HL Deb 10 February 2004 vol 656 cc1035-8

2.45 p.m.

Baroness Gardner of Parkes asked Her Majesty's Government:

Whether the chlamydia screening programme will only cover a quarter of primary care trusts; and, if so, what significant impact they expect this screening to achieve.

Baroness Andrews

My Lords, the aim of the chlamydia screening programme is to implement, by 2008 at the latest, a national prevention and control programme in England. We have already achieved coverage of over a quarter of primary care trusts in just over two years. Early detection and treatment of chlamydia not only reduces the prevalence of lower genital tract infections, but decreases the incidence of costly longer-term complications such as pelvic inflammatory disease and infertility.

Baroness Gardner of Parkes

My Lords, I thank the Minister for that Answer. I am glad that the Government are doing something. Unfortunately, it is not enough. Is the Minister aware that in the six years before 2002, chlamydia infection increased by 141 per cent, and in the most recent year's figures it increased by 14 per cent? Does she agree that one of the real problems is that 70 per cent of women and 50 per cent of men with the infection are totally unaware that they have it, and are symptomless? It is for that reason in particular and in view of the young age of those mostly affected that screening is the only thing that works.

Baroness Andrews

Yes, my Lords, all the figures that the noble Baroness has given are absolutely right. They present a depressing story, particularly because so many young women and men do not know that they are at risk. We have followed the National Strategy for Sexual Health and HIV, which is one of the first in Europe, and we have emphasised the screening programme that was introduced last year following the pilot. We are now at phase two, and by the summer we will have reached phase three, by which time over 100 PCTs will be involved. We will be reaching a lot of people in opportunistic screening where real use can be made of the findings. We are putting a lot more money into screening: £40 million in the past two years and another £26.4 million following the Health Select Committee's report.

Lord Rea

My Lords, can my noble friend reassure me that the screening programmes take adequate account of the role that men play in the spread of this infection? In sexually transmitted disease clinics, it is normal to ask the patient to inform their partner, and if that is not possible to slip them an anonymous calling card. At this time of year, it would be rather an unwelcome Valentine. Would she agree that to treat patients who then go back to their infected partners is rather a waste of time?

Baroness Andrews

My Lords, we are certainly targeting young men. We are conscious of the fact that young men are less confident about coming forward than young women. We have commissioned the Men's Health Forum to look at ways of helping us to develop the right strategies. We are looking at ways of reaching young men, through men's magazines, men's clubs, armed services bases and other places where we can be effective. In schools, the DfES is working with the National Children's Bureau to develop guidelines about how sex education can reach boys more effectively.

Baroness Masham of Ilton

My Lords, does the Minister think that in the long run it would be cost effective to make chlamydia notifiable?

Baroness Andrews

My Lords, we have chosen an opportunistic screening programme simply because we know that it is effective. We are reaching those people who we need to reach. For the moment, that is the most effective thing to do.

Baroness Barker

My Lords, does the Minister have an estimate of the cost of delaying the full roll-out of this programme to 2008, as opposed to the cost of increases in infertility and ectopic pregnancies and the cost to the department of treating those conditions?

Baroness Andrews

My Lords, I do not have a comparative cost. It is difficult to cost infertility. I take issue with the word that the noble Baroness used— "delaying". We are actually rolling this programme out faster, because as each phase comes on stream, we can learn from what we have achieved. Introducing a screening programme is not an instant fix, especially something like this where there must be a framework for follow-up, testing and treatment. We are actually making better progress than we thought at the beginning.

Baroness Perry of Southwark

My Lords, given that the 16 to 24 year-old age group is most affected by chlamydia, is it not particularly important that clinics in universities and colleges, and those dealing with upper secondary schools, are given priority in this programme, and that the educational programme carried out in schools emphasises the dangers and risks?

Baroness Andrews

Yes, my Lords. That is precisely why we are phasing in the programme to target educational establishments, such as colleges of further education, in particular. The reason for the age limit of 24 is that that is the age of greatest sexual activity. In addition, I understand that women are less likely to contract chlamydia as they grow older. We need to focus our resources where they would be most useful.

Baroness Gould of Potternewton

My Lords, I declare an interest as the chair of the Independent Advisory Group on Sexual Health and HIV. Is my noble friend aware that last year NICE recommended free IVF treatment on the NHS, but in doing so it did not refer to the relationship between infertility and chlamydia, which has been raised in this Question? What action is being taken to ensure that if the NICE proposals are implemented, that causal effect will be taken into account?

Baroness Andrews

My Lords, one of the reasons that we are accelerating the programme is the devastating consequences of infertility. An estimated 20 per cent of infertility cases are caused by chlamydia. The guidelines are scheduled for publication at the end of this month. The Government's position will be determined in the light of the final version. I am afraid that I shall have to ask my noble friend to await that outcome.

Earl Howe

My Lords, can the Minister clarify her earlier answer in which she said that 100 PCTs would be eligible for the screening programme later this year? Am 1 not right that the Department of Health's own report into the pilot screening programme in 2000 said that chlamydia screening should be introduced nationwide? What is the time-frame for doing that? Although the Minister is keen to tell us that the rate of progress has been good, I am not sure that I see it that way. Why has progress not been faster?

Baroness Andrews

My Lords, by the summer one-third of all PCTs will be in the screening programme. The noble Earl is right; it followed a highly successful pilot in which the efficacy of screening was proved by the take-up and the outcomes. I believe that in my original Answer I said that it would happen by 2008 at the very latest. We might be able to make faster progress if we can learn as the programme evolves We are quite optimistic. We are taking radical steps to inform people, as I am sure noble Lords will have seen, about the need to be aware that they are at risk. It is to be hoped that we will make fast progress.