hampstead
My Lords, I am sure we are all grateful to the noble Lord, Lord Kilmarnock, for enabling us to have this debate. I was glad to hear the way in which he introduced it and I am grateful to him 1200 for it. I am also very pleased to be following the noble Baroness, with whose speech I agreed very much.
AIDS is a worldwide problem. In this country by the end of October 1986, 548 cases of AIDS had been reported to our Communicable Diseases Surveillance Centre. Of those 278 have died. As we have been told, the number of cases doubles about every nine to 10 months. It is estimated that there will be 1,300 patients in 1987 and 3,000 in 1988. It is likely that 30,000 individuals may have been infected with the AIDS virus. It is estimated that 30 per cent. may—the word is "may"—go on to develop the full pattern of the illness that is AIDS. But as there is no known maximum possible incubation period before the disease becomes apparent this percentage may increase.
Even if further transmission of the virus were to stop forthwith, there would still be thousands of cases within the next few years. We know that many others will suffer from dementia, as the virus attacks the central nervous system. If you are infected with the virus, you can infect others for the rest of your life. Some time later, four weeks to a year, you can develop antibodies and you may—the word is still "may"—go on to develop the full AIDS pattern of illness in which diseases such as pneumonia may be fatal.
Although all these people in the UK are already infected with the AIDS virus—so there will be several thousand sufferers over the next few years—we are faced with a challenge which we can meet. It is not yet too late to prevent the spread of AIDS into the general population of this country. AIDS is not the plague that it is often made out to be. I was glad to hear the noble Baroness speak the way she did, because she reminded the House that the virus is easily destroyed by bleach or by heating to above 90 degrees for 10 minutes.
AIDS is not spread through the air, by coughs and sneezes, nor indeed through food or water. It is safe to eat food prepared by infected individuals, to share most washing, eating and drinking utentils or toilet facilities and to live with infected individuals, provided sexual contact is avoided. Sharing toothbrushes. razors or other items likely to become contaminated with blood may be a source of risk, though, as the noble Baroness had told us, so far no one is known to have become infected by this route. The AIDS virus is only spread through sexual contact, infected blood or from mother to unborn child. This allows great scope for the control of the spread of infection.
Since the advent of AIDS into this country there has been a marked decline in sexually transmitted diseases among homosexuals, suggesting that they have changed their habits. This suggests that a really concerted effort at health education, using the best expertise and all forms of the media, could be effective in slowing the spread of infection in this country. I am glad that the Government have provided additional resources for this, but the campaign should be long, hard and intensive. Resources greater than the £20 million so far suggested will be required.
Health education is vital and should explicitly describe the way in which AIDS is transmitted and how it can be avoided. However, if we are to persuade our young people that we really mean it, something 1201 more than mere advertisement is needed. We should reinforce the health education message by making condoms widely available at the places and times where sexually active young people meet. For people who inject drugs it is not enough just to say "Always use a clean needle". We must provide the clean needle.
But we must do more than that. We must make it very much easier for drug addicts to receive treatment and very early in their treatment they must be persuaded to stop injecting. This involves a tremendous increase in drug rehabilitation clinics so that drug addicts can walk into one and be accepted for treatment, just as they can a VD clinic. Active treatment of drug addicts must be regarded as an important part of the campaign against the spread of AIDS. The Government must take this on board.
There are grounds for hope. Thanks to remarkable developments in the sciences of immunology and molecular biology during the last 20 years or so, the cause of AIDS was identified extremely quickly after the first cases appeared among homosexuals in America. We now know far more about the virus that causes AIDS and how it attacks the body than we have ever known about any other disease at a comparable stage in its history. A new drug called AZT is being tested. It does not cure AIDS but it may help to slow the progression of the disease. Currently scientists are working towards a vaccine to prevent AIDS. While we should not expect this vaccine to be available for a few years at least, the more support and resources we provide for research the sooner we shall be able to prevent and treat this dreadful disease. I could not agree more with what the noble Lord, Lord Kilmarnock. had to say.
The Government must increase resources not only for the MRC but also for the pharmaceutical industry, for it is the pharmaceutical industry that is most likely to help us by providing a drug which will destroy the virus, slow its activity, enable the immune system to overcome it or strengthen the immune system. We must always remember that it was through the arsenicals, and later penicillin, that we conquered syphilis. Success in the fight againt AIDS requires the co-operation of the groups most at risk and we must not alienate them by blaming them, by imposing upon them moral views they do not share or by isolating or discriminating against them.
Because AIDS cannot be transmitted through ordinary forms of contact, there is no medical reason to restrict the rights of sufferers or infected individuals. Because of the nature of AIDS and the available methods of testing for infection, screening and isolation would not be effective in controlling it. We must not spend our time going down that road. Finally, we must be prepared to take care of those who are affected and we must show them the standards of care and compassion that all ill people have a right to expect.
At different stages of the illness they have different needs. Full in-patient treatment in a general acute hospital is needed during episodes of acute illness, but in the later stages of the disease sensitive nursing in a peaceful home or hospice environment is more appropriate. All this requires money. As the noble Lord, Lord Kilmarnock, said, it may cost about 1202 £18,000—or, as is the estimate given to me, about £20,000—per patient spread over two years.
What we want is for the Government to make sure that resources are available. That is very much part of their job. I hope that when the Minister replies she will be able to assure the House that the Government are fully alive to their obligations and will provide the necessary resources to enable the community to withstand this challenge successfully. The point is that we can successfully overcome this challenge if we pursue it in the right way and with the requisite amount of vigour. I hope that we shall do so.
§ 6.23 p.m.
My Lords, in the earlier short debate today which I had the honour of opening the noble Lord, Lord Pitt of Hampstead, apologised to your Lordships and to me for not having been here to hear my speech. He will realise that I have had no opportunity of avoiding hearing his speech since I had to speak immediately afterwards. But he may like to know that I listened to it with very great care and I agree wholeheartedly with his concluding remarks.
I think that the first debate we had in your Lordships' House on this subject was on 18th March—that is, about 21 months ago—initiated by the noble Baroness, Lady Cox. It was a most interesting debate. At that time I think that I asked some eight or nine questions and looking back at them I find that only about three so far have been finally and clearly answered, which shows that we still have much to learn.
At that time I told the Government spokesman who answered the debate that I thought that one of the most urgent requirements was to convince the British public that this was not a disease which exclusively affected the homosexual population. I am bound to say that we have not yet succeeded in that task. There are still people who think that this is a disease that affects homosexuals and homosexuals alone. Of course we know that it affects haemophiliacs and we know that of one class of patients suffering from haemophilia 50 per cent. are now infected with AIDS; a tragic figure. We also know that babies are born with AIDS. Mainly these are babies born to parents who are intravenous drug addicts. We know that too, and I do not think that anybody suggests that these babies are homosexuals or anything of the kind.
The important lesson to get over is that the disease is a disease and that it is very important indeed that the whole British public should understand fully how it is transmitted. When they understand that, we are in with a chance perhaps of conquering it. Much of the earlier work done for the public in regard to this disease was done by members of the Terrence Higgins Trust. I say this not as a criticism of that trust, which has done marvellous work, but it was set up as a result of the tragic death of a homosexual youth, and that tended to reinforce the belief in the public mind that this was exclusively a problem for homosexual people. It is not.
Having mentioned the Terrence Higgins Trust, to which we should all be grateful, let me say that counselling both of sufferers and of friends and relations of sufferers is crucial in this area. Most of the 1203 early counselling was provided at very considerable personal cost by members of the trust. Counselling is not just a matter of being sympathetic, and saying kind words and listening; it is a highly skilled, professional craft. If people are counselling patients in this desperate condition they themselves are exposed to serious dangers of psychological trauma. A counsellor is attached to one patient and develops a relationship with that patient. In the fullness of time the patient dies—and these patients all die; I know that we all die but they die sooner—and the counsellor goes to another patient, establishes another relationship and then that patient dies.
That is not a satisfactory situation. I mention it merely to say that there is a desperate need for more professionally trained counsellors in this field. Had she been here, I think that the noble Baroness, Lady Faithfull, would have echoed that. I think that the requirement is for training and for investment. It also requires a certain amount of government action to provide the necessary skills and professional expertise for counselling.
I now come to the remarks of the noble Baroness, Lady Gardner of Parkes, with whom I always agree profoundly because she is at the grass roots of some medical matters. What she said about screening was very important indeed. A lot has been said about screening. It has been suggested in your Lordships' House that everybody coming to this country should be screened and tested. About 6 million visitors come to Britain every year. It takes about three months to get a result from a blood test. What do you do in the interval? Do you put them all in hotels near Heathrow and then wait for three months? And when you have the answer, what do you do then? You can do nothing at all. Perhaps you can send some away. The same applies to screening the whole population here. It would consume a massive amount of resources, resources which are already in scarce supply.
Having screened people and obtained the answers. what do you do? We are in the sad situation that we can do nothing except to tell people that they are infected or they are not infected. Let us look at screening not as a measure whereby if we screen everybody suddenly we know whether or not we are all right. What are we to do? Are we to have them all coloured blue, red or some other hue as being the people with the wrong blood test result? It is not a practical proposal at all. I ask noble Lords to remember that.
My noble friend Lord Kilmarnock, in his excellent opening speech, concentrated very much on research. How right he is. I should like to say a few words about that. Certainly we all hope that some day there will be a vaccine that will provide protection against this desperate disease. But it takes very many years indeed to pioneer and develop a protective vaccine and I do not see the possibility of one being available for at least 15 years. If one is available then, splendid! The answer is to develop a specific and effective therapeutic agent as rapidly as possible. It is in that field that more research needs to be carried out.
We have in Britain perhaps the leading virologists in the world. We also have a situation at the moment where most of the clinical work in looking after AIDS 1204 patients is being done by members of university academic staff, clinical teachers. The people who ought to be doing the research do not have the time. They are busy dealing with the patients, because the resources for dealing with them are not there. The research is being left to the Americans. I am not saying that they will not do it properly; they might do it as well as we could. One of my fears is that some of our brightest research workers in this field may decide to go over to America and perhaps work there, where they have better resources and better opportunities to carry out the research work. This point was referred to in a debate only very recently with regard to the crisis over academic clinical staff.
Let me come quickly to one other point; I shall be as quick as I can. I am not one for censuring television. I am not one of Mrs. Whitehouse's gang. I do not like violence on television and I always switch it off; but I am not in favour of censorship. However, I believe that fictional television has some effect and it sets an example. I find that now in a television fictional series if ever a man meets a woman you can guarantee they will be in bed together in no time at all; similarly, if a boy meets a girl it is suggested somehow that casual sex and promiscuity are the norm.
They were not the norm in my young days, even for me, and I was not one for following the rules! I do not honestly think that they are the norm today, but I believe that in fictional series in particular an example can be set. If we all agree, and I think that we do, that we should set an example in regard to smoking, that characters in fictional series should not smoke and that there should be less smoking, perhaps on television there should be less of something which rhymes with "smoking", although I shall not actually say what it is.
Let me refer briefly to one other point. This has been an interesting short debate. The Alliance, which is two parties, is allowed three days on which to choose the subjects for debate. Divide three into two and you get one and a half; and so today on two very important subjects—first housing and now AIDS—we have two short debates. If the Alliance had four days instead of three, your Lordships would have had a full day's debate on housing and you would now have a full day's debate on AIDS—and both warrant that.
§ 6.32 p.m.
§ The Lord Bishop of Birmingham
My Lords, I should like to thank the noble Lord, Lord Kilmarnock, for introducing this timely debate. I should like to say how much I agree with him that we must not be moralistic about those who may unfortunately already have the AIDS virus. The noble Lord, Lord Winstanley, has just given us a very grim picture about research. That is all the more reason to ask that research should be co-ordinated internationally, if possible. It seems to me that this is a worldwide disease. I read the World Health Organisation's forecast and it seems that there will be 100 million people infected with this virus by 1988. It seems to me that if ever there was a case for international co-operation, it is here.
I am sure there will be a general welcome for the publicity that the Government are giving to the dangers of AIDS. Most AIDS cases, as I am sure the noble Lord, Lord Winstanley, would agree, actually 1205 come from sexual transmission. However, I wonder whether the present advertisements are explicit enough. What is needed is clear language; words which ordinary people understand and use. I confess to being a little disappointed by what I have seen so far. It seems to me it is better to be explicit than to cause death by failing to convey a warning crudely enough. I should like to think that Her Majesty's Government would call on young people's magazines to co-operate here. Also, I should like public advertisements to be oriented towards those carriers of the AIDS virus who have not developed the disease. Surely, they are the people who are most dangerous and who have a special obligation not to pass it on to others.
I spoke at some length on this subject when we were debating the Address on the gracious Speech. Obviously I do not want to repeat myself but I feel that I must again enter a call for chastity as the only safe way of avoiding AIDS, transmitted through sexual intercourse. By "chastity" I refer to abstinence from all immoral sexual intercourse, to chastity before, during and outside marriage and, so far as homosexuals are concerned, either to sexual abstinence or, if thought right, to exclusive loyalty to a single partner.
I do not think it is impossible to bring about a fundamental change in lifestyle in this matter if we have the co-operation of the mass media that the noble Lord, Lord Winstanley, has indicated we need. Condoms, which feature in Government publicity, no doubt have a place for people who will not adhere to this standard. There seems to be no objection to continuing the provision of free condoms, providing it is done in a way and in places that would not encourage their use in a promiscuous way. However, it is a fact that condoms are not totally effective. They are not totally effective as contraceptives, and they will not be totally effective in preventing AIDS. Also, publicity for condoms does not guarantee their use. The "safer sex" campaign in the United States did not raise the profits last year of the best-known company which manufactures condoms. I could wish that Government publicity would focus less on condoms and more on chastity—not for moralistic reasons, but as the only really safe way of avoiding AIDS.
I hope that the Government will make facilities much more easily available for anyone wanting a test for antibodies against the AIDS virus. An increasing number of worried people want tests. They want results very quickly. And that is now possible, with certain new techniques. However, it takes some months before the antibodies develop. So a negative result does not guarantee freedom from infection. People who find that they have a positive result need counselling—not only those who actually have AIDS but those who suddenly find that they are positive following a test. This ought to be available both before and after a test. The Government should make sufficient money available for the training and employment of a sufficient number of counsellors to deal not only with those who actually have the syndrome but also with those who wish to be tested—both before and after the test—to see whether they have the virus.
1206 Since AIDS is not caught in the normal way of infectious diseases, the possession of a positive test surely ought not to be a notifiable disease. This might deter some people from coming forward for the test. The test should not be compulsory for all, as argued by previous speakers. That would be quite impracticable. For the same reason—this seems to me very important—there should be no discrimination against those who are positive but who have not developed the disease and who are not infectious in the normal way. Furthermore, the results of a test should be totally confidential to the person concerned, since communication to others might affect reputation or career. The noble Lord, Lord Winstanley, has already pointed out how absolutely impracticable it is to test everybody who enters this country or who returns from abroad. In any case, the test might not show the actual state.
As for the care of those who already have the disease, the Board for Social Responsibility of the Church of England has issued a little pamphlet, simply called AIDS, of which very large numbers have already been sold. It explains what it is actually like to find that you have been afflicted with this killer disease and it makes helpful suggestions about the needs of such a person. It also deals with the terrible difficulties faced by family, friends and sexual partners, who suddenly wake up to what has happened. Equal difficulties, already touched upon, are encountered by medical staff and indeed by clergy who minister to such people. The pamphlet gives practical advice to those who nurse AIDS patients at home, and it also gives advice about hospital care.
Incidentally, hospices have been mentioned. I gather that not all of them are willing to take AIDS patients. I think that they should be persuaded to take at least some. It may be necessary to open new hospices with part government funding. I believe that the churches ought to take some kind of initiative here, although I must confess to your Lordships that I do not know exactly how they would do it. People really do need pastoral care; those suffering from AIDS, and especially those who are dying. I hope that this booklet may be a help. Of course I gladly acknowledge the other agencies that are making a large contribution, and especially the Terrence Higgins Trust. I am glad that somebody else has asked that its grant should he increased, because it is under tremendous pressure.
§ 6.39 p.m.
§ Lord Colwyn
My Lords, it is a pleasure to follow my noble friend the right reverend Prelate. I agree with most of his remarks this evening. He was widely quoted during a debate in the other place, and I am sure he will be quoted again after our debate this evening.
I know that this is not the first time we have discussed the problem of the Acquired Immunity Deficiency Syndrome, and there is no doubt it will be a subject for debate here for many years to come. I am sorry that owing to the extreme pressure of my daytime work at this time of year I have not had as much time as I should have liked to enable me to work on a more interesting contribution to our debate this evening. In the debate in another place on 21st November there was no mention of a dental 1207 connection. This evening, 12 per cent. of the speakers are dentists. I therefore hope that I shall not repeat too much of what has been said by my noble friend Lady Gardner.
As your Lordships will know, it is inevitable that I have a personal interest in the progress of this epidemic. Like my noble friend, I practise as a dental surgeon. I use normal dental techniques and I also use some techniques from alternative therapies. The acceptance of the fact that there are now about 30,000 people in this country who are infected with the HVI virus leads to the projection that about one million people will be infected by 1990. This increase, along with a similar increase in the incidence of hepatitis B, enables the calculation to be made that general dental practitioners in the United Kingdom could now be treating approximately 250 carriers a day. In the majority of cases, these carriers will not have been identified. The growth in the number of carriers of hepatitis B virus, non-A, non-B hepatitis virus and HVI virus is such that as many of 10 per cent. of the population might be affected by one of these in the foreseeable future. Members of my profession will be treating positive patients every day where neither the dentist nor the patient will be aware of the condition.
It follows from this that new standards are required, including full case histories, safe sterilisation and surgery hygiene routines which will prevent cross-infection. In view of the inevitable shortage of resources, I believe the Government are doing as much as can be expected at this stage. However, I do have some questions for my noble friend the Minister a little later in my remarks.
In April 1986 all medical and dental practitioners were sent a letter from their respective chief officers with a document of guidance for dealing with patients infected with HVI. This guidance was very comprehensive, although (as my noble friend Lady Gardner has said) perhaps it was not very practical with its advice. I should hope that, in view of the escalating costs of this sort of change to our surgery routine, the Minister will be able to confirm that any extra costs arising from recommended procedures for routine practice will he taken into account by the Dental Rates Study Group calculation of expenses, and that it will also be realised that the treatment of patients known to be carriers of HBV and HVI will involve the dental practitioner in extra time as well as expense which will have to be considered when the General Dental Services Committee discusses with the DHSS the basis on which fees are calculated.
It should be pointed out that in this country there has not yet been any recorded incident of dental treatment being the cause of any patient becoming a carrier of the virus; nor has any dental surgeon caught the disease or become a carrier. I have a copy of the latest CDR report containing details of the cases of AIDS reported in the United Kingdom up to the end of October. It contains a follow-up survey of health service staff who have been exposed to HVI infection and it includes a substantial number who have sustained needlestick injuries. With one very unusual exception, no seroconversions have been observed. A similar study in the USA, reported in the Weekly Epidemiological Record of the World Health Organisation, followed up a serological study of 1,758 1208 health care staff where only 26 persons or 1.5 per cent. were found to have HVI antibody in their blood. But of these, 23 were in a high risk group.
I can also confirm that there have been no known cases of patients who become infected after acupuncture treatments; nor are there any cases of acupuncture therapists contracting the virus. As with dental practice, all acupuncturists are considered to be irresponsible and negligent if they do not either use disposable needles or effectively sterilise their instruments. I know that they would be quite happy to see legislation to make this compulsory.
Perhaps I may mention that I myself have started using acupuncture. I am learning this at the International Society of Biophysical Medicine in Liverpool, which has set up one of this country's foremost centres for the treatment of heroin addiction. It is opening a clinic in Glasgow and will soon be opening one in London. Owing to the high-risk nature of their patients, they are teaching the use of and using stimulation with electrodes rather than needles. Some of your Lordships will have attended a presentation which I organised with the society a year ago in the House of Commons and will be pleased to hear that their splendid results are continuing.
There are alternative treatments for AIDS which basically involve the stimulation of the patient's immune system and of the affected T-lymphocytes. Whether this is done by acupuncture, homoeopathy, oesteopathy or other means, I should like to ask the Minister (knowing of her interest in alternative therapies) whether her department has made any assessment and given any consideration to this form of treatment.
I have here a letter from an AIDS sufferer. I hope your Lordships will permit me to read a few sentences.I was diagnosed as suffering from AIDS a year ago during a severe attack of TB which very nearly killed me. I stopped allopathic treatment halfway through, and the TB has been successfully controlled by my homoeopath. I now refuse to take allopathic medicine in any form, although I am going for check-ups at St. Mary's clinic.The TB quickly followed by the appearance of Kaposi's sarcoma which I have inside and outside, particularly in the lungs. The Kaposi's sarcoma in the lungs impedes the correct flow between oxygen and blood, and I have ordinary infections as a result.Some two or three months ago I sought acupuncture and Chinese herbal treatment, which seems to he giving good results. I also visit an osteopath once a week.My last check-up at St. Mary's was on Thursday, 27th November, and the doctor said that I had not deteriorated as much as he had expected, and that on the strength of these encouraging signs I would wish to continue my therapies.The reason why I am writing to you is because I am finding it impossible to cover the expense of these treatments as my pension allows me only £49.50 per week. I would he very grateful indeed if you could be of any help in assisting the cost of my therapies, particularly in view of the very promising progress I have made so far".As we are going to hear this sort of depressing story more and more often, can the Minister offer any encouragement to AIDS sufferers who find relief through the natural therapies? Is she prepared to offer financial help to all sufferers from AIDS so that they can take advantage of any treatment that may be able to alleviate their physical distress and prolong their lives?
In conclusion, I believe that your Lordships will see that there must be a change in standards. Routine 1209 procedures for sterilisation and surgery hygiene must be adequate to prevent cross-infection. These procedures will include the use of operating gloves, comprehensive decontamination and sterilisation of equipment and instruments, burrs and hand pieces being autoclaved between patients and a maximum use of disposables. On no account may needles or anaesthetic cartridges be used for more than one patient. It may well be that some practices already meet these standards, but it is more than likely that a substantial number do not.
I am able to tell your Lordships that the BDA are continuing their campaign to persuade the profession to take this matter seriously. At the same time they are becoming fearful of the impact of AIDS on the population at large. There are reports of patients who are cancelling their appointments because they are not sure that dental treatment is safe. The problem is likely to increase following the Governments' distribution of the AIDS leaflet to all households next year.
As dentists, we must consider how best to reassure the public. That is a matter of urgency. However, such reassurances will be ineffective unless all dentists are thorough in their procedures to prevent cross-infection and are seen to be thorough in doing things properly. Clearly we require from the Government and from the DHSS support which must include recognition of the extra costs which dentists will face and support for their efforts to reassure the public.
§ Lord Parry
My Lords, before the noble Lord, Lord Colwyn, sits down after his extremely helpful speech, may I ask one question? Would it not be possible for practitioners and surgeons, whether in dentistry or general physiology, to sample the blood of patients after each operation so that a bank of information about the presence of the virus is built up?
§ Baroness Trumpington
My Lords, may I say that if I do not start at three minutes to seven, I shall not have 20 minutes to speak and I shall not have a hope of answering your Lordships' questions?
§ 6.50 p.m.
§ Lord Kilbracken
My Lords, I was very worried when the noble Baroness spoke about having to rise to reply to the debate at three minutes to seven because that would have abbreviated my remarks considerably.
Like all noble Lords who have spoken in the debate, I am grateful to the noble Lord, Lord Kilmarnock, for tabling this Motion and I know that all noble Lords are fully aware of the terrible threat posed by this disease, no one more so than I am. If my remarks today are critical of the Government it is only because I am 1210 convinced that their campaign in this grievous matter is wholly misguided and erroneous, and I hope they may he persuaded to put it right.
The campaign's whole thrust is epitomised by the words that are used so prominently all the time: "AIDS is not prejudiced". Those words are designed to indicate that everyone is at risk and almost equally at risk. That is the linchpin of the campaign yet it simply is not true. I exclude from all my remarks the dangers posed to haemophiliacs and drug addicts. I am concerned here with sexual transmission.
Large sections of the community are in fact at absolutely no risk at all. Those who have never been sexually active, whether because they are too young, because they are indifferent to sex or because sex has never been available to them, are at no risk at all. Those whose sexual activity has been confined to kissing or masturbation, whether mutual masturbation, group masturbation or individual masturbation, are at no risk at all. Those whose sexual practices fall short of anal or vaginal penetration are at exceedingly low risk. Couples who have no other partner are not at risk. In all those cases AIDS is totally prejudiced in their favour, to use the catchy phrase employed by the ad-men responsible. The people embraced by those categories probably represent over half the population.
On the other hand, AIDS is highly prejudiced against other categories. In saying that it is strongly prejudiced against homosexuals I must add that I am not. I find it extremely unfair that they should happen to be so susceptible, but my sympathy for them must not divert me from the truth. The truth must be given, and that the Government do not appear to have done. Of some 600 fully-blown cases in the United Kingdom, only four have resulted from heterosexual intercourse, even though there are many times more heterosexuals than there are homosexuals. We have to ask why.
The first reason is that homosexuals in general are much more promiscuous, sometimes compulsorily promiscuous. Secondly, sodomy happens to be the sexual practice through which infection is most likely of all to take place. I could go into details but I do not intend to do so. The risk is at its very highest if unhealed lesions in the anus have been caused through frequent, violent penetration. If the so-called submissive partner allows anal ejaculation when he has these lesions it is very close to suicide, especially if he is promiscuous; and yet this is commonplace.
Many homosexuals know all this, but, again, many do not. They have to be told and told with great emphasis. A condom is an effective barrier but homsexuals are not accustomed to using them; and because their use greatly detracts from satisfaction they are very much disfavoured, even apparently at the risk of death.
As the noble Lord, Lord Winstanley, and the right reverend Prelate—neither of whom are still in the Chamber—pointed out, one of the great problems is that a person who is screened will not be shown to be carrying the virus if infection took place in the preceding three or four months. Therefore, it is no safeguard if a partner says, "It is all right. I had the test done last week and I am clear". Furthermore, it may 1211 be five years after infection before apparent symptoms develop.
The syndrome can be carried across the border between the homosexual and the heterosexual communities if a heterosexual is infected through injection or transfusion, with which I am not here concerned. Otherwise it can be only through the agency of bisexuals of either sex, though male bisexuals are more of a danger than females. The particular danger of bisexual acts should therefore be strongly emphasised, and it has not been. Once the virus has crossed that border, as it has in Britain, it can obviously be spread by one heterosexual to another—more ususally from the male to the female—but that is likely to happen less quickly, except that the hetrosexual community is of course much the larger. That is, first, because anal sex is less common among heterosexuals and, secondly, because full intercourse takes place relatively seldom during menstruation—the other occasion at which the risk of sexual transmission is the greatest.
If AIDS is therefore very far indeed from being unprejudiced, how do we account for the completely mistaken emphasis, I suggest, in the Government's campaign? I can only suppose it sprang from a mistaken desire to avoid being thought prejudiced themselves. Let me put it like this. If a mortal disease were known to be confined 99 per cent. to, say, left-handed people, the whole thrust of any campaign to counter it would be directed towards those unfortunate enough to be left-handed. No one would mind being thought prejudiced against left-handed people.
Of course promiscous heterosexuals are at risk, but when such a dire threat exists, as it does at present, surely the government attack should be overwhelmingly directed towards the specific people and the specific areas where the risks are greatest. Instead of doing that, the campaign has had, and is having, two serious deleterious results. It has thrown into panic millions who are at no risk at all, or at the very slightest risk, undoing much of what has been accomplished in recent decades in spreading the gospel that sex is not dirty, wrong or shameful but an incomparable delight. It must also have the effect of giving false reassurance to homosexuals—those who, on the contrary, chiefly should be made aware of the dangers and many of whom are bound to react by thinking, completely mistakenly, "Oh, AIDS is not prejudiced. I must be less at risk than I thought". The danger is then clouded instead of being emphasised.
Finally, I refer to the Surgeon-General in the United States, who said recently,Knowledge is the only vaccination against AIDS".It is this absent knowledge that the Government should be disseminating, not inaccurate generalities.
§ 7 p.m.
§ Lord Young of Dartington
My Lords, I should like to start by declaring an interest. I am the chairman of the College of Health. The college has an offshoot called Health Line, which is a telephone information service that includes AIDS in its coverage. We started the service on the subject of AIDS in November 1985 1212 and in the first six days after opening it for this purpose we had something like 30,000 calls, which showed the degree of concern and desire for information that existed at that time. That desire has abated hardly if at all.
It was not possible to deal with anything like the demand because we did not have the resources and in particular we did not have enough telephone lines to deal with such a large number of calls. It was only because we received support from the DHSS that we were able to increase the range and add to our number of telephone lines and have those lines staffed so that in small measure at any rate we could attempt to meet some of the demand for information about this new epidemic.
I do not think that it is only because of the interest that I have just mentioned that there is cause to congratulate the Government, as I very much want to do, on what they have achieved in the few months since last summer. If one goes back to July or August last year—and it is such a short time ago—that was a time when I at any rate was almost in despair. All those who had their eyes open could see that we were already faced with an epidemic that was spreading at an alarming rate.
We knew what had happened in the United States. The United States had mightily forewarned us about what would happen here unless action—drastic action—was taken. We have about three or four years' grace. Unfortunately we are following behind the United States on the same course; but we are about three or four years behind them, which gives us a chance to learn from their experience and to take the kind of preventive action which may mean that in the end we do not continue to follow the same dread course that they have followed.
Despite that warning, hardly anything seemed to be done on the front of public health education. It almost seemed as though the advertisements which the Government published earlier in the year were the first-ever advertisements that were meant not to carry any conviction with those who read them. They were opaque in the extreme, to say the least of it. Of course there were bright spots. Our own noble Baroness, Lady Trumpington, was a tower of strength, and there are excellent doctors and excellent civil servants in the DHSS. But it was not until the Cabinet reshuffle and the arrival of Mr. Newton as Minister for Health that those of us who were concerned about the epidemic began to feel that at least there had been a change and there was a spirit of courage and determination and a sense of action being taken—with the people concerned being ready to take action—which had not so far been in evidence.
Now we have had the beginning of an outspoken advertising campaign with the promise of more to come. We have been told that we shall have a national leaflet drop in January, and that is greatly welcomed. Despite what was said by the right reverend Prelate earlier in the debate, we are expecting next week to have a special sub-campaign directed at youth through advertisements in the papers and magazines that are read by young people. So there has been a change and it is very much welcomed by all the voluntary bodies in the field. I should like to make that point quite clear.
1213 Tribute has already been paid (and quite rightly so) by the noble Lord, Lord Winstanley, and the right reverend Prelate and other noble Lords to the work of the Terrence Higgins Trust. I should like to add my voice to that tribute. The Terrence Higgins Trust was out in the forefront long before it became accepted, as it has now been accepted, that in this epidemic there was a challenge to the whole nation. The trust was trying to focus attention on this problem long before it became general and, as it were, popular. Other voluntary bodies such as the Gay Switchboard, Body Positive, the Haemophilia Society and others, have all done whatever they could—and it has been a great deal—to mobilise their own members and arouse interest and concern in this great problem.
I am afraid that there is a great deal of concern in this sector in particular at the moment about the consequences of setting up a special health authority in place of the Health Education Council. I have no doubt that this is a good step to have taken, though there must be some doubt about whether the new special health authority will have the degree of independence that the Health Education Council used to have and whether it will be able to speak out with an independent voice and when necessary be critical of government policy. However, by and large the setting up of this special health authority is welcome.
The anxiety on the part of the voluntary bodies in the field is that there may be a hiatus in administration. Nearly all the bodies which receive support from the DHSS are seeking support for next year. They need support for at least a whole year if they are to plan ahead sensibly. But will the continuity of policy that is so necessary be interrupted by the setting up and coming into action of the special health authority next April? I think that with complete unanimity the voluntary bodies hope that the Government will be able to assure them that there will be continuity of policy and continuity of the necessary funding. If the Minister is able to say something at the end of this debate to that effect it will be most welcome to all the people who are working with the voluntary bodies that I have mentioned and those that I have not mentioned.
If I may, I should like to say a word about the reasons the voluntary agencies are so important in this field. AIDS is not just a medical problem but a social problem of the gravest possible kind, above all because prevention is not only the best cure but is the only cure. Preventive work and education of the public cannot be carried out only by doctors and medical people any more than it can be carried out only by the Government. It goes much wider than that and the important messages that need to be put across can only be conveyed with the backing of voluntary agencies that cover a very wide spectrum.
I think I can illustrate the point by referring again to the Government's advertising campaign. This campaign is greatly welcomed but it is almost certainly the case that behaviour will not be changed merely by advertising. It never has been and it is unlikely that it ever will be. If advertising has an effect it is a two-stage affair. First, there is the advertising and then there is the personal influence that can follow it, which comes through the leaders of public opinion in their localities and workplaces who take up the message. The advertising campaign will only be effective if it is 1214 backed up and followed by large numbers of people who are going to translate the message contained in the advertising campaign into the kind of language and the kind of backing which will really carry conviction with the population at large.
This is just one reason why voluntary bodies are so necessary; there are other reasons. I hope that the Minister will be able to say something reassuring, not only on the particular point that I have mentioned but also on the much broader point about the value of the contribution that voluntary bodies can make.
§ 7.11 p.m.
§ Lady Saltoun of Abernethy
My Lords, I was very glad to read in the Secretary of State's speech in another place on 21st November that the Government are trying to get over the message, stick to one partner. That will not be easy, or popular with a public which has indulged in pill-happy promiscuity for a generation or more under the purblind eye of a succession of governments, and, I am afraid, the Church. And it has been encouraged by fiction both on the screen and in print, as the noble Lord, Lord Winstanley, so truly said.
I was less happy with the continuation of the Secretary of State's message that if you do not stick to one partner you should use a condom. However, the right reverend Prelate the Bishop of Birmingham has already touched on that, and so I shall not repeat the argument.
I was rather disappointed about half an hour ago when I got hold of the Health Education Council pamphlet, AIDS—What everybody needs to know. I read through it and it merely says that the fewer partners you have, the less you are at risk, and that the fewer partners your partner has, the less you are at risk. It is positively anodyne and I was very disappointed. I am sorry, but I think that morals do come into this. I make no apology for being thoroughly old-fashioned about it.
I keep hearing and reading that we do not want to equate AIDS with the wrath of God. Why not? With very great respect to the right reverend Prelate, who is not here—perhaps that is just as well—I should like to say a word to two about the wrath of God. I believe that the wrath of God to a great extent was the name that the old prophets (who were no fools) gave to the disagreeable consequences which they had observed were liable to follow upon flouting the laws of nature.
I know of no animal other than mankind which indulges in homosexuality. Many animals and birds are faithful for life to one partner. I think it is fairly safe to assume that homosexuality, and very often promiscuity, are against the natural order of things, and therefore if persevered in may bring trouble, often on innocent and guilty alike. I do not think it is possible to get away from the wrath of God altogether, although you may not wish to call it that. I believe that fear of dire consequences will be the Government's best ally in combating the AIDS epidemic with which we are threatened. I hope that the Government will stand firm and harness that fear.
AIDS is caused by a virus and viruses can mutate. Some viruses, such as the common cold virus, mutate continually, which is why it is so difficult to produce a 1215 vaccine against the common cold. Bubonic plague, the black death of the Middle Ages, was a virus and its chain of infection was man to flea to rat to flea and back to man again. At that stage, with greater knowledge of hygiene and good sanitation, it might have been easier to control. Then the virus mutated and it became pneumonic plague, and it spread from coughing and sneezing as colds and flu do today. That was the plague which was the great plague of London in 1665.
If the AIDS virus were to mutate in a similar manner, it would be rather a disastrous state of affairs to put it mildly. Therefore, it is vital to take all possible steps to check the spread of the virus now, at this stage, even though they may appear draconian and akin to scaremongering.
§ 7.15 p.m.
My Lords, in answer to a Starred Question on 14th October the Government were not very forthcoming on plans to combat AIDS. However, in answer to a further Question on 19th November, the Minister then told the House much more about their proposals, which were very well received by your Lordships.
Today we have heard a great deal more and a great deal of information has been given to your Lordships by previous speakers. I should like to congratulate the Government on what they have done so far. The situation which the whole world is facing is a desperate one. We all realise that. Co-operation among all countries is surely vital if we are to find a cure in the future, but as other noble Lords have said that may be very many years ahead.
I believe that the Government have the balance about right in their publicity campaign. I have read all the literature that they have so far produced. They are advising people in a very clear way how to avoid contracting AIDS and at the same time preventing panic, as I understand there has been in some parts of America. Obviously, the unknown strikes fear into us all. However, when we are faced with the plain truth I think that we all react to it, especially when we understand the language in which it is written. I find the government publications easy to read and to comprehend.
Other noble Lords have spoken about the press and television. I feel that if the press and television will now show responsibility in both their articles and programmes on the scourge of AIDS, the Government's task in combating this vile disease will be that much easier. For example, in Time Out earlier this year there was an excellent and well informed article by Tim Clark entitled, "Safe Sex". This is a magazine, as your Lordships are aware, which is read by a great number of young people in the city.
Finally, my noble friend will be relieved to hear that I shall not burden her with any questions this evening. The Government have my full support in all the measures they have taken so far.
§ 7.18 p.m.
§ Lord Kennet
My Lords, I shall be very brief in an attempt to allow the noble Baroness her proper time to answer questions. I am all for campaigns of informa- 1216 tion directed towards young people, as everybody must be. But we should not lose sight of the fact that AIDS is not a young people's disease. In Europe, two-thirds of people who have AIDS are over 30, and more than a quarter are over 40. It is essentially a grownup's disease. It is a world phenomenon, although we have not heard much about this in the debate so far.
I have read in a report of an organisation called Panos, which appears to be a good report, that the World Health Organisation has been rather slow to get started. Even in November of this year, the WHO had still no organised information on the legal measures taken by governments to control AIDS, the education programmes in different countries, the national policies operating in different countries, and the results of blood tests showing the level of HIV infection in different countries. Obviously, this is not all the fault of the international organisation. The difficulties experienced by some African countries where AIDS is at its worst are well known. When the noble Baroness answers, will she say what we, as a highly developed member of the World Health Organisation, are doing to help the organisation overcome those difficulties?
I imagine that there are four scenarios. The first is that AIDS will die out of its own accord, and that would be the best. Secondly, we may lick it by a combination of chastity and research. Thirdly, it may go on as it is, with a doubling time of nine months worldwide. Fourthly and worse, it may mutate so as to become infectious, in which case it does not much matter what we do.
I suppose that AIDS is the most dreadful microbe ever to hit mankind, not only because there is no prevention, no cure and no hope of survival—all that we have survived in earlier mortal pandemics—but because beyond all those, AIDS, and it alone of all the killers we have yet known, is transmitted by the act of love. People will therefore learn to feel differently about one another's bodies and their own or, more accurately perhaps, to think differently about what they feel. That will be difficult. Mankind will of course survive unless we face scenario four, because some people will succeed in doing that, and those naturally incapable of doing so, will be bred out. For those who do want to do so, there is a ready-made, highly thought-out system of morality and feeling, proven over centuries, which will provide what is needed.
The ideal of chaste marriage has always exerted a magical fascination. It has always been a beacon. To a great extent it will now be not only the beacon but the lifeboat.
§ 7.22 p.m.
§ Lord Hunter of Newington
My Lords, at this stage in a debate so eloquently conducted by previous speakers, all that one can do is comment on some of the points that have been made. What do we know about various matters? The first thing we know is that we have an outstanding public health laboratory service. We have first class medical advisers. As a medical man, that is a great comfort.
We know that AIDS is a virus disease which attacks the immune system. It takes time to develop antibodies and therefore, as has been said, it cannot be detected for a matter of months. Only about 20 per 1217 cent. of people develop them. Unfortunately, women can catch the disease from normal intercourse. Having children may upset not only the woman's immune mechanism, so that she develops the disease, but, also, she can pass on the disease to her child. We know that some of the most tragic cases have resulted from blood transfusions with contaminated blood to haemophiliacs or after surgery. We hope that that is under control.
We know that in many parts of the world the disease is widespread and that it is spread by both sexes. We know that there is no cure for the disease and that people cannot be immunised against it. There are no immediate prospects of a vaccine. We know that the spread in this country, whatever happens elsewhere, has been mainly by homosexual contact. Whatever one's views about homosexuality, the facts must be faced, and, in the absence of prevention or cure, the only ways to control the disease must be examined.
We know that the rapid development of cancer of the cervix in the past 20 years, associated with promiscuity, was largely ignored by a great many young people. Fortunately for them, a treatment is now available if the disease is caught in time.
We know that the Government have taken active, vigorous steps to inform people about the disease, its dangers and the methods of minimising them. But we do not know what the public response will be and how effective the proposed measures will be. To be earnest is not enough. I am not blaming the Government; it is just a fact of medical research.
We know that many of the social and religious conventions of previous generations were introduced to protect women and children. What steps are now being taken by responsible individuals to protect the women and children on whom the future depends?
Fifty years ago, many men had a Wasserman test for syphilis before they married. Sometimes their prospective wives did so as well. Should some form of AIDS test not be available for people if they think that there is such a possibility? To demand that the Government spend more and increase resources on this disease to the detriment of other priorities in health such as cancer, coronary by-pass, the care of the mentally handicapped, and so on, is not an answer.
§ 7.26 p.m.
§ Lord Harris of Greenwich
My Lords, it will be commonly agreed that this debate has been valuable. It was opened by my noble friend Lord Kilmarnock in a thoughtful and persuasive speech. That has characterised the contributions made on both sides of the House. I propose briefly to discuss three issues: first, the question of research; secondly, the problems caused by drug abusers; and, thirdly, the resources available to the National Health Service, a matter mentioned by the noble Lord, Lord Hunter.
First, research: as my noble friend Lord Kilmarnock said, there is an extremely dangerous attitude abroad in this country on this question. It is, "Let's leave it all to the Americans". There, as we are aware, hundreds of millions of pounds have been made available for research. Here, the sums of money made available have been trivial.
1218 As the noble Baroness, Lady Trumpington, will be aware, earlier this year a number of doctors who had been working in this field asked whether a substantial budget should be made available for research into AIDS. They were told that money would only be made available for specific projects which were sent to the Medical Research Council. To date, many of those requests have been turned down because, the researchers have been told, the MRC has inadequate resources. A general view has been expressed that we must have an adequate research budget. Many of us will look to the Government to give a clear assurance on that.
Secondly, there is the issue of drug abusers, which was also mentioned by my noble friend Lord Kilmarnock. We have discussed the problem of drug abuse in the United Kingdom in this House on several occasions. As we are all aware, there has been a steep rise in the level of heroin abuse in the United Kingdom, and it is continuing to escalate.
We must recognise that there is a genuine dilemma. We must take heroin abuse extremely seriously. As we are aware, in the United States it has run like wild fire through many communities. It has not so far had such a substantial impact in the United Kingdom, but it has been growing. In many inner city areas and elsewhere, we have the extremely serious problem of drug abuse and especially of heroin, to which I shall refer this evening. It is a major problem in many areas of inner London, Edinburgh, and Merseyside, and, I suspect the right reverend Prelate the Bishop of Birmingham will agree, in many parts of the West Midlands.
In such a situation it is the height of folly to take action which could in some way encourage drug abuse. However, there is clear evidence that the sharing of needles by heroin addicts is leading to the most rapid growth of AIDS among drug abusers. In my view it is the availability of heroin that will determine the number of drug abusers and not the availability of needles. The Under-Secretary of State for Home Affairs, Mr. Mellor, who has special responsibilities in this field, has made clear his personal position, that he is in favour of making needles available. I believe that he is absolutely right on this question. Many of us would be reassured to discover that the Government shared Mr. Mellor's view and were taking action accordingly. We cannot delay this matter too long.
My noble friend referred to that tragic piece of film on "News at Ten" the other night when we saw those two Edinburgh prostitutes who had contracted AIDS as a result of sharing needles. What were they doing? They were going back on the streets in order to earn enough money to obtain more heroin to feed their habit, and thus of course infecting more people with AIDS. I hope very much that we shall have an early Statement on what the Government are prepared to do in this field. In my view it cannot be delayed. I recognise, as we all do, that it is a difficult issue but I believe that it is right to take action along the lines I have suggested.
The question of resources has underlain many of the contributions which have been made in this debate. There are two issues here. The first is the National Health Service, and the second the voluntary movement. On the National Health Service, in the United Kingdom, as we know, there are 600 AIDS 1219 patients. Half of that number are being treated in two hospitals: St. Mary's, Paddington. and St. Stephen's, Chelsea. Each therefore has had in the region of 150 patients. However, we know that the numbers in those hospitals will probably double within the next ten months. Those two hospitals face what most of us recognise to be a crisis situation.
Let me illustrate the problem facing one of them—St. Stephen's. In the clinic at St. Stephen's they are facing overwhelming pressure. There will be no medical social workers until next April at the earliest. There is a desperate need for nurse counsellors—a point raised by my noble friend Lord Winstanley during his speech—to talk to patients and to plan their discharge arrangements. When these patients are released from hospital they face massive problems in the community. Many face the risk of almost immediate eviction from their accommodation as soon as their landlord discovers that they have AIDS. They even face the problem of getting food from Meals on Wheels. People are frightened to have anything approaching physical contact with them. There is the difficult problem of talking to these patients about how they will break the news to their families. It seems to me that this indicates the urgent need for nurse counsellors at that hospital and also at St. Mary's. I very much hope that the Government will indicate that they are prepared to give priority in these areas.
St. Stephen's wants approval in principle for a special AIDS clinic. Unlike many projects this requires only partial funding by the National Health Service because a large proportion of the capital funding has already been offered to the hospital by a private charity, CRUSAID. But the project requires a guarantee of revenue funding to meet its revenue costs. I believe that this is urgent. So far patients have been treated on an out-patient basis in the John Hunter clinic for sexually transmissible diseases or in an inpatient ward, the Macaulay Ward. They are now being swamped with patients. There is a real problem facing the Riverside Health Authority. It does not have the resources to meet the revenue funding of this new clinic. I again remind the House that 25 per cent. of all AIDS patients in the United Kingdom are passing through this hospital. I therefore very much hope that the noble Baroness will be able to offer us something here.
Finally, I very much hope that the noble Baroness will have paid attention—as I am sure she did—to what the right reverend Prelate the Bishop of Birmingham said about the problem of where those patients are likely to go when they become terminally ill and have to be cared for in the community. As we know, many of these institutions which look after the terminally ill are extremely nervous about taking AIDS patients. I believe that there is need for some contribution between the private and public sector, perhaps with funding on a pound for pound basis between the private and public sectors. If we do not get action here we shall face the very serious problem of substantial numbers of dying people not being able to obtain any form of civilised treatment in the community.
As I have indicated, the need in these areas is urgent and I very much hope that the noble Baroness and the Government will respond accordingly.
§ 7.37 p.m.
§ Lord Ennals
My Lords, most of what was said by the noble Lord, Lord Harris of Greenwich, referred to St. Stephen's Hospital in the Riverside district. The last I heard was that this hospital was on the regional list for closure. I hope therefore that the Minister will be able to give an assurance that St. Stephen's will not close.
I wish to say how grateful I am—as I think the whole House is—to the noble Lord, Lord Kilmarnock, for opening a debate which has brought forth some extremely interesting and important contributions. I found myself in agreement with a very large amount of what was said and perhaps particularly with the references that have been made to the important role that the media can play in trying to get across the message to the public. This has been mentioned by four noble Lords.
There is no doubt that Britain and other countries face the greatest threat to their nation's health in modern times or perhaps ever. To put it at its starkest, if the Government's education campaign fails, if people take no notice, at the present rate of growth of AIDS, AIDS victims could occupy all the present NHS acute beds by about 1995. That would be 145,000 beds.
"All out war"—a phrase that came from the leaders of Europe's 12 nations a few days ago—puts it dramatically. I think that we should see it in dramatic terms. It is not only a European problem, but an African problem and a problem for the World Health Organisation. However, that kind of projection need not occur if the Government put adequate resources into a massive campaign beamed at the key targets, and even more important, if people actually respond to the message. We all know what the targets are. I shall touch on four of them.
If we take sexually active homosexual people there is no doubt that there has to be a great deal of straight talking, using terms that homosexuals understand and describing clearly the sexual activities which put people—not just themselves but anyone with whom they have contact—at risk. Sir Donald Acheson, the chief medical officer, circulated all medical officers a few days ago with a statement. I should like to take one or two facts from it. He said:Male homosexuals with more than one partner and bisexual men—some of whom may be married—need 'urgent advice' on the dangers to themselves and others from their current lifestyle. Nearly 90 per cent. of the 599 cases of AIDS reported in this country fall into this category".The chief medical officer also reports that one in four of those homosexuals attending clinics for sexually transmitted diseases in London are infected with AIDS. Whether one calls it morality or something else, this is the greatest area of danger and the area to which we have to get our message through.
It is rightly said that AIDS also affects sexually active people in a heterosexual sense. They must learn the message. We must direct it to them in very stark terms and above all explain the risk they take if they have more than one partner. I think the right reverend Prelate goes a little far is saying that all of us who are married must totally follow chastity. I think I ought to be allowed to have a sexual relationship with my wife without—
§ The Lord Bishop of Birmingham
My Lords, the noble Lord has misunderstood what I said. I defined "chastity" as abstinence from all immoral sexual intercourse, and I do not include that.
§ Lord Ennals
My Lords, I am glad that the right reverend Prelate has made that absolutely clear. I entirely agree that we must learn a lesson. If we do not learn that lesson now, those who sleep around and think they can get away with it will not only suffer themselves but others will too.
The noble Lord, Lord Harris of Greenwich, made a very important statement concerning drug addicts. He spoke of the sharing of needles and the habit of mixing blood in the syringe in the mistaken belief that that purifies the drug before passing on the syringe for another person to use. Drug addicts are a section to whom we have to speak very sharply indeed.
I am most sad about two particular groups—the tragic case of haemophiliacs who have been infected with contaminated blood through no fault of their own, and, worst of all, small babies who have been infected by their mothers. They are indeed groups for whom we must express genuine and real sympathy.
The test of success of the Government's campaign is the exent to which people's behaviour patterns change. No longer can there be the easy morality—or immorality—the easy assumption that it is natural for young people to go to bed just because it is fun. No longer can that be thought as reasonable behaviour for the welfare of themselves or the nation. It is a major challenge to millions of our people.
I am concerned that the resources made available to the DHSS by the Chancellor of the Exchequer may be seriously inadequate. I should like to put six questions to the Minister concerning resources, about which I gave advance notice. First, how much is now available for AIDS research? That is a question which was quite rightly asked by the noble Lord, Lord Winstanley. Secondly, how much new money is being spent on public education? I do not mean funds already available to the Health Education Council. I share all the concerns expressed by the noble Lord, Lord Young of Dartington, about the damage that may be caused to health education if the council's work is to be under the control of the Government and if it is not free to deal, as it does now, with issues that sometimes involve it in pressure upon the Government. Thirdly, how much money is available for the treatment of AIDS cases? In other words, how much is it costing to look after those already in our hospitals, and what extra money will be available on top of existing budgets?
Fourthly, what facilities will be available for voluntary screening and at what cost to the DHSS? I do not believe that it is enough to say to health authorities that they must prepare their plans for opportunities for screening in different parts of the country where people will undoubtedly want to be screened and for them to take it out of their very heavy budgets. I think that the Government need to put new money into health authorities. Fifthly, what resources are now available for counselling? That again is a point made by the noble Lord, Lord Winstanley. In many cases people are feeling desperate and need advice. As 1222 he and others have said, counselling is a specialised art. It is not something that any mug can do.
Finally, are the Government still proposing to cut £4 million from the funds of the Public Health Laboratory Service? That was referred to by the noble Lord, Lord Hunter of Newington. It is in fact the national agency for monitoring the AIDS epidemic. I believe that if there were such a cut it would be an extraordinary form of saving.
My time is up and I am glad that the noble Baroness has plenty of time in which to answer all the questions that have been put to her.
§ 7.46 p.m.
§ Baroness Trumpington
My Lords, I am glad too. The subject of this debate is of the utmost importance and in the interest of providing as much information as is known, I shall gladly answer as many of your Lordships' questions as possible. My right honourable friend, in the debate in another place on 21st November, made a detailed statement on the present situation and on the actions that the Government are taking.
Your Lordships have raised a number of points already covered in that debate in another place but have characteristically also introduced new and important aspects and further dimensions of the problem. I have also received many helpful letters. including one from my noble friend Lord Vivian. All such correspondence is being carefully studied.
Since the speech of my right honourable friend, we have received further information about the numbers of AIDS cases. At the end of November, 599 cases had been reported to the Communicable Disease Surveillance Centre in Colindale; 296 have died. This represents an increase of 51 cases since the previous month. The trend is upwards and will remain so certainly for the next few years. In the light of this immensely worrying prospect, the important suggestions made by a number of noble Lords are all the more valuable. So let me now turn to the points raised by the noble Lord, Lord Kilmarnock, and the noble Lord, Lord Ennals. I was most grateful for the advance notice given by those two noble Lords.
Research into AIDS is clearly of enormous importance. All possible steps should be taken to find effective treatments, and a cure for and a vaccine against it. Worldwide, a massive research effort is being mounted by the scientific community and by private industry. Considerable progress has been made, for example, in identifying the AIDS virus and methods of transmission. But, clearly, much more needs to be done. This country has some of the world's best scientists in this area and is making a full contribution.
A large-scale programme of publicly-funded research is being undertaken. It is being co-ordinated by the Medical Research Council, which has set up a working party on AIDS. On top of the work being carried out at its own research institutes, the MRC awards special project grants for research on AIDS. I am informed that, to date, the MRC has had sufficient funds for those AIDS projects that it has wanted to fund. I understand from a press release issued today from the MRC that it regards research on AIDS in this 1223 country, and by British researchers in Africa, as a high priority. We are to discuss with it the funding that will be needed for the new investigations that it believes are needed.
The noble Lord, Lord Harris of Greenwich, spoke about research money, and I would totally disagree with his statement. The MRC, according to my information, has not yet turned down any worthwhile projects for lack of funds. I must repeat that.
The MRC is not the only body that funds research. Other public sector bodies are also pursuing significant programmes of research. These include the Public Health Laboratory Services, the National Blood Transfusion Service and the National Institute for Biological Standards and Control. A number of university departments are undertaking research in this field. It adds up to a considerable programme of work in the public sector. In the private sector, the British pharmaceutical industry devotes over £500 million a year to research work, and an increasing proportion of that is devoted to research on AIDS. I agree with the right reverend Prelate that research should be co-ordinated internationally.
AIDS is an international problem and there is growing international co-operation on research in the European Community, which has set up an AIDS working party. At the recent meeting between the EC countries, the need to exchange information was agreed. On a wider scale, the WHO is emphasising the need for co-ordinating research work as part of its global strategy on AIDS.
It should be clear from all that I have said that a great deal has been and is being done. Already significant advances have been made, for example, in identifying the AIDS virus and its methods of transmission. But much more needs to be done and this country will be playing its full part.
Turning to the engagement and training of new staff for AIDS clinics, most patients who are concerned that they may have been infected with the AIDS virus are seen at genito-urinary medicine clinics. The staffing of these is a matter for district health authorities, but my right honourable friend the Secretary of State for Social Services will be writing to all district chairmen asking them to ensure that their clinics are given adequate resources to meet the demands made upon them.
So far as concerns training, we have provided funds for programmes of training in counselling of HIV patients and those at risk of infection at three centres, in London, Birmingham and Bolton. They provide training not only for health care professionals but also for social workers and those employed in drug agencies and voluntary bodies. Over 1,500 people have been on courses in the London unit in the past 10 months.
The charity CRUSAID has put forward an imaginative and generous proposal for our outpatients' centre at St. Stephen's Hospital, Fulham. That centre would combine out-patient requirements with day care facilities. Riverside District Health Authority (in which St. Stephen's is situated) and North-West Thames Regional Health Authority are urgently considering the practicalities of longer-term funding and location. They are pressing ahead with 1224 this work as they are very supportive of the scheme. The outcome should be known very soon.
North-West Thames Regional Health Authority has asked its districts to put in bids by the end of the year for increased AIDS resources. There is a growing need for increased resources and of' course a growing need for increased in-patient beds. Paddington and North Kensington Health Authority is considering what increased resources to bid for. It has not yet put in its bid to the RHA. There are up to 12 beds at St. Mary's at present.
Paddington and North Kensington's short-term programme is out for consultation. One cost improvement proposal includes £100,000 to be saved by more efficient diagnostic services—pathology and radiology. That is an efficiency measure, not a cut. There will be a special meeting of the health authority to consider the short-term programme and comments on the proposals later this month.
We regard preventing the spread of AIDS among the drug-misusing population and through them to the heterosexual population in general, as of the highest priority. We are already doing a great deal to curb the spread of drug misuse through co-ordinated strategy designed to tackle supply, demand and treatment. The fewer the numbers who become involved in drug misuse at all, the greater our chance of limiting the spread of AIDS. Both our education and information campaign against heroin and that about AIDS inform the public, professionals and drug users about the risks associated with sharing injecting equipment.
Nevertheless, we believe that we shall need to do more to ensure that as many drug users as possible give up their habit or modify their practices in the light of the threat posed by AIDS. I am glad to be able to assure the noble Lord, Lord Hams of Greenwich, that we are therefore urgently considering further measures in the light of the McClelland report, which recommended: education in safer drug taking practices for injecting drug users who will not abstain; the issue of sterile injecting equipment to drug misusers on a one-for-one exchange basis, where assessment, counselling and treatment is available; the consideration of substitution prescribing for those patients whom it is likely to help stop (or reduce) injecting; and that advice on safe sex should be given to all drug users.
The noble Lord, Lord Ennals, the noble Lord, Lord Harris of Greenwich, and other noble Lords will agree that the issues raised are complex and controversial, but I hope that we shall be in a position to make a Statement shortly. The noble Lord, Lord Pitt, added his voice to suggestions that condoms should be provided free as part of the fight against AIDS. Careful consideration will be given to whether that is likely to be worth while, given that they are already widely available at low cost.
The noble Lord, Lord Kilmarnock, also mentioned support for the voluntary sector. I fully recognise the valuable contribution of the voluntary organisations working in the AIDS field. The Department of Health and Social Security already grant-aids several voluntary organisations and has increased that support substantially this year to over £200,000. The department will do all it can to ensure that the voluntary sector can make as effective a contribution 1225 as possible. Sickness and invalidity benefits already make provisions for all sick and disabled people, including AIDS sufferers. I believe that the same rules should be applied to all beneficiaries.
I now turn to the point made by the noble Lord, Lord Kilmarnock, about a new mechanism for meeting NHS costs. As the noble Lord rightly says, AIDS is a growing problem and will make increasing demands on NHS resources.
What is the future? It would be a very brave person who would make a prediction. All suggestions about how to provide necessary funding in the most efficient and effective manner are welcome. The noble Lord, Lord Kilmarnock, has had some very interesting things to say on this matter and has made some detailed and quite far-reaching proposals for a new framework for taking decisions on funding. I have taken note of the points he has made and I shall ensure they are conveyed to my right honourable friend the Secretary of State for Social Services. Extra funds have already been allocated to the NHS to meet the demands on it of the spread of AIDS. Further funds will be allocated for next year. Those funds are on top of the main NHS budget.
To reply to the further questions of the noble Lord, Lord Ennals, and the noble Lord, Lord Pitt, about resources, we have already taken action to provide extra resources to those health authorities which are dealing with the great majority of AIDS cases. In both 1985–86 and 1986–87 extra money was made available to the three Thames regions which together account for some three-quarters of the AIDS caseload to date. Those sums were £700,000 in 1985–86 and £2.5 million in 1986–87. Indeed, £750,000 was provided for HIV testing to the public health laboratory service, and £370,000 has been provided this year for counselling services in the six haemophilia reference centres and for training courses in counselling. Decisions on funding for 1987–88 will be announced shortly.
I should add that the PHLS Board has not had its budget reduced. Over the past four years its funding has been increased by £7 million. In real terms the increase has been £2 million. Next year it will receive about £1.2 million extra cash. The board plays a vital role in the fight against AIDS. In recognition of that role it has been given special additional funding of £0.7 million to enable it to set up special facilities to do HIV antibody tests. That work is not under threat. Nor would we agree to any measures which would put its other important contributions to the AIDS fight at risk.
The response of the National Health Service is, of course, not confined to these centrally financed initiatives. All health authorities will be submitting their plans by the end of this year for taking local action to deal with AIDS. In the light of this, the Department of Health will be assessing the need for resources and for the training of staff in order to ensure that the necessary response is made to this terrible problem.
I was most grateful to my noble friend Lady Gardner of Parkes for her reassuring comments about dentists, which correspond with the advice that my department has given. My noble friend Lord Colwyn—I might as well take together the 12 per cent. 1226 of my noble friends who are dentists—spoke about the extra cost involved when dentists follow our guidance on sterilisation procedures. We are taking note of the possible extra costs incurred by dentists and others in following the guidance issued by my department. The system for their remuneration means that general dental practitioners are already reimbursed indirectly for all practice expenses. The NHS pays the dentists' fees for the treatment that they provide. These fees are set in such a way that the average dentist can earn the target net income set by the Government and have practice expenses reimbursed in full.
My noble friend Lord Colwyn asked me about alternative medicine and its use—an interesting thought. Some natural therapies such as homeopathy are already available in the National Health Service. We have seen no evidence that any of them is effective in preventing this disease or reversing its effects. However, if my noble friend has any new evidence on this, I should be most interested to have the details.
The noble Lord, Lord Pitt, spoke about health education as a vital means to control the spread. I thank him for his helpful comments, which entirely accord with the advice given by the department. The noble Lord, Lord Winstanley, applauded the work of the Terrence Higgins Trust. I acknowledge from our side the very important contribution made by the trust in counselling those whose lives are affected by HIV. We have provided funds for a programme of training counsellors in the counselling of patients, as I mentioned earlier.
The noble Lord, Lord Ennals, touched on treatment costs. We expect health authorities to spend some £10 million on tackling the problem of AIDS in the current financial year. This should increase in 1987–88 to about £17 million. A further £7.5 million will be spent in this financial year rising to £16.5 million next year on publicity, the public health laboratory service and research funded directly by the Department of Health.
We are funding a study to investigate the costs of treating individual patients with AIDS. This will enable us to establish the cost of treatment to the National Health Service more precisely than we can at present.
The noble Lord, Lord Winstanley, brought up the question of haemophiliacs. I should like very much to share the feelings of great sadness expressed so eloquently by the noble Lord, Lord Ennals. I wish, however, to reassure the noble Lord, Lord Winstanley, that his figures are not quite right. A recent survey showed that 32 per cent., not 50 per cent., of those tested have evidence of HIV infection. I am sure that our sympathy goes out to those people who, anyway, have a horrid disease. If I may just include the babies, I think that this is perfectly terrible. Indeed, I think that it is terrible for babies to be born with withdrawal symptoms from drugs, let alone AIDS.
The right reverend Prelate the Bishop of Birmingham spoke of a publicity campaign for young people. The government publicity campaign includes newspaper advertising, a poster campaign in major cities and a campaign aimed specifically at young people which will involve advertisements on the radio, in cinemas and in young people's magazines. BBC radio will also be running a youth campaign this 1227 month tied into ours. I should like to pay tribute to the BBC and ITV for the willing way in which they have helped the Government and have promised help in the future. We are most grateful.
The right reverend Prelate also spoke about condoms being not totally effective. Throughout our public education campaign we have stressed that having a number of sexual partners increases the risks of catching the infection. The need to avoid casual sex and reduce the number of sexual partners is our primary message. But there is evidence that condoms reduce the risk of the virus being transmitted. It would be irresponsible of us if we did not try to get that fact across, given that people's habits will persist. We agree that condoms are not totally effective in all circumstances, which is why we present them as second best to restriction in sexual partners to one who is faithful.
The noble Lord, Lord Harris of Greenwich, and the right reverend Prelate the Bishop of Birmingham raised the question of hospices. Hospices provide a tranquil environment in which terminally ill people can end their days with dignity. But by no means all—whether AIDS patients or not—wish to be in hospices. Some will need forms of acute care that hospices may not be able to provide. What is important is that a broad range of facilities is developed to meet the differing needs and wishes of AIDS patients.
The noble Lord, Lord Kilbracken, spoke of bisexual and homosexual activity. We agree that most cases in this country so far have been male homosexuals. But, as we know from evidence in Africa and elsewhere, the disease can be transmitted heterosexually. We believe it important therefore, in our public education campaign, to encourage people to take action to prevent such a wide spread among heterosexuals in this country.
The noble Lord, Lord Young of Dartington, spoke again of the role of voluntary bodies. He made a very strong plea. I should like to pay tribute to the healthline telephone service which, like the Terrence Higgins Trust, has provided a vital service to the public. We have no intention of allowing our proposals for setting up the special health authority next year to interrupt our continued financial support for those bodies whose work we regard as of the utmost importance.
I am grateful to the noble Lady, Lady Saltoun. There is indeed a morality issue but if we were seen to be moralising we would alienate may of the people whose attitudes and behaviour we are aiming to change.
In the course of the debate, we have considered a wide range of issues, including the various measures that the Government have taken or will be taking. However, there is one point above all that I should like to emphasise. It is that the problem of AIDS is not one that can be solved by the Government alone. Certainly the Government have important responsibilities. They must ensure, for example, that their citizens receive adequate treatment and care; they must get the facts across to the public.
The facts are that the disease is being spread by sexual contact and by drug misusers sharing infected 1228 needles. It is not being spread by people picking it up in swimming pools or pubs, or through any of the wide gamut of everyday social activities.
We must get these facts across to the public. That is why the Government have embarked upon a massive public information campaign. My right honourable friend the Secretary of State has announced that we shall be spending £20 million in the next 12 months on this campaign. I hope that your Lordships will give this vital campaign your fullest support. But, in the end, the major responsibility must fall upon individuals. It is by the actions of each and every person that the spread of this terrible disease can be halted and in time, I trust, reversed. This is the battle that we simply cannot afford to lose.
§ 8.10 p.m.
§ Lord Kilmarnock
My Lords, I have a few minutes in hand and I want to thank all noble Lords who have taken part in this important debate. I was glad to hear the noble Lord, Lord Pitt, say that we are facing a challenge that we can meet, provided we face it with the necessary resources and determination. I should like to add my plea for the haemophiliacs. Even if the numbers were wrong, they need help. It must be remembered that they are in the condition they are because of the imported Factor 8 which had to be imported because we did not have the facilities to make it. It is a consideration that the Government must bear in mind.
I was grateful to the right reverend Prelate the Bishop of Birmingham for giving us a definition of chastity that we could live with, and also to my noble friend Lord Kennet for his felicitous phrase that chastity in marriage was a beacon and it has now become a lifeboat. It was interesting that it was the noble Lady, Lady Saltoun, and not the right reverend Prelate who raised the issue of the wrath of God. I am happy to be able to reassure her that the AIDS virus is a retro-virus wrapped in a fatty membrane which cannot behave in the way that she suggested and turn into some sort of bubonic plague.
I am grateful to the noble Baroness for the wide-ranging response she made. She tried to pick up all our points. There are still one or two things I am a little unhappy about. She referred to the Secretary of State's request to the districts asking them to ensure that they have the necessary facilities to cope with AIDS. This is the wrong way round. It is up to the Secretary of State to ensure that they have the necessary facilities. They can make the bids but he has to put the money on the table.
As regards St. Stephen's and the out-patient clinic, I noted that she said that a decision was expected very soon, but I understand that the region is not likely to be able to cope with the recurrent revenue costs, and I hope that the Government will bear that in mind. Where she referred to efficiency measures as not being cuts, of course there are two ways of looking at that. I am not sure that you can pare path labs any further by efficiency measure without calling them cuts. Perhaps the Government will bear that in mind too.
On the question of drugs and the issue of clean needles for old, the noble Baroness told us that there will be a statement soon. We must hope that it will be 1229 a statement in the sense that has been widely expressed in this House, despite the difficulties that we all recognise about the dangers of encouraging drug abuse. I understand that the Secretary of State has been in Amsterdam today, where a scheme is operating. Maybe that will help him to come down on the side of the general sense of the debate today.
On voluntary bodies, the noble Baroness gave us some hope, although it was not specific. I was a little disappointed that she was not more forthcoming on the sickness benefit, the social security side, for AIDS patients. Some are in extreme difficulties, and I hope that she will have a look at that. Some are living on very low margins indeed.
I was grateful to the noble Baroness for saying that she would bring to the attention of the Secretary of State the sort of framework that I have suggested for funding. I certainly was not suggesting that it was the only possible model. I think possibly the Government themselves will come forward with a better one, but I hope that my suggestion will possibly be of some help and provoke some thought on the matter.
On the question of hospices, it is of course true, as the noble Baroness said, that there must be a wide range of provision, but hospices in particular are extremely difficult to get off the ground. They certainly will be needed so that AIDS patients can move out of acute beds and can pass their final months in humane and civilised conditions. I hope that the Government will look again at the possibility of helping the London Lighthouse and any other body of that nature which may be contemplating doing something in this direction.
Finally, I was most grateful that the noble Viscount the Leader of the House was able to be present at the opening of the debate. He told me that although he had a pressing commitment at Downing Street he would do his best to listen to as much of this debate as he could. We know that it is a subject that he bears close to his heart. I think all noble Lords will be encouraged that not only the noble Baroness but also the Leader of the House will be taking note of what has been said in your Lordships' House this evening.
I thank everybody for having made what I consider to be extremely valuable contributions. I am sure that the Government will look at them closely. I beg leave to withdraw the Motion for Papers.
Motion for Papers, by leave, withdrawn.