Health: Ebola

Lord Bruce of Bennachie Excerpts

Wednesday 9th March 2016 Lords Chamber

[Baroness Verma]

My Lords, I thank the noble Lord and the APPG for the useful and timely report, which draws attention to the importance of communities’ role in ownership and in delivering in crises. We agree that engaging with communities in the delivery of public health systems is essential. To provide stronger, people-centred health services that reflect their needs, we are looking at lessons learned from the crisis, and very much looking at the recommendations of the noble Lord’s report.

[Lord Bruce of Bennachie (LD)]

My Lords, will the Government acknowledge that, prior to the Ebola crisis in Sierra Leone, they were planning to cut support for health systems in that country? As the Minister said, they subsequently spent nearly £500 million tackling the crisis. Does she accept that if we are to have health systems fit for the future, we must maintain long-term commitments? Can we be satisfied that the Government have reviewed their policy, given the cutbacks that have been applied in sub-Saharan Africa in order to support the Syrian refugee crisis?

[Baroness Verma]

My Lords, as the noble Lord knows, we are currently undergoing bilateral and multilateral reviews. We will learn from that process where our future funding will go. To take the noble Lord’s point about concentrating on fragile countries, a number of the countries to which the noble Lord referred will be among the 50% that we are targeting in our support for conflict-ridden and fragile states.

Neglected Tropical Diseases

Lord Bruce of Bennachie Excerpts

Monday 1st February 2016 Lords Chamber

[Lord Bruce of Bennachie (LD)]

My Lords, I recognise the importance of tackling neglected tropical diseases, for the reasons that other noble Lords have already identified. I do not have specialist knowledge of this subject, but I had the good fortune to have on the International Development Committee Jeremy Lefroy, chairman of the all-party group, who focused on it and kept me informed of the importance of it. It is no accident that the all-party group focuses on malaria and neglected tropical diseases, because their eradication is clearly linked. That is part of the theme that I would like to take forward. There should be no conflict between the silo approach to tackling specific diseases and ensuring that other diseases that impact on the same communities are tackled as well. For example, when evidence was provided about treating and preventing HIV/AIDS, it became obvious that malaria, TB, hepatitis and other diseases are linked to immune deficiency. It quickly becomes apparent that to tackle these diseases requires strengthened health systems, which can then provide the infrastructure for diagnosis, treatment and prevention and, equally important, health education.

I have seen at first hand, on successive visits to Ethiopia, the valuable impact of community health workers, who are recruited from their local communities and trained to offer informed advice on a range of public health matters, basic treatments and referrals. This can make a huge contribution to tackling, preventing and treating diseases. The British Government have been a major backer of the fight against high-profile diseases and, in particular, the quest to eradicate malaria. The announcement last week of the partnership with the Gates Foundation is of course welcome. The Liverpool School of Tropical Medicine, with which I am sure the noble Lord, Lord Trees, is very familiar, is a world leader in its field and can make a contribution to the challenge.

I ask the Minister to give us a little more information on how the £200 million identified within the Ross fund for NTDs will be spent, and how the spending on NTDs, malaria and other major diseases can be interlinked in ways that will give a synergy in tackling them.

I was aware of the fact that, prior to the Ebola outbreak—I take the point that Ebola is not one of these diseases, but this is instructive—the UK Government were planning to reduce spending on health systems in Sierra Leone and Liberia, but in the event ended up spending five times as much as they had been planning to in order to tackle the outbreak. Although they were late in tackling it, there was a very good example of cross-government co-operation when they finally addressed it.

What must be hoped for after such an event is that the health systems of affected countries have been strengthened so that there is a legacy and they have the ability, in future, to tackle these things much more effectively. We cannot just zoom in and zoom out; there has to be a continuing capacity to deliver. The Global Fund and other targeted funds have been criticised, not for failing to deliver their objectives but for not always leaving that legacy behind. I suggest that the Government consider, in their engagement with the Global Fund and their own substantial initiative, that the Global Fund should also address NDTs. It is logical to do so at the same time. These diseases cause death and disability to hundreds of millions, and people who are sick or disabled inevitably compromise development. They cannot work and their children suffer, missing out on education and having to work to help the family income, as well as being at risk themselves.

In my maiden speech in this House, I broadly welcomed the Government’s development strategy but warned of the dangers of short-term changes in priorities. We have just heard that the demands of the Syrian refugee crisis have put pressure on DfID’s development budget. It is therefore important that we get maximum synergy and that the Government co-ordinate everything they do on all these diseases, because in that way we can eradicate them much more quickly.

Bilateral Aid Review

Lord Bruce of Bennachie Excerpts

Wednesday 27th January 2016 Lords Chamber

[Baroness Verma]

My Lords, the noble Lord raises some really important questions. That is why we are looking at all our programmes and the programmes we do with the multilaterals to make sure that ultimately, we capacity-build in those countries where the need is greatest. While we are undertaking these reviews, it would not be prudent of me to comment further.

[Lord Bruce of Bennachie (LD)]

My Lords, in the light of the current unrest in Burundi, do the Government think it was right to close the UK’s bilateral programme in the last bilateral review? In the light of the Government’s commitment to spend 50% of DfID’s budget on fragile states and the intervention of the African Union as a peacekeeping force, is it not time that the Government reopened our bilateral programme in Burundi?

[Baroness Verma]

My Lords, of course we are extremely concerned about the ongoing political unrest in Burundi and its humanitarian consequences. The UK is the second largest bilateral donor to the regional appeal, after the USA. We are monitoring the situation closely, and we may consider additional funding for the region. As I said to the noble Lord, Lord McConnell, we are reviewing everything we are doing to see whether we are best placed as we currently are or whether we need to increase or decrease in certain places.

Oral Answers to Questions

Lord Bruce of Bennachie Excerpts

Wednesday 18th March 2015 Commons Chamber

[Sir Malcolm Bruce (Gordon) (LD)]

I commend the Secretary of State, her Department and her Ministers for their campaigning work on this issue on behalf of women and girls. May I ask her not to hold back in countries such as Sierra Leone, where secret societies perpetrate female genital mutilation? The girls do not even know what is happening to them and they do not discuss it. Will she work with campaigners in that country to ensure that the matter is addressed?

[Justine Greening]

My right hon. Friend is right to address that point. In spite of the challenges that Sierra Leone faces with Ebola, FGM has, ironically, stopped. This is because it was one of the main ways in which the disease could spread. The key now is to prevent those practices from coming back, and I am already having discussions on that.

Given that my right hon. Friend is leaving the House soon, I should like to take this opportunity to pay tribute to all the work that he has done as Chair of the Select Committee on International Development since 2005. The Committee has published more than 90 reports in that time. On a personal level, I have very much valued his objectivity and constructive working with our Department.

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[Mr Speaker]

I call Jesse Norman. The hon. Gentleman is not here.

I call Sir Malcolm Bruce.

[Sir Malcolm Bruce (Gordon) (LD)]

Does the Prime Minister agree that the best prospect for the people of Scotland is to be a successful part of a growing United Kingdom, and that Alex Salmond’s mission to shake this House to its foundations will deny recovery, jobs and mortgages, and threaten both the UK and Scotland, which is why the people of Gordon are uniting to deny his return to this House?

[The Prime Minister]

My right hon. Friend makes an important point, which is that what the SNP wants is to break up our country. That is why it is so appalling that although the Leader of the Opposition has now said that he does not want a formal pact with the SNP, he will not rule out a confidence and supply agreement. He will not rule out relying on the SNP in vote after vote after vote, making sure that it would get the advantage and people in England, Wales and Northern Ireland would be let down—[Interruption.] Yes, we rule it out. What I would say to the shadow Chancellor is that his boss threw both his kitchen sinks at the NHS and he still could not win. [Interruption.]

Sustainable Development Goals

Lord Bruce of Bennachie Excerpts

Wednesday 28th January 2015 Commons Chamber

[Mary Creagh]

I am going to make some progress.

There is nothing wrong with supporting the private sector and infrastructure investment in poor countries, but we Opposition Members have grave concerns about the lack of transparency over where this funding for private sector development is going. That area will account for £1.8 billion—nearly one fifth of the Secretary of State’s budget next year.

[Sir Malcolm Bruce (Gordon) (LD)]

Just before this debate, the Select Committee was taking evidence from the Secretary of State on precisely the issue of private sector investment, but not a single Labour member of the Committee attended the session.

[Mary Creagh]

Perhaps my hon. Friends were writing their speeches. I know that my hon. Friend the Member for East Lothian (Fiona O'Donnell) is planning to speak in this debate. I pay tribute to the work of the Select Committee, which the right hon. Gentleman chairs, and I shall quote extensively from some of his reports, if he will give me the chance.

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[Sir Malcolm Bruce (Gordon) (LD)]

I am pleased to follow the right hon. Member for Coatbridge, Chryston and Bellshill (Mr Clarke), who has a long and distinguished record of championing development issues and was the author of important legislation in this field.

I welcome this debate. In a year when momentous decisions have to be taken on international development, it is important to have such a debate. However, I am disappointed by the tone and terms of the motion. I have had the honour to chair the International Development Committee for nearly 10 years, in opposition and government, and during the tenure of four different Secretaries of State. I have never feared our being critical of Governments so long as our criticisms are constructive, evidence based and designed to improve the quality of our aid delivery and to probe how effectively it can be delivered. That is the tone with which we most assuredly deliver the best outcomes.

Many people, including representatives of donor Governments who have not achieved the 0.7% target, ask me how we have managed to do it. I say, “It’s quite simple. The overriding reason has been cross-party consensus”. The suggestion, therefore, that the Labour party might now break that consensus is deeply disappointing, and it should reflect on the implications. The motion criticises the Government for not having legislated on the 0.7% target, but only one country, Belgium, has done so; there is no requirement to do so; and, most importantly, we have actually delivered the target—0.71% in fact. Having said that, I am pleased that the Bill introduced by my right hon. Friend the Member for Berwickshire, Roxburgh and Selkirk (Michael Moore) is well on the way to completion, with Government support. Yes, of course it could have been done by the Government, and I wish it had been, but that is not a point of substance, because it is happening thanks to cross-party support.

The motion also criticises aspects of the SDGs, which, like the Secretary of State, I do not actually understand. We have 17 draft goals and 169 supporting resolutions, which is clearly unmanageable. It has to be boiled down to something that people can work with and remember. Ban Ki-moon has got his own six essential elements, for which I think he is seeking support. The Secretary of State or the Minister might want to say where the Government stand on that, although I imagine that we will want to be constructive and work with the United Nations. After all, it is the United Nations that to a substantial degree has ownership, although we are all members of the United Nations and Britain is a particularly important member. I think Ban Ki-moon understands, as we do, that having a plethora of goals dilutes them to the point where nobody can remember them.

Those six points—which I am sure will receive support—encapsulate the very essence of what is being criticised in today’s motion. There is a commitment on health and a commitment on climate change—they are central to those six overriding sustainable development goals. What we should be doing is working to get the maximum international consensus for a set of goals that are understandable and transparent and that enable all those commitments to be delivered in terms that will make a difference, which means ending absolute poverty by 2030 and leaving no one behind. Surely we are all agreed about that.

I believe that is where we should go. In addition, I am particularly pleased that the hon. Member for Wakefield (Mary Creagh) referred specifically to women and girls and disability, two things that have been particularly championed by the present Government—I am not saying they were not championed by the previous Government, but they have been taken forward. I pay tribute to the Secretary of State and her former colleague as Under-Secretary, my right hon. Friend the Member for Hornsey and Wood Green (Lynne Featherstone), who took those causes up and championed them with her brand of campaigning enthusiasm.

That has made a difference, not just here and in our policy, but globally and internationally, because the thing I have found in the 10 years that I have had the privilege of doing this job in the House is that the UK gives huge leadership, not just through the volume of what we do, but through the quality of the way we do it. I know that there is an election coming up in May, but there are people outside who want to discredit and destroy our commitment on international development. I would plead with Members to recognise that what will ensure that it is delivered is for us to stay together in our commitments and to ensure that our criticisms are constructive and designed to improve the outcome and make sure that what we do actually makes a difference.

As for the final criticism—of the engagement of the private sector—in reality, unless people can gain livelihoods and employment that will enable them ultimately to pay taxes and fund social services, health care and education, the countries we are supporting will never get out of poverty. The question is: what is the role of the private sector, what is the role of the donors and how do they work together? The questions we have heard are perfectly legitimate—let me be clear about that—but the implication behind them is that, somehow or other, DFID is doing the wrong thing by pursuing that agenda, and I could not agree less.

The Committee has taken evidence from the Secretary of State this afternoon; we will publish a report that will give our view on this issue in due course. We will also publish a report next week on the future of aid, giving real challenges to DFID, but ones that are based on evidence and that I hope all parties in the House will support, so that we can continue to lead the world on the quality of development that we deliver.

[Several hon. Members]

rose—

Oral Answers to Questions

Lord Bruce of Bennachie Excerpts

Wednesday 17th December 2014 Commons Chamber

[Justine Greening]

Yes, of course. We will continue to deliver the promises we have made such as getting hospitals open and delivering extra beds. A key announcement I made during my visit over the past few days was to provide more protection for the many children affected by the crisis. Many of them are orphaned or themselves suffering from Ebola and needing to recover. There will be lots more support for them. I can assure the hon. Lady that as we are able to scale up the operation, we will reach more and more patients.

[Sir Malcolm Bruce (Gordon) (LD)]

I would like to thank, through the Secretary of State, the British personnel who are engaged in tackling the outbreak. Following up the question on the WHO, does she acknowledge that it did not respond quickly enough and that its mechanisms are not really fit for purpose? Will she press for a review of the workings of the WHO so that it can be more efficient in future?

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[The Prime Minister]

Every excess winter death is a tragedy, and 18,200 deaths last year was too many. However, that is half the level of excess winter deaths in 2008-09, when the Leader of the Opposition was the Energy Secretary. We will continue with the long-term patient work of the warm home discount, keeping the winter fuel and cold weather payments, and schemes to insulate people’s homes. That is the right way forward.

[Sir Malcolm Bruce (Gordon) (LD)]

Will the Prime Minister confirm that NHS spending under the coalition Government has risen by 4% in real terms? That has been passed on to Scotland, where spending has in fact been cut by 1%. Is he also aware that Grampian has a £70 million two-year shortfall in funding? Consequently, the responsibility for the crisis in the health service in the north-east of Scotland lies firmly with the Scottish Government, led until a few weeks ago by Alex Salmond, the MSP for Aberdeenshire East.

Health Systems (Developing Countries)

Lord Bruce of Bennachie Excerpts

Thursday 11th December 2014 Westminster Hall

[Sir Malcolm Bruce (Gordon) (LD)]

I am pleased to have the opportunity to debate these three reports, which as it happens are timelier in their outcomes than we realised when we started them. The Select Committee on International Development decided that we should visit Sierra Leone and Liberia to see how the Department for International Development was working in post-conflict situations and how it was working with development partners, particularly the Americans, in Liberia. That was an interesting and informative inquiry. When we visited the two countries in June, Ebola was present, but at the time, it was apparently not imminently as out of control as it has become. At the same time, we had also been doing an inquiry into DFID’s role in helping to strengthen health systems. One can see a certain irony in how those things came together at the time we were conducting our inquiry.

I will take things in that order, concentrating on health and then adding a couple of points about the development programmes. In those countries where we have a bilateral partnership and health is a significant part of the engagement, DFID has a good record, supported by all the evidence, of using the funding to help build stronger and more effective and coherent health systems.

About half of DFID’s health money goes in that direction, but the other half goes to the vertical and multilateral funds, where we found much less concentration on building health systems, perhaps for the understandable reason that targets were being set to deliver reductions in malaria and HIV/AIDS and everything was set in those terms. However, to achieve those targets, an infrastructure for delivering them is ultimately needed. We were anxious to ensure that the money going into vertical funds left a legacy of stronger health systems. What has happened with Ebola vindicates the argument that we made.

In Sierra Leone and Liberia, we saw health systems that were beginning to show some signs of effectiveness, but as we now know, they were totally overwhelmed by the Ebola crisis, which they are incapable of handling. The Liberian system was probably in slightly better shape than Sierra Leone’s, but then it was ahead on the curve. Nevertheless, both of them were overwhelmed.

One thing we are clear about is that if the international effort now going into bringing Ebola under control is to have a lasting legacy, it should also go into ensuring that when the immediate emergency is ended, Sierra Leone, Liberia and Guinea, on which there is more of a French lead, have health systems in place that will be resilient and robust enough to withstand any further similar outbreak. The situation also makes it clear that strong health systems are an essential component of development and in the global national interest, because such diseases, whether resistant, endemic or epidemic, can spread everywhere if not contained in their own territory. Strong health systems are in everybody’s interest.

One disappointing thing is that although the African Union countries made a declaration at Abuja that they should spend 15% of their Governments’ budgets on health, of the 50 members, only six have actually done so. Although I commend DFID—I am looking at the Minister here—we must urge the development partners to share the commitment. Without their commitment, they will never achieve effective health systems, which requires both political will and commitment. Therefore, we conclude that we need to put even more resource into completing the job that had only just started in Sierra Leone, and ensure that the legacy of tackling Ebola is not just that we get it under control but that we leave behind something much more substantial for the future of those countries. That is essentially the major point we must make.

Interestingly, the evidence told us that the UK national health service has a significant contribution to make in this area, in a number of ways. First, contrary to some popular opinion, in a Commonwealth evaluation of health services across the developed countries, the NHS ranked top, as the best health service in the world. We know that it is not perfect, but we should not sell short what it can do. We are seconding people right now from our own health service to work in Sierra Leone; perhaps not quickly enough, but we are doing so.

However, several issues came to light. One is that there ought to be a permanent partnership across Government to use DFID and NHS capacity and expertise to help build those health systems. That was and is being done in Sierra Leone, but our inquiry revealed—my hon. Friend the Member for Stafford (Jeremy Lefroy) raised this issue with the health adviser this morning—that we are not training enough health service staff for our own needs. I argue, and to some extent the Committee’s recommendations suggest, that we should be training more than enough staff for our own needs, on the grounds that we could then second people abroad without leaving our own health service understaffed.

Although we have a policy of not recruiting directly into the NHS from a long list of developing countries in a worthy attempt to avoid brain-draining qualified health professionals from poorer countries, the fact remains that they are not prevented from coming here or applying, and there are doctors and nurses from Sierra Leone working in our health service when one would like to think they would be working in their own health service alongside our volunteers and secondees to tackle the problem. This needs a cross-Government approach and it is not the responsibility of the Minister’s Department, but I ask him to take it on board that discussions with the Department of Health should address those issues, which are in the national and international interest.

I will touch on the reason why we went to Sierra Leone and Liberia before the crisis engulfed them. Those countries had been riven by civil war. The UK effectively intervened in Sierra Leone and ended the civil war, for which I can testify the people of Sierra Leone are extraordinarily grateful. It might amuse the House to observe that one sees more Union Jacks driving through Freetown than in Ayr. It is a declaration of appreciation. The partnership is constructive and is valued by both parties.

Sierra Leone is a bit of a forgotten country. The UK is the lead donor, and there are few others. It is literally a far-away country of which many people know very little, yet it and Liberia have an interesting history that is different from anywhere else in Africa. Liberia was settled by freed slaves from America in the early part of the 19th century. Interestingly, the country that first recognised Liberia as an independent state was not the United States of America but the United Kingdom, a fact that Liberians are anxious we should know.

I will say in passing, however, that some of us were a little shocked or bemused—I do not know which—by Liberia’s national flag and symbol. I think it has a ship with a pennant saying, “We came here in search of freedom.” The vast majority of Liberians never left, and there is a dichotomy between the freed slaves and their descendants, who are the elite, and the majority of the people, who have not had good governance over a very long period of time.

The current president is to be commended, in that the situation is changing and there is a much greater will to govern for the whole country. We made only a short visit; we were only able to go to Monrovia. However, people told us that while Monrovia looked a reasonable city, the rest of the country had virtually no roads, no infrastructure and no support. Again, that is a development challenge that needs to be addressed.

Sierra Leone was founded on a similar basis, by freed slaves from the Caribbean, and it has a definite Caribbean feel to it. Obviously, it enjoyed—I think “enjoyed” is the right word to use—administration by the British for many years, before it gained full independence. There is a legacy of roads and infrastructure that, again, the people value. However, it is still at a very low base; Sierra Leone is still a very poor, deprived country.

Our Committee recommends that, first, regardless of the Ebola crisis, we continue the current level of support. However, now we are where we are and both countries have been knocked back, the Department, although it has immediately given extra resources, needs to reassess its long-term programme, especially for Sierra Leone, which will need more resources than have so far been committed. That is not a criticism but a recognition of reality. We hope the Department will be able to provide those extra resources.

We made some criticism of the centrally managed programmes—we have engaged with the Department since on this issue—because, to say the least, we were a bit disappointed to find that we were not getting all the information on what the British Government are doing in Sierra Leone. We got it in bits and pieces from different sources. When the Committee visits a country where the UK has a bilateral aid programme, we almost expect—we have asked for this for many years—to get a full breakdown, or at least an assessment, of the bilateral programme, the multilateral programmes and engagement with the international agencies such as the World Bank and the African Development Bank; of course, it may not be an absolutely precise figure. However, we found that substantial programmes were being delivered in Sierra Leone that local DFID staff had no engagement with at all, and knew very little of. There may be good reasons for that, and we have asked DFID to give them if there are, but we still think that openness and transparency and an understanding of those programmes’ interaction would be helpful.

[Fiona Bruce (Congleton) (Con)]

The right hon. Gentleman is making an extremely good point. He will recall that exactly the same issue arose when the Committee visited Brazil: it was only almost as we were leaving that we were provided with a comprehensive plan.

[Sir Malcolm Bruce]

My hon. Friend is right; in fact, it was actually after we had left. We have now learned—I am smiling at the Minister—how to ask the questions. We asked in general terms what our official development assistance was, and DFID said, “We don’t have an ODA programme in Brazil, but HM Government do.” On returning from Brazil, we found that the Foreign Office had a £40 million ODA programme there. We do not object to that; we just think we should know about it, and the reason for it.

We had a similar concern regarding Sierra Leone. It is a question of transparency and understanding. Such knowledge helps us to make a good case: we are doing much more in Sierra Leone than is apparent, so why not say so? Ironically, when we went to Liberia, where our programme is a lot smaller, everything had been thrown into the pot to make the budget look bigger. So, the exact opposite approach to that taken in Sierra Leone was being adopted in Liberia.

I get the impression that the Department has learned something from this dialogue, and that the situation will change. We have asked the Independent Commission for Aid Impact to look at the centrally managed programmes, simply because the Department has not given us a clear explanation of strategy, listing exactly what should be done through centrally managed programmes, what should be done locally, and why. What is the rationale for choosing one method rather than the other? We are not saying that those ways are wrong and do not deliver, but it is not clear what they deliver and why, and we would like some clarity.

As the reports state, it is absolutely right for the UK to be the lead donor in Sierra Leone. We have a degree of responsibility, and the partnership works and is appreciated by both sides. Playing a supportive role in Liberia, with the US, benefits Liberia and the UK’s interaction with the US, because the UK and the US have a strong connection. We urge the Government, perhaps once they have gone a little further in dealing with the Ebola crisis, to tell us how they propose to set out a reconstruction programme for Sierra Leone in the coming years, because that is what is required. We urge DFID to take on board our recommendations on strengthening health systems. In particular, DFID should use its influence with the multilateral agencies to ensure that, where they put aid money into health—whether through vertical funds or other health programmes—they build in the objective of leaving a legacy of stand-alone functioning systems.

We should also open a dialogue with partner countries to get them to make health a greater priority on behalf of their citizens, not least because the aid community’s prioritising of health is almost giving some countries an excuse not to do so. The scale of the challenge is such that the aid community will never deliver a sufficiently strong health system on its own, and nor should it. Unless there is a partnership and a willingness on the part of Governments to contribute, we will not get the result we seek.

Notwithstanding the Government’s formal response, I hope the Minister will pick up on the points I have made. We are very appreciative of what DFID is doing. The circumstances have changed. There were a number of criticisms, which I hope the Department will address. Our engagement in these two countries is extremely important, but it needs to be ramped up if we are to get them back on their feet after the crisis that has engulfed them in the last few months.

[Fiona Bruce (Congleton) (Con)]

I begin by thanking the Minister for the Government’s detailed response to the Committee’s report, “Strengthening Health Systems in Developing Countries”, which I will speak to. I also wish to put on the record—and not just because we are approaching the season of good will—our appreciation of the International Development Committee’s Clerks and assistants for their expert help and invaluable contribution to our reports, and indeed to all the Committee’s work.

Strengthening health systems gets to the heart of much of what the Department for International Development must now be about, as we move from the millennium development goals to the sustainable development goals. Aid must be proactive as well as reactive, seeking prevention as well as cure. Clearly there will continue to be epidemics and tragic random events of nature or war, such as the Ebola outbreak or the current crises in Syria or Iraq. That is precisely when a robust in-country health system becomes so important. A mature and progressive approach must focus on the long-term goals of building the organisations, in-country institutions and the attitudes that will enable developing nations to become truly independent and truly developed.

One of the ways that is done is through building the networks by which health care resources can be spread, establishing training institutions that can make health care systems sustainable and bringing Governments to account, so that they realise the realistic and significant benefits of prioritising health care. If the latter in particular is not done, much of the health care action that this country’s aid workers overseas seek to undertake will be only half done.

I am reminded of the time that the Committee visited Ethiopia. We saw some dedicated community health workers, who were funded by DFID. They were young women who were going out into remote rural communities and talking to women in their homes about how to improve their health and hygiene with 10-step plans. Those women were visited and revisited until the good practices had been embedded. However, we visited the clinic in the same region, to which these women would go to give birth to their children and have treatment if they were ill, and quite frankly it was filthy. What was of even more concern was that when we challenged the Government Minister on this issue, he responded, if I recall correctly, “Yes, hygiene is a problem in Ethiopia.” Unless we have more joined-up thinking on the part of the Governments and institutions of the countries in which we are seeking to support the health systems, we will, as I say, find our work only half done. That is why this has to be a priority.

It is good that DFID takes this matter seriously and that the Government have responded positively to almost all the recommendations in our report. It is also good that much of our report recognises the excellent work that DFID does. DFID is an acknowledged leader in this field, particularly in transparency and sharing information. Our Committee is always reminded, wherever we go, of its significance in the field of development around the world.

[Sir Malcolm Bruce]

I agree, but does my hon. Friend acknowledge that we heard some evidence that, good as DFID was, it was rather hiding its light under a bushel, and that people felt that it should be doing much more to provide leadership and that it had slightly lost its edge in that area—not what it is doing, but in inspiring and encouraging others?

[Fiona Bruce]

The right hon. Gentleman pre-empts me, so I thank him for that pertinent comment. One of the thrusts of the report is that although DFID is in a prominent and influential position, it does not take advantage of that. Many of the Committee’s recommendations ask not for a change of policy, but for DFID to use its expertise and good practice to improve the practice and governance of the organisations, institutions and partners with which it works. It is good that the Government largely agree with that aspect of the report.

Let me turn to specific recommendations in the report. First, in response to recommendation 14, the Government state that they have shown leadership on working with women and girls,

“nutrition, female genital mutilation and early and forced child marriage, all of which require dismantling cultural barriers.”

I commend the Government’s work in this area, which gets to the heart of effective aid. It is not just about money pumped in or relief parachuted to problem spots; it is about dedicated work over time with locals on the ground to address fundamental barriers to health provision.

I cite, for example, the work done by aid workers in rural villages and rural communities in Ethiopia, where early child marriage involves children as young as six being married off and where children are even pledged to one another at birth. We heard a moving story of a young girl in her early teens who benefited from the teaching of some of the health workers in rural communities, who encourage young women not to allow themselves to be married early, but to stay in education and preserve their health and well-being, so that they do not end up with early sex and early childbirth. Instead, they can give themselves hope and a future and can contribute more fully to their communities than they would do were they married off early, which, in the misguided view on the part of their community, is somehow regarded as strengthening the community’s future.

It was really moving to learn that that young girl was only a few years younger than her older sister in her late teens, who had been married off early. She described how her older sister was already damaged and isolated, living almost alone, having been abandoned by her so-called husband, her education wrecked and her future looking very bleak. That is just one example of where the work of our DFID representatives, in strengthening health systems in a proactive, long-term way, is so effective.

Transparency is another area where DFID’s performance is exceptional in the field—if I remember rightly, it has been ranked second out of 68 countries. I commend this work. Will the Minister elaborate on the Government’s response to recommendation 6 in our report? The Committee recommended

“that DFID work harder to encourage its partners to make more data on their health systems strengthening work freely available.”

The right hon. Member for Gordon also mentioned that.

In their answer, the Government emphasised DFID’s good record, but regarding other organisations and partners they merely said:

“DFID will continue to set a good example to its partners on transparency and to encourage them to follow this example.”

Perhaps that could be more strongly stated. Perhaps the Minister will put some flesh on the bones of that statement. How will DFID seek to do that and what are its realistic aims and hopes in this area? The Committee’s inquiry showed that although DFID is world leading in this area, perhaps it is not leading the world as much as it could. I encourage the Minister to make use of DFID’s position, its reputation and its relationship with the various multinational organisations to have a greater impact in this area.

I now turn to recommendations that the Government partially accepted. I am pleased that the Government seem to be in general agreement with the Committee on how DFID needs to move forward to apply aid more effectively. Recommendation 4, for example, examines the need for an internationally agreed measure of

“system strengthening expenditure and efficacy as part of discussions about the post-2015 development goals.”

This is clearly an essential task over the next year.

The Government response states that such measures are not part of the post-2015 process. However, they also state:

“Some early thinking has been done about what would be required to develop a common framework for tracking health systems strengthening expenditure.”

Perhaps the Minister could expand on where that thinking is taking DFID and whether the Department has any time line on drafting such a framework.

Recommendations 15 and 16 relate to volunteering, which the Committee Chairman mentioned. I thank the Minister for his Department’s commitment to develop better frameworks and practices for volunteering in response to those recommendations. I should like to reflect with him, and with hon. Members in the Chamber, on the impact that nurses, doctors and even finance and management specialists—which the Committee made recommendations on—can have on health work in developing countries.

Let me mention the work of some volunteers with medical expertise in the Conservative party’s Project Umubano, of which the Minister—whom I am delighted to see here—is an august member, having been a part of that volunteer project virtually every year since its inception. Volunteers in the project go out for one or two weeks a year to Africa: Rwanda, Burundi and Sierra Leone. They are self-funded—so they are really on a minuscule funding basis—and go out there to make a difference in those countries. I remind the Committee of the difference that can be made, even in such a short time, and why it is therefore so important that we look at supporting volunteering from people with NHS expertise.

I should like to quote from an account from this year’s Umubano from Dr Sharon Bennett—who is, if hon. Members are not aware, apart from being a qualified and practising doctor, the wife of my right hon. Friend the Member for Sutton Coldfield (Mr Mitchell), the former Secretary of State.

“This was my 8th year in Rwanda, and it was wonderful to return to this special place, where I have made so many friends and treated so many patients over the last decade.”

She speaks of spending time at the Umubano health outpost, a clinic in a fairly remote area founded by Umubano volunteers, who raised funds to build it, and opened in 2011:

“I am happy to report that it is thriving, and we are now putting together a proposal not only to do preventative clinics—HIV, immunisation, ante-natal—but to have a daily minor ailments clinic there. This will bring healthcare closer to this extremely vulnerable group of people.

Every year I see the Health Centre grow, in all ways. The dedication of the staff at the centre is truly humbling.”

She is speaking about the staff that the volunteers have gone out to help train as they set up systems in the health outpost. She said:

“My most happy story this year, and possibly from all my visits, was reviewing a young woman with her happy and healthy seven month old baby. The outlook for mother and child was very different a year ago. In 2013”—

Dr Bennett went out in the summer of 2013—

“she came to see me late on in her pregnancy, when she was very short of breath. She had been treated for a chest infection. However, when I examined her it became clear that she was in heart failure, caused by a valve problem in her heart. If this had gone undiagnosed, she and the baby would almost certainly have died in labour from the huge amount of strain that is placed on the heart during child birth. She was transferred to Butare Hospital and put on medical treatment to take the pressure off her heart. The baby was delivered safely. In February next year, surgeons will be visiting from the United Kingdom to give her a new heart valve.”

Is that not a wonderful story and a microcosm of what can be done if we encourage volunteering from this country to such countries?

I want also to touch on the wonderful structural work being done by Mr Sheo Tibrewal, a consultant orthopaedic surgeon who has helped to set up a postgraduate orthopaedic course in a university in Rwanda. That is a wonderful piece of work he has done over many years. He has strengthened the structure of the university departments and ensured that medicine and dentistry are better able to implement a strategic plan, in conjunction with the Government’s work out in Rwanda. Those are just two examples of where volunteering can make a difference, and I am sure that, with greater support from DFID in conjunction with the NHS, we could see many more. Will the Minister update us on how deliberations on that are progressing? How can support be given to those NHS workers who would like to volunteer abroad, whether in the short or longer term?

That leads me neatly to recommendations 5 and 8, which touch on the difficult topic of how we can encourage other organisations or partners in other countries to take health system strengthening seriously. The Committee recommended:

“If DFID is not satisfied that system strengthening is being given sufficient priority by an organisation, and that organisation does not change, DFID should be prepared to withhold funds.”

That is strong—it may be a nuclear option—but as the Committee’s discussions with the Minister in Ethiopia showed, we have opportunities to challenge thinking at the highest level in those countries, and we should take them. I know how much those countries value the financial support and expertise that come from the UK and DFID, and we should not hold back from challenging Governments at the highest level on such issues.

The Government response rightly states:

“A decision to withhold funding to Gavi or the Global Fund would have a significant impact in developing countries”.

Although I am sympathetic to the Government’s caution, can the Minister satisfy the Committee that he intends to make progress in this area? Progress is vital and should not be seen as an optional extra. We should ensure that we take a tough line with Governments who are unwilling to take responsibility for the long-term health of their populations.

We also have a duty to take a tough line not only in-country, but in our country. That is critical. The Chair of the Committee touched on this, but we need to ensure that our people are made aware of the remarkable work done by DFID and representatives across the world, so that there is a greater degree of support than at present. The debate on the 0.7% Bill showed that there is a strong and vocal, but perhaps small group of people who are critical of what DFID is doing. One only has to look at the amount of private donations made to appeals to see how much the people of this country support what DFID is doing on international development. However, we need to spend some time focusing on that work to ensure not only that we challenge other Governments to take up the responsibility of communicating the importance of that work to their inhabitants and residents, but that we do the same here at home.

--- Later in debate ---

[Anas Sarwar]

I thank the Minister for that helpful intervention. In the spirit of transparency, and to ensure that we do not darken the name of any Government and that we have the strong trust of the people on every penny spent by the UK Government and by our EU partners, I encourage him to share any information gleaned from those investigations with the House and the Committee.

[Sir Malcolm Bruce]

I am very glad to see the hon. Gentleman back in the international development debate. To clarify how this issue arose, we were told by the Health Department in Liberia that the money had been earmarked for it and that it had not received it—that the Minister of Finance had either held it back or was spending it elsewhere. I am grateful for the Minister’s intervention, and I am interested in his reply that our Government have checked and found that that is not the case. I just want to be clear that this information was given to us in good faith and on the face of it, it was shocking. We just thought it was important, and if it has been checked and it has not happened, that is absolutely fine, but nevertheless, it was a significant factor. When money is given, sovereign Governments can, of course, in the end redistribute it, but the question of whether it went where it was meant to go should really be followed up on.

[Anas Sarwar]

The Chair of the Committee mentions an important issue, and it is right that the Committee raised it and that the Minister has looked into it. I think we would all welcome that information and clarity, but it also highlights an issue in recipient countries, where perhaps that information is not shared between Departments. That undermines both the way in which Departments can operate and the state-citizen relationship in recipient countries. That information should be shared with the Committee, and there should be a way to share that information with a recipient country’s Government, and particularly its Department of Health.

It would be interesting to hear what indicators are in place to measure how much of the money spent through multilaterals is used specifically on strengthening health systems, and in which countries, and how the success of that spending is measured. Transparency is again the key issue, in terms of gaining the public’s trust. That same principle should be reflected in our bilateral agreements, ensuring that where we do give budget support, an emphasis is put on universal health coverage by recipient countries. Aid should never be a blank cheque. Recipient countries must make a commitment to medium-term goals and take responsibility for long-term health system development. We should never be afraid to take a tough line with Governments who do not adhere to that principle.

However, we must not fall into the trap, as we often do, of believing that our biggest impact comes just from the money that we spend and the global influence that we exert. There must also be a recognition, as has been made clear by many Members today, that through our NHS, we have built up expertise, and if we share that, we can help shape global systems. We have the talent among our health workers to develop strategies and plans, to provide professional and personal development, and to manage and learn in a meaningful two-way relationship with recipient countries. That is why we should encourage volunteering, as the hon. Member for Congleton (Fiona Bruce) suggested.

I push the Minister to respond more thoroughly to the Committee’s recommendation to build schemes that are more co-ordinated, structured and scaled up. That should include detail on how the Government would support those people who choose to volunteer with specific benefits and entitlements. Such schemes would help to promote the good work that the Department and this country do on development and would also help build public support and trust at a time of public cynicism.

Linking that to the Ebola crisis, I want to re-emphasise the question that my hon. Friend the Member for York Central asked. We know that 650 NHS front-line staff and 130 public health staff have volunteered to work in Ebola-stricken west Africa, but how many have actually gone? We still do not have a specific figure from the Government, and I hope that the Minister will have an answer for us today. We should not shy away from giving all the support that we can to the people who are bravely volunteering their expertise and putting their lives on the line, in many senses, to go and protect the lives of others. We should absolutely support them.

--- Later in debate ---

[Mr Swayne]

Absolutely, I give my hon. Friend that reassurance. We have already established the post-Ebola team to take that work forward once we have got on top of Ebola. Of course, it will have to consider how we develop the programme on jobs and employment opportunities.

I was as surprised as the Committee, and indeed the former Under-Secretary, at the lack of a programme for female genital mutilation, as highlighted in the report. It is not within my bailiwick to commit to such a programme, but I accept that the Department has placed great importance on that issue, as our girls’ summit earlier this year demonstrates.

[Sir Malcolm Bruce]

One of the survivors in Sierra Leone, a brave and beautiful campaigning lady, told us that, the day before she met us, she received a phone call from a senior Government Minister threatening her if she continued to speak out against FGM. That indicates the scale of the problem. These secret societies in Sierra Leone have a powerful hold on the political class. We do understand how difficult the challenge is, but I agree with everyone who said that that is not a reason for not trying.

[Mr Swayne]

I agree entirely and take on board exactly what my right hon. Friend says about the secret societies and the role that senior females—the “cutters”—have in them. Given the priority that the Secretary of State has attached to gender and the role of women and girls, it is vital that we do not shy away from this challenge and put it in the “too difficult” box. We must deal with it.

--- Later in debate ---

[Sir Malcolm Bruce]

I thank all colleagues who have taken part in this interesting and useful debate. I do not want to delay hon. Members, because we have an important debate to follow. I welcome the Minister’s response to the hon. Member for York Central (Hugh Bayley) about reviewing recruitment into the NHS and the implications for developing countries. Alongside that, I suggest that the Minister have a dialogue with the Department of Health about training. If we do not train enough, we will not solve the problem. I also welcome the Minister’s commitment to more transparency of spend, which has been a frustration for the Committee for a long time. He has identified some of the problems and given some commitments, and I am grateful for that. In anticipation of the next debate, I would like to say that its shortness does not in any way qualify its importance.

Disability and Development

Lord Bruce of Bennachie Excerpts

Thursday 11th December 2014 Westminster Hall

[Sir Malcolm Bruce (Gordon) (LD)]

I will try to be brief and simply highlight the main points. We decided a couple of years ago to do a report on disability. Although it took us a while to get round to doing it, for various reasons, the fact that we were going to do it had a galvanising effect on the Department for International Development, which found itself in a better position to explain what it was doing than might otherwise have been the case. Our announcing the inquiry well in advance was therefore quite a good thing to do.

The first thing we wanted to identify was just how big an issue disability is. There are reckoned to be about 1 million people suffering disabilities in developing countries, and they are mostly very poor—they are the poorest of the poor. They are not often visible, and they are subject to a lot of prejudice and stigma. They are often hidden away, disadvantaged and kept poor.

[Fiona Bruce (Congleton) (Con)]

I apologise for interrupting the right hon. Gentleman, but did I mishear him or did he say 1 million?

[Sir Malcolm Bruce]

The correct figure is 1 billion, and if I mis-said it, I am glad that my hon. Friend has given me the opportunity to put the record straight.

The challenge is huge, so we felt it was critical that the Department addressed it specifically and explicitly in a way that had not been done before. We issued a challenge, to which the Department has responded, which I think is a classic example of the galvanising and dynamic effect of the Committee’s relationship with the Department. We were disappointed when the Government rejected our recommendation for a disability strategy; however, we have been extremely pleased with the framework document that has emerged, so frankly I think we can park that disagreement. The framework document has been widely welcomed by organisations and others representing disabled people.

I would like to pay a personal tribute to my right hon. Friend the Member for Hornsey and Wood Green (Lynne Featherstone), a former Minister in the Department, for taking up the challenge. When she came into the Department, she basically said to me, “I’m a junior Minister. I can only do a limited amount, and the best way I can do it is to pick up two or three issues and make them my own,” and this issue was one of them—the others were women and girls and female genital mutilation. She is a great campaigner. My understanding—the Minister may correct me—is that direct responsibility has been transferred to my right hon. Friend’s successor, Baroness Northover, who has also given me an undertaking that she is determined to ensure that the commitments made by her predecessor are taken forward.

That is all very welcome. Hon. Members will know that I have an interest in disability, having a grown-up deaf daughter and being chair of the all-party group on deafness. I have always recognised the fact that if nobody rises up and challenges the problems that disabled people face, and if nobody works with disabled people, their problems will not be addressed.

Having welcomed the framework, I want to ask a few questions. We think that the process has been enormously positive and that the framework is ambitious. The Department is doubling the size of the disability team, making new commitments in humanitarian response—water, sanitation and hygiene—and advocating for a disability-inclusive post-2015 agenda. Put simply, if the aim is to eliminate absolute poverty by 2030 and leave no one behind, it is not possible to do that without specific policies to address disability and the needs of disabled people. What is being done for the first year of the framework to try to achieve measurable impacts? There are more staff and there is more awareness, but will the Department set some objectives that it hopes will be met by the end of the year?

Will the Minister consider committing the Department to an annual stocktake or progress report? The current Secretary of State for Health used to be a member of our Committee—many of the best people in the House of Commons, including the hon. Member for Glasgow Central (Anas Sarwar), have been members of the Committee—he recognised that the international community had set a commitment to halve the number of people with HIV/AIDS who were not receiving treatment. That was a five-year programme, but he insisted, and secured agreement, that the target would be hit only if we had annual reviews and targets. I commend his initiative. The Committee and the Government accepted the proposal, which ensured that the target was hit. The logic is that annual targets require us to keep our eye on the ball, whereas a five-year target can be left until there is a push upwards at the end, like a hockey stick. I ask the Minister to consider that.

There have been criticisms from some organisations that represent disabled people. Some of those criticisms are a bit sharp, and I will not report them here, but they boil down to the Minister and the Department needing to understand that organisations representing disabled people are not the same as disabled people’s organisations. Disabled people should be a visible part of the process of addressing disability in development. Indeed, people within the Department who have a disability should be encouraged to take part in the process and be a role model—I am not talking about tokenism, nor should the Department specifically recruit such people. Again, I hope the Minister might consider that. What specific measures will the Department take to engage disabled people’s organisations? At the moment, such organisations still feel that they have not been properly engaged. Some of them have been sharply critical, but that is the nature of such organisations. I get a lot of that in my work with the deaf community. Let us just take it is a practical thing to be addressed.

DFID has acknowledged that we are a long way from being in the lead on disability. I understand that a member of DFID staff has been seconded to Australia to look at their examples, and I hope that in a relatively short period of time, as in so many areas, DFID will be a leading world role model. I am glad that the Department is looking to learn from international partners that may be ahead of the game. What more might the Department do to build on the experience of international organisations?

My right hon. Friend the Member for Hornsey and Wood Green recently held a seminar on collecting data, and part of the problem is that, precisely because they are hidden, we do not know the exact nature of the challenges. I was invited to the reception at the end of the day, and I got the impression that people were pleased that that was taking place. A progress report on how data collection will be taken forward would be helpful.

As with the problems faced by women and girls, in the humanitarian disaster agenda we have been shocked by the lack of awareness of the needs of disabled people. If there has been a disaster, by definition there will be newly disabled people who have suffered injury, been shot or wounded, or been affected by that catastrophe. The needs of disabled people, as well as the needs of women and girls, must be prioritised in the immediate aftermath of disasters because they tend to be forgotten at a critical and vulnerable time. The World Bank has an ongoing review. It would be good to know how DFID, as a very influential player in the World Bank, is trying to ensure that the bank also takes a strategic view of the needs of disabled people.

Finally, people need support when they are disabled, but quite often those disabilities are preventable, whether they be caused by illness or accident—road traffic accidents are devastating. What will DFID do to reduce the incidence of disability? Yes, we must provide for those who are disabled, but we must also help to reduce the incidence of disability. The consequences of female genital mutilation can be catastrophic, as can the consequences of disease. We have had that debate, but it is relevant in this context. I draw out mental illness and incapacity, on which we took specific evidence. Mental illness is a major problem. Frankly, poor people have a higher chance of suffering mental illness, yet that is almost unrecognised—it is stigmatised. I ask that mental illness and mental disability be included in the strategy.

I have some practical suggestions. I say that I speak on behalf of the deaf community, but there are others with specific disabilities. Surely we can provide cost-effective access to wheelchairs, hearing aids and hearing tests, simple interventions on sight, and so on. How will that be built into the strategy, so that we can create partnerships? I suggest cross-Government and cross-society partnerships, because it should not all be down to DFID, although DFID can provide the leadership.

In order to ensure that other colleagues have an opportunity to speak, I will finish by saying two things. I am glad that the Committee undertook this report. More evidence was submitted to this inquiry than to any other we have done. The engagement and participation of disabled people throughout the process has been very strong. They were passionate about the need for the strategy. Having had a slight stand-off with the Department, we can honestly say that the disability framework is more than we might have expected, provided it is delivered. I therefore commend the report, and the Government’s response, to the House. I hope the Minister will be able to answer some of my questions, because a wonderful declaration is meaningless without a series of measures and reports that enable us to make progress. I hope that in five years’ time disability will be mainstreamed and that the UK, once again, will have a leading role across the world in encouraging others to do the same.

--- Later in debate ---

[Sir Malcolm Bruce]

I thank all colleagues from all parts of the House who have taken part in this debate. I said at the beginning that the shortness of the debate does not in any way qualify the importance of this big initiative. I am grateful to the Government for their response, and to the Minister for his response and his tribute to my right hon. Friend the Member for Hornsey and Wood Green (Lynne Featherstone). I feel encouraged that we will get real progress. Our Committee’s legacy will be to ensure that our successor Committee comes back next year to monitor that. I believe that we have made a good partnership with the Department and we look forward to seeing real progress.

Question put and agreed to.

Oral Answers to Questions

Lord Bruce of Bennachie Excerpts

Wednesday 5th November 2014 Commons Chamber

[Justine Greening]

As I said, I think we should be proud of the work we are doing, and we are doing a huge amount. Alongside the beds we are providing, we are helping to make sure that burials can take place safely, we are scaling up the training of health care workers—800 a week are being trained by the MOD—and we are rolling out more community care. As the hon. Gentleman says, this care is often being delivered by volunteers from Sierra Leone, who are involved in safe burials, and from our own country, and we should thank them for their generosity of spirit.

[Sir Malcolm Bruce (Gordon) (LD)]

Will the Secretary of State join me in thanking those dedicated workers from Sierra Leone, the UK and across the world who are risking their lives to tackle this? Will she also ensure that the UK Government’s cross-departmental working delivers a long-term legacy to Sierra Leone of a strong health service capable of preventing any such disaster from happening again?

[Justine Greening]

I am pleased that my right hon. Friend has given me the chance to give a very personal thank you to my staff, who have really played a role in leading our efforts on the ground in Africa, pulling together the MOD, Public Health England, and NHS workers—who have done an amazing job—alongside our Foreign Office staff. We have nearly doubled our DFID team in Sierra Leone. Many of them are people who thought they would be doing something entirely different, but are now working round the clock to tackle Ebola. We should be proud of what we are doing. My right hon. Friend is of course right that we should also look to ensure that we can strengthen health care systems in countries such as Sierra Leone, so they are better placed in future to combat these challenges on their own.

International Development (Official Development Assistance Target) Bill

Lord Bruce of Bennachie Excerpts

Friday 12th September 2014 Commons Chamber

[Sir Malcolm Bruce (Gordon) (LD)]

I am pleased to follow the hon. Member for Bristol East (Kerry McCarthy) and recall the visit that she and I made to Uganda. I welcome the positive news now that most of those people have been able to return to their homes, after an appalling period as refugees. I also follow the shadow Secretary of State, who is not in his place, in his tribute to Jim Dobbin, with whom I visited Bangladesh a couple of years ago when he was looking at the cold chain for a vaccination against pneumonia. He was dedicated to his work and a thoroughly decent man, and I think the House will miss the further contributions he could have made.

I am pleased to support the Bill introduced by my right hon. Friend the Member for Berwickshire, Roxburgh and Selkirk (Michael Moore). I am glad he has been able to bring it forward, generate support across the House and fulfil the promises that all three main parties and the coalition agreement made. I think the Bill is timely. Some might say, “If you’ve already met the 0.7% target, why bother to put it in law”. It is precisely because we have achieved it that people need to know that the commitment will continue, not least because, contrary to what people might think, there is a rising need for development assistance.

The crisis in the middle east has led to a substantial demand for humanitarian relief, of which the UK has been one of the most important sponsors: £600 million of our funding has gone to support refugees in Jordan, Syria and Lebanon, and of course continues to go to Israel and Palestine. It is unfortunate that other countries with a similar interest to ours in that region—France, in particular—have come nowhere near our level of commitment. It is important that we continue to pressurise these countries to accept their share of the responsibility. Being the first G7 country to deliver 0.7% and then enshrine it in law would be a clear statement to our allies that we expect more of them. We should continue to pressure them to rise to the challenge. Unfortunately, however, as the humanitarian demand increases so some of our bilateral programmes are having to be cut. If we can maintain a rising aid budget, we should be able to maintain the bilateral programmes and deliver the humanitarian relief, and not have to choose between the two, as is currently the case—a concern expressed by the International Development Committee, which I chair.

As the right hon. Member for Kirkcaldy and Cowdenbeath (Mr Brown) said, our commitment helps to draw out further commitments from our development partners. My Committee today published a report on health systems strengthening, which DFID does well within our bilateral programmes, but which others are not so good at. The problem is that many of the countries in which we are operating with bilateral development programmes are not matching their own commitments on health. Under an international agreement, they are supposed to be spending 15% of their Government budgets on health, but only about two countries in sub-Saharan Africa are doing that. We can use our leverage to say, “We will put money in, provided you match it, and between us we can help to deliver sustainable health systems.” DFID has not done that everywhere, I am afraid, but it has the power to do it where nobody else can, and this kind of commitment will enable us to do so.

That brings me to another point. Our meeting the 0.7% target is not just about showing the country’s macho commitment to compassion; it enables us to deliver real leadership in the world. I have had the privilege of being Chair of the International Development Committee for more than nine years, and I have made nearly 30 visits to developing countries. I know what the UK looks like from the other end of the telescope. It is treated with much greater respect and regard than we often recognise ourselves, and that is because—I give credit to Labour, actually—our aid is untied and focused on poverty, which gives it a much cleaner edge: people see that it is not about the UK’s short-term commercial interests, but about a genuine desire to eradicate poverty, improve living standards and deal with humanitarian crises. Yes, as my hon. Friend the Member for Leeds North West (Greg Mulholland) said, it is in our national interest to do this in the long run, but it is a long-term objective, not one we measure in the short term. It is based on recognising that the development of these poorer countries helps our development, which helps their development—and so the cycle continues.

I have no compunction whatever about defending our commitment. I have been challenged on it on many occasions. People frequently say how much they would like the money to be spent on something else. During the floods in Somerset, for example, people were saying we should divert the aid budget to deal with that. On a live programme when I was standing next to a woman standing up to her thighs in water in her home, a politician—of a party not represented by any currently elected Member—said, “We should take the aid money and give it to this lady”. I said, “I would rather take this lady to some place in sub-Saharan Africa to meet a woman who has had three children who did not live to their fifth birthday and invite her to tell me that she would rather have the money than let that family have it.” I am glad to say that the woman said, “Of course I wouldn’t”. We know where the difference is. Poverty in these countries does not compare to poverty here; we should make no such comparison.

In passing, it is worth saying that DFID delivers what it does with a remarkably small staff and low administrative costs from offices around the world and its shared headquarters in London and East Kilbride. I have visited both centres on a number of occasions. I think the system works extremely well. It is sad that many people in Scotland do not realise how much activity on the development front is delivered by 600 people in East Kilbride, or appreciate its quality.

If Scotland were to vote to leave the UK next week—I hope it will not, and I do not believe it will—it would have an immediate disruptive effect on DFID. For a start, DFID would lose £1 billion of its budget—the Scottish share, effectively—and would have to redesign its programmes, readjust and, over time, relocate its headquarters. That would be a distraction from delivering poverty reduction where it is most needed. Much more to the point, it would weaken what I think is the transformational capacity that the UK has in development, of which Scotland is an integral part. I would personally hate to see Scotland breaking away and setting up another agency, which would take years and would weaken the one we have got, by no means delivering one as comparably good in any short order. People need to understand what would be lost if we did that. It is just one other aspect of what breaking up the UK would do, which, to my mind, it is not in the interests of the people of Scotland or of the people in the rest of world that we are seeking to help.

[Mr Weir]

I am sorry to hear the right hon. Gentleman going down this road, as I agreed with him up to that point. Does he not understand and accept that the Scottish Government are committed to writing in the 0.7% figure and that Scotland’s international development would add to overall international development? There is absolutely no reason why this should lead to a reduction; it would lead to an increase. Does the right hon. Gentleman not accept my earlier point that small, north European, independent countries have always been in the lead with this?

[Sir Malcolm Bruce]

I am sorry I gave way, because the hon. Gentleman had already made that point. I thought I had made the point that we would be breaking up a world-class organisation, damaging and distracting it. I do not think Scotland will be able to come up with anything comparable any time soon.

[Mr Tom Clarke]

I think that the House should calm down and examine exactly what the right hon. Gentleman is saying; it is factual. Judith Hart believed in the dispersal of civil service jobs. She headed what was then the Department for Overseas Development. East Kilbride became the headquarters for the United Kingdom, working in tandem with Victoria. It stands to reason that if Scotland is foolish enough—I do not believe it will be—to vote for independence, those jobs will simply be lost because they are serving a much bigger united—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. We must have shorter interventions. There are many Members still to speak, and it is helpful to all if we can have short interventions, quick answers and Members carrying on with their speeches.

[Sir Malcolm Bruce]

All I will say is that a Scottish agency of similar efficiency would require only a fifth of the jobs that are currently based in East Kilbride.

I want to conclude by saying two things. The first is about the Independent Commission for Aid Impact, which reports to the Select Committee that I have the honour to chair. I believe that ICAI has become an established and useful body that holds DFID to account—I know that Ministers find it uncomfortable. Although it is appointed by Ministers, it is accountable through the Select Committee to Parliament. I believe that that arrangement could usefully be enshrined in law. I say in passing that there are some concerns that, as ICAI moves to its second phase and has been reassessed, there may be some compromise of its independence, albeit not intentionally.

Putting ICAI’s independence in statute and ensuring that it operated as an independent body, reporting through Parliament to DFID, would be an essential component of ensuring not only that we delivered the 0.7% and that justifications for any variations could be independently examined, but also—to make the former Secretary of State’s point—that the quality of what we delivered was continually assessed, so that we did what was best and made it work better. That would be beneficial to all of us. I hope the Government will consider that proposal—maybe my right hon. Friend the Member for Berwickshire, Roxburgh and Selkirk can come to an arrangement about it—because it would be valuable.

One privilege of being the Chair of a Committee such as mine is that I have had many opportunities to visit other countries. I think I have made more than 30 such visits to sub-Saharan Africa, south Asia and other parts of the world to see the work we do, on our own and in partnership with other international organisations, bilateral donors and NGOs. It is transformational and world-class work and something of which this country can be proud. We lead the world in what we do and the effectiveness with which we do it, and that is understood and appreciated wherever we go. We have fantastic, dedicated staff working in those places, sometimes in extremely difficult and challenging conditions. As a country, we have every reason to be proud of what they do. This Bill stands up, as people have said, as a great British totem of a country that has engaged in what poverty reduction really means, is committed to it and is absolutely clear that we will go on delivering on our obligations in future, regardless of what anybody else does, but also as a beacon to others, so that they are a little ashamed of what they have done and perhaps respond to our challenge.

--- Later in debate ---

[Alison McGovern (Wirral South) (Lab)]

Further to that point of order, Madam Deputy Speaker. The Opposition are saddened by the loss of Lord Bannside, the former Member of Parliament for North Antrim. My colleagues and I support most deeply the words of the hon. Member for Foyle (Mark Durkan) and the Minister. Our thoughts are with Lord Bannside’s family. We send them our deepest sympathies, most particularly his son, the current hon. Member for North Antrim (Ian Paisley).

[Sir Malcolm Bruce]

Further to that point of order, Madam Deputy Speaker. May I join in the tributes and recognition? Ian Paisley was one of those larger-than-life characters that this House has been proud to embrace. He never had any difficulty making his voice heard. Before the microphones came in, he showed that he did not even need one. The hon. Member for Foyle (Mark Durkan) is right that he will be remembered as a different man in private from the one he appeared in public. He was a man with a great sense of humour and great charm, which I think will surprise many people. He also had his principles. In the end, he was able to stand his ground and yet to reach across and help deliver a peace settlement in Ireland, which many thought he would not do. I think that that is the finest tribute to him.

[Madam Deputy Speaker]

I thank right hon. and hon. Members for their points of order. It is right that we should spontaneously remember our former colleague Lord Bannside and send our very best wishes and great sympathy to his family.