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Mr David Burrowes (Enfield, Southgate) (Con): Will the right hon. Gentleman give way?

Mr Denham: I will take one more intervention.

Mr Burrowes: I thank the right hon. Gentleman and congratulate him on securing this debate. In 2012 there was an international conference on the genocide of Hazaras—indeed, the new Minister, whom I welcome to his post, was present. I notice that at that time not a single perpetrator had been arrested or brought to justice. Has there been any change in that regard?

Mr Denham: There have been some arrests, as I understand it, but nobody has yet been successfully brought to justice. That is a matter of grave concern.

As I said, the UN has strong policies, but we have to make much more progress at the international level. Let me turn briefly to Afghanistan. The fall of the Taliban brought representation in the political system and support for the Hazaras’ long-standing commitment to educate girls as well as boys, though widespread discrimination continued. There have, of course, been atrocities, notably the killing of more than 60 people, mostly Hazaras, in Ashura in December 2011. However, fears are now rising of what might happen after the withdrawal of international troops. Secure and stable government is by no means assured, and the current political stalemate following the elections is hardly encouraging.

The security situation is becoming increasingly volatile, and Taliban forces are increasing their control of territory. We have seen the killing and forced displacement of Hazaras from Khas Uruzgan and killings and disappearances along the roads from Kabul to Bamiyan, Ghazni and Heart, with 30 Hazaras killed in three separate attacks on those highways in July 2014 alone. It is understandable that Hazaras fear a return to the scale of abuses they experienced under the Taliban regime. It is hardly encouraging that two of the Taliban released by the US in a recent prisoner exchange were Mullah Fazl and Mullah Norullah Noori, who both participated in the massacre of thousands of Hazaras in the late 1990s and early 2000s. That does not show a sensitivity to the history or the future dangers.

The message that we want to convey from tonight’s debate—happening as it is just a few days before the NATO summit—is that even as troops are withdrawn, the international community cannot afford to lose interest in what happens in Afghanistan. The international community needs a clear agenda for its continuing aid and political relationship with the Afghan Government, which should include pressure to address the continuing discrimination and under-representation of Hazaras within the Afghan Government and state, and to assist the Afghan Government in ensuring the protection of ethnic and religious minorities following troop withdrawal.

Stella Creasy (Walthamstow) (Lab/Co-op): Will my right hon. Friend give way?

Mr Denham: I will give way one last time.

Stella Creasy: I thank my right hon. Friend for giving way. I wonder whether he believes it would also be helpful to have direct Hazara representation in discussions at the NATO summit as a result of the points he is making so eloquently.

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Mr Denham: It is a real issue that the Hazaras have often not been given a voice in international conferences and also, I have to say, in relation to our Government and their aid programme. That voice must be found.

My final point is this. The international community now generally recognises that talks between the Afghan Government and the Taliban are both unavoidable and necessary, but it has to be made clear that such talks cannot be allowed to exclude the protection of minority rights as part of any long-term solution. Even after the withdrawal of international troops, I still think we should be in a position to ensure that those issues remain on the agenda.

Several hon. Members rose—

Madam Deputy Speaker (Mrs Eleanor Laing): Order. Unfortunately, because there has been a surge in demand to speak in this debate, I shall have to maintain the three-minute limit of the previous debate. I call Jeremy Lefroy.

9.20 pm

Jeremy Lefroy (Stafford) (Con): Thank you, Madam Deputy Speaker, and I congratulate the right hon. Member for Southampton, Itchen (Mr Denham) and indeed the Backbench Business Committee on bringing this debate forward. You will be glad to hear, Madam Deputy Speaker, that because the right hon. Gentleman has eloquently outlined the situation that the Hazaras face, I intend to make just one point.

I wish to say that it is the responsibility of every Government on this planet to look after their minorities—whatever they think of them, whatever the background or history. Governments have the responsibility to protect their minorities. We are not necessarily here to dictate political systems or say whether minorities such as the Hazaras should have this or that kind of democracy, but it is a fundamental role of any state to protect and to provide safety and security for all its people, and not to discriminate against any one people because of their faith, creed, colour or whatever else.

That leads precisely on to the point made by the right hon. Member for Southampton, Itchen: it is up to the UK Government, in whatever way they interact with another Government, in Pakistan, Afghanistan or elsewhere around the world, to oppose any discrimination against and persecution of minorities simply because of who they are, and wherever that discrimination and persecution are taking place. It is for the UK Government at each and every opportunity, whether it be through development, military, diplomatic or even economic relations, to make that point. As I say, this does not apply only to Pakistan and Afghanistan, as we could think of dozens of other places where it is happening. It is a duty to protect minority citizens and give them equal rights with others.

In my work on the International Development Committee, I sometimes feel that we do not take up this challenge enough. Let us not forget that Pakistan is the single biggest bilateral recipient of UK aid. We have clout there. When our Committee visited Pakistan a couple of years ago, we could not go anywhere near Quetta or to Balochistan because of the situation there. We could go to Khyber Pakhtunkhwa and Punjab and we saw some excellent work being done there, but we

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could not go to a place where all these things were going on at the time. I believe that it is for our Ministers in the Department for International Development and for parliamentarians on the International Development Committee to raise those matters whenever we have the opportunity. We may be ignored and there may be no action, but we could be listened to and it is our responsibility to act as I have suggested.

9.22 pm

Dr Alan Whitehead (Southampton, Test) (Lab): As my right hon. Friend the Member for Southampton, Itchen (Mr Denham) eloquently put it in his introduction to the debate, this Hazara community does not have a nation; it has parts of a nation and has had a substantial diaspora across the world, with perhaps a million Hazaras in Iran, more than half a million in Pakistan and between 1 million and 2 million in Afghanistan. These people have suffered historically from enormous persecution, which in many ways continues today.

If I have time, I would like briefly to read out a letter that was circulated in Quetta at the time of the arrest of a leader of the Lashkar-e-Jhangvi, a body that continues openly to pursue attacks against Hazaras in Quetta and around. The letter says:

“All Shi’ites are worthy of killing. We will rid Pakistan of unclean people. Pakistan means land of the pure and the Shi’ites have no right to live in this country. We have the edict and signatures of revered scholars, declaring Shi’ites infidels. Just as our fighters have waged a successful jihad against the Shi’ite Hazaras in Afghanistan, our mission in Pakistan is the abolition of this impure sect and its followers from every city, every village, and every nook and corner of Pakistan.

As in the past, our successful jihad against the Hazaras in Pakistan and, in particular, in Quetta, is ongoing and will continue in the future. We will make Pakistan the graveyard of the Shi’ite Hazaras and their houses will be destroyed by bombs and suicide bombers. We will only rest when we are able to fly the flag of true Islam on this land of the pure. Jihad against the Shi’ite Hazaras has now become our duty.”

That organisation is dedicated to eradicating an entire ethnic group from the face of the earth. Those are the circumstances under which the Pakistani Hazaras live daily, with the results that my right hon. Friend the Member for Southampton, Itchen described.

There have been atrocities—for example, when a number of people were blown up on a bus while on a pilgrimage. When asked how he intended to “stem the tears” of the Hazara community, the then Chief Minister of Balochistan said:

“Of the millions who live in Balochistan, 40 dead in Mastung is not a big deal. I will send a truckload of tissue papers to the bereaved families.”

That is the reality of life for Hazaras in Pakistan and in other places. It is incumbent on us to raise the issue internationally and to call on the Pakistan Government and international agencies to ensure that the rights that any of us would expect are protected, including the rights of this vibrant community, part of which I am delighted to say is resident in my constituency.

9.26 pm

Mike Thornton (Eastleigh) (LD): I pay tribute to the right hon. Member for Southampton, Itchen (Mr Denham) for his sterling work on the issue. The subject was

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brought to my attention by Luci Woodland, who is part of the APPG and who told me that no one knows this is happening. We have heard about what is going on. We have heard the numbers. Amnesty International says that the targeting of Hazaras is increasing. That must frighten all of us. It is incumbent on all Members to spread the word. That is what we need to do. We need to ensure that people know what is going on. The press do not report it. The BBC does not report it. Sky News does not report it. We must persuade people to let everyone know what is happening.

Many years ago, people of my generation used to write postcards to Amnesty International about prisoners of conscience because we knew that, once the dictators knew that we knew what was going on, they would start to change their behaviour. It is the same when it comes to the Hazaras. Governments have been pursuing those kind, decent, gentle people, who educate all their children, male and female, and are renowned for their music and poetry, not violence and intolerance. The only way we can get Governments to listen and people to pay attention is if people know what is going on. If enough people start making a noise, things will change. Therefore, I ask everyone in the Chamber and anyone out there who happens to be listening to the debate to make the situation known, to listen and to write to the newspapers to ensure that people hear what is going on in Pakistan and Afghanistan.

Martin Horwood (Cheltenham) (LD): My hon. Friend is speaking eloquently. He is calling for a public outcry. Will he also press the Government to ensure that the half a million pounds or so that we are spending on the Afghanistan Independent Human Rights Commission is reflected in the concern for the Hazara community, too?

Mike Thornton: I thank my hon. Friend for that intervention. It is vital that we do that. It is important that we use the money, the influence and the power we have to ensure that things start to change. I have been horrified by what I have found out. I was almost moved to tears in talking to Hazaras who have been exiled from their homeland by intolerance and violence. I knew nothing about it before I turned up at the first APPG, which the right hon. Member for Southampton, Itchen chaired. We have heard the figures. There is no point in my repeating what I have written down and what everyone else has said. I ask Members to pay attention and to think what it would be like to live in a situation where one is persecuted not just because of one’s religion but because one looks different from one’s neighbours. Hazaras look different from other Pakistanis and Afghans because they have a Mongolian ancestry, so they are being persecuted for racial as well as religious reasons. It is shocking and horrifying, and we must spread the word to make sure that things change. I ask all Members to do everything they can to ask for that change.

9.29 pm

Mrs Madeleine Moon (Bridgend) (Lab): As we have heard, the Hazaras are Persian-speaking people who live mainly in central Afghanistan. They are overwhelmingly Shi’a Muslims and make up the third largest ethnic group in Afghanistan, forming about 9% of the population. Their distinctive facial features in comparison with the

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Pashtuns, who make up 42% of the Afghan population, makes them easy to identify, marginalise and persecute. During the Taliban rule, the Hazaras suffered a repeated and systematic campaign of violence. Wholesale persecution of the people dates back to fatwas issued against them in the 1890s. Despite the genocidal campaigns, the Hazaras are still the third largest ethnic group in the country. Approximately 4.8 million live in Afghanistan, 1 million in Iran, and 550,000 in Pakistan. Despite their numbers, however, the Karzai Government had no Hazara Ministers, only 5% of Government officials are Hazara, and none of the 10 candidates in April’s presidential election was Hazara.

One of the main achievements in Afghanistan has been to bring a measure of democracy and representative government to the people of that country, but many obstacles still exist. All of us know all too well that there is more to democracy than voting and more to democratic government than representing the views of the majority. A true democracy is one where not only are the views and wishes of the majority represented but the needs of the minority are given protection and respect.

Jim Shannon (Strangford) (DUP): There seems to be an attitude permeating through the Pakistani Government that picks on small ethnic groups and religious groups, and does so purposely because they are small. Does the hon. Lady think that we should take the action suggested by other Members and try to redirect DFID money to those who need it most rather than to the Government who are taking it out on people in minorities?

Mrs Moon: The hon. Gentleman, as always, is trying to steal my best lines. I ask him to wait until my conclusion.

If Afghanistan is going to survive, the rights of groups such as the Hazara need not only to be tolerated but fully accepted and incorporated into the workings of the state. This is no small task or easy feat even in the best of circumstances, but many of the ingredients are there. Article 2 of the constitution guarantees freedom of worship and article 22 clearly states the equal rights of all Afghan citizens before the law. The most difficult tasks that Afghanistan has to meet are freedom of worship and equal rights. At the end of the day, this will be the only way of ensuring the well-being of minorities and the stability of the whole country.

The British Government have committed to provide ongoing financial support for Afghanistan and Pakistan. This House must make it very clear today that we will be watching to see how all minority groups are protected and engaged with, and that when considering our financial support we will be looking for freedom of worship and equal rights for all minorities.

9.33 pm

John McDonnell (Hayes and Harlington) (Lab): Like everybody else in the Commons today, I knew nothing about Hazaras until a small group of my constituents turned up in my constituency office and took me through their experience, which was horrendous. The group travelled as pilgrims and on the coach they were divided on ethnic lines, taken off, and a number of them murdered on the spot. That was just one experience. When I witnessed the photographs and the reports, I felt, like everyone else, lacking because I did not know about this and a sense of a sin of omission in not doing anything about it.

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The other thing that came up in the discussions with the group was their anxiety that the perpetrators of this violence against them, particularly in Pakistan, were operating with virtual impunity, with no action taken against them or only tokenistic arrests. Then there was the bizarre element that some of those who had been arrested were allowed to escape, with clear collusion on the part of the authorities.

I told my constituents that I would do everything I possibly could to support the all-party group—I congratulate my right hon. Friend the Member for Southampton, Itchen (Mr Denham) on establishing it—and also to look at how we systematically approach this issue so that we have a method of working in which, as my hon. Friend the Member for Bridgend (Mrs Moon) said, we bring attention to it and do not allow it ever to be dropped again.

I want to thank Baroness Warsi for the work she did and the commitment she undertook on this issue, but may I make a suggestion to the Minister? I know he has offered to meet the all-party group, but a systematic report from Government on how we are going to approach this issue on a whole range of levels would be helpful.

Obviously, there is an element of carrot and stick. In terms of positive assistance through DFID, there is a question as to how we target resources on the Hazara community in Pakistan and Afghanistan, and what support we can concretely give them, because they are suffering economically as a result of the oppression they are facing. The second point is to do with the conflict pool and conflict prevention and resolution. We have looked at proposals in other areas where we support Human Rights Watch and other human rights organisations to put people on the ground, including supporting the Hazaras with the legal representation they need on individual cases.

Thirdly, there is an element of stick. As has been said, Pakistan receives a significant amount of aid from this country. It is also a significant trading partner with us. All of those trading agreements now have a commitment to human rights embodied in them, but that is not being fulfilled. We must explain to the Pakistani Government in particular that if they want this relationship with us, they have to start delivering by addressing human rights abuses in this particular instance, and we should invite them to bring forward their programme of work for tackling this disgraceful abuse of the Hazaras.

I want the Minister to meet the all-party group, but also to prepare a systematic report on how we can bring forward this issue so that we can protect this community.

9.37 pm

Mike Gapes (Ilford South) (Lab/Co-op): In recent weeks we have been commemorating events relating to the first world war. One thing we have been commemorating is the contribution of the British Indian army and those people who came out of the colonial past of 100 years ago and gave their lives for our country. Many of them were Hazaras.

Hazara groups were part of the British Indian army from the early years of the last century. They were involved in many parts of the world, including the middle east, as part of a group of Hazara Pioneers who came out of Quetta.

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At that time, the colonial civil service was also staffed by many Hazaras. Their commitment to education and the role of women in society has been mentioned, and that is an important reason why they were used by the British colonial authorities. As a result of that, however, there is discrimination against and hostility to this minority from some other groups. The Hazaras face not just the problem that they are Shi’a predominantly, but the problem that their commitment to girls’ education draws hostility from adherents to the more virulent forms of misogyny and hatred of education of girls that comes out of the Taliban, as we have seen in recent years.

The Hazaras come from Bamyan province in Afghanistan, which is where the Taliban destroyed the ancient Buddhas of another religious minority that were part of the history of that country. As my hon. Friend the Member for Bridgend (Mrs Moon) said, we need to be very vigilant about what happens in Afghanistan over the next two or three years. Whoever eventually becomes President—if anybody ever does and they ever do finish the process of election verification and counting—must be held to account.

We will need to make sure that the Afghan Government speak for, and represent, all of the communities in Afghanistan, and we must also use our diplomatic channels and our aid programme in a targeted way to assist minorities within Pakistan. Britain has a great relationship with Pakistan and that must continue, but we also need to speak up for minorities there.

9.40 pm

Mr John Spellar (Warley) (Lab): First, I congratulate my right hon. Friend the Member for Southampton, Itchen (Mr Denham) on securing this short but significant debate. He has had a long history of campaigning for the Hazara community during his time in Parliament, and they will greatly miss his voice when he retires at the next general election, as indeed will his wider constituency in Southampton.

As hon. Members will be very much aware, the persecution of the Hazaras is part of a greater tide of religious and ethnic intolerance and persecution around the world, and of appalling brutalities perpetrated on those of a different faith or community. The barbarities of ISIS are the most recent, graphic and disgusting examples, but, unfortunately, they are by no means unique. Equally reprehensible is the acquiescence, even complicity, of state bodies in actions against minority groups, particularly faith groups, and hon. Members have given examples of that. My right hon. Friend and his parliamentary neighbour, my hon. Friend the Member for Southampton, Test (Dr Whitehead), drew attention to some of those, particularly the failure to take action against Lashkar-e-Jhangvi. That organisation has proudly claimed responsibility for some of the attacks, yet many of its leaders continue to play command and leadership roles, they avoid prosecution, they escape and they evade accountability. Some of them, having been arrested, have even escaped from military and civil detention in circumstances the authorities have found hard to explain.

Bob Stewart (Beckenham) (Con): The International Criminal Court is the court of next resort which may well prosecute such people, and we should make much greater use of it when states refuse to prosecute individuals.

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Mr Spellar: I thank the hon. Gentleman for his intervention. I am sure it has been noted by the Foreign Office Minister. Part of the effectiveness of this debate is in raising this issue in the order of priorities of not only the Foreign Office, but the Department for International Development, which has been mentioned by a number of hon. Members.

The only redeeming feature at the moment of this situation is the much greater level of public awareness and debate on these issues, and the welcome attention in the political world. Today’s debate is one example of that. In this House there has been a growing interest in the persecution of not only the Hazaras, but of Rohingya Muslims in Burma, of Baha’is in Iran and of the Ahmadiyya community in a number of Muslim countries. Increasingly, we have also seen persecution of various Christian groups in a variety of countries across the world, particularly in the middle east and Indian subcontinent, including Pakistan, to which I will return in a moment. For many people, campaigning on their behalf often seems a lonely road to be travelling, as they try to get a message across about the horrors to a world that is unaware, as many colleagues have rightly indicated. Therefore, this level of interest from Parliament and Government is particularly welcome. As we are seeing tonight and in other debates, these issues unite those on both sides of the House—Government and Opposition alike.

In early July, the shadow Foreign Secretary, my right hon. Friend the Member for Paisley and Renfrewshire South (Mr Alexander), rightly said in a speech to Christians on the Left that

“The first centuries of Christianity are often described as being scarred by blood, violence and brutality. And yet the plight of Christians today could go down in history as one of the most brutal periods of our common history.”

That is being borne out on a daily basis on our television screens. He also rightly stressed that

“wherever Christians are persecuted, the right to religious freedom for all is jeopardized.”

There have been particular concerns about the failure of the state—and even its involvement and that of its institutions—to protect those who practise Christianity in Pakistan. As my hon. Friend the Member for Bridgend (Mrs Moon) rightly said, we will be watching carefully for any failure of the state to protect minorities, including the Hazara. We will be watching for any failure of the state in Pakistan, and indeed in Afghanistan, in its duty to provide that protection: where it is failing to protect them from other groups, leaving aside what it is doing in its own right. We also need to be clear that the right to freedom of religion includes the right to change one’s religion, as well as the right not to believe. Those rights are enshrined in the Universal Declaration of Human Rights, which was agreed in 1948 after the horrors of world war two. In ringing tones, it declared:

“Everyone has the right to freedom of thought, conscience and religion; this right includes freedom to change his religion or belief, and freedom, either alone or in community with others and in public or private, to manifest his religion or belief in teaching, practice, worship and observance.”

The international community should be working, striving and insisting on those rights.

It is good to see this issue being dealt with in the broader context, but we must also focus on the particular, so that the voices of the persecuted are heard. That is

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why today’s debate is so welcome. As my right hon. Friend the Member for Southampton, Itchen said, the position of Hazaras in both Afghanistan and Pakistan is especially hazardous, particularly with the uncertainties that we are anticipating with the end of the NATO military drawdown. There are also continuing uncertainties over the outcome of the presidential election and whether there will be an inclusive Government in Afghanistan. That inclusivity needs to draw in not just all the major actors but all the communities in the country. As I have repeatedly said, it is also vital that there is early involvement by the neighbouring countries, all of which have an interest in stability in Afghanistan, but all of which could lose out if they try to play for sectional advantage, which will contribute to breakdown. Minorities such as the Hazara, which is probably one of the worst treated groups in the region, need to have their rights protected.

It is clear that many extremist groups are still receiving protection from the authorities. Although a ban has been in place since 2002, it has not stopped them from carrying out attacks across Pakistan. Civilian and military security forces deployed in Balochistan have done little to investigate the attacks on the Hazara or to take steps to prevent the next attacks. The head of LEJ has been prosecuted for alleged involvement, but has not been convicted. Now we are seeing some of those who have been involved in the atrocities against the Hazara being released from prison.

Tonight, all parts of the House are calling not only for greater public awareness but for the Foreign Office and Department for International Development and international forums to make the persecution of Hazaras a priority in their discussions with the Governments of Pakistan and Afghanistan. Such a call is not only in our interests but a matter of decency.

9.48 pm

The Parliamentary Under-Secretary of State for Foreign and Commonwealth Affairs (Mr Tobias Ellwood): I am grateful to the right hon. Member for Southampton, Itchen (Mr Denham) for calling for this debate and for ensuring that it took place on such a busy day in the Chamber. Important contributions have been made by Members from all parts of the House. I will try to touch on some of them, but if I do not get through them all, I will write to hon. Members.

My hon. Friend the Member for Stafford (Jeremy Lefroy) mentioned the important role of the International Development Committee and the work of DFID. I hope that they will continue their studies in this area. Britain is committed to providing £70 million for a number of years in Afghanistan, and we are one of the major donors in Pakistan as well.

The hon. Member for Southampton, Test (Dr Whitehead) spoke about the role of Iran and the responsibility of the Pakistani Government to do more and not turn a blind eye to the various incidents taking place.

My hon. Friend the Member for Eastleigh (Mike Thornton) spoke about improving knowledge of what is happening with the Hazaras not just in this place but in Britain as a whole. The hon. Member for Bridgend (Mrs Moon) said how easy it is to identify the Hazaras because of their make up and also spoke about the role of the Afghan Government in addressing some of the

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issues. It is good to see that the second assistant President is a Hazara and that one fifth of MPs in the Afghan Parliament are Hazaras, too. Unfortunately, the same cannot be said in Pakistan.

The hon. Member for Hayes and Harlington (John McDonnell) spoke about a report on tackling these issues. This is now the third such debate in as many years and I hope that it will become an annual event. The FCO’s annual human rights report and quarterly updates comprehensively cover persecutions faced by all, including the Hazaras, so perhaps we should have a debate on the report itself to highlight that point.

The hon. Member for Ilford South (Mike Gapes) spoke about the future of the Afghan Government. He is perhaps better aware than most that we are in a bit of a stagnation period at the moment and are waiting for an outcome and for votes to be counted. Once that happens and there is agreement about what Britain’s and the international community’s role can be, we can step forward and start addressing some of the other issues.

The right hon. Member for Warley (Mr Spellar) spoke about LEJ, the prime persecutor of the Hazaras. We should bear it in mind that it is not the only one, but it is obviously the focus of our attention.

The conflict pool was mentioned by a number of right hon. and hon. Members and has now been replaced by the conflict, security and stability fund, which is a much longer phrase for us to get our heads around. There certainly needs to be more focus on what we can do using that fund. The forthcoming NATO summit was mentioned and I will certainly do my best to have a number of bilaterals on this subject. I had the fortune of speaking to our high commissioner in Pakistan on the matter this evening.

This is an area with which I am familiar. I congratulate the right hon. Member for Southampton, Itchen, who is a bonus to this House, on showing how a constituency matter can be moved forward. He has become very much an expert in the matter and I think the whole House is grateful to him. I am the former co-chair of the all-party group on Afghanistan and I visited the country and the region a number of times, so I am pleased to be able to take on the portfolio and move the agenda forward.

As I have said, this is the third debate since 2012 on the position of the Hazaras and it remains an issue of grave concern for Her Majesty’s Government. Sadly, the difficulties faced by the Hazara community, which the right hon. Member for Southampton, Itchen raised in this House last year, remain in 2014 and it is a tragedy that people from minority communities across Pakistan and Afghanistan, including the Hazaras, suffer the scourge of sectarian violence, a scourge that should not have a place anywhere in the world in the 21st century.

The appalling acts of sectarian violence are well documented by human rights groups and the FCO’s own quarterly human rights report on Pakistan, which I have mentioned, highlighted that the first three months of 2014 saw no substantial improvements. Our human rights report on Afghanistan continues to view the situation as poor.

In Pakistan and Afghanistan, sectarian violence is not isolated to the Hazara community. We must remember that the former senior Minister of State at the Foreign

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Office, the right hon. Baroness Warsi, who has already been mentioned in the debate, highlighted on many occasions how ethnicity, religion, the freedom to have a religion and the right to believe what one chooses to believe extend across sectarian lines. Both Pakistan and Afghanistan have laws and constitutional protections for the rights of citizens and minorities, but turning those words and genuine commitment from the Governments into action is where much of the challenge lies. We recognise that Afghanistan and Pakistan face significant internal security challenges that have seen thousands of their citizens of all faiths killed in terrorist and other violence, which is why Her Majesty’s Government are committed to ensuring that both countries understand the need for urgent resolution to the violence faced by the Hazaras as well as by other minority groups facing persecution.

We do not underestimate the difficulty of that challenge, but we will not shy away from urging real commitment to progress. We remain unequivocal in our call for the Governments of Pakistan and Afghanistan to address the concerns of all their citizens, regardless of ethnicity, religion or gender, and we continue to raise the issue at both ministerial and senior ministerial level, including Baroness Warsi’s visit to Pakistan last year following her meeting with representatives of the all-party parliamentary group on the Hazara. We will monitor and shine a spotlight on the plight of the Hazara and other minorities in Afghanistan and Pakistan, including through the Foreign and Commonwealth Office human rights report.

Our relationship with Afghanistan and Pakistan on aid remains significant. Of course, we do not make our aid conditional on specific issues, which will remain the case, but UK aid to any country is based on three shared commitments with partner Governments: first, poverty reduction and meeting the millennium development goals; secondly, respecting human rights and other international obligations; and thirdly, strengthening financial management and accountability. In Pakistan, our aid helps the authorities to make progress in those areas, including concrete measures to improve the economy, reform education and devote proper attention to human rights.

Mr Spellar: Many of those objectives are undermined by the uncertainty and the terrorism inflicted on the Hazara and other communities, particularly those who are among the most commercially productive and entrepreneurial. Is there not therefore a direct link between the objectives and getting change in behaviour?

Mr Ellwood: The right hon. Gentleman is right to highlight that. That is why we are focusing on those three areas of education, tackling poverty and confronting the extremist narrative.

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I am conscious of the time and wish to allow the right hon. Member for Southampton, Itchen the opportunity to give us his final thoughts on the subject, so I conclude my remarks by reiterating that the UK is committed to the enduring relationship with Pakistan and Afghanistan and all their peoples, regardless of faith or ethnicity. We will continue to work with the leaders of Pakistan and Afghanistan to address ethnic and religious persecution. We will remain unwavering in our commitment to frank discussion with them as our friends. We will not shy away from tough messages on the rights of minorities.

Having recently taken the responsibility for Afghanistan and Pakistan within the Foreign Office, I am committed to ensuring that those issues receive the attention they deserve. I look forward to meeting members of the all-party parliamentary group in due course to ensure that I understand the issues fully. Once again, I thank the right hon. Gentleman and others for ensuring that this important issue receives the attention it deserves.

9.57 pm

Mr Denham: I thank the Minister. I know that his interest in these matters predates his appointment to the Front Bench, on which I congratulate him. I hope that we can develop the same relationship we had with his predecessor, who personally went further than other Ministers had done to raise the issue with the Pakistan authorities.

I want to say three things. First, I want to put on record my tribute to the Hazara community in this country. A group of people, most of whom came here as refugees and asylum seekers, have managed to use the system of parliamentary democracy by talking to hon. Members individually as constituency MPs to have the affairs of their communities in Pakistan and Afghanistan, many of which have personal links—personal sufferings connect them—raised in the House. That is a significant achievement.

Secondly, beneath the points of principle on action raised in the debate, policies that could be changed and reports that could be made, there is a great deal of detail that we would like to discuss with the Government about how they could develop relationships with Afghanistan and Pakistan, and develop the aid programme. I look forward to the opportunity of doing so.

Thirdly, our country has been tied up with the histories of both Afghanistan and Pakistan for many years, including recent years. People, including many of our constituents, are tired of our involvement. I hope that, tonight, we have made the simple point that we cannot walk away. We have responsibilities for the position faced by the Hazara community and others in Afghanistan and Pakistan, and we must ensure that we do not allow them to slip.

Question put and agreed to.


That this House has considered the position of Hazaras in Afghanistan and Pakistan.

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Clinical Technology Appraisals (NICE)

Motion made, and Question proposed, That this House do now adjourn.—(Dr Thérèse Coffey.)

10 pm

Eric Ollerenshaw (Lancaster and Fleetwood) (Con): I welcome the Minister to his place. I hope that he does not feel that he has drawn the short straw by having the 10 o’clock slot. I am pleased to be here to have the opportunity to raise an issue of growing concern to NHS patients throughout the country, particularly those suffering from cancer. It will be a debate about how new drugs and treatments are approved, or not, by the National Institute for Health and Care Excellence. That organisation’s acronym is NICE, but, sadly, for many patients, the decisions it makes often seem anything but that.

Tonight’s debate is particularly timely given the announcement last week about the expansion of the cancer drugs fund. That is of course welcome, but it does serve to highlight the ongoing problem. That announcement comes on the back of a number of recent decisions by NICE not to fund important new cancer drugs. Both Kadcyla for metastatic breast cancer and Abiraterone for routine use in prostate cancer are high- profile examples, so the whole issue of the affordability of the drugs bill is back in the news, and especially how NICE carries out its cost-benefit analysis and comes to its decisions.

My original reason for raising this issue was the current review of NICE’s technical appraisals, the consultation on which closed earlier in the summer. I will make some specific points on that, but first I want to set out the problem as I see it and give some wider context. Put simply, I do not believe that the appraisal system is fit for purpose, at least not for cancer drugs. In 2011-12, NICE rejected 60% of the cancer medicines that it assessed. What makes it worse is that the rate at which they have been turned down has actually increased since 2010. That is largely because the methods used to work out the cost-benefits of each drug are too restrictive. The use of what are called “quality of adjusted life years” does not take into account many potential benefits for patients and their families. The appraisal process is also far too long—it can take a year to conclude that a new drug priced by a company at X is not cost-effective. Subsequent resubmissions by a company, based on a new price or new clinical data, can then take just as long.

Most of these drugs are already licensed for use in the UK but can be obtained only through private health care. It was that repeated failure to give patients on the NHS the same access to cancer drugs that led to the creation of the cancer drugs fund. That was a hugely welcome move, and I commend the Government for it. Because of the fund, 55,000 patients have since 2010 been able to access drugs that they would not otherwise have had. But we have to admit that the CDF is, in a sense, a sticking plaster. It was only ever envisaged as an interim measure until NICE got its act together and became more user-friendly. Even with the welcome new boost to its total funds, the CDF is scheduled to expire in 2016. That expiry date is fast approaching and many, particularly among the charities, are worried about what will happen after that date.

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There is another level of uncertainty. Drugs on the CDF can be de-listed at any time. The failure of NICE to approve treatments means that the fund has been working at or above its planned financial capacity. Again, I am grateful that the Government have recognised that with the announcement last week, but the chair of the fund seemed to hint last week that time may be called on some of the drugs on the list very soon. That would be a disaster for possibly thousands of patients and their families around the country. I understand that these things need to be considered in detail, but I would be very grateful if the Minister could address this specific issue in his response. In particular, will he clarify the process and likely time scale for any de-listing of drugs?

What does this mean in practice? The Minister knows that I have a particular concern for improved treatments for pancreatic cancer patients. He may remember an Adjournment debate back in March when we discussed the new drug Abraxane. When used in combination with standard chemotherapy, it has been shown in trials to extend eligible patients’ lives by an average of just over two months, although in some cases it is significantly more.

At the time of the debate in March, I expressed my support for Pancreatic Cancer UK’s “Two More Months” campaign, which gave a number of examples of what two more months in life would have achieved for various people, and asked Ministers for the drug to be added to the CDF. Imagine my delight when that happened. As I understand it, between the end of March and the end of June this year, 118 patients have accessed Abraxane on the NHS. That would not be happening if the CDF did not exist.

Abraxane is currently under consideration by NICE for routine use for eligible metastatic pancreatic cancer patients on the NHS—a move that would make it easier for patients to access the drug. I believe that a decision on whether to approve Abraxane for use will be made in the next few weeks. However, if we use the quality-adjusted life-year system, the price of an additional two months of life looks set to be deemed too costly. Most drugs are capped at £30,000 a year, and Abraxane is estimated at slightly above £50,000.

Although NICE allows a higher cost threshold of about £50,000, that is only for drugs that meet its current end-of-life criteria, which demand that a new drug provide at least three months’ extra survival on average. The evidence so far does not show that Abraxane does that. However, if we consider that the average survival time for a pancreatic cancer patient from diagnosis is just two to six months, we can imagine that an extra two months’ survival is massively significant. Instead of having arbitrary targets in terms of months, why do we not look at percentages of the average survival rate as a means of dealing with these more difficult cancers and diagnoses?

If Abraxane is rejected by NICE, as I fear it might be, we will be back to relying on the cancer drugs fund to provide it. It will end up like other treatments that are available for pancreatic cancers, only one of which has been approved by NICE. Non-drug alternatives such as NanoKnife and CyberKnife, which have been discussed in this Chamber, are in use in private practice but have not been approved by NICE for clinical use on the NHS. Patients are forced to spend tens of thousands of pounds of their savings to access those treatments privately.

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We are in a position where new treatments might start to make a small difference in survival rates for pancreatic cancer—there have been no improvements in those rates over the past 40 years—but such improvements will have been despite, not because of, NICE. That must change.

Indeed, change is now in prospect. NICE is currently looking at introducing a new way of assessing drugs, called value-based assessment. The consultation on it closed in June and I understand that some next steps are due to be announced very soon.

I have looked at the proposals, but I must say to the Minister that there are worries that the new system will not improve the current situation. Briefly, my concerns are these. First, the proposals maintain a quality-adjusted life-years system as the basis of an appraisal. That will still mean that many benefits to patients and their loved ones highlighted by patient groups might not be taken into account. Secondly, it is proposed that specific end-of-life criteria be removed and incorporated in a wider “burden of illness” measure. There is no guarantee that this measure will capture the unique requirements of end-of-life drugs. Thirdly, the way the proposals are framed could well mean that the age of patients with a particular condition could count against the drugs, which is a particular concern given, as everybody knows, that the likelihood of getting cancer increases with age. Perhaps more importantly, I see nothing in the proposals that suggests that the new appraisal process will be any quicker than the current one, and time is one thing that many cancer patients do not have.

I have serious reservations about the proposals. The crucial question is this: will the new system make more cancer treatments available or fewer? If there were confidence that the new set of criteria would solve the problem, we might not be facing the need for extra funds, but as things stand, the extra CDF money remains the lifeline. If the new system does not solve the problem and the CDF ends in 2016, we will be back to square one, with thousands of patients not getting the drugs they need and deserve—drugs which over the past four years have been proved to make an immense difference to patients’ and their families’ and friends’ lives.

These fears are shared by many cancer charities and patients groups. I hope that their responses to the consultation will be given the consideration they deserve. If they are, it should be possible to devise a system that genuinely works. That means a system that works faster. The NICE process is extensive, but it takes too long. Why on earth when a drug is rejected at one price does the whole elongated process that I have mentioned have to start again when it is resubmitted at a new price? There is an argument that that simply encourages companies to pitch a high price to begin with, and therefore creates further delays as the argument goes on to get the price down. Why can we not have a system where there are sensible negotiations between NICE and the drug companies immediately after a drug is licensed, along the lines of systems used in many continental countries?

The system should also give more weight to patients’ and carers’ needs and experiences. At the moment, the process is almost exclusively focused around clinical effectiveness—that is understandable—and value for money. Patient engagement is ostensibly taken into account, but it needs to be given a higher priority. The

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Scottish Medicines Consortium has just changed its system along those lines, and that might be a good model to consider.

Lastly, a specific end-of-life weighting really must be maintained in the new system. It cannot, however, be so prescriptive that it excludes new treatments for cancers with extremely poor prognoses, such as pancreatic cancer. NICE’s current three-month rule makes that a specific problem that the new system must tackle.

To sum up, of course the NHS does not have an unlimited budget—we all understand that—and it is right to seek value for money for taxpayers. Drug companies must also be realistic when pricing their drugs, but as I have said, the current system provides incentives for them to pitch high. This review of appraisals gives us an opportunity to make them work better. We urgently need reform because for too many cancer sufferers NICE simply is not working.

Until that improved system is in place, the cancer drugs fund will remain vital, and the extra money will be well spent. I hope that it will be extended beyond 2016 to make sure there is at least one fast and effective route for cancer drug approvals. However, that can only ever be a temporary fix. There must be a more reliable long-term system to get cancer patients the treatments that they so desperately need. Such decisions can literally be life-and-death ones, and too often we are not getting them right. Cancer need not be a death sentence, but the rejection of a drug based on a flawed assessment might be one.

For many patients, extra days and months are not just numbers in a cost-benefit equation, but precious moments with loved ones. NICE must recognise that the timeline is arbitrary, and it must start to build on the success of the cancer drugs fund.

10.13 pm

The Parliamentary Under-Secretary of State for Business, Innovation and Skills (George Freeman): May I say what a pleasure it is to start my role on the Front Bench under your careful guidance tonight, Mr Speaker?

I pay tribute to my hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw) for his tireless campaigning on this subject, his leadership in the House and his work on the all-party group on pancreatic cancer. He has been a tireless campaigner on behalf of patients affected by pancreatic cancer, which is a terrible disease. I know that the subject is very close to his heart, having been affected by the tragic loss of his partner from pancreatic cancer. I applaud him and pay tribute to him for the work he has done. I pay tribute to all the patients and charities who are so active in this area, and I assure him and all those affected that we want to see the best possible outcomes for all NHS patients and loved ones, including those with pancreatic cancer. As is so often the case, the impassioned advocacy of patients and their loved ones forces the system to address the priorities of the patients whom we are all here to serve.

It is vital for people, especially those affected by long-term and life-threatening conditions, to have access to new and promising treatments. That is one of my key priorities in my new role. I well understand how disappointing it is for patients and carers when NICE does not recommend a particular drug or treatment for which they have held out such hope. A central part of

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my mission as the UK’s first Minister for life sciences—an opportunity that reflects the Government’s commitment and the Prime Minister’s personal commitment to this agenda—is to accelerate the discovery, design and adoption of new drugs in the NHS, making the UK the best place in the world to discover and design 21st-century health care technologies.

My hon. Friend raised a number of important points that I want to address. In particular, he asked whether the appraisal process of the National Institute for Health and Care Excellence is fit for purpose and spoke about the time that is taken over the approval of new drugs and the importance of the cancer drugs fund. He made a number of specific references to treatments, not least to Abraxane. I will reflect on those references and write to him so that I have time to address his substantive points.

I will start by taking a step back to reflect on the context in which NICE works, including the pressures and opportunities that the extraordinary pace of biomedical discovery is unlocking. In an age when so many new drugs and treatments are being discovered because of the extraordinary success of our scientists and our life sciences industry in bringing innovation to the market, and in a world in which more people are living longer and in which our resources are under ever more sustained pressure, it is no surprise that we hear with increasing frequency stories of new drugs and of NICE’s decisions to restrict their use to smaller groups of patients.

As my hon. Friend is all too aware, we, like other Governments across the globe, face a great challenge to ensure that every pound of health service money is well spent on effective treatments. The NHS does not have an infinite budget. As we make significant advances in these areas, which in turn will bring more treatment options, the demands on those resources will increase. The discovery of new treatment options is great news, but it brings new challenges. That is particularly relevant to cancer, for which a number of new high-cost drugs have arrived in recent years. Some of those, despite their cost, offer only marginal improvements in quality and length of life. I recognise, as my hon. Friend pointed out, that for patients who are dying, a few extra months provide precious extra time for them and their loved ones. The challenges is to find an equitable way of dealing with the difficult ethical, medical and economic judgments that we have to make. That is where NICE fits in.

Over the years, this country has, through NICE, led the way in developing an evidence-based assessment system to determine how drugs and treatments are best used in the NHS. Initially set up in 1999, NICE has played an invaluable role in providing internationally respected guidance to the NHS on the clinical and cost effectiveness of drugs and treatments. Those are difficult decisions to make. NICE reaches its final decision on the use of a particular technology only after careful and thorough consideration of all the available evidence and following extensive consultation with stakeholders.

The Government firmly believe that cost-effective, clinically appropriate drugs and devices should be routinely available to NHS patients. That is why NHS commissioners are legally required to fund treatments that are recommended by NICE’s appraisals, why the right of patients to NICE-recommended drugs and treatments is enshrined in the new NHS constitution, and why we are acting to promote the rapid uptake of NICE-recommended drugs in the NHS. Many thousands of

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people in England have, as a result, benefited from the treatments that are recommended by NICE, including for cancer. I am pleased to note that so far this year, NICE has recommended five new cancer drugs on the basis that they are clinically effective and cost effective.

However, the rapid development of breakthroughs in genomics, informatics and new diagnostics means that NICE’s processes will have to adapt. Since it was established in 1999, NICE’s internationally renowned technology appraisal process has evolved constantly to meet new challenges. I am confident that it will continue to do so—it will need to if it is to keep its place at the vanguard of international health technology assessment.

The UK and NICE led the world in the late 20th century in pioneering the health economics of drug discovery. However, the breakthroughs in genomics and clinical informatics are transforming the way in which drugs are discovered and are allowing us increasingly to design drugs around patients and their tissues, data and genomic and phenotypic history. That is unlocking a new era of targeted and, ultimately, personalised medicine. Drugs may be designed for patients in whom we know they will work. That will allow us to change the way in which we procure and provide reimbursement for drugs—from payment on performance to outcome-based payments.

We are at the dawn of an exciting new age of more accurate, effective, specific and targeted medicines. We no longer expect to give every drug to every patient. We do not expect the industry to bring drugs to us that can be proven to work in every single patient. We will be able to unlock huge efficiencies in the NHS’s £12 billion drugs budget through a much more targeted model of medicine, and it will mean a radically different mission for NICE in the coming years. Accelerating this country’s leadership in that area is central to my appointment, and I am delighted to be able to take the opportunity to spell that out.

I note my hon. Friend’s concerns about the length of time that it can take for new drugs to be made available. I very much recognise that as both a core barrier to making the UK the best place in the world to develop new medicines and a great opportunity. I should like to speak a little about a particular case that illustrates the importance of early access.

I recently met, and got to know, a leukaemia and lymphoma patient who was diagnosed 10 years ago with chronic myeloid leukaemia. He was in his early 40s and had a young family, and he was given about three years to live—10 years ago. He is alive today because he was one of just three patients placed on a clinical trial by his oncologist at the university of Birmingham hospital back in 2001. The trial, of Glivec, now one of the most commonly used CML drugs, was his lucky break. He was one of the first patients to receive a groundbreaking new treatment, giving him an extra decade with his young family and now a clean bill of health and a life that he is using as a pioneering campaigner for the revolution of targeted medicine.

Of course, it is important that any new medicine is shown to be effective and safe before it is used routinely within the NHS, but I believe that we need to do much more to help the patients in the direst need to access pioneering drugs more quickly so that luck does not come in to it. That is why the Prime Minister and I have committed to the early access to medicine scheme, which we launched earlier this year. That UK-only scheme addresses unmet need on an unlicensed or off-label

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basis for patients with life-threatening or seriously debilitating conditions who do not have adequate alternative treatments, by supporting access to very promising new treatments long before we would normally expect to receive them through the usual approval process. We have much more work to do, but I am pleased to see that the UK medicines regulator, the Medicines and Healthcare products Regulatory Agency, is now starting to receive applications for the scheme. I am also pleased to say that pioneering life science companies have pledged their support and made applications to the European Medicines Agency’s adaptive licensing pilot. NICE has also been involved in discussions on both those initiatives, along with NHS England, to ensure that licensing decisions translate into patient access. The central aim of the early access to medicines scheme is to create a new fast-track runway to get a new generation of innovative medicines to the patients for whom there is no alternative treatment, to give them a chance and some hope that their suffering might help to prevent suffering for future generations.

My hon. Friend also raised the important issue of the length of the NICE appraisal process. I appreciate how important it is, when new drugs are licensed, that the NHS has good guidance on their use as quickly as possible so that clinicians can make the best possible use of them. In drug discovery, time is money, and accelerating assessment and approval is the single most important reform that we have to make. I am absolutely committed to it. In fact, I met NICE’s chief executive and chair today to highlight that point. For me, tonight’s debate marks the beginning of a conversation about the new model for NICE and our work with it on that model. NICE is an independent organisation, and it is not for me to second-guess what its final proposals will look like, but we have made it clear in the terms of reference that the end of life will continue to be given important consideration. There will certainly be no unlawful discrimination.

I mentioned genomics. Genomic technologies are allowing us to make groundbreaking discoveries about how disease works, how different patients become susceptible to different diseases and how we can diagnose disease earlier, treat it and ultimately prevent it. That is why the Prime Minister and I recently announced a £300 million investment to make the UK the world leader in genomic medicine. For the first time in the world, 100,000 full human genomes from volunteers will be sequenced by 2017. It is the most ambitious project in biomedicine in the world, and it is a world first. The development of genomically informed medicine will lead to faster diagnosis, with knowledge based on genomic technologies being used to better target treatments and get the right patients the right treatment faster than is possible today. I do not think it is an exaggeration to say that it has the potential to transform how we evaluate medicines, the benefits they deliver, who they deliver them to and how effectively. It will help bring to an end the averaging of outcomes, which sits at the heart of the current NICE model, allowing us to work out how to give the right drugs to the right patients much quicker than is currently possible.

My hon. Friend mentioned the cancer drugs fund and the benefits that it has brought to many patients and their loved ones. More than 55,000 patients have

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benefited from the fund since October 2010, and I am delighted to be able to confirm that the Prime Minister, the Secretary of State for Health and I are all committed to the renewal of the fund. Indeed, we announced last week that an additional £160 million would be made available to the fund through to March 2016, which will allow patients to continue to receive the extra drugs that are right for them.

We also announced plans for NHS England, NICE, charities and industry to work together to improve the way cancer drugs are commissioned. We must make better use of the cancer drugs fund to generate better data on new drugs, so that we can address the uncertainties that so often affect early clinical trial evidence, and help NHS patients and clinicians to understand the real world value of those drugs—indeed, today I met Harpal Kumar from Cancer Research UK to discuss that point. I note my hon. Friend’s concerns about future access to cancer drugs, and will carefully consider with NHS England what arrangements should be put in place for the fund in the longer term.

Central to this quiet revolution is patient empowerment, and 21st-century health care will move from being something in the 20th century that was done to patients by the Government when they deemed it appropriate, to something that 21st-century citizens will be entitled to and empowered to take more responsibility for themselves. In access to research and drugs, access to outcomes data, and people’s ability to shape their health choices, we are committed to accelerating that quiet revolution.

Ensuring patients have more say in how their care is delivered and embedding choice are key themes in the Health and Social Care Act 2012, and I intend to accelerate that in the field of health care technology. This quiet revolution is what the Government’s life science strategy sets out to frame and accelerate. That is why we have created a new Office for Life Sciences, bringing together officials from the Department of Health, the Treasury, and the Department for Business, Innovation and Skills. There is a new directorate in the Department of Health to accelerate innovation, and a new ministerial post, which it is my honour to hold. A package of other measures will help to make the UK in the 21st century once again what we were in the early 20th century—the world leader in medicines discovery.

Twenty-first century health care is being utterly transformed by breakthroughs in genetics, informatics, diagnostics and the new field of targeted medicine. It will transform the way we design and procure new medicines, and the way that NICE assesses their costs and benefits. I intend to ensure that this country seizes the opportunity for the benefits of our children, so that Britain is once again the best place in the world to discover new medicines and to be treated by them.

I congratulate my hon. Friend again on his advocacy and the important issues he has raised tonight, and I will write to address his specific points in detail. I look forward to working with him and the many other groups in Parliament and outside who are increasingly active in that space, to ensure that his partner, and many hundreds of thousands of others like him, have not died in vain.

Question put and agreed to.

10.27 pm

House adjourned.