To ask Her Majesty’s Government how many outbreaks of tuberculosis there have been in London schools in the past year.

My Lords, data indicate 39 TB incidents in schools in London to date this year. Since data collection began in 2004, there have been 148 TB incidents in London schools, which include nurseries but exclude higher education. Incidents are defined as occurrences where potential transmission to non-household contacts is identified as a public health risk warranting wider investigation. Outbreaks are a specific sub-set of incidents. It is not possible to provide data on outbreaks alone.

My Lords, I thank the noble Lord for that reply. As 70 per cent of TB cases in this country come from abroad, should not immigrants coming to this country have a blood test when they arrive? Later on, should not leave to remain in this country be dependent on their having a screening?

My Lords, I agree with the noble Baroness. Individuals immigrating from abroad who have a high susceptibility to tuberculosis are currently screened. There are two screening mechanisms. First, there is a screening pilot, which we started in 2005, in which all individuals staying more than six months in the UK are screened at the time of acquiring a visa. If they happen to have active disease, they will be treated completely at their own cost until they are free of disease and before they obtain a visa. These countries happen to be Bangladesh, Sudan, Tanzania, Thailand, Ghana, Kenya and Pakistan. If individuals are coming from other countries in which the prevalence is greater than 40 per 100,000, they will be screened at the port of entry.

My Lords, does the Minister agree that school nurses carry out a vital role in health and education, in the link between school and home and in detecting diseases like tuberculosis? If so, does he realise that there is a desperate shortage of school nurses up and down the country and many in post now are due to retire very soon? Will he tell us what he is going to do to encourage primary care trusts to achieve the Government’s target of 3,300 school nurses by 2010? I understand that, at the moment, there is a shortfall of 1,000.

My Lords, we recently completed the next-stage review as the noble Baroness is fully aware. A subset of that review was on a high-quality workforce through which we addressed some of the needs, gaps and future demands. I agree on the role that school nurses play, not just in schools but in the co-ordination of care in schools and in a primary and community setting. So that document itself has a number of policies which will address that gap and I will be more than happy to take questions on any further issues in relation to that.

My Lords, what research is going on into developing treatment for new drug-resistant strains of TB that are emerging in the UK?

My Lords, there is plenty of research into addressing this challenging problem of multidrug-resistant TB, which is about 1 per cent of the current infections. Recently, we have also identified through the WHO guidance so-called extensive drug-resistant TB. As far as I am aware, we knew of one case in Scotland, but, using the WHO criteria, we have been able to go back and now believe that we have had eight such cases in the UK. Every attempt is being made, working with the pharmaceutical industries, to obtain new therapies that will address these new, challenging multidrug-resistant infections.

My Lords, does the Minister have any statistics on the incidence in higher education in Greater London?

My Lords, as I said, we have had 148 incidents in London schools. I do not have the figures for higher education, but the figures for the past five years in London schools are: 31 in 2004, 32 in 2005, 17 in 2006, 29 in 2007 and, as I said, 39 in 2008. However, I will be more than happy to look at the incidence in higher education and get back to the noble Lord.

My Lords, the Minister mentioned working with the pharmaceutical industry. Does that mean that in this case, given the Government’s recent negotiations with the industry on reducing the price of medicine, this will be treated as an orphan drug, or will there be another form of incentive to ensure that this work is done?

My Lords, historically this country has always enjoyed research and development and investment by the pharmaceutical industry, because the best brains are in this country. As a result, I am very optimistic that with the recent negotiations and completion of the PPRS we will see further investment by the pharmaceutical industry in the United Kingdom.