Monday, 8 December 2014.
Arrangement of Business
My Lords, it is now 3.30 pm. As is the wont on these occasions, I have to advise the Grand Committee that in the—I think unlikely—event of there being a Division in the House, the Committee will adjourn for 10 minutes.
Sudan and South Sudan
Question for Short Debate
My Lords, I warmly welcome the Minister and thank all colleagues for joining this debate. I have chosen the anniversary of the fateful coup in South Sudan last December as a reminder of the continuing conflict in the north and the south.
I start with a brief interview with a woman from Upper Nile called Nyantay, who went blind at the time of South Sudan’s referendum and then became a refugee. Nyantay, a mother of four, fled from gunfire in her village but then found herself alone. “I just kept running”, she said. She fell into holes, ran into trees and suffered from heat exhaustion. At one point she sat down expecting death. She went on, “I thought, if the animals eat me, that’s fine. If the soldiers kill me, that’s fine. I no longer felt fear”. Luckily, she was found and taken across the border into Ethiopia and later reunited with her family, whom she had presumed had died.
Nyantay has survived but many thousands have not. At least 10,000 have died in the south—perhaps twice that number. Nearly 2 million have fled from their homes; half of them are in neighbouring countries. Ethiopia now has the largest refugee population in Africa. Some 100,000 are in UN camps in the south but many of them still live in fear for their lives, the Nuer from Salva Kiir’s SPLA and the Dinka from Riek Machar’s opposition SPLA 1.0. There have been terrible massacres on both sides. With the onset of the dry season, fighting will resume and further genocide may be around the corner. One-third of children are acutely malnourished and literacy levels for women remain among the lowest anywhere.
South Sudan is now a level 3 crisis, which is the highest UN category. The figures from UNOCHA’s situation reports are staggering: 618,000 are displaced in Jonglei state alone. Can we even imagine the challenge this presents to aid workers? Nyantay, the blind refugee, nearly gave up hope and, as onlookers, we, too, at times feel helpless and hopeless. So long as the warring parties fail to agree, South Sudan—the world’s youngest country—will remain in a state of chaos.
We may ask why we should care. We should care because people are suffering; because we may have friends living or working there; because any failed state threatens its neighbours; because we, as a country, have a historic commitment, not least as one of the troika who have been continually present at the talks in Addis; and because if we do not end the conflict in South Sudan, more refugees will come to Britain.
If we do help, will aid through the Government reach the people, considering that oil revenues have gone direct to the SPLA and South Sudan is near the top of the corruption list? Did not the World Bank health programme seize up altogether so that NGOs had to take over? Is this not a reason for some to argue that we should reduce our aid budget, or will the Minister confirm my view, which is that through the UN, aid agencies and NGOs, we can and do help effectively if we apply strict conditionality? In principle, humanitarian aid is given safe passage by both sides but there are many obstacles and restrictions, especially on foreign aid workers. The UN doctrine of responsibility to protect is the hardest to apply in such conditions.
I do not want to imply that South Sudan is not functioning, because it has a professional elite and a vigorous civil society—and not only in Juba—with many NGOs and heroic individuals providing essential services where the Government have failed. I remember them from my last visit. For the moment, famine has been averted. Although the UN mission is constantly harassed by the Government, the ICRC is now active again. The British Council has stayed open for most of the conflict. Ministers and celebrities such as David Miliband are also constantly visiting. There is a Jamaican singer in town this week. The churches are preaching reconciliation and, despite widespread unemployment, people are getting by. So I ask the Minister: what part has the UK played in the recent Addis negotiations, and to what does she attribute their failure? Does membership of the troika give the UK a particular advantage? Can the Ugandan army remain on one side of the conflict when IGAD, the regional authority, is promoting dialogue?
In Sudan itself, while there is a so-called national dialogue at the political level, whole areas of the country are still cut off by civil war. The UN say that 6.9 million are in need of humanitarian assistance across the north. Over half of these are in Darfur, with 431,000 displaced up to November of this year alone. Peace negotiations with the JEM and SLM factions in Doha, and more recently in Addis under Thabo Mbeki, have stalled yet again. One can sympathise with the writer who said that Addis is just a paid holiday for wealthy male negotiators in large cars who bring home nothing for anyone else.
Meanwhile UNAMID, the UN mission, has been severely criticised by NGOs and others for inaction and providing too little security. The noble Lord, Lord Avebury, can testify that it was slow to respond to allegations of rape of 200 women and girls by Sudanese soldiers. Lubna Hussein, the human rights activist, says the UK should stop funding UNAMID, as it may be causing more harm than good. DfID has turned lately more to WFP and the other humanitarian agencies. In any case, UN peacekeepers have been progressively opposed and are now reduced in numbers by Khartoum. South Kordofan and Blue Nile are the other two provinces most affected, with civilians now caught between two wars, with the overspill from the southern conflict, and continuing hostilities between north and south. Um Dorein county has suffered renewed aerial bombardment since October. Other counties see regular overflying and troop movements. Only last week, Antonovs dropped 32 bombs in six different locations. The two areas have also suffered heavy rainfall, although it is said that SPLA-controlled counties are less affected by flooding and damage to crops. However, food insecurity has raised market prices in general, and there has been a higher incidence of malaria and malnutrition.
In Abyei, since the murder of the Ngok Dinka chief in May last year by a member of the Misseriya tribe, there has been no progress in negotiations. The town is scarcely functioning, even with the presence of peacekeepers, and the hospital is short of drugs. The national dialogue, which has offered some hope to reformers, has stalled again, with Khartoum resiling from AU-backed agreement, and Islamist rhetoric taking over from serious commitment on the part of the National Congress Party. The landmarks this year have been the Paris declaration in August which brought together the Umma party and the Sudanese Revolutionary Front; the Addis Ababa agreement in September, which included members of the Government’s dialogue mechanism; and valiant attempts by the AU Peace and Security Council to bring parties to all the conflicts together. Some of us had a positive glimpse of this dialogue when Sadiq al-Mahdi came to address our All-Party Group on Sudan and South Sudan, although it is hard even for a seasoned politician to hold the line between so many power blocs.
Two points emerge. First, we should not—in our natural concern in the UK for the Christian south—be diverted from the necessity of a political solution in the north, intractable as it is. We must give the strongest support to the AU high-level panel and IGAD forums. Taking account of Sudan’s oil revenue, there needs to be a concerted international effort on the scale of the peace agreement between north and south, which, in spite of its many failures, at least led to South Sudan’s independence.
Secondly, Khartoum seems to be reverting to its old habit of suppressing legitimate opinion in the media and civil society, and there our embassy and the NGOs must be especially watchful. There have been some alarming attacks on universities and discrimination against Christians in Khartoum, including the partial demolition of a church last week.
What is HMG’s response to the Government’s attempts—and, more recently, their failure—to achieve greater openness to dialogue? How do they judge the performance of the UN mission in Darfur and the security of aid workers? Can our Government, as a major contributor to the UN’s Common Humanitarian Fund, match their generosity with more diplomatic effort and results? Finally, will they give an assurance that the Sudan unit in the FCO will survive the cuts and be strengthened, if necessary, to inform and advise diplomats, politicians and civil society? Does the Minister share my regret that the position of EU special representative was combined with that for the Horn of Africa?
We should remember that ECHO, the EU’s humanitarian agency, has warned of famine in the south. I end with the words of the new Commissioner, Kristalina Georgieva:
“Aid operations will remain inadequate as long as the conflict continues. It is the responsibility of the political leadership of South Sudan to end the unnecessary suffering of its people”.
My Lords, my noble friend Lord Sandwich has a long-standing and consistent interest in the people of Sudan, and we are all indebted to him for instigating today’s debate. When the noble Baroness, Lady Anelay, comes to reply, I hope that that she will share whatever information she has about the continuing humanitarian crisis in Blue Nile and South Kordofan states—which my noble friend talked about—about Khartoum’s refusal to allow charities and NGOs into the area, and about the regime’s aerial bombardment of civilian populations.
Endorsing what my noble friend just said, the South Kordofan and Blue Nile Coordination Unit told me that, last month, a total of 28 Antonov bombing raids dropped more than 130 bombs on 20 different villages. Can the Minister tell us when we last raised what Dr Mukesh Kapila CBE, a former senior British official and former United Nations resident and humanitarian co-ordinator for Sudan, described at a meeting held in Parliament as,
“the second genocide of the twenty first century … unfolding in South Kordofan”?
The first was in Darfur, and the perpetrators in South Kordofan are the same indicted war criminals and fugitives from justice.
I will use my short time today to concentrate my remarks on Darfur, where up to 300,000 people have been killed and 2 million people displaced. A further 300,000 people have been displaced this year. Darfur is a region where governance as a civil concept has collapsed, law and order are a distant memory and the social fabric has been left in tatters. The current policy responses, including UNAMID, the Doha Document for Peace in Darfur that was finalised in 2011, and the government-led national dialogue, are all wholly inadequate to address the national political and the local social and economic drivers and consequences of the crisis. Are the objectives of the DDPD now being reviewed?
In its paper, Darfur 2014: Time to Reframe the Narrative, the Sudan Democracy First Group says:
“The relevance and performance of UNAMID continues to be severely questioned by many observers. Recent events and revelations have not only shown that UNAMID is unable to undertake its mandate to protect civilians and provide protection for humanitarian actors, but it has become complicit in undermining these goals”.
Following my visit to Darfur in 2004, I welcomed the UN Security Council’s decision to send a peacekeeping force with a Chapter VII mandate to protect civilians. However, peacekeepers were only part of what was required: it was also crucial for the international community, and the UN in particular, to hold Sudan accountable for the continuing aerial and ground attacks against civilians by its armed forces and their proxies. UN Security Council resolutions imposed targeted smart sanctions on the architects of the ethnic cleansing. They should have been enforced but they were not, sending Khartoum a signal that there was little political will to hold it to its commitments under international law. Little wonder, then, that Darfur has happened all over again in South Kordofan. That failure meant that there was no peace to keep, and it soon became apparent that UNAMID was not fit for purpose, despite its annual £1.29 billion cost.
There is a wealth of anecdotal evidence that UNAMID has repeatedly failed to properly investigate alleged attacks on Darfur civilians, and that it has been systematically impeded and intimidated by Sudanese security services and the Sudanese authorities, in direct contravention of the 2008 status of forces agreement signed by the Khartoum Government.
Those concerns, expressed by local people and international NGOs, have been reinforced by the testimony of former UNAMID spokesperson Aicha Elbasri. The events on the night of 31 October in Tabit, in which 200 girls and women were allegedly raped—and which I have raised in questions and correspondence with the noble Baroness—are only the latest incident in which UNAMID has failed the people of Darfur. When UNAMID personnel finally went to Tabit to investigate, they allowed Sudanese security services not only to accompany them but to film, and therefore intimidate, the local witnesses to whom they spoke.
Following Aicha Elbasri’s allegations, the UN Secretary-General set up an internal review of UNAMID—the Cooper review. However, the Security Council has not been given the full Cooper review team report, and the Secretary-General gave an incomplete summary of its contents to the Security Council. This only adds to the sense that fundamental problems at UNAMID are not being addressed as they should be by either the Department of Peacekeeping Operations or the UN Secretary-General. I hope that the noble Baroness can tell us what we are going to do to insist on transparency and accountability
As a permanent member of the Security Council, and as a general contributor to the peacekeeping operations, the UK must hold Hervé Ladsous, the head of the UN’s peacekeeping operations, accountable for UNAMID’s lamentable performance. There must be an independent external evaluation that examines Aicha Elbasri’s accusations and Ladsous’s appeasement of senior Sudanese officials. Moreover, lessons learnt must be applied to other vastly expensive peacekeeping operations, because this is hardly the first time that civilians have been badly let down by those who were ostensibly protecting them.
Dag Hammarskjöld, one of the great Secretaries-General of the United Nations, once said:
“We should … recognize the United Nations for what it is—an admittedly imperfect but indispensable instrument of nations working for a peaceful evolution towards a more just and secure order”.
He also said:
“The UN wasn’t created to take mankind into paradise, but rather, to save humanity from hell”.
What has happened in Darfur—and most recently in Tabit—does not reveal an imperfect organisation creating a more just and secure order, nor has it saved the people from the hell which Khartoum has imposed. It is our duty to say so.
My Lords, I, too, must congratulate the noble Earl on securing this short debate to question the Government on whether they are taking the lead in the response to the conflicts in Sudan and South Sudan.
It is hard to believe that more than three years have passed since I travelled with the noble Earl as part of a parliamentary delegation to Juba in Southern Sudan, as it then was, and then to Khartoum in the north. In the south there was great excitement over the referendum on the creation of a new and independent South Sudan and the prospect of self-determination. Meetings with President-elect Salva Kiir and his team of Ministers were full of promise and reasonableness, of welcoming the expertise of aid and development NGOs, and of deploying teams of volunteers to train teachers, nurses, technicians and administrators to help rebuild the economy shattered by decades of war.
Less than three years after gaining independence, South Sudan finally degenerated into civil war. Negotiations in Addis Ababa continue in their tortuous fashion, holding out the possibility of a peace agreement but, more likely, a power-sharing arrangement between the warring parties. The danger here is that many in South Sudan would see this as rewarding the aggressors without resolving the underlying issues. Of course, talks continue in Tanzania between the three factions of the governing Sudan People’s Liberation Movement—the SPLM—attempting to overcome the tensions that led to the civil war.
Many commentators take the view that a genuine national reconciliation process will be needed to bring together the different communities set against each other by this conflict. Notwithstanding the tension and outsize egos at the top of the SPLM, there is an ethnic dimension, too. President Salva Kiir is a Dinka, the largest of some 60 ethnic groups in South Sudan, many of whom are his supporters. The rebel leader and previous deputy, Riek Machar is a Nuer, the second largest group, of which many support him. When fighting broke out in December in Juba, hundreds of Nuer were killed on suspicion of loyalty to Machar. This provoked Nuer military units to defect and Machar’s rebels responded with ethnic massacres in Bor, Bentiu, Malakal and elsewhere.
The ethnic power bases of each leader are a significant part of their strength, and many believe the hardest task will not be to stop the fighting but to restore trust between the different communities in South Sudan. Meanwhile, UN Secretary-General Ban Ki-moon has said that the international community has grown impatient with the failure of South Sudan’s leadership to stop the fighting. Last Wednesday, the United States warned South Sudan’s Foreign Minister that UN sanctions could be the punishment for people who stand in the way of peace.
For the past three years, the Government of Sudan have denied international aid organisations and the media access to non-government controlled areas in South Kordofan and Blue Nile states, as the noble Lord, Lord Alton, made clear. According to the US NGO the Enough Project, which campaigns against crimes against humanity:
“Taken together, the desperate situation of the people in rebel controlled areas, the Sudanese Government’s aid blockade, the indiscriminate attacks on civilians, and statements attributed to senior commanders in the government forces, lay the foundation for a case of crimes against humanity”.
While Sudan expert Eric Reeves considers the Government of Sudan’s military campaign,
“unique, presently and historically. Never has a recognized government, and a member of the United Nations, over many years deliberately and extensively bombed, strafed, and rocketed its own citizens—with almost complete impunity”.
The ICC has issued an arrest warrant for Sudan’s President Omar al-Bashir on the charge of genocide, yet he travels without hindrance throughout the region.
The United Kingdom is one of the troika of nations appointed to oversee the comprehensive peace agreement process, yet our observer status apparently carries no enforcement powers. What, therefore, as a permanent member of the Security Council, is the UK doing to deliver on its responsibilities in the humanitarian and diplomatic fields? What measures is it taking within the UN to strengthen sanctions and other measures to tackle impunity, as practised in Sudan? What actions is the UK taking within the UN to hold the UN mission in Darfur to account for the accusations, so graphically described by other Members, of mass rape criminality? What further measures is the UK taking within the FCO to strengthen the UK’s response to the tragedy that is South Sudan and Sudan?
This month, South Sudan marks one year since the return to brutal conflict. The humanitarian impact has been catastrophic, with at least 1.9 million being displaced. The UK Government have responded accordingly, spending more than £143 million on humanitarian relief. However, if short-term relief is to translate into long-term recovery, emergency humanitarian aid must be accompanied by a wider focus on the risks to the development of a fair and democratic state in the long term.
My Lords, I am grateful to my noble friend Lord Sandwich for securing this important debate on one of the most pressing challenges facing Africa. I wish to devote my brief contribution to current challenges in South Sudan.
I met President Salva Kiir just a few weeks ago when I was in Juba on a private visit, and was able to meet several NGOs there. My first impression on landing in Juba—it was my first time there—was that it was as though one were landing at a United Nations military airport, with few domestic airlines. It is indeed tragic that the dreams of peace and prosperity after gaining independence in July 2011 have been shattered through the recent political and ethnic power struggles. The new conflict has reversed so many of the gains achieved post-independence, particularly disrupting health services, access to clean water, sanitation, transport infrastructure and, most importantly, food security.
As my noble friend mentioned, South Sudan is now in a level 3 crisis. The country faces chronic poverty, inequality is a massive problem, and there is a growing threat of famine now that the dry season has started. Almost 2 million people are displaced, with at least 400,000 South Sudanese across the border in Ethiopia and other neighbouring countries. Many of this displaced population are in camps that are largely inaccessible to relief agencies. It is alarming that ethnic tensions and violence have returned to the forefront of intra-South Sudanese relations, with increasing mistrust of their political leadership. There is a strong supposition that both sides have used ethnicity to fuel conflict to stay in power and that the fighting has been more complex than simply Dinkas fighting Nuers. I am in no position to pass judgment, but what appears to be the case is that the military lacks decisive leadership and is deeply divided. To quote a recent Chatham House report:
“South Sudan is not a country with a military. Rather, it is a military with a country”.
Most people in South Sudan either want the security of being left alone to get on with their lives or want the SPLA to deal with threats to local security, which normally stem from outside their immediate community.
One issue that we discussed with President Salva Kiir was that of the borders. Clearly, one of the unresolved issues following the 2005 CPA is the demarcation of the borders, particularly in Abyei, South Kordofan and Blue Nile. The President mentioned that he was seeking to identify the original maps to resolve this dispute.
The dramatic recent drop in oil production revenues over the past few years has also had a catastrophic impact on the economies of both South Sudan and Sudan. As the recent Chatham House report on South Sudan said:
“Politics and development are not alternatives in South Sudan, they are two sides of the same coin … It appears that Western countries, including members of the Troika, do not have a coherent policy towards South Sudan, with strongly worded statements followed up by inaction”.
There is an ever-growing groundswell of support for civil society, more specifically the churches, traditional local authorities, media and other civil society groups. Despite the continued conflict and worsening humanitarian crisis, there are a few positive developments. Since independence, there has been a revision of the national curriculum for all primary and secondary pupils, which has so far been remarkably successful. This has been funded by Global Partnership for Education and supported by DfID. I have the report here, but time restricts me from speaking to it. There is a strong need for a shared vision for South Sudan that unites rather than divides the very diverse society. Most commentators are in agreement that inclusivity is the only way in which to achieve a sustainable peaceful solution. The international community has a pivotally important role to play, but it is clear that there needs to be a more co-ordinated effort. Our Government’s work in South Sudan has made a significant contribution to addressing the MDG challenges, but we need to keep the focus.
My Lords, I, too, congratulate my noble friend Lord Sandwich on holding this debate. In this media-driven world, there is always a risk that the perennial turmoil and conflict in Sudan and South Sudan will be just out of view and that the attention given rightly to Afghanistan, Libya, Syria, ISIS in Iraq and Ebola will keep questions about Sudan and South Sudan just below the media’s—and therefore the public’s—radar screen. At least the Guardian realises that Sudan and South Sudan need the continued attention of the world, Parliament and the Government.
When I was in Juba and elsewhere in South Sudan just before independence, there was a powerful sense of excitement and expectation, as the referendum results and their immediate aftermath showed. However, at that stage, among many external observers and analysts, that sense of expectation was more than tinged with concern about the prospects for both stability and economic development in South Sudan itself and for relations between Juba and Khartoum. So far, alas, as the noble Earl, Lord Sandwich, said so eloquently, the pessimists have been proved right.
The conflict between Sudan and South Sudan is just the kind of conflict in which well directed external pressure, encouraged by media attention, can make a real difference to both their and our benefit. I very much support the questions raised by the noble Earl, Lord Sandwich, and look forward to the Minister’s replies. I just add one or two points myself.
First, on Darfur, I very much share the views of my noble friend Lord Alton. I well remember, when I was in the Foreign Office, the noble Baroness, Lady Amos, when a Minister there, asking me whether, with all the Foreign Office’s proper focus on relations between Khartoum and Juba, the north and the south, we risked forgetting about the humanitarian disaster then under way in Darfur. That was indeed one reason why a joint Foreign Office-DfID Sudan unit was established, and I am delighted that it is continuing and has been strengthened since then. Can the Minister assure us that Darfur continues to get to the attention that it needs at a time when, once again, focus is rightly on relations between Khartoum and Juba?
Secondly, there is the role of the European Union. Again, when in Juba, I was impressed by the European Union’s aid effort in South Sudan, which I am sure is continuing, although no doubt adversely affected by the continuing conflict. Can the Minister assure us that the US-UK-Norway troika is working closely with the European Union and that the United Kingdom is, in the jargon, leveraging its position as the only country present in both the troika and the EU?
Thirdly, there is the role of China. China has for some years now had a close relationship with Khartoum. It also has substantial interests in the south, in particular with its investment in the oilfields. It is striking that it has recently agreed to contribute to the peacekeeping forces in the UN mission to South Sudan—deficient though those forces are in many ways. China has traditionally tried to see its economic interests in the developing world as separate from the politics of individual countries and tried to avoid involvement in those politics, but China’s influence in both the north and the south mean that it can be a major player in working for longer-term peace and security interests with both Khartoum and Juba. Finally, what are the troika and the EU doing to work with China in a truly international effort to end conflict in the region?
My Lords, I very much support the noble Earl and all Peers who have spoken today, who have persistently, over the years, drawn attention to the atrocities that have been committed in Sudan, from Darfur to Blue Nile province, and from Kordofan to the south, and to the humanitarian crises which face both Sudan and South Sudan.
I am probably the least expert of all Peers who will have spoken today, but on the other hand, my link goes back to the late 1940s—55 years ago when, as a child, I watched my father contribute alongside other administrators in Sudan to the move towards independence, which took place on 1 January 1956. I had very clear impressions in my mind as a teenager of the beginning of the development of institutions such as the parliament in Sudan, which I remember attending, the judiciary as it developed and the very strong administrative system and civil service. In the south, when I visited Equatoria Province in 1950, I remember the relative peace between the various Nilotic tribes but there was a very separate administration between the north and the south. At one time, the British contemplated linking South Sudan, as it now is, to east Africa in the form of a federation. That was an historic decision, which I will not comment on now, but it probably would have had profound consequences because they decided not to do so.
Since the first rebellion took place in the south in August 1955, the people of the south have lived in almost perpetual conflict. Noble Lords have demonstrated that with all the statistics they have given today—the displaced people, the deaths, the hunger and starvation, the violence, and the refugees, from Darfur to Kordofan to the south. It is simply a total tragedy. I have often thought about what our attitude should be once a country has been granted independence from our former Empire, and as far as Sudan is concerned— South Sudan above all—I have no doubt that after 60 years of colonial rule we have a moral responsibility to do our best to help the African Union and east African nations do their best for Sudan.
As far as Sudan is concerned, I want to endorse and reinforce the words of the noble Earl that there needs to be a genuine dialogue if the international world is going to recognise and support what Sudan says it wants to do. If there is to be a road to peace and unity in Sudan, it has to embrace everybody: it has to be inclusive and comprehensive. Yet the undermining of freedom of expression, the imprisoning of opposition politicians, the detention and torture of activists, press censorship, and continuing violence in Darfur, South Kordofan and Blue Nile do nothing to give one confidence that Sudan is moving in the right direction. All I can say is that I hope the Government are watching and monitoring very carefully and will give support to that dialogue only if it moves forward in a comprehensive and inclusive way.
As far as the south is concerned, it is an untenable position, above all for the long-suffering people of the south but also for the international community, because following the euphoria of independence in 2011 we have had an interminable cycle of failed attempts to end the conflict, with the militias resuming fighting time and again, and human rights abuses and atrocities, with the international community constantly needing to step in with fresh humanitarian support—against compassion fatigue, which is undoubtedly taking place, and other competing demands, from Syria to Somalia to Zimbabwe, for example. The south can be described only as having the makings of a failed state.
The first thing that the people of the south need is the ability to survive—before you can even talk about development or political institutions. To that end, I ask the Government to consider one thing, which is our experience in Sierra Leone, where there was a serious civil war in the 1990s. At that point, the United Nations, with Britain in the lead, took up a UN peacekeeping mission which was mandated by the UN Security Council. Britain led reforming the police force and revamping the country’s courts. In the past decade we have seen one of the fastest rates of development in Africa in Sierra Leone. Yes, it is a new kind of trusteeship, and I ask the Government if we can learn from that experience and see whether this is not the best way in which a new transitional Government—with the help, no doubt, of the diaspora— can hold the ring and give the long-suffering people a chance to move forward and have a decent quality of life.
My Lords, I thank your Lordships for allowing me to make a brief contribution to this important debate. I also express my appreciation to the noble Earl, Lord Sandwich, for instigating this discussion.
My interest is in South Sudan. I am a trustee of AID—Anglican International Development—which manages a number of projects in South Sudan in conjunction with the Episcopal Church of Sudan: in healthcare, microfinance, sanitation, agriculture and, hopefully, education. The disruption in South Sudan caused by the conflict a year ago between Salva Kiir and Riek Machar has been devastating. Following the comprehensive peace agreement and the vote for independence, South Sudan promised so much. The potential is huge, whether in food production or in wealth creation more generally. However, for understandable reasons, inward investment is on hold; many NGOs and companies we wish to work with are not interested, in the current climate, in investing in South Sudan. This is a tragedy for the people of South Sudan.
We have to be realistic and accept that these two egotistical leaders will never reconcile their differences and that neither is now capable of uniting his country. I request of the Minister that we redouble our efforts, through the UN and the African Union, to find a solution. The noble Lord, Lord Chidgey, has suggested a Government of national unity, if that is possible. The current stalemate is destroying the country. If peace were to prevail today, South Sudan would have a massive uphill struggle to address health issues—it is bottom of the international league table in its health status—poverty and its dependency on aid. Without a resolution, these devastating circumstances are going to continue. The people of South Sudan had hope until 12 months ago. That hope has been replaced by despair, and we need to help them re-establish hope in the future of their country.
My Lords, I congratulate the noble Earl on securing this debate and thank the other speakers for their expertise and interest in this subject. We look forward to the Minister summing up and giving us the government position, particularly on the UNAMID question that has been raised by a number of noble Lords.
The people of both South Sudan and the Republic of Sudan continue to suffer in a way and to an extent that is almost incomprehensible to us in the UK and the West. Reports from both countries indicate that the inhabitants of these two states are the victims of practically every kind of outrage known to humankind. This is a story that seems very difficult to stop or to break into, however hard the rest of the world tries. There can be no doubt that the world, whether in the form of the United Nations, the African Union, various NGOs or individual countries, including our own, has employed and continues to employ considerable resources in personnel, advice and finance in an attempt to encourage peace and to get good government—or at least moderate government—in that part of Africa.
From this side, we support Her Majesty’s Government in their aid programmes to both countries. By way of example, as part of the humanitarian response to the rising food crisis in South Sudan, I understand £150 million has already been given. However, there is clearly a need to widen the international effort from other countries. As we have heard, nearly 2 million people have been displaced by a civil war that has already killed a vast number, and now the rainy season is over, hostilities have been resumed. As the Daily Telegraph wrote on 10 November,
“a resumption of hostilities … could tip the country into a full-blown famine”.
The politics of both countries seem cursed. As we have heard, South Sudan’s independence, only a few years ago now, was warmly welcomed by the outside world, but the civil war, now one year old, has changed all that. Attempts at mediation by IGAD, allowing prolonged peace talks, are of course to be praised, but the failure of three or four deals already that were meant to stop the fighting, and the recent putting on hold of a new round of talks in neighbouring Ethiopia are, frankly, not good omens.
The position of the Republic of Sudan today is hardly more promising. As was referred to by the noble Lord, Lord Jay, the Guardian is running a series of articles all week, which is very much to be welcomed. The first is out today and sets out the backdrop to where we are. President Bashir, now 70, having been in power for 25 years, now has an even greater desire to stay there, of course, because five years ago the International Criminal Court issued an arrest warrant so that he might face grave charges, now also including genocide. Of course, any successor might well be tempted to hand him over. The description in the paper this morning is of a pervasive climate of fear and paranoia in Khartoum.
The economy in the Republic of Sudan seems moribund. There is little hard currency because of the loss of a huge amount of oil production to South Sudan. Many teachers and doctors have left in the past few months—the figure of 4,000 is given. There is the new influx of refugees from South Sudan, to add insult to injury. Add to that 40% inflation and the effect of American trade sanctions.
It is disappointing but perhaps inevitable to end by quoting the head of the UN’s Mission in South Sudan, who told the Security Council:
“I have been shocked by the complete disregard for human life”.
That is a suitably depressing note on which to end. I hope the noble Baroness may be able to cheer us up a bit, but I fear that we have to say what we find, and the situation at the moment looks very grim indeed.
My Lords, I add my congratulations to the noble Earl on securing today’s debate at such a timely moment, as he well put it, in the development of the recent conflicts in Sudan and South Sudan. I also take this opportunity to commend the work of the Associate Parliamentary Group for Sudan and South Sudan, of which the noble Earl is an active member—as, of course, are other noble Lords here today.
Peers have practical experience of the problems facing this area, as the noble Lord, Lord Luce, reminded us of his experience. Their work together ensures that parliamentarians on all sides of the House are well informed about developments in the region. It helps to raise awareness of the dire humanitarian situation facing millions of people.
The Government listen, especially my noble friend Mr Duddridge, the Minister with special responsibility for Africa. I have made him my noble friend too soon; he will win his seat at the next election. I meant my honourable friend Mr Duddridge. We would not like him to be translated here just yet.
Today’s debate comes as we approach a grim milestone: one year since the outbreak of the current conflict in South Sudan. It had a devastating impact on ordinary people in a nation that was born amid such hope barely three years before.
The noble Lord, Lord St John, reminded us that he made a recent visit to the area and gave us a description of it. The noble Earl, Lord Sandwich, gave a moving example—the story of Nyantay.
Those are both examples of the background, where there are terrible humanitarian consequences of conflict. In the past year, nearly 2 million people have been displaced from their homes, almost a quarter of them to neighbouring countries. Many remain without any source of food and are dependent on the assistance of the international community, in particular the United Nations.
The conflict has led to appalling violations of human rights, with reports of villages being razed to the ground, with widespread ethnic and sexual violence. Despite the signing of a cessation of hostilities agreement in January, both sides have continued to re-arm, and have yet to demonstrate the leadership, commitment, and urgency needed to end this suffering. It is essential that any agreement brings peace on the ground of South Sudan, and also leads to an inclusive transitional Government.
The UK has demonstrated strong leadership in responding to the crisis throughout this period. At the outbreak of conflict in December 2013, the former Secretary of State for Foreign Affairs, my right honourable friend Mr Hague, and the Secretary of State for International Development, my right honourable friend Ms Greening, immediately called on all parties to lay down their weapons and come to the negotiating table. Our officials have worked tirelessly to press the parties on this. In New York they have worked to strengthen the UN Mission in South Sudan, and in South Sudan itself they have worked to support the safe evacuation of British nationals. The noble Earl, and the noble Lord, Lord Jay, raised the issue of the Sudan unit. To ensure that we had a proper response, extra staff were brought in to strengthen the Sudan unit during that period, but we continue to keep that under review; it is not a one-off. So we will keep our levels of resourcing under regular review to ensure that we respond appropriately to the range of government priority issues in Africa, which must include Sudan and South Sudan at all times. I can say to the noble Lord, Lord Jay, that Darfur gets the attention it needs from us.
Since January, we have been active in supporting the peace process led by the region and the Intergovernmental Authority on Development, through the engagement of our special representatives and with our troika partners in the peace talks. The noble Earl asked about the troika, while the noble Lord, Lord Jay, asked about our engagement with the EU and China. Our troika partners, Norway and the United States, have been deeply involved in the region for a number of years. We work with them in a way that leverages our authority together. That includes our work through the EU. It is used as a strong method for negotiating influence and will, I hope, eventually lead to a successful conclusion. Together, we played a key role in the comprehensive peace agreement that led to South Sudan’s independence in the first instance. So we do have strong links.
The noble Lord, Lord Jay, also asked about China, and our engagement there. China is an increasingly important international actor in both Sudan and South Sudan, and we engage with it diplomatically on a regular basis. In particular, our former special representative and our ambassador in Beijing have discussed the South Sudan peace process with Chinese Special Representative Zhong, and we raise the two countries regularly with China in international fora in New York and in Addis Ababa.
Returning to the peace process itself, the UK has provided expertise and more than £2 million to support both the talks and the monitoring and verification mechanism, to ensure that violations of the ceasefire are investigated, and that those who are responsible are held to account. We continue to champion the need for accountability for all the grave human rights abuses that have been perpetrated by all parties to the conflict. It is important that impunity is not permitted.
My noble friend Lord Chidgey referred to sanctions. The UK was a leading player in pushing for the EU sanctions implemented in July, and we think the time has come for the United Nations Security Council to consider sanctions. As well as leading international efforts to support peace, the UK has also been the second largest contributor to the humanitarian response. I will not repeat information given by noble Lords. In particular I am grateful to the noble Lord, Lord Bach, for pointing out the detail of the contribution that this country, over many years, has provided under different Governments. In particular, the noble Lord, Lord Alton, referred to humanitarian aid. The UK has provided clean water, or improved hygiene and sanitation, to more than 180,000 people in South Sudan, and nutrition for more than 90,000.
Throughout all this, I have taken account of what has been said: severe malnutrition exists. It is something we bear in mind. There is danger to the harvest in this current season, and nobody should relax their attention as to the severe outcome that there may be for those in this whole area in the next spring. However, we think that the Government of South Sudan should do more from their own funds to support their own people. The UK is also a leading donor in neighbouring Sudan. However, I shall not repeat the figures—instead, I shall move over to other matters raised by other noble Lords, because those facts have been put in Hansard during the debate.
To end the humanitarian situation, there has to be an end to Sudan’s internal conflicts. Sadly, this year’s events in Darfur, South Kordofan and Blue Nile, have reminded us of the violence and criminality suffered by the people of Sudan. The noble Lord, Lord Alton, raised Darfur in particular and the violence alleged to have taken place there. I am glad that he put on record the detail of that, although time does not permit me to go into as much detail myself. He reported what is in the media. What I can say is that we are using every opportunity to press the Government of Sudan, through bilateral discussions and through the United Nations Security Council, to end this violence and culture of impunity.
The noble Lord gave the particular example of Tabit, and the noble Earl, Lord Sandwich, referred to this as well. The fact is that we do not know precisely what happened in Tabit. We know why we do not know—because of they way in which soldiers in the Sudan army went in with UNAMID when it was making its inquiries—but we do not know the detail. It is vital that we uncover whether there were indeed such gross violations of human rights and human dignities. If those are uncovered and proved, the perpetrators must be held to account.
The Tabit case is a reminder of the difficult environment in which UNAMID operates. The noble Earl is right to draw attention to that. This makes it especially important that the mission communicates clearly and openly with the UN Security Council and the wider international community, and provides all relevant facts. We recognise the constraints that UNAMID faces and, for that reason, we are strong supporters of the ongoing UN-led strategic review. We are working with the UN, the African Union and international partners to consider what further steps can be taken to increase the mission’s effectiveness, especially in its core function of protecting civilians. To the noble Lord, Lord Alton, I can say that we welcome the fact that the Cooper review was established to investigate reports of past underreporting in UNAMID. We believe that it is essential the United Nations communicates its findings openly and transparently, including through publishing a full report, and we have raised this in the Security Council. It is important that the UN system acts as a result of the report to ensure that in future all relevant facts are reported to the UN Security Council.
The noble Lord, Lord Alton, also drew attention to the ICC. I am grateful to him for what he said about how valuable that organisation is. I am visiting the ICC later this week, and I shall make a statement there. I would be happy to discuss the matter of the ICC further with the noble Lord after I have made that visit.
We certainly support all the efforts in Sudan to achieve a full resolution. A national dialogue is crucial. The noble Lord, Lord Luce, is right that the UK, building on its historical ties, should continue to play a leading role in efforts to promote reform in Sudan and bring stability to South Sudan. There is clearly a huge amount yet to be done to bring peace to both countries—and peace also means stability and being able to grow your crops and have a living, not relying on others to feed you and keep you going. It means to have your own dignity and your own country. Ultimately, it is the region and, most importantly, leaders in Sudan and South Sudan who must take the initiative. But we, along with our partners in the international community, will not give up our support.
Question for Short Debate
To ask Her Majesty’s Government what plans they have to work with global stakeholders to address investment in research and development in global health, and particularly to support the development of new tools and treatments for tuberculosis.
My Lords, an estimated 13.7 million people die every year from or in connection with a group of diseases known as “poverty-related and neglected diseases”. These include TB, HIV, malaria, dengue fever, yellow fever and many others.
Research and development is expensive. Some estimates claim that developing a new drug through commercial routes can cost £1 billion. Naturally, pharmaceutical companies therefore invest in developing products where there is a potential to see a significant financial return to pay for the original development costs and, ultimately, to make a profit. Because the diseases that I have mentioned primarily affect poor people, there is no financial market to incentivise commercial sector pharmaceutical development and accordingly very few new products are developed.
Where there is an affluent market, as is the case with adult HIV drugs, we can see significant private investment. In comparison, there are very few formulations of paediatric HIV drugs, where the market is smaller and more heavily based in developing countries. There is therefore a market failure in developing drugs, diagnostics and vaccines for diseases that impact predominantly on low-income and middle-income countries. This market failure is similar to the failure of the commercial sector to develop new antibiotics—again because there is insufficient financial return on offer for such products.
In the absence of the commercial sector, public and philanthropic organisations attempt to fill the gap, but progress is slow. The purpose of today’s debate is to highlight that there are significant improvements to be made in co-ordination, the level of financing and the policies of public sector donors. In 2002, DfID launched the Commission on Intellectual Property Rights, which looked at the impact of intellectual property on development policy. In a landmark document, it recommended that Governments should invest more to explore the impact of IP on development. DfID supported this recommendation by sponsoring the establishment in 2003 of the World Health Organization’s Commission on Intellectual Property Rights, Innovation and Public Health, which paved the way for global reform efforts.
However, those efforts have since stalled and significant controversy remains over the role of IP within global health research and development, particularly around de-linkage, a term meaning separating the incentive for R&D from the potential financial returns, a point that I made in an Oral Question to the Minister last week, on World AIDS Day. During that exchange, I also mentioned the launch that day of Access Denied, a report by the All-Party Parliamentary Group on HIV and AIDS, which the noble Baroness confirmed that she was attending, and of course I saw her there. In response to questions at the launch about the absence of a formal response from the Government to the report, the Minister promised to share her speech notes with the all-party group so that they could be viewed publicly. Does she still intend to do so? Can she tell me whether her department will be championing within government the recommendation from both the All-Party Parliamentary Group on Global TB and the HIV/AIDS all-party group that the UK commission an economic paper to contrast the total costs of developing and purchasing medical tools using the current R&D model with the costs of a de-linked model?
Global reform efforts have stalled. There is a lack of global consensus around the reforms necessary to drive improved investment in global health and there is a lack of global co-ordination around what is funded. What steps will the Minister take to initiate dialogue between the pharmaceutical industry, civil society and the Government to reach an agreement over a possible R&D treaty in the run-up to the World Health Assembly in 2016?
Product development partnerships, of which I am sure we will hear more in today’s debate, are non-profit organisations which attempt to fill the gaps in global health R&D. They receive public and philanthropic donations, build partnerships with pharmaceutical companies and attempt to develop new drugs, diagnostics and vaccines. Successful examples of these are found in the TB field, with Aeras helping to bring a new vaccine through trials and TB Alliance aiming to bring a new drug regimen to the market. There are many other examples of successful partnerships in the fight against malaria. Again, I am sure that we will hear more of that in this debate. Nevertheless, products from PDPs, despite often being publicly funded, are sometimes protected by patents, which make them more expensive.
On a similar theme, the UN Secretary-General recently stated:
“Public funding often subsidizes private sector research, at times leading to the public being priced out of the benefits through disadvantageous licensing and patent”.
The reports from the all-party groups on HIV and TB—the latter came out last year, which prompted me to table this debate—recommend that DfID should continue to support R&D through product development partnerships. However, both argue for a commitment to open access, generic production and a non-patent-monopoly-based approach. Will the Government commit to reviewing PDP funding with regard to a potential top-up of funding and will they commission a paper examining the impact of open access requirements on products generated with public money? Can the Minister tell me what her department will be doing to address the growing problem in middle-income countries, as highlighted in the Access Denied report, of funding being pulled out from all directions, including from the Global Fund, while the pharmaceutical industry continues to expect such Governments to afford higher prices for ARV treatment?
DfID is one of the world’s leading funders of global health. Its commitment to the Global Fund will save a life every three minutes. Commitments to Gavi could save a life every two minutes. The work of these organisations relies on having appropriate drugs, diagnostics and vaccines to test and treat people. If we are to move beyond investments to control diseases such as TB, HIV and malaria and towards eradication, we desperately need new tools. We will not eliminate HIV unless we have a cure, nor wipe out TB without an effective vaccine.
DfID’s R&D strategy expired at the end of 2013 and has not been replaced. Will the Minister state the UK Government’s long-term strategy to secure the development of the new drugs, diagnostics and vaccines needed to eliminate HIV, TB and malaria? Will the Minister reassess the Government’s decision to cut funding for the development of AIDS vaccines as part of a larger review of the scale of investment that the Government are making to ensure that we have the pipeline of new medical tools that the world so desperately needs?
My Lords, it is a great pleasure to follow the noble Lord, Lord Collins, and to thank him for introducing this debate with great authority and conviction. I shall confine my remarks to tuberculosis.
Historians such as me are under no illusions about the dreadful threat that tuberculosis presents to mankind. Large numbers of people in our country have in the past fallen victim to it. In the 19th century, it was responsible for one in every four deaths in Britain. Our culture has been deeply marked by it. Harrowing accounts of the suffering that it inflicted can be found widely in English literature. It is a significant theme in opera, too, although often in unduly romanticised form.
In human affairs, final victories are hard to achieve over determined enemies of well-being. For a time, we came to believe that Britain had conquered tuberculosis and made it a spectre that belonged firmly in the past, but we now confront this terrible menace once again. Some 9,000 new cases are being diagnosed year by year. The threat to our country’s well-being is heightened by growing resistance to the drugs that are used to treat it. Medical advance is urgently needed to bring new, effective drugs into the service of mankind that can overcome the severe problems created by increasing resistance to the drugs that are currently being prescribed. These drugs were, in most cases, developed decades ago. I understand that only one new drug has been approved by the Food and Drug Administration in the last 50 years.
In Britain, we face a return of an old enemy. The world faces a pandemic. What is happening here surely sharpens our consciousness of the extent of the global threat and of our duty to do all that we can to tackle it, drawing on the highly developed skills and expertise that we possess and pressing for the medical advances on which so much depends. Across the globe, nearly 9 million new cases of tuberculosis occur each year. Well over 1 million people die of tuberculosis annually, part of the estimated 13.7 million who are victims of poverty-related and neglected diseases, to which the noble Lord, Lord Collins, referred. That is why the debate that he has initiated is to be welcomed so greatly. Once again, this afternoon, the noble Lord has demonstrated the deep concern and commitment that he consistently brings to global health issues. I much enjoy working with him on the cross-party basis that is so necessary in this area of policy, which includes combating the prejudice—particularly prejudice against gay people—that sets back progress in too many countries of the world.
Successive Governments in this country deserve the credit that they have been given for the major contributions that they have made to the global campaign to tackle poverty-related and neglected diseases. The significance of our country’s role was underlined in the impressive and authoritative report Dying for a Cure: Research and Development for Global Health, published in July by the All-Party Parliamentary Group on Global Tuberculosis. The report shows that Britain is the world’s second-largest provider of funds for global health research—only the United Sates provides more. The report sums up our record as follows:
“From policies, to levels of funding, to coordination and cooperation, the UK is at the forefront of R&D for global health”.
It is not the least of this Government’s achievements to have kept our country at the forefront of this vital work. The report acknowledges that what the Government have done, and are continuing to do, could have huge implications for global health.
The reason why Britain’s official contribution under successive Governments has been so important, and will remain crucial, has been emphasised by the noble Lord, Lord Collins. Although they often demonstrate deep concern for public welfare, pharmaceutical companies are not charitable undertakings. They invest in developing products where there is a potential for significant financial return, in order to pay for development costs and make a profit. Diseases such as tuberculosis mainly affect poor people, so there is little financial incentive to encourage pharmaceutical investment in research and development, to repeat the point made so effectively by the noble Lord.
It is widely agreed that in this overwhelmingly important sphere of global health the market has failed. The all-party group’s report in July was emphatic. It stated:
“The failure of commercially driven R&D for these diseases is a problem that affects us all”.
Public spending in Britain can help to overcome that failure. The report continues:
“From government departments to academic institutions, we support, fund and conduct outstanding research. Every penny of public funding should be spent as effectively and efficiently as possible. As a nation we excel at research and development, we should do more of it and we should share our expertise with our colleagues and neighbours”.
Against this background, the group recommends that the Department for International Development’s budget should be rebalanced to a certain extent, in order to enhance R&D capacity further in future.
There are many areas of global health in which decisive progress is needed, as the noble Lord, Lord Collins, has made clear. As regards tuberculosis, the search for new and more effective drugs is the highest priority in order to shorten basic treatment and to deal with the bacteria that to an increasing extent are resistant to existing drugs. To that end, DfID should surely consider investing more in drug developers such as the TB Alliance, which are not seeking a financial return. Would there not also be merit in considering a prize fund to encourage TB research and development, along the lines of the Longitude Prize, designed to stimulate diagnostics for microbial resistance?
At the recent global consultation on research for TB elimination conference in Stockholm, a Swedish spokesman said:
“There has been a 45% reduction in TB mortality since 2,000. A great achievement, but not enough. Investments in research and innovations now are crucial to reach the global targets”.
Here in Britain we look to our Government to continue and, if possible, to enhance the contribution that has brought them much well deserved praise. The world will not eliminate tuberculosis until an effective vaccine has been found.
My Lords, I, too, congratulate the noble Lord, Lord Collins, on initiating this debate and I echo the remarks of the noble Lord, Lord Lexden, about the contribution of the noble Lord, Lord Collins, to this field and his determined work to improve healthcare for some of the world’s poorest and most marginalised people. I draw attention to my interests in global health, particularly malaria and NTDs.
It is about those two areas and the need for more and innovatively funded research in them that I shall speak. I congratulate the All-Party Parliamentary Group on Global TB on its overall report, Dying for a Cure: Research and Development in Global Health, with its emphasis on TB and its recognition that the needs of the 1.4 billion people who suffer from neglected tropical diseases are tremendously important, as is the interaction of those disabling, disfiguring diseases with the big three killers, TB, AIDS and malaria. It has also recognised that these are diseases not only born of poverty but which create poverty. They undermine education, employment, health—all the opportunities that would allow people to claw their way out of poverty. Therefore, combating the diseases of the poor, including the big three, is an essential element of the fight against poverty and for social and economic development.
For some of those diseases, we already have treatments for which we need more resources—for example, for mass drug administration for soil-borne helminth diseases—but we still desperately need to develop better medicines, smarter diagnostics and, above all, vaccines if we are to make progress. If we look at the position with malaria, there is an urgency to do all those things and to develop new insecticides if we are not to face exactly the same problems of resistance that plague the current fight against tuberculosis.
The main point I want to make today echoes that made by the noble Lords, Lord Collins and Lord Lexden, in terms of the challenges that are born not of scientific difficulties and obstacles but of economic difficulties and obstacles in developing new products. I think it is now universally accepted that we have a market model in pharmaceuticals that will never, on its own, deliver for the poor.
Ebola is a very good example. Ebola was such a minority interest until this year that it was not even on the WHO’s list of 17 neglected tropical diseases—it was a neglected neglected tropical disease. But the reason that treatments and vaccines have not been developed for Ebola is not because it is a uniquely difficult scientific challenge but because so few people were considered at risk and those few people were considered to be poor and a long way away. As I understand it, the candidate vaccines and treatments now being rushed through are all compounds that had already been discovered but not developed because, although potentially valuable in therapeutic terms, they were not potentially valuable in commercial terms. Of course, we now have the recognition that in a global world, epidemics are a mere flight away, so the world has now pledged to spend $2.4 billion on combating Ebola but did not in the past invest the fraction of that which would have been necessary to develop a new vaccine.
Of course, progress has been made in the area of funding of research for such diseases. We should pay tribute to the UK Government and DfID for their support for the concept of product development partnerships and to the work of the philanthropic, academic and private sectors in coming together with Governments in important and fruitful partnerships such as the Drugs for Neglected Diseases initiative and PATH, and in malaria vaccine development. But the number of chemical compounds with potential being brought forward is still worryingly low. Ebola should have taught us that we cannot afford for potential drug candidates to be left on the shelf because pharma companies have no incentive to screen them against key diseases. We have to find a way to fund discoveries that are potentially life-saving, even when they are not in the current market, profit-making.
My plea to the Government today would be for them to increase their commitment, and the resources they devote, to the vital work of PDPs. As the noble Lord, Lord Lexden, said, this is an area where we have tremendous skills and expertise. I recently took up the position of chair of Cambridge University Health Partners, and seeing the huge scientific potential we have for patient benefit on that fantastic campus is a real privilege. We also have a history of, and a great ability for, knowledge transfer through our academic institutions, particularly the London School of Hygiene and Tropical Medicine, and the Liverpool School of Tropical Medicine. I was in Zimbabwe and saw midwives and obstetricians from this country delivering training packages for midwives and skilled birth attendants in Zimbabwe, which then became sustainable programmes for supporting maternal health.
I have one other plea: we should not neglect the importance of the research that can take place in the countries and the communities where diseases are themselves endemic. Building capacity in those countries, as enlightened funders are now recognising, can have really powerful results in the quality and relevance of the research undertaken. Finally, I would encourage the Government to look at mechanisms to invest in local clinician-led research agendas in developing countries.
My Lords, I, too, wish to congratulate my noble friend on securing this important debate, in particular for his persistence, and for it happening so close to World Aids Day. I wish to concentrate my remarks on the need for better tools, research and development for HIV/AIDS, and why it is so necessary. Unfortunately, listening to the three previous speakers, the story is the same, which is a real tragedy.
HIV/AIDS has placed a huge burden on developing countries, where the majority of the 35 million people with HIV now live. The disease kills 1.5 million people each year. Two-thirds of those living with HIV are in sub-Saharan Africa, where families can ill afford to bear extra healthcare costs or care for orphan children. Initially seen as a male disease, HIV/AIDS is rapidly becoming a female epidemic, with further impacts on families, given the greater share of responsibilities of women within households. HIV/AIDS is the leading cause of death among young women of reproductive age in Africa. The region’s young women are twice as likely to contract HIV as their male counterparts. This is in part due to a greater biological risk, and in part due to the unequal status of women, the effect of which constrains women’s ability to negotiate condom use, which is a major problem for those women, particularly those who are sex workers. Risk to sex workers stems from an increased number of sexual partners, greater exposure to sexual violence, being forced to have unprotected sex, or accepting more money to have sex without a condom. Sex workers can also face harassment from the police, who in many countries have been known to use the possession of condoms, or attendance at HIV clinics as a reason for arrest, or as a basis from which to extort further money or commit incidents of sexual violence. I found it strange, but I was told by a cousin who for many years was a sexual health worker in Africa, that in the 1960s and 1970s they wrapped condoms in coloured paper to make them look like sweets for exactly the same reasons. Is it not an indictment that all these years later we are still having exactly the same debates?
There are other identified groups who are particularly at risk of HIV. For example, the estimated 75 million male clients who visit the 10 million sex workers globally, and are a key transmission group to other women and men in the community. Men who have sex with men are 13 times more likely to be living with HIV than the general population due to the biological risk of transmission and having higher numbers of partners, yet they are stigmatised if they attempt to attend an HIV clinic. It is truly frightening to witness the current slide to criminalisation of homosexuality, for this impacts on the wider population, given that men who have sex with men will often have wives or other female partners. Ban Ki-moon, the UN Secretary-General, recently remarked:
“Not only is it unethical not to protect these groups; it makes no sense from a health perspective. It hurts all of us”.
Therefore, it is crucial that tools are designed to provide diverse groups with innovative and long-term ways of protecting themselves from HIV/AIDS.
The International AIDS Vaccine Initiative, which I was fortunate to visit earlier this year with my noble friend, is undertaking trials on several innovative approaches, from broadly neutralising antibodies to cell responses, and including replicating vectors for vaccine delivery. It is also carrying out follow-up trials to studies in Thailand that pointed to the efficacy of two vaccine candidate compounds when used together. We hope that those will be able to be developed. Such a vaccine would protect women, particularly those most at risk such as the female sex workers whom I mentioned earlier. Not only is it essential in helping to save those women’s lives but, from the decrease in the need for treatment alone, the savings are estimated to be $95 billion over the first 10 years.
Another study by the International Partnership for Microbicides is undertaking clinical trials of its new ring. It is a simple and affordable product. It is worn internally and works by releasing an antiretroviral drug that has been found to prevent HIV infection. Other studies are looking into gels and films that work in similar ways. If there is ever going to be a reduction in, or the elimination of, the 2.3 million new cases each year, prevention is key. It is absolutely essential, and the funding and the resources have to be found to make that possible. There are four new cases for every three people who are started on treatment. Detailed modelling has estimated that, even after significant scaling up of treatment efforts, there will still be 1.4 million new cases each year. Add a vaccine to that, however, and the number drops to 400,000, and very likely, with herd immunity, it will be brought down still further year by year.
Moreover, we must look at what can be done to change a situation where diseases affecting richer countries are prioritised for research and development above diseases that affect those less able to pay. I found it absolutely shocking to discover that 15 FDA-approved drugs were initiated to treat hay fever in the last 50 years compared with the one drug for TB mentioned by the noble Lord, Lord Lexden. Health programmes must be targeted at the poorest and most marginalised groups, not at those where the pharma companies are going to make the most profit.
The millions of women I mentioned earlier who cannot protect themselves from HIV/AIDS desperately need leadership from people such as us. However, there is another side to this debate. I have talked about availability—the need for drugs to be developed—but there is also a need for the drugs to be affordable. The excellent report of the HIV/AIDS all-party group, Access Denied, records how the generic medicine industry has been pivotal in bringing down the price of antiretroviral drugs from more than $10,000 per patient to less than $100. This has allowed nearly 10 million people to access HIV treatment, with 1.6 million of these beginning their treatment in 2012. To put this in context, 28.6 million people are estimated to be eligible for treatment under new World Health Organization guidelines, and that figure is expected to be 55 million by 2030. However, only 34% of the millions in need can access treatment in low and middle-income countries. That is just for adults. Access to treatment for the 3.3 million children living with HIV in developing countries is only 18%—how disgraceful; that is half the adult rate.
Surely the partnerships that have been talked about should also agree that the price of essential drugs and vaccines should not be out of reach of those who need them—perhaps through voluntary or compulsory licensing of patented products. My noble friend rightly referred to this as market failure. De-linking the final cost of a drug from research and development incentives could not only spur investment in work on diseases of poverty but also ensure that those drugs can be marketed at a price affordable to the greatest number of people, and so save many millions of lives. After all, if we think about it, manufacturing a drug is a remarkably low-cost exercise. We should be looking to pharmaceutical companies to ensure that there is more transparency in their research costs, to make it possible better to access the level of finance needed.
The UK, as a global leader, can ensure that the partnerships can continue their work, but only if they get adequate funding to do so—funding that allows long-term planning to progress potential candidates through the many stages their work requires—and take steps to explore how a reformed system might work that pushes companies to do the right thing, which will allow us, one day, to cross World AIDS Day off our agenda.
My Lords, I congratulate my noble friend Lord Collins of Highbury on securing this debate on a subject so important to a world which contains an estimated 35 million people living with HIV.
Today’s debate is focused on investment in research and development in global health, in particular to develop new tools and treatments for TB. I welcome the fact that the TB Alliance has four combinations of drugs in late-stage development and will soon launch a trial of a combination of drugs suitable for those who are co-infected with TB and HIV. More people living with HIV die from TB than any other coinfection, but the first new drug available for TB in 50 years, Bedaquiline, is still not reaching the 1 million people who may need it because of its high price, as the noble Lord, Lord Lexden, mentioned.
The Doha declaration of 2001 must continue to be enforced and respected by all countries to ensure that public health is prioritised over profits. Currently, a number of free trade agreements are causing concern. Most, if not all, FTAs involving the EU or the USA contain provisions on intellectual property rights that are TRIPS-plus and have the potential or likely effect of hampering or preventing the use of one or more TRIPS flexibilities—TRIPS being Trade Related Aspects of Intellectual Property Agreements. Where there is a public health imperative, countries can issue a compulsory licence to a generic manufacturer on payment of a royalty to the owner of the patent.
We need to examine the role of the pharmaceutical companies as part of the debate. In 2002, the world watched as 39 pharmaceutical companies took the South African Government to court. Their complaint was that the Government, under the presidency of Nelson Mandela, had passed legislation paving the way for the purchase of cheap anti-HIV drugs from India to tackle the worst HIV epidemic in the world. By buying those cheap drugs, the companies claimed, the South African Government would be breaching their intellectual property rights. Thankfully, the case was eventually dropped, but the issue of intellectual property rights in that context remains controversial.
In 2003, the Labour Government launched a commission to explore the relationship between IP and development. They published a landmark document recognising the enormous impact of intellectual property legislation on international development. The commission recommended that further research be carried out, and the Labour Government led the way by supporting the establishment of the World Health Organization’s Commission on Intellectual Property Rights, Innovation and Public Health. The commission sought to create global consensus around research and development for global health, and led to a series of reform proposals. Progress on these reforms has stalled and has been pushed back to 2016, as my noble friend has already highlighted, but the progress of diseases such as HIV and TB has not stalled, and the time wasted in coming forward with new research and possible vaccines sees 2.7 million people die from these two diseases alone every year.
As noble Lords have already emphasised, intellectual property is not, in itself, a bad thing, but IP is designed to incentivise innovation by helping innovators to make a profit on the products they invent. Companies will concentrate on developing drugs to address the illnesses besetting the developed West more quickly than addressing the needs of the developing world, as my noble friend Lord Collins has already mentioned. The disparity in wealth between high- and low-income countries means that the markets which offer greatest returns are those in the developed countries. The pharmaceutical companies predominantly invest in developing products with the greatest potential to generate sales in high-income countries, and price their products accordingly.
The establishment of the Medicines Patent Pool—MPP—in 2010 to address intellectual property barriers to generic production is of course welcome and is already making a difference, but there is still a time lag from the period when a licence is agreed, given the two to three years it takes for a generic manufacturer to develop a new drug. More pharmaceutical companies need to be encouraged to sign up and there is still a need for greater investment in R&D.
The Government need to show the same leadership as the previous Labour Government did in this field by commissioning a new report to examine the differences in overall costs between a commercially driven model of development and models that are open access and do not include IP protection, so that global solutions can be found to global health problems. The aim of such a study would be for the UK Government to find the most effective ways of creating incentives to encourage investment in R&D, and to look at the benefits and challenges with different approaches to drug development.
As my noble friend Lord Collins highlighted, there is a concern about this Government’s reduction of funding into research and development around a vaccine for AIDS by more than 80% for the period 2013 to 2018. The new grant for the next five years has been reduced to only £5 million—one-eighth of its previous level. Does the Minister support the recommendations in the report launched by the All-Party Parliamentary Group on HIV and AIDS, Access Denied, to carry out an inquiry into alternative models of research and development investment which separate the cost of R&D from the demands of profitability? As my noble friend Lord Collins has already mentioned, a new global research and development fund could reward all who contribute to it, and the UK Government could negotiate with the pharmaceutical industry and civil society to create a research and development treaty to provide the framework for such a fund. Notably, the report calls on,
“the UK government, the pharmaceutical industry and multilateral organisations to work together to make second and third-line ARV drugs available and affordable to all, including marginalised populations and people living”,
in middle-income countries. The report also says:
“DFID should lead the way in harnessing donor support for the Global Fund to cover the cost burden of the increased numbers of people (28.6 million) now eligible for ARV treatment under WHO guidelines”.
Most importantly, Access Denied suggests that,
“DFID should use its leverage as a donor to ensure multilateral institutions such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, WTO, WHO, World Intellectual Property Organization (WIPO) and UNITAID are doing enough to bring prices down. It must use its voice to demonstrate leadership on this issue”.
My Lords, first, I thank the noble Lord, Lord Collins, for securing this important debate. I also thank all other noble Lords who contributed to the debate this afternoon. This is indeed a very important area and I am glad that we have recently had Oral Questions on it and that my noble friend Lord Fowler has a related debate on the Global Fund on Thursday. I was very glad to speak at the All-Party Group on HIV and AIDS, of which I used to be an officer, at the launch of its report Access Denied, and I am very happy to share my speech.
As the noble Baroness, Lady Hayman, pointed out, these are not only diseases of poverty; they are diseases that cause further poverty. I thank the noble Baroness for her tribute to DfID. Like her, I pay tribute to our outstanding institutions that are working in this area, and I welcome her new involvement with Cambridge University Health Partners. We have a formidable academic record in the United Kingdom in this area.
The noble Lord, Lord Collins, pointed to a market failure in drug development in relation to diseases of poverty. Other noble Lords made reference to this as well. Between 1975 and 2000, just 13 new drugs were registered for use against the so-called diseases of poverty. That is about 1% of the total number of new drugs developed globally. Of course, the question is: why have those diseases been so badly neglected? As noble Lords have indicated, the answer lies in the lack of incentives for the pharmaceutical industry. Developing and bringing a new drug to market is an extremely costly and risky business and the industry did not see the incentives to bring those drugs forward. If we add the extremely limited profit margins associated with making those badly needed drugs available, it is not hard to see that fundamental market failures have meant that the development of affordable and accessible treatments has not been prioritised in the way it should have been. Noble Lords were quite right in their analysis of that.
The noble Lord, Lord Collins, and others mentioned the product development partnerships—PDPs. These have changed the situation, harnessing the best of the private sector so that it is channelled for the public good. The noble Lord, Lord Collins, also spoke about de-linking and several noble Lords spoke about intellectual property. All PDPs negotiate access to intellectual property for all products developed in order to ensure affordability and access. We need a number of approaches, not just de-linking, to ensure that many players can be involved and to bring in the expertise and resources from the private sector that may contribute to the PDPs.
The noble Lord, Lord Collins, and the noble Baroness, Lady Healy, asked whether we would commission a report on de-linking. I assure them that a number of groups are already looking at this, including a Treasury-sponsored group looking at antimicrobial resistance. If they want further details of that, I am sure that we can assist in that regard.
Since the emergence of PDPs, we have seen 10 new technologies brought to market and there are more than 350 candidates in the pipelines of PDPs collectively, including 90 drug and vaccine candidates and 32 diagnostic or vector control candidates. The UK is a leading investor in PDPs; in 1999, we were the first Government to provide support to a PDP, and currently support 10 PDPs covering neglected diseases. Since 2008, we have committed approximately £323 million to PDPs.
I assure the noble Lord, Lord Collins, that DfID has an open access policy. All research funded by DfID has to be placed in the public domain. For product development research, all new products must be made available for the lowest possible price. The noble Baroness, Lady Gould, rightly emphasised the key importance of such access to medicines and vaccines. I hope that they are reassured by what I have just said.
I am pleased to report that the DfID-funded PDPs have a strong track record of delivering a wide range of new technologies for diseases of poverty and of getting those into use in the developing world. This has included five new diagnostic tests for TB and six new drug combinations for malaria.
My noble friend Lord Lexden referred to the long history of TB and humankind. Like him, as a former historian, I am fully aware that that history is very different from the situation today. However, TB disproportionately affects the most vulnerable and marginalised in society. In 2013, 9 million people fell ill with TB and 1.5 million died. TB ranks as the second leading cause of death from an infectious disease worldwide, after HIV. The UK remains committed to help achieve the goals of the Global Plan to Stop TB to reduce deaths and prevalence of TB by half, compared to 1990 levels, by 2015 through our bilateral and multilateral support. A big part of that effort is investing in research into more effective diagnostics, treatment and vaccines. Noble Lords are absolutely right about that.
I assure my noble friend Lord Lexden that DfID is already the second-largest government funder in this regard. Following a funding gap for TB drugs this year, we gave an extra £5 million to the TB Alliance. I want to highlight the work of two DfID-funded PDPs in particular. The Foundation for Innovative Diagnostics has developed GeneXpert, a new diagnostic test for tuberculosis that gives fast and accurate results in four hours, compared to a previous wait of between six and eight weeks. Noble Lords will appreciate immediately how important that is. The Global Alliance for TB Drug Development is about to start a registration trial for a new combination of TB drugs. If successful, it has the potential to reduce treatment times for drug-resistant TB from between 24 and 30 months to six months—another issue that my noble friend raised.
What are we doing to change the global landscape? We recognise that effective co-ordination is crucial but challenging, given the number of different players in the field, including Governments, philanthropic organisations, the private sector and others. As well as investing directly in research and development, the UK will continue to play our part, working with others to improve co-ordination and maximise overall returns for the global poor. We are working with the WHO Secretariat as it develops a mechanism to implement the recommendations of the recent consultative expert working group process.
We welcome the proposed global observatory for health R&D, to be based at the WHO, which will provide an opportunity for co-ordinating information about what health research is going on globally. In tandem, the WHO Secretariat is developing a mechanism to operationalise the pooled WHO member states fund for product development, which, if established, will aim to attract new funders and donors to support product development. We currently chair the PDP funders group—an informal group of bilateral agencies and philanthropic foundations that provide support to PDPs and encourage others to invest.
The noble Baroness, Lady Hayman, emphasised the need to build research capacity. We are working not only within the United Kingdom but she will know, I hope, that we are also working within Europe generally, supporting the European & Developing Countries Clinical Trials Partnership, which has a UK lead—the Medical Research Council. The EDCTP is a partnership of 16 European and 48 African member states to pool resources and skills and to co-ordinate and implement clinical research.
I note what my noble friend Lord Lexden said about the incentive of a prize. I suggest that he might look to a major donor with an interest in naming such a prize. Given the impact on India, he might initially look to that country.
The noble Lord, Lord Collins, also mentioned HIV funding. We discussed this the other day. He will know that past vaccine research looked promising but looks less promising now and needs a basic research approach. That work is therefore much more appropriately taken forward by the MRC and the Wellcome Trust, which have been increasing their funding for AIDS vaccine research. I note that an incredibly interesting research paper may indicate that HIV may be weakening slightly. Let us hope that it heads in that direction.
The noble Baroness, Lady Gould, mentioned the Ring Study. DfID has committed £15 million to the International Partnership for Microbicides, and I hope that she will be encouraged by that.
The noble Baroness, Lady Healy, talked about TRIPS. DfID supports countries that use provisions to overcome IP barriers through TRIPS.
Solving many of the challenges that we will face tomorrow will rely on the R&D investments that we make today. DfID has an outstanding record in this area in terms of its support over the last few years. We are committed to maintaining our record of funding high-quality, high-impact research and playing our part in improving global communication. We are committed to putting that knowledge into use so that ultimately it will save lives. We also emphasise that rights should underpin our support for the poorest and most marginalised, as my noble friend Lord Lexden made clear should be the case.
Noble Lords mentioned Ebola. That has shown how interlinked we are. It will not have escaped the notice of the pharmaceutical industry that a disease that was seemingly limited to a poor area geographically and socially may well have a far wider impact. Those who had Ebola vaccines on their books are now able to power ahead. We need to ensure that we support those suffering from the so-called diseases of poverty. We also need to recognise that we are in a changing world, and we need to do our best to ensure that that is fully recognised.
Question for Short Debate
My Lords, I start by thanking everyone who has put their name down to speak in this short debate. I also thank the various organisations that have sent copious briefings. There is far too much to discuss in the time available; nevertheless, it is extremely interesting. I particularly mention the John Muir Trust, which motivated me to table this Question.
I live in the Pennines on the border of Lancashire and Yorkshire, where I am surrounded by peat-covered moors. This becomes obvious every time there is heavy rain and our local becks turn dark brown. I first came across peat in a big way when I started wandering round these moors when I was still at school. I remember a friend and I doing that on Kinder Scout when we would have been about 15. We discovered the peat-covered plateau and the groughs, which dissect the peat. We thought that it was wonderful and a great playground and we went racing up and down the peat, and all the rest of it, probably doing no good at all to it. Those groughs themselves are a significant indication of the erosion of the peatlands that is taking place in many places. When I was in university, I did an undergraduate dissertation on the North York Moors and came across a wonderful book written by a man called Frank Elgee, The Moorlands of North-Eastern Yorkshire, where he divided the peat-covered moors into the fat moors and the thin moors. The fat moors were where the peat was six feet thick or more and the thin moors were where it was just a few inches. I learnt to love peat and I have spent a lot of my life since on mountains and moors and in peat areas.
While peat is important, most people would not consider it an exciting subject; they think of it as fairly uninteresting, so it is undervalued. But it dominates our upland landscapes and the moors and mountains of all the countries in the United Kingdom. Both the upland blanket bogs and the lowland peat bogs are an ecological treasure house that has reduced in size enormously in the past 150 years, particularly in the lowlands, yet it is our largest natural carbon store and a vital part of our water environment—it is vital for water management and flood prevention, which is pretty topical nowadays.
Peat is the remains of plants, particularly sphagnum and other mosses, which are not fully decayed; they are only partly decayed due to the presence of water and a lack of oxygen. The great blanket bogs of the British Isles have developed mainly in the last 4,000 years, some over a longer time than that. Peat bogs are very slow growing, whether they are the raised bogs of the lowland or the blanket bogs of the uplands. They form very slowly. It is estimated that they form at no more than 0.5 millimetre to 1 millimetre a year, so they are not something that can be quickly replaced, in comparison with ancient forests—those are impossible to replace, but you can at least replace the trees. In the case of peat, offsetting is simply not an option when development takes place. The United Kingdom peatlands store more than 3 billion tonnes of carbon, so it is vital to preserve what we have and restore the quality of the bogs that we have, thereby reducing the annual loss of carbon from them.
What are the problems? First, there is digging it up for commercial purposes, particularly as fertiliser in the horticultural industry, in the case of the lowland bogs. There is still a certain amount of digging up peat for fuel, particularly in the Western Isles, but I do not think that that is a major contribution to peat loss. Then there is destroying it for development of any kind and degradation by past activities, particularly agricultural activities. Government grants were given to drain the uplands and moors and dry out the peat, resulting in the exposure of peat and its serious loss by erosion, of which the prime example is Kinder Scout. Only 18% of the United Kingdom’s blanket bog is in natural or near-natural condition and, overall, the position is getting worse. It is better than it used to be in that people recognise the importance of peat and recognise the problem, but it is still getting worse year by year.
I have a number of questions to put to the Government. I had hoped to send them in advance to my noble friend the Minister but, unfortunately, other things got in the way. Nevertheless, I hope that he will be able to answer some of them. First, the new Scottish planning policy from the Scottish Government reads:
“Where peat and other carbon rich soils are present, applicants should assess the likely effects of development on carbon dioxide … emissions. Where peatland is drained or otherwise disturbed, there is liable to be a release of CO2 to the atmosphere. Developments should aim to minimise this release”.
I would like to ask the Minister whether the National Planning Policy Framework that refers to England and is the direct responsibility of the Government could include a statement similar to this. The Minister will not be able to answer that now, but he may be able to do some digging within the Government and have discussions with his colleagues in the Department for Communities and Local Government. Will the Government consider amending the National Planning Policy Framework to include a requirement that where significant development takes place on peatlands, an assessment of the balance of carbon emissions must be made as part of the assessment of the planning application?
Secondly—and this may be more in the Minister’s own domain—will the Minister give an update on progress on the Peatland Carbon Code and the pilot phase, which was expected to run from September this year? In the past he has been quite enthusiastic about this, I believe. Thirdly, will the Government promote the best practice guide that is currently being updated by the John Muir Trust and the Yorkshire Wildlife Trust? Will they put their weight behind it?
Fourthly, most upland peatlands are mapped as access land under the CROW Act. Will the Government work closely with the Ramblers and the British Mountaineering Council and similar organisations—I declare my interest in relation to the BMC—to promote better understanding of good practice in relation to peat both by walkers in areas of blanket bog and the people managing the areas where people walk?
Next question: following the statement of intent to conserve peatlands issued in February 2013 by the four United Kingdom Environment Ministers—that is, the United Kingdom Government in relation to England and the three devolved Administrations—what further progress is being made for joint action by the four countries?
What measures are included in the new environmental grants under the common agricultural policy that are replacing the old environmental stewardship schemes, particularly in relation to the conservation of areas of peat? What measures are being taken to close down the use of peat for horticultural and gardening purposes? That is entirely unnecessary. There are perfectly good substitutes that can be used and the time has now come, surely, to phase out in a serious manner the use of organic peat.
What action is being taken to ensure that the burning of heather moors occurs only under best practice conditions? This refers to the burning of heather on grouse moors, which, if it is carried out in inadequate ways, results in huge releases of CO2 from those moors. It is estimated that burning accounts for 74% of all emissions from blanket bogs. I am not against heather moors. I am not against grouse shooting. But the heather moors are one of the glories of the north of England and the burning of them, which in my part of the world is known as swithering, should be properly controlled.
Finally, what progress has been made in developing a national plan for the restoration of England’s peatlands and when will such a plan be published, particularly as our peatlands are such a big factor in future flood mitigation measures? I would be very grateful to have answers to these questions from the Minister. If he cannot answer any today, perhaps he could write to me. I look forward to hearing everybody else in this debate.
My Lords, I am very grateful to my noble friend Lord Greaves, who has been assiduous in pursuing this important interest. I need to declare my interest in that my family leases to Natural England 750 acres of lowland peat bog, or raised mire as it is sometimes called, situated in south Cumbria. It adjoins one of Natural England’s oldest nature reserves, called Roudsea, which is also part of our estate. The total land involved is about 1,000 acres. Much of the remainder of the estate falls under one or other of the numerous designations that will be familiar to your Lordships.
Natural England pays us a decent rent, on time, and relations between us are mostly cordial. Whatever opinion I might venture this afternoon, let me be clear that I feel no animosity towards Natural England personnel and that I would single out the senior reserve manager, Mr Rob Petley-Jones, as being especially approachable and, I would even say, visionary. That said, while they are all experts in their field, I would argue that their field is a narrow one and it is that which contributes to the problems which I want to touch on this afternoon.
As I understand it, until the Great War there was quite extensive exploitation of these bogs; I believe a number of families had turbary rights over them. The experts agree that the integrity of the bog, which the noble Lord has touched on, cannot be restored to pristine condition but that a high enough proportion can. It will therefore be rewetted, restored and preserved in line with whatever European directive deals with matters of this sort. The directive’s authors are specific that our bog is important and merits the expenditure that, in my estimate, runs to millions of pounds.
I am not qualified to challenge this assessment of the desirability of making this bog boggier. However, when I am told something is important, I feel entitled to ask how importance is measured against other desirable things such as education, health, care for the mentally ill, the plight of refugees and much else. Plainly, no one is pretending that the well-being of a raft spider ranks alongside that of a child trafficked into slavery, but what no one can tell me is whether anyone looks at this kind of policy and this kind of expenditure with the independence of mind capable of determining where the balance of advantage lies. Is a totally committed bog buff really the right person to give the Government advice? Can such advice realistically be impartial? What mechanisms are in place to allow Ministers to challenge both policies and outcomes?
When I commented gently to Natural England in passing on the cost of its operation, I was truly shocked by the reply that I need not worry, as it was mainly “European money”. It is difficult to imagine a better illustration of the attitude of so many in the public sector to matters of financial accountability. I very much doubt that our local experts would agree with one bog owner who observed some years ago:
“Many of these sites are cultural landscapes, forged by a subtle interaction between people and nature over centuries”.
Natural England is clear with us that its intention is to obliterate that interaction. Its ambition is to eliminate trees, mainly by drowning them. Its original plan was to remove these trees by helicopter, although that plan was mercifully abandoned. I like to think that the prospect of implementing such an insensitive plan within view of hill farmers suffering the effects of foot and mouth and low farm prices might have contributed to this change of heart. Rural poverty deserves more attention than it gets. It seems to have bypassed many of those who have safe jobs in the countryside and who are more comfortable with high-vis jackets and clipboards. I see scant evidence of policymakers in Brussels losing much sleep over rural poverty in the Cumbrian fells.
The up-to-date position on our bog is that Natural England has already killed some of the peripheral trees that it promised to preserve for amenity reasons and seems very well pleased with that outcome. It is hard to see how destroying perhaps half a million naturally regenerated trees sits with a mission statement of protecting England’s nature and landscape, especially given that no one disputes the fact that Britain has too few trees rather than too many. In fact, the world has too few trees. Natural England will not tell me—it probably cannot tell me—what the impact will be of this destruction and what habitats will be lost. What will the effect be, for example, on our nightjars? How will the destruction of our unique post-war wilderness impact on the safe haven it offers to a range of species seeking refuge from ever increasing human access, dogs and noise? There is no balance to be found in the argument. Who will benefit from these policies and how? The website offers a few bland lines, which itself is a failure of accountability, given the scale of change being imposed. I even understand that the alleged value of peat bog as a carbon store has been challenged by some scientists, and it remains an uncertain field.
It is fashionable nowadays for experts to run things. Experts are wonderful people—we could not do without them—but with every year that passes, I move increasingly to the view of Winston Churchill, who believed that experts should be on tap, not on top.
My purpose in speaking today is not to target Natural England specifically—it does a huge amount of good work, which I see every day. It is just one of numerous agencies that impact on all of us who try to earn a living in the countryside. My purpose is to draw attention to the fact that most if not all quangos, often through no fault of their own, are unaccountable, hugely bureaucratic, frequently conflicted and a cost to the taxpayer. Does my noble friend plan to look at those questions?
My Lords, I, too, thank my noble friend Lord Greaves for initiating this debate this afternoon, for his constant championing of the peatlands in our country and because it allows me the chance to reminisce on a rather wonderful weekend I spent over the summer up in Exmoor on the blanket bogs, looking at the Exmoor Mires project, which is being run by South West Water—one of a number of pioneering projects by water companies that have come to understand the importance of peat bogs for their long-term business sustainability. Peat obviously dissolves in water, which then needs to be cleaned, so the companies are looking to restore the peatlands, with ensuing benefits not only for their business but the local community, wildlife and biodiversity more broadly.
My noble friend Lord Greaves outlined the challenges facing peatlands, so I want to pick up on only two issues in the time allotted to me. The first is to say a little more about what I believe is a strong need for a national plan for the restoration of England’s peatland. Some noble Lords may be aware that the Scottish Government have recently conducted a consultation on a national peatlands plan to protect and restore peatlands. The plan fully recognises the important contribution that restoring peatland makes to carbon capture and storage, clean water, flood alleviation—critically—improved biodiversity, tourism and outdoor recreation. If it is good enough for Scotland to have a clear plan with a set of long-term objectives for peatland restoration, I, too, ask the Minister what progress we are making in developing a national plan for the restoration of England’s peatland and when it will be published.
More fundamentally, I want to touch on the need for secure funding to ensure well-managed upland peatlands through a combination of market-related funding routes. I mentioned at the beginning how South West Water and other water companies are increasingly aware of the value to their businesses of investing to reverse the damage to peatlands. A further new model for the corporate sector to support the challenge of restoring and maintaining peatlands was championed by the Ecosystems Market Task Force back in May 2013. Since then, as my noble friend Lord Greaves mentioned, work has begun on a peatland code to help to provide the standards and verification of the carbon storage and other benefits arising from peatland restoration projects. I am delighted that Defra has been funding the pilot phase of the UK peatland code. I say to my noble friend Lord Cavendish of Furness that it is very encouraging that it is using some of that funding to develop metrics to measure some of the greenhouse gas emission reduction benefits of restoration which, as he rightly said, are at the moment still at a very early stage. We cannot proceed until we have those metrics in place, but it is welcome news that Defra is contributing that funding.
As I understand it, that project is designed to provide a credible and verifiable basis for business sponsorship of peatland restoration in the UK, operating in a similar way to the Woodland Carbon Code, assuring that restoration delivers tangible greenhouse gas emissions, alongside other environmental benefits.
Although I understand that the code is in a pilot phase at the moment, working with those businesses that are very much interested in developing their own corporate social responsibility projects, I ask what the Minister sees as the longer term potential for the plan and the code. I also ask the Minister whether the Government believe that, longer term, that peatland restoration could be included in the greenhouse gas accounting guidelines, which would be a more sustainable long term way of building in further market funding to develop peatland restoration? Growing markets in this area would not only provide funding for peatland restoration, but stimulate competitive rural businesses and provide new opportunities for knowledge providers, for technical and market-support services, which can have very important export potential. It is very much in my mind that, having recently looked at the Defra website, just how geared the department is to export potential. It is important that we do not forget that peatland restoration, and finding new markets for supporting peatland restoration, could in the long term have export potential for us and our rural businesses.
For too long, the benefits of peatland in its natural state have been frankly undervalued. Consequently, as both my noble friends carefully articulated, many are in a damaged and deteriorated state. I hope that we are now entering an era where the value of peatlands is recognised for the ecosystem services that they provide, and that those benefits for society, community and businesses are reflected more broadly in public policy, and achieve more sustained leadership by the Government on this important issue.
My Lords, I join my noble friends in thanking my noble friend Lord Greaves for raising this important debate. I declare two interests. One is that I am a patron of the IUCN’s Commission of Inquiry on Peatlands. The other is that I am the chairman of Scotland’s Moorland Forum.
Given the title of this debate, and the proportion of the United Kingdom's peatlands that are north of the border, it would be appropriate if I said something about the Moorland Forum and its relevance to policy-making in Scotland. The Moorland Forum has developed into a unique partnership consisting of 30 or more member organisations, all of whom have an interest in the uplands and moorlands of Scotland. These member organisations are drawn from across the Government, the public sector, the private sector, the NGO community and the science and research sector. With every relevant perspective involved, the Moorland Forum is able actively to engage on all interests and all issues, with a breadth of focus which I think my noble friend Lord Cavendish would welcome; is able to actively seek consensus; and, importantly, actively to promote improvements in policy, as well as practice and management.
The Moorland Forum’s value to policy-making is proven in practice and we are regularly consulted by the Scottish Government and their various agencies for advice and commentary on policy options and policy delivery. Five years ago, I and others were concerned that peatlands in the United Kingdom were on the edge of the policy agenda, both in Westminster and Edinburgh. I therefore start by commending the United Kingdom and the Scottish Governments that that is no longer the case. Both have shown leadership and commitment to safeguarding our peatlands.
I initially focus on developments in Scotland. I welcome, as did my noble friend Lord Greaves, the new Scottish planning policy, announced by the Scottish Government this summer, with its special provisions for peatland protection. Like my noble friend Baroness Parminter, I also warmly welcome the National Peatland Plan that is being developed and overseen by Scottish Natural Heritage in consultation with all interested parties. The National Peatland Plan, which will be launched in March, will include a strategic vision for Scotland’s peatlands, an analysis of their current state, and opportunities for achieving better collaboration in order to deliver healthier peatlands.
For the first time, in Scotland we will have a clear set of long-term objectives for peatland restoration, and I commend the Scottish Government and Scottish Natural Heritage for this overarching initiative, and for their ambition. The National Peatland Plan would be even more valuable to both Scotland and the United Kingdom if it was linked to similar initiatives elsewhere in the United Kingdom. I also welcome the Scottish Government’s commitment to provide £15 million for peatland restoration. Five million pounds of funding is already in place through the Peatland Action project, and restoration work on the ground is under way on approximately 120 projects. I would be interested to hear from the Minister whether he has plans for measures and initiatives similar to those that are taking place in Scotland.
As have other speakers, I want now to touch on a UK-wide point—the importance of the development of the peatland code. As we have heard, of the many benefits that will flow from having an agreed peatland code, perhaps one of the most significant is its potential to provide the confidence that would unlock corporate funding for peatland restoration. If corporate and private sector funding could be secured, as has been so successfully the case for forestry and woodland planting through the UK Woodland Carbon Code, it would enable the restoration and improved management of tens of thousands of additional hectares of peatland over and above those that can be afforded through government and EU-funded schemes. I would be interested to hear from my noble friend what steps are being taken by the Government to encourage private businesses to fund peatlands through the peatland code.
I should also ask my noble friend what steps the United Kingdom and Scottish Governments are taking to support and co-ordinate their efforts with the IUCN UK Peatland Programme, as it is that programme which is overseeing the all-important development of the peatland code. The IUCN UK Peatland Programme deserves considerable credit for attracting and maintaining a solid partnership of relevant interests. However, if it faces a challenge, it is the same challenge that I believe Governments are facing, and that is the mixed success to date in reaching out beyond the usual suspects of the academic and NGO communities to inform, influence and motivate the mainstream private owners and private land managers of our peatlands.
Private owners and managers will be key if we are to secure and save our peatlands, but so far they have had little substantial engagement with the debate. To this end, the Moorland Forum is promoting the establishment of demonstration sites as one way in which private owners and private managers can become better engaged. The forum also feels that there are fears among land managers that peatland restoration techniques could trigger problems relating to livestock health, heather management, increased costs and foregone income. We are of the view that policymakers and others must understand and address those concerns if the efforts of land managers are to be fully harnessed.
In closing, therefore, I ask for my noble friend’s thoughts on demonstration sites for restoration purposes and other initiatives to engage private landowners and land managers. I also ask about the extent to which efforts are being made to understand and address the concerns felt by land managers.
My Lords, along with other noble Lords, I thank my noble friend Lord Greaves for instigating this debate. I was particularly interested in hearing about the North York Moors and the thin moors and fat moors. We always learn something in every debate we attend in your Lordships’ House.
My noble friends have drawn attention to the various ways in which the management of the peatland has benefited the environment, from its effect on the ecology and wildlife to possible carbon capture and, last but by no means least, the effect of these lands on water management.
I will specifically mention horticulture, which was touched upon by my noble friend Lord Greaves. I want to look at the relationship between peatlands and horticulture in the United Kingdom and the resultant pressure on these lands from the extraction of peat. As far as I am aware, this extraction, amounting to in the region of 3 million cubic metres, is largely from lowland peat sources, of which, I gather, all but 6% remain from extraction which started in the 1960s. I acknowledge that in the whole scale of things the area involved is not that large. In total, I understand it to be in the region of 960 hectares.
In response to concerns raised by the industry, the Minister’s department set up the Sustainable Growing Media Task Force, which delivered a comprehensive road map to reduce and phase out the use of horticultural peat. The major commitment in Her Majesty’s Government’s response was the phasing out of all peat use in domestic gardens by 2020, and commercially by 2030. Can the Minister tell the Committee whether targets have been met and if this commitment is still achievable? There was also a planned review in the second half of 2015. Is this still going to happen? I also understand that a committee was to be set up to meet on an annual basis. Can my noble friend confirm that this has happened and, if so, have the reports been published?
Having looked at what is on offer to the public, progress has definitely been made on labelling products. No longer can I find bags of compost labelled “low peat”, which can, in fact, contain up to 60% peat. However, having visited a garden centre yesterday, I found 26 different types of compost containing peat at varying amounts, from 70% down to 40%. I asked a member of staff whether any peat-free material was available, and was told there was not; there is obviously still much to be done. There still does not appear to be much evidence of education of the gardening public into the use of peat-free materials, but these must be available for the general public to purchase—not only to those committed individuals who work hard to find them. Over the years, I have used many hundreds of bags of green waste compost, with excellent results; so it is possible to be peat free.
I know that there are documents stating that the issue of peat extraction has been exaggerated by environmentalists, and that the use of lowland peat is acceptable. However, when we have a finite resource, we want to think very carefully about any use that could lead to the reduction of such a natural asset.
My Lords, I join others in thanking and congratulating the noble Lord, Lord Greaves, on securing and introducing this debate. I declare my interest as a farmer in Cheshire in receipt of EU funding, but the farm has no peat.
The noble Lord has highlighted the importance and significance of peatlands in the UK, covering about 9.5% of the land area, and from which around 70% of all drinking water is derived, and surface water from upland catchments is generally peat dominated. In the Peak District, my area of northern England, there are 55 reservoirs providing water to major conurbations to the east and west. Peatlands are significant natural carbon stores, and in England hold an estimated 140 million tonnes of carbon, worth billions of pounds. Furthermore, nearly 40% of the upland peat areas in England are designated as sites of special scientific interest.
Peatlands’ importance is highlighted by Professor Joseph Holden of the University of Leeds, who called peatlands the “Amazon of the UK”. Yet, as the noble Earl, Lord Courtown, said regarding the horticultural aspects of peat, our peatlands have been degraded to such an extent that, in the words of the Adaptation Sub-Committee of the Committee on Climate Change, only around 4% of England’s deep peat is in a sufficiently good condition to still be actively forming peat.
The noble Lord, Lord Greaves, spoke on the effectiveness of restoration, even though the timescales can be significantly long. All speakers have highlighted the benefits to society of restoration, which clearly outweigh the costs. Achim Steiner, the executive director of the UN Environment Programme, has been quoted as saying:
“The restoration of peatlands is a low hanging fruit, and among the most cost-effective options for mitigating climate change”.
Against this yardstick, the Government have made very little progress. It will be two years next February since the Government published their response to the report of the International Union for the Conservation of Nature and the UK Commission of Inquiry on Peatlands. Peatland habitats continue to degrade and to reduce water quality regulation services.
Since the recent change in Secretary of State, flooding has needed to be restored as a key priority of Defra, yet iconic species continue to decline and the rate of release of CO2 stored in England’s upland peat is increasing. The current scale of restoration, although worthwhile and important, has to be improved upon by a strategic step change resulting from clear improvements that the Government need to make.
The Adaptation Sub-Committee has highlighted that two-thirds of upland peat is still without a management plan. While much good work has been undertaken by several NGOs and funds have been leveraged up with contributions from water utilities, the Government have failed to achieve widespread buy-in from private landowners. While some £27 million has been paid to farmers and landowners to take up moorland restoration under the higher level scheme since 2007, will the Minister outline what new measures under the greening proposals the Government will be focusing on? Even now, large areas designated as SSSI continue to burn peat and heather. Surely there needs to be better enforcement of existing protocols. Perhaps this could be improved upon by the wide range of NGOs that the noble Lord, Lord Cavendish, spoke of today.
In an earlier debate, my noble friend Lord Knight highlighted the issue of water management in the uplands and asked the Minister what costs could be avoided if the water storage and purification provided by peatlands were to be restored. I hope that the Minister will be able now to give us a clearer answer. This would underline the target and set clear goals through the England biodiversity strategy of restoring 15% of degraded ecosystems by 2020 for climate change mitigation. The water companies could benchmark their activities against this figure, and provide data and be informative in the debate on reducing greenhouse gases under the UK’s targets for emissions reduction. Here I welcome the remarks of the noble Baroness, Lady Parminter. Will the Minister update the Committee on the percentage of deep peat that is currently in a degraded condition, and is that figure improving?
How will the newly announced environmental stewardship schemes be used to restore peatlands, address the continuing burning, especially by shoots on private estates, reduce the amount of inappropriate grazing, and encourage the blocking of “grips” and gullies to reduce water run-off? Does the Minister agree that the restoration of peatland ecosystems should now be a more important priority in his department? From this side of the Committee, Labour will ensure that investment by water companies in peatland increases in line with their resilience duty under the newly passed Water Act 2014. Will the Ofwat determinations show any increase in investment in upland restoration?
Recent debates have also highlighted that effective restoration is a key factor in future flood mitigation planning. What progress has been made in developing a national plan for restoration, and when is it likely to be published? What measures is the noble Lord’s department bringing forward to extend the uptake of management plans, especially through improving incentives to landowners?
Labour will follow the example of the successful use of payments for ecosystem services and regulation to improve flood management, such as in the Pumlumon Project in Montgomeryshire. This highlights that co-ordination has to be encouraged across a wider area. The noble Earl, Lord Lindsay, spoke of similar experiences provided by the Moorland Forum in Scotland.
The noble Baroness, Lady Parminter, and the noble Earl, Lord Lindsay, highlighted the important focus provided by the Peatland Carbon Code. The noble Baroness, Lady Parminter, spoke of the need to utilise these benefits in carbon accounting. Labour will provide the development of a Peatland Carbon Code to facilitate further private investment in restoration and build on the existing incentives for environmental stewardship schemes and catchment-scale management plans. We see advantages in the long-term aim to have a system in place whereby landowners and managers can offer up for sponsorship the carbon and other benefits of peatland restoration to businesses that are interested in helping to deliver action against climate change and other environmental benefits.
A very important development to capture long-term improvements could come through implementing conservation covenants to future public funding that will be attached to land. While it seems that this introduction may be captured only through new primary legislation—and we all know how difficult it can be to secure that—could the Minister inform the House what plans his department may have considered to capture in large measure the benefits of attaching such conditions of positive action to management behaviour through other measures that the Government could take? That and other measures need to be put in place with utmost urgency.
My Lords, I am very grateful to my noble friend Lord Greaves for giving me this opportunity to discuss the extremely important topic of peatlands, particularly since Friday marked the start of the International Year of Soils. As we have heard, peatlands are an essential resource and deliver much for the climate, environment and society. I have recently had a number of meetings on peatlands, and it is clear that there is strong support for action on peat from a wide range of organisations. This interest has led to a number of examples of landowners, conservationists, scientists, local communities and businesses being brought together, working together to deliver local solutions to peatland degradation.
Over the past few years, we have had significant successes in the protection of peat soil. There have been reductions in horticultural use, with the total volume of peat used in horticulture having decreased by almost 30% since 2011. I am pleased to see that the Defra family is nearly peat free, and that the Royal Botanic Gardens at Kew continues to lead the way in using new alternatives and working with its supply chain to deliver high-quality plants without peat. There have been significant reductions in the amount of peat cut in the UK and, in many locations, peat extraction and milling operations have been brought to an end. One such location is Bolton Fell Moss, where Natural England has now commenced an ambitious programme to restore bog vegetation to the 400-hectare site. This site will complete our network of special areas of conservation for this habitat type, which is an important step forward.
The Committee for Climate Change suggested that we should improve,
“incentives for land-owners to invest in restoration”,
and we are doing just that. Defra has committed over £3 million to peat-related research between 2010 and 2015, improving our evidence base on issues including restoration, lowland peats, peatland-related greenhouse gas emissions and alternatives to horticultural peat. This will be used to inform future policy and to aid landowner guidance. However, of course, there is more we must do to strengthen the policy framework to enable further peatland conservation.
In 2013, through environmental stewardship covering around 98,000 hectares, we committed more than £30 million to management options for the maintenance and restoration of moorland habitats. A further £4 million was committed in capital grants for grip blocking. Support will continue to be provided under the new countryside stewardship scheme, a forward-looking measure seeking to maximise opportunities to deliver biodiversity, water quality and flooding benefits together.
Natural England is developing an operational plan for the strategic restoration of blanket bog, covering special areas of conservation and much of the uplands. The plan flows from work prompted by the uplands evidence review and recognises the need to ensure that this habitat is actively moved towards favourable conservation status.
The protection of our peatlands for future generations is not a challenge that the Government can meet on their own. We need to work with others, encouraging local communities and landowners to deliver the best land use and management for their peaty soils. There are examples of how such partnerships are already delivering results on the ground, such as the Dark Peak nature improvement area, and we should learn from and build on them.
We need to be innovative and explore new economic opportunities as new technologies and approaches become available. For example, some companies are already growing sphagnum moss as a wetland crop. There is ongoing research to explore the economic feasibility of that and other ways of using areas of lowland peat in a manner that both enhances habitats and protects farming livelihoods.
Three billion tonnes of carbon are locked up in UK peat. That makes peat the single biggest terrestrial carbon store in the country—even bigger than forests. By including wetlands in the UK greenhouse gas emissions inventory, peatland restoration will contribute to UK emissions targets. That will provide another incentive to invest in peatland restoration.
We are doing more work to put tangible figures on the benefits that peat delivers, and that will help us to make the business case for saving peat. The UK pilot peatland code is exploring how we can encourage funding from businesses to restore damaged peat bogs. If successful, it will provide standards and robust science to give businesses confidence that their financial contribution will make a measurable and verifiable difference to UK peatlands. That will help to mobilise private sector finance: investing in natural capital because it makes sense for the bottom line but delivering benefits for wider society. The pilot phase is scheduled to finish in July 2015, but early signs are promising. Water companies have been particularly responsive, due to the known improvement of water quality with healthy peat.
My noble friends Lord Greaves, Lady Parminter and Lord Lindsay, and the noble Lord, Lord Grantchester, asked a number of related questions about national peatland planning and how we compare to Scotland. The Natural Environment White Paper set out the Government’s ambition for the environment, including a commitment to sustainable management of all soils by 2030. Natural England is currently developing an operational strategy for upland peat to help to identify where progress has been made and where more work is needed. My officials and I work closely with our counterparts in the devolved Administrations, and I will consider whether we need to review the joint ministerial statement which commits our four Governments to work together on peatlands, including on the peatland code.
On funding, on which my noble friends Lady Parminter and Lord Greaves, and the noble Lord, Lord Grantchester, commented, I can confirm that support for moorland and peatland habitat management will indeed continue to be provided under the new countryside stewardship scheme. The new scheme will be more targeted, aiming to identify the options which should be prioritised in agreements with farmers and other land managers to deliver the right action in the right place.
My noble friends Lord Greaves and Lord Lindsay asked about the future of the peatland code. We will continue to support the code’s initiatives to encourage private businesses. Our objectives for the remainder of the pilot phase will be to seek out opportunities to promote the code and attract indications of interest and firm offers from potential private sector sponsors.
We recently held an event with the IUCN for a number of business contacts, run by the Institute of Environmental Management and Assessment, to seek feedback on the code’s operation and to raise awareness of it in the business community—indeed, to improve the code’s offer to businesses. We are in discussion with the IUCN, the UK peatland programme, the devolved Administrations and others on the possibility of future projects across the UK, building on what the peatland programme has achieved over the past four years.
My noble friend Lord Greaves and the noble Lord, Lord Grantchester, referred to the burning of moors. Natural England is in the process of reviewing its guidance on burning and blanket bog restoration as part of a broader refreshment of its guidance, working closely with all interested parties and reflecting work undertaken by the Best Practice Burning Group.
My noble friend Lord Lindsay spoke about the role of private owners. The partnerships we already have in the UK are a novel mechanism for delivering results, but we recognise the need to engage a wider audience. Successful engagement depends on a strong evidence base with improved interpretation and dissemination, hence the commitment of over £3 million to peat-related research between 2010 and 2015. All involved will need to use this evidence to engage with landowners and local communities and make restoration decisions around which services are most important for them.
My noble friend Lady Parminter spoke of the inclusion of wetlands in greenhouse gas emission inventories. Including peatland carbon fluxes in the GHG emission inventories will reinforce the value of restoration and contribute to UK emissions targets. Three billion tonnes of carbon are locked up in UK peat, making it the single largest terrestrial carbon store in the UK. As of 2011, damaged UK peatlands are releasing about 3.7 million tonnes of carbon dioxide each year, which is equal to the average emissions of about 660,000 UK houses. Restoration would stop this and eventually lead to slow carbon sequestration once the peatland was back to actively forming condition in many years’ time.
The difficulties in including GHG emission reductions from peatland restoration were due to a lack of an approved international methodology for calculating emission removals from peatland restoration. The methodology now exists, but it still requires significant further work to make it operational in this country. The Department of Energy and Climate Change is leading on this work. The peatland code will provide guidance on quantifying climate and other benefits. To reinforce the value of the sponsoring of restoration, it may also be possible to count these benefits in corporate carbon accounts in future.
My noble friend also asked about Ecosystems Markets Task Force recommendations. The recommendation for carbon reduction through nature resulted in the pilot peatland code, which of course we continue to support. Other recommendations such as using nature to enhance resilience and soft flood defences also have the potential to be addressed by peatlands, but the evidence is limited and needs further work.
My noble friend Lord Cavendish raised a number of issues. Much of what he said needs to be heard, and I propose to send a copy of Hansard for this debate to the chairman of Natural England. My noble friend asked in particular about progress on the bonfire of the quangos. There are now around a third fewer quangos than there were in 2010. We have abolished at least 185 and merged more than 165 into fewer than 70. Over £2 billion has been saved cumulatively since 2010 through reforming and abolishing public bodies, and we are on track to reach the forecast £2.6 billion saving ahead of schedule.
My noble friend Lord Courtown spoke about the use of peat in horticulture. UK sales of peat for horticultural use fell from 2.8 million to 2.2 million tonnes between 2011 and 2012, and the total volume of peat use in horticulture has decreased by almost 30%. The Sustainable Growing Media Task Force report published in 2013 sets out where our resources will be focused over the next few years to assist in the transition to sustainable growing media and reduced peat use.
The noble Lord, Lord Grantchester, asked what estimate the Government have made of the costs that could be avoided if the water storage and purification services provided by upland peat were restored. There is an estimated overall benefit of £2 billion over 30 years from restoring 200,000 hectares of uplands, due to carbon sequestration, biodiversity and other ecosystem services such as water storage and purification.
Although the scale of the challenge both financially and on the ground is daunting, the size of the prize is great. We have had some successes but I recognise that there is more to do. By building on the wide support for this important ecosystem and the good practice that is demonstrated in so many places across the United Kingdom, I have great hopes that it is a challenge that we will be able to meet.
Multi-agency Initiatives in Health and Social Care
Question for Short Debate
My Lords, I declare my interests as recorded in the register.
Multi-agency working is not new and some agencies have worked together well over the years, but in the field of health and social care there are some serious problems. Apart from the universal ones of lack of funding and high staff turnover, most importantly, there is no governance framework. This concept is familiar to the Department of Health and to social services for research projects but for some reason there is no framework for multi-agency working. This means that, after major changes in working practices over the past five to 10 years, there is a severe lack of leadership, accountability and conformity in the provision of health and social care for some of the most vulnerable members of our community.
In its introduction to multi-agency working, the Social Care Institute for Excellence states:
“Working in collaboration is essential if individuals are to be offered the range of support they require in a timely manner. Multi-agency working is about providing a seamless response to individuals with multiple and complex needs”.
I will show that this is not so. Professor Steve Field, Chief Inspector of Primary Medical Services and Integrated Care, said in the introduction to the Care Quality Commission’s June 2014 report on the transition of young people from childhood to adulthood, From the Pond into the Sea:
“This report describes a health and social care system that is not working, that is letting down many desperately ill youngsters at critical times in their lives. We have put the interests of a system that is no longer fit for purpose above the interests of the people it is supposed to serve”.
In my contacts with people suffering from myalgic encephalomyelitis—also known as chronic fatigue syndrome or CFS/ME—particularly those who are very severely affected, I encounter some of the worst practice, although I recognise that there are other rare and misunderstood diseases that cause similar problems for the authorities. Part of the problem is the perception held by many in the medical profession that ME is a psychosocial behavioural problem and that the people concerned do not deserve the benevolence of health and social care providers. This is despite an increasingly large body of evidence that demonstrates that this is a very real illness, albeit with psychological symptoms common to many chronic illnesses.
One case that I have been dealing with since the summer is of a young lady who is in the transition process. Prior to reaching the age of 18, she had the very unpleasant experience of being locked away in a unit for anorexics for 16 months when she did not have an eating problem. Her parents, threatened with child protection proceedings, agreed simply because they were terrified of losing their daughter altogether. Little did they realise how ill their child would be when, after the intervention of a very good social worker and myself, she was allowed home. She is now bedridden and has to be tube fed. Health and social care was provided within the purview of social services, which took the lead. The current problems started with negotiations between the CCG and social services for her transition from children’s to adult services in March 2013. She turned 18 in November 2013. Because of the mismanagement of her case by the neighbouring CCG, which had been appointed to conduct her assessment for adult health provision, and the inability of social services to call anyone to account, no decision has yet been made.
It seems that those concerned have not read the National Framework for Continuing Healthcare and NHS-funded Nursing Care, which requires assessments to be completed within 28 days. Her parents have had dealings with at least nine different agencies, excluding her GP, nutritionist and hospital. The health authorities are disputing her need for funded nursing care. Instead of resolving differences together, social services believe that healthcare is necessary and must now appeal to a committee. This is only a very small part of a very complex story. The acute stress that this is causing to the family is not conducive to the patient’s recovery.
In another case, a 16 year-old is also bedridden and being tube fed after being forced to perform graded exercises in a hospital because a paediatrician diagnosed idiopathic chronic pain, and later produced a string of alternative psychological diagnoses. Her parents had, again, co-operated with the authorities in the face of Section 47 proceedings under the Children Act, but they also asked for a second opinion as they were convinced that their daughter had ME. This was refused by the paediatrician. Subsequently the parents obtained two opinions from recognised CFS/ME specialists, both of whom found their daughter to have the illness in its severest form. In fact, she has been found to be only 3% functional. The community paediatrician refused to engage with them and called a strategy meeting without the parents knowing. Senior hospital paediatricians then became involved in the case. The parents have also had to cope with five different social workers in 10 months. To cut another long story short, the hospital finally agreed to withdraw, provided that certain physical tests were conducted on the child. These were done by one of the CFS/ME specialists, himself a paediatrician, who had given a second opinion, and the child’s GP. Her social worker was also present and agreed that the child was well cared for and that there were no child protection issues. The specialist and the GP agreed that they could manage the case until a suitable and acceptable adult hospital physician could be found.
What concerns me about this case is that the hospital medical professionals involved have been determined to hound the parents of this very sick young girl in their determination to prove a point—that the child has a psychological condition. They have distorted evidence at joint strategy meetings, to which the parents were not invited and could not defend themselves. In fact, I have been described as writing intimidating letters to them when I have been trying to help. They are still pulling strings in the background, despite their agreement to withdraw, by demanding to be present at meetings when the parents and the patient have made it perfectly clear that their trust in the doctors has irretrievably broken down and that the doctors are not welcome. They seem determined to pursue a vendetta against this family because they have had the audacity to disagree with the doctors’ diagnosis of the child’s condition. Yet they are answerable to no one unless patients complain to the GMC—a very protracted process.
These problems do not affect only children. A young woman who has had ME with other complications for five years became severely affected and required health and social care. She was then given a psychological diagnosis by a psychiatrist and, on the basis of this, her GP ordered social services to gradually withdraw her care provision over a period of six weeks so that she would be forced to care for herself. Her food was left out of her reach, yet she could not hold a bowl. She has not had her hair washed for eight months. When care was finally withdrawn, kind friends and neighbours went in to cook for her and to feed her. Fortunately, they have managed to help her change her GP and some of her social care requirements are now being met—but no one is answerable for her previous treatment.
I have spoken of instances with which I am familiar. A charity, the Young ME Sufferers Trust, has dealt with more than 140 cases of children with ME where child protection proceedings were instigated at the behest of doctors or teachers because the children were not recovering or attending school. None of these cases was found to be proven, but no one could be held accountable for the untold pain and anxiety suffered by the families. Many are still very frightened that their case might be reopened and are afraid to speak out publicly. This is a terrible situation and it is kept under covers because the parents are so afraid.
I am sure that those who designed the health and social care legislation did not mean it to be like this, and I ask the noble Baroness the Minister to do all in her power to improve the situation. There really is a crying need for leadership, accountability, integrity and competence in this field.
My Lords, I very much welcome the noble Countess securing this debate and what she has to say. She has used examples of a number of young people with CFS/ME and has illustrated some of the issues that arise where it appears that no one person or agency ultimately takes responsibility for the way that they are treated and supported. It would be helpful if the Minister were prepared to have a look at some of the detail of the issues raised by the noble Countess. I understand that Ministers cannot intervene in such cases, but there may be a pattern here which it might be valuable for her department to be prepared to look at.
The question of accountability applies to many aspects of health and social care. Recently, I was reading the National Audit Office report on the better care fund, the fund that has been created, partly from NHS money, to invest in community care in order to reduce some of the pressures on our health service. The Minister will be aware that the original fund ran into trouble and that there was a redesign of the scheme in April this year. Interestingly, the National Audit Office has some concerns about how what should be an integrated approach will actually work. I was also interested to read another report, from the King’s Fund, which was cited in a briefing that I received from the Royal College of Nursing. The King’s Fund looked at common challenges to integrated care. It talked about lack of funding, lack of GP engagement, the inability of wider health systems to innovate effectively, the lack of integrated IT systems and problems caring for people in remote and rural locations.
It is patently obvious that unless you have some agency, or a multi-agency approach, in which someone is held accountable for the way the whole thing works, we are unlikely to see major improvements. My experience in Birmingham, when I chaired the Heart of England NHS Foundation Trust, was of the kind of pressures that you get in the health service: problems with out-of-hours and primary care, and big cutbacks in social care. Demographics mean that more frail and older people go into hospital, and then it is hard to discharge them. There can be any number of meetings, and you can have regulators coming down to beat the acute trust up, but nobody seems to be able to hold the system to account. It is so obvious that these are problems of a collective system.
That is why I think that the noble Countess is absolutely right to ask this Question. My party’s proposal for whole person care is designed to try to deal with those issues by bringing health and social care together under the auspices of the health and well-being board, with an integrated budget and a single point of contact for people with multiple needs. These seem to me to be the essential ingredients. Also, we have to get back to a situation where someone takes responsibility for the way that a local health and care system actually works.
I do not want to reopen our debates on the Health and Social Care Bill in 2012, but it is patently clear that the Government have produced a set of arrangements in which nobody is accountable for anything. That is the huge problem that we face. If we try to raise issues with Ministers on a particular condition—I have three cases running in relation to different medical conditions—essentially, they will say that it is a matter for NHS England. You then go to NHS England, where you find that there is no one responsible for single service areas, because they have the mantra either that it is specialised commissioning or that it is down to clinical commissioning groups.
That is replicated elsewhere. For instance, I ask the Minister: who is responsible for the effectiveness of the Birmingham health system? Nobody is, because it is split between different clinical commissioning groups and a variety of NHS trusts. The local office of NHS England clearly does not have the capacity to exercise leadership, nor do people at the centre think that it should.
One way or another, we have a big problem around the need for integrated services, whether it is services for the community as a whole or services for individuals, in the cases that the noble Countess has cited. At the moment, it seems very difficult to produce a set of arrangements where, in the end, you can finger somebody and actually say, “You are responsible for making this thing work together”. The noble Countess has done us a great service in raising a fundamental issue about the current arrangements. We all look forward to the Minister’s response.
My Lords, I thank the noble Countess for securing this debate. She has raised some important issues. I would particularly like to thank her for providing information to me and my officials in advance of today’s debate. She will understand that I am not able to comment directly on specific cases, save to say how much I sympathise with those afflicted with this terrible condition, and indeed their families supporting them. She is right to emphasise the need for integrated approaches to meet the needs of people with ME or chronic fatigue syndrome. This is a condition that presents in a variety of systems, but the point that she raised is that it remains incompletely and inconsistently understood. Partnership working between different professionals is key to getting a consensual approach to treatment.
I am not able to determine from her speech whether she was talking about one particular geography, or a whole different load of geographies, so what is the common factor? Maybe ME is the common factor of that geography. But certainly, a lot of work has been done very recently to put in place a framework for achieving multi-agency working. There is consensus about the need to better integrate health and care and, in the case of children, education services, too. You need the three services working together. Under the Care Act, the much maligned Health and Social Care Act, and the Children and Families Act, we have made progress in ensuring that the right statutory enablers are there, while allowing local areas the freedom to develop their own accountability mechanisms depending on their local circumstances.
NHS England and clinical commissioning groups are under statutory duties to promote integration. They are required to act with a view to secure that health services are provided in an integrated way, and to secure the provision of health services integrated with the provision of health-related services, or social care services, where this would improve the quality of the services. The better care fund and integration pioneers provide a mechanism for driving the good practice of integration of health and social care for adults. Areas have pooled £5.3 billion of health and social care funding through the better care fund, with each area needing to set out a robust plan to access their share of the fund. Noble Lords are clearly aware that the Government asked areas to revise plans following an initial submission in April. They were asked to resubmit to ensure that their visions for integration, no matter how impressive, were supported by robust governance and accountability that was required to ensure the successful delivery of these joint plans. This included more evidence of how areas would move towards having a single accountable professional for people with the most complex needs, so they do not repeatedly have to tell their story; they know who to turn to when they have questions or concerns about their care. I should highlight that from 1 April 2015, all GP practices will have a named GP for every patient, including the children, taking responsibility for co-ordination for their care, which should help strengthen the links between primary and secondary care, particularly for those with a long-term condition.
For children and young people with special educational needs or disability, we have introduced a statutory framework for integration across health, social care and education. Children in this group usually have complex needs and, too often, families face a battle to get the care they need, having to repeat the same story to different services and professionals. The new framework will change that. The statutory requirements are designed to improve integrated working across health, education and social care, to deliver improved outcomes for children and their carers. Clinical commissioning groups and local authorities will work together to develop for each child an individual education, health and care plan, focused on the outcomes that will make a real difference to the child or their family. It is a statutory framework; its key points set out in the Children and Families Act 2014 and its accompanying code of practice. It requires clinical commissioning groups and local authorities to have formal arrangements in place for working together to secure joint needs assessments and the subsequent care required by the plan, as well as agreeing personal budgets for the child or young person.
Involvement of children, young people or adults in care planning, as well as their families and carers, is essential, and not just for children with special educational needs. It should be fundamental to securing an understanding between professionals and patients. For children, the EHC plan should capture the services that the child is receiving and the specific outcomes that those services will deliver. The plans must be truly person-centred by describing what success looks like in terms of the child’s experience and abilities, and each plan will have a section that allows the child and their family to talk about themselves, their wishes and aspirations. This new approach has been extensively piloted by local authority pathfinders, which have found it a tremendously invigorating way of bringing commissioners together and thinking about provision in integrated ways. I am confident that this new approach will be a powerful exemplar for other services, not just for children, on effective integration.
We should also acknowledge the related issue of getting transition right. We have heard about this through discussions of mental health and disability, when suddenly at 18 one becomes an adult. Moving from children’s to adult services, for both physical and mental health services, is too often a challenge. It is important for services to work together around the needs of young people as well as their families and carers. This is something that necessarily requires the service as a whole to be mobilised to change.
The noble Countess highlighted the CQC’s report, From the Pond into the Sea, which showed how much more we need to do to secure effective transitions. Our system-wide pledge, signed last year by the major health organisations, includes the ambition to secure care co-ordinated around the individual young person with complex needs, to deliver a positive transition to adult services. The partners to this pledge are working to deliver it, not least NHS England, which has a specific mandate commitment to support smooth transitions between children’s and adult services. NICE is developing for publication in 2016 a guideline on transition from children’s to adult services for young people using health or social care services for use in England. This promises to have a big impact on stimulating cultural change.
Our mandate to Health Education England requires it to work with key partners, including the Royal College of General Practitioners and the Royal College of Paediatrics and Child Health to develop a training course to allow GPs to develop a specialist interest in the care of young people with long-term conditions, for introduction by September 2015, which will include particular emphasis on supporting transition from childhood.
Of course, there are cases in which integrated approaches may not work as smoothly as intended, but such disappointments will be fewer in number as we develop the necessary culture and partnership, working across health, social care and other services. I hope that I have provided some reassurance to the noble Countess that we have in place the right national legislative and policy framework.
I would just like to pick up on some points. Both the noble Countess and the noble Lord, Lord Hunt, talked about the funding for the NHS and the social care issue. The care that a person needs must not be held up by disputes over who pays or the distribution between nursing care and social care. The statutory guidance for the Care Act makes that absolutely clear. In the case cited, if discussions had begun earlier, before the young girl’s need for transition, this would have allowed significant differences of opinion to have been resolved.
I can tell the noble Lord, Lord Hunt, that it is not the case that there is a lack of accountability just because we have local commissioners. CCGs remain responsible for the healthcare they commission; local authorities are responsible for social care. In social health and well-being boards, we have a means of unifying local accountability. Health and well-being boards have local members and Healthwatch members. The parents of the children the noble Baroness has been dealing with may be making complaints, and we know from the Francis and Clwyd reports that there is more to do in improving complaints handling for health and social care. However, there is still a duty on all NHS bodies to handle complaints, and obviously the health ombudsman, to whom one can have recourse subsequently, can link up with the Local Government Ombudsman where issues covering health and social care demand it.
This has been a really interesting debate. I am quite happy to have a conversation with the noble Countess afterwards about some of the individual cases, but it is not appropriate to raise them in this context. I hope that she is confident that robust governance and accountability mechanisms are coming down the track and will be in place. They were incorporated in legislation—the Care Act and the Children and Families Act—and we should allow these mechanisms to happen locally.
Committee adjourned at 6.51 pm.