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Immigration: Tuberculosis Testing

Volume 741: debated on Tuesday 11 December 2012

Question

Asked By

To ask Her Majesty’s Government whether they will introduce blood tests for latent tuberculosis for immigrants from countries where tuberculosis is common.

My Lords, the Department of Health is evaluating the effectiveness of latent TB screening in migrant populations. NICE produces clinical guidelines on testing for diagnosing latent TB. It also advises on which is the most accurate approach in diagnosing latent TB in those who have recently arrived in the UK from high incidence countries.

My Lords, is the Minister aware that the moment you arrive here you become the responsibility of the National Health Service? Would it therefore not be much wiser to have these tests carried out in the country of origin where the visa application is made? As I understand it, something like three-quarters of the people diagnosed in the past year would have been missed with the present test. Can he assure me that, if country-of-origin testing is introduced, the Home Office will take action to ensure that the tests are up to standard and not subject to interference or even possible corruption?

My Lords, my noble friend is absolutely right. Overseas tests already take place, first by X-ray and then by a sputum test in the event of a positive result. This results in cost savings because we do not need to treat someone suffering from tuberculosis if they come to the UK.

My Lords, given that tuberculosis is not exclusive to immigrants, does the Minister agree that everyone coming into the United Kingdom from some of the suspect countries should be tested?

My Lords, sadly, about 30% of the world’s population have latent TB. We would not test people from other European states even if they have a TB problem.

My Lords, TB and HIV co-exist. The NHS is required to test all new healthcare workers for tuberculosis and blood-born viruses, including HIV. In relation to overseas recruitment, it is recommended that the tests are performed in the country of origin before applying for employment. Can the Minister confirm that compliance with this guidance is being maintained and is it possible to move towards the situation that currently pertains in Australia, New Zealand and Canada?

My Lords, eventually for all the 82 high- risk countries, you will not be able to get a visa to the UK unless you are clear of TB. To clarify further my answer to the noble Lord, Lord Morris, arrivals from the other European states are not tested for TB because of course they do not need to be tested. They can come and go as they please.

My Lords, is the noble Earl aware that the growing incidence of TB is actually a feature now in the UK, particularly in cities such as London and Birmingham? What priority are the Government giving within the National Health Service to dealing with a problem that is causing a great deal of concern?

The noble Lord is absolutely right: it is a problem in the big conurbations, due to deprivation and very dense accommodation. I can assure the noble Lord that the Government are on the case. We regard it as a serious problem. Further to the article in the Financial Times, we recognise that we must not let it get out of control. That is partially why we are insisting on testing people outside the UK so that we do not incur the costs for the NHS. It costs about £6,000 to treat someone who is very susceptible to treatment with antibiotics but if they are multiresistant it can cost £100,000 to treat them. We need to make sure that we do not import health problems and we concentrate on solving our own health problems—not just by activities in the NHS but also by improving housing, which I am sure all Governments have striven to do over the years.

My Lords, as blood tests for latent TB are already available to migrants through their GPs, is not the answer to encourage greater voluntary take-up in areas such as the noble Lord opposite mentioned—Birmingham, Hounslow and Newham—and enlist the help of diaspora organisations from the 67 countries where TB is most prevalent to increase the rates of take-up? Since the countries that undertake pre-emptive screening all depend on X-rays, as we are now doing with overseas checking of would-be migrants from those countries where active TB exists, and none is contemplating pre-emptive blood testing, should we not have discussions with those countries to concert a common approach on what should be done about pre-entry blood testing in overseas countries?

My Lords, I look forward to reading my noble friend’s comments in Hansard in the morning but it is important that testing is targeted. The health professionals will offer tests where they are most effective and most likely to find a problem.