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29 Apr 2008 : Column 19WH—continued

The origin of the debate initiated by the hon. Member for North Norfolk is, quite rightly, the question how we plug the sanctions regime for which we are responsible, but there is no doubt that countries such as Malaysia have provided much of the financial support that Mugabe’s regime has required. The real question is how we help to shift Mugabe and his party. I think we will do so, first, by doing what we are doing now. Secondly, we should provide as much publicity and support as possible for those who are attempting to effect change and give a lot of support to those in the Southern African Development Community countries—I spoke recently to some senior Kenyan politicians about this—to bring pressure to bear on their Governments. Thirdly, we should make certain that there is no let-up in the sanctions that we are already applying. Once again, members of the MDC say that what happens to the children and other family
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members of senior members of the regime in terms of the education that they have been privileged to have outside Zimbabwe has an impact on the regime.

We also have to recognise—the hon. Member for Vauxhall (Kate Hoey) might disagree—that there are splits within ZANU-PF. The MDC has, either directly or indirectly, been talking to people in that party who wish, for whatever reason, to see change. Some genuinely recognise that the system cannot continue; others are like Fouché and Talleyrand, whom experts in French history will know managed to glide seamlessly from supporting Napoleon Bonaparte to supporting the Bourbons. They want to survive regime change.

A number of hon. Members have made the point that the international community and Britain in particular should be thinking now about how we prepare for the regime change that will undoubtedly come. It could come very quickly or within the next year or two, but I take the point made by the hon. Member for Vauxhall that the last thing we want is the international aid caravan to descend on Zimbabwe, and not only on the grounds that vast profits will be made. Many of us, including my hon. Friend the Member for Banbury (Tony Baldry), have seen that happen in vast parts of the world—the descent of hundreds of 4x4 caravans and people looking for the best hotels and so on. The people of Zimbabwe and many of the politicians are perfectly able to run their own country. It is not a backwoods, third-world country at all. They need some help and advice to turn it into a modern democracy that is capable of being a powerful regional force and of providing the economic aid that is necessary to help to feed and develop the rest of southern Africa.

I congratulate the hon. Member for North Norfolk on initiating this important debate. Let us look forward to having such a debate in Government time on the Floor of the House.

10.49 am

The Parliamentary Under-Secretary of State for Foreign and Commonwealth Affairs (Meg Munn): I congratulate the hon. Member for North Norfolk (Norman Lamb) on securing this important and timely debate. It seems that I might have caught his sore throat, from which I hope he recovers soon.

The subject of the debate is Zimbabwe and the application of sanctions, but hon. Members rightly and inevitably referred also to the current situation—a subject that preoccupies us all. The concerns about the terror there and the pressure that is being exerted were mentioned by a number of hon. Members, but particularly by my hon. Friend the Member for Barnsley, East and Mexborough (Jeff Ennis).

I shall deal first with the issue that has provoked today’s debate. We will respond shortly to a freedom of information request from the hon. Member for North Norfolk, who asked for information on the investigation being held into the activities of a British bank in Zimbabwe. We take seriously the obligations of the European Union common position, and carefully investigate suspected breaches. We are reviewing all the details that we have in order to present the hon. Gentleman with a full reply. That led to the need for an extension to the original deadline, which we will meet.

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Norman Lamb: I appreciate the Minister’s response. If the allegations in respect of Zimbabwe are true, and if it is engaged in activities that would have breached the sanctions regime were they the activities of a company based in Europe, will she condemn Barclays for that activity?

Meg Munn: That is a lot of ifs. I shall make some progress, and I can then happily come back to the hon. Gentleman.

We are determined to see that EU-targeted measures are properly enforced. The activities of banks incorporated in Britain and operating in Zimbabwe are subject to EU regulations. A number of hon. Members asked about the matter. Member states investigate such matters. We take allegations of possible breaches seriously, and we will always investigate. If there is a breach, we will act.

The Treasury leads on the issue, but with the support of the Foreign and Commonwealth Office. However, as the hon. Gentleman has observed, the EU common position applies only within the EU’s area of jurisdiction. It is therefore possible for EU-based companies to own parts of business entities that are incorporated in Zimbabwe. I confirm that, to date, there have been no cases in which British banks have been found to be in breach of prohibitions under the EU regulations. We are confident that the common position is robust enough to prevent regime members from doing business with UK companies.

I turn to the specific issues raised by the hon. Gentleman regarding the response of the Foreign and Commonwealth Office. He first wrote on 12 November, and my noble Friend Lord Malloch-Brown replied on 7 December saying, “We share your concerns” and agreeing to look into the matter. The hon. Gentleman wrote again on 16 January, and the response was as follows:

The hon. Gentleman has indeed had a response.

The common position targets those at the top. It consists of a travel ban and an assets freeze on 131 named individuals responsible for repression or human rights violations in Zimbabwe. However, targeted measures are not the only means by which we are trying to bring about peaceful and democratic change in Zimbabwe. Only regional action backed by support from multilateral bodies can solve Zimbabwe’s crisis. The EU has made clear the need for the election results to be released without further delay, and it has expressed deep concern about the deteriorating human rights situation. We hope that another strong EU political statement will be issued today to underline member states’ concern about the ongoing situation.

At the UN Security Council today, the UN Secretariat will hold a briefing on Zimbabwe. We welcome the involvement of the Security Council and hope that it will facilitate further activity, particularly in allowing a greater focus on action to tackle human rights abuses.

Mr. Benyon: Will the Minister give way?

Meg Munn: I need to make progress.

As a number of hon. Members said, even at grass-roots level, regional action has proved effective. When considering our response to regimes such as that in Zimbabwe, it is important to remember that we have available a whole range of responses, and not only sanctions. Civil society
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has an enormously important role to play, and we have seen it in action—for example, the South African dock workers who refused to unload a ship bearing weapons destined for Zimbabwe sent a clear message.

I welcome the firm response of the South African Development Community countries in preventing the unloading and transhipment of the arms. The concern that those weapons could fuel violence during the election period was very real. It was a credit to those who stood against it that the shipment did not reach those who would have used the weapons to repress and violate innocent Zimbabweans. The reaction against that ship’s load shows the strength and breadth of feeling. It also highlights how important international co-operation can be.

The message from Africans that they would not allow the weapons to reach Zimbabwe was the most effective means of preventing the shipment from reaching its destination. We played our part in that, delivering the message that supplying arms to Zimbabwe while its people are being subjected to violence and intimidation cannot be right. However, it is international and African action that will lead to changes on the ground. We are now considering ways to halt the sale of deadly weapons to the regime in Zimbabwe, at least during the current period of instability and crisis. The EU and the US already have arms embargos in place.

Hon. Members raised a number of other questions. We are pressing for others to match the embargo, and we are working to get it translated into international policy. The subject will be raised at today’s meeting of the Security Council, following the UN Secretariat’s briefing. Ultimately, our intention is to aim for an embargo by the Security Council, particularly if the constitutional crisis in Zimbabwe continues, but our current priority is to prevent arms from reaching Zimbabwe, and we are open on how states achieve that. The Security Council discussion is a useful opportunity for taking that forward.

On the current situation, our primary focus is to find a resolution that upholds the democratic choice made by the people of Zimbabwe over a month ago. Robert Mugabe is trying to steal the election, and we will support all who are working for democratic change. The African Union and the Southern African Development Community are both calling for the presidential results to be released. Africans across the continent have expressed their growing concern that Zimbabwe is sliding further away from a peaceful solution. We continue to work with those states in the region that are best placed to apply pressure on Robert Mugabe and those who surround him.

We all share the wish of the Zimbabwean people to secure their democratic rights. We commend civil society groups in Zimbabwe, which continue to fight for democracy and good governance under incredible pressure. It is a sad fact that the election process has already been undermined, as hon. Members have outlined. Robert Mugabe has unleashed a campaign of violence and intimidation. We cannot be fully confident that what is ultimately announced will not have been manipulated by those who want to keep Robert Mugabe in power.

The international community will continue to work for a peaceful resolution to the crisis in Zimbabwe. The UK, with many other countries and international organisations, stands ready to assist in the economic
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recovery process of Zimbabwe once conditions allow. Zimbabwe needs change and it needs sensible economic and political policies. Once there is evidence of such change, we will give substantial support to recovery there. It is important to note that the UK already provides aid to support the people of Zimbabwe—£49 million in 2007 and a total of £173 million since 2000.

The UK and the international community are committed to seeing a return to democracy and prosperity for Zimbabwe. That cannot happen until the will of the people is respected. We are clear that EU-targeted measures do not hurt ordinary Zimbabweans; they target the regime. That is what we must continue to do. The crisis must not continue. We believe that the solution to the crisis must be an African one, and we hope that it will come soon, for the sake of the people of Zimbabwe.

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Primary Care Trusts (Exceptional Cases)

10.59 am

Dr. Ian Gibson (Norwich, North) (Lab): I am delighted to serve under your jurisdiction for the next hour and a half, Mrs. Humble. The debate has caused many different organisations to pick up this issue and put forward points of view on which I should like to expand today. I thank the bowel cancer groups that have been in touch with me. There might be over-emphasis on cancer in the debate, which also relates to drugs used to treat macular degeneration, for example, but cancer has received most publicity, and reports have appeared in every major newspaper. Almost daily, the issue of the availability of drugs in exceptional circumstances arises, so I shall concentrate on the meaning of “exceptional”.

I thank the NHS Confederation, Macmillan Cancer Relief and the various lawyers who have been in touch with me. The latter seem to do rather nicely out of taking up cases around the country—some 110 such cases have been taken up to protest against decisions made by primary care trusts on exceptional cases. I also thank the specialised healthcare alliance and the Pamela Northcott Fund for the information that they have given to me on their experiences. All that makes me confident that this is a major issue. If I were Prime Minister for a day—God forbid, but it could happen given the way things are going these days—I would recognise that inequality in the health service and the unavailability of drugs is a major problem in this country. It should be a priority to get rid of something we often call the postcode lottery, but which I shall call “exceptionality” in our debate. Finally, I thank Myeloma UK. Myeloma is a rare cancer, but the debate involves rare cancers as well as bowel, breast and lung cancer, which are more common. The chances of obtaining a drug for the rare cancers are pretty poor in this country because of the financial considerations that I shall discuss.

PCTs commission health care services for their local populations. The majority of services are commissioned through a process that involves contracting arrangements with health care providers, but there are occasions when patients and clinicians may request a treatment that is not ordinarily provided. I shall concentrate on those situations, rather going through the usual arguments about drugs approved by the National Institute for Health and Clinical Excellence. Such cases usually arise because of the rarity of the treatment or condition, as I have pointed out, and the use of high-cost drugs.

The NHS has a finite budget, and tough decisions must be—and are—made to determine which treatments should be routinely available. NICE—a fine organisation—must consider the clinical cost-effectiveness of treatments and issue guidance as to why a PCT should fund them. If NICE issues positive guidance on a particular treatment, PCTs in England have three months, I believe, to make arrangements for funding; if NICE turns down a treatment, having judged that the NHS should not fund it, or if does not provide guidance, it can be difficult for clinicians and patients to gain access to those particular treatments, as we know. That is illustrated effectively by the Health Committee report that we shall debate later this month—I am sure that everybody will be present for that debate.

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On the exceptional case and exceptional funding process, some PCTs have a system that allows individual patients to apply for a treatment that is not usually funded by the PCT concerned. I have lots of anecdotal evidence from organisations and individuals who have tried to use such systems, as I am sure every MP does. Not every PCT has a system in operation, and there are no countrywide standard processes or criteria for making decisions on whether patients can access treatment in exceptional cases. I shall give one or two examples later, but the measures used are commonly referred to as “exceptional case processes”, although their titles vary according to PCT.

The issue was brought to public attention as a result of Ann Marie Rogers’s fight to access Herceptin for early breast cancer. The Court of Appeal ruled that Swindon PCT’s policy of prescribing Herceptin in exceptional cases was irrational and unlawful. The court did not rule that Mrs. Rogers should be able to receive Herceptin, but rather that the PCT needed to formulate a lawful policy on which to base such decisions, which I believe was a fair comment. Lots of different names for the practice are used by different PCTs, but we all know that going to court is stressful and extremely costly, and people are inhibited by such a system. The inequalities that are created by the exceptional case process have become apparent. Every PCT has its own system, and they are given different names—some are called “special funding”, some “special circumstances”, but there is no uniformity to define that arena of activity.

Norman Lamb (North Norfolk) (LD): I apologise for arriving late and also for the fact that I must leave early.

Having spoken to the hon. Gentleman before the debate, I know that he is aware of the case of a constituent of mine, Mr. Barry Humphrey—the hon. Gentleman has a local newspaper article on the case in front of him. Mr. Humphrey has been refused cancer drugs by Norfolk PCT. As the hon. Gentleman said, the PCT must decide whether the circumstances are exceptional, but no one seems to be able to clarify what that means. Does he agree that there is no transparency or guidelines on what test must be applied? In that particular case, everything, including the clinicians’ view, points to the fact that Mr. Humphrey should receive the treatment that he needs and which would give therapeutic value.

Dr. Gibson: I agree with the hon. Gentleman—sorafenib, which would slow the growth of the cancer in that case, is available, but it is has not been made available by the PCT under its exceptional circumstances rules. People in other counties would be able to get the drug from their PCTs, but that is not the case in Norfolk. Lawyers around the country have been in touch with me about the matter. The availability of the drug is unequal and unfair. I have promised not to say anything about Scotland, because I no longer know what is true there and what is not. I am rather fed up being told, “If such and such happens in Scotland, why don’t you go back there”—that is a familiar argument in politics—but it is possible to say that the situation in Scotland is different.

The Minister of State, Department of Health (Mr. Ben Bradshaw): If my hon. Friend went back to Scotland, he would have to wait twice as long for his operation.

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Dr. Gibson: Yes, but depending what type of operation we are talking about, I might live longer if I had it. I might live to see my local team in the Scottish cup final while I waited.

Mr. Oliver Letwin (West Dorset) (Con): The point made by the hon. Gentleman’s Norfolk compatriot, the hon. Member for North Norfolk (Norman Lamb), applies to my constituents in Dorset. Does the hon. Gentleman agree that part of the problem, apart from the inequities, is that the process is highly non-transparent? In fact, it is almost impossible to obtain clarity on what South West Dorset PCT means by “exceptional circumstances”, so apart from questioning whether it means the same as it does for other PCTs, one cannot find out for one’s constituent what rule is applied.

Dr. Gibson: I agree. It is also true that the systems that have been set up to examine whether exceptionality, special needs or whatever they are called in a particular county are different, and are not transparent. It is not even clear whether people can appeal against decisions—some PCTs say that people can appeal and some say that they cannot. I might well come to the obvious conclusion that we need uniformity throughout the country, and a discussion on that subject so that we do not have a postcode lottery.

Although such systems exist, patients who, together with their clinicians or oncologist, believe that they face a unique set of circumstances, and that the NHS should make the treatment or drug available to them and fund it because of the clinical benefit, can apply for it to be made available as an exception to the usual rules. A panel will typically consider such cases on their individual merits, and the factors that may be considered include the patient’s medical history; the medical need that the exceptional funding is requested to meet; the expected benefits of the drug or treatment; details of any relevant research or trial supporting its use; and the patient’s personal circumstances. Although a patient in one PCT may be considered an exceptional case and receive the treatment requested by their clinicians, they may not qualify under the criteria used by a different PCT.

That creates a decision-making lottery. The Department of Health does not give PCTs guidance on how, or whether, they should consider individual applications for treatments that are not routinely funded. In 2007, I asked the Minister about the committees established by PCTs to consider such cases, and he told me:

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