§ Mr. Gavin Strang (Edinburgh, East)
I beg to move amendment No. 1, in page 1, line 14, after 'other', insert 'relevant'.
§ Mr. Deputy Speaker (Mr. Harold Walker)
With this it will be convenient to take the following amendments: No. 5, in page 2, line 7, at end insert—'(5A) The Schedule to this Act may be modified or amended under subsection (5) above by altering or deleting any of the matters for the time being specified in it or by specifying additional relevant information.'.
No. 6, in line 16, leave out 'and'.
No. 7, line 17, at end insert'and "relevant information" means information relating to, or to any matter connected with, AIDS or HIV.'.
No. 8, in clause 4, page 2, line 29, at end insert—'(1A) In this Act "AIDS" means "Acquired Immune Deficiency Syndrome" and "HIV" means "Human Immunodeficiency Virus.".
No. 10, in, Title, line 2, at end insert 'and Human Immunodeficiency Virus.'.
§ Mr. Strang
Amendments Nos. 1, 5, 6 and 7 are technical. The Secretary of State is empowered by the Act to give directions and make orders changing the information that is to be contained in the reports. The amendments ensure that only relevant information can be required, "relevant" being defined asrelating to, or to any matter connected with, AIDS or HIV.10 am
It has been suggested that amendment No. 5 could be used radically to alter the nature of future legislation. That is not so. I am grateful to the British Medical Association for its advice in this context. I shall quote from what I believe to be a helpful letter that is based on the advice of the BMA's legal department and signed by its parliamentary officer, Sue Marks. She points out that the Secretary of State can introduce regulations to make AIDS a notifiable disease. The Secretary of State already has these powers under the Public Health (Control of Disease) Act 1984, which is a consolidation Act that brings together various earlier enactments.
I understand that the Government's position remains, as it has always been, that they have no intention of making it a notifiable disease. The letter says:The regulations were introduced in 1985 which made provision for certain sections of the 1984 Act to apply to AIDS— for example, removal to hospital, attention in hospital, compulsory medical examination, isolation of the body, etc. Further regulations could therefore at any time apply under various sections of the 1984 Act to AIDS.
Amendment No. 8 moves the definition of AIDS and HIV from paragraph 9 of the schedule to a new subsection in clause 4. We have deliberately not included in the Bill a scientific definition of HIV or AIDS. Scientists are still learning about the nature of the virus and about the condition described as AIDS. Any current definition could be outdated by further research. We refer to HIV and AIDS as they are understood at present.
674 Amendment No. 10 makes it explicit that the Bill covers the human immunodeficiency virus, of which AIDS is but one manifestation. This is an important scientific point. Hon. Members know that the main effect of HIV on the health of an individual is that it attacks the immune system, with the result that after a period of years the individual dies from a disease such as pneumonia. HIV can also cause a form of cancer— again, it is believed, through the immune system. The virus also causes dementia. It is believed that that is not caused by an attack on the immune system, but that there is a direct attack by the virus on the central nervous system. Therefore, the Bill does not cover just AIDS. It recognises that HIV infection can cause conditions other than AIDS.
The amendments improve the Bill significantly, and I commend them to the House.
§ Sir George Young (Ealing, Acton)
I have read the Standing Committee proceedings, which seem to have been very good natured and to have led to a great deal of all-party agreement. However, amendment No. 5 says:The Schedule to this Act may be modified or amended under subsection (5) above by altering or deleting any of the matters for the time being specified in it or by specifying additional relevant information.
Following an article in today's edition of The Times, there seems to be a need to stress the difference between the incidence of HIV and AIDS. In his important article, Mr. Paul Vallely says:among the soldiersthese are the soldiers of the Zambian army—the rate is virtually 100 per cent.He is referring to the incidence of HIV. Then he says:Interestingly, however, fewer seem actually to die from the disease here than we would expect. Perhaps the strain is slightly different. Perhaps the local population have had it for years and have developed partial immunity.
If information is to be published, as the schedule requires, it is crucially important to make the distinction between the incidence of HIV and AIDS casualties. A number of Opposition Members made this point during the Standing Committee proceedings. In the light of that article, I hope that my hon. Friend the Minister will be able to draw a distinction between the two sets of statistics, because the public assume that they are the same. However, the work in Zambia makes it clear that there may be an important difference.
§ Mr. Simon Hughes (Southwark and Bermondsey)
I support the amendments. However, subject to the safeguards that are included in the Bill, amendment No. 5 provides for a wide variety of options that enable the Miniser to amend the schedule. There is concern about, giving a potentially open-ended power to Ministers, particularly in relation to confidential information. Medical information is a good example of that.
What developments does the Minister think might lead him to avail himself of these open-ended powers? The phrase "additional relevant information" is included, and we understand what that means, but what additional relevant information would lead the Minister to introduce a statutory instrument? The hon. Member for Ealing, Acton (Sir G. Young) dealt with the incidence of the disease and its effects. We need to hold a balance between informing the public and not creating undue alarm or undue publicity, or breaches of confidentiality concerning pople who are either AIDS carriers or AIDS victims.
§ The Minister for Health (Mr. Tony Newton)
May I explain to the House the purpose of this group of amendments. They have the unusual, and in this case meritorious, characteristic of being amendments that stand in the names of both an Opposition Back Bencher and a Government Minister. That is a happy sign of all-party unanimity. [Interruption.] I hear a slight murmuring behind me from my hon. Friend the Member for Mid-Worcestershire (Mr. Forth). I realise that all-party unanimity may not extend to all Members of all parties. I suspect that that applies to my hon. Friend.
Amendments Nos. 1, 5, 6 and 7 are technical. They flow from the amendment of the long title to include HIV. That almost immediately picks up the point raised by my hon. Friend the Member for Ealing, Acton (Sir G. Young). Their objective is to ensure that the Secretary of State can give directions and make orders to amend the schedule to require health authorities and boards to provide information, not just about full-blown AIDS, but about HIV and HIV-related conditions.
Amendment No. 8 moves the definition of AIDS and HIV from the previous paragraph 9 of the schedule to a new subsection of clause 4. The reason for this is that in the previous version of the Bill AIDS and HIV were mentioned only in the schedule, and that is the correct place for this definition. AIDS and HIV are now referred to in clause 1(8) and it is therefore necessary to provide a definition in the body of the Bill.
Amendment No. 10 links the purpose of several of these amendments, amends the long title of the Bill and makes explicit that the scope of the Bill covers human immunodeficiency virus, of which AIDS is only one manefestation. This is directly relevant to the point raised by my hon. Friend the Member for Ealing, Acton.
Although the short title of the Bill is the AIDS (Control) Bill, it was always intended to cover not only full-blown clinical AIDS but other conditions that result from infection from the human immunodeficiency virus. HIV is the causative factor, and not everyone who becomes infected with it is known to develop full-blown AIDS. The provisions of the Bill clearly cover HIV as well as AIDS, and this change to the long title is designed to make the scope of the Bill absolutely plain.
§ Mr. Robert Rhodes James (Cambridge)
My hon. Friend might consider at a later stage changing the title further in another place. As he knows, I am a strong supporter of the Bill, but it is not really an AIDS control Bill. It is an AIDS information Bill.
§ Mr. Newton
I do not want to engage in semantic quibbling with my hon. Friend the Member for Cambridge (Mr. Rhodes James). The underlying purpose of the Bill is to assist in the control of the spread of clinical AIDS and of the virus which causes it, by requiring reports from health authorities and by publishing information about what health authorities are doing. While I accept that the superficial purpose of the Bill is simply to bring about the publication of reports on various items, its underlying purpose is to assist in the control of the spread of this terrible disease. Therefore, it is not unreasonable that the title reflects that underlying purpose.
I was asked about amendment No. 5 and also about one or two rather broader issues. I shall start by replying to the points raised by my hon. Friend the Member for Ealing, Acton. I hope he will feel that I have already 676 answered them in a sense. In public discussion of this matter there is still a certain amount of confusion, if only because AIDS is such an easy acronym to use in newspaper headlines and in the ordinary course of public discussion.
It is basic to public understanding of what is happening to say that even now relatively few people have died from AIDS or have full-blown clinical AIDS. The number of such people known to the Communicable Disease Surveillance Centre is between 700 and 800. This is a very small part of the problem, in the sense that although we have no firm knowledge of how many people in Britain are infected with the human immunodeficiency virus, our best estimates are about 30,000 to 40,000. We have acknowledged that the figure could be lower or higher than that, and some people have said that the figure is higher.
The number of people with HIV is considerably higher than those who have AIDS. There are many uncertainties, including information about the number of those now infected with the virus—which certainly runs into tens of thousands— who will develop full-blown clinical AIDS, thereby adding to the number of between 700 and 800 who are currently known to have or to have had full-blown AIDS. The estimate given by my right hon. Friend the Secretary of State for Social Services is the best available to us at the moment and shows that the number of AIDS cases will rise to about 4,000 by the end of 1989. However, that prediction is subject to some degree of uncertainty. I accept the distinction that my hon. Friend the Member for Ealing, Acton draws between AIDS cases and those infected with the virus. Part of the purpose of the amendments is to make that clearer in the Bill and, therefore, in the reports that flow from the Bill.
§ Sir George Young
Will the statistics published under this part of the Bill show whether partial immunity to AIDS is being developed? By looking at the percentage of notifiable HIV cases that have turned into AIDS, will they show whether the human body is capable of producing its own immunity to the strain?
§ Mr. Newton
I do not think that the statistics required by the Bill will in themselves show that. The general exercise of seeking to improve our statistical knowledge of AIDS will assist in improving our clinical knowledge of AIDS and the virus. As I am sure my hon. Friend knows, this virus has been known in Britain for significantly less than 10 years. It is only three or four years since the organism was identified, and although our knowledge about it is probably greater already than at this stage of any other disease in history, because our knowledge has grown rapidly, in a sense we are still at a relatively early stage in learning about this organism and its effect on people.
§ Dr. John Marek (Wrexham)
There is an important point here, because statistical knowledge helps clinical knowledge. We shall come to that later in the schedule. There have been certain changes in blood tests, which I can understand, but the important question is how statistically significant the results will be as a consequence of the Bill.
§ Mr. Newton
Clearly, any additional information about the pattern in people who are infected and the extent to which they do or do not progress to full-blown clinical AIDS will assist our clinical and our epidemiological 677 knowledge about the course of this virus. I must be frank and say that it is unlikely that the information that will be published in the form and shape required by the Bill relating to areas of district health authorities will be as significant in adding to that knowledge as the information collated nationally through the Communicable Disease Surveillance Centre.
One of the problems that we shall come to when discussing one of the later amendments about the publication of information about those infected with HIV, as distinct from those with full-blown clinical AIDS, is that of knowing whether the information available to a district health authority relates to the people in its area or to people from other areas. There is little doubt that in this case, as with other sexually transmitted diseases, many people prefer not to go either for assessment or for treatment to places in their own areas but to go to places, where, to put it bluntly, they think that they will not be known.
There is little doubt that that is one of the explanations for the fact that the overwhelming majority of clinical AIDS cases at the moment are in only three out of the 14 health regions in England. They are almost all in the North-West, North East and South East Thames regions. The largest numbers are in the North East and North West Thames regional health authority areas. In the Thames regions the problem is heavily concentrated in a number of well-known inner London hospitals. No doubt that partly reflects people's preference for being treated in more anonymous circumstances than would be possible if they were the only cases in a local district hospital.
Information collected and published on a district basis in the way that we are suggesting is unlikely to add as significantly to our broad knowledge, in the way that some hon. Members have suggested, as the information that is collected and analysed through the Colindale Communcable Disease Surveillance Centre. Much of the local information may, in the end, have to be drawn from that.
I hope that that goes some way towards satisfying the proper thirst for knowledge of my hon. Friend the Member for Ealing, Acton. I hope also to have satisfied the hon. Member for Wrexham (Dr. Marek), whose other point will be dealt with when we come to a later amendment.
The hon. Member for Southwark and Bermondsey (Mr. Hughes) asked about the purpose of amendment No. 5. Amendment No. 9 leaves out paragraph 3 of the original schedule, and if the hon. Member for Edinburgh, East (Mr. Strang) had not already done so, I should have explained to the House that that paragraph in the schedule, as it emerged from Committee, was designed to impose a requirement to publish certain information about the number of people in an area who were thought to be suffering from HIV, but it has proved to be defective. We therefore propose to leave it out at this stage, on the basis of a firm undertaking that we wish to have in the schedule a requirement to publish the best available information about HIV sufferers.
Bluntly, frankly and without any sense of shame, I can tell the hon. Member for Southwark and Bermondsey that what has happened to the proposed requirements to publish information on HIV-positives is that we were not able to draft what we regard as an adequate provision in 678 time to put it in the schedule. That explains our reasons for having the powers in amendment No. 5— about which the hon. Gentleman was concerned— which enable us to add to or amend the schedule. There is nothing sinister in that. The problem has been the speed with which we have worked on the Bill. As the hon. Gentleman will know, the Government have been cooperating actively with the hon. Member for Edinburgh, East since Second Rading, which was not long ago, and through the Committee stage, and we have not been able to solve all the problems involved in determining exactly what information we can sensibly require to be published.
Our reason for amending the schedule is to cope, in the short term, with the difficulty relating to HIV-positives and, in the long term, to make sure that we are not, by the rapid passage of primary legislation locked into something which, in the end, will turn out to be nonsensical in practice. We want room to manoeuvre by means of secondary legislation, rather than have to return to all the paraphernalia of passing another Bill.
§ Mr. Simon Hughes
I am grateful for the Minister's confirmation, and I accept his good faith. He will understand that the only concern of people outside the system is that the Minister will have power to ask for information about an individual or his condition. It would be helpful for the record to hear the Minister deny that, to complement what he has said about the reason for needing the power to keep up with the process of the disease.
§ Mr. Newton
I can readily give that assurance. I would need to take advice before giving a categorical assurance that the provision could not conceivably be used to do what the hon. Gentleman suggests. I doubt whether the Bill could legally be used in that way, but I can give the hon. Gentleman a categorical assurance that the Government would not use the powers to obtain information about an individual. Indeed, one of our main concerns has been to ensure that the Bill and the reports from district health authorities and the health boards of Scotland cannot conceivably risk breaking confidentiality. That has been the subject of extended discussion between the hon. Member for Edinburgh, East and me. We were determined not to have a Bill that created the risk of breaching an individual's confidentiality, or which could be perceived by an individual as creating such a risk. I can give the hon. Gentleman the basic assurance that he wants.
I now come to another, not dissimilar, issue—that of notifiability. Although compulsory notifiability is a separate issue from those contained in the Bill, I understand that it has been raised by Opposition Members, so I shall comment on it. The House is well aware that the Government's position is that there is no merit or benefit in making AIDS a notifiable disease at present, and we have no plans to do so. A system of voluntary reporting of cases on a confidential basis to the Communicable Disease Surveillance Centre and its equivalent unit in Scotland has been in operation since 1982. A statutory system might produce less accurate reporting, because patients are reluctant to come forward for testing and doctors are reluctant to give a firm diagnosis because of their fears, justified or otherwise, of loss of confidentiality.
The risks are obvious. The historical argument against making sexually transmitted diseases notifiable is that 679 such action drives them underground. I understand that no sexually transmitted disease is notifiable in the United Kingdom, for that reason. The other problem with AIDS is the long time lag between exposure to the virus and the development of the symptoms. It would therefore be extremely difficult, or indeed impossible, to trace former contacts, which is one of the usual reasons for making a disease notifiable.
Contacts are traced and can then be helped, but that would be impossible in many cases in which people with active sex lives may have picked up the virus as long ago as five, six or seven years. Therefore, one of the practical arguments for the compulsory notification does not exist in this case.
In any case, as the hon. Member for Edinburgh, East said, the Government already have clear-cut powers to make diseases notifiable if they wish to do so. I have said that that is not our intention with AIDS, and I can give the House a categorical assurance that the powers in the Bill will not be used to bring that about. If it is thought in the future that it would be a good idea to make AIDS notifiable, the powers to do so already exist in a different form.
I hope that I have relieved the anxieties that have been expressed in the debate about these innocuous amendments. I also hope that I have been of assistance to my hon. Friend the Member for Ealing, Acton, and that I have cleared up any lingering doubts or worries in the minds of Opposition Members.
§ Mr. Strang
I agree with the Minister for Health about the points which he covered and I am grateful for the speech of the hon. Member for Ealing, Acton (Sir G. Young).
My hon. Friend the Member for Wrexham (Dr. Marek) raised a point that related purely to the statistical information required. My information is that other clauses will have a bigger impact in controlling the disease. Nevertheless, the statistical data will be important, partly for the reason at which the Minister hinted. We shall eventually use the data from the Public Health Laboratory Service and from the Communicable Disease Surviellance Centre. It is important to recognise that, once the statistics are properly published annually— unfortunately, this problem will be with us until the end of the century—we shall have a valuable measurement in the health board areas of Scotland and in the district health authority areas in England and Wales.
§ Dr. Marek
I agree with my hon. Friend, but the question is: are the statistics significant? If we are to collect them, we should ensure that we attach as much significance to them as possible, subject to all the constraints mentioned by the Minister. That is an important point, although I agree with my hon. Friend that other provisions in the Bill are more important.
§ Mr. Strang
I agree with my hon. Friend. There is no problem with the AIDS statistics. I think that my hon. Friend is referring particularly to the HIV statistics. It is important that the footnotes in the documentation should make absolutely clear the testing circumstances of the results. I do not doubt that we shall be able to produce a new paragraph in the schedule which will ensure that the data published on HIV infection on a regional and district basis are scientifically valuable.
680 The hon. Member for Cambridge (Mr. Rhodes James) has taken an interest in the Bill and supports it. The Bill is about controlling AIDS. As hon. Members said on Second Reading, there is no doubt that, when the legislation is enacted, it will contribute significantly over the years to restricting the rate of spread of HIV, thus saving lives. Although I understand the view of the hon. Member for Cambridge, I urge him not to press his point about changing the Bill's title to the extent of perhaps threatening the prospects of enactment within the next couple of months. All the hon. Members who spoke on Second Reading were anxious that the Bill should be enacted promptly. I believe that the Minister and I have responded positively to the views expressed then.
§ Amendment agreed to.
§ Mr. Strang
I beg to move amendment No. 2, in page 1, line 18, after 'Authority', insert 'District Health Authority'.
§ Mr. Deputy Speaker
With this it will be convenient to consider the following amendments: No. 3, in page 1, line 19, after 'Board', insert'by which they are made and'.
No. 4, in page 1, line 21, leave out from 'State' to end of line 23.
§ Mr. Strang
The amendments are a tidy way of placing a clear duty to publish on each authority in England and Wales and each board in Scotland producing a report and to require them to collect and collate such reports. The words referring to Wales have been left in the Bill because, strictly speaking, Wales does not have a regional health authority, so there would not be a body responsible for collating the reports.
§ Mr. Simon Hughes
I should like to seek a little truth from the Minister or from the hon. Member for Edinburgh, East (Mr. Strang) on amendment No. 4. I understand that the purpose is to ensure that reports are published. I am happy to support that end. Should one infer that, if the public want those reports, they will be able to obtain them? Obviously Members of Parliament receive the reports, but they may not be available to the public. We are deleting the words that expressly relate to that. I hope that that does not mean that the public will not be able to obtain the reports, whatever the reasonable demand is.
§ Mr. Newton
The amendments deal with the fact that under the previous drafting of the Bill the only requirement was to make reports available. There was the curious anomaly that the Bill, whose primary purpose was to bring about the publication of reports, contained no requirement that they should be published, but required only that they should be made available. I think, subject to any advice that my lawyers might care to give me, that "publishing" subsumes "making available". I assure the hon. Member for Southwark and Bermondsey (Mr. Hughes) that our intention in this, as in all senses, is entirely honourable.
The effect of the amendments is to provide that all the reports will be published, including those made by district health authorities. The note which the Department has kindly provided says that in Committee I said that we accepted the need to amend this clause to provide for the publication of district reports rather than merely make 681 them available. We are obviously sure that this is the right course, and that is what the amendment does. The hon. Gentleman need not, therefore, worry.
§ Amendment agreed to.
Amendments made: No. 3, in page 1, line 19 after 'Board', insert—
'by which they are made and'.
No. 4, in page 1, line 21, leave out from 'State' to end of line 23.
No. 5, in page 2, line 7, at end insert—
'(5A) The Schedule to this Act may be modified or amended under subsection (5) above by altering or deleting any of the matters for the time being specified in it or by specifying additional relevant information.'.
§ No. 6, in page 2, line 16, leave out 'and'.
No. 7, in page 2, line 17, at end insert—
'and "relevant information" means information relating to, or to any matter connected with, AIDS or HIV.'.— [Mr. Strang.]