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Viscount Simon: My Lords, my noble friend mentioned the 18-week pathway for chronic pain. I was seen within that period. Three or four months afterwards, I saw the consultant and we established that the procedure had not worked. I am now advised that it will be 52 weeks before I can have further treatment because of the new system of allowing patients to be seen in one or two places and the particular expertise of the consultant. Is this right?
Lord Darzi of Denham: My Lords, as I said earlier, we need to develop a network of pain provision between the acute sectorwhere I understand my noble friend had his visitand the community sector. In other words, there should be a proper handover of patients after their visit to the acute pain clinic, or the pain clinic within a hospital setting, back to their primary care physician.
The Parliamentary Under-Secretary of State, Department of Health (Lord Darzi of Denham): My Lords, data indicate 39 TB incidents in schools in London to date this year. Since data collection began in 2004, there have been 148 TB incidents in London schools, which include nurseries but exclude higher education. Incidents are defined as occurrences where potential transmission to non-household contacts is identified as a public health risk warranting wider investigation. Outbreaks are a specific sub-set of incidents. It is not possible to provide data on outbreaks alone.
Baroness Sharples: My Lords, I thank the noble Lord for that reply. As 70 per cent of TB cases in this country come from abroad, should not immigrants coming to this country have a blood test when they arrive? Later on, should not leave to remain in this country be dependent on their having a screening?
Lord Darzi of Denham: My Lords, I agree with the noble Baroness. Individuals immigrating from abroad who have a high susceptibility to tuberculosis are currently screened. There are two screening mechanisms. First, there is a screening pilot, which we started in 2005, in which all individuals staying more than six months in the UK are screened at the time of acquiring a visa. If they happen to have active disease, they will be treated completely at their own cost until they are free of disease and before they obtain a visa. These countries happen to be Bangladesh, Sudan, Tanzania, Thailand, Ghana, Kenya and Pakistan. If individuals are coming from other countries in which the prevalence is greater than 40 per 100,000, they will be screened at the port of entry.
Baroness Tonge: My Lords, does the Minister agree that school nurses carry out a vital role in health and education, in the link between school and home and in detecting diseases like tuberculosis? If so, does he realise that there is a desperate shortage of school nurses up and down the country and many in post now are due to retire very soon? Will he tell us what he is going to do to encourage primary care trusts to achieve the Governments target of 3,300 school nurses by 2010? I understand that, at the moment, there is a shortfall of 1,000.
Lord Darzi of Denham: My Lords, we recently completed the next-stage review as the noble Baroness is fully aware. A subset of that review was on a high-quality workforce through which we addressed some of the needs, gaps and future demands. I agree on the role that school nurses play, not just in schools but in the co-ordination of care in schools and in a primary and community setting. So that document itself has a number of policies which will address that gap and I will be more than happy to take questions on any further issues in relation to that.
Lord Darzi of Denham: My Lords, there is plenty of research into addressing this challenging problem of multidrug-resistant TB, which is about 1 per cent of the current infections. Recently, we have also identified through the WHO guidance so-called extensive drug-resistant TB. As far as I am aware, we knew of one case in Scotland, but, using the WHO criteria, we have been able to go back and now believe that we have had eight such cases in the UK. Every attempt is being made, working with the pharmaceutical industries, to obtain new therapies that will address these new, challenging multidrug-resistant infections.
Lord Darzi of Denham: My Lords, as I said, we have had 148 incidents in London schools. I do not have the figures for higher education, but the figures for the past five years in London schools are: 31 in 2004, 32 in 2005, 17 in 2006, 29 in 2007 and, as I said, 39 in 2008. However, I will be more than happy to look at the incidence in higher education and get back to the noble Lord.
Lord Naseby: My Lords, the Minister mentioned working with the pharmaceutical industry. Does that mean that in this case, given the Governments recent negotiations with the industry on reducing the price of medicine, this will be treated as an orphan drug, or will there be another form of incentive to ensure that this work is done?
Lord Darzi of Denham: My Lords, historically this country has always enjoyed research and development and investment by the pharmaceutical industry, because the best brains are in this country. As a result, I am
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L Best, L Currie of Marylebone, L Eatwell, L Forsyth of Drumlean, L Griffiths of Fforestfach, B Hamwee, B Kingsmill, L Levene of Portsoken, L MacGregor of Pulham Market, L Moonie, L Paul, L Tugendhat, L Vallance of Tummel (chairman);
That the Committee have power to appoint a sub-committee and to refer to it any of the matters within the Committees terms of reference; that the Committee have power to appoint the chairman of the sub-committee;
(c) in respect of draft remedial orders and remedial orders, whether the special attention of the House should be drawn to them on any of the grounds specified in Standing Order 74 (Joint Committee on Statutory Instruments);
(a) in relation to any document containing proposals laid before the House under paragraph 3 of the said Schedule 2, their recommendation whether a draft order in the same terms as the proposals should be laid before the House; or
That a Select Committee of six Members be appointed to join with the Committee appointed by the Commons to consider tax law rewrite Bills, and in particular to consider whether each Bill committed to it preserves the effect of the existing law, subject to any minor changes which may be desirable;
That the procedure of the Joint Committee shall follow the procedure of Select Committees of the House of Commons when such procedure differs from that of Select Committees of this House, and shall include the power of the chairman to select amendments.
That a Select Committee be appointed to advise the House on the resources required for Select Committee work and to allocate resources between Select Committees; to review the Select Committee work of the House; to consider requests for ad hoc committees and report to the House with recommendations; to ensure effective co-ordination between the two Houses; and to consider the availability of Members to serve on committees;
Lord Bassam of Brighton: My Lords, my noble friend Lady Royall of Blaisdon will repeat a Statement entitled EU Council: Visit to Afghanistan, India and Pakistan, after the noble Lord, Lord Greaves, has made his speech on Second Reading of the Marine and Coastal Access Bill.
The Minister of State, Department of Energy and Climate Change & Department for Environment, Food and Rural Affairs (Lord Hunt of Kings Heath): My Lords, there can be no denying that our oceans, seas and coasts have a huge impact on our lives. The UK marine area is a vast and important resource; not only does it provide us with valuable economic, environmental and cultural benefits, it also plays a major role in influencing our climate and in sustaining life. Our seas provide food, transport, recreation, relaxation and inspiration. The UK has one of the richest marine environments in the world, with more than 8,000 species, from tiny plankton to minke whales, recorded in our seas. Protecting the sea must therefore be a high priority.
Without a Marine and Coastal Access Bill, we risk severe long-term damage and reduced sustainability of our valuable marine resources. If we do not act now, we are likely to require more severe restrictions in future with consequently higher costs. Protecting our
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If we are to ensure that future generations can continue to see these benefits, we must recognise and manage the pressures on the seas and create a healthier, productive and more biologically diverse marine environment. The Marine and Coastal Access Bill will raise the management and protection of our seas to a world-leading level while enabling its rich resources to be used sustainably and for the benefit of all. It has been said many times before but it is worth saying once again: this Bill is groundbreaking legislation. The UK will be the first country in the world to take such an ambitious and wide-ranging, structured approach to marine management.
The Bill addresses the whole management cycle from setting policy objectives to ensuring the activities permitted, and then what people actually do, are consistent with that policy. The provisions to designate a network of marine conservation zones to conserve rare and threatened habitats and species, together with those to provide recreational access to Englands coastline, will also deliver important elements of our vision for making the most of our seas and coastline.
I would like to take this opportunity to say how helpful the process of pre-legislative scrutiny has been in developing this Bill. In particular, I thank the noble Lord, Lord Greenway, and the other members of the Joint Committee who carried out pre-legislative scrutiny under his chairmanship. The committee faced a challenging task over the summer and we are most grateful for the constructive report which they produced. Undoubtedly, the Bill has benefited from their thorough and careful examination of its draft.
We have also had assistance from the Environment, Food and Rural Affairs Committee in the other place, which examined the coastal access provisions of the draft Bill and last, but by no means least, from some 15,000 organisations and members of the public who responded to our public consultation. I am pleased to report that the consensus has been strongly in support of the Bills principles, often expressed with proposals aimed at strengthening its provisions. Our proposed approach has attracted significant public support and, in some areas, has been long-awaited. As a result of this pre-legislative scrutiny process, a good draft Bill has been improvedmade stronger and more transparent.
The Governments response to pre-legislative scrutiny, published in September, set out how we intended to further develop the draft Bill. Before moving on to the detailed provisions of the Bill, noble Lords might find it helpful if I outlined some key changes made to it following pre-legislative scrutiny.
We have introduced a requirement on policy authorities periodically to review the marine policy statement, which has been made subject to a parliamentary process similar to that on national policy statements recently
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