HEALTH PROTECTION AGENCY – 21 June 2004
Dr Julian Lewis: The House owes a debt of gratitude to all those hon. Members who have spoken following the initial brittle, unfleshed skeleton that the Minister outlined at the outset, for trying to add some substance to the debate. When one looks at the Bill's fine print, one sometimes forms an impression that it is designed largely to try to get round some of the self-inflicted problems brought about by the way in which devolution impedes the carrying out of the functions of the existing agencies, rather than introducing any major or substantive change to the way that the problems that the agencies are supposed to address will be addressed.
It was a pleasure to listen to my right hon. Friend the Member for Hitchin and Harpenden (Peter Lilley) renewing his gallant campaign on behalf of the victims of MRSA. I find it quite incredible that, in the 21st century, it is necessary for a politician of his seniority to have to plead with those who work in the health services to adopt the measures of basic hygiene, basic cleanliness and basic common sense that Florence Nightingale pioneered more than 150 years ago. It is quite deplorable that so many hon. Members find that our constituents tell us terrible tales of relatives – often elderly folk, as I said in an intervention – who go into hospital for one ailment and then contract an infection that, all too often, proves fatal.
My hon. Friend the Shadow Secretary of State for Health (Andrew Lansley) outlined the case for considering topics such as MRSA, HIV, TB and hepatitis C in the context of the Bill. He was right to do so, but the dimension that I wish to address is that which concerns the defence aspect, for which I have some responsibility on the Conservative Front Bench. The Bill has been portrayed as establishing an agency that will fulfil a valuable role if this country is subjected to chemical, biological or radiological assault. That needs further clarification because the sort of measures that are necessary to deal with those types of threat are very different.
A chemical attack, if carried out, has a very quick effect. That was well seen in the sarin attack on the Japanese subway. A biological attack, by contrast, if carried out against animals, may make itself apparent somewhat more slowly, and if carried out against humans, much more slowly still. A radiological attack can be very slow indeed in making its effects apparent. So entirely different types of plan must be ready to deal with those emergencies if they come to pass. The threat and the attack need to be contained. If the attack involves one of the longer-lasting or slower agents to act, it needs to be traced and then treated. The Bill does not make it clear who will actually do that work.
The Research Paper on the Bill prepared by the Library points out that the existing agency had already been involved in some exercises. I quote from the briefing material:
"Two exercises based on the release of smallpox have already been conducted to assess the effectiveness of the major incident plans. More recently a field exercise based on the deliberate release of sarin, involving more than 200 volunteer casualties, was conducted in Newcastle. The exercise also included a desktop training exercise, where members of the health and emergency services planned a response to additional major emergency incidents."
It quotes Dr Nigel Lightfoot, director of the emergency response division at the Health Protection Agency, as saying:
"We are very pleased with the way in which the day has gone. The procedures involved in the field exercise went so well that we finished an hour ahead of schedule."
I felt on reading those words that there was something terribly British about all this and something terribly amateurish. I am concerned that, in focusing on the structures of the agencies to the extent that the Government have, they are taking their eye off the central question of how the agencies will relate to the people on the ground who must cater with a disaster if one were to occur.
When the issue was raised in Committee in the other place on 3 March, Earl Howe said:
"The first question that we must ask is how the provisions of the Civil Contingencies Bill interrelate with those in this Bill. The Health Protection Agency will have a major role to play in many types of civil emergency, yet the most that is hinted at in the Bill is that it will be obliged to, 'co-operate with other bodies ... which exercise functions relating to health or any other matter in relation to which the Agency also exercises functions'." – [Official Report, House of Lords, 3 March 2004; Vol. 658, c. GC 287.]
But what are those bodies with which co-operation must take place?
My hon. Friend the Member for Newark (Patrick Mercer) was involved in his responsibilities of Shadow Minister for Homeland Defence – even though we do not have a Minister for Homeland Defence, despite the fact that we should – in taking the Civil Contingencies Bill through Committee. In doing so, on 29 January, he made a point about the civil contingencies reaction force – the volunteers on whom so much will depend if an attack is mounted and to whom my hon. Friend the Member for Rayleigh (Mark Francois) alluded in an intervention. My hon. Friend the Member for Newark said:
"It is no coincidence that the CCRF has found itself extremely stretched in terms of declaring itself operationally ready. Just before the Bill's Second Reading – strange to relate – the Government said that the force was ready. However, the facts are rather less than the theory." – [Official Report, Standing Committee F, 29 January 2004; c. 89.]
My hon. Friend went on to point out that, of the 7,000 CCRF volunteers who are supposed to be under arms, only 5,000 are physically accredited as part of the organisation. He then went on to make an extremely important point that further cuts that total: the sort of people who volunteer to undertake such dangerous duties are all too often the same people who already have a reserve liability with the Armed Forces and who, in the present climate and intensity of military operations, are already on call for dispatch to active service outside the United Kingdom's boundaries. So we do not have anything like that total of volunteers readily available, but the same applies, a fortiori, to the regular Armed Forces.
The regular Armed Forces, with the normal emergency services, would be in the front line of tackling any of those catastrophic attacks if they were to occur.
We know perfectly well the strain under which they are already labouring. Their morale is not improved by constant reports of imminent announcements from the Secretary of State for Defence – which have yet to happen but which we are pretty sure will happen – of major cuts in front-line forces. So we must ask ourselves how the new agency will be able to deliver what it is supposed to deliver.
It is not even clear where the borderline will lie between what the agency is supposed to do and what the emergency services, Armed Forces and Reserve Civil Contingency Forces are supposed to do. When one looks at the Bill and in particular at clause 3, one sees under the heading "Radiation protection functions" that
"The Agency has the following functions in relation to risks connected with radiation (whether ionising or not)" –
and it gives two:
"(a) the advancement of the acquisition of knowledge about protection from such risks;
(b) the provision of information and advice in relation to the protection of the community (or any part of the community) from such risks."
On reading that subsection, one is inclined to agree with the interpretation of my hon. Friend the Shadow Secretary of State (Andrew Lansley), who said in response to one of my interventions that, as far as he could see, much of the role of the Health Protection Agency is one of surveillance – as well as, perhaps, tendering advice. One wonders, given the agency's independence, what sort of advice and guidelines it will be given on how it should try to prepare the public for what might be a devastating attack by chemical, biological or radiological means.
If I may be forgiven, I shall cast my mind back to the most recent occasion that I can think of when the problem of how much sensitive and worrying advice to give to the public was last aired. The year in which I remember that being a particular issue was way back in 1980, when there was beginning to be the stirrings of concern about the involvement of the United Kingdom both in a new generation of its own nuclear weapons and the basing here of certain American nuclear weapons. The anti-nuclear campaign pressed very hard for the Home Office advice to the public to be published, and under that pressure, it was published in the form of the "Protect and Survive" booklet. When it was published, the very people who had pressed for its publication proceeded to mock it, to rubbish it and to say how useless it was. I would not be surprised if the Health Protection Agency found itself faced with a dilemma when it considers that precedent, which I am sure will be brought to its attention.
After all, we experienced an incident in this Chamber, after which it was said that not even the people present at the time had been given the correct advice on what to do in the event of the possibility that something of a chemical or biological nature had been thrown into the Chamber. Yet, when the security services came forward with advice on what they think we ought to do, straight away people were saying, "You are alarming the public; you are being unnecessarily alarmist. You are cutting off the House of Commons from the people." These issues are not easy ones to deal with. I hope that the Minister in his reply will make it clear to what extent it will fall to the new Health Protection Agency to decide what sort of information should be made public to educate the British people on how best to protect themselves in advance of such a terrible incident, and to what extent it will do so under Government authority.
David Taylor (North West Leicestershire): The hon. Gentleman describes the dilemma that the Government face, but the present Opposition face such a dilemma too. The Government are either over-zealous, nanny-stateist and alarmist, or they are neglectful of their duties, derelict in their duties and ought to be doing more. The Opposition have made a living out of that for the past three months or more.
Dr Lewis: That would be a fair point if the hon. Gentleman could show that the Opposition have made any remark about the nanny state or over-zealousness in the context of the serious issues that we are debating. I have been present for the entire debate and have not heard one such point made from the Opposition Benches. It obviously depends on the subject under consideration. When the Labour Government inflict their opinions on the public about ways in which they should conduct their lives that fall far short of the implications for serious security or life and death of the issues that we are discussing, it is quite right for us to describe them as over-fussy. When dealing with matters of gravity, such as those before us, the hon. Gentleman will not hear comments of that sort from the Opposition Benches.
Shadow Secretary of State for Health (Andrew Lansley): I am interested in what my hon. Friend has to say, which he is setting out very well. Does he agree that the criticism that we might be trying to have it both ways is able to be made only when the Government have failed to tell us how they are proposing to deal with these matters? There is a problem with discussing the Bill in that clause 5, by its structure, effectively says nothing more than the Health Protection Agency will co-operate with other bodies, unspecified, and that other bodies, unspecified, will co-operate with the Health Protection Agency. The argument about a list of such bodies is secondary. We need some idea of the manner in which the co-operation is to be carried out, and by whom and in what structure.
Dr Lewis: My hon. Friend is absolutely right. In particular, we need to know the chain of command. What does the co-operation involve? Let us suppose that the Health Protection Agency decides that certain steps must be taken instantly in the case of a quick-acting chemical attack, a slow-acting biological attack or a very slow-acting radiological attack. Let us suppose that the Health Protection Agency comes up with the idea, "We'll need troops to do this and emergency services for that", but the troops and emergency services say, "That's all well and good but we haven't got the forces available", or "We've worked out rather different ways to tackle the problems." It sounds as if the people who will be theorising and conducting the surveillance – the people who are affected by the Bill – are not properly connected to those who will have to do the real work on the ground in such dire circumstances.
David Taylor: To set the hon. Gentleman's point in context, the right hon. Member for Hitchin and Harpenden (Mr Lilley) rightly focused on MRSA conditions and the worsening of that problem. All the increases in morbidity and mortality associated with MRSA pale into insignificance when compared with that linked to obesity and smoking – passive or otherwise. So, on the one hand, we have the over-zealous nanny state, and on the other we are told that the Government are washing their hands of responsibility for MRSA – pun intended.
Dr Lewis rose –
Mr Deputy Speaker (Sir Alan Haselhurst): Order. Before the hon. Gentleman is tempted too far down that line, he might recognise – as I hope will the hon. Member for North-West Leicestershire (David Taylor) – that that point is taking us a little far away from the subject of the Bill.
Dr Lewis: I do, Mr Deputy Speaker. With your indulgence, I shall respond with a single sentence. There is all the difference in the world between people who choose to overeat or to smoke and people who go into hospital because they are ill and who then fall victim to a hospital-acquired infection, without having exercised any choice.
In line with your stricture, Mr Deputy Speaker, I return to the Bill. I am concerned about the lack of clarity about connections between those who will be governed by the operation of the new agency and of the legislation and the emergency services, the Armed Forces and the Civil Contingencies Reaction Force. I was impressed by the point made by my right hon. Friend the Member for Hitchin and Harpenden, who referred to clause 4(2), which states:
"The Agency may do anything which it thinks is –
(a) appropriate for facilitating, or
(b) incidental or conducive to,
the exercise of its functions."
What does that mean – the agency may do anything? Ought implies can, according to the basic moral philosophy lectures that I recall from all too many years ago, but we do not know what the agency's powers will be. I suppose it means that, provided that the agency has the power to do certain things, it will have the discretion to do them – but in what areas will it be able to exercise its authority? We do not even know whether the agency will have the power to require the emergency services, the Armed Forces or the Reserve Civil Contingency Forces to co-operate with its schemes. The subsection means both everything and nothing. It is all rather mystifying.
Having touched on the information that the organisation may issue, the relationships that it might have, and the command structure that it needs but that is not clearly set out in the Bill, I am concerned that we are being asked to sign a blank cheque. If the Bill was about the ordinary business of life, we could say, well, sometimes we just have to leave discretion to people in high places to use their judgment as best they may; but the Bill deals with exceptional and grave situations. Whenever an attack occurs, be it a conventional military attack or an unconventional terrorist attack, the odds are that it will not have been predicted. All history indicates that that will be the case. We therefore have to work on the assumption that something will happen at some stage, and that when it happens it will be unexpected. For that reason, we need to have confidence that the structures are in place to mitigate the impact of such an attack when it occurs – it will be too late to plan when the attack is under way.
We are being asked to sign up to a template with few features, a plan with few details, a strategy with few conditions or explanations attached. As the Bill progresses, we will need a great deal more reassurance from the Government that they know what they are doing and that the agency will be something more than a purely bureaucratic and administrative reshuffling of the deckchairs on the deck of the Titanic.