Universal Health Coverage

Steve Brine Excerpts

Thursday 5th July 2018 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)]

I am sorry for my musical chairs during the debate, Mr McCabe, but I could not hear everyone from the end of the Chamber—I think it is my age and the heat. I thank the hon. Member for Strangford (Jim Shannon) for, as always, an interesting speech. I congratulate him, especially today—birthday day—on securing the debate in his residence of Westminster Hall. He mentioned that he might still be here in 2050—I would almost hazard a wager with the hon. Gentleman about that one, but I hope we shall all still be here.

Was not 5 July 1948 a pivotal day for our country, with the inauguration of healthcare free at the point of use for all our citizens? Seven decades later, the NHS remains one of our nation’s most loved institutions. The NHS is often described as the closest thing we have to a national religion, and this lunchtime a service in Westminster Abbey proved the point. The NHS is one of our country’s crowning achievements, possibly the crowning achievement—along with the English football team, of course—and it is the envy of people across the globe. When I travel around the world in this job, people are fascinated by and envious of the NHS in equal measure.

As has been said by my shadow, the hon. Member for Washington and Sunderland West (Mrs Hodgson), and everyone else who has spoken today, the NHS is of course nothing without its fantastic staff, who show such a level of Christian compassion—some without even knowing it—day in, day out. More than 1.5 million people work each day to provide the best possible care for our constituents.

The questions that the hon. Member for Strangford asked are important. We are the proud owners of an excellent universal healthcare system, albeit one we continually strive to strengthen, as we must—the best friends are prepared to criticise, and the NHS is not above criticism in our struggle to make it better—but he asked what we are doing to share our experiences. I shall certainly be able to cover that point.

The health of UK citizens is not dependent only on action in the UK. Diseases do not respect borders, and we need to act internationally to protect ourselves as well as to help others. Not only is that relevant when an outbreak hits—recently we had an Ebola outbreak, which I have monitored closely—but we must keep working with other nations to strengthen their capacity to prevent, detect and respond to diseases. UHC is critical to that. Threats such as that of antimicrobial resistance, which the hon. Gentleman mentioned in his opening remarks, can be tackled only through global action.

There is much that we can learn from each other. The NHS has evolved a huge amount since the late 1940s, and the next 70 years will require ongoing adaptation and innovation as we deal with the challenges of 1 million more over-70s—the ageing population—and further reap the rewards of scientific advancements, which have been so central to the NHS in its first 70 years. Other countries develop innovative approaches that we may not yet have considered—it is not all about the great empire of Britain, telling the rest of the world how things shall be—and there are plenty of challenges that no one has yet cracked. We should work together, and we do. It is right that we support others who have not yet achieved universal health coverage to do so, including by sharing our experiences.

We are committed to delivering the sustainable development goals, which the hon. Member for Cumbernauld, Kilsyth and Kirkintilloch East (Stuart C. McDonald) mentioned, including SDG 3. That is crucial to tackling many other health challenges, including the improvement of maternal, newborn and child health, as he said, and specific diseases such as TB, HIV, malaria and—everyone rightly mentioned this—pneumonia, the single largest infectious cause of death in children worldwide.

Universal health coverage is a goal, not a blueprint. Country needs, plans and perspectives are central to our work, and we have no interest in imposing an NHS model. It is crucial for each country to find its own path to UHC, which may entail greater private sector involvement, if that is what the country wishes, or a national health insurance scheme if that is what the politicians are brave enough to do. That is not our choice, but it is the choice in some parts of the world. We cannot just go with our judgment in trying to help other countries achieve universal health coverage.

Poorer, marginalised populations must achieve better access to good-quality essential services without the risk of financial hardship, as we choose in our NHS. Support for UHC must also involve helping countries to achieve sustainable funding mechanisms for their system, whichever they choose. The countries in greatest need deserve our financial support, but the ultimate goal must remain to transition to domestic funding, so that countries can maintain health systems in the long term.

The UK engages on UHC in a number of international forums. We strongly support the World Health Organisation’s focus on UHC through its new general programme of work, and we provide funding through a number of DFID programmes. We engage on this topic at governing body meetings and our annual UK-WHO strategic dialogue. I have a good, open and direct relationship with the head of the WHO, as part of my responsibility for international health at the Department of Health and Social Care. Underpinning the WHO’s success is a strong and effective organisation, and the UK continues to promote reform of the WHO so that it is the best it can be. As the second largest donor to the WHO, we are in a very strong position in that regard.

We promote UHC as a priority in other forums such as the G20 and the G7; I attended the G7 Health Ministers meeting last year in Milan. We were pleased to see strong commitments on health in the recent Commonwealth Heads of Government meeting, including on eye care, which I am passionate about. We will continue to follow up with the Commonwealth secretariat on the implementation of everything that was agreed in London. The high-level meeting on UHC at the UN General Assembly in 2019 will be an important opportunity to share experiences and to drive greater collective action. I will pass on the hon. Gentleman’s request, which I agree with, for us to use our chairmanship of the Commonwealth to further the UHC agenda that we all believe is so important.

My Department has rightly taken on a global leadership role on patient safety, along with our German and Japanese counterparts, to whom I spoke directly at the G7 Health Ministers meeting last year. Hon. Members will know that patient safety is the central mission of the Secretary of State. It is crucial to universal healthcare—as the hon. Member for Cumbernauld, Kilsyth and Kirkintilloch East rightly says, the aim cannot just be universal healthcare but must be good-quality and safe universal healthcare. Providing access but not quality care is not truly delivering on the sustainable development goals. We hosted the first global ministerial summit on patient safety in 2016, bringing together political leaders and experts to galvanise action on this crucial issue. Subsequent summits in Germany and Japan have continued that legacy.

Another key but often overlooked facet of universal health coverage is addressing mental as well as physical health. Again, my Department is taking an international role: we will host the first global ministerial mental health summit in October. The summit will bring together political leaders, experts by experience, policy makers and civil society to share innovative and effective approaches to mental health care, which the Prime Minister has rightly said is one of her main priorities. The Department of Health and Social Care frequently receives ministerial and official delegations from overseas to look at topics as diverse as childhood obesity, on which we lead the world; emergency response, as we often send people around the world; and elderly care.

The international team, which the hon. Member for Strangford mentioned and which I look after, manages the Department’s bilateral and multilateral engagement, working closely with colleagues at DFID and across Government. The team also leads on co-ordinating global health strategy across Government and on the health implications of trade and of the UK leaving the European Union.

The hon. Gentleman asked about our support for low and middle-income countries. The UK has a number of programmes with those countries. They are largely led by DFID, although a number draw on my Department, the NHS and Public Health England, for which I have ministerial responsibility. The UK supports the aim of countries working towards universal health coverage, with priority given to ensuring that poorer, harder to reach populations achieve better access to good-quality essential services without risk of financial hardship.

We apply a health systems strengthening approach to all health investments. That includes addressing global health security issues such as antimicrobial resistance; scaling up nutrition interventions, which are about building up country resilience; improving reproductive, maternal, newborn and child health; and targeting specific diseases such as HIV, TB and neglected tropical diseases. One of the first things I was able to do in that space was to speak at the family planning summit organised by DFID over the road at County Hall, which was backed by Bill and Melinda Gates, about our record in driving down the teenage pregnancy rate in this country. Of course, getting reproductive health right often helps developing countries to make their health systems more robust and sustainable.

The hon. Gentleman mentioned the delicate subject of male circumcisions and HIV. He is right to say that circumcision is practised across many parts of Africa to prevent HIV. The WHO and the UN consider male circumcision to be effective in HIV prevention, where there are heterosexual epidemics and high HIV and low male circumcision prevalence. However, the practice provides only partial protection. The procedure should not be seen as a green light to risky behaviour; it should be one element of a comprehensive HIV protection package. It would be remiss of me not to mention that I get a lot of letters on this subject. A number of campaign groups in this country and around the world make arguments about the human rights elements of the matter, especially when children undergo circumcision surgery, and its impact later in life. It is important to recognise all those facts, but the hon. Gentleman is right to mention it as part of the toolkit used in certain countries, Tanzania being one of the most prevalent.

We provide support directly to countries, work through the WHO and scale up targeted, cost-effective preventive and treatment interventions through global initiatives such as the global health fund, Gavi and the global financing facility. We are the largest donor to Gavi, which provides developing countries with pneumococcal vaccine to protect against the main cause of pneumonia. Between 2010 and 2016, 109 million children received the vaccine; we estimate that saved about 760,000 lives.

The health partnership scheme is another good example of how the UK can use our expertise overseas. Since 2011, we have trained 84,000 health workers across 31 countries. The scheme relies on volunteers from the NHS who help to support the training of staff overseas and benefit themselves through gaining new skills and motivation. Last October, the Minister of State, Department for International Development, my right hon. Friend the Member for North East Bedfordshire (Alistair Burt), who I work closely with across Government, announced the new £30 million programme with the catchy title “Stronger Health Partnerships for Stronger Health Systems”. It will run for five years from 2019 and will support partnerships between leading UK institutions and those in developing countries.

One of the benefits of being the Minister in these debates is that sometimes I can mention the good things that happen in my constituency. Hampshire Hospitals NHS Foundation Trust, which covers the Royal Hampshire County Hospital in Winchester and the Basingstoke and North Hampshire Hospital, has two very good international links, including with Yei in South Sudan, where a number of medical professionals from that trust have worked on antibiotic resistance studies, looking at the bacteria that can cause pneumonia. In collaboration with the Rotary Club in Winchester and the Brickworks, which is a Winchester-based charity, it has secured funding for textbooks to repopulate a midwifery and lab training institution and funding to build schools for South Sudanese refugees in Uganda, so that refugee children can continue their primary and secondary education. There will be examples in the constituencies of Members throughout the House of health professionals using such expertise as part of their upskilling, but also to help those less fortunate than us.

The UK offers development opportunities for the medical workforce globally. The medical training initiative allows overseas medical specialists to train in the UK for up to two years, to see our system close up, so that they can return to their home country and apply their skills and knowledge to the benefit of their population. Of course, that benefits the NHS by providing extra staff, who we desperately need, and enhances the clinical capacities of health systems in low and middle-income countries. We estimate that just over 3,300 overseas doctors have taken part since 2009. I know the House will be interested in that positive programme.

We are passionate about tackling AMR, and we are committed to doing so. My Department is working across Government with a wide range of stakeholders to refresh our AMR strategy, which rightly gets a lot of attention in the House, with a view to republishing it at the end of 2018. I know that the hon. Member for Strangford will be interested in that. One of the ambitions we set out in response to Lord O’Neill’s independent review of AMR, which was established by George Osborne when he was at the Treasury, was to halve healthcare-associated gram-negative bloodstream infections. We are focusing on E. coli infections this year, but we are also collecting data on Klebsiella and Pseudomona pathogens.

I think there will be a lot of interest among Members in the refreshed AMR strategy. Health Question Time seldom goes by without AMR being mentioned. AMR is important. As the chief medical officer, who is busy in other ways today, has said, it is one of the greatest threats, if not the greatest threat, that our world—not just our healthcare world—faces.

We welcome all new research that contributes to our work to tackle AMR—especially great research such as that produced by Queen’s University Belfast, which the hon. Gentleman mentioned. There are a number of funding opportunities, and high-quality proposals are always welcomed. He rightly mentioned that people from Queen’s were at the House yesterday. He and I met them together—we had our photo taken with them—at an excellent Breast Cancer Now event, which was a great chance to hear about some of the incredible research that is being done on that disease in our United Kingdom.

Great research projects often start with relatively small grants from charities such as Breast Cancer Now, which act as the building block for other researchers to jump on board and get with the plan. That is very important. This is not all about the Government starting research projects; it is about institutions such as Queen’s being world-renowned. The lady I met yesterday was clearly on top of her game. She deserves great credit, and I thank her and all her colleagues at Queen’s for the work they do for our country.

We have strong join-up across Government. My Department, DFID, Public Health England and the Foreign Office in particular take a “one HMG” approach to global health, which was recently praised by the Independent Commission for Aid Impact. That includes regular meetings between Ministers, and a co-ordination group of senior officials meets very regularly to look strategically at our international activity and some of the programmes I mentioned. It includes joint delegations to WHO meetings and daily contact between our officials. It also includes joint working on projects such as the UK public health rapid support team. That is a partnership between the Department of Health and Social Care, Public Health England and the London School of Hygiene and Tropical Medicine that, at countries’ request, deploys people rapidly to some of the poorest parts of the world to investigate significant disease outbreaks and support capacity building. I mentioned examples of times when that has been invaluable, such as during the Ebola crisis.

In concluding, let me return to the incredible achievements of our NHS over the past 70 years, during which time life expectancy has leapt. Its staff work tirelessly to ensure that it remains the best in the world. We are committed to ensuring that it provides universal health coverage in the UK for generations to come, but we do not keep it all to ourselves—we are desperately keen to go on sharing our knowledge to help other countries do the same, so that people around the world can benefit from the incredible privileges we have in this country.

[Steve McCabe (in the Chair)]

Mr Shannon, would you like to make some concluding remarks?