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We need legislation. At business questions, I heard the discussion about whether we have too much or too little legislation. The point is that we should have good legislation. We need a piece of legislation whose purpose is to deliver NHS independence. The national health service needs greater freedoms—not a free-for-all, “Here’s £90 billion and do what you like”—but an NHS board responsible for commissioning, free from the day-to-day controls and political top-down targets imposed by Ministers. We need the independent
structure of patient and public engagement that I mentioned, and an independent health care regulator, based on Monitor and the Healthcare Commission, which will be responsible for tariff setting and the fair allocation of resources.
I heard the nonsense from the Secretary of State about the impact of a more equitable system for the allocation of resources— [ Interruption. ] It is nonsense, because all she has done is to calculate figures on the basis of premature mortality, not on the basis of morbidity data, which might give very different outcomes— [ Interruption. ] I am not trying to predict the outcome; we need an independent structure to set up the system. The Secretary of State obviously has not been listening to the evidence given to the Select Committee on Health by academics, which makes it clear that the extent to which Ministers have tampered with the formula is driving it towards social deprivation indices as a principal determinant of resource allocation, in the fond hope that spending more money on NHS services in a location is the best determinant of future health. It is not.
The best determinant for future health is a public health structure for those resources. We have always talked about that, but the Secretary of State does not distinguish between, on the one hand, money for the public health service, which needs to be allocated on the basis of health inequalities and future need, and, on the other hand, the genuine burden of disease in an area. Such a distinction would ensure the availability both of equitable access to services through the NHS and of resources for public health support and intervention. That distinction needs to be made, but at present that is not happening.
Steve Webb: Will the hon. Gentleman give way?
Mr. Lansley: No, I should finish—[Hon. Members: “No, keep going”.] There is always a lot more to say, but I had better stop saying it.
There are commitments to legislation in the Queen’s Speech. I asked the Secretary of State about embryology. There are two important points about the proposals. The first is to recognise that the legislation has been successful since 1990, so the Government would be well advised to take note of how the Conservative Government made it clear at the outset—at the White Paper stage—that the measure would be based on consensus. There should be a free vote, and the Government should not try to drive through the legislation on whipped votes.
Secondly, abortion and the reform of abortion legislation should not be part of the debate on the human tissues and embryos Bill. Those issues should be tackled separately. I hope that Ministers will take account of the recommendation made by the Select Committee on Science and Technology that the Government should give time to private Members’ legislation—the conventional route—to allow discussion of those issues entirely separately from the legislation on embryology and tissues. If the two are brought together, there could be serious complications.
I ask Members to look back to a debate earlier this year, when we made it clear that we have to tackle the stigma of mental health, and that mental health services should have a priority in the NHS that they
have not been accorded. As always, the Government had good intentions at the outset but they have not delivered. It would have been a good idea if the Government had listened to the Ginevra Richardson expert committee in 1998. They produced a Green Paper, a White Paper, draft Bills in 2002 and 2004, a commitment to legislation in the last Queen’s Speech and then in March the Minister had to announce that they would not proceed with the Bill. It all collapsed, so we have a commitment to legislation in this Queen’s Speech—the Groundhog day speech.
We need the Government to bring us—preferably to this House, as I have told the Minister—a Bill that genuinely reflects the fact that mental illness is indeed an illness; it should not be treated as part of the criminal justice system. The role of legislation is to secure effective therapy. The proposed measures need an evidence basis, and the example of the Scottish legislation in 2003 should be looked at carefully and positively. We need to ensure that the stigma attached to mental illness is minimised, so we need to ensure that compulsion is used as a last resort, not a first option, and that there is no attempt to incorporate the requirements of the criminal justice system into what should properly be health legislation. That is the test that we shall apply to this legislation, and frankly, so far the Government have not matched up to those requirements in the legislation that they have drafted.
We have heard a Queen’s Speech that says nothing new on health—a Queen's Speech which, frankly, just repeated last year’s. We know why. It is because, in the absence of any understanding of where they are going, the Government are paralysed. A Government who are divided are paralysed. The Prime Minister says that he is in favour of choice. The Chancellor of the Exchequer says that he is against choice. The Chancellor of the Exchequer gets up and says that he wants the NHS to be more independent. The Prime Minister gets up and says that he does not want the NHS to be more independent. They are paralysed. The Secretary of State and Ministers in the Department of Health have no influence over this matter at all; their mismanagement of their legislation in the previous Session means that they have no slots, other than for a mental health Bill, in this Queen’s Speech. They spend their time sitting down with the Labour party chairman, trying to work out how to wrest some modest political advantage out of the financial mismanagement and the chaos that they are creating in the NHS.
This Queen's Speech has done nothing for the NHS. Improvement in the public services will not stem from this Government. The improvement of public services will be the priority of the next Conservative Government, and I look for that day as soon as possible.
12.21 pm
Judy Mallaber (Amber Valley) (Lab):
I know of a number of local examples, from just the past few weeks, of the modernisation of health services under this Government, and of steps to raise educational standards as highlighted in the Queen's Speech. For example, for the past year I have been following the
progress of my local newsagent as he struggled to get healthy enough to give a kidney to his sister, who is on dialysis every day. He is now proudly showing off his scars—or rather the lack of them, because amazingly he had a kidney transplant at Nottingham hospital by keyhole surgery. If that is not modernisation, I do not know what is.
I have a friend who is undergoing breast reconstruction after a mastectomy, which she got astonishingly quickly after a scan and a diagnosis of breast cancer.
On Monday I saw a new science, art and technology block going up at Mill Hill school at Ripley in my constituency, where the school buildings were scandalously neglected under the Tories. I was also giving out Skills for Life awards to local people, as part of a project that is developing new training rooms at a local resource centre for people with disabilities. It is part of a partnership between my union, Unison, and Derbyshire county council, involving those union learning reps that the Conservatives so bitterly opposed in spite of their apparent commitment to education.
So I know of many local good examples, but I want to indulge myself today by focusing on health and education in an international context. Specifically, in view of the Government's commitment in the Queen's Speech to continue their focus on Africa, I want to give some examples from the Democratic Republic of the Congo. As a member of the all-party group on the great lakes region and genocide protection, I have been an international election observer there in recent weeks, for the first election in more than 40 years. I was hosted by Christian Aid. The election is widely regarded as the most important in Africa since Nelson Mandela's election as President of South Africa. As I am away on Select Committee business next week and cannot speak in the foreign affairs debate, I cannot miss this opportunity, the day after the provisional presidential election results were announced in the Congo, to speak about the situation.
There is huge tension in the country, including in the capital, Kinshasa, where some have died as a result of the tension between presidential candidates. That election is key to the future of Africa. It holds enormous potential for the future stability and development of Africa, but comes with enormous dangers of reigniting instability and conflict. Undoubtedly, the foreign affairs debate next week will be dominated by Iraq, Afghanistan and the middle east, but in debate on a Queen's Speech that focuses on security, and on countering terrorism and its roots, let us remember that civil war in the Congo cost 4 million lives and involved six neighbouring African countries, whose rebel troops traipsed over Congo, partly lured by its mineral resources. Let us remember that the current largest United Nations peacekeeping force in the world is in the Congo. Therefore, I may be indulging myself, but I could not let this opportunity go by without ensuring that we talk about this matter.
Let me return briefly to the themes of the day: health and education. I have been delighted by the work of the Chancellor and the International Development Secretary in launching the international finance facility for immunisation. Every day, 29,000 children die of diseases that are preventable by vaccination, yet immunisation of a child costs just £20. Now the
international finance facility is developing a programme to front-load the mass inoculation of children against the five key illnesses, which has fantastic potential to improve the health of children around the world. I remind people of our debate about MMR. It is critical to achieve herd immunity by getting that vaccination done on a mass basis, as we did in eliminating smallpox. That can make a phenomenal difference to the health of the world's children.
I am delighted by the Government's decision to commit ourselves to universal primary education and to take a new initiative on that—with 19 countries committed to building their capacity to provide it. On my recent visits during the elections in the Congo, I saw for myself just how essential those programmes are, and what an important part they will play if we are serious about doing something about the education and health problems around the world.
Just a few weeks ago I was in a hospital in Kindu in eastern Congo, surrounded by children and families stricken by those five diseases, which are completely and utterly preventable. I saw children with malaria, which we are going to tackle after addressing the five initial illnesses. I saw a child with meningitis. I thought it a miracle that that child reached the hospital, given that there are only 300 miles of paved road in a country two thirds the size of western Europe. That child was able to get there only because we had that hospital, which could not have existed without the support of Medical Emergency Relief International—Merlin—and the Department for International Development. The election officials told me that it was a lifeline for their area. They could not have provided such facilities themselves.
For every 1,000 live births in the Congo, 205 children die before they reach the age of five. If we can do something about that, we can really feel proud of ourselves. In my constituency, I am very engaged in all our local problems concerning education and health, but thinking about what is faced in other countries such as the Congo has not half made me come back down to earth and put our problems in perspective and be proud of our achievements.
When I was with Christian Aid in the Congo, we went up the road calling on about 10 polling stations between Kindu and Kalima. We were greeted by a group of Swahili women, singing and dancing. Their children cannot go to school because it is too far for them to walk. There are few roads. It is impossible for them to get to school until they are about 10. They have been dispersed even further than the distance that we went to meet them. We had to go by motorbikes off a long trail to get to see them. They had been dispersed because of the violence of the then Mai-Mai rebels. They had been burned out of their homes. There was mass rape, and the sexual violence in that country has been appalling. The Mai-Mai are not there now, but people have been dispersed. Of perhaps 40 women, only five had been to school. When we asked whether children died under the age of five, they said, “Oh yes; her child died two days ago.” We did not have the heart to ask of what.
I was curious about the project that we were visiting. DFID paid Christian Aid to run a micro-financing project, lending women the money to buy two goats. I asked the people from Christian Aid to ask in Swahili
why people did not lose their goats, because the goats and the pigs were wandering all over the place. I learned something: apparently goats have a homing instinct, like that of cats. They wander around but go home at the end of the day. The women were given goats, which will reproduce and provide them with some capital. That is a great project that we are involved with.
Once I knew the distances that people travel, the impossibility of those children going to school and the difficulties that they have, I realised how difficult it is for us to get the programmes that we are committed to in that country up and running. We gave a lift to one woman who was heavily pregnant; we must have taken her 30 km. The people who walked to the polling stations covered long distances. How can children get an education? There are all the street children who have been chucked out of their houses because of allegations of sorcery and witchcraft, because of a lack of finance, or because they have been abducted to be child soldiers.
I am excited by the immunisation programme and by what we are talking about in relation to primary education. However, just as with problems in this country, it will work only if there is good governance. One of my reasons for raising the matter today is that I want to make sure that we focus on it. We can be proud of what we have done. We are the largest European bilateral donor to the Congo. With the international community, we have put a great deal into the elections. We have given a lot of help with civic education and development, but we have to keep on the ball in trying to assist people as they experience the difficult situation that they are in at the moment, after the elections, and as they go forward into the future.
A number of the themes in the Queen’s Speech—education, health, security, dealing with terrorism and climate change, which I will come on to—are international. They are not themes that can be considered only in relation to this country. The Congo is a country that should be able to feed itself—if we did not dump our food on it. It is a country that can provide electricity for the whole of Africa and that has huge resources in diamonds, gold, and coltan, which is used for mobile phones. It has massive resources to be able to do things, which is precisely why it has been plundered and pillaged by the Belgian colonisers, by Mobutu, the dictator, and by the rebel armies that have plagued it.
Why have the neighbouring countries got involved? They have had an incentive to try to get some of the mining contracts through the international mining companies. It will be hugely difficult to put that right, but we must consider the potential for stability in Africa if we can get stability in that country. Of the neighbouring countries, half a dozen have civil wars and internal conflicts, and their troops have bases in the Congo, or have had. The potential for stability if we can get that country moving is incredible.
It is important to mention the matter today because the important provisional results of the election were announced yesterday. Joseph Kabila got 58 per cent. of the votes and Jean-Pierre Bemba got 42 per cent. Members of the all-party group have met representatives of both the candidates. The results are being contested. There is a danger of continuing
violence: 29 people died in violence in Kinshasa after the first round and several people died at the weekend. Those results have to be upheld by the supreme court. It is important that we keep trying to apply pressure for peace and for them to accept those results. Because of the way in which the results have gone, the losing candidate will have fantastic power and influence in the country. Within a large part of it, he will have a great deal of support through the provincial and parliamentary elections. He will be able to have great influence in that context.
I was in one part of the country where Kabila was the clear favourite and in another part, last time, where Bemba was the clear favourite. I was astonished that in that massive country—there are 55 million people in a country nearly the size of Europe, with 300 miles of paved road—the elections were run as well as they were. They were more transparent than some other elections that I have heard of recently. Every ballot paper was held up for people to see. The forms were allowed to be copied and given to the witnesses of the political parties, so they can be checked. Any complaints about things going wrong in the election have to be followed through to make sure that people have confidence in the outcome. However, I hope that the presidential contenders do not go back to conflicts, arguments and deaths. We cannot afford that.
We can be proud of our country’s contribution and what we have done to try to assist, but we have to keep a forward-looking perspective. We have to carry on putting effort and work into making sure that the Congo gets through this period and starts to tackle some of the fundamental problems. I and others will seek an Adjournment debate when the results of the election have been confirmed. The issues that we want to raise and that we want to keep our Ministers’ continuing attention on include security sector reform. We clearly need a single body to co-ordinate security sector reform. There are problems. If people in the army do not get paid, it is hardly surprising that they pillage, rape and live off the countryside. If the country has not got one co-ordinated security force, if each of the contenders has his own forces, and if there are still the remnants of rebel armies, it is not surprising that there is a problem with peace and stability.
We also have to look at the issue of natural resources, which have been hugely exploited. Reports have shown that the contracts have been given out in a way that has not been fair and reasonable. That will have to be tackled, but it will be difficult because there are too many interests involved. That needs to be taken on board. It is estimated that the resources are worth perhaps $300 billion over the next 25 years.
Norman Lamb (North Norfolk) (LD):
The UN panel of experts described a multi-billion dollar theft of the country’s natural resources and implicated a number of western-based—including UK-based—companies and individuals as having had an involvement in that awful scandal. However, no one has been brought to justice as a result of that process. Has not the international system failed in that context? The Department of Trade and Industry—the responsible Department in this country—failed to carry out any investigation into
the UK-based individuals and companies that have been implicated in that process. Is that not something that we ought to be rather ashamed of?
Judy Mallaber: I absolutely agree. The all-party group has taken up the issue of company transparency and has been working with some of the companies in relation to that. There has been an International Development Committee report quite recently on that subject. There has also been a parliamentary report of the old Parliament in the Congo. One difficulty is all the vested interests of those who have been involved in giving out the contracts. The potential wealth is there, and as that wealth increases again and people start getting things out of the mines again, one of the dangers will relate to where that money will go. If it is available and goes in the wrong direction, and not into dealing with education and health, will we have less influence?
The education and health system went backwards under Mobutu. Our driver showed us the school he had attended. He had managed to get to the point where he was going to go to university and then Mobutu closed the university down. Now, the children cannot even get to school. Unless we find a way of using those resources—I agree that that means putting pressure on the companies, making sure that we take the issue on board, and keeping international pressure on the new Government to take it on board seriously—we are not going to make progress.
Mr. John Horam (Orpington) (Con): In relation to the intervention from the hon. Member for North Norfolk (Norman Lamb) and what the hon. Lady was saying about the use of resources in the Congo, which I happen to know rather well, will the all-party group take a particular interest in the evolving role of China in mopping up resources throughout Africa, with no attention at all being paid to good government or humans rights? That is an emerging issue that the all party-group should look at.
Judy Mallaber: That is interesting. I assume that we will get some reports back from the recent events involving China and Africa, looking at precisely that. I am a member of the Trade and Industry Committee and we have been interested in the role of emerging countries. I suspect that we will do more work on China. I agree with the hon. Gentleman.
The issue of governance and democracy is critical, looking to the future. It may be quite hard, given some of their histories, to know how the leading presidential contenders will react to what has happened with the election and to their future responsibilities, but with provincial and national elections there is the potential to get local people to start to realise that they can put pressure on and demand things. That is important. I am pleased that the Department for International Development is putting work into education about parliamentary procedures and how to work at a parliamentary level, and also that we have done a lot of work with civil society. It is important that we work with those local organisations so that they can stimulate developments locally.
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