World Health Organisation

Lord Hunt of Kings Heath Excerpts

Wednesday 2nd July 2014 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, it is a great pleasure to take part in this debate. The noble Lord, Lord Ribeiro, has raised some very interesting questions on health in a global context, on which I hope that we will get some helpful responses from the Government tonight.

His argument essentially is that surgical interventions —focused, as the noble Lord, Lord Crisp, reminded us, on 15 common interventions—can play a very positive role in improving global public health. I thought that the argument was very persuasive and, as I said, I hope that the Government will respond. The comparison of access to surgery in the richest and poorest nations was striking. When we come to the core question of whether surgery is perceived by DfID as a public health measure, we must bear in mind this obvious inequality between the richest and poorest nations.

I would like to ask the Minister whether she accepts that surgery can relieve many of the most important health conditions that millions of people suffer from globally. It is very important that we get an affirmative response on that.

The comment made by the noble Baroness, Lady Brinton, using club foot as an example, was very striking. The example that she gave from Malawi seemed to be absolutely life-changing and very persuasive.

Of course the noble Baroness, Lady Chalker, speaks from great experience and is much admired in your Lordships’ House as well as internationally. She spoke of some of the major challenges in Africa regarding childbirth, including, as she clearly said, the need for surgery, and in particular of the problems in rural areas. She also mentioned issues arising with cleft palate: the challenge of early diagnosis and the problem of the availability of surgery. Again, it would be interesting to know whether that is a point that is recognised in DfID’s development plans for the future.

As ever, it is a great pleasure to hear the noble Lord, Lord McColl, whose personal contribution is remarkable. Politically correct perhaps he is not, but we are always entertained by his contributions. He mentioned the example of helping with the curriculum in a developing country, which, because it would not then be recognised by western universities and health systems, did not prove to be acceptable to the country itself.

It brings us to the difficult problems of both the emigration of doctors from developing countries and the fact that many students from other countries who come to the UK and other developed countries do not want to return. This brain drain is very worrying indeed. Can the Minister confirm whether it is government policy firmly to discourage such a brain drain? I would also like to ask her, given the example of the programmes training surgeons in the home country, whether the Government support that and will endeavour to give further support to bodies such as the Royal College of Surgeons in future.

The noble Lord, Lord Ribeiro, also raised questions about DfID’s priorities for low-income countries. He suggested that in terms of budgetary expenditure, middle-income countries—if I can call them that—were gaining at the expense of the poorest countries because of natural disasters. It would be good if the noble Baroness could confirm that.

The noble Lord, Lord Crisp, said that the issue was becoming more visible internationally, and mentioned the Lancet Commission on Global Surgery. I thought that one of his most telling comments was on the advantage of partnerships in which the NHS is a full partner but where it is acknowledged that enabling NHS staff to go abroad for a certain time and then come back to the UK can be a real advantage to the NHS. I am sure that that is right. My question to the noble Baroness is the one that the noble Lord raised. Inevitably at the moment, the NHS is under great pressure—and I know from my experience that when an NHS trust is under pressure, it worries about losing staff abroad. That applies to the services as well. Is there work to be done to help the NHS to recognise that there could be great benefits from encouraging young staff in particular to take advantage of these programmes? I doubt whether the noble Lord will get an answer to the question on whether student loans can be discounted, but it would be interesting to know whether the Government were at least prepared to talk to the noble Lord, as he suggested.

We come now to the crunch question. Do the Government accept that surgery has a key role to play in improving health globally, and, as the noble Lord, Lord Ribeiro, said, will they support surgery as a public health matter? That is a very important question. I yield to nobody in my admiration for public health doctors—indeed, I stand here as president of the Royal Society for Public Health—but beloved though public health doctors are, I sometimes think that the only interventions that they are concerned with are those that have absolutely nothing to do with medicine. This is because in the developing world inevitably they think about sanitation, access to water and all those sorts of things, which is entirely understandable. However, it is a question of global equality, too; and the evidence is that medical intervention, medicines and surgery can have a huge, positive impact on individuals. For that reason—the noble Lord’s point was persuasive—these should be regarded as public health measures and are as deserving of DfID’s support as what might be considered as the more traditional public health approach.