“Reduce ecosystem degradation and biodiversity loss… Manage natural resources that are essential for people’s basic needs within their natural limits… Embed sustainable consumption and production in national policies and practice.”

Again, those goals apply not just to developing countries, but to the UK. There is much that we could do and need to do to meet those targets.

Goal 10 is about linking human development with the future of the planet. As has been said, we cannot eradicate poverty unless we tackle climate change. It has an impact in many ways. It affects whether a country can produce enough food to feed its people and whether people can move beyond subsistence farming to being able to make a living from farming. It affects the water supply. For example, we can look at the impact that climate change and glacial melt are having on the mountainous areas of Nepal and Tibet, which are sometimes described as the third pole because they make up the third biggest ice mass after the Arctic and Antarctic. It causes natural disasters that range from droughts to floods and that include typhoons, tropical storms and landslides due to soil degradation.

Yesterday, I met seven of the eight ambassadors and chargés d’affaires from central American countries and last week I met the high commissioner from the Maldives. Those countries see the impact of climate change on their lives on a daily basis. The Maldives might no longer exist if we do not meet the 2° target. That is why what happens in Paris at the end of the year is so important.

I have asked the Secretary of State at International Development questions about the Government’s commitment to a stand-alone climate change goal. I admit that I am still slightly confused. I have heard from other people that we will probably accept all 17 goals. However, in her response to me, the Secretary of State suggested that she would prefer to see sustainability mainstreamed across the post-2015 framework. I agree that it is important that the issue is mainstreamed, as it ought to be across all Departments in the UK, but that does not mean that there is no need for a lead Department on climate change in the UK. In the same way, I believe that a stand-alone sustainable development goal on climate change would help to focus minds, keep the issue firmly on the agenda and ensure that we do not drop the ball on what is a very important issue.

28 Jan 2015 : Column 965

6.38 pm

Anas Sarwar (Glasgow Central) (Lab): As we have heard from a number of speakers, 2015 has the potential to be an historic year for international development. The international community will come together in September to agree the sustainable development goals and at the end of the year to agree a framework to tackle climate change. That will happen just in year one of the next Parliament. The next five years must be about not just making the right agreements but, crucially, delivering on them. That will require commitment, energy and, crucially, leadership on the international stage. We will need the ability to set the agenda, to advocate and persuade, to build alliances, and to use our influence to make a difference for some of the world’s poorest and most vulnerable people.

I echo the comments of my right hon. Friend the Member for Dulwich and West Norwood (Dame Tessa Jowell), who rightly mentioned how we strove for consensus. Let us remember that the consensus was built by the last Government; it was not there from the beginning. It is also important to recognise that our criticism of the Government is not that they do not act on the international stage on international development—of course they do and we welcome that—but it is the force of their advocacy and leadership. Compare that with the last Labour Government. We created the Department for International Development. We trebled the aid budget. We founded the Global Fund to Fight AIDS, Tuberculosis and Malaria. We led on cancelling debt. We created the Extractive Industries Transparency Initiative and we drove the efforts on the millennium development goals.

In contrast, the Government have failed to show leadership at home, never mind abroad. They had a clear manifesto commitment to legislate on 0.7% gross national income in international aid—[Interruption.] If the hon. Member for Skipton and Ripon (Julian Smith) listens, he will find that we are much more in agreement and perhaps he too will be open to transparency, accountability and debate—things that both sides of the House welcome. The 0.7% aim was in the Conservatives’ manifesto and the coalition agreement. Thankfully, the right hon. Member for Berwickshire, Roxburgh and Selkirk (Michael Moore) delivered a Bill on 0.7% and I pay tribute to him and all the Members who got behind the Bill to make sure that we delivered on our international obligations. I just wish that it had been done in Government time, which would have shown more leadership—

The Lord Commissioner of Her Majesty's Treasury (Mr David Evennett): The Government supported it.

Anas Sarwar: Well, we should also highlight the fact that more Labour MPs voted in favour of the Bill than MPs from every other party combined.

With crucial negotiations and agreements coming up, I want the next Government to be drivers, not passengers. The new sustainable development goals must go faster to eliminate extreme poverty and focus on tackling inequality, as mentioned by my hon. Friend the Member for Stoke-on-Trent North (Joan Walley). To add to that, we would prioritise universal health coverage, human rights for all, including women, children and the disabled, and the effects of climate change.

28 Jan 2015 : Column 966

Access to health care should be based on a person’s need, not their ability to pay. It should be a right, not a privilege. That is why, unlike the Government, we will support a stand-alone goal on universal health coverage. Universal health coverage does not just help improve health outcomes, it would help reduce inequality and stop 100 million people a year from falling into poverty. I pay tribute to two Conservative Members who spoke passionately about causes that are dear to them. The right hon. Member for Arundel and South Downs (Nick Herbert) has shown a tremendous commitment to the fight against tuberculosis and raised the important point of multi-drug resistance. Universal health coverage could be an important element of that fight in the future. I had the privilege of serving on the International Development Committee with the hon. Member for Stafford (Jeremy Lefroy) for almost 18 months, and he spoke of his commitment to the issue of malaria, and the work done by the last Government and this to tackle it. I know first hand, from our conversations and from serving on the Committee, of the good work that he does. I am sure that that will have the support of both sides of the House and, I hope, the next Labour Government.

Negotiations on universal health coverage are also about resilience to humanitarian disasters or outbreaks of disease, and we have already heard about the difference that can make. Nigeria, which has invested strongly in building its health systems, was able to contain and beat the Ebola virus, but Sierra Leone—let us remember that the Government cut support for that country—has struggled to cope, resulting in loss of life and the need for even greater support from the Government and the international community.

On the issue of Ebola, I wish to put on record again, on behalf of both sides of the House, our thanks to and appreciation of Pauline Cafferkey and all those from the United Kingdom who volunteer to go and help in the fight against Ebola. Pauline is an example of a real hero in our community, and I am sure that we all want to send her our best wishes as she recovers from Ebola and returns home to Rutherglen in Scotland.

I echo the comments made by my right hon. Friend the Member for Coatbridge, Chryston and Bellshill (Mr Clarke), who rightly paid tribute to our tremendous staff at the Department for International Development. They are heroes in their own right, struggling and fighting to make a difference to people’s lives across the world.

Pauline Latham (Mid Derbyshire) (Con): The hon. Gentleman mentioned that we had cut aid to Sierra Leone. We have spent more money on health in Sierra Leone in every year of this Parliament than the previous Government. Where is he getting his figures from? It is duff information.

Anas Sarwar: It is good to see the hon. Lady taking part in the debate. She was not here earlier when we were discussing that very important issue. She may want to refer to the House of Commons Library and to a Westminster Hall debate with the Minister of State, Department for International Development, the right hon. Member for New Forest West (Mr Swayne) on this important issue. In that debate, the Minister admitted he did not know how much money the Government were spending in Sierra Leone. He also said he would go away and find out. I am still waiting for an answer.

28 Jan 2015 : Column 967

Another point raised with the Minister in that debate was how we recruit from developing countries to our NHS. The Minister said he would investigate and come back on that. I would be interested to hear the result of that investigation. There is a sad irony in the UK recruiting one in four doctors trained in Sierra Leone into our NHS, when it has an acute need itself. Our NHS—thought of, created and saved by Labour—is the envy of the world. The previous debate is proof enough of this Government’s shoddy commitment to it and its values. That is why only Labour can be trusted to make the case for universal health coverage at home and abroad.

Another priority is to put women and girls at the heart of the sustainable development goals. We would like gender equality, access to education, clamping down and taking action against female genital mutilation, and making sure every child is protected from slavery or abuse to be included.

On private sector development, Labour agrees that a thriving and free private sector is vital to the elimination of poverty, but it cannot be based on the ideology of trickle-down economics. Labour believes the most sustainable and dignified route out of poverty is work. We must ensure that that also means decent pay, fair conditions and the freedom to join a trade union. That is why we will reverse the Government’s decision to slash funding to the International Labour Organisation. DFID’s spending on private sector development in 2011-12 was £549 million. That now sits at £1.8 billion—a fifth of DFID’s budget.

At the same time, we have seen Ministers completely fail to ensure value for money or transparency, a point raised by my hon. Friends the Members for East Lothian (Fiona O'Donnell) and for Llanelli (Nia Griffith). It is very difficult to establish what DFID is spending that money on. It is channelled through private bodies such as the Private Infrastructure Development Group, a multilateral organisation that is considerably less transparent. Government Members may criticise Labour’s approach, but the National Audit Office and the Government’s own Independent Commission for Aid Impact warn that oversight of this funding is inadequate and risks wasting taxpayers’ money. We await the Public Accounts Committee report tomorrow.

It is completely unacceptable that any Government Minister can fail to answer basic questions on how we spend £2 billion of taxpayers’ money. It is not just the Government who have a responsibility, but companies too. It is an absolute scandal that every year three times as much is lost in tax revenues to developing countries than the global aid budget combined. That is why we must make tackling tax avoidance a priority at home and abroad. We must look at supply chains adopting the same principles we apply in this country.

My hon. Friends the Members for Bristol East (Kerry McCarthy) and for Cardiff South and Penarth (Stephen Doughty), and many other colleagues, raised the issue of climate change. Labour will, unlike this Government, put the fight against climate change front and centre of international agreements. We will use the G8 in Germany to push for climate change to be a permanent standing item at the UN Security Council. It will be on the agenda of every meeting with world leaders here in the UK. Leading on the sustainable development goals; leading on climate change; leading on private sector

28 Jan 2015 : Column 968

development; leading on universal health coverage; and leading right around the world. That is the leadership this country needs.

6.49 pm

The Minister of State, Department for International Development (Mr Desmond Swayne): This debate has, to a large extent, been wrested from the Opposition Front-Bench team and rescued by the many excellent contributions we have heard. We began with the right hon. Member for Dulwich and West Norwood (Dame Tessa Jowell), who rightly pointed out the importance of pre-school education, and then my right hon. Friend the Member for Eddisbury (Mr O’Brien) brought the benefit of his expertise in stressing the need for security. I always welcome the experience and wisdom of the right hon. Member for Coatbridge, Chryston and Bellshill (Mr Clarke), who made an excellent point about development education. I hope the project that our schools go through every summer, Send My Friend to School, spreads to parents, because the children’s enthusiasm for the agenda is an example to us all.

I thank the right hon. Member for Gordon (Sir Malcolm Bruce) for his excellent speech. He hit the nail on the head, as one would expect from a Select Committee Chairman of 10 years, and I shall return to his speech shortly, if time allows, because it was a seminal contribution. The hon. Member for East Lothian (Fiona O’Donnell), who rightly concentrated on malaria, made some important points, and my right hon. Friend the Member for Arundel and South Downs (Nick Herbert) concentrated on tuberculosis and brought the benefit of his long experience, as did my hon. Friend the Member for Stafford (Jeremy Lefroy), who has long been committed to these issues.

The hon. Member for Llanelli (Nia Griffith) concentrated on the importance of our taking a lead and asked several questions about TradeMark Southern Africa. The Independent Commission for Aid Impact, which we set up specifically to examine what was going on, drew attention to the problems with the project, and, as a result, my right hon. Friend the Secretary of State cancelled it. The hon. Lady also mentioned the PIDG, which, I recollect, was set up in 2002—perhaps when the hon. Member for Cardiff South and Penarth (Stephen Doughty) was in the Department. However, we will attend to the issues raised in the NAO report. I share some of the concerns, but we need to bear in mind the huge leverage of the PIDG in getting private finance into poor countries. In her short, but pithy speech, the hon. Lady also asked about the ILO, as did other hon. Members. We took the decision we did following the multilateral aid review, but we still work closely with the ILO—in Bangladesh, for example.

I thought the remarks of the hon. Member for Cardiff South and Penarth on fair trade were particularly pithy. He rightly drew attention to the false dichotomy between security and defence, and development; they are intimately connected. My right hon. Friend the Member for Banbury (Sir Tony Baldry) gave us the advantage of his 30 years’ experience, including as a Minister, and rightly drew our attention back to climate change and sustainability. The hon. Member for Stoke-on-Trent North (Joan Walley) highlighted the important report from the Environmental Audit Committee and asked several detailed questions. I offer her a trade. I have every intention of reading her report, but perhaps she will read this report: “A New

28 Jan 2015 : Column 969

Global Partnership: Eradicate Poverty and Transform Economies through Sustainable Development”. It is all in here: exactly how every single one of the targets has to be permeated with the key issue of sustainability. We are confident that the goals will be universal and we are ready to play our part: we have a strong cross-Government approach to this agenda, which is crucial to ensuring that all Departments are engaged and that the UK will be well placed to deliver these goals—it says.

My hon. Friend the Member for South Derbyshire (Heather Wheeler) raised our sights and our ambition, pointing the debate back to the millennium goals. The hon. Member for Edinburgh North and Leith (Mark Lazarowicz) focused our attention back on the Environmental Audit Committee report, but also made an excellent point about the international citizen service. He is right to praise that excellent initiative, which we are now considering what we can do to expand. I hope I have been able to reassure him on that point.

The hon. Member for Bristol East (Kerry McCarthy) brought her long experience and knowledge of nutrition to this debate, but when she went on to climate change there was an element of criticism. I would point out that we were one of the few countries that constantly tried to get a specific reference to the 2° target back into the goals.

This has been a very good debate in many respects—[Interruption.] Yes, there is a “but”. I want to return to the opening of the debate. We have a motion before us that seeks to divide the House. I have sat here and listened to all these excellent speeches and searched for the issue of substance that divides us. What have we got in the motion that seeks to divide us? The 0.7% target? We were all in the same Division Lobby on 0.7%. The only gripe is one of process—what kind of Bill it was.

We are also absolutely united in our approach to the importance of health. I pay tribute to the last Labour Government, who increased the bilateral spend on health. We have continued that; so much so that in the last seven years, bilateral health expenditure has doubled and now represents almost a quarter—23%—of our spend. We have already heard about the £1 billion commitment that has been made to the global fund. That will fund life-saving treatment for an additional 750,000 people with AIDS. There is no issue between us on health. [Interruption.] The hon. Member for Luton South (Gavin Shuker) asks, “What about the SDGs?” We canvassed hard and we have succeeded in getting specific targets and goals on health care.

When it comes to climate change, there is again no division of substance between us. On equality, there is the principle of no one being left behind before a target can be met. Again, there is absolutely no division of substance between us.

I come back to the speech by the Chairman of the Select Committee. He pointed out that we now have some 17 goals and 169 targets, when it was the ambition of the Secretary-General that we would have something small and understandable—something that we could all get behind and campaign on, something that we could measure and something that we could hold Governments to account on. That is what we should have been talking about tonight: how we get behind that agenda. They wasted the opportunity—

28 Jan 2015 : Column 970

Ms Rosie Winterton (Doncaster Central) (Lab) claimed to move the closure (Standing Order No. 36).

Question put forthwith, That the Question be now put.

Question agreed to.

Main question accordingly put.

The House divided:

Ayes 200, Noes 290.

Division No. 144]

[

7 pm

AYES

Abbott, Ms Diane

Abrahams, Debbie

Alexander, rh Mr Douglas

Alexander, Heidi

Allen, Mr Graham

Anderson, Mr David

Austin, Ian

Bailey, Mr Adrian

Bain, Mr William

Balls, rh Ed

Banks, Gordon

Barron, rh Kevin

Beckett, rh Margaret

Begg, Dame Anne

Benn, rh Hilary

Betts, Mr Clive

Blackman-Woods, Roberta

Blenkinsop, Tom

Blomfield, Paul

Blunkett, rh Mr David

Bradshaw, rh Mr Ben

Brown, Lyn

Brown, Mr Russell

Buck, Ms Karen

Burden, Richard

Campbell, rh Mr Alan

Campbell, Mr Ronnie

Caton, Martin

Champion, Sarah

Clarke, rh Mr Tom

Coaker, Vernon

Coffey, Ann

Cooper, Rosie

Cooper, rh Yvette

Corbyn, Jeremy

Creagh, Mary

Cruddas, Jon

Cunningham, Alex

Cunningham, Mr Jim

Curran, Margaret

Dakin, Nic

Danczuk, Simon

David, Wayne

Davidson, Mr Ian

De Piero, Gloria

Denham, rh Mr John

Docherty, Thomas

Dodds, rh Mr Nigel

Doran, Mr Frank

Doughty, Stephen

Dowd, Jim

Doyle, Gemma

Dromey, Jack

Dugher, Michael

Eagle, Ms Angela

Eagle, Maria

Edwards, Jonathan

Efford, Clive

Elliott, Julie

Ellman, Mrs Louise

Engel, Natascha

Esterson, Bill

Evans, Chris

Farrelly, Paul

Field, rh Mr Frank

Fitzpatrick, Jim

Flello, Robert

Flint, rh Caroline

Flynn, Paul

Fovargue, Yvonne

Francis, Dr Hywel

Gapes, Mike

Gardiner, Barry

Gilmore, Sheila

Glass, Pat

Glindon, Mrs Mary

Godsiff, Mr Roger

Goodman, Helen

Green, Kate

Greenwood, Lilian

Griffith, Nia

Gwynne, Andrew

Hain, rh Mr Peter

Hamilton, Mr David

Hanson, rh Mr David

Harman, rh Ms Harriet

Havard, Mr Dai

Healey, rh John

Hepburn, Mr Stephen

Heyes, David

Hillier, Meg

Hilling, Julie

Hodge, rh Margaret

Hodgson, Mrs Sharon

Hoey, Kate

Hood, Mr Jim

Hopkins, Kelvin

Hosie, Stewart

Howarth, rh Mr George

Irranca-Davies, Huw

James, Mrs Siân C.

Jamieson, Cathy

Jarvis, Dan

Johnson, rh Alan

Johnson, Diana

Jones, Graham

Jones, Mr Kevan

Jones, Susan Elan

Jowell, rh Dame Tessa

Kane, Mike

Kaufman, rh Sir Gerald

Keeley, Barbara

Kendall, Liz

Khan, rh Sadiq

Lavery, Ian

Lazarowicz, Mark

Lewell-Buck, Mrs Emma

Llwyd, rh Mr Elfyn

Love, Mr Andrew

Lucas, Caroline

Lucas, Ian

MacNeil, Mr Angus Brendan

Mactaggart, Fiona

Mahmood, Shabana

Malhotra, Seema

Mann, John

Marsden, Mr Gordon

McCabe, Steve

McCann, Mr Michael

McCarthy, Kerry

McClymont, Gregg

McDonagh, Siobhain

McDonnell, John

McGuire, rh Dame Anne

McInnes, Liz

McKechin, Ann

McKenzie, Mr Iain

Mearns, Ian

Miliband, rh Edward

Miller, Andrew

Mitchell, Austin

Moon, Mrs Madeleine

Morden, Jessica

Morrice, Graeme

(Livingston)

Morris, Grahame M.

(Easington)

Munn, Meg

Murphy, rh Mr Jim

Murphy, rh Paul

Murray, Ian

Nandy, Lisa

Nash, Pamela

O'Donnell, Fiona

Onwurah, Chi

Osborne, Sandra

Paisley, Ian

Pearce, Teresa

Perkins, Toby

Pound, Stephen

Powell, Lucy

Raynsford, rh Mr Nick

Reed, Mr Jamie

Reed, Mr Steve

Reynolds, Emma

Robertson, Angus

Robinson, Mr Geoffrey

Rotheram, Steve

Roy, Mr Frank

Ruane, Chris

Ruddock, rh Dame Joan

Sarwar, Anas

Sawford, Andy

Seabeck, Alison

Shannon, Jim

Shuker, Gavin

Skinner, Mr Dennis

Slaughter, Mr Andy

Smith, Angela

Smith, Owen

Straw, rh Mr Jack

Stuart, Ms Gisela

Tami, Mark

Timms, rh Stephen

Trickett, Jon

Twigg, Derek

Twigg, Stephen

Vaz, rh Keith

Vaz, Valerie

Walley, Joan

Watts, Mr Dave

Weir, Mr Mike

Whiteford, Dr Eilidh

Williams, Hywel

Williamson, Chris

Wilson, Phil

Winnick, Mr David

Winterton, rh Ms Rosie

Wishart, Pete

Woodward, rh Mr Shaun

Wright, David

Wright, Mr Iain

Tellers for the Ayes:

Karl Turner

and

Bridget Phillipson

NOES

Adams, Nigel

Afriyie, Adam

Aldous, Peter

Amess, Sir David

Andrew, Stuart

Arbuthnot, rh Mr James

Bacon, Mr Richard

Baker, rh Norman

Baker, Steve

Baldry, rh Sir Tony

Baron, Mr John

Barwell, Gavin

Beith, rh Sir Alan

Bellingham, Mr Henry

Benyon, Richard

Beresford, Sir Paul

Berry, Jake

Blackwood, Nicola

Blunt, Crispin

Boles, Nick

Bone, Mr Peter

Bottomley, Sir Peter

Bradley, Karen

Brady, Mr Graham

Bray, Angie

Brazier, Mr Julian

Bridgen, Andrew

Brine, Steve

Brokenshire, James

Brooke, rh Annette

Browne, Mr Jeremy

Bruce, Fiona

Bruce, rh Sir Malcolm

Buckland, Mr Robert

Burns, rh Mr Simon

Burrowes, Mr David

Burt, Lorely

Byles, Dan

Cairns, Alun

Campbell, rh Sir Menzies

Carmichael, Neil

Carswell, Douglas

Cash, Sir William

Chishti, Rehman

Clarke, rh Mr Kenneth

Clifton-Brown, Geoffrey

Collins, Damian

Cox, Mr Geoffrey

Crabb, rh Stephen

Crockart, Mike

Crouch, Tracey

Davey, rh Mr Edward

Davies, Glyn

Davies, Philip

de Bois, Nick

Dinenage, Caroline

Djanogly, Mr Jonathan

Doyle-Price, Jackie

Drax, Richard

Duncan, rh Sir Alan

Duncan Smith, rh Mr Iain

Dunne, Mr Philip

Ellis, Michael

Ellison, Jane

Ellwood, Mr Tobias

Elphicke, Charlie

Eustice, George

Evans, Graham

Evans, Jonathan

Evans, Mr Nigel

Evennett, Mr David

Fabricant, Michael

Fallon, rh Michael

Field, Mark

Fox, rh Dr Liam

Francois, rh Mr Mark

Freeman, George

Freer, Mike

Fuller, Richard

Garnier, Mark

Gauke, Mr David

George, Andrew

Gibb, Mr Nick

Gillan, rh Mrs Cheryl

Glen, John

Goodwill, Mr Robert

Gove, rh Michael

Graham, Richard

Gray, Mr James

Grayling, rh Chris

Greening, rh Justine

Grieve, rh Mr Dominic

Griffiths, Andrew

Gummer, Ben

Gyimah, Mr Sam

Hague, rh Mr William

Halfon, Robert

Hames, Duncan

Hammond, Stephen

Hancock, rh Matthew

Hancock, Mr Mike

Hands, rh Greg

Harper, Mr Mark

Harrington, Richard

Harris, Rebecca

Hart, Simon

Harvey, Sir Nick

Haselhurst, rh Sir Alan

Hayes, rh Mr John

Heald, Sir Oliver

Heath, Mr David

Heaton-Harris, Chris

Hemming, John

Henderson, Gordon

Hendry, Charles

Herbert, rh Nick

Hermon, Lady

Hinds, Damian

Hoban, Mr Mark

Hollingbery, George

Hollobone, Mr Philip

Holloway, Mr Adam

Hopkins, Kris

Horwood, Martin

Howarth, Sir Gerald

Howell, John

Hughes, rh Simon

Hunter, Mark

Huppert, Dr Julian

Hurd, Mr Nick

Jackson, Mr Stewart

James, Margot

Javid, rh Sajid

Jenkin, Mr Bernard

Jenrick, Robert

Johnson, Gareth

Johnson, Joseph

Jones, Andrew

Jones, rh Mr David

Jones, Mr Marcus

Kawczynski, Daniel

Kelly, Chris

Kirby, Simon

Knight, rh Sir Greg

Kwarteng, Kwasi

Lamb, rh Norman

Lancaster, Mark

Latham, Pauline

Laws, rh Mr David

Leadsom, Andrea

Lee, Jessica

Lee, Dr Phillip

Leech, Mr John

Lefroy, Jeremy

Leslie, Charlotte

Letwin, rh Mr Oliver

Lewis, Brandon

Lewis, Dr Julian

Lidington, rh Mr David

Lilley, rh Mr Peter

Lloyd, Stephen

Lopresti, Jack

Loughton, Tim

Luff, Sir Peter

Lumley, Karen

Macleod, Mary

Maynard, Paul

McCartney, Jason

McCartney, Karl

McIntosh, Miss Anne

McLoughlin, rh Mr Patrick

McPartland, Stephen

Menzies, Mark

Metcalfe, Stephen

Miller, rh Maria

Mills, Nigel

Milton, Anne

Mitchell, rh Mr Andrew

Moore, rh Michael

Mordaunt, Penny

Morgan, rh Nicky

Morris, Anne Marie

Morris, David

Morris, James

Mosley, Stephen

Mowat, David

Mulholland, Greg

Mundell, rh David

Murray, Sheryll

Murrison, Dr Andrew

Newton, Sarah

Nokes, Caroline

Nuttall, Mr David

O'Brien, rh Mr Stephen

Offord, Dr Matthew

Ollerenshaw, Eric

Opperman, Guy

Ottaway, rh Sir Richard

Paice, rh Sir James

Parish, Neil

Patel, Priti

Paterson, rh Mr Owen

Pawsey, Mark

Penning, rh Mike

Penrose, John

Percy, Andrew

Perry, Claire

Phillips, Stephen

Pincher, Christopher

Poulter, Dr Daniel

Prisk, Mr Mark

Pritchard, Mark

Pugh, John

Raab, Mr Dominic

Randall, rh Sir John

Redwood, rh Mr John

Rees-Mogg, Jacob

Reevell, Simon

Reid, Mr Alan

Rifkind, rh Sir Malcolm

Robathan, rh Mr Andrew

Robertson, rh Sir Hugh

Robertson, Mr Laurence

Rogerson, Dan

Rosindell, Andrew

Rudd, Amber

Ruffley, Mr David

Rutley, David

Sanders, Mr Adrian

Sandys, Laura

Scott, Mr Lee

Selous, Andrew

Shapps, rh Grant

Shelbrooke, Alec

Shepherd, Sir Richard

Simmonds, rh Mark

Simpson, Mr Keith

Skidmore, Chris

Smith, Chloe

Smith, Julian

Soames, rh Sir Nicholas

Soubry, Anna

Spelman, rh Mrs Caroline

Spencer, Mr Mark

Stanley, rh Sir John

Stephenson, Andrew

Stevenson, John

Stewart, Iain

Stewart, Rory

Streeter, Mr Gary

Stride, Mel

Stunell, rh Sir Andrew

Sturdy, Julian

Swales, Ian

Swayne, rh Mr Desmond

Swinson, Jo

Syms, Mr Robert

Teather, Sarah

Thornton, Mike

Thurso, rh John

Timpson, Mr Edward

Tomlinson, Justin

Tredinnick, David

Truss, rh Elizabeth

Turner, Mr Andrew

Tyrie, Mr Andrew

Uppal, Paul

Vickers, Martin

Walker, Mr Charles

Walker, Mr Robin

Wallace, Mr Ben

Ward, Mr David

Watkinson, Dame Angela

Weatherley, Mike

Webb, rh Steve

Wheeler, Heather

Whittaker, Craig

Whittingdale, Mr John

Wiggin, Bill

Willetts, rh Mr David

Williams, Mr Mark

Williams, Roger

Williams, Stephen

Williamson, Gavin

Willott, rh Jenny

Wollaston, Dr Sarah

Wright, rh Jeremy

Wright, Simon

Young, rh Sir George

Zahawi, Nadhim

Tellers for the Noes:

Harriett Baldwin

and

Dr Thérèse Coffey

Question accordingly negatived.

28 Jan 2015 : Column 971

28 Jan 2015 : Column 972

28 Jan 2015 : Column 973

28 Jan 2015 : Column 974

Business without Debate

Delegated legislation

Motion made, and Question put forthwith (Standing Order No. 118(6)),

Public Service Pensions

That the draft Judicial Pensions Regulations 2015, which were laid before this House on 11 December 2014, be approved.—(Gavin Barwell.)

Question agreed to.

Motion made, and Question put forthwith (Standing Order No. 118(6)),

Animals

That the draft Microchipping of Dogs (England) Regulations 2015, which were laid before this House on 11 December 2014, be approved.—(Gavin Barwell.)

Question agreed to.

28 Jan 2015 : Column 975

Hormone Replacement Therapy Implant

Motion made, and Question proposed, That this House do now adjourn.—(Gavin Barwell.)

7.13 pm

Tracey Crouch (Chatham and Aylesford) (Con): I am very pleased to have the opportunity this evening to speak on behalf of not only my constituents but many women across the country on the issue of commissioning and funding the hormone replacement therapy implant.

While I appreciate that for the overwhelming majority of women experiencing the menopause alternative HRT treatments are perfectly effective in addressing their symptoms, for a small number this is not the case, and the impact is significant. This issue was first brought to my attention by a group of my constituents who were being treated with the implant from the well woman clinic at Lordswood community healthy living centre in my constituency. In March 2014, after Medway clinical commissioning group announced that it would no longer be providing funding for the insertion of HRT implants, they sent me a copy of a petition signed by 200 women, one of whom has since sadly passed away.

After receiving the petition, I met a number of the individuals concerned to discuss why the alternative treatments were inadequate. They described the effect on their quality of life of no longer having access to the implant, and the problems that they had experienced with other formats of the therapy not addressing their menopausal symptoms.

The purpose of today’s debate is not to advocate access to the implant for all women going through the menopause. I am aware that many women either go through the menopause without any major problems or can sufficiently negate their symptoms with the cheaper licensed alternatives such as patches and gels. However, for a selection of women, the HRT implant provides benefits not addressed by alternative forms of the therapy.

A small percentage of women are severely affected by this issue. They include women with a history of breast cancer in the family. HRT has been thought to increase the risk of breast cancer, especially when used over long periods of time. However, the implant is seen as a preferable option for those seeking HRT treatment as there is a reduced risk, because it is absorbed directly into the blood and bypasses the liver. They also include women who experience some of the more severe symptoms. Symptoms such as joint pain and depression, which cannot be eased by the other licensed formats of the therapy, can also be improved by the implant. These more severe symptoms can have a huge impact on the quality of daily life and on well-being, affecting factors such as employment and mental health, which have cost and health implications of their own, both to the economy and to the individual. The small percentage of women severely affected by this issue also includes women who suffer from early menopause. This means that they are likely to suffer symptoms over a protracted period, and they have also been seen to have much better results from the implant.

The personal experience of my constituent Sarah clearly highlights the reality and severity of the effects involved, as well as the benefits that the implant can provide. Sarah King is suffering early menopause. She is a lovely young married mum with three young boys. For most of her life she had been healthy, active and happy,

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but in recent years she suffered a number of accumulating health problems. These included joint pain—to the point of hospitalisation—skin problems, depression, headaches and lethargy. After a number of years of various treatments and no real improvement, she was sent for a simple blood test which revealed extremely low hormone levels, indicating that she was suffering an early menopause.

Owing to a family history of breast cancer, Sarah was first offered the opportunity to try the HRT implants. Within a short time, all her poor health issues had gone. When the HRT implant service stopped, she tried the HRT patches and then the gel, but neither gave her the same result that she had experienced with the implants. Her health deteriorated to the point that she had to quit her full-time job as a teaching assistant. She started researching on the internet and discovered that the Chelsea and Westminster hospital in London had a specialist menopause clinic and HRT implant service.

Jim Shannon (Strangford) (DUP): I thank the hon. Lady for bringing this delicate issue to the House for our consideration. My understanding is that this hormone replacement therapy is available only in certain locations across the United Kingdom. Does she agree that we need consistency of availability, from Aberdeen to London and from Cardiff to Belfast, and that it should be available to everyone?

Tracey Crouch: I am grateful to the hon. Gentleman for his intervention. The implant is no longer uniformly available nationally. The decisions being taken locally are affecting people who might not be able to travel to London, for example. I shall come to that later in my speech.

Sarah contacted Medway CCG to ask whether it would object to her being referred to the Chelsea and Westminster hospital as an NHS patient. The CCG told her that there was no objection and that the patient’s well-being was its priority. Following that consultation, Sarah had her first appointment at the Chelsea and Westminster on Monday 12 January this year. She was accompanied by her husband, and he was able to tell the medical practitioner who interviewed Sarah what it had been like before she received HRT implants at the Lordswood clinic, what it had been like after she had the implants, and what it had been like to see her health deteriorate again when that treatment was no longer available. He said:

“I just want my happy, healthy Sarah back.”

The medical practitioner that Sarah saw said she was an ideal candidate for the HRT implant and did not hesitate in giving it to her during that first visit. Within a week Sarah says she is already feeling much better, and she has now set up a website dedicated to supporting women suffering severe menopausal symptoms. I am sure that Sarah is just one woman of many who have found themselves in this predicament, but not all have had such positive outcomes.

I would like to take this opportunity to thank the constituents of mine, especially Val Weeden, who have tirelessly researched and campaigned on this issue. They have actively searched for solutions and continuously shared their information with me. They have constantly supported each other through what has clearly been a very tough situation for many. It is extremely unlikely that this issue is unique to my constituency; I am sure that many women across the country and beyond who

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suffer from severe symptoms no longer have access to this potentially life-enhancing treatment because of localised commissioning structures. They may not all come across information for Chelsea and Westminster’s specialised service, and women in the far north or far south of the country who do may struggle to travel to London, at a potentially extortionate cost. Although I appreciate that this is not a cost to be incurred by the health care system, it is one that I would like the Minister to consider today.

After some research into this issue, I identified that on 5 July 2011 MSD, the only licensed provider of the Estradiol implant here in the UK, issued a letter to GPs stating that it was to cease manufacture of the product. It stated:

“the company’s global decision to discontinue the manufacturing of Estradiol was made after consideration of commercial factors and the fact that therapeutic alternatives are available in most countries. The decision is not related to a product quality or safety issue”.

For most women, this issue of cost has no impact on their treatment and well-being, but the 200 women in my constituency, and, I imagine, many others beyond for whom the alternative forms of HRT are not suitable, have been left with a void in their health care. The UK now has no licensed provider for a treatment that enables sufferers to live a normal, high-quality, day-to-day existence.

I recognise that the lack of a licensed provider is not necessarily a problem, as GPs are able to prescribe unlicensed medicines if they feel there is a special need and an unlicensed provider of the product exists in the UK. However, in my constituency this process has not adequately represented the women for whom this treatment is so important, because when our CCG made the announcement in March 2014 that it would no longer be providing funding, the justification was that 200 women was far too great a number to be treated with an unlicensed medicine when licensed alternatives were available.

Although I disagree with the idea that an increased demand for treatment somehow de-legitimises its suitability, I am aware of the potential concerns about licensing. However, just because a product is unlicensed, it does not necessarily mean that it is unsafe, as has been highlighted in MSD’s notice of cessation. In fact, in this case the unlicensed treatments being provided have been widely used across the country and the world. The only reason they are currently unlicensed is that the license holder deemed its provision economically unviable.

That brings me to my conclusion. My constituents found the Chelsea and Westminster clinic through independent research on the internet. That is not a good enough procedure to ensure that women have access to the vital services they need in our health care system. I, for one, recognise the positive changes that this Government have made to our health care system—namely the emphasis on the importance of well-being. I also believe that, for the most part, our doctors are best placed to commission our local services, but this case is an example of where the economics of devolved commissioning are perhaps having a negative impact on specialist services.

The Chelsea and Westminster clinic is proof that there is clearly a recognised medical need for the HRT implant to be made available, as a uniquely successful

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treatment, to a significant minority of women. I therefore ask the Minister to commit to take steps to ensure that our shared vision of our health care system is a reality for all who use it, including these women. I urge the Minister to take steps to make sure that this specialised service is available to all women who may need it, in an appropriate location, and that appropriate referrals take place. To follow any actions that he may take on this issue, will he make a commitment to publish new guidance or write to GPs to inform them about best practice for their patients in this position.

Looking forward, we also need to understand early menopause better and how it may be affecting women from an earlier age. I urge the Minister to engage with national organisations such as the Daisy Network, which was set up for this age group to see how best we can do that. We also need more research into severe menopausal symptoms and treatment for them. Will the Minister commit to look at this whole area of concern?

Finally, I thank Val, Sarah and the rest of my constituents who have campaigned tirelessly on this issue. Their support has enabled me to raise this issue in the House not just for them but for many, many women across the nation in similar circumstances.

7.25 pm

The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter): I congratulate my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) on securing this debate on the funding of hormone replacement therapy implants. She gives me the opportunity to discuss the issues she has raised on behalf of her constituent, Sarah, and others more generally.

Hormone replacement therapy is effective for treating women who are entering the menopause and experiencing hot flushes and night sweats as well as sleep and mood disturbances. There are a number of different types of hormone replacement therapies available, including an oral tablet taken daily, or a transdermal patch applied once or twice weekly.

We should acknowledge that there are risks for those who are prescribed hormone replacement therapy, and the guidance of the National Institute for Health and Care Excellence suggests that, among other risks, there is a small increased risk of breast cancer, stroke and gallbladder disease.

Turning to the issues raised today concerning hormone replacement therapy implants, I have been advised by the Health and Social Care Information Centre that the number of items prescribed and dispensed for hormone replacement therapy implants has been declining since 1996, from around 36,700 prescription items per year to around 5,300 in 2010, the year prior to the licence being withdrawn. HRT implant prescriptions are now down to negligible levels.

HRT implants are no longer routinely offered as a treatment for menopausal symptoms, as my hon. Friend said, and that has been the case since 2011 when the manufacturer of the licensed product, the pharmaceutical company MSD, stopped making the implants. The decision to cease manufacture was based on two main factors. First, therapeutic alternatives are available in the UK, including tablets taken by mouth, patches and gels. Secondly, cost-effective manufacturing processes are unsustainable because few countries use the implant formulation.

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GPs and prescribers were advised in 2011 that treatment should be continued until a discussion could take place between the patient and their prescriber. I understand that most GPs and prescribers reviewed their patients at that time and agreed suitable alternative treatments to switch to. The Medicines and Healthcare Products Regulatory Agency advises me that the only HRT implant preparations now available are not licensed for use in England, as my hon. Friend pointed out.

There has been a change in the prescribing culture surrounding HRT implants. In the past, they were popular as they gave a steady amount of oestrogen over a period of time and women did not experience fluctuating hormone levels. However, the insertion of HRT implants requires a small surgical procedure, and that can only be done by certain clinicians. Some women increased their tolerance to HRT as a result of having an implant, and returned for higher and higher doses at reducing intervals.

Newer hormone replacement therapy patches now provide steady amounts of oestrogen hormone without the disadvantages of the implant, and this phenomenon of HRT tolerance occurs less frequently.

Tracey Crouch: I understand what the Minister is saying, but does he recognise that some women have allergic reactions to the patches? Certainly, my constituents who came to see me found that neither the patches nor the gel offered a suitable alternative to the implant, not least because the patches often fall off or there is some kind of reaction to them.

Dr Poulter: Indeed. My hon. Friend makes a fair point, and I shall make some reassuring comments in that regard in a moment. It is possible to have a reaction to a device or implant, and one would hope that if people have an allergy or reaction to any product, that would be taken into account before it is used. If it causes discomfort, irritation or any adverse reaction, its use should be discontinued and alternative therapies considered.

Clinical commissioning groups are responsible at local level for commissioning the majority of NHS services, and decisions about those services should be made, we would all agree, as close to patients as possible by those who are best placed to work with the patients and the public to understand their needs. Local NHS commissioners now have the freedom and autonomy to take responsibility for meeting the needs of patients in their area, and other health care professionals can work with the CCG, including in secondary care, to help to integrate and join up services more effectively. While clinical commissioning groups are led by primary care professionals, they are also guided by the expertise of other local clinicians.

I understand that my hon. Friend’s local CCG—Medway CCG—released new guidance on HRT implants in 2014. The guidance states that from April 2014, patients will no longer be able routinely to receive hormone replacement therapy implants from their GP. Medway CCG has advised me that the guidance was developed for HRT treatment following clinical input and review through a clear governance process. Because HRT implants are no longer licensed and more suitable alternatives are generally available, the CCG decided that it would no longer pay GPs for inserting such implants from 1 April 2014. The CCG’s policy is in accordance with General Medical Council guidance on prescribing unlicensed

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medicines, and my hon. Friend will appreciate that medical professionals and doctors have to have regard to those requirements under the licence that they hold, and because they are regulated by the GMC. The CCG has assured me that it does not prevent doctors from inserting an HRT implant if they think it is clinically necessary for an individual patient, having assessed their needs and tried alternatives, and providing that they have sufficient evidence to demonstrate the treatment’s safety and effectiveness.

In exceptional circumstances, where a licensed medicine is considered unsuitable or ineffective for an individual, I would expect those patients to be referred for expert opinion. I am pleased that that is exactly what happened in Sarah’s case, and that Chelsea and Westminster hospital provided her with excellent care and support. We would expect a similar process to be in place in other CCGs. If someone needs more expert support and care, perhaps because they are suffering from the menopause and their GP finds their symptoms and presentation complicated, there should always be a facility for referral to specialist care and support. What happened in Sarah’s case—thankfully, it has resulted in a positive outcome for her—is available at other centres of excellence. Expert care and advice is there, and available for patients.

Medway CCG has written to GPs locally to issue information that they can share with all patients who are still using HRT implants, and to ask them to discuss alternative forms of HRT with them at their next routine appointment.

The CCG advises me that patients should be referred to a gynaecologist for expert opinion if the GP and their patient consider that there is no suitable alternative to the HRT implant. I hope that that is reassuring to my hon. Friend. At a local level the CCG has taken the issue seriously and has written to local GPs and reminded them of the importance of reviewing the current treatment plan for women who have the implant, but if they need more specialist support and advice, to make sure that a referral is made to a specialist centre of care. That process should be available to patients throughout the country. Where specialist support is required, CCGs should routinely refer those patients on. That is part and parcel of good medical practice.

Most of the time, HRT therapy and the expertise of GPs in supporting patients through menopause is enough for the majority of patients, as my hon. Friend outlined, but sometimes there is a need for more specialist support. Centres of excellence such as the Chelsea and Westminster can provide that and consider alternative treatments and therapies where they may be appropriate.

I hope my hon. Friend finds that reassuring. I thank her once again for bringing the issue to the attention of the House. I hope I have been able to provide some reassurance to her on the issues she raised regarding support for women in Medway who need HRT therapy and potentially implants, and more generally on the process that is in place to ensure that women who need specialist care and support can receive it, and that all CCGs and all doctors would always be mindful to take the right action for the patients they look after.

Question put and agreed to.

7.36 pm

House adjourned.