Defence, Diplomacy and Development Policy

Baroness Wheeler Excerpts

Thursday 30th January 2020 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, I also thank my noble friend for securing this debate and pay tribute to his vital work across the international development field and on the all-party parliamentary group. The House will realise that I am standing in for my noble friend Lord Collins, our FCO and international development spokesperson, who was not able to be here today. He hates missing these important debates, but I know that he is with us in spirit and will avidly read Hansard as soon as he possibly can.

I also welcome the noble Baroness, Lady Penn, and congratulate her on her maiden speech. I am pleased to say that she recently became a fellow vice-chair of the cross-party Specialised Healthcare Alliance of charities, so I have the pleasure of working closely with her on these important health care services in the future, to which I look forward.

As we have heard, the debate takes place against an important backdrop. Our geopolitical relationships are being reset at 11 pm tomorrow night, when we leave the EU, and we now have a majority Government undertaking a detailed integrated review of our foreign, defence and security policy. We await its outcome but, from information being dripped out to the media, it is clear that big changes are coming, not least for defence procurement and how the UK approaches development.

I am confident that there is consensus in this House around the aims set out in the debate of striving to create “a safer, fairer, and cleaner world”. But how we utilise defence, diplomacy, and development policy to reach this ambition is more difficult. That is why the integrated review must include a wide-ranging and public consultation and not be conducted behind the closed door of the Prime Minister’s senior adviser.

Throughout our approach to each of these issues, the UN sustainable development goals must continue to be the base for all our efforts. These internationally recognised ambitions, if achieved, will put an end to global challenges, including hunger, extreme poverty, and all forms of violence against women and girls, ensuring that, in their place, every individual has access to key rights, including safe drinking water, quality education and modern energy. In the developing world these individual rights, if achieved, will engineer a cleaner, happier environment for us all.

The UK has a vital role to play in diplomacy as the promoter of a rules-based order and the international primacy of law. We must urge state actors to interact through international institutions and use these as our primary mechanism for defusing tensions and distancing ourselves from the populism which treats our self-interest and values as two combating aims. Above all, we must recognise that a co-operative foreign policy is the greatest strategy to realise national and global security. Among the unpredictable events on the global stage, which characterised the last decade, and likely the next, the UK must stand tall as a stable force for universal development, reaffirming our commitment to the United Nations as a means of peace, and exploring options available there to find a solution to the world’s crises.

When institutions fail to mitigate conflict and defend human rights, we must work with our allies to sanction those at fault and offer remedy for those who have become victims. The international stage is a platform for the UK to advance not only our own interests but our values too. The international community expects the UK to promote these values, but this Government failed to live up to them in the last Parliament. We need assurances that they will now do so. Under this Government, the UK has often shied away from enacting these principles.

In respect of the treatment of Uighur Muslims in Xinjiang province in China, for example, Amnesty International has reported that up to 2 million of them may be mass detained in political re-education camps. Uighur activists have also reported that they have been forced to denounce Islam, swear loyalty to the Chinese Communist Party and eat pork and drink alcohol, but the Foreign Office’s criticism has been contained to not much more than a whisper. Can the Minister tell the House how the FCO will ensure that UN observers have access to the detention centres in the immediate future?

On the greatest threat of all to global security—climate change—the UK must start to utilise our diplomatic standing to unite world powers on the mission to cut emissions. The Paris agreement was an opportunity to do exactly this, but when President Trump walked away, our Government chose not to step on his toes and instead gave up on those ambitions. As Glasgow hosts COP 26, the UK must begin a new chapter in climate diplomacy and show real leadership to save our planet, not least by dedicating sufficient diplomatic resources to make the summit a success. During Boris Johnson’s reign as Foreign Secretary, the FCO cut climate staff by 25%. What action are the Government taking to ensure that the summit will have the diplomatic resources it needs to ensure its success?

On development, the same principles that guide our diplomacy should also guide our development policy. Using the model of the sustainable development goals, the UK can extend beyond the principle of alleviating suffering and lay a claim to shaping the world in the vision of our values.

However, if we are to make any significant contribution to global development, the Government need dedicated focus; at the very least, we must continue strongly to support a separate Department for International Development, alongside the Foreign Office—and, indeed, a separate Secretary of State with resources amounting to at least the internationally agreed 0.7% of gross national income.

The Government must also ensure in future that any spending earmarked as aid is consistent with ODA spending rules. At present, it is difficult to know exactly how true to this the Government are, since there is often an alarming lack of transparency and accountability on spending details. All too frequently, there is not enough information on spending on certain schemes and evidence to suggest that aid has been misspent.

For example, the Government have conceded that the Conflict, Stability and Security Fund, which is partly classified as ODA spending, has supported the rule of law programme in Pakistan, which aims to

“increase Pakistan’s civilian capacity to investigate, detain, prosecute and try terrorists.”

Thus, it would not be wholly unreasonable to assume that, on this occasion, aid has not been spent on helping the world’s most vulnerable. Can the Minister detail what steps the Government will take to promote greater transparency in their aid spending?

On defence, the repeated erosion of international co-operation and institutions is endangering global security. Negotiations on nuclear disarmament and non-proliferation have stalled, undermined in part by the USA’s unilateral decision to tear up the Iran nuclear deal and its withdrawal from the Intermediate-Range Nuclear Forces Treaty. To achieve a safer world, the UK must maintain a Trident continuous at-sea nuclear deterrent as well as seek greater transparency, accountability and monitoring of nuclear weapons. We must also stay committed to spending 2% of GDP on defence, with NATO as the cornerstone of the UK’s defence policy, while looking to increase financial contributions for UN peacekeeping operations. Co-operation in the EU’s piracy and Balkans operations must also continue after we leave. Do the Government want our future security relationship with the EU to be on a case-by-case basis, or with a bespoke agreement?

Regrettably, years of government cuts and mismanagement of major projects have severely affected the UK’s capability as a global player. Recruitment and morale are in free fall across the Armed Forces and mismanagement has hampered projects, resulting in delays and increasing costs. The recent revelation of a six-year delay and £1.35 billion overspend across the defence nuclear estate is just one example. Can the Minister confirm whether the integrated review will examine how falling recruitment and morale has impacted on the UK’s ability to operate globally?

We owe all of our armed services personnel, veterans and their families the very best support, including pay rises, decent housing and new avenues for representation. Defence policy also has a role to play in tackling the new challenges of modern technology and conflict driven by the climate crisis. It is not good enough for the Government to indicate intentions without the drive to take a lead in developing international agreements on the use of autonomous weapons and reducing carbon emissions. Will the integrated review look at the use of modern technology in warfare, and will it include the Ministry of Defence in any cross-departmental strategy to combat climate change?

This has been an excellent debate. I have certainly learned a great deal, and I thank all noble Lords who have spoken in it. The Government have a responsibility to promote our values and interests on the global stage. This crucial moment in our nation’s history should not be marked as the end of UK-EU co-operation, whether that be on defence, peacekeeping or conflict prevention. Instead, we must make a renewed effort to utilise our standing on the world stage to promote and enact our values. It is only through these means that we can contribute to building a safer, fairer and cleaner world.

Health: Neurological Services

Baroness Wheeler Excerpts

Tuesday 20th November 2012 Lords Chamber

[Baroness Wheeler]

My Lords, I too would like to thank my noble friend Lady Ford for initiating this debate. Like others, I pay tribute to her work as honorary president of Epilepsy Action and as a campaigner for improved services for people with neurological conditions. As usual, we were fortunate in this debate to have contributions from noble Lords with huge experience and expertise in this field, either as medical experts themselves or from working with health and social care professionals and expert organisations, institutions and community groups that provide such vital support for patients, clients and their carers. The debate is very valuable, because we know that we need a more holistic approach to the provision of neurological services if the barriers to progress are to be overcome and large-scale, consistent improvements are to be made at the urgent pace necessary.

Noble Lords have spelt out the facts and figures, issues and concerns very comprehensively, covering many of the specific conditions. On epilepsy, my noble friend Lady Ford drew a wide-ranging picture of the challenges to improving services and of what could be achieved given the political will to make those improvements happen. Both the noble Baroness, Lady Masham, and my noble friend Lord MacKenzie spoke of motor neurone disease—my noble friend referring to our wonderful mutual friend and work colleague who succumbed to this terrible disease, which kills an increasing number of people year on year. My noble friend Lady Gale focused particularly on Parkinson’s disease. The stark fact is that every hour, someone in the UK is told that they have this degenerating disease. The noble Lord, Lord Patel, asked some key questions about the real progress being made since the last debate, and I look forward to the Minister’s response to them.

I thank the Neurological Alliance, Epilepsy Action, the MND Association, Parkinson’s UK and the Sue Ryder charity for their excellent briefings for this debate. It is clear that much still needs to be done to allay the fear and confusion among people with neurological conditions, staff and their carers and the organisations providing support and care for them about how the new NHS structures will work, particularly the process and outcome of commissioning for neurological conditions across health and social care.

The two recent debates in your Lordships’ House on epilepsy and long-term neurological conditions and the important role played by the NHS and social care allied health professionals both took place in the early days of this Government, before we began on our marathon deliberations on the Health and Social Care Bill. Substantial reductions in both NHS and social care resources are starting to have a major impact. There is massive upheaval in the NHS as the new structures come in. Many CCGs are still in the early stages of development and are only just beginning to decide how commissioning will take place in their areas. We know that, despite Government denials, the NHS is having to make substantial cuts in resources that have already led to the loss of 6,000 nurses—including the deletion of specialised nursing posts—and the closure of many services.

In social care, many local authorities have had to make dramatic cuts to services and do not have systems in place to cope with the scale and quality of care that is needed. The recent Sue Ryder report on social care, The Forgotten Millions, spells this out quite vividly. This found that only 10% of local authorities had an agreed commissioning strategy for people with neurological conditions and only 6% categorised all specific neurological conditions.

I would quickly like to pick up on some common themes from today’s debate, starting with the issue of preventable early deaths. In epilepsy, for example, estimates show that one in three deaths is avoidable and that mortality is two to three times more than in the general population. We saw last week the publication of the Government’s NHS mandate, promising “measurable progress” against the NHS outcomes framework, rather than specific targets to reduce premature deaths or enhance the quality of life for people with long-term conditions. Will the Minister tell us, for example, how progress in reducing the number of avoidable deaths of people dying from epilepsy as a result of late diagnosis or misdiagnosis is to be measured across the two NHS outcomes domains?

Last week, my noble friend Lord Hunt expressed his concerns that the mandate was a wish list. I see that the Independent echoed this sentiment, describing it as,

“worryingly short on specifics and suspiciously free of concrete commitments”,

as well as giving,

“the unmistakable sense of a Minister expertly ensuring that he would not be blamed for any failings come the election”.

Perish the thought.

Secondly, noble Lords have underlined the need for expert commissioning for services, involving those with knowledge and experience of the treatment and nursing and care needs of patients and clients. Clarity over how services are to be commissioned in the future is urgently needed. During the mandate debate, we were promised regulations on exactly what “conditions”, “specialised conditions” and “highly specialised conditions” are. It is hard to see how commissioning planning either at national Commissioning Board level or CCG level can proceed effectively without the Government being clear and definitive about this. Will the Minister tell us when we can expect the regulations? Will they spell out exactly how the Commissioning Board is to provide leadership and direction on this matter?

Thirdly, there is evidence that the number of specialist nurses for neurological conditions is diminishing, not increasing—this when their role and cost-effectiveness is widely acknowledged and recognised. Parkinson’s, motor neurone, MS and epilepsy nurses, for example, make a huge difference by being a focal point of advice and support for patients and their carers; they signpost and provide important access to a range of therapies and other services.

With their support, people stay independent for longer, are better able to manage their own conditions, and the number of unnecessary hospital and care home admissions is reduced.

However, we know that we will be told by the Minister that provision is down to decisions made by local CCGs, hospitals and local authorities. Does the Minister accept that the provision of specialist nurses is an essential element of care for people with specific neurological conditions, including dementia and stroke? What action will the Government be taking to ensure that the number of posts is maintained and increased?

In the time left, I should like to highlight the often forgotten but vital importance of effective and dignified continence care for people with long-term conditions and its need to be integrated into care and treatment pathways. The noble Baroness, Lady Masham, touched on that issue. As I have stressed previously, this requires specialist knowledge and understanding of the different needs of continence care in primary and secondary care settings, and a joined-up approach across the full care pathway. We know that the system is too often slanted towards containment through pads and catheters rather than assessment for treating incontinence. We also know that these types of services have been undercommissioned in the past. Is the Minister confident that CCGs and social care will have the specialist knowledge to ensure effective and consistent commissioning of this service? What work has been undertaken by the Department of Health on this issue?

Finally, the need for an integrated, overall strategy for neurological diseases, which joins up and integrates provision with that for the higher profile conditions such as dementia and stroke, has been underlined. Does the Minister accept that the NHS Commissioning Board needs to show leadership on this issue, as called for by the report published by the Commons Public Accounts Committee earlier this year? Getting back to the NHS mandate, will she spell out for those of us who are still very confused how Ministers will account to Parliament over performance of the mandate generally and the provision of services for neurological diseases in particular?

EU: Healthcare

Baroness Wheeler Excerpts

Wednesday 11th January 2012 Lords Chamber

[Baroness Wheeler]

My Lords, I, too, congratulate the noble Lord on initiating this debate, and I also congratulate other noble Lords who have very comprehensively covered the wide range of important EU healthcare issues currently in the process of discussion, development or implementation in the UK. Considering these issues as a whole in the one debate, rather than tending to debate them separately as various reports or new proposals or directives come up, has been invaluable. It provides us with an overview of the key issues, how they impact on each other and how they can reach into every aspect of the NHS care and treatment of patients, research, and the working lives and training of healthcare professionals.

The cross-border health directive, which we are required to enact by October 2013, the draft directive on the mobility of health professionals, and the implications for our NHS of the EU’s proposals for revising the energy efficiency directive—with the prospect of huge expenditure and further upheaval for our NHS if, as a public body, it is to become a major driver in achieving EU energy efficiency targets—all present major challenges for the NHS, and one does wonder how well equipped it is to meet them in its current state of uncertainty and upheaval.

In view of the short time available, I want to focus on four questions to the Minister. First, on the clinical trials directive, I echo the concern of noble Lords who have pointed to the UK’s steadily diminishing global share of clinical trials. I look forward to hearing from the Minister how the Government are addressing this decline. How will the new NHS architecture impact on this, and when might we expect our share to start rising again?

Secondly, on EU procurement law, the question we need to address when we come to it in the next stage of the Health and Social Care Bill is the proper balance between planning and the social solidarity that is expressed by the NHS. We also need to consider the effect of EU procurement law on commissioning and the progressive effect of the EU procurement regime to the point where commissioning decisions and planning become victims of court cases. What is the Minister’s opinion of where the balance lies? Will he expedite the meeting that he promised with noble Lords, including my noble friend Lady Thornton, to discuss ways forward on this matter?

Thirdly, how is EU work progressing on tackling health inequalities across EU countries? What initiatives are being undertaken or supported by the Government and what are the timescales for report and development? Finally, I note that last year the UK NHS was owed more than £38 million from EU member states for healthcare treatment for their nationals, so it would be helpful if the Minister could update the House on the progress and systems that are in place to ensure that this money is collected.