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City & Hackney PCT (Tuberculosis)

March 20, 2009

City & Hackney PCT (Tuberculosis)

Mark made a number of contributions to a debate tabled by Diane Abbott MP on tuberculosis.

Mr. Field: Although the time constraints are not quite what they otherwise would be, I nevertheless thank you, Madam Deputy Speaker, and my near neighbour, the hon. Member for Hackney, North and Stoke Newington (Ms Abbott). I agree with much that she has said so far, particularly about how the disease can almost seem like something out of the pages of bygone novels—although I recently read the autobiography of the former football commentator and journalist Brian Granville, who came from a relatively wealthy London family, but who suffered from the TB in the late 1940s. The hon. Lady said that hitherto the main concern was about immigrant groups in our part of central London, as well as in relatively poverty-stricken groups. Does she recognise that the increase in tuberculosis now poses a threat to health more generally, rather than just within the most poverty-stricken groups to which she has referred?

Mr. Mark Field (Cities of London and Westminster) (Con): I will not detain the House for long, and I appreciate that the great bulk of the comments of the hon. Member for Hackney, North and Stoke Newington (Ms Abbott) concerned a particular constituency case. As I am sure she and the Minister are aware from the title of the primary care trust under discussion, it covers a small part of my constituency in the City of London, where we have Barts hospital and a thriving and growing residential population. Most of my constituents are based in Westminster and look to St. Mary’s, Paddington as their local hospital, and others of them look east to the London hospital, but the Homerton plays an important part for those of my constituents who live in the City of London.

To be fair, some of the concerns and problems in my constituency are on a much smaller scale than those in the hon. Lady’s, but an increasingly large street-sleeping homeless population has become a growing problem in particular. Tremendous and positive strides forward had been taken on that, but it has become more of a problem over the past year or so, and I fear that it will continue to be so.

Ms Abbott: Does the hon. Gentleman agree that one current problem is the numbers of eastern Europeans among the street homeless? With the collapse in the economy and their not being able to access public funds—I am not disputing that—there is a very worrying rise in their numbers among the street homeless, and there are simply not the resources to deal with them.

Mr. Field: I entirely agree. Another feature worth mentioning is that a considerable number of street sleepers in the City of London are employed. They are people who have come to this country to find work, and who find it so expensive to get any housing that they utilise the open spaces in the City of London. The hon. Lady is right that there has been such a rise in the five years since the 10 new nations joined the European Union, and particularly around the Victoria area, given the importance of the Catholic cathedral in Westminster to much of the population concerned.

I hope that the Minister will make a few general points, as well as respond to the specific points in the hon. Lady’s speech, and that she touches on some of the issues to do with screening of the migrant population in particular risk areas. The hon. Lady referred to the port-of-entry screening. I entirely agree that much of this problem is in every sense beneath the surface in that, as she pointed out, a significant number of illegal immigrants do not register with GPs and play no part with any officialdom. Given the concern about general health—I would be interested to know the answer to this, because I am not an expert on tuberculosis—what advice is the Minister getting from public health experts about the precise nature of this threat? Is there a real threat to the population at large?

With that in mind, what steps are being taken to ensure that there is proper port-of-entry screening for migrants coming from specific target countries where there is much risk, and that more care is taken of street sleepers? Are we ensuring that where there is any risk of TB starting in that population, proper public health steps are being taken? I appreciate that it is important that we do not get hysterical and make a big fuss, but those of us who represent inner-city areas recognise that the sheer hyper-diversity and hyper-mobility of the population makes not just TB but other diseases a real concern.

Ms Abbott: The hon. Gentleman mentioned port-of-entry screening. There seems to be an opinion among the professionals that comprehensive port-of-entry screening would not be practical and would increase the stigma. My argument is simply that people should not say that there is port-of-entry screening if there is not. If it is seen not to be effective and to have too much stigma attached, let us not do it. It is misleading to pretend that we have some port-of-entry screening when we do not.

Mr. Field: I thank the hon. Lady for her intervention; she obviously has become more acquainted with the nuts and bolts of this issue than perhaps I have had reason to do hitherto. We do not wish to become hysterical about this, but great and increasing mobility is part of what it is to represent our large city. I suspect that even in Bristol—the Minister must have found this in her constituency—there is an increased amount of mobility and great diversity in the population. I hope that she will be able to touch on some of these strategic issues, as well as deal with the specifics raised in the contribution made by the hon. Member for Hackney, North and Stoke Newington. Stigma is not an issue of which I, for one, have become especially aware. The hon. Lady rightly pointed out that TB was so widespread at some times that no great stigma was attached to it; it applied throughout all areas of the population. The single most important thing for us to do, on behalf of all our constituents, is to give our level best to ensure that a public health problem that we thought had been consigned to history remains just that and does not become a major problem in the years and decades ahead.