Wellbeing of Future Generations Bill [HL]

Lord Crisp Excerpts

2nd reading & 2nd reading (Hansard) & 2nd reading (Hansard): House of Lords
Friday 13th March 2020 Lords Chamber

[Lord Crisp (CB)]

My Lords, I am delighted to have the opportunity to speak in support of this Bill. I offer my congratulations to my noble friend Lord Bird.

As we came here, I reflected that this extraordinary moment in time when we are waiting for a virus to hit us is a good time to think about the long term, the big picture and the frailty of the way we do things. I agree with noble Lords who made the point that we need to get better at long-term thinking; indeed, I hope that it can be changed. There are many positive elements to the Bill. It is good that it has been road-tested in Wales, to an extent, so that we have examples and learning.

Let me pick up one point in the Bill: the report on future trends and risks. This could just be a token thing, but it could also be an important thing: the opportunity for Parliament to discuss the big picture on a regular basis. It could be good in itself, enabling us to pick up some of the weak signals of what may be coming round the corner and may cause us problems in the future. The test is whether that would turn into action, to pick up on some of the points made by the noble Lord, Lord Whitty, about the technical things that will make it either happen or not happen.

Let me use two examples, where I want to ask whether this Bill would enable us to act early enough. The first is that, for years, we have seen the growing problem—forgive me, I am not trying to pun here—of childhood obesity and the health problems that children face. We have seen bits of legislation and bits of action on it, but it is only in the past year that we have understood that the life expectancy of the younger generation will be less than ours, and that that is a consequence of many things that have happened over the years. It has crept up on us, but we now have the understanding that we need to act. It is the same story as in the point made by the noble Baroness, Lady Boycott, about the environment: this has been going on for a long time, so why has it taken us so long to act on it?

Will the Bill enable us to act and be wise before the event? There are some indications that it would, but that is the test. There is one example that I am worried about—noble Lords must forgive me, but I have only recently discovered and understood the nature of this problem; many others have understood it for a very long time. Around 20,000 children are excluded from school each year, which has a long-term effect on their lives. My noble friend Lord Bird made the point about storing up problems for the future right at the start of his speech. We can see those problems being stored up now. Will this Bill enable us to act and to do something about them before they become chronic, long-term problems? I do not know; it will depend on the technical issues that we were just talking about.

Let me end on a bigger point. My noble friend Lord Bird has caught the moment. This is a really good moment for us to think about these things. Massive changes are happening in society. We need to think about things like Extinction Rebellion, which has had a big impact—bigger than most people thought it would. After we recover, coronavirus will have a big impact on how we do things, from how we behave to how we think about society. There will be other issues like this. There will be issues that will make us think differently about the future, and many of them will come to us with pressure from outside Parliament to make changes. I therefore hope that the Government are listening, that they will be forward-thinking and that they will support the Bill.

Soft Power and the UK’s Influence (Select Committee Report)

Lord Crisp Excerpts

Tuesday 10th March 2015 Lords Chamber

[Lord Crisp (CB)]

My Lords, I congratulate the noble Lord, Lord Howell, and his committee on this excellent report. It provides an extremely interesting and useful analysis and I welcome and support its arguments—with one caveat. I believe that there is one aspect of the UK’s special capabilities and significance in the world that is underplayed.

However, first, I want to praise the report. I found the main thrust of its arguments compelling: the dramatic change in the international environment that it talks about; the importance of smart power; the understanding that power is now dispersed away from central control; and the importance of understanding and respecting other non-western points of view. On specifics, I could mention many, but I note the importance of the UK being the best networked state in the world; the actual and potential role of the Commonwealth; the idea that the British need to feel confident in knowing who we are and what our role is in a transformed and turbulent world; the role of the diaspora and diversity; and the importance of trust and impartiality. These are all extraordinarily important issues.

I now turn to what I believe is missing. Health is one of the largest sectors in the world, with expenditure of more than $7 trillion annually, and it is one in which in almost every aspect the UK is widely recognised as first or second in the world. It is an area where, in line with this report, we have profound influence, are extremely well networked and could play an even bigger and more confident role globally. I believe that health addresses all the issues drawn out in paragraph 86 of the report of what soft power is about. But the key point that I want to make here is not just about the capabilities of the UK but that there is a demand for those capabilities right now.

I will first deal with the supply side and I will address it in four areas. The first is academia. I will not say very much because I believe that my noble friend Lord Kakkar, himself a distinguished medical researcher, will say more about this. Today, the UK is top-rated in research publishing in many areas of health, even beating the US in terms of the citations it receives in peer-reviewed journals. As the report notes, we have those extraordinary journals, the Lancet, the BMJ and Nature. Interestingly, in the context of the networks that this report talks about, for articles where British people are the first authors in these journals, 62% of them have foreign collaborators. In the US, only 25% have foreign collaborators. The UK works very collaboratively in these networks. Moreover, as people may well recognise, all doctors, at some point in their lives, do research. These networks are huge. Finally, the medical royal colleges in the UK are hugely valued in terms of their qualifications. I believe that membership of the Royal College of Obstetricians and Gynaecologists is still the most valued qualification in India and I know that the Royal College of General Practitioners accredits all family practitioner courses in south-east Asia, with the exception of Burma. There is extraordinary influence and these are extraordinary networks.

The second area is the state sector. I will not say very much about DfID, which was mentioned in the report, but it is, as everyone knows, extraordinarily influential and does an enormous amount with regard to health. I now turn to the NHS. As a former chief executive of the NHS, I was delighted to see that it came top in a recent assessment of health systems around the world. While I am pleased about that, it is also a reminder of just how hard it is to run a health system. We recognise that we have problems, but actually we are doing very well in that context. My point here is not about the performance of the system itself but about the influence that it has. Almost every Commonwealth health system was modelled on the NHS, as was, for example, the system in Portugal. China has had a flirtation with the private sector system and is now looking to the UK. Mongolia, one of the fastest growing countries in the world, has turned to us for assistance. It is not just about the values and the whole organisation of the NHS; it is about the elements. Apparently, every country now wants to have a NICE to assess the value of medicines around the world. Public Health England is another example that is modelled. Then there is the influence of individuals in health and in the World Health Organization. I will not go back into the past, although I note that the noble Lord, Lord Fowler, is here and would say that we have had an enormous impact on what has happened around HIV/AIDS in the world. Today one of the big issues is antimicrobial resistance, or antibiotic resistance, where the UK is leading the fight in trying to tackle that globally. We have had fantastic influence.

I move on now to philanthropy. We could talk about the Wellcome Foundation, the Children’s Investment Fund Foundation, the great NGOs and what they are doing around the world, and international partnerships. Again, many of these are rated among the top in the world.

Finally, I turn to commerce, where we come slightly lower on some of the factors. Nevertheless, it is UK researchers who have developed 25 of the top 100 drugs that are in use in the world. I am delighted to see that the present Government have recognised the enormous scope of the life sciences sector in the way that George Freeman, the Minister, has taken it up. I also note that Healthcare UK, developed recently, supported an estimated increase of £1 billion in commercial exports of health products in the current financial year and identified further opportunities worth more than £20 billion.

There is a huge supply side but the demand side is actually bigger. As countries grow richer, their citizens demand healthcare, and they want their governments to invest in health. We in Europe are accustomed to contracting in health whereas around the world countries are doubling their expenditure and looking for support. Part of this is in response to public demand and part of it is about social control. Some countries around the world are trying to keep their populations interested. Some of it is a recognition of the link between healthier people and the economy. Many are turning to the UK for help. Health is salient economically and domestically in these fast-growing economies and should also be seen as a critical component of foreign policy and, indeed, a soft power.

The US got there 18 years ago. It published the document entitled America’s Vital Interest in Global Health: Protecting Our People, Enhancing Our Economy, and Advancing Our International Interests. It was launched by Hillary Clinton when she was First Lady and she has returned to the theme often since. To an extent, the UK, with its policy of “Health is Global”, has tried to develop a policy around this but, frankly, it is not as influential as it might have been and is not even mentioned in this report.

Perhaps I may ask why health is not generally seen as an area in which the UK has extraordinary influence globally and why it is not a crucial element of British foreign policy. One reason may be, importantly—it has nothing to do with this committee or the Foreign Office—that health leaders have not done what others in other sectors, such as culture, have done where they have deliberately set out, in a systematic way, to promote their international profile, with the results that we have seen and talked about. The Government need to be systematic about this, as the report says, but so, frankly, does the health system.

This is an important message for health leaders. The All-Party Parliamentary Group on Global Health, of which my noble friend Lord Kakkar and I are both officers, is seeking to map the activity of the UK in health globally. We will be looking at how this can be expanded across the board so that the UK can build an even stronger position as a centre of health. To do so, however, health leaders need to rise to the challenge.

I say to the Foreign Office and a future Government that when they are looking at these issues and the great agenda set out by the committee, please do not forget health. There is a range of links between individual doctors and organisations which can exert an extraordinary influence. On any given day, thousands of health professionals and scientists are in touch with their colleagues and peers elsewhere and we should build on, cherish and, importantly, use these networks.

Finally, I have two questions for the Minister. First, does he recognise the important role that the UK health sector has in promoting the UK’s power and influence internationally? Secondly, what are the plans to update the Government’s global strategy “Health is Global”?