Queen's Speech

Lord Crisp Excerpts

Wednesday 26th May 2010 Lords Chamber

[Lord Crisp]

My Lords, in congratulating noble Lords on their appointments as Ministers, I warmly welcome the clear commitment to international development that I see coming from the coalition Government, despite the financial circumstances—and perhaps, even more importantly, because of them—and their clear determination to maintain and even enhance the leading role that the UK has played over the years. The UK has been a leading player in international development in recent years. It will be encouraging to see that supported and continued.

I will talk about health and development, and I will touch on foreign policy. I will make three points. The first is about health workers, the second is about using UK experience and expertise and the third is about links to global security. In all of this, I will stress the interdependence of rich and poor countries. This point should underlie all UK policy in this and other areas.

There is a desperate shortage of health workers. I was sorry to see that this point was not mentioned in the brief coalition statement on international development. It is mentioned strongly in the Conservative Green Paper of last year, and I hope that it will be returned to in subsequent policy documents. It should be one of the most important areas for international development. Health is very much about human contact. It is about access to the advice and knowledge that health workers can produce. Too often in poor countries, we see children dying of diarrhoea because nobody knows how to rehydrate them. We see a lack of immunisation. We see the dreadful problems, referred to by my noble friend Lady Flather, of pregnancy-related illness, injury and death. Some of these things are very simple for trained professionals to deal with, while others are complex.

Moving from the personal to the general, I will say that we will not achieve the millennium development goals without more health workers in these countries. I am not talking about the same staff mix as you would have in the UK. This is not about many more doctors and nurses. It is about massively increased numbers of community workers—people trained to mid-level, nurses with extra skills that allow them to do Caesarean sections—and some more professionals. It is not about just transferring our model abroad. Nor is the problem simply one of migration. In the UK, we have benefited from large numbers of people from poorer countries coming to work in our health system. However, the best estimates show that over the past 35 years, 135,000 people who first had some health training in poorer countries have come to richer countries. That is a big number, but the need is for somewhere between 1 million and 1.5 million more in sub-Saharan Africa. Dealing with migration will deal with only part of the problem. In that context, I congratulate this and the last Government on the fact that the World Health Assembly last week passed a new code of conduct on health migration, to help to manage the problems that come from that.

The biggest issue is getting more people trained. It is about helping people to be trained in all those areas, whether they are community workers, mid-level workers or fully trained professionals. That must be part of the wider set of policies to retain, support and employ them. Training them is something with which we in the UK can help.

I turn to our expertise and experience. If the Government want to put a greater emphasis on getting more health workers into poorer countries, they can do so in many ways. One is simply to give more priority, with their partners, to the issue. PEPFAR, the President’s Emergency Plan for AIDS Relief, has made a commitment to train 60,000 health workers over the next five years. It can ensure that all its programmes embrace the need for more health workers. It can also use the extraordinary experience, expertise, tradition and history that we have in the UK of training health workers. Still today, our royal colleges and other institutions are part of the training and accreditation systems of health workers around the world. We have a great tradition and history to build on. We also know that there is great willingness among health workers in the UK to help. Can we not do more to put this together? Can we not make something of all the small-scale efforts that are happening in the NHS and in the universities? I refer to places like King’s in London, which is working in Somalia, or a hundred NHS organisations that have links with African countries. They are only part of the solution, but a valuable part.

I also acknowledge a point made by the noble Lord, Lord Howell, about how much the world is changing. I spend a lot of time in Africa, and I see that poor people with creativity, without all our baggage of history and without our resources, can innovate. They can teach us things that we need to know about how to run health systems. I have written about this. I note that the private sector is starting to develop ideas along these lines. GE Healthcare, for example, has identified a number of products that it has developed in poorer countries for translation into richer countries. McKinsey, the management consultancy firm, has also identified that many of the greatest innovations in healthcare today are developing and being created in poorer countries. This is a win-win situation.

I turn finally to security. At its simplest, building relationships and partnerships and links across the world will help. We see it all over Africa, where there are many strong links. Before I started to work in Africa, I did not think that the Commonwealth was terribly important. I now understand how important it is in forging the links between this country and many countries in Africa and elsewhere. We also know that poor health services, and poor services generally, foster discontent. We know that there is great unfairness in how health resources are shared—unfairness about patents and about how drugs and health workers are shared around countries—which builds tensions. On the positive side, we also know that health can improve the economy, that an improved economy can build stability in a country, and that health can play a bigger part in future in the Government's plans for post-conflict resolution and reconstruction.

On global security, there is the question of the risks of disease. We know that new diseases will develop in the poorest countries. They will develop where health systems are poorest. It is in our interest that those countries have reasonable health systems, so that they can protect the security of the world and not just of themselves. That is why I echo other words of the noble Lord, Lord Howell: international development is about not just moral imperative but enlightened self-interest. He talked earlier about mutuality and respect. When we put this together, we are in this together. We should be talking much more about co-development and not just about international development, where we are seen as doing things to and for other people.

On a personal level, I shall be seeking discussions with other Members of your Lordships’ House to see whether there is a need for an all-party group on global health. There are many specific groups which deal with specific issues but nothing as yet that looks at all the issues that join us together globally in health terms, at our interdependency and at promoting thinking and appropriate policies.

Finally, I urge the Government to do three things: first, to embrace the notion of interdependence and the linked point of co-development as underlying policy, taking further the previous Government’s work on Health is Global as their global strategy; secondly, to embrace and promote the need for more health workers—do not let people die for lack of simple advice and help—and, thirdly, to use the experience and expertise here in our universities and health service, as people are ready to play a role and people are ready for a lead.