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Health: Tuberculosis

Volume 749: debated on Thursday 21 November 2013


Asked by

To ask Her Majesty’s Government when Public Health England will publish its strategy for tuberculosis.

My Lords, I beg leave to ask the Question standing in my name on the Order Paper, and declare an interest as a member of the All-Party Group on Tuberculosis.

Public Health England has made TB one of its main priorities, and is leading a coalition of key stakeholders to inform its development of a strategy for tuberculosis. This aims to bring together best practice in clinical care, social support and public health to strengthen TB control, leading to a year on year decrease in incidence and a reduction in health inequalities associated with TB. The strategy will be published by March 2014.

My Lords, I thank the noble Earl for his Answer, but is he aware that London is now known as the TB capital of Europe? It has some good facilities for prevention and treatment, but are those the same throughout the country? That is why the strategy is so important. There is plenty of tuberculosis—and drug-resistant tuberculosis, which is the big concern—in Birmingham, Bradford, Leicester and many other cities. Will he ensure that the strategy is pushed out as soon as possible? That is vital.

The noble Baroness is absolutely right about the seriousness of the position, especially in some of our big cities. I can tell her that a TB control board has been set up in London, where about 40% of TB cases occur in the UK. The board is developing a dedicated London TB plan to strengthen measures to prevent, diagnose and treat TB in London. There are similar initiatives in Manchester and Birmingham. However, she is also right to say that we need to focus on the rest of the country, not least some rural areas, and the strategy there will be different to identify cases, diagnose them quickly and intervene early. Work is going on to roll out the plans for that.

My Lords, does the noble Earl accept that some years ago there was an increased incidence of drug-resistant tuberculosis in the UK, and it was discovered that that was, at least in part, the result of the disease being detected in an increased proportion of immigrants? When I went to the United States in 1953 as a visiting fellow, I had to take an X-ray with me to show that I did not have TB. What is now government policy on the medical screening of potential immigrants?

My Lords, the policy now is that migrants to the UK from outside the European Union who apply for a visa for more than six months need to be screened in the country of origin. That work is proceeding, although I have to say that implementation has proved patchy, so we cannot be complacent. That is why it is vital to have services in this country capable of identifying people, particularly with multidrug-resistant TB, who may pose a threat to the community in that sense.

My Lords, is the Minister aware that the cost of treating multi-drug-resistant TB is £100,000 a year, compared with the cost of £5,000 a year to treat non-resistant TB? We now have a new category of extensively resistant TB, which is even scarier. I hope that Public Health England will treat as a matter of urgency getting a national strategy that brings standards up to those of Homerton Hospital, which is completing treatment of most patients whereas the rest of the country lags behind.

The noble Lord is absolutely right. That is one reason why we are placing a particular focus on research into multidrug-resistant TB and diagnostics in that area. We fund UNITAID, which aims to triple access to rapid testing for MDRTB and to reduce drug prices for treating the condition. We have made a 20-year commitment to UNITAID of €60 million a year, subject to performance.

Following the comments of the noble Lord, Lord Walton, is the Minister aware that point of entry is very important? When I was involved in a health issue as a local councillor, we had a case of someone detected at Heathrow. It took two weeks to track him down, by which time he had infected 40 other people because he had moved into very limited accommodation where many people were all living in one room. This situation is developing again. What facilities are available at the airport now to pick up these cases?

My Lords, there are regulations covering ports and airports which provide a contingency for when a passenger on a ship or a plane enters the UK, is suspected of having a notifiable disease and perhaps refuses to seek medical attention. The regulations include provisions for notification of such a case to the destination port health authority and for the detention of that person for the purposes of a medical examination. There are also quite flexible powers for local authorities to deal with incidents or emergencies where infection or contamination presents or could present a significant risk to public health.

My Lords, I refer noble Lords to my health interests. The Minister referred to a number of strategies in London, Manchester and Birmingham. Will he confirm that the implementation, particularly of some preventive strategies, will depend on the work of TB specialist nurses? Is he aware that some budgets are under pressure and there is a risk that we will not have enough nurses to do the job? Will he guarantee that we will see an increase in the number of TB nurses?

My Lords, as the noble Lord is aware, NHS England allocates funding to clinical commissioning groups which commission health services on behalf of their local populations. It is for CCGs to decide how best to use the funding that is allocated to them, underpinned by clinical insight and knowledge of local healthcare needs. We expect health and well-being boards to have a major say in those areas where TB is commonplace.

One of the key strands of the directly observed therapy recommended by the World Health Organisation for TB is standard treatment with supervision and patient support. What steps are being taken to empower patients with TB so that they can support DOT? Is there an expert patients scheme, as there is with many other chronic illnesses?

My Lords, we do not regard directly observed treatment as necessary in the majority of cases. It is, however, helpful for certain hard-to-reach groups in society, for example, the homeless, and there are pharmacies which are equipped to do that.