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UK Prime Minister Remarks On NHS, Afghanistan And The Human Cost Of War

Source: Office of the UK Prime Minister
Posted on: 11th November 2009

Prime Minister:

Tomorrow, the 11th of November, is as you know Armistice Day.  It is the day the First World War ended, and this year we are marking the passing of the last of the First World War generation.  But it is also a time to reflect on the courage and the sacrifice of our armed forces, who in Afghanistan have laid down their lives to ensure our safety and security here in Britain.  Again today, the fallen will return home in solemn ceremony.  And again, I pay tribute to them and to the friends and families who will honour their return.  Each life lost is an irreplaceable loss from a family.  It reminds us all of the stark human costs of armed conflict in the service in our society, so my thoughts and prayers today, as every day, are with those now struggling with the loss of loved ones and with all those whose loved ones are still in active service overseas.

Today, Andy Burnham is launching the next stage of our National Health Service reform.  In that reform, we give three guarantees to individuals: a free health check every five years for those aged over 40; the right to see a cancer specialist within two weeks; and the right to treatment within 18 weeks.  These will be put in place as soon as possible.  It is part of the move away from a target-led approach that was needed to raise standards to give more power to patients and to frontline staff.  But now frontline staff, who are essential to deliver these reforms, are able to be held to account by the general public with the guarantees.  I would like Andy to explain a little more about what we are doing, and then of course I’ll be able to take questions on any and every concern that you want to raise.

Andy Burnham MP:

Thank you, Prime Minister.  Good morning, everybody.  You’re used to ministers making big claims about the NHS, but last week we achieved an outstanding endorsement from the internationally respected Commonwealth Fund, which compared international healthcare systems and concluded that England has one of the best, if not the best, primary healthcare system in the world.  I’ve always said, since I took on this job, that I don’t want to over-claim for the NHS.  It can be even better.  My judgement is that it has gone from poor to good in the last ten years.  The mission for the next decade is to take it from good to great.  That, as the Prime Minister said, will need a new approach: less about central targets, and more about patient rights and entitlements.  The next era of reform in the NHS should be led by empowered patients and staff.

The publication of the NHS Constitution was part of this shift.  It brought together in one place the principles and values of the service, as well as the rights and responsibilities we expect of patients, the public and staff.  Today, I want to take this further by proposing new rights and guarantees for patients.  Waiting times are now the shortest they have ever been.  To lock in this process, we want to give patients a legal guarantee of a maximum wait.  I am proposing that from April 1st 2010, patients will have the legal right to start their treatment with their consultant within 18 weeks of GP referral, and to be seen by a cancer specialist within two weeks of GP referral.  If the NHS cannot deliver on time, it will have to take steps to find a range of alternative providers that can.  With this new power behind them, patients can be certain that they will receive the same high standards of care, regardless of who they are or where they live.  Under this government, there will be no return to postcode prescribing.

In the next decade, the NHS must make a clear move towards being a more preventative service, and a more people-centred service.  So, from April 2012, we want everyone between the ages of 40 and 74 to have the legal right to an NHS health check every five years, to assess their risk of heart disease, stroke, diabetes, and kidney disease.  By identifying the risks early, the NHS health check will mean that patients can get help and support to stay healthy and reduce the incidence of these diseases and the damage they cause.  To move further towards a people-centred service, we are seeking views on a legal right for people to choose to die at home rather than in hospital, and on access to personal health budgets to give people power over their own care.

Finally, as we have already set out, we are also looking at the right to key diagnostic tests for suspected cancer patients within one week of seeing a GP, with an interim milestone of two weeks, and the possibility of guaranteeing access to an NHS dentist.  Prime Minister, these proposals are part of a decisive shift, building on the NHS constitution, guaranteeing standards for patients, and putting power in their hands.

Prime Minister:

Thank you very much, Andy.  Now, I am going to ask for questions.

Question:

We have now all heard or read the conversation you had with a mother of a solider who was killed in Afghanistan.  Could you tell us what you felt after that: was it sadness, or anger, or shame?  Do you fear that not just this incident but recent incidents mark a moment when the country has lost the will for the fight?

Prime Minister:

I feel for the mother’s grief.  I understand the pain that she is going through.  It’s a terrible personal sadness, and raises questions in her mind about what could have been done.  Of course, she’s got to think of the rest of her family, one of whom is a training instructor, a corporal in the army.  I understand very well the sadness that she feels, and the way she has expressed her grief is something that I can also clearly understand.  I wanted to say during that conversation with her, but thought I couldn’t really do so because I did not know her, that when there is a personal loss as deep and as immediate as she has experienced, it takes time to recover.  That loss can never be replaced.  You’ve got to take every day at a time.  You’ve got to think of the rest of your family.  Over time, comfort comes from understanding that your son has played an important role in the security of our country and died in such a courageous and brave way that nobody will ever forget him.

I think the whole of the country feels a sense of loss when anyone who has been serving our country in Afghanistan is injured or dies, and I think we will see today at Wootton Bassett large numbers of people who want to express their thanks and gratitude to our forces.  It is, of course, eight years since our forces were sent abroad to Iraq and to Afghanistan, first to Afghanistan and then to Iraq.  I can understand that people ask the question all the time: why are we there?  They also ask the question: what will success mean?  What is our plan for the future?

I feel I have a constant duty to explain to people that the reasons that we went to Afghanistan in 2001 are still the reasons why we are there.  We are trying to protect the streets of Britain from Al Qaeda and from the supportive work that could be done on their behalf by the Taleban, both in Pakistan and Afghanistan.  I want to explain also to people that we have a plan to move things forward, to train up the Afghan forces.  I want to say to you today that we want to transfer, district by district, to Afghan political and military control, starting next year with districts we believe the Afghans can run themselves.  We want to re-integrate those people who are today perhaps part of the insurgency, but are prepared to abandon violence, and are prepared to join the political process.  We want to ensure that the Afghan government is free of corruption and therefore able to be a strong authority against any Taleban insurgency in the country.

So, I have a job.  First of all, I need to do my best on behalf of the nation to comfort those who are bereaved.  I want to offer them any welfare services that can be made available.  In every letter, or at least most of the letters I do – and I sometimes write to two members of the family, or people who are direct relatives, as in some cases there’s a husband who has died who has a mother and father but also a partner or wife that I feel I ought to write to – I keep saying to them that if there’s anything we can do to help, we will, and I have of course met some of those people who are bereaved.  My first job is obviously to convey the sense of sympathy the nation has.  I have also got to explain to people why we are still there, why this is a justified effort, why in the same way that we have had to fight abroad before, we have to fight abroad now, and why at the same time the plans that we have with our allies – because this is a 43 country exercise – are plans that we are doing together, and are designed to allow our troops to come home as we increase the strength of Afghanistan to govern itself.

Question:

Prime Minister, first of all thank you for this conference, and I hope we have another one before Christmas after a long gap.  I haven’t heard anyone, even your bitterest political opponents, doubting the sincerity of your feelings about the fallen that you have just expressed now, but there is the fact of the evidence of the document which does appear to contain misspellings and errors in it, and yet neither you nor your spokesman, even you in the telephone call, seem to be prepared to admit that perhaps under pressure, under strain, trying obviously to do the right thing, you made mistakes.  Wouldn’t it just ease the situation now to just say there are mistakes in the letter, and you are sorry about it?

Prime Minister:

I apologised to Jacqui Janes yesterday for any mistakes that had been made.  I also said to everybody whom I’ve written to that if my writing is difficult to read, I apologise for that.

I understand the sense of grief that people have.  I understand the loss that people feel.  I understand also that people ask: why my son?  Why has it happened to our family?  I’ve got to try to explain to people that this is service for the security of the country, as well as understanding the feelings that people have.

Obviously, I wanted to communicate to Jacqui Janes the importance I attached to her feelings of sadness.  My understanding is that there is real grief that we have got to answer, but equally at the same time, I wanted to explain to her that some of the things that had been said – both about the letter, and about our troop movements – I wanted to make sure that she understood that I was saying things that were accurate.

Question:

Prime Minister, when American servicemen die, by and large their grieving families don’t criticise the government about sending the troops out there with poor equipment.  In this case, clearly Jacqui Janes reflects the views of many servicemen who feel that at times the troops haven’t had the right kit.  In your dark moments, do you occasionally think: in the early stages at least, we got it wrong, and we didn’t have everyone out there with the right stuff?

Prime Minister:

Look, Tom.  Every time someone dies in action, every time I have to write a letter to a family that is bereaved, every time I read out the names of people who have died in the House of Commons, every time I go to Selly Oak in Birmingham to visit patients who are injured and need rehabilitation, every time I meet someone in my constituency who has either suffered a bereavement or has someone they’re worried about who is training for Afghanistan or in Afghanistan, I’ve got to ask the question: Are we doing the right thing by our troops, by our armed forces, and by the country as a whole?

My answer is: yes, we have tried to provide the best equipment in the world.  We have increased the investment we’ve made in helicopters and in vehicles, and in the equipping of the armed forces, in a way that we have never done in our country before.  We have ordered 1,000 additional vehicles in the last few years to deal with the terrain in Afghanistan.  We are increasing the number of helicopters every time.  I have asked for an assurance from our military chiefs that every solider, every member of the armed forces we send abroad, is properly equipped for the task in hand.  I have that assurance from our armed forces.

So, the idea that we are in any way careless, or in any way unthinking about the demands and responsibilities we place on our armed forces, is completely wrong.  These are concerns that we debate every day.  These are issues that we deal with on every occasion we discuss these matters.  We have a committee of the ministers and the armed forces and our security services looking at issues such as these on a very regular basis.  And yes, criticism of me is a part of the job, and I understand that, but I hope people will understand that every decision about equipment and about the armed forces is made for the best interests of the country.

Now, I think it’s also true to say that in every country, as a result of what’s happened in Afghanistan – Canada, the Netherlands, the United States – every country – Italy had major casualties in the last few weeks – the same questioning arises, and we have to explain to people why we are there in the first place.  Three-quarters of terrorist plots arise from these border areas that hit the streets of London, and we have also got to explain our plan, because it is not enough to say we are there and it is never enough to be thought of as an occupying army.  We have to show that our strategy is to move to Afghan control, and that is why people can see progress in what we are trying to do.

Question:

Jacqui Janes says that her son bled to death because there wasn’t a helicopter to take him out to medical help.  Can you categorically say that she is simply wrong about that?

Prime Minister:

I have asked for a full report on all the circumstances surrounding Guardsman Janes’s death.  I am assured that in normal circumstances, there is always helicopter capability.  We share this with the Americans.  We have increased the co-ordination of that in recent times.  The investment in our on-field and Bastion health care has been massive in recent years.  We have some of the best facilities in the world at Camp Bastion.  We try then to airlift people to Birmingham, to Selly Oak, as quickly as possible, when it is possible.

But obviously I will look at all the evidence and information that comes from the circumstances in which Guardsman Janes died.  I have to say that nothing that is said can ever be taken as a criticism for the bravery of our healthcare staff, who are out in very dangerous circumstances in Afghanistan trying at all times to do their best and never neglecting the needs of any one individual.

Question:

Thank you, Prime Minister.  You talked about a transfer district by district starting next year.  Are you referring there to what has been talked about the withdrawing from countryside to population centres? Some people have wondered whether that’s a good idea.

Prime Minister:

Look, our strategy is the same, of course: to contain the Taliban but to win the support of the population of Afghanistan.  That means that we concentrate on the populated areas and not simply on territories which are depopulated or not densely populated.  The counter-insurgency strategy is to make sure that the Afghan people understand they are not with an occupying army, they are partnering with a British army that is there to strengthen their forces.

I think what you’ll see over the next few months is that in situations where we took ground, we had hoped to be able to hold it with Afghan forces – Afghan people themselves, working with the Afghan people – that has been unable to happen on the scale we want it.  We don’t yet have sufficient Afghan troops to do so or ones trained up to sufficient standards.  But that is what we hope to have over the next few months.

Now, moving to Afghan control is not simply a military process, but a political process, and we want to be in a position where a number of the districts of Helmand over the course of the next year are not only filled with Afghan forces able to do the job but can be transferred politically for control by the Afghan people.  Now, that is a major progress of course, if it can be done.  That is the task we have set ourselves.  We think by mid-next year probably two parts of Helmand probably can be transferred from our side, from our responsibility, and of course the Americans will be thinking likewise in the areas for which they have fullest responsibility.

So, if you think of our strategy moving forward, it is to get more Afghan forces and police in the field, to complement that by stronger Afghan government and local government, then to transfer control district by district to the Afghan people, at the same time to try and divide the Taleban so that people will come over and adopt a non-violent political process, and of course to give the Afghans themselves by the investment in wheat and agriculture a stake in the future.

So it is a very clear strategy to get the Afghans more in control of affairs, and it’s chosen not because it’s the easiest strategy, I have to tell you.  We saw last week at our cost, and today we will see at Wootton Bassett the bodies of five very, very brave and courageous men returning, who were training the Afghan police and the cost that they paid in their lives by someone who turned on them is something we have to bear in mind in increasing the security arrangements for us.

So we haven’t chosen this strategy because it’s the easiest one; it is in many ways more difficult, but it is the right strategy to show that this is unlike anything the Russians did, unlike any other occupying army.  It is to show that the Afghans themselves can take more responsibility for their affairs.

Question:

What do you say to those, Prime Minister, who suggest that one of the problems, as evidenced by opinion polling, is the way that you personally are viewed by the country and that may be getting in the way of your ability to explain and maintain support for the mission in Afghanistan?

Prime Minister:

You know, I am a shy person, but I try to go round the country, talk to people.  I had a debate about Afghanistan in Manchester. I’m ready to discuss these issues and talk to people about them, but I also do feel the pain of people who are grieving.  I do understand the sadness and the anger in some cases of people who have lost loved ones.  And I think it is very important that someone in my position understands that when people have died over the summer it’s right for the families to be able to ask for explanations, it’s right that they understand why we’re there and what we’re doing, it’s right that they understand that their son’s or their partner’s death has been in the cause of our country and for its future security.

So I have both got to explain why we are in Afghanistan and what we are trying to do to make sure our troops can leave Afghanistan, and I think I’ve got a duty on behalf of the country to reflect the country’s sadness and grief at the loss of people, and that I do try to do.

Question:

Despite your efforts, the polls clearly show that you’re failing to convince the public that war in Afghanistan is worth fighting.  Why do you think you’re failing?  Do you think there is some sort of problem with modern society that we are somehow less able to tolerate the level of casualties that we’ve seen in previous conflicts?

Prime Minister:

I think if you look at how Afghanistan is seen by the British public at the moment that there are only three possible strategies.  So I think we’ve got to deal with the issues that people are raising. We could have a Fortress Britain strategy.  We could say that everything should be done in Britain at an even higher level, which would include greater surveillance of individuals to prevent Al Qaeda attacks in this country, and you would therefore say this is a Fortress Britain in the sense that we would make all our effort about protecting inside our borders, our country.

Now, that cannot be the right answer, even though we’ve trebled the spending on security and doubled the number of security staff and doubled the number of police who are dealing with terrorism, because we know that three-quarters of terrorist plots don’t arise in Britain.  They are not thought out by people in Britain; they are not planned by people in Britain.  They are planned by people in the Pakistan-Afghan border.

So then there’s a second strategy.  You could say, ‘Look, Al Qaeda is the real problem because they have mounted terrorist attacks.  It may be possible to deal with the Taleban in different ways.’ Therefore all the concentration would be on bombing Al Qaeda or getting into Waziristan, and this is a lot of what we’re trying to do now because half the top leadership of Al Qaeda have been eliminated in recent months.  At the same time the Pakistan army is moving into Waziristan and trying to do major exercises there.  And you could say that would be the best effort, so leave it to, if you like, a campaign directed wholly at Al Qaeda.

But I don’t think our experience allows us to ignore the fact that if Al Qaeda has any power the whole environment around them is polluted, and if they can control the environment in Pakistan, as they have done for many years around Waziristan, and if they can control the environment in Afghanistan by us leaving and the Taleban taking control again, then they would pose an even greater risk to us.

So I’ve got to explain to people that the reason that we’re in Afghanistan – and remember there are 43 countries with us, this is a United Nations endeavour, this has not the divisive qualities the Iraq exercise had, where it was a divided coalition facing the problem of dealing with Saddam Hussein – that the decision that we’ve all made is that we’ve got to be in Afghanistan to make sure that the Taleban cannot flourish in a way that would give succour to Al Qaeda.

So, there are different strategies.  We’ve got to deal with them; we’ve got to explain to the British public why that’s the case.  This is a land that is far away and people have got to know why we are there.

Now, there is Al Qaeda presence in Yemen, there is Al Qaeda presence in Somalia.  There are people coming to our country who may threaten us, who are coming from these countries as well.  But the truth is the main threat our security services have detected to the future of the security of our country is from Al Qaeda in the border areas of Afghanistan and Pakistan, and that’s why we’re there.

So my duty is to explain that, but I think people also need to know, as I’ve tried to explain today, what our strategy is for the future.  And I accept that we await the McChrystal Report’s acceptance.  We await the NATO decision on that, as well as the American decision.  I’ve actually led the way in saying that we are prepared to make the additional troops available for the Afghanisation strategy, so we are able to show people that we have a strategy for the time ahead.

Now, these are the questions people ask: why are we there?  And what are we going to do for the future?  What is your plan for the future?  In addition to questions about equipment and helicopters and training, these are the questions we have to answer, and I believe a debate in this country to answer these questions is something that we should welcome.

Question:

Prime Minister, a few weeks ago you said that you would send 500 extra British troops to Afghanistan.  Since then, last Friday, you said that President Karzai’s government was a by-word for corruption, so will he, can he, can his Government, meet the test for the sending of the 500 troops?  And how much is it a problem that President Obama is delaying his decision about sending the troops that General McChrystal has requested?

Prime Minister:

Well, I talk regularly to President Obama.  I’ve talked to him about these issues, and I’m absolutely sure that the decisions that we’re making and the conditions that we’re laying down are very much in line with the American thinking and the NATO thinking.

I said on Friday that Afghanistan had to deal with its problem of corruption.  I’ve talked to President Karzai on a number of occasions in the last few days.  I’ve assured him that we want to help him clean up the government of Afghanistan, both at a local and a national level.  That will be partly his choice of district and provisional governors, and we’re insisting in Helmand that Governor Mangal remains as governor, despite the controversies over whether he should be replaced.

At a central-government level I’ve asked him, and I believe I’ve got grounds for thinking that he is now himself ready to consider and adopt a new set of anti-corruption laws, a new anti-corruption commission or commissioners – outside help to deal with the problem – of commissions with people of stature who are known for their integrity coming from the international community to monitor these matters.  And I’ve reason to believe that President Karzai agrees with me that these things need to be done.

The 500 troops are conditional on the three things that I’ve said: that we have the Afghan government to deliver these troops; that we have an agreement with the coalition themselves that these troops are going to be coming from America and other countries; and that at the same time we have an assurance that all troops going to Afghanistan are fully equipped and properly equipped for the task at hand.

Question:

Prime Minister, one final question on Jacqui Janes.  If you do now concede, as I think we understand that you did misspell her name and her son’s name, why did you not tell her that and admit that to her on Sunday night?  Because she tells us that’s all she wanted to hear from you.

Prime Minister:

I talked to Jacqui Janes on Sunday night, and I said I was sorry if any offence had been caused.  I wanted her to understand that when I send these letters, and I send a letter to every family who suffers a bereavement, I think very carefully about what I say.  And I wanted to assure her that the words I was using, even if she had found them difficult to read which I understand from my writing, were sincerely meant.  I issued a statement yesterday apologising for any grief that had been caused by that.  The last thing on my mind was to cause any offence to Jacqui Janes, and I think people know me well enough to know that it would never be my intention, by carelessness or by a failure, to cause any grief to a grieving mother.

Question:

Prime Minister, do you have a sense of relief that the Foreign Secretary appears now to have definitively rejected himself as a candidate for the High Representative role?  If he has, who would you like to take on this vital job of representing Europe’s foreign and defence policy?  And, in choosing to commit himself so firmly to domestic politics, has David Miliband confirmed that he would be a worthy successor in the future to yourself?

Prime Minister:

That’s four questions in one, isn’t it?  David Miliband was never a candidate for the High Representative job.  Britain has only one candidate for the European Council positions that are being discussed at the moment.  That candidate is Tony Blair, and his candidature is for the Presidency of the Council.  These matters will be sorted out in the next few days.  I repeat; there has only ever been one British candidate for these jobs.

Question:

Just a couple on the economy, if I may. Could I firstly ask you to respond to a report by Fitch this morning, which is questioning Britain’s credit rating, saying that we need to adjust our budget to keep our credit rating?  And the second one is on your call for a Tobin Tax now the Americans say they don’t favour this, whether you intend to continue pursuing it?

Prime Minister:

I think if you read my speech on Saturday, what I was talking about was the social responsibility of financial institutions. We’ve reached a stage in the world where financial institutions are global and we can only ensure that they are responsible stewards of people’s money by action, not simply at a national level, but at a global level. We’ve found in this crisis that there are costs incurred to society way beyond an insurance policy that can be taken out for the loss of savings if a bank goes under.  We have found also that, in good times, the banks achieve very high rewards. In bad times, it has been the nation’s taxpayers as a whole who have had to underpin the banking system.

I have said there should be a debate about a new contract between banks and the society that they serve.  It will have to be a debate conducted at a global level about what we can all do to ensure that banks have the right responsibilities assumed by them for the job they have to do.  I mentioned four possible ways that we could do this: an insurance levy; a resolution fund; contingent capital liabilities; or a global levy.  I said we had a duty to discuss these and I wanted to discuss them with the business community.  That is actually what I said in my speech; that is what the debate will be about and I do not think this debate can be avoided.  This debate is fundamental to the future of banking.  Banking depends upon trust.  If trust is not there, the public will not see the banks as proper stewards of people’s money, so this debate is important for the banks themselves and not just for governments.

As far as our country is concerned, I say to you that ratings agencies report every now and then.  We have assured people, as a result of the deficit reduction plan announced in our budget in April, that we are taking the necessary action to cut our deficit by half.  We are doing what is being done probably ahead of other countries.  Our debt levels are roughly the same as America, France and Germany when this crisis ends.  The world will have to come to a conclusion about how it deals with what has been a necessary one off adjustment to the problems of globalisation, which is a failure of the financial sector, not problems unique to one country but happening in all countries.  The ratings agencies will take into account that these are world issues that have to be dealt with, not just by one country, but many countries.

Question:

Please could you clarify the position on what will happen if our NHS hospital cannot meet the maximum waiting time?  You said in your statement earlier that the NHS hospital might be expected to pay up to the NHS price if that patient had to be treated privately, whereas at the moment NHS hospitals often pay over the NHS price in order to meet their waiting-time targets.

Andy Burnham MP:

If a hospital could not meet the guarantee as set out here, what would happen is that the patient would be able to seek redress by their Primary Care Trust.  They would be offered a range of alternatives at NHS prices.  As we have said, that could include a range of NHS hospitals or private providers.  If the hospital could not fulfil the commitment, it would not be paid under the tariff system and the patient would go elsewhere.  It would be for the patient to enact their right to have treatment within 18 weeks.  It would depend upon how quickly they sought help and at what point they were made aware that they could not be treated within the 18-week time.

Question:

On the economy, is there anything you have seen in the past few days that makes you any more or less confident that we will see a recovery at the turn of the year?

Prime Minister:

I was very encouraged by the sense among the finance ministers of the G20 when they met at St Andrews that, if we maintained the policies of fiscal stimulus as every country has agreed to do, and the monetary activism of keeping interest rates low as America, as the Euro area and Britain have agreed to do, by our co-ordinated action, we can see the economy moving forward.

A year ago, when I was talking to you, people were facing the largest banking collapse in history.  The predictions for the levels of unemployment were far beyond the levels we have now reached.  The predictions for mortgage repossessions were far above those that have actually happened.  The number of small businesses that were expected to go under was at a far higher level than has actually happened.  The support we have given to 200,000 small businesses, 300,000 owner occupiers with their homes, and to people to go back to work is an important element in moving what has been a very painful financial crisis, followed by a collapse of world trade by more than 10% – the two things most destined to hurt Britain, as we have a large financial sector and one of the most open trading economies.  These were the two areas hit hardest, but the action we are taking shows we are in a position to look forward with some optimism about the future.

Question:

Prime Minister, a recent petition on the Downing Street website attracted tens of thousands of signatures calling on you to resign.  You said earlier in this press conference that criticism is part of the job.  Is your attitude to this very general criticism that you just shrug it off?  If so, were these signatories wasting their time?

Prime Minister:

Criticism is part of the job and I accept that people will have differing views on major questions of concern for our country.  I think there is more of a consensus among the parties about what needs to be done in Afghanistan than is often reflected in the coverage.  But I am a parent also.  I feel the pain of people who lose their loved ones.  I understand that, when people are grieving, they are looking for the answers that I talked about earlier.  I am a parent who understands the feelings when something goes terribly, terribly wrong.  I understand also how long it takes for people to handle and deal with the grief we have all experienced.  I can understand.  I can understand that around the country, when there are deaths, people ask the question, ‘Why?’  We have to be able to explain satisfactorily to people what has been happening and what we are going to do.

Question:

Prime Minister, you promised to clean up expenses.  Yet, Sir Ian Kennedy, the man who is now in charge of it has indicated that he is not willing, as you suggested, to implement the Sir Christopher Kelly reforms in full.  How do you respond to that?  Also, what would your advice be to some of your own MPs and MPs across the board who disagree so fundamentally with Sir Christopher Kelly’s findings?

Prime Minister:

I said last week that I expected the findings of the Kelly Committee to be implemented.  I am pretty sure myself that, despite all of this speculation, these findings will be implemented.

Question:

The Home Secretary has said that the government’s handling of immigration policy has been maladroit.  Do you agree?  If so, can you say where you think the government’s policy on border control has gone wrong, specifically?

Prime Minister:

I just say this: it was in recognition of the issues that we faced as a result of migration that we made a change of policy in the last two years to introduce the points system.  The points system has made a huge difference and I think people will see that effect over the next period of time.  It means there has been a 44% fall in net migration into this country over the last year.  It means that only people with specialist skills that we do not have in this country are able to come into the country.  As I will report later this week, it means we are able to take further measures to deal with some of the problems associated with skills in this country, where British people with qualifications can fill vacant jobs.

As far as border control is concerned, I have to say it was the last government that removed the controls on entry and exit from our country.  As you know, we now have the identity card for foreign nationals coming into the country and are introducing a system for checking entry and exit.  We have made changes and that is right to do.  When you look at a problem and the issues that arise, and accept that changes have to be made, the best thing is to go ahead with those.  The points system, border control and the UK Border Agency are things we have done to deal with these problems.  We will never be complacent.  Managed migration – and it is managed – is the policy of this country, not uncontrolled immigration.  I must make it very clear that the points system is designed to restrict the number of people without skills who can enter Britain for work.

Question:

Will a deal be made to give pleural-plaques victims compensation before the current parliamentary session ends, or will they face a wait of unknown length?

Prime Minister:

I have said before that I am having a meeting with Members of Parliament about this.  We have medical advice on these issues.  We also have to deal with legal judgments on these issues.  We have situations in other parts of the country where legislation or administration is moving in a different way.  My concern all along has been those people with pleural plaques who end up suffering from one of the worst diseases, because I have seen the effects of asbestosis mesothelioma.  My concern is to make sure also that the people suffering from that disease are given the compensation they deserve as quickly as possible and do not have to wait for a time.  Therefore, we are looking both at the issue of pleural plaques and that of compensation for asbestosis.

Question:

When President Barack Obama decides what to do in terms of scaling up in Afghanistan, if he decides to commit more troops, will you rule out sending any more above and beyond the 500 that you have already pledged?

Prime Minister:

I have already made it clear and I think our American friends understand this; we have raised the number of troops in Afghanistan from 8,300 to 9,000 in the pre-election period and we are now raising the number from 9,000 to 9,500.  Over the last year we have plans for and have numbers that move from 8,300 to 9,500. We make the temporary 700 permanent and we add an additional 500 and I think the Americans understand that is what we are prepared to do.  We put our conditions on it, but it is also an offer that is made that I think will help the NATO effort.  I do expect other countries in NATO to make commitments as well; I don’t think this will be wholly an American or British announcement. I think there are other countries ready to play their part in Afghanistan and I know that President Obama will also be looking for other countries to join him in making whatever commitments he makes.

Question:

Having discussed this with your EU counterparts, what is your assessment at the moment of Tony Blair’s prospect of success in his candidacy for President of the Council?

Prime Minister:

Well, given that no one has been nominated and there has never been a discussion at the European Council, it is a process that is just starting and not completing so I am not in a position to give a running commentary on it.  All I know is that Tony Blair is an excellent candidate and he is highly respected across Europe.  Obviously a person who has been a Prime Minister is controversial for some people because of decisions that have been made, but that is the way of politics.  I think we will have a very reasoned discussion about it; our candidate is Tony Blair.

Question:

It is almost three months since Abdelbaset al-Megrahi was released and some people are wondering whether he was as ill as he was said to be at the time.  Have you any information about his health?

Prime Minister:

The medical reports that were done at the time were done independently, but it was and is a matter for the Scottish administration to deal with the consequences of these reports.  They made their decision, we accepted their decision, medical advice was provided to them and the Foreign Office is aware of what medical advice was given.

Question:

Thank you very much, Prime Minister.  My point is if there is still an opportunity to make up a wide range of climate political agreement in Copenhagen, what would you expect Japan and other countries to do to make such an agreement?

Prime Minister:

This is the climate-change agreement and we are determined to do what we can.  Japan has announced a 25% cut in emissions, which is very much in tune with our determination to get a 2020 agreement on a far bigger intermediate lowering of emissions targets and I appreciate what the Japanese government is doing.  In the next few days I will be meeting Mr Rasmussen, who is leading the negotiations.  I will be going to the Commonwealth conference where climate change is right at the centre of the agenda with India, South Africa and other countries present and we will work with Japan to get an agreement.

Question:

Overnight in Australia a bulk of senior conservatives including the former Finance Minister, Health Minister and Energy Minister came out to say that man-made climate change is a myth.  They also pointed to Treasury estimates that say that it will take 20 years to build a carbon capture and storage facility that proves that it works, and 30 years before it is proven to work on a commercial level.  Can I get your reaction to that?

Prime Minister:

I am anxious that we are running out of time.  First of all, I do not accept that; there is a climate-change problem and the world has got to take action and do so urgently.  Few people dispute that and I am sorry that some people have chosen to enter the argument in that way.  There is a climate-change problem.  What we do about it does include carbon capture and storage but it also includes many other measures moving from high-carbon usage to low-carbon usage, cutting emissions in different ways.  The fact that the whole of the world is coming together at Copenhagen is a signal that most of the world at least believes this a problem to be addressed.  Thank you all very much.

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