Menopause

Jim Shannon Excerpts

Thursday 26th October 2023 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman for raising this issue. It is a massive issue for my constituents and the personal experience through my own wife is very clear. Given that 10% of women leave work during the menopause, saying that they feel and have felt unsupported and unable to continue—which really should not be the case—does he agree that there should be a greater obligation on businesses to help women?

[Peter Dowd]

That is another point that I will touch on later, but the hon. Gentleman is spot on.

Anyone who happened to be in Westminster Hall on Wednesday last week will be able to testify to the work that the APPG has done. More than 100 Members and others gathered for a photograph to mark and celebrate World Menopause Day. My hon. Friend the Member for Swansea East said she was not sure that visitors to Westminster Hall were ready to see so many women parliamentarians and others doing impromptu exercise squats. However, she also said that, if it was a good enough location for Henry VIII to play real tennis, it was certainly good enough for a group of menopausal women to highlight the benefits of exercise to their physical health and mental wellbeing.

The fact that those influential women, grassroots campaigners and clinical experts were brought together in Parliament showed the world that Westminster was listening; but listening alone is not enough while women continue to suffer. Listening will not help them get a diagnosis or access to treatment, or find the support they need. That requires action, and on World Menopause Day the APPG, which is chaired by my hon. Friend the Member for Swansea East, launched the menopause manifesto. Based on evidence that the group gathered by speaking to those affected by the menopause and experts in the field, the manifesto sets out seven recommendations, which we are urging all parties to adopt in their own manifestos ahead of the next general election.

I cannot stress enough how important it is to the 13 million women in the UK who are currently perimenopausal or menopausal, and to all around them who are indirectly affected—the hon. Member for Strangford (Jim Shannon) raised that point—to know that those in power will support them. The first recommendation in the manifesto is for health checks. Every time that is mentioned in conversation, people are genuinely surprised that it does not already happen. Many will remember receiving, on turning 40—along with the cards, gifts and the good wishes—an invitation to a 40+ NHS health check. Those “MOTs” monitor our weight and blood pressure, and are used to assess the risk of developing conditions such as diabetes, heart disease and strokes. What they do not include for women, at present, are any questions about, advice on or reference to the menopause, which is at best a surprise and at worst quite shocking.

There is strong evidence showing that many women are accessing primary care and being treated for individual symptoms because neither they nor their clinicians are recognising the root cause of those symptoms—a point raised earlier by my hon. Friend the Member for Blaenau Gwent (Nick Smith).

By raising awareness among medical professionals, who can, in turn, help to educate women at their 40-plus health checks, we can reduce the number of extra visits that women make to surgeries and prevent further misdiagnosis and inaccurate prescribing. We can also dramatically increase the number of women who get prompt and correct diagnoses and access to treatment pathways. We know that this would save the NHS money in the long run.

Many healthcare providers are now starting to include menopause in their standard packages, having identified the fact that patients are being sent for appointments in secondary care for an array of symptoms that have not been correctly diagnosed as menopause. By including menopause treatment as standard, they are reducing the cost to the NHS of these unnecessary appointments.

The second recommendation of the APPG’s manifesto is a national formulary for hormone replacement therapy. Although HRT is not the answer for all women, millions across the country rely on this treatment to manage their symptoms. We know that, in a 10-minute consultation, prescribers do not have the capacity to go searching for alternative treatments if a patient’s usual product is out of stock, and we have seen a supply shortage for many of these products. A national formulary would resolve this issue, as all eligible products would be easily accessible on surgery systems, thus eliminating the postcode lottery and regional variations that women are currently experiencing.

[Jim Shannon]

The hon. Gentleman is most gracious in giving way. He mentioned that there are sometimes disparities from, say, county to county. There are also regional disparities. I know he accepts that, and the Minister has taken note too. When it comes to providing better treatment, a recommendation has to be that every part of the United Kingdom—England, Scotland, Wales and Northern Ireland—should have an agreed strategy for helping women. Does he agree that there should be the same policy, the same strategy and the same response everywhere?

[Peter Dowd]

I agree with the hon. Gentleman. It is crucial that women are able to go to any surgery and, although there may be marginal differences in treatment or access to treatment, the substance is that they should ultimately get more or less the same access and the same treatment, depending on their needs.

The third recommendation also relates to prescribers. The manifesto calls for the inclusion of menopause as an indicator within the GP quality and outcomes framework. This change would help to balance the deficit in knowledge and understanding among GPs by incentivising improvement in diagnosis levels and treatment provision within primary care. If clinicians were better informed, they would be more confident in discussing menopause with patients at their health checks and in prescribing appropriate treatment, which would greatly benefit patients who visit their GP to seek support.

Moving away from healthcare, I am proud to say that, earlier this year, Labour committed to the fourth recommendation: mandating that all companies with more than 250 employees introduce menopause action plans to support those experiencing symptoms. That goes some way to addressing the points raised by hon. Members.

Alongside this, the APPG would like to see the provision of specific guidance for small and medium-sized enterprises and the introduction of tax incentives to encourage companies to integrate menopause in their occupational health plans. There are great examples of companies embracing the issue, and there are some excellent tools available to help, such as the British Standards Institute’s menstruation, menstrual health and menopause in the workplace standard. With research showing that one in 10 women are leaving the workforce and thousands more are reducing their hours or avoiding promotion, it is vital that more is done to address the impact of menopause on women’s economic participation.

The APPG is not asking for women to be given special treatment; we are asking merely for an understanding that working arrangements and environments may need to be flexible. This willingness to incorporate flexibility will benefit businesses, boost the economy and give women the confidence to progress in their career.

The manifesto’s fifth requirement is about the licensing of testosterone for women. It has always struck me as odd that when women reach menopausal age, which is different for everyone, they become deficient in three hormones—oestrogen, progesterone and testosterone—yet only the first two are available to women when they are prescribed hormone replacement therapy on the NHS. As my hon. Friend the Member for Swansea East has noted previously, if a woman wants the third hormone, they have to pay for a private prescription. The all-party group is calling for an evaluation of female-specific testosterone treatments, with a view to their being licensed by the Medicines and Healthcare products Regulatory Agency.

In the sixth recommendation, we are calling for better funding for research into the potential links between menopause and other health conditions, as well as the varying experiences of women from different backgrounds and ethnicities—that is very important. We know from the evidence that the APPG has received that those with conditions such as autism and attention deficit hyperactivity disorder can struggle more with their menopausal symptoms, and that those who have been treated for cancer often experience early menopause. So it is vital that much more is done to better understand the different journeys that women from different backgrounds are experiencing. In the past week, my hon. Friend told me said that she had been lucky enough to visit two universities, one in London and the other in her own home city of Swansea. Both are keen to do more to support their staff and to bridge the significant gaps in understanding around more complex menopause experiences.

[Jim Shannon]

I thank the hon. Gentleman very much for the scene he is setting. Small and micro-businesses are predominantly male-owned, so the issue for them is understanding how to put over the requests on behalf of ladies who are going through the menopause. Does he feel that the Government and the Minister should take that on board as well, to ensure that those businesses have the relevant information and guidance to do that within the small workforce that they look after?

[Peter Dowd]

The hon. Gentleman makes a good point and sets out an excellent idea. I am sure that the Minister, as part of the expansion or integration of the manifesto, can take it on board.

As I was saying, my hon. Friend was delighted that Swansea University announced last Friday that it would be introducing menopause into the curriculum for all of its medical students, as well as launching a menopause clinic for staff and students. I truly hope that it will be the first of many universities to do this. Future policy in this area, and an improved women’s health strategy, will be possible only if more funding is dedicated to this vital research.

The seventh and final part of the manifesto calls for a review of the demand for specialist menopause care. We need to look at existing provision, evaluate where increased secondary care is needed and assess other ways in which women could seek help. That might, for example, include access to specialist nurses in primary care and pharmacists, to ease the demand on GPs. That is another simple recommendation that would be easy to achieve, while having a significant impact on the care and support that women are able to access.

Nothing in the all-party group’s manifesto is difficult to achieve; no big contracts or big budgets are needed to make the changes that will significantly improve women’s experiences. The only thing that is needed is a commitment to prioritise this area of women’s health. We need a commitment to improve support, diagnosis and access to treatment for all those who need it. Who would not want that? I know that every Member of this House would want it. We need a commitment to show the 51% of the population who will directly experience menopause that they matter—that they really matter.

[Eddie Hughes (Walsall North) (Con)]

It is an absolute pleasure to follow my good friend the hon. Member for Bootle (Peter Dowd). I was originally excited to see that the hon. Member for Swansea East (Carolyn Harris) was going to be opening the debate, simply because her enthusiasm for this subject is contagious and draws people in, but he has done incredible justice to the opening of the debate.

It is marvellous to see a number of male colleagues in the Chamber. I grew up in a house with five brothers and an Irish Catholic mother, and the word “menopause” would in no circumstances ever have crossed her lips. I then went to an all-boys school and went on to do civil engineering at university. There were no girls at my school and just two women on my civil engineering course, in the whole of the department, so my exposure to women was somewhat limited until I finally got off the building site and into a traditional workplace. There I found that men whose experience was not as sheltered as mine had no greater knowledge or understanding of this topic, although I felt they had far less excuse.

So when my wife began to experience the symptoms of the menopause, originally neither she nor I, nor her GP, fully understood what was going on—certainly, menopause was not the initial diagnosis. That highlighted for me how difficult and challenging it must be for some women: they present to their GP, the GP misdiagnoses or misunderstands their symptoms, and then the problem is protracted because the appropriate treatment is not identified quickly enough.

With an understanding of that and as an MP representing the good people of Willenhall, Bloxwich and Walsall North, it was important to me to engage as much as possible with people who could help. We found a place for a menopause café—somewhere where women and men could come and sit down and talk about this topic, over a cup of tea and a slice of cake, in a relaxed environment. I think it is beholden on us, particularly male colleagues, in our role as MPs, to do everything we can to ensure that everybody is as well informed as possible. As I said in my intervention, in our male roles as family members, friends and relatives, it is incredibly important for us to first understand the symptoms and the range of appropriate treatments available, so that we can fully provide the necessary support.

[Jim Shannon]

The hon. Gentleman has mentioned families, groups and work colleagues. Does he agree that women who go through early menopause may find it difficult to discuss the subject with their employers? Those conversations need to be had, to ensure that women of any age are supported and enabled to engage fully in all aspects of their workplace instead of being excluded, perhaps unintentionally.

[Eddie Hughes]

I thank the hon. Gentleman for that intervention. Given that my wife, myself and her GP did not fully understand what the symptoms were and at what age they could arise, it is completely understandable that an employer might be challenged in terms of providing such support. That is why it is vital that we do our best to ensure that everybody is as well informed as possible, because, exactly as the hon. Gentleman says, such symptoms might start to appear at any age, so it is important that their root cause is identified quickly and people can provide that support.

I am delighted to say that, now that my wife has a very senior role in her company, it is easier for her to drive that ethos throughout the company. I pay credit to phs Group for its work countrywide. I have invited the hon. Member for Swansea East to come and speak at one of its offices in the south of Wales—I hope we can arrange that soon.

I pay tribute to all colleagues in the Chamber today, particularly the men in our role as champions, fighting side by side with the women to ensure that this topic is completely understood by as many people as possible, so that we can all provide the support that is so well deserved.

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Member for Bootle (Peter Dowd) for setting the scene so well. I have made a few interventions, but I will add a few words to put on record my support for the motion, as I am here on behalf of my party.

The hon. Member for Walsall North (Eddie Hughes) made an interesting point to which I subscribe from a personal point of view. My wife Sandra went through this, and it was quite difficult for her, not just physically but emotionally. The hon. Gentleman put forward some incredibly helpful ideas: better understanding in the home, better understanding in the family and better understanding in the workplace. I employ seven girls and one fella in full-time and part-time roles, and although I am not better or more knowledgeable than anyone else, I do understand some of the issues that are apparent in the office. That understanding has to start with me and end with everyone in the staff to ensure that the right things happen.

Over the last period, we have had a menopause support group in Northern Ireland. It was created for one reason. The hon. Member for Walsall North referred to a private place. Sometimes people need a private place where they can discuss their experiences and talk about what is happening with others, sharing information on the perimenopause, the menopause and any hormone-related issues. I know the knowledge that women will be able to give each other in those private circumstances and discussions. That is so very important.

The hon. Member for Bradford South (Judith Cummins), who has the Adjournment debate on osteoporosis, reminded us all of the increased risk of osteoporosis, fractures and brittle bones through menopause. She clearly and helpfully reminded us that when it comes to understanding those things better, the health sector needs to be a bigger part of the picture.

[Wera Hobhouse]

It is important that everybody understands that osteoporosis leads to many premature deaths. That is why we need to talk more about it. I am glad that we have all been talking about osteoporosis in connection with the menopause. Does the hon. Gentleman agree that we need to raise awareness of it, because it leads to many premature deaths?

[Jim Shannon]

I thank the hon. Lady for her intervention. I referred to the groups in Northern Ireland because, in many cases, we find that it is the women themselves who are initiating the private support groups and ensuring that things are happening. I ask the Minister, is there any help from Government to ensure that these advice groups are available?

To go back to the subject of osteoporosis, the hon. Member for Bradford South is right. In my office, I have a staff member specifically tasked with looking after benefit issues, and the work for that lady is enormous; she is probably working the equivalent of a five or six-day week. She tells me that, in many cases, the issue is access to personal independence payments. I know that this does not come under the Minister’s Department, but is there a process in place to help ladies understand and apply for that benefit, which is there for a purpose? Government have created the benefits system, and people should never feel that they should not apply for a benefit if it is there for them, which I believe it is.

When people are drained and emotionally raw, which many are, and when the sweats mean they have to shower several times a day and they need prompting to eat and take care of themselves, we need a system, and we need someone there to help along the way. I am my party’s health spokesperson, and I want to add my support to all those who have spoken.

The Government need to be proactive and ensure that guidance is given to businesses, so that they can do things the right way. Some 45% of women felt that menopausal symptoms had a negative impact on their work, and 47% said they needed to take a day off work due to the menopause. That underlines the need for support.

With that, I will conclude, ever mindful that we are fortunate to have a shadow Minister, the hon. Member for Erith and Thamesmead (Abena Oppong-Asare), who will add her support to the debate—I look forward to hearing from her—and a Minister who well understands our requests. I am very confident that we will have the help we need, not for us, but for our constituents, for the women who contact me, for my wife and for all the other women who find it very hard to deal with these issues.

[Mr Deputy Speaker (Sir Roger Gale)]

I call the shadow Minister.

Rural Postal Services: Sustainability

Jim Shannon Excerpts

Wednesday 25th October 2023 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for bringing this forward. It is more than just post offices; it is about rural communities. Does he agree that isolated communities rely heavily on a reliable, frequent service, and investment should be made to ensure that daily deliveries, as the postie does his rounds in our rural constituencies, are not a bonus but are a standard? Would he join me in thanking posties and delivery personnel who carry out this vital service on difficult roads in difficult conditions at the right time for us all?

[Jamie Stone]

Again, a very good intervention; I completely agree. I have described a success story, for which I thank the Post Office for seeing that it happened. Now I turn to a more difficult situation. On the north coast of Sutherland, in my constituency, there are two local post offices at villages called Melvich and Bettyhill. They are now worried about their viability.

--- Later in debate ---

[Jamie Stone]

I will say in passing that I am very considerably encouraged by the number of interventions. It leaves me in very good heart.

[Jim Shannon]

There are more to come. [Laughter.]

[Jamie Stone]

Perhaps I asked for that one.

As I said, there are ways of keeping the post offices open. Getting rid of the Driver and Vehicle Licensing Agency services is absolutely not one of them.

Future of Horseracing

Jim Shannon Excerpts

Wednesday 25th October 2023 Westminster Hall

[Matt Hancock]

I totally agree and could not have put it better myself. That shows the cross-party nature of the work needed to ensure that racing has a bright future, for the reasons the right hon. Gentleman set out and those that I have set out. I completely agree with every word he has said.

[Jim Shannon (Strangford) (DUP)]

I commend the right hon. Gentleman for securing this debate. He said he would outline three reasons why this is important. Can I add a fourth one? With the costs of stabling and even learning to ride escalating, does he agree that there is a danger that the sport will soon be enjoyed only by the elite? Does he agree that steps should be taken to ensure that people of all classes should have access to the sport and the opportunity to take part? In my constituency, we have that. I hope we can agree that as well in this debate.

[Matt Hancock]

I could not agree more. The hon. Gentleman’s intervention shows that this is an issue for the whole United Kingdom, and for people of all backgrounds across the country. In my constituency, I have Heads of State rubbing alongside those from every background who love horseracing. It brings people together, and we should celebrate that. The hon. Gentleman is right to raise that point.

These are the three issues I want to raise with the Minister. The first is levy reform, which was promised. Critically, although we legislated a decade ago that anyone betting on a horserace through an offshore platform counts for the levy, we should also say that anyone betting on an offshore race counts for the levy. Otherwise, people will be increasingly driven to betting on races that happen overseas, and the international problem is significant. Prize money, which entices people to put horses into GB races, at an average of £16,000 per race, is lower than in Ireland, at £22,000, and France, at £24,000. That is not sustainable.

Levy reform is critical, and it is vital that the horseracing and gambling industries come together, shepherded by the Department for Culture, Media and Sport, and bring forward a strong, credible proposal. I say to those who are in and support the gambling industry that they need people to bet on races—that is, real betting, on unknown outcomes, as opposed to computerised betting on a smartphone, where everybody knows they will lose money if they keep going. Horserace betting is a joy and a pleasure for millions. It is the best way to defend gambling, and supporting the horseracing industry is massively in the interests of the gambling industry.

The second issue, which deeply affects my constituents, is the importance of ensuring that some of the necessary occupations for horseracing are on the Migration Advisory Committee’s shortage occupations list. I have written to the Home Office about this issue and they said, “Speak to the Department for Digital, Culture, Media and Sport.” The DCMS Minister is here today, so this seems an opportune time to raise the issue.

Economic Crime and Corporate Transparency Bill

Jim Shannon Excerpts

Consideration of Lords message
Wednesday 25th October 2023 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

The Minister said clearly that there has been consultation with Scotland and Northern Ireland. Will he indicate who those discussions have taken place with? Was it banks, or the Departments looking after matters in the absence of a functioning Northern Ireland Assembly? I am keen to know who does the work to ensure that there is accountability for everyone.

[Kevin Hollinrake]

That is a good point. There are clearly different legal jurisdictions in Northern Ireland and Scotland, with of course the Court of Session in Scotland. From a legal perspective, the counsel in those jurisdictions are the people who discuss this. In wider issues such as failure to prevent, banks and many other stakeholders have people who will consult during the process. I am happy to keep up the conversation with the hon. Gentleman.

[Jim Shannon]

The reason I asked the question is quite specific, although it might not necessarily relate to the issue directly. The Minister refers to banks. A number of local organisations and community groups back home, which are registered and constituted as community institutions, have had their bank accounts closed. Banks have closed their accounts down because they say they are non-profitable. Is it right that banks should be able to do that? I know the Minister understands the matter—

IVF Provision

Jim Shannon Excerpts

Tuesday 24th October 2023 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to speak in this debate. I thank the hon. Member for Jarrow (Kate Osborne) for raising the issue of IVF provision and setting the scene so well. I will raise some examples from my constituency, where IVF treatment issues have had a detrimental effect on ladies who wish to have a family, with costs and financial implications for their lives, which have been changed in dramatic ways. A number of my constituents have contacted me about the issue over the years.

I am ever mindful that the Minister present does not have responsibility for the figures or the subject matter in Northern Ireland, but there is a real anomaly that I have to put on the record. I always bring a Northern Ireland perspective to these debates, as everyone knows. I do so because I hope to add to the conversations that we are having and perhaps show where the shortfalls are.

This important issue has an impact on many parents daily—it is indeed daily—and it is a pleasure to speak about it as my party’s spokesperson on health issues. Nothing is more precious than the gift of life. It is awful that for so many it is a struggle, so it is great to have the opportunity to debate, discuss and request further provision of IVF across the United Kingdom.

I will first highlight some differences between the mainland and Northern Ireland to add perspective to the debate. It was recently brought to my attention by a young constituent going through the process of IVF that on the mainland a person whose BMI is 35 can access medicated ovulation support, but in Northern Ireland it is 30. Sometimes that request is difficult for people in Northern Ireland to achieve. On the mainland, too, a person whose BMI is 30 can qualify for IVF, but in Northern Ireland it must be 25. Again, the criterion set in Northern Ireland is more stringent and difficult to achieve than that on the mainland. That is not the Minister’s fault, but it provides perspective for the debate.

Many women in Northern Ireland have stated that the BMI issue is by far the biggest, and it leaves them with a feeling of sheer inequality. We have a clear issue of inequality in the system. Some of my constituents have come to the mainland to get IVF treatment. It can have a significant cost for them, which cannot be ignored. Why do they have to have a lower body mass index and be smaller to achieve the same fertility treatment as their English counterparts?

There is definitely an equality issue to be addressed. The hon. Member for Jarrow set out inequality in the system, and I support what she said. I reiterate the clear inequalities that my constituents face in comparison with those here. It is also worth mentioning that a woman suffering from polycystic ovary syndrome will struggle to lose weight at the same pace as someone who does not have PCOS.

There is already a prolonged process in place before people even achieve the criteria set back home. In England, according to NICE, women under 40 should be offered three rounds of NHS-funded IVF treatment if they have been trying unsuccessfully to start a family for two or more years. In Northern Ireland, it is only one round, and if the person or their partner has prior children, the entitlement is zero. As the hon. Member for Jarrow set out, the inequality is very apparent. Additionally, given that the chances of success vary depending on age, one round can be completely worthless in some cases. Unfortunately, some of the ladies who have come to me over the years have put themselves into debt in excess of a five-figure sum just to have a child, and the treatment may not be successful. Some of them are still paying the money back, and they have not had the child they sought to have in their life. It really is frustrating.

The Stormont Executive committed in 2020 to increase the number of funded cycles for a woman to have a baby. However, this is purely dependent on the money that Northern Ireland receives under the Barnett consequentials. Financial capacity restraints are the reason why the change has not been implemented. In this afternoon’s Westminster Hall debate on the future of NHS funding, I will highlight the issue of IVF funding and how it affects my constituents. We cannot expect to have a sustainable NHS if we do not make the effort to fund it properly.

I understand that capacity is different in Wales, where women are able to have only two rounds of IVF treatment. The fact that women in Scotland and England get three is completely unjust, as those in Northern Ireland get only one. It is a clear example of how we continue to be left behind, and it demonstrates the inequalities in the system for us in Northern Ireland.

NHS funding for IVF cycles varies considerably across the United Kingdom. In 2021, Scotland had the highest rate of NHS-funded IVF cycles, at 58%, compared with 30% in Wales and 24% in England. I know that the hon. Member for Livingston (Hannah Bardell) will give the figures for Scotland; I commend the country for achieving that percentage. Let us give it credit for doing so, because we should all be trying to achieve that.

The figures for Northern Ireland are not available, although I have sought hard to get them. I have written to the Department of Health back home to see whether they can be accessed, so hopefully I will have them in the next week or two. Self-funding is not always an option for couples due to the sheer cost of the process, but it is important to note the comparison.

Every time a lady undergoes an IVF cycle and is not successful, anxiety, depression and disappointment creep into the process. Then she might do it again and again. I know of one lady who has had IVF treatment at least five times, but it has never been successful. I feel for ladies who are keen to have a child and who go through the cycles of IVF treatment but are not successful. I believe that children make a marriage or a relationship. They might sometimes stress parents out but, at the end of the day, children are a bonus and a pleasure to have. I am pleased that at least some of us have had that opportunity.

I urge the Minister to take my comments into consideration and to discuss these matters with the Department of Health in Northern Ireland. I seek the Minister’s input; she always responds with compassion and understanding, which we appreciate. In relation to where we are in Northern Ireland, will she accept my request to have discussions with the Department of Health back home and see whether there is some way we can work together better to help my constituents and those across Northern Ireland who do not have funding for IVF? We must allow people in Northern Ireland the same right as those in the rest of the United Kingdom, and implement NICE’s recommendation to have three cycles of IVF for women struggling to conceive.

I wanted to make this small contribution to the debate, because it is important that we share our experiences. For those in Northern Ireland whose IVF treatment has been successful, the experience has been wonderful, but for many people it has not. The inequalities are clear.

Birth Trauma

Jim Shannon Excerpts

Thursday 19th October 2023 Commons Chamber

[Theo Clarke]

I thank my right hon. Friend for her intervention and for her excellent work on the start for life programme to ensure that children under five get the help that they need.

It was the most terrifying experience of my life— I genuinely thought that I was going to die—so I put on the record my immense thanks to the fantastic NHS team at Royal Stoke University Hospital, who carried out my surgery, and to the midwives who were with me during labour. I thank in particular my surgeon Nitish, my midwives Michelle and Stacey, my health visitor Chris, my mental health advocate Judith, and Nicole at the perineal clinic. However, the entire experience has also completely opened my eyes to challenges in post-natal care in this country.

I remember being wheeled into the recovery ward after surgery, where I encountered a nurse who had not read her notes and assumed that I had had a C-section. I was then moved to a side room, where I was hooked up to a catheter and a drip, and was lying in bed next to my baby, who was screaming in her cot. I could not pick her up. I pressed the call button for help, and a lady came in and said, “Not my baby; not my problem,” and left me there. That is unacceptable behaviour, especially when you are extremely vulnerable. I have subsequently met the hospital trust chief executive and the chief nurse, and I appreciate their apology and commitment to providing quality, safe care to women in Stafford going forward.

I spent nearly a week in hospital. One of my main reflections was the lack of aftercare for mothers. There is so much focus on the baby that we sometimes seem to forget that the mum has had a traumatic experience and needs care, too. I had never heard of birth injuries before. I later discovered that during childbirth I had suffered from what is known as a third-degree tear, when the baby stretches the vagina and rips the muscle in the back passage called the anal sphincter, which it is vital to repair. It is important to say that, although many women will have no issues in childbirth, some will, like me, be unlucky and have a third or fourth-degree tear, which occurs in about three in 100 vaginal births. I now know that around 20,000 women a year in the UK suffer from birth injuries. The consequences of an untreated obstetric tear can include urinary and faecal incontinence, as well as ongoing pain, so it is clear that we must do more to help those women.

On my return from maternity leave, I contacted those at the Birth Trauma Association, who are here with us today, and asked them to bring some mums to visit me in Parliament. I discovered that there is huge disparity across the UK in care for mothers who have experienced birth trauma. I was genuinely shocked at some of the stories those mums shared with me. For example, Gill Castle suffered from a fourth-degree tear and now has a stoma bag, and she had to give up her job as a police officer. She has since become an amazing campaigner on birth injuries, and I congratulate her on just becoming the first person with a stoma bag to solo swim the English channel.

It was so upsetting to hear their stories following that meeting, including sad examples of babies who had died and examples of medical negligence. That is why I decided to launch a new all-party parliamentary group on birth trauma with my Labour co-chair, the hon. Member for Canterbury (Rosie Duffield), who I am delighted is here today supporting the debate. Our APPG is cross-party, and we are so pleased that many colleagues from across the House have joined us to provide support. I welcome NHS England’s commitment to addressing these issues and the fact that it has now set out a three-year delivery plan for maternity and neonatal services, published in March, but it is clear that we still need to do more to improve post-natal care.

Birth trauma is caused by traumatic events or complications in birth. It is a term that can apply to those who experience symptoms of psychological distress after childbirth or physical injuries sustained during delivery. Those can include surgical procedures such as a sudden emergency requiring a caesarean section or a long and very painful labour in a severe state of pain for many hours.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Lady for her courage in sharing her personal story with everyone in the Chamber and those further afield. One of my staff members had an emergency C-section. It started before she was under anaesthetic, and she was unaware it was coming. The trauma of it was very real, and it is clear that she should have been offered help to come to terms with it. She left hospital with a beautiful baby, yes, but she also left with a scar and a memory of traumatic events that she could not process because she did not know what was happening, and it all came upon her very quickly. Does the hon. Lady agree that in such scenarios, counselling and help should be offered at the beginning and should be accessible for all?

[Theo Clarke]

I thank the hon. Member, and I absolutely agree. If he will bear with me for a few more minutes, I will get on to that later in my speech.

I was talking about examples of birth trauma, which can also include a premature or very ill baby, having a difficult forceps birth, or a post-partum haemorrhage with severe loss of blood. Women have told me that they felt fearful that they or their baby might die. The traumatic event can be exacerbated by unkind or even neglectful care, or when women who feel physically or emotionally damaged after a traumatic birth are expected to look after their baby without any help.

Research shows that 4% to 5% of women will develop post-traumatic stress disorder after birth, which translates into about 30,000 women a year in the UK. The diagnosis of PTSD does not just relate to mothers but can also include fathers who have been present at their partner’s birth. Many of them have told me that they were kept in the dark about what was happening to their partner and baby. Symptoms of PTSD can include flashbacks or nightmares; negative alterations in mood such as guilt, sadness or self-blame; and a feeling of being constantly anxious and on high alert.

Birth trauma is obviously compounded by the stress of looking after a newborn baby, including months of sleep deprivation. Mothers have written to me to say that medical procedures that remind them of birth, such as a cervical smear test, can induce feelings of terror. Others became so fearful of their baby coming to harm that they refused to leave the house or let anyone else hold their baby. In many cases, their relationship with their partner has deteriorated because the woman has become so distressed. Women have told me that they found it impossible to return to work due to flashbacks or because they have physical injuries that make it impossible to do their job. Psychological, as well as physical, birth trauma also occurs when the mother is separated from her baby immediately after birth, which is what happened to me, and when they are poorly treated by healthcare professionals.

I was extremely lucky that I was treated by a specialist perinatal mental health team called the Lotus Service in Staffordshire, which included trauma-focused cognitive behavioural therapy and eye movement desensitisation and reprocessing, known as EMDR, in addition to attending a specialist perineal clinic for my tear. I welcome the fact that NHS England is setting up regional perinatal mental health services, but I am afraid that it is still patchy, and many women still face long waiting lists for therapy. In 2014, fewer than 15% of localities provided specialist perinatal mental health services for women with complex or severe conditions at the full level recommended by National Institute for Health and Care Excellence guidance, and I am afraid to say that 40% provided no service at all.

Clearly, we must end the postcode lottery that mothers in the UK currently face. It is unacceptable to me that a mother can receive a different level of care just because of where she lives, so today I call on the Government to ensure that perinatal mental health services are available to all mums across the UK.

I turn now to post-partum psychosis, which is a serious mental health illness that can affect mothers after they have had their baby. Tragically, it affects around one in 500 mothers after giving birth. Post-partum psychosis is very different from what is sometimes called the baby blues, which is more about mild mood changes post-birth: this is a serious mental illness that is treated as a medical emergency. Symptoms can range from hallucinations to manic moods and delusions, and it can sometimes take up to a year to recover. In my constituency of Stafford, we are privileged to have an amazing parent and baby unit at St George’s Hospital, which I recently visited. It is a specialist facility that aims to provide in-patient mental health services for women experiencing psychological and emotional difficulties specifically related to the latter stages of childbirth and early motherhood.

Next, I want to highlight the recent reports into maternity care at Morecambe Bay, Shrewsbury and Telford, East Kent and Nottingham, which have all identified problems in birth that arise from inadequate care. Sadly, those reports identified problems such as understaffing, poor team working or a culture of blame, which all contributed to the very sad and avoidable deaths and injuries of mothers and babies. We also know that a difficult birth is much less likely to lead to a woman developing trauma symptoms if the staff treat her with kindness and dignity, make sure that consent is obtained for procedures, respect her wishes for pain relief, and display sympathy when she is clearly distressed.

I have spent the past few months meeting with experts in the field, including the Royal College of Obstetricians and Gynaecologists, the Birth Trauma Association, the MASIC Foundation and the Maternal Mental Health Alliance. Following this, I partnered with Mumsnet—the online forum for mothers—to conduct a national birth trauma survey, given the lack of data. Our survey received 1,042 responses. The key results showed that 53% experienced physical trauma; 71% experienced psychological or emotional trauma; 72% said that it took more than a year to resolve; 84% who experienced tears said that they did not receive information about birth injuries ahead of time; and 32% experienced notes not being passed on between shifts. These results are shocking, and we shared them recently at our first meeting of the all-party parliamentary group on birth trauma.

I was very grateful that Dr Ranee Thakar, president of the royal college, came to that meeting to talk to us about her initiatives, including on obstetric anal sphincter injuries—known as OASI—which, as I have already mentioned from my personal experience, are third and fourth-degree tears. Long-term consequences can include chronic pain, sexual dysfunction, and difficulty or inability to control the bladder, bowels or passing of wind, and can significantly affect mental health and people’s ability to carry out everyday activities. We need to break the taboo by talking about this, and that is what I am trying to do today. Childbirth has been identified as a key risk factor for the development of pelvic floor dysfunction later in life, with one in 12 women having a pelvic organ prolapse.

To reduce the likelihood of birth injuries, UK experts led by the royal college created the OASI care bundle, which has already been rolled out in 19 new maternity units since 2019. That care bundle has been significant in reducing birth injuries by 20%, so today I call on the Government to roll it out across NHS England to all hospital trusts. I also put on record my thanks to Mr Speaker for extending my proxy vote after my maternity leave, in order for me to recover from my own birth injury. This new system of remote voting will make a huge difference to MPs who are new mothers or have had to undergo major surgery, as I did.

Sadly, ahead of today’s debate I have been inundated with hundreds of emails and letters from mothers who have experienced birth trauma. I thank each of those, and in some cases the partner, who have taken the time to write. I know how difficult and painful it is to talk about this. With their consent, I will briefly share some stories that I believe powerfully highlight the issue.

One mother, who gave birth in Leicester General Hospital, writes:

“I delivered my son naturally and without intervention, but I did suffer a third-degree tear. This wasn’t really explained to me at the time, other than to tell me that I needed stitches. It was only afterwards, when I received a copy of the consent form, that I realised exactly what the surgery had been for.”

Another mother writes:

“Labour was progressing well, then I started to…tear, so an episiotomy was performed. But I had torn all the way to the back, I was taken into theatre for repair…which took nearly 2 hours. I lost about 1 litre of blood… Currently I experience pain and bleeding after bowel movements, pain during sex”

and, as we can imagine, a

“smear test several months ago was agonising”.

She said she had been

“experiencing nightmares, awful intrusive thoughts and panic attacks, all concerning leaving or being separated from my son”,

and she was referred to her GP for post-traumatic stress disorder.

A mum called Stacy says:

“I was told I’d either need forceps or a C section so would be taken to theatre. I couldn’t read the form I was so out of it and I remember my signature sliding down the page”.

Another writes:

“I suffered birth trauma, feeding issues, bad medical advice, poor mental advice, long term sleep deprivation”,

and even PTSD was triggered in her husband.

Sadly, there have also been examples of inequalities in treatment among ethnic minority groups. One mother explains that

“the nurse did not spot my haemorrhage due to the colour of my skin. There needs to be more diversity training, as the medical professionals fail to recognise symptoms in non-white patients”.

Finally, an NHS doctor who served as an obstetrician wrote to me to say:

“Occasionally it was dads who were traumatised. Watching your partner experience a major obstetric haemorrhage and literally being left holding the baby whilst she is being wheeled away from you into the operating theatre was…a distressing experience and as time went by the dads were sometimes left wondering if they might be bringing up the baby as a single parent. Everyone was busy with their wife in theatre and no one came to speak to them for quite some time”.

Unfortunately, none of these are isolated incidences—they occur all too frequently—so the Government must take action to improve the experiences of women who have traumatic births.

I welcome the fact that the Department of Health and Social Care published its 10-year women’s health strategy for England last year. I also welcome the appointment of Professor Dame Lesley Regan as the Government’s first ever women’s health ambassador for England, and I look forward to meeting her in a few weeks’ time. However, on reviewing the Government’s strategy, I was surprised to find the mention of birth trauma only once in the entire document, which was in the context of a call for evidence for the public inquiry. Given that the public in their response to the Government’s strategy included a request for birth trauma, it is now essential that this is delivered in any future updates to the women’s health strategy. So today I am calling on the Government to add birth trauma to the women’s health strategy in a meaningful way.

Lastly, I want to touch on staffing. We know that our brilliant NHS workforce is essential to ensuring safer and more equitable maternity services. This has been recognised in both the Ockenden and the East Kent reports. We know that safe staffing levels are essential to the provision of safe maternity care, and we also know that workforce recruitment remains a priority concern. I note that NHS England’s long-term workforce plan has set out commitments to support our maternity and neonatal workforce, but unfortunately staffing gaps remain, with an 11% vacancy rate.

In conclusion, it is so clear to me that so much more needs to be done to support women who experience traumatic births. Today I call on the Government to add birth trauma to the women’s health strategy; recruit more midwives; ensure perinatal mental health services are available across the UK; provide appropriate and mandatory training for midwives with a focus on both mental and physical health; ensure that the post-natal six-week check with their GP is provided to all mothers, and will include separate questions on both the mother’s physical health and her mental health in relation to the baby; improve our continuity of care so there is better communication between secondary and primary health care, including explicit pathways for women in need of support; provide post-birth services nationally, such as birth reflections, to give mothers a safe space to speak about their experiences in childbirth; roll out the obstetric anal sphincter injury care bundle to all hospital trusts in England to reduce the risk of injuries in childbirth; provide better support for partners and fathers; and, finally, have better education for women on their birth choices and on risks in order to ensure informed consent.

Let me thank all the birth trauma organisations and the mothers who have contributed to this campaign. I really hope that the Government will listen to my plea today, and ensure that women who suffer from birth trauma will now receive additional support.

Youth Programmes and Girlguiding

Jim Shannon Excerpts

Tuesday 19th September 2023 Westminster Hall

[Dame Caroline Dinenage (Gosport) (Con)]

I beg to move,

That this House has considered the role and future of youth programmes and Girlguiding.

It is a great pleasure to serve under your chairmanship, Sir George. We are so lucky to live in a country that gives our young residents so many opportunities to learn new skills, have adventures and make lifelong friends. From the guides to the scouts and from the Duke of Edinburgh awards to the cadets, volunteers across our country devote so much of their time and energy to the youth programmes that add so much to the formative experiences of our young people. It has been an incredibly difficult few years for children and young adults. The damage caused by the covid pandemic is impossible to fully ascertain, but NHS figures show that the number of children seeking help for their mental health has risen by almost 50% since the start of the pandemic. Schools were closed and socialising banned, and all of this means a lasting and painful legacy for our young people.

We all know that outdoor activities and spending time with friends in nature are good for people’s mental wellbeing. There are myriad different studies to that effect. Even NHS England has started offering nature prescriptions. So now is the time we need more opportunities for young people to have fun and spend time outdoors, and to socialise and be children. As more and more young people spend longer and longer on the internet or their phones, cooped up indoors, now is the time to provide more opportunities for them to get out and do something fun and adventurous—to build a raft and see if it sinks, go abseiling or learn life skills such as cooking. Now is not the time to be pulling away from providing these opportunities, so I ask the Minister what his Department is doing to provide more opportunities for young people that get them out and about, help them learn new skills and help them build friendships.

The girl guides have a very proud tradition of having this kind of positive impact on the lives of girls not just in the United Kingdom, but across the world. The board of Girlguiding has recently taken two incredibly concerning decisions regarding the future of the organisation: the proposed closure of all five of its outdoor activity centres across the country; and the full shutdown of British Girlguiding Overseas. It goes without saying that Girlguiding has touched the lives of so many thousands of girls across the globe. First and foremost, I would like to take this opportunity to thank the thousands of people across the country and across the world who have given countless hours, evenings and weekends, and much more to the betterment of opportunities for young girls everywhere.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady for bringing this forward. It is a subject that is very important to us all, which is why we are all here. Does the hon. Lady agree that the positive mental health influence for children of organisations such as the girl guides, as well as the scouts, the Campaigners, the Boys’ Brigade and the Girls’ Brigade—I have them in my constituency in some numbers—cannot be overstated? Does she agree that our thanks should go to those in the voluntary sector and the churches, which are deeply involved in this, who give of their time to teach children skills and practical topics, but also to build self-confidence and self-worth? Their value to society should be highlighted and recognised, and the hon. Lady has done that well today.

[Dame Caroline Dinenage]

I thank the hon. Gentleman so much for making such an excellent point. I did not mention the Girls’ Brigade and the Boys’ Brigade, which, as he says, make such a wonderful contribution. They build the formative skills that young people need to face the challenges of life ahead, and make such a huge difference to individuals’ lives.

That is why this decision to close down every single one of the five Girlguiding activity centres across the United Kingdom is so bizarre. Girlguiding is closing down opportunities for young women and girls who would otherwise struggle to afford them. This decision comes after the body blow to Girlguiding that is the move to end their overseas operation, which serves thousands of girls across the world and has been doing so for decades. Both of these utterly bizarre decisions came after no real warning and no consultation with members.

UK Export Performance

Jim Shannon Excerpts

Monday 18th September 2023 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

I noticed in the paper last week that very statement that the Minister made about a young, vibrant economy full of young people who wish to excel. I know that he always tries to respond positively to questions that I and others ask in the Chamber, so let me ask him this: can Northern Ireland be part of the exports success story? We want to be.

[Nigel Huddleston]

Absolutely. I can assure the hon. Gentleman that we are focused very much on supporting and enabling Northern Ireland exporters to be successful—as, indeed, they have been. No matter where we go in the world, there is huge enthusiasm for UK goods and services, and Northern Ireland has some outstanding products that the world wants to consume. That is why we are focusing not just on the EU but on the rest of the world, where there is an insatiable appetite for UK goods and services. We want to make sure that we deliver those and get benefits from trade deals for every nation and region of the UK.

The month before I visited Vietnam, I was in India, where I announced a package of partnerships on electric mobility and construction, positioning our businesses to sell into those fast-growing sectors. Everywhere I have visited, from Oman to Indonesia, I have heard the same story: “We want to buy British.”

My message to the House is that we are working flat out to help businesses grab these opportunities—and, best of all, we are succeeding. We are not scared of challenging ourselves to do more and to move faster. That is why we have set ourselves a target of reaching £1 trillion of exports by 2030, around five years earlier than previously expected. That is an ambitious target, but one that I feel is achievable with Government and business working together.

Trade deals are at the heart of our approach, and our programme of negotiations is one of the largest in the world. We are negotiating trade deals tailored to the modern UK economy and the opportunities of individual markets. Of course, each deal is different, but all of them remove barriers to trade so that we can create the right conditions for decades of future growth, security and innovation, to help the UK thrive in a changing world. We have already secured trade deals with 73 countries as well as the EU, turbocharging key areas such as services, food, drink, automotive and life sciences, creating new opportunities in forward-leaning areas such as data and digital—as my hon. Friend the Member for Newcastle-under-Lyme (Aaron Bell) mentioned—and enabling our businesses to sell into the economies of the future.

In July, we took a huge step forward in enhancing our presence in the Indo-Pacific when the Secretary of State signed the agreement on our accession to the comprehensive and progressive agreement for trans-Pacific partnership. That is a vast free trade area spanning from Asia to the Americas and now, with our accession, Europe. The deal will give businesses right across the UK access to a market of half a billion people—the 21st century’s middle class, with money in their pockets ready to spend on our goods and services. This is our biggest trade deal since Brexit and we are the only European member of this free trade family.

As the House will be aware, we also recently ratified our first from-scratch trade deals with Australia and New Zealand, sweeping away the majority of tariffs on goods and services with those nations and creating even closer and warmer economic partnerships. The Secretary of State recently returned from India, where she met her counterpart, Minister Goyal, and advanced our free trade agreement negotiations, which are now in their final stages. Beyond that, we are working towards deals with a host of growing economies, including members of the Gulf Co-operation Council, Israel and Mexico—one of the world’s largest consumer markets, with its population projected to reach nearly 150 million by 2035.

We are using our trade policy to maintain our position as the world’s second largest services exporter. Having worked in that field prior to politics, I have seen at first hand our huge expertise in the sector, and I know that it is vital that we reinforce our reputation and make it easier for our service providers to sell around the world. That is why we should all be excited about our talks for a new, updated trade deal with Switzerland, for example. There is a huge prize on offer for both UK and Swiss companies in everything from finance and legal to accountancy and architecture. The current trade deal is almost 50 years old and really only covers goods. The modern British economy is over 70% services, which is why we are so active in upgrading and enhancing our trade deals to suit it.

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

Thank you very much for that, Mr Deputy Speaker. I thank all right hon. and hon. Members, including the shadow Minister, for their contributions, and especially the Minister for setting the scene so well, as he often does.

I do not want to put a dampener on proceedings, but I have to put on record my concerns about the Northern Ireland protocol. I say that gently, because I believe we are at a stage in negotiations where we are trying to find a way forward and I hope they will be successful. The hon. Member for Newcastle-under-Lyme (Aaron Bell) spoke of his hopes that the Northern Ireland protocol would move forward. There is nothing wrong in hoping that, but the reality is very, very different. I say that very gently to him and he knows where I am coming from. I am very pleased to learn of the export rates and I also note that Members believe we can improve on them. From a Northern Ireland perspective, the notion of export performance is intrinsically linked with the Windsor framework. It is important that I give an honest Northern Ireland perspective in a gentle way to the House. I always try to be constructive in my comments. I do not try to be aggressive or nasty, or say things that are unhelpful to the debate, because we hope that things will work out.

A House of Lords Select Committee report, released in the summer, shows the depth of the problems with our exports caused by EU interference, something we were keen to shake off with Brexit. As a Brexiteer, I want the same Brexit as England, Scotland and Wales, and we do not have that for Northern Ireland. The report highlights a number of significant issues. Just last week, Lord Dodds, the speaker at our association annual general meeting, outlined where we are very clearly. One key conclusion is that the Windsor framework makes things worse for many businesses compared with what they have experienced up to now. Honestly, that is the situation for many of the businesses in my constituency. There is a way forward, which my party has outlined through our seven-point plan. With the Prime Minister, the Secretary of State and all the other Ministers involved, we are seeking to find that way forward.

The original protocol was unworkable and could not be implemented without major damage to our economy. That led to the grace periods and easements. Now those are to be done away with and replaced with the more onerous and burdensome Windsor framework provisions. The Windsor framework renders Northern Ireland worse off in terms of the Irish sea border, and creates greater checks and barriers to trade with the rest of the UK compared to what we experienced thus far, even if it theoretically improves on the original version of the protocol, which was unworkable in any case. Some may believe that that has no effect on UK exports, but Northern Ireland is an integral part of the supply chain. The Minister, in response to my intervention, made that very clear and I welcome that. He stated very clearly that we want Northern Ireland to have all the advantages England, Wales and Scotland have in export trade. That would be really good news, if only that was where we were.

If we cannot, in pharmaceuticals for instance—engineering is a second one—source our medical ingredients, we cannot produce the vaccines or veterinary products and supply the global market as we currently do. That affects our global output, never mind the fact that without a permanent solution, the supply of over 50% of veterinary medicines to Northern Ireland may be discontinued, posing a risk to both animal and human health, and the agri-food supply chains and the resulting transfer to exportation. My hon. Friend the Member for North Antrim (Ian Paisley) has spoken at some length in different questions to different Ministers, including the Prime Minister, on the problems for veterinary health.

If we cannot source steel and parts to carry out our engineering, which delivers parts in many industries from aerospace to boats, to defence weapons and any number of other chains in which we have been, to date, an integral part of the UK machine for export, and if we have divergence in regulation between Great Britain and Northern Ireland, or between Northern Ireland and Ireland, there is a valid underlying fear that Northern Ireland will find itself in a no man’s land between Great Britain and the EU, placing the competitiveness of Northern Ireland firms and their complex supply chains in jeopardy.

I welcome the fact that the Minister of State, Northern Ireland Office, the hon. Member for Wycombe (Mr Baker), has undertaken to highlight our global potential with investment in Invest Northern Ireland’s new offices in Seoul—the Minister for International Trade, who opened the debate, referred to the potential for trade with South Korea; that is good news, and we hope to be part of it—to learn how Government funding is boosting Northern Ireland’s profile in the Asia-Pacific region and helping to connect Northern Ireland businesses to the world. He announced back in December that £8 million of funding from the New Deal for Northern Ireland would enable Invest Northern Ireland to expand Northern Ireland’s presence on the international stage as it supports Northern Ireland businesses in new locations from Paris to Toronto, as well as providing additional trade advisory support in their Belfast offices.

I know that this is not this Minister’s responsibility, but let me just say that I am keen to see a trade deal with India—with one proviso. I will mention, in a Westminster Hall debate on religious persecution which starts at 9.30 am tomorrow, what has been happening recently in the Indian district of Manipur. I consider it imperative for any trade deal with India to enshrine the preservation of human rights, the equality of rights, and freedom of religious belief. Some 60,000 people have been displaced, and some 360 Christian churches have been damaged. I want a trade deal with India; everyone wants one; but if we are to have one, it must be conditional. It is disappointing that, as I understand it—although I will not pose this question to the relevant Minister in Westminster Hall tomorrow morning—our Prime Minister never once raised the issue of freedom of religious belief, even after all that violence, destruction and displacement.

By and large, we should welcome the Government’s UK export performance, but I do want to make the case for Northern Ireland. I ask our Minister to implore his colleagues in the Cabinet to act, and to ensure that Northern Ireland can play her full and functioning part in the story of UK global exports, from which we are currently precluded. We have the potential to become so much more in a post-Brexit UK, but we have a great deal to do, and in my opinion that should start with our ending the strong-arming of Europe, embracing true global trade and allowing Northern Ireland to play her part. We deserve that, as loyal British subjects. I love telling people that I am a member of the United Kingdom of Great Britain and Northern Ireland—I am a British citizen, and I am proud to be British—but I want to be proud to be British and have the same equal rights. That is my request.

[Mr Deputy Speaker (Mr Nigel Evans)]

I call the shadow Minister.

Football and Dementia

Jim Shannon Excerpts

Thursday 14th September 2023 Commons Chamber

[Ian Blackford]

Yes, it is. I made the point that all of us who support football clubs can think of people we know. Sometimes they are in the public domain, but in many cases they are not. We are not just talking about those who played top-flight football; we are talking about those who played in the lower leagues and in the amateur game. This goes beyond the high-profile public cases we are talking about. The common link is a disease that we know is a direct consequence of heading a football in a game that we all love.

[Jim Shannon (Strangford) (DUP)]

I am of the same generation as the right hon. Gentleman.

[Ian Blackford]

What?!

[Jim Shannon]

Yes! I can recall well that the footballs in those days were much heavier. They were harder on the foot and on the head, so the dementia and Alzheimer’s that came off the back of heading the ball in those days was much more severe than it is today. I am not taking away from what happens today, but that illustrates the issue of the balls used in football at that time.

[Ian Blackford]

I am grateful to the hon. Gentleman for making that point, because it is a really important one. The damage that could be done to a player by those heavy leather balls, which could be sodden with water, is very real and marked.

I will come to a conclusion, because I know that others want to speak. Let me thank the Professional Footballers’ Associations in both Scotland and England for shining a light and campaigning on this issue. In particular, we need to thank Tony Higgins of the Professional Footballers’ Association Scotland and Dr Adam White in England for their leadership.

When we talk of footballers who sadly are suffering from football-related brain injuries, it goes way beyond the public cases we know about. There are scores of cases ranging all the way from the Scottish Highland league right up to renowned figures in European football. Just as this ailment does not discriminate, neither should the support that we offer these individuals. By classifying dementia in footballers as an industrial injury, we can ensure that these players receive the support they so desperately need. Financial assistance can cover medical bills and provide for their families, who often shoulder the burden of care. Moreover, it is not just about the money; it is about recognising the sacrifices these players made for the sport and the nation, whatever level they performed at. These people went out on the pitch to do a job and to entertain. Now it is our turn to stand by them as they suffer the consequences of their employment.

Both the UK and the devolved Governments must step up and take responsibility for this issue. The health and wellbeing of former football players should not be relegated to the sidelines. The recognition of dementia as an industrial injury is not just a matter of justice; it is a moral imperative. Dementia among football players is a crisis that demands our attention and action. Reclassifying it as an industrial injury is a crucial step toward providing the necessary support to these players. Moreover, it serves as a reminder that the beautiful game should not come at the cost of players’ long-term health.

Let us honour the legacy of those who brought us joy on the pitch by ensuring that they receive the care and recognition they deserve. It is time to take responsibility and make a positive change in the lives of our footballing heroes.

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

First, may I congratulate the right hon. Member for Ross, Skye and Lochaber (Ian Blackford) on introducing the debate, all Members who have made contributions, and those who will reply from their Front Bench? I look forward very much to the Minister’s response. I do not mean to put any pressure or expectation on him, but we are very fortunate to have a Minister who always tries to give us a response that is constructive and helpful. We as MPs are trying to garner a response for our constituents. I know that he will listen to all of the points of view put forward and then respond in a way that helps us.

We have asked the Government to investigate the links between football and sport-related neurodegenerative disease. A 2019 public study revealed that football players were at increased risk of diagnosis of neurodegenerative disease. The risk increase was observed for Alzheimer’s disease and other dementias, but not for all types of neurodegenerative disease, and for outfield players but not goalkeepers. As others have said, if three or four of the 11 who play in a team do not have it but the others do, there must be an issue. The call for this to be classified as an industrial injury is heavily backed in Northern Ireland as well, so it is important for me to be here to give that Northern Ireland perspective.

Last year, some of Northern Ireland’s most iconic footballers reunited to raise funds for Dementia NI at the Spirit of ’82 event in Belfast. It was held in memory of their good friend and teammate, the legendary Northern Ireland manager Billy Bingham, who had been living with dementia for 16 years before he passed away on 9 June 2022. I do not think there is much between my age and that of the right hon. Member for Ross, Skye and Lochaber, but I am old enough to remember Northern Ireland playing at the World cup in Spain in 1982. I had the opportunity to meet all the football players and Billy Bingham, who was an inspiration to me at that early age. He was an inspiration on the pitch as a footballer, and he then became an inspiration as a manager.

I was also in Mexico in 1986, which was before I got married—everything changes when we get married, and we are not able to get away the same as we used to—and on coming home I had the opportunity to get the autographs of the Northern Ireland team and Billy Bingham. A Brazilian football supporter and I swapped a Brazilian shirt and a Northern Ireland shirt, so I have in my office a shirt with the autographs of all the Northern Ireland team of 1986 plus Billy Bingham. I pass that shirt every day and remember very clearly that he was a player who inspired me and inspired us all, yet he passed away as a result of the game he played so well. It is important to be here today to speak on behalf of the Billy Binghams of this world and others who have suffered and passed away.

It is fantastic that high-profile footballers recognise the link. That is also true of retired managers such as Sir Alex Ferguson and Alex McLeish. They were great players who we all looked up to as young boys and young men. That emphasises the importance of investigating this link further and gathering the evidence.

A study has found that footballers are 50% more likely to develop dementia than the rest of the population—that is evidence, factually based and cannot be ignored—fuelling calls to restrict rules for heading a football. Classifying it as an industrial injury would mean that former footballers suffering with the disease would be able to claim certain benefits for industrial injuries that occurred in the workplace. Their employment and the source of their income is the sport that they play. I support those calls, given the evidence, which is becoming clearer. My belief has been reinforced by all Opposition and Government Members who have spoken today. They have been galvanised by what they have heard in their own constituencies and from their own personal experience. The hon. Member for Glasgow South West (Chris Stephens) spoke of what Rangers football club is doing. It is really important to have that in place.

The other evidential base is from football in the States—or soccer, as they call it. I find it hard to get my head around the word “soccer”, because we call it football. In the US, they have imposed guidelines limiting players’ exposure to heading, despite controversy over whether dementia is caused by heading the ball. The fact is that, as has been said, they have introduced precautions. The hon. Members for Easington (Grahame Morris) and for Glasgow South West referred to evidence from the universities. There is quite clearly an evidential base in the United States of America.

[Chris Stephens]

Will the hon. Gentleman give way?

[Jim Shannon]

Absolutely.

[Chris Stephens]

I have always wanted to intervene on the hon. Gentleman. He has mentioned Billy Bingham and footballers in Northern Ireland. I am sure he will agree that it is important to note that the wages in Northern Ireland football are not at the elite level that we read about in all the sensational headlines in the newspapers. Does he therefore agree that access to the industrial injury benefit will help former footballers and their families?

[Jim Shannon]

The hon. Gentleman is absolutely right. The wage structure in Northern Ireland is nowhere near that level. There is some expectation of teams in the Irish league. There have been many buy-outs and clubs with lots of money-making financial investments, but let us be honest: in the years past many people probably played because they loved the sport. I thank the hon. Gentleman for his intervention.

Will the Minister undertake discussions with our American counterparts and share information so as to ensure that we have the most accurate information available on which to base our response to tackling this issue?

[Grahame Morris]

The hon. Gentleman makes some great points about international comparators and co-operation. Earlier he raised the issue of the old fashioned footballs—we used to call them caseys—that would be soaked with water. They were like heading a cannonball. It has been suggested to me in mitigation that in the modern game the footballs are much lighter, but that is not actually true. They may be of a different construction, but they are the same weight and they travel much faster—40, 50 or 60 mph. If I am not mistaken, Peter Lorimer, the Scottish footballer who played for Leeds—or perhaps it was a Manchester City player—had the record for the hardest shot, of more than 70 miles an hour. Imagine being hit on the head regularly—that must cause some damage. I do not think the new construction of the balls is any mitigation.

[Jim Shannon]

The right hon. Member for Ross, Skye and Lochaber (Ian Blackford) and I are of a certain vintage, and therefore probably remember those footballs better than most. The hon. Member for Easington (Grahame Morris) is absolutely right. It is about the force and the distance of the ball, how hard it is hit and the person on the receiving end.

There is no reason that the correlation and the evidential base that everyone has presented should not be considered for industrial payments for our retired footballers. There is much cross-party support, mostly from the Opposition Benches, though that does not take away from the Government side—those who have spoken are of the same mind. There is support from lobby groups and football clubs that have contacted us. The information that we have received over the years from interactions with retired footballers and ex-managers cannot be ignored. We must do our best to support them. This debate is so important to all constituents and footballers.

We have a love of football. We cherish the game of football on a Saturday afternoon. In my house, my wife supports Leeds, my second son Ian supports Chelsea, my third son supports Arsenal, my eldest son supports Ipswich, and I support Leicester. At 10 minutes to 5 on a Saturday it is interesting when the scorecard comes in.

[Mr Deputy Speaker (Sir Roger Gale)]

I call the SNP spokesperson.

Oral Answers to Questions

Jim Shannon Excerpts

Thursday 14th September 2023 Commons Chamber

[Kemi Badenoch]

It is a very interesting idea. Investment zone policy is owned by the Department for Levelling Up, Housing and Communities, so I will raise it with the Secretary of State there and the Secretary of State for Northern Ireland. Officials from the UK Government and the Northern Ireland civil service continue to work closely to explore developing investment zone policy in the country. The lack of a functioning Executive there has, of course, limited the scope and nature of engagement on investment zones. If the Executive is restored, we will work together to progress an investment zone at pace, and if it is not formed, we will set out different plans in due course.

[Jim Shannon (Strangford) (DUP)]

First, I thank the Secretary of State and the Government for the investment conference they held in Belfast over the last two days. It clearly shows a commitment to Northern Ireland, and I am very pleased to see that. When it comes to international investment, we are happy to see in Northern Ireland that Harland & Wolff, which has specialised in ship repair and shipbuilding for some years, has recruited almost 1,000 people in the last few months. What discussions has the Secretary of State had with the relevant Department back home to ensure that Northern Ireland can play its part in the UK shipbuilding industry and therefore benefit from that investment?

[Kemi Badenoch]

The hon. Gentleman is quite right: this is an area where Northern Ireland has a comparative advantage. As we hosted the summit, we all looked out on the docks, and we could see that shipbuilding is integral to the country. UK Export Finance is supporting many of the companies that build ships and want to export this magnificent UK product all across the world. My hon. Friend the Minister for Industry and Economic Security spoke about the UK shipbuilding guarantee. We have been talking about this all week. Maritime investment is key, and if the hon. Gentleman would like further details on what we are doing that has an impact on his constituency, we can provide him with that information.

--- Later in debate ---

[Kemi Badenoch]

That is an excellent question, because it raises something fundamental. The transition to net zero will change the nature of the UK supply chain and, as I said earlier this week, China poses a systemic challenge here. The path to net zero creates a risk of even greater reliance on China, especially when it comes to the battery manufacturing needed for zero emission vehicles. We cannot be naive about that. That is why I am working hard to ensure not only that business competitiveness is at the heart of our transition, but that British national interests come first. We cannot depend on a single country. We must protect our national security, so we are working with like-minded allies. My hon. Friend the Minister for Industry and Economic Security has spoken about our critical minerals strategy and we are working to diversify and build those supply chains. That is what the Atlantic declaration, which I mentioned earlier, is also about. We are very aware of this point, but I think it is important to reinforce it.

[Jim Shannon (Strangford) (DUP)]

I thank the Secretary of State very much for the encouraging positivity of her answers—[Interruption.] At least, most of us are encouraged.

Great Britain is Northern Ireland’s main export market for agricultural goods, accounting for some 64.1% of all exports. What discussions has the Secretary of State had with the Department of Agriculture, Environment and Rural Affairs back in Northern Ireland to ensure consistent, free-flowing agri-trade, given the complications caused by the Northern Ireland protocol?

[Kemi Badenoch]

The hon. Gentleman is right. The first thing we want to see is the restoration of the Executive. When I was in Belfast this week, I spoke to Members of the Legislative Assembly from across the parties, and this is something they repeatedly raise. Businesses are telling us that the Windsor framework is helping, and we are working closely with the ones that still have issues. Such discussions facilitate business conversations and encourage the restoration of the Executive, which would help to drive the changes the hon. Gentleman wants to see.