---

Debate on the Address

My Lords, I was going to congratulate the noble Lord, Lord Warner, on a speech free from the shackles of government, but as, judging from his last remarks, he seems a bit reluctant to leave those shackles, I shall modify my congratulations. The noble Lord was a senior civil servant in the DHSS when I became Secretary of State. I do not take it personally but I note that he left immediately I arrived. I congratulate my noble friend Lord Howe on his speech. I was concerned only by his reference to the Maastricht experiment. I do not know what the Maastricht experiment is, but my experience as Conservative Party chairman leads me to the conclusion that we should strongly avoid anything to do with Maastricht. It sometimes needs an outside intervention to clear the mind on the National Health Service. Over the last weeks, two prominent American politicians—both, as it happens, fighting for the Republican nomination for president—have gone out of their way to criticise the National Health Service as well as many other things European. At the end of October, Mitt Romney singled out the British National Health Service for criticism and warned America of the danger of becoming a second-tier nation like Britain and other European countries. Then Rudy Giuliani attacked the National Health Service even more specifically and claimed—as it happens, quite wrongly—that the survival rate from prostate cancer in the United Kingdom is only 44 per cent under what he termed ““socialised medicine””. In actual fact, the figure is 75 per cent, but that has not prevented him from launching a radio advertising campaign complaining of European-style socialism. For six years I was Health Secretary in Margaret Thatcher's Cabinet. As we developed the National Health Service—I hope that the noble Lord takes note of that phrase—it had not occurred to me that we were involved in some vast left-wing project. It was not a criticism normally made of Margaret Thatcher, any more than it was of Churchill or Harold Macmillan, who also followed the same policy. The sensible attitude to take, and the point to remember, is that the National Health Service has been developed by Governments of both parties and will continue to be so. Frankly, I do not entirely comprehend the language of the two contenders campaigning against the nations of Europe when we assume that their aim—if ever they were to be elected president—is to have good relations with those European nations. I should not have thought that the United States is so rich in overseas friends that it needs to kick those who are already friends, but I leave that to one side. The principle of the National Health Service and its whole basis is that no one should be prevented by a lack of income from accessing good healthcare. That is an important principle and one worth fighting for. I am delighted that the leader of my party, David Cameron, has emphasised his commitment to it. Does that mean that the National Health Service is perfect? Of course it does not. Too often extra resources have not resulted in improved services. Back in the 1980s, I introduced not administrators but general managers. That has led to much improvement. If I was to go one step further, I would separate the management of the health service from the health department. The latter contains much professional expertise but not necessarily vast management experience. There are undoubtedly areas where the health service can be improved. Examples were given by the noble Baroness, Lady Finlay, who leaves the Chamber immediately that I mention her name. That practice seems to be catching, but the noble Baroness may go; I shall not mention her again. The National Health Service is failing in the area of public health, particularly HIV/AIDS and sexual health generally. I doubt whether that would come high on the list of Messrs Giuliani and Romney. Almost exactly five years ago in a debate in this House, I warned that: "““It is estimated that there are currently 30,000 to 35,000 people living with HIV. New reports of HIV infection last year approached 5,000. That is the highest ever annual total and represents the fourth year in succession that there has been an increase””.—[Official Report, 19/11/02; col. 305.]" Today that position has deteriorated further. New diagnoses are now 7,500 a year—a figure that has trebled in the last 10 years. The number living with HIV is now between 70,000 and 75,000, not 30,000 and 35,000, and there is unmistakeable evidence that young people in particular are ignoring safe sex messages. The Royal College of Nursing rightly points out that HIV is not just a sexual health issue but a chronic condition, as people with HIV now live into their 50s and 60s, producing a need for specialist nurses working in HIV care, while all the time many of those with HIV suffer prejudice. Recently I was looking at HIV in India, where there were certainly examples of prejudice. I regret to say that there are examples of it in this country, too. I am a trustee of the Terrence Higgins Trust and only this week a very reputable charity wanted to know what it should say in warning its clients that the furniture donated to it had belonged to someone with HIV. This is 25 years into the epidemic in a highly educated society. The prejudice is born of ignorance, which in turn comes back to a lack of public information and discussion. Of course, HIV/AIDS is not the only problem. The figures for sexual health generally provide no greater comfort. The latest figures show that new instances of chlamydia have doubled over the last decade. In 1998 the figure was 48,000; today it is something like 110,000. If you take another sexually transmitted disease, syphilis, you find that whereas in 1998 it had almost disappeared, today there are almost 3,000 cases a year. This is a great challenge to this country. Why do we not take the issue more seriously? Perhaps we take the view that, as the issue is more serious in some overseas countries, such as those in Africa, we can be relaxed about it. I do not think that that is right. If we have pretensions to give aid and help in those areas, we should set an example. The great irony is that we took more urgent action back at the time of the First World War when confronted with the scourge of venereal disease. We set up a royal commission, opened clinics around the country and promised immediate walk-in and anonymous treatment. Today, the clinics are overcrowded and too often rundown, and delays in treatment are all too common because appointments have to be booked. It is not a good story. Almost 100 years ago our predecessors showed more determination to tackle the issues effectively. I do not claim for a moment that all the issues can be solved by government. The churches, particularly the Roman Catholic Church, can do more. It is a tragic irony that the Catholic Church, with all its influence and power to do so much through its aid societies—it does a vast amount through them—to care for the victims of HIV/AIDS, does so little to prevent it. Its attitude to condoms as a disease prevention measure is a case in point. So much suffering and death could have been prevented by taking a more sensible attitude in that area. Government cannot do everything but they can do much more to tackle the crisis—and it is a crisis—that we face today. There are three central failures of policy. The first failure is in public education. The efforts to get over general messages of information and advice in this area have been woefully inadequate. The public will listen to authoritative advice given by professionals such as the Chief Medical Officer in the Department of Health, but that advice has not been given on a national scale in a convincing and persuasive way. It never occurred to me when I ran my campaign in 1986 that the Government would, in a truly national sense, go off the air for the next 20 years. The second failure is in education. Young people are often still not receiving good-quality sex and relationship education. We raised that point with the Minister in a debate some months ago. Properly taught, it can lead to young people starting sexual activity later, having fewer partners and being much more likely to take precautions against sexually transmitted infection. The third and crucial failure is funding, to which my noble friend on the Front Bench referred. Not only is the area generally underfunded, but even when an effort is made to provide resources they all too often do not reach the service providers. The Government made a much publicised announcement about how they were providing £300 million to be targeted on sexual health. Press releases were written and ministerial Statements were made, but the only trouble was that a large proportion of that £300 million did not reach the sexual health services or result in major public education campaigns. The decision was left to the primary care trusts, many of which used the money to pay off budget deficits or for other purposes. Many trusts do not have HIV or sexual disease as a priority. It is not a cause that has loud public support and the trusts reflect that. I am in favour of devolution, but in public health, particularly sexual health, the case for ring-fencing budgets seems to me to be overwhelming. Public health is a national responsibility; there are no boundaries in infection and it should be dealt with in that way. This is not a popular area of policy-making; we all know and recognise that. Those who enter it are liable to be attacked from the right and ridiculed from the left. Nevertheless, it is a vital area. Disease is disease and in a truly national health service it should be tackled with commitment and energy. Most of all, this area needs political leadership. Frankly, that leadership has been lacking for a number of years.