AIDS (Control) Bill

HL Deb 29 April 1987 vol 486 cc1564-95

9.11 p.m.

Lord Stallard

My Lords, I beg to move that the Bill be now read a second time.

I am particularly honoured to have been asked to sponsor this Bill through your Lordships' House and I hope that I shall be able to do justice to the gravity of the cause that it espouses. I am also particularly honoured because we are to hear later a maiden speech from the noble Lord, Lord Trafford, who is a recent newcomer to your Lordships' House.

I certainly look forward to his speech. I know his background and I feel already some affinity to the noble Lord, strange as it may seem, because I know that he is the consultant physician to the Brighton Health Authority and has been since 1965. That was the year when I moved over from the smaller inner London local authority of St. Pancras to the larger authority of Camden and became chairman of the health committee there and a member of the health authority in Camden.

I remember when we were struggling with our designs to build health centres that Brighton was one of the places that we had a look at. We had discussions with the people of Brighton, because I know the record of Brighton Health Authority on the question of health centres; as indeed, when I had experience of some other facilities in Brighton in the North Chailey district, I was able to see some of the work. That must give a great deal of satisfaction to the noble Lord, Lord Trafford.

I also knew of him when he was a Member in the other place when I was there, and we saw each other from time to time in that place. So I certainly welcome him and look forward to his contribution to this debate and to the whole question of the Bill that we are discussing tonight.

AIDS, or, to give it its full title, acquired immunity deficiency syndrome, is a new disease. There were no known cases of the disease before 1981. So rapidly has the disease and our knowledge of it spread in this country and in most of the rest of the world that it now poses a health threat unparalleled in our time. I know that none of your Lordships will underestimate the seriousness of that health threat. The disease could have a major impact on our social, economic and political affairs, increase the cost of hospital care, result in a loss of human resources and have an effect on families and communities which would undoubtedly create many problems.

The purpose of the Bill is to provide information to help to control the spread of the disease in the United Kingdom. It is rare for a piece of legislation to relate exclusively to a specific disease and I should like to begin by saying something concerning the future and current situation in the United Kingdom and in other parts of the world, based on expert opinions and statistics.

By the end of 1986, 74 countries had diagnosed cases of AIDS. Europe had recorded 3,500 cases and the United States of America had recorded 25,000 cases. That might not seem alarming in the face of a far greater number of deaths caused by other diseases. However, the problem is not only a matter of the disease of AIDS itself. There is a bigger problem. AIDS results from a virus known as human immunodeficiency virus—HIV—which destroys the immune system of the body. That means that the body is no longer able to resist infections and diseases with which an otherwise healthy body might cope. People with AIDS die of infections rather than because of AIDS. Examples of such infections are rare forms of pneumonia and skin cancers.

It is therefore to the spread of HIV that much attention is turned, and quite rightly so. One of the key factors in combating AIDS is to establish the percentage of people with HIV who will go on to develop full-blown AIDS. The presence of HIV is detected by testing for HIV antibodies in the blood. People with HIV can remain quite ignorant of the fact that they have the virus. In fact, I understand that the virus incubates in the blood for an average of five years before developing into AIDS or such generally less serious conditions as AIDS-related complex.

During incubation, a person carrying the virus may quite unwittingly pass it on to others. In the early days of AIDS it was thought that around 10 per cent. of the people with HIV went on to develop the full-blown disease. However, as the years have passed the estimates of that vital percentage have increased. The Government now place the figure at between 25 per cent. and 30 per cent., although that seems low in respect of other world-wide estimates. The United States National Academy of Science and the Institute of Medicine believe that the current figure lies between 25 per cent. and 50 per cent. Others, notably scientists in West Germany, speak of 75 per cent.

The problem with estimating the percentage is that AIDS has been known for about four years in this country. The magazine New Scientist in its issue of 26th March 1987 reported research that had taken place over five years. That showed that 15 per cent. to 20 per cent. of people known to be infected with HIV had developed AIDS within three years and that 25 per cent. to 30 per cent. had developed the syndrome within five years. The percentage is expected to rise as time goes on and there are some scientists who believe that the figure will eventually reach 100 per cent.; in other words, all those people who have HIV will one day develop AIDS. It is a frightening prospect.

The World Health Organisation believes that there are between 5 million and 10 million people in the world who are infected with HIV and who are known as CO positives. I expect that many noble Lords will have heard about or read reports of the World Health Organisation conference which is taking place this week. Yesterday it was reported that it had been said that 50 million to 100 million people will be infected with the AIDS virus by 1991. It was also said that the magnitude and impact of the world AIDS epidemic had been seriously underestimated and under-appreciated.

We know that America already has a massive AIDS and HIV problem. The Lancet of 6th December 1986 carried a study report by Ron Brookmeyer and Mitchell Gail showing that the United States could expect 102,000 new AIDS cases between1986 and 1991, based solely upon the number of people infected with HIV by the end of 1985. If more recent infections are included, the estimate reaches 207,000 cases in the United States by 1991. Such projections are backed up by other studies. Perhaps the most authoritative are those carried out by the Harvard School of Public Health and the American Academy of Science. They estimate a cumulative total of 179,000 deaths in the United States by 1991, with 54,000 deaths in that year alone.

In Africa there are an estimated 2 million sero-positive cases, and it is in that Continent that AIDS can wreak its worst havoc. Because of a lack of screening and an inadequate supply of syringes and medical equipment, as well as inefficient means of education and communication, the situation there will rapidly worsen. Already the risk of receiving blood contaminated with HIV through a transfusion is much higher than it is in the West.

At the moment the situation in Britain is less dramatic because the virus was introduced into these islands a few years after it appeared in America. We are fortunate to have had the benefit of their experience with the casualties. However, the potential for similar developments over here during the next few years is just as worrying and horrific. Indeed, roughly speaking, we are at the stage now that America was at four years ago. Further, the situation outside London is similar to the situation in London four years ago. We need no further warning as to why appropriate action is needed, and needed immediately.

As at the end of March in 1987 the total number of people who had developed AIDS here was 734. Of these, 405 have already died. The Secretary of State for Social Services said recently that the best available estimate shows that the number of AIDS cases here will rise to about 4,000 by the end of 1989. In a recent publication the BMA estimates that 30,000 people could have the virus and that unless people stop spreading it now there could be 10,000 cases of AIDS and 1 million people infected in this country by 1991.

It is against this background that this AIDS (Control) Bill comes before your Lordships' House this evening. It is a modest measure which will be only a part of the fight against AIDS. However, it is a vital one and needs to be in place quickly. It will fit alongside the work already being done by the Government, by the health authorities and by voluntary and non-statutory bodies. The advertisement campaign, the educational campaign, and educational material, the action on dirty needles and the £14 million extra resources being ploughed into research are all positive and very welcome measures already initiated by the Government.

This Bill is another urgently needed measure. Noble Lords who have followed the passage of the Bill through the other place cannot fail to have been impressed by the co-operation between the sponsor of the Bill, Mr. Gavin Strang, Member of Parliament for Edinburgh, East, and Mr. Tony Newton, the responsible Minister. Their efforts ensured that both their names appeared above the amendments at both revising stages of the Bill, and that is quite a unique experience on a Private Member's Bill. The result has been a vastly improved and practical measure.

The Bill is the result of substantial consultation with over 50 individuals and organisations involved with the disease. They include health authorities, environmental health officers, community medicine specialists, voluntary organisations and of course the DHSS AIDS units which have done sterling work both on the Bill and in other respects.

The Bill has been welcomed and supported in all quarters, notable among which are the Health Education Council, as was, and the British Medical Association, which wrote to all Members of the other place and to many Members of your Lordships' House expressing its commitment to the Bill's measures. The Bill was introduced because it became apparent last year, as a result of a number of meetings up and down the country that were reported and read about, that there was no clear picture of what was actually being done at a local level in the fight against AIDS which was available to interested parties.

Many organisations within health authorities and boards were doing and continue to do large amounts of good work on AIDS. For instance, London and Edinburgh have considerable experience in dealing with HIV and AIDS. Indeed, Edinburgh had a particular problem to deal with in Hepatitis B, which is transmitted remarkably similarly to HIV. Their experiences would be extremely valuable to areas which are just beginning to cope with the AIDS problem. Unfortunately, people working within one area often have no idea of some of the initiatives taking place in other areas. Further, within many authority areas some organisations concerned with AIDS have no idea of each other's existence, let alone what they are doing. That is particularly true of some voluntary and non-statutory bodies.

How will the Bill help that situation? The Bill is mainly an enabling clause and a schedule. That is the nub of it. It places a duty on all 191 district health authorities in England, the nine authorities in Wales and the 15 district health boards in Scotland to produce a report on AIDS and HIV in their areas at intervals at present envisaged as yearly but which as time goes on might become more frequent. The reports will be published and made available to those who want to see them. They will also be collated by the 14 regional health authorities in England and the Secretary of State for Wales to provide a further tier in the structure.

Each authority and board will have to report on a number of areas, including the number of AIDS cases that their services have diagnosed and whether the persons are alive or dead. The original Bill included a similar breakdown for HIV figures but that had to be dropped because it has not yet proved possible to find a means of providing district-based HIV figures that is compatible with the Communicable Diseases Surveillance Centre's system of reporting. However, appropriate wording is now being sought in consultation with all interested parties in time to be added to the schedule well before the first reports are due. This is one illustration of why the Bill provides the Government with the power to amend the schedule. Clause 1(5) gives the Secretary of State the power to make these necessary amendments.

The area of AIDS is such a fast-moving one—it is extremely rapid—that the schedule to the Bill that specifies details of the report may need amendment as the situation develops. I think we all appreciate in the circumstances the need for some very early action. Clearly, with the Government publishing monthly national and regional AIDS figures, some of these statistics may be slightly inaccurate by the time the report is published. That does not affect their importance. They will serve as a record which over a number of years will indicate local trends as well as being vital in the allocation of resources in the future.

I should like to emphasise the importance of confidentiality and anonymity for people with HIV and AIDS. Any intrusion may make life even more difficult for those affected as well as deterring people from coming forward for testing and treatment. For that reason the schedule specifies that if any area has a total of between one and nine people with HIV or AIDS that is all that should be stated in the report. In that way it is less likely that a person with AIDS can be identified than if it were known there were just one or two cases in any area. The Minister in the other place gave further assurances that we may touch upon later.

HIV and AIDS statistics are but a small part of the report that will be required. They will be useful data against which the bulk of the report can be read and interpreted. The authorities and boards will have to state what services they are providing in relation to all facets of AIDS and HIV and these are spelt out in the schedule. This relates to testing, treatment, counselling and caring for people with HIV and AIDS and also to what steps they are taking to prevent the spread of the virus. In addition, the authority is expected to look beyond its own provisions and services to include those of non-statutory and voluntary bodies operating within its area. That is vital, because it is often those agencies which are bearing the brunt of the task.

The Bill also recognises the demands on the people implementing these services as well as the skills required by the services. It states that the report shall include reference to what is being done to train those people who will be working not just with members of the public with HIV or AIDS but in the community in general.

The collation of reports and the reports themselves will facilitate the recommendation of guidelines for good practice. They will highlight areas of need and those where there may be some duplication of resources. If enacted, the Bill will allow financial and resource targeting locally and nationally. AIDS will prove a costly burden on the National Health Service. The Office of Health Economics estimates that hospital care alone costs £6,838 for each AIDS patient. That adds up to £2.25 million for the care of AIDS patients who are known to be alive today. With the number of cases doubling roughly every 10 months at the moment, great resources will be needed in the future. It is therefore incumbent on all of us to see that the money which needs to be spent is spent where it is most effective and with as little waste as possible. The Bill will help that process.

The Bill represents the first long-term approach to AIDS and will lay down the framework that will be of use for years to come. It will help the depiction of the fight against AIDS and HIV locally, regionally and nationally. The Bill will provide an information base for people and organisations associated with AIDS. They will be able to learn from the successes and failures of others. The duty to produce a report should have a galvanising effect upon those authorities, if there are any, that believe that AIDS cannot happen in their areas as well as those striving to cope with the problem.

The report will serve as a handbook for members of the public who may be worried that they have HIV. In the report they would find organisations to which they could go for a test and advice and be assured of confidentiality.

I know that noble Lords recognise the gravity of the situation. I hope they will recognise the value of the Bill and provide it with a speedy passage through this Chamber. I commend the Bill to the House. I beg to move.

Moved, That the Bill be now read a second time.—(Lord Stallard.)

9.32 p.m.

Lord Trafford

My Lords, I welcome this Bill. First, I must thank the noble Lord, Lord Stallard, for his kind remarks. If I had had a sense of déjà vu as he has, having met in another place, he has upstaged my memory by going back to the 1960s. I welcome the Bill for the obvious reason that it requires that reports and information are brought forward, are made public and are usable. Without information no plan of action can be formulated and no exercise of useful value can take place. Knowledge strengthens the arm of any authority or government who have the difficult task of coping with such an epidemic.

We are not unfamiliar with epidemics. There have been small and large ones in the past. We have the classic example of the great pandemic of influenza after the First World War. It is reputed, incidentally, to have killed as many people as the First World War. We had of course the Black Death, which was reputed to have killed one-third of the population of Europe in the 14th century. So great was the economic damage from that epidemic that it resulted in the introduction in this country of the first incomes policy. History relates that it was not too successful.

There is one fundamental difference with this epidemic to which we are addressing ourselves tonight. With all the others, the diseases struck, they killed, or did not kill, and they departed. With this one, so far no person suffering from AIDS has survived. If but one person survived the disease, the epidemic would disappear from the point of view of danger and proportion similar to the famous example of lassa fever. All we need is one person who has survived, who has the correct antibodies and who can therefore deal with this problem. This has not happened and the disease so far has resulted in 100 per cent. mortality.

It is said that somewhere between 10 per cent. and 14 per cent.—the figure given by the noble Lord is not one I would dispute—of infected persons subsequently develop the disease. But I agree that as time goes on, the very pattern of this disease—the mode of infection and the type of viral involvement—suggest strongly that this is a low estimate and that the higher estimates will turn out unfortunately to be the correct ones.

In your Lordships' House tonight we have already heard that between 50 million and 100 million people worldwide may even now be infected with this virus. These are horrendous figures. If one refers to the figure of 1 million, people can identify this figure with one city. With the figure of 100,000, people can identify this with a large town. But 100 million—the combined population of France and the United Kingdom—is an unimaginable figure. However, it gives weight to the size and seriousness of the problem.

It is estimated that in the United States 1.5 million people are infected. From the Americas as a whole, 86,000 deaths have already been reported. It is thought on very good authority that in France 150,000 people are infected. In this country estimates vary between 30,000 and 100,000.

One of the points of this Bill—the acquisition of information, which has not so far unfortunately come forward—means that we have to use such rather vague figures as between 30,000 and 100,000 simply because we do not know. But in Western Europe the rate of progress of this disease has been a little slower than in other parts of the world. We may look upon this as encouragement or—if we are somewhat pessimistic—we may say that it is only early days. However, we still have a chance to prevent a truly grim situation arising. We maximise that chance with knowledge. From the figures of those infected with AIDS and the methods by which they have been infected, there appears fortunately still to be some barrier at the heterosexual spread level. This is not true of Africa where it is well known that the spread is now largely heterosexual. In this country this has not apparently so far been the case.

I would draw to the attention of noble Lords that there is here both a message and a clue: a message from the point of view of action; and a clue from the point of view of further surveys and research. Of course we always need to know more. I do not know of any field of medicine in which we do not need or would not like to know more. If one speaks without knowledge, one ends up pontificating from prejudice rather than from a reasoned opinion. Fortunately, we are quite good in this country at collecting health statistics.

The point already raised of confidentiality is critical, particularly in relation to this disease. It is not by chance that no sexually transmitted disease in this country is a notifiable disease. We must not lose the co-operation, not only of the victims of AIDS, but of those who might be infected or who fear that they might be infected. Confidentiality is therefore critical. I am very pleased that by and large one can say that the manner and method of collecting health statistics have so far managed not only to preserve that confidentiality but give some confidence for future co-operation from those concerned.

May I interpolate a sad and worrying point which is relevant to the broad aims of this Bill and the debate although not directly related? It is the fear that the victims of this disease seem to create in others. One is hearing endless stories of people declining to go to the houses of those who have AIDS, who will not help them, who will not deliver to them, or who want to put on gloves, masks or special equipment before they deal with them. Worse still, one hears stories of nurses, nursing patients with AIDS, who are ostracized by other members of the general public and to a lesser extent by their own profession in this connection.

I can assure your Lordships that there is no medical or scientific justification whatever for any of this. It is a trend which must be very quickly reversed; otherwise, we shall have large groups of pariahs in the land and we shall have developed a caste of untouchables of our own. This is false, and we must take every step to stop it. At the same time, we must allay those unfounded fears which afflict people when they are faced with a rapidly spreading epidemic.

This Bill goes some way to helping ensure that information is brought forward. It helps us in resource allocation, to which the noble Lord, Lord Stallard, has already referred. It also helps us to prevent misallocation. By that I mean putting money in the wrong place when it is needed elsewhere. It also allows us to present some resistance to what I call the bandwagon syndrome. The bandwagon syndrome means that when a sum of money becomes available, too many people find that their work is in some way related to it and they put in for a slice of that money, which may not be totally justified. Many examples of that abound.

I am sure that the sponsors of this Bill would not claim that it is in any way an answer to the problem of AIDS, but it is certainly a welcome move in the right direction. Of course we need a vaccine. Of course we need an effective therapy. These matters are being actively pursued. But we also need this type of information and these sorts of reports to find out what is happening at present in the land so far as concerns dealing with patients, developing hospices and developing community care of the afflicted. The collection of information is the best chance of containing a very serious situation, and with good fortune—I emphasise with good fortune for we need it—we shall be able to avert what could easily become not just an international disaster but an international catastrophe.

9.42 p.m.

Lord Winstanley

My Lords, I am particularly privileged tonight in that it falls to me to fulfil the very pleasant and welcome task of congratulating the noble Lord, Lord Trafford, on his truly excellent maiden speech. I assure him that I take pleasure in doing this not merely because it is customary but because congratulations are merited and well deserved in his case. We have listened to an important, highly informed and very wise speech. We are all most grateful.

As a doctor, I am always delighted to welcome any additions to our ranks in your Lordships' House, but when the doctor is so distinguished and comes to us with such a high academic and professional record my delight is doubled. The noble Lord will soon discover that we spend a great deal of time in this House discussing medical matters, and he may come to realise that the Government are often in need of advice on these matters. I am sure that the noble Baroness, Lady Trumpington, will tell him that she gets a great deal of advice. Sometimes she heeds it, but I venture to express the hope that now that she will get advice from her own Benches, and from one who has served in another place as well, she may take even more notice of it. I am sure that we all hope to hear from the noble Lord on many occasions in the future.

I have little to say about this Bill, which I support warmly, save to ask why it should be necessary at all. It seems to me that the Secretary of State already has powers to do what is required in the Bill. Frankly, I believe that he should have been doing these things for the last three or four years. Perhaps the noble Baroness at the end of the debate will be able to tell us that the Secretary of State and Ministers have been using their powers to collect this absolutely vital information.

As the noble Lord, Lord Stallard, has rightly said, information is absolutely crucial. The BMA has pointed out that one cannot plan public information services unless we have proper information about the extent of the disease, its geographical distribution and other matters of that kind. There are, as the noble Lord said, many other things which we need to know as well. Noble Lords will remember the first time we debated this subject in the House quite a time ago. I remember saying that one of the things we needed to know as soon as possible was the incubation period. The noble Lord, Lord Rea, who is to speak tonight, said that we already knew that. I said to him, and he will recall this, that I was aware that many people thought they knew, and apparently he believed them but I did not. It is now becoming clear that we cannot yet place an upper limit on the incubation period. We do not yet know. It will be helpful when we know matters of that kind.

The part of the Bill that I particularly welcome and should like to say more about is set out in paragraph 4 of the schedule that concerns not merely the number of cases, but the number of cases that have occurred in different districts and the number of people working for health authorities and district health authorities and the people: known to [the authority] to have been provided in its district or area by others". The words "by others" very often mean people from voluntary bodies.

Counselling is specifically referred to. The Bill refers to: facilities and services … for the treatment, counselling and care of persons with AIDS or infected with HIV". Much of that burden falls on voluntary bodies of one kind or another. They are having great difficulty in fulfilling those functions. I think I am right in saying that Sir Gerard Vaughan in another place has been working actively to raise funds for counselling and has been having meetings with Ministers on this subject. We are concerned not merely with counselling in the earlier stages of the disease and assisting relatives but sometimes with terminal care. We have seen some of the voluntary bodies set up institutions for the terminal care of these tragic cases and we have seen them getting into very serious financial difficulties.

There are serious problems with regard to counselling. I have said this before and I say it again: counselling is not just a matter of being a good Samaritan. It is a highly professional job requiring professional and proper training. It is a dangerous job, not because of the possible danger of contracting the disease. I think the noble Lord, Lord Trafford, illustrated this. The disease is not as easy to catch as all that. People must realise that it is quite difficult to catch AIDS. We must not encourage any lack of thought about it, but the fact remains that some people who have been exposed to it for a very long time have not contracted it. It is unfortunate that the public should be encouraged to have this idea that once they set eyes on a person who is infected with AIDS they will automatically be infected.

The danger to the counsellor is that he is attached to a patient. He gives emotional support and develops a relationship with that patient over a continuing period until the patient dies. Then the counsellor is moved on to another patient with whom he or she develops a relationship, gives the support that is necessary to that case and to the relatives until that patient dies. Then on goes the counsellor to another patient. The possibility of very serious psychological trauma from doing that kind of work is immense. That is the reason why—as the noble Baroness, Lady Faithfull, would say if she were here—that we need professionally trained counsellors and we need to make absolutely sure that the voluntary bodies providing counselling services have the resources with which to effect the necessary training of the people concerned.

I particularly welcome that part of the Bill that will do something that has not yet been done. It will properly quantify the number of people working voluntarily in different areas, it will show where they are and give us an opportunity to see what support they need. One should also say perhaps in general—and I think the noble Lord, Lord Trafford, again hinted at this—that all the information that is available should be made properly public. I am aware of the dangers of knowledge. We often hear about this. We are told that we must not frighten people but I say from all my experience practising medicine over a long period that the dangers of knowledge are nothing compared with the perils of ignorance. We must make sure that this information is properly disclosed.

Once it is properly disclosed we may very well see that there are hopeful signs on the horizon. I understand from my medical colleagues that there are possibilities of new therapeutic substances coming along in addition to the one already pioneered by Wellcome—others for which great hopes are held. The noble Baroness may perhaps be in a position to tell us more about them. If there is a new therapeutic substance, first, that can treat cases, and, secondly, that can render them non-infective, we are on the way to getting something very important done. Be that as it may, it is still very important indeed that information should be collected on a regular, systematic and continuing basis and that it should he kept by the department and disclosed where necessary to the public who need it.

In that connection let me say, too, that it is necessary to be aware that we have to preserve a careful balance between frightening people unnecessarily and failing to remind them of dangers to which they might be exposed. It is a difficult path to tread, and I say straight away that I believe so far that the Government have trodden that path pretty accurately and kept roughly in the right position. But there are dangers.

I am old enough to remember—other noble Lords may remember too—the time in the early days of the war when we had certain draconian measures. We were very frightened about the escalation of venereal disease. Emergency powers were taken whereby people notified other people of the contacts from whom they could have obtained the disease, and in certain circumstances there were emergency powers whereby people could be called into hospital for compulsory treatment.

One of the effects of that campaign—and I saw it when I was practising medicine both in the civilian population and in the forces—was that we had a great deal more work and trouble from people who thought that they had venereal disease but who had not than from people who had actually had. People with guilt feelings as a result of some act they had committed harboured guilt of a profound degree. We had a great many suicides in those days by servicemen and other people who thought somehow that they had contracted syphilis and we could not assure them that they had not. I am told by consultants in this field that we are not yet seeing that phenomenon in connection with AIDS. I find that very encouraging because I feared with publicity that has been spread we might already have had a number of people suffering from the kind of neuroses which developed on that other occasion.

Finally, let me give just one other warning. A great deal is now said about the lifestyles and morality of people, the permissive society and so on. Perhaps it is right that people should be given warnings about their personal conduct. This is right. But we do not wish to return to the Victorian attitudes towards sex that we had at the beginning of this century and from which my profession suffered a great deal. An enormous amount of work arose in the psychiatric field from distorted attitudes towards sex as a result of fear being, as it were, established in the community quite wrongly.

It is a difficult path to tread. I believe that the Government have trod the right path so far, but I say this. Information should be made readily available. In particular good information should be made available. When all the facts which will be collected together as a result of this Bill and as a result of other steps being taken are examined, we may well find that the situation in this country at the moment is, frankly, improving in terms of the growth being delayed rather than accelerating in the way we thought. We may find that we are doing better than we feared a year or two ago. That would be helpful news. I do not think it would make people careless. I do not think it would stop people having any regard to the situation. But I think it would be useful information if that information exists.

I welcome the noble Lord's Bill and I hope that it passes speedily on to the statute book.

Lord Rea

My Lords, since the noble Lord mentioned my name at the beginning of his speech, perhaps I may hark back to a debate we had some two years ago about AIDS. If he looks at Hansard he will find that I never said what he attributed to me. He said that we knew nothing about it. I said that one thing we know about it is that it is extremely variable, and I think that that still applies.

9.55 p.m.

Baroness Masham of Ilton

My Lords, I should like to add my congratulations to the noble Lord, Lord Stallard. I hope that he will enjoy the wonderful companionship of your Lordships' House. I wish him good speed with the Bill. The noble Lord is a very caring person—the ideal person, I am sure, to take this Bill through your Lordships' House.

I should like to welcome the Bill as far as it goes. Last week I was present at a regional health authority seminar where health districts reported to the regional health authority members their plans for the future. Only two districts out of 17 mentioned that they were considering their strategy for AIDS. It is interesting how priorities differ considerably over HIV. The Bill will make the health districts and boards get themselves organised and enable health regions to collect information which can be made available to the Secretary of State. If the legislation is not implemented quickly, I think that some districts and regions will be slow to provide these important reports and will not organise their provisions speedily.

I see a serious omission in the Bill. I ask the noble Lord, Lord Stallard, and the Government this very important question. How do they intend to get the information relating to AIDS and HIV from the prisons and other penal institutions and from the armed forces? These institutions do not come under the Bill at present. Unless the number of AIDS cases and the relevant problems of the prison population, a high risk group, and the armed forces, who travel abroad and can also be at risk, are collated with the information from health regions, there will be an incomplete picture of the country at large.

If these groups are left out, should there not be added to the Bill the requirement that the Home Secretary collects AIDS and HIV information and reports to the Secretary of State at the DHSS, and that the Secretary of State for Defence does likewise?

For the past year I have been dealing with a very serious health problem on behalf of the mother of a remand prisoner. The health problems within prisons seem to need a great deal of improving if this complicated case is anything to go by. The prisoner concerned, when his mother last telephoned me, was on life support and in a coma, having been transferred to a National Health Service hospital from prison.

With regard to AIDS and HIV I feel that the prisons need legislation just as urgently as the health authorities. Are they going to treat dying AIDS victims in prison or send them out? If they are to be treated in prison, there should be special wards to do this with trained staff, otherwise numerous problems will result. Is not adequate health care in prisons a human right?

With the World Health Organisation's prediction which was in the papers yesterday that there may be millions more cases in the future than was previously predicted, prevention of the spread of the virus must not be neglected in any way.

The prison population and that of youth custody and detention cover thousands of males who often have their hair cut. Many of these people suffer from acne and spots. The barbers use clippers, which I am sure are not sterilised. I have spoken to the governor of the institution to which I am attached, and he thought that that was a valid point.

Are the prison population offered blood tests for AIDS? Those who are sero-positive should not be in the same cell as non-sero-positive prisoners. When prisoners are locked up in a cell for 23 hours a day, I am told that homosexual acts often take place. All efforts must be made to stop the HIV virus spreading.

Recently I have spoken with some doctors who are most concerned that some sero-positive people have such a grudge against society that they want to infect as many people as possible. This is a terrible thing and it needs careful psychology and diplomacy to change this serious conduct.

I have met some very caring and dedicated doctors and nurses who are working with the AIDS patients, which is highly commendable. All patients who need treatment and care should have it in the best way possible. I am beginning to hear from seriously disabled people statements of worry that so much effort and money is being channelled into AIDS that they are wondering whether their needs will be pushed out. The noble Baroness, Lady Trumpington, understands what serious disability can mean. Research must also continue for such diseases as multiple sclerosis, motor neuron disease and rheumatoid arthritis, to mention just a few of the many. The care of those very severely disabled people is vital.

I received a letter only last week saying that seriously disabled patients from a specially adapted ward, which I officially opened some years ago at Poole Hospital in Cleveland, were being transferred to a less suitable and inferior ward. The patients are most upset. The chairman of the district has written to tell me that this is to save money because of the nurses' pay, not under the recent award but under the previous one. The Minister will receive a letter from me, but I sincerely hope that she will give an assurance that the interests of these disabled patients will be safeguarded. As the AIDS situation develops demands on the Health Service will increase.

One now sees advertisements in papers for private AIDS counselling and testing. Maybe many people will prefer to have themselves checked by private arrangements. Will these clinics be registered? Will they give numbers of sero positive people to the Government to count in with their figures? AIDS is teaching doctors and health care staff how to counsel. That has been a neglected subject up to now. I hope that it will also teach government departments to cooperate and work together over this matter in a quicker and more efficient way.

I should like to end by congratulating the Government for their efforts so far on combating these complicated viruses. It is something that the whole community should be helping with, with the greatest possible co-operation.

10.3 p.m.

Lord Colwyn

My Lords, I apologise to the noble Lord, Lord Stallard, for missing the beginning of his speech. I am grateful for the clear and concise way in which he explained the Bill. I am sure that the Minister will agree that it is very important that the information specified is made available. To that extent, I support the Bill.

I am aware that we are not here this evening to go over the many aspects of AIDS again. However, in my brief intervention I feel that it is right for me to take the opportunity to continue to try to persuade the Government to look at the problem from a far wider point of view. Perhaps this Bill could be extended in order to include the kind of information that I consider absolutely vital when assessing the scale of the problem and the best way to deal with it.

The large amounts of money available for research, confirmed by the Secretary of State for Social Services in the debate in another place on 25th February this year, are very impressive. The public information campaign is certainly having the desired effect, even if it has created an atmosphere of minor panic. We know that the AIDS virus reduces and ultimately destroys the efficiency of the immune system—thus reducing the natural defence mechanism and making the AIDS victim susceptible to all manner of infection—which invariably, we are told, results in an early death.

Where I feel the Government are wrong is in their concentration on the research for an anti-viral therapy or a vaccine rather than on research into ways of improving the efficiency of our natural defences. Conventionally we are told that we are all vulnerable to the AIDS virus, yet this is patently untrue. The virus certainly triggers off a rapid breakdown of the immune system, but very little seems to have been said on why certain people with the virus should exhibit serious symptoms while others do not.

A recent article by Carolyn Reuben, published in East West in September 1986, referred to a study of the histories of AIDS patients in the United States. There were 10 factors which seemed to show up in most cases. I shall not list those this evening but I would be happy to let any noble Lord see the article or take a copy. All these factors, ranging from a history of bottle feeding, incorrect diet, removal of tonsils and the extended use of antibiotics, had a weakening effect on the patient's immune system.

While congratulating the noble Lord, Lord Trafford, on his excellent maiden speech, I fear I must disagree with him. Telling people that AIDS is always fatal is both untrue and, I believe, misguided. This is to ignore the fact that many patients have experienced remissions and now lead normal lives. Equally important, it is an entirely negative approach. The will to live is a key element in the fight for survival. AIDS patients must be allowed to live in a wholly positive atmosphere in which their self-healing capacity is encouraged and enhanced.

In the public mind at least, complementary therapies have been largely ignored. This is rather curious, not just because orthodox medicine seems to have very little to offer to AIDS patients, but mainly because there is already a substantial and growing body of evidence that a number of integrated therapies are improving the quality of life for many AIDS patients, and indeed starting them on the road to recovery in several cases.

As an example, some of your Lordships may have seen an item on ITN on Tuesday, 21st April, where the International Society of Biophysical Medicine (of which I must declare my membership) was reported to have discovered a new diagnostic method for AIDS by means of electrographic imaging and a resultant treatment method for the reduction of stress, which was having very encouraging results. In my excitement at this discovery, I was guilty some days earlier of ringing the office of my noble friend the Minister, but I regret to say that the enthusiasm shown in the office did not match that of the Americans, who are now considering financing this major British development, in the diagnosis and treatment of the disease.

In conclusion, while welcoming this Bill and hoping perhaps that it might be altered in order to widen the scope of the information that is to be reported, I beg the Government to broaden their perspective and to realise that an individual self-healing capacity is the key to the problem. Government finance should be directed away from the discovery of powerful synthetic agents and focused instead on ways of enabling people to maintain their own inner strength and health.

10.9 p.m.

Lord Young of Dartington

My Lords, I should like to join in the general congratulations to the noble Lord, Lord Trafford, on a most powerful speech. I was most impressed, as I am sure we all were. I am also sure that the noble Lord would not want to be left with the impression on this occasion that we are always in agreement. That certainly would not be giving the right impression and I am not going to join in the chorus of praise for this Bill. I am afraid I am going to disagree with everyone who has spoken so far.

So lift up your hearts, there is still hope for us. I shall take as my text, at least in the first part of my brief remarks, something that Mr. Newton said in the other place when the Bill received its Second Reading. He said of the Government (in the Commons Hansard of 23rd January 1987 at col. 1191): We could perfectly easily have thought of endless reasons for not having the Bill and for seeking to prevent it being passed. I am bound to tell the House, if only as a matter of propriety, that, strictly speaking, we do not consider that the Bill is needed. Quite apart from the existing accounting arrangements for reporting within the Health Service, the National Health Service Act 1977 already contains provisions that enable the Secretary of State to direct local authorities to provide him with certain information". He continued with a non sequitur which I completely failed to follow: Having made those points, I certainly do not intend to use them as reasons for advising the House not to proceed with the Bill". The heart has reasons that the mind knows not of. The noble Baroness who will reply to the debate later is well known in this House and elsewhere for her heart. I hope that we shall be able to vouchsafe that what comes out of that heart will support reason and do it in a more convincing way than the Minister for Health was able to do on that occasion. I found the whole thing most mysterious.

Perhaps the most important question is whether the Government were or were not right in the past to refrain from using the powers that they had to require district health authorities and the rest to provide all the information that the Bill will now make compulsory. I think that the Government were right then and have been wrong since in supporting this Private Member's Bill.

There has not been any complaint as far as I know. There certainly has not been any complaint voiced in this debate tonight, nor was there in the other place in any of the sessions about the way, manner and the accuracy of the figures that have already been collected about the incidence of AIDS. The figures are collected in what seems to me a properly English and very reputable way. They are collected throughout the country in a voluntary manner without using compulsion and are reported to the Communicable Diseases Surveillance Centre. That gives the country an adequate picture, broken down geographically into quite small areas, about what is happening with the incidence of this disease.

There has been no complaint about that, but now, because of this Bill, in what I think of as a fussy, Germanic way laid on top of our decent English ways, there will be compulsion requiring the district health authorities to do what within considerable limits they have done perfectly well so far in providing us all with the vital information which we need about the disease.

I fear that the danger is that the Bill will not make the statistics better but worse, because introducing compulsion into a scene that has been dominated so far by the voluntary principle could undermine the confidentiality which the noble Lord, Lord Trafford, talked of so well. This is a matter where the psychology of sufferers is vital. Some AIDS sufferers may fear that if their individual case has to be reported by law to district health authorities, it will not be treated as confidential.

This is not a realm in which reason generally prevails. It did not prevail with the Government when they decided to support the Bill and it has prevailed perhaps still less among many people who are stricken with the disease. They may withdraw their cooperation and not supply information, or not even let on about symptoms and so on, if they fear that there will be any breach of confidentiality; and I fear that this Bill will give some reason to people to think that the confidentiality principle may be broken.

The most vital part of any statistical collection is the voluntary basis of it. Unless people are prepared to provide the basic raw material, statistics as they are aggregated will be that much less good. To lay a statutory hand on statistics, whose supply is voluntary anyway at the root, could be to undermine the voluntary spirit.

There is a very grave omission from the Bill, which is that there is no guarantee of confidentiality. It would have done something to allay any fears people might have had on these grounds if a guarantee of confidentiality had been written quite specifically into the Bill. That at least would have been reassuring. I should have welcomed it if, in addition to that, provision had been made against discrimination in jobs and housing and on the insurance market, which is already affecting AIDS sufferers. But there is nothing of this in the Bill and I think that is one reason why, despite what the BMA may have said earlier on, when I do not think they had taken the full measure of the Bill, there is a good deal of growing disquiet among doctors concerned with AIDS.

I do not know whether other Members of this House have been written to by people at the Middlesex Hospital on behalf of Professor Adler, Dr. Ann Johnson and others there, but they are quite alarmed about this Bill, partly because they are afraid of what it might do on this issue of confidentiality. There is also some disquiet in the Faculty of Community Medicine. There obviously is not unanimity on this, and I do not think there is unanimity either way. But the fact that some eminent doctors who are in the front line of the fight against AIDS are worried about it is something which should give us pause.

Another fear is that the Government do not treat and trust voluntary bodies for the voluntary principle as they should. It is many months now since the Secretary of State was asked to help in setting up a national AIDS council for the voluntary bodies in this field, like the Terrence Higgins Trust, Gay Switchboard, Body Positive, the National Council for Voluntary Service, the College of Health, of which I have the honour to be chairman, and others. They could all do more good work with proper coordination and support. But in reply to the overtures that have been made to the department on this matter, the silence has been almost deafening. It is a serious matter which should be raised in this House and elsewhere on another occasion.

The delay is encouraging several voluntary bodies, and important ones, to think about going it alone and with a critical stance to the DHSS, which would be the greatest of pities. What we want is co-operation and not conflict and any bad feeling. We want it partly because if this Bill is to do some good, as well as any harm—which I am afraid it may do—then the cooperation of the voluntary bodies will be essential because, very strangely, the duty is laid on district health authorities in the schedule to this Bill to collect information about the work of voluntary bodies in their own area. It will not be possible to do it in any reasonable way unless much more energetic steps are taken at national and at regional and district levels to gain the fullest co-operation of the voluntary bodies, to support them and to give them sustenance over a very wide area.

So I am afraid that for those reasons I cannot possibly support this Bill. I am sorry that it has come to us and that it went through the other House. I hope that even at this late hour in the proceedings the noble Baroness will show that not only does she have a heart but she has a mind, and that mind is able to listen to good reason.

10.20 p.m.

The Lord Bishop of Newcastle

My Lords, I should like to add my congratulations to the noble Lord, Lord Trafford, on his notable maiden speech and to say what a pleasure it was to listen to a speech of so much expert content delivered with such clarity.

At this late stage in the debate there is just one point I wish to make with regard to the Bill. It is a point close to one upon which the noble Lord himself touched. In the schedule attached to the Bill we find mentioned twice, treating, counselling and caring for persons with AIDS or infected with HIV". There is general agreement that the counselling of such persons and their care in the wider sense—that is, wider than nursing or medical care—needs deft and expert handling. The noble Lord, Lord Winstanley, has already touched on that subject and it needs no underlining. Equally deft and expert handling is needed with regard to the counselling and care of the families and friends of those who are suffering from the disease and with regard to the care and counselling of those who have been bereaved as a result of it. Expert counselling is also necessary for those who have nursed persons suffering from the disease, whether they are professional nurses or not.

I gather that pressure on hospital beds may mean that the terminal stage of this illness, when the sufferer is heavily dependent on care and support, will not infrequently have to be spent at home. I am sure that families and those closely associated with persons suffering from this disease will need help of a depth and a quality beyond that required by those who watch death approach or suffer bereavement from other causes.

Understandably, family and friends in particular are likely to suffer a conflict of doubt, guilt, anxiety and anger and a veritable turmoil of thoughts and emotions, both rational and irrational, which it may be that only time can heal. Many of them will need—and will, I trust, receive—expert personal and pastoral care and support from the caring agencies and, I like to think, from the clergy. But, of course, there will be no answer to their distress, grief, rage and anxious reproaches—that is, no answer capable of crisp formulation.

There will be no answer because this disease and the problems associated with it bring us all face to face with some of life's inscrutable mysteries. Any sickness or grief, any suffering or death—in a word, any tragedy—brings us up against deep questions about the meaning of existence and about the good governance of the universe. But this disease and the problems associated with it present those questions to us in a particularly intractable and uncompromising manner.

Do we not all know that tragedy is inseparable from life? That is why we go to performances of "King Lear"' and "Hamlet". That is why we read the Greek tragedians or Racine or parts of the Bible. The tragedy is not removed by these performances or by reading. However, we come to see our tragedy as part of a much wider context of tragedy and so we are enabled to live with it and are sustained to cope with it.

Similarly, expert care and counselling, provided for those who watch those close to them suffering from this disease or who have watched them suffer and die as a result of it, will not cure their hurt. However, it may help them to live with it. I have heard of a London borough which, thanks to a charity, has been able to appoint an AIDS care organiser. I believe that he or she has responsibility, among other duties, to organise and provide care for families and friends, co-ordinating care from medical sources, the social services and the voluntary agencies.

In a word, we need to broaden our understanding of those who need support. Reference needs to be made to a dimension wider than that to which this Bill explicitly refers. It needs to refer to the needs of relatives, friends and nurses of AIDS sufferers and provision needs to be made for that. Why should this type of provision not be included in the schedule attached to this Bill?

10.25 p.m.

Lord Rea

My Lords, I should like briefly to say that, like all other noble Lords except the noble Lord, Lord Young of Dartington, who has made some very good points, I support this short but very useful Bill. I also confirm that it has the backing of the BMA.

By requiring the publication of the annual reports and defining their content and format the Bill will make available a great deal of information which will be extremely useful to health care planners and advisers in the National Health Service, the social services and the voluntary sector. The Bill will not greatly advance our epidemiological knowledge of the disease because we already have a pretty effective system running through the Communicable Disease Surveillance Centre which is based at Colindale. As the noble Lord, Lord Stallard, said, the information will also be very helpful to sufferers and their friends and families.

I believe that "publication" is the key word in the Bill, implying as it does that the information will be available to all—the public, in fact. Regions and districts which, as might appear from the report, apparently are not allocating resources appropriate to the size of their problem locally will immediately be called upon to justify their action or inaction. If lack of finance is blamed, then public pressure can be brought to bear to correct this through Parliament, local authorities and the media, both national and local.

I am glad that the Bill does not go into great detail in the schedule and specifically allows the changes to be made by the Government in keeping with the rapidly advancing knowledge of the nature of the problem and its complexity. I wish that I was as optimistic as the noble Lord, Lord Colwyn, about encouraging regeneration of the patient's own immune system.

There are a few problems in the Bill, to some of which the noble Lord, Lord Stallard, has referred. For instance, are districts the appropriate size of authority to be making reports, especially as they may not coincide with the size of the Communicable Disease Surveillance Centre's areas? They may contain very few cases, and some may contain even none. Another problem relates to the long incubation period. The district where the disease is diagnosed may not be the patient's district of residence where he may finally be looked after in the terminal stage of his illness. However, I am aware that there are methods of handling this problem which may be written into the Bill at a later stage.

As the noble Lord, Lord Young of Dartington, points out, confidentiality is quite a worry. However, I think that this has been anticipated in the Bill, particularly in paragraph 3 in the schedule which provides that if the number of cases is from one to nine in any district, fewer than 10 shall be stated.

I agree with the noble Lord, Lord Trafford, who pointed out in his excellent and clear maiden speech that it is of the utmost importance to allay people's irrational fears about the disease and to combat the danger of making AIDS patients into social pariahs.

10.30 p.m.

Lord Kilmarnock

My Lords, if I were strictly to follow the Companion to Standing Orders I should not be congratulating the noble Lord, Lord Trafford, because previously that was a duty reserved only to the first speaker who followed a maiden speaker. However, in recent years in your Lordships' House all speakers have tended to join in genuine congratulations on remarkable maiden speeches, so I shall not allow myself to be left out on this occasion just because Standing Orders tell me that I cannot do so.

This Bill comes to us with a fair wind from the Commons and it seems to me from what I have heard that there is little desire to impede its passage. I was going to say there is no desire but my noble friend Lord Young has expressed some severe reservations about it. The noble Lord, Lord Stallard, referred to the collaboration between the promoter of the Bill in the House of Commons, Mr. Strang, and the Minister for Health and their joint sponsorship of some of the main amendments. That is an impressive fact which we must take into account. We have cross-party collaboration on this subject which I am keen to preserve.

The noble Lord, Lord Stallard, said this is basically a Bill about information on a single disease and he gave us a great deal of background statistics for which we are grateful to him. There is only one figure on which I take issue with him. He mentioned a figure of something in the region of £6,000 each for AIDS patients. I suggest that that is an underestimate and possibly refers only to hospital expenses. It is, I believe, an underestimate of the cost of an AIDS patient from diagnosis to death. Perhaps the Government will back me up on that because it does not accord with the figures which are at present being studied and collated in St. Stephen's and other London hospitals. All I am saying is that I think the figure given by the noble Lord is an underestimate.

My noble friend Lord Young is concerned that the Bill is unlikely to add substantial relevant information. I think he called it a fussy, Germanic Bill, if I have his words right. I am not going to agree fully with him, and that is a further illustration that this is an entirely non-party matter; and long may it stay so. We do not have to speak with identical voices from the same Bench and that is a healthy factor in our approach to this terrible disease.

My noble friend was mainly concerned in his remarks with the number of cases, whether information would be improved on that and whether confidentiality could be preserved. I am not going to follow him down the confidentiality road because I think that is a complicated one and perhaps needs further consideration. However, it strikes me that the Bill is an improvement so far as concerns paragraphs 4 and 5 of the schedule. My noble friend did not like them particularly but it appears to me that paragraph 4 of the schedule will help to provide a clearer picture of the AIDS-related activities within a district and by whom they are provided.

I think my noble friend will allow me to say that he saw some limited good there in that it would at least bring more to the attention of the Government the level of voluntary activities that exist and probably also accentuate rather more clearly their need for support. That would become rather more apparent in the long term. I think my noble friend saw a tiny ray of light there. However, I take the point made by my noble friend that what the voluntary bodies need is not just year-on support but a clear view over a longish planning period of where they are going and what they can hope to get.

It also seems to me that paragraph 5 of the schedule will show the actual number of people each authority is deploying to cope with the disease. It may be said that this paragraph 5 information is already available to those who seek it, and no doubt that is true; but I believe it will be of considerable value in manpower planning and will show the areas and particular hospitals in which the whole burden rests on very few shoulders indeed. There is a real danger of the burnout of small, dedicated teams. This clause may help the Government recognise that danger. One can only hope that they will act upon it.

Lord Young of Dartington

My Lords, I hate to ask of a valued colleague a question that could be thought to be in any way critical. Does my noble friend accept that that there are many people employed by authorities to provide the services mentioned in paragraph 5 who, while concerned with AIDS patients, are not wholly or mainly engaged with them? They are members of wider teams in hospitals and employed by district health authorities. One of their jobs is to deal with AIDS patients. Merely to pick out those who are wholly or mainly dealing with them could surely give a wrong impression. Does that cause him some disquiet?

Lord Kilmarnock

My Lords, I respect my noble friend's intervention. There are three or four London hospitals which are bearing the main brunt of the disease at the moment. There are wards which although not originally designed to deal with AIDS, are now doing so. They find that there is severe pressure on recruiting for that work. They cannot obtain registrars because the work does not count towards the credits that young doctors need to allow them to proceed to the next stage. If my noble friend looks into that, he will find that there are some problems, especially on those wards.

I want to probe the Government about two points. The first concerns the duty of districts to report to regions as laid down in Clause 1(1). It is important that the current system of voluntary reporting to the Communicable Disease Surveillance Centre should not lapse. Here I am in agreement with my noble friend. Currently it provides our most reliable source of information.

It is also important to remember that reports to regions from districts will properly be concerned with manpower and resource implications. The reports will spell out the aggregate for each region and the region will pass that on to the Secretary of State. On the other hand, information fed to the CDSC is much more relevant to the research effort and to plotting the spread of the disease nationally.

I understand that at least one region, and there may be others, is looking at the possibility of adopting a dual form, giving the demographic, epidemiological and clinical data of each AIDS case. The suggestion is that one copy should go to the region and the other to the CDSC for the rather different purposes that I have indicated. The probability, the authority suggests, is that the present reporting by busy clinicians, which is often recognised to be under-reporting, would improve. I should like to ask the Government whether the idea of a dual form—one copy to the region and one to the CDSC—is one that the Government consider worth pursuing.

The next point I wish to make concerns paragraph 6 of the schedule. The Bill was substantially rewritten in Committee in another place. The equivalent paragraph, numbered 5 in the earlier version, said that the report must include: an estimate of the facilities or services which the authority or board will require"— I stress the words "will require"— in the next twelve months for persons under treatment for AIDS as inpatients or outpatients". The difference I want to stress is that in the present version of the Bill the phrase "will require" has been removed and the phrase "will provide" has been inserted. It is a rather crucial difference. An authority may need or require to provide all kinds of things, but actually be restrained by its likely funding level from providing anything but, let us say, a quarter of an AIDS prevention officer. That presumably will be all that it can report under the Bill as it is written.

That takes me back to the criticism I made when the Secretary of State required all authorities to state to him their plans for AIDS by the end of last year. I said at the time that these plans would depend on the level of additional funding that he would find. In other words, he had to speak first, and he did not do so. That criticism still remains. In my view there should be a strictly controlled fund to which authorities can make bids according to the development of their needs and the problem in their districts, and that does not yet exist.

As a halfway house, this Bill might have acted as a vehicle whereby authorities could state their estimated requirements. That was written into the first draft of the schedule, and I rather regret that this change has been made. It will be extremely useful if under paragraph 6 they could set out in one column what they required and in another what they could provide. Any discrepancy would then have a high claim for speedy attention.

As the noble Baroness knows, there are some very serious discrepancies. The Riverside Health Authority is to get £900,000 for AIDS this year, which is £300,000 more than last year but is only a quarter of what it has asked for on a rising tide of cases. It seems likely that £400,000 of that may be withheld for community nursing and housing in the community—very necessary purposes also—but they are all to come out of the same pot. As the Wellcome Foundation drug AZT comes on stream in this country it will quite properly absorb increasing sums of scarce money for which allowance will have to be made.

The noble Lord, Lord Trafford, in his remarkable speech, referred to a bandwagon syndrome. There is always a danger that if there is something to be bid for people will bid for it. But I do not see the danger as being as imminent as he does. The greater danger with health authorities is that where funding for AIDS is insufficient there will be a temptation to switch money from other purposes into the AIDS field, building up rivalries among departments and shortages of resources. I do not agree with his argument that it is an immediate danger.

I am not suggesting at this stage that there should be any amendment to the Bill. The Secretary of State has a rolling power to amend the schedule. That is set out in Clause 1(5)(b) and subsection (6). Subsection (7) specifies the negative procedure in Parliament. The Secretary of State can therefore amend the Bill in the light of experience. That seems a sensible provision. I should ideally like to see paragraph 6 of the schedule amended to read, "will require and can provide". This would give a truer picture of the situation in districts and any discrepancies between resources and needs.

The general feeling in your Lordships' House is clearly that the Bill should go through as it stands. We need to keep a careful eye on it and to bear in mind that the Secretary of State has power to amend it by the negative instrument. We are all interested in these matters. We should keep a close eye on the Bill and make suggestions on it in the future where we feel that there are inadequacies. With that proviso, I support the Bill.

10.44 p.m.

Lord Prys-Davies

My Lords, the House is grateful to my noble friend Lord Stallard for his explanation of this short but important Bill and its background. I should like to thank the noble Lord, Lord Trafford, a distinguished doctor, for and congratulate him on his illuminating speech with admixture of realism and hope. By any standard the speech of the noble Lord, Lord Trafford, was a major contribution to the debate.

The number of AIDS sufferers is relatively small in relation to the incidence of many other illnesses, but it is recognised that the illness will almost certainly be the biggest threat to public health in this country and in many other countries during the rest of this century. That is why it requires urgent attention. That is why there is very strong public interest in ensuring that we have up-to-date and reliable information about the impact of this new disease, its concentration in various areas of the country and its spread into new localities from year to year, and we hope one day about its contraction. The information will help the departments of health of the United Kingdom to prepare and assemble the facilities to fight the disease where they may be required.

The point has been made that AIDS cases are already being reported on a national confidential basis, but that reporting does not rest on any legal requirement. The Bill provides the legal requirement. That is its primary significance. The hope is that because it rests on a legal requirement the incidence will be fully reported.

The Bill places a statutory duty on each district health authority to collect and publish the information which is specified in the schedule and which has been referred to by my noble friend Lord Stallard. The schedule may be imperfect but it has been said by my noble friend Lord Rea and the noble Lord, Lord Kilmarnock, that the Secretary of State has reserved to himself the power to amend the schedule, or indeed to amend the Bill in the light of experience.

The Bill is supported by the British Medical Association. It has been supported by the many organisations referred to by my noble friend. That is reassuring. Yet we cannot ignore the fact that the Bill has led to misgivings. That is my word for it. I would not use the word "alarm", which was used by the noble Lord, Lord Young. It has led to some misgivings among one or two of the leading medical people in the front line in the battle against AIDS. I am sure that we must take note of those misgivings, so I trust that the House will bear with me and that my noble friend Lord Stallard will forgive me if I press the noble Baroness for two assurances, of which I have given prior notice to the Minister and also to my noble friend.

My request is based on the advice which I sought and obtained from Professor Michael Adler of the Middlesex teaching hospital. Professor Adler has already been referred to by the noble Lord, Lord Young, and I am sure that the House would like to take this opportunity of paying tribute to the work of the professor and his staff on behalf of AIDS patients in London.

There is concern about confidentiality. That is an obvious problem. The noble Lord, Lord Trafford, referred to it as a critical problem, and it was also raised by the noble Lord, Lord Young. If—and I underline that—there is a weakness in my noble friend's Bill as drawn, it lies in the possible threat to confidentiality.

It is important that an AIDS sufferer or an HIV carrier whose self-esteem may be low should not be deterred in the slightest degree from seeking advice, tests or treatment at the earliest possible moment. He or she should not be deterred from taking such advice, because he fears that confidentiality and trust will be breached and that a breach of trust will lead to adverse local publicity. If a breach of confidentiality were to occur, one fears that this would lead to under-recording, not to improved recording, and that would weaken the fundamental objective of the Bill. It is to be regretted that nowhere in the Bill is there a specific injunction to the health authorities to observe individual confidentiality.

I accept that it may not be an easy task to draft the wording of such an injunction with perfection, but I think that my noble friend Lord Stallard has already indicated his belief that the right form of words may well find its appearance in regulations or guidance to be issued by the department. I understand that the department for its part accepts that there is a need at all times to preserve confidentiality, but it would be reassuring if the Minister, when she replies to the debate, will confirm that the Secretary of State will take steps to ensure that the need for confidentiality will be brought home to and respected by the health authorities and their staff.

As the Bill reserves power to the Secretary of State to amend these provisions—and we have already indicated that this may be beneficial—we shall press the Minister to go further and to give us an assurance that the power to amend the Bill and the schedule will not be exercised in any way that will endanger, threaten or weaken confidentiality. I hope that the Minister can give us an assurance along those lines.

I move on to the next area of concern. As I understand it, there are only two areas of real concern. According to Professor Adler, the second is that we could be lulled by the Bill into a false sense of activity simply because the reports are being written and sent to the departments or the regional boards without giving attention to the content of the reports. Professor Adler has a valid point. I think it is right, subject to the issue of confidentiality, that each area health authority should record the information correctly but that statutory requirement should not be an end unto itself.

The information, with due deference to the noble Lord, Lord Winstanley, should not merely be kept: it should not remain untouched by human thought. The health departments must constantly inquire of themselves to what extent the facilities available in their areas are appropriate or effective. This was stressed by my noble friend Lord Stallard when he said that this should lead the authorities to galvanise themselves into action.

My second question to the Minister is: will the noble Baroness assure the House that the reports will be studied by the department and that it will take the appropriate action where necessary to ensure that the facilities are in the right place at the right time? I shall listen with interest and great attention to the speech of the noble Baroness in reply to the debate.

I have just one other question for the Minister. I am interested in the position of Northern Ireland because AIDS recognises no boundaries. It does not recognise the Irish Sea either. Can the Minister tell the House how long the Province will have to wait for an Order in Council that will replicate the provisions of the Bill for Northern Ireland? It would be helpful if the Minister could tell us something about the intended timetable for legislation in Northern Ireland and the adoption of the provisions of the Bill. Is it intended that the appropriate order will be introduced before the end of this year; or, as is often the case, will the Province have to wait a couple of years for similar legislation?

Those are the few questions that I have to ask the Minister. I know that my noble friend, and it appears to me all Members of your Lordships' House apart possibly from the noble Lord, Lord Young, are anxious that this Bill should become part of the law of the land with due dispatch. It comes here with the support of the Commons and I should have thought that if the Minister can deliver the assurances which I have sought, that should satisfy even the noble Lord, Lord Young, also.

Lord Young of Dartington

My Lords, emboldened by what has just been so well expressed, may I add just one point, if the House will bear with me? Mr. Newton did extraordinarily well in the other place in coming together with Members there to improve the Bill. Can I ask the noble Baroness in all sincerity whether she would be prepared to consider putting some suitable guarantee of confidentiality into the Bill at later stages. It may not be possible easily to get it right. If the noble Baroness were prepared to work with sympathetic people in this House, it might be possible to produce some kind of guarantee, or at any rate statement, about confidentiality that would go a long way to allay fears and might do a great deal for the way this disease is handled in the coming years.

10.57 p.m.

The Parliamentary Under-Secretary of State, Department of Health and Social Security (Baroness Trumpington)

My Lords, perhaps I may begin by paying tribute to the noble Lord, Lord Stallard, and to the honourable Member for Edinburgh East who introduced this Bill in another place. They have put a vast amount of hard work into getting it to this stage and I can only admire their achievement. Next, I should warmly like to add my voice to those who have congratulated my noble friend Lord Trafford. He is a most welcome addition to this side of the House and I know that his future contributions will be eagerly awaited.

We have had a very useful debate on the Bill and a number of very constructive points have been made on all sides. This, I am sure, reflects the seriousness with which we all view the threat of AIDS not only for the present population but for generations to come. First, let me say to the House that the general principles of the Bill, so ably set out by the noble Lord, Lord Stallard, have received all-party support not only in another place but also in your Lordships' House, despite the noble Lord, Lord Young of Dartington. I am so sorry that he takes the view he does, but I hope that he is a lonely little cuckoo in his nest.

Lord Young of Dartington

My Lords, I cannot really let that go—the lonely little cuckoo. I feel that on this issue of confidentiality, which baulks in many people's minds, there would be a good deal of support for an attempt to do something. I rest my case and implore the Minister to consider that, if not tonight, then at any rate on some future occasion, as a constructive way forward.

Baroness Trumpington

My Lords, if the noble Lord would give me a chance to pursue my arguments, I was sad that he said that he was totally against the Bill.

The Bill represents a very important contribution in the fight against AIDS. Although its Short Title is the AIDS (Control) Bill, it is intended to cover not only full blown clinical AIDS but also other conditions which result from infection by the human immunodeficiency virus. Your Lordships have listened to the impressive words of my noble friend Lord Trafford. There is no cure or vaccine for AIDS. In answer to the noble Lord, Lord Winstanley, it is true that a number of pharmaceutical companies are devoting increasing resources to develop therapeutic drugs. I am hopeful that new, helpful palliative drugs will emerge from this work. Your Lordships will appreciate that commercial confidentiality prevents companies making the details public.

The most effective weapon that we have in the fight against this terrible disease is public education. The more people know about AIDS, the better they will be able to deal with it. The detailed and accurate reports envisaged in the Bill will make an important contribution to the dissemination of information locally. This can only assist in getting over the vital facts—literally vital—and dispelling some of the myths that have unfortunately arisen.

Your Lordships may find it useful at this stage if I give the number of AIDS cases as known in this country. At the end of March, 734 cases had been reported, of whom 405 have died. The April figure will not be available until mid-May. United Kingdom cases, as Lord Stallard said, are doubling every ten months. These figures reinforce the need for the Bill.

Your Lordships will understand if I confine my remarks to matters that concern the Bill. There will, I know, be many future opportunities to debate more general matters. There are a few points on which I should like to touch to clarify the Government's position. I am grateful to the noble Lord, Lord Prys-Davies, for giving me advance notice of the questions that he intended to raise.

The noble Lord, Lord Winstanley, and the noble Lord, Lord Young of Dartington, asked about the powers to provide information. Under the existing powers, Ministers have already asked health authorities to provide details of their action plans for dealing with AIDS. These plans have come into the Department of Health, where they are being analysed. However, as the noble Lord, Lord Rea, has said, the important difference that the Bill makes is to provide for the publication—that is the important word—of comprehensive reports on what is being done in the local areas.

The Bill, said the noble Lord, Lord Young of Dartington, introduces unnecessary compulsion, and may lead to the loss of confidentiality. The Government welcome the Bill because it sets out a clear and comprehensive set of requirements for information to be provided by health authorities. If these prove to be inappropriate, Clause 1(5)(b), which gives the Secretary of State power to make amendments, can be involved.

On confidentiality, paragraph 3 in the schedule will ensure that it will not be possible to identify individuals in areas where there are few cases. Furthermore, health professions are bound by a code of professional ethics which requires them to keep medical information confidential.

The Secretary of State has announced a code of confidentiality directed at health authorities which will ensure that all health authority employees are required to keep medical information confidential. It is very important that I stress that, while the Bill requires this information about AIDS and HIV for authorities and boards, it also provides safeguards to maintain the confidentiality of the individual. I want to take this opportunity to underline the categorical assurance given in another place about confidentiality. None of the information which the Bill specifies should be included in the reports will threaten individual confidentiality. Nor is there any intention that the powers under the Bill to make orders and directions will be used in a way that could undermine confidentiality.

Secondly, the timing of the reports will be the same throughout the United Kingdom. We are still considering the precise timetable, but it is likely that it will be linked to the financial year to tie in readily with other information used by authorities and boards for planning purposes. The timetable for the reports is not specified in the Bill because it is sensible to retain an element of flexibility. Indeed, the provisions of the Bill generally have been drafted to avoid establishing a rigid framework which could become quickly out of date and which could be altered only by means of primary legislation.

A third point I should like to mention is that there remain a few details still to be ironed out. For example, on the content of the reports as the noble Lord, Lord Prys-Davies, mentioned. But I am confident that these will be sorted out well before the first reports from authorities and boards are due during 1988.

I wish to add that the preparation of the Northern Ireland legislation is in hand and the necessary Order in Council relating to Northern Ireland would be made as soon as possible after the Bill received Royal Assent.

The Bill's purpose is to ensure the information is provided as a basis for proper action to be taken at local level to control the spread of AIDS, together with an assessment of future requirements for planning purposes. And of course having these reports produced by authorities and boards will enable us to take action, where necessary. We must therefore make very sure that the information to be provided is needed and useful.

I should like to amend the figure given by the noble Lord, Lord Stallard, regarding government expenditure on research. The figure of £14.5 million, to which the noble Lord referred, relates to funding of the MRC for directed research. In addition, a further £3 million has been allocated elsewhere for research in 1987–88.

The noble Baroness, Lady Masham of Ilton, was worried about prisons and the armed forces. The essential purpose of the Bill is to impose a duty on health authorities to report on what is happening in their areas. Separate arrangements already exist for the reporting of cases of AIDS in prisons and the armed forces.

The right reverend Prelate the Bishop of Newcastle said that the Bill does not require health authorities to describe what help is provided for the families and friends of AIDS sufferers. I am confident that health authorities will consider the needs of families and friends as they do in relation to those who suffer from other serious diseases and who may need support and counselling. If any express reference is found to be needed in this respect, it would be open to my right honourable friend the Secretary of State to amend the schedule using his powers in Clause 1(5)(b).

The noble Lord, Lord Kilmarnock, spoke of the present reporting system and the CDSC. That system will certainly continue. An expert group has been set up to consider ways of improving the available information on AIDS and HIV. It will be looking at the reporting system and may consider the suggestion of dual reporting form which was raised by the noble Lord.

The noble Lord is correct in noting the change in wording. This reflects the view taken in another place that it was more important for reports to give details of what was actually going to be provided by authorities. The previous wording asked authorities to give just an open-ended statement about what they thought might be required, with no indication of how this was going to be provided in practice—or even whether it was.

There can be no doubt that the threat we face from AIDS is one that we simply must overcome. This Bill is a fairly modest measure but it is nonetheless important. The Government are fully committed to the Bill and the necessary action will be taken to ensure that the first reports go out next year. I wish the Bill of the noble Lord, Lord Stallard, a speedy passage through your Lordships' House.

11.10 p.m.

Lord Stallard

My Lords, at this stage I merely want to say that I am most grateful to all those who have participated in the debate. I should particularly like to add my thanks to the noble Lord, Lord Trafford, for his excellent maiden speech—excellent far beyond my expectations. I am very grateful indeed for what he said. I should also like to thank your Lordships for the constructive criticisms that have been made. They have supported the Bill in principle, and I know the noble Lord, Lord Young, will understand (as most of us do) the difficulties involved in getting any Private Member's legislation through Parliament.

He has mentioned some of the problems: for instance, that the Minister, Tony Newton, had said one thing on Second Reading and then had changed later. It is of course obvious that there was a Committee stage, the purpose of which was to try to persuade people to change whatever attitudes they may have held in the first place. Also, a great deal of discussion went on between the Minister and the Bill's sponsor, with the department, the BMA and other interested bodies. At that stage all this changed the Bill quite dramatically; and that accounts for the apparent change of view on the part of the Minister in the other place.

I should also like to say that this is a voluntary system. So far as I am concerned, the Bill does not in any way impinge on the voluntary system of reporting or collecting information. It simply requires the publication of the totals. It does not impinge on the voluntary aspect that now exists for the collection of these statistics. I would say, too—

Lord Young of Dartington

My Lords, may I interrupt for one moment? Will it be the case that voluntary bodies will be compelled in any way to provide information about the facilities they are making available for counselling, treatment, care in hospices, and the like? That will not be compulsory.

Lord Stallard

My Lords, I see no provision in the Bill for that kind of function at all. On the contrary, we would all hope that there would be complete cooperation from the voluntary organisations in the compilation of these reports and statistics. That has not been lacking so far in many of the fields in which I have been involved and I do not think it will be lacking in this field. On the contrary, I think they will be only too pleased to co-operate in the way the Bill envisages.

I am very grateful to the noble Baroness for her support and assistance and for the replies she has given—including the correction to my figure for research, which I gladly accept. She has repeated the assurance which was given in the other place on two separate occasions by the Minister on the points of confidentiality and the compilation of the statistics.

As regards confidentiality, it was made clear from the beginning in the other place that the schedule is quite deliberately worded. The Secretary of State has powers and these are not lightly given by either House, in my experience.

The Secretary of State has some extraordinary powers to amend the schedule in view of the seriousness and gravity of the matter with which we are dealing. That means of course that he has to lay a statutory instrument and any Member in either House can pray against that, and there will be a debate in the House before it is put into the schedule. Therefore, there are safeguards in that respect as well; but it means that the Secretary of State can, from time to time, vary the schedule and the requirements that are necessary according to the reports and so on and take care of the question of the confidentiality that has been raised. I understand from the discussion that I had with the CDSC and the BMA that they are well aware of Professor Adler's very valid criticisms on that point. It was their intention to contact and write to him and also to have some discussion to enlarge on and explain to him their support, the kind of reservations that they have and what they intend to do about them.

However, in no way did they think that that ought to impede the progress of the Bill on to the statute book. From there we can proceed in a normal way, and with the Secretary of State's new powers we can amend and add whatever we think may be necessary from time to time. I am exceedingly grateful for all the help and support that I have been given and for the way in which this debate has been conducted. I hope that your Lordships will give the Bill a Second Reading and that it will have a fair and speedy passage. I commend the Bill.

On Question, Bill read a second time, and committed to a Committee of the Whole House.