§ 3.6 p.m.
§ Lord WarnerMy Lords, I beg to move that this Bill be now read a second time.
I am pleased to have the opportunity to open the debate on the Second Reading of the Health Protection Agency Bill, which was introduced to this House on 27 November. It is only a small Bill, but an important one because the agency which it creates is a central part of improving the delivery of frontline health protection services. During the debate on the Queen's Speech, I was therefore pleased to hear support for the Bill from all sides of the House.
I would like to start by outlining the background to the Bill. The need to create the agency arises from a number of recent developments which have made us all much more aware of the risks posed by chemical, biological and radiological threats. Diseases such as TB and HIV/AIDS are still not beaten, and continued vigilance is required to keep them under control. Alongside those known diseases, the outbreak of SARS last year provided a stark warning of the threat posed by the emergence of new diseases, as well as of the risks of importing exotic infections into this country. In addition to those natural threats, we are faced with the spectre of a deliberate release of pathogens, such as anthrax and smallpox, or of chemical or radioactive agents. All those factors have led us to look afresh at how we can best respond to those threats to health and protect our population.
The establishment of the Health Protection Agency was first proposed in Getting Ahead al the Curve, the Chief Medical Officer's strategy for infectious disease and other aspects of health protection, which was published in January 2002. That strategy brought together a number of proposals which offered a more systematic approach to improving health protection. The creation of the Health Protection Agency is a top priority because it will also help us to achieve many of the other proposals in the strategy.
Our key aim in creating the agency is to strengthen and co-ordinate the arrangements for specialist support for health protection on which local NHS bodies and local authorities rely. In the past, a considerable number of different bodies and interests have provided support for health protection issues. Advice on infectious disease generally came from the Public Health Laboratory Service, including the Communicable Disease Surveillance Centre. The National Focus for Chemical Incidents and various regional service provider units provided support on chemical hazards.
Regional advisers supported the health contribution to emergency planning, and consultants in communicable disease control took responsibility for much of the action at local level, in relation to both infectious disease and other hazards. Advice on radiological hazards is currently provided by the National Radiological Protection Board. There was also the National Poisons Information Service and the Centre for Applied Microbiology and Research. The Health Protection Agency will combine all those 14 functions in one organisation for the Secretary of State for Health, with the devolved administrations deciding the precise role that the agency will play in Scotland, Wales and Northern Ireland.
That wide-ranging role for the agency is an important development, because when an incident occurs it is not always immediately clear whether it has a chemical, radiological or an infectious source. A single agency can provide quick access to all relevant expertise. We also expect to see benefits as all these different specialist areas learn from each other. By placing different responsibilities within a single unified agency we should see a beater degree of cross-fertilisation of good ideas and good practice than in the past.
From June to September 2002 the Department of Health conducted an extensive consultation exercise on the creation of the agency, to which it received 215 responses. One of the results of the consultation exercise was that in November 2002, my honourable friend Hazel Blears, who was at that time the Minister for Public Health, announced the decision to create the agency through a two-stage process. The first stage was to create the agency on 1 April 2003 as a special health authority in England and Wales, which is able to carry out functions under the National Health Service Act 1977. The second stage is to establish the agency as a non-departmental public body which will be able to carry out a wider range of functions, including those that are currently exercised by the National Radiological Protection Board.
That two-stage approach enabled us to move speedily to create the agency as a special health authority covering England and Wales on 1 April 2003. It also gave the Scottish Executive time to complete its own consultation exercise to help determine what role the agency might have in Scotland before we started the second stage. The NI-IS, local authorities and others who undertake health protection and health emergency planning at a local level are now supported by specialists who are part of a national agency who can supply expertise and backup and run programmes on their behalf.
The agency also enables the UK government to make an integrated contribution to a range of international initiatives. In particular, the agency is working to ensure that there is effective international co-operation regarding the surveillance of emerging infections, poisons, chemicals and radiological hazards. That enhances the high reputation for health protection which the UK already has in the international community. A prime example of this was the agency's contribution to the international effort to control SARS. From day one, the agency was linked into the international effort, both in surveillance and laboratory work. The agency had representatives in China, Hong Kong, Vietnam, Canada and at the World Health Organisation where the modelling of SARS was led by the agency. A senior official of the World Health Organisation reported that it would not have been able to manage that work without the UK. As a result of this work the agency is about to sign a memorandum of understanding with the new health protection authority in Hong Kong to work on research, training and emergency planning. That will 15 enable the UK to be well ahead of diseases that arise in the far east, as well as having a shared international approach.
Since April 2003 the agency has taken the opportunity to establish itself as a modern, forward-looking organisation. It committed itself to transparency and openness; high standards of corporate governance, integrity and value for money; and working in partnership with other organisations to develop and deliver programmes and policies and ensure public involvement. Its work is based on the best available evidence together with high clinical and public health standards. At this point it is worth mentioning a few of the more significant achievements of the agency so far. Almost from the day of its creation the agency was tested by a number of incidents which posed a threat to public health—some within the UK and some international. I am pleased to say that the agency met those challenges head on, proving that the change process had not disrupted the essential business of its predecessor bodies.
The most prominent and serious of the threats was the emergence of SARS. In addition, the agency has strengthened our ability to respond to chemical, biological, radiological and nuclear terrorist threats. The agency is now supporting the UK Government in that field of work in the same way as the predecessor bodies. In particular, the agency has already coordinated a number of training exercises and provided other forms of emergency response training. As well as ensuring business continuity, it has also made significant progress in delivering a broader vision for it to provide a health protection service at local level in England. It has set up nine regional and 36 local health protection teams to bring a more unified and consistent approach to public health threats across the country. The new relationships and networks will take time to bed down, but the agency, the NHS and local government are working constructively together. In particular, the agency is currently working closely with primary care trusts to finalise the memoranda of understanding which govern their relationships and contribute to the aim of achieving the same high standards of response throughout the country. That should resolve earlier difficulties with some PCTs.
That is only a snapshot of the agency's work, but it demonstrates that at regional and local level the synergy in the CMO's vision for the agency is already producing results. The agency now offers more coherent and better co-ordinated arrangements for health protection than we had in the past and is successfully delivering that service at local level. Therefore, I pay tribute to the staff who worked so hard to achieve that remarkable transition so quickly. They have created a solid and effective foundation upon which we can use the Bill to develop the agency further.
The Bill gives the agency wider functions than could be provided for in the statutory instruments which set up the agency as a special health authority and establishes it now on a proper statutory basis throughout the UK. Without the legislation to give it the additional functions that we originally intended, the agency will be unable to 16 undertake the full role that was envisaged for it in Getting Ahead of the Curve. An important feature of the Bill is that Clauses 2 and 3 give the agency specific functions in each of the four parts of the United Kingdom and enable the Secretary of State for Health and each of the devolved administrations to give the agency additional functions in the future if circumstances change. The extent to which the agency will be given additional functions in the different parts of the United Kingdom will vary to take account of the different needs of the Secretary of State for Health and the devolved administrations. It will be for the devolved administrations to shape their use of the Health Protection Agency to meet their particular needs and the Bill reflects that situation in Clauses 2 to 4 and 6.
The other major change in the Bill is contained in Clause 3, which will give the agency the radiation protection functions which are currently exercised by the National Radiological Protection Board. So, alongside the bringing together of different functions, the Bill enables us to reduce bureaucracy further by cutting the number of quangos, because the Special Health Authority and the National Radiological Protection Board will both be replaced by the new body. It is more than just a tidying up of existing arrangements: a more powerful system than we have at present will be created.
In future therefore, the Government and each of the devolved administrations will look to the new agency to provide the functions that are currently exercised by the NRPB. I pay tribute to the service that the NRPB has provided to this country. Originally set up in 1970, the NRPB has been the Government's principal source of scientific advice on radiation issues. Over the years the board has built up an outstanding national and international reputation as a source of expertise on radiological protection issues. That has enabled it to provide an authoritative and independent service to both the Government and the people of this country.
Nevertheless, it is possible to strengthen that service even further by transferring those radiological functions to the Health Protection Agency. Establishing a more integrated source of advice will improve the overall arrangements for the delivery of health protection and will enable the agency to exploit the synergies between the various health protection functions. One particular step that will assist in the exploitation of those synergies has been the decision to co-locate the headquarters of the new agency's chemicals division within the NRPB headquarters building at Didcot.
Transferring radiation protection functions to the agency does not compromise in any way the independent nature of the advice that the HPA will provide, or reduce its quality. The new agency will be an executive non-departmental public body, which is exactly what the National Radiological Protection Board is now. That will ensure the continuing authority of this advice.
The Bill will enable the NRPB staff and assets, as well as those of the Special Health Authority, to be transferred to the new agency. Organisational change can be unsettling for the staff concerned, but I am 17 confident that it will be managed smoothly, with the minimum amount of disruption to both staff and work. To facilitate that process, the two bodies are already working together closely and share the same chairman.
The remaining elements of the Bill are primarily concerned with the practical aspects of setting up and running the agency. The provisions relating to the agency's hoard in Schedule I are in line with the proposals in the 2002 consultation paper that I mentioned, on which there was little comment. Future appointments are likely to be delegated to the NHS Appointments Commission. The funding of the agency will come from the Department of Health and the devolved administrations, plus contracts with the private sector and other parts of the public sector.
The provisions in the Bill on accounts, audit and annual reports are broadly comparable to provisions in existing legislation for equivalent bodies and will provide the framework to ensure that the agency is properly managed and accountable. Clause 5 provides for the agency to work co-operatively with other bodies and Clause 6 identifies who can give directions to the agency and on what functions. Clause 7 provides for the publication of information by the agency and Clause 8 for the transfer of property and staff.
The final point that I want to emphasise to your Lordships is that the Bill will not entail any additional public expenditure or changes to public service manpower. But those resources can be used more efficiently in a single agency. The transitional costs involved in widening the agency's powers will be met from the existing resources available to the Department of Health and the NHS.
Setting up the Health Protection Agency Special Health Authority has already illustrated the kind of developments which changes to arm's-length bodies can achieve. It has shown how, without the need for the Department of Health to seek additional resources from the Treasury, the agency has been able to set up an emergency response division virtually from scratch, strengthen the ability to provide chemicals advice so that there is now the capacity to be proactive as well as reactive, and develop local and regional services.
I hope that I have made it clear why the Government have introduced the Bill. They have done so to bring into full effect this important new body for carrying out the full range of functions envisaged in Getting Ahead of the Curve. The Bill will enable the new Health Protection Agency to respond more effectively to the changing and sometimes dangerous challenges to public health in the 21st century and to deliver an improved health protection service to the public. I commend the Bill to the House.
§ Moved, That the Bill be now read a second time.—(Lord Warner.)
§ 3.23 p.m.
§ Lord FowlerMy Lords, I welcome the Bill and agree with the noble Lord that it is an important measure. I also agree that we are fortunate in having in the agency some very skilled and dedicated staff who already have 18 an international reputation. To place much of this on a United Kingdom basis obviously makes a great deal of sense.
I shall not seek to repeat all the arguments in favour of the agency, which the Minister summarised extremely well. Instead, I want to concentrate on what I regard as one of its most fundamental roles—that is, gathering information on HIV/AIDS and sexually transmitted disease generally. Perhaps I may say in parenthesis that I was slightly surprised that the Minister did not say more about that area. In fact. I am not sure that he said anything about it. I find that surprising for reasons that I shall explain.
It seems to me that the information that the agency collects is entirely fundamental in guiding policy and informing the public of dangers that have emerged or show signs of emerging. In the area of sexual disease, there is no question that we are seeing problem after problem: we are seeing alarming rises in sexually transmitted infections generally; we are seeing new dangers in the area of HIV/AIDS; and we are seeing the clinics set up to deal with those problems operating under acute difficulties. In other words, we see a public health crisis.
That is not only my view; it is the view of the House of Commons Select Committee on Health. It gave its verdict last summer when it said:
We have been appalled by the crisis in sexual health we have heard about and witnessed during our inquiry. We do not use the word 'crisis' lightly but in this case it is appropriate. This is a major public health issue and the problems identified in this report must be addressed immediately".I refer also to a very important letter in the Times of 15 December from Professor Michael Adler, who is a most respected figure in this area. He said:The Department of Health's desire to shift the balance and devolve responsibility to primary care trusts…means that no one takes responsibility for sexual health".He went on:The time has come for strong central political leadership and recognition that we are dealing with a major public health crisis".Therefore, against that background, I believe that we have a public health crisis and, also against that background, it must be in the public interest that the new agency should have the resources and means to gather up-to-date information; otherwise, informed debate is impossible and we revert to prejudice and predetermined views. There are few areas where there is a greater temptation to go down that road than in sexual health.I take it as accepted that in the publication of the information that the agency gathers, the Government will give the agency complete and unfettered independence. I also take it that there is no question of health Ministers or civil servants wanting to alter any findings that could be embarrassing to whatever government happen to be in power.
I believe that in Committee we shall need to consider Clause 7, which sets out when information will not be published. I assume that the provision on the Data Protection Act covers patient confidentiality. That is clearly a very important issue in this area. But I am 19 always wary when I see that publication can be banned when it is "not in the public interest". We shall need to examine who judges what is in the public interest and what is not.
However, my major concern about the Bill is that the collection and analysis of information on sexually transmitted infection should not be some theoretical exercise. Where problems are identified, the information should be accompanied by statements of action on how the problems are to be remedied. There is no point in allowing the reports of the agency to gather dust on the shelves of medical libraries. The public will want to know what Ministers intend to do to put the position right.
What concerns me about the Bill is that it places a great number of duties on the agency—a great number indeed—but not many on the Government in how they respond. Let us take the annual report as an example. In Clause 24:
The Agency must as soon as possible after the end of each financial year prepare and send to the Secretary of Statean annual report and,must provide the Secretary of State with such other reports and information as he directs".And what is the duty on the Secretary of State? Only that he must lay copies of the reports before each House of Parliament. There is not even an "as soon as possible" requirement on the Secretary of State.However, that is a minor irritant. What is really lacking in the Bill is any requirement on the Government to respond to the reports of the agency and, in particular, to its annual report. There is no requirement on Ministers to set out what they are doing. There is no requirement on Ministers to set out how their policies are tackling or will tackle the issues raised. That is certainly not because everything is going so fantastically well as this moment that any statement would be entirely unnecessary.
One has only to look at the very important update report of the Health Protection Agency, published to coincide with World AIDS Day, to know that that is not remotely the case. The report presents a very grim picture. It shows that sexually transmitted infection generally has increased alarmingly; that in the past 12 months, for example, diagnoses of infectious syphilis in men increased by 73 per cent and in women by 33 per cent; that there have been significant increases in sexually transmitted infections among gay and bisexual men; that cases of gonorrhoea, again among gay men, have almost doubled since 1999; and that those same sexually transmitted infections may facilitate the transmission of HIV.
The report also reveals that there has been an increase in the number of heterosexual HIV diagnoses acquired in this country, and that over the past 12 months there has been a 20 per cent increase in the number of people living with HIV to an estimate today of about 50,000. The figures also show big increases in the number of HIV infections acquired outside the United Kingdom, notably in sub-Saharan Africa, which provide other—but I would suggest different—challenges.
20 It would be a profound mistake to blame the deteriorating position simply on people coming to this country from abroad. Both with sexual disease generally and with HIV/AIDS, there is a major problem which is entirely home-made. The irony is that so much of the disease is entirely preventable. However, the position remains that either through ignorance—which remains very high among young people, who are most at risk—or through risk-taking by men who believe, utterly incorrectly, that HIV can be cured, precautions are ignored.
The net result is not only needless suffering, but also treatment clinics under unprecedented pressure, particularly in cities such as London. Anyone who doubts that has only to cross the river to St Thomas's Hospital to see facilities stretched to bursting point. The net result is further public health risk. The whole idea of the clinics was that they would offer immediate and confidential walk-in facilities. The rule today is that consultation is by appointment and that there is waiting and delay—delay in which infection can be spread further.
In policy terms, the lack has not been of information on the spread of this danger. Information has been collected faithfully and well by the predecessor bodies to the Health Protection Agency. As I think my figures have demonstrated, that continues to be done by the agency. The lack has been of the action necessary to counter the threat. None of this has happened overnight. The figures started deteriorating from about 1996–97. The public can judge for themselves whether the responses of governments have measured up to the scale of the problem. I doubt that many will say that they have.
I have to observe that it took this Government four years—one whole Parliament—to produce their much-promised strategy document on sexual health. It was as if Ministers were embarrassed by the whole subject and, above all, wanted it to go away. Perhaps I may advise the Government: before they publish documents such as the one that I have with me entitled UK's call for action on HIV/AIDS, in which there is more than a hint of self-congratulation in what they have done in pushing HIV/AIDS up the world agenda, they should first examine whether they have the authority to make such claims, based on what they have actually done at home.
I do not claim that by placing a duty on the Government—any government—to respond to the reports of the Health Protection Agency we will solve all the difficulties, but I certainly believe that it would help. I notice from the agency's own report, in November 2003, that it had 10 quite specific proposals, which ranged from reducing the waiting time at clinics to increasing prevention efforts directed at gay and bisexual men and promoting voluntary confidential HIV testing of migrants from sub-Saharan Africa who present themselves at clinics. It is a very wide range of important proposals, all of which are very closely directed at urgent issues. Surely no one denies the need to reduce waiting times at clinics. I find there is also 21 increasing support for much more extensive public education and advertising directed particularly at young people.
At Question Time today, Ministers defended the money spent on government advertising. I suggest that there would be little criticism if more money were spent in this particular area, warning young people of the present dangers. It remains vital that we reduce the undoubted ignorance that exists and persuade people generally of the importance of sensible prevention measures.
Of course, what matters is not what I think, or even what the Health Protection Agency believes, but what the Government decide to do. Quite rightly, in this Bill the Government are holding the agency to account and setting out what they require the agency to do. However, the public also have rights over the Government. We are dealing with important threats to public health. The public have a right to know what the Government intend to do to meet those threats. This is not a function that can he sub-contracted to an agency. An agency can measure the size of the problem and make proposals. However, when it comes down to it, it is the duty of the Government, not the agency, to protect the public.
I support the Second Reading of the Bill. However, I believe that there is much more to do to achieve the purposes that we all desire.
§ 3.36 p.m.
§ Baroness Finlay of LlandaffMy Lords, like the noble Lord, Lord Fowler, I welcome the Bill. The Health Protection Agency has many important and different aspects, as the Minister so clearly outlined. I shall concentrate my remarks on the incorporation of the National Radiological Protection Board. I declare an interest as an employee of the Velindre NHS Trust in Wales.
As an independent public body the National Radiological Protection Board has indeed provided independent advice to protect public health and to protect workers exposed occupationally and patients undergoing medical treatment from the hazards of radiation. Its remit covers both ionising and non-ionising radiation. It has also carried out research to underpin the advice it has given. It has established a national and international reputation for scientific excellence, particularly in relation to dosimetry and the health effects of ionising and non-ionising radiation.
The National Radiological Protection Board has also made major contributions to the development of plans to deal with nuclear emergencies and model the behaviour of radionucleotides in the working and natural environments; to the assessment of workers and members of the public who are exposed, including those involved in medical irradiation; and to protecting people from the health effects of ultraviolet and electromagnetic radiation, including power frequencies and radio frequencies. All of those data are incredibly important and are sometimes the result of 22 government policy. The agency's independence must be preserved within the new body to ensure that it can hold government policy to account, and vice versa.
The National Radiological Protection Board has consistently been represented on all the relevant premier scientific committees. It also developed the UK gold standard for professional training in radiological protection. All of that comes at a price. The board currently holds assets; it is very important that there is no risk of it being asset-stripped.
The contribution of those from radiation protection to the Health Protection Agency started with enthusiasm under the leadership of Professor Roger Clarke and now of Professor Roger Cox. The collaboration is already demonstrating that the National Radiological Protection Board has much to contribute within the HPA and that it will gain scientifically. Those are all positive events. As the Minister outlined, the key areas of collaboration are emergency response planning, including chemical, biological, radiological and nuclear incidents; the provision of training and radiological protection for the local and regional units of the Health Protection Agency; and modelling of the dispersion of noxious agents in the environment.
Future research and development is absolutely crucial as it will affect the assessment of human exposure to genotoxic agents including chemical and radiological agents. However, I seek reassurance from the Minister that the radiological protection work and other work of the agency within the devolved administrations will remain adequately funded in the long term; that staff developments, both within the UK and through international collaboration, will be encouraged; and that the retention of expertise will be adequately resourced. Because once that expertise is lost, it will take many years to regain.
It is essential that the National Radiological Protection Board develops and maintains the expertise necessary to respond to health concerns when they arise, often at very short notice. Examples include the Chernobyl incident, concerns over mobile phones and base stations and the work done in assessing concerns about childhood leukaemia occurring near nuclear sites. These matters need work between the board of the Health Protection Agency and other disease registers. I should like to address briefly some aspects surrounding disease registration in a moment.
The independence of the board, with its UK-wide responsibilities, has led to its well established reputation far beyond our shores. This international role is extremely important for all. As the Minister outlined, in Getting Ahead of the Curve Sir Liam Donaldson referred to the National Radiological Protection Board being a "distinct entity" within the Health Protection Agency. I hope the Minister will be able to confirm that the resources required to maintain that expertise—and that distinct identity—will be available; and that the independent work of the protection board will he supported so that it can hold government to account over their policies, and that its information can be used to inform policy, just as Defra has consulted over contaminated land and radioactive waste disposal.
23 The board's independent opinion is of great value and must not be stifled, even though at times the information it puts into the public domain may appear to be uncomfortable for whichever government are in power.
The noble Lord, Lord Fowler, has eloquently called for action on sexually transmitted diseases. Disease registration and issues of confidentiality and consent will need to be clarified for the Health Protection Agency and disease registration processes to work effectively.
To date, there is The Government need to engage the public in understanding why epidemiological data are so important. The public needs to understand why every citizen's disease data are important to contribute to the mosaic picture of health, so that policies can be scrutinised and early warning signs detected. Without addressing some of the broader aspects, I fear that the Health Protection Agency may find itself in shackles and unable to operate as effectively as one hopes it will. So my plea throughout will be for independence to be maintained; for the cross-border working between devolved administrations to continue; and for some of the broader issues of registration to be addressed.