Ebola

Debate between Baroness Williams of Crosby and Baroness Northover

Thursday 6th November 2014 Lords Chamber

[The Parliamentary Under-Secretary of State, Department for International Development (Baroness Northover) (LD)]

My Lords, I, too, would like to thank the noble Baroness, Lady Kinnock, for securing this debate and for so ably and movingly introducing it. On behalf of DfID, I thank noble Lords for their tributes to the department in this crisis. As I said the other day, if anything shows the importance of aid, both morally and for our self-interest, it is this epidemic. We are all globally linked and noble Lords made that point extremely clearly. I assure the noble Lord, Lord Giddens, and the noble Baroness, Lady Kinnock, that we will be examining the lessons from this crisis. Because of that global linkage, it becomes extremely important that we draw out what we can learn from this.

My noble friend Lord Ridley and other noble Lords are right that the root of this—the cause of the spread of this epidemic—is poverty. Of course, we will need to work internationally to improve and strengthen our international organisations. However, as my noble friend Lord Chidgey says, we need other countries to respond as well, not only to this crisis but to that analysis, and to take forward the ability to respond internationally.

The noble Lord, Lord Giddens, is also right that we need to make huge efforts to contain this in case we should see, as we do not yet see, a levelling off of numbers; obviously, we hope that with the measures we put in place we may be able to detect that. However, if and when we see that, we should not lessen our efforts, otherwise the epidemic will spiral further. He and other noble Lords are right about the economic effect of Ebola. As regards Sierra Leone, the IMF estimates that its GDP growth is likely to be about 6% rather than the 11.3% it had estimated before this crisis. As other noble Lords—the noble Baroness, Lady Kinnock, my noble friend Lord Fowler and others—have emphasised, the health systems we are facing here reflect the fragility of these states, which is why the epidemic has been able to take root.

We are certainly very fortunate in the United Kingdom to have the outstanding staff in DfID who are working both here in the UK and in Sierra Leone. I pay tribute to them as well as to the staff in the Ministry of Defence, the FCO, the Department of Health, from across the NHS and from NGOs who have volunteered their services in one of the most dangerous situations in the world. The audio diary that we hear on the “Today” programme should bring it home to everyone how important, but also how incredibly challenging, their work is. The noble Baroness, Lady Armstrong, spoke of health workers, and the numbers are extraordinary. Some 852 NHS front-line staff and 130 staff via Public Health England have volunteered, which is clearly outstanding.

The Ebola epidemic in west Africa continues to grow. The latest figures from the WHO as of 31 October put total cases in the region at 13,567, with 4,951 deaths. We know that that number is an underrecording. The UK has now committed a total of £230 million to the response in Sierra Leone. As noble Lords know, we are focusing on that country while the United States focuses on Liberia and France on Guinea. That sum includes the commitment to aid-match the first £5 million of the appeal launched by the Disasters Emergency Committee. I, too, pay tribute to the DEC and to the public response to its appeal. We are now the second largest bilateral contributor in this epidemic. We have committed, among other things, to provide over 700 beds. I can assure the noble Lord, Lord Alton, that the first UK 92-bed treatment hospital opened yesterday in Kerry Town. That facility includes 12 beds that are set aside for health workers who are staffing the beds, which will increase to 20. As I said in a previous answer to the noble Lord, Lord Alton, it may well be best, on a case-by-case basis, to treat a case there in Sierra Leone rather than to expose that person, if very sick, to being transported home. The intention is to be able to provide the same level of care, whether it is here or there.

As the noble Baroness, Lady Hayman, noted, ensuring safe burials is key to turning around the epidemic. With the United Kingdom’s support, International Red Cross burial teams in the western area, which accounts for approximately a third of Sierra Leone’s population, are now burying 100% of reported bodies within 24 hours. That is a huge improvement over the situation just a few weeks ago.

We are also expanding laboratory capacity and have pledged £20 million to establish, equip and run at least three new laboratories. We are also providing isolation within communities through up to 200 community care centres, which are the most effective way to prevent further spread. The noble Lord, Lord Crisp, noted that that model is innovative and unique and he is correct. The purpose is to have safe, humane isolation as the key to reducing community transmission. The faster we can bring down those transmission rates, the sooner the health system can resume functioning. Noble Lords mentioned the challenges with other diseases, maternal care and so on, which are also being undermined by this epidemic.

Some of the CCCs are to be located within primary healthcare facilities, which will allow rapid separation of patients presenting with fever—suspected Ebola cases—from others, which will allow healthcare workers to continue to offer routine services such as antenatal care, routine immunisation and other essential health services. The noble Baroness, Lady Kinnock, in particular, flagged the concerns of pregnant women who are reluctant to come in for care. Of course, the centres also help to protect healthcare workers, which, again, is absolutely vital.

We are also supporting this with social mobilisation work. I too noted the very interesting report from the BBC World Service on what it is doing to encourage behaviour change. All that work is overseen by a command and control centre to co-ordinate the response.

Many noble Lords have mentioned the weakness of the health systems in Sierra Leone and elsewhere. Of course that is, as I said, part of the root of the problem. Clearly our current priority must be to help tackle this epidemic; but obviously, we will then wish to help Sierra Leone to return to the trajectory it was on before the crisis, which was moving from a fragile state after conflict to a middle-income economy. That, of course, will include the strengthening of its health system. I note what my noble friend Lord Fowler has said about health workers, and I know the efforts that have been made by the NHS to try not to draw upon staff from developing countries such as Sierra Leone.

We are engaging with partners to ensure that other countries in the region are prepared. We are ensuring that our bilateral programmes in high-risk countries actively support national emergency preparedness. It is of course encouraging to see that, in the first instance, Nigeria was able to contain the case that arrived in Lagos, and to see the way in which it ensured that although others were affected, the virus did not spread further. However, we are constantly vigilant, because other cases may develop.

The UK is also playing a leading role in galvanising international support—a number of noble Lords mentioned that. We are very glad that, last Friday, the UK signed an MOU with Norway to establish the deployment of up to 200 Norwegian health personnel in Sierra Leone. We also welcome the Government of Australia’s commitment yesterday to manage and run a 100-bed treatment facility in Sierra Leone. The EU has pledged €1 billion towards that, and we will be meeting with all our partners to discuss bringing aid forward.

We are working closely with UN agencies, for example with UNICEF on social mobilisation, child protection and so on. A number of noble Lords—especially the noble Baroness, Lady Kinnock, and the noble Earl, Lord Listowel—emphasised the dire situation of children. We are working very closely with UNICEF to support the needs of vulnerable children, including those who have been orphaned by Ebola. We do not underestimate the challenges that they face.

[Baroness Williams of Crosby]

My Lords—

[Baroness Northover]

I am very short of time; I will be very happy to speak to my noble friend afterwards, and I will come on to her point about NATO. NATO is following closely the situation through its crisis management and civil contingency functions, and the allies are assessing whether and how NATO would add value at this stage of the response. However, I also note what my noble friend Lord Chidgey said with regard to what the military might or might not be able to contribute.

The noble Lord, Lord Patel, is right to emphasise the need both for treatments and for vaccines. I hope he will be reassured that we are prioritising both. It is immensely encouraging to see the work of the Lister Institute, for example, and the possibility of a vaccine. Clearly, it could be critical to this epidemic if that work was brought forward, but it will certainly be critical in stemming future epidemics. I note very much what the noble Lord says.

An unprecedented outbreak requires an unprecedented response. That is what we have committed to and we are encouraging the international community and all the international players in each country to play their part to ensure that this terrible epidemic is defeated. As noble Lords have said, poverty is at the root of what we are seeking to address here. That is why we have made the commitment to aid to the poorest countries, as the noble Earl, Lord Listowel, pointed out. That is what it is all about.

Women: Rights

Debate between Baroness Williams of Crosby and Baroness Northover

Tuesday 4th June 2013 Lords Chamber

[Baroness Northover]

That sounds like a very good idea. Given that the noble Lord taught me history, perhaps he will take it forward.

[Baroness Williams of Crosby]

My Lords, I thank my noble friend and the noble Baroness, Lady Hayter, for their spirited responses in this brief discussion. I want to ask about one area where, sadly, the move towards equality has been extremely slow—the finance sector. Perhaps my noble friend can say something about what steps are being taken and how successful they are in increasing the proportion of women on the boards of major banks and other finance-sector companies.

[Baroness Northover]

We are pushing very hard to increase that. I note that the number of boards in the FTSE 100 that have no women on them has fallen to six, down from 21 in 2011. We are acutely aware of this.

NHS Mandate: Health Inequalities

Debate between Baroness Williams of Crosby and Baroness Northover

Monday 28th January 2013 Lords Chamber

[Baroness Williams of Crosby]

To ask Her Majesty’s Government what steps they are taking to reduce inequalities in health provision in line with the objectives of the NHS Mandate.

[Baroness Northover]

My Lords, legal duties in relation to reducing health inequalities will apply to the Secretary of State and NHS commissioners. Local authorities must have regard to reducing inequalities when commissioning public health services. The NHS and public health outcomes frameworks will be used to monitor progress. We are working across government to address inequalities through tackling the wider causes of ill health.

[Baroness Williams of Crosby]

I thank my noble friend for her reply. In November, the BBC pointed out that the gap between the least served and best served people was widening in this country. Cancer Research UK pointed out in a recent survey that the likelihood of an unskilled worker dying of cancer was twice as great as that of a professional worker in the same region. In light of these figures, the Liberal Democrats proposed, and the Government accepted, a specific duty on the Secretary of State to have regard to inequalities in health. Despite that, the outcomes framework has among its five domains no reference to health inequalities and, despite the very strong support expressed by the public in the mandate consultation, there was no specific reference to inequalities in health in any of the recent DfH documents. Can I therefore ask the Minister directly whether she will agree that, when the review of the outcomes is made next year, a greater attempt will be made to have a specific section dealing with health inequalities and, one hopes, measuring real progress in this most difficult of areas?

[Baroness Northover]

My noble friend is right to focus on health inequalities that remain. The last Administration and previous Administrations have sought to address them, as have we. In the Health and Social Care Act 2012, for the first time there were specific legal duties to reduce health inequalities. I am slightly puzzled by what my noble friend says about outcomes, because if she looks at the public health outcomes framework and the NHS Outcomes Framework —in particular the public health ones—the two overarching outcomes are increased health life expectancy, and reduced difference in life expectancy and healthy life expectancy between communities. That is the measure against which we will judge what is done in public health.

Afghanistan: Women’s Rights and the Education of Girls

Debate between Baroness Williams of Crosby and Baroness Northover

Tuesday 26th June 2012 Lords Chamber

[Baroness Williams of Crosby]

To ask Her Majesty’s Government whether they will propose at the forthcoming Tokyo conference on support for Afghanistan that at least 25% of aid should be directed to the support of women’s rights and the education of girls.

[Baroness Northover]

My Lords, at the Tokyo conference in July we will be working to ensure that Afghanistan and its international partners reaffirm their commitments to the rights of Afghan women and children, as enshrined in the Afghan constitution. We wish to see long-term financial commitments from the international community in Tokyo matched by promises from the Afghan Government to deliver key services and policy reforms, including in the areas of human rights and equal status and opportunity for women. The Tokyo conference is not, however, the forum for detailed spending priorities.

[Baroness Williams of Crosby]

I thank my noble friend for that Answer. The Tokyo conference is the last occasion, and the best occasion, to try to change the attitude of the Afghan Government towards their handling of what is called the transformational period, the period that follows the removal of ISAF from Afghanistan next year. In the past few weeks we have had very troubling evidence of backsliding on women’s rights, including the poisoning of 120 schoolgirls for daring to attend school. All 120 of them are now in hospital.

Given all that, I ask the Government for two promises. First, will they insist that some part of the aid provided by this country—the $110 million we have committed to Afghanistan—should be devoted to the education, training and advancement of women as a condition of our aid being supplied? Secondly, there should be a transparent account of how that money is spent so that the Afghan Government cannot again escape their responsibilities in the way that, frankly, they have done all too often over the past couple of years.

[Baroness Northover]

My Lords, my noble friend is quite right that the position of women in Afghanistan is not at all as we would wish it to be. They have made a lot of progress, and we must make sure that we secure that progress and continue to make progress. As far as the UK Government are concerned, the way that DfID approaches its support for Afghanistan is underpinned by human rights, and women’s rights are part of human rights. That will continue to be the case into the future. As we look at the transformational decade that my noble friend referred to, that approach will continue as far as international donors are concerned. The protection of women’s rights is written into the Afghan constitution, and that is what is going to be expected of the Afghan Government.

Health and Social Care Bill

Debate between Baroness Williams of Crosby and Baroness Northover

Thursday 8th March 2012 Lords Chamber

[Baroness Williams of Crosby]

Before the Minister concludes, perhaps I may press him on what is implicit in Amendment 220B, although I shall not move it. If, for example, the governors were to oppose a figure of more than 5 per cent, and the figure were greater than appears to be proper in the light of health services, what steps would be available to ensure that health services are protected?

[Baroness Northover]

As we are on Report, perhaps noble Lords will allow the Minister to develop his argument and then put brief questions in the light of what he said—otherwise he will lose his train of thought.

NHS: Reorganisation

Debate between Baroness Williams of Crosby and Baroness Northover

Thursday 16th December 2010 Lords Chamber

[Baroness Williams of Crosby]

My Lords, I, too, thank the noble Lord, Lord Touhig, for introducing this crucial debate in such an effective way. I strongly agree with my noble friend Lord Rodgers of Quarry Bank when he suggests there should be more opportunities for this House—which has a very substantial level of medical knowledge which is not so clear in another place—to debate and discuss reorganisation, an issue which is still very much in the making. The greater the discussion and debate, the more likely it is that we will get an outcome on which everyone can agree.

I should like to add a personal note, and I hope I will not in any way embarrass my noble friend in saying it. My noble friend Lord Rodgers of Quarry Bank is a remarkable example of the successes of the NHS. Anyone who knows what he has climbed back from will, I think, agree with me. On another personal note, my family and I have always been NHS patients and never private patients. I have to thank the NHS for, on at least two occasions, saving the lives of relatives in the most remarkable conditions. I can find very little to fault it with when it comes to critical illnesses and accidents as compared with other health services, some of which I know very well indeed.

I should like to begin by considering the current position, and here I find myself in some agreement with the noble Lord, Lord Hunt of Kings Heath. If you read—as I hope every noble Lord will, especially those involved in health discussions—the quite remarkable report of the Commonwealth Fund, which is nothing to do with the United Kingdom but to do with the Commonwealth of Massachusetts, which is where the word comes from, you would be standing on the rooftops cheering—or at least you would if you were in any other country except our own. The report is remarkable. It shows that our NHS, along with the one in New Zealand, is almost certainly the most cost-effective system we know. Surprisingly—indeed, amazingly—it also shows that the gap between the service provided to those in very low income groups and those in very high income groups is less than in any other developed country. The gap here is 5 per cent whereas in other countries it ranges from 20 per cent in what one might call core Europe, to as much as 60 per cent in the United States. Perhaps even more amazingly, it also shows that the amount of time taken up in waiting to see a consultant or senior clinician in the NHS is very near the bottom of the list. In other services, some of which are much more inclined to be clinician-led, the time spent waiting is much greater.

We have to think very carefully about how to ensure that reorganisation improves the existing NHS and not try to indicate that the NHS has been a failure. By any international standard it is not a failure. It is one of the most remarkable, dedicated public services anywhere in the world.

There is another truly important point. It is clear that the NHS has, over more than 60 years now, won an astonishing level of public trust. The noble Lord, Lord Hunt, mentioned that. Anyone who cares to look at, for example, the recent study of social attitudes in the United Kingdom will see that the NHS is rated as being at the top of all the large public services. It is, rather sadly, ahead of education, but also ahead of almost all other public services. That means that we have to consider very carefully what we do to reorganise it. The bar has been set very high indeed in terms of public trust and public attitudes.

I should like to say one word to the noble Lord, Lord Kakkar, who is no longer in his place. There is a great importance in giving clinicians the widest public say and influence in the services that their patients can expect. I think that all of us in this House—some of us in this House are clinicians, although I certainly am not—would recognise the importance of their influence on the NHS and any other health service. Picking up on the words of my noble friend Lord Alderdice, I suggest that clinicians on their own will not be an adequate response to the need to change the health service for the better.

Wonderful men and women though many of them are, they are not, any more than the rest of us, completely immune from occasional selfish attitudes. I will give an example, which, in the spirit of a bipartisan approach to the problems of the health service, I hope even the noble Lord, Lord Hunt, might conceivably nod at. Many of us recognise that one of the things that went wrong with the NHS in recent years, apart from the increases in expenditure which were clearly good, was the unfortunate contract that enabled GPs to get very much more money and to do so without making any commitment at all to out-of-hours service. I have quite a lot of GP friends, including my own GP NHS trust, who are embarrassed at the way in which they got so much more money for less work at a time when almost all of us can expect not much more money for a great deal more work. The outcome of this debate would be improved if most of us were able to hang up for the moment our tribal loyalties and look at the responsibilities all of us owe to the NHS and to the reorganisation of the NHS. Those responsibilities are honesty, frankness and admission of our own mistakes.

I move on to what most worries me about the reorganisation, apart from the fact that it did not appear in the coalition agreement in any shape or form. Indeed, the coalition agreement specifically promised no more top-down reorganisation and, at least as important, there is reference after reference to PCTs, which would mean that anyone who read it carefully would think that PCTs were likely to survive and not suddenly to disappear.

I want to suggest to my right honourable friend the Secretary of State—and perhaps at least as much to the greatly admired Minister of State, my noble friend Lord Howe, whose devotion to the National Health Service is known to us and who we all, I think, trust and respect very deeply—that a reorganisation needs to carry with it changes that are seen by the public to be improvements. One of those was referred to by my noble friend Lord Alderdice and he is absolutely right. I suggest that clinicians look at the significance of accountability in a public service that is massively financed by the taxpayer.

The provisions for accountability are very weak and not clearly spelt out. I do not understand why it would not be possible with the White Paper to move towards a different system. PCTs are disappearing very fast, as the noble Baroness, Lady Masham, and others have suggested. Commissioning bodies should include not only clinicians but also representatives of the public, some from local areas. The noble Lord, Lord Hunt, was right when he said that there should be an executive lay chairperson whose responsibility would be to the community and not to clinicians or any other group which is bound to have its own concerns and special interests, rather than the wider interests of the public as a whole. The public would buy strongly into that kind of reorganisation. One which leaves that issue of accountability so vague and so little spelt out will not carry the trust that we need. My right honourable friend in another place who is today the Minister of State in the Department of Health, Paul Burstow, has suggested on several occasions the strengthening of accountability. The outcome has been existent certainly, but not strong. We need a much clearer system of accountability.

I will not detain the House for very much longer, but next I want to refer to my noble friend Colwyn who, in discussing the issues of NHS dentistry—I defer to him because he is much more knowledgeable on that subject than I could ever hope to be—referred to trial or pilot schemes.

[Baroness Northover]

My Lords, I hate to do this, but this is a strictly time-limited debate. When the figure seven shows, noble Lords have exceeded their time.

[Baroness Williams of Crosby]

I apologise. I did notice that it was not completely stuck to in several other speeches, but never mind. I will wind up quickly. First, if there were to be a trial period with an outcome that would be open to discussion and debate, I would support it. But that is not my understanding. I believe that these are called pathfinders and are the first wave of the reorganisation. Lastly—

[Baroness Northover]

I am sorry, but no one has got close to this length of time. I realise that this is very significant and I hope that we will come back to it in debate.

[Baroness Williams of Crosby]

I apologise. I said that I would wind up in two sentences and here is the second. I am very worried that if we do not think about the reorganisation thoroughly, we will be in real trouble with the public.