Covid-19: UN Sustainable Development Goals

Lord Crisp Excerpts

Wednesday 22nd July 2020 Lords Chamber

[Baroness Sugg [V]]

I completely agree with my noble friend. We know that we will not achieve all the goals without strong action on gender equality, and women and girls are key to their success. We absolutely agree on the importance of girls’ education. The Prime Minister and the department champion the right of every girl to 12 years of quality education.

[Lord Crisp (CB) [V]]

My Lords, the pandemic has dramatically demonstrated the importance of having strong health systems everywhere in the world. In that context, what assessment have the Government made of progress towards universal health coverage—part of goal 3—and will they increase their support for achieving universal health coverage?

[Baroness Sugg [V]]

My Lords, the weakness of developing countries’ health systems is one of the biggest risks of the global impact and spread of Covid-19. Equitable, resilient and sustainable systems for health are the foundation for meeting all health needs and preparedness for future health threats. Working towards universal health coverage is more important than ever, given the increased barriers to, and needs for, accessible healthcare. The Government will continue to support access to universal health coverage.

Covid-19: Overseas Development Assistance

Lord Crisp Excerpts

Wednesday 22nd April 2020 Lords Chamber

[Baroness Sugg]

I can absolutely confirm our commitment to 0.7%. we need to respond both multi-laterally, though the global system, and bilaterally, in country. We are working quickly to pivot our programming to support the Covid response, reinforcing health, humanitarian and social protections or economic support programmes in country.

[Lord Crisp (CB)]

My Lords, I very much welcome the investment the Government are making in vaccines against Covid-19. Will the Government impose public interest conditions on UK-funded vaccines, treatments and diagnostics, so that they can be affordable and accessible not only in the UK but to low and middle-income countries? Will the Government also encourage and persuade other Governments to do the same?

[Baroness Sugg]

My Lords, we absolutely need an effective Covid-19 vaccine to be developed, trialled and approved for use as quickly as possible. We are doing that in three ways. First, we are the largest funder of the Coalition for Epidemic Preparedness Innovations. Secondly, we have launched a vaccine task force to expedite and co-ordinate efforts to research and produce a coronavirus vaccine. Finally, in June we are hosting a replenishment for Gavi, the Vaccine Alliance. That will be really key to the operational delivery of a vaccine at an affordable price to those who need it across the world.

International Women’s Day

Lord Crisp Excerpts

Thursday 7th March 2019 Lords Chamber

[Lord Crisp (CB)]

It is a great pleasure to speak in this debate. As other noble Lords have said, it is an occasion for both celebration and publicising what more needs to be done, and an opportunity for renewing the energy for and commitment to more advocacy and change. This area is enormous, so I will talk specifically about health, and just a part of it. To start with, let me say that health is a field in which women play by far the largest role—a fact that is not always, if ever, recognised and acknowledged.

I will start at the celebratory end by congratulating Dr Roopa Dhatt and her colleagues at Women in Global Health and its sister organisation, Women Leaders in Global Health. Women in Global Health aims for gender equality in global health leadership in order to achieve better global health. Leadership in health globally is largely male but, as Women in Global Health argues, many excellent and well-qualified women are simply not recognised. Women in Global Health works to increase their visibility and opportunities for inclusion in leadership at all levels everywhere. It advocates for organisations to adopt gender-equal leadership, draw leaders from the entire talent pool and address the inefficiencies caused by gender inequality that weaken global health. It is great to see Women in Global Health growing in membership and influence, and it is very important to note that gender balance in the way it describes it is fundamental to improving health globally.

Let me widen this out by talking about nursing. Nursing is not a gendered profession, but about 80% of nurses globally are women. Incidentally, although this is not my main point, nursing needs to attract more men. It is one of the few fields in which there will be enormous growth in future years, and we need to involve the whole population. The All-Party Parliamentary Group on Global Health recently reviewed nursing globally and found, across all countries, a systematic undervaluing of nurses—a devaluing, really—and an underutilisation in the sense of nurses being well trained but not being able to work to the top of their potential—“to the top of their licence”, as the Americans might put it.

In our survey, we read comments like, “We are invisible”, “We are taken for granted and kept down” and “We are seen as just nice women doing what doctors tell us”. They are not seen as truly trained professionals or allowed to work as such. Evidence suggests that this is happening partly because most nurses are women—how women are treated in particular countries seems to be reflected in the way nurses are treated there—and partly because they are not doctors and there is some territorialism about who does what. Whatever the cause, this is a most extraordinary waste of talent, passion and commitment—and, frankly, resources, if the largest part of our global workforce is unable to work to its full potential and contribute fully.

Moreover, as our report, Triple Impact—which came out of that study—shows, if you develop nursing, you do not just improve health and promote gender equality, you also promote the economy. For example, in African countries you involve more women in the cash economy. As my noble friend Lady Flather said, when women have money in their pockets, they are more likely to spend it effectively and for the benefit of a wider range of people. So there are three big wins from promoting and developing nursing, which is why my noble friend Lady Watkins and I set up Nursing Now, to improve health globally by raising the profile and status of nursing.

I have three questions on what the UK can do to advance gender equality globally. First, what are the Government doing to support the aims and work of women in global health? Secondly, what are the Government doing to raise the status and profile of nursing in the way that I have described—beyond their very welcome support for the campaign Nursing Now that Ministers have already pledged? Finally, perhaps I may raise a domestic issue. Noble Lords will know that the majority of carers in this country are women and that almost all of them are on zero-hours contracts. It would be interesting to know whether the Government recognise this as a problem, and, if so, what they will do about it.

Nursing

Lord Crisp Excerpts

Monday 14th May 2018 Lords Chamber

Asked by

[Lord Crisp]

To ask Her Majesty’s Government what priority they will give to investing in nursing globally, in the light of the impact of such investment on improving health, promoting gender equality and strengthening local economies.

[Lord Crisp (CB)]

My Lords, it is a great pleasure to open this debate. I thank noble Lords who are taking part in it and hope that it has not disrupted too many dinner plans. I am going to address three matters in turn. First, I am going to talk about the background to the debate. Secondly, I am going to talk about why strengthening nursing globally is one of the most important things that we can do to improve health globally, and why it should be given a higher priority and greater investment. Thirdly, I shall conclude with some questions for the Government.

The background to this is that I co-chair the All-Party Parliamentary Group on Global Health, which undertook a review of nursing globally, with a review panel that I am delighted to say included the noble Baronesses, Lady Watkins and Lady Cox, and the noble Lords, Lord Ribeiro and Lord Willis, as well as Dan Poulter and Maria Caulfield, a doctor and nurse from the other place. Interestingly, nobody has done such a global review before. My focus is global, but what we are saying is also relevant to the UK, and I know that other noble Lords will mention nursing in the UK. I also say at the start that while our focus is nursing, a lot of it is also relevant to midwifery—and, of course, nurses work in teams.

As a review, we concluded three things. First, we will simply not achieve universal health coverage without strengthening nursing and the role played by the 20 million nurses and midwives globally—half the health workforce globally.

Secondly, nurses are too often undervalued and underutilised, unable to operate at the top of their licence. In other words, nurses are trained to a certain level, but then not in practice allowed or enabled to work to the level of their training. This is different in different countries but, interviewing nurses around the world, we found the same story everywhere. This is a huge waste of talent and resources.

Thirdly, the triple impact of strengthening nursing globally is that it will have an impact on three different sustainable development goals: improving health, promoting gender equity—nursing is clearly a route to women’s empowerment in Africa—and promoting a stronger economy.

These are important conclusions, but let me get to the heart of what I want to say and why I believe that now is the right moment to strengthen and develop nursing; why this is one of the most important things we can do to improve health globally; and why nurses will become even more important and influential in future. There are several reasons for this, but I want to talk about just three major ones.

The first is that diseases are changing. There is a global increase in non-communicable diseases—diabetes, heart disease, cancer and the like—and in co-morbidities in older people. As we all know, these diseases require holistic, patient-centred care, and this is at the very heart of nursing philosophy. Nurses address the whole person. They take not just a biomedical view but consider psychological, social and environmental aspects. We need a fundamental change of approach in how health services are delivered globally—new models of care—and nurses will be at the heart of that.

Here in the UK, we already have nurse-led and nurse-based services—for example, in diabetes and other long-term conditions. Those are increasing here in the UK, and there are now many similar services globally. We can see the impact of allowing nurses in South Africa to initiate treatment on anti-retrovirals, which has helped to turn around the epidemic of HIV, nurse prescribing in Botswana, the development of community services in Singapore and the strengthening of nursing in Uganda. These are all countries which understand the change which is happening. It is about improving access and quality and more cost-effective delivery of care. Nurses are very capable in all those areas.

The second big argument is that nurses are the health professionals closest to the community and, in many rural areas and slums are the first and often the only people who patients see. They are best able to help community health workers, the people in the most remote areas, to make them more effective and of higher quality.

Thirdly, this closeness to and being part of the local community also makes nurses the most effective health workers at promoting health, preventing disease, improving health literacy, early detection and tackling the social determinants of health.

I believe that those three aspects—holistic, person-centred care, reaching the most remote groups and promoting health and preventing diseases—are central to health policy in every country of the world. As I said, nurses are particularly fitted to handling it. It is for this reason that I believe that they will become even more important and influential in future.

I must say that our all-party review group thought that this was a no-brainer, but we were unable to persuade the UK Government or international bodies to act, so we started our own global campaign—Nursing Now. Here I pay tribute to my noble friend Lady Watkins, who has been with me on every step of this way, as well as offering invaluable advice as a nurse.

I do not have time to say anything about the campaign. We have a website, which I encourage people to visit. It is run in collaboration with the World Health Organization and the International Council of Nurses and supported, among others, by the Burdett Trust for Nursing, the Royal College of Nursing and THET. The Duchess of Cambridge, our patron, launched the campaign a little over two months ago, and there are now national groups in more than 40 countries, without us providing any financial support. It is clear that we have caught a tide. Our aim is to accelerate the changes that I think are under way around the world.

I turn to the Government and the question of improving the priority for developing nursing globally. I very much welcome the £5 million ring-fenced for the developing nursing within the health systems strengthening in partnership fund announced at the launch of our campaign. Here in the UK, I welcome the golden hellos to be offered to postgraduates starting in nursing in mental health, learning difficulties and district nursing. I hope that the Minister will be able to tell us about other things that the Government are doing to strengthen nursing.

However, none of these initiatives is truly strategic or embraces the need for a radical change in how we see nursing and its potential to make a major difference in the world. These are incidental, isolated issues, and they need to be brought together into a much larger programme. I am sure that we all understand and accept the importance of nursing, but do we understand how much bigger an impact it could have if it was enabled to do so? That is the crux of the matter.

I have many questions, but let me ask only a small selection. Four of them are about health. First, what are the Government doing to promote nurse-led services in countries where the Government are working with partners? Secondly, what are they doing to enable nurses to play a leading role in supporting community health workers, the people who reach into the furthest part of the African and other continents? What are they doing to support nurses to provide training, supervision and a point of referral so that the community health workers can operate to the highest level of quality, be more effective and therefore deliver universal health coverage in those countries?

Thirdly, what are the Government doing to strengthen nurses’ role in promotion, prevention, health literacy, early detection and tackling the social determinants of health? These are roles where nurses, who are close to and part of the community, could play an even greater role in future. Finally, what are the Government doing to ensure that nursing is at the forefront of the global strategies to promote universal health coverage and tackle non-communicable diseases? It is interesting to note that in those strategies, there is currently virtually no mention of the workforce, let alone nursing. The UK Government could play an important role in bringing the health workforce, and nursing in particular, up the agenda to tackle these important issues.

I have not talked about the gender aspects of nursing, but I hope that other noble Lords will. My question here is: what are the Government doing to engage and develop nursing as part of their strategy and action to promote gender equity? Surprisingly, nursing figures very little in all the strategies around the world for the development of women and gender. Similarly, I have not talked about the economic aspects. What are the Government doing to engage and develop nursing as part of their strategy and action to promote economic growth?

Strengthening nursing in the way I have described is a big and bold strategic idea. Is the Minister willing to arrange a top-level meeting for senior nurses to meet Ministers and officials from his department—or wider within government—to discuss the strategic impact of strengthening nursing globally and what the UK can do to take a lead on it?

In conclusion, I am convinced that strengthening nursing is one of the most important things we can do to improve health globally. Nursing is a profession whose time has come, and I very much hope that the Government will embrace these ideas wholeheartedly and increase their priority for investing in nursing.

Health: Alma-Ata Declaration

Lord Crisp Excerpts

Monday 22nd January 2018 Lords Chamber

Tabled by

[Lord Crisp]

To ask Her Majesty’s Government whether they have plans to celebrate the 40th anniversary of the Alma-Ata Declaration on primary health care.

[Baroness Watkins of Tavistock (CB)]

My Lords, on behalf of the noble Lord, Lord Crisp, and at his request I beg leave to ask the Question standing in his name on the Order Paper.

Aid Reviews

Lord Crisp Excerpts

Friday 2nd December 2016 Lords Chamber

[Lord Crisp (CB)]

My Lords, I welcome this review and the general direction it takes, including that it is in Britain’s interest to have an effective development programme. I note that the Statement mentions,

“sharing skills from the best of British institutions”,

including the NHS, as part of this development programme. What is meant by that? More generally, we should recognise that in this process of development and indeed codevelopment, it is in our mutual interest to see that there is a lot we can gain from our partners in developing countries, as well as a lot we can give.

[Lord Bates]

That is why the review process has been so widely welcomed by so many agencies, not least Gavi and Oxfam, which have put on record their support. This needs to be seen in the context of the multilateral and bilateral development reviews. Reviews of our civil society relationships and of the research are currently under way. We have added a commitment to spend 3% of our budget on research. Much of that will be spent in British universities to help us get better at tackling the issues around the world that are the cause of extreme poverty.

Neglected Tropical Diseases

Lord Crisp Excerpts

Monday 1st February 2016 Lords Chamber

[Lord Crisp (CB)]

My Lords, I welcome this debate and the continuing attention that it gives to neglected tropical diseases, at a time when they are becoming more prominent and well known. After all, as my noble friend said, it was only a few years ago that some UK academics coined the phrase, in a masterstroke of marketing. It is very good to see that NTDs are now mentioned in the sustainable development goals, great foundations and indeed great NGOs are tackling them—here I declare an interest as a recently retired chairman of Sightsavers—and there are great efforts in that regard by the UK Government.

This is an area, like much in development, where the UK is a world leader. As an example, DfID funded the mapping of blinding trachoma globally, with Sightsavers as its lead co-ordinating agent. I am delighted to say, although I claim no personal credit, that Sightsavers delivered the mapping on time and on budget. Arguably, this is the largest ever public health mapping exercise, and is now bearing results as we can target the right areas globally to tackle the disease.

My noble friend Lord Trees draws attention to neglected tropical diseases in impairing social and economic development. This is two way—they do not occur in prosperous countries. He mentioned rabies, but trachoma was a major problem in 19th-century Europe. There are strong links between prosperity and these diseases, which are, as has already been mentioned, the diseases of neglected people, who are certainly excluded from prosperity. They impact most heavily on women because they are generally the care givers, and on their children, because they are most likely to come into contact with dirty water. My noble friend also makes a strong point that some things are associated with neglected tropical diseases as a class, not just with individual ones: poverty, dirty water, low levels of education, high birth rates, and much more.

My noble friend Lord Trees references the third report on progress since the 2012 London Declaration on Neglected Tropical Diseases. It points out that there has been pretty good progress: NTDs provide one of the strongest returns on public health investment, and points to the extraordinary levels of partnership here, between the public, private and voluntary sectors, and globally, nationally and locally. It is a terrific example for elsewhere.

However, here is the rub: it is now all about implementation: chasing down—as I suspect President Carter may say to us—the last guinea worm. As the report says,

“Coverage is increasing, but the pace is too slow to meet key milestones”.

We all know what will happen if the pace is slackened or people slow down. It happened with polio a few years ago, when it was eliminated in a number of countries but came back because people did not chase it down to the last moment. The paradox is that catching those last few microbes or worms is very expensive, and it is very important that we keep up the political will here in this country and elsewhere. The biggest risk for many of these diseases is that we do not finish the job properly; that is still an issue, for example, for polio. Like others, therefore, I urge the Government to keep up and even increase their current commitments.

Finally, I have two questions, which relate to the point made by my noble friend Lord Trees about the social and economic impacts, and which largely follow what the noble Baroness, Lady Warwick, and the noble Lord, Lord Bruce, have already said, on integration. We know that successful and sustainable elimination of these diseases will depend on many other developments, including provision of clean water, economic development and the education of adults and children. I therefore ask how the Government, through their wider development programmes, are integrating their support for eliminating NTDs with these wider programmes. I also note that this depends on surveillance and the provision of even basic health systems. How, therefore, are the Government both supporting the development of health systems in the poorest countries in the world and ensuring that these will be able to address NTDs?

Women and Girls: HIV

Lord Crisp Excerpts

Tuesday 1st December 2015 Lords Chamber

[Baroness Verma]

My Lords, the noble Baroness is right to bring the question back home. It is a mandatory duty for local authorities to ensure that the services are available and accessible to those who require them. If the noble Baroness would like further detail on that, I will be more than happy to write to her.

[Lord Crisp (CB)]

My Lords, the noble Baroness is well aware that many young people and young people’s organisations are active in advocacy, on both the prevention and treatment of HIV/AIDS, and they are, of course, very well placed to influence those most at risk. What are Her Majesty’s Government doing to support the work of young people in this field?

[Baroness Verma]

My Lords, the noble Lord and I enjoyed a very good session earlier today at which we listened to very eloquent testimonials from three young people who are not only living and dealing with HIV infection themselves but doing the broader work they are trying to deliver for others. It is important that, through the work I do with my department, DfID, and the FCO, we collectively ensure that we are engaged with all organisations across the civil society base and Government to Government.

UN: Global Goals

Lord Crisp Excerpts

Thursday 29th October 2015 Lords Chamber

[Baroness Verma]

My Lords, the noble Baroness and I worked very closely on these issues. I can assure her that both domestically and internationally, this is cross-government and will be led by the Cabinet Office. All departments will ensure that, as we have shown, they are implementing many of the goals and targets that are within the 17 SDG goals.

[Lord Crisp (CB)]

My Lords, can the Minister say something about UK plans for supporting countries in delivering universal health coverage, and in particular whether those plans will take account of the UK’s enormous strengths in health systems, especially the professional education and training of health workers, which is done both in this country and abroad?

[Baroness Verma]

The noble Lord is absolutely right, and we are really pleased to see that one goal is focused on health outcomes. In its important pledge, it encompasses the principle of leaving no one behind. The noble Lord has brought in the need to ensure that all the goals have been agreed universally for that outcome. We are making sure that every country is signed up to strategically developing health outcomes that are beneficial, particularly for the poorest and the least accessible in the world.

Sierra Leone

Lord Crisp Excerpts

Monday 29th June 2015 Lords Chamber

[Lord Crisp (CB)]

My Lords, like others I congratulate my noble friend Lady Hayman on this very important and timely debate. I also, like others, congratulate the many people from the UK who are playing, and have played, a significant part in tackling these dreadful events. I also note that this is a devastated country. The health issues go far beyond the direct effects of Ebola and there are the economic impacts which we have heard described so fluently. These impacts have been on business, tourism and trade in a country which already had a fragile infrastructure.

When I talk to friends working in Sierra Leone, they tell me that the first thing that the UK and other donors need to do is maintain continuity of support. They pick out three particular areas. The first is sustaining help for local communities to achieve better hygiene and infection control, otherwise there are—as we know—going to be continuing new outbreaks. The second thing they advocate is using some of the money which is now available to continue supporting the salaries of health workers in Sierra Leone and to redistribute some of those health workers to rural areas. The third area is surveillance. We still do not have a very clear picture of what is happening throughout the country and a major effort is still needed there. The final point which has been made—on which I have asked a Written Question and received a reply from the Minister—is about research on rapid diagnosis and other technologies which are starting to be available and the importance of deploying them. A lot of it is just about continuing what we are doing now.

My second point is about learning lessons. I congratulate everyone but I hope that the British Government and others will be listening to the frustrations and learning frankly from many people about problems that have occurred—not just the well-publicised problems with the WHO, but the problems of co-ordination and communication between different agencies and how we can do that better. I also hear some disquieting things about competition between donors and agencies for credit or resources. Those are very worrying aspects of what has happened.

In addition to the existing support, there is a real need for integrated action from the many British agencies that want to help. My noble friend Lady Masham has already mentioned BBC Media Action. Various other people have written to us to say what they can do to help with support. Perhaps the biggest need is for more health workers, a point which the noble Baroness made in introducing the debate. I note the offer from the Royal College of Paediatrics and Child Health to bring together the royal colleges on training more health workers. I will come back to that important point, because this is about Africa, not just about what we Brits can do. It is worth noting that Ebola was stopped in its tracks in Uganda, Nigeria and even in the DRC without external intervention. People had just enough skills and abilities to do that. Africans have contributed an enormous amount to this and there is some fear about directive intervention from outside as a result of these problems. There is a danger that we will—with the best will in the world and the best intentions—be imposing our solutions from outside rather than from within.

There is a considerable African response; there is great community knowledge. We should be able to draw on African leadership and not perpetuate the dependence which is too often associated with aid. It is interesting to note that the World Bank, and others, have picked up on the important point of developing and training community health workers: local people who understand local customs and are better able to institute and support changes in customs that may be dangerous and to introduce new habits and norms to promote health, well-being and hygiene. I hope the Government, and others looking at this, will think about education and training in terms of three levels. The first is the need for community health workers who are local people—very often village women—who are trained to identify and support things at a local level. Then there is the need for classic, African, mid-level nurses and other workers who are doing things that doctors do in our country. There is also the need, proposed by the Royal College of Paediatrics and Child Health, for the specialists: more paediatricians and clinicians of various sorts. There needs to be an integrated education and training plan but, importantly, this also needs to involve the development of institutions. The noble Lord, Lord Giddens, referred to a Marshall plan. There is a need here for the sort of approach that recognises that it is not a matter of training a few health workers, or providing a few drugs and facilities: it is institution-building and supporting the development of the economy.

Finally, I hope the UK will play a major role here. We have so many people who are willing and able to help, coming from all sectors of our community. It would be interesting to hear from the Minister about how this will be handled but I suggest that there is a great deal to be gained from bringing together some of these people, who may be outside the normal DoH and Department for International Development systems, and challenging them on how they can help, always bearing in mind my point about African leadership. This is about Sierra Leone, but it could also be about showing what can be achieved by a determined global effort in a country that needs global solidarity.