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Homelessness: Tuberculosis

Volume 725: debated on Tuesday 1 March 2011


Asked By

To ask Her Majesty’s Government what plans they have for detecting tuberculosis amongst rough sleepers.

My Lords, from 1 April, the National Health Service in London will fund continued provision of the Find and Treat outreach service to detect TB among the homeless, including rough sleepers, and to help to ensure treatment completion. There are also initiatives for TB testing among the homeless in cities such as Liverpool and Leicester. The National Institute for Health and Clinical Excellence is developing guidance on tuberculosis among hard-to-reach groups, including rough sleepers.

I thank my noble friend for that encouraging reply, but is he aware that the chaotic lifestyle of homeless people with very poor immune systems means that they are extremely difficult to diagnose and to treat for the six-month period for which they need antibiotics? Are Her Majesty’s Government working with other organisations to help these homeless people?

My noble friend is absolutely right: this is a particularly difficult group of people in that they are hard to reach. There is a high incidence of TB among the homeless in London and a service of the kind to which I have referred appears to be cost-effective in reaching those people. On my noble friend’s second question, we are engaging with the Mayor of London’s office to see how it can become involved in helping to deliver cost-effective services to this group of people.

My Lords, will the Minister invite Westminster City Council to think again about the proposed by-law, on which it is consulting, which will make it illegal not only for rough sleepers to live on the streets around Westminster Cathedral but for charities such as Housing Justice to distribute food and soup to them? It describes the Westminster City Council proposal as an over-the-top response. Is it not right to say that? Does he agree that the problems of tuberculosis, which are the subject of this Question, will be much more difficult to identify if rough sleepers are driven off the streets and forced to live elsewhere?

My Lords, I very much see the force of the noble Lord’s point. We are very much committed to preventing homelessness and to protecting the most vulnerable. We have maintained the funding for the homelessness grant at the levels of the current year— £400 million over the spending review period, which is £100 million over each of the next four years. We are specifically providing £18.5 million a year to support the voluntary sector. This is a priority, but I will take away the point that he has made about Westminster City Council.

My Lords, is it possible for a person who has no fixed address to have a doctor or to get immediate medical attention?

My noble friend puts her finger on a key difficulty with this group of people, who are often very difficult to keep track of. I heard of one case where a patient required 800 interventions, sometimes with the police involved. Clearly a lot of effort has to go into this group. However, it is possible, if the patient is willing, to register that person with a GP. The challenge is whether they actually return to complete their treatment, which of course extends over many months.

My Lords, I ought to declare an interest in that I chair the Cyrenians in the north-east. We have been working on a programme that has been identifying and keeping contact with these most vulnerable and disaffected people and we have reduced the number who have become, as they are called, “frequent flyers”. However, does the noble Lord acknowledge that there simply is not a straightforward system in the National Health Service to deal with people who do not have a fixed address and do not have regular contact with a particular locality or GP? Is it not about time that we looked at this much more holistically? There are some good individual examples around the country, but there is no guarantee that we will intervene sufficiently early to stop what is now known, which is that most people who sleep rough will be dead long before they are 50.

My Lords, I was very interested to hear about the noble Baroness’s experiences in the north-east and I would like to hear more. The points that she raises lie behind our intention in the Health and Social Care Bill to make GP consortia responsible not just for the patients on the GP lists but for all the population in the local area. The health and well-being boards, which we propose should be set up at local authority level, will bring together all the relevant stakeholders to look at how the health needs of an area can best be met and prioritised.

My Lords, this is a group of our fellow citizens who are particularly vulnerable and can so easily be lost in the system. At a time when there is considerable pressure on budgets, will the noble Lord use whatever good offices he can to ensure that this remains a priority in all the public services and is not seen as a soft option?

My Lords, the short answer to the noble Lord’s question is yes. We have committed to ring-fence the public health budget and I think that there is no better earnest of our intentions for public health than that.

Following on from that very helpful question, may I ask specifically about the mobile X-ray units in London, which we have discussed before in your Lordships’ House? These were funded through pooling relatively small amounts of funding from the PCTs across London, organised by the strategic health authority. Those bodies are about to disappear, so what will happen in the transition period to those mobile units and how will the new arrangements work with the consortia that are being planned?

My Lords, the position for 2011-12 is that the NHS in London will fund Find and Treat. During the next year, the NHS will consider future funding, taking into account the final evaluation of the service by the Health Protection Agency and the emerging guidance from NICE. As regards the more medium-term agenda, the Government’s strategy is for a much more joined-up service. We will have the public health service working both locally and nationally. We will also have the GP consortia commissioning treatment at a local level. I hope that, as the system evolves, the noble Baroness will see that there is no loss of momentum in this very important area.