Universal Health Coverage — [Mr Laurence Robertson in the Chair]

– in Westminster Hall at 9:30 am on 10th July 2019.

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Photo of Alistair Burt Alistair Burt Conservative, North East Bedfordshire 9:30 am, 10th July 2019

I beg to move,

That this House
has considered universal health coverage.

It is a great pleasure to serve under your chairmanship again, Mr Robertson, and to be here in Westminster Hall. I am pleased to have the opportunity to say a few words about universal health coverage.

Let me begin with one or two words of thanks. First, I thank Alison Stiby-Harris and, through her, all at Save the Children, which prompted me to seek the debate. I also thank all the colleagues who supported the effort to secure it, and the various agencies and supporters who have contributed to it through their briefings. Secondly, I thank the Library for its briefing pack, which of course is distributed far and wide—far beyond our boundaries. I thank Tim Robinson, Jon Lunn and Philip Brien for their contributions to it.

I also thank my former colleagues at the Department for International Development, who I know will have prepared the Minister for the torrid time he can expect this morning, and with whom I worked so joyfully before Brexit intervened. I thank them and all those they represent, here and around the world, for the immense contribution they make, not only to this area but to all other aspects of aid and development delivery. As I frequently told them and Foreign and Commonwealth Office colleagues around the world, life may be very difficult in some of the spots where they work, but without them things would be just that bit more difficult.

I will first set out the themes of universal healthcare and why I think it is so important, and then offer a few sobering facts and figures about where the world is, and point the way, with reference to what is being done, towards opportunities for the UK to continue to lead in this field, as I hope and believe it can. It is such a vast field that I cannot cover everything.

It is rather nice to start a debate, rather than to have the eight or 10 minutes at the end and have to respond to a veritable volley of questions from Front Benchers and others—not least Stephen Twigg, who we heard with great sadness will not be with us in the next Parliament. No doubt there will be plenty of opportunities to thank him for the contribution he has made. It is nice to have the opportunity to kick off a debate, but I will try to ensure that I do not abuse that privilege by going on until at least half-past 10, as I would love to.

Universal health coverage means that

“all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.”

That is the World Health Organisation definition, which embodies three related objectives. The first is equity in access to health services. Everyone who needs services, not only those who can afford to pay for them, should get them. Secondly, the quality of health services should be good enough to improve the health of those receiving services. Thirdly, people should be protected against financial risk, ensuring that the cost of using services does not put people at risk of financial harm. Universal health coverage cuts across all the health-related sustainable development goals, particularly SDG 3, and brings hope of better health and protection for the world’s poorest.

I am sure it is not difficult for us to explain to the British public why this topic has such resonance. Health is fundamental. Our nation’s commitment to a national health service, free at the point of delivery, is now such a staple of our lives that its principle needs little further emphasis. So it is around the world.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

I congratulate the right hon. Gentleman on all he has done in the positions he has held, but it is good to see him leading a debate in Westminster Hall. Tuberculosis is the world’s deadliest infectious disease, killing more people each year than HIV and malaria combined. It affects the most vulnerable and marginalised—those with less money—and both the disease and the treatment have long-lasting consequences. Does he agree that it is imperative that we prevent rather than treat TB, since the latter leads to the emergence and spread of drug resistance, which is a real danger to individuals—especially the vulnerable—and to public health more broadly?

Photo of Alistair Burt Alistair Burt Conservative, North East Bedfordshire

I am grateful to the hon. Gentleman for that intervention. He is a noble champion of many health causes, and of the rights of people across the world. TB is indeed a key part of the delivery of universal health coverage. I will cover it later in relation to our contribution to the Global Fund, but it is absolutely right that some of the diseases that we have begun effectively to marginalise in the United Kingdom are still a risk in many parts of the world, particularly for the poorest.

A healthy society is one in which children can fulfil their potential, mothers can give birth safely and the cruellest of preventable diseases, such as TB, can be tackled, with life and nation-changing impact, but to do this effectively, the world needs to tackle it collectively. Colleagues will know how important I hold collective multilateral activity by the world’s nations to be. As multilateralism seems under relentless threat from many quarters, universal health coverage reminds us that a common issue or threat is dealt with not by even the best-intentioned individual or bilateral action, but by pooling sovereignty and making collective effort, whether that is in vaccination, in the fight against HIV/AIDS, or in combating anti-microbial resistance. Collective effort also means creating partnerships between the public, private, and charitable and voluntary sectors, which all have a place. Efforts to exclude, or to advocate exclusivity for, one or other of those sectors need examining very carefully.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

I thank the right hon. Gentleman for giving way again; he is being most generous. On collective responses, the UN’s high-level meeting on universal health coverage must build on the success of last year’s UN high-level meeting on TB and reaffirm the commitment to diagnose and treat 40 million people with TB by 2022. Does he agree that though our commitment to the Global Fund is a great first step by this Government and the United Kingdom of Great Britain and Northern Ireland, we need others to give the same commitment?

Photo of Alistair Burt Alistair Burt Conservative, North East Bedfordshire

Indeed. Once again, the hon. Gentleman anticipates something I will come to later. Our 16% uplift in relation to the Global Fund is remarkable in itself, but of course it should be an example to others.

Efforts to build sustainability and to encourage and work towards health system strengthening around the world are really important. Although there will always be a need to respond to outbreaks or emergencies, basic healthcare and steady improvement are achieved not by continual external intervention, but by dedicated work to build, train and equip those who take national responsibility for their nation’s health. A DFID brief puts it as follows:

“Countries need strong health systems if they are to achieve Global Goal 3, and ‘ensure healthy lives and promote well-being for all ages’”— that is SDG 3—

“and the target of UHC aimed at reaching the most excluded and living in the most remote locations, leaving ‘no one behind’.”

That determination to ensure that responsibility for health is rightly taken by a nation itself, and our view that our role is to enable such a transition in health to take place, helps us to explain in this country why UK aid and development assistance works, and why our commitment to spending 0.7% of gross national income is so important. Few question the role the UK plays in immunising millions of children around the world, including some 8 million victims of the war in Syria.

Photo of Tim Farron Tim Farron Liberal Democrat Lords Spokesperson (Communities and Local Government)

Something like 5 million refugees from the Syrian conflict are in camps in the countries around Syria. Will the right hon. Gentleman reflect on the impact on the physical and mental health of people of all ages, particularly the 1.5 million children, of being in camps, rather than in settled communities, often for many years?

Photo of Alistair Burt Alistair Burt Conservative, North East Bedfordshire

We could spend another 20 minutes reflecting deeply on that. Like others in the Chamber, I have had the good fortune to visit refugees in various locations. Some are in camps. The majority in Lebanon, for example, where a quarter of the population are Syrian refugees, live on the outskirts of other communities. The hon. Gentleman is absolutely correct.

Although, understandably, there used to be a concentration on the basic needs—shelter, food and water—there is now a clear recognition of the damage that is done, particularly but not exclusively to children, over a longer period. Of course, one area of concern is education. It is reckoned that perhaps a third of refugee children lose primary education, and perhaps two thirds lose secondary education. There are also the limitations on their action and the impact of that on mental health. Some time ago, the UK and DFID stopped seeing mental health as a nice add-on to support and saw it as essential. We have put money, effort and support into putting workers in to protect against mental health problems.

Of course, if the wars were not occurring, such problems would not be there. That encourages us to redouble our efforts in conflict prevention and peacebuilding in the areas most at risk.

Photo of Bambos Charalambous Bambos Charalambous Labour, Enfield, Southgate

Is the right hon. Gentleman aware that more than 5.6 million children under the age of five die from preventable diseases every year? Does he agree that immunisation is a critical backbone of any universal health strategy?

Photo of Alistair Burt Alistair Burt Conservative, North East Bedfordshire

I do, and I may say something further about vaccination in just a moment. The hon. Gentleman is absolutely right.

Photo of David Simpson David Simpson Shadow DUP Spokesperson (Environment, Food and Rural Affairs), Shadow DUP Spokesperson (Business, Energy and Industrial Strategy)

Alongside the health and mental health issues of young people, there is grave concern in many countries about the trafficking of children and young people in camps and outside. Does the right hon. Gentleman agree—I am sure he will—that that also needs to be addressed?

Photo of Alistair Burt Alistair Burt Conservative, North East Bedfordshire

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.

Photo of Philippa Whitford Philippa Whitford Shadow SNP Spokesperson (Health and Social Care)

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.

Photo of Alistair Burt Alistair Burt Conservative, North East Bedfordshire

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.

Several hon. Members:

rose—

Photo of Laurence Robertson Laurence Robertson Conservative, Tewkesbury

Order. I ask hon. Members to keep Back-Bench speeches to around seven minutes. That will enable me to call everyone to speak. I call Stephen Twigg.

Photo of Stephen Twigg Stephen Twigg Chair, International Development Committee 9:54 am, 10th July 2019

It is a pleasure to serve under your chairmanship, Mr Robertson. I draw your attention to a relevant entry in the register—I visited Liberia in 2017 with the fantastic organisation, RESULTS UK, to look at Liberia’s efforts to rebuild a public health system after the Ebola crisis. I congratulate Alistair Burt on securing the debate and on his fantastic work as a Minister, and the passion and commitment that he has demonstrated once again today.

As the right hon. Gentleman said, the third of the sustainable development goals commits the world to achieving universal health coverage for all by 2030. It seeks to ensure access to a full range of essential health services based on need, not on the ability to pay. Before I became Chair of the Select Committee on International Development, in 2014 the Committee published a report, “Strengthening Health Systems in Developing Countries”, which concluded that universal health coverage cannot be achieved without properly functioning health systems. At that time—five years ago—the Committee urged the Department for International Development to grasp the opportunity and demonstrate genuine global leadership worthy of its health systems expertise.

In recent years, we have seen some serious progress, and it is worth reminding ourselves of the progress that the world has made. For example, incidences of malaria and the number of new cases of HIV have each fallen by around a third since the turn of the century and the adoption of the millennium development goals. The global child mortality rate has been cut in half since 1990. Nevertheless, half of the world’s population lacks access to essential healthcare services and, every year, around100 million people are pushed into extreme poverty because of the cost of healthcare.

Let me say a few words about Ebola. In 2014, we saw the deadliest outbreak of Ebola in history—the first to hit epidemic levels. Three years ago, the Committee published an inquiry report on that. We said that a major factor in the Ebola outbreak reaching an unprecedented scale was the weak state of health systems in the affected countries. It is extremely concerning to see what is happening in eastern DRC at the moment, where there have been more than 2,400 Ebola cases. The International Development Secretary, on a visit to the Democratic Republic of the Congo this weekend, called for the World Health Organisation to declare the outbreak an emergency. It is crucial that the international system redoubles its efforts in response to the emergency. Health-system strengthening must surely form a core part of recovery efforts in the DRC. DFID has an opportunity to play a leading role in supporting that work.

As the right hon. Gentleman said, we are at a critical moment with this September’s high-level meeting. Here in the UK, we have the finest system of universal health coverage anywhere in the world, with our national health service. That gives us the expertise, knowledge and capacity to make a lasting impact on the global debate and to be a powerful voice in it. I support what the right hon. Gentleman said about high-level UK representation at September’s meeting, and on supporting other countries to increase domestic resource mobilisation, ideally to see their health spending rising to 5% of gross national income. We can share policy expertise from our NHS to support other countries to increase their own domestic investment in health.

The coming year provides an unparalleled set of opportunities, with the various replenishments to which the right hon. Gentleman referred. I look forward to the Minister appearing before the International Development Committee this afternoon, as we will have an opportunity to address some of the issues in more detail. I hugely welcome the £1.4 billion pledged by the Government to the Global Fund. It is genuinely excellent news that that commitment has been made and that it has been made early. That has lessons for replenishments in other areas, such as education, but that is for another day.

Let me endorse what the right hon. Gentleman said about Gavi. The United Kingdom hosts the replenishment of Gavi next year. The Mayor of Liverpool, Joe Anderson, and I have written to the Prime Minister, bidding for Liverpool to host Gavi’s replenishment, not least because of the presence of the School of Tropical Medicine in our city. Let me also support what the right hon. Gentleman said about polio—I welcome his focus on that. As he said, we have seen remarkable progress since the establishment of the Global Polio Eradication Initiative, with a 99% reduction in incidents since 1988, but it is still endemic in Nigeria, Afghanistan and Pakistan. The Global Polio Eradication Initiative strategy states:

“Full implementation and financing of the GPEI Polio Endgame Strategy 2019-2023 will result in a world where no child will ever again be paralysed by any poliovirus anywhere”.

We are close to a world free of polio, but this will require one last push to end polio once and for all. I pay tribute to the groups that have come together to form the One Last Push campaign. It was a pleasure to join them at a fantastic event in Birmingham in April, which was also attended by my hon. Friend Jess Phillips. We heard from campaigners from a range of non-governmental organisations, as well as British people living with polio. I learned a lot about some of the challenges facing British people living with polio in this country, and about the challenge of one last push to end polio globally.

The polio initiative is vaccinating the hardest-to-reach children. Our country can be proud that we have provided £1.3 billion to GPEI since its creation. I hope we will be able to show commitment once again to a polio-free world—we have done so with the Global Fund—with a generous financial pledge ahead of the GPEI’s upcoming replenishment in November.

Let me finish by echoing strongly what the right hon. Gentleman said about the importance of multilateralism and our standing up for values. I will perhaps be a bit more explicit than he was. The Trump Administration are clearly standing in the way of many of the things that he talked about—not least on sexual and reproductive health. Those global health multilaterals have consistently been shown to deliver high-quality, effective channels for UK aid. The Department’s multilateral development review three years ago demonstrated that once again. Those multilaterals have at their heart the Department’s strategic objectives of reducing poverty and promoting global prosperity. That makes moral sense, which we rightly focus on, and it also makes economic sense. For every dollar invested in immunisation, it is calculated that around $16 is returned directly in reductions in healthcare costs, avoiding lost wages and lost productivity due to illness and death.

Over the next two years, let us grasp these key opportunities to make progress on health outcomes and work together towards the goal of achieving universal health coverage for all. The UK has been central to this endeavour over the past two decades, and I hope very much that we can continue to lead efforts to achieve a world where everyone can get access to healthcare based on their needs, not on their ability to pay.

Photo of John Lamont John Lamont Conservative, Berwickshire, Roxburgh and Selkirk 10:03 am, 10th July 2019

It is a pleasure to serve under your chairmanship, Mr Robertson. I, too, congratulate my right hon. Friend Alistair Burt on securing this important debate. I recognise that he was a great champion of these causes during his time as a Minister, and he has continued that valuable work from the Back Benches.

A key part of progress towards worldwide universal health coverage is tackling the world’s major health challenges. Only once those are under control can developing nations achieve sustainable healthcare systems and move towards universal health coverage. I am pleased that the United Kingdom is a world leader in supporting the Global Fund to tackle AIDS-related illnesses, tuberculosis and malaria, which kill around 2.5 million people a year.

Photo of Nicholas Dakin Nicholas Dakin Opposition Whip (Commons)

I congratulate Alistair Burt on securing this debate and opening it so well.

Does the hon. Gentleman agree that TB is a perfect example of the need for universal health coverage, and that if we invest well in TB programmes with universal health care in mind, it will make a real difference to developing countries across the world?

Photo of John Lamont John Lamont Conservative, Berwickshire, Roxburgh and Selkirk

I absolutely agree, which is why the UK’s role in tackling TB is so important.

As a country, we will pledge up to £1.4 billion to the latest round of the Global Fund, which will help to provide life-saving antiretroviral therapy for more than 3.3 million people living with HIV, support treatment for 2.3 million people living with tuberculosis, and distribute 92 million mosquito nets to protect children and families from malaria. The UK is the second largest donor to health aid, having contributed $5 billion over the past 30 years. I believe that is something that we as a nation should celebrate.

This global effort, which is being led by the United Kingdom, is changing the world. Child survival rates are one of the greatest success stories, with child mortality levels more than halving since 1990. However, there is still a huge distance to go. Although access to healthcare is improving globally in both developed and developing nations, progress is slow and the gap between countries with the best and worst access to healthcare shows little sign of closing. We need to address that, which is why I support calls from Save the Children for the UK to champion a universal health coverage approach at the UN’s high-level meeting on universal health coverage in September—something my right hon. Friend the Member for North East Bedfordshire has already raised.

This is not about dictating to other nations how they should manage public finances. It is about explaining the benefits of investment in healthcare—not only in improving the health of local populations, but in facilitating improvements in education, poverty and long-term economic development. The UK should champion the principle of healthcare being free at the point of use, and support Governments to increase health spending to 5% of GDP and integrate nutrition and immunisation into national healthcare plans.

Access to universal health coverage needs to be as broad a principle as possible. In some areas, a little investment can make a huge difference to people’s lives. Cerebral Palsy Africa is a charity based in Duns in Berwickshire in my constituency, and it provides support to enable children to attend school in Ghana and other African countries. It was set up by physiotherapist Archie Hinchcliffe, after she saw what rehabilitation could do for young cerebral palsy sufferers—the condition was simply not seen as a priority in many African nations. That is despite early intervention making a huge difference to the lives of sufferers. DFID’s small charities challenge fund recently awarded the charity £50,000, which is being used to train special needs teachers and specialist physiotherapists in Africa. We should all welcome that, and it demonstrates how funding from the United Kingdom Government can have a real impact on UK-based charities working in other parts of the world.

Photo of Jeremy Lefroy Jeremy Lefroy Conservative, Stafford

Does my hon. Friend agree that DFID’s small charities fund is an excellent innovation? In fact, we should see far more resources from DFID channelled through that to support all those great initiatives in our constituencies. They often offer the best value for money.

Photo of John Lamont John Lamont Conservative, Berwickshire, Roxburgh and Selkirk

My hon. Friend makes an excellent point. All of these are very good examples of where UK money is invested locally but the benefits are felt all around the world. Very often, it is volunteers from the UK who ensure that funds are spent to best effect.

Although we absolutely must lead the fight against worldwide killers such as HIV and TB, supporting treatment and therapy for rarer conditions has to be part of the move towards universal healthcare coverage. Again, I congratulate my right hon. Friend the Member for North East Bedfordshire on securing this important debate and allowing hon. Members to highlight the great work that the United Kingdom is doing around the world to improve the lives of so many people.

Photo of Philippa Whitford Philippa Whitford Shadow SNP Spokesperson (Health and Social Care) 10:08 am, 10th July 2019

It is a pleasure to serve under you, Mr Robertson. I declare an interest in this subject, as I travelled to Ethiopia with RESULTS UK and saw the impact of setting up vaccination services as the initial building blocks towards universal healthcare. I pay tribute to Alistair Burt for opening this debate and for his work as a DFID Minister. I am the chair of the all-party parliamentary group on vaccination, and I really welcome the commitment he showed in giving evidence to our inquiry on the next decade of vaccines. Our report was published in January, and I thank the team he worked with at the time.

As the right hon. Gentleman said in his introduction, universal health coverage is the idea that everyone should have access to quality healthcare without ending up in financial hardship. Half the world’s population simply does not have that, while 100 million people are thrown into extreme poverty when trying to access healthcare.

The UK has absolutely been a leader in this sphere. It is the No. 1 funder of Gavi, The Vaccine Alliance, which helps to provide affordable vaccines to low-income countries, and also helps those countries to develop their own systems to deliver vaccines. I particularly welcome the £1.4 billion commitment to the Global Fund and the fact that it was made in advance of the replenishment date. The replenishment of the polio eradication initiative is coming up this November, and the UK making a pledge in advance helps to put pressure on other countries to make similar commitments. The Global Fund is particularly involved in tuberculosis, HIV and malaria, which shows that this about not just a single thing, but a combination of vaccinations, antiretroviral drugs and malaria nets. Underneath all that, there is the need for clean water, among other things.

Vaccination itself has saved 20 million lives in the last decade. In 1988, when the polio eradication team came together, there were 350,000 cases of polio a year. Last year, there were 33 cases, in a difficult area on the border between Pakistan and Afghanistan. There is no treatment for polio. One problem when people talk “anti-vax” and say, “I don’t believe in vaccination” is that they do not remember what these illnesses look like. When I was in Ethiopia, we pulled into a garage to get petrol, and I saw a young man of about 30 standing there with the obvious deformity of flaccid paralysis from polio. The last time that I saw someone in that situation, it hit me like a boot in the face.

On Monday, we held an event in the House for polio survivors, and I thank those hon. Members who attended to hear their stories. Many of the older polio sufferers now use wheelchairs and are not therefore as recognisable as the children with polio, who used callipers or crutches. People are complacent and have forgotten the harm that polio can do and is doing elsewhere.

The Global Polio Eradication Initiative has done an incredible job using oral drops, which are critical because the gut protection a child gains from an oral vaccine protects against the further spread of the virus. The injectable form we use here protects the individual, but they can still spread the disease. It is therefore crucial that we eradicate it.

The problem is that, previously, we talked as though we would achieve eradication—obviously, we had hoped to achieve it by next year—and then look at transition. However, much of the infrastructure, staff and funding used to eradicate polio is also holding up the basic vaccination systems in low-income countries. In fact, people are now reluctant to take the oral vaccine. Some of that is because they say, “Here you are again, back in our village with your drops, but I can’t get my baby treated for another condition. We don’t have clean water. My children aren’t even fully immunised.” That is why we need the transition. Universal health coverage is now critical to achieving the eradication of polio; if there are outbreaks in Nigeria or elsewhere, it is because the routine levels of immunisation are simply not high enough.

Seth Berkley, the head of Gavi, pointed out a shocking figure to us when we set up the APPG. He said that although we think we are doing a great job, 85% of children in low-income countries are vaccinated only with DTP3—one of the very basic vaccines—and we put a tick next to them. However, only 7% of children in those countries are fully vaccinated and receive all 11 vaccines recommended by the WHO. More than 90% of children are still vulnerable to disease, and 15% have had no vaccinations at all, so we still have a lot of work to do.

I commend the UK for the 0.7% commitment to aid, which must be maintained. DFID must be maintained as a separate Department, not just for its function, but to show that commitment and drive. If our constituents say, “Charity begins at home, so why on earth are we bothering to spend money miles and miles away?” we should remember the Ebola outbreak and the fear over people arriving at Heathrow and having their temperatures taken. With air travel, the world is now a very small place, so infectious diseases threaten everyone. Vaccines will be critical to preventing antibiotic resistance, which threatens us all.

We should see our commitment both as a way to help those countries to invest in their children’s health, which helps them to develop economically and—a little selfishly—as a way to protect ourselves. Vaccination on its own will not be enough unless it is part of a system of universal health coverage that improves the health of all people, particularly the future generations of developing countries.

Photo of Karen Lee Karen Lee Shadow Minister (Home Office) (Fire) 10:15 am, 10th July 2019

It is a pleasure to serve under your chairmanship, Mr Robertson. I thank Alistair Burt for securing the debate.

When our NHS was created, it was the first time in history that healthcare was made available on the basis of citizenship rather than insurance of payment. We are all proud, across parties, of that achievement. The prioritisation of public health has been the bedrock of our country’s success ever since, with a healthcare system that treats all of its patients as equals, not as potential customers. As a frontline nurse for almost 15 years, I was really proud to be part of delivering that healthcare —I still miss it today.

After a decade of underfunding and privatisation, however, our NHS now delivers a postcode lottery health service. Even in my constituency, the healthcare afforded to those in the centre of Lincoln is different from that afforded to those in the village of Skellingthorpe. The compression of the budgets afforded to clinical commissioning groups means CCGs have to make difficult choices that can, in some cases, result in the centralisation of service provisions to ensure that the quality of healthcare is maintained. I understand that rationale, as it prioritises patient care, but it degrades the ability of our constituents to reap the benefits of our NHS, as their access to care is restricted and they can no longer rely on local services. That is particularly striking in my constituency, where some healthcare facilities have been forced to shut, and local hospitals need considerable funding and support.

Last July, the chief inspector of hospitals recommended that United Lincolnshire Hospitals NHS Trust remain in special measures. The trust has missed its A&E waiting time target by 32%, has not met the national standard since September 2014, and has an estimated deficit of £80 million. As an ex-member of staff, I know that that has nothing to do with the dedication, commitment and hard work of the staff there.

The pressures at regional level are being passed on to local healthcare in Lincoln. The doctor’s surgery in Skellingthorpe, run by the Glebe Practice, has announced that it intends to close because of recruitment issues. That will be consulted on, but services will be centralised in Saxilby, 4.3 miles away. That does not sound far, but it is very difficult to get to. The doctor’s surgery serves a majority of the community and is highly regarded by local residents. Some 82% of patients who responded to the national patient survey felt that their overall experience was good or very good, so this is not a reflection on the GPs at the practice. If the surgery closes, my constituents’ access to care will be downgraded and their right to free care at the point of need will be undermined.

In June, I held a public meeting in Skellingthorpe, to listen to local residents’ concerns. As it is such a sleepy little village, I thought, “We might get six people, or we might get 26.” We actually saw 80 people over three hours—it was a really busy and lively meeting. They all had the same concerns. There are infrequent public transport links, and not everyone can access the new location by car—either they have not got a car or they are too old or ill to drive. They talked about age, illness and poor mobility—if they take the bus, it does not go near the the GP surgery. Surely, all my constituents should be able to see a GP without worrying about a long or expensive journey; that is the last thing they need when they are ill.

I completely acknowledge that the Glebe Practice is struggling to recruit clinicians in a rural Lincolnshire village. That reflects the national picture, as the NHS is short of more than 100,000 staff, including 41,000 nurses and 10,000 doctors. I was at a meeting yesterday, and the withdrawal of the nursing bursary has contributed hugely to the fact that we are so short of staff in the NHS.

What concerns me most of all is that, in places such as Lincoln, which are suffering from the Government’s mismanagement, the situation does not seem to be improving; instead, it is getting worse. As the co-authored report from the Nuffield Trust, the King’s Fund and the Health Foundation found, the NHS could be short of 7,000 GPs within five years. Rural areas are already suffering from undertraining and underfunding. I urge the Minister to assess the implications of closing Skellingthorpe health centre for the health provision of my constituents, and to implement an effective national programme to incentivise GP recruitment in rural areas. We can all talk about the problems of recruiting GPs, but, come on, the Government have had nine years to get this sorted out—they should have been looking at this. We should be supporting GPs such as those at the Glebe Practice, not punishing the public by reducing their access to healthcare.

Before I sit down, I want to say something about the comments we’ve heard about nutrition and healthcare. As a nurse, I obviously appreciate the links between nutrition and healthcare—I remember the dieticians coming on the ward—but, in a country with the wealth that we have, to see food banks at the level we have is appalling. When we talk about healthcare in this country, we ought to ask whether people really should have to access food banks because they are starving and that is the only way to get food.

Photo of David Linden David Linden SNP Whip 10:21 am, 10th July 2019

It is a pleasure to see you in the Chair, Mr Robertson.

I, too, congratulate Alistair Burt on securing this important debate and pay tribute to him. In my experience—even though I have been here only two years––he was one of the most thoughtful members of the Government, and it is a pity to see him on the Back Benches.

The debate is timely, given the year of opportunity ahead of us, with the high-level meeting in September and the various health financing moments between now and the end of 2020. The concept of universal health coverage is so valuable because it recognises how all health interventions interlink.

As my hon. Friend Dr Whitford said, a strong immune system can only be developed with good nutrition. Without a strong immune system, vaccines and medicines are far less effective, and people are more vulnerable to disease. People living with diseases such as HIV or diabetes are more susceptible to developing other diseases, such as tuberculosis. At this juncture, I draw the House’s attention to my entry in the Register of Members’ Financial Interests. It was a pleasure to join my hon. Friend out in Geneva last month.

I will focus the majority of my remarks on nutrition, as chair of the all-party parliamentary group on nutrition for growth. I will reflect on our recent visit to agencies of the Geneva-based World Health Organisation and the Rome-based Food and Agriculture Organisation to discuss universal health coverage and the various challenges faced by Governments and civil society in achieving it. It was fascinating to see the steps being taken to achieve universal health coverage, but I was struck by the number of challenges.

One significant challenge to overcome is political ownership of health interventions. Here in the UK—Karen Lee touched on this—where parties jostle and compete at election time to express their support for and admiration of the NHS, it is easy to forget that in many parts of the world healthcare remains politically sensitive. Even more politically sensitive are investments in preventive measures such as nutrition, which, if done right, reduce the burden on health systems and so, in the long run, the funding that they require.

Despite that, the deputy director-general of the World Health Organisation told us that 95% to 97% of health budgets are still spent on institutions such as hospitals. Through the high-level meeting, the UK Government have an opportunity to encourage Governments around the world to invest more and smarter in preventive health measures such as nutrition. Will the Minister do what he can to ensure that strong wording to that effect is woven through the political declaration of the high-level meeting?

Another challenge is the siloed approach to healthcare that we see even in this Chamber, with different Members, including me, focusing on different areas of interest. A degree of siloing is perhaps inevitable, but the Government can help to break down the silos in a number of ways. First, DFID should use its position of leadership at various health multilaterals, such as Gavi, the Global Fund and the Global Polio Eradication Initiative, to encourage organisations to work together and to add nutrition elements to their programmes. DFID should also take steps to embed nutrition more effectively across its portfolio. Nutrition elements should be woven into the fabric of all DFID’s health programmes in order to gain maximum impact from each intervention. Lastly, the UK Government should apply that holistic view of healthcare to their own investments.

As I said at the beginning of my speech, there will be multiple health financing moments over the course of the next year. Politically, it is vital at the moment, despite the turmoil and a lot of changes, that every single Member of this House gets behind that, so that health does not become a political football. I hope that it does not.

Globally co-ordinated initiatives such as Nutrition for Growth, and multilaterals such as the Global Fund, Gavi and the Global Polio Eradication Initiative, are proven to be highly effective, and they offer value for money for the UK taxpayer. All those investments complement each other, and are the building blocks to achieving universal health coverage. Likewise, failure to invest in any one block compromises the effectiveness of the others. DFID should invest ambitiously and equitably as each of those moments comes up—as it already has done for the Global Fund—and encourage others to do likewise.

As John Lamont said, the UK is well respected as a major donor when it comes to global health, and it should not shy away from wielding that influence to encourage others to step up in the campaign for universal health coverage. I hope that the Minister will take on board my recommendations, and I look forward to his response.

Photo of Laurence Robertson Laurence Robertson Conservative, Tewkesbury

Before I call the first Front-Bench spokesperson, I will say that I would like to leave two minutes at the end for the mover of the motion to wind up.

Photo of Chris Law Chris Law Shadow SNP Spokesperson (International Development) 10:26 am, 10th July 2019

It is a pleasure to serve under your chairmanship, Mr Robertson. I thank Alistair Burt for securing this debate, for his great work as a Minister, and for championing the need for a separate Department for International Development.

Sustainable development goal 3 aims to

“Ensure healthy lives and promote well-being for all at all ages”, and target 3.8 looks to “Achieve universal health coverage”, which is something that all of us in this House and across these islands have taken for granted since the establishment of the NHS in the 1940s. Everyone here already knows that implementing universal health coverage ensures that everyone receives quality healthcare without financial cost. We know that that reduces the risk of people being pushed into poverty, drives inclusive growth, builds more trust in health systems, and is more sustainable than simply responding to global health security threats.

Globally, it is important to note that access to healthcare has been increasing fairly steadily over the past 35 years. The healthcare access and quality index shows that almost all countries have seen at least some improvement during that time. However, we still have a long way to go if we are to meet sustainable development goal 3 by 2030. While access to healthcare has been increasing, the countries with the worst healthcare are still a long way behind those with the best, and that gap shows little sign of closing.

At least half the world’s population still do not have full coverage of essential health services, with one in eight people in the world spending at least 10% of their household budgets to pay for healthcare. As a result, about 100 million people are still being pushed into extreme poverty because they have to pay for their healthcare. Furthermore, the World Bank has identified that low-income developing countries are starting to face the challenges of ageing populations, and of increases in chronic, non-communicable diseases. That will only exacerbate the funding gap between what those countries have and what they need to provide universal health care. Aid spending on health is just as important now as it has ever been.

To turn my attention to the UK’s impact on universal health coverage, it is important to remind ourselves that of the $58 billion spent on health aid between 1990 and 2017, the UK spent $5 billion, and is the second largest national donor after the US—something we should all be proud of. Is it not ironic that the birthplace of national healthcare is second to a country that does not provide that for its citizens? Indeed, regressive attempts have been made by the US Administration to roll back the progress made under Obamacare.

The Department for International Development states that it is committed to supporting progress towards sustainable development goal 3, and aid spending on health is generally higher now than in previous years, representing 10.5% of all bilateral aid. That has to be welcomed. Last month, the UK increased its pledge to the Global Fund by 16%, in advance of the time of replenishment. That is a total of £1.4 billion.

We cannot be complacent about our past or current successes. The pathway to universal health coverage will be long and winding with no quick fixes, and the UK Government need to maintain their commitments in that area. All hon. Members in the debate have shown they are fully committed to that. However, there are possible changes ahead. In two weeks’ time we will have a new Prime Minister. The leading candidate has stated:

“We could make sure that 0.7 % is spent more in line with Britain’s political commercial and diplomatic interests”.

Let me be crystal clear: the SNP is unequivocal about the fact that trade and development are two different areas and must not be forced together at the expense of the world’s most vulnerable. Will we respond to an Ebola outbreak only if that is in the UK’s commercial interest? Who will judge if it is in our political interest to distribute mosquito nets to prevent the spread of malaria? Will children be vaccinated only in countries with whom the UK is on good diplomatic terms? Those questions may need to be answered. We should consider seriously the comments that have been made—they should send a shiver down our spines.

The same lead candidate has said:

“We can’t keep spending huge sums of British taxpayers’ money as though we were some independent Scandinavian NGO. The present system is leading to inevitable waste as money is shoved out of the door in order to meet the 0.7 per cent target”.

Let us examine that ludicrous statement. Of course, the UK is not some independent Scandinavian NGO, but one of the largest economies in the world. It has both a legal and moral duty to commit to 0.7% aid spending, and to assist in the fight against the diseases we have heard about in the debate. That is not inevitable waste or shoving money out the door; it is exactly what the UK should spend its money on while meeting the 0.7% target.

Let us look at an alternative approach in these islands. Ben Macpherson, the Scottish Government’s Minister for Europe, Migration and International Development, has given the following pledge for the Scottish Government:

“international development should be in the national interests of our partner countries and not in Scotland’s national interest.”

We should all agree that that is what international development means. We firmly believe that spending that must be focused on helping the poorest and most vulnerable, and on alleviating global poverty.

The SNP Scottish Government are playing their part in tackling global challenges, including epidemics and health inequalities. For example, as part of Scotland’s global goals partnership agreement with Malawi, the Scottish Government have pledged to strengthen the prevention and management of infectious diseases such as malaria, tuberculosis and HIV/AIDS. The Scottish Government respond to humanitarian crises through the humanitarian emergency fund, which includes provision to ensure the containment of diseases at times of crisis. While the challenges are fewer at home than abroad, the SNP is committed to defending the NHS, and to ensuring access to universal healthcare domestically; health spending is £185 higher per person in Scotland than in England.

To deliver universal health coverage, all countries must strive to provide quality healthcare at home. Those who are able to do that have a responsibility to support the same abroad. With a Department committed to international development and a 0.7% aid target, the UK already plays a significant role in doing so, and should never lose sight of that. The likely next Prime Minister talks about the UK walking away from its aid commitments, but it is imperative that the UK instead uses the opportunity of the universal healthcare agreement, which is due to be signed at the UN General Assembly in September, to refocus and renew efforts, for many years to come, to ensure universal health coverage.

Photo of Preet Kaur Gill Preet Kaur Gill Shadow Minister (International Development) 10:34 am, 10th July 2019

It is a pleasure to serve under your chairmanship, Mr Robertson.

I thank Alistair Burt for securing this debate, and for his work in his previous role at the Department for International Development and the Foreign and Commonwealth Office; I know he is well respected by the whole House for his contributions and openness. He spoke compellingly about the importance of universal health coverage, and passionately about the strides made. He coined the term “Global Britain in action” in respect of our commitment to the Global Fund. He referenced, as many Members did, the high-level meeting in September on universal health coverage, and the UK’s role in that and our ongoing commitments. Finally, he made the point that DFID should remain a stand-alone Department.

As chair of the International Development Committee, my hon. Friend Stephen Twigg has made a vast contribution, and it will be a huge loss when he leaves that role. I thank him for raising the serious concerns about Ebola in the Democratic Republic of the Congo, and the Secretary of State’s declaration of an emergency. He spoke passionately about the One Last Push campaign to end polio globally.

John Lamont spoke of the small charities fund in the UK, and the impact it can have in supporting DFID’s work. My hon. Friend Dr Whitford, chair of the all-party parliamentary group on vaccinations for all, spoke of how vaccinations have saved 20 million lives, but that must be in the context of access to universal health coverage. My hon. Friend Karen Lee and David Linden talked about the importance of incorporating nutrition in UHC.

Last week, the national health service celebrated its 71st birthday. The NHS has rightly become nothing short of a national treasure in the UK. It has allowed us all to access quality healthcare free at the point of use, regardless of our income. But for too many people across the world, their right to quality healthcare is far from realised. Despite the global commitment to sustainable development goal 3—to

“Ensure healthy lives and promote well-being for all”— some 3.6 billion people do not receive the most essential health services they need, and 100 million are pushed into poverty from paying out-of-pocket for health services. It is right that securing health for all is a top priority for our international development work. It is essential that we take seriously this year’s UN high-level meeting in September, at which a universal health coverage agreement will be declared. I am delighted that this debate has been called, so that we can discuss how to achieve healthcare for all and what needs to be included in that declaration.

I will use my short time to cover four priority areas, starting with the need for public health systems. I mentioned the NHS; we know from our own experience that having a publicly provided universal health system, funded through progressive taxation and free at the point of delivery, is crucial to ensuring everyone can access the healthcare they need. It is only through putting people, rather than profit, at the heart of the agenda that we will ensure truly universal access to healthcare and meet the SDGs. After all, universal health coverage is about the social contract between the state and the population.

Country Governments are accountable to their population for delivering the right to healthcare. The NHS has provided us with a wealth of experience and expertise in universal health systems. That means the UK is well positioned to work with Governments, civil society groups and other stakeholders across the world to support the development of public health systems. Labour has committed to establishing, when it comes into government, a new dedicated unit for public services in DFID for that very purpose. We know that is crucial to gender equality. Women bear a greater burden of unpaid care work, so when a fully functioning health system is in place, women are freed up to engage in paid work opportunities, political decision making, education and other aspects of life.

Rather than strengthening public health systems, this Government have too often undermined them through their support for privatised forms of healthcare. Promoting public-private partnerships and private health facilities is not the way to achieve health for all. Health should never be commodified and turned into a profitable commercial venture, because that is a recipe for leaving the poorest without healthcare. Will the Minister inform us of the steps he is taking to ensure that we strengthen, not weaken, public health systems across the global south? Will the Government ensure that a strong focus on public health systems is included in the UN declaration?

Secondly, let me talk about health financing. Researchers at the World Health Organisation have estimated that the annual cost to poor countries of meeting the SDG target on healthcare for all by 2030 would be $112 per person. That is a significant increase on previous estimates, and would leave low-income countries facing an annual funding gap of up to $35 billion. The WHO estimates that poor countries will need to spend up to 20% of GDP on health to bridge that gap—clearly an impossible ask. If low-income countries are to have any chance of making up even part of the shortfall, Governments of rich countries and international institutions urgently need to address their role in creating global poverty and inequality, including through enabling unjust global tax and trade rules, demanding unsustainable debt repayments, failing to regulate their corporations properly, and imposing costs on poor countries through their contributions to climate change. I hope the Government will use their leadership position at the UN meeting in September to ensure that there is honest recognition of their responsibilities and the reasons why many poor countries do not have the domestic resources necessary to fund public health systems.

My third point is on access to medicines. We will never achieve healthcare for all without access to affordable medicines, vaccines and diagnostics. According to the STOPAIDS coalition, the price of new medicines worldwide is rising year on year. Due to a lack of transparency in drug pricing, too often we are left in the dark by pharmaceutical companies, which are free to set their own prices. As a result, treating a number of diseases remains unaffordable for both individuals and national health systems. Will the Minister ensure that improved affordability and access to medicines is championed in the declaration agreed at the UN meeting in September?

Fourthly and finally, I raise an important point about the “leave no one behind” agenda. At the launch of the SDGs, the Government pledged to ensure that

“every person counts and will be counted”, and that the

“people who are furthest behind, who have the least opportunity and who are the most excluded, will be prioritised.”

Five years on from the SDGs being agreed, too often the most marginalised are still being left behind. An important piece of research by the UN’s population fund, and the UK non-governmental organisations Health Poverty Action and the Minority Rights Group, found that women from indigenous and ethnic minority communities experience far worse maternal health outcomes than the majority population in all 16 countries that they studied.

In the light of this evidence, do the Government agree that including data on ethnicity is a vital part of ensuring that we can keep track of inclusion in health systems? Will the Minister explain why ethnicity continues to be neglected in DFID’s inclusive data charter action plan? When do the Government intend to meet their commitment under the SDGs by disaggregating data by ethnicity? Can the Minister assure us that the most marginalised ethnic groups will be counted and included in the high-level discussions in September?

I conclude by saying a few words about the Government’s record on universal health coverage to date. It has been five years since the International Development Committee urged the Government to formulate a strategy for its approach to health systems strengthening. The Government accepted this recommendation, yet nearly five years on, there is still no sign of the strategy. It is true that there have been promises of imminent publication, most recently last December, but there is still nothing. I hope the Government will tell us why there has been such a delay to this most important document. After all, strengthening public health and health systems is the most important step we can take towards achieving health for all.

Photo of Andrew Murrison Andrew Murrison Minister of State (Foreign and Commonwealth Office) (Joint with the Department for International Development) 10:41 am, 10th July 2019

I congratulate all involved today on an excellent debate. It is timely because on 23 September we will be discussing universal health coverage at the high-level meeting in New York.

I am pleased to have heard almost universal praise from across the House for the advanced declaration that the UK has made in relation to the Global Fund. I am proud of that, and I hope everybody here is proud of it too. Not only is it a significant sum of money and an uplift to what we were spending before, but when taken with the other Global Funds, it propels us to the top of the league table of international development, particularly relating to healthcare.

It is more important still because it is advanced notification. The whole point is to encourage others to pledge and commit—the two are slightly different—generous funds aimed at dealing with the healthcare issues we all struggle with, because we are all in this together, particularly in relation to infectious disease. That point has been made by a number of right hon. and hon. Members, because infectious diseases respect no borders.

Having started on a positive note, may I introduce an element of gloom? Strategic development goal 3 and the 17 development goals related to it are not on track to be successfully rolled out. Universal health coverage is an aspiration, but it is not secure; the glass is indeed half empty.

I congratulate my right hon. Friend Alistair Burt. It is ironic that I am here potentially answering for decisions that he made in Government.

Photo of Andrew Murrison Andrew Murrison Minister of State (Foreign and Commonwealth Office) (Joint with the Department for International Development)

I was about to say that I am really comfortable to do so, because the decisions he made, and those he is associated with vicariously, are good ones. I am happy to have inherited his portfolio, but he is a difficult act to follow, that is for sure.

My right hon. Friend identified all the issues in his contribution, as I would expect him to do. He started by highlighting universal health coverage and its contribution to SDG 3, but he also made the point that universal health coverage touches on the other SDGs as well. In advance of the high-level meeting on 23 September, he was right to ask about the aims and ambitions the UK Government have for that meeting. They are encapsulated in getting more money—obviously—and getting better quality and integrated healthcare. That is something many of the contributions have touched on one way or another. I have been struck by the level of support for an holistic approach to delivering universal healthcare.

We have talked about immunisation and about the mistake we would be making if we simply imagined that going around the world offering people vaccinations and inoculations would be “job done”. It really would not be. Those interventions would be treated with a great deal of suspicion by communities, as they are at the moment, if that were all we were offering. It has to be much more than that; it truly has to be integrated. I look forward to making this point loud and clear in September in New York.

On a broader theme, as I have gone around the world, I have been struck by the roll-out of healthcare systems. Very often, there is a temptation for politicians to roll out shiny things that they can demonstrate to their constituents. That generally means hospitals, and hospitals are great things, but they may not be the right thing in low and middle-income countries.

Photo of Philippa Whitford Philippa Whitford Shadow SNP Spokesperson (Health and Social Care)

In the four health systems across the UK, we are trying to address our obsession with hospitals and tertiary centres, realising we have not got enough resources in primary care, and certainly not in prevention. We need to share that knowledge with developing countries.

Photo of Andrew Murrison Andrew Murrison Minister of State (Foreign and Commonwealth Office) (Joint with the Department for International Development)

I agree with the hon. Lady. In the context of low and middle-income countries, my focus would be on primary healthcare and public healthcare, by which I understand something slightly different from public healthcare in the context introduced by Preet Kaur Gill, who speaks for the Opposition, and I will come to that in a minute. The focus needs to be on prevention and on things that deal with the problems that the poor are exposed to, first and foremost. The difficulty with shiny stuff—electorally obliging though that might be—is that it risks exacerbating health inequality; shiny things tend to be in urban centres and accessed more easily by the better off, rather than the poor, and particularly the rural poor. We need to be very careful about that.

We need to introduce the notion that countries themselves must grow their healthcare systems, and a number of contributions touched on that. That means addressing unpleasant things such as taxation. In addressing universal health coverage, we need to ensure that we encourage Governments to establish proper mechanisms for raising taxation, so that countries can ultimately stand on their own feet. I am pleased that the UK has introduced some trailblazers in that respect—the four in Africa are Rwanda, Ethiopia, Ghana and Uganda, and the other is Pakistan—where we will be assisting Governments to build structures that will make their healthcare systems sustainable in the longer term.

A number of contributions touched on polio. I know that will be the subject of my grilling later by Stephen Twigg—I will say lots of nice things about him in anticipation that he will give me an easy ride this afternoon. I am sorry that he is standing down; it will be a great loss to the House, and I urge him to think again. Polio is on the cusp of being defeated. There were 33 cases last years, from only three countries—only two countries, really. We must make sure the boot remains on the carotid, because there is a real risk that, if we are tempted to divert funds from this, we will be back to square one. That would be a tragedy because of the lives that would be lost, and because, at some point, we would have to pick up the pieces. It makes no sense, in raw economic terms, to relieve the pressure on that particular nasty at this point. I hope we will make sure in September that the pressure stays on that particular one of the “Captains of the Men of Death”.

I appreciated the comments made by right hon. and hon. Members about nutrition; they were absolutely right. Dr Whitford rightly said in an intervention that there is no point vaccinating people if they are undernourished. It is nonsense epidemiologically and in public health terms to do so, and we must adopt an integrated, holistic approach to universal health coverage. If we can get that across to people in New York in September, we will have done the world a great service.

I am proud to be a member of a Government who are fully committed to not just the Global Fund but other funds that require replenishment. Our leadership has been salutary over many years—not just under the present Government, although I am pleased about the commitment they have made to the Global Fund—and I am confident, whoever wins in two weeks’ time, to answer the point made by Chris Law, that that process will continue.

Photo of Alistair Burt Alistair Burt Conservative, North East Bedfordshire 10:50 am, 10th July 2019

It is a pleasure to briefly conclude the debate and to thank all those who took part for the contributions they made in a variety of ways. The hon. Members for Birmingham, Edgbaston (Preet Kaur Gill) and for Dundee West (Chris Law), speaking from the Front Bench, ensured that I was not far wrong when I spoke about the Minister having a torrid time. Theirs were thoughtful contributions that will remind the Minister that his post is not an easy wicket all the time. There are serious questions to be asked about development, and they were well asked, as always. My right hon. Friend responded very well. I thank him for his generous remarks and his response to the debate. We can all feel that the matter is in good hands.

I thank colleagues—the hon. Members for Glasgow East (David Linden), for Lincoln (Karen Lee) and for Central Ayrshire (Dr Whitford)—for the variety of contributions they made. The hon. Member for Central Ayrshire always speaks with great authority in such debates, and she reminded us about complacency and how things that we take for granted can easily be lost. My hon. Friend John Lamont reminded us of the efficacy of small charities, and he was ably supported by my hon. Friend Jeremy Lefroy, who is quite a champion of their work in many parts of the world. He speaks with great knowledge about that.

We shall miss Stephen Twigg, who is a thoughtful critic. He is always good at supporting the good things that the United Kingdom does, but keen to press the point where things are not right and to move us in the right direction. He has made a significant contribution, and his reputation across the House and beyond is well deserved. However long we are all here, I know he will continue to add to that.

I want to say a brief word about the conundrum that is the United States. On the one hand, it is the most extraordinarily generous contributor to the world—billions of dollars flow from it. There is a great risk of confusing the United States in general with elements of the Administration, and that would be unfair. We all work with colleagues in America who are the most generous and gifted of individuals. There will be the odd clash with an Administration of any sort, particularly at the moment. We have to be careful. The American Government are themselves a significant donor. There is a conundrum, and there are areas where we will challenge, but we must be careful that that does not tip over into unwarranted criticism.

In relation to partnerships that need to be created—I noticed the emphasis placed by the hon. Member for Birmingham, Edgbaston on public systems—medicine and health cannot work without a partnership between the private, the public and philanthropy. With the sheer scale of what is available, and the ability of the private sector to make a contribution, the skill is to use that effectively to ensure that the poorest, and those in the most difficult locations and with neglected conditions, are still brought in. That is where political skills can be exercised. We have a role to play.

The gist of the debate was about focusing on what is meant by universal health coverage and about looking ahead to the meeting in September. If there is any part of my former role that I miss, it is UNGA week. I did 60 engagements in four days; that was my best. I sincerely hope that the Minister will be well used and well worked. It is an opportunity for him to see all the people involved and to make the contributions he needs to, and for the UK to lead by example. Because he represents DFID, he will find, as I did, that he is received everywhere he goes—he will be standing on the shoulders of all those who work for DFID—in a way that would warm anyone’s heart.

This is about a partnership, with people in the UK working hard for something that DFID and Ministers deliver at top level. As we head towards the high-level meeting, I know the Minister will be determined to ensure that the global leadership continues, and that the example is set. We will all do our best to contribute to the good things, to mount challenges when that is needed, and to give praise when it is deserved. We need to stay in the forefront in relation to what the world needs. We know that the problems are not going away, and that the challenge, and the need for determination, will continue for some time.

Question put and agreed to.

Resolved,

That this House
has considered universal health coverage.