Wednesday, 4 November 2009.
My Lords, it has been agreed that should any of the Questions for Short Debate not run for their allotted hour this afternoon, the Committee will adjourn during pleasure until the end of the allotted hour. Therefore, each of the Questions for Short Debate will start at 45 minutes past the hour. If there is a Division in the Chamber, the Committee will adjourn for 10 minutes and the next debate will start 10 minutes later; so each debate will get injury time.
Question for Short Debate
To ask Her Majesty’s Government what measures they are taking to encourage the Government of Sudan to increase their efforts to resolve the disputed census and referendum law and to develop plans for the 2010 elections, in the light of violence and rearming in the south of the country
My Lords, first, I crave the indulgence of your Lordships, for I have very little voice. I hope that by the electronic wizardry before us noble Lords will be able to hear what I have to say on this important matter.
The comprehensive peace agreement signed in 2005 between the north and south put an end to the civil war that had left nearly 2 million dead since 1983. It gave the Sudanese nation an opportunity for what was referred to as “attractive unity”. The CPA laid out an interim period between 9 July 2005 and 8 July 2011 during which all citizens of the Sudan, both northerners and southerners, were to be afforded equal rights politically, legally, economically and religiously.
In the comprehensive peace agreement, there are six protocols: a protocol setting out a transition process; a security arrangement agreement; a wealth sharing agreement; a power sharing agreement; a resolution process for the conflict in southern Kordofan and Blue Nile states, and a resolution process for the conflict in Abyei area.
If the CPA had been fully implemented from the outset, a peaceful, attractive unity might have had a chance in Sudan. But what has happened is that not one protocol has been fully implemented; and some are under discussion for less than full implementation. This stalling in the process means that unity between north and south is no longer an attractive goal—even if it were believed to be possible—especially to southern Sudanese.
Crucial to the implementation of the CPA is the national census. On its basis constituencies will be decided, the internal border drawn, and any referendum about secession taken. Yet this census was conducted a year late in 2008 and the results, released in June this year, were rejected outright by the Government of Southern Sudan, all the state governors and the Sudan People's Liberation Movement, following its claims that south Sudanese make up only 21 per cent of the population. SPLM officials have said that they estimate Southern Sudan to account for a third of Sudan's population and that they will not accept figures less than that. The 92 per cent increase in south Darfur's population is also considered fraudulent.
The national general elections, which were to give Sudan a chance to see what a democratic and united Sudan could look like, were to have been conducted by the end of 2008. These have now been postponed twice and are due to be held in April 2010. If the elections fail to occur in a manner acceptable to all parties, the possibility of a peaceful referendum process becomes even more unlikely.
The referendum Bill, which will govern the process whereby southern Sudanese are to exercise their right of self-determination under the CPA, was supposed to be enacted by 9 July last year, along with those to govern the popular consultations in the Nuba mountains and southern Blue Nile, as well as the Abyei area referendum. But these Bills have not been promulgated to date and indeed agreement has still not been reached over the major referendum, with the south now rejecting the two-thirds quorum agreed with the north by its own negotiator on the grounds that that is too high a percentage to expect for such an underdeveloped region. If no deal is reached before the parliament closes its current and last session before Christmas, there will be no legal basis for the referendum until after the elections next year, when a differently constituted parliament in Khartoum may come to a different decision.
A further source of deterioration of trust between the north and south is that the northern Government have not been transparent with the national oil revenue figures, of which a vast amount has gone to the northern Sudan.
Consequently, there is a widespread lack of confidence, signalled by the SPLM parliamentary bloc walking out of parliament for an indefinite period. It is now evident, according to a statement last month by the leaders of all the churches in Sudan, that the vast majority of the southern Sudanese people no longer trust any talk of confederation or attractive unity and want an independent Southern Sudan. The six years given to prepare for the referendum have now been whittled down to just 14 months. The time to make unity attractive is fast running out.
Meanwhile there are significant crises in Southern Sudan: a surge of ethnic clashes in the south have killed more than 1,200 people this year, many of them women and children. According to the UN, the rate of violent deaths in the south now surpasses that in Darfur. Recently, the UN deputy resident co-ordinator in Southern Sudan said that more than 2,000 people had died and 250,000 had been displaced by inter-ethnic violence across the region this year alone. Much of the recent violence has taken place in Jonglei, Unity and Lakes states, which are on what the south sees as its border with the north, if voters were to choose independence in 2011. The Archdeacon of Wernyol was shot dead during a church service and Archbishop Daniel visited a village an hour out of Bor on Good Friday this year to pray where 40 people had been shot on Palm Sunday, five days previously.
The Church leaders of all denominations believe that these are not isolated incidents, but a co-ordinated campaign to destabilise the south in the run-up to the elections and the referendum. Nor has the UN peacekeeping force been effective: during the violence in Ezo, there were calls for UNMIS troops to be sent. The response was to send a planeload of Bangladeshi troops from Juba to Yambio, a day's journey from Ezo, and back again the same day, according to the UNHAS-WFP manifest.
In the first half of this year in Ezo, Western Equatorial State, the Lord's Resistance Army (LRA) attacked the town and the county commissioner's headquarters, killing tens and displacing thousands. None the less, John, the Bishop of Ezo, has pushed ahead with his school-building programme, gaining with the DfID funders a significant reputation for the Episcopal Church in Sudan, as almost the only body that sticks with people when other NGOs have pulled back to Yambio.
On 20 September, Duk Padiet village in Twich was attacked and at least 167 people were killed, and many more wounded. In Bentiu, fighting has recently broken out between rival factions of the Sudan People's Liberation Army, and between rival factions of the Joint Integrated Unit in Malakal. UNMIS, the Government of Southern Sudan and the SPLA are seemingly unable to protect their own population from attacks by other southern Sudanese. Indeed the SPLA has recently attacked UN peacekeepers.
The escalation of this destabilising violence, specifically targeting civilians and the Government, will make registration and voting in the elections and referendum very difficult if not impossible. There are also grave UN-African Union concerns at the build-up of rebel and government forces in north Darfur, which might signal a new cycle of fighting in that area also.
Military forces in north and south Sudan are engaged in an arms race that risks plunging the nation back into civil war. Church leaders and the Geneva-based Small Arms Survey report significant rearming of northern and southern troops and militias. The report said that China and Iran continued to be the main source of weapons, adding that the SPLA had been stockpiling light and heavy weapons, mostly from Ukraine, for the past two years, including Soviet-era T-72 tanks and BM-21 multiple rocket launch systems.
The situation in Sudan is very grave, yet there is no alternative on the table to the comprehensive peace agreement. In this brief debate, I call for further efforts by Her Majesty’s Government as a guarantor of the CPA to avert an unimaginable disaster among our friends and neighbours.
My Lords, I thank the right reverend Prelate for bringing this important issue before the Committee. It was a remarkable achievement when, with the assistance of the international community and IGAD, the comprehensive peace agreement was signed between the warring parties with time given to allow a certain amount of healing and reconciliation to take place. As the right reverend Prelate has mentioned, very little of this has progressed. It is essential at this stage that a clear picture is maintained of how vital issues need to be resolved. The first remaining deadline occurs in five months when the postponed nationwide elections are due to take place. At this point, the Governments of both parts of Sudan should be seeking a new mandate.
Noble Lords will be aware that the governing National Congress Party in the north is in serious constitutional dispute with the opposition parties, such as the Umma, who have withdrawn, perhaps temporarily, from the national parliament. We must hope that these issues in the north can be resolved as the election approaches, as well as all the others. Even more comes one’s way in the news emanating from the south, of which the right reverend Prelate has given a fairly extensive example. I have heard it said that the northern Government, through their intelligence arm, are sending weapons to opposing tribal leaders in the south. Then again, the military commanders in the south are supposedly illegally passing weapons to their relatives who are in conflict with rival clans of their own tribe. I have been told about the Dinka people of Warab state. It gives the appearance of a lack of leadership. Will the Minister tell us the Government's evaluation of whether those responsible in Southern Sudan have the resolve or resources to establish a better level of law and order, and what could be done to encourage or assist them in this?
The CPA brought to an end 22 years of civil and inter-regional war. It is always easier to play on people's fears and promote hostility than it is to create unity. Here in Europe, 50 years after a five-year war, today's headlines tell us that we are still hesitant to say that we can or should adopt all the philosophies of our European neighbours. How much more difficult it is when quantities of people in an area are unaccountable and armed to the teeth.
For those watching the faltering way in which the CPA is progressing there was great encouragement to see that one issue of agreement had been reached between the two vice-presidents representing the different ethnic interests. As the right reverend Prelate has just informed us, this has been rejected. The proposal of a simple majority of two-thirds would have given some reassurance that the referendum would be acceptable. Can the Government tell the House what steps are still required to complete the framework for the referendum which has, as the right reverend Prelate has mentioned, not been agreed?
As the question of actual numbers voting rises up the agenda, could we get some idea of how the registration of voters is progressing? Further, when the referendum comes, how will the wishes of southerners living in the north of Sudan be assessed? Without a certifiable process, there could be an unfortunate polarisation between ethnic elements, and even a mass return of those in the north who wish to emphasise their new allegiance to the south, which will serve only to drive the different elements further apart. Whichever way the 2011 referendum goes—presuming that it takes place—Arabs and Africans will have to learn to co-operate just as much as the Russians, Poles, Germans, French, British and other European nations still need to do to work out a common destiny. What other steps are the Government prepared to take as guarantors of the CPA?
My Lords, may I say how much I appreciate the opportunity to take part—with my noble friend Lady Tonge, who is far better versed in the affairs of Sudan than I am—in this debate this afternoon?
The coming elections in Sudan have been very uncertain because of the census return and so on over the past two years. Some 20 political parties are threatening a new boycott of next year’s elections. The elections were supposed to be a milestone in the democratic transformation of Sudan, but the considerable challenges that it faces could very well destabilise the country and further undermine an already shaky peace deal between the north and the south.
The London-based African Centre for Justice and Peace Studies said that there had been an,
“increasing crackdown on freedom of expression in Sudan, targeting public discussion of, and preparation for, the elections. Since the beginning of August, Sudanese authorities have systematically targeted any activities, symposia, public rallies or lectures related to the elections”.
The 20 discontented parties are demanding changes to laws on civil liberties, press freedom, democracy and transparency. The prime problem is the unfairness of the distribution of the oil revenue. Some 95 per cent of the oil revenue comes from the south, while 65 per cent comes from the Khartoum area. Some 50 per cent is supposed to go to the south; yet today’s news is that Southern Sudan’s semi-autonomous Government have received nearly £4.2 billion in oil revenue since they took over after the 2005 peace deal. The question is whether they are doing enough with the revenue for the people there.
A report issued this morning tells us that in a village half-way up a steep mountain slope in Southern Sudan, a woman is grinding up leaves plucked from a tree. The drab green powder added to some water will have to do for her lunch. She says, “Every day we eat these leaves”—they are convinced that this very unhealthy diet might at least serve for the present. We have known of this dreadful situation in Darfur and elsewhere in Sudan for many years, and the present distribution of income is doing nothing at all to alleviate it. The corruption in Khartoum—indeed, the whole situation—is very uncertain indeed.
Signatories to the Juba declaration include the Sudan People’s Liberation Army/Movement, which governs semi-autonomous Southern Sudan and has been a partner in the fragile national Government since 2005. The comprehensive peace agreement put an end to 20 years of the north-south war. In the Juba declaration, the parties have said that they will stay away from presidential, parliamentary and local polls unless the row over the results of the census, which affects electoral constituencies, is resolved. The President says:
“I believe that the general elections, if properly conducted, shall be a critical impetus for change and empowerment of our people to choose their political leaders and elect their democratic institutions”.
But his concern is that the results of the population census are,
“too flawed and lack the minimum acceptable level of credibility”.
“Without the resolution of this issue … the election process, despite our preparedness for it, may be put in jeopardy”.
Most of the people facing a poll have never voted in their lives. It is a very complex poll and it is in jeopardy because of the flaky census results. The stakes are very high. If the election should lack credibility, it is hard to see how the comprehensive peace agreement can survive.
My Lords, the right reverend Prelate has done a great service in raising the Sudan prior to the election and the referendum. My interest goes back a very long time, to 1947. I was the son of a British civil servant in the Sudan and I recall witnessing the 1953 elections which led to internal self-government in the Sudan. Those elections were very successful and were backed up by a good governance system in the Sudan in those days. I retain a picture of very decent people in both the north and south. But since then they have faced two prolonged civil wars, which have caused absolute devastation, enormous loss of life—2.5 million people—and the displacement of more than 4 million people. The Sudanese deserve better than that. Sudan is now on the verge of disintegration and faces interrelated issues, the north/south issue being the central one; the Darfur issue and other issues in the Blue Nile province and the Abyei area.
Our hope has to lie in the comprehensive peace agreement. There is no option, it seems to me. I look forward to hearing the Minister’s assessment of the prospects for making at least some progress in that area. There needs to be confidence in this process on the part of all the parties if this whole venture is to succeed. The right reverend Prelate and others have mentioned the conditions that need to be satisfied if this problem is to be resolved; for example, as regards boundary demarcation in areas such as Abyei, which will become like Kashmir in the future if that is not resolved and the questions of security, the militias, the training of the police and dealing with displaced people. There needs to be adequate governance and the rule of law. Previous speakers have referred to the sharing of wealth, particularly that derived from oil. The census question needs to be addressed, as do the electoral arrangements. At the moment, they are very complex and people have to vote several times, employing several voting methods, in both the north and the south. We need to put aside preconceived views because only one thing matters; namely, that the people of Sudan are confident that the arrangements are trustworthy and will be honoured. If that does not happen, the whole thing will disintegrate and there will be violence all over again.
It seems to me that we have to take a view of the two main parties—the National Congress Party in the north and the SPLM in the south. Both sides must feel that they have a self-interest in the success of the elections. If one party feels cornered, it will lash out, as we are seeing now in Zimbabwe. There is a lesson to be learnt from that. Therefore, to reassure people, there needs to be contingency planning for not only the electoral period and the referendum but for what happens after the referendum. That seems to be the key thing. People need to know that there will be a stable transition. Whether people vote for complete independence, a confederal arrangement, or whatever, they need to be assured that they can trust that arrangement and that adequate reconstruction plans in which many international Governments and multilateral bodies will participate are in place.
Britain’s role is limited compared with our position 50 years ago. Nevertheless, we have a position. We have an envoy to Sudan. We have a role as a guarantor of the 2005 agreement. We must work with our colleagues in Egypt, China and the United States as closely as possible to try to move this forward satisfactorily.
Sudan is at yet another crossroads. Failure would lead to disaster, disintegration and military conflict. Our interest is to do whatever we can, however limited our influence, to help the long-suffering people of Sudan.
My Lords, I add my thanks to my noble colleague for introducing the debate. His diocese and the diocese of Bradford have shared links with the Episcopal Church of Sudan over many years, and we have many friends in that vast and troubled country.
I was privileged to be in Juba 18 months ago for the enthronement of Daniel Deng as the Archbishop of the Episcopal Church. It seemed to me that it was a case of “cometh the hour, cometh the man”. At his enthronement, the archbishop committed the Church to work for peace both in the north and south. Other denominations share that commitment. The archbishop is living by his word. He has been criss-crossing the country since his enthronement, witnessing at first hand the suffering that the people are experiencing, especially in the south. At Easter he visited the Nuer area of Ayod. He was one of a group of Dinkas. He spoke of love and peace between the tribes and discovered, after he had returned to Juba, that the trouble between the two tribes—the cattle rustling and the violence—had stopped.
Across Sudan, the Church is determined to work for peace. The archbishop said:
“The church is one of the most effective ground-level players in the peace process, and is proof that our message of love and reconciliation is one that is most effective in the peace building among the tribes of southern Sudan”.
The Church is present in nearly every small village in Southern Sudan. Its presence is unmatched by either the military or government. The Church does not run away when the NGOs run away. My noble colleague has already referred to the Lord’s Resistance Army attacking over the border. Whereas all the NGOs fled, the Church has remained there, doing its work in schools.
There is a concerted effort to undermine the peace agreement. People in Sudan need to believe that peace is in the best interests of all of them, whatever part of Sudan they come from. I worry that sometimes we might imagine that there could be a neat tear across Sudan from Darfur to the Red Sea. It would not be a neat tear at all. Some of our links are with the diocese of Kadugli in the Nuba mountains. That is right on the boundary—the area is technically in the north, but its heart is in the south. During most of the country’s life, Muslims and Christians have got on happily side by side. That is not the case now. Many people from the region, along with others, have fled to Khartoum. There are something like 3 million internally displaced people, many of them from the south. Some of them are now fairly well established, but others are living in desperate poverty.
It is a hopeless situation. I visited Jabarona. The people there had been forcibly moved from the desert on one side of Khartoum to the desert on the other. They named their new settlement “Jabarona”, which means, “We were forced”. That illustrates how so many people in Sudan feel at the moment—forced hither and thither, with no say over their destiny. Our Government, as has been said, are one of the guarantors of the peace agreement.
I believe for myself that the elections should not take place until after the referendum, but it seems that no one can dare say that because they would be accused of undermining democracy and it was used as an argument by their opponents. But it is necessary to have the referendum and then to work beyond it, whether in one state or two states.
On behalf of the Church in Sudan and its friends in this country, I offer the Government our wholehearted support in working for peace, whether it be the Church on the ground over there or the Church here represented by the two right reverend Prelates.
My Lords, I thank the right reverend Prelate the Bishop of Salisbury for securing this debate. The political situation in Sudan is a major cause for concern both to its citizens and those in the African diaspora. There is an obvious and persistent threat that the unrest in Sudan will permeate its borders.
The political and social unrest in Sudan is far more complex than simply a case of the predominantly Muslim north locking heads with the Christian majority in the south. Peace in Sudan has been challenged by disputes over mineral resources and tensions among ethnic groups coupled with the conflict in Darfur and cross-border violence from rebel militias. Under the terms of the comprehensive peace agreement, the south of Sudan is eligible for a secession referendum. I strongly welcome the decision of the National Congress Party to abandon the disputed results of the 2008 census. I am also pleased that the party has decided against its initial proposal of 90 per cent to 66 per cent respectively for the elections. The decision made by the Sudanese People’s Liberation Movement to end the stalemate with the National Congress Party and recognise the referendum law by agreeing to a 50 per cent plus 1 per cent majority is encouraging. These developments reveal a willingness in both parties to adhere to the spirit of the comprehensive peace agreement. Measures must now be put in place by the international community to ensure that the coming elections are fair and free of violence and intimidation as their outcome will be historic for both sides and may set a precedent for other disputed regions in the world.
Reports have estimated that there are up to 4.5 million displaced refugees as a result of the north-south feud. Eastern Sudan is also experiencing a surge in refugees from Somalia and Eritrea due to their respective political challenges. Approximately 2,000 people have been killed in Southern Sudan this year, a startling figure as the death toll now surpasses that in Darfur. Greater dialogue is needed between the African Union and the United Nations peacekeeping forces under the terms of the Darfur peace agreement to address the reported lack of resources that has affected progress in the region. A stronger commitment to achieving a ceasefire in the Darfuri states must coincide with a regime change that should result in making the perpetrators of heinous crimes committed in the region accountable for their actions.
The British Government were an active member of the peace negotiations and the Darfur peace accords, and therefore have an obligation to work towards a favourable outcome for all Sudanese citizens. The international community has a responsibility to strive towards achieving peace and stability in Sudan through building a multinational coalition that produces tangible results. The potential for the precarious situation in Sudan to escalate and jeopardise stability in other parts of the region and in Africa as a whole must not be underestimated. We should recognise the recent progress made in Sudan, but we must also acknowledge and reiterate our commitment to achieving peace in the region.
Sitting suspended for a Division in the House.
My Lords, I, too, congratulate the right reverend Prelate on this timely debate and on his comprehensive introduction. I will focus briefly on five concerns.
First, in Southern Sudan and the Nuba mountains earlier this year, we found widespread fear that the Government in the north would try to undermine the peace agreement, as they do not wish the south to gain independence. There was deep suspicion that the north was arming surrogate militias to destabilise the south, to create terror and to undermine confidence in the Government of Southern Sudan—for example, supporting the infamous Lord’s Resistance Army’s activities in Sudan. It was a not unreasonable fear, as Khartoum had allowed the LRA to run its horrific training camps for thousands of Ugandan child soldiers in Khartoum-administered territory for many years. Will Her Majesty’s Government urge the Assessment and Evaluation Commission to ensure that no arms are being supplied to any militias from any source?
Secondly, there is a dire humanitarian situation in many parts of Southern Sudan, Southern Blue Nile, the Nuba mountains and the Beja lands. Darfur has inevitably been a priority for many major aid organisations, leaving immense areas of unmet need elsewhere. I give just two shocking statistics: in Southern Sudan, only 19 per cent of the population receive immunisation, leaving the majority of children vulnerable to diseases such as TB, tetanus and polio; and one in eight mothers will die in childbirth. Does DfID’s funding policy adequately address these critical situations, including consideration of the appropriateness of the shift from relief to development priorities?
Thirdly, many leaders in the south feel under pressure from the international community not to secede, but many feel that they have suffered too long from being part of a united Sudan and their only hope for freedom and justice lies in independence. The Roman Catholic Archbishop in Juba told us earlier this year that it would be helpful if the international community understood the fundamental differences in motives between the north and the south: the north wishes to maintain unity for reasons of wealth- and power-sharing, while motives influencing the peoples of the south are passion for religious freedom and the preservation of their African identity. Remember that the war which broke out in the early 1980s, resulting in 2 million dead and 4 million displaced, was in response to an attempt by the north to impose Sharia law in Bor; and that African southerners—Muslims, Christians and traditional believers—have long felt victims of perceived Arab domination, racism, slavery and attempts to destroy African culture.
Fourthly, there was the abduction into slavery of tens of thousands of Africans, especially from Bahr-el-Ghazal and the Nuba mountains, during the last war. I met many who had escaped and whom we had helped to freedom, and we heard their heartbreaking stories. Many thousands are still in captivity. Two days ago, an Anglican priest told us that members of his own family are still enslaved, but it is too dangerous to try to rescue them. Will Her Majesty's Government put great pressure on the Government in Khartoum to ensure that all remaining abductees are identified and returned to their homes as a matter of urgency?
Finally, given the recent unfortunate cancellation of a visit by the President of Southern Sudan, will Her Majesty’s Government undertake to reinstate a visit as soon as possible?
The comprehensive peace agreement is the only hope on the horizon for peace and alleviation of suffering for the people of Sudan who have suffered too much, too long. But it is fragile and inevitably some do not wish it to proceed. The Sudanese look to the United Kingdom as a special friend, but also as the nation which has a historic responsibility to help them in these critical times. I trust that history will show that we fulfil that responsibility honourably.
My Lords, I, too, thank the right reverend Prelate for expressing not only his concerns but those of the whole diocese of Salisbury. It is tragic to read of the latest fighting between Dinka and Nua and Shilluk in Southern Sudan. Over 30 years ago, I was the guest of the Sudan Council of Churches in that region. We must remember that it was the churches and not diplomats who laid the foundations of the peace agreements of Addis and Naivasha.
The right reverend Prelate referred to the recent statement from seven church leaders condemning the failure of the north and of our international guarantors to make progress with the CPA. In their words:
“There is a widespread lack of confidence by Southerners ... in the fairness or true democracy of the upcoming elections and referendum because of a general lack of trustworthiness and transparency from the Northern government ... If the CPA is to be made to work, it must be fully implemented by both signatories and fully supported by those guarantor governments who promised to do so in 2005.
The Southern Sudanese people will now no longer accept any renegotiation of the CPA. If such a thing happens … the Southern Sudanese people will feel betrayed by the rest of the world as in 1956 and 1972”.
That is the southern perspective, and politicians from Khartoum must recognise that unity is drifting away from them. The stakes are high. The National Democratic Institute in Washington estimates that 90 per cent of southerners would vote for independence in a referendum. We should welcome the new US initiative, led by the special envoy. The State Department argues that it is now time to act with a sense of urgency.
I am sure that the Minister will explain what is delaying the agreement and how the US can assist the guarantors at this critical time. The most urgent area may be the JIUs, which are looking flaky at certain points, although they must provide security in some key areas, such as Malakal. That is a vital part of the CPA. Pre-election assessment is too slow. More work must go into the detailed legal framework, as others have said, to provide for credible elections—including voter education and monitoring—and to prepare for the referendum.
Despite outbreaks of violence, October seems to have been a month of reconciliation. For example, more than 7,000 ex-combatants were disarmed in southern Kordofan. Opposition parties from north and south have met in Juba. In Abyei, the Dinka, Ngok and Misseriya seem to have sunk their differences, following the Permanent Court of Arbitration’s decision. Here, again, the US has had some impact, but I am sorry to hear that development funds are being held up for lack of United Nations and NGO support on the ground.
Many humanitarian problems persist, and parts of the south face severe food insecurity. I hope that we shall continue to be the largest European humanitarian donor and continue our assistance through non-governmental organisations, where they are allowed to operate. The work of churches and NGOs has been impressive when we consider the lack of infrastructure and the conditions in which they have to work.
Finally, I declare my interest as the treasurer of the All-Party Group on Sudan. I am pleased to say that we will publish a report early in the new year and have requested evidence from the Government and many other organisations. I trust that that will help to provide greater awareness of the urgent situation in Sudan.
My Lords, I congratulate the right reverend Prelate on securing this debate on the hugely important topic of the biggest country in Africa. Perhaps it should not be one country, but it is. He pointed out clearly the problems with the elections and, in particular, the census, which has gone so badly and about which there are so many quarrels. That leads me to reflect often concerning Sudan and, indeed, Afghanistan, whether we are right to push our form of democracy on to people that we know little about. Sometimes, we should reflect on that.
My noble friend mentioned the problem of oil revenues, as did many noble Lords. It is interesting to reflect that Global Witness recently produced a report that stated that Khartoum’s official figures on the volume of oil produced do not match official Chinese National Petroleum Corporation figures. Specifically, the volumes reported by Khartoum are smaller than those reported by the Chinese by up to 26 per cent. The one productive oil block located entirely in the north—and therefore not subject to revenue sharing—was the only block where the volumes tallied. That is an interesting snippet.
Sadly, as my noble friend pointed out, in the south, the SPLM Government are not declaring how much they are getting from oil revenues either, although people have made estimates. In my view, as a former shadow international development Minister in the other place, this is key. There is no evidence that much development has taken place in Southern Sudan since the comprehensive peace agreement.
Nine years ago I was in Bahr-el-Ghazal just when the famine was easing during the civil war. The only thing those people had were cartridge cases which were melted down and made into jewellery. I see that the noble Baroness is nodding in agreement. That was all that was left for those people. They had no food, no nothing, but they did have plenty of cartridge cases. Indeed, this necklace was given to me to remember Southern Sudan and not to take it off until there was peace. I have not taken it off yet, and I wonder how many more years I will be wearing it.
Development is key to Sudan. People will be happier, they will not rebel or join rebel groups if they have healthcare and education as well as the basic amenities for living. But we see little of that, despite the oil revenues and the amount of aid being pumped into the country. In those days, the Janjaweed were known as the Murahaleen. They are willing recruits to join in the pillage, burn and rape of the population of Southern Sudan and in Darfur because they have nothing either. Their lands are gone due to climate change. It is getting drier and they have to move south to access more resources for their cattle. I repeat: development is the key here, but even if the oil revenues were used properly and development were to take place, we doubt whether there would be the capacity in Southern Sudan to govern, a point made by the noble Duke, the Duke of Montrose. What plans do the Government have to increase that capacity so as to ensure that the administration will be a proper one after the election?
I reiterate, as a vice-chairman of the All-Party Parliamentary Group on Sudan, that we are holding a series of hearings to look at the implementation of the CPA and its implications in the run-up to the elections. I hope that many noble Lords will join in and give evidence to those hearings.
Like other noble Lords who have spoken I, too, deplore the recent bursts of violence that have brought Sudan back into the news. It is a grim reminder that the underlying problems in that country have never been fully resolved, and that sadly, nor is the trouble confined to Darfur. The bubbling tensions between south Sudan and the Government in the north have a history of decades ridden with strife as their backdrop, and I fear that as the country gears up towards the elections in 2010 followed by the referendum on the possible secession of the south the following year, we may hear yet more unfortunate news from that part of the world. The Question posed by the right reverend Prelate the Bishop of Salisbury is timely and I thank him for asking it today.
The demarcation of the border is likely to continue to be a fraught, difficult exercise and it should not be left until it is too late to have any chance of success. Like other noble Lords, I question how satisfactorily the internal border can be demarcated without the full participation of the Sudanese themselves. One of the biggest stumbling blocks to demarcating the border is continuing disputes, as we have heard, over the rights to the oil reserves. What assessment has the noble Lord made of the recent Global Witness report which argues that the existing rules on the sharing of oil reserves by Khartoum with the south are not being followed?
We on this side believe that however imperfect the comprehensive peace agreement of 2005, it remains the best way forward for Sudan, and I support the noble Lord, Lord Luce, in what he said about that. Implementing it will involve much hard work and frustration, and we believe that while the situation remains so fragile, the insecurity of the south Sudanese is harming the development of the area. Despite the boost in oil revenues, the infrastructure there is pitiful and, as we have heard, food shortages are exacerbating the plight of the people—this in a country with great agricultural potential.
The United States has refocused its policy towards Sudan to prod the Khartoum Government to make progress on preparing for the elections, for the referendum and for finalising the boundary. There are rewards on offer if the Sudanese Government engage. However, the US has renewed sanctions in order to show that it is serious when it insists that progress must be made. Will the Minister say whether this policy is in accordance with that of Her Majesty’s Government; and has the FCO been working with its US counterparts on the issue?
Given the increasing economic input of China into the region, what have the Government been doing to co-ordinate their approach with those of other members of the Security Council and of our European Union partners? Noble Lords will be aware that the presence of the Lord’s Resistance Army in the south has caused considerable disturbance in recent years, and that in the past two weeks it has reportedly attacked Darfur’s citizens for the first time. Will the Minister update the Committee on the presence of the LRA, which threatens to destabilise this already volatile country?
We are the second largest bilateral donor to Sudan. What progress can the Minister report on government efforts to seek an agreement with all parties on wealth sharing and citizenship rights ahead of the referendum? With recent developments in a region where, as the noble Baroness, Lady Cox, said, we have a historic responsibility as a special friend, it is crucial that the Government make it clear what their policy is.
My Lords, I thank all noble Lords who have taken part in this constructive and stimulating debate on a country with great problems. In particular I am grateful to the right reverend Prelate the Bishop of Salisbury for prompting the discussion. The right reverend Prelate has identified some of the core issues and considerable difficulties that we face in Sudan. Noble Lords analysed all the problems that we recognise and for which we have great difficulty seeing immediate solutions. I also have great difficulty believing that in the eight minutes that remain I will be able to answer all the questions. We are due to finish at 4.55 pm and I did not rise to my feet until a minute ago. However, I will write to all noble Lords.
I agree with the comment made by the noble Lord, Lord Luce, and others, that the comprehensive peace agreement remains the foundation for the future peace and stability that one needs to ensure that any development can take place. As the right reverend Prelate also said in his introductory remarks, we are approaching the end of the interim period in 2011 and face a series of problems that have been identified by noble Lords concerning issues such as the referendum. There is a deep urgency to resolve the impasse that exists between both main parties over the census and election arrangements—we are within six months of the election and 15 months of the referendum.
High-level discussions on these issues are under way between Vice-President Ali Osman Taha and the Vice-President of South Sudan, Riek Machar. The discussions seek to bridge the disagreement over the census results and reach agreement on the election arrangements, which depend on the census for constituency demarcation. Both parties are also debating the content of the referendum Bill in order that it should meet its parliamentary timetable and we can move forward.
We welcome indications in recent weeks that the parties are moving closer to agreement on these issues, and we are supporting efforts to encourage this. My ministerial colleague Gareth Thomas visited Khartoum and Juba on 14-15 October for this purpose and met senior members of the NCP and SPLM. Our ministerial team in DfID and the FCO is closely engaged on the issue, and I welcome the extensive experience of development issues that my noble friend Lady Kinnock is able to bring to Sudan in her new role as Minister for Africa.
We share noble Lords’ concerns about the slow progress of preparations for the elections. There are significant political and technical challenges to be overcome. We are closely engaged to ensure that these issues are addressed by the National Elections Commission. We are also working with partners in Khartoum on a robust mechanism to assess progress towards free and fair elections. We have committed £11 million in support of the elections so far, which is focused on the technical preparation, voter education and conflict management. We also are pressing the European Commission to deploy an EU election observation mission.
Across all the areas that I have mentioned, Her Majesty’s Government are actively engaged with the Government of National Unity and other partners in seeking progress. We are working particularly closely with the United States and its special envoy General Gration, and with Norway, as part of the troika. We are also in close contact with the Assessment and Evaluation Commission, chaired by Sir Derek Plumbly. Finally, we are pressing both parties to address outstanding Abyei milestones, to complete the north-south border demarcation and to give serious consideration to oil revenues and the sharing of them, to which a number of noble Lords referred.
On the insecurity and violence in Southern Sudan, we are deeply concerned by the ongoing tribal fighting and by attacks by the Lord’s Resistance Army. The violence is having a terrible impact on the ordinary lives of the Sudanese, as has been said, which risks undermining the implementation of the CPA. The UK is providing significant support to Southern Sudan to help to address this insecurity, to provide emergency relief and to support broader development issues. I will return to the latter when I deal with noble Lords’ questions. A significant focus of our assistance is on helping strengthen the capacity of the Government of Southern Sudan—GoSS—to address the challenges. We are also supporting community-led conflict resolution and arms-control programmes.
At a political level, we have raised the issue of insecurity at very senior levels with GoSS, including with President Salva Kiir. GoSS also have a critical role to play in seeking proactively to prevent the violence and to address root causes by promoting dialogue and reconciliation with the affected communities. The UN mission in Sudan—UNMIS—also has a key role to play in supporting GoSS.
I also highlight the UK’s leading contribution to demobilisation, disarmament and reintegration—DDR—in Sudan. DDR is a key component of the security arrangements of the CPA and critical in the support of stability and recovery across Sudan. The DDR programme was launched in February. So far, it has demobilised more than 12,000 ex-combatants, and we have committed some £20 million between 2009 and 2011 to that cause.
Finally, I draw attention to the value of involving senior figures in the faith communities, which have been highlighted, in addressing the current insecurity. The head of the British embassy office in Juba recently met local Anglican and Catholic archbishops to discuss the insecurity. On this note, I should say how much we welcome our regular dialogue with the diocese of Salisbury, which has strong links to the Episcopal Church of Sudan, as well as to other church groups and many other actively engaged NGOs. I echo the point that in many cases faith groups have the closest contact, see the hardship, and seek to alleviate it on the ground.
I hope that I have been able to outline some of the challenges that we face. Your Lordships have certainly done a tremendous job in filling in the detail, particularly of the elections, the referendum, security in the south, and what we need to do to address these questions. I will try to deal with some of the points that were made in the debate.
The noble Duke, the Duke of Montrose, asked about our assessment of the insecurity in Southern Sudan. Other noble Lords made the point that more people have died this year in Southern Sudan as a result of tribal fighting in Darfur, and the LRA has forced more than 300,000 people from their homes—more than double the number in 2008. We are urging the Government of Southern Sudan and UNMIS to respond proactively, and are supporting a range of programmes to strengthen law enforcement and community-led security work to promote reconciliation.
The noble Lord, Lord Roberts of Llandudno, talked about the Juba compact, which was signed this June and which we welcome. It is an important response to the crisis in Southern Sudan and is now the key to ensuring robust implementation. Donors are taking forward their commitments under the compact, and we are urging GoSS to do the same.
A number of noble Lords referred to arms transfers from the Government of Sudan to groups in the south. We have no hard evidence of this being the case, but there are anecdotal reports of it happening. Until we have evidence suggesting that this is actually happening, we have to continue to press both parts of the divided community in that regard.
Registration for voting started this week. Our embassy in Khartoum and the mission in Juba are monitoring the registration of voters and we have urged the EU to deploy a mission, as I have said. As regards assistance to Southern Sudan for humanitarian purposes, £28 million is being provided for basic research services, helping some 300,000 children. The noble Earl, Lord Sandwich, raised the question of our co-operation with the United States review. We are co-operating with that review. It is important that we co-operate simultaneously in Darfur and with the implementation of the CPA.
I shall answer in writing other questions that were raised, particularly those asked by the noble Baroness at the end of the debate. We have had a stimulating debate. We need to keep this issue in the public arena. Long-term issues are involved. We have a commitment and responsibility to that part of the world. I believe that the Government are doing everything they can and, with the support of your Lordships, will continue to do everything they can, to bring peace and stability to that troubled country.
Health: Cerebral Palsy
Question for Short Debate
My Lords, I hope that this Question today, which refers specifically to cerebral palsy, will highlight the issues which are directly relevant to prevention of this condition. It is often said by Members in their opening remarks, “This debate is long overdue”, when introducing a topic close to their hearts. However, the paramount issues of health and prevention have been repeatedly raised since the Black report in 1980, the Winterton Select Committee on maternity services in 1990 and the Wanless report in 2002. It is therefore all the more astonishing that constructive action to reduce cerebral palsy's prevalence remains overdue.
Our duty to act has been intensified since the Little Foundation funded a European-wide programme revealing significant results, the outcome of which was that, despite popular perceptions, this condition is preventable. I should at this point declare an interest as president and trustee of the Little Foundation. Although it is widely believed that cerebral palsy results from obstetric complications, the research undertaken by the Little Foundation indicated that infection and poor maternal foetal nutrition before birth significantly increase the risk of damage to the brain's development. There are startling statistics for everyone to see; for example, cerebral palsy costs the National Health Service a staggering £4 billion per year, with 50 per cent of cases associated with low birth weight. This prevalence rises from one or two per 1,000 live births to more than 200 cases of cerebral palsy per 1,000 live births when birth weights are below 1.5 kilograms. The most severely affected may require 24-hour nursing care. Very low birth weights are not only associated with cerebral palsy but also with diffuse brain injury and disordered brain development leading to poor cognitive abilities and learning difficulties in general.
It is astonishing to think that so clear an association, which costs the already over-stretched NHS £4 billion per annum, has not dictated a clear and proactive policy in favour of preventing or reducing further instances of cerebral palsy. This condition varies in its severity with problems including motor disabilities, visual difficulties, hearing problems and trouble with writing, eating, talking and walking. Epilepsy, autism and behavioural pathology are only a few of the many difficult conditions associated with cerebral palsy.
Because of the lifelong impact of cerebral palsy, the financial and social costs are disproportionately high, which should provide a sharp and prompt action. Furthermore, just as we currently have campaigns to prevent obesity in children and to educate the public about the dangers of smoking, there is a clear moral obligation to take serious action in preventing cerebral palsy and allied brain disorders from further escalation.
However, when we look at how seriously we take the issue of prevention influencing good health in the United Kingdom, the results are disturbing. According to Sir David Cooksey's report to the Treasury on medical research in this country, only 2 per cent of the research budget was spent on prevention. One year later, Dr Jo Nurse of the mental health division at the Department of Health revealed that the cost of brain disorders has now overtaken all other burdens of ill health at £77 billion in 2007. This cost is now greater than the cost of heart disease and cancer combined. That clearly is a major priority for action on what we already know and for research on the means of prevention.
What is the problem and what exactly can provide a solution? The fundamental problem directly relevant to cerebral palsy and allied developmental disorders is quite clearly related to the prevalence of low birth weights in the UK. Britain now has the highest rate of low birth weights in western Europe, with a record close to that of Romania, and twice that of Finland and Samoa.
Contributing factors to this alarming prevalence include a lack of education across the board, including academics and professionals, on the value of nutrition and hygiene, which were removed from the school curriculum in the 1970s. Their value is not emphasised in medical schools, despite its vast importance. In short, leaders in government and industry, and even within the medical profession itself, are largely ignorant of the power of nutrition in accelerating and sustaining a cycle of good health.
I deliberately select the term “cycle” in this context, because the impact of nutrition is circular and multi-generational. Despite numerous reports and recommendations on this topic, we have failed to grasp the nexus of preventing low birth weights and their severe consequences; namely, we have neglected the health of the mother. The mother's health remains pivotal prior to conception, throughout pregnancy and lactation, towards the health of her child.
Further practical solutions to protecting and improving women's health during pregnancy might include incentives through the benefit system to ensure that a nutritious diet is maintained, with the appropriate types and amounts of nutrients. For example, in order to tackle this problem in France, women had to attend antenatal appointments to secure their maternity benefits. Exposure to the advantages of nutrition, channelled through the education system, as I have previously outlined, would provide a double incentive for women to be proactive in ensuring that they are maintaining an appropriate diet and hygiene during pregnancy.
In conclusion, I seek to emphasise how fundamental prevention is when aiming to address serious health concerns within the United Kingdom. I have outlined the impact of cerebral palsy on individuals and on the rest of society in terms of financial and human cost. But cerebral palsy is only the tip of the iceberg. It constitutes only one ripple in the rising tide of mental illness, as a result of the increasing problem of impaired brain development. I focus on cerebral palsy to demonstrate how this condition is one of many that we can and should work harder to prevent, due to its clear medical severity. Finally, to reiterate my earlier point, the cost of brain disorders to the National Health Service stood at £77 billion in 2007. I hope, therefore, that we are moved to enhance this debate in the very near future on a much wider and deeper level.
My Lords, in a seven minute slot, it is impossible to do justice to this subject, which is as important now as it ever was. It places a heavy burden on families, the health service and social services, as the noble Lord, Lord Hameed, has just pointed out. The incidence of cerebral palsy—from now on, I shall just use the initials CP to avoid getting tongue-tied and to save time—at just two per thousand births, has not changed very much in recent years, although the prevalence in the population may be increasing, because of better survival rates, especially among premature babies.
I shall mainly consider the topic of prematurity and possible ways of reducing it, as it is strongly related to the risk of developing CP. The figures are striking. For instance, in a recent Australian study of 6,399 babies with very low birth weight—that is, under 1,500 grammes—who were followed up for three years, it was found that the incidence of CP was 77 per thousand births, compared to 2.5 in the population as a whole, a rate 30 times as high. Other studies have had comparable findings.
One possible reason for that is that immature tissues are more likely to be damaged during delivery, with the resultant intracerebral haemorrhage, although that can also occur before delivery. There may be asphyxia—oxygen lack—due to immature lungs. The maintenance of adequate oxygenation is perhaps the most important part of intensive care for premature babies. Low birth weight is strongly associated with CP, but as only about one in eight deliveries result in a baby with low birth weight—that is at the higher 2,500 grammes cut-off point—they contribute only about one half of all cases of CP. The rest occur in children of normal birth weight. Some of those cases are presumably of genetic origin, but the cause of many of them is not fully understood.
In recent decades, there has been great improvement in antenatal and obstetric care, so that birth trauma and asphyxia are now not significant causes of CP. However, there are some possible causative factors that can occur during pregnancy or delivery, which may well be amenable to treatment or prevention. For example, a recent paper by Dr Martin Bax, describing a large European study on cerebral palsy—to give it its full name—showed, rather surprisingly, that infection, especially urinary infection, in pregnant mothers is significantly associated with cerebral palsy. Therefore, it is essential that antenatal care includes detection and treatment of maternal infections. However, one hypothesis is that the infection is not causal but is related to a common factor which reduces a pregnant mother’s resistance to infection and, at the same time, predisposes the foetus to neurological damage.
To return to the association of prematurity and low birth weight with cerebral palsy, there is a social class gradient in the incidence of low birth weight, as there is in almost all measures of ill health. Some of that is due to the class gradient in smoking and alcohol consumption, which both, independently, have an association with low birth weight, but the social class gradient persists even when those factors are taken into account. The incidence of CP is, however, independent of social class according to several studies. That is surprising to me, and I intend to look into that further. More research is needed to determine which aspects of social deprivation are most important and how they affect the foetus.
There is evidence from studies in the East End of London, for example, that inadequate maternal nutrition may play a role. Low birth weight is much more common in the developing world. The worst figures are in the Indian subcontinent where the calorie intake and nutrition of poor women is particularly poor. The basic structure of the brain and cardiovascular system—the heart, the arteries and the veins—is laid down early in the first trimester of pregnancy. The intrauterine environment, including the nutrient supply to the foetus, is very important at that stage. The brain increases in size and complexity most rapidly in the final trimester. A premature infant misses out on this important developmental stage and comes into the world in a vulnerable state. The infant is more likely to suffer damage during delivery and it is at this stage that intracerebral bleeding may occur, often leading to permanent damage if the child survives.
Nervous tissue and blood vessels require good supplies of nutrients to develop normally. The foetus is a very efficient parasite and will rob the mother to obtain what it needs. But if the mother is depleted in important nutrients, the foetus may not obtain enough to develop optimally. Maternal nutrition is thus of great importance in reducing the incidence of premature birth. Omega 3 essential fatty acids are in the public eye at the moment. They are important in foetal development since they form a large part of the structure of brain cell membranes and the lining of arteries. The diet commonly found in deprived communities is often lacking in these essential nutrients. Even when overt cerebral damage does not occur, there is some evidence that brain function may be affected if a mother’s diet is deficient.
Here, I declare an interest as chairman of the All-Party Food and Health Group. Last year, we published a report on an inquiry into the links between diet and mental health. It confirmed the importance of essential fatty acids in pregnancy, early childhood and, in some areas, in adult mental health, but recognised that Omega 3 is not a panacea. We recommended that the Government should fund further urgently needed research into the whole area of diet and brain function. The same should apply to prematurity and cerebral palsy. More basic research is urgently needed to guide measures to reduce the distress of parents and children, and the heavy cost to the health and social services that they cause.
My Lords, we are all used to speaking in debates when sometimes we might not know the subject well, but before we speak we try to understand the subject. Fortunately, on this occasion, for me, that is not the case. I have to declare an interest: I have been an obstetrician for nearly 39 years. I have particularly looked after women in premature labour and those whose problem was foetal growth retardation.
Cerebral palsy is a major issue. It causes a lot of heartache for those families of children who suffer from it. It covers a whole spectrum, from minimal motor and intellectual deficit to considerable severe intellectual and motor deficit. The cost to the families and the state is enormous, as has been mentioned. Anything that can be done to prevent or reduce the incidence of cerebral palsy would be nothing but beneficial.
There are lots of causes. Anything which tends to produce a low birth weight baby will increase the likelihood of cerebral palsy. That will include multiple births; for example, twins and triplets. Being the father of twins, you can imagine, with my interest in pre-term labour, how concerned I was at the time. Fortunately, they did not have any problems. It also includes a damaged placenta which may interfere with foetal growth; infections, particularly rubella; poor nutrition; exposure to toxic substances, including alcohol and nicotine; maternal diabetes, hyperthyroidism, hypertension and other maternal diseases; biochemical genetic disorders or disorders of metabolism; chance malformation of the developing brain; rhesus incompatibility; enduring intrapartum period; premature labour and delivery; and, in the neo-natal period, jaundice and intrapartum hypoxia. The incidence of cerebral palsy is two per 1,000 births, and 10 per cent of that figure is related to intrapartum hypoxia. As has already been mentioned, 50 to 60 per cent of children with cerebral palsy are born prematurely; the lower the gestational age, the higher the incidence of cerebral palsy.
What this tells us is that any strategy to prevent cerebral palsy has to address all these causes because no single treatment is likely to succeed. That is the case for any medical condition where there are multifactorial causes of the disease. Pre-term labour, for instance, is increasing in this country and is now reported in 8 to 9 per cent of all births. The number of babies being born between 20 and 28 weeks is increasing. Eighty per cent of these children will suffer some form of cerebral palsy compared with around 2 per cent of babies born at term between 37 and 40 weeks. Not just prematurity itself increases the risk, rather it is the way labour is managed and what facilities and trained staff are available for the care of very premature babies that influences the incidence of all complications for extremely pre-term babies, not only that of cerebral palsy. There is also a risk of infection if the membranes are ruptured prematurely. Such infection can cause abnormalities to the blood supply which results in an increase in the incidence of cerebral palsy.
I turn to birth asphyxia. We should set out in guidance for our hospital maternity units that any mother going into labour with a normally formed baby over 32 weeks’ gestation should not have a birth that results in asphyxia; it should be an event that never occurs. We have the facilities to diagnosis intrapartum hypoxia. While that will reduce or prevent only a small percentage of children being born with cerebral palsy, none the less it would make a significant contribution. These incidents do arise, unfortunately because the only way of diagnosing birth asphyxia is through the interpretation of foetal heart rate patterns. It is not an easy thing to do and requires a lot of training. The lawyers use this as if it is a case of cause and effect, and litigation mostly relates to children with cerebral palsy whose aetiology is not intrapartum hypoxia, but may be prenatal. However, these cases are based on the association between abnormal foetal heart rate tracings with the subsequent development of cerebral palsy. The issue is not as simple as that because we need to discuss acid-base balance; that is, acid levels in the baby’s blood at birth and so forth. However, I shall not go into that.
The question of nutrition is difficult. It is easy to cite nutritional factors, but in my view, in the developed world the nutrition even of people whose diet is not healthy is unlikely to be a major cause of large numbers of children being born with cerebral palsy. The figure is not zero and it may be avoided, but nutrition is not likely to make a major contribution because of multifactorial causes. Restriction in growth may occur due to dietary deficiencies, but some factors might cause both cerebral palsy and poor growth, with poor growth being the epiphenomenon, not the causal pathway. Is growth restriction irrespective of aetiology causally linked to cerebral palsy, and the more severe it is, the higher the risk of cerebral palsy? Does intrauterine growth restriction cause conditions such as hypoglycaemia in the baby, which then leads to poor brain development? We have to understand all these phenomena to be able to say that a particular diet or remedying a certain nutritional deficiency will lower the incidence of cerebral palsy. However, it is true that rectifying iodine deficiency, which is not a major cause of nutritional deficiency in this country but is in some other parts of the world, will significantly reduce the incidence of cerebral palsy.
My time is up, but noble Lords can tell that I could go on for quite some time.
My Lords, I thank the noble Lord, Lord Hameed, for initiating this debate about a condition which causes suffering in so many and for his very informative contribution. In the company of the noble Lords, Lord Rea, Lord Patel and Lord McColl, with all their medical expertise, I speak with some humility. From what we have heard, it is clear that cerebral palsy, in all its forms, is a major healthcare issue in the UK. As we have heard, it afflicts about two in every 1,000 babies. Assuming 600,000 births per year in Britain, that will mean about 1,500 new cases a year. Given a lifespan averaging 70 years, that means around 100,000 people with cerebral palsy in total. That makes it the most common motor disorder, one often accompanied by epilepsy, learning and behavioural difficulties and dystonia, each bringing additional problems in need of solutions.
I am told that it is not easy to predict which babies will develop cerebral palsy. As the noble Lord, Lord Rea, has said, we know that it is much more common in premature babies and that more babies are surviving evermore premature births because of medical advances. However, about half of all cases are not evident at birth and are detected only in the first year of life, often without a maternal or perinatal disorder being evident. Clearly, that makes the detection and prevention of these cases very difficult. We know that perhaps up to 10 per cent of cases follow a conspicuous episode of birth asphyxia. Another 10 per cent may have suffered a stroke in utero and a similar proportion might be due to genetic causes. We should note that in up to 20 per cent of cerebral palsy cases, no structural brain damage can be detected even with the best available imaging equipment. We have been told that the last trimester of pregnancy is a particularly vulnerable time for the foetal brain.
A dilemma for doctors must be that the damage found in the first year following normal term deliveries is often very similar to the brain damage in premature babies; namely, what appears to be a wasting away of the cabling linking neurons within the brain which is found in some 40 per cent of cases of cerebral palsy. Therefore, I suggest that research should try to find common factors at work. The priority might be to concentrate on that 40 per cent category, which shows the wasting away of cabling in the white brain matter linking neurons. I am told that that damage pattern is known as periventricular leucomalacia or PVL.
Many factors may contribute to this early brain damage known as PVL—some genetic and some environmental. The noble Lord, Lord Patel, gave us a very strong sense of the complexity of it all. Clearly, a major concern is maternal infection or inflammation of placental structures. However, it can be very difficult for doctors to identify those pregnancies at risk, except by watching very closely for clinical symptoms or previous complications in pregnancy. Indeed, it can be very difficult to find guiding patterns among the complexity.
Does the Minister agree with those consultants who believe that more comprehensive national registers and databases linking maternal and child health records are a necessary basis for future research strategies? At present, the collection of data on cerebral palsy is said to be ad hoc and patchy. Might there not be some kind of legal requirement to collect such data? Good data on foetal and neonatal brain damage and neurological dysfunction are seen by some specialists in this area as essential for progress, alongside appropriate epidemiological clinical and scientific input, to identify national strategies and interventions, including new imaging methods.
I declare an interest in the prevention of cerebral palsy as patron of the Dystonia Society. Dystonia is a general term used to describe a range of movement disorders that cause involuntary muscle spasm and contraction. A recent study indicates that dystonia is present in up to 20 per cent of all types of cerebral palsy. On the basis of my earlier calculation, that means 300 new cases of dystonia per year, and a UK total of about 20,000 cases related just to cerebral palsy.
Many young people with cerebral palsy and dystonia are treated in the excellent Evelina Children’s Hospital, just across the river from your Lordships’ House in St Thomas’s Hospital. I have leaned extensively tonight on the specialist knowledge of the Evelina’s consultant paediatric neurologist, Dr Jean-Pierre Lin. I hope that he will forgive any errors in translation. Dr Lin believes that dystonia in cerebral palsy cases is of particular concern as it can result in continuous muscular spasms and twisting that are both painful and disabling. The child with dystonic cerebral palsy can be helped by medication such as botulinum toxin injections to relax muscles and, as appropriate, intrathecal baclofen pumps injecting another muscle relaxant into the spinal canal. Specialists are also encouraged by the results of deep brain stimulation in specific circumstances, although the treatment is relatively recent. The specialists also believe that care for these children is best delivered through multidisciplinary teams within approved frameworks, working in close liaison with children and their families.
In order to support children with cerebral palsy and their families, the Government should prioritise more training and education of healthcare professionals on cerebral palsy and dystonia; better co-operation between health, education and social services in the interests of the children; nationwide resources for data collection and the development of national protocols and studies; and greater support for organisations such as Scope, HemiHelp and the Dystonia Society to develop strategies within communities to help children with cerebral palsy and dystonia. I trust that these groups, with the health professionals and medical researchers, can count on enhanced support from government in working towards the ultimate goal of preventing cerebral palsy blighting so many young lives.
My Lords, my background is in local government and transport. I hope that expert noble Lords who have spoken will tolerate someone speaking as a layman. However, two people close to me have children with cerebral palsy, so I see regularly at first hand what the noble Lord, Lord Patel, described at the heartbreak that is involved in raising a child with this condition. As it affects one in 500 babies, it is likely that many of us will know someone who deals with this on a daily basis.
I start by paying tribute to organisations such as Scope, the Dystonia Society and the numerous local charities that do so much to support parents and children, raise awareness of the issues throughout society and provide the practical help and support that is needed. What strikes me about my two friends is that their children were born 17 years apart and yet have had very similar experiences. This demonstrates that, while we have invested a huge amount in research, we have not kept our response up to date in terms of what happens after birth. That is what I will focus on.
It is strange that, despite the consensus that early diagnosis is extremely helpful, too often it does not happen unless there has been a crisis at birth. Often one hears from parents that they sense that something is not right about their child, but cannot get the health professionals to take them seriously. Having listened to the debate this evening, it seems that if we could understand more about the causes—the poor nutrition and other factors that are linked to low birth weight and increased risk—it might be possible to identify the condition much earlier.
A friend of mine has a toddler with CP. He was diagnosed fairly early because his parents were articulate people who knew their way around the system and would not take no for an answer. When they eventually received the diagnosis, they were told that there would be a seven-month waiting list for physiotherapy and then their son would receive one hour a week. They have done what other parents have done and have turned to the Peto Institute in Hungary for help for their son.
I recognise that there is controversy about the methods of the Peto Institute, and that the jury is still out. Nevertheless, for many people, that has provided the only hope, because the Peto Institute offers an essentially optimistic way forward for parents and children who are suffering very badly from low morale and a sense of hopelessness. The work that the institute does through its conductive education programme, working to improve social, emotional, cognitive and communicative skills, as well as motor problems, is enormously powerful for the parents and the young people. I am told by parents that the conventional approach that they receive in this country fails to educate them about how much they can do, even about simple things, such as massage.
Few parents have access to conductive education. When they do, they often find that it comes to an end when the child reaches school age. Then, the child usually regresses. That is very demoralising for the child and for the parents. That points to, to use the cliché, a lack of joined-up thinking between the healthcare professionals, the social care professionals and education professionals, many of whom do not really understand that a child with CP will often have multiple problems. They often find that the specific programmes aimed at people with learning difficulties assume that the child has no other impairments, while the programmes aimed at people with physical problems often ignore the fact that they may also have learning difficulties. There are some harrowing stories about the failure of health services to understand the special needs of some individuals. Scope gave evidence to the Human Rights Committee in another place and talked about how a student from one of its residential schools was unfed in hospital for three days because no one knew how to do it.
Although it is clear that the reduction of cerebral palsy is the ultimate aim, the fact is that over the years, we have not been able to achieve that. Therefore, I hope that the Government will continue to invest as much as is needed to make the lives of those children who have it better.
My Lords, I, too, thank the noble Lord, Lord Hameed, for introducing this important debate. I was fortunate in being trained at Guy's Hospital, where we had a marvellous paediatrician called Dr Ronnie MacKeith, who did a lot to pioneer the subject. He was centred at the Evelina Hospital, which was part of the Guy’s complex, and it is great that the name has been retained as it has moved around Southwark. He has been succeeded by Professor Brian Neville, who has continued to do excellent work.
There are several well defined cerebral palsy syndromes, and they have distinctive clinical manifestations and causes. Primary prevention requires interruption of the causation trail. For instance, there is full-term birth asphyxia giving rise to athetoid CP, as has been mentioned. Secondly, there is neonatal jaundice. Kernicterus is a condition of very severe jaundice which is largely preventable. Thirdly, there is premature birth, which has been mentioned by the noble Lord, Lord Hameed, and others. Fourthly, hemiplegic CP and tetraplegic CP have multiple causes.
A key part of primary prevention is, therefore, high-quality paediatric neurological services. Currently, those are underprovided, especially at district level. The additional impairments should include psychiatric and behavioural impairments, which are very common in early-onset brain impairments, especially when there is cognitive impairment. These include ADHD, autism spectrum disorders, confrontational behaviour and depression. There are currently major problems in providing psychiatric and behavioural diagnosis and care for children with early brain damage. This is a major problem in childhood disability and epilepsy spheres, and a lot is being done to try to remedy this.
As has been mentioned, one primary-prevention priority might be adequate pre-pregnancy care, including persuading mothers to desist from alcohol and smoking, to attend antenatal care, to take regular exercise, to have a healthy diet, and to ensure that their vaccinations are up to date. Ten per cent of CP is genetic, so families need to be investigated carefully, especially those who have had one affected child, and given genetic counselling. I am not clear that vulnerable potential parents are being identified and supported. Pregnancy decisions asked of young people might be better rehearsed when they are in their early teens at school. They are interested in themselves as parents at that time, but have time to consider the major issues that may arise in the future.
Others develop more severe problems. In addition to alcohol and smoking, they take addictive drugs and are at risk of infection, including HIV. They take up crime and in effect drop out. There is a great deal of evidence that the failure to identify and manage childhood cognitive and behavioural problems, especially ADHD, underlies many of these troubles. They are in turn a potent associate of early unplanned and high-risk pregnancy. Pre-term birth is a major preventable cause of cerebral palsy in rich countries, as has been mentioned, and despite better management the survival of more immature babies tends to balance these improvements. Although high standards of antenatal care contribute to prevention, a major issue remains that requires research and funding.
Secondary prevention is of great importance, especially in preventing contractures and maximising the potential of children with established impairments. This involves the community-based child development centres, which should provide ongoing medical and therapeutic input. In the case of CP, there is also a need for specialist referral centres, usually at tertiary paediatric neurological centres, which provide specialist diagnostic and management services in orthopaedics, epilepsy, and communication and behaviour disorders. These services have severe problems and lack appropriately trained therapists.
Community-based services often concentrate on those under five, so the provision for school-age children is often rather patchy, and access to specialist medical services is very difficult. The solution is to set standards for these services. There have been a number of contributions in this direction, but there are no NICE guidelines except on highly specialised interventions. Will Her Majesty’s Government alert NICE to this omission? These disorders are complex and multifaceted and show many individual changes that are characteristic of developing children. The medicine is thus very complex, and it is essential that able professionals are attracted to the subject. Long-term complex disorders require the integration of health, education and social services, for which there are no clear guidelines. Charities and NGOs have traditionally provided many of the services for childhood disability, but there is an unwillingness to engage in long-term contracts with them. This is quite an omission.
As has been mentioned, perinatal brain damage has markedly reduced in rich countries but is still a very serious problem in resource-poor areas of the world. A lot needs to be done in this area. Could we suggest that Her Majesty’s Government consider setting up a five-year research project—with obstetrics, paediatric neurology, neonatology and the legal profession as partners—to investigate the science underlying claims for compensation? It could investigate the evidence for perinatal damage and build up a body of case law. The five-year introduction of such a service would cost no more than one legal settlement. I would be grateful for the noble Baroness’s reaction.
I congratulate and thank the noble Lord, Lord Hameed, for picking up this debate from the noble Baroness, Lady Finlay. I knew that I might find myself, at least with the noble Baroness, Lady Scott, as the least qualified person in the debate, and indeed that has proved to be the case. However, I am pleased to have the opportunity to discuss what the Government are doing to reduce the incidence of this disabling neurological condition which affects approximately two per 1,000 live born children. As has been mentioned, it is the largest cause of childhood physical disability in the developed world.
Cerebral palsy is a group of disorders of movement and/or posture and motor function that are permanent. This is due to a non-progressive abnormality of the developing brain. There are several types of cerebral palsy. While some people are severely affected, others have only minor impairment, and that depends on the part of brain that has been damaged. I am not going to go into the detail of the different types of disorder because other noble Lords have done so more adequately than I could, including my noble friend Lord Macdonald. However, many children and young people have combinations of the different sorts of palsy, and may have epilepsy and visual impairment as well.
Before relating what we are doing towards trying to reduce the incidence and effects of cerebral palsy, perhaps I could also touch on the causes, although I have to say that the noble Lord, Lord Patel, has, as they say, written the book on this and gave us a brief masterclass. It is worth pointing out, however, that many people still think of cerebral palsy as primarily a condition caused by problems resulting in a lack of oxygen during labour and birth. These account for 10 per cent of cases, a proportion of which are definitely avoidable. Another 10 per cent are due to postnatal factors, but the 80 per cent majority have pre-pregnancy and antenatal causes. Children born prematurely with low birth weight or as one of a multiple birth have an increased risk of cerebral palsy. The condition may be due to congenital malformations of the brain and may be associated with genetic defects.
It would be wrong to consider action to reduce the incidence of cerebral palsy in isolation since it is one of the outcomes of maternity care. Action must aim to improve all outcomes. Causes of cerebral palsy during pregnancy can include infections caught by the mother such as German measles or pelvic inflammatory disease, by abnormally low or high blood pressure, or trauma to the unborn baby’s head. Better research is required to understand the causes, which is why the Government have funded the National Perinatal Epidemiology Unit to produce high quality research relevant to maternal and neonatal care. Since 1999, the Collaborative Network of Cerebral Palsy Databases, Registers and Surveys in the UK has monitored the prevalence of cerebral palsy, vision loss and hearing loss in children. In relation to the potential to reduce the incidence of damage to a baby occurring during labour, a major new government-funded study called INFANT is about to start. It is a multi-centre randomised control trial to compare the effect of an intelligent system to support decision-making in the management of labour using the cardiotocogram. The study has received funding of almost £6 million and is due to report in mid-2015. In response to the noble Lord, Lord McColl, we take very seriously the need both to count and carry out research. The Government have also funded a study called TOBY, and emerging evidence from this suggests there is a decrease in the risk of cerebral palsy diagnosed by 18 months in the at-risk children who received cooling treatment following birth.
We continue to expand our knowledge of the causes of this condition. In the mean time, we are taking action to reduce the incidence of prematurity and babies that are small for gestational age. That means that women need to be in the best possible health before conceiving. The Government have undertaken a range of public health initiatives towards improving maternal health, such as reducing smoking in pregnancy, the sexual health strategy, reducing obesity and diabetes and improving nutrition; for example Change4Life, the Sure Start maternity grant, Healthy Start vouchers and the health in pregnancy grant. That is prevention work. I say to the noble Lord, Lord Hameed, that this Government have understood the need for prevention work and its importance. At the risk of making a political point—I do not make this to the noble Lord—it was a Conservative Government which removed the nutritional guidelines for school meals, which we have now replaced. We absolutely accept the need for prevention. Only in the past year, we have introduced legislation to link maternity grant to the advice that women expecting babies should receive about their diet and health during pregnancy. That grant is not available unless that advice has been given to the mother.
It is important to improve our maternity services so that women have easy access to supportive, high-quality maternity services designed around their individual needs and those of their babies. Identifying and managing risks early in pregnancy provides the best chance to reduce premature births and low birth weights. The national service framework for children, young people and maternity establishes clear standards for promoting health and well-being. To support clinicians, the National Institute for Health and Clinical Excellence—NICE—provides a comprehensive suite of evidence-based clinical guidelines designed to improve outcomes for mothers and babies.
As I said earlier, cerebral palsy is more common in multiple pregnancies. The Human Fertilisation and Embryology Authority has developed a national programme to transfer one embryo at a time so that more births are singletons and the risk of cerebral palsy is reduced.
Uncommon, but potentially catastrophic, causes of cerebral palsy are prevented by the administration of vitamin K to reduce the risk of intracerebral bleeding in the newborn baby. Appropriate management of jaundice in the newborn also prevents cerebral palsy.
There is no doubt that improved neonatal care of premature babies has improved outcomes and one factor contributing to the reduction of cerebral palsy is the increased use of steroids given to women in threatened premature labour which significantly reduces the incidence of respiratory distress syndrome. Just today, my honourable friend has launched a newly published toolkit for a high-quality neonatal service, providing principles for the commissioning and provision of high-quality neonatal care. I know I am not allowed to use visual aids but I am very happy to share this with any noble Lord who might want to see it afterwards.
By funding the Centre for Maternal and Child Enquiries—formerly Confidential Enquiry into Maternal and Child Health—progress can be audited and recommendations made to inform change and improve outcomes. That echoes the point made by the noble Lord, Lord McColl.
My noble friend Lord Macdonald referred to dystonia and medication. I want to put on the record that NICE has been commissioned to produce guidance on the management of spasticity in children with cerebral palsy. That will include medicines effective in dystonia. My noble friend and other noble Lords raised the issue of training for healthcare professionals. The training curriculum for paediatricians includes immediate resuscitation of the newborn to deliver adequate circulation of blood, and hence oxygen, to the brain—measures to maintain adequate circulation.
The noble Baroness, Lady Scott, mentioned the Peto Institute, which is renowned and provides many parents with additional support, advice and education. It is one of a range of models of care which helps to meet the needs of some children with cerebral palsy and their parents.
While we know some services are patchy, this Government have made unprecedented investment in a range of services for disabled children. Most recently, we have given £340 million funding to the NHS through PCTs for services aimed at disabled children. It is supported by a new indicator on parents’ experiences of services for their disabled children. We are not just giving money; we are also asking the questions as part of our Vital Signs report. We have asked PCTs to provide us with specific statements on their progress in relation to wheelchairs, palliative care, short breaks and community equipment. That information will be used to inform where we should go next.
In conclusion, we believe that maternity services are the touchstone on whether we are delivering quality care based on safety, effectiveness and patient experience. Our overwhelming objective is to improve outcomes, including reducing the incidence of cerebral palsy. This means continually seeking the right kind of research over the right kinds of periods and improving the quality of care for women, babies and their families.
Question for Short Debate
My Lords, it is a privilege and a pleasure to introduce this debate. In asking for it, the aim was to raise the profile and to argue that blindness and eye health should be much more mainstream in international development. It is reasonable to say that we have already got a degree of success in raising the profile by the large number of noble Lords who have decided to speak, to whom I am very grateful. I am very much looking forward to hearing the contributions from so many Peers, including their experience and their concerns. I know that we will be hearing about this in the context of India and Africa. I am only sorry that there is such a short allocation of time.
My task is setting the scene. I will be brief and will ensure that I do not go beyond my more generous time allocation. First, I declare an interest: I am proud to be chair of Sightsavers International, which for almost 60 years has promoted and provided programmes and services to prevent and treat blindness, and to support blind and partially sighted people in partnership with local organisations in 33 countries. Sightsavers International is a founding member of the International Agency for the Prevention of Blindness, which brings together the world's leading eye organisations to deliver Vision 2020: the Right to Sight as a joint programme with the WHO. We are tied in with the IAPB and the WHO. In declaring that interest, perhaps I may also say that Sightsavers International and the IAPB enjoy generous support from the Standard Chartered Bank through its Seeing is Believing campaign, which was launched in 2003, and whose previous chief executive, now the noble Lord, Lord Davies of Abersoch, has been such a personal and prominent supporter. Additionally, Merck, the drug company, has provided large quantities of the drug Mectizan to help control river blindness.
My point is not just to declare an interest and record appreciation, but to say that there is an enormous unity of purpose among eye organisations, excellent corporate support and good support from the World Health Organisation. I would like to see the Government give eye health an even more prominent place in their thinking and give it more support. I understand that the Government have not ignored eye health and that £50 million has been allocated for neglected tropical diseases, which include, for example, onchocerciasis, for which allocations will be made. I am disappointed that they do not also include trachoma, a neglected disease which particularly in many cases affects women.
Let me be clear about what I am asking about progress and Vision 2020. Vision 2020 was launched in 1999 with two aims; first, to eliminate avoidable blindness by 2020 and, secondly, to prevent the projected doubling of avoidable visual impairment by 2020. So there are two very clear aims. This is a big problem but we can deal with it.
I want to describe the problem and make it clear that action can be taken. I shall give a few figures to illustrate why we should act and give this issue greater prominence. Three hundred and fourteen million people live with severe visual impairment, of whom 45 million are blind. Those are very big numbers. Seventy-five per cent of that blindness is treatable or preventable. Most of it comes from cataracts, trachoma and river blindness, all of which are perfectly treatable or preventable. I know that some noble Lords will speak about these diseases and what can be done. My third, and sad, statistic is that 90 per cent of blindness occurs in poorer countries. That statistic speaks for itself. Less well known—I apologise to noble Lords for producing all these statistics—is that this is also a gender issue. The best estimate suggests that two-thirds of blind people in poorer countries are women. The reason for that is twofold. First, they are more likely to be affected by conditions such as trachoma because they look after the children, deal with the dirty water and are exposed to infection. Secondly, in most cases they are, sadly, less likely to get help, so they are hit two ways. As I say, the best estimates suggest that, consequently, twice as many women in poor countries are blind than men.
This is not just about blindness as if blindness were a simple and single thing; it also affects people’s life chances. We need to ensure that we do not see it just in terms of health. According to research from the International Centre for Eye Health, a blind person who gets their cataracts dealt with returns to something like their previous economic status within a year once their blindness is treated. In other words, they are able to resume some kind of economic activity, or at the very least their carer can resume that activity. This is about the economy and employment. It is also about education. A third of the world’s children not attending primary school are disabled, although not necessarily blind. I know that progress is being made—this is all doable—and I shall be interested to hear what the Government say. When I say that it is astonishingly cheap to tackle this problem, I mean that doing so represents astonishing value for money. It is feasible to talk about eliminating trachoma over the timescales that we are talking about. The organisation that I work with, Sightsavers, works with BRAC in Bangladesh and we are looking at how we can eliminate the backlog of cataracts in one of the major provinces. Enormous things can be achieved.
I said at the outset that I wanted to gain greater prominence for this issue within the Government and more widely, and to “mainstream” it, as eye health is too often left out of the thinking. I talked recently in Mali to an American involved in international development who thought it was strange that eye doctors were being trained there when the country had other pressing needs. He ignored the fact that eye health affects so many people in a community. I fear that that sentiment is relatively common. Eye health should be seen as key to the millennium development goals, including education, women's rights and employment. I want to make three suggestions to the Government and I look forward to the Minister's response.
First, there is, rightly, renewed emphasis on primary care. A great deal of eye health disease can be dealt with very easily in primary care; for example, the more minor conditions, not necessarily cataracts or trachoma but diseases arising from poor hygiene, living in dusty and desert conditions and sometimes from using traditional remedies. These are too often missed out. We want to see eye health emphasised as part of primary care, so that when you are pushing forward your policies on primary care, eye health is a central part.
Secondly, there is a growing emphasis on human resources and training more health workers in Africa. It is equally important that eye health is part of this, not separate. Training is needed from the most local level of community worker to deal with the most local issues to the specialist. There are a lot of innovative models of mid-level workers in eye care. Thirdly, greater prominence should be given to disability in DfID programmes. Education, employment and rehabilitation need to be addressed to achieve all the millennium development goals. Disability is implicated in, if it is not the cause of, at least 20 per cent of world poverty. These are the three big issues for mainstreaming: ensuring that primary care policies relate to eye health; ensuring that human resources policies relate to eye health; and giving disability greater priority.
Finally, I ask that DfID looks again at its whole support for eye health and Vision 2020. A good start might be a meeting with the Minister and the IAPB—I do not think that this has happened yet but, if it has, it has not happened recently—to demonstrate how seriously committed the Government are to this and to mainstreaming.
Let me end on hope. This is a big problem, but there are solutions. Most of these conditions are treatable or preventable, and treatment can have quite a quick impact. There is a great deal of interest in this, as shown by those noble Lords who are speaking in this debate, as well as support from the corporate sector in the form of the Standard Chartered Bank and from the WHO. Eye health organisations are also well organised, and we want even clearer government policy working alongside us.
My Lords, in my maiden speech in this House, I described blindness as one of the severest disabilities and suggested that, considering the critical role that sight plays in enabling us to interact with our environment, couching everything in terms of disability is unhelpful because it obscures the central importance of sight. There is now a pressing need for blindness to be placed higher up the political and social agenda. It therefore gives me great pleasure to be the first to congratulate my noble friend Lord Crisp on bringing these matters to wider attention today and on having secured this opportunity to set out his stall in an already overcrowded marketplace. I am sure all noble Lords will agree that it was an impressive presentation. I am only sorry that I missed his first few sentences in the commotion of the albeit seamless changeover from the previous debate.
In my maiden speech I talked about the domestic agenda, but the problems in the developing world, although not exactly the same, are if anything even more pressing. I therefore join others in paying tribute to organisations, such as Sightsavers International, the Christoffel Blindenmission and the IAPB, which are attempting to tackle them. At a time when it is difficult to find anyone with a good word to say about bankers, it is good to learn that the Standard Chartered Bank is putting so much of its considerable weight behind such endeavours. As my own organisations, the RNIB and Skill, are less active internationally, I do not have quite so much of an interest to declare this afternoon.
It is also very gratifying, as my noble friend has said, to see such an impressive turnout for this short debate. When such an impressive list of speakers is so obviously seized of the issues, it is clear that the message is getting through. I am sure that the Government have got the message; I just hope that the debate will reassure them that they have the support that they need to give this priority, and that it will give them some pointers on how this can be done most effectively.
After the formalities, which are important, it is not possible to say very much of substance in four minutes. I want to make just two points within an overarching framework of rights. Where blindness cannot be prevented, it behoves us to have particular concern for the rights of those who are left to grapple with it. Two of the most important of these are the right to education and to information in a form in which people with little or no sight can access it.
On education, 6 million children worldwide are living with a disabling visual impairment, 80 per cent of them in under-resourced developing countries. Of these, more than 90 per cent—4.4 million—receive no education at all. In 1990, the Education for All programme was launched by the United Nations, with the goal of universal access to education by 2015. EFA has made significant progress in reaching non-disabled children, but I fear that it has in large measure failed to include children with disabilities, particularly those who require alternative modes of communication.
The funding for EFA comes largely from developed countries, so those countries should be asking why children with disabilities are still not being reached effectively by EFA and should be insisting that Governments which receive EFA funding should serve all children, including those with visual impairment. EFA-VI is an initiative led by the International Council for Education of People with Visual Impairment and the World Blind Union—I am a board member of both. The initiative will assist developing countries with technical advice and support to ensure that their EFA national plans include provision for children with visual impairment. Any support which the Government can give to this initiative will represent a very good investment of effort.
On access to information, efforts are under way through the World Intellectual Property Organisation to agree a treaty which will dismantle copyright barriers to the free flow of information between states in forms made accessible to the visually impaired. More than 100 countries have expressed support for such a treaty but some of the big players, like the United States and the EU, are digging their heels in. Any assistance which the Government can give to promote a more positive approach would be very welcome, and I shall be happy to give the Minister a full briefing if he would find that helpful.
My Lords, I, too, congratulate my noble friend Lord Crisp on securing this very important debate. I also put on record the great work that his charity, Sightsavers, does. I am pleased to say that a charity of which I am a trustee is pleased to support it year on year. I agree with all that has been said about the burden of blindness and the loss of visual acuity in the developing world. I have seen it at first hand most recently in Cameroon, where 50 per cent of the villagers were blind from black flies attacking their sight.
However, in the few minutes available to me, I would like to speak about the issues we face in our country. One relates to retinopathy of prematurity. In the previous debate we discussed the incidence of cerebral palsy in babies born prematurely—10 per cent of births are premature. Retinopathy of prematurity is emerging as an important cause of visual loss and sometimes blindness. Retinopathy of prematurity is one of the few causes of childhood visual disability which is largely preventable. Many extremely pre-term babies will develop some degree of retinopathy. Although, in the majority, that will never progress beyond mild disease, in some it will become serious and occasionally cause blindness. In the previous debate, the Minister said that the Government have just launched a strategy for neonatal care and I hope that it includes screening of all births in the United Kingdom before 32 weeks, checking for retinopathy of prematurity. That would certainly reduce the incidence of visual impairment in those children.
Next, I want to focus on diabetic retinopathy. We know that the incidence of obesity and, therefore, diabetes is rising; 30 per cent of our population now has a BMI—unfortunately, including me probably—greater than 30. The incidence of diabetic retinopathy is 5 per cent; 2 per cent of people with diabetes develop blindness after 15 years and 10 per cent develop severe blindness, apart from other things such as hypertension. Diabetic retinopathy is a well recognised complication of diabetes mellitus. Well conducted clinical trials have shown that good control of diabetes and hypertension significantly reduces the risk of diabetic retinopathy. Good services, which provide not only better glucose control for diabetics but rigorous screening for diabetic retinopathy and early detection of it, will reduce significantly the burden of eye problems.
I turn to age-related macular degeneration. As the name implies, it is a common cause of reduced vision in the United Kingdom and it occurs in 30 per cent of people over the age of 60. Probably some of us here today suffer from the condition. Unfortunately, there is no immediate treatment or cure. We require greater research and identification at an earlier stage of development of the disease, because it has been shown that early detection will reduce further deterioration if treatment can be started earlier.
I am pleased to say that recently the first phase of a four-year clinical trial of the use of embryonic stem cells has been launched by MRC and the California Institute of Regenerative Medicine. The trial shows great promise. I have addressed three issues and finish by echoing what the noble Lord, Lord Crisp, said.
My Lords, I, too, thank my noble friend for highlighting one of the most urgent priorities in development assistance. It is not often mentioned in Parliament. I still remember the relief felt by aid agencies when onchocerciasis in Africa was all but conquered. Surgery and medicine have made many advances, and there have been victories along the way; but the combination of disability and poverty described by the Indian novelist Rohinton Mistry is almost unimaginable for us.
I am most grateful to Vision 2020 for its briefing, which helped me to see the facts more clearly. For example, as much 75 per cent of blindness is avoidable. I had not realised that cataracts are by far the most common cause of blindness. I knew that successful operations take place daily to tackle the 15 million or so cases worldwide every year. In the poorest countries, the operations do wonders for the beneficiaries. A survey in Madurai, for example, found that 85 per cent of males and 58 per cent of females who had lost their jobs as a result of blindness got them back again.
The underlying case of blindness is poverty. It is estimated that children born in the world’s poorest regions are four times more likely to suffer from blindness than those born in higher-income countries. Conditions associated with childhood blindness, such as measles, rubella and vitamin A deficiency, are also causes of child mortality, and they are preventable. It is a sad fact that nine out of 10 visually impaired children in the poorerest countries are deprived of education, with the consequent loss to their local economies.
Many charities are combating blindness, and some smaller ones achieve huge results. The Fred Hollows Foundation has reached thousands in Nepal. One agency for which I have great respect is Sightsavers. I will give an example of its work last year in India. Its local partners treated more than 1.9 million people for sight-related problems. They performed 115,000 cataract operations and provided rehabilitation training for more than 3,000 people with irreversible blindness or low vision.
Rehabilitation is an essential part of the agency’s work. One agency related to them, Jana Jagarana in Orissa, tells of a boy called Ravi Nayak who asked his carer, “Aren’t you going to be helping me any more?” She was in difficulty, but replied firmly, “Since you are capable of doing things on your own, I should spend more time with those who need me”. She gradually reduced her visits to him, but the agency has since helped Ravi with capital to start a cycle repair shop, and offered to send him for vocational training. He is apparently now happy and planning his future.
I end with a short song from a Vietnamese girl in Saigon known to Save the Children whose mother was poisoned by Agent Orange. I will never forget her story, which I have no time to recount now. She sang:
“I dream of seeing the colour of the trees
Of seeing the home where I might live
Of seeing the mountain with its waterfall
I dream of seeing my mother’s smile”
My Lords, the unfortunate reality is that levels of poverty are higher among the blind than among those suffering from any other disability. We are all grateful to the noble Lord, Lord Crisp, for securing a debate in this crucial area. Vision 2020 has been a shining example of how partnerships—and in particular public-private partnerships—can be so effective. There is no better example of this, as noble Lords mentioned, than the Seeing is Believing campaign launched by Standard Chartered Bank in 2003. What a difference it is making.
We are also fortunate that we have with us my noble friend Lord Low, who is such a tremendous inspiration to us all in the amazing work that he has carried out with the RNIB, which he led for so many years. I have personally seen the power of public-private partnerships in founding the UK India Business Council, which is supported by UK Trade and Investment—the Government working together with business in promoting the UK-India relationship.
India, which was mentioned by the noble Earl, Lord Sandwich, has the highest population of visually impaired people in the world by far. One-third of the world's blind people live in India. A study performed by the Prasard Eye Institute in my birthplace of Hyderabad at the turn of the millennium calculated the direct and indirect economic loss due to blindness in India at $4.5 billion per year. To put that figure in perspective, in the year of the study, it would have cost a tiny fraction of that to treat all the cataract cases in India.
I have seen in India institutions such as the Happy Home and School for the Blind in Mumbai, run by the inspirational Meher Banaji, and the amazing, positive impact that they have. Childhood blindness accounts for 28 per cent of the lifetime economic loss. Those children are robbed of a start in life, their disability hindering their primary education and with family members coming to stay at home as caretakers, poverty becomes a real prospect. An investment in developing nations and in their children is an investment in the future, and the future of the children.
The problem of disability, and, more specifically, blindness, not only causes hardship at the level of the individual but has a domino effect. The scope of that knock-on effect is hard to grasp. As the noble Lord, Lord Crisp, said, 90 per cent of those living with blindness live in low-income countries. We can see how real the effects are. It is not only the blind who feel the desperate grip of hardship, but the families of the blind and the communities in which those families live.
Access to healthcare is a human right and there is no question that under that principle, every possible action should be taken to ensure that those living with impaired sight are given the treatment that they need. If that is not incentive enough, the global economic burden of blindness is shocking. The global impact due to low vision and lost productivity was estimated at $42 billion in 2000. In the UK, once you reach the age of 40, an annual glaucoma test is provided free, funded by the Government. Just imagine how many unnecessary cases of impaired sight could be avoided if that were available in developing countries throughout the world.
In our work at the UK India Business Council, we have realised, with British companies working in India, that corporate social responsibility is not a nice thing to do, it is a must. I believe that, through the power of government, and governments working together with the private sector and NGOs, we can eliminate unnecessary blindness forever throughout the world. I urge the Minister and the Government to do everything that they can to make that a reality.
My Lords, most of what I wanted to say has already been addressed more eloquently by other Peers, especially by the noble Lord, Lord Crisp, whom I congratulate for introducing the debate. I intended to quote something that he stated in another report. At the risk of repetition, he said that there is a huge shortage of health workers globally and what is needed is a powerful and co-ordinated international response to address that shortage, with the developed countries, including the UK, supporting the scaling-up of training, education and employment of health workers.
The UK Government have made an important start with their initiative in Malawi, which provided $99 million over six years to address urgent health and human resource problems. This was a most welcome development and, combined with increased support for health from other donors, has produced some excellent results and is an indication of what can be achieved when such an investment is made. It showed that 40 per cent more doctors were working in Malawi than in the four years previously, and 5 million more people visited a health facility.
As I have said, the relatively small expenditure of $99 million over six years on this initiative has made a huge difference and provided such an excellent return on the investment that I would suggest to the Minister that consideration should be given to reordering the priorities of DfID’s aid budget so as to ensure that a greater proportion is allocated towards eye care services. We should bear in mind that this concerns about 300 million individuals in the developing world and the fact that with the increase in population and life expectancy, this problem could well get worse rather than better, despite all the progress that has been made.
I join others in congratulating my noble friend Lord Crisp on initiating this debate, and I, too, declare an interest, as chair of the medical aid charity Merlin, which I am glad to say works closely with Sightsavers in some of the poorest countries in the world, including Liberia, which I recently visited. The key point that struck me in my noble friend’s opening remarks was that 80 per cent of the world’s blindness is avoidable and can either be treated or prevented by known, cost-effective means. Some progress has been made, of course, but nothing like enough, and there is a real risk that without major and effective intervention, the number of avoidably blind people worldwide will increase rather than decrease as we approach 2020. That is why the Vision 2020 programme is so important.
I want to stress three or four points which put the issue of blindness into a broader context than just its treatment. First, avoidable blindness is best eliminated when eye health programmes are embedded in health systems and underpinned by effective government policy. Efforts to tackle blindness and visual impairment must be made within an approach that supports and strengthens national health systems. It is particularly important, as my noble friend Lord Crisp said, that that should be done at the primary healthcare level because it provides the best means of reaching the greatest number of people.
My second point was also made by my noble friend Lord Joffe: the importance of adequately trained eye care personnel and the lack of those staff, which is a sub-sector of the broader issue of the chronic lack of effective health workers in developing countries. My noble friend Lord Crisp has done a terrific amount himself on that, on which I congratulate him, but it is a crucial element in treating blindness.
Thirdly, disabled people, including blind people, are among those most affected by natural disasters and conflicts. Refugees with disabilities are among the most isolated, socially excluded and marginalised of all displaced populations, which means that efforts to respond to emergencies both acute and chronic must address the issue of people with disabilities.
Finally, but most important, is the fact that eye disease is no respecter of national boundaries. Initiatives such as onchocerciasis control are dependent on cross-border collaboration in political and health terms among countries. I stress that this is as much a political issue as it is a health issue, which allows me to draw attention to a point that I have made in other contexts in your Lordships’ House. There is a need in our own country for DfID, the Foreign Office and even the Ministry of Defence to work closely together to ensure the right political context in which social measures such as health can be taken and thus the incidence of blindness reduced.
My Lords, I join in thanking my noble friend Lord Crisp for introducing this very important and topical debate. I would like to devote my allotted few minutes to addressing the problem of river blindness in Africa, where I have spent most of my life. A number of rather chilling statistics exist and one reads that more than 100 million people are at risk in 30 African countries, with almost 18 million already infected with the disease.
In researching for this debate I read the initiatives of Vision 2020 to prevent avoidable blindness. I was encouraged to read that between 75 and 80 per cent of the world’s blindness is avoidable, 60 per cent is treatable and 20 per cent is preventable. I returned last week from a visit to Ghana where the health authorities have been fighting the scourge of river blindness for almost 50 years. West Africa, particularly Nigeria, has been worst affected. Despite treatment with ivermectin, concerns are growing that this crippling disease is endemic and may be developing a resistance to the drug. It is encouraging that its mass administration has been effective in preventing nearly 40,000 cases of river blindness a year, but that figure could be considerably increased with better management. I was pleased to hear that phase three trials have recently been launched in the Democratic Republic of the Congo, Ghana and Liberia to assess the effectiveness of moxidectin in preventing transmission from the worms that cause river blindness. It is also encouraging that scientists in Cameroon and Ghana have identified the first biological agent, a midge, which can be cultivated, that eats the pupae of the blackfly that cause river blindness. Like my noble friend Lord Bilimoria, I also support the work of public-private partnerships in preventing avoidable blindness.
I have always been a firm believer in prevention rather than cure. While it is unlikely that the scourge of river blindness will be eradicated, it is encouraging that there are cost-effective solutions to the problem. In a recent article on combating river blindness in Cameroon, my noble friend’s charity, Sightsavers International, has estimated that for an average cost of just 5p, the drug ivermectin can protect an individual against the devastating effects of the disease for a whole year. However, 15 years of such protection would be needed because that is the period during which the river blindness bug stays in the system. Getting the treatment to remote communities and training people to distribute it is a challenging task. As most speakers have already mentioned, river blindness predominantly affects poor people in remote areas. In many cases, children have missed out on education because they are forced to stay at home to act as full-time carers for relatives who have become blind. In some cases, residents have fled areas where the level of infection has hit hard, leaving “ghost” villages behind. These are often situated in arable areas of Africa, near to fast-flowing rivers.
It is well known that lack of eye care can have a severe economic impact by perpetuating poverty or pushing a family into poverty. Clearly, effective and low-cost solutions exist to eradicate avoidable blindness. To this end, I wholeheartedly support the aims of the Vision 2020 initiative.
My Lords, we come to the concluding part of this debate. I thank all those whose contributions have highlighted the scale of blindness worldwide. I thank the noble Lord, Lord Crisp, for his excellent contribution, in which he set out the statistics.
I hope the Minister will have noted that we are talking about more than 45 million people with total blindness and a further 269 million with poor vision. A fact that we often seem to forget is that if one breadwinner in a family loses their sight, it is likely on average to affect the development of at least four or five members of that family. Therefore, we are talking about a much wider problem. Those of us who have travelled in many parts of the world, particularly in undeveloped countries, are aware that unless we take drastic action and develop proactive programmes, the number of blind people worldwide will increase substantially. It is estimated that we can add a further 30 million to the present number of 45 million by 2020. We also know that there is a direct link—I am again grateful to the noble Lord, Lord Crisp, and a number of other noble Lords who have spoken about it—between blindness and poverty. This disadvantage often results in families who are unable to afford the often simple treatments that could retain their sight.
Earlier today, the noble Lord, Lord Patel, mentioned the link between premature birth and cerebral palsy. Yesterday, when I spoke to him in the corridor about this debate, he said that a similar link could be established with blindness on the same principle, which is interesting. At this stage, some of the research may ultimately lead to a solution, but we now need to put initiatives in place so that the projected increase in the number of blind people does not happen. The Government’s record in tackling poverty is not bad, but that does not mean that it could not be better. We must remember that poor people will suffer most during the economic depression. Millions of people could build a sustainable life if their sight was restored.
I welcome the initiatives taken by Vision 2020. At the national level, a strong partnership between ministries of health, NGOs, professional organisations and civil society groups, all of which have been brought together by Vision 2020, should facilitate the development and implementation of effective and sustainable national eye care plans worldwide. I hope that the Minister will be able to comment on the role in place for developing and assisting in the strategy that has been developed by Vision 2020. It should not be difficult. Examples have been cited in this Chamber. Pharmaceutical firms and medical providers now operate at the global level. If one of the millennium goals is to eliminate poverty, which is often supplemented by blindness, this is an example of how effective co-operation and co-ordination of effort can assist. A very interesting example was cited by the noble Lord, Lord Bilimoria, about the partnership that could provide this initiative.
The overall objectives of Vision 2020 are entirely commendable; namely, to increase awareness within the key audiences of the causes of avoidable blindness and to look for the solutions. The other aim is to secure the necessary resources to increase prevention and treatment activities. I ask the Minister if he could throw some light on the type of resources that we are making available to tackle this problem.
There can be no excuse. Blindness prevention strategies are among the most cost-effective in healthcare. There are blind people around the world who should not be blind because their condition is treatable. In so many cases, had there been a comprehensive eye care system available, they would have got that treatment and would not be blind. It is imperative that the good work of Vision 2020 is built on and developed further. Support from the Government must be wholehearted and the continuation and furthering of partnerships between the private and public sectors must be actively encouraged. In this way, a future envisaged by Vision 2020 will be realised; that is, a world in which no one is needlessly blind.
My Lords, I thank the noble Lord, Lord Crisp, for initiating this debate. He rightly emphasised that addressing gender inequality needs to be a key component of future efforts to develop the eye-care industry because this involves childhood access as well. We need to remember that although the number of blind children is far smaller than the number of blind adults, the number of blind years is almost the same. Assigning priority to blindness conditions should be considered, therefore, in terms of blind years rather than just the absolute number of blind people.
The noble Lord, Lord Crisp, asked me to describe the cataract work that we do on a mercy ship in West Africa. This is a hospital ship with six operating theatres, two of which are devoted to eye surgery. We can treat 40 cataracts a day because there are no EU restrictions on the number of hours we work.
The joy of being able to see again after years of blindness is really quite indescribable. I shall never forget my first cataract operation. When the bandages were taken off the man the following day, he shrieked with joy, threw his hands in the air and for the next five minutes praised the Lord—I mean the real Lord, not me. We have witnessed some amazing scenes. Twin boys aged two who had been blind from birth and had never walked were carried onto the ship. It is unusual to see twins in West Africa because they usually die in childbirth. Their eyes were sunken, expressionless and wandering around. The cataracts were removed and on the following day when the bandages were removed, these two little chaps began looking around in total amazement. They had never seen anything before, so they saw each other for the first time and then their mother. It was an emotional scene. They began to walk within an hour. I must tell noble Lords the whole story. The next day, being boys, they started fighting each other, so they were perfectly normal in all respects.
One problem is that in the western world cataracts are removed through a 3 millimetre incision using very expensive ultrasound equipment. Most developing countries cannot afford this kind of machinery, so we do without it and teach the locals a technique that uses a 6 millimetre incision which is almost as good, and in many ways is better because African cataracts tend to be much harder. There is a need to ensure that western countries include this alternative technique in their training programmes so that doctors can visit Africa and teach the local staff how to do it. Perhaps the Minister could encourage this.
I begin by adding my congratulations to the noble Lord, Lord Crisp, on securing this debate and bringing the important issue of blindness, whether avoidable or unavoidable, to our attention. I know that over many years he has made a great contribution to health, including more recently in developing countries. I also thank all the other contributors to the debate who have brought to it their experience, interest and knowledge. The noble Lord, Lord Crisp, effectively set out three challenges which I hope to answer as I go through the narrative of my speech and respond to questions. On the fourth challenge, his reward is an immediate “Yes” to the question of meeting Ministers. That is a given and can be arranged.
I can certainly confirm the statistics used by the noble Lord and others that, globally, some 340 million people are visually impaired and 45 million are blind. As has been said, the vast majority—almost 90 per cent—live in poor countries with weak health systems and little or no immediate access to health services which could prevent or treat blindness. It was also pointed out that cataracts, which can be removed using a relatively simple surgical procedure, continue to be one of the main causes of blindness. However, they are avoidable if healthcare is available at a reasonably simple level, and I am grateful to the noble Lord, Lord McColl, for his expertise in describing the treatment. The noble Earl, Lord Sandwich, also raised the issue.
Trachoma is the second most common disease. It is linked to extreme poverty and poor sanitation, but even the simple acts of face and hand washing are not easy if there is no access to water. Glaucoma cannot be detected early enough where there are no systems for eye checks. Childhood blindness often arises from poor diet, inadequate sanitation and through diseases like measles, for which a vaccine exists. Onchocerciasis, which henceforth I shall call river blindness—although I got the pronunciation right once, I may not do it a second time—is a parasitic infection that infects the poorest of the poor. They are the people who find it most difficult to access the necessary drug treatment.
There is no need for me to dwell on the huge suffering that blindness brings to individuals because it has been graphically described by other noble Lords. The $64,000 question, or perhaps the rather more expensive question to ask, is what are we doing about it. The important thing has been said already: there are many health challenges across the world, and when it comes to avoidable blindness, it does not have to be this way.
In the vast majority of cases, tried, tested, simple and cost-effective interventions already exist for blindness and other visual impairments. They are preventable and treatable—as indeed they are in developed countries. Let me put that statement into context. We are therefore talking about poor countries—countries where Governments have to contend with manifold health priorities, if not crises, including HIV, TB, malaria, complications in pregnancy and childbirth and other neglected tropical diseases; where there are few doctors and ancillary services; where the system for delivering health care is often dysfunctional; where resources are limited; and where, sadly, health is often not the top priority on the Government's agenda. Here, I am at one with the noble Lord, Lord Bilimoria, in believing that access to health is a public and human right. Therefore, it seems to me that a Government, whether rich or poor, should put that high on their list of priorities.
The question is: what has the UK done and what are we doing to contribute to the elimination of avoidable blindness and to support those who are unavoidably blind? The causes of visual impairment are numerous, so we must address them as part of a global effort on multiple fronts. The noble Lord, Lord, Lord St John of Bletso, raised the important issue of river blindness in Africa. DfID is a long-standing supporter of the African programme of onchocerciasis control. That is a global partnership led by the World Bank and the WHO. In 2008, the programme treated 120,000 communities affected by the disease. The UK also supports research into that and other tropical diseases. The clinical trial of the drug moxidectin, which could dramatically speed up the elimination of river blindness across Africa, was launched last year.
We are addressing vitamin A deficiency and measles vaccinations through core funding to UNICEF—by £21 million in 2008. We support the GAVI Alliance—by £30 million in 2006-08. Through our bilateral programmes in Sudan, 6.5 million children received vitamin A supplements through one such programme and, in 2008, thanks to the work of DfID, more than 3 million children have been vaccinated against measles.
There are clear linkages between malnutrition and the level of blindness, especially among children, so we are now stepping up our efforts against malnutrition with the new nutrition strategy. However, those interventions are not sustainable unless countries have underlying strong and lasting healthcare systems—another point made by the noble Lord, Lord Jay. Those systems must be able to deliver. As noble Lords, including the noble Lord, Lord Crisp, said, that means having a trained workforce, the infrastructure and systems for drugs delivery and healthcare, including eye care, where they are needed. That is why last year the Secretary of State for DfID committed £6 billion until 2015 to improve health systems and services. That is why the UK has led the development of the international health partnership to support developing country Governments who want to improve the health of their people according to their priorities.
In addition to raising additional funding for health systems, we set up the high-level task force chaired by the Prime Minister and the president of the World Bank, Robert Zoellick. The task force reported this year and helped to secure $3.2 billion funding for improved health services across the developing world. However, developing country Governments must lead the way by investing more of their own money in healthcare systems and meeting the Abuja target of 50 per cent of government spending towards healthcare.
I echo the point made by the noble Lord, Lord Crisp, that this is a partnership that is both public and private, national and international, and the task that we have can be achieved only if we work together. The noble Lord, Lord Crisp, made three points. One concerned making sure that primary care included eye healthcare. We agree that it is important that eye care is integrated into primary healthcare. DfID funds health sector plans of developing countries, with a focus on primary healthcare and the diseases of poverty. We also agree that it is important to improve the number and quality of healthcare workers, and healthcare workers at community and health centres will be trained across a range of priority issues, including eye health.
The third point related to the desire for disability to have greater prominence in DfID. DfID recognises that disabled children are excluded in many instances from access to education and that disabled adults are excluded from other services. This is clearly damaging not only to the individual but to families and the local economy. That is why disability is clearly on the DfID agenda.
The noble Lord, Lord Low of Dalston, talked about dismantling copyright barriers, which, as he rightly says, is being discussed in Whitehall. I would welcome any more information that he has on that so that I can take the matter further and discover precisely where matters are and how we can assist. He also asked about DfID’s support for education. DfID has provided £8.5 billion over a 10-year period—from 2005 to 2015—for education. That includes funding to support disabled children, a large number of whom are blind.
The noble Lord, Lord Patel, made a number of important points, including one about diabetic retinopathy. Important though they were, however, they relate to the United Kingdom and its health service, so I am happy to pass them on to my colleagues in the Department of Health. DfID has an interest in their impact in the developing world, but I am glad to say that other ministerial colleagues have the responsibility for them here in the UK.
The noble Earl, Lord Sandwich, talked about avoidable blindness. We support action to prevent blindness by funding international organisations and partnerships and by giving countries bilateral support for research. This support will have a direct and indirect impact on avoidable blindness. We also support the strengthening of healthcare systems. The kind of money that I am talking about is £6 billion to improve healthcare systems between 2008 and 2015; £13.14 million to the World Health Organisation for 2009-10; and £30 million, which I have already mentioned, to the Global Alliance for Vaccines and Immunisation. I also mentioned the African programme to eliminate river blindness. This is dealt with through the World Bank, which manages donor-pooled funds—currently £500,000 per year—and we as a country have supported it continuously since 1974. UNICEF has £21 million of core funding to provide food and other humanitarian aid.
I see from the clock that I have spoken for 10 minutes. I shall have to speed up, which will be of great sadness to the Hansard writers. I am already too fast for most people to understand, which is not always accidental.
India was mentioned. We are supporting the health sector in four states with a total population of 260 million. We are giving West Bengal £100 million from 2004 to 2010, Andhra Pradesh £40 million from 2007 to 2010, Orissa £50 million from 2007 to 2012, and Madhya Pradesh £60 million from 2007 to 2012. That includes support for work on tropical diseases, blindness, and child health and nutrition, the focus of which is on poor and excluded groups, including the disabled and the blind.
I will have to respond in writing to a number of points that noble Lords have raised or I will fall foul of the Deputy Speaker, which I would hate to do. The noble Lord, Lord Jay, made the important point that we need a political context and cross-border collaboration between government departments. I agree. In recent months, we have seen closer co-operation between DfID, the MoD and the FCO on health issues, including a cross-departmental Whitehall group that always includes the Department of Health.
Finally, the noble Lord, Lord Dholakia, pointed out that the recession will clearly have a damaging impact on the world’s poor. We agree, which is why we have made a commitment to continue to support health. Eye care is central to this. We do that best by supporting the kind of programmes that we are supporting and by remaining on track to achieve the UN target of giving 0.7 per cent of our national income by 2013.
I will write to noble Lords on any points that I have missed. I will also ensure that my ministerial colleagues in the Department for International Development have a copy of this debate, so that they can see noble Lords’ awareness of this issue and their desire to raise it. This has been a matter of importance to your Lordships, and the quality of the debate has been excellent.
Question for Short Debate
To ask Her Majesty’s Government, with reference to the Agreement of July 2006 between the Secretary of State for Culture, Media and Sport and the BBC, what is their assessment of the extent to which the BBC has paid sufficient regard to the importance of reflecting humanism in its programmes.
My Lords, sometimes “Auntie” is hard to love. Recently, the BBC, the venerated home of public service broadcasting, gifted the British National Party a public platform while we humanists are still denied even a walk-on part on “Thought for the Day”. Tonight I argue that the BBC has failed the humanist community in Britain both in the spirit and in the letter of the Communications Act 2003, which requires the BBC to schedule programmes on religion and other beliefs, including humanism, as was made clear in the debate by the then Minister, the noble Lord, Lord McIntosh.
The Human Rights Act and other equality and anti-discrimination law similarly accord humanism the status of a belief, but humanism is ignored by the BBC. We humanists are atheists who do not have a Bible or a Koran, or indeed a Moses bringing tablets down from the mount, to fix our beliefs. We make do with our human nature and our life experiences to establish our moral values. We believe in a naturalistic explanation of life provided by patient scientific inquiry and careful reason. We share a respect for human rights, celebrate individual responsibility and social co-operation, and promote mutual respect. We create, if we can, our own meaning to our one-off lives. The humanist tradition established by the Greco-Roman thinkers predates monotheistic religions although it has, of course, influenced Christians’ own version of humanism. We arrive at our beliefs independently by reason and experience, not by dogma or indoctrination.
Humanism in the UK is significant and substantial in number but still single and silent in expression. None of us marches under a humanist banner in anger, arms or hatred. Nevertheless, we are subject to verbal excoriation; witness the gratuitous attacks on the courageous Professor Dawkins by those who should know better. We have been quiet, perhaps for too long. Now that established religion loses heart, congregations and credibility, it searches for a scapegoat and chooses us. I believe that our voice should now be heard in the public square, and especially in the BBC. We do not want just to take part in others’ scheduled religious programmes, although our voice is seldom heard in, for instance, the otherwise excellently chaired “Sunday” programme. When we are called, we perform the obedient role of token members of God’s loyal opposition, but we have a distinctive voice. We want programmes made for us—humanists talking humanism to other humanists on a variety of issues that interest us. These might include how we conduct non-religious funerals or how to educate free from the straitjacket of rigid religion. I would love to debate with humanist colleagues our common admiration for church music, or why we appreciate listening to Bach or Handel in the architectural settings of England’s finest churches. The BBC can and should provide a platform for these searching debates. It should encourage a new set of cultural and intellectual programmes tailored to humanists. Similarly, combined debates of humanists and religionists could examine issues of common interest such as the environment, poverty reduction, your Lordships’ House or what new uses our wonderful churches could be put to in a modern, secular age. We have common humanist concerns that can unite us across the religious divide in the face of crass commercialism.
Unfortunately, the BBC treats humanism as the absence of religious belief, ignores its noble and ancient history and underestimates the strength of the humanist community in Britain. According to the Social Trends 2006 survey, 46 per cent of us are non-religious. However, we remain a community disregarded. The BBC quaintly argues that the vast majority of its output is secular; but have you ever watched a humanist “Match of the Day” or an atheist “Strictly Come Dancing”? The truth is that religious public broadcasting is growing while Anglicanism contracts. Mark Thompson confesses that the liturgical or contemplative religious content occupies some three hours each week on Radio 4. Basically, it is Christians talking Christianity to other Christians—and the output is doubled at Easter and Christmas. However, not a single minute is allowed to humanists.
Other forms of Christianity are given public space alongside the established Church of England—but not us. This is at a time when the Church of England is dwindling as our constituency grows. We still have no town crier to speak up for us in the public square. Why not? In a pluralising Britain, many non-Christian religions are rightly and readily invited to the public debate. Why not humanists? Even the 5.45 am slot “Prayer for the Day”, once the brief intonation of a short prayer, has elongated into a mini “Thought for the Day”. It is a form of mission—or should I say missionary?—creep.
My concluding thought for the day is that the title “Thought for the Day” does not guarantee an exclusive religious viewpoint—but that is what it is, and it is discriminatory. By excluding us, the BBC implies that humanists are bereft of a moral compass; or worse, that we are amoral or immoral. It implies that we have no way of commenting sensibly on contemporary events. The BBC’s excuses are strange and strained, as well as offending the spirit of the BBC charter. It says that “Thought for the Day” is an oasis of religion in a stream of unremitting news. In the BBC’s taxonomy, items on sport, politics or culture are bizarrely classified as humanist.
Does the BBC really believe that only the religious can be spiritual? I respond to sunsets, Shakespeare and song, but I do not find God filtering my emotions. The Reverend Giles Fraser, a contributor to TFTD, said it would be madness to let secularists in—this from a man who recently hosted a rerun of the famous Putney debate in the 17th century when his church rang to the rafters with unorthodox views. The BBC fears that humanists will stridently attack religion, but all we want to do is tell a listening and willing audience what humanism is about and what it has to offer. We leave internecine religious squabbling to those who are best at it—witness the unseemly exchange on last week’s “Sunday” programme provoked by the Pope’s recently proffered pastoral chalice to unhappy Anglicans.
I conclude by saying to my colleagues that I understand that the BBC is about to make a decision on this, and I hope that it will be influenced by tonight’s debate. We do not want to oust religious believers from the church pew or the park bench, but we do ask them to budge up a bit and let us be heard in the public square. Finally, I invoke the Church Times which supported our cause in 1994, and I ask our colleagues from the church who will speak later in the debate that, when they wake up tomorrow morning, they might remember the words promoted by the Church Times that:
“Believers have no monopoly on illuminations on dark mornings”.
I am delighted that my noble friend Lord Harrison has given us an opportunity to debate this very important topic and I look forward to the contributions from all sides—by which I mean faith sides. I shall be speaking up for respect for diversity. I declare an interest as a happy humanist and should say how impressed I am by the British Humanist Association’s spirited stance in support of those who profess no religion but who certainly have moral codes. I wish that the BBC would recognise the strength of the arguments and the need to recognise the varying forms of individual and collective morality.
Humanism is growing in strength. It has growing public recognition in non-religious ceremonies such as marriages, funerals and baptisms. This has made significant contributions to public policy. The moral values held by humanists are weighed and considered. Humanism is a philosophy in its own right and is not a negative response to religion. The BBC needs in its programmes to give a perspective from the non-religious viewpoint. It needs to embrace debate on morality and ethics as expressed by humanists as well as by religious faiths, otherwise it is being unequal and one-sided. I think that the last programmes on humanism on broadcast media were in 1965, yet the Human Rights Act 1998 and European equality and anti-discrimination law give religious and non-religious beliefs such as humanism equivalent status in law.
The BBC is ignoring the fact that the British Social Attitudes Survey has found that over two-thirds of people—69 per cent—either did not claim membership of a religious organisation or said that they had never attended a religious service. Many only attend religious ceremonies such as weddings, funerals and baptisms. Some 70 per cent of people believe that the Church and the state should be kept separate in modern Europe. More dramatically, 44 per cent say that faith is one of the world’s greatest evils, comparable to the smallpox virus but more difficult to eradicate. Even I would not go as far as that.
Why is the BBC ignoring this diversity of expression and feeling? Is it trying to convert people to religion or to reflect specific moral viewpoints? If so, it should include humanism. The BBC has an important role to play in this. The British Humanist Association evidence to the House of Lords Communications Committee on the duty of public service broadcasting stated that,
“members of society should be able to learn about each other and negotiate the terms on which they share their community”.
Clearly, “Thought for the Day” is an ideal place to allow members of society to experience different moral and ethical standpoints. Humanists, after all, have thoughts. The BBC is being too defensive, is ignoring evidence of society’s diversity and is denying access to a wider range of debate.
I, too, thank the noble Lord, Lord Harrison, for introducing this debate, which gives us an opportunity to reflect on a number of issues concerning religion, diversity, humanism and public service broadcasting. I also declare an interest as a happy humanist, as the British Humanist Association would have it. It is worth pointing out that this subject has not just popped up in the early 21st century. In 1955, psychologist, broadcaster and humanist Margaret Knight courted controversy by suggesting in two talks on the BBC’s Home Service, as was, that moral education should not be inextricably linked to religious education. The need that she felt to make it clear that moral and ethical values are not the preserve of the devout is, sadly, still with us today.
I want to raise just three main points. First, I suggest that we are rather vague and inconsistent when we are discussing humanism and religion. Just as atheism and agnosticism are often confused, so the terms atheism and humanism seem to be used interchangeably. As the noble Lord, Lord Harrison, said, “secular” seems to have accumulated such a general meaning that the BBC, anxious to defend the paucity of humanist or non-religious programming, puts sport, weather and news in that category. This bundle of disparate concepts is then set up as being inherently, irrevocably and sometimes violently in opposition to religion. I do not see that as a helpful or a productive view.
I wonder whether fear discourages the BBC from doing more to serve the needs of humanists and the wider public who might like to know more about humanism. I really cannot see why that should be the case unless there is a religious lobby in the UK as hypersensitive and anti-intellectual as in the US, where one programme provoked an avalanche of vitriol simply because it discussed atheism. Although some high profile commentators such as Richard Dawkins have attacked religion in all its guises, not all atheists or humanists take such assaults to be the foundation of humanist thoughts and values. Where exactly are our voices explicitly heard?
My second point concerns what we are looking for. I would not want humanism to be exclusively confined in a category “religion”, a genre of programmes with declining audiences and unimaginative approaches to questions of morality and ethics. Thinking about this issue within the framework of diversity makes me think that although it may be a tactical coup for humanism to be included on “Thought for the Day”, it does not amount to a strategic win. We should continue to look at bolder, more innovative ways of disseminating ideas and generating debate. With all the different modes of technology-based communication available to us, noting how many communities are deserting the main television channels and recognising that conventional modes of viewing on television at fixed times, et cetera, are rapidly being supplanted, we could do more to be much more innovative ourselves in reaching a wider audience. Humanists need to engage with young people and groups with similar values— for example, the British Muslims for Secular Democracy, which is made up of Muslim democrats from diverse ethnic and social backgrounds and supports a clear separation between religion and the state.
Thirdly, from a reading of Mark Thompson’s speech last year, “Faith and the Media”, which was given at the Cardinal Cormac Murphy-O’Connor lecture series, a number of points seemed to be quite contradictory. I guess that I would sum it up by saying that, although his examples of exemplary programming came from the religious and ethics department, almost every example was related to Christianity and not even across other religions. They were about nativity, the daily service, et cetera. Although he spoke of,
“how limitlessly diverse and complex, how imperfect the world is that we broadcast to”,
the idea of complexity and diversity was not borne out in his speech. All I would ask is that we see a much broader representation of that complexity and diversity from the BBC.
My Lords, I am grateful as a happy Christian to be given this opportunity to find myself surrounded by so many happy humanists and I hope that happiness will prevail. I have three minutes, which is about the time a “Thought for the Day” script takes to read, so I shall limit myself to saying that I am a Christian, will speak as a Christian and will speak about “Thought for the Day”. First, I need to say that I simply do not understand my religious faith as being determined by dogma and indoctrination. I do not understand my religion to be rigid and I do not understand Richard Dawkins to be possessed of particularly great courage, since as the professor for the public understanding of science, he has resorted again and again to so much evidence of lack of the use of scientific method in the way that he has pilloried—yes, pilloried—religion.
I wish British humanists all the best in developing programme content and satisfying their desires to contribute more widely to the output of the BBC.
I want to make one point on “Thought for the Day”. As a contributor to “Thought for the Day” for 17 years, I honestly believe that I could deposit the 198 scripts which I have written for the programme in front of everyone in this Grand Committee and that noble Lords would not find one single occasion when I took a swipe at anyone who did not believe. If I could have the same assurance that British humanists using the same slot would not take a swipe at people who did believe—there has been a little bit of evidence of that in the contributions made thus far—then it would seem to me that their place in the slot would be perfectly justified and justifiable.
I have taken from the website of the British Humanist Association its vision:
“A world without … discrimination, where people are free to live good lives on the basis of reason, experience and shared human values”.
I would say “Amen” to that if it would not cause them offence. Its mission is stated as:
“The British Humanist Association exists to promote Humanism and support and represent people who seek to live good lives”.
I say “Amen” to that. The trouble is that in each case I have left out a phrase. The vision actually says:
“A world without religious privilege or discrimination”,
and its mission includes the words,
“who seek to live good lives without religious or superstitious beliefs”.
I wish to see people live good lives whether or not they have religious beliefs. I wish to see a world without discrimination and I want to encourage people of varying beliefs, whether in the transcendental or not. I submit my little case here and I encourage British humanists to be a little more generous and a little less sectarian in the way they view religion.
My Lords, I, too, welcome the opportunity for this debate and I thank the noble Lord, Lord Harrison, for introducing it.
It was the late Gerald Priestland, the former religious affairs correspondent of the BBC, who, some 25 years ago, was asked why the BBC had religious viewpoints only on “Thought for the Day”, and why the BBC did not provide atheists and humanists with their own slot. Priestland, in his own inimitable way, replied: “Actually we do. We call them news bulletins”. I guess one had to be there to know whether that was humorous or not. I have had the privilege of debating with Richard Dawkins on television and hearing him say on the same programme, “But I’m a cultural Anglican”. So there is an interesting observation to be made here.
Today, I speak as someone who has not been asked to contribute to “Thought for the Day”, unlike my illustrious predecessor, the late Jim Thompson, whose contributions to the programme were perhaps most notably marked by his “Thought for the Day” following the 9/11 attacks in 2001. Neither do I speak as someone who needs to defend the programme from humanist or secular thought. That is a little like St. Irenaeus who, when asked whether he would defend the Bible, replied, “Defend the Bible. I would rather defend a lion”.
Paradoxically perhaps, I welcome debate and critique of faith, particularly my own, in order that it may be lived more appropriately to the precepts of its founder. I agree with much of what humanists have to say about the worth and dignity of human life and with Andrew Copson's article in last Saturday's Guardian on John Stuart Mill in which he enunciated those very values of,
“worth and dignity of human life—vital principles for modern humanists—stimulated him in social action, opposition to slavery, and a commendably anachronistic appetite for gender equality”.
I agree too with Copson when he observes that,
“the political principles he”—
that is Mill—
“evolved are ones that can be shared today by people of any religion as much as by humanists”.
I believe that there are places where the humanist secular voice can be heard in programmes made by the religion and ethics department, and I offer the “Moral Maze” and the Sunday programme as examples. Like the noble Lord, Lord Harrison, I would welcome the opportunity for something more imaginative in general debate between religious people and people who do not base their faith in humanity on a religious tradition. The difficulty about “Thought for the Day” is that it is defined by the BBC as providing,
“a unique reflection from a faith perspective on topical issues and news events. Speakers from across the world's major faiths offer a spiritual insight rooted in the theology of their own tradition. This brief, uninterrupted interlude has the capacity to plant a seed of thought that stays with listeners throughout the day”.
That is the nub of it: it is a distinctive slot where faith perspectives can be given on the day's news. Once that is lost, it loses its role. By their nature, both humanism and secularism are non-religious, and offer a valuable perspective by being so; but not on “Thought for the Day”. It is a bit like the lion lying down with the lamb. The only recorded incident seems to have been on Noah's Ark, and when Noah was asked, “Did it work?”, he replied, “After a fashion, but it took a new lamb each day”.
A recent BBC survey—we are all citing figures—by MORI indicated that 85 per cent of 2,200 people polled identified themselves as having a faith—62 per cent Christian. We can all throw figures at each other. Despite the fact that, as I have said, I would like be there to be wider programmes, I believe that “Thought for the Day” should continue to be as it is defined.
My Lords, I congratulate the noble Lord, Lord Harrison, not only on provoking this extremely interesting debate but on the skill of its timing. Soon after arriving at the BBC, I shared my convictions about “Thought for the Day”, with a wise old BBC stager—and there were a lot of them. I suggested to her that the programme was anomalous for two reasons. First, from a purely broadcasting perspective, it was an earnest sermonette placed bang-slap in the middle of the liveliest and most engaging political bazaar anywhere—the “Today” programme. The transition from one to the other always jarred, and still does. Secondly, the whole notion of imposing established religion in the heart of radio peak time seemed to me out of tune with the growing emergence of a predominately secular society. The wise old stager patiently admonished me. “You have many battles to fight”, she said. “Fight the ones that you can win. This isn’t one of them. You will never prevail against the embedded power of the established churches”. I confess that I accepted her counsel, for she was certainly right at the time. Perhaps one day she will no longer be.
As others have said, of course the BBC must respect, reflect and meet the needs of people of religious conviction and belief, but organised religion does not have a monopoly of the spirit, nor of perspectives on morality and ethics. The BBC must one day soon loosen the stranglehold of the established religious organisations and more fully embrace the humanist movement.
Humanism does not deliver stern principles carved in tablets of stone, nor does it create institutions whose rules must be obeyed. Rather, it is a tradition, a loose network of individuals broadly exercised by questions of the spirit, concerned to optimise the sum total of human happiness here on earth; individuals naturally respectful of others, wedded to rationalism and to scientific rigour, revering all life, unafraid to proclaim and to celebrate the joy of existence and the richness of human expression. I have no doubt that that movement, the humanist movement, is burgeoning.
The BBC has a long history of path-finding—of, for the most part, being ahead of the curve in most realms of human endeavour. It is time for the BBC to sniff the air in matters spiritual and to move ahead of the curve here, too.
My Lords, I, too, congratulate my noble friend on securing this debate. I speak from the perspective of a humanist, happy or otherwise, who has never had any faith-based beliefs. I am a lifelong supporter of a licence-funded BBC, but increasingly a critical friend.
For much of my life I have not been too fussed about people banging on about their religious beliefs, provided I am not expected to listen to them and they are not trying to convert me. However, over the past decade or so, I have detected a greater assertiveness and stridency by the faith-based communities. When there are issues of ethical complexity, I pick up a tone of ethical superiority from their spokespersons. Some of the faiths become campaigning organisations through the media when they detect a threat to their interests. A good example of this was the Catholic Church’s campaign against the Assisted Dying Bill of the noble Lord, Lord Joffe. Of course, the churches are entitled to put their views on these controversial issues, but so are we humanists, and we want our voices to be heard much more. This is particularly so as we live in a largely secular society where the overwhelming majority of people do not worship regularly and many who describe themselves as C of E on a form have weakly-held or no religious views. I consider my views, and those of my fellow humanists, to have the ethical equivalence to those of any bishop, priest or mullah, but they are often given air time to express their views while my fellow humanists are not. That is why I think it is important that public service broadcasters such as the BBC provide a proper opportunity for the alternative to the faith-based viewpoint to be heard regularly. That is the importance of the 2006 agreement. This alternative viewpoint also needs to be heard regularly on prime time and prestige programmes, not just “Thought for the Day” but also TV programmes such as “Question Time” or “Newsnight”. If a political hooligan like Nick Griffin can be given time, then I think that some of the rest of us should be given equivalent time. I would like to see more monitoring of the BBC’s performance in this regard and the provision of much more data on it in the public arena.
I conclude by drawing attention to yesterday’s ruling by Mr Justice Burton in the Employment Appeal Tribunal case involving an environmentalist, Tim Nicholson. The judge said:
“A belief in man-made climate change, and the alleged resulting moral imperatives, is capable, if genuinely held, of being a philosophical belief for the purpose of the 2003 Religion and Belief Regulations”.
This is a major change of ruling by the courts and the BBC might like to ponder that ruling when considering its programming arrangements. I look forward to hearing the Minister’s response.
My Lords, I, too, congratulate my noble friend Lord Harrison on initiating this overdue debate about the BBC’s duty under the Communications Act 2003 to make programmes about religion and “other beliefs”. I declare an interest as chairman of the All-Party Parliamentary Humanist Group, which, as we have heard, is increasingly frustrated at the time being taken by the BBC to put more about those “other beliefs” on screen alongside religion. However, the BBC Trust has now set up a committee to examine the issue further, and the trust chairman, Sir Michael Lyons, promises that the committee,
“won’t just be looking at Thought for the Day: they will be looking at the way the BBC serves the interests of citizens who are humanists, and have no faith”.
So, seven years on from the Communications Act, we can now anticipate that proper coverage of those “other beliefs” will be consolidated on BBC screens in 2010.
I also thank the BBC for setting up a standing conference on religion and belief, on which a humanist now sits alongside a dozen or so other representatives of major religions. The Director-General of the BBC, Mark Thompson, will be an ex officio member of the conference. The other ex officio member will be the new head of BBC religion and ethics, Aaqil Ahmed, and I welcome him to his new post. Mr Ahmed has an impressive record from his years as commissioner for religion and head of multicultural programming at Channel 4. It was therefore disappointing to read that Protestants in Ulster, and even the Church of England, had expressed concerns about the appointment of Mr Ahmed, a Muslim, to his BBC post. I assure those critics that, in my experience, television executives in such roles are professionals who understand concepts of fairness and impartiality and who will spend much of their working lives communicating ideas and information with which they might not agree if that is what public service broadcasting requires. I speak as a non-believer who was responsible as executive producer for factual programming, including religious output, at both Granada and Scottish Television. My humanist friend, the noble Lord, Lord Birt, will no doubt have had the same experience at London Weekend Television and the BBC.
I am sure that the noble Lord, Lord Birt, would also agree that the clerics who sat on our formal ITV religious advisory committees were tolerant, wise and broad-minded in the support that they gave us for producing our religious programmes, which were often rather good. My confession is that we godless producers helped to fill the pews with our electronic proselytising—more than can be said, I suspect, for “Thought for the Day”. With all due respect to the noble Lord, Lord Griffiths of Burry Port, I caution my fellow humanists not to strive too officiously for slots on “Thought for the Day” unless they are convinced that banality is not contagious.
It is worth noting in closing that the BBC’s review of its current religious and ethical output, circulated to noble Lords to inform this debate, suggests that more attention is already being given to other beliefs. I look forward to auditing the BBC’s output in the year ahead and revisiting this important issue with noble Lords in a future debate.
My Lords, I have always been struck by the incongruity of “Thought for the Day”, which offers the religious an unopposed platform, being inserted into the middle of a flagship current affairs programme—an invitation that the BBC would never extend to the non-religious. The result is that some in today’s society get the opportunity to express their views while others are denied the opportunity.
A letter dated 21 June 2009 from BBC complaints states that there are about 30 contributors to the 360 thoughts each year. Presumably each contributor gets many opportunities to express their views, but not a single one of these regular contributors appears to be a humanist. We are not even given a ration of one single thought. According to the same letter, these short talks plant a seed of thought and a spark of spiritual insight that stay with listeners during the day. Having heard Bishop Tom Butler’s polemic earlier this year on the assisted dying amendment of the noble and learned Lord, Lord Falconer, and having read the thought of the Chief Rabbi on 12 October 2005 expressing his opposition to assisted dying just before debates in this House on the matter, the seeds of doubt planted in my mind were not exactly spiritual. I wondered how the BBC could allow “Thought for the Day” to become a political platform for a self-proclaimed campaign by the churches to oppose any legislation on assisted dying, without allowing at least one slot on “Thought for the Day” for proponents of such legislation. If there is to be a “Thought for the Day”, it would be better sited in one of the BBC’s religious programmes, of which there are an abundance, where it would doubtless be of great interest to what is probably a relatively small and declining percentage of listeners, particularly compared to the audience of the excellent “Today”.
I do not for a moment accuse the BBC of being deliberately partial. The issues to which I have referred are probably the result of 40 years of “Thought for the Day”. The BBC may have lost sight of the world having changed. In conclusion, I say to the noble Lord, Lord Griffiths, that I am a great admirer of most of the work of the church and would respectfully suggest a more open-minded and less rigid approach to some of the controversial issues of the day, such as homosexuality, women’s rights and assisted dying.
If we must have “Thought for the Day”, it should not necessarily be any old thought. Perhaps a good slot would be a discussion of one of the moral issues of the day. In its present form, it seems to be assumed by the BBC that it must be a god slot, reflecting what many churchmen tell us on “Thought for the Day”, that only belief in God provides a basis for morality. This argument does not stand up.
Different gods promote very different moral values. The Greek gods were not exactly moral role models, but on the other hand they were interesting and sometimes fun, and did not encourage or command their worshippers to proselytise. The Old Testament Jehovah is a very unpleasant, tyrannical and cruel god. Judeo-Christian and Muslim gods have at different times commanded their followers to massacre Midianites and abduct their women, stone prostitutes and adulteresses, and slay heretics and infidels. At other times they have inspired their followers to shoot up abortion clinics, hunt down Salman Rushdie and crash aeroplanes into skyscrapers.
Christians, who take their inspiration from the Sermon on the Mount, a splendid moral text, do not acknowledge a god who issues such commandments. The god they worship is a god of love. Likewise, moderate Muslims disown passages of the Koran that incite people to murder or commit cruel acts, and tell us that his commands have been misconstrued because the true Allah is a merciful, tolerant and humane god. What both are saying is that to be a proper god, to qualify as the god they worship, he—there is no question of she—must be a god who cannot require worshippers to commit evil acts. There is therefore a standard of goodness by which God is judged. The Old Testament god, Jehovah, fails the test and is not the true god. The New Testament God, the father of Jesus and Jesus himself, passes the test.
Believers apply a standard of goodness independent of God. You do not obey or worship God just because he is God or is a god of authority, but because in your view he is good, and if he was not, you would not. It follows inexorably that there is no need for God as a basis for morality and we can leave him out of it. It also follows that humanists, who do not believe in a god, have as much right to have a say in a slot about morality as believers.
I, too, thank the noble Lord, Lord Harrison, for introducing this debate. I must declare interests within the Church of England as a patron of livings, a practising member of the Church of England, a member of parochial church councils and president of the Norfolk branch of the Prayer Book Society. I am sorry that took so long. The agreement of July 2006 requires the promotion of different cultures and viewpoints. Does this mean that humanism should be included within what is essentially a religious programme? It is hard to think that a creed, however laudable and much admired, as is humanism, but which has no belief in any god, is a religion.
When it comes to philosophical beliefs, one wonders not only whether the BBC is aware of humanism but whether it is aware of any secular philosophy outside the boringly and so depressingly unoriginal over-favouring of the so-called progressive family of Marxism, socialism and liberalism. If humanists feel that they do not get a fair look-in, they should talk to ordinary conservatives who sense an institutional prejudice against non-liberal, non-collective viewpoints. The article by Mr Charles Moore in yesterday’s Daily Telegraph about BBC commissioning editors’ assumptions about the nature of British history is a striking example.
However, it must be difficult for the trust to know where to draw the line when faced with demands to promote different viewpoints. There must be a very large number of different philosophies in this country, so I imagine it would be impossible to pay attention to every single one. Certainly, it would be difficult to include all philosophies within one programme such as “Thought for the Day”. It is an extraordinarily difficult task. For an organisation that has so lost its way that it can defend leaving offensive and obscene telephone messages, at the same time as condemning remarks made in private and pulling a programme because of a remark about biscuits, it must be well nigh impossible.
I hope that the BBC listens to what humanists are saying and does so with respect, but I hope it also understands the frustrations of millions who embrace the humane philosophy of conservatism, the values of which are so rarely voiced in an objective and balanced manner.
My Lords, only a parliamentary genius could have so constrained the debate that everyone’s contribution was in the three-minute slot of “Thought for the Day” perfection. In some respects, on all sides of the argument, the expertise with which the contributions have been made fitted exactly that slot. I want to emphasise that it is only in the House of Lords that one can be questioned at 2.30 pm by a bishop about how to look after flocks of sheep and at 7.30 pm reply to a debate on humanism, the BBC and the Government’s role.
I hope that it will be appreciated that I have difficulties in responding to this debate in the obvious sense. It has been a fascinating debate and I am not sure that it would not have sufficed to be produced as a one-hour programme for the BBC to consider all aspects and viewpoints of religion and humanism. But the real issue is where the Government stand in relation to this. The only reason I am responding is because I am speaking on behalf of the Government, who scarcely got a mention in the whole debate. The BBC certainly has been harangued, harassed and challenged, but very little has been said about the Government for the very good and obvious reason that the Government’s locus in this debate is very marginal. Of course, the Government set up the framework of the charter of the BBC by an Act of Parliament, which was debated and produced only a few short years ago, but the Government are concerned that the charter, which is set out in legislation, clearly stresses the most important feature of the British Broadcasting Corporation; namely, that it is independent of government. That is its glory and its role.
Within that framework, if this debate is to indicate that the Government should take a perspective on how “Thought for the Day” or other programmes should be presented by the BBC, I want to emphasise that the Government have no locus at all. It is the case that the BBC has answerability. I congratulate my noble friend Lord Harrison on taking this opportunity to identify an important matter for the BBC to consider. I also reassure my noble friend that he could not have been more timely in setting the debate for this day. “Thought for the Day” is the subject of a complaint that is going before the BBC Trust. “Complaint” is an odd concept, because when it becomes an item on the BBC Trust’s agenda it is rather more an appeal than a complaint. The trust is deliberating on this matter tomorrow, hence the great timeliness of this debate. All members of the trust have an obligation to be well informed about the nation and its views, and take great steps to be so.
I have a list of the BBC’s activities to analyse the views of the nation on issues such as this. The charter certainly confirms that it is the trust’s responsibility to assess the performance of the BBC executive in this area by conducting investigations, where appropriate, into any BBC activity. Of course the trust would say that it holds consultations and has audience councils where licence-fee payers can present their position on the BBC. There are also research projects through which the BBC analyses public opinion and seeks responses to its progress. The trust is active, but it is responsible for safeguarding the independence of the BBC. The BBC executive is responsible for discharging its functions under the charter.
I shall comment from the Government’s point of view on humanism and “Thought for the Day”. It is not the Government’s responsibility to make any diktat on programmes. The BBC certainly has an obligation to listen, so I would be more than a little surprised if members of the trust did not listen carefully to this debate, which would help their deliberations tomorrow. I emphasise the obvious point that this has been an extremely valuable and interesting debate. Indeed, this House prides itself on its ability to raise issues that it is often infinitely more difficult to raise at the other end of the building, if only because religious and humanist beliefs can from time to time raise passions and produce stances that, for elected Members of Parliament, can be difficult.
We delight in the fact that we are a little remote from the immediate political battle, and have had contributions tonight from Members of this House with a very wide range of experience of these important issues and whose opinions and perspectives are greatly valued. That is the great advantage of the debate. I hope that all participants will appreciate that in my winding-up speech on this occasion, reluctant as I am ever to seek to absolve myself of full responsibility, I have to say that the Government’s position is extremely limited. I do, however, hope that the BBC has been listening.
Committee adjourned at 7.44 pm.