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18 Mar 2008 : Column 209WH—continued

On the point raised by my right hon. Friend the Member for North-West Durham (Hilary Armstrong), gender inequalities continue to leave women and girls in developing countries disproportionately vulnerable to HIV and AIDS. The Department for International Development is recognised for its groundbreaking work on HIV and gender. I understand that a
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commitment has been made to put women’s rights at the heart of the new strategy. All hon. Members welcome and support that. My hon. Friend the Minister will know that organisations working in this field will be keen to see that commitment reflected in a range of targets and indicators in the strategy. Both he and my right hon. Friend have experience in this area and I do not doubt their determination and the importance that they attach to making progress for women and children. We know about the gender issue. My hon. Friend also knows that there is concern about the position of children. The availability of paediatric treatment remains low.

The international community has some notable opportunities in the coming months to accelerate efforts to tackle HIV/AIDS. My hon. Friend will be aware of meetings in Japan of G8 Development Ministers and Finance Ministers and that the G8 summit will be held in July. As I said, it was the G8 at Gleneagles that initiated the commitment to universal access by 2010. That is worth repeating: universal access by 2010. With just two years to go until 2010, HIV/AIDS must not be allowed to lose its priority. I hope that he will do all he can to ensure that delivery of universal access is again on the agenda and that we secure concrete, timed pledges from the G8.

In addition, the United Nations will be conducting a comprehensive review of the progress achieved in realising the 2001 declaration of commitment and the 2006 political declaration. To undertake that review, the UN will hold a high-level meeting on 10 and 11 June. Again, we look to my hon. Friend and his colleagues to secure from their international counterparts the political and financial commitment necessary to meet their pledge of universal access by 2010.

I am very grateful to have had the opportunity to raise this important issue. Last May, when I initiated a debate on HIV/AIDS in the developing world, we were anticipating the publication of the interim evaluation of DFID’s “Taking Action” strategy. Now we await the publication of the Department’s new strategy. It is clear that the world needs to amplify greatly its efforts to tackle the global HIV/AIDS crisis. I look forward to hearing what my hon. Friend has to say.

1.19 pm

Mr. Geoffrey Clifton-Brown (Cotswold) (Con): I shall be extremely brief, because I want the Minister to have a lot of time to reply. I shall speak perhaps for one minute, just to reinforce what the right hon. Member for Edinburgh, East (Dr. Strang) has said. I welcome his securing this debate; he has done the House a service in doing so. Along with the other killer diseases of polio, tuberculosis and malaria, HIV/AIDS is an important matter in which the global fund has played a huge part. The British Government, through DFID, have done an enormously good job of work.

I should like Minister to comment on just one or two other things. Does he agree that intermediate targets should be set, so that we begin to look as though we will meet the universal access target by 2010? Does he also agree that, as the right hon. Gentleman said, some countries do far better than others in tackling AIDS? For example, Thailand has a much better record than Swaziland. The solution must be country-owned if it is to be most effective.

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Does the Minister agree that the rate of maternal transmission of HIV/AIDS from mother to child in poor countries is shocking, given that it is just 2 per cent. in the richer western countries? Will he comment on what the Department for International Development is doing to increase research and development, because we must find more effective treatments for HIV/AIDS? Does he also agree that we should measure outcomes rather than solely the amount of money spent? Will he continually evaluate the effectiveness of DFID’s programmes to find out what works and what does not, and shift money towards those programmes?

I was greatly honoured to be present when the Secretary of State for International Development made a speech on College green on world AIDS day. One or two representatives of the NGOs present told me that, given the changes at DFID’s headquarters, they were concerned that it would not be able to operate its world health programme effectively. Will the Minister assure hon. Members today that those changes will be able to deliver that programme?

1.21 pm

The Parliamentary Under-Secretary of State for International Development (Mr. Shahid Malik): It is a pleasure to engage in this debate under your stewardship, Mr. Pope.

I am grateful to my right hon. Friend the Member for Edinburgh, East (Dr. Strang), who has an admirable track record of raising the issue of HIV/AIDS in the developing world, for introducing this important issue and for his concern about the impact of HIV/AIDS in developing countries.

My right hon. Friend will be aware that UNAIDS, the joint UN programme on HIV/AIDS, recently announced that global HIV prevalence—the percentage of people living with HIV—has levelled off and that the number of new infections has fallen. However, we must not be complacent. Globally, an estimated 33.2 million people are living with HIV. Every day, more than 6,800, people are newly infected with HIV. For each person who starts on a much-needed course of treatment for AIDS, another three or four people are newly infected with HIV. That is the size of the challenge, and there is much more to do before we can say that we have tackled AIDS.

Tackling the needs and rights of children affected by AIDS remains at the heart of DFID’s response. DFID is committed to spending £150 million to meet the needs of such children over three years to 2008. Achievements so far include work in 13 African countries with UNICEF to support national plans for orphans and vulnerable children. Those plans will ensure that vulnerable children have access to basic services and are protected from abuse.

The UK has played a leading role in the adoption of the universal access targets, both at the G8 Gleneagles summit and in subsequent years. Achieving universal access to prevention, treatment, care and support will be a huge challenge, but we remain committed to that target. In the last few years, unprecedented amounts of money have been pledged to finance programmes to tackle HIV and AIDS. The UK is now the second largest Government funder for AIDS programmes, and we have called upon other funding agencies to move
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forward and to turn funding pledges into reality. I know that my right hon. Friend subscribes to that sentiment.

My right hon. Friend the Member for North-West Durham (Hilary Armstrong) made a powerful intervention about the feminisation of the AIDS epidemic and the inherent inequality that arises from that. She is aware that there is increasing concern about that feminisation, especially in sub-Saharan Africa, where women account for 61 per cent. of all adults living with HIV and young women aged 15 to 24 are more than three times more likely to be infected than young men. That speaks for itself. There are many reasons for that, but a key issue is gender inequality. In many cultures, many young women face difficulties in negotiating whether to have sex. They have limited control of the circumstances in which they have sex, and they lack the means to protect themselves from infection.

Gender violence is another major issue to which my right hon. Friends alluded. For example, one in six women in rural Ethiopia report that their first sexual experience was coerced. That is why the UK Government have a strong focus on promoting sexual and reproductive health and rights, as an integral part of programmes to prevent HIV. In countries where the epidemic is concentrated among known high-risk groups, it is vital to ensure that prevention and treatment services are accessible to those who most need them.

Sex workers, injecting drug users, men who have sex with men, and prisoners cannot be reached through normal health services, because they are excluded or feel uncomfortable in such settings. The Government have played a leading role in developing innovative ways to provide services for those groups and helped to design programmes to reduce stigma and discrimination. That is important, difficult and sometimes controversial work, but we must support our partners in developing those innovative services if they are to have an impact on the epidemic in their countries.

When HIV and AIDS funding is provided in a way that actively strengthens health systems, there are benefits all round, particularly because long-term and sustainable AIDS programmes need a functioning and effective health service. However, providing AIDS funding in an entirely separate or vertical way can undermine the health system and even take away scarce health personnel from other important areas of work. We must work with all our partners to develop joined-up approaches that effectively build up the health service’s capacity.

Two initiatives demonstrate the importance of supporting countries to improve their health systems. In Malawi, DFID has committed some £100 million to support the health sector over a six-year period to 2011. That will enable better HIV and AIDS services to be delivered, and the aim is to double the number of nurses and triple the number of doctors that Malawi is able to recruit and, importantly, retain.

My right hon. Friend the Member for Edinburgh, East mentioned antiretroviral therapy. In Malawi in 2003, some 3,000 individuals had started on that treatment, and some four to five years later, 130,000 people have started on it. That indicates what can be done if there is vision and a real commitment to ensuring that things happen.

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The international health partnership was also mentioned. It was launched recently, and only today, I met the High Commissioner of Nepal who told me that user fees in health services in Nepal have been lifted as part of that partnership. Some eight countries are engaged in the partnership, which was launched by the Prime Minister in September and is a joint initiative with eight major funding agencies in the health sector.

In the time available, I shall not be able to get through all that I want to say. We will encourage programmes that work collaboratively in line with donor harmonisation principles and focus on the needs of those who are excluded and vulnerable, especially the high-risk groups. It is important to support the work of multilateral agencies and particularly a joined-up approach by United Nations agencies.

The UK Government have already pledged £1 billion to the Global Fund to Fight AIDS, Tuberculosis and Malaria from 2008 to 2015. My right hon. Friend raised that issue, and at the replenishment round for the global fund conference in September 2007, we raised more than $6 billion, and a further pledge of $9 billion allowed the global fund board to fund all projects deemed suitable for funding. New spending will be required, but we must all make greater efforts to make existing money work more effectively. We must also encourage those who have pledged funding for HIV and AIDS, but not yet moved forward, to allocate that funding.

This has been an important opportunity to discuss these issues. A number of questions remain outstanding, and I will write to my right hon. Friends and the hon. Member for Cotswold (Mr. Clifton-Brown) about them. I am grateful to my right hon. Friend the Member for Edinburgh, East for raising the matter. It is a timely debate, and I fear that it will remain timely for the foreseeable future.

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Post Office Closures (Highlands and Islands)

1.30 pm

Danny Alexander (Inverness, Nairn, Badenoch and Strathspey) (LD): I am grateful to the Speaker for selecting this subject for debate, particularly because it is only a week since the Post Office announced its final proposals for post office closures in the highland area, under the euphemistically entitled “network change” programme. Across the highlands as a whole, the Post Office plans to close 28 post office branches, 11 of which will be replaced with new outreach services. That means a net loss of 17 branches, although obviously in many cases outreach services will result in a significant reduction in hours. Of course, there will also be additional closures in the constituency of my hon. Friend the Member for Argyll and Bute (Mr. Reid).

I wish to draw attention to three points. First, there were flaws in the consultation process. Secondly, there is a matter on which I still have not had a clear answer: the status of branches that were temporarily closed and ignored in the consultation process, which is effectively additional closures by stealth. Thirdly, what are the Government’s plans for the future of the network? How will they ensure that we are not back in four or five years’ time debating yet another round of closures?

In my constituency, three post offices will be completely closed, and five will be closed and replaced with more limited outreach services. In addition, two areas that had post offices that were temporarily closed will now have limited outreach services. Given the strong public feeling in the communities involved, there are a number of particularly unfortunate examples in my constituency. I wish to draw attention to the fate of the Harbour street branch in Nairn, which is a very well used post office that serves a distinct part of the Nairn community—the harbour and Fishertown area. It also serves the part of Nairn most likely to be exposed to future growth. As my right hon. and hon. Friends who represent constituencies in the highlands and islands will know, the Inverness-Nairn corridor is likely to experience significant population growth. Over the next few years, the town of Nairn itself is also likely to experience significant population growth, as has happened in recent years. That forecast for growth was not taken into account either in relation to the closure of the branch in Nairn or in relation to the other branches in the Inverness-Nairn corridor affected by the programme—Farr, Croy, Cawdor, Ardersier and Balloch. Branches in all of those places have been either downgraded or closed. In the case of Balloch, to which I will return, there has been a failure to reopen the branch.

To the north of Inverness in Kirkhill there is a strong desire in the community to retain the existing post office. The Post Office has proposed that an outreach service should operate in that community for six hours a week. Strong representations were made by members of the community about the post office in Kirkhill, but again no change was made to the proposal as a result of the consultation. Anyone who has read the Post Office Ltd network change programme area plan decision booklet for the highlands and islands—I have a copy here if anyone is interested—will know that the
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public consultation on the initial closure programme in the highlands had 1,900 responses. Despite the consultation being conducted in the depths of winter in January and February, which many in the highlands would regard as the least propitious time for a consultation, there was a significant response from communities across the area.

In addition, several hundred people took to the streets of Nairn to protest against the closure of the Harbour street branch in a demonstration organised by the local community council. Yet the only decision changed in the programme was that relating the Pulteneytown branch in Wick. I congratulate my hon. Friend the Member for Caithness, Sutherland and Easter Ross (John Thurso) on his work on that and congratulate the community on having successfully saved its post office. However, there is no difference between the strength of feeling and power of representation made in that community and that made in the other communities I have mentioned. I am delighted that that branch has been saved, but the closures that will go ahead could have been reversed if the same account had been taken of the views of local communities.

In the city of Inverness, innovative ideas for extending the outreach model to an urban setting were made to replace the proposed closure of the Kingsmills branch in the Crown area. Again, the fact that outreach was proposed is mentioned in the booklet, but no reason is given by the Post Office for why it was rejected. I would be interested to hear whether the Minister thinks that the idea of the outreach model, which has largely been confined to rural areas, could be used in an urban setting if appropriate. Although geographically that community is within a mile or so of the city centre, there is a steep hill people must go up to get to the city centre and back, which is where people would be expected to go instead. Many elderly people live in the vicinity of that post office and feel strongly that it should be retained. The ideas put forward were not even responded to.

A concern expressed strongly by constituents who made representations is whether there was any point to the consultation. Except in the case of Wick, was it a real consultation? Was there a point to the huge effort that people went to not just to make representations, but to think through alternatives for the communities affected? What was the point in people doing all that when to all intents and purposes those views have been ignored? That also relates to a separate point about Postwatch because if it wished to it could have conducted a further review of some of the decisions. Given that 1,900 people in the highlands responded to the consultation process, I would have hoped that Postwatch at least sought to review some parts of the decision on the basis of the strength of feeling and the alternative ideas proposed. Postwatch will be abolished in October and replaced by a larger regulator that will cover a range of issues. At this stage, perhaps members of Postwatch have more of an eye to the new body than to carrying out their responsibilities to the full.

The experience in the highlands serves only to illustrate the entirely arbitrary nature of the consultation process under the closure programme. The Government picked the figure of 2,500 closures out of the air. It seems to have been based not on an assessment of the needs of communities across the country, but on financial demands from the Treasury that Post Office Ltd is then forced to
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meet. To that extent, one must have some sympathy for the process that the Post Office is going through as it is forced to ignore many of the strongly held views and needs at community level. It is a disgraceful situation, for which Ministers will have to take the blame in the end.

The process in the highlands raises a major new issue that has not been debated and is of wider significance. In my constituency, over the 12 months before the closure programme started, five post offices were subjected to temporary closures: those in Tomatin and Laggan, which because of the postcode criterion will have outreach services, and those in Cromdale, Glenurquhart, and Balloch. A large number of similar cases exist in the constituency of my right hon. Friend the Member for Ross, Skye and Lochaber (Mr. Kennedy). Four of the temporary closures were outstanding at the beginning of the consultation period. In most cases, those branches had not been through the permanent closure procedure as they should have and were not included in the consultation process. Effectively, those branches have been airbrushed from history.

When I first raised that matter, the confused responses from both the Post Office and Postwatch would have been laughable had the issue not been so serious. First, a spokesman for the Post Office told The Press and Journal:

this is the crucial point—

As someone who should have been consulted, I was able to explain that that had not happened. I also provided evidence that no consultation on a permanent closure had taken place in those cases. Community councils had also not received any consultation on the permanent closure. To clarify the matter for the House, there are supposed to be two stages—temporary and permanent closure—both of which are consulted on separately.

Next I was told that perhaps all the procedures had not been taken into account and that any representations would be considered in the consultation. I have read the report, and there is no mention of any of the branches to which I referred, despite a large number of public submissions regarding them being received during the public consultation process. My right hon. Friend and I took up the matter with Postwatch. We were told—this was the third line in a matter of weeks—that Post Office Ltd

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