Herbal Medicines

Baroness Northover Excerpts

Wednesday 24th April 2013 Grand Committee

[Baroness Northover]

My Lords, I thank the noble Lord, Lord Pearson, for securing this debate. I thoroughly enjoyed his speech, and as the last debate of the day, he made sure that we are all wide awake.

I recognise that the Government’s progress in establishing a statutory register for practitioners supplying unlicensed herbal medicines is of interest both to Members of this House, as has been demonstrated today, as well as to consumers and practitioners who use these products. I am glad that the noble Lord was assisted by a herbal remedy.

The issue of whether herbalists and traditional Chinese medicine practitioners should be statutorily regulated has been debated, as the noble Lord, Lord Hunt, will be well aware, since at least the House of Lords Science and Technology Committee report in 2000. The Government appreciate that there is, understandably, strong support from many herbal practitioners for the statutory regulation of this group, and the noble Lord, Lord Hunt, has made the case as well. In addition, many consumers of herbal medicines wish to access unlicensed manufactured herbal medicines. As noble Lords will be aware, on 16 February 2011, the Government announced that they intended to take forward the regulation of herbal medicine practitioners and traditional Chinese medicine practitioners specifically with regard to the use of unlicensed herbal medicines within their practice.

At the time that the decision to take forward the regulation of this group was made, the Government’s intention was to allow herbal practitioners to once again lawfully source unlicensed manufactured herbal medicines. That is something which practitioners have not been able to do since April 2011, when a European directive made it illegal for herbal practitioners in the UK to source unlicensed manufactured herbal medicines for their patients.

Where the noble Lord, Lord Pearson, criticised the EU, others may well feel that the EU can offer a level of protection, depending on one’s point of view. Perhaps I can address here the issue of subsidiarity. The noble Lord suggested that this meant that it was not applying to herbal medicines. The principle of subsidiarity does indeed apply. The directive makes provision to facilitate the free movement of herbal medicines while ensuring a high level of safe public health. It was thought that the directive strikes the right balance of rules to facilitate free movement to the EU level, while maintaining flexibility through domestic implementing regulations.

Since the announcement in February 2011, the Department of Health has been working with officials in the devolved Administrations and the Health and Care Professions Council to look at establishing a statutory register for herbal practitioners supplying unlicensed herbal medicines, along with a strengthened system for regulating medicinal products, to enable consumers to have safe access to unlicensed manufactured herbal medicines.

This process continues to be complex and lengthy and, with regret, I must say that we are not in a position to consult on proposed legislation. My noble friend Lord Colwyn asked about what “going out to consult” meant. As announced in the Written Ministerial Statement in February 2011, any proposed statutory legislation has to go out to an open and public consultation. I hope that that clarifies the issue and reassures him. However, I am sure the noble Lord, Lord Pearson, will appreciate that it would be irresponsible for the Government to undertake to alter the status of a group of workers without first ensuring that the policy and final decision offers an appropriate form of regulation and ensures the proposals adequately address the risks posed to consumers of unlicensed herbal medicines.

My noble friend Lord Colwyn flags the serious dangers associated with all medicines. Nothing is risk-free, whether it is conventional or complementary medicine, or doing nothing at all. That is why it is important that there is careful regulation and consideration of all these areas.

We recognise the need to balance the economic wish of practitioners to continue to supply unlicensed herbal medicines and the wish of some consumers to have continued access to them against any risks identified. We understand that there is a strong desire in the field to bring the matter to a conclusion both for practitioners and the public. However, it is clear that there is a potential risk to public health where practitioners supply unlicensed herbal medicines which may be potent. For example, the Medicines and Healthcare Products Regulatory Agency has recently become aware that an unlicensed herbal product containing aconite, a prescription-only medicine in the UK which can cause serious and potentially fatal adverse reactions if consumed, is being marketed and prescribed by traditional Chinese medicine practitioners for the treatment of migraine. It is therefore crucial that the nature of the regulation in the sector is carefully thought through.

[Lord Pearson of Rannoch]

My Lords, does not the noble Baroness agree that in this case, which was flagged up in the Daily Mail the other day, statutory registration of the people who supply the product would be helpful?

[Baroness Northover]

Various noble Lords have made that point.

My noble friend Lord Colwyn asked whether the Government have in fact dropped the commitment to regulate. The Government recognise that there is a body of evidence about the public health risks associated with herbal medicines. It is important that the department does not proceed with the statutory regulation of any group, including herbal practitioners, unless we are sure that this will provide the necessary safeguards for patients. In other words, it is being looked at very carefully—whether the balance of regulation helps or hinders. Noble Lords have heard various views expressed.

[Lord Taverne]

Will my noble friend answer one question? Is registration supported by the Chief Medical Officer?

[Baroness Northover]

I am afraid that I cannot answer that very simple question. I may be inspired to do so shortly, but in the mean time I should say that this is a more complex area than that. Although I will be happy to come back to my noble friend, I think that there are a number of wider issues to look at.

[Lord Hunt of Kings Heath]

Perhaps I may also intervene briefly. I am most grateful to the noble Baroness for her answers, but can she be absolutely clear? Mr Lansley, when he was Secretary of State, announced an intention to implement a register by 2012. Does that mean that the Government are not going forward with it? I am not clear about this. The noble Baroness has said that she is not in a position to consult and has suggested that the Government are taking a new look at the relative risks. Can she help the Committee to understand whether in fact these rumours that the proposal has been dropped are correct?

--- Later in debate ---

[Baroness Northover]

I think that what I should do is continue with what I was going to inform noble Lords about. It may be that that will satisfy them in this regard. They are seeking an answer right now which I do not think I can give.

I should point out that while the Government are working through the issues relevant to this policy, this does not affect the availability of over-the-counter licensed herbal medicines. Significantly, there are now more than 240 products registered under the Traditional Herbal Medicines Registration Scheme. In addition, practitioners can continue lawfully to prepare herbal formulations on their own premises for use with their own patients. I also want to make it clear that the previous announcement made by the Government and any steps taken to regulate herbal practitioners should not be seen as an endorsement of the efficacy of herbal medicines either way. The Government do not have a view on the efficacy of herbal medicines that do not have a full marketing authorisation; in other words, a product licence. However, the Government do recognise that members of the public may wish to purchase complementary or alternative treatments, including herbal medicines. The Department of Health would always advise someone considering the use of complementary or alternative medicines to find a practitioner who is a member of an organisation that has set robust standards of qualification, an ethical code of practice, and a requirement for appropriate public indemnity insurance.

As I stated earlier, I regret that the Government are still not in a position to go out to public consultation on this matter, but we want to make sure that any proposals are proportionate and fit for purpose.

[Lord Pearson of Rannoch]

My Lords, in that case, perhaps the noble Baroness, before she finishes her remarks, would be good enough to answer the point made by me, the noble Lord, Lord Hunt, and other noble Lords. Will the Minister concerned and his officials meet interested Peers and Mr McIntyre? If not, why not?

[Baroness Northover]

Funnily enough, I was just going to get on to the point about a meeting. The noble Lord will be well aware that I am filling in for my noble friend Lord Howe. I am very sorry that it is me rather than my noble friend, with whom I am sure the noble Lord would rather have disputed this. However, my noble friend might very well be detained by the noble Lord, Lord Hunt, in the Chamber and so therefore he is potentially otherwise engaged. My noble friend Lord Howe is, as the noble Lord will know, most forthcoming in terms of engagement and meetings. I will pass on the request for meetings. I am informed that my noble friend has not refused to meet noble Lords—knowing my noble friend, I absolutely believe that—and the department will be in touch shortly. I hope that that reassures the noble Lord, Lord Pearson.

The noble Lord suggested that other speakers in this debate should be included. I was very struck by that, so I look forward to hearing reports of such a meeting, which clearly must include my noble friend Lord Taverne.

[Lord Colwyn]

My Lords, my recollection was, in February 2011, that it had been settled. We shook hands and congratulated each other on the fact that strategy regulation had been promised by the Government.

[Baroness Northover]

As I say, my noble friend Lord Howe is happy to meet people and no doubt this will be discussed further. Maybe I had better hurry up and conclude because I think I am about to go beyond time. Unless I hurry up, nobody will have a chance to say anything else.

[Lord Pearson of Rannoch]

My Lords, we have 20 minutes on the clock.

--- Later in debate ---

[Baroness Northover]

No, we are all time-limited, as I know as a Whip. I am time-limited to 12 minutes. The fact that the debate can go up to an hour is neither here nor there.

I fully appreciate that this delay is causing concern among both practitioners of herbal medicines and consumers. However, I assure noble Lords that once the Government have worked through the difficult issues they face on this policy, an announcement will be made on their proposed way forward. I assure noble Lords that the Government are carefully considering this very important issue and that we anticipate being able to make a more substantive announcement shortly.

Committee adjourned at 7.02 pm.

Syria: Refugees

Baroness Northover Excerpts

Tuesday 23rd April 2013 Grand Committee

[Baroness Northover]

My Lords, I thank the noble Baroness for securing this debate. The scale of the humanitarian crisis in Syria and the region has reached catastrophic proportions. We already have a protracted humanitarian emergency. While the suffering of ordinary people increases, humanitarian operations on the ground are becoming ever more constricted, as we have heard from noble Lords.

When the noble Baroness, Lady Amos, briefed the UN Security Council last Thursday, she said:

“We are approaching a point of no return”.

The international political agenda must now refocus itself on the humanitarian response. Without this, the human suffering will only worsen and the threat to the stability of the region will be ever more severe, as noble Lords have so clearly flagged up. My noble friend Lady Falkner and other noble Lords portray a very chilling and bleak picture.

More than 70,000 people have died. Some 10 million people—half of Syria’s population—could be in need of assistance by the end of the year. The commission of inquiry has found evidence of war crimes and crimes against humanity. Children have been murdered, tortured and subjected to sexual violence. The long-term implications of such horrors are huge.

The right reverend Prelate has noted the effect on the Christian population. Minorities often suffer disproportionately in these situations, as we are well aware.

The humanitarian situation is now desperate, but it could rapidly worsen should chemical or biological weapons be deployed on a large scale. The implications of the usage of such weapons, accidental or otherwise, are extremely serious. Such weapons usage could lead to large numbers of critically ill persons as well as causing major population movements across the region, as noble Lords have flagged up. All parties to the conflict must recognise the seriousness of the threat posed by these weapons. We are increasingly concerned that there is evidence of the use of chemical weapons in Syria, and we press the UN to investigate further.

The crisis is having a devastating impact on the region. More than 1.3 million refugees have now fled Syria for other countries in the region, and the UN predicts 4 million refugees in the region by the end of the year. This is putting unprecedented strain on the Governments and communities so generously hosting refugees. We are well aware of the effects on those countries. That is why aid is targeted to them, in answer to the noble Lord, Lord Collins. Aid is often given in a way that supports not only the refugees but their hosts as well.

The right reverend Prelate was right to say that the system is near breaking point. Prior to the refugee influx, Jordan was facing its own internal domestic challenges. There are now almost 500,000 Syrians in Jordan, with approximately 2,000 more arriving each day. While media images often show refugees living in camps, such as Zaatari, the majority of refugees live, as noble Lords have emphasised, in Jordanian communities, which were already resource-constrained. Tensions are already beginning to rise. Last weekend saw the most serious violent incident to date in the Zaatari refugee camp.

Lebanon is hosting 428,000 refugees. The projected refugee caseload by the end of the year is 1 million. As the noble Lord, Lord Warner, flagged up, that means that one in four people in Lebanon will be a Syrian refugee. The cost to the Lebanese economy is no less worrying. The response for July to December 2013 is expected to be $600 million. The refugee influx is also putting pressure on Lebanon’s delicate political balance. North Lebanon has already seen increasing levels of violence spilling over from the conflict in Syria.

Turkey and Iraq are hosting 291,000 and 133,000 refugees respectively. Egypt is now hosting more than 50,000 refugees. As the right reverend Prelate noted, Egypt has also hosted Sudanese refugees. As numbers increase, so too does the need for the international community to respond.

The noble Baronesses, Lady Blackstone and Lady Jay, and the noble Lord, Lord Warner, were right to flag up the position of the Palestinians. The impact on Palestinian refugees is acute. Of a pre-crisis population of 500,000 Palestinian refugees in Syria, 400,000 are now in need of urgent assistance. A further 40,000 have fled to Lebanon and 5,000 to Jordan. As the noble Baroness, Lady Blackstone, highlighted, before the crisis Lebanon was already hosting close to 500,000 Palestinian refugees, and Jordan was hosting 2 million, in very difficult circumstances.

Countries hosting refugees must not be left to shoulder the responsibility alone. The UK has been and is at the forefront of international humanitarian efforts. We have provided more than £141 million in humanitarian funding to provide vital food, water and medical care to hundreds of thousands of people in Syria and across the region. We are very close to the top of the table in terms of our national input. We are assessing the level of support needed for the next two years, looking to the longer term.

I assure noble Lords that the United Kingdom is fully committed to the pledge that we made in Kuwait. Aid will go to the United Nations World Food Programme, the United Nations children’s fund, UNICEF, and the World Health Organisation to provide lifesaving assistance. We are also working tirelessly to encourage others to move from the pledges that my noble friend Lord Selkirk mentioned, through commitment to contribution. At a time of global financial constraint, the longer-term need to do so is self-evident.

Some £56.8 million of UK funding is going to support the refugee response in neighbouring countries. We are seeking to assist those host countries because we are well aware of the pressure on them. We are targeting some of the most vulnerable refugees. Our aid includes psychosocial help for people who have experienced trauma, including sexual violence, as well as £5 million to the United Nations Relief and Works Agency to support Palestinian refugees affected by the crisis.

We are supporting vulnerable host communities. For example, in Lebanon we are funding the delivery of clean water, undertaking upgrades to sanitation infrastructure and providing schooling in the Lebanese host communities. That addresses the points made by the noble Lord, Lord Collins. I reiterate to the noble Lord, Lord Judd, that we realise the importance of supporting children who have been traumatised.

Humanitarian aid to the region is only one part of the story. In Jordan and Lebanon the UK is also providing support through the Arab Partnership to support political and economic reform, as well as funds through the Conflict Pool to tackle the drivers of conflict and provide support, where appropriate, for security-sector reform. However, the levels of humanitarian funding remain woefully inadequate. We continue to lobby donors to deliver on the pledges made at Kuwait. I can tell the noble Baroness, Lady Blackstone, that the UN has still received only 52% of the funding that was pledged. We are working very closely with other countries. Last week Kuwait fully translated its $300 million pledge from the Kuwait conference. That is an update since I answered the Question of the noble Lord, Lord Selkirk, recently. We continue to use all channels to lobby those who have not yet committed their pledges.

In order to meet needs in the long term, the international community must radically increase the levels, timeframe and predictability of funding for its response, including by further engaging development actors such as the World Bank, the EU and the International Monetary Fund.

The noble Baroness, Lady Blackstone, asked how the funds were being distributed across the region. I can supply a lot of detail if needed, but will outline a few points now. For the UN appeal for Syria in the region there is a $1.5 billion contribution, with $0.5 billion going to Syria, $0.5 billion to Jordan, and $0.5 billion divided between Lebanon, Turkey, Iraq and Egypt. The UK and the UAE met with UN representatives in the Gulf recently to discuss closer co-operation over Syria. We constantly discuss with the Gulf states the importance of working together and with the UN in this area, something that noble Lords flagged up.

Access for humanitarian agencies operating inside Syria is indeed increasingly constrained, as the noble Lord, Lord Judd, emphasised. They are facing considerable bureaucratic hurdles as well as enormous insecurity. The noble Lord is right to commend the enormous bravery of those working on the front line in Syria. The UK is calling on the Government of Syria to remove the bureaucratic barriers as a matter of urgency, and are calling on all parties in Syria to take immediate steps to ensure that humanitarian agencies have safe, full and unimpeded access to deliver lifesaving aid to those in need by the most effective routes.

I understand the frustration expressed by my noble friend Lady Falkner, who urges that we should consider no-fly zones and selectively arming. This is an extremely challenging situation. We believe that political transition has to be the best way to end bloodshed in Syria. However, in the absence of a political solution, it is right that we do not rule out any options. The use of chemical weapons would force us to revisit our approach but these are not straightforward or easy decisions, as my noble friend knows. I also point out to her that humanitarian enclaves in other contexts have not always operated to protect people; she will be acutely aware of that. At a minimum, we urge all parties to the conflict to respect international and humanitarian law and point out the consequences that we see through the International Criminal Court for those who do not do so.

We fully recognise the importance of this terrible conflict and the enormous challenges in tackling it. Noble Lords have rightly highlighted the particular destruction and devastation of civil war. We seek a negotiated end to the conflict and continue to work with UN Security Council members in pursuit of this. I assure noble Lords that we will continue to monitor closely the situation in Syria and the region. We will remain, as we have been thus far, at the forefront of the international humanitarian response.

Committee adjourned at 7.13 pm.

Syria: Refugees

Baroness Northover Excerpts

Tuesday 26th March 2013 Lords Chamber

[Lord Selkirk of Douglas]

To ask Her Majesty’s Government whether they will make representations to the European Union and the Government of the United States about the long-term humanitarian implications of the increasing number of refugees escaping from Syria into neighbouring countries.

[Baroness Northover]

My Lords, this month marks the second anniversary of the crisis in Syria. Recognising the significant challenges that this protracted humanitarian crisis presents, the UK remains in contact with the United States, the European Union and other international partners regarding how best to support Syrian refugees in the short and longer term.

[Lord Selkirk of Douglas]

Does my noble friend accept that while Britain, the United States and Germany have given generously to aid agencies to help alleviate the plight of more than 1 million Syrian refugees who have fled to neighbouring nations, according to the United Nations a very large part of the more than $1 billion pledged by 32 countries has not yet been delivered? Does she agree that it is time for those who have promised funding to act and that, as the Secretary of State for International Development has so wisely said, warm words are not enough?

[Baroness Northover]

My noble friend is right. States made very generous pledges in Kuwait earlier this year to the UN appeals for Syria and the region. However, not all pledges have yet been translated into actual contributions. Given the scale of the challenge— 4 million people are in need, of whom 2 million have been forced to leave their homes—that is extremely worrying. We call on donors to expedite the transfer of funds without delay and are actively encouraging that.

[Lord Wright of Richmond]

My Lords, does the Minister accept that providing lethal weapons, as the Government appear to want, to the deeply divided Syrian opposition can only exacerbate the civil war in Syria and lead to a further deterioration of the appalling humanitarian crisis which is affecting both Syria and her neighbours?

[Baroness Northover]

The noble Lord speaks with great wisdom. He will know that there are already huge dangers of instability in the region and that any action, or inaction, can promote further instability. We have no current plans to send arms to any groups in Syria, but, as again he will know well, others are arming groups in Syria. As the noble Lord will also know, nothing is off the table, but we are doing our very best to try to bring about a diplomatic resolution to that, which I am sure everybody would welcome. In the mean time, DfID’s key aim is to assist in relieving the humanitarian disaster that has come into existence there.

[Lord Collins of Highbury]

My Lords, not only is the issue one of current spending but the situation is deteriorating speedily. Funding so far has been allocated up to 30 June. Obviously aid agencies need to plan for the future as well. It is important that the Government not only deal with current need but look at future need. Another issue is that the clear majority of refugees in Jordan are women, children and the elderly. In representations to the European Union and the United States, will the Minister highlight the plight of female refugees and the support they will be given to cover basic living costs?

[Baroness Northover]

The noble Lord is right on both counts. The $1.5 billion that was pledged in Kuwait will last only until June and only about 20% of that so far has been forthcoming. There is a major challenge there. We welcome the Disasters Emergency Committee appeal that was launched in the United Kingdom on 20 March. The United Kingdom is third at the moment in its contribution in this regard and we are keenly aware of the situation with women and girls. We are supporting them in particular in the countries around Syria. We are well aware that they are very vulnerable in this situation and have targeted support at them.

[The Lord Bishop of Exeter]

My Lords, on a previous occasion I asked the Government for an assurance that our humanitarian response to the situation on Syria’s borders would ensure that adequate provision was still given to the survivors of sexual and gender-based violence. In being given that assurance, I was also assured that more would be done to document these abuses so that the perpetrators might be brought to justice in due course. Can the Minister say what is being done to carry that commitment forward?

[Baroness Northover]

The right reverend Prelate is right. My right honourable friend the Foreign Secretary has promoted the Preventing Sexual Violence in Conflict initiative, which supports women particularly in Syria but also in Jordan. Local health professionals are being trained in how to respond to reports of sexual violence with the objective of improving the prospect for future investigation and potential prosecution, which the right reverend Prelate rightly identifies as very important.

[Lord Alderdice]

My Lords, on previous occasions I have sought assurances from Her Majesty’s Government that we would concentrate our attention on humanitarian aid, particularly to Turkey and Jordan, which have huge burdens of Syrian refugees, and also to Lebanon and Iraq. Given the recent remarks of our Prime Minister and President Hollande of France, can I press my noble friend to assure us that whatever others do we will not be engaged in military support, other than giving proper support to our front-line ally Turkey, but that we will concentrate on humanitarian aid?

[Baroness Northover]

Following on from the question asked by the noble Lord, Lord Wright, I reiterate to my noble friend the risks of action and inaction. We take very seriously the points that he makes. I would point out that the United Kingdom has already pledged almost £140 million in humanitarian relief. It has committed £22 million in terms of non-lethal equipment and practical support for the Syrian opposition and civil society. That is separate from our humanitarian support, but the noble Lord will note the difference in the sizes of those figures.

[Lord Eden of Winton]

My Lords, should we not be looking to some of the oil-rich nations, such as Saudi Arabia, to do much more to help in this tragic situation?

[Baroness Northover]

At the conference in Kuwait, a number of the Gulf States made very generous pledges. For example, the UAE pledged $300 million, as did Kuwait, and Saudi Arabia $78 million. We are concerned that they now deliver on those pledges. We were encouraged that they made them and now hope to see them implemented.

Global Health

Baroness Northover Excerpts

Monday 25th March 2013 Grand Committee

[Baroness Northover]

My Lords, I, too, thank the noble Lord, Lord Crisp, for securing this debate. His commitment to improving the health workforce is international and has been internationally valued. This debate on skills-mix changes and task-sharing is very welcome and is derived from the extremely interesting report, All the Talents.

One of the refreshing aspects of the report for me, as spokesperson for both DfID and the Department of Health, is that it applied its analysis and conclusions and took its evidence not only internationally, across a range of both developed and developing countries, but from across the United Kingdom. That meant that it brought fresh perspectives in both quarters. Often, the assumption is that in developing countries it would be good if more basically trained personnel undertook more work, whereas in the United Kingdom we need a workforce that is as regulated and as trained as possible. I note the reference made by the noble Lord, Lord Collins, to what Peter Carter of the RCN said in the report and I look forward to discussions in health debates. However, this report challenges us to think again and to look beyond our assumptions to what works and why it works in various settings and what does not work in various settings. The noble Lord, Lord Crisp, emphasised leadership, planning, supervision and teamwork as being essential. The noble Baroness, Lady Warwick, also emphasised how important it is to do this work well, otherwise it will not work at all.

We fully support the principle that a strong health service needs skilled and motivated health workers in the right place at the right time. As the noble Baroness, Lady Flather, knows, we have promised to save the lives of at least 50,000 women during pregnancy and childbirth, and the lives of 250,000 newborn babies by 2015 in developing countries. We have promised to support 2 million women to deliver their babies safely with the support of skilled midwives, nurses and doctors. As the noble Baroness, Lady Flather, made clear, meeting these commitments means improvements across the health systems in developing countries but, above all, demands skilled health workers across all levels of the workforce. We strongly agree with the noble Lord, Lord Crisp. We are supporting the workforce in 28 of the countries in which we work. This includes training new health workers, building skills among existing health workers and supporting government planning.

Even in the wealthiest countries it is not easy to make sure that everyone, rich or poor, living in town or country, can see a health worker when they need to. Many countries, especially in Africa, suffer from a critical shortage of health workers, as we have heard. Tackling this shortage demands creative and innovative approaches. Task-sharing and organising the roles of health workers can be such a creative approach. Around the world, health workers are taking on new responsibilities as countries try new ways of building an effective health workforce in the face of financial constraints and a serious shortage of health professionals.

The excellent report of the All-Party Parliamentary Group on Global Health, of which the noble Lord is co-chair, is a valuable addition to the thinking about the issue. The report pinpoints the factors that create success when reorganising roles and makes practical recommendations on how professionals, Governments and institutions can best support the talents of health workers. With increasing global focus on universal health coverage, the timing of this report is excellent.

I can assure noble Lords that we share their concern about the importance of this area. We agree that task shifting can improve health service access and quality. I can assure the noble Baroness, Lady Warwick, and others that we support partner countries which wish to do this. In Ethiopia, for example, DfID is supporting the Ethiopian Government to expand access to health services through the training and deployment of village health extension workers. With one year of training, these workers can take on basic preventive and curative services that would otherwise be seen as the preserve of health officers, nurses and doctors, who remain scarce. UK support means an additional 2,000 community health extension workers will provide a package of basic health services for 5 million people. Other countries, such as Zambia, are looking to learn from Ethiopia’s experience with UK support. It is important to learn from the good and bad examples of where this is happening.

To answer the noble Lord, Lord Crisp, on assisting national Governments with human resource planning, which is a key point, it is very clear that robust health workforce planning is recognised as being critically important. That is why DfID works with Governments, such as the Government of Nepal, to develop such national health workforce strategies.

There are other areas where strengthening the health workforce is key. The noble Baroness, Lady Flather, is right to make reference to the significance of family planning. I thank her for what she said. The UK’s leadership of last year’s family planning summit encouraged new thinking about expanding access to contraception. It was notable that several countries included task-shifting for family planning within their summit commitments, and DfID is working with country partners on implementing these. For example, Zambia has just confirmed its summit commitment to allow community health assistants to provide contraceptive injectables, an excellent development that will expand access to family planning.

A number of organisations are focusing on task-shifting and I hear with interest what the noble Baroness, Lady Warwick, had to say about VSO. In east Africa, a mid-level cadre of ophthalmic clinical officers provides most of the community eye care services. This cadre has only recently been admitted to the professional body for ophthalmologists, the East Africa College of Ophthalmologists. I can assure the noble Baroness, Lady Warwick, that through the United Kingdom Government’s health partnership scheme, about which she asked, the UK’s Royal College of Ophthalmologists will work with its east African counterparts to integrate these clinical officers and boost the quality of their work still further.

Sharing skills beyond those traditionally considered to be the responsibility of the health workforce can also be successful. Again, the Health Partnership Scheme is also supporting the East London NHS Foundation Trust to work with Butabika Hospital in Uganda. In this innovative project, recovered psychiatric patients work alongside community mental health services to provide care—an example of task-shifting.

My noble friend Lord Eccles has spoken compellingly about the UK’s track record on research—in particular, the practice of the London School of Hygiene and Tropical Medicine, the Hospital for Tropical Diseases and other institutions. He is, as are we, rightly proud of the international contribution that our institutions have made, not least in rendering neglected tropical diseases less neglected, as he says. I assure him that UK institutions successfully secure a high proportion of the global funds available for research, including from DfID. The London School of Hygiene and Tropical Medicine and the Liverpool School of Tropical Medicine are two among many centres of excellence for health research in the United Kingdom, and we expect UK institutions to continue to compete effectively for funding in the future.

My noble friend also asked about working across government departments. I would point out that the Department of Health, for example, funds the National Institute for Health. The London School of Hygiene and Tropical Medicine and other institutions can and do apply for grants, and there is a lot of discussion between DfID and the Department of Health on this.

As noble Lords will be aware, and as the noble Baroness, Lady Flather, pointed out, DfID puts women and girls front and centre, recognising that they are likely to be the poorest and the most vulnerable in the world. Supporting women and girls brings particular benefits to the individuals themselves, as well as to their families and their communities. Task-shifting can bring particular benefits to women both as employees—many community health worker programmes prioritise women’s training—and as beneficiaries of expanded services. Pakistan’s Lady Health Worker Programme, which we support, makes it easier for women to access healthcare. However, as All the Talents points out, and as noble Lords have emphasised, task-shifting needs to be done well. Fragmented approaches, delivered separately from the wider health system or driven solely by efforts to cut costs, are not the way forward. Crucially, Governments need evidence of what works to be able to design effective programmes. Research and evaluation need to establish best practice and inform policy. The noble Lord, Lord Crisp and the noble Baroness, Lady Warwick, are right in this regard.

The noble Lord, Lord Crisp, asked me, interestingly, about Jeffrey Sach’s campaign to train 1 million community health workers. We believe that the initiative to expand access to good-quality healthcare is welcome. However, we are concerned that the evidence to support such a dramatic scale-up in community health workers is weak. Any such initiative needs in-built evaluation plans to build evidence and understand impact. The noble Lord, Lord Crisp, emphasised that and so do we.

The UK Government support research into task-shifting. DfID has commissioned a cost-effectiveness study on using community health workers to deliver essential health services, and the ReBUILD research programme looks at opportunities to reallocate health worker responsibilities in fragile and post-conflict situations. An overarching policy question for this research is: can they be a cost-effective investment for MDG progress? If so, can a defiaced set of competency-based roles and functions, founded on a strong evidence base, be specified to maximise value for money and health systems requirements for effective scaling-up?

How might things move further forward, given that we are already strongly supporting this in a number of countries? This November, there will be a Global Forum on Human Resources for Health in Brazil, convened by the Global Health Workforce Alliance and hosted by the Government of Brazil. This will be an important opportunity to ensure that the human resources for health agenda remains relevant to current global health policy discussions. Task-shifting will undoubtedly form part of this. We are playing our role in the run-up to this conference and looking forward to hearing the evidence brought to it. This will be a chance to map and share, in the way that the noble Lord, Lord Crisp, outlined.

In conclusion, I thank all noble Lords for taking part in this debate, and even more for all the work they are doing, nationally and internationally, to ensure that, wherever people need medical assistance or healthcare of one sort or another, we work across barriers to do everything possible to maximise their chance of receiving such support. DfID will continue to work with developing countries, to support them in their efforts to build health service quality and access, including where this means rethinking health worker roles.

Motion agreed.

Ethical and Sustainable Fashion

Baroness Northover Excerpts

Tuesday 19th March 2013 Lords Chamber

[Baroness Young of Hornsey]

My Lords, I am pleased to open this second debate on ethics and sustainability in fashion, especially as there is a full-page account of a round-table discussion on the subject in today’s Guardian. I am particularly grateful to colleagues on the All-Party Parliamentary Group on Ethics and Sustainability in Fashion for their hard work and to the Centre for Sustainable Fashion for providing a secretariat alongside MADE-BY. Special thanks go to Dilys Williams, the head of the CSF, for bringing me up to date on key developments.

Fashion is about so much more than the clothes we wear. It may be an expression of our professional and personal identities, an expression of where and how we see ourselves in relation to our peer group, our cultures, our families and communities, and an expression of our creativity and our sense of fun. However consciously or otherwise we do it, as we dress, so we make a statement, even if the statement is, “I don’t care or think about what I wear”.

In spite of its importance in so many people’s lives, the perception persists that fashion is frivolous and inherently ephemeral. However, better than most, the Minister will be aware of the size of the UK fashion industry and of its contribution to the economy. The estimated amount spent on clothing in the UK in 2011 was £43.9 billion. Despite the high level of garment manufacture carried out overseas, the estimated value of UK-manufactured clothing and textiles in the UK was £8.1 billion in 2011, and the overall estimated export value of UK clothing and textiles was £7.3 billion.

If we take the volume of clothing sales and look at the global nature of the supply chain, and then start to unpack what that means in terms of the relationship between the environment and consumption, a worrying picture emerges. The Waste and Resources Action Programme, known as WRAP, reported in Valuing Our Clothes that we have stashed away in our wardrobes some £30 billion-worth of clothes, unused for at least a year. About a third of the clothing we no longer need ends up in landfill—that is, around 350,000 tonnes or an estimated £140 million-worth of used clothes. On average, the global water footprint of a UK household’s clothing exceeds 200,000 litres a year—enough to fill more than 1,000 bathtubs to capacity.

We have to work much harder and be more creative and inventive about how we tackle these problems. Not enough of us make connections between “fast fashion” and climate change, environmental degradation, labour issues in developing countries and resource scarcity. This is not to suggest that nothing is being done. On the contrary, parts of the fashion sector supply chain and increasingly aware consumers, campaigners and legislators have embraced a range of measures, instruments and strategies to mitigate the damage caused by our current practices and processes.

Last month, I was in Copenhagen, where I gave a presentation to Danish MPs on the APPG on Ethics and Sustainability in Fashion, which I chair. Jonas Eder-Hansen, the director of NICE, the Nordic countries’ umbrella group promoting sustainable fashion, and Michael Schragger of the Sustainable Fashion Academy work with Ministers and MPs from Sweden and Denmark, as well as representatives from the industry, to develop and deliver sustainable business models and other strategies to take us forward.

Here in the UK, the work of Defra and WRAP in promoting the Sustainable Clothing Action Plan, known as SCAP, is seen as a model of good practice and held in high esteem internationally. Indeed, WRAP and Defra were presented with the Global Leadership Award in Sustainable Apparel by the Swedish Sustainable Fashion Academy in Stockholm last month. At the event, I found a strong appetite for collaborating internationally with politicians and the sector. All of us are aware that in our contemporary, globalised world, pollution and unsavoury labour practices are no respecters of national boundaries.

Industrial dyes are a case in point. For a start, fabrics are dipped or washed in dyes that are made using copious amounts of precious water. In spite of regulations intended to ensure that the excess, dye-laden water is treated before being disposed of, it is cheaper to dump the dye effluent than to clean and reuse it. The Wall Street Journal’s report on an instance of severe pollution in China where a river literally ran red makes chilling reading. Of course, by not treating water, costs are kept low, as demanded by large retailers wanting to sell cheap clothes to their customers in the USA and Europe.

Consumers need to make the links between their desire for cheap clothing and the loss of livelihoods through depleted, polluted fishing stocks and ever diminishing food and water resources. Add to that the fact that more than 400 people have died in fires in Bangladesh and Pakistan in the past six months, with at least one of the factories involved producing garments for a British retailer, and we have to acknowledge that our current mode of “enjoying” fast, cheap fashion makes no sense whatever.

Fashion today is both global and local, and even much of the produce of many of our high-profile “heritage” British brands, such as Burberry, Aquascutum and Crombie, is often all or mostly made outside the UK. The global nature of the fashion industry means that it is imperative that we work with colleagues internationally to secure more effective international standards on, for example, sophisticated factory inspection measures, labelling countries of origin, instituting traceability mechanisms and so on. Thanks to the horsemeat scandal, the general public is becoming acquainted with the unforeseen complications brought about by globalised processing and trading practices. The longer and more dispersed the supply chain, the more difficult it is to ensure transparency and accountability.

One equivalent to the horsemeat issue, if I may put it that way, in clothing terms is cotton. There are many people who would not wish to wear garments made from cotton harvested by children forced to work in the cotton fields of Uzbekistan instead of attending school—I should declare an interest here as a patron of Anti-Slavery International, which has worked ceaselessly to try to persuade Governments and the EU to work harder to stop this practice—but it is impossible to know the source of your shirt, skirt or trousers. Yet some of our largest fashion retailers will not undertake to demand that the companies in their supply chain stop using cotton gathered by state-sponsored forced labour.

Businesses and consumers alike can be powerful agents of change, and it is clear that education and awareness-raising have a crucial role to play. However, there is also a need for leadership from government in hosting platforms for initiatives, supporting change-makers and investigating the risks of not thinking through the consequences for environmental sustainability. This leadership role should also be concerned with working in partnership to educate consumers and skill up young people on manufacturing and other skills, as well as investing in sustainable fashion SMEs and other projects focused on a sustainable future still infused with excitement, individuality and style.

We have all the incentives we need to act and to act quickly, and we have the individuals and organisations with the talent, so what more can government and politicians do to enhance the effectiveness and reach of these people? Clear, vocal leadership is important, and government Ministers and their officials can fulfil a useful role in supporting initiatives across the spectrum of departments with a stake in finding solutions to the problems we have created. The Sustainable Clothing Action Plan is a good example of government leadership, with an NGO and industry working together to find solutions to complex problems.

I cannot mention all the different departments that could have some sort of purchase on this issue. Some time ago, DfID, for example, introduced the Responsible and Accountable Garment Sector Challenge Fund. Fashion, of course, lies within the DCMS’s remit. It is also within the BIS agenda because of the manufacturing element and also because of the potential of the Green Investment Bank. In fact, in November last year, Business Secretary Vince Cable promised government support to breathe new life into UK textile manufacturing as a study revealed that the cost gap with Asia is narrowing. Can the Minister tell the House how far such plans have gone and the extent to which sustainability and ethics in fashion is a priority consideration? Other departments, such as the MoD or the Department of Health, can support sustainable clothing via the purchase of uniforms and so on through ethical procurement procedures.

Will the Minister undertake to set up a meeting with me and other Members of both Houses on the APPG to discuss how we can best help to support the development of this part of the fashion sector? We need to get a commitment to develop practical, effective strategies across the different departments for realising the potential of rethinking how we “do” fashion. Because of its experience with the Sustainable Clothing Action Plan, Defra is perfectly placed to broker and animate the necessary discussions.

To end on a positive note, technological innovation is crucial. I look forward to the day when waterless production techniques, air-purifying textiles, as being developed by Professor Helen Storey and Professor Kate Storey, and closed-loop technologies, in which the garment is manufactured, sold and eventually reformed so it can go back into the manufacturing process, will be the norm. Then we will know we are getting somewhere. However, we should also acknowledge that there is no single magic potion that can cure our environmental excesses. We need multiple strategies and to work collaboratively and internationally to effect sustainable change.

At the British Fashion Council’s Esthetica Showcase at London Fashion Week last month, a young designer showed the collection with which she won a competition for fashion designers. The material she had to work with was the discarded clothing and waste materials of Veolia, whose employees collect our rubbish and sweep our roads. It just goes to show that with support, creativity, vision, skill and invention, even the fluorescent strips from a refuse collector’s jacket can be turned into a garment of true beauty.

[Baroness Northover]

I remind noble Lords that this is a time-limited debate and, if my maths is right, we have no spare capacity. When the Clock shows four, noble Lords have had their four minutes.

Children: Developmental Care and Autism

Baroness Northover Excerpts

Tuesday 19th March 2013 Grand Committee

[Baroness Northover]

My Lords, I am very grateful to the noble Lord, Lord Maginnis, for raising this issue and for introducing it so effectively. The noble Lord is right to emphasise the importance of this disorder, and he and my noble friend Lord Addington, as well as the noble Lord, Lord Hunt, are all absolutely right to stress the importance of picking it up early and supporting people from the earliest stages. As my noble friend Lord Addington points out, it is important to pick it up later and monitor the progress of a child.

I want to place special emphasis on the role that the new commissioning bodies will have in ensuring that children with special needs, including autism, receive the care that they need. I hope that I can reassure the noble Lord, Lord Hunt, in this regard. We know that there is a need to improve the early identification and assessment of special educational needs and thus remove the duplication and frustration which many families have encountered in securing an assessment. That is absolutely vital. We have already made progress in delivering the necessary improvements. For example, we have introduced an early years progress check for children at the age of two in order to pick up problems early and tackle them. Several noble Lords have mentioned this assessment. It is extremely important in terms of the early identification of autism. We recognise the importance of a key universal service for improving the health and well-being of all children through health and development reviews, immunisation programmes and so on. Between the age of two and two and a half, a child will have a full health and development review at which parents will have the opportunity to raise any concerns, ask questions, and prepare for the next stage of their child’s development. This can trigger the need for a formal SEN assessment which must include doctors, educational psychologists and paediatricians if that seems to be necessary.

[Lord Maginnis of Drumglass]

Before the Minister moves on, can she clarify one point? Is this a procedure whereby parents will be aware that they can shop, if I can put it like that, for this sort of support or is it something that every single two year-old will be given as a matter of course?

[Baroness Northover]

It is planned that every two year-old will have that kind of assessment. It is extremely important not only in terms of autism, but for picking up other problems.

The noble Lord, Lord Maginnis, asked about the availability of health visitors. To support the delivery of the Healthy Child programme, we are committed to expanding the number of health visitors—he is quite right about their importance—by a further 4,200 full-time equivalents by 2015 and to develop health visiting services in order to improve health outcomes and reduce inequalities.

We recognise the pressing need for a new system of commissioning special educational needs provision, so I hope that noble Lords will be pleased to hear that the Children and Families Bill will introduce this. The provisions of the Bill will build on the new approach to commissioning introduced by the Health and Social Care Act 2012. They will introduce an integrated approach to meeting the needs of children and young people with special educational needs, requiring CCGs and local authorities to make joint commissioning arrangements and focusing on a single, co-ordinated assessment involving a range of professionals. Moreover, these arrangements can include people up to the age of 25. It is extremely important that they should go beyond the transition points that others have found to be problematic. The assessment process will result in an individual education, health and care plan. I hope that noble Lords are pleased to hear about this because it will bring together the health and education sides. The process will be focused on improving outcomes for the child. The commissioners, working together, must agree their relevant contributions to delivering the plan, and they will have to work out who is going to be responsible for the different elements.

These plans will not be developed in isolation, of course. The boards and the CCGs will co-operate with relevant local authorities and participate in their health and well-being boards. Each board will provide a forum for the effective assessment of local need, and special educational needs will be part of that so as to ensure the translation of those commissioning plans and arrangements into something that is effective. Health and well-being boards will undertake a joint strategic needs assessment and a joint health and well-being strategy for the local authority area. The CCG will draw on this in developing its annual commissioning plans. Moreover, health and well-being boards will help to ensure the accountability of CCGs by giving their opinion on the extent to which the commissioning plans take account of the local strategy and how the CCG has contributed to its delivery. Noble Lords need to bear in mind that special educational needs are in there, and they have to assess what is being provided against that.

The new arrangements will be introduced in 2014, depending on the passage of the Bill, but a number of pathfinder local authorities are working with local children and their families in piloting new approaches. As the noble Lord, Lord Hunt, will be aware, the mandate for the NHS for the next two years has indicated the particular need for improvement, working in partnership across different services in supporting children and young people with special educational needs and disabilities. In particular, it gives the NHS Commissioning Board the objective of ensuring that children have access to the services identified in the agreed care plan. I hope that that will reassure the noble Lords, Lord Maginnis and Lord Hunt.

We are also amending the Children and Families Bill to place a duty on CCGs to secure the necessary health services in an education, health and care plan. This is a significant step, and highlights how much importance we attach to ensuring that the NHS delivers the right service for children with special educational needs.

We want to ensure that CCGs and local authorities, as commissioners, and the health and care professionals who provide assessments and diagnoses are supported, particularly in relation to their education and training. The noble Lord, Lord Maginnis, is absolutely right to stress the need to link up health and education.

For the past two years, the Department for Education has been funding the Autism Education Trust to develop tiered training materials for schools, as well as national standards for provision for children with autism and a competency framework for those who work with children with autism. These are relevant points for the noble Lord, Lord Maginnis, and my noble friend Lord Addington.

The new qualified teacher standards came into effect in September 2012. These have sharpened the focus on meeting the needs of children with SEN and disabilities. The Government have also strengthened initial teacher training and continuing professional development provision through the publication of additional online training materials for teachers of pupils with the most common and complex special educational needs, including autism.

We have also highlighted the importance of having good quality data that measure the outcomes which are most important to children and young people and their families. The work of the Children and Young People’s Health Outcomes Forum has informed actions across the health and care sectors to identify the best indicators of outcomes for this group, particularly in relation to the time taken from first presentation to diagnosis. The noble Lord, Lord Maginnis, highlighted this as being a problem, particularly in the past, which we certainly do not want to have repeated; we want to address that. One element of this is ensuring the effectiveness of transition at different life stages, particularly from children’s to adults’ services.

The recent University of York report into transitions for young people with autism highlighted that we need to do much more to support young people in planning for leaving school, gaining employment and living independently, while maintaining good health. The NHS Outcomes Framework for 2013-14 includes the forum’s proposal that all data should be presented in five-year bands up to the age of 25 to enable the effective monitoring of that transition. That is quite a significant change. Here, too, I want to reassure my noble friend Lord Addington in relation to those children whose need for support does not become apparent until they are well established in school. The Government’s approach is to strengthen awareness in schools through staff training; for example, extended placements in special schools for trainee teachers. We want to ensure that needs are detected as early as possible, but I emphasise that at any point the school can request an assessment by the local authority. The education, health and care plan approach provides a basis for taking an all-round view of the children’s needs across different sectors. Of course, schools are providing additional support for many children through teaching assistants.

[Lord Addington]

My Lords, teaching assistants have rather a patchy record when it comes to implementing the current statementing system. For instance, there is a nasty tendency for them to become a babysitter for a child who is having trouble within the class. I suggest the Government should look at this because it is something that has been going on for years. Unless you get that person trained to at least implement the strategy across all disabilities, it will not deliver the required outcome but may simply keep the child out of the way of the teacher.

[Baroness Northover]

The teaching assistant may be assisting with other children while the main teacher focuses on those with particular needs. My noble friend is absolutely right that it is extremely important that the right and appropriate support is given according to what a child needs, which is why those plans I mentioned are so important.

Partnership working will be the key to making a difference. We want to work closely with partner organisations, such as the Council for Disabled Children and the National Autistic Society. However, the most significant partners, if you can call them such, will be the patients and their families. The joint arrangements for assessment will be built around the individual; it is a bespoke plan tailored to the needs of the individual and agreed with them and their family.

I am afraid I am running out of time and I will write on any points that I have not picked up. I want to emphasise, however, that clinical commissioning is built upon patient involvement particularly for this group, whose needs have not always been well met in the past. This will perhaps be the most important factor in ensuring they get the care and support that makes the difference to them.

Global Green Growth Institute (Legal Capacities) Order 2013

Baroness Northover Excerpts

Wednesday 13th March 2013 Lords Chamber

Moved by

[Baroness Northover]

That the draft order laid before the House on 29 January be approved.

Relevant document: 19th Report from the Joint Committee on Statutory Instruments, considered in Grand Committee on 6 March.

Motion agreed.

HIV/AIDS: Commonwealth Countries

Baroness Northover Excerpts

Wednesday 13th March 2013 Lords Chamber

[Baroness Northover]

My Lords, I, too, thank my noble friend Lord Black for introducing so effectively this important debate on the stigma and discrimination facing gay men and women in Commonwealth countries, and the additional stigma of HIV/AIDS. My noble friend Lord Black makes clear that the criminalisation of homosexuality in 42 Commonwealth countries can indeed lead to death, possibly not only of the person in question but of partners and children. We are reminded, both by him and the noble Baroness, Lady Gould, and others that the laws that criminalise are a colonial legacy. We heard a powerful account from my noble friend Lady Brinton about the situation in Zambia, where homosexuality is criminalised and where families and communities take severe measures to “cure” homosexuals of their apparent illness.

Homosexuality is criminalised and homosexuals suffer terrible discrimination. Those with HIV also suffer discrimination. As my noble friend Lord Lexden said, we have here two grave issues—and they can be literally grave. It is appalling that HIV-related stigma and discrimination in the family, community and workplace is still so widespread around the world and in the Commonwealth. Unless stigma and discrimination are addressed, as the noble Baroness, Lady Gould, and others said, we will not meet our global commitment to halt and reverse the spread of HIV. The noble Lord, Lord Collins, outlined the particular risk in the Caribbean and elsewhere. Our response cannot neglect these populations who are most marginalised and today I hope to highlight areas where the UK Government will do more.

Legal barriers create a climate of fear that prevents people accessing the prevention, treatment and care they need. In many countries, including many Commonwealth countries, rather than providing protection, as we have heard, the law—and the law of the street—dehumanises sex workers, men who have sex with men, people who use drugs, transgender people, prisoners and migrants. This drives these key populations underground and hinders their access to information and services, which in turn promotes risky behaviour that makes them even more vulnerable to HIV infection and fuels the epidemic further.

In defiance of international human rights standards, 78 countries, half of them in the Commonwealth, make same-sex sexual activity a criminal offence, as we have heard. When we have specific concerns about a Government's failure to protect their citizens’ rights—for example, through the persecution of lesbian, gay, bisexual and transgender people—we raise these directly at the highest levels of the Government concerned. My noble friend Lord Black asked whether the UK Government will make decriminalisation a stated policy commitment for the FCO and DfID. The UK’s LGBT action plan includes an international commitment to advocate changing discriminatory practices and laws that criminalise homosexuality and same-sex behaviour, and to work with international institutions to oppose the introduction of new anti-homosexual legislation. We work with our embassies and high commissions and through international organisations, including the UN, the Council of Europe and the Commonwealth, to promote tolerance and non-discrimination and to address discriminatory laws, in particular those that criminalise homosexuality.

We see the Commonwealth and its networks as a potentially valuable partner in protecting and promoting human rights globally. However, the rights of homosexual men and women remain a very difficult and controversial issue in the Commonwealth. Like the right reverend Prelate the Bishop of Newcastle and others, I am delighted with the positive outcomes from the Commonwealth Foreign Affairs Ministers’ meeting in New York last September, including agreement on the outstanding recommendations of the Eminent Persons Group, now reflected in the Commonwealth charter signed by Her Majesty the Queen on Monday on Commonwealth Day. This sets out the Commonwealth’s core values and aspirations, including that discriminatory laws that impede access to HIV treatment should be addressed. Protecting human rights is a core value of this unique organisation and endorsement of the charter reiterates its commitment to opposing all forms of discrimination on any grounds.

I will read certain elements of the Commonwealth charter. Various noble Lords have referred to this and quoted from it, but it is worth reading again, for the reasons that my noble friend Lord Lexden gave. In the section on human rights, it states:

“We are committed to equality and respect for the protection and promotion of civil, political, economic, social and cultural rights, including the right to development, for all without discrimination on any grounds as the foundations of peaceful, just and stable societies. We note that these rights are universal, indivisible, interdependent and interrelated and cannot be implemented selectively … We are implacably opposed to all forms of discrimination, whether rooted in gender, race, colour, creed, political belief or other grounds”.

If noble Lords read on, they will see under “Tolerance, respect and understanding” the emphasis on,

“the need to promote tolerance, respect, understanding, moderation”;

under “Separation of powers”,

“the promotion and protection of fundamental human rights”;

and under “Access to health”,

“emphasise the importance of promoting health and well-being in combating communicable and non-communicable diseases”.

It is worth emphasising those, because I urge noble Lords to take heart from these words. They are the words that citizens can use to hold their Governments to account; and for countries to hold other countries to account. As my noble friend Lord Lexden will know, international human rights may seem to make slow progress historically, but it is often through these statements that gradually things move forward.

My noble friend Lord Black asked why the Commonwealth Secretariat has not included LGBT rights, legal reform or HIV in its new strategy. The draft Commonwealth Secretariat’s draft strategic plan is quite high-level and does not go into much detail about proposed activities. It foresees a role in health, human rights and justice, which are all relevant here. We will continue to work with the secretariat and the foundation to see what more they could do in this important area. To address a question from the noble Lord, Lord Watson, we in the UK do not ourselves set the agenda for CHOGM, but we will continue to raise these issues in Commonwealth fora. It is extremely important that countries have signed up to the language that I have just cited.

I hardly need to draw noble Lords’ attention to the fact that policies, programmes and resources for HIV for key populations are grossly inadequate, despite the growing infection rates in the groups that we have talked about. For example, in 2009, only 18% of countries had established HIV prevention goals for reaching men who have sex with men.

That is why, in the Government’s position paper on HIV in the developing world, Towards Zero Infections, published in May 2011, we committed to build on our track record as a voice for a public health approach—as emphasised by the noble Lord, Lord Collins, and the noble Baroness, Lady Gould—to the key populations affected by HIV that respects human rights and addresses stigma and discrimination. The world must work much harder to empower those groups whose life circumstances place them at increased risk of HIV.

I could draw on many examples to demonstrate DfID’s support, which echoes the approach that we have taken in the Department of Health within the United Kingdom. I shall mention three. The Global Network of People Living with HIV has been conducting policy research in South Africa on the criminalisation of LGBT. The Global Forum for Men who Have Sex with Men is engaging in international policy dialogue to promote laws, regulations and policies that improve HIV prevention programmes for men who have sex with men. I hope that my noble friend Lord Black and others will be pleased that, last July, my right honourable friend the Minister of State for International Development, Alan Duncan, announced new resources for the Robert Carr fund to support global and regional networks to improve HIV responses reaching key populations, and this new funding is being disbursed.

My noble friend Lord Black asked whether the UK Government will consider introducing a specific funding mechanism for LGBT organisations working for legal or social reform in those countries. The UK funds a number of programmes in that area. For example, 21% of the networks that the Robert Carr fund, to which I just referred, is supporting involve work for legal or social reform in those countries, so that is being addressed. My noble friend Lady Brinton made the point that there are new ways of promoting equality, such as through social media. She is surely right about that; there are a number of ways to do that.

My noble friend Lord Lexden asked about the FCO rights toolkit. We are very pleased that NGOs feel that it is a world reference and that the United States has used it as a basis for developing its own toolkit, but we take his point that it is now somewhat dated. We plan to update it this year and will be happy to receive suggestions from anyone on how to strengthen it further.

The noble Lord, Lord Collins, asked about support for the global fund. The United Kingdom remains a strong and reliable supporter of the global fund. I am writing to my noble friend Lord Fowler with an update on the situation because, as the noble Lord will know, the global fund went through something of a difficult time, but the United Kingdom is on track to meet our £1 billion commitment to the fund by 2015. I am happy to copy the noble Lord into my letter to my noble friend Lord Fowler. We are working with others to ensure that there is successful replenishment.

It is clearly critical in all our support for local civil society organisations to empower those most at risk from HIV, so that they understand and can advocate for their rights, and to challenge HIV-related discrimination and criminalisation. Without grass-roots support to tackle legal barriers that hamper the HIV response, and without the ability to hold Governments to account, change will not be sustained. People living with or directly affected by HIV understand their needs better than anyone. Involving those communities is not just their right; it is essential to an effective response to the epidemic that their voices are heard in policy, decision-making and budgeting processes.

This has been a very important debate linking the terrible discrimination against homosexuals in many Commonwealth countries with the terrible discrimination against those who suffer HIV/AIDS. As the noble Lord, Lord Collins, the noble Baroness, Lady Gould, and others said, public health is assisted by promoting the rights of homosexuals, but it is right in itself, as others have said.

I assure noble Lords that we recognise those challenges and how important it is to support the rights of all, especially those who are the most vulnerable around the world.

House adjourned at 8.06 pm.

DfID: Tied Aid

Baroness Northover Excerpts

Monday 11th March 2013 Lords Chamber

[Baroness Northover]

My Lords, I will now repeat the Answer to an Urgent Question asked in the other place earlier today. The Answer, given by my right honourable friend the Secretary of State, is as follows:

“I am delighted to update the House on my speech today. There is no change on Her Majesty’s Government’s policy on tied aid. I was clear in my speech on 7 February, and again this morning when I said:

‘I am not talking about tied aid. I do not believe that is the way to achieve good, sustainable development … It’s the wrong way to go about things’.

That answers his first point. DfID contracts are awarded in line with EU procurement regulations. The vast majority are subject to competitive tender. The evaluation process for large contracts includes an assessment of technical and commercial criteria, which are published at the outset of the tender. That answers his second question.

In relation to today’s speech on pursuing poverty reduction and an end to aid dependency through jobs, it is clear that economic growth is critical. Wherever long-term per capita growth has been higher than 3%, we have also seen significant falls in poverty. Sustainable public services in the developing world, as here in the UK, need a funding stream of tax receipts and that means a thriving private sector.

DfID will be putting an increased emphasis on economic development, including: reducing overall barriers to trade and investment; unlocking the ability of entrepreneurs and business people in developing countries to drive economic growth through their own businesses; and fostering greater investment by business in developing countries. I want to see more businesses, including those in the UK, joining the development push with DfID. We all have the opportunity to help build up responsible trade with developing countries.

Finally, I welcome the positive response from organisations like CARE International and the Overseas Development Institute, with the former saying that,

‘It’s no longer an option for development agencies to view business as operating in a parallel universe’”.

That concludes my right honourable friend’s Statement.

[Lord Collins of Highbury]

My Lords, we also welcome UK companies seeking access to growing markets across the developing world. However, from the media reports at the weekend, the Government’s policy was not clear. We are vehemently against tied aid, trickle-down economics, and growth that has no focus on either inequality or sustainability. I have two specific questions for the Minister. Can she tell the House what steps her department will take to ensure private sector-led projects by DfID will be required to meet decent work and labour standards? Secondly, under what circumstances does she believe it right that a British company should be awarded a contract in a developing country without having to compete in a fair and transparent tendering process?

[Baroness Northover]

My Lords, I thank the noble Lord for his acceptance that economic growth through the expansion of businesses and so on is very important for developing countries, as it was in the United Kingdom. As we have seen in China and India, it obviously has a transformative effect. I reassure noble Lords that DfID remains poverty focused. That underpins everything that we do. Therefore, we are trying to ensure the development of the private sector, it is so that those long-term aims of relieving poverty are addressed. On how British companies would be awarded contracts, as I said in the Statement from my right honourable friend, contracts awarded to British companies by DfID go through the EU procurement regulations. However, the focus of DfID is always on the relief of poverty.

[Lord Laming]

My Lords, I, too, am grateful for the Statement repeated by the noble Baroness. Could the noble Baroness reassure the House that actions are always in place to ensure that when these decisions are made the beneficiaries receive the benefit—I am expressing this badly but noble Lords know what I mean—that the money goes to the right place for the right purposes, that it is properly monitored and that we are reassured that it is not being diverted into other means?

[Baroness Northover]

I thank the noble Lord for that question. I assure both noble Lords that DfID supports responsible business standards, which are very relevant here, through various schemes such as the Ethical Trading Initiative, the UN global compact, OECD guidelines for multinational enterprises and so on. One striking thing about the United Kingdom’s potential help for developing countries is what we can offer by way of our law and justice system. I was struck in meeting the Minister responsible for mines from Afghanistan the other day to learn how initially they found that in dealing with Chinese companies the benefit was probably not for Afghanistan so much as for the Chinese companies, but that now they are rooting it very much in British law guided by British companies. That is an instance where it is of mutual benefit. Of course, it is of benefit in business to the British companies working in this area, but you can see immediately the effect in terms of the poorest in Afghanistan. That is where the greatest benefit is. Therefore, these things can be looked at as of not exclusive but mutual benefit.

[Lord Elystan-Morgan]

My Lords, I am left with the very clear impression from the Minister’s Statement that there will be no difference as far as the future is concerned in the total amount of aid that is disbursed at every level and in every way. If that be so, I heartily congratulate the Government. It is all very easy when the going is benign and happy to be charitable, but it is in situations of difficulty such as this that the true test of a community’s charity is put to the proof.

[Baroness Northover]

I appreciate what the noble Lord has to say, and I hope that he continues to say such things loud and clear, because in a time of austerity there is a clamour of voices asking whether this is the right thing to do. As we meet the 0.7% commitment, which we have built to and kept to, we have a moral obligation to address the difference in the levels of need around the world. There is also the interest in terms of greater stability. If you are addressing the most abject poverty around the world, that helps to stabilise things for everybody, whether in that region or in our own.

[Lord Tugendhat]

Does the Minister agree that Africa is now one of the fastest growing regions in the world and that we should all be very pleased about that? Aid is now a relatively small proportion of the disbursements that go from the developed world to what used to be called the developing world. Remittances and direct investment have grown enormously, and the role of aid is far less significant than it used to be. It is not a question of this Government cutting back on what they have been giving; the extraordinary thing about this Government is that, at a time when they are cutting back on almost everything else, they have been increasing the overseas aid budget by 30%. I find that barely explicable.

--- Later in debate ---

[Baroness Northover]

If the noble Lord listens to Bill Gates, for example, he will hear how small contributions looked at globally can leverage an enormous effect. The noble Lord is right that remittances are coming in and there is more inward direct investment and so on, and that is very welcome. We have to make sure that, as the noble Lord, Lord Laming, indicated, the poorest are included in that benefit and that there is the health and education provision to make sure that there is a skilled workforce to benefit from this, because it is in nobody’s interest to have countries with the instability and inequalities that that lack of provision would ensure. It is extremely important that we retain our commitment in this area, but at the same time we must make sure that these other areas, such as direct investment, grow as well and that they are to the benefit of the poorest in these countries.

[Lord Kerr of Kinlochard]

I thank the Minister for repeating the Statement. I was very pleased to hear her strictures on tied aid and her support for competition. Will she confirm that the same applies to consultancies? The only thing that worried me in her Afghan homily was the interjection that investors in mining in Afghanistan were advised by British companies. When such advice from consultancy firms comes from the aid programme is it subject to the same degree of open competition? In developing countries, one sometimes hears that rather a large share of the British aid programme does not go into projects on the ground but into consultants in London.

[Baroness Northover]

The Afghan Government chose to gain their legal advice in the way that I indicated. Consultancies are subject to open competition, so the noble Lord can be reassured in that regard.

[Lord Fowler]

I agree with what my noble friend set out as her department’s general policy. I have a specific question about the statement by the former Secretary of State that new money, extra money, would be going to the global fund for HIV and other diseases. Will that pledge be kept?

[Baroness Northover]

I am going to have to write to my noble friend to clarify that. I know that the Global Fund had some problems, with which he will be extremely familiar. I also know that DfID was working extremely closely with the Global Fund, because it had been so effective in the past, to bring it back to that position. I have not had the most recent update. I will make sure that he gets it.

Sport: Women and Girls

Baroness Northover Excerpts

Thursday 7th March 2013 Lords Chamber

[Baroness Massey of Darwen]

To ask Her Majesty’s Government what action they will take to encourage women and girls to take part in sport, and how they will seek to improve the profile of women’s sport in the media to that end.

[Baroness Northover]

My Lords, the Government are committed to encouraging more girls and women to play sport regularly as part of the sporting legacy. Sport England’s £1 billion community and youth sports strategy includes programmes designed to appeal specifically to women and girls. In addition, my right honourable friend the Secretary of State for Culture, Media and Sport has been working closely with the broadcast and print media to encourage them to cover more women’s sport.

[Baroness Massey of Darwen]

I thank the noble Baroness for that encouraging Answer, but can she expand on the consultation that is taking place not only with the media but with sports advisers in schools to encourage girls? In particular, what kind of sports are being identified as problematic for women and girls, and how will the media be asked to deal with that?

[Baroness Northover]

The picture here is encouraging but there is a tremendous amount more to do. I was struck by the fact that the latest figures, from December 2012, show that 1 million more women are taking part in sport than was the case when we won the Olympic bid in 2005. On coverage, in 2005 the Women’s Sport and Fitness Foundation estimated that only about 5% of media coverage was of women’s sport. The BBC has just told us that women’s sport now amounts to 25% of its sports coverage. Clearly, a lot more needs to be done and one of the things that is being taken forward by Sport England is to look at how best to encourage further development of this and encourage more women and girls to take part in sport.

[Baroness Heyhoe Flint]

My Lords, does my noble friend the Minister agree that developing a sporting habit for life is something that needs to start in primary school? There is a minimal amount of physical education within that sector and teachers of primary school children receive only a meagre six to 10 hours within a one-year training session. Back in the last century, my physical education training took three years. Would the Minister agree if I suggested that the introduction of physical education to primary school teachers would be a great advantage in developing that habit for life?

[Baroness Northover]

My noble friend speaks from a huge amount of experience and she is of course right that it is extremely important that we develop this from the earliest age—getting children out of pushchairs, for example, and onwards. As for primary schools, she is right. I am sure that she will be reassured to know that discussions are happening at the moment about how to strengthen school sport from primary schools upwards. An announcement will be made very shortly.

[Baroness Grey-Thompson]

My Lords, media coverage is very important and I declare an interest as chair of the Women’s Sport and Fitness Foundation’s Commission on the Future of Women’s Sport. However, for elite success and media coverage we also need good participation figures and recent data have shown that mums are much less likely to take their daughters to play sport than their sons because of their own experience of sport in school. Can the Minister say what plans the Government have to insist in changing the culture around women so that they encourage their daughters to play as much sport as their sons?

[Baroness Northover]

Again, the noble Baroness speaks with huge amounts of experience and the Women’s Sport and Fitness Foundation is a crucial body in trying to take this forward. Sport England has awarded a grant to that organisation to try to identify how best to encourage women and girls to be involved in sport. The noble Baroness is absolutely right that mothers who were themselves switched off from sport are less likely to encourage their children to be involved in sport. That is one key area where we welcome insights into how best to tackle this.

[Baroness Nye]

My Lords, does the Minister agree that, after the success of women athletes at the Olympics last year, it is a disgrace that two-thirds of boards of sporting organisations do not meet UK Sport’s minimum target of 25% female members and six, including British Cycling, do not have a woman on them at all? Given that public money is involved, do the Government have a strategy to deal with this?

[Baroness Northover]

The noble Baroness is right; Sport England and UK Sport are both encouraging national governing bodies of sport to increase the number of women on boards and the Government expect that all publicly funded sports bodies should have at least 25% women on their boards by 2017. That is very important but we also need more women as editors of newspapers, political programmes and so on.

[Baroness Sharples]

My Lords, does the Minister accept that the earlier you start to play sport, the more chance you have of playing golf, as I do, at the age of 90?

--- Later in debate ---

[Baroness Northover]

The noble Baroness is a model we should all emulate.

[Baroness Meacher]

My Lords, is the Minister aware of the outstanding work being done in many of the mental health trusts in London to promote sport among psychotic young people? We found that taking part in regular football matches, exercise and so on significantly reduces the readmission rates of these young people. Would the Minister please put pressure on her colleagues in the Department of Health to exert pressure on the commissioning bodies to promote sport among psychotic people? Without it, many of them make very little recovery over decades?

[Baroness Northover]

The noble Baroness is right to highlight mental health generally in relation to sport. Public Health England is well aware of the importance of sport in relieving depression and so on. I am very happy to take the points that she makes back but I can assure her that the Department of Health is well aware of the significance of sport in this regard.

[Baroness Billingham]

My Lords, the Government are determined that competitive sport in schools is the key to greater participation; that view is certainly not shared by the majority of physical education experts, who fear that such a programme will alienate many boys and girls and do nothing to produce a “sport for all” approach and lasting participation. What evidence is there for the Government’s proposed formula? Our evidence suggests the reverse. As for representation in the media, will the Government look at Title IX, the American system which guarantees equal exposure in sport for girls? We cannot reproduce it perfectly here but we could do a modified version, which may well help with the lack of women’s sport seen in our media.

[Baroness Northover]

We now have 50% of schools taking part in competitive games. There is mixed evidence as to the interest of girls and boys in that, and the noble Baroness is right to highlight to need to make sure that we analyse it properly. Sport England is looking at how best to encourage girls as well as boys to come forward. Some girls enjoy being part of a team, even if that may seem too competitive for some. I hear what the noble Baroness says on Title IX. We are taking a lot of measures to try to ensure that the media recognise the significance of covering women’s sport and the appeal of it—everybody could see how outstanding the women’s team was in the Olympics.