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Mr. Cash: The Minister may well know from the letter dated 23 July that I received from the Secretary of State for International Developmentfor whom I have a very high regardthat he said that, in respect of the poverty reduction budget support, he regarded this as being the most effective use of aid. He wrote:
Mr. Thomas: I was going on to saythis is to help the hon. Gentlemanthat budget support must be provided in the right circumstances. We analyse these matters extremely carefully and take a considerable time to ensure that the circumstances are right before we go down the route of budget support. As the hon. Gentleman knows, it would be entirely inappropriatethis has not crossed the minds of Ministersthat we should use budget support in countries such as Zimbabwe. That would be in entirely inappropriate circumstances.
John Bercow: I am extremely grateful to the Minister for generously giving way. Does he agree that, given the purpose of the Bill, there should be an annual debate on the Floor of the House on the contents of the annual report?
Mr. Thomas: The hon. Gentleman will know that that is not an issue on which I can give him satisfaction today. Those who can do so will have heard his comment. If there is any doubt that they have listened to what the hon. Gentleman has said, I will ensure that they are aware of his question and aware also of the comments of other hon. Members who have made similar points during the debate.
Perhaps it would be helpful to the hon. Member for Stone and others if I set out briefly some of the processes that we go through before we take decisions on budget support to provide further reassurance that his suggestion that there should be an amendment to clause 8 is not required. We undertake a comprehensive fiduciary risk assessment that is based on an evaluation of the partner Governments' public financial
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management systems. That includes a specific evaluation of the risk of corruption. Our approach to those assessments has been agreed with the NAO. The hon. Gentleman may know that several internationally recognised assessments are carried out in partner countries to help provide that evaluation of the quality of public financial management systems. For example, the World Bank and the International Monetary Fund provide assessments.
We have recently strengthened the evaluation of public financial management in the countries where we work by developing a comprehensive assessment framework in partnership with the World Bank, the IMF and several other countries. Such a framework includes a specific assessment of audit processes and arrangements for the scrutiny of public finances.
Several hon. Members, for example, the hon. Member for Bournemouth, East, referred to the need for much more information in the annual report. The intervention of the hon. Member for Rochford and Southend, East (James Duddridge) and his exchange with my right hon. Friend the Member for Coatbridge, Chryston and Bellshill should strike a cautionary note about the need for even further information. There is a balance to be struck between the understandable appetite for as much information as possible and the need to recognise its impact on the Department's resources. The presence of my right hon. Friend the Paymaster General earlier means that hon. Members will recognise the need to be prudent and minimise the impact in bureaucracy. However, we shall reflect further on hon. Members comments.
The Government welcome the Bill. There are some problems with drafting that we want to tackle in Committee. For example, there is some overlap between clause 2 and clause 4 and some duplication between clause 5 and clause 7. Clause 3 deals with the bulk of financial reporting, to which clauses 9 and 10 are relevant. The Committee therefore needs to deal with a series of technical but important issues. Not least, it will be important to ensure that the definitions of aid are aligned with internationally agreed definitions, including the time periods for reporting that are already in common use.
The Government agree with the thrust of clause 8, but believe that it is over-prescriptive. For example, the proposal to specify planned levels of assistance to be provided to each country for the current year and at least three future years is beyond what is permissible under the current spending review.
As many hon. Members have said, last year's commitments need to be delivered. The Bill will help to do that. Subject to the minor drafting changes that I mentioned, the Government support the Bill and I warmly commend it to the House.
During my speech, I propose to set out the current position of the national health service breast screening programme as well as explaining my proposals. I shall also try to deal with other important issues, including funding and resources.
The Bill has cross-party support and acknowledges that the United Kingdom has one of the highest breast cancer death rates in the world. One in nine women in the UK will suffer breast cancer at some point in their lives. Every year, 41,000 women are diagnosed with breast cancer and, sadly, some 13,000 die of the disease.
We must not forget that there are other victims: husbands, partners, parents, children, other relatives and friends. I shall quote briefly from an e-mail that I received from somebody in Devon, who sums up the anguish caused to other family members. His wife died when she was 40. He says:
"it is more likely that there will be parents, a partner and children who will also suffer the impact of this disease. In our case our daughter was 4 when my wife died and both her parents still survive her . . . for my daughter to have been able to have spent a few more years with her mum would have been priceless."
Breast cancer also has a knock-on effect on everyday life. A diagnosis can, and does, affect relationships, employment, mortgages and life insurance. Prescription charges can be a long-term strain, and for those with children, child care can become a problem, especially for those with young children. Finding or being able to afford child care while having chemotherapy or radiotherapy treatment is neither easy nor cheap. Incidentally, it is a little-known fact that, every year, some 300 men suffer from breast cancer, of whom about 95 die.
The present policy is that women between the ages of 50 and 70 are invited to have a screening free of charge every three years. However, those over 70 have to apply for a referral themselves. My proposal is that the age spectrum be increased to cover women between the ages of 45 and 75in effect, adding five years at either end. I want to put on the record the very valuable work that the staff involved in the screening programme undertake on a daily basis. We cannot praise highly enough their dedication and their commitment to their work. They are a tribute to the health service.
Mr. Philip Hollobone (Kettering) (Con): I congratulate my hon. Friend on introducing the Bill. Does he agree that the national health service should concentrate far more on the prevention and early detection of illnesses? NHS staff would far rather be involved in that kind of work than in administering extensive and expensive treatments later on.
My hon. Friend raises a valuable point, and I shall come to that subject later in my speech. We should indeed be in the business of prevention rather than cure. Prevention is always cheaper, and we are always dealing with limited funds.
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No one doubts that early screening saves lives. Indeed, in her foreword to the 2005 annual review of the NHS breast screening programme, the Minister of State, Department of Health, the hon. Member for Doncaster, Central (Ms Winterton), said:
The need for screenings was recently highlighted in a survey carried out by the charity Breakthrough Breast Cancer, which found that 80 per cent. of the women questioned had not checked their breasts in the previous month, and that 47 per cent.almost halfadmitted that they did not know how to do so.
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