Grand Committee
African Legal Support Facility (Legal Capacities) Order 2014
(10 years, 6 months ago)
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Baroness Northover
That the Grand Committee do consider the African Legal Support Facility (Legal Capacities) Order 2014.
Relevant documents: 27th Report, Session 2013-14, from the Joint Committee on Statutory Instruments
Baroness Northover (LD)
My Lords, this draft order covers the ratification of the international treaty agreement establishing the African Legal Support Facility. The order was laid before the House on 6 May.
Since its inauguration in 2009, the ALSF has grown its membership to 57 members, consisting of 46 African countries, five non-African countries and six international organisations. Its primary objective is to support African countries to make the most from their natural resources. It helps countries to combat vulture funds and strengthens legal expertise within Africa.
First, on extractives, Africa as a continent has been unable to capitalise fully on the development and growth opportunities offered by its significant natural resources. In many cases the exploitation of oil, gas and mining resources has helped to enrich the powerful and well connected, but failed to bring about widely shared poverty reduction. Many countries do not have the laws and rules required to create modern extractive industries that share the benefits from resource extraction through fair taxation and job opportunities for local people. Even where sound legislation exists, the capacity to implement it is often woefully inadequate. To make matters worse, poor people and communities often bear the brunt of the negative impacts of resource extraction such as environmental degradation, displacement and, in some cases, conflict.
Bad contracts are often the reason why extractive industries do not work for the poor. Governments in developing countries do not have the legal capacity to match the expertise that investors are able to mobilise through international law firms. This expertise is very expensive and therefore beyond the reach of Governments who do not even have the funds to pay their civil servants or deliver the most basic social services to their people. As a result, they lose out through bad deals.
Over 60% of ALSF’s active and completed projects are therefore assisting countries to negotiate complex commercial contracts, especially in the natural resource and extractive industries, that strike a better balance between host Governments and investors. It is important to emphasise that responsible investors are strongly supportive of the assistance that the ALSF provides because more balanced contracts are less likely to be renegotiated by future Governments.
A secondary objective of the ALSF is to support African countries facing legal proceedings by vulture funds. African Ministers have called on the international community to assist countries facing this challenge, particularly those that have benefited from relief under the Heavily Indebted Poor Countries Initiative. Vulture funds have been and remain a major problem for developing countries. They buy up commercial debt at a discount and then sue for the full amount plus interest. When vulture funds pursue settlement of these debts, they often use aggressive tactics such as seeking court orders to seize physical or financial assets belonging to the sovereign debtor. Vulture funds siphon resources that UK taxpayers and other international donors have pledged through debt relief and aid to African Governments for poverty reduction, and often base themselves in countries that require limited transparency, so it is difficult to restrict their practices. Although they are an important objective for the ALSF, there has been less demand for this service than on extractives. Combating vulture funds represents 22% of the ALSF’s completed and active projects.
Thirdly, the ALSF also provides technical assistance to regional members, to help strengthen their own legal expertise on extractives and vulture funds. Providing training for African lawyers means that they can take the lead for future debt and contractual negotiations.
Ratifying membership of the ALSF helps meet the UK’s commitment made as part of last year’s G8 presidency to support African leaders on making the most of their natural resources for inclusive growth. Membership of the ALSF is also part of DfID’s growing efforts to harness oil, gas and mineral wealth for economic development and poverty reduction. The Secretary of State for International Development has asked the department to scale up work on extractives with a focus on: raising global standards of extractives’ transparency and accountability, for instance through the Extractive Industries Transparency Initiative, which the UK helped to launch in 2005; increasing capacity of resource-rich countries to manage their resources better, especially through the department’s bilateral programmes in Africa and Asia; and building partnerships with the private sector to promote transparency, build skills and maximise the impact of their investments on poverty.
I therefore commend the order to the Committee.
Lord Collins of Highbury (Lab)
My Lords, I very much welcome the comments of the Minister in introducing this instrument. However, it is a bit unfortunate that it has taken nearly five years from 2009, when the UK signed the agreement for the establishment of the ALSF, to our taking this step today towards fulfilling our obligations under Article 3 of the agreement to grant the facility full juridical personality in the UK. Can the Minister explain that significant delay? I would also appreciate it if she could update the Committee on the status of the other signatories to the agreement fulfilling their obligations under Article 3, particularly the four other non-regional signatories—France, the Netherlands, Belgium and Brazil. I also wonder whether she could highlight whether the delay in obtaining the juridical personality has hampered the operation of the facility since its establishment.
As the Minister highlighted, one of the key tasks of the facility has been and remains to empower African nations in tackling vulture funds. Has she assessed how effective it has been in that role? She mentioned 22% of work in that respect. Given that the UK has introduced legislation domestically to rein in such funds, what steps have been taken to ensure that our experience and expertise gained is shared through the facility and other means? Has the department considered providing financial or material support to the facility to fulfil that role?
My final point is very much to welcome the decision to award £7 million to the facility over the next three years to provide legal support for the negotiations that the Minister highlighted about extractives contracts. Given the number of such contracts being negotiated in Africa over the coming years, does she believe that the planned split of the funding, with just 15% going towards the building up of domestic legal capacity, is adequate to build self-sufficiency in the sector?
Baroness Northover
My Lords, I thank the noble Lord, Lord Collins, for his interest in this facility and also for providing me with his questions prior to this debate, which was extremely helpful.
This organisation clearly has significant potential impact. We are well aware that the rich mineral resources across Africa offer the potential for accelerated progress in poverty reduction. On the other hand, as the noble Lord indicated, there is a risk associated with that as well, and we have to make sure that the advantages of that richness in mineral resources benefit the people in these countries right across their societies. That is why we are taking forward our support for this organisation, which was initially begun under the previous Government and I pay tribute to them for that.
The noble Lord asked why it has taken five years to get this far, given that the United Kingdom signed the agreement in 2009. I reassure him that the slow ratification process has no direct impact on the operations of the African Legal Support Facility and the United Kingdom’s engagement with it. Ratification of an international treaty can take a very long time, as many official entities in the United Kingdom and elsewhere need to be involved, and a number of processes took longer than expected. In order to ensure inclusion and transparency, this necessarily included, for example, lengthy consultation with the overseas territories and Crown dependencies through the Ministry of Justice regarding their inclusion in the ratification of the agreement. Nine overseas territories and three Crown dependencies will, I am pleased to say, be included.
The noble Lord asked for an update on the status of other signatories in fulfilling their obligations under Article 3. I am very happy to provide those details for the noble Lord in writing.
He also asked about reviewing the effectiveness of operations and how that is looking at the moment. The ALSF governing council regularly reviews the effectiveness of its operations. While there were concerns about its value in initial years, new leadership has transformed its effectiveness. UK government officials maintain good links with the ALSF to exchange lessons, and DfID support forms part of a package of assistance from a wide range of donors. The ALSF agrees priorities for the use of these funds on an annual basis.
The United Kingdom is represented on the ALSF’s governing council, which obviously helps us to be well aware of exactly how it is moving forward and how we can best make sure that it benefits the communities that we are talking about here. Other organisations are also involved, including the World Bank, the Natural Resource Governance Institute and international senior lawyers. They have all helped in providing capacity building, and no doubt that is also helping the organisation to move forward.
Having paid tribute to the previous Government for initiating this process, I hope that the noble Lord and other noble Lords are reassured on those points.
Armed Forces Act (Continuation) Order 2014
Baroness Jolly
That the Grand Committee do consider the Armed Forces Act (Continuation) Order 2014.
Relevant documents: 1st Report from the Joint Committee on Statutory Instruments
Baroness Jolly (LD)
My Lords, the purpose of the order is to continue in force legislation governing the Armed Forces—the Armed Forces Act 2006—for a further period of one year, until November 2015. In many respects this is a routine item of business; the legislation which makes the provision necessary for the Armed Forces to exist as disciplined forces is renewed by Parliament every year. This reflects the constitutional requirement under the Bill of Rights that the Armed Forces may not be maintained without the consent of Parliament. There is a five-yearly renewal by Act of Parliament, which is the primary purpose of Armed Forces Acts. The most recent Armed Forces Act was that of 2011 and the next is required by 2016.
Between Acts, there must be an annual renewal by Order in Council. That is the purpose of the draft order. This order is necessary for the Armed Forces Act 2006, as amended by the Armed Forces Act 2011, to remain in force. If the Order in Council is not made by the end of 2 November 2014, the Armed Forces Act 2006 will automatically expire. The effect of this would be to end the powers and provisions to maintain the Armed Forces as disciplined bodies. I will say more about this later.
The 2006 Act transformed the legislation governing the Armed Forces by introducing a single system of law that applies to all service personnel. It replaced three separate systems of service law contained in separate service discipline Acts which dated back to the 1950s. It includes a comprehensive system of discipline covering such matters as offences, the powers of the service police and the jurisdiction and powers of commanding officers and service courts, particularly the court martial. It applies to all service personnel, wherever in the world they are operating.
The service justice system is a bespoke criminal justice system that recognises the wide spectrum of environments and situations in which the Armed Forces serve. It ensures that the same basic rights and procedures apply to all members of the Armed Forces accused of misconduct. It fits the context in which the men and women of the Royal Navy, the Royal Marines, the Army and RAF train and work together. However, let us not forget the civilians in this equation, because in certain circumstances while overseas they are subject to service discipline too. The service justice system underpins the maintenance of discipline through the chain of command so fundamental to the operational effectiveness of our Armed Forces and it works very well.
I said I would say a bit more about what would happen if the 2006 Act were to expire. I know that the noble Lords, Lord Rosser and Lord Tunnicliffe, have a particular interest in this and I am grateful to them for giving me prior notice. The 2006 Act provides nearly all the provisions for the existence of a system for the Armed Forces of command, discipline and justice, as well as a large number of other important provisions such as those for their enlistment, pay and current system for the redress of complaints. As noble and gallant Lords will know, the obligation of members of the Armed Forces is essentially a duty to obey lawful orders. They have no contracts of employment and so no duties as employees.
Without the 2006 Act, commanding officers and the court martial would have no powers of punishment for disciplinary or indeed criminal misconduct. It is true that members of the Armed Forces would still owe a duty of allegiance to Her Majesty but Parliament would have removed the power of enforcement. Discipline, in every sense, is fundamental to the existence of our Armed Forces and to their success. That is why we need to continue this legislation.
Earlier I mentioned the Armed Forces Act 2011. That Act was much smaller in scale than that of 2006. It provided for the continuation of the 2006 Act for another five years and made changes to the Act to keep it up to date with the needs of the services. There will need to be another Armed Forces Act in 2016. However, the 2006 Act is doing a good job. It serves the Armed Forces well, and they deserve nothing less. In turn, the Armed Forces continue to serve us well.
Lord Rosser (Lab)
My Lords, I thank the Minister for her explanation of the content and purpose of this order, to which we are asked to agree each year and which we again fully support.
As the Minister said, my noble friend Lord Tunnicliffe asked the department exactly what the effect would be if this draft continuation order for the Armed Forces Act 2006 was not approved, since neither he nor I was entirely clear about the answer to that question. My noble friend received a very helpful reply. In thanking Mr Morrison, who had sent the reply, he expressed the view that the Explanatory Memorandum had been useless in regard to the question he had asked—unlike the reply, which certainly did not lack clarity. The next time this order is required, the department might wish to consider whether the Explanatory Memorandum could not also contain at least some of the content of Mr Morrison’s reply.
I appreciate that what I am going to say is largely repetition of much of what the Minister has said, but if it places on record for a second time the explanation we have had from the Ministry of Defence that will not be a bad thing. The draft order, which I am sure will be agreed, extends the life of the Armed Forces Act 2006 from 2 November 2014 to 2 November 2015. As the Minister said, if the appropriate Order in Council is not made by 2 November this year the Armed Forces Act 2006 will automatically expire. That would have consequences, not least that it would bring to an end the powers and provisions to maintain the Armed Forces as disciplined bodies, which would mean, among other things, that the duty of members of the Armed Forces to obey lawful commands, and the powers and procedures under which that duty is enforced, would no longer have effect. As the Minister said, commanding officers and the court martial would have no powers of punishment for disciplinary or, indeed, for criminal misconduct.
The response that my noble friend Lord Tunnicliffe received went on to say that while members of the Armed Forces would still owe a duty of allegiance to Her Majesty, Parliament would have removed the powers of enforcement, which obviously is of considerable significance, as the obligation of members of the Armed Forces is a duty to obey lawful orders. As the Minister said, they have no duties as employees since they have no contracts of employment.
The response from the department concluded by saying that the requirement for renewal of the 2006 Act is based on the assertion in the Bill of Rights 1688 that the Army—and now that includes the Navy and the Air Force—may not be maintained within the United Kingdom without the consent of Parliament, and that Parliament’s ability to maintain that constitutional position depends partly on its powers of command and discipline. Until the mid-1950s an Act of Parliament was required annually for renewal of the services’ system of command and discipline; since then an annual Order in Council has been required, with a renewing Act of Parliament every five years.
The debate on this order provides a legitimate opportunity to talk about many matters relating to our Armed Forces. However, we have a general debate on the Armed Forces next Monday, as well as Second Reading of the Armed Forces (Service Complaints and Financial Assistance) Bill. I do not wish to try to use this afternoon as a trial run for that debate even in the light of last week’s worrying report on Army 2020 from the National Audit Office.
I therefore simply conclude by saying that, while we will have a general debate next week, concerns have been expressed in the past by a number of Members of this House that debates on our Armed Forces and defence generally are, at times, a bit few and far between. Bearing in mind the significance of the order we are debating today, which relates to the Bill of Rights 1688 and the consent required of Parliament to maintain our Armed Forces, perhaps consideration should be given to using approval in the future of this order as the opportunity for a scheduled set-piece defence debate. I reiterate our support for the order.
Baroness Jolly
I am grateful for the support that noble Lords have given to the continuation order. Parliament’s ability to maintain the constitutional position that the Armed Forces may not be maintained without the consent of Parliament depends partly on its powers over expenditure and particularly by the requirement for annual renewal of its powers of command and discipline. I thank the noble Lord for his suggestion of using this as a set-piece debate in years to come. That clearly is not in my gift but I will pass the request to those who make the decisions on these matters. I will further study Hansard to check whether any areas are uncovered by my response.
National Health Service
(10 years, 6 months ago)
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Lord Crisp
To ask Her Majesty’s Government what plans they have to give citizens and patients more power in the National Health Service.
Lord Crisp (CB)
My Lords, I am very glad to have the opportunity to initiate this debate and I am very grateful to noble Lords who are taking part. I am looking forward to hearing what they have to say. People are coming from a range of different backgrounds and experiences, which should be very illuminating. I am also conscious that the Government have already said a great deal about patient empowerment and patients taking a greater role. Therefore, to some extent I am pushing at an open door in this debate. I am trying to make sure that the progress being made is accelerated and that specific things happen to change the dynamic.
We are talking about one of the most important things happening in health over this decade. I know that discussions about patient and citizen empowerment have been going on for much longer than that but there is a building global momentum. Most noble Lords will know that six all-party parliamentary groups have recently published a report on patient empowerment in which we looked at the global picture as well as the UK picture. I will come back to that.
The UK is part of, and can be a significant leader in, what is happening globally. There is a change from everything within health and healthcare being defined by the professionals to things being defined much more by the citizens, the public and the patients; that is, everything, including what quality consists of in healthcare, being defined much more by the patients, the citizens and all of us, involving of course the professionals.
I have a confession to make. As the NHS chief executive for some years I, like lots of other people, said that patient empowerment was a top priority. But in reality, although we said that for a number of years, not a great deal has happened in this area. As I will say in a moment, I think that England is ahead of much of the rest of the world, but there is very much further to go. We all said it because we were sincere about it, but we did not well understand how to make it happen in reality. It is now beginning to be well understood. I think that people can understand how to make the change. Of course, we now have technology and science that is literally putting things into patients’ hands in ways that enable them to be more empowered as patients and citizens.
I deliberately included patients and citizens in the Question, recognising that both are the same people. I wanted to draw attention to the fact that patients have particular roles but there are particular roles for citizens as well. I mean the whole range of citizens, including the very important group of carers, whom I suspect we may hear more about in due course.
Before turning to the specific all-party parliamentary group report and its recommendations, which I will ask the Minister about, I will say a few things about citizens and why it is really important that citizens have more power. I will give three reasons although there are others. There is enormous epidemiological change going on, as every Member of the Committee will understand as well as I do. We are moving towards a world where the biggest issues facing us are non-communicable diseases. As we all know, those will be significantly affected by people’s behaviour. People themselves will be part of the problem and part of the solution as well.
However, this is not just about individual behaviour but about societies and serious changes in society. Programmes are developing across Europe that come under the title of “Health in all Policies”, which are about making sure that education, employment, commerce and every other part of society has a role to play in improving health and in not damaging health. Over this parliamentary Session, we will no doubt see examples such as discussions about the impact of sugar on people’s health. Wider society has a significant role in improving health. The best estimate that people make is that health services contribute about 20% to our health improvement and wider society contributes about 80%. That in itself is an argument for citizens being much more empowered within our NHS.
The second argument is about carers, which I will not dwell on very long. The last time I looked at the figures, if you monetised the informal care systems and attempted to estimate their value in cash terms, the amount that they contributed to England was roughly equivalent to the total cost of the NHS. As we all understand, if those informal systems were to fail for whatever reason, the burden would fall on the NHS. If those informal systems were to be strengthened, as they should be, that would help the formal health system to become more sustainable. We need the engagement of carers and citizens as carers—and most of us will be carers at some point in our lives—within the NHS for its continuing success.
However, this is also about democracy, values and priorities. Here in England and in the UK, we have had in recent years debates about the future of the NHS—what it is and what its core values are. Those will no doubt continue. For all those reasons—the epidemiological, the role that informal care plays in our society and democracy—it is fundamental that citizens have more power. It will be interesting to hear what the Minister has to say about that.
I turn specifically to the patient empowerment review. First, I put on record my thanks to the many people who contributed from six all-party parliamentary groups and to Meg Hillier MP, who chaired the review. As we noted in that report, the NHS is ahead of the field in many ways. There are many good examples, from personal budgets to expert patients’ programmes and so forth. The NHS has been moving, but it has not yet reached a position where this is central to where the NHS is and wants to be. As we noted in the report, there are many good global examples as well. Those come from low and middle-income countries as well as from rich countries. Our simple message in the report is that we need to give renewed emphasis and investment to patient participation to improve health, satisfaction, quality and sustainability.
Let me touch briefly on two examples which illustrate that very well. The first is the pure and simple example of diabetes. A patient with diabetes—a person with diabetes—may be involved in something like 500 hours a year of self-care, but have only two 15-minute sessions with a professional. It is just as important that those 500 hours, or however many they are, are handled well and appropriately to improve health and, indeed, keep pressure off the formal health system.
I turn to satisfaction and quality. Maureen Bisognano, who is president of the Institute for Healthcare Improvement in America, has a very good expression about what the future should look like. The question between the clinician and the patient has often been, “What’s the matter with you?”. She says that the future question should be that, but also, “What matters to you? What are the things that you need in terms of your request for help, if you like, from the National Health Service?”. She makes the very simple point that most patients have complex conditions. If you have something such as Parkinson’s disease, you may have many different symptoms and, therefore, many different things that can be done to control them. It should be about your choices, not just the clinician’s choice. “What matters to you?” seems to me to be the watchword for the future.
My questions for the Minister are, first, of course: what are his plans, as the title of the Question asks? Secondly, I would like his response to the modest four recommendations that we make in the report. The first is that patient empowerment should be a top priority and that that means that all the systems and incentives should be aligned behind it to make it happen—something we have not done satisfactorily in the past. The second is to ask whether the Government will revive the revolution that was started in decision-making tools earlier this century. Decision-making tools are about helping patients to be able to make shared decisions with their clinicians. That is the area of “What matters to you?”, which I just talked about. The third is to ask whether the Government will give patients co-ownership of their records, by which I mean that they should own their health records. The only other co-ownership should be that the anonymised information is available for research. That is where we were coming from as an all-party parliamentary group. We see no reason why patients should not just have access to records—why should they not own them? Fourthly, what are the Government going to do to encourage patients to ask more questions and support them? That happens in some countries: the example we give is Denmark, which has a programme called Just Ask about encouraging patients to do just that.
With that list of questions, I am delighted to have the opportunity to initiate this debate and look forward very much to hearing what noble Lords have to say.
Baroness Pitkeathley (Lab)
My Lords, there are few Members of your Lordships’ House who know as much as the noble Lord, Lord Crisp, about the NHS, so I am grateful to him for his focus on citizen and patient power—and indeed, carer power, which he mentioned, something with which I have been concerned for much of my working life. I declare an interest as the current chair of the professional standards authority, which prides itself on being patient-centred and public-centred and being a strong, independent voice for patients in the regulation of healthcare professionals throughout the United Kingdom.
However, I want to start with a personal experience about changes in attitudes to patient involvement. I started in the mid-1980s, when I was first diagnosed with cancer. A young registrar came to my bedside and, with no preparation whatever, told me that the tumour they had removed was cancerous but that I was absolutely not to worry because almost 40% of his patients made a full recovery. I gathered my wits and asked him what I could do to ensure I was in this 40% and he leaned across, patted my arm and said, “There is nothing you can do, my dear, just leave it all to us”. I think I got better to spite him.
Contrast that with my next experience in the early 2000s when, during a prolonged stay in hospital of over six months, nothing was ever done to me by doctors, nurses or therapists without seeking permission, asking if it was okay and what my view of it was. All right, you could say that that was about me being an assertive patient, which I am, and there not being many Baronesses on NHS wards. But, as far as I could see, the same respect and attempts to involve the patient were offered to every patient, regardless of their age, background or ability to communicate. Of course, the odd consultant swept in with an entourage and attempted to talk about me as though I was not there, but that was far from general. Therefore, my personal, as well as my professional and parliamentary experience, tells me that much progress has been made. I was very glad to hear the noble Lord, Lord Crisp, confirm that.
We all know about the reports that put patients first. We know their names and could write them in our sleep. We are all familiar with the phrases—patients first, patient at the centre, listen to patients and more patients. Yet patient involvement is not the same as patient power. “How far have we have really come?” is the question that we must ask ourselves, especially in the wake of the Francis report; patients manifestly had no power at all and those who blew the whistle on behalf of the patient—their carers and their families but not the professionals who should have been concerned—were not only not believed but ignored and vilified.
It is striking that, even with the emphasis we all embrace on patient-centred care, it is still on the whole the health professionals who lead and the patients who follow. That is in spite of the welcome growth in patients’ organisations in the voluntary sector, of which there are many, as your Lordships will know. I speak as a founder member of National Voices, which has made an important contribution in that regard.
The ideas as regards patient leaders were developed by two long-term service users, David Gilbert and Mark Doughty. They asked why patients cannot lead rather than always follow the professionals when it comes to power. With that in mind, they set up the Centre for Patient Leadership to give service users the skills and confidence to lead change and not just be the beneficiaries of it. We all know how disempowering it can be to be the only patient representative on a committee—we might say the token representative. Not only is there no one to support that representative, but they do not know how the committee will work. They would not have had any input to the agenda or any idea of what is expected of them, and so on. They would know that they are there to represent the patients’ interests but would not be sure whether to represent their own interests, those of groups of patients or those of patients with particular disabilities and so on. That is a very disempowering role in which we frequently put patients and their representatives.
However, patient leaders have developed the skills and confidence to lead change. They take control of changes and improvements in healthcare, and shape and help drive that change. They become real partners in care because they share power with professionals. I commend that approach because it helps both patients and professionals to see the benefits that can be gained in terms of patient care.
Power must go with responsibility. Patients must understand that they must keep their appointment times, must let someone know if they cannot attend and must take medication in the prescribed and agreed way. Giving patients power means professionals have to give some away. That is how the power balance works. We know that many are still reluctant to do that but there can be no let-up in our efforts to make progress in this area because of the benefits which can be gained, as the noble Lord, Lord Crisp, reminded us.
Finally, the noble Lord, Lord Crisp, tempted me to talk about carers. If you engage with carers and empower them, unbelievably, you get cost savings. All the research shows that they habitually ask for less support than the professional thinks is necessary. Progress towards that kind of empowerment makes very sound economic, as well as moral, good judgment.
Baroness Brinton (LD)
My Lords, I thank the noble Lord, Lord Crisp, for initiating this interesting debate on citizen and patient power. In the brief time available I want to focus on an issue that I believe is more likely to produce real reform in the NHS than many structural changes.
Before doing so, I must declare my interest as a patient with a chronic illness—rheumatoid arthritis—and it is RA Awareness Week, to get the plug in. I have some knowledge of my disease and its consequences and read up on treatments and their side effects. Later on I will talk a bit about the expert patient programme and it will be obvious that I am a convert to it.
First, however, let us go back 50 years. In those days, doctors liked the bedside manner approach, key to which was putting patients at their ease. It certainly was not intended to give patients more power in the NHS. The picture that comes to mind is of James Robertson Justice as the paternalist consultant, patting a patient on the knee and saying, “Don’t worry your pretty little head about it, my dear, that’s my job”—rather like the consultant mentioned by the noble Baroness, Lady Pitkeathley. The good news is that things have improved greatly, but sadly it is also patchy.
Empowering patients about their health issues and treatment seems to have been introduced first in chronic conditions, where a range of healthcare professionals are involved, and frankly, where it is in the best interests of the NHS to make patients more involved in their treatment, whether informally or in a more formal system such as the NHS expert patient programme. In April this year the Health Foundation published a thought paper by Dr Alf Collins, a clinical expert in pain management. This brief 12-page paper is well worth the read: it is a revelation. Right at the start the Health Foundation sets out its goals for,
“a more person-centred health care system. One that supports people to make informed decisions about and successfully manage their own health and care, including choosing when to let others act on our behalf”.
It goes on to say:
“This requires a change in behaviour and mindset from patients and clinicians, supported by a system that puts patients at its heart”.
Let me give you two brief examples of people that I know, to illustrate the difference between the more usual and traditional patient-reported outcome measure, versus the person-centred patient-reported experience measure.
Jane—not her real name—has a chronic disease with pain and fatigue. She is finding her new medication hard to manage, it is making her sick, and she is worried about managing her children and her part-time job. She goes to see her GP and bursts into tears, saying that the pain is excruciating, she thinks the medication is not working and she is at her wits’ end. The GP says, in a kindly way, that she wants to refer her to the mental health team for some psychiatric support. Jane goes home, absolutely convinced that the GP thinks she is mad and does not believe that she is ill at all. Jane's story is real; in fact, yesterday I read it on a bulletin board. The GP was focusing on the outcome. What could she do for this patient to help her instantly? There was a magic solution: a referral elsewhere.
Contrast that with another patient. It is the same illness with the same treatment, but all the healthcare professionals involved with her care ask her questions. The GP in this case asks about the side-effects and what she wants to achieve: does she need time off work, or medication to reduce the nausea so that she can continue to work? She is reminded that depression is a common issue for people with this disease, especially for people with her side-effects at the moment. Does she want further help? The patient consultation lasts exactly the same time, but the latter patient walks away with reassurance, knowing that if she needs more help it is available, and with a prescription for the nausea so that she can try to stay working, which should also help to reduce the depression. This, too, is a recent story—it is mine.
The latter is a patient-reported experience measure and is great for the patient. It is worrying for commissioners, though, because most commissioning is based on clear, achievable outcomes—referrals, medication, operations—rather than the softer and qualitative experience measures. A typical NHS expert patient programme provides patients help with dealing with pain and fatigue; relaxation techniques; healthy eating and exercise; how to communicate with their family, friends and healthcare professionals; and how they can best plan for their future.
Research into expert patients shows that they need fewer interventions, are less anxious, more confident, can communicate better with healthcare professionals, take less time off work and are less likely to suffer acute episodes requiring expensive admission to hospital.
I agree with the noble Lord, Lord Crisp, that England may well be ahead of the curve. A French consultant gave a Gallic version of James Robertson Justice to my mother-in-law just last year, even though she is a retired nursing sister with 40 years’ experience of the NHS and speaks fluent French. What I like about Dr Collins’s paper for the Health Foundation is that it sets out clearly for healthcare professionals how they can move to this different mindset. What is particularly encouraging is that it really helps patients and saves money. What is not to like? Let us hope that this is the sort of thing that moves us to real patient empowerment in the future.
Baroness Masham of Ilton (CB)
My Lords, I thank my noble friend Lord Crisp for obtaining this debate and for all that he does in promoting better health globally. I have heard the Government say so many times that we should have a patient-centred NHS, but two weeks ago, when I chaired a session at the Westminster Health Forum, one of the delegates brought up a problem that some commissioners are not co-operating and working with the third sector, which did not feel welcomed. It is important that everyone working for the good of the NHS should work together and communicate with one another. The NHS should appreciate voluntary organisations for all that they do.
This year, we celebrate the 40th anniversary of the Spinal Injuries Association, which is a self-help organisation. I quote a rhyme:
“Humpty Dumpty sat on a wall,
Humpty Dumpty had a great fall;
All the king’s horses and all the king’s men
Couldn’t put Humpty together again”.
I feel that we who are spinally injured, resulting in paralysis, are Humpty Dumpties. Across the world, expert neurologists and orthopaedic surgeons have not been able to mend or regenerate the spinal cord. Our full members of the SIA are spinally injured people, but we work together with our associate members. We always felt that the voice of our members should be heard and not diluted by others who had not experienced being paralysed and all the difficult consequences that follow.
SIA does its best to support its members. It publishes information, trains lawyers on the needs of paraplegia and works with interested professionals. It has a library, peer support for new members and a helpline. It campaigns for the much needed specialist services. There is also a parliamentary group.
There is a need for ongoing research so that one day a way of mending and regenerating the spinal cord will be found. We are vulnerable Humpty Dumpties. We have unfortunate accidents too easily. I have broken my legs in three separate incidents, including one getting stuck in a fire door in your Lordships’ House. More recently, last Tuesday, my friend and colleague, the noble Baroness, Lady Wilkins, went to use a lift in another place. The lift was not level, with a substantial drop on the inside. The noble Baroness did not see this and fell from her wheelchair. She was picked up by two Members of Parliament. Not knowing whether anything was broken, she went to the Charing Cross A&E department at about 10 pm. She was not seen until about 3 am, by which time her condition had deteriorated, and she was not in bed until 5 am. The clerk who took details in A&E, when told that the noble Baroness is a paraplegic, had said, “What is that?”. Unfortunately, the noble Baroness has fractured her femur and both legs. There are complications from being paraplegic and having weak bones with a Humpty Dumpty body.
I give this as an example of how important it is that citizens and patients are given more power in the NHS so that their needs are heeded and understood and that specialist services are available when needed. There is a desperate shortage of spinal beds at the moment, especially at Stoke Mandeville Hospital.
As a citizen, the noble Lord, Lord Fowler, is an advocate for people with HIV/AIDS. He has just written a book, AIDS: Don’t Die of Prejudice. The Patients Association, of which I am a vice-president, is about to launch its “one million voices” campaign concerning what the public think of the NHS. Relatives did speak out about the disastrous situation at the Mid Staffordshire NHS Foundation Trust, but they were not listened to. How are the Government going to change the culture of professionals not listening to worried people? There should not be fear of giving citizens and patients more power in the NHS. They are the people who can change attitudes and will support the NHS.
Baroness Murphy (CB)
My Lords, none of us can listen to the noble Baroness, Lady Masham, talking about the noble Baroness, Lady Wilkins, without being moved and horrified by her story. It is indeed a very sad reflection of how, not only occasionally, patients can be treated quite appallingly in the NHS, and I speak as somebody who has worked in the NHS all my life.
There seem to be three sorts of power relations in the NHS. We have been making enormous progress in some of the areas that the noble Lord, Lord Crisp, outlined, as mentioned by the noble Baroness, Lady Brinton. We have thrown ourselves at developing patient involvement groups, voluntary organisations and pressure groups, encouraging them to get involved and to try to change the agenda of the NHS to being more patient-focused. Shifting the perception of clinical outcomes to patient perception outcomes is of course crucial.
We have had the major initiatives on personal budgets, which are very positive, and we have also had, for example, NHS Choices websites, where you can now, TripAdvisor-fashion, comment. I know that GPs take that seriously because I had an e-mail from my own GP in Norfolk—he e-mailed every patient, I might add—saying that he was having difficulty recruiting a partner. He was worried that his ratings on the NHS Choices website were not very good for the practice. He asked whether, if any of us had had good experiences, we would like to comment, which of course we all did. He is now one of the top-rated GPs in the whole of Norfolk. I approve of having a TripAdvisor-type website but we must not take it all too seriously. We have to find other ways of having real surveys.
These sorts of patient powers where groups of patients make a difference, and citizens make a difference through enabling groups, are a substitute for the other, more important power which comes through knowledge of the expert patient and indeed through knowledge from the web. Certainly, there has been a dramatic improvement in people’s ability to access really good information on websites. For example, you can now get cancer information from Cancer Research UK in a very accessible fashion and from the websites of other voluntary organisations. Macmillan has a wonderful website, too. I typed into Google “patient power”. When you do that, you get a wonderful American website run from Seattle which gives information. When my husband was recovering from prostate cancer, I remember that the most important information we got about the rehabilitative phase came from an Australian website called “You Are Not Alone”. It was about men talking about how they managed and it was absolutely wonderful. There was even a section where wives, spouses and partners could comment, which was great.
I want to talk briefly about the other structural problem. This is where I will tread in very dodgy waters and no one will like what I have to say. It probably refers only to access to GPs and A&E. There is a structural problem caused by there being apparently no relationship between what we pay for and what we get. Of course, the vast majority of the population understand that we pay for the NHS out of our taxes, but it is desperately remote. Staff still behave as though they were a charitable clinic dishing out paternalistically to the grateful masses.
The question arises of how we get patients to act more like consumers when they often feel very vulnerable. They also need to feel that they have a stake. I remember being extraordinarily impressed when I first went to the States. I am not by any means praising United States’ healthcare to the roof, but because people have to pay for insurance or care at point of access, Americans have a deep and abiding interest in their own health and that of their children. I remember meeting young women who were my age and being extraordinarily impressed by what they knew about their own health.
We are one of the very few countries where the relationship between us and the GP or doctor in A&E is one of supplicant and provider. It is because we do not make a small direct charge. Let us face it: there are charges within the NHS although not many people pay them. A small contribution for access would make a difference to how you are likely to perceive your immediate relationship with a doctor or nurse. Most people now use private chiropodists; even those who have very little money. They go along to a foot care place run at a supermarket or in Boots and get direct treatment. They do not wait for an NHS chiropodist these days: they organise it themselves. They feel that they are getting the service they make a contribution to and that they are making a choice.
I know that this raises enormous concerns, but we are now in a minority of countries in western Europe and in liberal western democracies that do not make that charge at the point of access. That discourages people. It diminishes and belittles what they need to know to look after their own health and shifts the power base too far towards the professionals who deliver it. We need a little bit of patient power through a little bit of a contribution. It is politically very unpopular, but I believe that it would make a difference just as it does in the way you feel about going to see a doctor in western Europe. It is quite different from how you feel when you go to see one in Britain.
Lord Hunt of Kings Heath (Lab)
My Lords, it is a great pleasure to wind up on this side and to respond to the noble Lord, Lord Crisp. I am sure that we are all very grateful to him for the work that he has done and the initiative that he has taken today. I very much echo his point that there seems to be a global movement in health where there has been a move from what he described as professional development to patient and citizen development. That is to be warmly welcomed. He also referred—and the noble Baroness, Lady Murphy, backed him up—to the power of technology. None of us has really woken up to the impact that technology will have in the future and its ability to give individuals much more control over their own destinies. We are just on the edge of a revolution that will force the pace of change, even in the most conservative reaches of the health service.
Early this morning, I was at a meeting of regulators to discuss whither the Law Commission Bill. It was interesting that the chief executive of the GDC referred to one of its new roles as being to pick up complaints from patients on Twitter when they had just been to a dental surgery. That was an interesting illustration of how we need to change to adapt to new circumstances.
The noble Lord, Lord Crisp, also made the point that our main clientele for the future will be people with complex conditions, yet we still seem to find it very difficult to organise services around those patients. A recent paper by the NHS Confederation looking at the challenges for 2015 says that,
“the health service largely operates as it did decades ago, when the predominant need/expectation was treating episodic disease and injury rather than providing long-term, often complex, care”.
I have been very interested in the work of the Royal College of Physicians in looking at the new hospitals of the future. Essentially it is saying that we need to build those hospitals around people who have complex conditions and that, instead of the ever increasing drive towards specialisation, we need general physicians to look at the patient in the round. The question I put to the noble Earl, Lord Howe, is: to what extent can the Government encourage the health service rather to re-engineer some of its services so that it is built round the patient, particularly the patient with complex health needs?
My noble friend Lady Pitkeathley referred eloquently to carers and the noble Baroness, Lady Brinton, made very good points about expert patients. My noble friend used the term “patient leaders”; I would love to see more on that idea and I hope that the Government can give some support to it. The noble Baroness, Lady Masham, referred to the very unfortunate events concerning one of my noble friends. The problem with that is that the noble Baroness herself has experienced similar issues, so these are lessons that we have to take to heart.
On the structural issue raised by the noble Baroness, Lady Murphy, I understand the point that she is making about consumers having a stake. She referred to charges and then made the point that not many pay them. This is always going to be one of the issues about charges: their administrative complexity and the fact that the people she is trying to get at are those who will probably not pay because, one way or another, they will be given a dispensation. In any case, I gently remind noble Lords that, whatever the faults of the NHS, in its latest 2014 comparator of all the wealthy healthcare systems in the world the Commonwealth Fund has today moved the NHS up to number one from number two. There are obviously lots of issues relating to the ways in which it makes those comparators but this shows that we have something going for the service. If we could only add more patient involvement, it could be a very fine service indeed.
I ask the noble Earl three things. The noble Lord, Lord Crisp, mentioned the citizen but other noble Lords did not really follow him. However, I wonder whether the noble Earl could, in three ways, encourage more involvement of the citizen in health decisions in the future. First, in relation to Healthwatch, can he say how far it could be encouraged to move beyond the individual patient issue to acting as, perhaps, a representative of the public when it comes to problems with health systems in its patch? This is a real issue in the current, fragmented health service: it is very difficult to find out who is in charge and Healthwatch can play a role.
Secondly, perhaps I may raise the issue of foundation trust members. I think that well over a million people could, one way or another, count as members of foundation trusts. We have not yet made enough of their own role in holding the people who run foundation trusts to account. For instance, my own former trust had more than 100,000 members and I always thought that was a powerful way of letting patients get through to the heart of decision-making in a trust.
Finally, I come to clinical commissioning groups. I admit that I am waiting for the first letter to be received from my own CCG saying that it is in business and feels somewhat accountable to the public. CCGs may have set up token patient groups but I do not get a sense that they feel accountable to the public. I want to hear more about how we can encourage CCGs to do that.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, I am delighted that the noble Lord, Lord Crisp, has raised this important topic for debate this afternoon. I would like to thank him for sharing the report on patient empowerment by the six all-party parliamentary groups to which he referred, which I read with great interest.
Giving patients more power in the NHS involves concerted effort at every level: national, regional and local and, perhaps most importantly of all, in the consulting room itself, in the one-to-one conversations between clinician and patient. As the noble Baroness, Lady Pitkeathley, pointed out, the terrible events at Mid Staffordshire show what can happen when patients have no power at all. The deeply unfortunate experience of the noble Baroness, Lady Wilkins, as recounted by the noble Baroness, Lady Masham, is a further example. As a Government, we are committed to putting patients genuinely at the heart of the NHS, to giving them the information, tools, support and care to help them get well and stay well and to give real life to the commitment in the NHS constitution on that theme.
Involving patients and the public in health matters is something that the Government, my department and our partner organisations are firmly committed to. Indeed, there is a general consensus that patients should be at the heart of the health system and that putting the patient first needs to be made a reality.
Ensuring that patients have more say in how their care is delivered and embedding choice are key themes in the Health and Social Care Act 2012, to ensure that we genuinely put the patient first and drive improvements in quality. As part of that, involving patients and ensuring that there is “no decision about me without me” needs to become the norm, not the exception. The same applies to the very apt question, “What matters to you?”
We are passionate about ensuring that people have every opportunity to have their voices heard; that people have the opportunity to shape the services that affect them and their families; and that they are empowered to make decisions about their own healthcare and management. That is why we want everyone to be able to make informed choices about health and social care.
The noble Lord, Lord Crisp, asked me to endorse the principle of patient empowerment, which I readily do. We know that empowering patients and citizens is key to ensuring that health services meet people’s needs, that people have a better experience of care and are able to take better care of themselves; all of which—as the noble Baroness, Lady Pitkeathley, pointed out—will help to sustain the system itself, a system in which we all place so much value.
My noble friend Lady Brinton referred to the need to measure the patient experience, not just patient outcomes, and of course she is right about that. There are a number of measures for collecting information about different aspects of patients’ experience. One way of doing that, which is supported by various parts of the health system, is a validated measure devised by Warwick University.
To do all this it is vital that we understand what patients want from their care. There are a number of ways in which we do that. One in particular can be mentioned; namely, that we have received over 2.5 million responses to the Friends and Family Test in inpatient and A&E settings. That is proving to be a really useful tool in shining a light in almost real time on patient experience.
Patients must be given the chance to be as involved in their decisions about their care as they wish to be. We know that there is an appetite among many people to be more involved in their care than they currently are. Involved patients are in a far stronger position to manage their own healthcare, resulting in improved patient outcomes, a reduction in unnecessary consultations, improved patient experience and better use of resources. This is not a new agenda, and already a lot of progress has been made.
The noble Lord, Lord Crisp, asked about patient decision aids. NHS England is updating the patient decision aids as part of its work to establish a sustainable model of PDA which is underpinned by clinical leadership and partnership with organisations that can stimulate patient use and clinical buying in. Research shows that the tools need to sit within a wider system amenable to partnership, with patients and shared decision-making with clinicians as the norm. Patient decision aids comprise a shared decision-making website. That allows patients to plan their healthcare pathway. As for NHS England, the NHS Citizen programme seeks to put the patient voice at the heart of the decision-making that NHS England itself undertakes. That is a commitment from NHS England.
I am struck by how much engagement has taken place throughout the healthcare system in the past year, with a diverse range of people and organisations: patients, carers, the public, the voluntary sector, social enterprises and the community sector. It is important that we get this right, and we must engage the support of the public and other stakeholders in doing so.
The noble Baroness, Lady Pitkeathley, referred to carers as citizens, and of course I agree fully with her. It is important to gather the views of carers through a number of feedback mechanisms, including the Friends and Family Test and the GP Patient Survey. We have to understand the particular needs of carers to ensure that we can tailor the support that is required. NHS England will be publishing commitment to carers this year.
Of course, if we are serious about putting the patient first, that involves much more than giving patients and the public a chance to shape the services, although that issue should not be overlooked. The noble Lord, Lord Hunt, asked whether Healthwatch England was making a difference. We can now see the role of Healthwatch England making itself felt, ensuring that people’s experiences and views about their care and treatment are listened to and acted on. It is providing worthwhile leadership, support and advice to the local Healthwatch network, which is promoting a local consumer voice.
The noble Baroness, Lady Pitkeathley, referred to the patient leaders concept. The Care Quality Commission aims to involve people who use health and social care services in everything it does. For example, Experts by Experience takes part in inspections of health and social care services and visits to monitor the use of the Mental Health Act. Furthermore, NHS England has invested a significant amount of effort to improve the way in which it supports people to manage their own care. There is a number of core programmes, such as personalised care and support planning, so that people with long-term conditions and disabilities can work together with their health and social care professionals. Personal health budgets will give people more choice and control, and sites have now been chosen for piloting personal health budgets for people with mental health conditions.
The noble Lord, Lord Crisp, referred to the benefit of empowering patients to ask more questions. The key to giving patients more power in the NHS is the provision of high quality and accessible health information. Already, NHS Choices helps to put people in charge of their healthcare. The noble Lord, Lord Hunt, and the noble Baroness, Lady Murphy, referred to technology. NHS Choices also includes a health apps library spanning a whole range of lifestyle and clinical conditions to help people choose apps that are safe to use. As part of NHS England’s work to give patients access to their records, the Patient Online programme’s accelerator sites will be testing how that is impacting on patients and clinicians. That represents a real shift in emphasis and the relationship between patients and professionals, so it is important that we test it out first. It is about doctors trusting patients to use information responsibly. Having said that we need to test it, the principle of giving patients practical ownership of their records is surely right, and I think that that work will provide the foundation for that. Of course, we would like to move faster with this critical agenda, but it is important that we do this at an appropriate pace to bring people with us and to learn lessons from trying out new ideas.
Let me pick up the theme that my noble friend Lady Brinton spoke to so powerfully. We must not forget the importance of supporting the workforce. Some are already doing an excellent job in involving patients in their care. But more widely, the right medical education and clinical training needs to be in place, because by empowering health professionals we can empower patients. The NICE standard on patient experience defines best practice in this area and provides evidence-based statements for commissioners to support a cultural shift towards a truly patient-centred service.
I am pleased that NHS England together with other organisations across the health, social care and voluntary sectors has formed a coalition, the Coalition for Collaborative Care, to make person-centred care a reality for people living with long-term conditions. Furthermore, a key part of increasing the involvement of patients in their own care is being able to measure the skills, knowledge and confidence that people have that predispose them to be able to manage their own conditions better. As the noble Lord, Lord Crisp, said, diabetes is an excellent example but we must also think in terms of more complex conditions, as the noble Lord, Lord Hunt, rightly pointed out. Working in partnership with the Health Foundation and the King’s Fund, NHS England is piloting the patient activation measure in five CCGs and the renal registry. This is an exciting development. It is a score based on patients’ responses to 13 questions that include measures of an individual’s knowledge, beliefs, confidence and self efficacy. It has the potential to drive real improvements in participation.
Finally and importantly, the move to a new health system, including the transfer of the public health function to local government, has created the potential for action on health and health inequalities to be centred on people and places. I am delighted to see how Public Health England and NHS England are working in partnership. With Healthwatch championing the needs of children, young people and adults, the health and care system as a whole is working together to make things better for everyone, especially the most vulnerable in our communities.
There are a number of points that I feel I should pick up, but in view of the time I hope that noble Lords will allow me to write to them on those points. In saying that, I would like to thank all speakers for their contributions to what has been a very fruitful debate.
Eastern Mediterranean: Turkey, Cyprus and Syria
(10 years, 6 months ago)
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Lord Sharkey
To ask Her Majesty’s Government what is their assessment of the situation in the eastern Mediterranean with particular reference to Turkey, Cyprus and Syria.
Lord Sharkey (LD)
My Lords, the Question calls for an assessment of the situation in Libya, Egypt, Gaza, Israel, Lebanon, Syria, Turkey and Cyprus. Not a single one of those countries is now without significant problems—problems which are a direct threat to the larger regional stability and an indirect threat, at least, to the West. Some of the problems are long standing; some are of recent origin; some are the consequence, or at least the aftermath, of western military intervention.
I start with Libya. Here, a tyrant who oppressed his people was removed by the power of the West. We supported the idea of bringing democracy and pluralism. We had stability and security as objectives. None of that happened, except for the removal of the tyrant. There is no real democracy, no pluralism, except in the very worst sense, no stability and no security for the people. The country is left in the grip of civil war. Can we argue that intervention was beneficial there?
Then there is Egypt. Once seen as the most promising instance of the Arab spring, the country has reverted to what looks like and feels like a pre-uprising Government.
Gaza, after North Korea, has the world’s largest confinement of people and the longest lasting. Has western policy improved the conditions of the people there?
Israel is a flashpoint for conflict locally, regionally and internationally. It is a close ally of America and the West, yet an unrepentant and serial flouter of UN resolutions. Has western policy helped the course of peace and reconciliation here? Has it reduced the dangers that the Israeli situation has generated and continues to generate?
The people of Lebanon have suffered terribly from civil war and civil strife, all connected with the root Israel/Palestinian problem. April’s House of Commons report on Lebanon made the point that instability is increasing in the country, with cross-border fighting and armed clashes between Sunnis and Shias. In addition to all this, there are more than 1 million Syrian refugees in Lebanon, a country of 4.5 million people. It is to our credit that we have already given more than £110 million to help the country with the refugee crisis. None the less, no one would pretend that the current state of affairs in Lebanon is stable. No one would pretend that the current situation is what western policy would have wanted.
As for Syria, the world knows how truly dreadful the situation is. There is in progress a three-cornered civil war. There are the supporters of Assad, the moderate opposition and the jihadist opposition, all of whom fight each other, and of course there is the appalling and widespread use of barrel bombs by the Assad Government against their own population. All this has inflicted and continues to inflict death and destruction on the entire population on a truly dreadful scale.
According to the UNHCR, 9.3 million Syrians need humanitarian assistance—that is 43% of the entire population. Some 6.3 million of these people have been displaced internally and 2.8 million have fled the country, and the UNHCR expects this figure to rise to 4.1 million by the end of this year. This mass flight places intolerable burdens on neighbouring countries. Jordan, for example, a country of 8 million people and not without its own problems, now has 600,000 Syrian refugees.
The same House of Commons report sets out some of the major criticisms of western policy towards Syria. They range from a failure to recognise the need for negotiation with Assad to western encouragement and then lack of support for an uprising, to a lack of support for the moderate opposition and an absence of military intervention.
Whatever the failings of western policy, it is surely clear that the current situation in Syria is unsustainable, getting worse and a direct threat to western interests. Here in the UK, Parliament has decided against military intervention—in my view, very wisely—but obviously we have not been inactive. We are the second largest contributor of humanitarian aid, with £600 million committed to date. This aid is a credit to UK foreign policy, but it is a patch. It is necessary but it is obviously not a means of bringing long-term stability to the region.
Then there is Turkey—a NATO member, an accession candidate and a good friend of the UK. It is now host to three quarters of a million Syrian refugees in its most sensitive border areas. Since independence, Turkey has endured long periods of unstable government, periods of military rule and very slow economic growth. All that began to change in 2002 with the victory of the AK party. The country has prospered. It has become a true regional power and seems to have moved past the possibility of military intervention in political life. The regime has demonstrated that a large, Islamic country can operate a democratic and economically successful society.
All this, of course, is critical to the interests of the West. It is directly in our interests to have a strong, prosperous and stable Turkey as a NATO member and committed to democratic values. But Turkey is now under immense strain. Until very recently, Turkey had been largely driven by an admiration of and respect for western values. This admiration and respect is in decline. Turkey continues to imprison journalists and restricts freedom of speech. Its Executive interfere in the police and in the judiciary, and their tone with their own people has grown increasingly hectoring and peremptory. There is growing civil unrest. There is the unresolved Kurdish question, which is not made easier by the events in Iraq. Turkey appears to be turning away from the EU. Many Turks see the prospect of EU membership as neither realistic nor desirable. The glacial progress of EU accession negotiation feeds this point of view.
As a friend of Turkey, I am very glad to be able to say that Her Majesty’s Government remain strongly in favour of Turkey’s EU membership. We must continue to make the case to our EU partners for Turkey’s membership. Turkey sits at the fulcrum between the East and the West, as it always has. It needs the West’s encouragement, empathy and help as it faces internal difficulties and very great difficulties on its borders with Iraq and Syria. The West needs to be sensitive to Turkey’s alarm at the prospect of a Kurdish state straddling these countries and to the prospect of a prolonged Sunni/Shia conflict in the region drawing it into dangerous interventions in Iraq and in Syria. The West needs to help or, in our case, continue to help Turkey.
Where we can help to solve problems, we should. Cyprus is a case in point. The island has been divided for more than 40 years. In those 40 years, talks for reunification have been an enduring feature of political life, without any success. The Annan plan of 2004 was the last and most comprehensive proposal for a settlement. It was enthusiastically accepted by the Turkish Cypriots and comprehensively rejected by the Greek Cypriots. The reasons for rejection have been intensely analysed. Essentially, the Greek Cypriot political elite and the Greek Cypriot people saw no benefit to them in the proposals, so they voted against.
We are now in the middle of a renewed negotiation. Many see this as the best and final hope for reunification. It is clear this time that both sides must see the benefits to them of any proposal for reunification or—as the Turkish Cypriot chief negotiator, Dr Kudret Ozersay, puts it—they must at least see the real harm to their interests that rejection would bring. The negotiations are by Cypriots for Cypriots, as they should be, although the benign interest of the UK and recently of the US has undeniably been of some help.
I particularly commend the FCO for its bold step in inviting the Turkish Cypriot leader and his chief negotiator to London. This is the first time that an official invitation has gone to Northern Cyprus and it is a helpful and very imaginative step on the part of the Government. I urge the FCO to continue to do all that it can to provide any welcome assistance in and around these negotiations. Cyprus is, after all, a Commonwealth country and an EU member state, and we are a guarantor state. I ask the Minister to tell the House this afternoon what steps the Government are taking to help and what progress is being made in the nomination of a UN replacement for Alexander Downer. Does she agree that it is vital that a choice is made very soon?
In conclusion, I return to some of the larger questions raised in the summary of the situation in the eastern Mediterranean countries. It is clear that the whole region is unstable and becoming more so; that we are witnessing a religious war between Sunni and Shia; and that the situation in Iraq and in Syria has profound consequences for the whole region and for the West. This weekend, Tony Blair argued that the situation in Iraq is not the consequence of our illegal invasion, which strikes me as nonsense. But it is surely indisputable that the current state of affairs is not desirable and not in conformity with western policy objectives.
If stability, the rule of law and justice are the policy objectives, western policy has not delivered very much of them. I acknowledge our outstanding humanitarian efforts and our belated military restraint. I acknowledge too our occasional willingness to be bold. Today’s announcement about our relationship with Iran is a case in point. But I ask the simple question: what else can we do? If stability, the rule of law and peace, and an end to cruel oppression are among the West’s policy objectives for the region, what do we do now that is different?
Lord Howell of Guildford (Con)
My Lords, I feel privileged to follow the masterly survey by the noble Lord, Lord Sharkey, of this tumultuous and fragile region. I think he is quite right, while taking us around the whole area, to avoid going too deeply at this stage into the even greater turmoil of the Syria-Iraq situation and the beginnings of the end of the post-Ottoman settlement. That is a major issue with huge implications for this country and requires in due course a full day’s debate in your Lordships’ House on all the implications that flow from it.
I will concentrate on a narrower aspect today, and simply ask: what can we in the West salvage and what further can we pick out in the way of a winning thread for the UK’s strategic interests from this general situation in which there is so much turmoil and grief and, I fear, more grief to come?
One slightly more cheerful aspect is that the region as a whole is changing very fast. Issues which seemed intractable only a few months or years ago are beginning to change. One aspect of that new scene is the energy dimension in the eastern Mediterranean, with significant new gas resources discovered off Cyprus, Israel, Lebanon and offshore from the Nile Delta, in which Turkey is also very interested. I think that the Lebanon aspect has to be put on the backburner for the moment, regrettably, because of its political difficulties. It does not yet have a president and its politics are very tricky indeed. As the noble Lord, Lord Starkey, reminded us, it has been almost submerged by a colossal influx of Syrian refugees. I do not think it will be able to carry forward new policies for developing its offshore resources, but the others can. Israel has gone fast ahead already with gas from the Tamar and, shortly, the Leviathan fields in very large quantities, which could be exported through an Israeli pipeline, possibly through Cyprus, north and south, into Turkey or by other means. So there are new chess pieces on the board quite suddenly. I should like the Minister and her colleagues to think about how they can be rearranged and what could be gained from them.
What are the new pieces on the board? First, Turkey continues to want to join the EU, but it wants a reformed EU and finds the present, protracted process, which has gone on and on with chapters opening and closing, humiliating. Secondly, both Northern Cyprus and the republic want to be in on the gas developments when they come. They may be anticipating the benefits a little, but the gas is there. Thirdly, Egypt also wants access to gas in its region, the Nile Delta. Indeed, Israel is now supplying gas to Egypt, which is a remarkable turnaround from the situation that used to exist, when Egypt was supplying gas to Israel.
Anything which helps Egypt at this stage to meet its colossal economic difficulties and which stabilises it is something we should support. Some of us have just had a chance to talk to General Fattah al-Sisi, the new president. It is clear that if Egypt can be a rock in this region, there is a chance that some kind of stability can be injected into the region generally, but if Egypt fails, we are looking into a black pit. After the disastrous wobble that some people had over Mr Morsi, who was clearly a major setback for Egypt's recovery, we should now be quite clear in our support for General al-Sisi.
Israel wants to diversify its export routes. The north and south Governments in Cyprus want to move, as the noble Lord, Lord Sharkey, reminded us, but negotiations are extremely slow. I had a chance to hold some talks with Mr Özersay, the TRNC negotiator, and he explained to me some of the difficulties the other day, but there is a will to make progress.
All this creates a possibility of a sort of grand bargain for the region in which Britain could play a useful and even beneficial part. Britain should support Turkey on EU reform. We are natural allies in wanting to be in the European Union, at least from my point of view, but it needs to be a reformed European Union. I think practically everyone is agreed on that.
We could ask Turkey to be supportive and to encourage TRNC to move positively, as it is already trying to do, and we could urge the republic in the south to be readier to share gas with the north and with Turkey. We could ensure that British companies are fully involved. Just as a warning, Russia is already there, signing agreements with Israel and obviously very involved in Cyprus and in its recovery from its financial woes. We could remind Cyprus that it is a member of the Commonwealth and to look for its needs for finance to the rich Commonwealth countries for investment, which it badly needs. I do not think that Cyprus will get enough gas to build an LNG export plant as it hopes, but certainly some gas developments are possible. Some gas could come from Israel for export.
There are plenty of snags and territorial sub-sea border disputes in all that I am saying. It is not straightforward at all. But it is just possible that out of it the Cyprus reunification process, which some of us have been involved in for more than half a century, could at last begin to go forward. That would extract one win out of a generally deteriorating situation in which of course the so-called Arab spring is turning out to be far from a spring and more a scene of Arab anarchy and difficulty which we now have to tackle with renewed skill and diplomacy—of which Britain has a plentiful supply. We should use it and not be ashamed of the fact that we know rather more about this region than almost any other country.
Lord Anderson of Swansea (Lab)
My Lords, I congratulate the noble Lord, Lord Sharkey, both on his choice of subject and on his tour of the horizon. I also have great pleasure as always in following the noble Lord, Lord Howell. I make two points on the question as drafted. Asked for an assessment of the eastern Mediterranean, I am less optimistic than the noble Lord, Lord Howell. I think that the answer should be “Dire, with few signs of hope”. Clearly, the question was drafted before the recent advances of ISIS in Iraq, which will perhaps be a day’s debate at some stage. Not to mention Iraq and to particularise the other three contraries is like Hamlet without the Prince of Denmark. It shows the pace of change and the unexpected and unforeseen in the Middle East.
I am also a little puzzled why these three countries were particularised. What is the nexus between Cyprus, Syria and Turkey? All are so very different. Perhaps the gas fields are one element of the nexus, as the noble Lord, Lord Howell, said. Perhaps in the Middle East all problems are interconnected. Cyprus is a good friend and a member of the European Union and the Commonwealth. Our hopes are at last renewed of a settlement with President Anastasiades who was of course a yes man in the 2004 referendum. Syria is torn in so many different directions and the military balance is now appearing to shift a little in favour of the Assad regime. There is a desperate refugee and IDP problem.
Turkey is moderate and a good ally although there is currently some slippage in terms of human rights. We have to pose the problem: is the aim of EU membership still realistic? Are we perhaps moving—because also of the cooling in Turkey itself—to something close to Chancellor Merkel’s idea of a privileged relationship? Perhaps the freedom of movement provision is one of the key obstacles. Certainly, I have spoken to Turkish businessmen who still wish to be part of the European Union and recognise, given the sensitivities of immigration today, that the freedom of movement may be put on hold for some considerable time.
Overall, the picture is depressing. I recall an article in yesterday's Financial Times by Richard Haass entitled, An Abrupt Awakening to the Realities of a Recast Middle East.
He concluded:
“The only thing that is certain is the old Middle East is disintegrating. The question is what takes its place”,
so I venture a few brief reflections.
First, traditionally Israel is blamed for all the troubles in the region. Clearly, looking at the current turbulence, even the most arch-critics of Israel cannot find its fingerprints in all the many problems which are self-standing. So far as the Middle East peace process is concerned, the Kerry initiative is dead. We commend his valiant efforts but what will follow? Will there be any chance of EU unity, as there was not over the Palestine question at the UN General Assembly 20 months ago? We understand the Israeli priority of security, yet part of the problem is posed by asking the question of Prime Minister Netanyahu: what is your aim or vision for the region in 10 years’ time? Answer there is none, probably, because he simply wishes to keep the ship afloat. He is a man with no serious wish to look long and that is part of the problem, apart from the obvious fact that there are no interlocutors on the other side with whom he can seriously deal.
Secondly, history is not dead. As a Welsh nonconformist, I remind myself from time to time that Armageddon is sited somewhere in Israel, in Har Megiddo. It is important to understand that each of the countries has its own burden of history. I recall when I first came across the Sykes-Picot agreement of 1916 and was told by Syrians that in respect of Lebanon, “We are two countries but one people”. I ask the Minister: is it now clear that we accept that a redrawing of the map of the region is in prospect? Are the old colonial frontiers, which ignored geography and demography, now being redrawn by force of arms? Is that development necessarily against our interest and it is possible that redrawn, more rational boundaries will be more stable? What prospects are there for a division of Iraq and Syria on the lines provoked by the jihadists and where will the Kurds fit in? I hope that the National Security Council and the planners in the Foreign Office—those who ponder imponderables—will be looking rather carefully at possible scenarios in the region.
My third reflection is that the hopes raised by the Arab spring have clearly been dashed. We see signs of reappraisal now in respect of President Assad. I recall that the noble Lord, Lord Wright, was almost on his own in the past but now some, at least, are seeing him as the lesser of two evils. Given what is happening in Iraq perhaps Saddam Hussein, with all his violence, may also have been the lesser of two evils. How does the Foreign Office respond to this? The Arab spring began in Tunisia, which is now the only good news country in the region. Why? It is because it was prepared to compromise and seek in some ways a consensus. By contrast, Egypt is proceeding very much in the other direction. Just as President Morsi was not inclusive so, alas, the Muslim Brotherhood which, like it or not, are a significant force in Egypt, have been totally marginalised and their activists imprisoned. There may be stability but it is a short-term stability.
One thing is clear. We in the UK and Europe have interests in the region in terms of migration and terrorism from the jihadists, who may return. There are also humanitarian interests. How do we respond? Yes, it is by being realistic and recognising that outsiders have a relatively marginal role. We should recognise, too, that intervention is not in fashion nowadays and that our financial contribution will be limited compared with that of the Gulf and the IMF. Our contribution will surely be in governance and technical issues while encouraging, so far as we are able, inclusiveness in those countries.
Iran is central to the regional problems, and I welcome the Government’s initiative. The nuclear talks began yesterday. They have to finish by 20 July and then there is likely to be a rollover, beginning again in October. There is the problem of encouraging Prime Minister al-Maliki to be more inclusive, a need to keep Jordan, weak and burdened by refugees, as stable as possible, and a need, pace Ukraine, to engage Russia in the region and to work with it. The noble Lord, Lord Sharkey, particularised three important countries. Turkey, of course, is a moderate NATO ally and a key player. The assessment must surely be that there are relatively few signs of hope: the foundations in the Middle East are shaking. Overall, there is a need for far-sighted diplomacy on our part and that of our European and US partners. We need to seek to build bridges so far as we are able and encourage a spirit of inclusiveness and consensus in a region which, alas, knows little of it.
Baroness Hussein-Ece (LD)
My Lords, I, too, congratulate my noble friend Lord Sharkey on securing this very timely and important debate. I shall not touch too much on the situation in Iraq because, as we know, the situation there is fast-moving and things will probably have moved on by the time I sit down.
Therefore, I shall focus mainly on Turkey, which is too big and influential a power to be ignored. No matter how much its relations with key countries in the region are strained—which can at times make Turkey appear irrelevant—no country in the region or in the West can genuinely say that they are not taking into account Turkey’s stance while shaping their policies.
Turkey’s successful economic policies have allowed more Turks than ever to share in the country’s prosperity and join the ranks of the middle class. This middle-class emergence, enabled by the AKP, has changed the nature of politics in Turkey as more are demanding a liberal democracy.
Turkey’s huge economic success over the past decade has been greatly admired and respected around the world, and nowhere more than in the Middle East, where it is seen as a role model for many countries going through their own Arab spring in an attempt to shed their dictators. It is a secular Muslim-majority country which is democratic.
It is not that long ago that Turkey’s established foreign policy was “zero problems with its neighbours”. This now appears a distant aspiration with the recent shattering events that we have seen. Turkey’s geostrategic positioning and its involvement in developments from Iraq to Syria and from Afghanistan to Egypt make it a power to be reckoned with.
In 2012, I attended the Ditchley Foundation lecture given by the Turkish Foreign Minister, Ahmet Davutoglu. He started memorably recalling Winston Churchill’s words:
“The farther backward you can look, the farther forward you are likely to see”.
He said that it was impossible to establish an order for the future without relating this closely to the past and the present. He emphasised the importance of history and geography as two permanent parameters for any country which could not be changed. He went on to say that he was well aware that his statement about the aim of Turkish foreign policy being “zero problems with her neighbours” had been criticised as Utopian, but he had, rightly, wanted to create a new and less fearful mentality. He said that neither Russians nor Greeks—nor should Armenians—simply be identified as big enemies for Turkey. He acknowledged that there were now serious problems with Syria—we should remember that this was three years ago—but they were not Turkey’s fault, and he felt that they did not invalidate his approach. Turkey wanted to be on the right side of history, with the Syrian people.
Turkey has for a long time been pursuing a proactive policy in its neighbourhood, including in the Balkans and central Asia as well as in the Middle East. She has actively pursued new agreements with Greece, although negotiations with the EU have, sadly, gone nowhere. However, Turkey continues to pursue a proactive policy in all other parts of the world, opening new embassies and developing relationships in Africa, Latin America and the Far East.
As Turkey grows and becomes a more dynamic economy with a dynamic middle class, it needs new markets. Until 2009, Turkey had had only 12 embassies in Africa. Now it has added another 21 and more are planned. The only foreign embassy in Somalia is that of Turkey. There are half a dozen new Turkish embassies in Latin America.
Turkey is also active in the G20 and has become a contributor to the IMF rescue packages rather than, as in the past, a recipient of its loans. For Turkey, what seemed Utopian in 2002 has now become more of a reality. Turkey is using its geography and history in a non-defensive and influential way. It has demonstrated relative stability at a time when the region around it has been in upheaval. Turks do much better because they have grown economically, while the world around them has melted down both in the Middle East with the Arab spring as well as in southern Europe with the eurozone crisis. The Turkish Government broke with the regime of Syrian President Bashar al-Assad and supported the opposition. For the past three years they have had to deal with a deadly civil war on their borders. That has put a strain on relations with Tehran and Moscow, which are both supporters of Assad.
The scale of the Syrian crisis is staggering: 600,000 Syrians are in Jordan; more than 1 million are in Turkey; and 6.5 million are displaced. Among the refugee population in Jordan, 90 people are more than 100 years old and 270 are more than 90 years old. The challenges remain enormous. We here in the safety of the United Kingdom cannot imagine what it must be like to be at the forefront of such a situation. At times, it is all too easy for us to call on what should or should not be done from the comfort of our country.
In April, the International Crisis Group reported:
“Turkey has built for its Syrian guests the world’s best shelters, but they are expensive, temporary and not sufficient for the continuous flow”,
and that:
“Continuous refugee flows from Syria are stretching Turkey’s capacities and necessitate long-term adjustments as well as stronger international engagement to better share the burden”.
Turkish Prime Minister Erdogan’s recent visit to Iran symbolised a shift towards Tehran and a shift in Ankara’s Middle East foreign policy. He declared a desire to stand shoulder to shoulder with Iran in combating terrorism, driven by Turkey’s evolving policy toward Syria. That is significant in terms of its implications for the Syrian conflict and for the region’s landscape, as both countries have the ability to influence the course of future events throughout the Middle East. Since I wrote that, it is interesting, given the recent crisis with ISIS, how the US has now followed the very same policy.
Throughout the 20th century, the Turkish Republic always focused and oriented itself towards the West and away from the Middle East. Iran was therefore not a central focus of Turkey’s cold war foreign policy. However, the Iranian revolution of 1979 unfavourably created tensions. Turkey’s ruling secular elite viewed Iran’s regime in an unfavourable manner. That perception was in part fuelled by Ankara’s belief that Tehran sponsored terrorist groups in Turkey with the intention of exporting the Islamic revolution to neighbouring countries. The Syrian conflict brought unprecedented tension to the Turkish-Iranian relationship. Turkey assumed wrongly that Bashar al-Assad would suffer a fate similar to that of Mubarak, Gaddafi and Ben Ali.
Prior to the Arab spring, the Turkish model was hailed across the region as a prototype for blending moderate Islamic politics in a democratic framework. Many polls found that Prime Minister Erdogan was the most popular political leader on the Arab street. Ankara’s evolving Syrian strategy has become more focused on the economic and security threats posed by continued conflict in Syria, with Turkey dealing with the menace posed by foreign jihadist militants who have established a presence on both sides of the Turkish-Syrian border.
My noble friend Lord Sharkey and others mentioned how, despite recent movement, the EU’s dealings with Turkey have been disappointing with so many chapters kept closed since 2009. I hope that the EU will start to treat Turkey in a more mature way than it has in the past.
I have a minute to say something about Cyprus. I was there a few weeks ago and I echo what my noble friends Lord Howell and Lord Sharkey said. The mood music does not look too encouraging. However, as someone who has been involved in the region and is from a Turkish Cypriot background, we live in eternal hope that one day there will be a peaceful settlement where the equal rights and prosperity of both communities will be enshrined in a peaceful solution.
Baroness Morgan of Ely (Lab)
I congratulate the noble Lord, Lord Sharkey, on securing this debate and on ensuring that we maintain our attention on the unfolding situation occurring in this difficult and sensitive part of the world. Events in the past week have underlined how vulnerable and unstable the political situation is in the eastern Mediterranean and the Middle East. The one thing that has become increasingly clear is that instability in one country in this region is bound to spill over into other countries, with violence and masses of refugees and displaced people—some of whom join up with extremist groups causing chaos in the region—fleeing their countries.
We must be extremely vigilant and do all that we can to ensure that the region does not fall further into sectarian violence, so that we end up with religious communities who have previously tolerated each other being forced to choose sides by extremists who have an interest in fuelling the situation. Ultimately, what is important is that minorities in any country are treated with respect. I will focus my comments on the three countries mentioned in the Question although I must admit, like my noble friend Lord Anderson, that I was a little puzzled by why these three specific ones were chosen.
The situation of Syria continues to produce victims by the million. The horrific statistics that the noble Lord, Lord Sharkey, pointed out underlined that. The UN stopped counting the number of dead in July last year when they reached the figure of 100,000. Millions of refugees have sought security in neighbouring countries and hundreds of thousands have been internally displaced, struggling to survive because of the widespread destruction of basic services and with vital infrastructure in a state of near collapse. Neighbouring countries, already suffering from a lack of political or economic stability, are reeling from the impact of the Syrian conflict as refugees continue to flow in.
As the conflict drags on, the inability of those neighbouring countries to cover the basic needs of refugees and the local population could easily result in a further aggravation of the humanitarian crisis. While the UK Government have been forthcoming in their support for humanitarian aid, it is worth asking what they are doing to encourage other countries to step up and take their share of responsibility. Will Her Majesty’s Government support a fresh donor conference urgently to secure the additional funds, and if not can the Minister set out for the Committee the mechanism by which she judges that the funding gap in relation to humanitarian aid can be better closed?
The question beyond this remains. We can use some sticking plaster for the crisis but the blood will continue to flow, so what is the political strategy in the area beyond aid support? We seem to have seen an end to the Geneva process, and the UN focus seems to be entirely devoted to humanitarian aid. Can the Minister inform us of the latest developments in the London 11 group?
The sham presidential election of Bashar al-Assad in June served to underline how advances by anti-Assad militants have been reversed in recent months. It will be interesting to see how events in Iraq, with the takeover of Mosul and the fear in Iran of the possible consequences, might force a rethink of how Iran reviews the situation in the wider region. The recent developments in Iraq are already affecting Syria. The advance by a few thousand ISIS fighters on Iraq has been carried out from their base in Syria’s Raqqa province.
Turkey remains a central and pivotal country in the eastern Mediterranean. One of my first votes in the European Parliament back in 1994 was on whether we should agree to a customs union. I remember vividly sitting through hours of debate. It was difficult for me because I had just finished being secretary of a branch of Amnesty International, which I joined because I had seen “Midnight Express”, a film produced by my noble friend Lord Puttnam, and I was aware of the country’s dismal record on human rights and the death penalty in particular. Turkey’s human rights record has improved significantly since then, although there have been worrying developments in recent years, with increasing authoritarian tendencies by Prime Minister Erdogan and the sharp slowdown—if not regression—of reforms essential if Turkey wants to attain EU membership. Can the Minister update us on the latest situation regarding Turkish accession to the EU? Recent developments in Turkey which undermine the independence of the judiciary and freedom of expression are of concern, in addition to lawmaking. There is an urgent need for the country to re-engage fully in the reform process in line with European standards.
Turkey has been actively engaged with developments in Syria, hosting the leaders of the political opposition in Istanbul, which has endeared it to some countries in the region and led it to make enemies of others. Turkish Prime Minister Erdogan has alienated most Arab states by siding with the Muslim Brotherhood in Egypt following the removal of former President Mohamed Morsi. He has also been slow to reconcile with Israel despite a partial apology by Prime Minister Benjamin Netanyahu over the deaths of Turkish citizens during the Gaza flotilla incident in 2010. At the same time, he is in direct conflict with Iraq and Russia over his robust support for the Syrian opposition, although, as the noble Baroness indicated, the relationship with Iran is improving.
Turkey needs Europe more than ever to stimulate structural reforms, such as modernising the education system, which is critical to future prosperity and stability. Europe remains the primary source of technology, know-how and inspiration for governance and institutional reforms. That taking of sides by a country previously defined as secular, uniquely for the region despite its huge Muslim population, has probably compromised its ability to take as leading a role as it might have hoped in the past as a pivotal state that could accommodate both western and Middle Eastern approaches. However, an interesting relationship has developed between Turkey and the Kurdistan Regional Government in Iraq. Turkey may yet be of immense importance in events unfolding in Iraq.
In Cyprus, attempts to try to attain a stable and negotiated settlement for the divided island seem to advance and then retreat over the decades. Traditional UN peacekeeping has been successful in that it has prevented the Cyprus conflict from igniting into a wider Greco-Turkish dispute, but it has failed so far to bring the two communities together, and to an extent the divisions have become institutionalised. The joint declaration reached in February gives great hope for talks, stating that a settlement would have a positive impact on the entire region, with an agreement to respect each other’s distinct identity and committing to a common future in a united Cyprus within the European Union. That has allowed the resumption of formal settlement talks to start again in earnest. There are still, however, some significant and continuing areas for disagreement on key issues such as sovereignty, territory, return of refugees and compensation for property. What is being done to speed up the process of appointing a new UN special adviser to the Secretary-General on Cyprus, which will bring a new sense of urgency to the talks? On the whole, the situation in Cyprus provides a tiny beacon of hope while the political volatility of the region seems to be worsening.
Nobody can deny how difficult the situation is in the Middle East and the eastern Mediterranean. We need to keep our focus on those innocent victims in the upheaval and crisis, and to ensure that the international community delivers the essential aid to keep them alive. Ultimately we need a political solution, and the international community needs to use all the tools it has available to ensure that the right people sit around the table and thrash out a long-term agreement which will bring peace and stability to that difficult region. The final additional question is whether we will in time see in the region the development of pluralistic democratic politics, where people live together as citizens rather than dividing along sectarian, ethnic or religious lines.
The Senior Minister of State, Department for Communities and Local Government & Foreign and Commonwealth Office (Baroness Warsi) (Con)
My Lords, debates like today’s remind me of the incredible expertise and quality of debate that are such a feature of this House. I am almost inclined to succumb to the temptation to respond without reference to any of my brief, but that may be too much for my officials.
My noble friend Lord Sharkey’s opening analysis outlined the incredibly complicated world that we face and the challenges of a modern Foreign and Commonwealth Office. It raised the question of what is in Britain’s interests and how we pursue those interests. What are our responsibilities in pursuing those interests and how, in light of what is happening in Iraq, do we ensure that we learn the lessons of the past? I heard various theories about that as I listened to noble Lords. I do not think that everything can be distilled down to a simplistic view that it can all be blamed on Western action or Western inaction. We see that we have to use our diplomacy to respond to a changing world. We have seen in Iraq over the past few weeks how quickly the situation on the ground has changed.
It was interesting to hear my noble friend Lord Howell describe the UK’s strategic interest and to work out ways in which we can salvage and further that strategic interest. One of the challenges for the Foreign Office is ensuring that we look at what we lose when we gain something. It is important to make sure that our strategic interests in that way are balanced. For example, we see clearly that it was right, despite some concerns, for the United Kingdom to raise its relationship with Iran, with which we have common interests. The announcement today of the opening of an embassy in Tehran after first appointing a chargé in November last year clearly shows that it is important for us to continue to reach out and engage.
Turkey—which was mentioned in what was a wide-ranging debate—was raised by several noble Lords: my noble friends Lady Hussein-Ece and Lord Sharkey and the noble Baroness, Lady Morgan. The UK consistently has been one of the strongest supporters of Turkey’s EU accession process. We believe that that process will benefit the UK, the EU and Turkey and will contribute to a shared prosperity and regional security.
We firmly believe that the EU accession process is the most effective way to deal with some of the issues that need reform in Turkey, as was said by my noble friend Lady Hussein-Ece and the noble Baroness, Lady Morgan. Some European partners question the logic of helping Turkey to make progress on opening accession chapters that are relevant, for example, to human rights, in light of recent events. However, my noble friend Lord Sharkey was right to say that that can become a humiliating process. We must not let that process effectively to allow Turkey to ask whether it is in its interest to continue to pursue it. We must make sure that we keep Turkey engaged, because, among other things, it has a vital role to play in building that very regional stability that noble Lords have been speaking about. We therefore encourage Turkey to align its foreign policy with the EU Common Foreign and Security Policy. Turkey has demonstrated its commitment to EU foreign policy goals through its diplomacy and peacebuilding work, for example in the Balkans and in Somalia; and the UK worked closely with Turkey on both.
More recently, we have encouraged Turkey to align itself with the EU approach on Ukraine. Of course, Turkey continues to play a vital role in the international response to the situation in Syria.
The Foreign Secretary and his Turkish counterpart, Foreign Minister Davutoglu, have regular discussions about Turkey, not least about how to check the flow of foreign fighters transiting Turkey to join the conflict in Syria. The importance of that relationship was raised by the noble Lord, Lord Anderson; we continue to work with Turkey as a key strategic partner. It was of course part of the London 11 meeting last Friday to which the noble Baroness, Lady Morgan, referred, and we are still working together to look at ways in which we can provide stronger and more cohesive support to the national coalition. The noble Baroness will be aware that Turkey hosts the Syrian national coalition.
The UK has been at the forefront of the international humanitarian response to Syria. Our total funding is now in the region of £600 million. In parallel, we continue to work with Turkey and other members of the London 11 to provide the political and economic support which the Syrian national coalition needs. Turkey is of course also providing refuge for hundreds of thousands of refugees who have fled the violence in Syria, most of whom now reside outside the designated camps. We cannot thank Turkey enough for its generosity, because it includes allowing international NGOs to use its border crossings to deliver aid into Syria as well as hosting the refugees. It is important that, in the end, we find a political solution to ensure that, someday, those refugees are allowed to return home, but we also need to work through the United Nations. A further Security Council resolution could step up efforts to deliver humanitarian aid across the border and across lines irrespective of the consent of the regime.
My noble friend Lord Sharkey referred to recent developments in Iraq, as did other noble Lords. I covered this in a Statement yesterday and, indeed, in a Question earlier today. The horrific pictures emerging of the atrocities that are being committed by ISIL are of course deeply concerning, and it is important for us to go back to what several noble Lords said: regional stability is ultimately what will fight extremism. We have been highlighting the importance of having a newly elected Government in Iraq, a Government who are inclusive and do not make communities feel that they are not part of the decision-making process, and who do not create the space for extremist groups to exploit. It is important that in both Syria and Iraq we continue to work with those forces that are there stamping out that extremism.
My noble friend Lord Howell referred to the potential that the eastern Mediterranean region can provide as an alternative source of energy. In the light of the situation in Ukraine, the importance of diversifying energy supplies to the EU is another priority, but it is difficult to see how we could realise the full potential of energy from the eastern Mediterranean without a Cyprus settlement—again mentioned by several noble Lords. The Government are determined to support the leaders of both communities to realise this important window of opportunity for a comprehensive settlement. My noble friend Lady Hussein-Ece said that she is an optimist on this, but I think that a real opportunity is being presented.
That settlement would make a substantial contribution to the security and prosperity of the region. A Cyprus settlement is also crucial to the prosperity of the two communities on the island. For those reasons, the UK will play its full part in supporting the prospects for a settlement through our active diplomacy, support to the UN good offices mission and close co-operation with our partners in Ankara, Athens and the EU. Several noble Lords mentioned the joint declaration signed in February. There is a Cypriot leaders’ meeting in Cyprus next week, which needs to agree the ambitious vision set out in the declaration for achieving progress in the settlement talks over the summer, with the aim of capturing an agreement on the core issues of the settlement in a UN Security Council product in the autumn.
I was asked about UK action to support the Cyprus settlement. Last week, the Minister for Europe gave strong political support to the two negotiators when he met them. We are providing diplomatic support to the UN good offices mission. We are also keen to see a new UN special adviser to the settlement process to expedite a final settlement. We are working closely with the UN on the acceleration of that appointment. Again, I go back to the fact that I do not think there has been a better time in several years for a lasting settlement and therefore we commend the two leaders at this point for their determination. The noble Baroness, Lady Morgan, also asked about recent events in Iraq, which I think I dealt with earlier.
It is incredibly difficult to conclude such a wide-ranging debate. Of course, Iran and Iraq were mentioned, as were Syria, Lebanon, Cyprus and Turkey. To try to deal with the situations in each of those countries in any depth while outlining the extent of the FCO and DfID engagement would be almost impossible. However, I am sure that those issues will come up in the form of subjects for Questions and debates in the coming months in this House.
I end on an issue which I have made a huge priority: that of faith and foreign policy. I have said that it would have increasing significance in terms of foreign policy, which is why I have been at the forefront of making sure that our Foreign Office is religiously literate. Only today, I hosted what I think was the 13th or 14th lecture from external and internal speakers on the issue of faith and foreign policy, when we had the pleasure of hosting Dr Rowan Williams—the noble and right reverend Lord, Lord Williams of Oystermouth. Those lectures give staff the opportunity to raise some of these issues and open their thinking.
However, we are also encouraging the officers to look at what levers faith presents. We often discuss what challenges faith presents but we should look also at what levers it presents and how we truly make sure that we take forward the human rights priority—my personal priority of freedom of religion and belief—because ultimately, if we have states and individual communities abiding by freedom of religion and belief, much of the conflict that we are seeing, both inter-religion and intra-religion, could start to be resolved. Having a deep and better understanding by being better historians and having a sophisticated understanding of faith issues will, I hope, make sure that as a Foreign and Commonwealth Office and as a Government, we face a rapidly changing world in a better way: one where Britain is engaged and informed.