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Commonwealth Heads of Government Meeting: 23-25 November 2007
2.59 pm
Lord Luce asked Her Majesty’s Government:
Whether they will outline the main achievements of the Commonwealth Heads of Government Meeting held in Kampala from 23 to 25 November.
The Minister of State, Foreign and Commonwealth Office (Lord Malloch-Brown): My Lords, noble Lords will be pleased to hear that the Commonwealth Heads of Government Meeting achieved a strong statement on climate change and significant commitments on
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Lord Luce: My Lords, I welcome very much the progress that has been made. However, does the Minister agree that it is difficult to make progress on important issues such as development, aid and trade unless it is accompanied by a strengthening of good governance and the rule of law throughout the Commonwealth? In view of the Commonwealth’s robust line on Pakistan, in marked contrast to the lack of a message on Zimbabwe, will the Minister say whether there was a sense of renewed commitment to democracy in the Commonwealth?
Lord Malloch-Brown: My Lords, the whole Commonwealth membership was united, when it came to Pakistan, in standing by its democratic principles and the need to demonstrate that there were not double standards. Zimbabwe, by contrast, is a country that chose to leave the Commonwealth when threatened with suspension. It is therefore no longer a subject for discussion in the Commonwealth, which limits itself to discussion of its membership.
Baroness Park of Monmouth: My Lords, the Minister mentioned new guidelines for membership. He also said that Zimbabwe left the Commonwealth. Is it not the case that in the Harare decision it was agreed that, on the model of how South Africa was treated, the fact that Mugabe left the Commonwealth did not mean that Zimbabwe did? Was that discussed, and is that what the Minister means by reviewing the laws of membership?
Lord Malloch-Brown: My Lords, the discussion of the laws of membership relates to the significant numbers of countries that wish, as the noble Baroness is no doubt aware, to join the Commonwealth. I think that that is a full indication of the Commonwealth’s current good health. Zimbabwe is currently demonstrating no such interest but I have no doubt that, were there a change of leadership in Zimbabwe and were it to come back to the Commonwealth, it would qualify as a democratic entrant under the rules which were adopted.
Lord Avebury: My Lords, I found the Commonwealth communiqué rather long on aspirations and short on recommendations for concrete action, in particular on climate change, which the Minister mentioned. The so-called Victoria action plan, which he agreed, did not contain any proposals that would alter the individual policies of member states. On the work of the Commonwealth Working Group on Asset Repatriation, why did CHOGM not agree to the recommendation that there should be progress reports on that work and better resources in the Commonwealth Secretariat to assist member states to implement it?
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Lord Malloch-Brown: My Lords, the noble Lord is too much of a veteran of these things to be entirely surprised that a communiqué of this kind ran long on aspiration. On climate change, I should point out that the summit took place just 10 days before the Bali conference opened this week and the objective was therefore to try to get strong language on the challenge of climate change from a grouping of all kinds of different countries. We felt, in that sense, that it was an effective way of teeing up Bali—by showing that a strong common position had been taken by countries as diverse as ourselves and other industrialised countries, but comprising also a large industrialising country such as India as well as small countries, island states and African countries which will be most hit by climate change. We thought it would put energy into Bali. On the noble Lord’s other point on asset recovery, I will need to come back to him.
Lord Judd: My Lords, does my noble friend agree that, hidden away in this rather long communiqué, there was a very important commitment to the exchange of youth within the Commonwealth, and to the contribution that can be made to understanding and reconciliation between different communities by communities getting together in partnership throughout the Commonwealth? We are aware that the British Government favour that in principle. Can my noble friend tell us a little about the practical support that will be given for the furtherance of this objective?
Lord Malloch-Brown: My Lords, I think that my noble friend is aware that this theme of community reconciliation ran strongly through the discussions both at Foreign Minister level and subsequently at the Commonwealth Heads of Government Meeting, where Professor Amartya Sen presented a report over lunch to Commonwealth members. In the aftermath, we need to look at how we can promote advancement on these issues of reconciliation. However, I say in general to all those in this House who support the Commonwealth that this meeting, with its focus on these kinds of issues of reconciliation, as well as on issues of climate change, despite our diverse climactic and economic interests, represents a renewal of the Commonwealth’s energy and ability to bring us together.
Lord Howell of Guildford: My Lords, I am very glad to hear the Minister talk about renewal of the Commonwealth. Does he accept that we on this side greatly welcome the appointment of Kamalesh Sharma as the new secretary-general? Obviously, we recognise that Don McKinnon did an excellent job, but clearly the Commonwealth is moving into an entirely new situation in which its potential will be very great. Does he accept that that potential is often best expressed not so much at government level but at non-government level and at the level of the huge network of about 250 different associations that spreads across the Commonwealth and keeps links between people? Will he welcome, and possibly say a word more about, the announcement from Kampala that the Commonwealth was thinking of extending not just its membership where it can but its links and associations with other countries? I refer not necessarily to English-speaking countries or those connected with the old British
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Lord Malloch-Brown: My Lords, I thank the noble Lord for all that he said, including his remarks about Kamalesh Sharma, which we on this side share entirely. Going to a Commonwealth summit is a little like going to the Edinburgh Festival, where the fringe is in some ways as exciting as the festival proper. It is remarkable to see the richness of the Commonwealth associations to which the noble Lord refers—for business, culture and different development activities—and to see the energy of the people involved in those activities and their desire to bring them to the attention of the government leaders there. In that spirit, I agree that an enlargement of the Commonwealth around shared values of democracy and openness and not necessarily just around shared language or historic links, offers the opportunity for a commonwealth of civil society to grow as strongly as a commonwealth of governments.
Business
3.07 pm
Lord Grocott: My Lords, with permission, we shall have a Statement this afternoon on the Nimrod board of inquiry report. It will be taken at a convenient time after 3.30 pm and will be delivered by my noble friend Lady Taylor of Bolton.
Child Maintenance and Other Payments Bill
Brought from the Commons; read a first time, and ordered to be printed.
Human Fertilisation and Embryology Bill [HL]
3.08 pm
Baroness Royall of Blaisdon: My Lords, I beg to move that the House do now again resolve itself into Committee on this Bill.
Moved accordingly, and, on Question, Motion agreed to.
House in Committee accordingly.
[The LORD SPEAKER in the Chair.]
Baroness Finlay of Llandaff moved Amendment No. 24:
“Infertility treatment“Infertility treatment(1) Each specialist service commissioner must commission a service for in vitro fertilisation in respect of the population for which they commission services.
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(2) An annual report on the performance and outcomes of each in vitro fertilisation service must be made to the relevant strategic health authority by the commissioner.
The noble Baroness said: This amendment, which is in my name and that of the noble Baroness, Lady Jay of Paddington, affects services for in vitro fertilisation as supplied within the NHS.
At present, one in six couples seeks an infertility specialist. Their infertility is a cause of enormous stress and no one should underestimate the extent to which couples who consider and go through IVF find that their lives are completely taken over by the process. NICE has produced guidance to commissioners on how services should be commissioned. It recommends three cycles of stimulated IVF for women between the ages of 23 and 39 who have either a proven cause of infertility or have been infertile for three years or more.
How are we doing in the UK? Sadly, not very well. In 1999, 1.4 per cent of births were by assisted reproduction whereas in other parts of Europe, on average the numbers were much higher, and in some parts of Europe they were 3.7 times our figures. And what do we know? A letter from Dawn Primarolo, as Minister, to primary care trusts in July this year, outlined the response to the Infertility Network UK survey, which is part of a project to reduce inequalities in provision of IVF services. In that letter, the Minister outlined the fact that fewer than half of the PCTs responding said that they funded the transfer of frozen embryos created in the course of an IVF cycle; that these embryos are not stored, despite the NICE guidance, in the states that they should be stored in and used before the next stimulated treatment cycle; and that many PCTs have not achieved the full implementation of the NICE recommendation, which I have already outlined.
So what happens? Couples desperate for treatment go privately. Under enormous financial pressure, they choose to have more than one embryo implanted, hoping that they will get their two babies in one go. But that is not without its risks and the problem, too, is that the risks and the costs of those risks then fall to the NHS, so it is actually a false economy for the NHS. The problems are that there is a sevenfold to tenfold increase in the risk of neonatal damage with multiple pregnancies, and, to the mother, there is an increased risk of bleeding, all the problems associated with caesarean sections, hypertension during pregnancy, diabetes and all that goes with that. Currently in the UK, about a quarter of births through IVF are multiple births, which is a very high figure. In countries such as Sweden, where they have a health service-related service and only implant one embryo at a time, they have a much better rate, with lower complications, through IVF. Because they implant one embryo, they create a single pregnancy and the women are able to go back later for another pregnancy—or, if that fails, they can go back for another attempt at implantation.
It has been said that some women make a financial commitment, which demonstrates their commitment to parenthood. I say “women”, but this involves couples
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Those people who may make excellent parents end up being excluded because of finance—just because they cannot afford the prices. It is also worth remembering that the tragedies that occur from multiple implantations happen right across the board, right across the economic spectrum. People who put themselves through enormous financial stringencies and then have a whole lot of complications may find that the NHS is not attitudinally as receptive as it ought to be when they have hit problems.
One other advantage of the NHS having greater involvement and proper commissioning across the board, in accordance with the NICE guidance, will be that it will be much easier to enforce regulation of services more stringently. Contracts could be specific, as in the example that I have already given the Committee.
It was with alarm that I read the comments in the report from the Joint Committee on the Bill. In volume 1, Charles Kingsland, an NHS consultant, told the committee that,
- “there are an awful lot of treatments that are in theory beneficial but have never stood the rigour of scientific evaluation”.
These treatments can be very expensive; whereas they may not do any harm, they may not do any good either. In this area of medicine, we have vulnerable patients who can be influenced by non-evidence-based medicine. Sheila Pike and Kate Grieve claimed that the policy of leaving treatment fees to be decided in relation to market forces has led to unjustifiably high prices for IVF in some centres, and is contributing to the disturbing phenomenon of fertility tourism. The committee made recommendations about fertility treatments, for fully costed treatment plans.
I urge the Committee to look at this amendment. It is completely in accordance with the NICE guidance and simply asks the commissioners to finally put their house in order for all couples suffering under infertility. I beg to move.
3.15 pm
Lord Winston: I rise in strong support of this amendment, and am sorry that my noble friend Lady Jay is unfortunately unable to be here this afternoon. Forgive me if I appear to repeat some of the points already made so ably by the noble Baroness, Lady Finlay, but I want to describe in some detail what the experience of infertility implies to the Committee, and to put it on the record.
People who are infertile initially face a degree of anxiety which causes quite a lot of personal stress. Eventually, when they start to realise that they are
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Males also feel that there is no point in having sex—one of the greatest gifts that God has given us—any more. There is naturally a huge incidence of marriage breakdown in infertile couples, and something akin to real physical pain. I do not want the Committee to underestimate that. The pain of infertility is as corrosive and serious as the pain of an osteoarthritic hip, for which treatment is easily available under the health service. A relationship breaking down is not good for anybody. The depression is sometimes so serious that even suicide has been contemplated and undergone by these people.
There is a biblical moment when Jacob is faced by his aggrieved and beautiful wife Rachel, and she says to him:
That cry rings down the ages. It is true in this country and, incidentally, in the third world, where infertile women are often abandoned. When people suggest that there are already too many babies in the world, and that these technologies are therefore not necessary, they only need to look at the suffering of, for example, African women in this situation, or women in Asia where there is a serious population problem. One should not equate the notion of overpopulation with the lack of need to treat these patients effectively and with genuine compassion. It is interesting that Jacob replied to his wife, “Am I in God’s stead, that I can give you children?”, an angry response that rings true today.
Most noble Lords are in this House because of singular, great, personal achievements—they have contributed hugely to society in one way or another and feel very proud of those achievements. I feel quite proud of some of my achievements, but I must tell noble Lords that nothing in my life is remotely as important as the fact that I have produced three healthy children who contribute to our society. For nearly all of us in our society, promoting the next generation is the single most important thing we do. We do it as parents, we can do it as children or in many other ways, but it is something that is denied to these couples. Indeed, it is denied in a very subtle way. Women who are infertile sometimes cannot even bear to go into a room where there are pregnant women or children. They cannot attend a dinner party where the commonest conversation will be how people’s children are getting on at school or how the rest of the family is. Very often, they cannot tell their parents that they are infertile because they are ashamed, embarrassed or in pain about such a private grief. I promise noble Lords that I am not exaggerating.
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One issue is that the National Institute for Clinical Excellence has in its wisdom, and I believe it was a wise decision, recommended that three treatments should be available to infertile couples under the health service. What has happened in practice has been well described already. Hardly any commissioning authorities will pay for more than one cycle, and many will not pay for any cycle at all. There is a postcode lottery in this form of treatment. Noble Lords should consider what that means. The implantation rate of the human embryo under ideal circumstances is about 18 per cent. That means that the rate for one treatment cycle under ideal circumstances, which is doing rather better than nature, is about 18 per cent. I do not suppose there are many people in this Chamber of child-bearing age but if you were, and you went home and had regular intercourse during your menstrual cycle, your chances of getting a pregnancy would be less than 18 per cent, much less in most cases. There is a cumulative need to repeat the cycles. What happens is that one cycle is given and then the treatment is refused. That is like treating a cancer and then withdrawing the drugs half way through the therapy. It makes no sense. It results in a huge waste of public money where it is undertaken in the health service; it results in these patients being put through the pain and the investigations and the results being ignored, even though they have been paid for.
There is another problem, which is the issue I referred to at Second Reading. As was so eloquently said by the noble Baroness, Lady Finlay, these patients are ripe for exploitation. The biggest single problem is that 90 per cent of patients go to a free-standing in vitro fertilisation clinic outside the health service. In the commercial sector, that means that they get in vitro fertilisation whether it is the most suitable treatment or not. There are hundreds of treatments for infertility. Infertility is not a disease; it is a symptom. If I have a pain my chest, I do not immediately ask for a bypass operation. I might have indigestion, high blood pressure, some cardiac impairment or bronchitis or I might have broken a rib, but once the infertile patient goes to a private clinic she gets a treatment that is not based on any solid medical evidence but is the treatment it can offer. That is why it is essential that these treatments are seen inside a comprehensive health service, the kind of health service that we are justifiably proud of in this country. Inevitably many patients who are given vitro fertilisation do not justify the treatment because if they were given much cheaper treatments they would become pregnant; indeed, some may get pregnant without any treatment whatever.
Exploitation is a real issue. The combination of desperation and high costs is corrosive not only to the patient but to medical practice. That is why the yardstick of having a really effective health service treatment is extremely important; indeed, in my view, if there had been proper health service provision in the beginning I doubt whether the 1990 Act would have been necessary because the health service could have very adequately regulated most of these clinical treatments, excluding the research. There are other problems.
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