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Lord Darzi of Denham: My Lords, at the moment anyone at the end of life who needs it should receive continuing care under the new framework, as I said earlier. The noble Baroness refers to the end-of-life strategy document. Within the spirit of the NHS Next Stage Review, nine different strategic health authorities across the country have end-of-life clinical pathway groups, currently designing the best models of care

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based on international exemplars. Those different clinical groups have representation from health and social care and the voluntary sector which makes a tremendous contribution to the pathway. Those will be published in about March or April next year with the belief that a locally driven pathway will be easier to implement than a nationally enforced end-of-life pathway.

Baroness Finlay of Llandaff: My Lords, given the known inequity in access to specialist palliative care services, and despite the much welcomed initiative that the Minister has just outlined in relation to strategic health authorities, can the Minister confirm that the delay in publication of a palliative care strategy will mean that palliative care services will be embedded in the long-term provision of health and social care and that it does not mean that the strategy is being shelved?

Lord Darzi of Denham: My Lords, I am grateful to the noble Baroness for mentioning the end-of-life strategy. This Government are committed to the pathway. In the history of the NHS this is the first time that such a pathway has been put together. We are committed to the pathway; we are committed to the commissioning of the pathway once it is launched; and we are working very closely with the voluntary sector. There are good exemplars of this across the country, such as Marie Curie Cancer Care in Lincolnshire which has implemented the pathway very successfully. We can learn from that exemplar as we implement it on a national basis.

Baroness Knight of Collingtree: My Lords, can the Minister inform the House whether there has been any advance in the problem of feeding frail and elderly people in hospitals? Has there been any advance in the idea, for instance, of involving families or volunteers more? Can he inform the House of anything that has been done in this regard?

Lord Darzi of Denham: My Lords, in my interim report, I published the principles on which the NHS Next Stage Review should be based, one of which was personalised care—in other words, tailoring care around the needs of patients. In-hospital nutrition is very much part of that. We are identifying pathways and models in which we involve not only nutritionists but also carers and the voluntary sector, which has a tremendous interest in this, in ensuring that the nutritional status of patients, either at the time of their admission, prior to their operation or when they are discharged, meets the needs of patients.

Baroness Howe of Idlicote: My Lords, are the needs of carers, as set out in the Carers (Equal Opportunities) Act 2004, being fully taken into account when assessments are made under the national framework, and how that will be monitored over time?

Lord Darzi of Denham: My Lords, on Monday we published the concordat with social services, including the involvement of carers, but on the specific point that the noble Baroness has raised I shall be more than happy to respond in writing.

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Baroness Oppenheim-Barnes: My Lords—

Baroness Barker: My Lords—

The Lord President of the Council (Baroness Ashton of Upholland): My Lords, it is the turn of the Liberal Democrats.

Baroness Barker: My Lords, the Minister will be aware of a survey produced earlier this year which demonstrated that within one strategic health authority individual PCTs were 15 times more likely than other PCTs to recommend the provision of NHS continuing care. Given the fast-track tool for end-of-life care, what will be done to train staff to ensure that there is greater uniformity of assessment across the country?

Lord Darzi of Denham: My Lords, I am grateful to the noble Baroness, Lady Barker, as I agree that variations exist across the country. Recently—in a previous life—I led a review in London on the end-of-life pathway. I came across one shocking piece of information: 58 per cent of those who approach the end of life are dying within a hospital setting, in contrast to their preferences since about 60 per cent wish to die at home with their family and loved ones.

Interestingly, finances have never been the main enabler in this; mostly, the enabling has been in how we integrate the different providers of that pathway. Those include social care, health services and the voluntary sector. It is in how we provide the training, which was highlighted, to make sure that that pathway is not only integrated but also delivered competently so as to ensure that the patient achieves their preferred place of death.

Baroness Hanham: My Lords, following on from that reply, I am sure that the Minister will be aware of recent research by the King’s Fund showing that the discharge community liaison nurses provide a really invaluable role in end-of-life choice, when people want to die at home. Are those nurses to be deployed across the country and, if so, on what timescale?

Lord Darzi of Denham: My Lords, I could not agree more. We need the integrator between health and social care, and those roles to which the noble Baroness, Lady Hanham, referred will be essential in that integration—and in getting rid of some of the virtual boundaries that we clinicians are good at creating.

Sudan: Military Helicopters

11.36 am

Baroness Williams of Crosby asked Her Majesty’s Government:

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The Minister of State, Foreign and Commonwealth Office (Lord Malloch-Brown): My Lords, we have not offered any helicopters to the UN for Darfur. I am afraid that is because our helicopters are fully committed elsewhere. I am not aware that any other NATO country has yet offered helicopters for UNAMID. The UN Department of Peacekeeping Operations wants 18 transport and six tactical helicopters for UNAMID. We are supporting its lobbying efforts with a range of countries, and working on options to meet that shortfall with others on the Security Council.

Baroness Williams of Crosby: My Lords, is the Minister aware that only one week ago the United Nations Secretary-General, Ban Ki-Moon, said that:

and that that was,

On 1 January, that entire mission takes responsibility for Darfur. It consists of 26,000 African Union and United Nations peacekeepers—the largest number that Africa has ever volunteered. It is absolutely vital that that mission does not fail, and that we do not stand by while another genocide occurs in Africa. Given that the Prime Minister announced yesterday that more Sea King, Merlin and Chinook helicopters were being made available for Afghanistan, could the Government not spare one helicopter to make peace instead of war?

Lord Malloch-Brown:My Lords, the noble Baroness speaks eloquently on a point that frustrates me as much as it does her, because we have not found those helicopters for Sudan. I am assured that all British helicopters are fully committed to operations in Iraq and Afghanistan, and that no others are available supplementary to our own homeland security needs.

There are other NATO helicopters. However, they suffer from needing upgrades and logistics support. We are looking at both those helicopters and others from elsewhere in the world to see if we can facilitate their availability. That matter has been raised in recent days by both the Prime Minister, in conversations with other leaders, and the Foreign Secretary with Mr Ban Ki-Moon since his letter of 6 December. I have also had a number of intense conversations with the peacekeeping department about it.

Lord Soley: My Lords—

Lord Howell of Guildford: My Lords—

The Lord President of the Council (Baroness Ashton of Upholland): My Lords, we have just begun a Question, but we have heard little from the Labour Benches. I suggest that we do it that way round, as we have time.

Lord Soley: My Lords, I am grateful. Are we looking at contractual arrangements to both convert and deploy helicopters brought in, if necessary, from some civilian sectors? I think that has been done elsewhere in the world. I understand the problems about both servicing and converting them, but looking at that would be a better option than trying to take some of our helicopters away from other vital needs. This is urgent.

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Lord Malloch-Brown: My Lords, my noble friend will be reassured that we have suggested to the DPKO a number of commercial options. There are real limitations to it—some real obstacles are to be overcome—as the AU lost some troops recently at Haskanita and the commercial helicopters were unable to fly in to bring out the wounded for insurance reasons. While there may be commercial solutions to the 18 transport helicopters, it is hard to envisage that the six tactical helicopters—attack helicopters—will be available on commercial terms. We need to find a troop contributor willing to provide them and to help it to be able to provide them.

Lord Howell of Guildford: My Lords, the noble Baroness, Lady Williams, is absolutely right. UNAMID is desperate for these 24 helicopters—18 transport and six light helicopters, as the Minister said. Was this matter raised at the rather unfortunate EU-Africa meeting the other day down in Lisbon? Certainly there was an intention by UNAMID and the Secretary-General of the UN to raise it, and I wonder whether we made any contribution.

Secondly, is the Minister really so sure about this lack of helicopters? Would he ask his officials to look again at the Army helicopter centre at Middle Wallop or at RAF Upavon or RAF Odiham? I can only say, living in those parts, that there seem to be an awful lot of helicopters buzzing around all the time and a lot more parked on the tarmac. Could not some of them help in this desperate situation?

Lord Malloch-Brown: My Lords, perhaps the noble Lord and I should go on a weekend scavenging hunt and see if we could rustle up some helicopters. On the other part of his question, the matter was raised at the Lisbon summit. The DPKO sent a team to meet the Government of Sudan to clear the other major obstacle, which is the composition of the force and willingness to allow non-African units to participate. We are working with other European partners to see how we can bring this back in front of the European Heads of Government or Foreign Ministers very early to see whether collectively we can find a solution to this problem.

Lord Alton of Liverpool: My Lords, does the Minister recall the meeting with the parliamentary group on Sudan two weeks ago in which he said that,

He also criticised the Government of Sudan for trying to determine the composition of that force. How is it possible for the force’s credibility not to be undermined if we do not provide the helicopters?

Lord Malloch-Brown: My Lords, the noble Lord is correct—it will be undermined if we do not have the helicopters. I share the view of this whole House: we have to find these helicopters. Having been part of the UN team that originally designed this force, I know that it was the smallest numerical option of those that we offered and its effectiveness was utterly contingent on having the mobility that helicopters would provide. There is no alternative—we have to solve this problem.

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The Lord Bishop of Salisbury: My Lords—

Lord Grocott: My Lords, I hate to offend the right reverend Prelate, but the 30 minutes is up.


11.43 am

Lord Grocott: My Lords, I have another minor apology to make in announcing today’s business. There will be one Statement not two, as it says on the Annunciator. The Statement today will be on the Security Industry Authority and will be delivered by my noble friend Lord West. It will be taken after the debate in the name of the noble Lord, Lord Alton.

House Committee: Second Report

The Chairman of Committees (Lord Brabazon of Tara) rose to move, That the second report from the Select Committee be agreed to (HL Paper 20).

The report can be found at the following address:

The noble Lord said: My Lords, I beg to move the Motion standing in my name on the Order Paper. Under the Parliament (Joint Departments) Act 2007, a joint department may be established only if the House Committee has made a recommendation to that effect which has been approved by the House of Lords itself. The report before the House contains the House Committee’s recommendation that the Parliamentary Information and Communications Technology department—PICT—be established as a joint department. The House is invited to approve that recommendation.

Moved, That the second report from the Select Committee be agreed to (HL Paper 20).—(The Chairman of Committees.)

On Question, Motion agreed to.

Africa: Conflict

11.45 am

Lord Alton of Liverpool rose to call attention to the causes and consequences of conflict in Africa; and to move for Papers.

The noble Lord said: My Lords, for the past 12 months I have been seeking a debate on conflict in Africa, and I am delighted that the House is to address the issue today. I express my gratitude at the outset to all those noble Lords who will participate. I declare a non-pecuniary interest as an officer of the All-Party Group on Sudan, as treasurer of the Parliamentary Friends of Cafod and as a founder of the charity, Jubilee Action.

If you take the estimated loss of life in sub-Saharan Africa, nowhere else in the world has seen such a haemorrhaging of life: 4 million lives have been lost in the Democratic Republic of Congo, 2 million in southern Sudan, 1 million in Uganda, 800,000 in Rwanda, and anything between 200,000 and 400,000 in Darfur. More than 8 million lives lost in less than two decades is surely a human catastrophe,

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one that registers too infrequently with us. The sheer scale of the loss of life makes this Africa’s Great War. As the noble Baroness, Lady Williams, intimated at Questions, Darfur is the first genocide of the 21st century. The causes of conflict are many: sometimes it is naked greed and the plunder of minerals and assets, as in Congo or Sierra Leone; sometimes, in addition to minerals, oil has become a factor; and as in Sudan and increasingly in Nigeria, when this is accompanied by attempts to impose a different culture or religion, it has had calamitous results; sometimes it has been the genocide of war lords or their agents, as with the Janjaweed in Darfur; sometimes the ethnic hatred of one group against another, as with the genocide of the Tutsis by the Hutu Interahamwe militia in Rwanda or the depredations of the Lord’s Resistance Army in Uganda; and sometimes local war lords and violence have been triggered by cattle raids for livestock, the stealing of territory or disputes over water, as on the Kenyan borders with Ethiopia and Somalia. Elsewhere in Africa, in countries such as Zimbabwe, corruption and the denial of political liberties conspire to set African against African, with disastrous consequences.

Others will speak with greater knowledge and authority on the crisis in Zimbabwe. The Government of Zimbabwe have in effect declared war on their own people. It will be years before we are able to quantify the full costs of Robert Mugabe’s destruction of Zimbabwe’s infrastructure. Not only agriculture, industry and commerce, but the entire health and education systems will need to be rebuilt. Compared with much of sub-Saharan Africa, Zimbabwe was well developed and exported food; now half the population of Zimbabwe depends on donor food aid. While unable to provide adequate water in the major cities, Robert Mugabe’s regime allocates almost half the national budget to security and the secret police. How will Africa ever attract the inward investment necessary for sustainable development while her leaders fail to condemn such wanton destruction and such squandering of natural and human resources? Many of us are full of admiration for the forceful leadership given by the most reverend Primate the Archbishop of York on the need for change in Zimbabwe.

In many parts of the continent, the consequences of conflict may be seen in the charred remains of development projects, in the harrowed faces of refugees, and in the haunting images of the victims. Throughout Africa the proliferation of weapons has made conflict more deadly and crime easier, feeding cultures of retribution and downward spirals of violence. In addition to taking a heavy toll on human life, small arms undermine nations’ development. The widespread abuse of weapons deprives developing countries of the skills and talents of the victims of small arms. Small arms are the preferred tools of violence in most internal wars, coups, militia and gang rampages, government oppression and human rights abuses. They are the weapons of mass destruction. The arms are also commonly used in domestic and transnational crime. In cultures of violence and gun ownership, these weapons become symbols of power and pride, even objects of affection.

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A recent report documenting the consequences of conflict was published by Oxfam International, IANSA— the International Action Network on Small Arms— and Saferworld, an independent non-governmental organisation that works to prevent armed violence and to create safer communities in which people can lead peaceful and rewarding lives. The report estimates that during the 15 years up until 2005 the cost of conflict in Africa has been around $300 billion. The study, Africa’s Missing Billions, represents the first time that analysts have estimated the overall effects of conflict on GDP across the continent.

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