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21 May 2008 : Column 1466

Lord De Mauley: My Lords, how can the Government claim to promote a low-carbon economy when admirable projects such as the one at Peterhead have been abandoned thanks to government delay and inaction?

Lord Jones of Birmingham: My Lords, we do promote a low-carbon economy. That is the entire basis, I sincerely hope, of every nation in the European Union. I wish that our friends 3,000 miles across the Atlantic had the same thought; one lives in hope. At the end of the day, I completely refute the suggestion that we do not promote a low-carbon technology.

NHS: Private Patients

3.23 pm

Baroness Gardner of Parkes asked Her Majesty’s Government:

Baroness Thornton: My Lords, if a private patient seeks help from the NHS, he or she is entitled to NHS services on exactly the same basis of clinical need as any other patient. Our guidance is quite clear on this. There should be no question of people ever being refused NHS care.

Baroness Gardner of Parkes: My Lords, I thank the Minister for that Answer. That cuts across what was stated in the paper on Sunday in the case I am sure she knows about. Is she aware that many people of limited means are prepared to spend their hard-earned money on private treatment? That is their choice. Yet if all but the richest people, who can more easily afford to pay fully for private treatment, transferred entirely to the National Health Service, would that not completely wreck the NHS by overburdening it?

Baroness Thornton: My Lords, that is a very interesting point. It would be wrong for me to discuss individual cases, although I have some information about that one. I reassure the noble Baroness that our guidance is quite clear that, when a patient who has previously received private healthcare seeks help from the NHS, they should be treated in the same way as any other NHS patient and offered treatments based on their clinical need. Their previous status as privately funded patients should, as far as is practical, neither disadvantage them nor allow them to access NHS care in a preferential way.

Our 2004 code of conduct for private practice says that,

I understand from the South Gloucestershire PCT that the case to which the noble Baroness referred does not routinely fund the particular treatment that

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was referred to in the press case. However, NICE is currently reviewing the safety and efficacy of this treatment, and expects its guidance to be published in September. In the mean time, that PCT can review, and says that it will continue to review, any individual funding requests that are made.

Baroness Pitkeathley: My Lords, does my noble friend agree that the very essence of the NHS, of which most of us are extremely proud, is the fact that the service is free at the point of use? Does she further agree, therefore, that it is very important to avoid any perception or impression that one can in some way buy a premium treatment by somehow combining private care with NHS care?

Baroness Thornton: My Lords, I agree with my noble friend that the fundamental principle of the NHS is that treatment is free at the point of use and is based on need and not on the ability to pay. That deserves to be celebrated and preserved, and is why the principle is supported by all the main political parties. If patients want to pay separately for private healthcare, of course they can. However, creating a premium NHS service by allowing people to pay the NHS for treatments that are not offered to all would indeed lead to patients receiving different NHS care, not because they had different clinical needs but because one person could afford to pay a top-up and another could not. This would make nonsense not only of the founding principles of the NHS but of the 10 core principles which the Opposition signed up to and are as vigorously in favour of as we are.

Baroness Tonge: My Lords, the Government seem to be getting into rather a muddle about the interface between the National Health Service and private healthcare. In fact, they seem quite happy to encourage primary care trusts to involve private companies in healthcare provision. They also talk an awful lot of talk about patient choice, so when are we going to see the day when NHS patients can use private healthcare whenever they wish, perhaps funded up to a certain limit by the NHS?

Baroness Thornton: My Lords, the NHS works with the private sector across many different provisions of its services. The point is that the service is available free to the user at the point at which they need it.

Lord Naseby: My Lords, is the Minister aware that it is now reported that in the charity-run hospices for the terminally ill, whether they are adults or children, drugs that are to be prescribed have to be paid for privately? I cannot believe that when Aneurin Bevan set up the National Health Service, he wanted those hospices and the patients in them to pay for their drugs, so will she look urgently into that situation?

Baroness Thornton: My Lords, I would be very surprised if that was the case, but I certainly undertake to look into it.

Lord Winston: My Lords, is the Minister aware that many IVF patients will be deeply grateful to her for the statement that she has made today? I know of a number of cases in which individual NHS clinics

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have unfortunately turned patients down on the grounds that they have had private care for IVF before, so her statement is entirely welcome.

Baroness Thornton: My Lords, I thank my noble friend for that. The code of conduct for the private practice of NHS consultants is, as he will know, very clear.

Baroness Shephard of Northwold: My Lords, I, too, am grateful to the Minister for her clear statement of the principles of the NHS, with which the whole House will obviously agree. Although she told my noble friend Lady Gardner that she cannot comment on individual cases, will she please look into this case, as the South Gloucestershire PCT has said:

Baroness Thornton: My Lords, the noble Baroness raises an interesting point. Primary care trusts have a statutory duty to fund the use of drugs that are recommended by NICE. If a drug has not yet been recommended by NICE—and I indicated that there would be guidance on this treatment in September 2008—that does not mean that the primary care trust does not use it, but it does mean that it may come to that conclusion. However, I undertake to approach South Gloucestershire to ask it to reconsider the case, as per the Question.

Lord Stoddart of Swindon: My Lords, is the noble Baroness aware that quite a number of people pay for private care in private hospitals because they cannot stand the possibility that they might be treated on the NHS in mixed-sex wards? Would the Government reconsider the policy which was announced by the noble Lord, Lord Darzi, that it is impossible now for the Government to guarantee that people—particularly women, incidentally—would not be treated in mixed-sex wards?

Baroness Thornton: My Lords, the noble Lord will be aware that the Government are determined that every patient should be treated with the dignity they deserve and we are working very hard to solve the problem of mixed-sex wards, making sure that people have the privacy they require.

Burma: Aid

3.32 pm

Baroness D'Souza: My Lords, I beg leave to ask a Question of which I have given private notice, namely:

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The Minister of State, Foreign and Commonwealth Office (Lord Malloch-Brown): My Lords, I visited Burma on 17 and 18 May. In my meetings with Burmese Ministers I pressed them to remove obstructions to the international aid effort. The situation has improved but it was clear from my discussions with NGOs and UN experts operating in Burma that the scale of need is enormous and too little aid is getting through too slowly. We estimate that as many as 2.5 million people may be in need of emergency assistance and we look to the ASEAN/UN conference to be held in Rangoon on 25 May to establish a logistic mechanism to channel aid in an effective and efficient manner to those most in need.

Baroness D'Souza: My Lords, I thank the Minister for his Answer. Could he tell your Lordships’ House a little more about the position that the UK Government will take at the ASEAN conference, and say whether he thinks that this initial visit on his part has helped to open the way for other political contact in that country?

Lord Malloch-Brown: My Lords, I think the visit has helped restore some dialogue with the Burmese Government. After all, the last visit by a British Minister was over 22 years ago and it was only possible in this humanitarian emergency to put aside the long held political objections we have to that regime and its behaviour. But I assured the Ministers I met that obviously dialogue and co-operation around this humanitarian emergency, if successful, might open channels of communication and trust which were previously not there. Equally, however, I made it clear that, while we have put aside our political agenda for now, our support for Aung San Suu Kyi and for democracy in Burma remains unshaken.

As to the relief, by introducing the idea of an Asian/ASEAN-led operation in partnership with the United Nations, we were able to break the gridlock that had prevented aid delivery by proposing a mechanism that will have the confidence of the Burmese authorities.

Lord Howell of Guildford: My Lords, it is good that the Minister was able to identify a funnel by which aid could get through the deadlock he described, even though obviously that will involve some delay. When Mr Ban Ki-Moon, the Secretary-General, arrives in Burma either today or tomorrow and sets up this grouping in Rangoon, which he calls a logistic hub, are there ways in which we can contribute to the mechanism even if we cannot be part of the transfer of aid funds directly, because they have to go through the other ASEAN countries? Does this whole tragic affair lead to any revision of views about how sanctions placed on Burma could operate in the next phase?

Lord Malloch-Brown: My Lords, on the noble Lord’s first point, already today the Secretary-General, Ban Ki-Moon, was able to announce that nine UN helicopters will be allowed immediately to

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start operating in the country. An air bridge has now formally opened between Bangkok Don Muang Airport and Rangoon, which will allow a steady acceleration of flights. Those flights will remain British and American, and will be provided by all donors. In addition to aid through this funnel of the ASEAN/Asian route, there will continue to be aid through British NGOs and British aid directly through UN agencies. The British NGOs are doing a remarkable job of expanding access already. On sanctions, like so much else which falls into the political realm, the time to draw lessons will come later. But let us hope that this, in different ways, will open a new chapter for the future in Burma’s sorry political history.

Lord Wallace of Saltaire: My Lords, many of us in this House will want to offer the Minister our congratulations on the delicacy and the tact with which he has clearly conducted a very difficult mission. While he was abroad, we heard a lot of discussion here and elsewhere about the responsibility to protect, the question of sovereignty and how far the definition of a new doctrine of international intervention by the United Nations changes the context in which we, the international community, should operate in the face of such disasters in authoritarian regimes. How does the Minister think that the discussions so far should have affected our understanding of this very delicate area?

Lord Malloch-Brown: My Lords, the fact that we are where we are and that the countries of Asia have risen to the challenge of partnering us to get aid into Burma demonstrates a new international consciousness of the responsibility to meet the needs of victims of a humanitarian tragedy of this kind. The fact that the Government of Burma have given ground and allowed this to happen equally reflects that they understand that they face an international community to which they cannot ultimately say no. Equally, it gives us pause for thought as to whether the approach briefly adopted last week of trying to come in through the Security Council is the right way to handle a humanitarian situation of this kind. We have got there through putting politics aside and engaging in intense humanitarian negotiation. We need to bear in mind that this proved more promising than the attempts to batter down the front door of the Security Council.

Lord Anderson of Swansea: My Lords, I, too, congratulate my noble friend on his pivotal efforts, however frustrating things must have been at the time. Is he confident that there would be no further hindrance on western experts coming in under a framework agreement, if there were to be one? Since every day counts, what is our estimate of the real danger of epidemics arising in the delta? He said some optimistic things about an air bridge, but what can he say about a sea bridge, as proposed by Bernard Kouchner and the French and American ships which lie offshore?

Lord Malloch-Brown: My Lords, on each of my noble friend’s points, I share his lack of confidence that we will necessarily have clear resolution of the

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issues. We will not have as many western experts as we would ideally want. It was the fact that the offer to deploy western experts on a wide scale had been so resisted by the Burmese that led us to pursue this other route, but western experts will be there as part of the UN team that is deployed and as part of Save the Children, Merlin and the other British NGOs and indeed American and western NGOs operating in the country.

The risk of secondary infection remains huge and we are in a race against time. This less-than-perfect funnel that we have created is nevertheless ratcheting up aid, and we will need to keep a close focus on whether it is ratcheting up fast enough, because there is a risk of cholera or other water-borne disease. Five thousand square kilometres are still flooded. The incidence of diarrhoea among children is rising alarmingly. We should not be complacent. This is going to be an extremely difficult operation.

As to the third point, many of these areas are better reached by river than by road even when the roads are not flooded, as they currently are. Building in a water-borne distribution system and allowing the supplies on the British, French and American ships to be unloaded through some ASEAN formula and to be distributed is a critical goal of the coming days.

The Earl of Sandwich: My Lords, the Minister rightly mentioned the high profile of British NGOs, but does he agree that it is only because of their partnership with indigenous NGOs—I am speaking of India and Burma—that it is possible to achieve such results? Will he comment further on India’s role and the efficiency of its own non-governmental organisations, since we have chosen to take that path?

Lord Malloch-Brown: My Lords, the implementation model that the British NGOs working in Burma have adopted has been one where they have much larger local national staffs than normal, because of their reluctance to work through any government entities in Burma. The good news is that this means that hundreds of Save the Children and Merlin staff, and similarly UN agency staff, are now working in the delta, which is a substitute for the limitations that have been placed on the deployment of international staff from the same organisations. These are dedicated, committed people who have been working for those organisations despite the political risk to them posed by their own regime.

India is one of those countries that will now help. I have had profitable discussions with the Indians about how they might provide naval assets. They are certainly well trusted, so one can imagine that their government teams as well as non-government teams will be a critical part of the Asian deployment into Burma going forward.

Lord Soley: My Lords—

The Lord President of the Council (Baroness Ashton of Upholland): My Lords, we have run out of time; it has been 10 minutes.

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Business of the House: Standing Order 41

3.41 pm

The Lord President of the Council (Baroness Ashton of Upholland): My Lords, I beg to move the Motion standing in my name on the Order Paper.

Moved, That Standing Order 41 (Arrangement of the Order Paper) be dispensed with tomorrow to allow the Motions to approve statutory instruments to be taken before the Motion in the name of Lord MacLaurin of Knebworth.—(Baroness Ashton of Upholland.)

On Question, Motion agreed to.

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