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

Lord Crisp Excerpts

Tuesday 10th March 2015 Lords Chamber

[Lord Crisp (CB)]

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

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

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

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

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

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

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

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

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

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

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

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

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