Health Systems (Developing Countries)

Hugh Bayley Excerpts

Thursday 11th December 2014 Westminster Hall

[Hugh Bayley (York Central) (Lab)]

This report on health system strengthening makes some important recommendations. It states that DFID’s work in the health field is often strong indeed. The Government’s responses to many of our recommendations are good, and I note and value all those good responses, but I want to talk about areas where the Government and DFID in particular should think further, because there are opportunities to strengthen further the good work that DFID does in this field.

In much of the Government’s response, they highlighted good practice in DFID’s work, but they did not say enough to convince me that Ministers and the clinical advisers in the Department are strongly committed to improving DFID’s health work yet further, especially its value for money. The hon. Member for Congleton (Fiona Bruce) rightly said that members of the Committee have a responsibility to challenge Government at the highest level to improve performance, not only on health policies relating to our partner countries—the developing countries with which we work—but on the health policies of our Government that relate to development.

I will build my remarks around two fundamental principles that underpin good health care universally. The first commitment in the Hippocratic oath, which every doctor takes before they qualify and go into practice, is “First do no harm.” We need to ensure that our health policies on developing countries do no harm, but in one respect our approach to the health services we provide for our citizens does immense harm to developing countries. I asked the Library to produce the latest figures on the number of health workers from developing countries working in the NHS. According to the hospital and community health service monthly work force statistics for September 2013, there were 68,673 health workers from low and middle-income countries working in the NHS. Included among that number were 16,615 doctors and 27,032 nurses. If those health workers were working in developing countries, they would hugely strengthen those countries’ health systems. We need to consider whether the way we run the NHS is appropriate.

In recommendation 10, the Committee said to the Government:

“The staffing of the UK health sector should not be at the expense of health systems in developing countries. We recommend DFID work with the Department of Health to review its approach to the UK recruitment of health workers from overseas. This review should consider options for compensating source country systems, promoting training schemes that involve a temporary stay in the UK, and strengthening local programmes”—

in developing countries, of course—

“to enable more medical training to take place in-country.”

By use of the word “medical”, I think the Committee meant the training of health workers more generally—all professional clinical staff, doctors, nurses and other professionals supplementary to medicine. In their response, the Government agree with our recommendation, but there was not enough detail to make me feel that our health system, strengthened as it is by many tens of thousands of health workers from developing countries, will change to enable more of those workers to work in their own country. I ask the Minister to think about that. The first line of the Government’s response to recommendation 10 states:

“The Department of Health (DH) and DFID will continue to work together to review their approach to the UK recruitment of health workers from overseas.”

It is the word “continue” that makes me think that they will carry on doing what they do at the moment. The Committee asks the Government to instigate a review and to think outside the box about how we could manage the UK’s health system in a way that does less harm to health systems in developing countries.

I remember suggesting many years ago to John Reid when he was Secretary of State for Health that we ought to undertake each year, as part of our aid work, to pay the Governments of developing countries to train one nurse for every nurse from a developing country working in the NHS, and to do the same for other disciplines. If we really want to ensure that good health care here does not come at the expense of the health care of poorer people in developing countries, that is the least that we should do. If we wanted to go further than that, we could train two nurses for every one in NHS.

We must remember that it is not only the NHS that sucks in the terribly valuable and scarce resource that is developing countries’ health workers. The private sector also does it, particularly private care homes, which suck in nurses in huge numbers. In fact, the private sector has a more predatory impact than the NHS on the health systems of developing countries, because the NHS has for the past few years—I remember discussing this with John Reid as well—instituted certain safeguards regarding employing people from countries where we can directly see a detrimental effect.

I ask for a discrete review to be jointly commissioned by the two Departments. If the Minister has not come with a brief to say that he will do that—I suspect that he has not—I would like him to discuss it with his opposite number in the Department of Health. Once it has been thought through, they could respond in writing to the Chairman of the Committee. We need to do more. The joint work that the Department does with the Department of Health should continue—I do not want to stop any of that—but we need to go further. I encourage the Minister to say that he will at least go back and talk with his clinical advisers, the doctors who work in DFID, to consider the question of commissioning a particular, discrete review.

In recommendation 16, which refers to volunteering and about which the hon. Member for Congleton spoke so eloquently, the Committee recommended that

“NHS staff should be supported in seeking to apply their skills where need is greatest.”

I agree with that. The Government’s response states:

“Over 650 NHS frontline staff and 130 Public Health England staff have volunteered to go out to Sierra Leone to help in the UK’s efforts on the ground.”

I welcome that. I hope that the Minister will tell us how many of those 650 and 130 staff have gone to Sierra Leone, what the total British complement of medical staff, including military medical personnel, is and how long they will stay. The hospital and community health service statistics provide a country-by-country breakdown that puts the issue in context. In September 2013, 567 Sierra Leonean health staff were working in the NHS, of which 347 were professionally qualified clinical staff. If for six months, a year, or a couple of years—or however long is needed to help Sierra Leone to respond to, deal with and recover from the Ebola crisis—we send a few hundred British health personnel to the country, but we typically take several hundred professionally qualified health staff from Sierra Leone, one of the poorest countries in Africa, year in, year out, are we helping or hindering its response to the health crisis?

Why are we sending staff? We are sending them now because the crisis affects us. If the epidemic spreads, there will be more and more cases in parts of the world other than west Africa—or central Africa, which has also seen some cases. We are doing it out of self-interest. If we are concerned about strengthening health systems in west Africa, and particularly in Sierra Leone, so that they can deal with this challenge, and if we are concerned about helping to build more robust health systems to raise health standards in Sierra Leone, we need to change the number of Sierra Leonean health personnel that we attract to this country to work in our NHS.

In recommendation 18, the Committee proposes that

“DFID publish a clear health strategy”.

I want DFID to explain why it does health work. We know that it is good and valuable, and we know the many things it does that every sane person would support, but let us get down to the real basics: why do we do it? Why do we spend DFID money on health systems rather than on job creation or other development measures? We do it because, going beyond the first principle of doing no harm, we want developing countries to use their limited resources for health—both the aid that we provide and the rather greater resources that they generate from their own revenues—as cost-effectively as possible. Cost-effectiveness must be measured in terms of maximising the number of lives saved from preventable diseases and maximising good health, while minimising the burden of ill health and disease in the developing countries that we aid.

In the National Institute for Health and Care Excellence, which is the UK’s health technology assessment system, a device called a quality-adjusted life year is used to measure the impact of a health intervention. I apologise for lapsing into jargon, but a QALY is a concept that marks each year of life that is lost through preventable disease. If somebody who would otherwise have lived to the age of 65 dies at the age of 45 through a preventable illness, 20 QALYs would be lost. If that person’s life is saved but they continue living with a disability such as blindness, the QALY will estimate what percentage of a person’s good life is lost. If they are a tailor, for example, they would lose their livelihood if they lost their sight.

We came across NICE International during our inquiry, and I would like to know whether the NICE principles of considering the cost-effectiveness of health interventions was being applied to the Government’s international health work. Does NICE International have a similar approach, and examine the impact of a health intervention? How many quality-adjusted life years on average does every £1,000 of locally or DFID-generated money buy, if the intervention is focused on immunisation, for example, perhaps through Gavi, the global fund for vaccines and immunisation? How many QALYs would that same £1,000 buy if it was sunk into maternal and child health, or into the purchasing and distribution of antiretroviral drugs for people with HIV and AIDS, and into backing that up with clinical interventions? Or the money could be invested in general health system strengthening, and training nurses in developing countries and encouraging them to work within the health system of that country; I implied earlier that we ought to do more of that.

We should be able to see how, if we targeted our resources better, the same amount of money could help more people, avoid more deaths and enable more people to return to good health so that they have viable and productive lives. For example, a woman with three children whose husband has died from AIDS and who is HIV-positive herself might be able to carry on looking after those children, instead of dying and leaving orphans for someone else to look after. We ought to quantify what benefit we get from different interventions.

DFID is well regarded internationally for its work on basic human needs, in health and education in particular. Other countries have especially strong records on using development finance to build infrastructure such as roads, which the European Union is much better at building than we are, or to support small businesses and create livelihoods, which I think the Germans do. We, however, are probably the global leader in using money effectively to provide for basic human needs. We should be proud of that, but if we could make our work more effective still, we most certainly should. That would improve the value for money that our taxpayers get from the money spent in developing countries to reduce the burden of ill health. Also, our practice would be copied by countries that look to the United Kingdom for a lead on how, through development assistance, we can strengthen the health systems of developing countries.

I want to mention one final recommendation. In recommendation 4, the Committee stated:

“It is impossible to know how well DFID is delivering its health systems strengthening strategy without knowing how much it spends or having indicators of its performance.”

I am not saying that we have to use QALYs, but they are certainly one indicator that it would be worth using. There are also other indicators. The recommendation continues:

“Nor can DFID allocate its resources efficiently in the dark.”

If we do not do the technical work of looking at how valuable intervention A is at reducing the burden of disease and disability by comparison with intervention B, we will not use as effectively as we might the limited money that we have for strengthening health care systems in developing countries.

The Government say that they agree partially. I want them to think further and to tell us what they will do to improve the technical work that their clinicians do, so that we can work out the effectiveness of health interventions. If we increase the clinical effectiveness of work done in developing countries, not only with our aid, but by the health system as a whole—funded by us, by multilaterals, by other donors and, more than anything else, by the country’s tax revenues—we will save lives. If we are trying to explain to our constituents why we put money into development assistance, saving lives is something that people understand, value and believe that we should do. That is why they think that the Government are right to respond to the Ebola crisis.

If we fail to do that, to raise our game and to do more to assess which interventions are most cost-effective, it will cost lives, because we will not be using the limited resources that we have as effectively as possible. None of us would want to explain to our constituents that we had simply not done the technical work to find out what works best, and so were spending their money less effectively than we might otherwise do in developing countries. Will the Minister think about that and write to us after the debate, once he has had the opportunity to discuss things further with his officials? Will he explain what more his Department could do to respond to the calls that came from our Committee?

It sounds as if I am complaining, but a lot of the Government’s response is good. I welcome it, but I was thinking out of the box in response to what the Government said about our recommendations. I want the Government to do 100%, not 50%, of what our Committee asked them to do. We have not got all the answers right; the Government have much greater technical expertise in Departments than we have in the secretariat of our Committee. Let us not be sloppy; let us be professional and focus on what we can do to improve the value for our health development money.

--- Later in debate ---

[The Minister of State, Department for International Development (Mr Desmond Swayne)]

It is a pleasure to follow such a well informed, if interrogative, speech from my opposite number, the hon. Member for Glasgow Central (Anas Sarwar). I thank hon. Members for their constructive, measured, informed and, if I may say so, welcome criticisms. They stand in some contrast to those made in other proceedings that have taken place at Westminster today—although this debate is not about Ebola, it is certainly stalked by and informed by Ebola.

I am glad that the Chairman of the Select Committee, the right hon. Member for Gordon (Sir Malcolm Bruce), referred to the flags being out in Freetown, because I believe we have a record of which we can justifiably be proud. We have launched an operation with military precision. We have put 850 military personnel on the ground, in addition to the NHS workers whom I have already mentioned, to support 750 beds, of which 282 are for treatment and 468 are the key, important beds for isolation. We have isolation centres in which people can be isolated while we determine whether they have Ebola. Seven out of eight patients will go home after what was just a bout of fever, for example; the others will go on to receive treatment for Ebola. It is a remarkable operation, costing £230 million, of which we have already disbursed £125 million, and people should not be critical of it. In Kerry Town, we already have 52 operational beds.

[Hugh Bayley]

I strongly support what the Government and the military are doing, and tomorrow I will visit the Army medical training centre at Strensall to see the hospital that has been created there, in which people are trained to deal with infectious diseases such as Ebola in a tropical climate. It is not just UK military medical personnel who are trained in that centre; military medical personnel from other countries, including the United States, use it because it is a centre of excellence.

[Mr Swayne]

I hope the hon. Gentleman will convey the Department’s thanks to Strensall for the magnificent work it has done in providing build-up training to for many personnel before they deploy to Sierra Leone.

[Hugh Bayley]

indicated assent.

[Mr Swayne]

As I said, there are 468 key isolation beds. We are supporting more than 100 burial teams—both the logistics and training, and their fleet. That has had a remarkable impact on the incidence of the disease. As I said in an earlier debate, people are almost most infective once they are dead. Removing bodies and dealing with local burial customs has been one of the main drivers of the disease. In the western part of Sierra Leone, in which a third of the population lives, we are achieving 100% burial within 24 hours, which will make a key difference.

Of course, the criticism will be made that we acted too late; that we should have spotted the problem earlier. Hindsight is the most exact of sciences, but when the Committee went to Sierra Leone in June, it was not obvious that the problem was going to be of the scale we have now discovered. Actually, in January DFID had already begun refocusing our effort in Sierra Leone to deal with the emerging problem. In July and August we started to pump in more money to deal with that. I was making telephone calls, I think in the latter part of July, to the chief officers of UNICEF, the Office for the Co-ordination of Humanitarian Affairs and the World Health Organisation to try to ginger up their response. Many of those organisations are in need of reform. I have some sympathy for the World Health Organisation, which does not have at its centre the levers of power to bring about immediate change in the regions and countries in which it operates.

Equally, we must remember what was happening in the humanitarian community at the time. First, we were distracted by the terrible events in Gaza. Then, we moved swiftly on to rescuing people from Mount Sinjar, and all the time we had the ongoing crisis in Sudan. It has been a busy playing field for humanitarian organisations and workers to deal with.

Starting from where we are now, we certainly have a proud record. Clearly, there are lessons to be learnt, but, having looked at both the reports we are considering, there is no doubt that both Sierra Leone and Liberia are among the poorest countries in the world and that they were so even before they were struck by this disaster. Our aid reflects that: Sierra Leone remains one of the largest per capita beneficiaries of UK aid. In 2010-11 it received £51 million in bilateral aid, and £68 million in 2013-14. Owing to Ebola, I anticipate that that figure will inevitably fall next year—I suspect by about 30%—as a consequence of being unable to spend on the programmes we had identified. Of course, that will be completely augmented by the £230 million we are spending on Ebola.

I hope that 90% of our programmed spend on health will continue, but there will be instances where we will be unable to distribute bed nets in the way my hon. Friend the Member for Stafford (Jeremy Lefroy) described. There will be an effect on our programmes, but we will seek to minimise that.

Security of Women in Afghanistan

Hugh Bayley Excerpts

Thursday 6th March 2014 Commons Chamber

[Sir Robert Smith (West Aberdeenshire and Kincardine) (LD)]

I beg to move,

That this House recognises, ahead of critical presidential elections in April 2014, the essential contribution of Afghan human rights defenders to building peace and security in their country; further recognises the extreme challenges, including violent attacks and killings, that they face as a result of their peaceful work; believes that sustainable peace and security cannot be achieved in Afghanistan without women’s full participation; and encourages the UK Government to improve its support and protection for women human rights defenders in Afghanistan.

I am sure that all hon. Members would like to take this opportunity to offer their sympathy to the family and friends of the soldier who died yesterday at Camp Bastion, bringing to 448 the number of British personnel who have died while serving in Afghanistan.

I would like to thank the Backbench Business Committee for allowing time for this debate on the security of women in Afghanistan.

Many people will remember 11 September 2001. I remember that I was trying to get a survival suit on while waiting for a helicopter to bring me back from a visit to an offshore platform when the offshore installation manager came to us and said, “There’s been an aircraft crash in New York; I’ll put it on the telly.” When we got off the helicopter at Aberdeen airport, we saw on the news that there had been another crash. It was obviously not an accident; it was a serious situation. That event has linked the mountains of Afghanistan and the living rooms of the UK and tied our two countries together since 2001. I pay tribute to the troops and to the staff of the Department for International Development, the Foreign and Commonwealth Office and the non-governmental organisations for all the work that they have done in Afghanistan since then to try to establish a more stable and secure situation for that country and for the wider world.

On a visit to Afghanistan in 2007, while I was serving on the International Development Select Committee, I saw at first hand some of the challenges involved, and some of the achievements, especially those relating to the role of women in society. It was particularly memorable and moving to visit a classroom of girls, and I remember sitting next to a girl who enthusiastically showed me the homework that she had taken from her school bag. Those girls were able to engage in the learning process again. In the context of the transition in Afghanistan, it is telling that on the successor Committee’s more recent visit to the same school, it was felt inappropriate that Committee members should visit the classroom where the girls were. That might be a measure of the hardening of attitudes towards women that is beginning to cause concern.

We also saw a project for start-up businesses, and it was pointed out to us that loans to women were considered far more secure than loans to men, because the women entrepreneurs repaid their loans far more effectively than the men. There was a great deal of enthusiasm for the range of businesses that could support the Afghan economy. We also visited a maternity hospital in Lashkar Gah, where DFID had built accommodation for the training of midwives. The development of women’s health and the support for engaging with women was recognised as an important contribution.

This debate is timely because international women’s day is coming up at the weekend. The security situation in Afghanistan is changing with the withdrawal of international security assistance force troops, the handover to Afghan security forces and the election of a new President in April. Progress has been made since 2001, but it has been fragile.

[Hugh Bayley (York Central) (Lab)]

I travelled to Afghanistan with the hon. Gentleman on that Select Committee visit in 2007. When our troops come back from Afghanistan and no longer have a security role in the country, we will not be able to enforce the rights of women in the way that we have to some extent been able to do while our troops have been in the country. The hon. Gentleman has been explaining how much DFID has achieved in changing the prospects of women through its aid programme. Does he agree that that aid programme should be maintained and should have a footprint across the whole of the country, rather than just being based in the capital, Kabul?

[Sir Robert Smith]

I certainly recognise the crucial importance of the aid programme in building on what has been achieved to date. I also recognise that we need to engage with the whole of Afghanistan to get the messages across.

Oral Answers to Questions

Hugh Bayley Excerpts

Wednesday 5th March 2014 Commons Chamber

[Mr Duncan]

The hon. Gentleman is right that in a proper liberal democracy everyone should be treated equally and fairly. That includes people of different religions, including the Christian communities to which he refers.

[Hugh Bayley (York Central) (Lab)]

4. How much her Department gave in aid to Mali in 2013; and how much it plans to give to that country in 2014.

[The Parliamentary Under-Secretary of State for International Development (Lynne Featherstone)]

The UK gave £23 million of bilateral aid to Mali in 2013, supporting some 650,000 people. We also pledged £110 million over four years for long-term resilience work in the Sahel region. The UK provides assistance through multilateral contributions, and we are considering additional bilateral funding for 2014.

[Hugh Bayley]

I welcome the fact that the Government are considering additional funding. To date, most of the money has been used for humanitarian relief because of the political weakness and the terrorist threat not just in Mali but across the region. Should we not now put money into development to provide livelihoods for young people, so that they do not turn to the terrorists and can make a future for themselves in their own countries?

[Lynne Featherstone]

The hon. Gentleman is absolutely right. Livelihoods and jobs are a key focus for DFID, and we are doing a great deal of work on them. Some of the money that we are providing is built into resilience work, because the problems in the Sahel are about drought and climate change. It is what we can do for the long term that matters most.

Oral Answers to Questions

Hugh Bayley Excerpts

Wednesday 17th July 2013 Commons Chamber

[The Minister of State, Department for International Development (Mr Alan Duncan)]

UK funding to the Palestinian Authority is used specifically to pay civil servants’ salaries, and that is subject to audit. It is absolutely right, and essential for peace, that we continue to support the Palestinian Authority.

[Hugh Bayley (York Central) (Lab)]

T5. In a Westminster Hall debate on 4 July, the Minister of State, who has just left the Front Bench, said that he would take on board my concerns about workers in debt bondage in Pakistan. Will he undertake to get the DFID office in Pakistan to write a plan of action over the summer and then to make a written statement when the House comes back in September?

[Justine Greening]

I am sure that I can speak on my right hon. Friend’s behalf by assuring the hon. Gentleman that we will follow up his comments in that Westminster Hall debate. We have a close working relationship with the new Pakistan Government and it will involve improving the lot of workers.

Pakistan

Hugh Bayley Excerpts

Thursday 4th July 2013 Westminster Hall

[Hugh Bayley (York Central) (Lab)]

I am most grateful to you, Mr Gray, for calling me to speak.

I will not trouble the Members here in Westminster Hall with a long peroration about the wise and thoughtful main recommendations made in the report, which I know the Chairman of the Select Committee, the right hon. Member for Gordon (Sir Malcolm Bruce), and other members of the Committee will have spoken about. However, there are two particular issues that, as a member of the Committee who participated in the visit to Pakistan—I have moved on from a debate in the main Chamber about another part of the world—I feel very strongly about and that I am glad to have the opportunity to raise.

It is quite clear to me why the UK has such an important development partnership with Pakistan; it is because of our history and because of the need for us to work with the Government of Pakistan to resolve security problems that threaten both Pakistan and neighbouring countries. Integral to that development process is empowering women to get an education, play a full role in society and have their human rights defended.

Shortly before we went to Pakistan, we heard about the dreadful shooting in that country of Malala, a schoolgirl who was shot simply because she had the effrontery to wish to have an education. That event stunned people around the world and, interestingly, changed attitudes in Pakistan considerably. I went with some other members of the Committee—a sub-group—on a field visit to Haripur in Khyber Pakhtunkhwa, where we went to a school. It was a Government girls’ secondary school, where the girls re-enacted a piece of drama, asserting, as a consequence of Malala’s shooting, the right of girls, like boys, to have an education, enter the labour force and have professional standing. It was extremely moving. When I talked to parents and teachers after the performance—there is a parent-teacher association at the school—they were very clear about the fact that the shooting of Malala had to change the nature of politics and society in Pakistan.

Following that visit, it struck me that, although the UK is a major aid donor, we do not always listen enough to the voices of women in the countries where we are working. It also struck me that, at the very least in respect of Pakistan, we ought to establish an advisory panel of women to work with our Department for International Development office to ensure that all our programmes address the women’s dimension of the issues that they aim to address, whether it be education or health care.

When we were in Khyber Pakhtunkhwa, we also met representatives of a number of Pakistani non-governmental organisations, including a quite inspirational woman, Maryam Bibi, who leads a women’s self-help organisation called Khwendo Kor. I have known Maryam Bibi for a number of years. She did a postgraduate degree at York university and then returned to the tribal areas of Khyber Pakhtunkhwa, where women’s rights are often threatened. She has done some remarkable things, such as establishing schools for girls and then standing up to men who threatened to kill her for doing so. She has a very persuasive manner. When we met her on this visit, she told us that she had been running a campaign to try to persuade Pakistani society in these conservative tribal areas to recognise that women should have rights of inheritance. She did that not by demanding those rights as a woman, but by seeking to find male community leaders who would make the argument. She had been talking for many weeks with a mullah, who appeared intellectually persuaded that women should have a right to inherit, but was unwilling to make a statement to that effect in Friday prayers, which was what she was urging him to do. That went on for many weeks and then, eventually, he made the statement. Maryam Bibi asked him what had finally changed his attitude, and he said, “Well, you persuaded me early on, but it took a long time for me to get my will changed, so that my wife could inherit.” He did not want to call on others to do something that he had not done himself.

Maryam is an extraordinary woman. I hope that she is the sort of person that DFID would consider using as an adviser. It is not for me to determine whom DFID selects, but it would be a mistake to think that we can get to the heart of the problems that Pakistani women face without Pakistani women advising us—not only on what the problems are, but on how to tackle them. I hope very much that the Government will consider that.

The second issue in Pakistan that I want to discuss, which struck me like a bolt out of the blue, was the gross—indeed, grotesque—violation of human rights that comes from debt bondage. One of our field trips, involving the whole Committee on this occasion, was to a low-cost private school. Doubtless, there will have been discussion earlier in the debate about the role that those institutions play.

After meeting the head teacher and some of the other teachers as we visited the classrooms, we had the opportunity to meet some parents. Those parents were brick kiln workers. They were very, very low paid and looked down upon by various members of society, and were living on the margins of a city in an area where the state had not deigned to provide a school, which was why a small private initiative had been set up to provide an education of sorts for their children. A state school would not have done any good anyway, because the children also had to work in the brick kiln. Consequently, the private school was arranged so that the children could come rather earlier in the morning than they would to a state school and so they could leave after lunch to do their share of labour in the brick kiln.

Those women told me that every one of them—every one of those parents—was indebted to the brick kiln owner and that debts ranged from 100,000 rupees to 300,000 rupees. Sometimes, they had taken out loans for things such as weddings, but more often because of injury and because they needed medical treatment. The typical earnings for people working in the brick kiln were 350 rupees per week per family—for husband, wife and two children. Those people owed perhaps up to two years’ wages. Such a debt for people on such a low, subsistence income is one they will never repay. Indeed, one woman told me that she had inherited her debt from her husband when he died.

Once someone gets into that kind of debt, there is no escape. Those people are illiterate, so even if they wanted to challenge the brick kiln owner over their debt, they would not have the skills to do so. One huge value of providing education for their children is perhaps that, in the next generation, it will be less possible for usurious moneylenders to pull the wool over those people’s eyes.

We raised that problem with the Chief Minister of Punjab. He told us that the law prevents debt bondage. His adviser, Zakia Shahnawaz, said that the intention was to introduce a Bill to establish a minimum wage of 600 rupees and to reinforce the law that ended bonded labour. I hope that that happens; it is desperately needed. If each wife and husband each earned 600 rupees a week, the children would perhaps not need to work in the brick kilns as well and could go to school in the normal way like other children. The debts of those people should be written off. Such debts should not exist in any civilised society anywhere in the world, but for that to happen we need not just UN resolutions and outrage expressed in this Palace of Westminster, but practical action to work with such people—the poorest of the poor and the lowest of the low—to give them the ability to go to court to challenge what is being done to them, crushing them and their children.

Although the issue exists not only in Pakistan, I would like a start to be made there with our Government putting together a programme of work to provide a citizens advice service to enable people such as those I have talked about to gain their freedom, which is their birthright, but which they are denied.

Post-2015 Development Agenda

Hugh Bayley Excerpts

Thursday 21st March 2013 Westminster Hall

[Mr Charles Walker (in the Chair)]

Just so that everybody knows where they are at, let me say that we will start the wind-up speeches at 4 pm.

[Hugh Bayley (York Central) (Lab)]

That rather limits the time for me to say anything.

I start by thanking colleagues from many of the all-party groups that take an interest in international development for joining me, on behalf of the all-party group on Africa, in seeking the debate. I also thank the Backbench Business Committee for giving it to us, particularly in this important week. Next week the United Nations Secretary-General’s high-level panel, charged with producing a report recommending global development goals for the period after 2015—the end date of the millennium development goals—meets in Indonesia. That will be its last full meeting before it publishes its report.

I should also begin by paying tribute to the Government and what the Chancellor said in his Budget speech yesterday.

“We will also deliver in this coming year on this nation’s long-standing commitment to the world’s poorest to spend 0.7% of our national income on international development.”—[Official Report, 20 March 2013; Vol. 560, c. 935-6.]

That is a statement that I imagine everybody here will warmly endorse.

The Select Committee on International Development has made criticisms from time to time of the way in which the Department for International Development is moving towards that goal. We were concerned that instead of increasing the budget in three equal stages over three years from the 0.53% of gross national income inherited from the previous Government, the budget has flatlined for three years and will now rise steeply in this year from, I think, 0.52%, which is slightly below the level inherited from the previous Government as a proportion of GNI.

[The Minister of State, Department for International Development (Mr Alan Duncan)]

If I may assist the hon. Gentleman, last year’s figure was 0.56%, so it has been rising gently but then will be steeper.

[Hugh Bayley]

I stand corrected and congratulate the Government on moving in the right direction. The concern from the International Development Committee was that it will mean a substantial increase in spend in this year. We were concerned about the absorptive capacity, particularly in countries where we have bilateral programmes. That is something that the Minister might address later.

The International Development Committee has also voiced concerns about the squeeze imposed by the Treasury on DFID’s administrative costs. Like all Members I want to see every Government Department lean and mean, but as DFID is unusual in having a sharply rising budget, we are concerned that reducing the number of people DFID has on the ground runs a risk of our aid spend being supervised and scrutinised less closely, and possibly being less efficient as a result. That needs some creative thinking.

On my visits with the International Development Committee to DFID offices in the field, it has occurred to me that it is now harder for DFID staff to spend time away from the capital, looking at what is happening in health clinics or schools. Perhaps DFID could contract out to non-governmental organisations some of that work of checking what is happening on the ground and delivering reports on whether the training programmes for teachers in rural schools are delivering trained teachers. That is just a thought.

Having said that, I acknowledge that in the current economic climate it is not an easy political decision for the Government to stick to the commitment. Those of us who think it is the right thing to do have a responsibility to make the case for international development, in church halls and local newspapers up and down the country. Although there is a strong constituency of support, often church or faith based, for international development, and support from many diaspora communities in Britain, there are also many people who ask why we are increasing our charity abroad when we are not able to increase spending on some essential services at home.

[Jeremy Lefroy (Stafford) (Con)]

I am grateful to the hon. Gentleman, and to the Backbench Business Committee, for initiating the debate. Does he agree that among young people—schoolchildren and students—there is tremendous enthusiasm for this subject? Nearly every primary school I visit in my constituency has displays about links with schools in the developing world. They seem as keen, if not more so, as any part of the adult population on the importance of those links, perhaps because they see the impact of poverty on children.

[Hugh Bayley]

I agree strongly. If we can win the hearts and minds of young people, we have a future on our side. The bold but right decision made by the Prime Minister and Government to raise our aid spending to 0.7% this year gives the Prime Minister great moral authority when he is involved in discussions with leaders of other countries. If the UK commits increased support to the world’s poor, we are in a position to argue that others should do so as well.

I want the Prime Minister to use that moral authority in the same way that Tony Blair and my right hon. Friend the Member for Kirkcaldy and Cowdenbeath (Mr Brown), the former Prime Ministers, used their authority. They decided to lead internationally the argument for debt write-offs, to increase aid substantially from 0.29% to 0.53% and to win commitments from other global leaders to do more for the world’s poor. It is particularly important for the Prime Minister to use that moral persuasion in his capacity as co-chair of the United Nations Secretary-General’s high-level panel, and in the G8 summit that he chairs this summer.

I want to talk a little more about the parallel I see with the last time the G8 was in the UK at the Gleneagles summit in 2005. The then Prime Minister Tony Blair put global development and climate change on the agenda. Many Members will recall the Make Poverty History campaign led by NGOs. It mobilised hundreds of thousands of members of the public in support of a demand to increase aid and make aid more effective. The Government’s determination, together with that support from civil society, led to a new partnership for Africa’s development.

On the one hand, donors such as the UK committed to double aid to Africa. That commitment was given by the G8 at Gleneagles and by the EU, which was under the UK presidency that same year, 2005. On the other hand, African leaders—led by Presidents Mkapa of Tanzania, Thabo Mbeki of South Africa and Obasanjo of Nigeria—gave commitments that, if the donors increased aid, leaders of African countries would do more to use that aid effectively. They established a number of peer review mechanisms—including the African Peer Review Mechanism—in which officials from one African country would audit the effectiveness of government expenditures and economic policies in other countries.

The single most important point I want to make this afternoon is that deals at international summits do not just happen. They do not happen because G8 leaders feel in a benevolent mood on the day and decide to put their hands in their pockets and double aid. It took two or three years of political mobilisation and preparation to deliver the results in the Gleneagles G8 and the British presidency of the European Union. That probably began in 2001—I remember the year well, because that was when Tony Blair sacked me from the Government. Rather nervously, he called me in afterwards to talk to him, and he asked what I intended to do. He had just made a speech about Africa and his commitment to do more to seek to reduce global poverty, and I said that I would like to do some work in that field. That was when, together with support from colleagues from other parties, we created the Africa all-party parliamentary group, and we worked closely with Downing street to identify what the UK could do in policy terms to build a better partnership with Africa.

About 18 months or so before the Gleneagles summit, Blair created the Commission for Africa—a team of eminent persons, the majority of whom were Africans—to write a proposal for improving development in the continent. They had a commission of some 36 people, headed by Myles Wickstead, who currently advises the Select Committee on International Development. They visited most countries in Africa and certainly met, as it says in the introduction to the report, representatives from 49 countries, as well as representatives from every G8 country and every country in the EU. I believe that the report was a turning point in the west’s relationship with Africa. It was soon out of print, because it was in great demand—in capitals—both in donor countries and in Africa, and Penguin Books printed a summary version in much greater quantities.

When the commission was doing its work, the all-party group on Africa sought to work with parliamentarians from other G8 and EU countries to explain what the UK Government intended to do, and to try and persuade our colleagues in the Bundestag, the Assemblée Nationale and Congress—the House of Representatives and the Senate—to ask questions of their Executive branch about how their country would respond to Blair’s proposals on increasing aid and improving the effectiveness of aid to Africa.

[Richard Graham (Gloucester) (Con)]

I congratulate the hon. Member for York Central (Hugh Bayley) on securing the debate. He is rightly talking about the importance of spending our aid budget effectively. As he knows, the Prime Minister, who is one of the three co-chairs of the high-level panel on the post-2015 development agenda, has said that his approach in part will be to speak to the issues that poor people themselves think important.

No. 7 of the millennium development goals is to ensure environmental sustainability, and earlier this year, in Bali, the first biodiesel plant in Indonesia—manufactured and installed by the Gloucestershire-based company Green Fuels Ltd on behalf of the Swiss NGO, Caritas—was opened, employing low-skilled workers to reduce the amount of unhealthy and environmentally-unfriendly recycled cooking oil in hotels in Bali. Does the hon. Gentleman agree that that would be a great project for the Secretary of State to visit on her trip to Bali shortly? Does he also agree that supporting companies such as Green Fuels would be a powerful way for DFID to help deliver the millennium development goals and help Britain’s environmental businesses?

[Hugh Bayley]

I thank the hon. Gentleman for that intervention. It is probably for the Minister, rather than me, to comment on what will be in the Secretary of State’s diary during her visit to Indonesia. I do not know about that particular project, but I would be grateful if the hon. Gentleman e-mailed me some details. I know that there is controversy over whether land in developing countries should be used for producing food or for producing biofuels, and whether it should be used for producing food for export or food for domestic consumption. If the hon. Member for Stafford (Jeremy Lefroy) were to catch your eye at some point in the debate, Mr Walker, he might well wish to say a few things about that. We need to get the balance right.

The last thing I want to say about the period leading up to the publication of the Commission for Africa’s report is that on one of my lobbying forays I was in South Africa, and I spoke to a man called Abdul Minty, who I have known for many years through the work of the anti-apartheid movement—the London-based solidarity movement—that sought the overthrow of apartheid. By that stage, he had been appointed deputy director general—that is to say, deputy permanent secretary—of the South African Foreign Minister, and he was the foreign policy adviser and speechwriter on foreign affairs for the then President of South Africa, Thabo Mbeki.

Abdul Minty said to me, “You really must take this message back to Tony Blair. In order for the report to make a difference, simply publishing it and hoping that all will turn out okay on the day is not good enough. You have got to build a political campaign to win support from world leaders, north and south, to ensure that it changes international policy. You have got, for example, to get the Germans to pledge something on 1 February, so that you can go to the French and say, ‘Surely you can match that or top it.’ You have to programme a series of steps so that when you get to Gleneagles, people know what the issues are. They will have talked with their Finance Ministers, their Development Ministers—if they have them—or their Foreign Affairs Ministers and will be in a position to make the sort of commitment that you seek. Think of it like one of our anti-apartheid campaigns. You do not get Barclays to disinvest from South Africa by writing a good report suggesting that that is what they should do. You have to organise a series of steps at shareholder meetings or on the street, getting media coverage, in order to get the change of policy that you seek.”

I had a conversation with Blair afterwards, and I hope that that was one reason why there was a choreographed political process that sought to move global leaders in the G8 and in the EU from a position of lack of commitment to a position of commitment on doing more for Africa’s development.

I believe that the high-level panel has the potential to be a turning point in international development that is just as significant as the Gleneagles summit eight years ago. Whether that happens depends on whether the key leaders of the panel, including the three co-chairs—our Prime Minister, and the Presidents of Indonesia and Liberia—see their task not only as writing a brilliant report, like the Commission for Africa report, which I am sure they will do, but as ensuring that a political process is put in train to make sure that the report makes a difference. Many people can write good reports—people at the World Bank and the United Nations Development Programme can, as can academics at the School of Oriental and African Studies, the London School of Economics or Oxford university—but what politicians can do is change international policy.

I know that at next week’s meeting, the UK will be represented not by the Prime Minister, but by the Secretary of State for International Development. She will be a powerful representative and I have every confidence in her, but in delegating that task, the Prime Minister should not delegate the rest of the task. When it comes to getting on the phone to President Obama or François Hollande and saying, “What commitment are you going to make to the proposals in the high-level panel report?” there is no substitute for that being on the basis of national leader to national leader, President to President, or Prime Minister to Prime Minister. Of course, the Secretary of State will have to do most of the heavy lifting directly with the Foreign Affairs Ministries of the other countries, but the top-level talks will have to be led by the Prime Minister.

Because of time constraints, I shall not describe in detail the goals that the International Development Committee proposed in its recent report, to which the Government have just responded. We strongly support the Prime Minister’s proposal to eliminate extreme poverty as one of the goals; to incorporate issues of environmental sustainability, as the hon. Member for Gloucester (Richard Graham) proposed; to set global goals but to accept that individual countries will need to adapt them and set national targets and indicators that are relevant to their own level of development; to ensure that there are robust processes for monitoring progress; to emphasise the importance of good governance, as our Prime Minister does with his argument about the “golden thread”; and to make job creation one of the development goals, because young people without work will not commit to and benefit from development.

Whatever goals appear in the high-level panel’s report when it is published in May, the thing that will make the most difference is not the language of a report or even the choice of one goal over another; it is political will. Can the high-level panel win the hearts and minds of world leaders north and south? That depends more than anything else on the work that the co-chairs do after they publish their report. I am talking about their getting on the road, meeting other Presidents and Prime Ministers, calling them up on the telephone, badgering them and saying, “This is an issue that won’t go away.” I think that if our Prime Minister does that, he will find his place in history as someone who has created the paradigm for development for the decade ahead, much as Blair did 10 years ago. I want him to do that, and I hope that will be the message that goes out from this debate today.

--- Later in debate ---

[Hugh Bayley]

I thank everybody who played a part in the debate. One or two Members have thanked me for securing it, but it was not by any means my initiative. It was a conspiracy—a joint effort—behind closed doors from, I think, 17 all-party groups to approach the Backbench Business Committee jointly. Such was our strength in numbers and unity of purpose that the first time we approached the Committee and explained that this week was a particularly appropriate week to hold a debate of this nature, it gave us the debate.

I particularly thank my hon. Friend the Member for Hackney South and Shoreditch (Meg Hillier), who turned up with me to make the case to the Committee, and the right hon. Member for Hitchin and Harpenden (Mr Lilley), who played as big a part as any of us in securing the debate. He made my point that politics does not just happen; it is organised, so I thank him for getting on the phone to colleagues to ensure that they turned up and made speeches. A former Cabinet Minister playing such a prominent role in debates and policy in the House, and of course in his party, is a tremendous boost to this area of policy. I very much welcome what he has done with his all-party group on trade out of poverty and his more general writing, thinking and leadership on international development.

It would be presumptuous of me to respond to the debate on behalf of a disparate group of Back Benchers, but I shall tell the Minister that I agree strongly—I think all those I spoke to when trying to initiate the debate agree strongly—that, first, the Government and Prime Minister are right to seek to integrate goals that unite social, economic and environmental actions and progress. Secondly, our Prime Minister is right to stress the “golden thread” and say that we can do development without democracy, the rule of law, accountable institutions and transparency, but we are likely to do it better and involve all people, including the poorest of the poor, if we subscribe to those principles. Above all, Government and government institutions, such as courts, need to be accountable to the people, not a weight bearing down upon them. In relation to the Minister’s point about whether we should seek universal progress, it is important that when we measure progress, we disaggregate the data, so that we can spot whether particular communities are being left out—if women are falling behind or if particular tribes or ethnic or racial groups in a country are being left out.

It is also important that we learn one lesson from the millennium development goals, which have been a great success in mobilising world opinion and action by Governments in developing countries: it was too much of a top-down process. They were agreed at the UN General Assembly and then rolled out as if through a mangle. That is why we get the oddity of universal targets—what is appropriate in relation to clean water or school enrolment in east Africa, might not be appropriate in East Anglia. I hope that the new approach will set a global framework that will leave individual countries—and in more populous countries, individual states—the task of setting the development strategy and determining how to measure progress.

We have had very good comments. As somebody who we all know of, although we may not all have been in the House with—a former Member for a Durham mining constituency—would have said, “Well guys, this has been a really rich and valuable discussion and it will take the debate forward,” and I agree. Every Member made comments that I scribbled down and have learnt from, which will help me to work out what we need to do to create conditions that will relieve the burden of poverty from some of the poorest people in the world. The private sector certainly has to be a driver and our development strategy must enable that. The hon. Member for Stafford (Jeremy Lefroy) made an important comment about how difficult it is for micro and small businesses to raise capital when they have no collateral.

The hon. Member for East Hampshire (Damian Hinds) started by saying that he did not know much about this field, but he made a really powerful point that in order to keep the House behind the Government and the public behind our parties, which espouse the cause of global development, we must address the question of why we do it at all and why Government have to play a part. We received answers to those questions in a number of the comments, and, indeed, some are not entirely new answers. It was back in the late ‘70s, as the right hon. Member for Hitchin and Harpenden reminds me, that a former Conservative Prime Minister, Edward Heath, served on the Brandt commission, which made the then revolutionary proposition that we get involved in international development because it is mutually beneficial. One thing that the Brandt commission said was that it promotes trade.

We live in an increasingly globalised world and if we simply close our eyes to the plight of poor and dispossessed people, we get more illegal immigration, more drugs, more organised crime and more public health problems, as my hon. Friends the Members for Hackney South and Shoreditch and for Bethnal Green and Bow (Rushanara Ali) said. Infectious diseases do not stop at the border when the customs officer says, “Can I search you?” When we provide security for our citizens, we need to provide security globally in many fields, which is why it is particularly important that our Government can play a leading role.

Finally, I say to the Minister, please knock on the door of No. 10 tomorrow morning, sit down and have breakfast with the Prime Minister, and tell him to put down The Times, pick up Hansard and read the debate to learn from the good advice he has received from many people sitting on the side of the House from which he would expect to get support and good advice and, interestingly, from those sitting on the side of the House from which he would not naturally expect to get support. We are behind the Prime Minister and his initiative. We want him to be a big player and drive forward a global agenda, so that the next decade of development addresses the fact that, as the Minister said, the world has changed since 2000 and we need to do more than just tweak the millennium development goals. We need a new, strong strategy.

UK’s Development Work (Girls and Women)

Hugh Bayley Excerpts

Thursday 7th March 2013 Commons Chamber

[Justine Greening]

Yes, I was delighted by that. It was very good of Amnesty to allow me to make my speech at its headquarters here in London. Amnesty has been pressing us for some time to focus more strategically on the work that we are doing, particularly on women and girls in Afghanistan, and I was pleased to be able to set those policies out to Kate on Monday.

[Hugh Bayley (York Central) (Lab)]

I welcome the priority that the Secretary of State is giving to women and girls, and I hope that she welcomes the work that the International Development Committee is doing on the subject at the moment. I once asked the noble Baroness Afshar, before she was appointed to the House of Lords, what would make the most difference to British development policy in supporting women and girls. She said that it would be to ensure that there always had to be a woman’s signature on the cheque book. When the Secretary of State is talking about budget support, will she seek to ensure that, when decisions are taken by the Governments to whom we give money, women Ministers in those Governments are required to sign off any decisions before they are made?

Global Hunger

Hugh Bayley Excerpts

Wednesday 23rd January 2013 Westminster Hall

[Mr Duncan]

Certainly. There are two aspects of the overarching label of corruption. First is the risk of our taxpayers’ money being fraudulently diverted, which happens minimally and against which we have the most rigorous safeguards in all our practices in the Department. The second is a broader issue. In many of the countries where we work, there is endemic or pervasive corruption in society and among politicians. We will therefore soon be publishing, as recommended by the Independent Commission for Aid Impact, corruption strategies for each of the countries where we work, primarily directed at the pervasive corruption in the country itself but always with an eye on how our own funds are properly used, I hope, in that country. The hon. Lady is absolutely right, because ultimately those who suffer from corruption are the poorest.

The UK is a partner of the Scaling Up Nutrition movement, which is a coalition of developing countries, donors, international agencies, NGOs and businesses, spearheading efforts to build an effective international response to the problem of under-nutrition. As part of our Olympic legacy, in 2013 the Government will host a follow-up to last year’s hunger event to continue our focus and that of the world on the issue. NGOs play a vital role on the ground delivering key food and nutrition services. They help to build national awareness and consensus on problems that are often complex. The NGOs’ IF campaign will therefore provide welcome momentum.

While working hard to tackle global hunger, the UK will continue to provide humanitarian relief and respond to emergencies as they arise. This year, for instance, we will provide £15 million to support more than 500,000 people in five Sahel countries. Furthermore, the Prime Minister has a role as the co-chair of the UN Secretary-General’s high-level panel on the post-2015 development agenda. The Government will have a role in shaping the future of development and an end to poverty. Finally, again this year, the UK will be the first G8 country to meet the commitment to spend 0.7% of its gross national income on official development assistance, giving us greater capacity to address the challenge of hunger and poverty, among many other such challenges. In conclusion, I assure the House that the Government’s commitment to tackling global hunger for the very poor will continue with renewed purpose in 2013 and beyond.

[Hugh Bayley (in the Chair)]

An excellent debate, which I am very glad to have heard. At the launch later this evening, I hope to see some of the Members who participated, including those who were present throughout the debate but were unable to speak, such as the hon. Members for Upper Bann (David Simpson), for Banbury (Sir Tony Baldry) and for Ipswich (Ben Gummer).

HIV (Developing Countries)

Hugh Bayley Excerpts

Wednesday 19th December 2012 Westminster Hall

[Several hon. Members]

rose—

[Hugh Bayley (in the Chair)]

Order. Three colleagues are trying to catch my eye. I will call the first Front-Bench speaker at 3.40 pm, so we have plenty of time for speeches of about 10 minutes each.

--- Later in debate ---

[Nick Herbert (Arundel and South Downs) (Con)]

I congratulate my hon. Friend the Member for Mid Derbyshire (Pauline Latham) on securing the debate and on drawing attention to the continuing importance of these issues. [Interruption.]

[Hugh Bayley (in the Chair)]

Order. I must interrupt the right hon. Gentleman early in his speech, because there is a Division in the House. I suspend the sitting, and I ask Members to get back as quickly as possible. We will resume as soon as those who are here have returned to their places.

Sitting suspended for a Division in the House.

International Development Committee Report (Afghanistan)

Hugh Bayley Excerpts

Thursday 25th October 2012 Commons Chamber

[Sir Malcolm Bruce]

I agree with my hon. Friend. Contrary to what Members might think, our visit was truly inspirational in terms of what it told us about amputees’ recovery and recuperation. The Red Cross runs seven such centres throughout Afghanistan, and its valuable work is supported very effectively by DFID, but it could indeed benefit from further support.

Our main concern is that we cannot predetermine where Afghanistan will go after 2014. There will be elections, but we do not know who will be elected. There will also be security challenges. Threats to security and development potential will vary and may fluctuate across the country. We recommend that DFID’s engagement should be flexible according to the prevailing circumstances at any given time. That may mean acknowledging that delivering development assistance may be more achievable in some provinces than in others. There are provinces in which virtually no violence has occurred, but not all of them are receiving the aid and support that they need.

[Hugh Bayley (York Central) (Lab)]

Given the current security situation, especially in Helmand province, it is much harder for DFID officials to get out and about and supervise and quality-control DFID projects than it was during the Committee’s earlier visits. Does the right hon. Gentleman agree that it is important for us to maintain the ability to carry out development work in that province—particularly given the loss of so many British lives in Helmand—and that it might be sensible to appoint more Afghan staff to manage DFID projects in the more conflicted areas of the country, given that they have less difficulty in getting out and about for security reasons?

[Sir Malcolm Bruce]

The hon. Gentleman puts his finger on a very important point. We acknowledge that Helmand will present difficulties, and we accept that DFID has decided that it will not be able to maintain an office there once the troops have been withdrawn. However, I agree with him that, given that the British forces’ engagement in Afghanistan has focused on Helmand, it would be a total negation of that if we could not deliver projects in that province. As he says, we need to find local partners who can probably operate much more effectively than armed foreigners.