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Health: Disease Control (Intergovernmental Organisations Committee Report)

My Lords, as the first speaker who has not been a member of the committee, I congratulate it on a very good report that dissected the issues, drew out the key points, and finished quite rightly on the sobering note that a pandemic is likely at some point. I very much agree with the noble Lord, Lord Soley, that the UK’s reputation in this field is very good indeed, and it is against that background that I make some comments about how more could be done. The first point that I was going to make was made by the noble Baroness, Lady Whitaker. I therefore merely echo her remarks, with which I agree completely, about the non-health issues—the determinants of health—and the importance in that context of the World Bank playing a full role alongside the World Health Organisation and others. Two points arise from the report and are crucial to the success in controlling the spread of communicable diseases; they are, if you like, about our vulnerability. The first point is about the UK’s interdepartmental collaboration. The report calls for more collaboration, the Government acknowledge it, and the big policy statement, Health is Global, is as good as any such broad policy document that I have ever seen on this. How good are the Government in practice at using the strengths of the departments to reinforce each other? This is a universal issue. Three years ago, on behalf of the previous Prime Minister, I called a meeting of a number of countries to look at health and development globally. I found that every country sent two representatives—one from its equivalent of DfID and one from its equivalent of the Department of Health—apart from France, which sent three. It also sent someone from its Foreign Office. The fact that government is not totally joined up is not unique to the UK. The important point is that the globalisation of health has implications. There is the potential for pandemics and a huge movement of staff. There is trade, drugs are sold all over the world, and above all there is an enormous movement of people around the world. We need to have a real understanding of the linkages between first-world health and development issues. The health service in the UK must act as a global player and in a global context, and when DfID deals with health it must do so with the best health knowledge available. I still do not think that I see this in practice. I know that there is good co-operation at the policy level, but is it happening in practice? The test question for the Minister is: when DfID is dealing with the development of a health system in a country, how often does it ask the Department of Health for help from its experts or ask for help from the best health experts in this country, or does it simply use its own parallel systems, processes and structures? I am not asking this question naively. I understand that there is a difference in health issues in different countries and I absolutely recognise the expertise in DfID on the health issues in developing countries. But many things are the same in both poor and rich countries, one of which is health systems. If you are looking for support for health systems, you are more likely to find that expertise in the people who are running the health systems in, for example, this country. Another question is: how often does DfID make use of the Health Protection Agency, which is probably the best or the equal best of its kind in the world? The parallel test question is: when the Department of Health or the Health Protection Agency is dealing with a problem originating outside this country, how often does it call on DfID for advice to make sure that it has a real understanding of what is happening in that country? This co-operation is getting better, but it is still a weak point. While I know about the relationship around health, I suspect that the same thing must be true in other areas, such as education. My second point concerns staffing. There is a huge shortfall of health workers around the world, which is the vulnerability that underpins all others. We globally are as vulnerable as the most vulnerable point, and the most vulnerable point is likely to be in a poor country with poor health and social conditions, with very few health workers and with people who may not be able to recognise the problems as they arise. That is our big vulnerability. I know that the UK and others are part of the innovative financing task force, which is co-chaired by the Prime Minister and the president of the World Bank. Again, I would ask the Minister for reassurances that in looking at its work, attention will be given not only to innovative funding for staffing, which is part of its terms of reference, but also to innovative approaches to staffing. My point is simple: staffing is not just about doctors and nurses. It is about all those public health professionals, public health local community workers and mid-level workers—they are called a number of names in different countries—who work in the most difficult conditions and are therefore most likely to see where the problems are. Therefore, the issue is not just about making sure that the UK supports innovative funding mechanisms in order to increase the levels of staffing in health services around the world but also about increasing the innovative structures. You do not want to have the same grades and types of staff as we have in the UK in many of these countries. We will miss an opportunity if we raise money to increase staffing, but do not use it to have the most impact on issues such as communicable diseases, which will tend to be at the most local level often with the staff who have had the least training. Incidentally, in parenthesis, the UK has the most tremendous tradition of health education, and throughout the world it has played its part in the education of doctors, nurses and others. It has, I believe, a great opportunity, if the appropriate arrangements can be made, to support training and education internationally. That would be a very positive contribution to the globalisation of health education and would help to support poor people globally. In summary, this excellent report has laid out the ground very well and has expressed our vulnerabilities. I believe that these two areas require more attention and more action.