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House of Lords

Tuesday, 27 March 2007.

The House met at half-past two: the LORD SPEAKER on the Woolsack.

Prayers—Read by the Lord Bishop of Peterborough.


Lord Judd asked Her Majesty’s Government:

The Minister of State, Home Office (Baroness Scotland of Asthal): My Lords, The Definition of Terrorism report by the noble Lord, Lord Carlile, was published on 15 March 2007. The Government’s response will be published in due course.

Lord Judd: My Lords, I thank my noble friend for that brief reply. I am sure that she would join me in expressing appreciation to the noble Lord for the thorough and important piece of work that he has undertaken. Does she agree that the credibility of the definition at the centre of our security and legislative arrangements is essential? Will the Government therefore give special attention to what the noble Lord recommends on the difference between influencing and intimidating target audiences, on including racial or ethnic causes in the definition, and on the role of the Attorney-General in extraterritorial cases and the issues to be considered by him? Does she agree that, notwithstanding the conclusion of the noble Lord, very careful consideration is needed of the position of those who may be faced with similar tyranny and state terrorism to that faced by Nelson Mandela in apartheid South Africa?

Baroness Scotland of Asthal: My Lords, I assure my noble friend that we share his appreciation for this very thorough piece of work. We will give every consideration to all the recommendations made by the noble Lord, Lord Carlile.

Lord Henley: My Lords, I offer our congratulations to the noble Lord, Lord Carlile, on this excellent report. I note that the Minister said that she would give her reply “in due course”, rather than the conventional “shortly”. Therefore, we presume that it will be some weeks, quite rightly, before the Government give their response, as the report came out only on 15 March, some 12 days ago. I know that this was not one of the recommendations made by the noble Lord in his report, but one of the propositions that he put forward was that no definition was needed. Will the Government also consider that as a possibility?

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Baroness Scotland of Asthal: My Lords, we certainly intend to give full consideration to each of the recommendations made by the noble Lord, Lord Carlile. As noble Lords will know, he took a great deal of care and attention in this. He spent about nine months going across the country speaking to a number of people to ascertain the proper way forward. We will give every consideration to everything that he says in that report.

Lord Teverson: My Lords, perhaps I may press the Minister a little more. The first of the 16 conclusions is:

Does she feel that such a definition internationally would be useful in the fight against terrorism? If so, how do the Government intend to achieve that?

Baroness Scotland of Asthal: My Lords, I agree that there is no single definition for terrorism, which is because no one can agree on what that definition should be. One has to take that reality into account, as we certainly intend to do. When we look at the four main recommendations made by the noble Lord, Lord Carlile, I assure the House that the Government see a great deal of sense in much of what he says. We have to give the report full and proper consideration in order to make a cogent and complete answer, which we will share with the House and the other place, as will be appropriate.

Lord Campbell of Alloway: My Lords, perhaps I may congratulate the noble Baroness on not having answered any of the six questions put by the noble Lord, Lord Judd. I have much gratitude.

Baroness Scotland of Asthal: My Lords, I am glad that I have given someone pleasure.

Health: Global Health Partnerships

2.40 pm

Lord Walton of Detchant asked Her Majesty’s Government:

Baroness Royall of Blaisdon: My Lords, the report of the noble Lord, Lord Crisp, highlights the valuable contribution that the UK can make to strengthening health capacity globally. The Inter-Ministerial Group on Health Capacity in Developing Countries, chaired by my colleague Rosie Winterton, will oversee the way in which this is taken forward. A small working group with representatives from the appropriate departments will undertake further analytical work to review the operational and financial implications of the report and suggest a phased approach for its implementation. We also have one immediate response, which is to commit £1 million over two years to help the Global

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Health Workforce Alliance to tackle the urgent need to find solutions to the lack of healthcare workers in poor countries.

Lord Walton of Detchant: My Lords, I thank the noble Baroness for that encouraging and helpful reply. Does she agree that this excellent report, based on an inquiry chaired by the noble Lord, Lord Crisp, contains a large number of recommendations, all of which require serious consideration? What action are the Government taking to enhance the opportunities for healthcare professionals in the developing world to undertake improved patterns of education and training? Further, can the Government give an assurance that the career progression of UK doctors wishing to work in the developing world will not suffer under Modernising Medical Careers? Finally, bearing in mind the crucial importance of collaboration between governmental and voluntary organisations, will the Government give their support to the Tropical Health and Education Trust, which is much concerned with this area?

Baroness Royall of Blaisdon: My Lords, the Government warmly welcome the thrust of the noble Lord’s report. It is an excellent document and, as I said, we intend to act on the vast majority of its recommendations. However, we have to examine it in detail. The noble Lord asked me about doctors working abroad. We are looking at this carefully because while we want doctors to work abroad, we also want to ensure that that does not have serious repercussions for our own health services and that doctors’ careers are enhanced when they undertake such missions. On the issue of doctors in developing countries, we want to assist them to stay in their countries where that is possible. Finally, on the Tropical Health and Education Trust, I am afraid that I do not have an immediate reply on that but I shall look into it and respond to the noble Lord in writing.

Baroness Whitaker: My Lords, in response to my noble friend’s Answer, is there not a problem with brain drain professionals from developing countries? Even if they would like to go back, their working conditions when they return are so unfavourable that they are deterred. What can the Government do about that?

Baroness Royall of Blaisdon: My Lords, it is indeed a problem. Inadequate health services in developing countries mean that doctors either do not want to train there in the first place or they do not want to return when they have trained in this country. They, like health professionals here, want to have a career. For that reason, DfID has provided £55 million over six years to fund an innovative emergency human resources programme in Malawi. The programme is helping to build up the health service there so that professionals will want to be trained there and to stay there. So far as we can see, there is evidence that fewer staff are leaving the service. We are now seeking to identify more remote areas for such an incentive package.

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Baroness Barker: My Lords, will the department provide incentives and resources to primary care trusts and GP practices to cover for leaves of absence, particularly of doctors, midwives and public health specialists, who can be of particular assistance in the developing world?

Baroness Royall of Blaisdon: My Lords, we are looking closely at that issue at the moment. We are aware of the problems. We want to ensure that doctors can leave when they need to, but we must examine that in detail. I will come back to the noble Baroness when we have a proper response.

Lord Swinfen: My Lords, what are the Government doing to co-ordinate the work between different NGOs to ensure that they are not acting in rivalry with each other and that the wheel is not continually being reinvented?

Baroness Royall of Blaisdon: My Lords, before I answer that question I must congratulate the noble Lord. He has a trust, the Swinfen Trust, which is cited in the Crisp report as a demonstration of excellence in the IT and telemedicine fields.

The Government are aware that NGOs need greater co-ordination. We are working on that in DfID, from a DfID perspective, but as this report relates to health matters I am sure DfID and the Department of Health will be looking at this issue and trying to co-ordinate NGOs better on the ground.

Baroness Uddin: My Lords, does my noble friend agree that one of the best NGOs, which is well known throughout the world for developing health advocacy, is BRAC? Will she join me in congratulating in particular Dr Fazle Abed, who has developed this method? I hope that this is worthy of all our attention globally.

Baroness Royall of Blaisdon: My Lords, BRAC is the most extraordinary NGO. I had the privilege of meeting the founder not long ago. He is a truly extraordinary man who is changing the face of the world, not only in Bangladesh but in places such as Afghanistan and in many developing countries. He certainly deserves our very warm congratulations.

Lord McColl of Dulwich: My Lords, does the Minister recognise that there is a real need for doctors to go out to these developing countries and to be able to improvise? For instance, there is a surgeon in Nigeria who has mastered the art of improvisation. He operates by sunlight on ladies with fistulae because he has no electricity. He has to move the table around quite a lot during the course of the day, but improvisation—making do with the available resources—is a very important principle.

Baroness Royall of Blaisdon: My Lords, improvisation, as the noble Lord has argued, is extremely important. I am sure we wish to look at

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ways of supporting such fantastic innovation. As I am in the business of congratulations today, I must congratulate the noble Lord on his work for Mercy Ships.

Lord Avebury: My Lords, is the Minister aware that the Tropical Health and Education Trust, mentioned by the noble Lord, Lord Walton, has particular expertise in, and knowledge of, the health services in Somaliland? Will she guarantee that in developing these global partnerships we will pay particular attention to the needs of Somaliland, which is an oasis of peace and stability in an otherwise very difficult and war-torn region?

Baroness Royall of Blaisdon: My Lords, I give the noble Lord the undertaking that we will do so. Indeed, we will view Somaliland in terms of best practice.

Baroness Masham of Ilton: My Lords, does the Minister agree that another good example is the Mildmay Mission Hospital in Hackney, which also has a hospital in Africa, and deals with very difficult cases of HIV/AIDS and dementia? I am sure those at the hospital would be delighted for her to visit it. It is most interesting.

Baroness Royall of Blaisdon: My Lords, any examples of best practice, such as the one cited by the noble Baroness, are extremely important. I would be delighted to visit that hospital.

Lord Turnberg: My Lords, will my noble friend support the work of the Health Protection Agency, which has so much to offer developing countries? It has all sorts of expertise in tropical diseases and the like, and does enormously good work.

Baroness Royall of Blaisdon: Yes, my Lords, I will be delighted to support its excellent work.

The Earl of Sandwich: My Lords, does the Minister agree that where the larger aid organisations so often go wrong is when they set up parallel health structures because they are frustrated with local government? Can she ensure, in the light of the Crisp report, that that will not happen under DfID?

Baroness Royall of Blaisdon: Yes, my Lords. DfID is acutely aware of such parallel structures. DfID is looking at that issue, but I know that the UN body is also looking at it, because those structures cause problems for countries on the ground rather than provide solutions at some stages.

Children: Abuse

2.49 pm

Lord Harrison asked Her Majesty’s Government:

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Baroness Royall of Blaisdon: My Lords, the Government are committed to improving child and adolescent mental health services—CAMHS—including therapeutic services, in line with the vision set out in the National Service Framework for Children, Young People and Maternity Services. We have invested more than £400 million over the past four years to develop services. Evidence-based national service guidelines on therapeutic and preventive interventions with child victims of sexual abuse and exploitation are scheduled for publication by the Department of Health in the spring of 2008.

Lord Harrison: My Lords, I thank my noble friend for that Answer, but if a child broke a leg, would it not be remiss if the NHS failed to follow up with appropriate therapy? Are not children who suffer abuse, particularly sexual abuse, also deserving of appropriate therapeutic services to make sure that they have a proper and happy life in the future? In view of that, will my noble friend urgently consult the NSPCC about its pilot studies establishing the scope of the problem and the financial needs to deal with it?

Baroness Royall of Blaisdon: Yes, my Lords, children who suffer the horrors of sexual abuse deserve proper therapy, over a long period, if that is what is needed. This issue is being explored in the context of the victims of violence and abuse prevention programme—guidelines which are being developed to help universal services to identify and respond to the needs of abused children.

We have just received information about the NSPCC pilot programme. It is being assessed by the department and we will decide what to do in the light of that assessment.

Baroness Howarth of Breckland: My Lords, does the Minister accept that the services required for abused children are much wider than simply mental health services, important as they are? Does she agree that services such as those provided by Childline, where children can come forward and talk about their abuse when they would not do so otherwise, and Stop It Now!, which provides an educational programme so that other young people can come forward, should also be within the programme?

Baroness Royall of Blaisdon: My Lords, Stop It Now! and Childline are extremely important programmes. In fact, my colleague the Under-Secretary of State for Care Services met Mary Marsh, the NSPCC chief executive, in October to discuss them and my right honourable friend the Chancellor announced that the Government will provide additional resources to the NSPCC to help support an extension of the very important listening services that it provides.

The Countess of Mar: My Lords, does the noble Baroness accept that some children who are abused will not talk openly about it but may develop eating disorders, an increase of which in very young children has been reported today in the press? Will she make

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sure that people know that eating disorders may not be just eating disorders but may be an underlying cause of abuse which needs to be investigated?

Baroness Royall of Blaisdon: My Lords, I fully agree with the noble Countess. One of the purposes of the guidelines is to increase awareness of sexual abuse and the things which can point to it in children, such as eating disorders. When people see that a child has an eating disorder, they can look to see what lies behind it. In that way, we can treat those children so that they do not suffer in later life.

Lord Davies of Coity: My Lords, I welcome what my noble friend has said about the extent to which the Government will make provision. However, have they evaluated the extent of the problem inasmuch as they know the number of children they will have to cater for?

Baroness Royall of Blaisdon: My Lords, the figures are quite staggering—they are shameful. Apparently, about 10 per cent of boys and 20 per cent of girls have been sexually abused. Those figures are quite disgraceful, but they show us the extent of the problem that we have to deal with. The problems have existed over many years but in the past we have not been able to talk about them. Now we can, and we must take action.

Baroness Barker: My Lords, given that 72 per cent of people jailed for a grave offence had been abused when they were children, does the health department plan to make the services of CAMHS specialists available to crime prevention charities, which often find children being disruptive and naughty at an early stage?

Baroness Royall of Blaisdon: My Lords, I believe that an interim steering group is looking carefully at this matter to see how best we can deal with these important issues.

Baroness Uddin: My Lords, despite the horrendous statistic of 10 per cent of boys and 20 per cent of girls being sexually abused, does the Minister accept that while child sexual abuse and mental health problems continue deeply to stigmatise all communities, they remain very difficult issues in minority communities in particular? Is she satisfied that government departments have ensured that enough attention is paid to those vulnerable children?

Baroness Royall of Blaisdon: My Lords, the stigma of sexual abuse is a huge problem throughout society, but I accept that it is probably much worse in minority communities. We must focus on it more when we look at issues relating to minority communities.

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