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Health: Tuberculosis

Volume 709: debated on Thursday 23 April 2009


Asked By

To ask Her Majesty’s Government what measures they are taking to combat the spread of tuberculosis in the United Kingdom.

My Lords, the Government are committed to tackling TB, and in 2004 the Chief Medical Officer for England published an action plan. Our key strategy is early detection and completion of treatment. To implement this, we launched an information pack designed to help NHS commissioners secure best services to meet local needs, and we are funding an awareness-raising programme for the public and professionals to help earlier identification of TB.

My Lords, I thank the noble Baroness for that Answer. Does she agree that one in three of the world’s population is infected with latent TB? Why are there not sufficient funds to do a blood test on people with possible latent TB, a test which costs only £30 whereas treatment of drug-resistant TB costs £60,000 per patient?

My Lords, the noble Baroness is absolutely right about the problems with drug-resistant TB. She will also be aware that there have been a very small number of cases. In the UK since 1993 we have identified eight cases, three of which needed treatment—the other five patients died—and all the cases have been confined to patients with certain types of lifestyles, involving people who are homeless or dependent on drugs. We attempt to identify those people as early as possible and ensure that they get treatment and follow through the course of treatment.

My Lords, my noble friend’s interest in DfID and its work is well known. We provide substantial support for TB control worldwide. We support programmes in a number of countries and we are part of the Global Fund to Fight AIDS, Tuberculosis and Malaria. We fund many programmes, and we do that in two ways: one is by helping support health services in the countries that have these pandemic problems, and the other is the provision of funding to those countries’ TB control programmes—for example, in India and Nepal.

My Lords, the Minister will know that failed asylum seekers are treated for tuberculosis without charge. However, does she acknowledge that failed asylum seekers with diabetes or HIV/AIDS have to pay for their treatment, yet they are at a much greater risk of contracting TB clinically and most live in the unsanitary conditions that lead to TB infection in individuals? Will the Government reconsider their refusal to give free NHS care to these very vulnerable people?

My Lords, the noble Baroness will be aware that we certainly regard TB as a public health issue, and anyone who is suspected of having TB will receive their treatment promptly, and it will of course be free. The noble Baroness is aware that we are reviewing the other issues that she has continued to raise with the Government, because it is not in anyone’s interest that people do not receive the treatment that they need for conditions such as HIV, TB or related illnesses.

My Lords, when I was a medical student, I was familiar with the ravages of bovine tuberculosis, which often caused serious spinal and bone tuberculosis in children. We thought that bovine tuberculosis was a thing of the past, having been virtually eliminated from the country, but now there is a recrudescence of the bovine infection in some cattle and in the badger population. What initiatives have the Government embarked upon to deal with this problem?

My Lords, the noble Lord will know that the Health Protection Agency indicates that there is no evidence of an increase in the infection of humans with bovine TB as a proportion of the overall number of TB cases. We maintain diligent monitoring of all types of TB. With regard to badgers, which are slightly outside my brief, we are guided by the science in this matter. My honourable friend has made an announcement about this in the past few months and it remains a subject for debate. We are aware that TB in cattle can spread easily, but I do not think that I should take the issue any further than that.

My Lords, is the Minister aware that over the past three years, there have been reports of 13, 14 and 15 cases respectively of bovine TB infecting the cat population? Therefore, is she not concerned about the possibility of zoonosis?

My Lords, as I said, the HPA maintains diligent monitoring of all types of TB, including that mentioned by the noble Baroness.

My Lords, will my noble friend confirm that the resources for dealing with TB are allocated mainly at a local level? That being the case, is she satisfied that the way in which the resources are allocated across the country is monitored by her department?

My Lords, it is indeed the case that the resources are provided at a local level, and that is why the Chief Medical Officer provided strong guidance to commissioners at a local level. However, to make sure that they are doing their job properly, the CQC, our new body, writes that into its assessments. The assessments are made against the guidelines issued by NICE, including the TB guidelines, and the CQC’s periodic and special reviews will look at whether TB services are monitored and delivered properly at a local level.

My Lords, the Minister will be aware that the prevalence of antibiotic-resistant tuberculosis is very high in the Far East. What action are the Government taking to make sure that migrants with TB who come to this country are examined or perhaps not even allowed to enter the country because they may spread drug-resistant TB in the communities to which they come?

My Lords, the noble Lord raises an important point. We know that the highest burden of TB in the UK falls on those born abroad who then go on to develop an active form of the disease in the UK—not the drug-resistant form; there is no evidence at all of that. That is why the plan that the Chief Medical Officer launched in 2004 is targeted at those specific populations. In addition, we have a long-standing government policy that immigrants from high-prevalence countries who seek to enter the UK for more than six months are screened for TB on arrival at the port of entry. Indeed, in countries of high incidence—Bangladesh, Sudan, Tanzania, Thailand, Ghana, Kenya and Pakistan—they are screened prior to being given permission to travel to the UK. Those who are found to have infectious TB must undergo treatment at their own expense before being allowed to enter the UK.