Universal Health Coverage

Debate between Philippa Whitford and Alistair Burt

Wednesday 10th July 2019 Westminster Hall

[Alistair Burt]

Yes, the hon. Gentleman is correct. When I was in the main camp in Cox’s Bazar—colleagues will have visited it—with those who had been there a year, protected from the atrocities in Burma, I asked, “What happens next?”. I was told the biggest worries on the camp were: boredom and lack of things to do; education for the children; domestic abuse in the camp; and trafficking. That is a signal to all of us that just keeping people in a camp, protecting them from one thing but leaving them exposed to another, is a further tragedy.

Let us look at the state of the world’s health, concentrating on three areas in particular. The first is children’s health, where the picture is not all gloomy. Each day, 17,000 fewer children die than did in 1990, but more than 5 million children still die before their fifth birthday each year. Since 2000, measles vaccines have averted nearly 15.6 million deaths. Despite determined global progress, an increasing proportion of child deaths are in sub-Saharan Africa and southern Asia; four out of five deaths of children under five occur in those regions. Children born into poverty are almost twice as likely to die before the age of five as those from wealthier families.

Secondly, let us look at maternal health. Maternal mortality has fallen by 37% since 2000. In eastern Asia, northern Africa and southern Asia, it has declined by about two thirds, but the maternal mortality ratio—the proportion of mothers who do not survive childbirth—in developing regions is still 14 times that of developed regions. The need for family planning is slowly being met for more women, but demand is increasing rapidly. Again, we see that in the camps, where women who, in the countries they come from, had been excluded from reproductive health advice, perhaps for religious reasons, gain rapid access to it in the camps. That again is a lesson for the future.

Thirdly, I turn to HIV/AIDS, malaria and other diseases. In 2017, 36.9 million people globally were living with HIV, and 21.7 million people were accessing antiretroviral therapy, but 1.8 million people became newly infected with HIV and 940,000 people died from AIDS-related illnesses in that year. TB remains the leading cause of death among people living with HIV, accounting for about one in three AIDS-related deaths. Globally, adolescent girls and young women face gender-based inequalities, exclusion, discrimination and violence, which puts them at increased risk of acquiring HIV. It is the leading cause of death for women of reproductive age worldwide, and now the leading cause of death among adolescents in Africa, and the second most common cause of death among adolescents globally.

More than 6.2 million malaria deaths were averted between 2000 and 2015, primarily of children under five years of age in sub-Saharan Africa. The global incidence of malaria has fallen by an estimated 37% and mortality by 58%.

What is DFID doing in these areas, and where are we going? The UK’s significant boost to the Global Fund, the combined effort to combat AIDS, TB and malaria, was announced by Prime Minister at the recent Japan summit. The 16% increase to our already generous contribution sets a new standard for others to follow, and I thank the Minister and all those behind him who worked on that over a long period. My friends at STOPAIDS and ONE and many others welcomed the achievement. ONE said:

“This is global Britain in action.”

There’s a phrase! It continued:

“It is fantastic to see the UK reaffirming its position as global health leader, working in partnership with other donors, countries affected by the diseases, the private sector and philanthropy to make the world a safe, and healthier place”.

However, we must ask the Minister how he plans to ensure that others follow. Will he outline any changes or developments in transition strategies, as nations take on more of their own responsibilities and work towards what, in such areas, is often a difficult process?

Let me say a few words about vaccination. Gavi, created in 2000, is a global vaccine alliance bringing together the public and private sectors with the shared goal of creating equal access to new and underused vaccines for children living in the world’s poorest countries. From 2016 to 2020, the UK is providing a quarter of Gavi’s funds. We are its largest donor, and have supported it since its inception. Gavi’s first replenishment conference was hosted by David Cameron in London in 2011.

As well as providing direct funding to Gavi, the UK was also instrumental in creating the international finance facility for immunisation, which raises funds for Gavi by issuing vaccine bonds on international capital markets. The UK also helped create the advanced market commitment for pneumococcal vaccines, which have helped protect millions of children in developing countries against the leading cause of pneumonia, as well as the matching fund, which encourages funding from the private and philanthropic sectors by doubling donations. That is my point about partnerships. It is always tempting to think that this work can be done by one sector or another alone. My experience is that that is not the case. Partnerships can contribute to the whole, but they need to be handled carefully.

Let me mention polio. As we know, it has decreased by over 99% since 1988, but transmission has never stopped in three countries: Pakistan, Afghanistan and Nigeria. There remains a risk of failure. We must thank the development and health workers who are responsible for vaccination. In particular, we recognise that in some countries they face genuine physical threats and loss of life.

In other countries, vaccination faces a threat from anti-vaccination campaigns, which are run for all sorts of reasons. It is essential that anti-science is combated by evidence of science and evidence of success. As far as I am aware, vaccination is about Edward Jenner and smallpox in the United Kingdom, and about Pasteur and others worldwide. It is not about big pharma trying to sell vaccines; it is a proven method of saving countless millions of lives. As we have learned to our cost, we might find a good argument lost for want of it not being made regularly. Let that not happen with vaccination.

Finally on polio, I must mention rotary. I am an honorary member of the Sandy rotary club—my father has been a member of the Bedford rotary club and Bury rotary club for many years—and we recognise that rotary has helped vaccinate 2.5 billion people in 122 different countries and given more than £1.8 billion over 30 years. I have met Judith Diment, the national representative, a number of times. We thank those in rotary up and down the country and abroad for their efforts and voluntary work.

Finally, on behalf of Save the Children and others who have written to me on this issue, I turn briefly to the high-level meeting. The first ever high-level meeting on universal health coverage will take place in September at the UN General Assembly. It is a critical opportunity to galvanise global momentum behind healthcare.

“The theme…is ‘Universal Health Coverage: Moving Together to Build a Healthier World.’ This…will be the last chance before 2023, the mid-point of the SDGs, to mobilise the highest political support to package the entire health agenda under the umbrella of UHC, and sustain health investments in a harmonised manner.”

I am shamefully reading out the briefing from Save the Children. I am not pretending to claim authorship of this; I am acknowledging the support we get from our remarkable partners. The high-level meeting has the potential to be a transformational moment for children everywhere, but countries need to step up their efforts to tackle the biggest challenges in global health today, from ending the scourge of preventable diseases to reigniting action on stalled global immunisation rates, for the reasons I mentioned.

I know the Minister will have been presented with a series of challenges for the high-level meeting. Perhaps I could outline them. We hope that the Secretary of State will attend the high-level meeting. The UK should champion free-at-the-point-of-use health and nutrition provision, helping to deliver on the “leave no one behind” agenda and to ensure that we reach those furthest behind; it should signal its support for domestic resource mobilisation, which is essential for encouraging more countries to work on strengthening their systems; it should champion the full integration of nutrition and immunisation into national universal health coverage plans; and it should fund UHC2030 as the main institution that can make a difference in driving the UHC agenda and on accountability, with a focus on meaningful civil society participation.

I could mention much more. Sexual and reproductive health is vital. At the 2017 summit, we announced £250 million of support over the next four years. Access to sexual and reproductive health services is under increasing threat from some developed nations that ought to know better. It is essential that the United Kingdom follows its independent path, and is not browbeaten by any of its larger partners or friends into offering restrictive reproductive health facilities just because somebody else does not like them, for questionable reasons.

We must continue the work on neglected tropical diseases. We are protecting some 200 million people from 2017 to 2022 with support of £360 million. I have not mentioned anti-microbial resistance and the work of Sally Davies. She moves on from her post relatively soon, and we should thank her warmly for all the vital work she has been able to do. Ultimately, it will protect us all; if we cannot find answers, that threatens us all. I thank those involved in the collaborative work that we now do internationally with the Department of Health and Social Care, and I hope the Minister will be able to take that work further.

I could mention the contribution of water sanitation and hygiene—the foundation for good health. I have seen remarkable projects that the United Kingdom is doing around the world on that. There is no point having a global health system or a national health system if there is no effective sanitation. It makes a particular difference to young women at important stages in their lives. It is absolutely essential. Nutrition, one of my favourite subjects in the Department, is much underrated. It is really vital to ensure that nutrition is correctly promoted. There is a difference between feeding people and feeding them nutritiously, as I learned in my first week in DFID.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Should we not also emphasise that vaccines will not work properly on a malnourished child? We need to see these subjects as two sides of the same coin.

[Alistair Burt]

The hon. Lady is absolutely right and speaks with great experience. A child may be physically alive, but the weaker a child becomes through lack of nutrition, or through existing on the barest rations, the more prone they are to disease, and the harder it is to ensure that preventive measures work. That is absolutely correct.

I wonder whether the Minister wants to venture an opinion on the Department for International Development remaining a stand-alone Department. It might be slightly unfair to expect an answer from him on that, but I hope that this debate will leave him in no doubt of the value that we see in an independent-minded DFID. It is always part of the Government, as I occasionally had to remind officials, but it very much has its own stand- alone processes.

I hope others will cover all those points, and that I have helped to lay the ground, and made it clear how important this House feels universal health coverage is, and how proud we are of the United Kingdom’s previous contribution and its determination to keep that up. There is a clear sense that we are a world leader, through the work of our hard-working experts. The Minister should know that he has the full backing of the House in his determination to make sure that this issue remains as important to him as it has been to me and all my predecessors.

World Immunisation Week

Debate between Philippa Whitford and Alistair Burt

Thursday 2nd May 2019 Commons Chamber

[Alistair Burt]

Absolutely, and I think that that is the model to take forward for the development of healthcare systems. We need to bear in mind the nature of that relationship, because it will be absolutely key.

I am proud of the United Kingdom’s support for Gavi. We are its largest donor, and we are

“currently responsible for 25% of its budget. The UK has committed £1.44 billion to Gavi from 2016 to 2020, including funding to its innovative finance mechanisms. This investment fully delivers on the UK commitment to immunise 76 million children and save 1.4 million lives by 2020.”

I am grateful to the team for the briefing it gave me for the meeting with the all-party group, which I have kept. Credit where it is due: that was a quote from the Department’s own briefing. The replenishment conference is coming up. There was very little I could say about that when I was a Minister, but speaking from the Back Benches, I can say to the Secretary of State that I am sure we will sort it out and I hope he will be really, really generous. He can be absolutely sure that I will be on his tail if we do not make a serious commitment to Gavi, because it really delivers. Seth Berkley delivers for us, and the visit to Bognor Regis in the past few months when he saw the work being done here was really important. I hope the Secretary of State will bear that in mind.

Vaccination does more than the obvious function of preventing diseases in children. Its background, not only in the health system but in the development of countries, is fundamental. A healthy child goes to school, is able to learn, and grows into a productive adult. Unless that basis for immunisation is clear, so much development work is stymied right at the beginning. Immunisation is part of a sustainable, integrated health system. The reckoning is that the overall impact is that every £1 spent on immunisation leads to a £16 saving in terms of subsequent health care bills and people’s inability to interact effectively in the community.

Before I deal with the threats, I want to remind the House of what this is all about, and I will talk briefly about measles, because measles outbreaks have suddenly returned in recent times. The tendency in the United Kingdom is to accept measles as a rudimentary childhood suffering that is easy to go through, so the misery of measles is forgotten. A recent piece in Forbes Magazine talked about the problems of anti-vaccination and included a quote from Roald Dahl. His oldest daughter, Olivia, died of measles in 1962 at the age of seven, and the article quotes his words:

“one morning, when she was well on the road to recovery, I was sitting on her bed showing her how to fashion little animals out of coloured pipe-cleaners, and when it came to her turn to make one herself, I noticed that her fingers and her mind were not working together and she couldn’t do anything. ‘Are you feeling all right?’ I asked her. ‘I feel all sleepy,’ she said. In an hour, she was unconscious. In twelve hours she was dead. The measles had turned into a terrible thing called measles encephalitis and there was nothing the doctors could do to save her.”

That is how real it is. When we talk about vaccination and take on those who are concerned about it, that is the reason.

Measles has largely died out in the United Kingdom, but it is coming back in different places, and it will come back here unless we challenge it. The United States declared measles eliminated in 2000, but there have been 695 cases this year, mostly concentrated in three outbreaks and mostly concentrated in small tightly knit communities. The rise in measles cases in both the developing world and the developed world is really frightening, and it must be challenged.

When I was first made aware of the rising figures, I had a discussion with my ministerial team about how to deal with it. I have to say that I was pretty gung-ho and thought, “We’ve really got to take this on aggressively.” The team, to their credit, tried to scale me down from that, saying, “There are different reasons for the threat to vaccination, and you need to handle them differently.” That was good advice, and my sense is that the challenges are as follows. The first is the straightforward matter of incomplete coverage—the millions of children who do not currently get vaccinated. Gavi needs to look at where it is developing its resources, but it is committed to go to the poorest areas, and we need to keep that up. We need to deal with the areas where coverage is not great, but there are other threats, too.

We can divide anti-vaccination into several categories. First, there are religious reasons. I am unaware of any tenet in any major religion that suggests that vaccination is inherently wrong. It is quite the reverse. As a practising Christian, I believe that one of the revelations of God has been to give us the skills to discern what harms us and what helps us. That is where science and medicine come in, and vaccination is part of that. We have been given the skills to be able to help our God-given children and keep them healthy.

No major religion contradicts that, but sects in various religious denominations are against it. When we do get an outbreak, such as in an Orthodox Jewish community in New York, it runs around quickly. The United States has seen recent outbreaks in the Orthodox Jewish community, among Slavic migrants, in the Amish community in Ohio and the Somali community in Minnesota, because measles spreads quickly in a small, closed group and then it affects anyone else they come into contact with outside who has not been immunised. The United Kingdom should urgently work with religious leaders worldwide and say, “Please make a declaration to ensure that none of your leaders—none of those who promote a faith under your auspices—are in any way in any doubt about the value and importance of vaccination and say that there is no religious tenet against it.”

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Is the right hon. Gentleman aware of the terrible measles outbreak in Israel? Many rabbis, including those in Orthodox communities, have come forward to point out that the Torah talks about the preservation of one’s own life and the lives of others. They are trying to counter what has almost become a habit, rather than something that is based on holy writings.

[Alistair Burt]

The hon. Lady is absolutely right. I have not been able to discern whether a poor El Al flight attendant who fell seriously ill in the past couple of weeks has recovered, but I am aware of that outbreak. Religious leaders, rather than Government figures or civil spokespeople, need to make the case. We can deal with the religious factor by understanding the fears and trying to descale them so that no one can go to a religious group and find some reason to campaign against vaccination.

A second reason might be conspiracy, which has certainly been an issue in Pakistan and Afghanistan, where those trying to disrupt the vaccination movement say that it is western influenced and designed to harm. All that can be done in response to that is more and more information and transparency, and Governments do have a responsibility there. It must be made absolutely clear that health workers are not to be used for any other purpose, so that there is no risk of any political contamination. We are aware that it has happened, but it must not happen again. If health workers are not to be targets, they must purely be health workers.

Thirdly, there are medical reasons why a vaccination may not be appropriate for a particular child. These are exceptionally rare, and there is scientific evidence to back that up and it must be handled purely through the medical profession. We have been asked this past fortnight to listen to the science. Whether on climate change or anything else, we should listen to the science. When it comes to medical reasons why vaccination may not be right, listen to the science and recognise how incredibly rare those reasons are. Someone is much more likely to protect their child by vaccination and immunisation than not.

The last reason is misinformation, which is really scary. This is part of the phenomenon of people trying to pull down authoritative sources of information—the mainstream media, experts or whatever. If someone wants to disregard something to try and minimise its impact, it is becoming popular and easy to claim that their own personal experience or anecdotal experience somehow trumps what people are being told by those from scientific backgrounds who are making a serious case. We are seeing an awful lot of that.

The issue follows from the false, discredited and debunked information about the MMR vaccine that came from a doctor in the United Kingdom some years ago, which is used by so many. The issue seems to be extremely prevalent in the United States, where picking up ideas that have little foundation but can be used to inflame people seems to be almost a way of life for some. It is seriously dangerous and anti-expert. It is based on a false dilemma between liberty and the state, which we can see creeping into arguments here on social media. It is all highly dangerous.

Now, there may be other ways of combating the other problems that I have mentioned, but I am afraid that we do have to be aggressive on misinformation. We have to be vigorous and gung-ho. It is nonsense, and we must be clear about taking it on. False information and those who provide it must be exposed, and those who have fallen victim to it must be understood and given as much information as possible.

I recently saw a good piece on the “Victoria Derbyshire” programme in which a couple who were uncertain about vaccinating their child were given the opportunity to question people about it and, in the end, they came to a different conclusion. It shows how worried people are, and we should understand that, but there are answers to their worries and we should not be afraid of making sure people have those answers. We must be clear about those who are deliberately spreading misinformation, who are connected to arguments that have no basis or who are trying to bring together issues of liberty and public health, which is particularly prevalent in the United States, where almost anything provided by the state is somehow suspect—a view I do not hold, as most in this House know. Public health programmes are good, and those who say it is all the state trying to control people are just wrong. That has to be challenged by every means possible.

Immunisation is good. It works and it has proved itself. It is one of the building blocks of world strength and world health and we lose it at our peril. Recent years have taught us that, just because we think something has become part of mainstream culture and is accepted by everyone, it does not mean that the argument does not have to be made over and again. We have lost valuable things in recent years by not vigorously making the argument for them because we thought everyone understood the argument—I will not go into detail—but we are not going to lose the argument on health and immunisation. If we do so, we would put ourselves at risk. We know it is safe and we know it is good, so let us not leave it to others to make the argument. Let us make the argument ourselves. I know that I can completely count on the Secretary of State and the Minister of State to do that job, and I know that I can rely on this House to do the same.

Oral Answers to Questions

Debate between Philippa Whitford and Alistair Burt

Wednesday 13th February 2019 Commons Chamber

[Alistair Burt]

The right hon. Gentleman of course knows as much about Yemen as anyone in the House. The peace talks are built on confidence, and the next round will take place when UN envoy Martin Griffiths believes that there is sufficient confidence for those talks to proceed. At present, the ceasefire, although fragile, has held. Confidence is building up between the parties, and when the time is right, we will be able to move forward to the next stage.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

4. What steps her Department is taking to support global surveillance systems for infectious diseases.

[The Minister of State, Department for International Development (Alistair Burt)]

Infectious disease surveillance is vital to global health security. The UK supports global, regional and national efforts to strengthen surveillance, including through the World Health Organisation, the global fund and the global polio eradication initiative. The Department for International Development’s tackling deadly diseases in Africa programme and Public Health England are helping to strengthen regional and national surveillance capacity.

[Dr Whitford]

The eradication of polio in the next few years represents an incredible achievement of both vaccination and international co-operation, but the infrastructure and staffing of the global polio initiative has provided a lot of the surveillance that helped to detect epidemics such as Ebola. How does the Minister plan to replace the polio resources and ensure that both vaccination and surveillance continues?

[Alistair Burt]

The hon. Lady, who understands this issue very well, is right to point to the importance of the global polio eradication initiative, which has been the bedrock for disease eradication efforts. Innovative approaches have helped to provide timely and high-quality surveillance. What we need to do is ensure, through both in-country programmes and the work being done through WHO, that surveillance on polio does not slacken off because of potential eradication, and we will continue to do that.

Oral Answers to Questions

Debate between Philippa Whitford and Alistair Burt

Tuesday 30th October 2018 Commons Chamber

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

8. What diplomatic steps the Government are taking to improve access to healthcare in Gaza.

[The Minister for the Middle East (Alistair Burt)]

The Government remain deeply concerned about the humanitarian situation in Gaza. I regularly raise with the Israeli authorities the need to ease restrictions there. Our ambassador to Israel discussed Gaza with the Israeli authorities on 17 October. The UK supports healthcare in Gaza through the International Committee of the Red Cross, and is a strong supporter of the UN Relief and Works Agency for Palestine Refugees, which provides basic healthcare in Gaza.

[Dr Whitford]

As well as many breast cancer patients not being allowed out of Gaza for treatment, it is very difficult for doctors to get out to access training, so Medical Aid for Palestinians has recruited specialists to bring the training to them. But on our visit last month, I was formally denied permission to enter Gaza and two other doctors on our team never received theirs. This totally wrecked our teaching programme. Will the Minister make representations to the Israeli authorities to allow these medical projects in Gaza to continue unhindered?

[Alistair Burt]

First, I have already done so. Secondly, although it is of course a matter for Israeli authorities to make those decisions, the value of the visits of the hon. Lady and her team cannot be overestimated. Thirdly, we are all in her debt for the work that she does to support those suffering conditions in Gaza.

Oral Answers to Questions

Debate between Philippa Whitford and Alistair Burt

Tuesday 26th June 2018 Commons Chamber

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

T10. Last month, when the House debated the shooting of unarmed protesters on the Gaza border with high-velocity live rounds, the Minister talked about pushing for an investigation, yet three days later the UK abstained on a UN vote on an investigation. Why?

[Alistair Burt]

Because both the resolutions brought forward by the Human Rights Council and the UN Security Council were biased and not likely to produce the required answer. That was why we did not support them. We still maintain that there should be an independent and transparent investigation and we have raised the issue with the Israeli authorities directly.

Gaza Border Violence

Debate between Philippa Whitford and Alistair Burt

Tuesday 15th May 2018 Commons Chamber

[Alistair Burt]

As I have answered a number of times already, Hamas’s part in this has to be opened up. It is clear from statements already intercepted that it was prepared to use any breaches in the fence for its own purposes, and it is clearly one part of this terrible event. The questions illustrate my sense of concern about the binary view of all this. There are many parts to trying to solve and deal with this, and it is the responsibility of the United Kingdom to make that clear, but my hon. Friend was right to raise concerns about Hamas’s activity.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Having worked in Gaza for almost a year and a half as a surgeon, I am one of the few people in this Chamber who has seen the result of live ammunition and what it does to the human body. Various Members talk about breaching the fence, but most of those injured were nowhere near the fence. More than 200 children and 17 medics were injured. They were not trying to invade Israel. How will the British Government push for an inquiry, and will they understand that, while Hamas may have manipulated people to encourage the scale of the protest, the despair that I see when I visit Gaza is the underlying cause? If we do not get a peace process, that will get worse.

[Alistair Burt]

We all defer to the hon. Lady’s contribution and expertise in terms of her work in Gaza and the efforts that she has made, and there is much in what she says that everyone should acknowledge and take note of. The despair and the hopelessness in Gaza are indeed prime movers in people’s concerns and in their wanting to see a change. The United Kingdom recognises that. That is why some of our efforts today at the United Nations will be in support of the UN Secretary General’s special envoy as he looks to do things in Gaza and for Gaza to seek to relieve that pressure. It is one part of the equation, and the hon. Lady was right to raise it.

Oral Answers to Questions

Debate between Philippa Whitford and Alistair Burt

Tuesday 21st November 2017 Commons Chamber

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

5. What steps he is taking to support a long-term political solution in Yemen.

[The Minister for the Middle East (Alistair Burt)]

Only a political solution will bring the long-term stability that Yemen needs. Yemeni parties themselves must engage constructively with peace opportunities when they come along. The United Kingdom is playing a leading part diplomatically, at the UN and elsewhere, to try to bring other parties together so that we can see the political solution that is needed.

[Dr Whitford]

Yemen is in the grip of a humanitarian disaster, with another 50,000 children expected to die before the end of the year because of famine and cholera, yet the UK’s arms sales to Saudi Arabia have been worth 18 times the aid given to Yemen over the past two years. What will the UK Government do to ensure that the blockade is lifted now and to contribute to Yemen’s reconstruction, rather than to its destruction?

[Alistair Burt]

The efforts being made with the coalition are not only to give its members assurances about the security they need to ensure that there are no further missile attacks like the one on Riyadh on 4 November, but to seek to relieve the restrictions that are preventing humanitarian access from getting through. No one doubts the scale of the humanitarian crisis that already exists in Yemen and that faces its people if those restrictions are not lifted. The United Kingdom is working with others on both the security for the coalition in the area and the need to relieve the restrictions to make sure that humanitarian access can be given.

Oral Answers to Questions

Debate between Philippa Whitford and Alistair Burt

Tuesday 17th October 2017 Commons Chamber

[Alistair Burt]

It does and, as many of us are aware, the outline of the parameters of a peace agreement, including some degree of land swaps, is known. However, the encroachment in recent years of Israeli settlements on areas well beyond those anticipated to be part of a future land swap undermines the credibility of the so-called commitment to that answer.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

17. It is 100 years since the Balfour declaration promised not just a Jewish homeland but to protect the rights of non-Jewish communities in Palestine. What I saw on the west bank during my recent visit amounts to conquest by concrete and totally undermines any possibility of a two-state solution. With Palestinian reconciliation providing new impetus, will the UK Government recognise their responsibility to re-establish a meaningful peace process?

[Alistair Burt]

We work extremely hard to play our part in fulfilling that second half of the Balfour declaration. I met one of the negotiators appointed by President Trump at the United Nations General Assembly in New York, and I was recently in Israel to talk to people there. We believe it is absolutely essential to make progress on the middle east peace process, which is not something to be managed but something to be solved, and the United Kingdom is bending all its efforts to seek to do so, particularly in this sensitive year.

--- Later in debate ---

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

T7. On my recent trip, I visited Gaza, where the humanitarian situation is appalling. In Northern Ireland, all parties were involved in achieving peace, so will the UK Government change their approach to Hamas and include it, to isolate those extremist groups?

[Alistair Burt]

The short answer is no, as the Foreign Secretary indicated earlier, until there is movement on the Quartet principles. However, resolution to improve the humanitarian situation in Gaza is urgently needed, and we are doing all that we can to support that.

Mental Health Taskforce

Debate between Philippa Whitford and Alistair Burt

Tuesday 23rd February 2016 Commons Chamber

[Alistair Burt]

I thank my right hon. Friend for the question and his own personal interest and work in this area. He, like me, has come across this conundrum: we talk from the Dispatch Box about more money going into mental health and then we go to areas and they say, “Well, it’s not happening here.” That has been a genuine reality that we need to do something about. We are being more hands-on towards clinical commissioning groups and having a more transparent system of examining their finances. In addition, guidance from the NHS says that it expects the increase in finance to the NHS to go proportionately to mental health services and we have now given specific commitments to the series of services announced by the Prime Minister and contained in these recommendations. In that way, we hope to make sure that the diversion of funds that has happened in the past will not happen in the future. Local areas will thus feel that they, too, must ensure that they have the share of the resource.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

All of us in the House welcome the strides made in changing the stigma around mental health, and people have been brave enough to speak out. In Scotland, we had the “See me” campaign, which was about seeing the person, not the condition.

Despite all the great talk, the money has often not gone to the services. Mental health trusts suffered a 2% cut in their budget between 2013 and 2015, and the number of psychiatric nurses decreased by 1.4%. The right hon. Member for North Somerset (Dr Fox) talked about money often ending up somewhere else, and we must avoid that. We need also to focus on children, because one in 10 of our children suffer from mental health problems between the ages of five and 16, and they are waiting a very long time to get help. We face the same challenge in Scotland. We measure it, we know how difficult it is to deal with, and we have managed to improve things by increasing staff and funding, but we also have a long road to walk.

One thing we are not doing enough is thinking about the whole spread of mental health support out into the community and about the way people work: people having insecure jobs; and people struggling to keep a roof over their head. Later, we are going to debate welfare reforms, and mental health issues arise from that. Three times as many poor children will have a mental health issue as children who are in a stable and well-financed family. Are we not going to try to join up our decisions and look at our other policy areas, in terms of how people work, how people are supported, and the mental health suffering that comes from the lack of that?

[Alistair Burt]

I thank the hon. Lady for her usual well-informed contribution to the debate on these issues, and for what she says about stigma and the general approach the Government have been taking. She is absolutely right about that. We have supported the Time to Change anti-stigma campaign, which has had some success, although we have to do more.

The hon. Lady is also right about children and wider cross-government work. On children and young people, for the first time we have a Minister in the Department for Education in England who has responsibilities for mental health, and the Under-Secretary of State for the Home Department, my hon. Friend the Member for Staffordshire Moorlands (Karen Bradley) is here to demonstrate that we take those cross-government responsibilities very seriously. One way in which we are going to manage the response to the taskforce is by having a cross-governmental team to make sure that Departments are joined up. Housing has something to do with this, as do education and work and pensions, as the hon. Lady said. We will make sure that that is done.

I should have said, but did not do so for reasons of time, that what has been said by the taskforce and what the Prime Minister has said is in addition to the £1.25 billion announced in March for the development of the child and adolescent mental health services in England and the £30 million a year eating disorder work, in order to recognise the increased pressures on children. As the hon. Lady rightly says, the more prevention work that can be done earlier, the better.

Oral Answers to Questions

Debate between Philippa Whitford and Alistair Burt

Tuesday 9th February 2016 Commons Chamber

[Alistair Burt]

The issue with ambulances and with quality of care elsewhere is the variation in quality. It is so important to ensure that local leadership addresses those local problems, because they are handled very differently in different places. It is right for my hon. Friend to raise this matter, and I am sure he has raised it with his local ambulance trust, as well as the hospital, to see how there can be better facilitation of patients going in and being discharged so that ambulances need not queue.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

The Health and Social Care Information Centre has shown that last year 124,000 patients waited more than 12 hours after arrival at accident and emergency, which compares with a figure of 1,700 in Scotland, and the number has doubled since 2013. The Royal College of Emergency Medicine has explained that these tend to be the sickest patients and that this delay is associated with increased mortality, so how do the Minister and the Secretary of State plan to improve that performance?

[Alistair Burt]

I have to tell the hon. Lady that patient satisfaction with A&E was rather lower in Scotland than it is in England, which indicates that we all have problems to deal with in this area. It is correct that we continue our progress both to increase resources throughout the health service and to A&E, and to improve transparency and people’s ability to see what is going on. Unacceptable waits are not part of what we all want to see from the NHS, which is why we are determined to drive them down. Patients in England will have the best information anywhere in the world about what is happening in their NHS, as we continue to drive efficiency and improvement.

[Dr Whitford]

Patients will not have the information about the four-hour waits, as that has not been published since November. The doctors required to look after these people are A&E specialists. There is already a major problem in retaining A&E trainees because they work a higher proportion of unsocial hours. These are exactly the hours that will be less rewarded in the new contract, so how does the Secretary of State plan to recruit and retain doctors in emergency medicine in the future?

[Alistair Burt]

There have been 500 more consultants in A&E medicine since 2010. The new contract is under negotiation at the moment and the majority of it has been agreed with junior doctors. It is designed to replace the failures in the old contract, which everyone knew needed to be corrected, and it provides the basis for the profession for the future to deal with some of the issues the hon. Lady mentions. All of us are concerned to ensure that the negotiations continue and that there should be no strike tomorrow, so that this pattern for the future, which is wanted by doctors and patients alike, as well as by the Government, gets a chance to work.

NHS and Social Care Commission

Debate between Philippa Whitford and Alistair Burt

Thursday 28th January 2016 Commons Chamber

[Alistair Burt]

I said that we have met the challenge that was put before us, which was to support what NHS England said it needed. We have done that through the financial commitment we have made. We looked very hard in the spending review to see what social care would need, and the Chancellor came up with the £2 billion social care precept, plus the £1.5 billion from other resources, so that is £3.5 billion extra by the end of 2020. We have put in place the financing that we believe will allow the delivery of health and social care over the next few years. But—and it is a big but, which I will refer to later—it is not just about the resources; it is also about how they are spent. Most colleagues have spoken about variability and how best practice is not always available elsewhere. We have to ensure that best practice comes in, and that is not just about resources; it is also about how things are done.

[Dr Philippa Whitford]

Is it not the case that the idea of seven-day-a-week, 8 am to 8 pm GP practice was not included in the NHS England estimates, and therefore the cost of that has been added on top? Will the Minister commit to taking the evidence from the pilot studies on whether that is a good use of money?

[Alistair Burt]

I will. We had this discussion in the Health Committee the other week. I will of course look very hard at the evidence, whether it comes from Greater Manchester and shows that somebody is working effectively and appointments are being filled, or from places where that is not currently the case. We have to wait and see in that regard.

The spending review showed our continued commitment to joining up health and care by confirming an ongoing commitment to the better care fund. Again, the integration process is extremely important. In terms of the general argument about what should be done, a clear commitment was made, based on an independent assessment of what was required. That required a Government who were prepared to make difficult decisions, and a strong economy, and we assumed that responsibility.

Let me deal with some of the remarks made by right hon. and hon. Members during this conversation—for it is, as the hon. Member for Central Ayrshire (Dr Whitford) said, a conversation, and a really good one. If more debates about health had the flavour of this afternoon’s discussion, the public might be happier. She said that her preferred method for dealing with things, as with most of us, is bringing people into the same room and having a conversation—but perhaps not this room. However, there are other rooms in this place in which to do that. Indeed, my hon. Friend the Member for Totnes (Dr Wollaston), the Chair of the Health Committee, does so regularly. This place can provide opportunities for the sorts of discussions that would be at the heart of any cross-party consideration of what we want to do. We should not neglect the fact that we can do that, and we have had a good conversation today.

I agree with the hon. Member for Lewisham East (Heidi Alexander) in that I am fundamentally shy of the idea that we can just put this on to others and with one bound we are free. I understand the sentiment that we somehow need to get, if not the politics, then the heat of the politics, out of it in order to allow for the conversation that we need to have. However, at the end of the day, that still requires a process. Like her, I believe that the process is that we discuss it, come to conclusions within our own party about what we can do, and offer it in a sensible way to the electorate. I entirely agree with those who say that there are times when we have all been guilty of the most ridiculous adverts. At the end of the last general election campaign, I was in a marginal constituency and had a piece of paper in my hand that was our last-minute leaflet. I knocked on doors and said, “Look, we have a choice—I can either hand you this leaflet, which is complete nonsense, or you can give me 20 seconds to explain why you should vote for David Cameron tomorrow and keep a Conservative Government.” They laughed and said, “Go on, then”, and I had my 20 seconds. We all know that we are sometimes guilty of producing material that in the cold light of day we would not wish to, and in relation to health we need to be extra-careful about that.

As the debate went on, I was concerned about whether the commission that the right hon. Member for North Norfolk and his colleagues is proposing can bear the weight of the many different things that we would like it to cover. My hon. Friend the Member for Totnes wanted it to report rapidly, but my right hon. Friend the Member for Sutton Coldfield (Mr Mitchell) intervened to say that it had to be for the longer term, so which is it to be? My hon. Friend also spoke about the problem of variation in the system, but that is not to do with resources. No commission could be so directive as to make sure that best practice is delivered everywhere. We have to do that in another way.

The hon. Member for Leicester West (Liz Kendall) in, as always, a very thoughtful and sensible speech, recognised the political problem in agreeing on this, and she was right to do so. It is very difficult for her, or any other Labour Member, to talk about the introduction of private medicine. If I did not stand here and say, with no deviation, that the Conservative party and the Government believe in a tax-funded health system free at the point of delivery, the roof would fall in. Therefore, there are constraints on what we can say politically, and we have to be thoughtful about how we deal with those responsibilities.

My hon. Friend the Member for Bracknell (Dr Lee) added more weight to the commission by talking about structure, and how we deal with these reviews of where hospital premises might be located. Again, there is this problem of politics. When approached by patients or doctors with a vested interest in keeping a physical bit of bricks and mortar and in saving “our” hospital, it would be a brave one of us who said, “Do you know what? That may not be the best thing.” That difficult problem was alluded to by my hon. Friend the Member for South West Wiltshire (Dr Murrison). No commission can get us over that sort of problem.

The hon. Member for Strangford (Jim Shannon) invited me to Northern Ireland to see some integration at work, and I would be keen to visit. My hon. Friend the Member for South West Wiltshire and a number of colleagues made the point about public health. Prevention is about not just the public health budget—significant resources are still going into public health—but what we are trying to do with the shift from secondary to primary care to ensure that people are seen earlier.

The hon. Member for Central Ayrshire talked about ensuring that we keep people well longer. She said that instead of seeing the national health service as an organisation that looks after just the ill, we should consider what it can do before that, which is very important.

The right hon. Member for Sheffield, Hallam (Mr Clegg) spoke principally about mental health. As a Health Minister, I know full well what the coalition Government as a whole did in relation to mental health. They picked up a trajectory that had been disappointingly low, but we are now well on track. I wish gently to correct something that has been creeping into the narrative, which is that it was all going fine until six months ago, but it has slightly come off the rails now. It has not. It was not all sorted during the coalition, and I reject the charge that it is now all about rhetoric and not delivery. We are delivering, and making sure that CCGs spend the increased money that they get on mental health, and we are tracking it for the first time.

That £1.25 billion for children and young people’s mental health, which was a very significant delivery by both the right hon. Gentleman and the coalition, has been increased to £1.4 billion, and it will all be spent in that area by 2020. We are dealing with the issue of mental health tariffs as well, and we want to have waiting and access times for children and young people’s mental health services.

I encourage the right hon. Gentleman to see, at least in this part of my portfolio, that what I seek to do is to build on what the right hon. Member for North Norfolk did in my role. I would rather that the right hon. Member for Sheffield, Hallam did not talk in that manner and think that it has all come to a halt, because it has not. We are having to repair one or two things, such as perinatal mental health, in which we have put significant resources. The conversation has been advanced enormously in exactly the right way by consensual discussion, and we will certainly carry that on.

--- Later in debate ---

[Alistair Burt]

I think that engagement with all involved is essential. When I am away from Westminster, engaging with patients, the public and staff is fundamental to the visits that I make to the services for which I have responsibility.

There is nothing to stop any of the work that the right hon. Member for North Norfolk is suggesting from starting. It is essential that everybody is fully involved. I do not think that the Government or the Opposition will make any of their decisions on the NHS or its expenditure by excluding anyone.

The hon. Member for Walsall South (Valerie Vaz), in a turbo-charged contribution, also spoke of the importance of getting integration right. She reminded us that Dick Crossman started it all off. I am sure that we have all had election manifestos that have spoken of an integrated transport system and integrating health and social care. Now we just have to make sure it happens. She made the point that no amount of talk or number of recommendations relieves someone of the burden of doing it. At the end of the day, it is doing it that counts. That is the role of the Government, while being appropriately challenged by all others.

I am delighted that my hon. Friend the Member for Faversham and Mid Kent (Helen Whately) spoke of the importance of the workforce, particularly the workforce in social care, who have a very difficult time of it. They have great skills and need to be on a career pathway where they can acquire more. They also need to be valued. Again, my hon. Friend believed that the current mechanisms were better than others for dealing with these difficult problems.

To conclude, I will give my sense of the debate. I found it slightly hard to distinguish what the foundations of the debate were—whether it was about the quantum of funding or how the funding was gathered into the health budget in the first place. The commission is expected to cover a breadth of issues, but I am not certain that it can bear the weight. Decisions need to be made, no matter how the information comes forward.

We do not need a commission to deliver the process or to take the heat out of the debate. We have to be careful about how we speak about these subjects. By and large, what happens upstairs gives the public a good sense of how we deal with witnesses who come in from outside, members of the public and each other. We can do much more of that without the need for a commission. We must remember to handle things carefully.

I am not sure that structural change could be handled through a commission. That is very much a local decision. This is not all about funding; it is about how the funding is used. We have to ensure that we do not get into the trap of measuring everything by what we put in, rather than by output. One of the most telling points was when the right hon. Member for North Norfolk said that in the Commonwealth Fund analysis that gave the NHS such a good rating, the one thing it dropped down on was outcomes—treating people and whether people stayed alive. To most people, that is probably the most important outcome of all. We have to make sure that, for all the other good things that we are doing, such as the work the Secretary of State is doing on transparency and all the efforts we are making to give people more information, we recognise the importance of that.

[Dr Philippa Whitford]

Just on the Commonwealth Fund analysis, the standard that the UK did badly on was actually healthy life expectancy. That is not the same as an outcome in hospital. We may have successful operations, but we have underlying deprivation and ill health.

Off-patent Drugs Bill

Debate between Philippa Whitford and Alistair Burt

Friday 6th November 2015 Commons Chamber

[Dr Whitford]

There is indeed a risk, as my QC expert has muttered. Part of the case would be that the doctor had prescribed an off-licence drug.

Experts in the field will prescribe many drugs that are off-patent for the treatment of secondary cancers. We are aware of the evidence, and we will use such drugs when we have the experience, but general practitioners will not. If a drug is not in the British National Formulary, they cannot check the dose, which might be different from the dose for the other usage.

We are seeing more and more non-doctor prescribers. We are seeing nurse prescribers and physio prescribers. We do not want to limit the use of future drugs that may be discovered by not sorting out the present position. It should not be beyond the wit of man. The NHS is surrounded by organisations, such as quangos, that could surely be used to deal with it.

[The Minister for Community and Social Care (Alistair Burt)]

Given the hon. Lady’s experience in this area, her presence in the House provides me with an opportunity that is too good to miss. Let me ask a question that goes to the heart of the reason for the Government’s concern about the Bill.

If I understand the hon. Lady correctly, it is not impossible to prescribe off-label if there is an indication that, say, the prevention of breast cancer may be aided by the use of tamoxifen. There is nothing to preclude that, although it may be difficult in the circumstances that she has described because of possible considerations of liability. Is she arguing that there should be no off-label prescribing because everything should be licensed, or not? I do not know whether it should be one or the other—[Interruption.] It is not a stupid question. We believe that if it is possible to prescribe off-label, the Bill is not necessary, but if it is not possible because of the difficulties that the hon. Lady has identified, perhaps that should not happen. Her experience is vital in this regard.

[Dr Whitford]

As I was trying to suggest, someone who is an absolute expert in a field will be comfortable prescribing off-label, because they are using the drug every day, and they know exactly what it does and how to use it. But our patients spend the majority of their time in primary care, and a GP, who is unable to look up and check the dose or indication, will be a little more uncomfortable. People who are non-consultants—those at staff grades, who are at other grades—will be less comfortable. We see that exactly in the prevention of breast cancer; this drug has not come on stream at the speed that would have been expected, because people are uncomfortable. There is certainly not enough protection to mean that nurses are going to prescribe a drug that is not licensed, and the vast majority of drugs do not have guidelines, so what the Minister describes is not a protection.

[Alistair Burt]

I just want to be sure about this. If I understand the hon. Lady correctly, that hesitation could apply to any off-label prescribing now, but off-label prescribing goes on—doctors and GPs do find the information and do it. I would not want to take the implication from her that off-label prescribing is wrong. It just needs the appropriate amount of information to make sure that it is right—otherwise, we do have to license everything.

[Dr Whitford]

When a drug is proven and is going to be in common usage, it should be licensed—otherwise, we are suggesting, “Why bother with licensing any drug?” We are talking about drugs that could make a big impact, but they will do that only if they are in common usage. Expecting doctors to face any potential that they are signing away their mortgage on their house by prescribing something is simply bizarre. Of course there is off-label prescribing as a drug develops, but once we have something with rock-solid evidence behind it, which we expect everybody of every grade and every profession within the NHS to use, we should give them the reassurance of licensing.

--- Later in debate ---

[Alistair Burt]

Because if the message that goes out from this debate is that there is only one way to get these drugs, and if people feel that they cannot get them because of what has been said here, that would be darkness indeed. That is not the truth. That is not the position.

[Dr Whitford]

I find it bizarre that the right hon. Gentleman says that we must not bring in this change because it would undermine access to other drugs, because that tends to suggest that we should not have any licensing at all. Why is he happy to have drugs licensed but also feels that we should have unlicensed drugs?

[Alistair Burt]

Because current medical practice appears to be that drugs are available on licence for indications that are already there, but it may then become clear that some drugs are also useful for things that were not previously indicated. If the patent position is as we have discussed, then no licence process is put forward and people can prescribe off-label, as they do in many cases. Accordingly, the system works with both. The Government’s worry about this Bill is that, because of the attention paid to what is being said, it will be suggested that there is some sort of prevention mechanism that does not enable people to get the treatment they need. I am very anxious to state that that is not the case, as I think the hon. Member for Central Ayrshire also said. These drugs can indeed be prescribed. That has to be the message.

[Dr Whitford]

rose—

[Alistair Burt]

I will give way, but then I want to set out what the position is rather than what it is believed to be.

[Dr Whitford]

As I said, there is still an implied risk to people, and those who are distant from the research will not do this. The only reason these drugs are not licensed is that it is not worth the company’s while. Surely letting the Bill go into Committee would allow us to iron out all the issues to the satisfaction of the Government.

[Alistair Burt]

The issue about licensing could apply to any off-label prescribing. What we are talking about for some would, in theory, have to apply to all, because there is a risk to everything. That suggests a provision of licensing for all, which is not where we are going. This matter is not closed—let us be quite clear about that. If this measure does not go through today, the matter is not closed.

--- Later in debate ---

[Alistair Burt]

In that case, I am more than happy to again let the message go out from the Chamber today that these drugs are available and can be prescribed. Where it is clinically appropriate, they should be prescribed. Seeking this legislation will not change that availability.

Members of the House are doing a highly effective job of bringing their constituents’ concerns to the attention of Ministers and asking our help to resolve this issue. We are not aware of colleagues bringing examples of people who have been refused treatment. It is vital to know if there is evidence of people being refused treatment. As I said, the clinician’s letter that the hon. Member for Torfaen read out was wrong. Unless there is a clinical reason for not supplying the drug, there is nothing to prevent the doctor from doing so.

[Dr Philippa Whitford]

I simply make the point that we are now not just talking about doctors prescribing. It is unrealistic to expect physiotherapists and nurses to prescribe drugs off licence. It just will not happen.