Universal Health Coverage

Stuart C McDonald Excerpts

Thursday 5th July 2018 Westminster Hall

[Stuart C. McDonald (Cumbernauld, Kilsyth and Kirkintilloch East) (SNP)]

It is a pleasure to serve under your chairmanship, Mr McCabe. I congratulate the hon. Member for Strangford (Jim Shannon) on securing this debate. It is a thoughtful and appropriate way to mark NHS70. I pay tribute to him for his typically expert and heartfelt speech.

Whatever the difference between our parties and the Governments of the UK on the details of health policy, we all agree about the extraordinary benefits that the national health service brings as a universal healthcare service, and about its immense contribution in tackling preventable and communicable diseases in this country, not just through treatment but through immunisation and other public health measures. I pay tribute to all NHS staff for their immense dedication and service. Like other hon. Members, I have benefited from the NHS’s care on many occasions, and I will forever be grateful for that.

As the hon. Gentleman said, that is not to say that the job is done. There are things to improve, but we are fortunate to have been born in a country with such a system, given that so many others are not. In the absence of universal health coverage in some countries, many are excluded from the healthcare they need, sometimes including the most basic care. As the hon. Gentleman pointed out, as recently as December 2017, it was reported that at least half the world’s population cannot access essential health services, and almost 100 million people are forced to live in extreme poverty simply because of the expenses associated with healthcare.

It is not just a question of finance and infrastructure; it is also about the barriers caused by culture, prejudice and even draconian and inhumane laws. The hon. Gentleman set out some of the tragic consequences for the affected individuals. For example, the terrible incidence of pneumonia among children in certain countries is a tragedy for individuals, for family after family and for community after community. It is also a disaster for those countries’ economies and public finances. In short, it is a circle of despair.

That is exactly why the goal of universal health coverage is enshrined in sustainable development goal 3—“health for all”—and is a global priority for the World Health Organisation and other international organisations. In simple terms, that means we need to work towards ensuring access to skilled medical professionals in good-quality facilities. We still have a long way to go even in that regard, particularly in the poorest countries and the remotest areas, where even the most basic of issues, such as access to safe water, sanitation and hygiene, remain challenging. Without those things in place, facilities cannot function effectively.

That is not an end to the matter. The goal of universal health coverage will not be realised unless good-quality care is provided without discrimination. There is no point in having facilities and doctors if absence rates among healthcare staff are 60%, as sometimes happens in certain countries. The goal is fatally undermined if discrimination against the most marginalised people, some of whom are the most in need of healthcare, means that they cannot access its full benefits or that they receive substandard treatment. In short, the goal is not simply universal health coverage but effective universal health coverage.

Disease-specific programmes continue to have a vital role to play, but ultimately diseases such as malaria, HIV/AIDS and many others can be eradicated only by establishing universal health coverage, which we sometimes take for granted in our country. That also means ensuring that HIV services are part of a universal health coverage system. People with HIV can often be among the most marginalised in a country—for example, sex workers and men who have sex with men. That can mean that their ability to pay for treatment is even more limited, and they face additional hurdles, such as culture, prejudice and inhumane criminal laws.

I am not slow to criticise the UK Government when they get it wrong, so it is only fair that I praise them when they get it right. I will do that in a moment. The goal of extending universal health coverage around the world will not be assisted by poorly planned and abrupt withdrawals by the Department for International Development from countries without a proper transition. The Independent Commission for Aid Impact gave an amber-red warning to DFID’s transition programmes. The Government have responded to that warning, but it is vital that, as that work is taken forward, DFID ensures that its transition programmes promote UHC and prioritise access to services for the most marginalised communities before it makes its exit.

I recognise that the UK has been a key global leader on this issue in years gone by, and long may that continue. This Government, and any Government, will have our support if they continue to pursue the goals in the universal health coverage 2030 partnership. We need to use the NHS’s expertise and experience to help shape new universal systems in other countries. We should continue to use DFID to put other Governments in a position to support such systems and end reliance on charges and out-of-pocket spending. We want the Foreign Office to be used fully to argue for an increase in health spending and an end to draconian criminal laws that marginalise communities and make access to healthcare difficult. We should continue to support efforts to better measure progress on who has access to universal healthcare and the quality of care they are receiving, so that we can check, for example, that HIV treatment is reaching marginalised communities.

We should continue to support non-governmental organisations and civil society in helping people to access healthcare and hold their national Governments to account. We should continue to be a leader in research and development. The hon. Member for Strangford rightly highlighted the work at Queen’s University, but universities across the United Kingdom play a pivotal role in researching diseases that affect low and middle-income countries.

We need to work with other countries and the World Health Organisation to create a global road map on access to medicines, and to end what is sometimes a medicines rip-off. That means encouraging the de-linking of research and development costs from medicine prices, and defending the use of so-called TRIPs flexibilities—those under the agreement on trade-related aspects of intellectual property rights—by low-income countries seeking to access medicines. It would be particularly helpful to hear a bit from the Government about their commitment to pushing for protecting such flexibilities in the outcome document from the forthcoming high-level meeting on tuberculosis, which I understand is to take place in September.

If all that helps to achieve the universal health coverage goal for 2030, then the NHS’s 82nd birthday will be an even more significant and happier occasion than its 70th.