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Health: Tuberculosis

Volume 712: debated on Tuesday 30 June 2009


Asked By

To ask Her Majesty’s Government whether they accept the recommendation of the Health Protection Agency that there should be at least two mobile X-ray units for tuberculosis screening in London; and, if so, when the second unit will become operational.

My Lords, my department accepts the recommendations of the Health Protection Agency evaluation, which clearly showed the benefits of the mobile X-ray unit. We will continue to fund the mobile unit through the find and treat programme, which actively screens homeless hostels across London until 2010. It will then be up to the London commissioners to reach a consensus on future support for find and treat, including whether there should be a second mobile x-ray unit.

My Lords, I thank the Minister for that Answer, which was not quite what I had hoped. Is she aware that there is now an exceedingly serious situation in London with drug-resistant tuberculosis among the homeless and within the prisons, which is where the mobile unit goes? The recommendation was that there should be at least two units, but the Health Protection Agency has actually recommended that there should be three. The only unit that there is at present is now getting very old, so they desperately need another one. That would enable them also to do schools and children.

My Lords, I am absolutely in agreement with the noble Baroness, as are the Government. What is required here is that the London PCTs agree to take this programme forward. The cost of one mobile unit per PCT in London would be £16,000 per year, and the cost of two would be £32,000 per year. We are not talking about enormous sums, but it will require co-operation among the London PCTs. We are doing our very best to encourage this.

I know that the noble Baroness has a particular interest in TB in prisons, and I am very pleased to report that we are funding the installation of screening systems in eight of the high turnover prisons, with a link into their local acute trusts. Those are Belmarsh, Brixton, Pentonville, Wandsworth and Wormwood Scrubs, with three other prisons outside London being chosen for those facilities later this year.

My Lords, I am not absolutely clear who is meant to make the capital payment for these things and who is meant to run them. Is it the same person, and which budget does it come from?

My Lords, because of the concern about the prevalence of TB in London, the Government have centrally funded what is called the find and treat programme, including a mobile X-ray unit, until 2010. After that, the London PCTs will combine to take on the programme, if the evaluation proves to be right, and the mobile units. We now know through the HPA of the recommendation to have two units. We are urging the London PCTs to undertake to pick up the funding in 2010 and to run that programme.

My Lords, when the find and treat programme was set up, it was a service for socially excluded groups. Does that include failed asylum seekers, who still do not qualify for NHS treatment? They may not have TB when they become failed asylum seekers but can contract it while awaiting deportation, especially if they have underlying conditions such as diabetes and AIDS, for which they cannot at the moment get treatment under the National Health Service.

My Lords, arriving passengers who claim asylum at the port of entry are referred for medical examination and, indeed, assessment for TB. If it is found that they have TB, they will receive treatment. Failed asylum seekers will also receive treatment. This is a health protection issue, apart from anything else. Our aim is to locate the people who are most vulnerable, assess whether they have contracted TB and then provide treatment.

My Lords, when the House of Lords Select Committee on fighting infection visited New York, we were most impressed when we visited the Harlem Hospital to discover its programme of tuberculosis detection and control. It has a very good TB-screening programme as well as a programme of directly observed therapy, or DOT. Is DOT also applied to the down-and-out population of London?

My Lords, the programme in New York was successful and DOT was used. The success of that programme has informed how we treat the most vulnerable groups of the homeless, in particular, once we have identified them. About half of them now receive their treatment through the directly observed treatment method so that they are being supported.

My Lords, I recall that the Chief Medical Officer announced a TB strategy five years ago. What has been the effect of that plan?

My Lords, in 2004, the Chief Medical Officer produced a TB action plan with 10 actions to bring TB under control. We are committed to tackling TB. The action plan involves reducing the number of people at risk of being newly infected by TB, providing high-quality treatment and care for them, and maintaining low levels of drug resistance, which has already been referred to, for multi-drug TB. We do this in several ways, including raising awareness of TB within the medical profession. The incidence of TB in the population has been stable for the past two years. The Care Quality Commission’s assessments of how these issues are delivered will include TB within the broad framework of how organisations are delivering at local level.

My Lords, what links do the Government have with organisations such as St Mungo’s or the Barka community, which go out to rough sleepers, homeless people and, increasingly, failed asylum seekers?

My Lords, one reason that the programme of find and treat in London is so successful is that we work with those organisations. Co-ordination between all the organisations in London that work with homeless people and drug abusers is vital.