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Bill Rammell: I acknowledge that there is an economic dimension to the conflict, and that is why, as I say, we have strongly supported the extractive industries transparency initiative at UN level. We are fooling ourselves if we do not acknowledge that there is a significant political, ethnic conflict taking place. That has to be addressed, but it can only be done through a political solution. In particular, it means that the Presidents of DRC and Rwanda have to come together, with regional partners and international support, to make political progress.

Mr. Chris Mullin (Sunderland, South) (Lab): Although the Congo is a vast country, the area in which the chaos has occurred is relatively small—not much larger than Sierra Leone. Given the disorganised nature of all the armed groups in the area, it is a place where a relatively small but well-disciplined and well-organised outside military force, under the command of MONUC or whoever, could make a difference, as the French demonstrated with Operation Artemis some years ago. One recognises the constraints, given our commitments elsewhere, but I hope that my hon. Friend and the Government will not rule out our making a contribution to whatever force eventually restores order there. Enforcing whatever political agreement is reached will have to be done by outsiders, because the internal forces are absolutely incapable of doing it.

Bill Rammell: I pay tribute to my hon. Friend; I know from having worked with him at the Foreign Office that he has enormous experience on this issue. He is right to stress that we are talking about a relatively small part of DRC. That is why our efforts are focused on ensuring that the MONUC force on the ground is appropriately and adequately deployed in the area. We do have some challenges, in that some of the international partners that form part of the MONUC force have caveats relating to their deployment. We are seeking to remove those caveats, so that we can deploy as effectively as possible.

Malcolm Bruce (Gordon) (LD): Britain has become one of the biggest donors in DRC precisely because we wanted the country not to move back into a conflict situation, as most post-conflict countries sadly do within five years. Will the Minister acknowledge that, in the short run, we must have international forces to deal with the crisis, but in the long run we have to develop the capability of a well-disciplined army and police force to enable the Government of the Congo to govern the country? EU countries have been noticeably reticent about providing the support and training for which they have been asked. What can we do to ensure that they play their full part?

Bill Rammell: The right hon. Gentleman is certainly correct to identify that we are, and have been, a very substantial aid donor. Through the Department for International Development, we are committing £300 million over three years, and that is making a difference. The £5 million that was announced by the Secretary of State for International Development last Friday is already helping to facilitate aid missions from UNICEF and others in beginning to make progress. In the longer term, as he says, increasing the capacity for self-governance of DRC and others is critically important. We are making a contribution; we need to ensure that all states are making the contribution as effectively as possible.

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Mary Creagh (Wakefield) (Lab): I congratulate my hon. Friend on the steps that have been taken. May I press him on the role of children, who are recruited by those on all sides? May we have absolute clarification that MONUC and UNICEF will be empowered to identify and remove children who are involved with the warring factions? The Congo has an appalling record on children’s rights. One in five children dies before they reach their fifth birthday. May I also ask him for clarification of the UN’s role, and whether it is allowed to enforce civilian protection to allow humanitarian aid to get through? Finally, may I ask him—

Mr. Speaker: Order.

Mary Creagh: I will leave it there, Mr. Speaker.

Mr. Speaker: Hon. Members should ask one supplementary question; I have given the hon. Lady two.

Bill Rammell: I thank my hon. Friend, who I know takes a real interest in these issues. Certainly, here and elsewhere in the world, her concern about the plight of children involved in conflict is critical, and the issue will be at the forefront of our thinking and planning. MONUC has not only a monitoring role but, importantly, an enforcement role—to enforce the accords that are already in place and, in particular, the zones of separation, which were announced through the UN. Ultimately, it has to be one of the building blocks for our substantive progress.

Mr. Bernard Jenkin (North Essex) (Con): May I reiterate the point—I think it is a strong feeling in the House—that our armed forces are already doing enough, if not too much? It really would be intolerable if British armed forces were called on once again to stretch themselves even further when so few of our European allies contribute significantly to current operations.

Bill Rammell: Like the hon. Gentleman, I think that our troops are doing a superb job in many parts of the world. It would be irresponsible to rule out contingencies, given what is a very difficult situation, but all our efforts and statements have made it clear that our overriding priority is to ensure that MONUC operates effectively and is deployed effectively. It is the biggest peacekeeping force anywhere in the world, and we want it to succeed.

Mr. David Drew (Stroud) (Lab/Co-op): When one goes and sees the MONUC force, it is actually very impressive, but we know that too often in the past troops have either been badly led, as my hon. Friend the Member for City of York (Hugh Bayley) said, or, more particularly, not been paid, which has led to ill discipline and problems on the ground. Will the Government ensure that, at the very least, the UN and all those who contribute to the force pay up front to make sure that it is equipped and able to do the work that it has set out to do?

Bill Rammell: My hon. Friend makes a powerful argument. We have a need, through the United Nations, for international peacekeeping forces, and given that need, it is critical that the troops in place are led effectively and properly paid. It has always been a priority for the Government, and it will continue to be the case here and elsewhere.

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John Bercow (Buckingham) (Con): Further to the Minister’s response to the right hon. Member for Gordon (Malcolm Bruce) about British aid to DRC, and in light of speculative reports about the less than wholly helpful attitude that the Government of Rwanda have taken thus far, reports about which the Minister will probably wish to be suitably circumspect, will the Foreign Secretary nevertheless remind the Rwandans of our strong aid relationship with them, including the relevant memorandum of understanding?

Bill Rammell: The hon. Gentleman is right to caution against irresponsible language in a fast-moving situation. He is right also to point out that this year we are committing £46 million to Rwanda. In this debate, it is important to make it clear that, even in this very difficult situation, some progress is being made. The military situation overnight in Goma town remains calm and under control; efforts are under way to reinforce troops in Goma; and humanitarian activity is slowly improving as access slowly improves. That is one of the key fundamentals in the situation. We must ensure that the non-governmental organisations and aid agencies gain access to the most acutely affected areas.

Rob Marris (Wolverhampton, South-West) (Lab): Another key fundamental is respect for the rule of law. Will my hon. Friend assure me that the Government will press General Nkunda to hand over his military chief of staff, Bosco Ntaganda, for whom I understand there is an International Criminal Court warrant outstanding?

Bill Rammell: Those individuals who have committed such crimes need to be brought to book. That has certainly been a key part of our focus. Indeed, the Nairobi agreement was a clear political process that was negotiated between the two countries and saw a way forward on this issue. That still remains on the table, and we are pushing very strongly to ensure that it happens.

Norman Lamb (North Norfolk) (LD): I noted the Minister’s response to the concerns raised earlier about the role of commercial interests. However, may I draw his attention to the UN panel of experts report, which specifically listed companies and individuals implicated in what it described as a multi-billion-dollar theft of the country’s natural resources? The report also described the role that that played in sustaining the conflict. Yet none of those interests—none of those individuals or companies—was ever brought to justice. Is there not a need for an international system to ensure that when companies or individuals are found to have breached fundamental rules, they are brought to justice?

Bill Rammell: As I said, there is an economic dimension. We have called and argued for transparency initiatives at an international level to help and facilitate the process. However, we are deluding ourselves if we think that the economic dimension is the sole driver of the conflict. There is a serious ethnic-political conflict, which needs to be addressed through a political solution in the region.

Mr. Douglas Hogg (Sleaford and North Hykeham) (Con): May I reinforce the view of my right hon. and learned Friend the Member for Kensington and Chelsea (Sir Malcolm Rifkind)? British forces are heavily engaged—
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indeed, overstretched—in Iraq and Afghanistan. Any significant deployment to the Congo would seriously dilute the resources available to British forces in Afghanistan and Iraq. That must not happen.

Bill Rammell: We are in danger of repetition on this issue. However, I understand the concerns being put forward. We would be irresponsible to rule out contingencies, but our overriding priority, in the United Kingdom and the international community, is that MONUC forces should be deployed as effectively and appropriately as possible. That is where our thinking is at the moment.

Dr. Andrew Murrison (Westbury) (Con): Although it is good to get some measure of clarification from the Minister about the deployment of our already overstretched troops, will he confirm that he will do what he can, with his colleagues, to make it clear to our European allies that any participation in central Africa should not be at the cost of a full and proper engagement in Afghanistan?

Bill Rammell: We have certainly made the case that a number of partners should commit more effort to the situation in Afghanistan, and we will continue to make those arguments. Notwithstanding the desire for that, some genuine progress is being made in Afghanistan and we need to reinforce that.

Mike Penning (Hemel Hempstead) (Con): If there is the slightest possibility of our overstretched troops being sent to the Congo, pre-deployment training and the ability to get ready will be the most important things. How many troops are likely to be sent, and when will the units be told? They will need to get the pre-deployment in place.

Bill Rammell: With respect, the hon. Gentleman is getting ahead of himself. As the Foreign Secretary, my noble Friend Lord Malloch-Brown and I have made clear, we would be wrong to rule out contingencies. However, the overriding priority for us and the international community is to ensure that the MONUC force, which I state again is the largest peacekeeping force anywhere in the world, acts and operates effectively.

Tony Baldry (Banbury) (Con): There is another angle to this issue. In 2005, every member of the Security Council and of the General Assembly signed up to the concept of the responsibility to protect, which, if need be, involves peacekeepers and peace enforcement. At present, disproportionately few members of the United Nations are contributing to UN peacekeeping. It is one thing for all those countries to sign up in New York to concepts such as the responsibility to protect, but they then have to deliver to the Secretary-General by being willing to contribute peacekeepers. Other UN member states do not have enough peacekeepers in Darfur, let alone in the Congo. When will we see the countries that subscribe to the responsibility to protect contributing to the UN by way of peacekeepers?

Bill Rammell: I know that the hon. Gentleman has taken a real interest in this issue, and I agree with a lot of what he has said. We do need international peacekeeping forces. If we are to ensure that policing the world—for want of a better phrase—is not to be left to one or two superpowers, others have to step up to the plate. We make the argument in respect of that political challenge, and I welcome the hon. Gentleman’s support for it.

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Mr. Andrew Mackay (Bracknell) (Con): Notwithstanding the possibility that the Minister will accuse me of repetition, is it not essential that the House should send a clear message to our European partners that if European Union troops are needed, as I suspect they might be, they should come from nations that failed to deploy in Iraq and Afghanistan? That message should go out loud and clear this afternoon.

Bill Rammell: I hear what the right hon. Gentleman is saying, but the other important point to make is that there is no military solution to the situation in eastern DRC without a political solution. That is why the efforts of the Secretary-General, who is sending an envoy to the region, are particularly important. The agreement from the African Union to convene the two leaders is important, as is the appointment of an emissary from the African Union. That political process needs to start being developed.

Mr. Crispin Blunt (Reigate) (Con): The price being paid by the people of the Democratic Republic of the Congo is a graphic demonstration of the fact that conflict is the most lethal way of demolishing our nation’s development objectives for the relief of poverty in other parts of the world. The Minister responded positively to two other hon. Members about the importance of the army of DRC, if it were properly trained, being an instrument to help to prevent conflict in DRC. Presumably training that army is a proper objective of British development policy.

Bill Rammell: The national forces in DRC play a key role in this respect. We must do everything possible to ensure that those troops can operate effectively, and that remains our thinking.

Mr. Stephen O'Brien (Eddisbury) (Con): I thank the Minister for paying tribute to His Excellency Jakaya Kikwete, the President of Tanzania. I, and the other members of the all-party group on Tanzania, wish to do everything that we can to support those good offices in helping to broker dialogue.

I declare an interest as chairman of the Malaria Consortium—we have people of our own out in the area at the moment. I hope that the Minister can give an extra assurance that MONUC and the other forces that are out there, including those in Uganda and Rwanda, can help to protect the aid workers and to ensure that they have access, as they require. We must also ensure, as a priority, that the World Food Programme is mobilising to supply through those countries, and that we do not hear further stories about the need first to count the people. We know that there are 500,000 people on the move; now we need to start getting the supplies to them and for those forces to be protected.

Bill Rammell: The hon. Gentleman is right: there are various elements to this process, and the political one is key. However, given the acute humanitarian concern—in the past week, 55,000 people have been displaced—we absolutely have to ensure that the aid agencies and non-governmental organisations have the access to ensure that they can get the support through. That remains a fundamental objective and priority. Our recent commitment of extra aid on top of that which was already being given is helping to facilitate that process. The push for a political settlement is at the top of our agenda.

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NHS Patients (Access to Medicines)

4.7 pm

The Secretary of State for Health (Alan Johnson): With permission, Mr. Speaker, I should like to make a statement about Professor Mike Richards’s review of current policy concerning NHS patients who wish to pay for additional private drugs.

I start by paying tribute to Professor Richards and his review team for the diligence with which they have conducted this review. The report is informed by evidence from thousands of patients, carers and clinicians across the country, and it was completed with necessary urgency but without in any way compromising its thoroughness. The time scales that I set were deliberately challenging, because this issue is causing great concern and distress to a number of patients and their families.

The review’s terms of reference were to examine current policy relating to patients who choose to pay privately for drugs that are recommended by their clinician but not funded by the NHS and who, as a result, are required to pay for the NHS care that they would otherwise have received free of charge. I also asked Professor Richards to make recommendations on whether policy or guidance could be clarified or improved.

Professor Richards quickly identified the underlying causes of the problem. His review starts from the fundamental principle that the NHS provides a universal and comprehensive service to all its patients, free at the point of need. During the Second Reading of the NHS Bill in 1946, Nye Bevan described the financial anxiety endured by people seeking medical help as the “first evil” that the NHS must vanquish. Yet Professor Richards’s report shows that access to certain treatments on the NHS, particularly drugs for the terminally ill, is inconsistent, and as a result a very small number of patients feel that they have to pay for additional treatment and are worried that in doing so they will jeopardise their entitlement to NHS care. His report makes recommendations not only to revise the guidance for those exceptional and rare circumstances, but to improve access to certain drugs on the NHS, reducing the need for such patients to resort to private care. His recommendations are accompanied by proposals put forward by Professor Sir Michael Rawlins, chair of the National Institute for Health and Clinical Excellence, to employ greater flexibility in the appraisal of certain treatments, specifically those relating to drugs for the terminally ill. I accept Professor Richards’s recommendations in full and today I can announce two immediate developments to make drugs more available on the NHS to those who could benefit from them.

Since it was established in 1999, NICE has ensured not only that many thousands of patients benefit from access to the latest treatments, but that the taxpayer gets value for money. NICE provides wholly independent and scientifically rigorous assessments of the latest medicines and treatments and is widely admired across the world for its work. Its guidance on drugs and treatments is internationally respected, and many other countries are adopting similar models.

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