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Vision 2020

I begin by adding my congratulations to the noble Lord, Lord Crisp, on securing this debate and bringing the important issue of blindness, whether avoidable or unavoidable, to our attention. I know that over many years he has made a great contribution to health, including more recently in developing countries. I also thank all the other contributors to the debate who have brought to it their experience, interest and knowledge. The noble Lord, Lord Crisp, effectively set out three challenges which I hope to answer as I go through the narrative of my speech and respond to questions. On the fourth challenge, his reward is an immediate "Yes" to the question of meeting Ministers. That is a given and can be arranged. I can certainly confirm the statistics used by the noble Lord and others that, globally, some 340 million people are visually impaired and 45 million are blind. As has been said, the vast majority—almost 90 per cent—live in poor countries with weak health systems and little or no immediate access to health services which could prevent or treat blindness. It was also pointed out that cataracts, which can be removed using a relatively simple surgical procedure, continue to be one of the main causes of blindness. However, they are avoidable if healthcare is available at a reasonably simple level, and I am grateful to the noble Lord, Lord McColl, for his expertise in describing the treatment. The noble Earl, Lord Sandwich, also raised the issue. Trachoma is the second most common disease. It is linked to extreme poverty and poor sanitation, but even the simple acts of face and hand washing are not easy if there is no access to water. Glaucoma cannot be detected early enough where there are no systems for eye checks. Childhood blindness often arises from poor diet, inadequate sanitation and through diseases like measles, for which a vaccine exists. Onchocerciasis, which henceforth I shall call river blindness—although I got the pronunciation right once, I may not do it a second time—is a parasitic infection that infects the poorest of the poor. They are the people who find it most difficult to access the necessary drug treatment. There is no need for me to dwell on the huge suffering that blindness brings to individuals because it has been graphically described by other noble Lords. The $64,000 question, or perhaps the rather more expensive question to ask, is what are we doing about it. The important thing has been said already: there are many health challenges across the world, and when it comes to avoidable blindness, it does not have to be this way. In the vast majority of cases, tried, tested, simple and cost-effective interventions already exist for blindness and other visual impairments. They are preventable and treatable—as indeed they are in developed countries. Let me put that statement into context. We are therefore talking about poor countries—countries where Governments have to contend with manifold health priorities, if not crises, including HIV, TB, malaria, complications in pregnancy and childbirth and other neglected tropical diseases; where there are few doctors and ancillary services; where the system for delivering health care is often dysfunctional; where resources are limited; and where, sadly, health is often not the top priority on the Government's agenda. Here, I am at one with the noble Lord, Lord Bilimoria, in believing that access to health is a public and human right. Therefore, it seems to me that a Government, whether rich or poor, should put that high on their list of priorities. The question is: what has the UK done and what are we doing to contribute to the elimination of avoidable blindness and to support those who are unavoidably blind? The causes of visual impairment are numerous, so we must address them as part of a global effort on multiple fronts. The noble Lord, Lord, Lord St John of Bletso, raised the important issue of river blindness in Africa. DfID is a long-standing supporter of the African programme of onchocerciasis control. That is a global partnership led by the World Bank and the WHO. In 2008, the programme treated 120,000 communities affected by the disease. The UK also supports research into that and other tropical diseases. The clinical trial of the drug moxidectin, which could dramatically speed up the elimination of river blindness across Africa, was launched last year. We are addressing vitamin A deficiency and measles vaccinations through core funding to UNICEF—by £21 million in 2008. We support the GAVI Alliance—by £30 million in 2006-08. Through our bilateral programmes in Sudan, 6.5 million children received vitamin A supplements through one such programme and, in 2008, thanks to the work of DfID, more than 3 million children have been vaccinated against measles. There are clear linkages between malnutrition and the level of blindness, especially among children, so we are now stepping up our efforts against malnutrition with the new nutrition strategy. However, those interventions are not sustainable unless countries have underlying strong and lasting healthcare systems—another point made by the noble Lord, Lord Jay. Those systems must be able to deliver. As noble Lords, including the noble Lord, Lord Crisp, said, that means having a trained workforce, the infrastructure and systems for drugs delivery and healthcare, including eye care, where they are needed. That is why last year the Secretary of State for DfID committed £6 billion until 2015 to improve health systems and services. That is why the UK has led the development of the international health partnership to support developing country Governments who want to improve the health of their people according to their priorities. In addition to raising additional funding for health systems, we set up the high-level task force chaired by the Prime Minister and the president of the World Bank, Robert Zoellick. The task force reported this year and helped to secure $3.2 billion funding for improved health services across the developing world. However, developing country Governments must lead the way by investing more of their own money in healthcare systems and meeting the Abuja target of 50 per cent of government spending towards healthcare. I echo the point made by the noble Lord, Lord Crisp, that this is a partnership that is both public and private, national and international, and the task that we have can be achieved only if we work together. The noble Lord, Lord Crisp, made three points. One concerned making sure that primary care included eye healthcare. We agree that it is important that eye care is integrated into primary healthcare. DfID funds health sector plans of developing countries, with a focus on primary healthcare and the diseases of poverty. We also agree that it is important to improve the number and quality of healthcare workers, and healthcare workers at community and health centres will be trained across a range of priority issues, including eye health. The third point related to the desire for disability to have greater prominence in DfID. DfID recognises that disabled children are excluded in many instances from access to education and that disabled adults are excluded from other services. This is clearly damaging not only to the individual but to families and the local economy. That is why disability is clearly on the DfID agenda. The noble Lord, Lord Low of Dalston, talked about dismantling copyright barriers, which, as he rightly says, is being discussed in Whitehall. I would welcome any more information that he has on that so that I can take the matter further and discover precisely where matters are and how we can assist. He also asked about DfID’s support for education. DfID has provided £8.5 billion over a 10-year period—from 2005 to 2015—for education. That includes funding to support disabled children, a large number of whom are blind. The noble Lord, Lord Patel, made a number of important points, including one about diabetic retinopathy. Important though they were, however, they relate to the United Kingdom and its health service, so I am happy to pass them on to my colleagues in the Department of Health. DfID has an interest in their impact in the developing world, but I am glad to say that other ministerial colleagues have the responsibility for them here in the UK. The noble Earl, Lord Sandwich, talked about avoidable blindness. We support action to prevent blindness by funding international organisations and partnerships and by giving countries bilateral support for research. This support will have a direct and indirect impact on avoidable blindness. We also support the strengthening of healthcare systems. The kind of money that I am talking about is £6 billion to improve healthcare systems between 2008 and 2015; £13.14 million to the World Health Organisation for 2009-10; and £30 million, which I have already mentioned, to the Global Alliance for Vaccines and Immunisation. I also mentioned the African programme to eliminate river blindness. This is dealt with through the World Bank, which manages donor-pooled funds—currently £500,000 per year—and we as a country have supported it continuously since 1974. UNICEF has £21 million of core funding to provide food and other humanitarian aid. I see from the clock that I have spoken for 10 minutes. I shall have to speed up, which will be of great sadness to the Hansard writers. I am already too fast for most people to understand, which is not always accidental. India was mentioned. We are supporting the health sector in four states with a total population of 260 million. We are giving West Bengal £100 million from 2004 to 2010, Andhra Pradesh £40 million from 2007 to 2010, Orissa £50 million from 2007 to 2012, and Madhya Pradesh £60 million from 2007 to 2012. That includes support for work on tropical diseases, blindness, and child health and nutrition, the focus of which is on poor and excluded groups, including the disabled and the blind. I will have to respond in writing to a number of points that noble Lords have raised or I will fall foul of the Deputy Speaker, which I would hate to do. The noble Lord, Lord Jay, made the important point that we need a political context and cross-border collaboration between government departments. I agree. In recent months, we have seen closer co-operation between DfID, the MoD and the FCO on health issues, including a cross-departmental Whitehall group that always includes the Department of Health. Finally, the noble Lord, Lord Dholakia, pointed out that the recession will clearly have a damaging impact on the world’s poor. We agree, which is why we have made a commitment to continue to support health. Eye care is central to this. We do that best by supporting the kind of programmes that we are supporting and by remaining on track to achieve the UN target of giving 0.7 per cent of our national income by 2013. I will write to noble Lords on any points that I have missed. I will also ensure that my ministerial colleagues in the Department for International Development have a copy of this debate, so that they can see noble Lords’ awareness of this issue and their desire to raise it. This has been a matter of importance to your Lordships, and the quality of the debate has been excellent.