Alcohol Harm and Older People

Jim Shannon Excerpts

Thursday 15th October 2015 Commons Chamber

[Fiona Bruce (Congleton) (Con)]

It is a pleasure to be here and I welcome the opportunity to speak about the very real and damaging effects of alcohol harm on older people. I am pleased that the Minister for Public Health, my hon. Friend the Member for Battersea (Jane Ellison), is present and commend her for her passionate commitment to ensuring that key public health matters, and a strong preventive health agenda, remain high on the Government’s set of priorities for this Parliament.

I should perhaps clarify at the outset that I am seeking not to promote further legislation or regulation in this sphere, but to highlight the need for more education and information to help people make positive choices about their drinking; to enjoy it but at the same time maintain their own health and wellbeing. We all want to live longer—and we are—but, importantly, we want to live longer and healthier so that we can enjoy those later years. That is why this subject is so important.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Lady for giving way so early in her speech—I indicated to her before the debate that I intended to intervene. The theme that she is talking about, which many Members of the House, including me, would agree with, is this: everything in moderation. In other words, people should be careful about what they take and how often they take it.

[Fiona Bruce]

The hon. Gentleman is absolutely right. Although most people are able to drink in moderation and enjoy the benefits of the socialising and relaxation often associated with drink, for many others it comes with significant costs.

Before proceeding any further, I ought to clarify what I mean by “older people”. Depressingly, I am referring to those of us who are over 45. A huge amount has been done in the past few years to tackle excessive drinking by the young, and encouraging figures show that drinking among young people is falling. I am also referring not so much to binge drinking, which perhaps is what we all associate with drinking among young people, but to harmful drinking. That does not have to mean getting wildly drunk and being hungover the next day; it can be continuous drinking, perhaps every day of the week, which does not allow the body’s organs to have a break from alcohol. People are often unaware that that can be extremely harmful.

Alcohol is a leading risk factor for death and disease in the UK; it is the leading risk factor after smoking and obesity. As a toxin, it is the cause of many acute and chronic diseases, and—Members might be surprised to hear this—it affects almost every organ in the body. The relationship between alcohol and liver disease is well known, but alcohol is also a risk factor in a number of cancers, in cardiovascular disease and in gastro-intestinal diseases such as pancreatitis, and of course it is also a leading cause of accident and injury. On that topic, the all-party group on alcohol harm, which I chair, is currently conducting an inquiry into the considerable impact of alcohol on the emergency services. I look forward to being able to update the House on that work in due course.

Given its associations with so many and such serious health conditions, it is unsurprising that the impact of alcohol on NHS services is considerable. In 2012-13 there were more than 1 million alcohol-related hospital admissions, where an alcohol-related disease, injury or condition was the primary reason for the admission or a secondary diagnosis. As the Minister will be aware, the costs of this to the NHS are estimated to be at least £3.5 billion per year—on its own, more than a third of the Treasury receipts from alcohol—yet estimates for the wider personal, social and economic costs of alcohol vary from £21 billion to £55 billion in England alone. We therefore have much to address.

I must emphasise, though, that recent trends in the decline of underage drinking and drinking among young people are encouraging, which leads me to believe that we can similarly address and support improved positive drinking among older people. The proportion of 11 to 15-year-olds who have ever had a drink fell from 61% in 2003 to 38% in 2014, and the proportion of those who got drunk in the past week declined dramatically from 26% to just 8% in the same period.

Encouragingly, this positive trend is beginning to extend to the 18 to 25-year-old age group, many of whom, interestingly, now choose not to drink at all. That includes my own son, a young man in his 20s. He is a sportsman who simply does not drink. A huge amount of work has been done in this area. I commend the Government and their partnership working with many agencies to educate and support this age group to reduce levels of harmful drinking. One of the successes has been the introduction of street pastors. Another has been the presence of club hosts in clubs and pubs, where people on the “older sister” model, perhaps slightly older than those who might drink irresponsibly, will approach a young person they think is drinking too much and say, “Perhaps you need to think about how much you’ve drunk.”

[Jim Shannon]

I thank the hon. Lady for her comment about street pastors. In the past month, street pastors have started to be active in my constituency, with 13 churches and 43 volunteers coming together on this. That is a very clear commitment by community members themselves to address the issue. I recommend those in any constituency where there are no street pastors to ask the churches to be involved, because the benefits are great.

[Fiona Bruce]

I entirely agree. In my constituency, similarly, there are some excellent street pastor groups.

Voluntary organisations, the drinks industry, publicans and the police, together with local and national authorities, have done a huge amount to address drinking by younger people. With older people, though, much of their drinking is a hidden problem, particularly among the baby boomer generation who often drink at home, many of whom have a dangerously limited awareness of alcohol’s harmful effects. This is a ticking time bomb not just for the individuals concerned but in terms of the public cost of their healthcare in the years to come, with an increasingly ageing population.

According to the Health Survey for England 2013, 10 million people in England drink at a higher level than the Government’s lower-risk guidelines, with serious long-term implications for their health. This is particularly true of older people. Many of those in the baby boomer generation drink on an almost daily basis. The survey found that 14% of 45 to 64-year-olds drank alcohol on five or more days in the past week, compared with just 2% of their younger counterparts in the 18 to 24-year-old group. Alcohol-related hospital admissions among this middle-aged group account for 40% of all alcohol-related hospital admissions and 58% of all admissions for alcoholic liver disease. Tragically, this age group also accounts for the majority of alcohol-related deaths.

Some of the impacts of alcohol are rather less obvious but no less devastating. For example, there is a significant link between alcohol use and the risk of hypertension, which is a factor in a number of related illnesses such as stroke, heart disease and other vascular diseases. Alcohol is generally associated with poorer mental health. In later life, alcohol can be used as a comfort for many of the shocks that people experience in middle age, such as adjustment to life after divorce, redundancy, retirement, children leaving home, or bereavement. Loneliness or depression can also be a factor. These points in life can be very challenging, and they are all associated with higher rates of alcohol use. People need to be made aware that when these life shocks hit them in later life, as they do the majority of us, they need to look out to avoid slipping into harmful drinking patterns because the consequences can be catastrophic in just a few years.

The majority of older people are not aware of the potential damage they are doing to their health or relationships through unhealthy drinking. Office for National Statistics figures show that the greatest number of people who did not drink but now do drink are women over 65, many of whom live alone. That is a particularly concerning statistic that we need to bear in mind. Research by charity Drinkaware and by Ipsos MORI suggests that there is a large group of people who are sleepwalking into poor health. Only 20% of 45 to 65-year-olds think they will have health problems if they continue to drink as they do, yet more than a third are drinking at above the level of Government guidelines. Shockingly, one in nine says that they have already been told by a friend, family member or health professional that they should cut down.

Interestingly, this issue was raised in the previous debate—I do not think the Minister was here—when the shadow Defence Minister, the hon. Member for North Durham (Mr Jones), spoke about needing to address it for those who had been in our armed services, although not in a nanny-culture way. I strongly echo that.

For many, drinking is an everyday occurrence, but when confronted with it, people do not realise that even drinking at relatively low levels but on a continuous—that is, virtually daily—basis can be harmful. Here is a typical comment:

“On reflection when you look back it’s not the fact that I drink to get drunk constantly—that would be a separate issue…but as part of the relaxing process…on a daily basis at home. I just didn’t realise how many excuses I have to…drink.”

Misuse of alcohol has a devastating impact on relationships and families, and on children in particular. That should be given greater prominence. In 2012, a survey by the Children’s Commissioner, “Silent voices: supporting children and young people affected by parental alcohol misuse”, estimated that between 1999 and 2009 more than 700,000 children were affected by parental or other significant adult drinking. It said that parental alcohol misuse is far more prevalent than parental drug use and called for a greater emphasis on it in policy and practice. It is a matter of social justice that we address this, not just for children but for the poorest in our society, because research shows that those who are less well-off are less resilient and more vulnerable to the impact of harmful drinking. Professional people, some of whom drink more, are able to withstand the impacts better.

As chair of the all-party group on alcohol harm, I urge that greater prominence be given to this issue, particularly to the harms caused to older people. A number of strands could be taken forward, alongside other initiatives that I am sure the Minister will consider. One very practical example was given in an excellent report that I had the privilege of launching here in the House last month: “Under Pressure” by the Treat 15 Expert Group, which comprises doctors, nurses and other health professionals. It suggested that whenever an individual has their blood pressure taken, mention could be made, just in those few minutes, of drinking being linked to the risk of high blood pressure, and indicators of the harmful health implications associated with that. It is estimated that about 7.5 million people in this country are at risk of high blood pressure. Just identifying the link with harmful drinking could help a large number of people to improve their health prospects. In those few moments, often when nothing else is done or said, there is a real opportunity, at no cost at all, for the medical profession to provide an important service.

There is also an urgent need for public education on the harmful effects that drinking can have on older people. People need information that is simple, accessible and non-judgmental. There are some innovative resources, such as the Drinkaware app and the Change4Life booze buster programme, which help people make informed choices about their drinking and support them to make a change that could have significant benefits for their health and wellbeing.

We also need more prominent, comprehensive and consistent public health messages from Government, the NHS and Public Health England about the risks of harmful drinking. A report will be released shortly and I look forward to reading its suggestions as to how the issue can be addressed. Given that people are living longer, it is important that they are informed about how to live healthier longer lives.

The alcohol industry also has an important role to play by working in collaboration with others. It is a key partner and has made a great deal of progress working in partnership with pubs and clubs and with the Government. The Government challenged the industry to remove 1 billion units from the alcohol market over two years. In fact, 1.3 billion units were removed—the equivalent, apparently, of the whole nation going dry for one week a year. One of the means by which that was achieved was through providing house wines of less alcoholic strength and smaller glasses. I also commend the industry for the fact that almost 93% of alcohol bottles now warn women that it would be better for them to consider not drinking during pregnancy.

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[Jim Shannon]

There has been talk in the press over the past two weeks about the best message to give to pregnant women about alcohol consumption. Does the hon. Lady agree—perhaps the Minister will say this in her response to the debate—that the best message and policy would be that pregnant women should drink no alcohol whatsoever?

[Fiona Bruce]

That is my personal view. Women have suffered from mixed messages over the past 20 years and more. It would be very helpful to have a clear message. Just six years ago, only 17.6% of products carried a warning label about drinking in pregnancy; the figure is now 93%. I would like it to be 100% and it would be very helpful if the Government gave a clear message that not drinking in pregnancy is probably the wisest choice of all for the woman and her child.

In conclusion, I ask the Government to consider working in partnership with us to develop strategies to reduce alcohol-related harms in older people, just as they have done, with some success, to reduce unhealthy drinking in younger people. No one now questions the role of Government in promoting healthy eating. The same rule could, I hope, be undertaken in future, with similar, commendable vigour, by the Government with regard to encouraging healthy drinking.

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[Jane Ellison]

I will come on to matters relevant to that, but I will also say more about a possible opportunity for a wider debate on this important issue a bit further down the line.

It is important to consider what can be done through secondary care. About 139 district general hospitals already offer some level of specialist alcohol service. I saw for myself such specialist work when I visited Blackpool in 2014. One team told me about how it took the opportunity of people being admitted for something related to alcohol to talk to them about their drinking. They described, with huge understatement, as a “teachable moment” the time when someone is in hospital having suffered, either through a disease or an accident, an unfortunate effect from alcohol. They are right: the idea of talking to people at the moment when they are most receptive is vital.

We would like to have similar alcohol care teams in every hospital to take such opportunities to identify the problem and provide brief advice to patients, as well as medical management. That is again based on the evidence that higher-risk and increasing-risk drinkers who receive brief advice are twice as likely to have moderated their drinking six to 12 months after an intervention—a quick response—compared with drinkers who get no intervention. We want greater use of such really good opportunities. It is not costly or, indeed, lengthy; it is about timeliness.

There are means for people to monitor and manage their own alcohol intake. Technology is increasingly deployed to good effect in a number of areas of personal health monitoring, and alcohol intake is no different. Apps such as the one developed by Drinkaware, which my hon. Friend mentioned, can help people to track how much they are drinking, what it costs them and even the number of calories. We know that personal estimates of weekly drinking are not always as accurate as keeping a log. That is quite well documented, so individuals may find apps and tracking mechanisms particularly helpful.

The Big Lottery Fund, in partnership with the support charity Addaction, is investing £25 million in an alcohol-related harm prevention and awareness programme for the over-50s. Rethink Good Health is a UK-wide programme aimed at those aged 50 and over. My hon. Friend very thoughtfully explored some of the reasons why people may find themselves in such a situation in later life. We would recognise from our constituency case load and perhaps from our social circles how life events can take a toll on health and lead to people drinking more. She mentioned some of them, but I would highlight how such problems can be a driver, and sometimes a product, of loneliness and isolation.

As the House will know, Dame Sally Davies, the chief medical officer, is overseeing a review of the lower-risk alcohol guidelines to ensure that they are founded on the best science. We want the guidelines to help people at all stages of life to make informed choices about their drinking. The guidelines development group, made up of independent experts, has been tasked with developing the guidelines for UK chief medical officers to consider. The group has researched and is developing a proposal on the guidelines, including a UK-wide approach for guidance on alcohol and pregnancy. We expect to consult on that.

I know that that is an issue, and that there are worries about people receiving different advice, so let me say a word about the consistency of health messages. As I have said before at the Dispatch Box, where the evidence base is not completely certain—leading experts to reach slightly different conclusions—there will be a certain level of debate. I appreciate that that can be extremely challenging for the public and that there is a role for trying to provide clarity, but guidance must always be based on the best evidence base.

[Jim Shannon]

The Minister knows that Members of this House, myself in particular, have the utmost respect for her and her position, for what she does and for the guidance she gives. However, the very possibility of uncertainty poses an important question for us. The message must go out from the Minister and from us as elected representatives that during pregnancy, there must be no alcohol at all. That has to be evidence-based, as she said, but there should be the same message so that there is no uncertainty.

[Jane Ellison]

The UK chief medical officers are extremely alive to that challenge and it is something to which they have given considerable thought. Perhaps we will return to it when the guidelines are consulted on. I assure the hon. Gentleman that I have had that conversation and that I have been at pains to emphasise how regularly the issue comes up in Parliament. I know that it is being addressed and that it will be talked about when we consult on the new guidelines.

It is clear that there is more that all of us can do. We have to recognise the contribution that not just individuals, but businesses, communities and local government can make to help people better understand the risks associated with alcohol. I agree with my hon. Friend the Member for Congleton that we need to do more. We are working to ensure that there is a better understanding of the risks.

This is an issue to which we will return. The publication of the new alcohol guidelines will provide a moment in the national debate when we can look at it closely with the public, experts, health professionals and industry. That will be a stimulus to fresh thinking, more public education and debate. Those in Parliament who have a particular interest in the issue will want to participate in that important debate. However, change will not happen overnight. I know that the hon. Members who are here will agree that raising awareness of the issue is key. We have an evidence base to show that, in some cases, raising awareness with individuals is the most important thing we can do to help them.

This debate has been an important opportunity to revisit these important issues. We will return to them in more detail in the coming months. That will be a great opportunity to reflect not just on the good progress that we have seen among younger people, but on the work that we are yet to do.

Question put and agreed to.

Mental Health (Armed Forces Veterans)

Jim Shannon Excerpts

Wednesday 14th October 2015 Commons Chamber

[Dr Cameron]

I thank the hon. Lady for her intervention, and I concur exactly with her sentiments.

From speaking to an ex-military medical officer in preparation for this debate, it appears that some hold the view that the prevalence of PTSD is much higher than acknowledged. Studies also found that the suicide rate was higher than expected for those under the age of 20, and that there was a two to three times higher risk of suicide in men aged 24 or under who have left the armed forces as compared with their counterparts in the general population and those still serving.

It is also recognised that alcohol misuse among UK military personnel is a significant health concern. I understand from Combat Stress that that presents as a significant issue among the clients with whom it works. It describes issues related to the culture of alcohol use in the forces, and the use of substances as a maladaptive coping strategy to manage symptoms of mental health problems.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on raising this matter. Everyone who is in the Chamber tonight is here for a purpose, because we have constituents who suffer from this condition. His Royal Highness Prince Harry said recently that we needed to do more to help those with what he described as unseen injuries. Only by talking about this and helping more can we make the necessary changes.

I want to make a brief point about people who live in the Republic of Ireland but served in the British forces. Some of those people are not receiving the help that they should be receiving, financially and in terms of benefits relating to mental issues and disabilities. For the record, will the hon. Lady ask the Minister to look into that?

[Dr Cameron]

I thank the hon. Gentleman. I should be pleased if the Minister would comment on those matters, which are very specific to Northern Ireland.

Problems arising in the current system appear to relate to a number of issues, including help-seeking, referral, assessment, and access to appropriate treatments. One study reported that only a quarter of those with diagnosed mental health problems had accessed medical help. It has also been reported that stigma and lack of trust or confidence in providers of mental health services represent some of the main barriers preventing service personnel and veterans from seeking help. Stigma concerning mental health problems is particularly problematic for military forces who are required to be physically and psychologically resilient. It has been emphasised to me that the attitudes of the Ministry of Defence are also important in that regard, and that there is a need to be upfront in acknowledging the mental health issues that can arise from military service, as well as the physical risks, in order to prevent such barriers.

--- Later in debate ---

[The Minister for Community and Social Care (Alistair Burt)]

It is standard to congratulate the hon. Member who has secured the debate, but I really do congratulate the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron). This has been a very interesting 18 minutes, and my only criticism is that we should have had at least an hour and a half, or maybe three hours somewhere else, but I suspect that might happen. I also congratulate the hon. Lady on raising this subject at Prime Minister’s questions today. If she permits, may I thank her for her service to the NHS and those in difficulties and thank her husband for his service to the country?

I am delighted to be joined by the Under-Secretary of State for Defence, my hon. and gallant Friend the Member for Milton Keynes North (Mark Lancaster), who has also seen active service and we have just heard from my hon. and gallant Friend the Member for Plymouth, Moor View (Johnny Mercer). I say to them that there are times when their Minister feels very humble in that their collective experiences outrank mine very considerably. So I will do my best to respond to the debate. Because of the length of the initial speeches, I have slightly less time in which to do that, but that is all right because I want to make some changes to what I was going to say.

I should like to set out what the Government are doing. In doing that, I do not intend to suggest that what has come forward up to now is not valid, relevant, important or challenging to the Government. It would, however, be fair of me to put on record what is going on, although it is palpably not enough. If the hon. Member for East Kilbride, Strathaven and Lesmahagow, with her experience, needs more and if my hon. Friend the Member for Plymouth, Moor View, with his experience, needs more, then it is clear that whatever we are doing—good though it is, and better than it was—is not yet meeting the demands and the needs. It is also clear from the comments of other Members tonight that it is not yet meeting the demands of the House. My hon. and gallant Friend from the Ministry of Defence and I have listened carefully and there will be more to be said.

The Government are fully committed to continual improvement in the treatment of mental health conditions for veterans and the general public alike. We are rightly proud of the courage and dedication of our armed forces. For those who have been injured either physically or mentally, it is our duty to ensure that they continue to receive the very best possible care. As Members have already said, the vast majority of those leaving the armed forces do so fit and well, having benefited from their time in the forces. Members of the armed forces are not significantly more likely to develop mental health issues than those in other professions, but support and clinical care that are geared to the specific needs of veterans need to be available.

Armed forces and veterans mental health provision has vastly improved since the publication of the landmark report “Fighting fit” in 2010. The report was produced at the hands of my hon. Friend the Member for South West Wiltshire (Dr Murrison), who recommended that there should be 30 mental health professionals across England to provide services to veterans. With 10 veterans mental health teams in place across England, we now have significantly more than the 30 professionals recommended.

In deference to the position of the hon. Member for East Kilbride, Strathaven and Lesmahagow, let me now say a bit about Scotland’s provision. Scotland is proud of its commitment to improving mental health, including for veterans and their families. Visibility and awareness of mental health issues have substantially risen in the nation over the past decade. That echoes something that my hon. Friend the Member for Plymouth, Moor View said. There is greater awareness following long-standing campaigns against stigma. We have not gone as far as we need to go, but it is easier for people to talk now. For those with very difficult conditions, however, those are easy words, and it is still very difficult for them.

There is better public awareness of mental illness, suicide prevention and faster access to NHS services and other sources of help. Veterans and their families have unhindered access to all NHS services, enhanced by priority treatment where that applies. Evidence-based care and treatment are provided across community-based settings through support from primary care, with specialist or hospital in-patient services provided as appropriate.

In partnership with NHS Scotland and Combat Stress, the Scottish Government recently renewed funding for the provision of specialist mental health services at the Hollybush House Combat Stress facility in Ayr, for veterans resident in Scotland. The sum of £1.22 million a year over the three years to 2018 will fund a range of specialist clinical, rehabilitation, social and welfare support at the facility. Evidence-based treatment programmes include an intensive post-traumatic stress disorder programme; trans-diagnostic and stabilisation; and anger management programmes.

NHS Lothian secured £2.5 million of armed forces covenant LIBOR funding to support the commitment, and established Veterans First Point Scotland to work with local partnerships to explore how the strengths of the Lothian service could be delivered in other localities. Over the past year, work has been taken forward in 10 health board areas across Scotland to assist each local area to establish key partnerships, identify premises, plan requirements and recruit and select staff. This work continues, with the service in Tayside now open with others to follow.

I want to demonstrate that England, too, is recognising and trying to respond to the needs of veterans. Before I say a bit about that, may I thank the hon. Member for Strangford (Jim Shannon) for raising the issue in relation to the Republic? I do not know the answer, but I will find out. I recognise the point that he makes.

Underpinning all that I am saying is the demand for more research. There is some good research. The King’s Centre for Military Health Research has done some good work in identifying the categories of those who might be more at risk. Reservists and their particular issues came up, as did the other groups of veterans, particularly those who have been back for some time. There are ways of picking up those issues, and I will say a little more about that.

NHS England spends £1.8 million a year on mental health services for veterans including the 10 veterans’ mental health teams. Up to £18 million funding is in place to provide the Combat Stress six-week intensive post-traumatic stress disorder programme for veterans, with an additional £2 million of LIBOR funding being provided to Combat Stress to help veterans with alcohol problems, which is a key indicator of problems. Help for Heroes has received £2 million of LIBOR funding for its “hidden wounds” work, offering low-level improving access to psychological therapies services to veterans. Subject to the spending review, a further £8.4 million will be provided over the coming five years to help the most vulnerable veterans who have mental health problems.

[Jim Shannon]

The Minister mentioned LIBOR funding, and that is something that I have been pursuing through the Defence Committee and other ways. We have been seeking to have some of that LIBOR funding available for Northern Ireland to provide a rehabilitation centre for the many people who have served and who will continue to serve. None of that has been forthcoming to the Province so far. I understand that the Minister cannot give me an answer today, but perhaps he can look at the matter and come back to me.

[Alistair Burt]

My hon. and gallant Friend from the Ministry of Defence says that there is money available in a bidding programme and he will write to the hon. Gentleman and see what more can be done in relation to that.

I want to say two things as we run towards a conclusion. Many of the servicemen affected will of course be treated by the NHS in the course of ordinary medical treatment. The so-called talking therapies from the IAPT programme have been particularly successful. It is important to ensure that the particular needs of veterans are catered for in this programme. Work has been under way to ensure that that is done. The IAPT programme has been very successful. For the first time, we have standard waiting times and access targets. That will help veterans too.

NHS: Financial Performance

Jim Shannon Excerpts

Monday 12th October 2015 Commons Chamber

[Mr Speaker]

We are straying a tad from the relatively narrow terms of the urgent question, to which I know colleagues will be eager to return, and none more so than the hon. Member for Strangford (Jim Shannon).

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for his statement. This is a question for Members across the whole of the United Kingdom of Great Britain and Northern Ireland, where there are pressures on the NHS, because while we all have passion and love for the NHS, we must ensure that there is enough money for it. Will the Minister confirm the amount of money that will be there for accident and emergency departments and say what will be done on waiting lists?

[Ben Gummer]

The hon. Gentleman will know that funding for the NHS in Northern Ireland is not within my bailiwick. I therefore point him in the direction of the Northern Ireland Office and his Assembly. As far as England is concerned, I confirm that we will deliver not the £8 billion that the NHS has asked for, but £10 billion over the course of this Parliament.

Adult Stem Cells and Life Sciences

Jim Shannon Excerpts

Tuesday 15th September 2015 Commons Chamber

[Mr Burrowes]

Absolutely, and I will come on to that. The quality of the data that can be shared is important, and the key ask of the Government is to support the call for a national stem cell transplantation network, which will help in that.

However, Professor Raisman’s pioneering work remains underfunded. He hit the headlines in 2014 when Polish surgeons, in collaboration with scientists in London, enabled Darek Fidyka, a man paralysed from the chest down in a knife attack, to walk again using a frame. Professor Raisman said that the achievement was

“more impressive than man walking on the moon.”

Sir Richard Sykes, chair of the UK Stem Cell Foundation, said:

“To fully develop future treatments that benefit the 3 million paralysed globally will need continued investment for wide scale clinical trials.”

We are trying to get to precisely that clinical basis.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on securing this debate on what is an important subject. Given that a third of adults and a fifth of children who receive a stem cell transplant do not survive the first year, does he agree that we need better post-care provision, perhaps by establishing a national care pathway for patients for at least five years after transplant?

[Mr Burrowes]

I do, and I want to look at the long-term outcomes.

My co-chair on the all-party group on stem cell transplantation, the hon. Member for Alyn and Deeside (Mark Tami), is present, and our group has been looking at some of the outcomes of research. Last year we joined together with the all-party group on medical research and heard from a number of experts, not least Dr Rob Buckle, director of the UK Regenerative Medicine Platform. He said that the major challenge which remains is translating the basic science into the clinic. He said that we are still at least 10 to 15 years off routine clinical use of stem cells.

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[Mr Burrowes]

Absolutely. I pay tribute to the Anthony Nolan trust, which has been supportive of the all-party group for many years. It has worked hand in hand with the Government on providing more collections, and its registry is world renowned for providing support and saving lives. The trust is making the call, as we are doing here, that we could do much more with high-quality research to support better long-term outcomes for patients.

I would like to highlight the success of the trials acceleration programme, which was established by someone the Minister knows well, Professor Craddock at the University of Birmingham. He is also connected with the Anthony Nolan trust. The early phase trials involve an initiative to speed up the pace of new clinical trials using a hub and spoke model to ensure that trials are conducted efficiently. The hub co-ordinates trial centres at hospitals around the UK and deals with bureaucracy and regulatory issues. The trials acceleration programme has successfully overcome the main barriers to research—namely, inadequate research infrastructure and inefficient data collection. I suggest to the Minister that this programme should be replicated in the form of a national stem cell transplantation trials network.

[Jim Shannon]

I understand that one in eight people in the UK fail to find a matching donor. That number increases dramatically, however, for people in black, Asian and minority ethnic groups. Does the hon. Gentleman agree that we should prioritise support for further research into stem cell transplantation and the factors that affect transplant survival rates?

[Mr Burrowes]

I agree with the hon. Gentleman on many of these issues. Progress has been made on collection rates, particularly among the black, Asian and minority ethnic communities, but we need to find better ways to do this. As I said, one in four people are unable to find a match. My hon. Friend the Member for Salisbury (John Glen) is himself a donor, and he can speak for himself on this. I know that others present in the Chamber have family members whose lives have been saved by people donating. I want to send out a message from the debate tonight for people to donate and to be part of the registry, so that they can help to save lives.

Contaminated Blood Products

Jim Shannon Excerpts

Wednesday 9th September 2015 Westminster Hall

[Ms Ritchie]

Thank you, Mr Owen.

To set the context for this debate, it is my duty and responsibility to acknowledge the very good work of the all-party group on haemophilia and contaminated blood. One of the joint chairs of the group, my hon. Friend the Member for Kingston upon Hull North (Diana Johnson), is here today for this debate. The all-party group published its report on contaminated blood products in January and clearly outlined the requirements of Government in respect of this very vexatious issue.

I secured this debate to highlight the cause of the victims of contaminated blood and blood products, in particular my constituent, Brian Carberry, a haemophiliac from Downpatrick in South Down. Along with all the other victims, he has waited too long for truth and an acknowledgement that the Government, through the Department of Health, imported such contaminated blood products from the USA in the 1970s and 1980s. The victims have waited a long time for proper compensation and access to drugs that are currently being assessed by the National Institute for Health and Care Excellence, and they need those drugs before stage 2 of the illness, which causes liver dysfunction, sets in.

I hope the Minister can today provide a detailed outline of how she will address this issue once and for all. Two thousand people touched by this tragedy have already died, and that number is rising, as people die waiting for the Government to make a final determination. I urge the Minister today to bring this prolonged delay to an abrupt close with a programme of action, including a commencement date for the consultation, which was announced back on 17 July, and the moneys to help those who have endured endless pain, suffering and anxiety for so many years.

In the ’70s and ’80s, around 7,500 people were infected with hepatitis C or HIV as a result of treatment with blood products provided by the NHS. Many of those people were being treated for haemophilia. Those viruses did not just transform their own lives; their families’ lives were also turned upside down, and some of them, including my constituent, can no longer work.

The several thousand people treated with contaminated blood and blood products by the NHS have been denied the real financial security, and the health and social care that they need. The support currently in place is only partial and does not offer the full and final settlement that those affected and their families need to live with dignity, and it falls far below the equivalent compensation in the Republic of Ireland. The development in support, financial and otherwise, over the years has been haphazard and has been delivered much too slowly. Contaminated blood victims already face substantial financial demands because of the nature of their infections and the inadequacy of their financial compensation.

One lady suffering from the infusion of contaminated blood products told me last week that some sufferers are denied even the basic stage 1 payments, even though they have a weakened and compromised immune system, and suffer chronic fatigue, fibromyalgia, depression and unexplained rashes, with a potential link to breast cancer for women. This lady also had an ileostomy, as her bowel burst, and she had a stillborn child, with all the attendant trauma attached to such an incident. Unlike other contaminated blood patients, she has been denied stage 1 Skipton fund payments. Needless to say, she did not receive the Caxton payments either.

[Jim Shannon (Strangford) (DUP)]

Between 1970 and 1991, almost 33,000 people were infected with hepatitis C; between 1978 and 1985, 1,500 haemophiliacs were infected with HIV, and some of them were co-infected with hepatitis C as well. The issue of compensation is a big one, and I congratulate the hon. Lady on bringing it forward for consideration—the number of people here in Westminster Hall today is an indication of its importance. Does she agree that, regardless of the stage of a person’s illness, compensation should be given to them?

[Ms Ritchie]

I thank the hon. Gentleman for his very helpful intervention. That is the case that I am trying to make—that there needs to be a full and final end to this issue, with a good story for the people affected, not only through compensation, but with proper access to the right drugs that will help them and ease their journey.

In the Commons on 25 March, the Prime Minister pledged to help “these people more” after the publication of the Penrose report, promising that “it will be done” if he was re-elected. He was re-elected, but that inquiry, which scrutinised events between 1974 and 1991, has been branded as failing to get to the truth by Professor John Cash, who is a former president of the Royal College of Physicians of London and a former director of the transfusion service.

Dementia Care Services

Jim Shannon Excerpts

Wednesday 9th September 2015 Westminster Hall

[Edward Argar (Charnwood) (Con)]

I beg to move,

That this House has considered dementia care services.

It is a pleasure to lead this debate—the first in my name since my election—under your chairmanship, Mr Davies. It is also a pleasure to debate with a Minister whose commitment to this cause is well known, on a subject of such importance. Indeed, its importance grows daily.

I am particularly pleased to see my hon. Friend the Member for Wealden (Nusrat Ghani) next to me. I hope that she plans to speak in this debate, because her work in her constituency on this subject, and the depth of her knowledge, is well known and will be of great benefit to the House.

Dementia is incredibly cruel; it can take a person away from you even while they are still with you. It is estimated that there are around 850,000 people with dementia in the UK; that 21 million people have a family member or close friend with dementia; and that a third of people over 65 will develop it. The majority of those 850,000 people are over 65, but an estimated 17,000 people below that age have dementia. In my constituency of Charnwood, it is estimated that just over 1,000 people have dementia. All of this—put aside the human consequences for a moment—is estimated to cost around £23 billion per annum, with a huge proportion of that being met by families, either through care that they engage or through the free hours of care that the 670,000 voluntary carers provide. The challenge before us is huge.

Significant progress on dementia has been made in this country in recent years. However, while we as a society have made significant strides in improving our longevity and our ability to fix and patch up our physical selves through the medical profession, our understanding of and care for the mind have fallen behind somewhat. Dementia poses a massive financial challenge to our country, as people live longer—a good thing, but a partial consequence is an increase in the number of dementia cases.

The last Labour Government should be rightly proud of their work in bringing forward the first national dementia strategy, and I pay tribute to them, through the shadow Minister, for that far-sighted step. It is a baton that the current Government, and particularly this Prime Minister, have seized with vigour; there has been the Prime Minister’s challenge on dementia 2012, the G8 dementia summit, and the Prime Minister’s 2020 challenge. All this is hugely positive, and dementia is an issue on which there is considerable consensus in all parts of the House, and among all the parties represented within it. However, we must not think for one moment that we have done enough, nor lose the momentum built up thus far.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on bringing this matter to the House for consideration. A great many of us across my constituency of Strangford and the whole of the United Kingdom of Great Britain and Northern Ireland know people who suffer from dementia. Just last week, I had the opportunity to go to what is referred to as a memory café, which is organised by the Alzheimer’s Association, which is a wonderful organisation. I met some wonderful people, as well as their carers and families. Does he recognise the good work that the Alzheimer’s Association does? Does he feel that now is the time to not only raise awareness of Alzheimer’s but commend the Alzheimer’s Association for its work?

[Edward Argar]

In addition to the hon. Gentleman’s many talents, which are well known in this House, he appears to be a mind-reader, as I was about to come on to that subject, having visited a similar memory café on Monday. He is absolutely right to highlight and pay tribute to the work of such places. On Monday, I went to the Syston community centre, where our local Alzheimer’s Society group was holding its regular Poppies memory café session for about 30 carers and people with dementia. As I am sure the hon. Gentleman did on his visit to his local memory café, I met some amazing people and it was a fantastic session. My memories of that session, and the lessons I learned from it, remain with me; I continue to reflect on them. However, across the UK, including in my region—the east Midlands and Leicestershire—the access to and coverage of such vital services remains patchy; that was a message I got loud and clear from the people I spoke to. As I suggested, that session left me in no doubt about the vital role of dedicated and passionate carers, including the amazing people whom the hon. Gentleman and I met, in helping people with dementia.

[Edward Argar]

Yet again, it appears that another hon. Member has the facility of reading minds and anticipating speeches, because I was about to say that there remains too little understanding of dementia in our communities, despite the progress made, and dementia-friendly communities and workplaces can play a hugely important role in supporting both those who have dementia and those who care for them.

I encourage the Minister to push all Government Departments to become dementia-friendly workplaces, and to keep talking about dementia and raising awareness of it. I also encourage her to keep the NHS talking about it. I know that other hon. Members—not least the shadow Minister, the hon. Member for Oldham East and Saddleworth, who is chair of the all-party group on dementia and possibly the only dementia champion in this House—will continue to raise these issues, as the shadow Minister has done over many years.

A recent survey showed that 25% of 18 to 25-year-olds are keen to learn and understand more about dementia, as opposed to only 15% of those aged 55-plus; that was a 2012 YouGov survey, so it is relatively recent. While it is encouraging that young people are keen to understand and learn more about dementia, those figures are still far too low.

[Jim Shannon]

One thing that I became aware of after visiting the memory café last week and speaking to some of the people there—by the way, the Big Lottery Fund was one of the funders of that café, so it is doing good work—is that the age of those being diagnosed with dementia and Alzheimer’s is starting to fall. There are some people in the 40-to-50 bracket who have dementia, which worries me. Does the hon. Gentleman feel that there is anything we can do to raise awareness of that issue?

[Edward Argar]

The hon. Gentleman makes a valid point. Just last Saturday, I was at a gala in Anstey, which is a village in my constituency, and a man came up to talk to me about this issue. He said that a lot of emphasis is put on those in their 60s or 70s who develop dementia, but he told me about a lady who had developed it very early in life, which creates a whole new set of challenges around children, paying mortgages and the support that should be in place but is not always there. I will come on to the support that is or is not in place shortly.

The second part of the picture is about diagnosis and care. Diagnosis rates have improved. In 2011-12, only 45% of people with dementia received a formal diagnosis, but Department of Health figures suggest that the figure is now up to 59%, which is real progress. I know that 66% was the target set for the end of this year, but can I encourage the Minister to go that little bit further and press for a 75% target for diagnoses by 2017? That is ambitious but achievable, and if we do not set ambitious targets we will not achieve them.

However, diagnosis is only the start. Too many people tell of being diagnosed and then receiving no information or support, or only very limited information or support. In a recent Age UK survey, 89% of those surveyed said that they did not feel they had enough information about dementia. We need to improve GPs’ understanding of dementia care; many GPs are fantastic, but that is not universal. We need to ensure that after a diagnosis, people and their families receive information on “What now?”, as well as support. What steps do the Government propose to take to create minimum mandatory standards to ensure that everyone with a diagnosis receives swift signposting and advice from dementia advisers and a proper support package for them and their carers, possibly through the NHS outcomes framework?

We all know—all the research shows this—that once someone is diagnosed with dementia, if they are to continue to lead a full life, it is best for them to be able to live independently at home with their family, but if they are to do that, we must ensure that carers are cared for and supported, and that support plans are in place—as much for the carers as for any individuals with dementia. A recent pilot in Norfolk on the use of Admiral nurses—they are the dementia equivalent of Macmillan nurses, and although they are sadly rather less well known, they do a fantastic job—saved more than £400,000 and provided a strong local support service for carers and people with dementia. What consideration have the Minister and the Department given to how that might be made more widely available? What support can be given to local authorities in that respect?

We are all aware of the funding pressures faced by local authorities—not least my own, Leicestershire. It gets one of the lowest per-head funding settlements in the country, and I hope that that can be reviewed and revisited in this Parliament, with rural councils being given a fairer share. While I would not presume to burden the Minister with responsibility for dealing with the local government finance settlement as well, what progress has been made nationally on developing integrated dementia care pathways, which can go some way to alleviating financial pressures?

While care and support to stay independent at home are key, there are times when people with dementia have cause to be admitted to hospital, and here the picture is by no means universally good. According to a recent survey, 41% of hospitals do not include dementia awareness training in staff inductions, and only 36% have a care pathway in place. Many people with dementia still have real problems when they are admitted to acute care. More research into the quality of personalised care for those with dementia, particularly in hospitals, would be immensely valuable. It is estimated that a quarter of hospital beds are occupied by people with dementia, although they might not necessarily have been admitted for dementia. On average, such people have a 20% longer hospital stay than others.

While some hospitals have made progress in having dementia-friendly wards, it simply is not enough. We should have hospitals that are dementia-friendly in their entirety. We often hear of instances of people with dementia not having that noted on their hospital records, meaning that no allowance has been made for it. We also hear of carers and partners not being allowed to stay with relatives with dementia in hospital, which often leads to acute anxiety and distress among those patients at being in an unfamiliar environment without any familiar faces around them. I hope that Simon Stevens and the NHS can look at that.

The national dementia strategy and the Prime Minister’s challenges on dementia for 2015 and 2020 set out an array of targets and objectives. The key to success, however, will be proper implementation to deliver clear and focused outcomes that are measured, monitored and reported. Will the Minister update the House on the implementation plan to achieve the objectives that we all welcome, and to ensure that dementia care gets its share of the very welcome additional funding that the Government have pledged to the NHS as a whole? Specifically, as we look at how to improve care and support, 37 NHS vanguard sites are piloting new care models, but only three make specific mention of dementia. Will she consider adding to that number? The National Institute for Health and Care Excellence is updating the 2006 clinical guidelines on dementia. That work is due to be completed in September 2017. Will she make representations to NICE on updating the dementia quality standard as part of that? It is an important tool in driving up NHS standards in this area.

The third and final part of tackling dementia is research. We have seen some encouraging early signs over the summer that finding a way of slowing down the progress of dementia might be that little bit closer. There is still a long road ahead for that research, but it is a reminder of the importance of a continued focus.

--- Later in debate ---

[Tom Tugendhat (Tonbridge and Malling) (Con)]

I declare an interest as a proud supporter of the Dementia Friends movement, which has done so much in my constituency. I praise in particular Mrs Christine Parker, whose work in bringing the Dementia Friends message to so many in Tonbridge has echoed across other areas. I draw inspiration from her for my remarks, which I hope I can make on her behalf as well.

The rising demand on the NHS in my community is not unlike that in others. One in three people in my constituency is over 65, so the pressure on dementia services is naturally high. Indeed, 1,600 people in my community have dementia, and in the west Kent NHS region, 322 are under 65 and therefore count as young dementia sufferers. As my hon. Friend the Member for Charnwood (Edward Argar) so eloquently put it, when we think about dementia and old people, we usually think about people for whom it is an end-of-life event, but for too many in our society it is not—it is part of life. It is something with which individuals, families and communities—indeed, our whole society—will have to live as they experience this terrible disease.

It is important that we work together, because this is not something that central Government can solve alone; nor, indeed, can the devolved Administrations or local government. It requires a fully joined up approach. The work by a lot of third-sector organisations to bring together the community at all levels has been essential. I particularly praise the organisations working in my part of Kent: Age UK, Crossroads, the Alzheimer’s Society and many care homes.

[Jim Shannon]

In his speech, the hon. Member for Charnwood (Edward Argar) mentioned the need for more research and development. There have been massive steps forward in the development of medication that can delay the onset of Alzheimer’s and dementia in some cases. Although that is a wonderful step forward, the cure is not yet here. Does the hon. Gentleman feel that, along with all the good work that the Government are doing, there should be more partnerships with the pharmaceutical industry to ensure that we can take more giant steps forward?

[Tom Tugendhat]

I can confirm that the hon. Gentleman is not reading my mind—I had not thought of those points. He makes a very important point about tying together with the pharmaceutical industry. I would also urge tying together with universities throughout the country, because many of them across the nation have done incredible work on this issue. I urge my hon. Friend the Minister to look hard at what more can be done to partner up.

Many of the issues have already been covered today so eloquently by Members, so I will just highlight one area that I feel is somewhat tragically overlooked. As we increasingly see younger people suffering from this terrible disease, we must recognise that their needs are different. We are talking about not only old people who may also suffer from other weaknesses and might not be going out as much as they once were, but younger people who rightly expect to enjoy some form of independence in their life. Indeed, through medical treatment, older people are, thank God, much stronger and fitter than they once were and rightly continue to enjoy active lives for longer and longer.

As a society, we should do more to encourage dementia-friendly transport. In my constituency, we have been working towards dementia-friendly communities, whether towns or villages, and we have had some success in different areas. In fact, some places have developed a dementia-friendly high street and various other spaces. Nevertheless, I feel we have not yet got dementia-friendly transport right. Whether we are talking about taxis, buses or trains, the ability to be able to put someone with dementia on a form of transport and know that the people on board will be aware that there might be an issue, allowing people with dementia to maintain some level of independence, is essential if we are ever to achieve the result we wish for: people with dementia living happily and comfortably as part of our society.

Finally, when I learned about dementia, what struck me most was the importance of emotion, which we too often forget when we medicalise and use too much science. When we deal with people in our communities who have dementia, it is important to remember that even if they struggle to understand who we are, the community they are in or the actions they are taking, the one thing that will stay will them, which we must really value, is the emotional response. We must remember that that will live with them for a lot longer than any confusion, and we must make sure that we play our part as individuals—not just as a society—in ensuring that that emotion is positive.

NHS Reform

Jim Shannon Excerpts

Thursday 16th July 2015 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right to draw attention to the fact that our manifesto commitment was to a true seven-day service across hospitals and general practice. That is why, a few weeks ago, we announced in our new deal for general practice plans to recruit 5,000 GPs so that we can increase capacity and make sure that people can get routine appointments in the evenings and at weekends.

[Jim Shannon (Strangford) (DUP)]

I welcome the NHS Pay Review Body’s report on seven-day services. There is a compelling case for such services, but contractual barriers to reform need to be addressed. Today’s statement refers to England and Wales, and the Northern Ireland Assembly has devolved responsibility for health. Will the Secretary of State consider having contact with the other UK regions, to assist them in engaging with national bodies based here on the mainland on how this important matter can be taken forward?

[Mr Hunt]

I am very happy to do that. We can learn a lot from each other across the UK about how things are implemented. I thank the hon. Gentleman for his interest in English health matters, because there is always a good read-across.

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 7th July 2015 Commons Chamber

[Mr Speaker]

Extreme brevity is now required. I call Jim Shannon.

[Jim Shannon (Strangford) (DUP)]

A recent study suggests that the NHS is starting diabetics on insulin much later than in other countries. What will the Department do to address that issue?

[Jane Ellison]

I thank the hon. Gentleman for his interest in this important subject. As he knows, we are looking at care right across the diabetes pathway, with a view to building on the first ever at-scale national diabetes prevention programme. I will take up the issue he raises and look at it in the context of all the other aspects of diabetes care we are examining.

Fibromyalgia

Jim Shannon Excerpts

Wednesday 1st July 2015 Westminster Hall

[Alok Sharma]

Yes, of course; the hon. Gentleman is absolutely right. I shall go on to provide more details of what is going on locally and perhaps what we ought to be doing nationally.

I first learnt about the condition almost by accident a few years ago, through a chance conversation with some constituents. Since then, through the work of the excellent Reading fibromyalgia support group, which meets regularly in my constituency, I have been able to learn more about fibromyalgia and meet many of the people locally who are trying to cope with the condition, as well as medical practitioners who are focused on helping sufferers.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for bringing this issue to Westminster Hall for consideration. In my constituency, many people have come to me with disability living allowance claims, which is where my interest in and knowledge of fibromyalgia comes from. What concerns me greatly as a result of the correspondence and communication that I have had with my constituents is that GPs seem not always to be aware of the symptoms of fibromyalgia. That means that the figure for diagnosis in Northern Ireland is only 3%, yet we have a significantly larger number of people who have the disease. Does he think we need greater awareness among GPs to start with and then we can address the issue?

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Life Sciences (George Freeman)]

I congratulate my hon. Friend the Member for Reading West (Alok Sharma) on securing a debate on this important issue. In his constituency, he has shown great support for his local fibromyalgia patient group by advocating on its behalf, raising money and raising the profile of the disease, which is so debilitating for its sufferers. He has helped the group to continue its important work of improving awareness of the condition and providing advice to patients and their families. I pay tribute to the work of FMA UK, other fibromyalgia charities and the many patient support groups around the country who work tirelessly to raise the profile of the disease and support those who are affected by it. I welcome today’s merger of FMA UK and FibroAction, which will help to give a stronger patient voice to those who are affected.

Fibromyalgia is an incurable musculoskeletal condition of unknown cause that can have a debilitating impact on those who are affected. Although no exact figures are available, research suggests that fibromyalgia affects around 2.5 million patients in the UK, the majority of whom are women over the age of 40. Fibromyalgia symptoms affect the soft tissues, muscles, tendons and ligaments of the body and result in widespread and variable pain throughout the body. Poor-quality, non-refreshing sleep contributes to an ongoing cycle of chronic pain and fatigue, and, in some cases, poor concentration and short-term memory problems. Irritable bowel syndrome, restless legs, head and neck pain and sensitivity to temperature change are also associated symptoms of fibromyalgia. The symptoms and their severity differ from patient to patient.

Diagnosing the symptoms of fibromyalgia can be challenging for GPs. Some 20% of the general population consult their GP about a musculoskeletal problem each year, which amounts to more than 100,000 consultations a day. The symptoms of fibromyalgia are common to other conditions such as rheumatoid arthritis, lupus and chronic fatigue syndrome. In addition, patients with fibromyalgia can often visibly appear well, despite their symptoms. GPs face a further obstacle because there is no diagnostic test that accurately identifies the condition. A diagnosis is usually made via a process of diagnostic investigation to exclude other potential causes of the patient’s ill health. It is, therefore, important that clinicians have the training, tools and resources to help them identify fibromyalgia symptoms when a patient presents.

Musculoskeletal conditions are a key part of the generalist undergraduate MBBS medical curriculum. The General Medical Council requires that the MBBS curriculum provide enough structured clinical placements to enable students to demonstrate the outcomes for graduates across a range of clinical specialties, including musculoskeletal health. Musculoskeletal health is also a key component of GP training, and the Royal College of General Practitioners’ curriculum statement on musculoskeletal conditions sets it out that GPs should be able to diagnose and manage common regional pain syndromes such as fibromyalgia.

In addition to clinical training and experience, GPs have at their disposal a number of tools and resources. They include: the Map of Medicine, an online evidence-based guide and clinical decision support tool available to GPs and other healthcare professionals in the NHS, which has a fibromyalgia and chronic pain pathway, and helps clinicians to identify the symptoms and make the right referral; a free e-learning course on musculoskeletal care, including fibromyalgia, developed by the RCGP and Arthritis Research UK, which aims to improve skills in diagnosing and managing musculoskeletal conditions; NHS evidence services, which provide access to a vast online repository of clinical knowledge and guidance covering a wide range of conditions, including fibromyalgia; and a fibromyalgia medical guide for health professionals developed by FMA UK.

Once a patient is diagnosed with fibromyalgia, a number of treatment options are available to them. In the absence of a cure, relieving pain and restoring quality of life are the primary clinical goals. Treatment options include pain relieving medication, physiotherapy, dietary and exercise advice, counselling or cognitive behavioural therapy, and self-management programmes to give patients the skills and confidence to manage their condition. The routine assessment and management of pain is a required competency of all health professionals. Many patients can have their fibromyalgia successfully managed through routine access to locally commissioned services via GPs, and community and secondary care services. I will turn to my hon. Friend’s point about specialist clinics in a moment.

[Jim Shannon]

The hon. Member for Reading West (Alok Sharma) and I asked how we can raise awareness within the GP profession to ensure that GPs understand the symptoms of fibromyalgia and diagnose it earlier. As I pointed out in my intervention, only 3% of people in Northern Ireland have been diagnosed with the condition, but the number of people who suffer from it is far larger. There seems to be a gap between those who have been diagnosed and those who have not. Is that because GPs are not really aware of the condition? How can we make them more aware?

[George Freeman]

The hon. Gentleman makes an excellent point, and he is helping to raise awareness today. I will pass on the points made today to the team at NHS England with responsibility for this issue. The answer to the question on awareness is to support debates such as this, and to promote the work of the charity and the patient advocacy groups.

The routine assessment of pain is a required competency for all healthcare professionals. However, patients who remain in high levels of pain after conventional approaches to treatment have failed are able to access specialised pain services, which are nationally commissioned by NHS England. Patients referred to such services receive multidisciplinary team care from clinicians with expertise in pain management.

Operational Productivity in NHS Providers

Jim Shannon Excerpts

Wednesday 1st July 2015 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

Thank you, Mr Pritchard. I apologise for having had to step out of the Chamber for a minute or two. I expected the speech of the hon. Member for Bristol South (Karin Smyth) to be a wee bit longer. It is always a pleasure to speak on these issues, and I thank the hon. Member for Hendon (Dr Offord) for bringing this subject to the House for our consideration.

The Carter report is important. Members will know that health is a devolved matter in Northern Ireland, and the responsibility for health falls clearly on the Northern Ireland Assembly and my party colleague Simon Hamilton, but it is important that we consider the issues and the recommendations in the report. I will speak to that in a few minutes, but first I pay tribute to all those who, despite the numerous difficulties facing us, make our NHS one of the premier care services in the world.

The tireless work of the doctors, nurses, surgeons, technicians, pharmacists, auxiliaries, cleaners, cooks, porters and those who work in admin behind the scenes has not gone unnoticed. I am sure everyone here would start by thanking them for their contributions, their efforts and the exhausting work they do. I thank them for their smiles to the patients and families, sometimes when the workers are so exhausted they can barely stand. I thank them for staying those extra 10 and 15 minutes beyond what they are paid for to make a patient comfortable. I thank them for choosing to come to work and sometimes having to face abuse from tired and perhaps frightened people. I thank them for retaining their dignity and helpful nature. In this debate, we do not stand in judgment on the NHS or the workers; rather, we look at the procedures in place and how we as Members of Parliament can help to make the NHS, which we are fortunate to have across all the regions, more effective for everyone.

[Mr Jim Cunningham]

The hon. Gentleman mentioned long hours. Some of the young trainee doctors are doing a 12-hour day, seven days a week. That can go on for months. That is not exactly conducive to good morale in the national health service, is it?

[Jim Shannon]

None of us here said that it was. It is important that our doctors and the staff are not over-tired.

The Carter report sets out how efficiencies can be delivered. The hon. Member for Angus (Mike Weir) who spoke before me clearly outlined the issues. The title of the debate refers to Lord Carter’s review of productivity in hospitals, and the interim report of that review, “Review of operational productivity in NHS providers”, which was published on 11 June. We all know that Lord Carter of Coles was appointed by the Health Secretary to chair the NHS procurement and efficiency board in June 2014, to review the operational productivity of NHS hospitals and to establish the opportunities for efficiency savings across the NHS. To do that, Lord Carter and the review board worked with a group of 22 NHS providers across England, and I think that what they have found in England will be replicated for us in Northern Ireland and for our colleagues in Scotland and Wales. There are lessons to learn, so we should take note of what the report says.

As I said, an interim report was published on 11 June outlining the work that has been carried out and the interim recommendations and next steps. The full report is to come in the autumn, and I look forward to seeing what it says. Back home, people are sick to death of the term “efficiency savings”, the idiotic behaviour of Sinn Féin and the Social Democratic and Labour party and others and the funding penalties we are facing. Our NHS is being asked to do the impossible and be more efficient than it is, but when I look at the findings of the interim report, I see things that may extend to our running of the NHS in Northern Ireland. That is what the Carter report is about, and I am sure the Minister will give his thoughts on that shortly. The report sets out ways we could ease the pressure off front-line services and enable the functioning of our country while we wait for action to cease the penalties and see Northern Ireland receiving what she is entitled to—what we would be getting, were it not for the inability of Sinn Féin to do what its Members were elected to do and work for the people. That, however, is a different debate for another day, and I accept that.

The interim report suggests that the NHS in England could look to make savings of some £5 billion per annum by 2019-20 and reports three major areas of opportunity. The first is hospitals getting a stronger grip on the utilisation of resources, particularly in four areas: workforce, hospital pharmacy and medicines, estates management and procurement. The second is achieving greater productivity in hospital workflow—how patients move through the system—and the subsequent use of assets such as operating theatres. I have always felt we could look at that, and the Carter report has examined it and offered some ideas on how it could work. The final area is gaining a better understanding of the need for hospitals to develop sub-acute services, either on their own or in collaboration with others, to facilitate the discharge of patients. It is about making it work better together.

We need a way of ensuring the highest quality of patient care, delivered at the lowest price possible to ensure that more funding can be diverted to cancer drugs. Members will know that I have advocated ensuring the availability of cancer drugs across the whole United Kingdom, rather than that being down to postcode. In Northern Ireland, we would like to use prescription charges to put some money towards cancer drugs. I know that the Government have given a commitment and that there is some help for the devolved Administrations when it comes to cancer drugs, but not to the extent that we would like. We also need more funding diverted to research and other areas.

I was surprised to see in the report that one hospital could save up to £750,000 a year by improving the way it deals with staff rosters, annual leave, sickness and flexible working. That was just one example, which would regain the £10,000 a month the hospital was losing due to people claiming too much annual leave. That is an easy way of getting money back into hospitals. Ensuring every hospital pays the best price for medicines and supplies would save money that could be invested in front-line care. One hospital with 23 operating theatres improved the way it tracks the products used during surgery and saved £230,000 in the first year alone. I am not saying that every hospital could do that, but it is an example of what can be done, and it would be unwise to ignore it.

When the Hansard report of this debate becomes available, I will send a copy to my colleague, the Health Minister in Northern Ireland, Simon Hamilton, to make him aware of the Carter report and this debate. Helpful lessons may emerge that we could use. For example, a hospital was using the soluble version of a steroid for multiple illnesses and paying £1.50 a tablet when the solid version costs just 2p a tablet. Using the soluble version only for children and patients who have trouble swallowing saved £40,000 every year. Those may be small examples, but they collectively show how something could happen. I have some concerns. Cheap is not always best, and we have many examples of the copying of tablets in China and elsewhere. Those tablets are not as effective and may be harmful, so we have to monitor how we best ensure that cheaper drugs are effective and tackle the diseases they are designed to tackle.

We must take these issues in hand if we are to see the best possible use of funding. With the publication of the full report in the autumn, we will have a better idea of where we are. I hope that that report will be seen not as a stick to beat the NHS with—if it is, that will be for the wrong reasons—but as a ray of light that will help make things better. I very much look forward to seeing what it says about how we can improve things here in England, because we will then, I hope, be able to use that example to improve things across the water in Northern Ireland and perhaps in Scotland, for my colleague and friend, the hon. Member for Angus.

--- Later in debate ---

[Ben Gummer]

I do not want to ruin the hon. Lady’s nascent reputation by agreeing with her again—happily, there are very few Opposition Members present to notice, although that is not an implied criticism—but she is absolutely right. We are lucky that nursing places are quite significantly over-subscribed. The position is popular, but she is absolutely right that we need to not only make far greater use of apprenticeships but widen the skills base in nursing full stop. We are actively working on that in the Department—I have spent much of the day on it, and I am sure there will be more to come.

To help chief executives in this interim period, we have forced all agencies that want to offer their services to ensure that they are doing so through framework contracts, and we are ensuring that there is an hourly cap on the rate that can be charged. We have also taken additional measures on managerial salaries, along with a few other measures, to ensure that managers have the opportunity to be able to manage costs as they wish. We understand, however, that this is the first stage of a much deeper programme of reform that is needed. Lord Carter’s report points in that direction by suggesting that we use our existing workforce far better, so that people are doing the job that they are suited to and qualified for and that their time is not wasted. That is the great win, not only for efficiency and patient care, but for staff enjoyment of their jobs.

The hon. Member for Coventry South (Mr Cunningham) made some helpful interventions about NHS workers’ quality of life. It has been a sad but persistent truth of the NHS for many years—decades, in fact—that staff-reported incidents of harassment and bullying have been higher than the national average and that workforce stress and illness is higher than average. Some of that is to be expected—parts of the NHS are extremely stressful working environments—but we can do much more. Part of that is about ensuring, when people turn up to work, that they are doing the job they wanted to do, with a suitable but not excessive degree of pressure, and that the system is not wasting their time. If we make them happier in their jobs, their patient care will improve and their commitment to the service will be even greater. I am therefore aware of the prize, not just in pounds, shillings and pence, but in an improvement to staff morale and therefore patient care.

[Jim Shannon]

One of the things that concerns me from a Northern Ireland perspective—this has also been raised in discussions with other Members in the Chamber today and outside—is that the NHS greatly relies on, in our case, Filipino workers, which is an immigration issue. Has the Minister had any discussions with the Minister for Immigration, the right hon. Member for Old Bexley and Sidcup (James Brokenshire), to ensure that there will be no shortfall when the gaps left by those who are here on work visas need to be filled and that the quality service in the NHS will not be lost? The hon. Member for Bristol South (Karin Smyth) referred to training people to ensure that keen, interested and able replacements are available. Has the Minister given any thought to that?

[Ben Gummer]

I was going to come on to that, so I shall do so now that the hon. Gentleman has prompted me. There have been long and deep discussions about this. Our estimate is that no more than 700 nurses will be affected by the time the new rules are in place, which is a different number from that given by the Royal College of Nursing, whose number we do not recognise. It is small challenge given the scale of the workforce and one that we will surmount at the time, but we must see it within the broader policy of reducing immigration to this country from the hundreds of thousands to the tens of thousands—a policy that has broad support across the House and certainly in the country at large. It would be wrong for the largest employer in the country—one of the largest employers in the world—to exempt itself from that overall ambition.

In the end, we will achieve a sustainable workforce in this country only if we do all we can to ensure that those who are British and have grown up here and want to work in the NHS have the opportunity to do so. That is why it is important that we widen and open the avenues into working in the NHS, as the hon. Member for Bristol South suggested, over the next few years, in order to meet the challenge to which the hon. Member for Strangford alluded.

I want to quickly run through the other issues raised by my hon. Friend the Member for Hendon. On master vendors, he has a specific issue regarding some constituents with whom he has been dealing, but I understand that master vendors are managed under a series of arrangements with the Crown Commercial Service. Officials will meet with that organisation soon to discuss the overall issues around master vendors. It is for individual trusts to make such purchasing decisions, but I understand the issue he has raised and the terms in which he put it, and I will ensure that it is investigated properly.

My hon. Friend identified two areas involving agencies and fraud. Fraud is of course unacceptable, and the NHS has quite good systems for identifying it. Given the scale of the NHS, I find it surprising—it is entirely to the credit of those who work in the NHS—that fraud makes up such a tiny proportion of the excessive costs in the NHS.

On the revalidation of locum doctors, for which the General Medical Council is responsible, some doctors find it difficult to gather all the required supporting information needed for revalidation due to the peripatetic nature of the work. To help with that, specific guidance is available for both the doctors and their employers via NHS England and NHS Employers. Locum doctors are part of a larger issue about agency spend and foreign workers working in the NHS. I imagine that the three organisations will come together in the next few years to produce a more stable situation.

[Mr James Gray in the Chair]

Let me turn to the remaining points of the hon. Member for Bristol South. On the stability of the system, I hope and anticipate that one product of the general election is that the system will be broadly stable over the next five years. We intend to continue with the current structure of the NHS. There will be some small changes, such as that identified by my right hon. Friend the Secretary of State last week concerning the NHS Trust Development Authority and Monitor, but we are broadly content with how the system is set up. We must now proceed to ensure that it works.

The shadow Minister made a point about structures and fragmentation. There will always be a genuine dilemma here, because one can approach any system and say that change can be achieved by altering structures, but changing structures can lead to the same outcome. That has been the story of the NHS since its inception. It would be a mistake to think—the hon. Member for Bristol South and the shadow Minister were not suggesting this—that a structural change would somehow produce the outcomes that we all want. The priority is to ensure that the system’s wiring works correctly—that everyone’s interests are aligned and that the incentives are correct—so that people want to sit around the table and come to a considered decision, which can too often not be the case when there is an adversarial relationship between providers, producers and purchasers. That is why I hope that the system’s stability over the next five years will allow us to focus on the significant challenges mentioned by the shadow Minister.