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4.13 p.m.

Lord Kilmarnock: My Lords, I must start by apologising to the House for behaviour which I dislike in principle. I am booked on a plane to Barcelona this evening for a pre-arranged meeting with members of the regional government of Catalonia to discuss their AIDS strategy and a conference that we are holding there next year with their support. Therefore, I am afraid that I shall not be able to stay for the end of the debate. I realise that this will probably forfeit a reply from the noble Baroness, Lady Blatch, to specific points that I shall raise, but I hope they will be given some consideration as part of the consultation process.

It is clear from the lucid speech of the noble Baroness, Lady Cumberlege, and from the document itself that the Government have devised a comprehensive interdepartmental strategy on which they are to be congratulated. I am glad, on behalf of my colleagues on the all-party parliamentary group on AIDS, that the Motion refers specifically to the spread of HIV and AIDS. Clearly, there is a much bigger AIDS debate than is contained in the Motion and a much bigger drugs debate than is contained in AIDS alone. All the same, it is doubly appropriate that HIV infection and the AIDS syndrome should receive some prominence today, it being World AIDS Day, the seventh in line since it was initiated in 1988. It is also today, as the noble Baroness, Lady Jay, said, that the AIDS summit hosted by the French Government is being held in Paris, where our own Secretary of State, Mrs. Bottomley, is representing this country right now.

Again following the noble Baroness, Lady Jay, I want very briefly to pursue the World AIDS Day theme before turning to the substance of the Motion. The British Government have an excellent record on AIDS control, treatment and prevention, but there is always the danger of this flaking at the edges, particularly as regards government relations with and use of the skills of the voluntary sector. I shall return to that point. The Government should not listen to siren voices, within their own party or without, that it was all a fuss about nothing, or is all over bar the shouting. The fact that we have just crossed the threshold of 10,000 AIDS cases, about two-thirds of whom have died--many in the most distressing circumstances--should give us pause for thought in two directions. First, the fact that the death

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roll is much less than the upper bracket of early predictions is a matter for congratulation rather than for carping or scaremongering, as I think the noble Baroness, Lady Jay, also said. Epidemiology proceeds through a series of refinements based on methodological improvements and lengthening experience. British predictions are now among the most accurate in the world with great benefit to public policy and planning. The relatively low prevalence rates compared with those of most other member states of the European Union are a tribute to prompt and effective government and voluntary sector action, working hand in hand --an advantage that should on no account be lightly surrendered.

The second thought triggered by our 10,000 cumulative AIDS cases is one of immense sadness that a condition which affects mainly the young and those in prime of life should have reached the proportions that it has. In this country public health and private prudence have built a formidable alliance against it. Yet, the results are still devastating for all those infected or affected by it. That is why we have World AIDS Day. The red ribbon that I am wearing is not some kind of trendy, leftish logo, or I would not be wearing it; nor, I suspect, would some other Members of your Lordships' House who are wearing it today. It is a symbol of solidarity with many people across the world who are faced not only with a devastating disease but one that too often falls on the wrong side of socially acceptable diseases. With this we should have no truck.

Now to the Motion. The consultation document, as I suggested earlier, is rather impressive in its cross-departmental scope, but that inevitably makes it somewhat hybrid. Where departmental interests conflict, how will these be sorted out? Chapter 3, paragraph 3.58 recapitulates the target in the health strategy document The Health of the Nation to reduce the percentage of injecting drug misusers who share needles from 20 per cent. in 1990 to 10 per cent. by 1997 and 5 per cent. by the year 2000. These are very concrete aspirations. How are they to be achieved? Abstinence is adopted on page 12 as the "ultimate aim", but it is recognised rightly that exhortation is not enough and that the Department of Health should ensure that drug misusers have,


    "easy access to cost-effective and appropriate services".

In effect, what is sometimes called "harm reduction", as mentioned by the noble Baroness, Lady Jay, or what we might equally dub "damage limitation", have to be brought into play as part of a dual strategy. In paragraph 7.3 it is stated that the success in limiting the number of infections among drug misusers must be sustained and paragraph 7.14 commits the Department of Health to encourage,


    "a range of initiatives which minimise the risks and damage of drug misuse ... to individuals who are not drug free, eg syringe and needle exchange schemes and advice on safer sex".

I am happy with most of the above, perhaps a little happier than the noble Baroness, Lady Jay. I am concerned with public health and it looks to me as though these passages were written by the Department of Health. But I ask myself how its aims are to be achieved. Paragraph 3.59 speaks of more than 300 needle and syringe exchange schemes which have been

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set up since the mid-1980s via pharmacies and other agencies, and on the next page I look at the graph that tells me that HIV infection through equipment sharing has come down from a high peak in the mid-1980s to a much lower plateau today.

I draw the conclusion that the exchange schemes have been a great success and I believe that that was acknowledged by the noble Baroness, Lady Cumberlege. But when I turn to the passages on policing in Chapter 5, I find no mention of them. I read that the chief constables are asked to consider,


    "establishing formal drugs strategies for their forces"

and to report their findings to the Home Secretary by the end of June 1995. There is an aim to establish a "national strategy". We are presumably a long way short of a national police force to which I would be totally opposed. But I do ask myself whether the new strategy will leave enough flexibility for force-by-force tactical decisions on the handling of the drug scene. The epicentres of drug misuse are bound to be different from the rest of the country. Needle exchange schemes such as that on Merseyside, which has been a great success--and there have been others--must depend to some extent on sensitive policing. I would like to be assured that they will not be affected adversely by the new strategy.

None of this is nit-picking. It goes back to our record of achievement and whether we can afford to relax our guard. I would suggest not. Across the European Union some 40 per cent. of AIDS cases are caused by intravenous drug misuse. In Spain generally and Madrid in particular, that figure is in the region of 60 per cent. to 70 per cent. of a higher per capita total than we have here. In our country the equivalent figure appears to have flattened out at about 8 per cent. or 9 per cent. But the word is "plateau" and the only right direction is further downward still.

I shall not say very much about prisons because others will speak with much more authority than I can in this area. I do however have some concern about how compulsory drug testing through urine will sit with the recent conversion of the old prison medical service into a Directorate of Health Care with a mission to provide better health care to prisoners. If a lot of addictions are discovered by this method, how will they be treated? Also it is hard to see how this policy would be compatible with the distribution of bleach, which was the response--correct in my view--of the governor of Glenochil Prison in Scotland following the discovery last year that at least eight and up to 13 prisoners were HIV-positive through needle sharing while in prison.

Another section of the document that drew my attention is Chapter 10, particularly the paragraphs on purchasing criteria and a voice for service providers. Now, I am not one of those who are bitterly opposed to the so-called "contract culture". I can see virtues in clear contracts to perform services, so I was glad to read the objective in paragraph 10.8 to,


    "improve contracting arrangements (for both purchasers and providers)"

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because there is a very real problem here. It is essential that public purchasing authorities agree and stick to viable schedules of payment when entering into contracts with voluntary sector or other providers, but particularly with voluntary bodies which often experience severe cashflow difficulties. I was therefore encouraged by Mr. Tom Sackville's Written Answer on 24th November to a Question in another place that,


    "The National Health Service Executive issued a requirement to health authorities on 28 October 1994 to comply with the Confederation of British Industry prompt payment code".

I hope that this will become standard good practice throughout the public sector, including local authorities, otherwise the contract culture will indeed fall into disrepute and become inoperable.

My final point is of a more general nature. On reading the document I was struck, like the noble Baroness, Lady Jay, by the rather minimal role allocated to the voluntary sector. The proposed drug action teams to which the noble Baroness, Lady Cumberlege, referred, in paragraph 8.9 on page 59, have no voluntary sector representative at all, as noted critically by Turning Point, the largest UK charity in the field, in its response to the Green Paper. Even for the rather larger and presumably merely advisory drug reference group whose suggested composition appears on page 64, only one or possibly two voluntary representatives are proposed out of a total of about 20, despite the noble Baroness's endorsement of their importance. There is mention of SCODA in paragraphs 10.10 to 10.12 as the umbrella body for service providers, but the impression given is that it will become increasingly an arm of government.

Obviously, this is a government-led initiative and rightly so, but no tools or weapons should be neglected wherever they are to be found. For instance, voluntary bodies working in the HIV-AIDS field have performed, and are performing, work of incalculable value. By analogy it makes sense to make the maximum use, across the whole field of drug abuse and prisons, of voluntary sector agencies which can operate so effectively in the interstices of public policy.

The word "together" appears in the largest print on the cover of this document, referring presumably to the five sponsoring government departments. I believe that the Government would be wise to extend its scope more widely to build in more positively and actively national voluntary bodies with all their accumulated expertise and commitment in the field and local community-based organisations. That could be done for a tiny proportion of the £526 million spent on drugs by the Government last year. Only then will the word "together" achieve its full potential.


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